Journal of Sexual Medicine最新文献

Background: The preoperative glycemic control of diabetic patients may increase the risk of penile prosthesis (PP) infection, but the published literature remains controversial.

Aim: To systematically review and meta-analyze available evidence on the impact of diabetes mellitus (DM) and glycemic control on PP infection. The study was completed under the auspices of the European Society for Sexual Medicine Surgical Academy.

Methods: An comprehensive Medline, Embase, and Cochrane search was performed including the keywords: ("penile prosthesis" and "diabetes mellitus"). Only English-language articles published between January 1, 1969 and May 31, 2024 were included.

Outcomes: The primary outcome measure was the risk of PP infection in diabetic patients. The secondary outcome measure was the contribution of glycemic control on PP infection rate.

Results: Out of 182 retrieved articles, 11 were included in the study, summarizing 10 024 subjects with a mean age of 59.7 years, and a mean follow-up of 37.2 months. Overall, a PP infection rate of 4.3[3.9-4.8]% was observed. The PP infection rate increased according to baseline HbA1c levels, and the latter result was confirmed following adjustment for age and trial duration (P < .0001). Accordingly, PP infection rate was more than 2-times higher when trials with a mean HbA1c ≥ 8% were compared to the rest of the sample (9.1[7.5;11.0] vs 3.8[3.2;4.5]%; Q = 43.18; P < .0001).

Clinical implications: Optimization of the preoperative glycemic control may reduce PP infection rate in diabetic patients.

Strengths and limitations: The present study provides evidence supporting a significant increased risk of PP infection for patients with DM and pre-operative HbA1c ≥ 8%. Analysis was primarily derived from retrospective studies, which represent a significant source of bias. The exclusion of those studies including less than 70% of diabetic patients can represent a further source of bias.

Conclusion: The present study shows a significant association between pre-operative HbA1c and PP infection rate. Further studies are advisable in order to better clarify the best threshold of HbA1c that is acceptable prior to implant surgery in diabetic patients.

Background: Inflammation may contribute to lower desire and arousal functioning in women; however, little research has examined effects across the reproductive lifespan.

Aim: To examine associations between inflammation and sexual functioning in pre- and post-menopausal women.

Methods: 103 healthy, sexually active cisgender women (48 pre-menopausal; 55 post-menopausal) completed a standardized sexual arousal induction paradigm. C-reactive protein (CRP), a marker of inflammation, was assessed from blood samples. Participants also completed validated clinical surveys and diagnostic interviews of sexual desire, arousal, and overall sexual functioning.

Outcomes: Self-reported sexual arousal to a sexual film; survey indices of sexual desire and sexual functioning; and female sexual dysfunction diagnosis.

Results: While there was lower sexual functioning and higher CRP in the post-menopausal group, there was no significant association nor interaction between CRP and menopausal status in predicting sexual function, self-reported arousal, nor diagnosis. Exploratory analyses revealed a significant negative association between CRP and sexual desire among women with higher lifetime exposure to sexual violence, but positive association at lower levels of lifetime sexual violence exposure.

Clinical implications: Caution is warranted for interpreting CRP as a clinical marker of sexual dysfunction in either pre- or post-menopausal women.

Strengths and limitations: Strengths include well-validated clinical assessments of sexual function, direct measures of inflammation, and inclusion of women across the lifespan. Limitations include a cross-sectional design, limited racial/ethnic diversity, and reliance on one inflammation biomarker.

Conclusion: CRP was not associated with subjective sexual arousal or sexual functioning in a sample of healthy women; further work may identify if more sensitive inflammation biomarkers are needed, or if inflammation has greater effects on sexual function in specific conditions such metabolic syndrome. Of note, CRP did predict lower sexual desire in women with sexual violence histories, suggesting that survivors of sexual violence may be particularly sensitive to inflammation-mediation suppression of sexual motivation and/or reward.

Background: Limited research exists on postoperative orgasmic function following feminizing genital gender affirmation surgery (vulvoplasty/vaginoplasty).

Aim: To describe the incidence of orgasm following vulvoplasty/vaginoplasty surgery and compare factors between patients who report the ability to orgasm and patients who do not.

Methods: A retrospective cohort study was conducted of transgender women undergoing gender-affirming vulvoplasty with and without vaginoplasty between January 2016 and June 2023. Patients were included if they had in-office follow-up for at least 12 months following surgery and documentation of an ability to orgasm.

Outcomes: Of 223 patients, 41 underwent vulvoplasty alone and 182 underwent vulvoplasty with vaginoplasty. The mean (SD) age and body mass index of the cohort were 38 (16) years and 26 (4.8) kg/m2. At 6 months after surgery, 90.1% (n = 201; 95% CI, 78.3%-94.6%) reported an ability to orgasm. Patients who reported an inability to orgasm were older (53 vs 36 years, P = .002) and had higher body mass indexes (27.6 vs 25.8 kg/m2, P = .04), a higher incidence of medical comorbidities (45.5% vs 18.5%, P = .003), and a history of prostate cancer (13.6% vs 0%, P = .003). Inability to orgasm was also associated with patients undergoing a vulvoplasty-only procedure (72.7% vs 27.3%, P = .003), but this was not significant when controlling for age and comorbidities. There were no significant differences in intraoperative complications between the groups, but patients who were unable to orgasm had a higher incidence of postoperative bleeding and reoperation.

Results: Among transgender women undergoing genital gender affirmation surgery, 90% reported the ability to orgasm within 6 months of surgery. Age and medical comorbidities were associated with an ability to orgasm.

Clinical implications: These findings suggest that most patients undergoing feminizing gender affirmation surgery can orgasm within 6 months postsurgery. This information is critical for preoperative counseling, enabling patients to make more informed decisions and set realistic expectations regarding surgical outcomes.

Strengths and limitations: Strengths include inclusion of patients with vulvoplasty only and patients with vulvoplasty and vaginoplasty. Limitations include the experience of a single surgeon and the retrospective nature of our study.

Conclusion: Our study's findings are encouraging for individuals considering feminizing genital surgery, as 90% of the transgender women in our cohort reported an ability to orgasm within 6 months of surgery. This study adds to the growing body of literature that can help patients make informed decisions and set realistic expectations for their gender-affirming surgical outcomes.