Journal of Sexual Medicine最新文献

Background: The Optilume benign prostatic hyperplasia (BPH) catheter system is a novel minimally invasive paclitaxel-coated dilation system that has demonstrated substantial and durable results in urinary flow and symptoms.

Aim: We now assess the impact of Optilume BPH procedure on sexual function.

Methods: Prior published results have described the methods of data collection during the PINNACLE study, which demonstrated durable improvement in urinary symptoms. Follow-up assessments for the current study included IIEF-EF and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD). Semen quality was also examined.

Outcomes: IIEF-EF and MSHQ-EjD scores in the Optilume BPH group were not different from the sham group at 3 months, 6 months, or 12 months.

Results: A total of 148 men were randomized to receive the procedure (100) or a sham surgical procedure (48). Subjects in both groups had similar rates of erectile dysfunction (ED) previously diagnosed at baseline (56% vs 54.2%, P = .83) and those men who were sexually active. IIEF-EF and MSHQ-EjD scores in the Optilume BPH group were not different from the sham group at 3, 6, or 12 months. Change in IIEF-EF scores remained consistent across all levels of baseline ED severity after Optilume BPH procedure. No clear trend was seen after treatment with Optilume BPH for semen volume, sperm motility, progressive motility, or sperm morphology.

Clinical implications: The Optilume BPH catheter system provides patients with a durable improvement in lower urinary tract symptoms while preserving sexual function.

Strengths and limitations: This study uses validated questionnaires to assess patients' sexual function at baseline and regularly for 1 year after the procedure. Given exclusion criteria regarding patient age and prostate size, the results may not be applicable to all BPH phenotypes.

Conclusion: Optilume appears to provide clinical benefit with a high degree of patient satisfaction and minimal impact on sexual function.

Background: There is inconsistent evidence as to the role of testosterone and pre-androgens in premenopausal female sexual function, and reported associations between blood concentrations of these hormones and female sexual function vary in strength.

Aim: To examine the patterns of testosterone and pre-androgen concentrations and variations in sexual function in premenopausal eumenorrheic women.

Methods: This was a secondary analysis of a sample of 588 premenopausal eumenorrheic women from the Grollo-Ruzzene Foundation Young Women's Health Study. Socio-demographics, health information, and questionnaire data were collected using online surveys. Eligible women were invited to provide a blood sample. We ran latent profile analysis (LPA) and subsequent analyses in R using RStudio.

Outcomes: Indicator variables in the LPA included sexual arousal and desire domains of the Profile of Female Sexual Function and testosterone, dehydroepiandrosterone (DHEA), and androstenedione, measured by liquid chromatography-tandem mass spectrometry.

Results: Analyses resulted in a pattern of 3 latent classes. Classes reporting relatively lower and higher sexual arousal (LPA-derived means and 95% CIs: -0.79 [-1.24; -0.34] and 0.62 [0.51; 0.72]) did not differ significantly in sex steroid concentrations (testosterone: -0.21 [-0.38; -0.03] and -0.33 [-0.47; -0.20]; DHEA: -0.47 [-0.57; -0.37] and -0.26 [-0.39; -0.13]; androstenedione: -0.36 [-0.50; -0.22] and -0.39 [-0.49; -0.29]), while the class reporting relatively medium arousal (-0.11 [-0.31; 0.08]) showed the highest testosterone, DHEA, and androstenedione concentrations (testosterone: 0.8 [0.60; 1.01]; DHEA: 0.99 [0.76; 1.23]; androstenedione: 1.08 [0.88; 1.29]). There were no significant differences in sexual desire between classes (-0.08 [-0.23; 0.06]; 0.00 [-0.13; 0.14]; 0.10 [-0.09; 0.30]) differing significantly in sex steroid concentrations (-0.69 [-0.80; -0.58], -0.04 [-0.15; 0.07], 0.94 [0.71; 1.16] for testosterone) nor associations between the sex steroid concentrations and degrees of sexual desire.

