首页 > 最新文献

Journal of Sexual Medicine最新文献

英文 中文
Pelvic floor and sexual dysfunctions after genital gender-affirming surgery: a systematic review and meta-analysis. 生殖器性别确认手术后的盆底和性功能障碍:系统回顾和荟萃分析。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae146
Mattia Dominoni, Annachiara Licia Scatigno, Marianna Francesca Pasquali, Carola Bergante, Fulvio Gariboldi, Barbara Gardella

Background: Genital gender-affirming surgery has become a crucial step in the transitioning process of numerous transgender people.

Aim: To highlight the consequences of genital gender-affirming surgery on pelvic floor function in transgender people.

Methods: Medical databases (PubMed, EMBASE, and Cochrane Library) were consulted according to a combination of keywords. All papers published up to February 29, 2024 were considered. Two reviewers independently screened the abstracts of the selected studies and extracted data from the full-text articles included. Data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the Observational Study Quality Evaluation (OSQE) method. This study is registered on PROSPERO number CRD42024522580.

Outcomes: Pelvic floor dysfunctions in individuals who undergo gender-affirming surgery, factors that may be involved in the increased prevalence of these dysfunctions and perspectives of treatment of the complications through pelvic floor physical therapy.

Results: Twenty-five papers were considered for systematic review, while 17 studies were included for meta-analysis. There was significant statistical heterogeneity across the included studies. Among transwomen who had undergone vaginoplasty, pelvic organ prolapse occurred in 1%-7.5% of patients, urinary incontinence affected up to 15% of patients, while urinary irritative symptoms up to 20%. Sexual dysfunctions were reported by 25%-75% of patients. Among transmen who underwent hysterectomy and phalloplasty, pelvic organ prolapse occurred in 3.8% of patients, urinary incontinence affected up to 50% of patients, while urinary irritative symptoms up to 37%. Finally, sexual dysfunctions were reported by 54% of patients.

Clinical implications: The findings of this study could be helpful for transgender patients pre-operative counselling.

Strengths and limitations: This is the first systematic review and meta-analysis about pelvic floor dysfunctions in transgender people undergoing genital gender-affirming surgery. The main limitations are the limited number of studies included and their heterogeneity.

Conclusion: Pelvic floor dysfunctions following genital gender-affirming surgery are an emerging issue. Adequate information for each surgical procedure, explicit postoperative instructions, continuity of care, communication with healthcare providers, and recommendation for tailored perioperative pelvic floor physiotherapy are necessary for a better surgical result.

背景:目的:强调生殖器性别确认手术对变性人盆底功能的影响:方法:根据关键词组合查询医学数据库(PubMed、EMBASE 和 Cochrane Library)。考虑了截至 2024 年 2 月 29 日发表的所有论文。两名审稿人分别独立筛选了所选研究的摘要,并从收录的全文中提取了数据。随后将数据制成表格并进行比较,以确保数据的一致性。根据观察性研究质量评估(OSQE)方法对每项纳入研究的相关偏倚进行了评估。本研究已在 PROSPERO 注册,注册号为 CRD42024522580:结果:接受性别确认手术者的盆底功能障碍、可能导致这些功能障碍发生率增加的因素以及通过盆底物理疗法治疗并发症的观点:有 25 篇论文被纳入系统综述,17 项研究被纳入荟萃分析。所纳入的研究之间存在明显的统计学异质性。在接受阴道成形术的变性女性中,1%-7.5%的患者会出现盆腔器官脱垂,15%的患者会出现尿失禁,20%的患者会出现尿路刺激症状。25%-75%的患者出现性功能障碍。在接受子宫切除术和阴茎成形术的变性人中,3.8%的患者出现盆腔器官脱垂,50%的患者出现尿失禁,37%的患者出现排尿刺激症状。最后,54%的患者出现性功能障碍:临床意义:这项研究的结果可能有助于变性患者的术前咨询:这是首次对接受生殖器性别确认手术的变性人盆底功能障碍进行系统回顾和荟萃分析。主要局限性在于纳入的研究数量有限,且存在异质性:结论:生殖器性别确认手术后盆底功能障碍是一个新出现的问题。为了获得更好的手术效果,有必要为每项手术程序提供充足的信息、明确的术后指导、持续的护理、与医疗服务提供者的沟通,以及建议进行量身定制的围手术期盆底物理治疗。
{"title":"Pelvic floor and sexual dysfunctions after genital gender-affirming surgery: a systematic review and meta-analysis.","authors":"Mattia Dominoni, Annachiara Licia Scatigno, Marianna Francesca Pasquali, Carola Bergante, Fulvio Gariboldi, Barbara Gardella","doi":"10.1093/jsxmed/qdae146","DOIUrl":"10.1093/jsxmed/qdae146","url":null,"abstract":"<p><strong>Background: </strong>Genital gender-affirming surgery has become a crucial step in the transitioning process of numerous transgender people.</p><p><strong>Aim: </strong>To highlight the consequences of genital gender-affirming surgery on pelvic floor function in transgender people.</p><p><strong>Methods: </strong>Medical databases (PubMed, EMBASE, and Cochrane Library) were consulted according to a combination of keywords. All papers published up to February 29, 2024 were considered. Two reviewers independently screened the abstracts of the selected studies and extracted data from the full-text articles included. Data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the Observational Study Quality Evaluation (OSQE) method. This study is registered on PROSPERO number CRD42024522580.</p><p><strong>Outcomes: </strong>Pelvic floor dysfunctions in individuals who undergo gender-affirming surgery, factors that may be involved in the increased prevalence of these dysfunctions and perspectives of treatment of the complications through pelvic floor physical therapy.</p><p><strong>Results: </strong>Twenty-five papers were considered for systematic review, while 17 studies were included for meta-analysis. There was significant statistical heterogeneity across the included studies. Among transwomen who had undergone vaginoplasty, pelvic organ prolapse occurred in 1%-7.5% of patients, urinary incontinence affected up to 15% of patients, while urinary irritative symptoms up to 20%. Sexual dysfunctions were reported by 25%-75% of patients. Among transmen who underwent hysterectomy and phalloplasty, pelvic organ prolapse occurred in 3.8% of patients, urinary incontinence affected up to 50% of patients, while urinary irritative symptoms up to 37%. Finally, sexual dysfunctions were reported by 54% of patients.</p><p><strong>Clinical implications: </strong>The findings of this study could be helpful for transgender patients pre-operative counselling.</p><p><strong>Strengths and limitations: </strong>This is the first systematic review and meta-analysis about pelvic floor dysfunctions in transgender people undergoing genital gender-affirming surgery. The main limitations are the limited number of studies included and their heterogeneity.</p><p><strong>Conclusion: </strong>Pelvic floor dysfunctions following genital gender-affirming surgery are an emerging issue. Adequate information for each surgical procedure, explicit postoperative instructions, continuity of care, communication with healthcare providers, and recommendation for tailored perioperative pelvic floor physiotherapy are necessary for a better surgical result.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"184-195"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictors of corporo-venocclusive dysfunction in men with bilateral nerve-sparing radical prostatectomy. 双侧神经保留根治性前列腺切除术男性体静脉功能障碍的预测因素。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae157
Jose M Flores, Luis F Novaes, Emily Vertosick, Carolyn Salter, Nicole Liso, Andrew J Vickers, John P Mulhall, Fecsm

Background: Erectile dysfunction (ED) is seen in some men who have undergone bilateral nerve-sparing surgery. Corporo-venocclusive dysfunction (CVOD) is the major pathway to permanent ED after radical prostatectomy (RP).

