Journal of Sexual Medicine最新文献

Background: Sexual function during pregnancy and the postpartum period is a complex component of maternal and couple health, and it's deeply influenced by an intricate interplay of physiological, psychological, childbirth, and relational factors.

Aim: This review seeks to explore the nuanced dynamics of sexual function during pregnancy and the postpartum period, shedding light on both the challenges and opportunities for enhancing maternal and couple sexual well-being.

Methods: Drawing on a combination of existing scientific literature and extensive clinical experience, this expert opinion delves into the physiological transformations, psychological adjustments, and shifts in relational dynamics that accompany pregnancy and postpartum. It sheds light on the sexual experiences of partners and underscores the necessity of a holistic understanding of sexual health in this context.

Outcomes: The review offers an enhanced perspective on sexual function during pregnancy and postpartum and aims to contribute to a deeper and more nuanced understanding that can inform both clinical practice and future research.

Results: The results highlight that pregnancy and postpartum phases influence sexual function, with fluctuations in sexual desire and activity resulting from changes in physiological, psychological, and relational factors. Women experience a decline in sexual function, particularly during the third trimester, with factors, such as hormonal changes, body image concerns, and partner dynamics shaping sexual experiences across pregnancy and postpartum stages.

Clinical implications: A thorough understanding of sexual function throughout pregnancy and postpartum is critical for enhancing maternal and couple health and it creates pathways to more effective and compassionate care.

Strengths and limitations: The strengths of this review include the integration of scientific literature with clinical experience to provide a holistic view of sexual function. However, the limitations are the reliance on cross-sectional studies and the scarcity of data on couple sexual functioning.

Conclusion: Understanding the interplay of physiological and anatomical changes, psychological factors, and partner dynamics is crucial in addressing sexual function during pregnancy and the postpartum period.

Background: Genitourinary syndrome of menopause (GSM) is a prevalent condition with a constellation of symptoms including burning, dryness, dyspareunia, and irritative lower urinary tract symptoms that result from vulvovaginal atrophic changes. Though hormonal therapy is a mainstay of treatment in GSM, some patients may pursue nonhormonal therapies.

Aim: To determine the efficacy of radiofrequency ablation of the vaginal canal with the MorpheusV applicator in reducing the symptoms of GSM.

Methods: We conducted a multicenter prospective case series of women with GSM as confirmed by Vaginal Health Index Score (VHIS). Subjects received 3 treatments of radiofrequency ablation ~4 weeks apart with follow-up to 6-month posttreatment.

Outcomes: The primary endpoint was VHIS at 6-month posttreatment. Secondary endpoints were VHIS at 3 months, Visual analog scale (VAS) pain with each treatment, 3- and 6-month measurements of urogenital distress inventory-6 (UDI-6), and female sexual function index (FSFI) questionnaires.

Results: From 2021 to 2023, 71 women were enrolled in the study with 51 followed to the 6-month follow-up time point. Treatments were found to be low in VAS pain score with mean values of 2.13 ± 2.1, 2.55 ± 2.38, and 2.18 ± 2.14 at treatments 1, 2, and 3 respectively. An improvement in VHIS score was seen from baseline to 3 months after the last treatment (15.00 ± 5.37 vs. 19.62 ± 4.44) and sustained at 6 months (20.23 ± 4.12) (P < .001). Significant improvements in both UDI-6 and FSFI were also noted. Between baseline and 6 months after treatment (FSFI: 18.81 ± 9.57 vs. 22.81 ± 10.34, P < 0.001; UDI-6: 39.58 ± 15.98 vs. 22.42 ± 14.03, P < 0.001). No adverse events were encountered by any subject during this study.

Clinical implications: A therapy that is safe and effective in the treatment of both GSM and lower urinary tract symptoms without the use of hormonal methods is clinically impactful for the many patients who cannot receive or do not desire to receive these medications.

Strengths and limitations: Strengths of this study include the utilization of 3 treatment sessions, with follow-up of subjects to 6-month posttreatment with a comprehensive assessment of patient symptoms. Limitations include the unblinded nature of the study and the lack of a comparator group.

Conclusion: The data from this study suggests that radiofrequency ablation of the vaginal canal by the MorpheusV applicator is a safe and effective intervention for GSM. It also shows subjective improvements in stress urinary incontinence, urge urinary incontinence, and sexual function.

