Journal of Sexual Medicine最新文献

Background: Circumcision is a common urological procedure performed for various medical, cultural, religious, and aesthetic reasons.

Aim: This study aimed to compare the effectiveness and safety of device-assisted (DeCi) and manual circumcision (MaCi) in adult European patients.

Methods: We conducted a prospective, comparative, non-randomized multicenter study including 200 consecutive adult males undergoing circumcision under local anesthesia. Patients were divided into two groups (MaCi or DeCi) based on patient preferences following proper counseling. Follow-up was scheduled at 1 week and 1 month post-surgery. Surgical and postoperative outcomes were recorded, with patient satisfaction with aesthetic results as the primary outcome, and procedure-related complications as secondary outcomes. Satisfaction was assessed using a 5-point Likert scale, while postoperative complications were classified using the Clavien-Dindo (CD) system.

Outcomes: A total of 200 patients (100 per group) were included. The DeCi group had a significantly shorter mean operative time than the MaCi group (11.20 ± 5.92 vs. 23.20 ± 7.93 minutes, P < .001). Patient satisfaction with aesthetic results was significantly higher in the DeCi group, with 67.4% of patients being "very satisfied" or "satisfied" compared to 36.7% in the MaCi group (P < .001). The DeCi group also reported significantly lower perceived pain during surgery (mean ± SD visual analogue scale [VAS] score: 1.54 ± 1.77 vs. 4.20 ± 2.10 points, P = .025) and at 1 month postoperatively (mean ± SD VAS score: 0.54 ± 1.03 vs. 2.35 ± 2.77, P < .001). Intraoperative and postoperative complication rates were similar between groups, with no significant differences (P > .05). Only 5% of patients in the MaCi group and 4% in the DeCi group experienced a CD Grade ≥ 3 postoperative complication.

Clinical implications: DeCi appears to offer superior aesthetic outcomes and reduced pain compared to MaCi, making it a promising option for circumcision in adult European men.

Strengths & limitations: This is the first study directly comparing DeCi and MaCi in a European adult population. The study's strengths include its prospective multicenter design, large sample size, and use of validated tools for outcome evaluation, which enhance the reliability and generalizability of the results. However, the non-randomized design, the age difference between groups, the testing of only one circumcision device model, and the lack of a cost-effectiveness analysis limit the generalizability of the findings.

Conclusion: In adult European men, DeCi offers superior aesthetic results and a similar safety profile compared to MaCi, though further research is needed to address the study's limitations.

Background: Dhat Syndrome is difficult to treat due to the unwavering belief of the patients about the harmful effects of semen loss. We hypothesized that this belief can be overcome by objective demonstration of zero health benefit of zero semen loss using reversible anejaculation property of silodosin.

Aim: To prospectively evaluate the efficacy of objective demonstration of zero health benefits of zero semen loss as treatment strategy to alter the mental construct of the Dhat syndrome patients using a randomized double blind placebo controlled two arm switchover study design.

Methods: The patients with complaints of Dhat syndrome were recruited post-confirmation of the diagnosis by Dhat Syndrome Evaluation Questionnaire (DSEQ). After excluding participants based on exclusion criteria, participants' anxiety and perceived physical fitness was assessed using Hamilton Anxiety Rating Scale (HARS) and Perceived Physical Fitness Scale (PPFS) respectively. They were randomized into two groups with Group 1 receiving placebo and Group 2 receiving silodosin 8 mg respectively with counseling being common for both. After 2 months, and a drug wash out period of 7 days, the participants were switched and interventions continued for another two months. In the end, Dhat symptomatology with DSEQ, anxiety with HARS and perceived physical fitness with PPFS were assessed and compared with initial assessment and discussed with the participants in a one to one session. Main outcome measure: The post-intervention change in Dhat Syndrome symptomatology in our study participants.

