Journal of Sexual Medicine最新文献

Background: The Optilume benign prostatic hyperplasia (BPH) catheter system is a novel minimally invasive paclitaxel-coated dilation system that has demonstrated substantial and durable results in urinary flow and symptoms.

Aim: We now assess the impact of Optilume BPH procedure on sexual function.

Methods: Prior published results have described the methods of data collection during the PINNACLE study, which demonstrated durable improvement in urinary symptoms. Follow-up assessments for the current study included IIEF-EF and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD). Semen quality was also examined.

Outcomes: IIEF-EF and MSHQ-EjD scores in the Optilume BPH group were not different from the sham group at 3 months, 6 months, or 12 months.

Results: A total of 148 men were randomized to receive the procedure (100) or a sham surgical procedure (48). Subjects in both groups had similar rates of erectile dysfunction (ED) previously diagnosed at baseline (56% vs 54.2%, P = .83) and those men who were sexually active. IIEF-EF and MSHQ-EjD scores in the Optilume BPH group were not different from the sham group at 3, 6, or 12 months. Change in IIEF-EF scores remained consistent across all levels of baseline ED severity after Optilume BPH procedure. No clear trend was seen after treatment with Optilume BPH for semen volume, sperm motility, progressive motility, or sperm morphology.

Clinical implications: The Optilume BPH catheter system provides patients with a durable improvement in lower urinary tract symptoms while preserving sexual function.

Strengths and limitations: This study uses validated questionnaires to assess patients' sexual function at baseline and regularly for 1 year after the procedure. Given exclusion criteria regarding patient age and prostate size, the results may not be applicable to all BPH phenotypes.

Conclusion: Optilume appears to provide clinical benefit with a high degree of patient satisfaction and minimal impact on sexual function.

Background: There is inconsistent evidence as to the role of testosterone and pre-androgens in premenopausal female sexual function, and reported associations between blood concentrations of these hormones and female sexual function vary in strength.

Aim: To examine the patterns of testosterone and pre-androgen concentrations and variations in sexual function in premenopausal eumenorrheic women.

Methods: This was a secondary analysis of a sample of 588 premenopausal eumenorrheic women from the Grollo-Ruzzene Foundation Young Women's Health Study. Socio-demographics, health information, and questionnaire data were collected using online surveys. Eligible women were invited to provide a blood sample. We ran latent profile analysis (LPA) and subsequent analyses in R using RStudio.

Outcomes: Indicator variables in the LPA included sexual arousal and desire domains of the Profile of Female Sexual Function and testosterone, dehydroepiandrosterone (DHEA), and androstenedione, measured by liquid chromatography-tandem mass spectrometry.

Results: Analyses resulted in a pattern of 3 latent classes. Classes reporting relatively lower and higher sexual arousal (LPA-derived means and 95% CIs: -0.79 [-1.24; -0.34] and 0.62 [0.51; 0.72]) did not differ significantly in sex steroid concentrations (testosterone: -0.21 [-0.38; -0.03] and -0.33 [-0.47; -0.20]; DHEA: -0.47 [-0.57; -0.37] and -0.26 [-0.39; -0.13]; androstenedione: -0.36 [-0.50; -0.22] and -0.39 [-0.49; -0.29]), while the class reporting relatively medium arousal (-0.11 [-0.31; 0.08]) showed the highest testosterone, DHEA, and androstenedione concentrations (testosterone: 0.8 [0.60; 1.01]; DHEA: 0.99 [0.76; 1.23]; androstenedione: 1.08 [0.88; 1.29]). There were no significant differences in sexual desire between classes (-0.08 [-0.23; 0.06]; 0.00 [-0.13; 0.14]; 0.10 [-0.09; 0.30]) differing significantly in sex steroid concentrations (-0.69 [-0.80; -0.58], -0.04 [-0.15; 0.07], 0.94 [0.71; 1.16] for testosterone) nor associations between the sex steroid concentrations and degrees of sexual desire.

Clinical implications: These findings cast further doubt on the utility of measuring sex steroids for diagnosing female sexual dysfunction in premenopausal eumenorrheic women, even when considered in combination.

Strengths and limitations: We analyzed a large community sample and controlled for potentially biasing factors. We analyzed sex steroid concentrations determined with gold-standard methodology. Excluding women with early menopause and menstrual dysfunction might have resulted in finding 3, rather than more, latent classes.

Conclusion: Testosterone and pre-androgen profiles do not clearly identify premenopausal eumenorrheic women with low sexual arousal and desire.

Background: Sexual dysfunction (SD) is a complication of poorly managed diabetes mellitus (DM). To prevent SD, patients should develop sexual health literacy (SHL).

Objective: This study investigated the relationship between SHL and SD in women with DM.

Methods: This cross-sectional study was performed between 1 October 2023 and 1 June 2024. The sample comprised 400 participants. The inclusion criteria were (1) being 18-65 years of age, (2) having been diagnosed with DM, and (3) having a sex partner. Data were collected using a personal information form, the Female Sexual Function Index (FSFI), and the Sexual Health Literacy Scale (SHLS).

Outcomes: The data were analyzed using the Mann-Whitney test, Kruskal-Wallis H test, Spearman correlation coefficients, and binary logistic regression.

