Journal of Sexual Medicine最新文献

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.

Background: While existing studies have predominantly focused on negative body image and its potential link to female sexual distress in women with endometriosis, no studies have investigated how positive body image (ie, body functionality appreciation) mediates the association between dyspareunia severity and sexual distress in this population.

Aim: This study aimed to investigate the mediating role of body functionality appreciation in the relationship between severity of dyspareunia and sexual distress in women living with endometriosis.

Methods: A total of 232 women with endometriosis (M = 35 years) took part in the study. Participants completed an anonymous questionnaire evaluating dyspareunia severity, functionality appreciation, female sexual distress, sociodemographic factors, and endometriosis-related clinical information. All participants were administered the following questionnaires: numerical rating scale, body functionality appreciation, female sexual distress scale.

Outcomes: Using a mediation model, the study analyzed both the direct and indirect effects of dyspareunia severity on sexual distress, with functionality appreciation as a mediator.

Results: The findings suggest that the severity of dyspareunia significantly contributes to sexual distress both directly and indirectly, by diminishing the appreciation for body functionality.

Clinical implications: Clinicians should not only focus on the severity of dyspareunia when evaluating sexual distress in women; instead, they should also acknowledge the protective role of positive body image. Integrated treatments that promote body functionality appreciation could enhance treatment outcomes.

Strengths and limitations: The study is the first to examine the mediating role of body functionality appreciation in the relationship between dyspareunia severity and sexual distress in a sample of women with endometriosis; however, the assessment was cross-sectional and did not encompass other factors that may influence the connection between dyspareunia severity and sexual distress.

Conclusion: These findings, in addition to advancing theoretical understanding of the role of positive body image in women with dyspareunia, may be valuable in guiding the design of interventions aimed at reducing sexual distress in women with high levels of dyspareunia severity.

Background: Climacturia is defined as urine leakage associated with orgasm and can negatively affect patients' quality of life. The high prevalence of climacturia after radical prostatectomy (RP) has led to continued efforts to reduce climacturia rates. It has been shown that puboperiurethral suspension stitch placement during RP assists in the recovery of urinary continence.

Aim: To evaluate the impact of puboperiurethral suspension stitch placement during RP on post-RP climacturia.

Methods: We conducted a retrospective study of patients who underwent nerve-sparing robot-assisted laparoscopic RP (RALP) at our institution between 2016 and 2023. The patients were categorized into 2 groups: Group 1 (n = 32) that underwent nerve-sparing RALP with puboperiurethral suspension stitch placement and Group 2 (n = 62) that underwent nerve-sparing RALP alone. Patients who were not able to achieve penetration at the last follow-up visit were excluded from the study. The clinical history, parameters of prostate cancer, details of medical and surgical treatments, and follow-up data were evaluated.

Outcomes: Differences in sexual and urinary function, climacturia rates, and complications between nerve-sparing RP with and without puboperiurethral suspension stitch placement.

Results: There were no significant differences between the groups in terms of surgical complications. The mean follow-up time was 14.62 ± 3.55 months in Group 1 and 14.43 ± 4.44 months in Group 2 (P = .42). Postoperative erectile functions were similar between the groups. At the last follow-up visit, climacturia was present in 4 patients (12.5%) in Group 1 and 24 patients (38.7%) in Group 2 (P = .016). The long-term stress urinary incontinence rates were similar between the groups.

Clinical implications: This study provides comparative results on postoperative climacturia rates between nerve-sparing RALP groups with and without puboperiurethral suspension stitch placement. These results show that puboperiurethral suspension stitch can help to prevent postoperative climacturia after RP.

Strength and limitations: This is the first study in the literature that evaluates the effect of puboperiurethral suspension stitch on climacturia. The limitations include the single-center, retrospective design with potential selection bias, possible inaccuracies in the recorded medical data, and challenges in controlling confounding variables.

Conclusion: Our study demonstrated that puboperiurethral suspension stitch was a feasible option for the prevention of climacturia after RALP without an increased risk of complications.

