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DERMATOLOGY AND VENEREOLOGY (164 journals)                     

Showing 1 - 164 of 164 Journals sorted alphabetically
Acta Dermato-Venereologica     Open Access   (Followers: 12)
Acta Dermatovenerologica Croatica     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Skin & Wound Care     Hybrid Journal   (Followers: 30)
African Journal of AIDS Research     Hybrid Journal   (Followers: 8)
AIDS     Hybrid Journal   (Followers: 24)
AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV     Hybrid Journal   (Followers: 10)
AIDS Patient Care and STDs     Hybrid Journal   (Followers: 3)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 9)
AIDS Research and Therapy     Open Access   (Followers: 15)
AIDS Research and Treatment     Open Access   (Followers: 2)
Aktuelle Dermatologie     Hybrid Journal   (Followers: 7)
Allergo Journal     Full-text available via subscription   (Followers: 2)
American Journal of Clinical Dermatology     Full-text available via subscription   (Followers: 26)
American Journal of Dermatopathology     Hybrid Journal   (Followers: 18)
Anais Brasileiros de Dermatologia     Open Access   (Followers: 2)
Anaplastology     Open Access  
Annales de Dermatologie et de Vénéréologie     Full-text available via subscription  
Archives de Pédiatrie     Full-text available via subscription  
Archives de sciences sociales des religions     Open Access   (Followers: 1)
Archives des Maladies du Coeur et des Vaisseaux - Pratique     Hybrid Journal  
Archives of Dermatological Research     Hybrid Journal   (Followers: 7)
Archives of Gerontology and Geriatrics     Hybrid Journal   (Followers: 13)
Archives of Industrial Hygiene and Toxicology     Open Access   (Followers: 8)
Archives of Medical Research     Hybrid Journal   (Followers: 3)
Archives of Physical Medicine and Rehabilitation     Hybrid Journal   (Followers: 58)
Archivio di Ortopedia e Reumatologia     Hybrid Journal  
Asian Journal of Dermatology     Open Access   (Followers: 2)
ästhetische dermatologie & kosmetologie     Full-text available via subscription  
Australasian Journal of Dermatology     Hybrid Journal   (Followers: 8)
Berkala Ilmu Kesehatan Kulit dan Kelamin / Periodical of Dermatology and Venereology     Open Access  
Biomedical Dermatology     Open Access  
BMC Dermatology     Open Access   (Followers: 13)
BMJ Sexual & Reproductive Health     Hybrid Journal   (Followers: 2)
British Journal of Dermatology     Hybrid Journal   (Followers: 54)
Case Reports in Dermatological Medicine     Open Access   (Followers: 2)
Case Reports in Dermatology     Open Access   (Followers: 9)
Clinical and Experimental Dermatology     Hybrid Journal   (Followers: 13)
Clinical Dermatology Review     Open Access   (Followers: 5)
Clinical Skin Cancer     Full-text available via subscription  
Clinical, Cosmetic and Investigational Dermatology     Open Access   (Followers: 10)
Clinics in Dermatology     Hybrid Journal   (Followers: 14)
Contact Dermatitis     Hybrid Journal   (Followers: 8)
Cosmetics     Open Access   (Followers: 5)
Current Dermatology Reports     Hybrid Journal   (Followers: 7)
Current Fungal Infection Reports     Hybrid Journal   (Followers: 5)
Current HIV Research     Hybrid Journal   (Followers: 7)
Current HIV/AIDS Reports     Hybrid Journal   (Followers: 6)
Current Sexual Health Reports     Hybrid Journal   (Followers: 3)
Cutaneous and Ocular Toxicology     Hybrid Journal   (Followers: 10)
Der Hautarzt     Hybrid Journal   (Followers: 2)
Dermatitis     Hybrid Journal   (Followers: 1)
Dermato-Endocrinology     Open Access   (Followers: 2)
Dermatología Venezolana     Open Access  
Dermatologic Clinics     Full-text available via subscription   (Followers: 4)
Dermatologic Reviews     Hybrid Journal  
Dermatologic Surgery     Hybrid Journal   (Followers: 9)
Dermatologic Therapy     Hybrid Journal   (Followers: 2)
Dermatologica Sinica     Open Access  
Dermatological Nursing     Full-text available via subscription   (Followers: 2)
Dermatology     Full-text available via subscription   (Followers: 20)
Dermatology and Cosmetic     Open Access   (Followers: 8)
Dermatology and Therapy     Open Access   (Followers: 4)
Dermatology Online Journal     Open Access   (Followers: 1)
Dermatology Reports     Open Access   (Followers: 3)
Dermatology Research and Practice     Open Access   (Followers: 4)
Dermatology Times     Free  
Dermatopathology     Open Access   (Followers: 3)
Egyptian Journal of Dermatology and Venerology     Open Access   (Followers: 1)
EMC - Cosmetologia Medica e Medicina degli Inestetismi Cutanei     Full-text available via subscription  
EMC - Dermatología     Full-text available via subscription   (Followers: 1)
European Journal of Dermatology     Hybrid Journal   (Followers: 15)
Experimental Dermatology     Hybrid Journal   (Followers: 10)
Expert Review of Dermatology     Hybrid Journal   (Followers: 15)
Forum Dermatologicum     Hybrid Journal  
Graefe's Archive for Clinical and Experimental Ophthalmology     Hybrid Journal   (Followers: 9)
Güncel Dermatoloji Dergisi     Open Access  
HautinForm     Full-text available via subscription  
hautnah     Hybrid Journal  
hautnah dermatologie     Hybrid Journal  
HIV & AIDS Review     Full-text available via subscription   (Followers: 13)
HIV Clinical Trials     Hybrid Journal   (Followers: 5)
HIV Medicine     Hybrid Journal   (Followers: 3)