Aim: To identify comorbidity factors that are associated with the presence of CVOD in men who had undergone bilateral nerve-sparing RP.

Methods: We included patients who had no ED before RP, underwent bilateral nerve-sparing RP, were unresponsive to pharmacotherapy, and had a penile Duplex Doppler Ultrasound (PDDU) with a diagnosis of CVOD. PDDU was performed with a redosing vasoactive agent protocol. A logistic regression model was created to define predictors of CVOD, defined as end-diastolic velocity (EDV) ≥ 5 cm/s bilaterally.

Outcomes: CVOD diagnosis.

Results: 135 patients with a median age of 60 (IQR 54, 64) years were included. 45% reported ≥2 comorbidities, 10% diabetes, 28% obstructive sleep apnea (OSA), and 44% were current or former smokers. At PDDU, 34% had less than penetration hardness erections, and 43% received 100 units of vasoactive agent. 44% were diagnosed with CVOD. Increased age at RP (OR 2.12 per 10 years, 95% CI 2.35, 3.73, P = .007) and OSA (OR 2.44, 95% CI 1.07, 5.73, P = .036) were associated with a diagnosis of CVOD.

Clinical implications: Comorbidities, especially OSA, have a role in erection recovery after surgery.

Strengths and limitations: The study used a well-established institutional RP nerve-sparing score, a strict PDDU vasoactive agent redosing protocol, validated cut-offs for CVOD diagnosis, and a validated erectile function questionnaire both pre- and post-operatively. The major limitation is that this is a cohort of men seeking treatment at a sexual medicine clinic for post-operative ED, which limits the generalizability of the results to patients without ED symptoms or who decided not to seek treatment. The dichotomous definition of comorbidities is also a limitation since patients can have differing degrees of comorbidities' severity.

Conclusion: Older patients and the presence of OSA were associated with the presence of CVOD.

背景:一些接受过双侧神经保留手术的男性会出现勃起功能障碍(ED)。目的:在接受了双侧神经保留前列腺切除术的男性中,找出与出现勃起功能障碍相关的合并症因素:我们纳入了接受双侧神经保留RP术前无ED、对药物治疗无反应、阴茎双相多普勒超声(PDDU)诊断为CVOD的患者。阴茎多普勒超声检查是在重新使用血管活性药物的方案下进行的。建立了一个逻辑回归模型,以确定CVOD的预测因素,CVOD的定义是双侧舒张末期速度(EDV)≥5 cm/s:结果:CVOD 诊断:共纳入 135 名患者,中位年龄为 60(IQR 54,64)岁。45%的患者合并症≥2种,10%患有糖尿病,28%患有阻塞性睡眠呼吸暂停(OSA),44%目前或曾经吸烟。在 PDDU,34% 的人勃起硬度低于穿透力,43% 的人接受了 100 单位的血管活性剂治疗。44% 被诊断为 CVOD。勃起时年龄的增加(OR 为每 10 年 2.12,95% CI 为 2.35,3.73,P = .007)和 OSA(OR 为 2.44,95% CI 为 1.07,5.73,P = .036)与 CVOD 诊断有关:临床意义:合并症,尤其是 OSA,对术后勃起恢复有影响:该研究采用了完善的RP神经保留评分制度、严格的PDDU血管活性剂再用药方案、有效的CVOD诊断临界值以及有效的术前术后勃起功能问卷。该研究的主要局限性在于,研究对象是因术后ED而到性医学诊所寻求治疗的男性,这就限制了研究结果对无ED症状或决定不寻求治疗的患者的推广性。合并症的二分法定义也是一个限制因素,因为患者合并症的严重程度可能不同:结论:老年患者和 OSA 的存在与 CVOD 的存在有关。
{"title":"Predictors of corporo-venocclusive dysfunction in men with bilateral nerve-sparing radical prostatectomy.","authors":"Jose M Flores, Luis F Novaes, Emily Vertosick, Carolyn Salter, Nicole Liso, Andrew J Vickers, John P Mulhall, Fecsm","doi":"10.1093/jsxmed/qdae157","DOIUrl":"10.1093/jsxmed/qdae157","url":null,"abstract":"<p><strong>Background: </strong>Erectile dysfunction (ED) is seen in some men who have undergone bilateral nerve-sparing surgery. Corporo-venocclusive dysfunction (CVOD) is the major pathway to permanent ED after radical prostatectomy (RP).</p><p><strong>Aim: </strong>To identify comorbidity factors that are associated with the presence of CVOD in men who had undergone bilateral nerve-sparing RP.</p><p><strong>Methods: </strong>We included patients who had no ED before RP, underwent bilateral nerve-sparing RP, were unresponsive to pharmacotherapy, and had a penile Duplex Doppler Ultrasound (PDDU) with a diagnosis of CVOD. PDDU was performed with a redosing vasoactive agent protocol. A logistic regression model was created to define predictors of CVOD, defined as end-diastolic velocity (EDV) ≥ 5 cm/s bilaterally.</p><p><strong>Outcomes: </strong>CVOD diagnosis.</p><p><strong>Results: </strong>135 patients with a median age of 60 (IQR 54, 64) years were included. 45% reported ≥2 comorbidities, 10% diabetes, 28% obstructive sleep apnea (OSA), and 44% were current or former smokers. At PDDU, 34% had less than penetration hardness erections, and 43% received 100 units of vasoactive agent. 44% were diagnosed with CVOD. Increased age at RP (OR 2.12 per 10 years, 95% CI 2.35, 3.73, P = .007) and OSA (OR 2.44, 95% CI 1.07, 5.73, P = .036) were associated with a diagnosis of CVOD.</p><p><strong>Clinical implications: </strong>Comorbidities, especially OSA, have a role in erection recovery after surgery.</p><p><strong>Strengths and limitations: </strong>The study used a well-established institutional RP nerve-sparing score, a strict PDDU vasoactive agent redosing protocol, validated cut-offs for CVOD diagnosis, and a validated erectile function questionnaire both pre- and post-operatively. The major limitation is that this is a cohort of men seeking treatment at a sexual medicine clinic for post-operative ED, which limits the generalizability of the results to patients without ED symptoms or who decided not to seek treatment. The dichotomous definition of comorbidities is also a limitation since patients can have differing degrees of comorbidities' severity.</p><p><strong>Conclusion: </strong>Older patients and the presence of OSA were associated with the presence of CVOD.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"93-97"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Modified calculation of the IIEF6-a more accurate assessment of erectile function in middle-aged men. IIEF6 的修正计算方法--对中年男性勃起功能更准确的评估。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae136
Florian P Kirchhoff, Rebekka D Hübner, Martina Kron, Stefan Schiele, Helga Schulwitz, Cornelia Peter, Valentin H Meissner, Matthias Jahnen, Jürgen E Gschwend, Kathleen Herkommer

Background: The Erectile Function Domain of the International Index of Erectile Function (IIEF6) is inaccurate in assessing erectile function in men who are not practicing sexual intercourse. Improvement through a modification was recently tested on patients after radical prostatectomy. This study examines the application of this modification in a population-based cohort of middle-aged men.