Background: The relationship between sexual dysfunction and burnout among physicians remains unclear.

Aim: To investigate the frequency of sexual dysfunction among physicians in primary hospital and explore the association between sexual dysfunction and burnout.

Methods: This study was a cross-sectional survey conducted through a questionnaire. We used the Arizona Sexual Experience Scale and the Chinese version of the Maslach Burnout Inventory-Human Service Survey to assess sexual function and burnout among physicians in primary hospital. Considering the working environment of physicians, we also evaluated the doctor-patient relationship and sleep quality.

Outcomes: Over one-third of physicians experience sexual dysfunction. Burnout is a significant factor to sexual dysfunction among medical professionals.

Results: A total of 382 doctors participated in this survey, and the prevalence of sexual dysfunction was 33.51%. Sexual arousal and orgasm were the main sexual dysfunctions faced by male and female doctors, respectively. The prevalence of burnout among physicians was 43.72%. The prevalence of sexual dysfunction among physicians experiencing burnout (45.51%) was higher than that observed in physicians without burnout (24.19%). Physicians with burnout exhibited significantly higher total and individual scores on the Arizona Sexual Experience Scale as compared with physicians without burnout (all P values <.05). There was a significant positive correlation between depersonalization and sexual drive (r = 0.508, P < .001), sexual arousal (r = 0.521, P < .001), lubrication (r = 0.432, P < .001), orgasm/erection (r = 0.420, P < .001), and sexual satisfaction (r = 0.434, P < .001). Logistic regression analysis confirmed that-in addition to burnout-older age, dissatisfaction with income, a poor doctor-patient relationship, and poor sleep were significant contributors to sexual dysfunction among physicians in primary hospitals.

Clinical implications: Sexual health is an integral aspect of well-being. Prioritizing the sexual health of medical professionals can significantly contribute to improving their productivity.

Strengths and limitations: First, our sample size was small, and the impact of different specialties on sexual functioning was somewhat overlooked. Second, we lacked laboratory data (eg, testosterone and prolactin levels) that could provide substantial support to sexual identification. Finally, although we used logistic regression to establish causality, the relationship between sexual dysfunction and certain factors may be bidirectional.

Conclusions: The issue of sexual dysfunction among doctors needs more attention. We should make targeted efforts to improve the quality of physicians' sexual lives.

Background: Erogenous sensation zones (ESZs) elicit sexual pleasure upon stimulation. General ESZ maps exist, but they do not assess internal areas of the body, differentiate between individual structures, or quantify the importance of individual ESZs to sexual pleasure. Maps of aversive sensation zones (ASZs), or bodily areas individuals dislike having touched during sex, have not been described.

Aim: To create detailed erogenous and aversive sensory maps of the vulva, vagina, and breasts, and assess the importance of each erogenous structure to sexual pleasure.

Methods: An anonymous online questionnaire was administered to 441 sexually active cisgender women (mean age 48.9 ± 15.5 years) from March to June 2020 via Qualtrics. Respondents selected ESZs and ASZs from anatomic illustrations and rated each ESZ's importance to their sexual pleasure. Respondents' reasoning for choosing each ASZ was queried.

Outcomes: Heat maps of ESZ and ASZ selection frequency, ESZ importance ratings, and ASZ reasoning.

Results: More respondents selected ≧1 areas of the vulva as erogenous (82.0%), in comparison to the breasts (77.4%) and vagina (59.4%). The two most erogenous areas of the breast were also the most aversive: breast tissue (57.8% ESZ selection; 5.4% ASZ) and nipples (42.7%; 6.5%). Respondents most commonly reported these areas as aversive due to: "It's overly sensitive" and "It hurts."The most frequently selected ESZs of the vulva were the vaginal introitus (50.8%), periurethra (42.6%), and glans clitoris (41.3%). The top ASZs were the anus (34.0%) and perineum (7.9%), with primary reasons being: "It's gross," "It hurts," and "I'm ashamed/embarrassed."Of the five ESZs of the vagina, the superficial anterior (48.1%) and superficial posterior (32.9%) regions were the most selected. The cervix (6.8%), superficial posterior (5%), and deep posterior (3.4%) regions were the top ASZs due to "It hurts" and/or "It's overly sensitive."

