Journal of Sexual Medicine最新文献

Background: The radial forearm free flap (RFFF) is the standard technique for gender-affirming tube-in-tube phalloplasty owing to its reliably vascular anatomy and pliable tissue. However, postoperative circumferential and volumetric changes, and their potential role in complications such as excessive phallic turgor, remain poorly characterized.

Aim: To quantify early postoperative circumferential and volumetric changes following RFFF phalloplasty in patients with an uneventful postoperative course.

Methods: A consecutive series of trans men who underwent RFFF phalloplasty between 04/2024 and 07/2025 were analyzed. Phallic circumference was measured intraoperatively and on postoperative days (PODs) 1, 3, 5, 10, and 14 at three levels (base, midshaft, tip). Volumes were modeled from these measurements using geometric formulas (two-frustum method). Patients requiring emergent reintervention (eg, operative revision) were excluded.

Outcomes: Primary outcomes were temporal changes in circumference and estimated volume relative to intraoperative values within 14 days.

Results: Twenty-two patients with a mean age of 32 years (SD 11) met inclusion criteria. Mean flap length was 12.3 cm (SD 0.9). In most patients (54.5%) three venous anastomoses were performed. Phallic circumference increased most prominently within the first 24 h and peaked at POD 3, with mean increases of 6.2 mm at the base, 8.1 mm at the midshaft, and 7.5 mm at the tip compared with intraoperative values. Circumferences then declined gradually but remained above baseline on POD 14 (residual mean increase: 3.7 mm at the base, 4.8 mm at the midshaft, and 5.3 mm at the tip). Estimated phallic volume rose from a mean of 111.3 cm3 (SD 21.7) intraoperatively to 131.2 cm3 (SD 24.5) on POD 3, before declining to a mean volume of 120.8 cm3 (SD 21.3) by POD 14. These changes corresponded to a mean relative increase of 16.0 % (SD 15.9) on POD 1 and 19.0 % (SD 15.9) on POD 3. Persistent edema was present in 81.8% of patients at POD 14.

Clinical implications: Vigilant monitoring during the first 72 h is critical for timely decompression. Individualized flap planning, particularly at proximal and midshaft levels, remains essential to avoid tension-related complications.

Strengths and limitations: This represents the first quantitative assessment of early postoperative swelling in phalloplasty based on multi-level measurements and volumetric modeling. Limitations include the single-center design and short follow-up.

Conclusions: RFFF phalloplasty demonstrates predictable swelling dynamics: rapid increase within 24 h, a peak on POD 3, and gradual decline thereafter, with persistent edema in most cases by POD 14.

Background: An increasing body of research has investigated the sexual functioning status in women with pulmonary arterial hypertension (PAH); yet, the evidence remains inconclusive.

Aim: The aim of this study was to examine whether PAH is associated with a higher risk of female sexual dysfunction (FSD).

Methods: The electronic databases MEDLINE, Embase, Cochrane Library databases, and Google Scholar were systematically screened for eligible studies before January 27, 2025. The pooled results were calculated using a random-effects model.

Outcomes: The strength of the association between PAH and risk of FSD was presented by calculating the relative risk (RR) with a 95% confidence interval (CI).

Results: A total of six studies involving 699 adult women with PAH (age range: 20-70 years) were included. High methodological quality was identified in 67% (4 out of 6) of the included studies. Synthesis results revealed that female patients with PAH had a significantly higher risk of FSD as compared to the general population who without PAH (RR = 1.80, 95%CI: 1.62 to 2.01, P < .001; heterogeneity: I2 = 23.5%, P = .258). Subgroup analyses indicated that those studies with a sample size less than 90 participants and those studies conducted in Brazil, the US, and Netherlands had a higher risk of the development of FSD. Sensitivity analyses indicated that no single study could dominate the overall synthetic RR and I2. Third, no remarkable publication bias has been detected among the six included studies.

Clinical implications: The present study confirmed that PAH significantly increased the risk FSD.

Strengths and limitations: This is the first study investigating the relationship between PAH and FSD. A lack of studies that focus on the six domains on FSD and the limited included studies.

Conclusion: The present study supported a significant positive association between PAH and the higher risk of FSD via a meta-analysis, while the etiology of PAH-induced FSD might be attributed to a complex of multifactorial mechanisms.