Aim: To assess the feasibility of a modified IIEF6 in a population-based random sample of 50-year old men in Germany.

Methods: 4924 men were included. IIEF6, Erection Hardness Score (EHS), and causes for the absence of sexual intercourse within the previous 4 weeks were assessed. Modified calculation (double weighting of non-intercourse IIEF6 questions) was applied in case of absence due to external circumstances.

Outcomes: Impact of the modification on erectile dysfunction (ED) prevalence and agreement between IIEF6 and EHS in ED classification.

Results: As a result of the modified calculation, ED prevalence in the overall study sample decreased by 6.2% to a rate of 27.2%. Agreement between IIEF6 and EHS was increased from 2.7% to 73.4% in men with no sexual intercourse due to external circumstances.

Clinical implications: An additional inquiry into the reason for the absence of sexual intercourse and modified calculation enhances the accuracy of IIEF6 in evaluating erectile function of the individual man.

Strengths and limitations: This study comprises a large population-based sample. As the study population was exclusively 50-year-old men, results may not be representative of the population average.

Conclusion: A more accurate evaluation of an individual man's erectile function may be achieved by using a modified version of the IIEF6.

背景:国际勃起功能指数(IIEF6)的勃起功能域在评估无性交行为的男性的勃起功能时并不准确。最近对根治性前列腺切除术后的患者进行了测试,结果表明通过修改该指标可以改善勃起功能。目的:在德国 50 岁男性人群中随机抽样,评估修改后的 IIEF6 的可行性。方法:纳入 4924 名男性。方法:纳入 4924 名男性,评估 IIEF6、勃起硬度评分(EHS)以及前 4 周内未发生性行为的原因。如果是由于外部原因导致缺失,则采用修改后的计算方法(对无性交的 IIEF6 问题进行双重加权):结果:修改对勃起功能障碍(ED)患病率的影响,以及 IIEF6 和 EHS 在 ED 分类中的一致性:结果:修改计算方法后,整个研究样本中的 ED 患病率下降了 6.2%,降至 27.2%。在因外部环境而没有性生活的男性中,IIEF6 和 EHS 的一致性从 2.7% 提高到 73.4%:临床意义:对没有性生活的原因进行额外调查并修改计算方法,可提高 IIEF6 评估男性勃起功能的准确性:优点和局限性:本研究包含大量人口样本。优点和局限性:本研究包含了一个基于人口的大型样本,由于研究对象仅为 50 岁的男性,研究结果可能无法代表人口的平均水平:结论:使用改进版 IIEF6 可以更准确地评估男性的勃起功能。
{"title":"Modified calculation of the IIEF6-a more accurate assessment of erectile function in middle-aged men.","authors":"Florian P Kirchhoff, Rebekka D Hübner, Martina Kron, Stefan Schiele, Helga Schulwitz, Cornelia Peter, Valentin H Meissner, Matthias Jahnen, Jürgen E Gschwend, Kathleen Herkommer","doi":"10.1093/jsxmed/qdae136","DOIUrl":"10.1093/jsxmed/qdae136","url":null,"abstract":"<p><strong>Background: </strong>The Erectile Function Domain of the International Index of Erectile Function (IIEF6) is inaccurate in assessing erectile function in men who are not practicing sexual intercourse. Improvement through a modification was recently tested on patients after radical prostatectomy. This study examines the application of this modification in a population-based cohort of middle-aged men.</p><p><strong>Aim: </strong>To assess the feasibility of a modified IIEF6 in a population-based random sample of 50-year old men in Germany.</p><p><strong>Methods: </strong>4924 men were included. IIEF6, Erection Hardness Score (EHS), and causes for the absence of sexual intercourse within the previous 4 weeks were assessed. Modified calculation (double weighting of non-intercourse IIEF6 questions) was applied in case of absence due to external circumstances.</p><p><strong>Outcomes: </strong>Impact of the modification on erectile dysfunction (ED) prevalence and agreement between IIEF6 and EHS in ED classification.</p><p><strong>Results: </strong>As a result of the modified calculation, ED prevalence in the overall study sample decreased by 6.2% to a rate of 27.2%. Agreement between IIEF6 and EHS was increased from 2.7% to 73.4% in men with no sexual intercourse due to external circumstances.</p><p><strong>Clinical implications: </strong>An additional inquiry into the reason for the absence of sexual intercourse and modified calculation enhances the accuracy of IIEF6 in evaluating erectile function of the individual man.</p><p><strong>Strengths and limitations: </strong>This study comprises a large population-based sample. As the study population was exclusively 50-year-old men, results may not be representative of the population average.</p><p><strong>Conclusion: </strong>A more accurate evaluation of an individual man's erectile function may be achieved by using a modified version of the IIEF6.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"36-42"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Timing of puberty suppression in transgender adolescents and sexual functioning after vaginoplasty. 变性青少年青春期抑制的时间和阴道成形术后的性功能。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae152
Isabelle S van der Meulen, Sara L Bungener, Anna I R van der Miesen, Sabine E Hannema, Baudewijntje P C Kreukels, Thomas D Steensma, Mark-Bram Bouman, Annelou L C de Vries

Background: Sexual function in transgender adolescents after puberty suppression has been a topic of recent clinical and scientific questions.

Aim: This study aimed to explore the long-term effects of early treatment with puberty suppression on sexual functioning of transfeminine individuals after vaginoplasty.

Methods: This retrospective cohort study included 37 transfeminine individuals treated with a gonadotropin-releasing hormone agonist (puberty suppression), estrogen, and vaginoplasty (penile inversion technique or intestinal vaginoplasty) at the Center of Expertise on Gender Dysphoria in Amsterdam, the Netherlands, between 2000 and 2016.

Outcomes: Experiences regarding sexual functioning and difficulties were assessed with a self-developed questionnaire ~1.5 years after genital gender-affirming surgery and compared between early (Tanner stage G2-3) and late (Tanner stage G4-5) treatment with puberty suppression.

Results: Following surgery, 91% of transfeminine individuals was able to experience sexual desire, 86% experienced arousal, and 78% could attain an orgasm. Seventy-five percent of transfeminine individuals who had not experienced an orgasm pre-surgery were able to experience one post-surgery. Of all participants, 62% reported having tried penile-vaginal intercourse post-surgery. The majority reported the presence of one or multiple sexual challenges. There were no significant differences in postoperative sexual function or sexual difficulties between groups treated with early versus late puberty suppression.

Clinical implications: With these findings, more adequate and tailored information on the expected effects of early endocrine gender-affirming treatment (including puberty suppression) can be given by healthcare professionals.

