Journal of Sexual Medicine最新文献

Background: The radial forearm free flap (RFFF) is the standard technique for gender-affirming tube-in-tube phalloplasty owing to its reliably vascular anatomy and pliable tissue. However, postoperative circumferential and volumetric changes, and their potential role in complications such as excessive phallic turgor, remain poorly characterized.

Aim: To quantify early postoperative circumferential and volumetric changes following RFFF phalloplasty in patients with an uneventful postoperative course.

Methods: A consecutive series of trans men who underwent RFFF phalloplasty between 04/2024 and 07/2025 were analyzed. Phallic circumference was measured intraoperatively and on postoperative days (PODs) 1, 3, 5, 10, and 14 at three levels (base, midshaft, tip). Volumes were modeled from these measurements using geometric formulas (two-frustum method). Patients requiring emergent reintervention (eg, operative revision) were excluded.

Outcomes: Primary outcomes were temporal changes in circumference and estimated volume relative to intraoperative values within 14 days.

Results: Twenty-two patients with a mean age of 32 years (SD 11) met inclusion criteria. Mean flap length was 12.3 cm (SD 0.9). In most patients (54.5%) three venous anastomoses were performed. Phallic circumference increased most prominently within the first 24 h and peaked at POD 3, with mean increases of 6.2 mm at the base, 8.1 mm at the midshaft, and 7.5 mm at the tip compared with intraoperative values. Circumferences then declined gradually but remained above baseline on POD 14 (residual mean increase: 3.7 mm at the base, 4.8 mm at the midshaft, and 5.3 mm at the tip). Estimated phallic volume rose from a mean of 111.3 cm3 (SD 21.7) intraoperatively to 131.2 cm3 (SD 24.5) on POD 3, before declining to a mean volume of 120.8 cm3 (SD 21.3) by POD 14. These changes corresponded to a mean relative increase of 16.0 % (SD 15.9) on POD 1 and 19.0 % (SD 15.9) on POD 3. Persistent edema was present in 81.8% of patients at POD 14.

Clinical implications: Vigilant monitoring during the first 72 h is critical for timely decompression. Individualized flap planning, particularly at proximal and midshaft levels, remains essential to avoid tension-related complications.

Strengths and limitations: This represents the first quantitative assessment of early postoperative swelling in phalloplasty based on multi-level measurements and volumetric modeling. Limitations include the single-center design and short follow-up.

Conclusions: RFFF phalloplasty demonstrates predictable swelling dynamics: rapid increase within 24 h, a peak on POD 3, and gradual decline thereafter, with persistent edema in most cases by POD 14.

Background: Inflammation may contribute to lower desire and arousal functioning in women; however, little research has examined effects across the reproductive lifespan.

Aim: To examine associations between inflammation and sexual functioning in pre- and post-menopausal women.

Methods: 103 healthy, sexually active cisgender women (48 pre-menopausal; 55 post-menopausal) completed a standardized sexual arousal induction paradigm. C-reactive protein (CRP), a marker of inflammation, was assessed from blood samples. Participants also completed validated clinical surveys and diagnostic interviews of sexual desire, arousal, and overall sexual functioning.

Outcomes: Self-reported sexual arousal to a sexual film; survey indices of sexual desire and sexual functioning; and female sexual dysfunction diagnosis.

Results: While there was lower sexual functioning and higher CRP in the post-menopausal group, there was no significant association nor interaction between CRP and menopausal status in predicting sexual function, self-reported arousal, nor diagnosis. Exploratory analyses revealed a significant negative association between CRP and sexual desire among women with higher lifetime exposure to sexual violence, but positive association at lower levels of lifetime sexual violence exposure.

Clinical implications: Caution is warranted for interpreting CRP as a clinical marker of sexual dysfunction in either pre- or post-menopausal women.

Strengths and limitations: Strengths include well-validated clinical assessments of sexual function, direct measures of inflammation, and inclusion of women across the lifespan. Limitations include a cross-sectional design, limited racial/ethnic diversity, and reliance on one inflammation biomarker.

Conclusion: CRP was not associated with subjective sexual arousal or sexual functioning in a sample of healthy women; further work may identify if more sensitive inflammation biomarkers are needed, or if inflammation has greater effects on sexual function in specific conditions such metabolic syndrome. Of note, CRP did predict lower sexual desire in women with sexual violence histories, suggesting that survivors of sexual violence may be particularly sensitive to inflammation-mediation suppression of sexual motivation and/or reward.