Background: 0.05% Chlorhexidine gluconate (CHG) is now commonly used as an antiseptic irrigation for inflatable penile prosthesis (IPP) surgery. Limited in vitro data suggest compatibility of 0.05% CHG with antibiotic impregnated IPP devices; however, very little clinical research exists to guide use of 0.05% CHG in this population.

Aim: Assess the relationship of 0.05% CHG and antibiotic impregnated IPP infection in a large multi-institutional cohort.

Methods: We retrospectively reviewed a multi-institutional cohort of patients who underwent antibiotic impregnated IPP implantation. We identified cases using intraoperative 0.05% CHG and an equal number of consecutive control cases without 0.05% CHG use from each center for comparison. The primary outcome was IPP infection requiring explantation. Patient demographics and surgical variables were analyzed using chi-square tests and multivariable logistic regression to identify variables associated with infection.

Outcomes: The primary outcome was IPP infection requiring device explanation.

Results: Among 14 participating institutions, 761 cases using an antibiotic impregnated IPP were analyzed. Of these, 348 (45.7%) had 0.05% CHG used during the case. Median follow-up was 4 months (interquartile range 1-12) for the 0.05% CHG group and 8 months (interquartile range 2-21) for the control group.Intraoperative 0.05% CHG utilization was not associated with antibiotic impregnated IPP infection rate (1.9% vs. 2.0%, P = .9). On multivariable analysis, prior IPP infection (OR 6.32, 95% CI 1.32-30.2, P = .021) and prior priapism (OR 10.01, 95% CI 1.18-89.7, P = .039) were associated with increased infection risk.

Clinical implications: The use of 0.05% CHG irrigation with antibiotic impregnated IPPs was associated with similar infection rates compared to antibiotic irrigation.

Strengths and limitations: Limitations include the use of a historical comparator cohort which may introduce unknown confounders, practice variation between multiple sites, shorter follow-up in the 0.05% CHG cohort, and the low incidence of IPP infection which may limit statistical power despite a large sample. The major strengths include the large, multi-institutional cohort, and the use of consecutive patients to minimize selection bias.

Conclusion: 0.05% CHG utilization was not associated with infection rates in antibiotic impregnated IPPs.

Introduction: Platelet-rich plasma (PRP) is an innovative tool in regenerative medicine. It is defined as an autologous product obtained by density gradient centrifugation of blood, resulting in a platelet concentrate rich in growth factors. In gynecology, PRP has been used to treat vaginal atrophy, sexual dysfunction, and inflammatory conditions such as vulvar lichen sclerosus. PRP injection into the vulvo-vaginal area is a potential treatment for several conditions; however, treatment methods and applications vary widely across the published literature.

Objective: To provide an updated synthesis of current evidence on the administration of PRP to the vulva and vagina as a stand-alone technique in a non-surgical outpatient setting, and to identify its main clinical indications.

Methods: A systematic search of PubMed and Embase was conducted for studies published up to October 2024 using the terms "platelet rich plasma" AND "vaginal" and "platelet rich plasma" AND "vulvar." Eligible studies included human case reports, prospective, and retrospective cohort studies, as well as randomized and non-randomized controlled trials, assessing PRP injections as a stand-alone technique in the vulvo-vaginal area. Extracted data included study design, patient characteristics, indications, PRP preparation and administration protocols, number of sessions, outcomes, and adverse events.

Results: Eighteen studies met the inclusion criteria: two randomized controlled trials, 10 single-arm clinical trials, one retrospective cross-sectional study, and five case reports, comprising 480 patients (401 treated with PRP). The most frequent indication was vulvar lichen sclerosus (n = 179), followed by sexual dysfunction (n = 133) and vulvovaginal atrophy (n = 87). Protocols varied in preparation methods, injection techniques, and treatment schedules. Across studies, PRP injections were associated with improvements in symptoms, sexual function, and vaginal health, with few and mild adverse events.

Conclusion: Current evidence suggests that PRP injections in the vulvo-vaginal area may offer clinical benefits across several indications, with a favorable safety profile. However, the high variability in protocols, small sample sizes, and methodological limitations preclude definitive conclusions. Further high-quality randomized controlled trials are required to establish standardized protocols and confirm efficacy.