Background: Diabetes mellitus-induced erectile dysfunction (DMED) is a common urological complication of diabetes, and current drugs often fail to provide an effective treatment. Smad2/3 signaling-mediated corporal fibrosis has a critical role in the molecular basis of DMED.

Aim: We investigated the effect of Niclosamide (Nic), an antihelmintic drug with antifibrotic effects, on erectile function in a rat DMED model.

Methods: Male Sprague Dawley rats were injected intraperitoneally (i.p) with streptozotocin (75 mg/kg) to induce diabetes. At week 8, both diabetic and nondiabetic rats were treated with Nic (10 mg·kg-1/day; i.p) or vehicle for 4 weeks. At week 12, erectile function was evaluated as intracavernous pressure (ICP) response to the electrical stimulation of the cavernous nerve (CN). Penile tissues were harvested for Masson's trichrome staining or western blotting to determine corporal fibrosis and Smad2/3 pathway-related protein expression, respectively.

Outcomes: At the end of the experimental protocol, in vivo erectile function was assessed by measuring the ratio of ICP/ mean arterial pressure (MAP) and total ICP following CN stimulation. Smooth muscle content and collagen fibers were evaluated by Masson's trichrome staining of the penile tissues. The expressions of fibrosis-related proteins (Smad2, Smad3, fibronectin) were determined using western blotting in the penile tissues.

Results: Erectile function, as determined by the maximum ICP/MAP and total ICP/MAP ratios, was drastically decreased in diabetic rats. Corporal tissues of diabetic rats were severely fibrotic with a significant increase in collagen fibers and a marked reduction in smooth muscle content. Also, the protein expressions of phosphorylated (p-)Smad2, p-Smad3 and fibronectin were significantly increased in the penis of diabetic rats. Both functional and molecular alterations in DMED were effectively reversed by Nic-treated diabetic rats without a glycemic alteration.

Clinical implications: Nic could be a promising candidate for the treatment of DMED due to its antifibrotic effects.

Strengths and limitations: The present study provides the first evidence that Nic has beneficial effect on erectile dysfunction by attenuating corporal fibrosis in a rat model of DMED. The effect of Nic on penile endothelial function and the other potential underlying mechanisms needs to be further elucidated.

Conclusions: Nic improved erectile function in DMED rats possibly suppressing penile fibrosis by inhibiting Smad2/3 signaling. These results suggest a potential therapeutic repurposing of Nic as an adjuvant treatment in DMED.

Background: Duty Sex-the act of engaging in sex out of a sense of duty or obligation to a partner-is a commonly reported reason why women have sex, with studies indicating associations between Duty Sex and sexual dysfunction, as well as nonconsensual sexual experiences (NSEs).

Aim: This study sought to examine the associations between Duty Sex frequency, sexual function, and NSEs using comprehensive, validated measures of sexual function and NSE histories in a large community sample of women.

Methods: Six hundred and fifty-eight women with (n = 293) and without (n = 365) NSE histories completed measures of sexual function and sexual motivations.

Results: Women with NSE histories reported more sexual pain, lower sexual satisfaction, and more frequent Duty Sex. The relation between NSE history and Duty Sex remained after controlling for the variance in sexual function. The type of NSE behavior, but not the timing of the first NSE nor the perceived impact of the experience, predicted Duty Sex frequency.

Clinical implications: Clinicians should consider sexual motivations, particularly Duty Sex, when treating women with NSE histories or who experience sexual dysfunction.

Strengths and limitations: To our knowledge, this was the first study to examine how NSEs relate to all domains of sexual function and sexual motives, revealing a link between NSEs, sexual function, and Duty Sex. However, we were unable to account for what percentage of sexual encounters are considered Duty Sex. Therefore, our measurement of Duty Sex lacks specificity, which may explain the relatively low variance accounted for by the models in our analyses.

Conclusions: There are consequences of NSEs, including difficulties with communicating sexual boundaries and impairment of sexual function, that may contribute to the increased likelihood of engaging in Duty Sex.

