Journal of Sexual Medicine最新文献

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.

Background: Dehydrated human amnion/chorion membrane (dHACM) has shown potential in enhancing neurovascular recovery and functional outcomes in robot-assisted radical prostatectomy (RARP).

Aim: To evaluate the effects of dHACM on continence recovery, sexual function, and oncological outcomes in patients undergoing RARP.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, analyzing data from PubMed, Cochrane, and EMBASE. Six retrospective studies comparing RARP with and without dHACM were included. Odds ratios (OR) and standardized mean differences (SMD) were calculated using a random-effects model.

Outcomes: The primary outcomes were continence and potency recovery, and secondary outcomes included biochemical recurrence (BCR).

Results: The meta-analysis included 4072 patients (1699 experimental and 2373 control). dHACM significantly improved early continence recovery (SMD 1.78, 95% CI 1.26-2.34) at <3, 3, and 6 months postoperatively (OR 1.95, 95% CI 1.13-3.36; OR 2.17, 95% CI 1.52-3.09; and OR 1.70, 95% CI 1.10-2.63, respectively). Time to potency recovery was shorter (SMD -0.55, 95% CI -0.67 to -0.43), with significant improvements at <3, 3, 6, and 9 months (OR 1.67, 95% CI 1.25-2.23; OR 1.27, 95% CI 1.06-1.53; OR 1.41, 95% CI 1.15-1.72; and OR 1.51, 95% CI 1.16-1.97, respectively). There were no significant differences in BCR (OR 0.85, 95% CI 0.54-1.35).

Clinical implications: dHACM offers potential as an adjunct to enhance functional recovery following RARP without compromising oncologic safety, but further high-quality studies are needed.

Strengths & limitations: Strengths include a comprehensive analysis of early functional outcomes and low heterogeneity in early potency and continence data. Limitations include reliance on retrospective studies and lack of randomized controlled trials.

Conclusion: dHACM may accelerate continence and sexual function recovery in early period after RARP while maintaining oncological outcomes, but further randomized studies are necessary to confirm these findings.

Background: Urinary tract infections (UTIs) significantly impact quality of life and can also lead to changes in sexual function.

Aim: This study aims to assess the symptoms associated with recurrent urinary tract infections (rUTIs) and their influence on both quality of life and sexual activity.

Methods: A case-control study was conducted, involving 383 patients with rUTIs and 161 healthy controls. The Acute Cystitis Symptom Score (ACSS) and Female Sexual Function Index (FSFI) questionnaires were utilized, with all surveys completed online through Google Forms.

Outcomes: The ACSS and FSFI were collected using online surveys designed through Google Forms.

Results: A higher prevalence of constipation was observed in the rUTI group compared to controls (37.6% vs 31.7%). rUTIs caused moderate to severe interference with work activities in 55.5% of cases, while 59% reported interference with social life. Sexual life assessment revealed that all FSFI domains were significantly affected in patients with rUTIs. Sexual desire was rated as low or very low in 61.9% of rUTI cases compared to 48.1% of controls (P < .001). Additionally, 35.3% of rUTI patients reported low or very low confidence in becoming sexually aroused, compared to 7.5% of controls (P < .001). Difficulty reaching orgasm was reported by 29.6% of rUTI patients versus 20.7% of controls (P < .001). Pain or discomfort following vaginal penetration was reported more than half the time by 43.9% of rUTI patients, compared to 19.6% of controls (P < .001). Dissatisfaction with sexual intercourse was noted in 53.6% of rUTI patients versus 15.8% of controls (P < .001).

Clinical implications: The assessment of sexual health should be integrated into the management of patients with rUTIs. Interventions targeting UTI management must also address strategies to improve sexual function and satisfaction.

Strengths and limitations: This study provides insight into the impact of rUTIs on sexual function across both pre- and post-menopausal women, allowing for an evaluation of how sexual perceptions evolve with age. However, the study's limitations include the lack of assessment of sexual practices, which may influence the risk of rUTIs and affect FSFI results.

Conclusions: Women with rUTIs report significantly lower sexual satisfaction and higher rates of sexual dysfunction. It is essential to evaluate the sexual function of patients with rUTIs, and management strategies must consider ways to improve sexual health as part of the overall treatment plan.