Strengths and limitations: This is the first study that has assessed sexual functioning of transgender individuals treated with puberty suppression, and has differentiated between the pubertal stage at treatment initiation. Limitations were the small cohort size and retrospective study design. This study focuses on sexual functioning, however, it is important to realize sexual wellbeing is multifactorial and encompasses more than genital functioning or the ability to have certain sexual experiences.

Conclusion: This study found that post-vaginoplasty transfeminine individuals after both early and late suppression of puberty have the ability to experience sexual desire and arousal, and to achieve orgasms. Outcomes are comparable to previous findings in those who started treatment in adulthood.

背景:目的:本研究旨在探讨早期青春期抑制治疗对阴道成形术后跨性别青少年性功能的长期影响:这项回顾性队列研究纳入了2000年至2016年间在荷兰阿姆斯特丹性别异常专家中心接受促性腺激素释放激素激动剂(青春期抑制)、雌激素和阴道成形术(阴茎倒置术或肠道阴道成形术)治疗的37名变性人:结果:在生殖器性别确认手术后约1.5年,通过自我开发的问卷对性功能和性困难进行了评估,并对早期(Tanner G2-3期)和晚期(Tanner G4-5期)青春期抑制治疗进行了比较:手术后,91%的变性人能够体验到性欲,86%的人体验到性兴奋,78%的人能够达到性高潮。在手术前没有性高潮的变性人中,75%在手术后能够达到性高潮。在所有参与者中,62%的人表示在手术后尝试过阴茎阴道性交。大多数人都表示曾遇到过一次或多次性挑战。在术后性功能或性障碍方面,早期青春期抑制治疗组与晚期青春期抑制治疗组之间没有明显差异:临床意义:有了这些发现,医护人员就可以就早期内分泌性别确认治疗(包括青春期抑制)的预期效果提供更充分、更有针对性的信息:这项研究首次对接受青春期抑制治疗的变性人的性功能进行了评估,并对开始治疗时的青春期阶段进行了区分。研究的局限性在于队列规模较小和回顾性研究设计。这项研究的重点是性功能,但必须认识到性健康是多因素的,不仅仅包括生殖器功能或获得某些性体验的能力:本研究发现,阴道整形术后的女性患者在青春期早期和晚期都有能力体验性欲和性兴奋,并达到性高潮。其结果与之前对成年后开始治疗者的研究结果相当。
{"title":"Timing of puberty suppression in transgender adolescents and sexual functioning after vaginoplasty.","authors":"Isabelle S van der Meulen, Sara L Bungener, Anna I R van der Miesen, Sabine E Hannema, Baudewijntje P C Kreukels, Thomas D Steensma, Mark-Bram Bouman, Annelou L C de Vries","doi":"10.1093/jsxmed/qdae152","DOIUrl":"10.1093/jsxmed/qdae152","url":null,"abstract":"<p><strong>Background: </strong>Sexual function in transgender adolescents after puberty suppression has been a topic of recent clinical and scientific questions.</p><p><strong>Aim: </strong>This study aimed to explore the long-term effects of early treatment with puberty suppression on sexual functioning of transfeminine individuals after vaginoplasty.</p><p><strong>Methods: </strong>This retrospective cohort study included 37 transfeminine individuals treated with a gonadotropin-releasing hormone agonist (puberty suppression), estrogen, and vaginoplasty (penile inversion technique or intestinal vaginoplasty) at the Center of Expertise on Gender Dysphoria in Amsterdam, the Netherlands, between 2000 and 2016.</p><p><strong>Outcomes: </strong>Experiences regarding sexual functioning and difficulties were assessed with a self-developed questionnaire ~1.5 years after genital gender-affirming surgery and compared between early (Tanner stage G2-3) and late (Tanner stage G4-5) treatment with puberty suppression.</p><p><strong>Results: </strong>Following surgery, 91% of transfeminine individuals was able to experience sexual desire, 86% experienced arousal, and 78% could attain an orgasm. Seventy-five percent of transfeminine individuals who had not experienced an orgasm pre-surgery were able to experience one post-surgery. Of all participants, 62% reported having tried penile-vaginal intercourse post-surgery. The majority reported the presence of one or multiple sexual challenges. There were no significant differences in postoperative sexual function or sexual difficulties between groups treated with early versus late puberty suppression.</p><p><strong>Clinical implications: </strong>With these findings, more adequate and tailored information on the expected effects of early endocrine gender-affirming treatment (including puberty suppression) can be given by healthcare professionals.</p><p><strong>Strengths and limitations: </strong>This is the first study that has assessed sexual functioning of transgender individuals treated with puberty suppression, and has differentiated between the pubertal stage at treatment initiation. Limitations were the small cohort size and retrospective study design. This study focuses on sexual functioning, however, it is important to realize sexual wellbeing is multifactorial and encompasses more than genital functioning or the ability to have certain sexual experiences.</p><p><strong>Conclusion: </strong>This study found that post-vaginoplasty transfeminine individuals after both early and late suppression of puberty have the ability to experience sexual desire and arousal, and to achieve orgasms. Outcomes are comparable to previous findings in those who started treatment in adulthood.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"196-204"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Penile suspensory ligament: anatomy, function, and clinical perspectives of its repair. 阴茎悬韧带:解剖、功能及修复的临床前景。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae166
Wen Liu, Ross Calopedos, Gideon Blecher, Christopher Love

Background: The penile suspensory ligament (PSL) plays a significant role in penile support and erection and its injury or congenital absence may result in functional impairment of erectile function.

Aim: To describe the diagnosis and surgical repair technique for PSL abnormalities and overall outcomes.

Methods: A comprehensive review of the literature was performed to understand the anatomic relevance of the PSL and historical management of PSL defects. A contemporary method for PSL repair is described using a transverse infrapubic incision with placement of midline anchoring (non-absorbable braided) sutures between the tunica albuginea (TA) and symphysis pubis to correct penile position and instability.

Outcomes: Surgical success defined as degree of penile curvature and penile stability for sexual intercourse as well as patient and partner satisfaction rates were reviewed.

Results: Though limited in number, available case series in the literature indicate a success rate between 85-100%, and more recent reviews fall in the 85-91% range. Patient satisfaction rates vary from 82-88%, but some series included patients with penile dysmorphic disorder and Peyronie's disease, which are known to have higher dissatisfaction rates related to the underlying etiology itself. In patients with venogenic erectile dysfunction (ED), resolution was 100% but de novo ED occurred in 3-5%; these cases were all successfully managed medically.

Clinical implications: This review addresses the diagnosis of PSL abnormalities and demonstrates a simple but effective repair technique to significantly improve erectile stability in men with acceptable risk.

Strengths and limitations: This is a comprehensive review of the available research on PSL abnormalities that outlines its diverse patient presentation and a systematic method to diagnosis and repair PSL defects. The patient satisfaction rates are reasonably high but given the relatively rarity of this entity, larger longitudinal multi-institutional studies are required to further elucidate risks of de novo ED, penile shortening, and functional outcomes over the long-term.