Clinical implications: Erogenous and aversive sensory maps could help identify sexual concerns, inform preoperative counseling, and track sensory changes.

Strengths and limitations: This study captured detailed maps of internal and external ESZs and ASZs of the breasts, vulva, and vagina. Limitations include recall bias and inclusion of only cisgender women, rather than all people who share the same anatomy, irrespective of gender identity.

Conclusions: Erogenous sensation was most prominent in the vulvar structures, including the vaginal introitus and glans clitoris, followed by the superficial surface of the vaginal canal. Aversive sensation associated with the anus primarily came from feelings of judgment and shame, while other ASZs were reportedly due to pain and sensitivity.

Background: Social factors and a lack of clearself-awareness may prevent women from explicitly reporting their non-heterosexuality, and implicit measures could provide more reliable data.

Aim: This study examined non-heterosexuality and gynephilia in a large, global sample of women using implicit and explicit methods.

Methods: A sample of 491 women participated in this cross-sectional study. Participants completed a biographical questionnaire, the Autobiographical-Implicit Association Test, the Sexual Preference-Implicit Association Test (SP-IAT), and an explicit measure of sexual orientation. In a follow-up study, 263 participants were recontacted and completed the Autobiographical Sexual Orientation IAT and answered additional questions about their sexual behavior and preferences related to the stimuli on the SP-IAT.

Outcomes: The main outcome measures were D-scores on implicit association tests and scores on explicit measures of sexual orientation and behaviors.

Results: Implicit measures showed a higher rate of gynephilia (67.8%) than explicit non-heterosexuality (19.6%), with consistent results across continents. The findings suggest that women may be attracted to other women without necessarily desiring sexual encounters with them. Furthermore, the results suggest a degree of fluidity in sexual preferences in the female population.

Clinical implications: Studying the prevalence of gynephilia and non-heterosexuality in adult women can inform the development of health promotion programs tailored to women's diverse sexual experiences and preferences.

Strengths & limitations: Strengths include the global sample and the use of both implicit and explicit measures. Limitations involve the cross-sectional web-based design, potential sample biases, and aspects related to the validity of the SP-IAT.

Conclusion: Implicit measures of non-heterosexuality appear to be less tied to social factors than explicit assessments. In women, gynephilia may not necessarily serve as a proxy for non-heterosexuality. Moreover, women seem to exhibit greater fluidity in sexual preferences and behaviors than men.

Background: Lymphoma and cancer-related treatment can cause many complications, including sexual dysfunction, a common symptom experienced by lymphoma survivors during the disease trajectory and survivorship.

Aims: A scoping review was performed to determine the current state of knowledge about sexual dysfunction in lymphoma survivors and identify knowledge gaps and implications for future research.

Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO were searched to identify all primary peer-reviewed research articles published in the English language that were pertinent to sexual dysfunction in lymphoma survivors. The framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist were used to assess and synthesize the available evidence on sexual dysfunction in lymphoma survivors.

Outcomes: This review provided supportive evidence that sexual function in lymphoma survivors is a major ongoing area of concern.

Results: Thirty eligible articles published from 1979 to 2023 were appraised in this review. Most of the studies (73.33%) used a cross-sectional design. Using the Methodological Index for Non-Randomized Studies, more than half of the publications (53.33%) achieved a C quality ranking. The reviewed studies revealed that sexual dysfunction was a prevalent symptom experienced by lymphoma survivors, with predictors such as age, gender, sex hormones, stage of disease, and types of cancer treatment.

Clinical implications: Healthcare providers need to consistently perform routine assessment of sexual function and provide adequate treatment options.

Strengths and limitations: The reviewed studies document the problem of sexual dysfunction and offer potential areas of improvement for clinical practice. However, in the majority of the studies, longitudinal data were not obtained which could provide valuable insights on sexual functioning in lymphoma survivors.

Conclusion: Despite many years of research on sexual function in lymphoma survivors, substantial gaps in knowledge regarding sexual issues in this population remain.

Implications for practice: Healthcare providers should routinely assess sexual function of survivors and provide treatment options. Psychosexual interventions should be tailored for the needs of cancer survivors. Sexual function education is essential for all oncologists and should be included in the care pathway from diagnosis until survivorship.