Clinical implications: These findings cast further doubt on the utility of measuring sex steroids for diagnosing female sexual dysfunction in premenopausal eumenorrheic women, even when considered in combination.

Strengths and limitations: We analyzed a large community sample and controlled for potentially biasing factors. We analyzed sex steroid concentrations determined with gold-standard methodology. Excluding women with early menopause and menstrual dysfunction might have resulted in finding 3, rather than more, latent classes.

Conclusion: Testosterone and pre-androgen profiles do not clearly identify premenopausal eumenorrheic women with low sexual arousal and desire.

Background: Sexual dysfunction (SD) is a complication of poorly managed diabetes mellitus (DM). To prevent SD, patients should develop sexual health literacy (SHL).

Objective: This study investigated the relationship between SHL and SD in women with DM.

Methods: This cross-sectional study was performed between 1 October 2023 and 1 June 2024. The sample comprised 400 participants. The inclusion criteria were (1) being 18-65 years of age, (2) having been diagnosed with DM, and (3) having a sex partner. Data were collected using a personal information form, the Female Sexual Function Index (FSFI), and the Sexual Health Literacy Scale (SHLS).

Outcomes: The data were analyzed using the Mann-Whitney test, Kruskal-Wallis H test, Spearman correlation coefficients, and binary logistic regression.

Results: Over half of the participants experienced SD (68,2%). Participants with higher education, those whose partners had higher education, those who did not have any chronic disease other than DM, and those who did not take hormone replacement therapy had a lower rate of SD (P < 0.05). Participants with higher income, those who used family planning, those with DM I, and non-menopausal participants had lower SD and higher SHL (P < 0.05). Insulin-only participants had higher SD and lower SHL than those who were on other types of medications (P < 0.05). There was a significant negative correlation between scale scores (FSFI and SHLS) and age (r = -0.388; P < 0.001 r = -0.326; P < 0.001, respectively), age of partner (r = -0.383; P < 0.001, r = -0.274; P < 0.001, respectively), duration of romantic relationship (r = -0.326; P < 0.001, r = -0.328; P < 0.001, respectively), number of children (r = -0.109; P < 0.001, r = -0.290; P < 0.001, respectively), and duration of DM (r = -0.254; P < 0.001, r = -0.125; P < 0.013, respectively). There was a significant positive correlation between scale scores (FSFI and SHLS) and number of sexual intercourse (r = 0,493; P < 0.001, r = 0.127; P < 0.011, respectively). A one-unit increase in DM duration resulted in a 3.7% increase in SD rate (OR = 1.037). A one-unit increase in the number of sexual intercourses reduced the SD rate by 35.5% (OR = 0.645).

Clinical implication: The data show that the prevalence of SD in diabetic women is directly affected by the number of sexual intercourses per week, menopausal status, and duration of DM.

Strengths and limitations: This is the first study to examine the relationship between SHL and SD in women with DM. Second, the results are sample-specific and cannot be generalized to all women with DM.

Conclusion: Healthcare professionals should ensure that women with DM have high levels of SHL to prevent SD and improve their quality of sexual life.

Background: Although many transmasculine individuals undergo 1 or more gynecological surgeries (ie, hysterectomy, oophorectomy, tubectomy, or colpectomy), little has been published about motivation, subjective experiences, and the effect on dysphoria and quality of life.

Aim: The aim of this study was to acquire an in-depth understanding of patients' motivations and experienced outcomes of gynecological gender surgery.

Methods: In this qualitative study, in-depth semi-structured interviews were conducted. Nine participants were included who were: on the waiting list for their first gynecological surgery (n = 2), or who had either undergone gynecological surgery as part of their transitioning (ie, hysterectomy) and were on the waiting list for another gynecological procedure (ie, colpectomy, n = 2), or who had undergone gynecological surgery and did not wish to undergo any further surgeries (n = 5). In-depth semi-structured interviews were conducted. Topics discussed were motivation to opt for a specific surgery, expectations, and experiences. Thematic analysis was carried out to compose themes from the interview transcripts using the concepts of body image and gender affirmation as a theoretical lens.