Conclusion: PSL repair using permanent anchoring sutures or a fascial graft between the pubic symphysis and the TA of the corpora cavernosa is a safe and efficacious way to restore an important part of the penile suspensory apparatus that helps stabilize the penis during erection for normal sexual function.

背景:阴茎悬韧带(PSL)在阴茎支撑和勃起中起着重要作用,其损伤或先天缺失可导致勃起功能障碍。目的:探讨PSL畸形的诊断、手术修复技术及预后。方法:对文献进行全面的回顾,以了解PSL的解剖学相关性和PSL缺陷的历史处理。本文描述了一种当代修复PSL的方法,使用耻骨下横向切口,在白膜(TA)和耻骨联合之间放置中线锚定(不可吸收的编织)缝合线,以纠正阴茎位置和不稳定性。结果:手术成功定义为阴茎弯曲程度和阴茎性交稳定性以及患者和伴侣满意度。结果:虽然数量有限,但文献中可用的病例系列表明成功率在85-100%之间,最近的评论在85-91%的范围内。患者满意度从82-88%不等,但一些系列包括阴茎畸形症和佩罗尼氏病的患者,已知这些患者的不满意率较高,与潜在的病因本身有关。在静脉性勃起功能障碍(ED)患者中,消退率为100%,但重新勃起的发生率为3-5%;这些病例都得到了成功的医学处理。临床意义:本综述讨论了PSL异常的诊断,并展示了一种简单而有效的修复技术,可显著改善男性在可接受风险下的勃起稳定性。优势和局限性:这是一篇关于PSL异常的综合研究综述,概述了其不同的患者表现和诊断和修复PSL缺陷的系统方法。患者满意度相当高,但鉴于这种情况相对罕见,需要更大规模的纵向多机构研究来进一步阐明新发ED、阴茎缩短和长期功能结局的风险。​
{"title":"Penile suspensory ligament: anatomy, function, and clinical perspectives of its repair.","authors":"Wen Liu, Ross Calopedos, Gideon Blecher, Christopher Love","doi":"10.1093/jsxmed/qdae166","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae166","url":null,"abstract":"<p><strong>Background: </strong>The penile suspensory ligament (PSL) plays a significant role in penile support and erection and its injury or congenital absence may result in functional impairment of erectile function.</p><p><strong>Aim: </strong>To describe the diagnosis and surgical repair technique for PSL abnormalities and overall outcomes.</p><p><strong>Methods: </strong>A comprehensive review of the literature was performed to understand the anatomic relevance of the PSL and historical management of PSL defects. A contemporary method for PSL repair is described using a transverse infrapubic incision with placement of midline anchoring (non-absorbable braided) sutures between the tunica albuginea (TA) and symphysis pubis to correct penile position and instability.</p><p><strong>Outcomes: </strong>Surgical success defined as degree of penile curvature and penile stability for sexual intercourse as well as patient and partner satisfaction rates were reviewed.</p><p><strong>Results: </strong>Though limited in number, available case series in the literature indicate a success rate between 85-100%, and more recent reviews fall in the 85-91% range. Patient satisfaction rates vary from 82-88%, but some series included patients with penile dysmorphic disorder and Peyronie's disease, which are known to have higher dissatisfaction rates related to the underlying etiology itself. In patients with venogenic erectile dysfunction (ED), resolution was 100% but de novo ED occurred in 3-5%; these cases were all successfully managed medically.</p><p><strong>Clinical implications: </strong>This review addresses the diagnosis of PSL abnormalities and demonstrates a simple but effective repair technique to significantly improve erectile stability in men with acceptable risk.</p><p><strong>Strengths and limitations: </strong>This is a comprehensive review of the available research on PSL abnormalities that outlines its diverse patient presentation and a systematic method to diagnosis and repair PSL defects. The patient satisfaction rates are reasonably high but given the relatively rarity of this entity, larger longitudinal multi-institutional studies are required to further elucidate risks of de novo ED, penile shortening, and functional outcomes over the long-term.</p><p><strong>Conclusion: </strong>PSL repair using permanent anchoring sutures or a fascial graft between the pubic symphysis and the TA of the corpora cavernosa is a safe and efficacious way to restore an important part of the penile suspensory apparatus that helps stabilize the penis during erection for normal sexual function.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":"22 1","pages":"175-183"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sexspan: a comprehensive framework for sustaining lifelong sexual health and vitality. Sexspan:一个全面的框架,维持终身性健康和活力。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae144
Gal Saffati, Mohit Khera
{"title":"Sexspan: a comprehensive framework for sustaining lifelong sexual health and vitality.","authors":"Gal Saffati, Mohit Khera","doi":"10.1093/jsxmed/qdae144","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae144","url":null,"abstract":"","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":"22 1","pages":"4-6"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Psychological modalities for the treatment of localized provoked vulvodynia: a scoping review of literature from 2010 to 2023. 治疗局部激惹性外阴炎的心理模式:2010 年至 2023 年文献范围综述。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae163
Gabrielle S Logan, Diana L Gustafson, Michelle Swab, Alex Rains, Michelle E Miller, Victoria A Jackman, Krisztina Bajzak

Introduction: Localized provoked vulvodynia is a common sexual health condition for which there is a lack of consensus on effective management, even though it can have a significant negative impact on psychological wellbeing, sexual functioning, and quality of life for women and their partners.

Aim: To map the research landscape related to the effectiveness/efficacy of psychological treatments for localized provoked vulvodynia, identify gaps, and make recommendations for future research.

Methods: We used Arksey and O'Malley's approach to conducting a scoping review to identify, organize, and summarize research published between 2010 and 2023 that investigated the efficacy or effectiveness of interventions in the management of localized provoked vulvodynia. Inclusion and exclusion criteria and the search strategy were developed by subject experts in collaboration with a health sciences librarian. A PubMed search used controlled vocabulary and keyword terms relating to vulvodynia, which were then translated into other databases. Studies not published in English or French were excluded. We did not consider other subsets of vulvodynia.Articles were uploaded to Covidence, duplicates removed, and titles and abstracts screened. The remaining articles were subject to a 2-person, independent full-text review followed by a hand search of eligible articles. All intervention studies were included regardless of the study design. Study details were reported narratively and analyzed.

Main outcome measures: Of the 88 included articles published between January 2010 and March 2023, 15 reported on the efficacy/effectiveness of psychological treatments for localized provoked vulvodynia, including group educational seminars, cognitive behavioral therapy, acceptance and commitment therapy, and somatocognitive therapy.

Results: Cognitive behavioral therapy was the most common form of psychological treatment studied (n = 7) with interventions for both individuals and couples. Education about the condition and the therapeutic process was a component of many interventions. Psychological therapies may be of some benefit, but only 1 RCT evaluating the efficacy of acceptance and commitment therapy appeared adequately powered to demonstrate improvement in dyspareunia. Studies sampled homogenous patient populations, primarily consisting of White, urban-dwelling, educated, partnered, heterosexual cis-women.