Background: Sleep is foundational for nocturnal erections, facilitating nutrient exchange and waste removal, which has brought widespread attention to the relationship between sleep and erectile dysfunction (ED). However, there is currently a lack of basic research confirming whether chronic sleep deprivation (CSD) leads to erectile impairment and its underlying pathological mechanisms.

Aim: The study sought to investigate whether CSD impairs erectile function in rats and the potential tissue damage it may cause in rats.

Methods: The modified multiple platform method was employed to induce CSD in 14 rats, randomly divided into a platform control group and a CSD group. After 3 weeks, erectile function was evaluated by measuring intracavernosal pressure following cavernous nerve stimulation.

Outcomes: Arterial blood samples were then analyzed for testosterone levels, and cavernous tissues were processed for advanced molecular biology assays, including Western blotting and immunofluorescence.

Results: After inducing CSD, rats exhibited a marked reduction in erectile function, yet their serum testosterone levels remained statistically unchanged when compared with the control group. More importantly, rats in the CSD group exhibited a significant increase in oxidative stress levels, accompanied by low expression of HO-1 and high expression of NOX1 and NOX4. Subsequently, elevated oxidative stress induced increased apoptosis in smooth muscle and endothelial cells, as evidenced by significant decreases in CD31 and α-smooth muscle actin expression in the CSD group, demonstrated through Western blotting and immunofluorescence assays. Endothelial cell apoptosis led to a significant decrease in endothelial nitric oxide synthase, resulting in lowered levels of nitric oxide and cyclic guanosine monophosphate, which severely impaired the erectile mechanism. Additionally, activation of the transforming growth factor β1 fibrotic pathway led to increased levels of tissue fibrosis, resulting in irreversible damage to the penile tissue in the CSD group.

Clinical implications: Our study lacks further exploration of the molecular mechanisms linking CSD and ED, representing a future research focus for potential targeted therapies.

Strengths and limitations: Our findings demonstrated that CSD significantly impairs erectile function in rats.

Conclusion: CSD severely impairs erectile function in rats. When exposed to CSD, rats exhibit significantly elevated oxidative stress levels, which lead to increased tissue apoptosis, endothelial dysfunction, and ultimately irreversible fibrotic changes in the tissues. Further researches into the potential molecular mechanisms are needed to identify possible therapeutic targets for ED related to CSD.

Background: Our team recently published outcomes of a novel technique for the administration of Collagenase Clostridium histolyticum (CCH), which resulted in improved curvature outcomes and reduced number of CCH injections required.

Aim: To provide a detailed and illustrated description of our CCH-administration technique.

Methods: A descriptive summary is provided of the technique, including drug administration, protocol modifications, and post-treatment protocols. Additional details are provided on measurement techniques and disease classification.

Outcomes: Key outcomes include a written and illustrated description of the injection technique and pre-, and postinjection management.

Results: The use of a modified CCH-administration technique has previously been shown to result in mean improvements of 54%-58% in penile curvature while significantly reducing the total number of injections applied. These findings represent the largest improvements published to date. Key aspects of the technique include back-to-back day administration of 0.9 mg suspended in 0.8 mL, application to an ~3 × 1 cm region, inclusion of the dorsal septum (exempting ventral curves), administration during a full erection (day 1), repeat artificial erections with the first injection of each series, in-office modeling (day 2), and post-treatment use of PDE5s and Restorex traction. Appropriate patient counseling on expectations and necessity of complying with all treatment protocols (including post-treatment wrapping) is critical to optimizing outcomes. Common side effects may include ecchymoses, hematomas, blood blisters, impacts on erections and penile sensation, bronzing of the skin, and skin scarring, while more severe complications are rare (<1%).

Clinical implications: The current manuscript provides a more detailed description of previously published techniques to aid providers in implementation and to mitigate potential adverse events.

Strengths and limitations: Strengths include reliance on the largest single-team series published on CCH outcomes, rigorous study methodology, prospective/sequential series, and step-wise improvements. Limitations include data obtained from a single center.

Conclusion: The current manuscript provides a detailed narrative and illustrated description of our current CCH-administration technique.