Background: Shockwave therapy is an optional adjuvant treatment for vascular erectile dysfunction (ED). There is variability in treatment protocols and challenges with patients adherence to the weekly protocol, which is the most commonly used.

Aim: This study aimed to evaluate the noninferiority of a monthly shockwave therapy protocol compared to the weekly protocol for treating vascular ED.

Methods: A randomized, open-label, control active, multicenter clinical trial was conducted. A total of 184 men diagnosed with vascular ED, without comorbid conditions associated with secondary dysfunction or active treatment for ED, were included across 5 clinics in Mexico and Colombia. Patients were randomized to receive either 6 sessions of weekly or monthly shockwave therapy, applying the same parameters for both groups.

Outcomes: The primary outcome was the change in the International Index of Erectile Function-Erectile Function Domain (IIEF-EF) Questionnaire score at 24 weeks after treatment, assessed using a noninferiority approach. Secondary outcomes included clinical improvement, erection hardness, and self-esteem (SEAR Questionnaire) at posttreatment, 12 weeks, and 24 weeks of follow-up.

Results: At 24-week posttreatment, the average change in IIEF-EF was 1.93 (± 6.55; 95% CI 0.49-3.38) in the weekly group and 4.30 (± 6.78; 95% CI 2.69-5.9) in the monthly group, demonstrating noninferiority of the monthly protocol (difference -2.36; 95% CI -4.4 to -0.2; noninferiority P < .0001). At the end of treatment, clinical improvement was achieved by 55.2% of participants in the monthly protocol and 30.9% in the weekly (P = .042). No significant differences were found in other outcomes.

Clinical implications: A 6-session monthly shockwave therapy regimen could improve erectile function in men with ED.

Strengths and limitations: This is the largest clinical trial to date evaluating shockwave therapy regimens for ED. The principal limitations were the absence of objective vascular assessment of the changes produced by shockwaves, and the absence of a placebo control group.

Conclusion: A monthly protocol of 6 shockwave therapy sessions is noninferior to a weekly protocol up to 6 months after therapy, in men with vascular ED.

Background: There have been many studies of the association between testosterone and cardiovascular disease (CVD). However, limited research has examined the association between testosterone and Life's Essential 8 (LE8), a recently updated algorithm for assessing cardiovascular health (CVH).

Objectives: This study aims to investigate the association between serum total testosterone (TT) levels and LE8 scores-where higher LE8 scores indicate better CVH-among adult males in the United States.

Method: Data from 3308 adult males were extracted from the National Health and Nutrition Examination Survey conducted between 2013 and 2016. Weighted univariate and multivariate linear regression models [β and 95% confidence intervals (CIs)] and logistic regression models [odds ratios (ORs) and 95% CIs] were used to explore the association between testosterone and LE8 and high CVH risk. Additionally, a smoothed curve fit (penalized spline method) and generalized additive model regression were applied to further explore these relationships.

Outcomes: LE8 includes 4 health behaviors (nicotine exposure, diet, physical activity, and sleep duration) and 4 health factors (body mass index, non-high-density lipoprotein cholesterol, blood pressure, and blood glucose).

Results: Serum TT levels were strongly associated with LE8 scores after adjusting for all confounders (continuous: β = 2.75, 95% CI: 1.92, 3.57, P < .0001; quartiles: Q4 vs Q1: β = 3.89, 95% CI: 2.78, 5.01, P < .0001). Similarly, high levels of TT were associated with a significantly lower CVH risk (OR = 0.59, 95% CI: 0.49, 0.73, P < .001). Compared to low TT levels, normal TT levels significantly reduced the risk of CVH (OR = 0.51, 95% CI: 0.38, 0.69, P < .001). Smoothed curve fitting showed a positive linear correlation between TT levels and LE8 scores, as well as a consistent linear negative correlation with CVH risk.

Clinical implications: These findings highlight the importance of endogenous TT levels in promoting CVH and provide new insights into factors influencing CVH.

Strengths and limitations: This study is the first to investigate the association between serum TT level and LE8 scores as well as LE8-assessed CVH among adult males. However, the observational nature of this study precludes any assessment of causality.

Conclusions: This study demonstrates a robust positive association between serum TT levels and LE8 scores in a nationally representative sample of adult men in the United States.

