Journal of Sexual Medicine最新文献

Background: To date, there is a lack of a structured national plan of sexual education in Italy, with large interregional differences and poor uniformity in the promotion and learning of sexual health.

Aim: The aim of this study was to evaluate the level of knowledge on sexuality and reproductive function among adolescents before and after a sexual education program, considering gender differences in the results.

Methods: A longitudinal and interventional study was conducted on high school students. Six sessions for each class were carried out by a multidisciplinary team. Anonymous questionnaires were administered to investigate basic knowledge of human sexuality and reproduction before and after intervention.

Outcomes: Participants were high school students who completed the questionnaires. Outcomes included pre and posttest answers on the knowledge questionnaire in study population.

Results: We obtained data from 842 high school students (mean ± SD age, 16.11 ± 1.74 years). The main informative sources on sexuality were social media in 37.9% of participants; family, school, and scientific material were the main source in 15.1%, 5.2%, and 4.4%, respectively. A total score of 12.6 ± 3.4 (range, 1-20) was obtained on the knowledge questionnaire; specifically, the score was higher in females than males (12.8 ± 3.4 vs 11.9 ± 3.4, P = .0001). In males and females, a statistically significant increase in level of knowledge was found after the multidisciplinary intervention (14.5 ± 3.6, P = .0001).

Clinical implications: The lack of sexual education programs in schools in Italy compels adolescents to refer to frequently unreliable sources, such as social media and peers, contributing to misinformation and adoption of risky sexual behaviors.

Strengths and limitations: This study is based on a large sample size and highlights the importance of sexual education programs. The main limitations are a greater representation of the female population and the inclusive nature of the school (ie, an artistic school), attracting students who identify with sexual minorities.

Conclusions: Adolescents have limited knowledge about sexuality and reproduction, with a notable gender disparity; sexual education programs in schools, providing information from sexuality experts, led to a substantial increase in knowledge and a reduction in the gender gap.

Background: In recent years, there has been growing interest in the use of hyaluronic acid (HA) for the treatment of premature ejaculation (PE). The efficacy of this treatment is quite controversial.

Aim: This study intended to evaluate the efficacy and safety of glans penis augmentation with HA gel for PE.

Methods: This systematic review includes randomized controlled trials (RCTs), primary clinical trials, prospective and retrospective studies, case series, and case reports. Searches in Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov were performed blindly by 2 reviewers.

Outcomes: Intravaginal ejaculation latency time (IELT), questionnaires about PE, glans circumference (millimeters), and adverse events.

Results: Thirteen studies were included in the evaluation: 4 RCTs, 8 prospective observational studies, and 1 restrospective study. The number of patients who received HA gel on the glans penis was 706. According to the results of 2 placebo-controlled RCTs, HA gel treatment significantly improved IELT at the end of the first month (mean difference [MD], 65.44 seconds). In the first month after the HA gel injection procedure, IELT increased vs before the procedure (MD, 176.18 [95% CI, 146.89-205.48]; P < .001, I2 = 83%). When the IELT values ​​were compared at 6 months after HA gel application, IELT improved vs before the procedure (MD, 143.93 [95% CI, 124.78-163.09]; P < .001, I2 = 82). The glans circumference expanded by approximately 1.5 cm after the procedure (MD, 14.82 mm [95% CI, 12.75-16.90]; P < .001, I2 = 65%). When the side effect profile of other studies was examined, side effects were observed in 91 patients after HA gel injection applied to 598 patients (15.22%). Among these side effects, the most common were pain (n = 46, 7.69%), bulla/nodule formation (n = 25, 4.18%), and ecchymosis (n = 20, 3.34%).

Conclusion: While HA shows promise as a therapeutic option for PE, ongoing research is essential to elucidate its clinical utility, mechanisms of action, and comparative efficacy.

Background: Vulvodynia is a chronic pain syndrome characterized by persistent vulvar pain, occurring without clinically identifiable disorders. Central sensitization (CS) is suggested to play a role in the pathophysiology of vulvodynia, as for other nociplastic pain conditions.

Aim: This study delves into the complex interplay between psychosocial factors and CS burden in women with vulvodynia, aiming to identify potential predictors (temperament, personality traits, childhood adverse events, defense mechanisms, and mental pain) and understand their impact on quality of life (QoL).

Methods: A cohort-based cross-sectional web survey of 357 women with vulvodynia.

Outcomes: Outcomes included 8 self-report measures to assess the Central Sensitization Inventory (CSI) and psychological variables, including sensory processing sensitivity, traumatic experiences, personality traits, defense mechanisms, and mental pain.