Results: A total of 32 adult males grouped as 1 (N = 18, mean age 28.9 ± 4.8 years) and 2 (N = 14, mean age 27.4 ± 4.3 years) participated in the study with none and 59% reporting semen loss while on silodosin and placebo respectively. The PPFS showed no statistically significant difference irrespective of the type of treatment in our participants and approximately 2/3rds of the participants reported relief from Dhat symptomatology and significant reduction in anxiety related to semen loss.

Clinical implications: Objective demonstration of zero health benefits of total prevention of semen loss to the patients of Dhat syndrome directly contradicts the unwavering belief about the harmful effects of semen loss in these patients thus altering their mental constructs.

Strengths and limitations: Prospective randomization design and objective demonstration of zero health benefits of zero semen loss are the strengths and the small sample size is the limitation of the study.

Conclusions: The alteration of the mental construct of the Dhat syndrome patients using novel treatment strategy was successful in majority of our study participants.

Introduction: Selective angioembolization for high flow priapism (Step-by-step guide).

Aim: Describe the indications and techniques of angioembolization for high flow priapism.

Methods: We outline patient selection, preparation, technique, outcomes, and potential complications of angioembolization for high flow priapism as supported by the literature.

Main outcome measure: The effectiveness of embolization for treating high flow priapism.

Results: Transarterial embolization is minimally invasive, low risk, and effective method from managing high flow priapism. Success rates range from 70% to 87% depending on the type of agent used for embolization. Side effects include erectile dysfunction with a reported rate of 7%-19%. Complications may be mitigated by embolizing as selectively as possible and using temporary embolic agents.

Conclusion: Embolization is a safe and effective treatment for nonischemic, high flow priapism in patients who have not responded to conservative management.

Background: Sex devices are tools that can improve the sexual health of users, but their effects on sexual outcomes in partnered intercourse have rarely been evaluated.

Aim: The aim of this study was to assess the relationship between partnered and solitary use of sex devices and different sexual health outcomes among sexually active women aged 18-35 in a heterosexual relationship.

Methods: The cross-sectional descriptive study was conducted with 361 participants between May and June 2023 recruited through a social media campaign. Female sexual function was measured with the Female Sexual Function Index and the Orgasmometer-F. The Generalized Anxiety Disorder scale, the Patient Health Questionnaire and the Dark Future Scale were used to investigate psychological health. Statistical analysis was performed with the statistical software R; the significance level for statistical analyses was set as P < 0.05.

Outcomes: The outcomes of the study include female sexual function and orgasmic intensity, as well as measures of symptoms of anxiety, depression, and uncertainty for the future.

Results: Compared to those who only used sex devices for solitary masturbation, women using sex devices in the context of partnered intercourse had higher arousal and satisfaction scores (P = 0.042 and P = 0.004, respectively), as well as higher subjective perception of orgasmic intensity over the last 6 months (P = 0.005) and in partnered sexual intercourse in the last 4 weeks (P = 0.002). Conversely, orgasmic intensity during masturbation in the last 4 weeks was higher among solitary users (P < 0.001). No significant difference was found between the two study groups for all other outcome measures.

Clinical implications: The use of sex devices in the context of partnered intercourse is associated with increased sexual function and more intense orgasmic experience.

Strengths & limitations: The study investigates a novel topic, on a large sample size, by using several validated instruments to measure sexual functioning of participants. However, a definite cause-effect relationship cannot be established due to the study design. Self-report bias and lack of clinical data on study participants are further limitations. Additionally, being a study limited to heterosexual, sexually active women involved in a relationship, results cannot be generalized to all women.

Conclusion: The study found an association between better sexual functioning and use of sex devices in partnered intercourse.

Background: Although sexual dysfunction is one of the most common symptoms in patients with multiple sclerosis (MS), there are relatively few studies on this topic.

Aim: The aim of this study was to assess sexual function in female MS patients and investigate its association with functional state, fatigue, depression, sleep, and quality of life.

Methods: This descriptive cross-sectional study was conducted between May and November 2019 with MS patients attending an MS outpatient clinic at a university hospital. Patients' sexual function was assessed using the Female Sexual Function Index (FSFI). Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Multiple Sclerosis Quality of Life Scale (MSQoL-54) were used to determine their relationship to sexual function.