Conclusion: Evidence of efficacy/effectiveness, drawn mainly from small studies, is promising and highlights opportunities for more robust studies with heterogeneous populations, more research on the role of education in treatment success, and greater attention to assessing patient-driven outcomes in partnered and unpartnered women.

导言:局部刺激性外阴炎是一种常见的性健康问题,尽管它可能对女性及其伴侣的心理健康、性功能和生活质量造成严重的负面影响,但目前对其有效的治疗方法还缺乏共识。目的:绘制与局部刺激性外阴炎心理治疗的有效性/效力相关的研究图谱,找出差距,并为未来的研究提出建议:我们采用Arksey和O'Malley的方法进行了范围界定综述,以识别、组织和总结2010年至2023年间发表的研究,这些研究调查了局部激惹性外阴炎治疗干预措施的疗效或有效性。纳入和排除标准以及检索策略由学科专家与健康科学图书管理员共同制定。PubMed 搜索使用了与外阴炎相关的控制词汇和关键词,然后将其翻译到其他数据库中。未以英语或法语发表的研究被排除在外。我们没有考虑外阴炎的其他子集。将文章上传到 Covidence,删除重复内容,筛选标题和摘要。对剩余文章进行两人独立全文审阅,然后对符合条件的文章进行人工检索。无论研究设计如何,所有干预研究均被纳入。对研究细节进行了叙述性报告和分析:在2010年1月至2023年3月间发表的88篇纳入文章中,有15篇报道了局部激惹性外阴炎心理治疗的疗效/有效性,包括团体教育研讨会、认知行为疗法、接受与承诺疗法和躯体认知疗法:认知行为疗法是最常见的心理治疗方式(n = 7),既有针对个人的干预,也有针对夫妇的干预。关于病情和治疗过程的教育是许多干预措施的组成部分。心理疗法可能会带来一些益处,但只有一项评估接纳与承诺疗法疗效的研究表明,该疗法对改善性生活障碍有充分的作用。研究取样的患者群体较为单一,主要包括白人、城市居民、受过教育、有伴侣的异性恋顺式女性:疗效/有效性的证据主要来自小型研究,这些证据很有希望,并强调了对异质人群进行更有力的研究、对教育在治疗成功中的作用进行更多研究以及更加关注对有伴侣和无伴侣女性的患者驱动结果进行评估的机会。
{"title":"Psychological modalities for the treatment of localized provoked vulvodynia: a scoping review of literature from 2010 to 2023.","authors":"Gabrielle S Logan, Diana L Gustafson, Michelle Swab, Alex Rains, Michelle E Miller, Victoria A Jackman, Krisztina Bajzak","doi":"10.1093/jsxmed/qdae163","DOIUrl":"10.1093/jsxmed/qdae163","url":null,"abstract":"<p><strong>Introduction: </strong>Localized provoked vulvodynia is a common sexual health condition for which there is a lack of consensus on effective management, even though it can have a significant negative impact on psychological wellbeing, sexual functioning, and quality of life for women and their partners.</p><p><strong>Aim: </strong>To map the research landscape related to the effectiveness/efficacy of psychological treatments for localized provoked vulvodynia, identify gaps, and make recommendations for future research.</p><p><strong>Methods: </strong>We used Arksey and O'Malley's approach to conducting a scoping review to identify, organize, and summarize research published between 2010 and 2023 that investigated the efficacy or effectiveness of interventions in the management of localized provoked vulvodynia. Inclusion and exclusion criteria and the search strategy were developed by subject experts in collaboration with a health sciences librarian. A PubMed search used controlled vocabulary and keyword terms relating to vulvodynia, which were then translated into other databases. Studies not published in English or French were excluded. We did not consider other subsets of vulvodynia.Articles were uploaded to Covidence, duplicates removed, and titles and abstracts screened. The remaining articles were subject to a 2-person, independent full-text review followed by a hand search of eligible articles. All intervention studies were included regardless of the study design. Study details were reported narratively and analyzed.</p><p><strong>Main outcome measures: </strong>Of the 88 included articles published between January 2010 and March 2023, 15 reported on the efficacy/effectiveness of psychological treatments for localized provoked vulvodynia, including group educational seminars, cognitive behavioral therapy, acceptance and commitment therapy, and somatocognitive therapy.</p><p><strong>Results: </strong>Cognitive behavioral therapy was the most common form of psychological treatment studied (n = 7) with interventions for both individuals and couples. Education about the condition and the therapeutic process was a component of many interventions. Psychological therapies may be of some benefit, but only 1 RCT evaluating the efficacy of acceptance and commitment therapy appeared adequately powered to demonstrate improvement in dyspareunia. Studies sampled homogenous patient populations, primarily consisting of White, urban-dwelling, educated, partnered, heterosexual cis-women.</p><p><strong>Conclusion: </strong>Evidence of efficacy/effectiveness, drawn mainly from small studies, is promising and highlights opportunities for more robust studies with heterogeneous populations, more research on the role of education in treatment success, and greater attention to assessing patient-driven outcomes in partnered and unpartnered women.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"132-155"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Penile length after penile implant surgery is determined by stretched penile length before surgery. 阴茎植入手术后的阴茎长度取决于手术前拉伸的阴茎长度。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae153
Koenraad van Renterghem, Helene De Bruyn, Cedric Jorissen, Andries Van Huele, Maurizio D'Anna, Josep Torremadé, Juan I Martinez-Salamanca, Laura Prieto Matienzo, Ignacio Moncada

Background: While various treatment modalities exist, penile prosthesis (PP) implantation offers a permanent solution for patients that do not respond to or are not suitable for other treatment options for erectile dysfunction.

Aim: The aim of this study was to establish stretched penile length before surgery as a reliable determining factor of penile length after penile implant surgery.

Methods: For this study, data on penile length before and after PP surgery from three European centers was analyzed. Penile length measurements were conducted preoperatively and postoperatively in different conditions using standardized techniques. Only virgin cases were included and a complete case analysis was performed.

Outcome: The outcome of this study was the comparison of stretched penile length before and the inflated penile length after PP surgery.

Results: Data on penile length before and after PP of 361 patients was analyzed. Preoperative stretched penile length was equal to postoperative inflated penile length in 33% of patients. The absolute mean difference between pre-surgery stretched and postoperative inflated lengths was 1.1 cm. No correlation was found between implanted cylinder length and postoperative penile length. Additionally, the choice of implant type did not significantly affect postoperative penile length outcomes.

Clinical implications: Our findings confirm the reliability of preoperative stretched penile length as a tool for proper patient counseling before PP surgery.

Strengths & limitations: Although our study is overpowered, our results show that preoperative stretched penile length serves as a reliable predictor of postoperative penile length outcomes after PP surgery. By providing clinicians with a tool for patient counseling, our findings contribute to enhancing satisfaction and quality of life outcomes in patients undergoing PP implantation.

Conclusion: Preoperative stretched penile length serves as a reliable predictor of postoperative penile length outcomes after PP surgery.