Background: Three common strategies exist for managing the inflatable penile prosthesis reservoir during revision surgery: the original reservoir can be (a) removed, (b) deactivated and left in situ, sometimes referred to as "drain and retain" (DR), or (c) validated and reconnected to new cylinders, which we have termed "reservoir recycling" (RR).

Aim: To compare the efficacy and safety of the RR approach to penile prosthesis revision against DR and the recommended approach of complete device removal and replacement.

Methods: A retrospective chart review of our single-surgeon inflatable penile prosthesis database between 2007 and 2022 was performed, identifying revision surgeries. Cases were stratified by reservoir management technique. Patients who had undergone at least 1 follow-up visit and had complete documentation regarding reservoir handling were included. Reservoir-related complications necessitating surgical intervention such as infection and device failure were compared between the 3 groups using a chi-square test. Mean follow-up duration, time to revision, and operative time were also assessed.

Outcomes: The primary outcome was the incidence of reservoir-related complications requiring surgical intervention and secondary outcomes included time to revision surgery and operative time.

Results: Among 140 patients meeting inclusion criteria, 62 underwent full reservoir replacement (FR), 48 DR, and 30 RR. Compared to FR, DR and RR groups had similar mean time to revision and intraoperative time. Follow-up duration was similarly limited for all 3 groups at a median of approximately 4.5 months. There were no postoperative infections in the RR cohort. However, when compared to the DR and FR groups, this did not reach significance (P = .398). There was no difference in mechanical failure rate between the 3 groups (P = .059). Nonmechanical failure was also similar between all 3 groups (P = .165).

Clinical implications: These results suggest that RR exhibits comparable outcomes to DR and FR, making it a viable option during select penile prosthesis revision surgeries, potentially decreasing morbidity without compromising outcomes.

Strengths and limitations: This is the first study to evaluate outcomes after RR. Limitations include small sample size, limited follow-up, and single-surgeon experience.

Conclusion: There was no difference in reservoir-related complications when comparing the 3 methods. These preliminary results suggest that reservoir recycling may provide a safe and effective reservoir-handling alternative in inflatable penile prosthesis revision surgery.

Background: Penile constriction devices offer a noninvasive approach to enhance the sexual experience and as the variety of penile constriction devices increases, it is crucial to assess patient preferences and device effectiveness to provide insights into their clinical utility.

Aim: We aimed to compare the preferences for and effectiveness of two medical-grade penile constriction devices: Eddie by Giddy and FirmTech.

Methods: Between May and July of 2023, males were recruited via social media and prospectively enrolled into an Institutional Review Board-approved, randomized, questionnaire-based study. Upon enrollment, the participants completed the Sexual Health Inventory for Men and Androgen Deficiency in Aging Males questionnaires. Participants were randomized to which device they received first. They used the device twice either during masturbation or intercourse in a two-week timeframe. Once utilized, the participants completed a 17-question, Likert scale, device satisfaction questionnaire, in which lower numbers indicated positive responses. The process was repeated with the second device. T-test and Chi-Square Analysis were run for statistical analysis.

Outcomes: The primary outcomes of this study were patient-reported device satisfaction and efficacy and the secondary outcome was the device preference for patients with and without erectile dysfunction.

Results: Fifty men were enrolled and 49 completed the study. The average age was 40 years old. Of the participants, 80% recommend the FirmTech device compared to 53% who recommend the Eddie by Giddy device (P = 0.0026). The FirmTech device was overall easier to put on both flaccid and erect (P = 0.0308 and 0.0002), was more comfortable, had better stretch, and was easier to adjust (P = 0.087, <0.0001, and 0.0119, respectively). The FirmTech device had a better overall impression amongst the participants (P = 0.0249). Eddie by Giddy was felt to improve erectile firmness more in those with ED than in those without (P = 0.0178).

Clinical implications: This study adds to the current literature on penile constriction devices that better guide providers as they counsel patients on these devices to enhance sexual function.

Strengths and limitations: The strength of this study is that this is a prospective randomized crossover study. The limitations of this study are that this is a single center study based on patient reported outcomes.

Conclusion: The FirmTech device performed better than the Eddie by Giddy with respect to overall impression of the device, likelihood of using the device in the future, and recommending the device to a friend, while the Eddie by Giddy device performed better at improving erectile firmness.

Clinical trial registration number: NCT05853822.