Outcomes: Sexual function, functional status, depression, sleep quality, and quality of life.

Results: The mean age of the 83 patients included in the study was 41.8 (±8.5) years, and all were married. The mean FSFI score of the patients was 21.1 (±8.9) and 26.55, 72.3% of patients were found to have sexual dysfunction. FSFI scores were found to have a negative correlation with age (r = -0.398, P = .001), duration of diagnosis (r = -0.338, P = .001), and EDSS scores (r = -0.326, P = 0.040). Patients taking symptomatic medication (P = .032) and antidepressants (P = .012) had lower mean FSFI scores. Additionally, the FSFI score showed a significant negative correlation with the FSS (r = -0.368, P = .001), the BDI (r = -0.423, P < .001), the PSQI (r = -0.314, P = .004), and the MSQoL-54 (physical health: r = 0.509, P < .001 and mental health: r = 0.431, P < .001).

Clinical implications: A comprehensive evaluation of sexual dysfunction and the development of tailored treatment plans, taking into account associated factors, will be beneficial for female patients with MS.

Strengths and limitations: Small sample size and assessment of sexual function by a generic scale are the limitations of this study.

Conclusion: Considering the multifactorial nature of sexual dysfunction in female MS patients, it is recommended that patients be assessed multidimensionally during outpatient follow-up visits.

Background: When an individual in a relationship is coping with low desire/arousal, both partners experience difficulties, including higher levels of sexual distress. Effective emotional regulation strategies, such as self-compassion, could have individual and interpersonal benefits for couples with sexual interest/arousal disorder (SIAD).

Aim: Using a dyadic design, we examined the role of self-compassion in the sexual distress of couples coping with SIAD, accounting for overall relationship satisfaction. The associations were analyzed cross-sectionally and prospectively. We also explored the moderating roles of having at least one member identify as sexually or gender diverse within the couple in the potential associations between self-compassion and sexual distress.

Methods: Individuals with SIAD and their partners (N = 263 couples) completed online measures at baseline and 6 months later.

Outcomes: Individuals with SIAD and their partners completed the Sexual Distress Scale-Short Form and the Couples Satisfaction Index.

Results: Controlling for relationship satisfaction, when individuals coping with SIAD and their partners reported greater self-compassion at baseline, they also reported lower sexual distress. For partners only, greater self-compassion was associated with the person with SIAD's lower levels of sexual distress at baseline. No statistically significant prospective associations were found between levels of self-compassion and sexual distress 6 months later. Belonging to a sexually diverse couple was a significant moderator of the cross-sectional associations between partners' level of self-compassion and their own level of sexual distress at baseline, such that the link between greater self-compassion and lower sexual distress was observed only in partners belonging to a sexually diverse couple. Belonging to a gender diverse couple did not moderate any of the associations.

Clinical implications: Findings indicate that self-compassion could be a promising tool to reduce sexual distress in couples coping with SIAD.

Strengths & limitations: Strengths of this study include the large, diverse sample of couples coping with SIAD, the use of a cross-sectional and prospective design, and the examination of the moderating role of belonging to a gender or sexually diverse couple. However, the possible lack of statistical power to measure moderation based on belonging to a gender diverse couple and the recall bias due to the use of self-report questionnaires should be considered when interpreting the results.

Conclusion: Greater self-compassion is associated with lower sexual distress in both partners of couples coping with SIAD. Self-compassion may be particularly beneficial for partners of individuals with SIAD belonging to a sexually diverse couple.

Background: Hypertension is an independent risk factor for erectile dysfunction (ED). Icariin can improve erectile function of spontaneous hypertensive rats (SHRs). GRK2 is closely related to the phosphorylation of eNOS and endothelial function.

Aim: To explore whether icariin can improve erectile function in SHRs by regulating the expression of GRK2 in penile cavernous tissue.