背景:目的:本研究旨在确定手术前的阴茎拉伸长度是阴茎植入手术后阴茎长度的可靠决定因素:本研究分析了欧洲三家中心在阴茎假体植入手术前后的阴茎长度数据。阴茎长度测量在术前和术后的不同条件下采用标准化技术进行。只纳入了处女病例,并进行了完整的病例分析:研究结果:本研究的结果是对PP手术前的阴茎拉伸长度和手术后的阴茎膨胀长度进行比较:结果:分析了361例患者PP术前和术后的阴茎长度数据。33%的患者术前阴茎拉伸长度与术后阴茎充气长度相等。术前拉伸长度与术后充气长度的绝对平均值相差 1.1 厘米。植入的圆柱长度与术后阴茎长度之间没有相关性。此外,植入类型的选择对术后阴茎长度的结果也没有明显影响:我们的研究结果证实了术前阴茎拉伸长度作为PP手术前对患者进行适当咨询的工具的可靠性:尽管我们的研究结果过于强大,但我们的研究结果表明,术前拉伸阴茎长度是预测PP手术术后阴茎长度结果的可靠指标。通过为临床医生提供患者咨询工具,我们的研究结果有助于提高PP植入术患者的满意度和生活质量:结论:术前拉伸阴茎长度是预测PP术后阴茎长度结果的可靠指标。
{"title":"Penile length after penile implant surgery is determined by stretched penile length before surgery.","authors":"Koenraad van Renterghem, Helene De Bruyn, Cedric Jorissen, Andries Van Huele, Maurizio D'Anna, Josep Torremadé, Juan I Martinez-Salamanca, Laura Prieto Matienzo, Ignacio Moncada","doi":"10.1093/jsxmed/qdae153","DOIUrl":"10.1093/jsxmed/qdae153","url":null,"abstract":"<p><strong>Background: </strong>While various treatment modalities exist, penile prosthesis (PP) implantation offers a permanent solution for patients that do not respond to or are not suitable for other treatment options for erectile dysfunction.</p><p><strong>Aim: </strong>The aim of this study was to establish stretched penile length before surgery as a reliable determining factor of penile length after penile implant surgery.</p><p><strong>Methods: </strong>For this study, data on penile length before and after PP surgery from three European centers was analyzed. Penile length measurements were conducted preoperatively and postoperatively in different conditions using standardized techniques. Only virgin cases were included and a complete case analysis was performed.</p><p><strong>Outcome: </strong>The outcome of this study was the comparison of stretched penile length before and the inflated penile length after PP surgery.</p><p><strong>Results: </strong>Data on penile length before and after PP of 361 patients was analyzed. Preoperative stretched penile length was equal to postoperative inflated penile length in 33% of patients. The absolute mean difference between pre-surgery stretched and postoperative inflated lengths was 1.1 cm. No correlation was found between implanted cylinder length and postoperative penile length. Additionally, the choice of implant type did not significantly affect postoperative penile length outcomes.</p><p><strong>Clinical implications: </strong>Our findings confirm the reliability of preoperative stretched penile length as a tool for proper patient counseling before PP surgery.</p><p><strong>Strengths & limitations: </strong>Although our study is overpowered, our results show that preoperative stretched penile length serves as a reliable predictor of postoperative penile length outcomes after PP surgery. By providing clinicians with a tool for patient counseling, our findings contribute to enhancing satisfaction and quality of life outcomes in patients undergoing PP implantation.</p><p><strong>Conclusion: </strong>Preoperative stretched penile length serves as a reliable predictor of postoperative penile length outcomes after PP surgery.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"165-169"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Response to Letter to the Editor on "Antibiotic dip and irrigation solutions confer increased antimicrobial efficacy of inflatable penile prosthesis hydrophilic surfaces compared with 0.05% chlorhexidine gluconate". 对 "与 0.05% 葡萄糖酸氯己定相比,抗生素浸泡液和冲洗液可提高充气式阴茎假体亲水性表面的抗菌效果 "致编辑的信的回复。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae165
Rishabh Simhal, Brian H Im, Sohan Shah, Samone Guillame, Carlos Perez Kerkvliet, Rachel Evans, Noreen J Hickok, Paul H Chung
{"title":"Response to Letter to the Editor on \"Antibiotic dip and irrigation solutions confer increased antimicrobial efficacy of inflatable penile prosthesis hydrophilic surfaces compared with 0.05% chlorhexidine gluconate\".","authors":"Rishabh Simhal, Brian H Im, Sohan Shah, Samone Guillame, Carlos Perez Kerkvliet, Rachel Evans, Noreen J Hickok, Paul H Chung","doi":"10.1093/jsxmed/qdae165","DOIUrl":"10.1093/jsxmed/qdae165","url":null,"abstract":"","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"209-211"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adenosine relaxes vagina smooth muscle through the cyclic guanosine monophosphate- and cyclic guanosine monophosphate-dependent pathways. 腺苷通过环鸟苷单磷酸和环鸟苷单磷酸依赖途径放松阴道平滑肌。
IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 DOI: 10.1093/jsxmed/qdae150
Ilaria Cellai, Sandra Filippi, Paolo Comeglio, Giulia Guarnieri, Gabriele Acciai, Chiara Cancedda, Sarah Cipriani, Elisa Maseroli, Giulia Rastrelli, Annamaria Morelli, Mario Maggi, Linda Vignozzi
<p><strong>Background: </strong>In males, adenosine (ADO) is known to relax penile smooth muscles, although its role in the vagina is not yet fully elucidated.</p><p><strong>Aim: </strong>This study investigated the effect of ADO on vagina smooth muscle activity, using a validated female Sprague-Dawley rat model.</p><p><strong>Methods: </strong>Contractility studies, using noradrenaline-precontracted vaginal strips, tested the effects of ADORA1/3 antagonists and ADORA2A/2B antagonists and agonists. Increasing doses of ADO were tested after in vivo or in vitro treatment with Nω-nitro-L-arginine-methyl-ester hydrochloride (L-NAME) or with guanylate or adenylate cyclase inhibitors. Immunopositivity for ADORA2A and ADORA2B was assessed, and messenger RNA (mRNA) analysis was performed. Cyclic ADO monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) were quantified both in rat vagina smooth muscle cells (rvSMCs) and in vaginal tissues with increasing doses of ADO.</p><p><strong>Outcomes: </strong>Demonstrating ADO's role in the relaxing/contractile mechanism in distal vagina smooth muscle.