Results: Hierarchical multiple regression analyses were conducted in study 1, revealing that the following predicted higher CSI scores in women with vulvodynia: higher emotional overexcitability, decreased low sensory threshold, increased bodily threat experiences, elevated psychoticism, greater use of immature and neurotic defense mechanisms, and heightened mental pain. The final regression model identified the following as the strongest predictors of CS: low sensory threshold (β = 0.316), bodily threat experiences (β = 0.145), neurotic defenses (β = 0.210), and mental pain (β = 0.269). In study 2, the model presented interactions among these psychological factors in predicting CSI values explaining 48.9% of the variance in CS, 30.3% in psychological QoL, and 57.1% in physical QoL.

Clinical translation: This model opens discussion for tailored psychological interventions aimed to improve overall QoL in women with vulvodynia.

Strengths and limitations: Strengths of the study include innovative insights into the interplay between psychological variables and the construct of CS and quality of life. As a limitation, the research was conducted as a cross-sectional study with self-reported measures.

Conclusion: The study calls for comprehensive assessments that consider physical and mental aspects, paving the way for holistic health care approaches in the management of vulvodynia.

Background: Pulmonary arterial hypertension (PAH) can have several consequences on sexual function, which can lead to worsened quality of life.

Aim: The study sought to assess sexual function and its association with health functionality and quality of life in females with PAH.

Methods: A descriptive cross-sectional study was carried out in pulmonary circulation outpatient clinics from January 2022 to March 2023 in females diagnosed with pulmonary hypertension. Assessment was carried out through the application of the Female Sexual Function Index, the 36-item World Health Organization Disability Assessment Schedule, and the Medical Outcome Study 36-Item Short Form Survey.

Outcomes: Data were analyzed using SPSS version 22.0 and JASP, and Spearman's correlation tests were applied between the instruments, with a P value <.05 considered significant.

Results: A total of 91 females were assessed. It was identified that 90.1% of females had sexual dysfunction, with worse scores in females with sexual dysfunction in the domains of satisfaction, arousal, and desire, with average health functionality and quality of life. There were significant correlations between the domains of mobility, getting along, life activities, and the overall functionality score with some domains of sexual function, especially arousal and satisfaction. We found significant correlations between some domains of quality-of-life assessment with the domains of desire, arousal, and satisfaction, and with the overall score of sexual function assessment, as well as strong correlations between health functionality and quality of life.

Clinical implication: The data reinforce the need for rehabilitation programs and social support for this population.

Strengths and limitations: This is one of the few studies to evaluate sexual function, quality of life, and health functionality in women with PAH. Due to limitations in data collection, we were unable to assess certain factors such as hormone levels and a history of sexual abuse.

Conclusion: We identified a high prevalence of sexual dysfunction in females with PAH with mild functional impairment and a moderate quality-of-life score with correlations between sexual function, health functionality, and quality of life.

Background: The primary reasons for labiaplasty usually revolve around aesthetic, sexual, and functional concerns. Upon delving deeper into these issues, it becomes apparent that sexual partners play a controversial role in influencing women's decisions to undergo surgery.

Aim: This study aimed to investigate the impact of sexual partners on women's choices to pursue labiaplasty.

Methods: A comprehensive search was conducted across electronic databases covering the period from January 2000 to February 2024. After removing duplicates, a total of 931 articles were retrieved by searching keywords in titles and abstracts.

Outcomes: The meta-analysis revealed that 36.7% of women who sought labiaplasty cited their partners' negative comments as a factor influencing their decision.

Results: After applying the eligibility criteria and excluding irrelevant articles, a total of 12 articles involving 962 participants were included in the analysis. With the exception of 2 articles, the majority of the studies suggested a discernible influence of male partners on women's decisions to seek labiaplasty. Frequently, sexual partners are not the primary decision makers, nor do they exert significant pressure when it comes to seeking labiaplasty. In certain instances, women seeking labiaplasty acknowledged that their sexual partners did influence their decisions, either by making disparaging comments about their genitalia or by directly pressuring or requesting them to undergo labiaplasty. Additionally, women might opt for labiaplasty out of fear of their partner's negative remarks or to enhance sexual pleasure for their partners. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity.

Clinical implications: The findings of this study can be applied in prelabiaplasty counseling sessions to acknowledge and explore the role of the sexual partner in women's decision making.

Strengths and limitations: This study stands as the inaugural systematic review examining the impact of sexual partners on women seeking labiaplasty, encompassing all original studies exploring the role of the sexual partner. However, a notable limitation lies in the varied interpretations of the sexual partner's role, that the heterogeneous nature of these interpretations poses a challenge to providing a more precise answer through meta-analysis.

Conclusion: Based on the findings of this systematic review, it is evident that sexual partners exert multifaceted influences on women's decisions to seek labiaplasty. While not serving as the primary decision makers, women opt for labiaplasty with the aim of enhancing attractiveness in sexual relationships and mitigating potential negative comments from their partners.