Methods: Eight-week-old WKY and SHR rats were randomly divided into four groups (n = 6 per group) as follows: WKY, WKY + icariin, SHR and SHR + icariin. The WKY + icariin and SHR + icariin groups were treated with 10 mg/kg/day icariin. After 4 weeks, the ICPmax/mean arterial pressure (MAP), serum testosterone, the levels of GRK2, p-AKT/AKT, p-eNOS/eNOS, and caspase-3; the protein interaction between GRK2 and AKT; the levels of nitric oxide (NO), superoxide dismutase (SOD), and malondialdehyde (MDA); and the level of apoptosis in rat penile cavernous tissue were measured.

Outcome: The expression of GRK2 in penile cavernous tissue of SHR was significantly higher than that in WKY rats, resulting in the inhibition of the AKT/eNOS/NO pathway, increased levels of oxidative stress and apoptosis, and the impairment of erectile function.

Results: The ICPmax/MAP ratio in the SHR group was significantly lower than those in WKY and SHR + icariin groups (P < .01). In the SHR + icariin group, the expression levels of GRK2 and caspase-3, the interaction between GRK2 and AKT, the level of MDA and the rate of apoptosis in the penile cavernous tissue were significantly lower, and the levels of p-AKT and p-eNOS, the p-AKT/AKT and p-eNOS/eNOS ratios, and NO and SOD were significantly greater than those in the SHR group (P < .01).

Clinical implications: Icariin may improve the erectile function of hypertension by downregulating GRK2 expression in penile cavernous tissue.

Strengths and limitations: The specific mechanism via which icariin downregulates GRK2 needs to be further elucidated.

Conclusion: Icariin downregulates the expression of GRK2 in the penile cavernous tissue of SHRs, upregulates the AKT/eNOS/NO pathway, decreases oxidative stress and apoptosis, and ultimately improves erectile function.

Background: While the use of testosterone replacement therapy (TRT) in men undergoing active surveillance (AS) for prostate cancer (PCa) has been historically contraindicated, recent studies have contributed to a paradigm shift to this approach.

Aim: To examine the impact of testosterone on prostate-specific antigen (PSA) levels and prostate biopsy progression in men with low testosterone on AS for PCa.

Methods: A retrospective single-center analysis was conducted on men undergoing AS for PCa who subsequently underwent TRT. Men previously treated for PCa were excluded. PSA and testosterone levels were recorded at regular intervals one year before and after the initiation of testosterone. ANOVA was used to analyze variance in PSA and testosterone levels, and paired t-tests and linear regression analysis were performed. Baseline and surveillance biopsies were documented.

Outcomes: The primary outcomes were changes in PSA levels and biopsy progression following initiation of testosterone therapy.

Results: Forty-three men met the inclusion criteria. Median (IQR) testosterone level before testosterone therapy was 272 (221.5-333.5) ng/dL and 578.5 (354.5-846.5) ng/dL after therapy (P < 0.01). No significant variation in mean PSA levels was observed (P = 0.87). Baseline biopsies were available for 27 patients, showing Gleason 3 + 3 = 6 in no more than three cores. Fifteen (55.6%) patients had one or more surveillance biopsies after starting testosterone therapy. Of these, 12 (80.0%) had no disease progression in biopsies over a mean of 44.3 months on testosterone. Three patients (20.0%) had a Gleason score 7 on biopsy after a mean of 79.5 months on testosterone therapy. No patients developed metastatic disease.

Clinical implications: Testosterone therapy did not result in statistically significant changes in PSA levels in men with low testosterone on AS. Pathology changes were inconclusive, but the available data showed no apparent increase in PCa progression or disease worsening in the cohort.

Strengths and limitations: The study's strengths include a longitudinal follow-up design and use of multiple statistical analyses. Limitations include the retrospective design, small sample size which may limit generalizability, and lack of control group.

Conclusion: No significant change in PSA level was observed after initiating testosterone therapy, despite an increase in testosterone levels. Despite limited biopsy data, our findings suggest similar rates of disease progression compared to the general AS population.