Outcomes: The primary outcomes of this study were composed themes based on thematic analysis of the interview transcripts.

Results: Three subthemes were identified, displaying how gynecological surgeries could contribute to gender affirmation: body representation matching oneself; achieving functional congruence; and enabling further surgical transition.

Clinical implications: This study offers valuable insights for healthcare professionals in patient counseling and shared decision-making and provides a foundation for developing patient-reported outcome measures tailored to transmasculine individuals.

Strengths and limitations: To our knowledge, this is the first qualitative report to study the motivations for and outcomes of gynecological gender-affirming surgeries in such depth; however, the results cannot be directly applied to other settings without considering the local context, including factors such as legislation and insurance policies.

Conclusion: This study highlights how gynecological surgeries, unlike more visible gender-affirming procedures like chest surgeries, address internal conflicts related to the masculine identity by altering the body's functioning, thereby playing an important role in the process of gender affirmation.

Background: Interoception may be linked to central sensitization in chronic pain.

Aim: We aimed to provide evidence about the role of interoceptive sensibility on central sensitization in vulvodynia.

Methods: In this cross-sectional study, a sample of females who received a diagnosis of vulvodynia filled out validated questionnaires relative to the individual level of interoceptive sensibility and the symptoms of central sensitization.

Outcomes: Interoceptive sensibility and symptoms of central sensitization were measured with the Multidimensional Assessment of Interoceptive Awareness and the Central Sensitization Inventory, respectively.

Results: A lower level of trust and a higher level of emotional awareness predicted a higher number of central sensitization symptoms in our sample.

Clinical implications: Our evidence may increase the researchers' and physicians' attention toward the involvement of the central nervous system in pain phenomenology in vulvodynia.

Strengths and limitations: No ad-hoc control sample was collected. No behavioral assessments about interoception were performed.

Conclusion: As registered in other chronic pain conditions, interoceptive sensibility may play a crucial role in the expressions of symptoms of central sensitization in vulvodynia.

Background: Demand for gender-affirming surgery (GAS) is rising. The main objective of this surgery is the creation of a perineo-genital complex that appears and functions as femininely as possible, with a sensitive clitoris and a vagina capable of receptive intercourse. Penile skin inversion is currently regarded as the gold standard technique. Although previous research indicates positive subjective outcomes following GAS procedures in transgender women, comprehensive data concerning their sexual satisfaction and health remains limited.

Aims: The aim of this study was to evaluate the impact of vaginoplasty on sexual health and satisfaction in transgender women using the penile inversion technique.

Methods: We performed a retrospective study on 56 patients who underwent primary penile skin inversion vaginoplasty. The survey was made of two validated questionnaires in cis-women (Female Genital Self-Image Scale and Female Sexual Function Index) and one custom questionnaire, which explored various aspects of sexual health and satisfaction.

Outcomes: Improvement in overall sexual life and satisfaction.

Results: Mean FGSIS score was 22.8 and mean FSFI score was 22.1. Sexual health after vaginoplasty was significantly improved. Around 70% (n = 39) of patients rated their post-operative self-confidence >7/10. Furthermore, 82% of our patients reported orgasm after vaginoplasty. Clitoral stimulation emerged as the primary method for achieving sexual arousal post-surgery. Upon asking: "Would you decide to have vaginoplasty again today? ", 93% patients answered "agreed or totally agreed".

Clinical implication: Using patient-reported data, these findings highlight the importance of vaginoplasty within multidisciplinary gender transition processes and its efficacy in perceived sexual health.

Limitations: Limitations of this study include reliance on patient-reported outcomes prone to recall bias and the use of non-validated questionnaires.

Conclusion: This study underscores the positive impacts of penile inversion vaginoplasty on sexual health, satisfaction, and functional outcomes, supported by patient-reported data; further studies will be necessary to provide questionnaires validated in transwomen.