Results: Over half of the participants experienced SD (68,2%). Participants with higher education, those whose partners had higher education, those who did not have any chronic disease other than DM, and those who did not take hormone replacement therapy had a lower rate of SD (P < 0.05). Participants with higher income, those who used family planning, those with DM I, and non-menopausal participants had lower SD and higher SHL (P < 0.05). Insulin-only participants had higher SD and lower SHL than those who were on other types of medications (P < 0.05). There was a significant negative correlation between scale scores (FSFI and SHLS) and age (r = -0.388; P < 0.001 r = -0.326; P < 0.001, respectively), age of partner (r = -0.383; P < 0.001, r = -0.274; P < 0.001, respectively), duration of romantic relationship (r = -0.326; P < 0.001, r = -0.328; P < 0.001, respectively), number of children (r = -0.109; P < 0.001, r = -0.290; P < 0.001, respectively), and duration of DM (r = -0.254; P < 0.001, r = -0.125; P < 0.013, respectively). There was a significant positive correlation between scale scores (FSFI and SHLS) and number of sexual intercourse (r = 0,493; P < 0.001, r = 0.127; P < 0.011, respectively). A one-unit increase in DM duration resulted in a 3.7% increase in SD rate (OR = 1.037). A one-unit increase in the number of sexual intercourses reduced the SD rate by 35.5% (OR = 0.645).

Clinical implication: The data show that the prevalence of SD in diabetic women is directly affected by the number of sexual intercourses per week, menopausal status, and duration of DM.

Strengths and limitations: This is the first study to examine the relationship between SHL and SD in women with DM. Second, the results are sample-specific and cannot be generalized to all women with DM.

Conclusion: Healthcare professionals should ensure that women with DM have high levels of SHL to prevent SD and improve their quality of sexual life.

Background: Historically, β-blockers have been associated with erectile dysfunction (ED). Nebivolol, a third-generation β-blocker, may have had no negative effect on erectile function because of its vasodilating properties. However, the evidence level was considered either as low or very low.

Aim: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of nebivolol on erectile function.

Methods: All published RCTs were searched through PubMed, Cochrane Library, Web of Science, and Embase until October 2023. Review Manager version 5.3.0 was used for statistical analysis. Sensitivity analyses were performed by excluding each study using Stata 17 software.

Outcomes: The primary outcome was the International Index of Erectile Function (IIEF)-5 score. We excluded publication types, including letters, reviews, and meta-analyses.

Results: We identified four RCTs in this meta-analysis. All included studies compared the effects of nebivolol vs metoprolol on erectile function. Eight parallel groups with 397 individuals reported IIEF-5 scores. A random-effect model revealed that the IIEF-5 score was significantly higher in the nebivolol group (MD 1.81, 95%CI 0.95-2.68, P < .0001, I2 = 99%). We conducted a sensitivity analysis by removing each individual study and observed that there was no significantly different result. Furthermore, we conducted a prespecified subgroup analysis based on the dosage of metoprolol, patients with ED at the time of enrollment, and disease type. Subgroup analysis revealed that heterogeneity significantly decreased, and the result of the IIEF-5 score was stable and consistent.

Clinical implications: Our results provides stronger evidence that nebivolol significantly reduced the risk of ED occurrence or progression.

Strengths and limitations: Our meta-analysis included high-quality RCTs and conducted a predetermined subgroup analysis. However, the main limitations are the limited number of included studies and their heterogeneity.

Conclusion: Our meta-analysis provided stronger evidence that nebivolol significantly reduced the risk of ED occurrence or progression compared with metoprolol, irrespective of whether the patient had ED or not. This meta-analysis could serve as an important reference for future studies in this field.

Background: Sexual minority women (SMW) have worse mental and physical health outcomes compared to heterosexual women, but literature on sexual function in SMW compared to heterosexual women is lacking.

Aim: To evaluate sexual function and sexual distress in women across sexual orientations.

Method: Questionnaire data were analyzed for women aged 18 and older who presented to women's health clinics at Mayo Clinic in Minnesota, Arizona, and Florida from 2016 to 2023. Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) scores assessed sexual dysfunction (FSFI ≤ 26.55 and FSDS-R ≥ 11). Multivariable logistic models adjusted for confounding factors.

Outcomes: Our main outcome was female sexual dysfunction as defined by a composite of FSFI ≤ 26.55 and FSDS-R ≥ 11 to include both sexual function and sexual distress.

Results: Of 6241 sexually active women, 3% were SMW and 97% were heterosexual women. The majority were White (93%), with average age 51.6 years old. There was no significant difference in sexual dysfunction rates between heterosexual and SMW by combined endpoint on univariate or multivariable analysis. SMW had higher total FSDS scores (17 vs 15, P = 0.037), indicating more sexual distress.

Clinical implications: Sexual health concerns may differ between SMW and heterosexual women emphasizing the need for inclusive, culturally competent care.

Strengths & limitations: This study assessed the association of sexual orientation and sexual dysfunction by incorporating sexual functioning problems and sexual distress. Limitations include a small number of SMW and a predominantly White, married, employed, and educated study sample, limiting the generalizability of the findings.

Conclusion: Rates of sexual dysfunction were similar between mostly White SMW and heterosexual women presenting to tertiary care centers. SMW reported more sexual distress than heterosexual women. Evaluating these variables in larger, more diverse cohorts is a critical next step.