</p><p><strong>Results: </strong>All ADO receptors mRNAs were expressed in vaginal tissue, with a prevalent content of ADORA2B. A high expression of genes regulating ADO catabolism (ADK) and de novo synthesis (NT5E) was found. In vaginal strips, ADO induced relaxation with IC50 = 144.7 μM and a flat pseudo-Hill coefficient value = -0.42, indicating an activity on heterogeneous receptors. Blocking ADORA1/3 shifted ADO response to the left and with a steeper slope. ADORA2A/2B agonists showed a higher potency than ADO in inducing relaxation. Immunolocalization confirmed the presence of ADORA2A/2B in vaginal musculature, in the blood vessels endothelium, and in the epithelium. ADO stimulation of vagina tissues induced a significant increase in cAMP and cGMP contents. Experiments on rvSMCs confirmed that ADO time- and dose-dependently stimulated cAMP production in these cells. However, ADORA2A/2B antagonists, although reducing the ADO-induced relaxation, did not completely block it. A similar inhibition was obtained by blocking adenylate cyclase. Overall, these findings suggest that ADO relaxation involves other pathways, eg, nitric oxide (NO)/cGMP. Accordingly, blocking NO formation through L-NAME substantially blunted ADO responsiveness, as it does the block of cGMP formation through 1H-[1,2,4]oxadiazolo-[4,3-a]quinoxalin-1-one. Simultaneous incubation with cGMP and cAMP blockers completely inhibited ADO responsiveness.</p><p><strong>Clinical translation: </strong>The study highlights ADO's role in regulating vaginal smooth muscle activity, suggesting its potential effect on the vagina.</p><p><strong>Strengths and limitations: </strong>This is the first study on ADO in the vagina, although the results are preliminary and limited to the rat model.</p><p><strong>Conclusion: </strong>These results show that ADO acts as a vaginal relaxing modulator through selectiv
背景:在男性中,腺苷(ADO)已知可以放松阴茎平滑肌,尽管其在阴道中的作用尚未完全阐明。目的:本研究采用雌性Sprague-Dawley大鼠模型,探讨ADO对阴道平滑肌活动的影响。方法:收缩性研究,采用去甲肾上腺素阴道预收缩条,检测ADORA1/3拮抗剂和ADORA2A/2B拮抗剂和激动剂的作用。在体内或体外分别用n ω-硝基- l-精氨酸-甲基酯盐酸盐(L-NAME)或鸟苷酸或腺苷酸环化酶抑制剂处理后,增加ADO的剂量。评估ADORA2A和ADORA2B的免疫阳性,并进行信使RNA (mRNA)分析。随着ADO剂量的增加,大鼠阴道平滑肌细胞(rvSMCs)和阴道组织中环ADO单磷酸(cAMP)和环鸟苷单磷酸(cGMP)的含量也随之增加。结果:证明ADO在阴道远端平滑肌松弛/收缩机制中的作用。结果:所有ADO受体mrna均在阴道组织中表达,ADORA2B的含量普遍存在。调控ADO分解代谢(ADK)和新生合成(NT5E)的基因高表达。在阴道条中,ADO诱导松弛的IC50 = 144.7 μM,平坦伪希尔系数= -0.42,表明ADO对异质受体有活性。阻断ADORA1/3使ADO响应向左移动,斜率更陡。ADORA2A/2B激动剂诱导舒张的效价高于ADO。免疫定位证实了ADORA2A/2B在阴道肌肉组织、血管内皮和上皮中存在。ADO刺激阴道组织诱导cAMP和cGMP含量显著增加。对rvSMCs的实验证实,ADO以时间和剂量依赖性刺激了这些细胞中cAMP的产生。然而,ADORA2A/2B拮抗剂虽然减少了ado诱导的松弛,但并没有完全阻断它。阻断腺苷酸环化酶也有类似的抑制作用。总的来说,这些发现表明ADO的松弛涉及其他途径,例如一氧化氮(NO)/cGMP。因此,通过L-NAME阻断NO的形成大大削弱了ADO的反应性,就像通过1H-[1,2,4]恶二唑-[4,3-a]喹诺沙林-1- 1阻断cGMP的形成一样。cGMP和cAMP阻滞剂同时孵育完全抑制ADO反应性。临床翻译:该研究强调了ADO在调节阴道平滑肌活动中的作用,提示其对阴道的潜在影响。优势和局限性:这是第一个关于阴道内ADO的研究,尽管结果是初步的,并且仅限于大鼠模型。结论:ADO通过选择性激活cAMP和cGMP等受体,发挥阴道松弛调节剂的作用。
{"title":"Adenosine relaxes vagina smooth muscle through the cyclic guanosine monophosphate- and cyclic guanosine monophosphate-dependent pathways.","authors":"Ilaria Cellai, Sandra Filippi, Paolo Comeglio, Giulia Guarnieri, Gabriele Acciai, Chiara Cancedda, Sarah Cipriani, Elisa Maseroli, Giulia Rastrelli, Annamaria Morelli, Mario Maggi, Linda Vignozzi","doi":"10.1093/jsxmed/qdae150","DOIUrl":"10.1093/jsxmed/qdae150","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In males, adenosine (ADO) is known to relax penile smooth muscles, although its role in the vagina is not yet fully elucidated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study investigated the effect of ADO on vagina smooth muscle activity, using a validated female Sprague-Dawley rat model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Contractility studies, using noradrenaline-precontracted vaginal strips, tested the effects of ADORA1/3 antagonists and ADORA2A/2B antagonists and agonists. Increasing doses of ADO were tested after in vivo or in vitro treatment with Nω-nitro-L-arginine-methyl-ester hydrochloride (L-NAME) or with guanylate or adenylate cyclase inhibitors. Immunopositivity for ADORA2A and ADORA2B was assessed, and messenger RNA (mRNA) analysis was performed. Cyclic ADO monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) were quantified both in rat vagina smooth muscle cells (rvSMCs) and in vaginal tissues with increasing doses of ADO.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Demonstrating ADO's role in the relaxing/contractile mechanism in distal vagina smooth muscle.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All ADO receptors mRNAs were expressed in vaginal tissue, with a prevalent content of ADORA2B. A high expression of genes regulating ADO catabolism (ADK) and de novo synthesis (NT5E) was found. In vaginal strips, ADO induced relaxation with IC50 = 144.7 μM and a flat pseudo-Hill coefficient value = -0.42, indicating an activity on heterogeneous receptors. Blocking ADORA1/3 shifted ADO response to the left and with a steeper slope. ADORA2A/2B agonists showed a higher potency than ADO in inducing relaxation. Immunolocalization confirmed the presence of ADORA2A/2B in vaginal musculature, in the blood vessels endothelium, and in the epithelium. ADO stimulation of vagina tissues induced a significant increase in cAMP and cGMP contents. Experiments on rvSMCs confirmed that ADO time- and dose-dependently stimulated cAMP production in these cells. However, ADORA2A/2B antagonists, although reducing the ADO-induced relaxation, did not completely block it. A similar inhibition was obtained by blocking adenylate cyclase. Overall, these findings suggest that ADO relaxation involves other pathways, eg, nitric oxide (NO)/cGMP. Accordingly, blocking NO formation through L-NAME substantially blunted ADO responsiveness, as it does the block of cGMP formation through 1H-[1,2,4]oxadiazolo-[4,3-a]quinoxalin-1-one. Simultaneous incubation with cGMP and cAMP blockers completely inhibited ADO responsiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical translation: &lt;/strong&gt;The study highlights ADO's role in regulating vaginal smooth muscle activity, suggesting its potential effect on the vagina.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;This is the first study on ADO in the vagina, although the results are preliminary and limited to the rat model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;These results show that ADO acts as a vaginal relaxing modulator through selectiv","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"14-25"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Sexual Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1