Background: Hormonal contraceptive use has been related to adverse effects, including impacts on sexual function and sexual satisfaction, although the difference in the effects on sexual function with the use of hormonal vs nonhormonal contraceptive methods remains controversial.

Aim: In this study we sought to compare the prevalence of dyspareunia, sexual function, sexual satisfaction, quality of life, anxiety, and depression between women using hormonal, nonhormonal, or no contraceptive methods and to compare these outcomes between the most frequently used contraceptive methods.

Methods: This cross-sectional study included sexually active women of reproductive age who were stratified into 3 groups: women using hormonal, nonhormonal, or no contraceptive methods. Based on the use of questionnaires administered to the study participants, we compared sexual function in the 3 groups and more specifically among users of oral contraceptives, copper and hormonal intrauterine devices, and barrier methods.

Outcomes: Participants completed 4 questionnaires to assess sexual function (Female Sexual Function Index), sexual satisfaction (Sexual Quotient-Feminine Version), quality of life (12-item Medical Outcomes Short Form Health Survey), and anxiety and depression (Hospital Anxiety and Depression Scale).

Results: This study included 315 women classified into 3 groups on the basis of contraceptive use: 161 in the hormonal contraceptives group (median [interquartile range] age, 24 [23-28] years), 97 in the nonhormonal contraceptives group (age 26 [23-30] years), and 57 in the no contraceptive methods group (age 28 [24-35] years). Dyspareunia prevalence showed no difference between the groups. In the quality of life domain, compared with women in the nonhormonal contraceptive group, women in the hormonal contraceptive group were younger and had lower sexual function satisfaction, reduced arousal, and heightened pain (P < .05), as well as higher anxiety and depression levels (P = .03, for both), increased pain (P = .01), and poorer overall health (P = .01). No difference was found between these groups in other quality of life domains. Regarding contraceptive methods, women using copper intrauterine devices had better sexual function, including higher rates of arousal and lower anxiety, than women using oral contraceptives (P < .05).

Clinical implications: The results of this study highlight worse sexual function and sexual satisfaction and higher levels of anxiety and depression in women using hormonal contraceptive methods than in women using nonhormonal methods.

Strengths and limitations: The findings of this study strengthen the evidence of differences in sexual function between women using oral contraceptives and those using copper intrauterine devices. Sexual function was also compared among users of

Background: Female cancer survivors often experience estrogen-deprivation symptoms, which may lead to decreases in sexual desire, vulvovaginal health (lubrication, dryness, discomfort), and sexual satisfaction. Interventions are needed to address these concerns.

Aim: The objective of this secondary analysis was to determine if women with higher (better) scores on the Female Sexual Function Index (FSFI) lubrication and pain subscales reported higher desire scores based on treatment with bupropion vs placebo.

Methods: Participants were part of NRG Oncology's NRG-CC004 (NCT03180294), a randomized placebo-controlled clinical trial evaluating bupropion (150 vs 300 mg) to improve sexual desire in survivors of breast or gynecologic cancer. All participants with baseline data from the FSFI lubrication, pain, and desire subscales with 5- and/or 9-week data were analyzed. The FSFI subscale scores were correlated using Spearman correlation coefficients. Logistic regression was used to determine associations between FSFI desire and other FSFI subscales while accounting for treatment arm and other covariates.

Outcomes: The primary outcome of NRG Oncology's NRG-CC004 (NCT03180294) randomized phase II dose-finding trial was change from baseline to 9 weeks on the FSFI desire subscale score. Similar to the parent study, the primary outcome for this ancillary data study was the FSFI desire subscale score at 5 and 9 weeks.

Results: Overall, 230 participants completed the FSFI at baseline and 189 at 9 weeks. The strongest correlations were between lubrication and pain at baseline (all participants, rho = 0.77; bupropion arms, rho = 0.82), week 5 (all participants, rho = 0.71; bupropion arms, rho = 0.68), and week 9 (all participants, rho = 0.75; bupropion arms, rho = 0.78), and the weakest correlations were between desire and pain. In patients in the treatment arms there were no interactions between lubrication or pain.The impact of various covariates on the FSFI score for desire at 9 weeks demonstrated that participants of non-White race (odds ratio [OR], 0.42; 95% CI, 0.21-0.81; P = .010), with a high lubrication score (OR, 0.36; 95% CI, 0.21-0.61; P = .0002), with a high pain score (less pain) (OR, 0.50; 95% CI, 0.29-0.87; P = .014), or with prior pelvic surgery (OR, 0.38; 95% CI, 0.23-0.63; P = .0002) had lower odds of having low desire.

