Journal of Sexual Medicine最新文献

Background: Erectile dysfunction (ED) is increasingly recognized as a marker of vascular health, yet its incidence following myocardial infarction (MI) remains imprecisely defined.

Aim: To quantify the pooled incidence of de novo ED after first-time MI and to examine its correlates.

Methods: Via a systematic review and meta-analysis, PubMed/MEDLINE and Web of Science were searched from inception to June 10, 2025, for studies enrolling adult men without prior ED and assessing post-MI ED using validated instruments (5-item International Index of Erectile Function or 15-item International Index of Erectile Function). Incidence estimates were pooled using random-effects meta-analysis and between-study heterogeneity assessed with I2. Sensitivity analyses included leave-one-out models; narrative syntheses described timing of onset and secondary sexual outcomes.

Outcomes: The main primary outcome was pooled incidence of de novo ED after first MI, while secondary outcomes included timing of ED onset, severity correlates, and changes in sexual activity/intercourse frequency.

Results: Five studies (n = 428 MI survivors) met inclusion criteria. Among the 428 men, 271 developed new ED post-MI, yielding a pooled incidence of 64.4% (95% CI, 44.0-85.0). Between-study heterogeneity was high (I2 = 90%). Narrative data indicate that most cases manifest within 6 months post-MI, and severity correlates with age and comorbid burden. Reporting on sexual activity resumption and intercourse frequency revealed significant declines compared to pre-MI levels.

Clinical implications: De novo ED is common and arises early after first MI. If clinically suspected, screening for sexual dysfunction, incorporation of structured sexual counseling into cardiac rehabilitation, and timely consideration of therapeutic interventions may be considered to improve quality of life and potentially signal broader cardiovascular risk.

Strengths and limitations: Focus on incident cases and use of validated ED instruments showing likely association in MI-ED development, but limited by small number of eligible studies, incomplete baseline reporting, and high between-study heterogeneity limiting precision.

Conclusion: New-onset ED affects a substantial proportion of men after a first MI and commonly appears within months of the event. These findings may warrant consideration of assessment of sexual function in post-MI care and integration of targeted interventions into recovery programs.

Background: Compulsive sexual behavior disorder is a new construct defined in the International Classification of Diseases. Problematic pornography use (PPU) is a common presentation. Prior studies have demonstrated genetic bases of sexual behavior using twin samples. However, these studies have failed to report outcomes for PPU indicators.

Aim: We conducted an analysis on twin data that included measures of PPU, pornography use, moral disapproval of pornography use, and past 30-day masturbation frequency.

Method: Our data were derived from a larger study piloting a community panel approach to twin research. Specifically, we partnered with YouGov to sample community members from across the United States who identified as having a same-sex twin. We then employed a large survey battery to twin identifying members. Participants were provided with bonus remuneration (~$25 USD) if both twins participated in the survey. Data were cross-checked to ensure demographic indicators were consistent (age, sex assigned at birth). We gathered k = 32 monozygotic female dyads, k = 21 dizygotic female dyads, k = 25 monozygotic male dyads, and k = 23 dizygotic male twin dyads (grand n = 202) with data fit for analyses. All outcomes were stratified by sex assigned at birth.

Outcomes: Brief pornography screen, pornography use frequency, moral disapproval of pornography use, and past 30-day masturbation frequency.

Results: In all cases, within-dyad intraclass correlations for monozygotic twins trended stronger than their dizygotic counterparts. Falconer's ACE estimates suggested genetic factors accounted for 50% of PPU for males and 74% for females. Genetic estimates were much lower for moral disapproval and were split for pornography and masturbation frequency (trending stronger in males relative to females).

Clinical implications: Funding bodies should support basic biological research for PPU to help identify biologically based interventions that could eventually be employed in treatment. Counseling interventions are likely the best approach for presentations defined by moral incongruence to pornography use (as genetics appeared to have a weak basis).

Strengths and limitations: This is the only twin study to demonstrate evidence of a genetic basis for PPU. This is also the first study to implement a community panel sampling design to twin research. While this methodology is novel it is also untested, we are limited by not having twin registry support for our indicators (to our knowledge, none exist for our outcomes). We were also limited by our relatively small samples.

Conclusions: PPU, pornography use frequency, moral disapproval of pornography use, masturbation frequency, and many other sexual behaviors have genetic and environmental underpinnings.

Background: Despite its high prevalence in infertile women and known impact on natural conception, the specific influence of female sexual dysfunction (FSD) on assisted reproductive technology (ART) outcomes, which bypass intercourse, remains unclear.

Aim: To investigate the association between female sexual function and ART outcomes, including live birth.

Methods: In this prospective cohort study, 300 women undergoing their first ART cycle completed the Female Sexual Function Index (FSFI) prior to treatment. Multivariable regression models were used to assess the association between FSFI measures (FSD status, total score, and domain scores) and ART outcomes, adjusting for key clinical confounders.

Outcomes: The primary outcome was live birth rate following in vitro fertilization or intracytoplasmic sperm injection treatment, with secondary outcomes including biochemical pregnancy, clinical pregnancy rate, ovarian response, and embryology parameters.

Results: Participants with FSD (n = 200) exhibited significantly lower biochemical pregnancy rates (55.5% vs. 82%, P < .01), clinical pregnancy rates (51% vs. 78%, P < .01), and live birth rates (36.5% vs. 54%, P < .01) compared to those without (n = 100). After adjusting for confounders, female sexual function, as measured by FSFI, held independent predictive value for these critical pregnancy outcomes. Furthermore, when analyzed as a continuous variable, higher total FSFI scores positively correlated with indicators of improved parameters of embryo development and increased pregnancy success rates. Notably, all six FSFI domains also demonstrated significant positive associations with key ART outcomes. Compared to the standard 26.55 threshold, a data-driven FSFI threshold of 20.70 showed higher Youden index values for predicting ART outcomes.

Clinical implications: Evaluating FSD should be considered part of routine infertility treatment, as addressing it may offer a novel strategy to improve ART outcomes.

Strengths & limitations: Key strengths are the prospective cohort design establishing temporality and use of a validated FSFI scale. However, as an observational study, it cannot establish causality; other limitations include the single-center design, potential unmeasured confounders, and the subjective nature of self-reported FSFI scores.

Conclusion: Lower female sexual function is significantly associated with poorer outcomes following ART, including substantially reduced live birth rates.