Clinical implications: Acute estrogen-deprivation symptoms should be addressed prior to sexual desire intervention.

Strengths and limitations: This secondary analysis was not powered to examine all variables.

Conclusion: Lubrication and pain were predictors of low desire. Therefore, vulvovaginal atrophy and associated genitourinary symptoms of menopause such as vaginal dryness and dyspareunia should be addressed prior to or in parallel with interventi

Background: While female ejaculation is viewed as a potential enhancer of women's sexual experiences and their relationships with their sexual partners, existing studies to date emphasize the need for further exploration of the squirting phenomenon.

Aim: The study sought to explore experiences and perceptions about the phenomenon of squirting in young adult women.

Methods: A descriptive qualitative study was conducted. Semi-structured, in-depth interviews were conducted between December 2022 and March 2023. Seventeen young adult women who experienced squirting were recruited using a convenience and snowball sampling. ATLAS.ti v.9 software was used for a thematic analysis of the interview data. The study adhered to the recommendations for reporting qualitative research (Standards for Reporting Qualitative Research).

Outcomes: The outcomes included (1) exploring factors influencing initial squirting experiences, (2) insights gained through squirting experiences, (3) communication as the cornerstone in sexual relationships, and (4) resources and sources for knowledge on the squirting phenomenon.

Results: After the analysis of the results, the following subthemes emerged: (1) first perceptions on squirting, (2) facilitating factors, (3) physical sensations and psychological aspects in squirting experience, (4) sources of information about squirting and (5) addressing squirting in comprehensive sex education.

Clinical implications: Frontline healthcare providers should undergo specific training to address anxiety related to squirting among certain individuals and enhance societal awareness while offering emotional support for diverse sexual response variations.

Strengths and limitations: Acknowledging limitations in our study of young women's experiences with squirting, a more diverse sample could provide alternative insights. Despite this, our findings contribute valuable knowledge, suggesting avenues for professional training to promote sexual and reproductive health in a more realistic and sensitive manner.

Conclusion: This study explored the emotional and psychological effects of squirting on women's sexual experiences, ranging from heightened arousal to feelings of humiliation and embarrassment. It emphasized the importance of a partner's reaction in interpreting the event and the limited understanding of squirting, often influenced by pornography.

Background: The mechanism by which a state of low testosterone leads to erectile dysfunction (ED) has not been determined. Endocan is a novel marker of endothelial function. However, whether endocan is involved in the regulation of erectile function under low testosterone levels remains unclear.

Aim: In this study we sought to determine whether a low-testosterone state inhibits erectile function by regulating endocan expression in the endothelial cells of the rat penile corpus cavernosum.

Methods: Thirty-six male Sprague-Dawley rats aged 8 weeks were randomly assigned to 6 groups (n = 6 per group) as follows: (1) control, (2) castration, (3) castration + testosterone treatment (treated with 3 mg/kg testosterone propionate per 2 days), (4) control + transfection (4 weeks after castration, injected with lentiviral vector (1 × 108 transduction units/mL, 10 μL), (5) castration + transfection, or (6) castration + empty transfection. One week after the injection, we measured the maximal intracavernous pressure/mean arterial pressure (ICPmax/MAP), serum testosterone and nitric oxide (NO) levels, and the expression of endocan, phospho-endothelial NO synthase (p-eNOS), eNOS, phospho-protein kinase B (p-AKT), and AKT in the rat penile corpus cavernosum.

Outcomes: Under a low-androgen state, the expression of endocan in the rat penile corpus cavernosum was significantly increased, which inhibited the AKT/eNOS/NO signaling pathway and resulted in ED.

Results: In the castration group, the expression of endocan in the rat penile corpus cavernosum was significantly higher than that in the control group (P < .05). Additionally, the levels of p-AKT/AKT, p-eNOS/eNOS, and NO in the rat penile corpus cavernosum and ICPmax/MAP were significantly lower in the castration group than in the control group (P < .05). In the castration + transfection group compared with the castration group there was a significant decrease in the expression of endocan (P < .05) and an increase in the ratios of p-AKT/AKT, p-eNOS/eNOS, and ICPmax/MAP (P < .05) in the rat penile corpus cavernosum.

Clinical implications: Downregulating the expression of endocan in the penile corpus cavernosum may be a feasible approach for treating ED caused by hypoandrogenism.

Strengths and limitations: The results of this study indicte that endocan may affect NO levels and erectile function through multiple signaling pathways, but further experiments are needed to clarify the relationship between endocan and androgens.

Conclusion: A low-testosterone state inhibits the AKT/eNOS/NO signaling pathway by increasing the expression of endocan in the rat penile corpus cavernosum and impairing erectile function in rats. Decreasing the expression of endocan in the penile corpus cavernosum can improve erectile function in rats with low testo