Indian Dermatology Online Journal     Open Access   (Followers: 3)
Indian Journal of Dermatology     Open Access   (Followers: 2)
Indian Journal of Dermatology, Venereology and Leprology     Open Access   (Followers: 4)
Indian Journal of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian Journal of Drugs in Dermatology     Open Access   (Followers: 1)
Indian Journal of Paediatric Dermatology     Open Access   (Followers: 2)
Indian Journal of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2)
International Archives of Medicine     Open Access   (Followers: 3)
International Journal of Dermatology     Hybrid Journal   (Followers: 14)
International Journal of Dermatology and Clinical Research     Open Access   (Followers: 2)
International Journal of Research in Dermatology     Open Access   (Followers: 1)
International Journal of STD & AIDS     Hybrid Journal   (Followers: 7)
International Journal of Women's Dermatology     Open Access   (Followers: 1)
International STD Research & Reviews     Open Access   (Followers: 1)
JAAD Case Reports     Open Access   (Followers: 1)
JAIDS : Journal of Acquired Immune Deficiency Syndromes     Hybrid Journal   (Followers: 4)
JAMA Dermatology     Full-text available via subscription   (Followers: 49)
JAMA Facial Plastic Surgery     Full-text available via subscription   (Followers: 13)
JMIR Dermatology     Open Access   (Followers: 1)
Journal of AIDS & Clinical Research     Open Access   (Followers: 3)
Journal of Clinical & Experimental Dermatology Research     Open Access   (Followers: 6)
Journal of Clinical and Investigative Dermatology     Open Access   (Followers: 2)
Journal of Cosmetic Dermatology     Hybrid Journal   (Followers: 11)
Journal of Cosmetics, Dermatological Sciences and Applications     Open Access   (Followers: 7)
Journal of Cutaneous Immunology and Allergy     Open Access  
Journal of Cutaneous Medicine and Surgery     Full-text available via subscription  
Journal of Dermatological Research     Open Access  
Journal of Dermatological Science     Hybrid Journal   (Followers: 2)
Journal of Dermatological Science Supplement     Full-text available via subscription   (Followers: 1)
Journal of Dermatological Treatment     Hybrid Journal   (Followers: 2)
Journal of Dermatology & Dermatologic Surgery     Open Access   (Followers: 1)
Journal of General-Procedural Dermatology & Venereology Indonesia     Open Access  
Journal of HIV/AIDS & Social Services     Hybrid Journal   (Followers: 9)
Journal of Investigative Dermatology     Hybrid Journal   (Followers: 28)
Journal of Investigative Dermatology Symposium Proceedings     Full-text available via subscription  
Journal of Sexual Medicine     Hybrid Journal   (Followers: 6)
Journal of Sexually Transmitted Diseases     Open Access   (Followers: 3)
Journal of Skin and Stem Cell     Open Access   (Followers: 3)
Journal of Skin Cancer     Open Access   (Followers: 3)
Journal of Surgical Dermatology     Open Access   (Followers: 1)
Journal of the American Academy of Dermatology     Full-text available via subscription   (Followers: 37)
Journal of the Dermatology Nurses' Association     Hybrid Journal   (Followers: 3)
Journal of the Egyptian Women’s Dermatologic Society     Partially Free  
Journal of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 15)
Journal of the International AIDS Society     Open Access   (Followers: 10)
Journal of the Saudi Society of Dermatology & Dermatologic Surgery     Open Access   (Followers: 1)
Karger Kompass Dermatologie     Full-text available via subscription  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Langenbeck's Archives of Surgery     Hybrid Journal   (Followers: 4)
Medical and Surgical Dermatology     Hybrid Journal   (Followers: 1)
Medical Mycology     Open Access   (Followers: 4)
Nepal Journal of Dermatology, Venereology & Leprology     Open Access   (Followers: 1)
Neurobehavioral HIV Medicine     Open Access   (Followers: 2)
OA Dermatology     Open Access   (Followers: 1)
Open AIDS Journal     Open Access  
Open Dermatology Journal     Open Access  
Perspectives On Sexual and Reproductive Health     Hybrid Journal   (Followers: 7)
Pigment International     Open Access   (Followers: 1)
Psoriasis : Targets and Therapy     Open Access   (Followers: 4)
Revista Internacional de Ciencias Podológicas     Open Access  
SAHARA : Journal of Social Aspects of HIV / AIDS Research Alliance     Open Access   (Followers: 5)
Scars, Burns & Healing     Open Access  
Serbian Journal of Dermatology and Venereology     Open Access   (Followers: 1)
Sex Education: Sexuality, Society and Learning     Hybrid Journal   (Followers: 5)
Sexual & Reproductive Healthcare     Hybrid Journal   (Followers: 2)
Sexual Health     Hybrid Journal   (Followers: 4)
Sexually Transmitted Diseases     Hybrid Journal   (Followers: 7)
Sexually Transmitted Infections     Hybrid Journal   (Followers: 6)
Skin Appendage Disorders     Full-text available via subscription   (Followers: 1)
Skin Pharmacology and Physiology     Full-text available via subscription   (Followers: 7)
Skin Research and Technology     Hybrid Journal   (Followers: 6)
Southern African Journal of HIV Medicine     Open Access   (Followers: 3)
Sri Lanka Journal of Sexual Health and HIV Medicine     Open Access  
Studies in Gender and Sexuality     Hybrid Journal   (Followers: 21)
Surgical & Cosmetic Dermatology     Open Access   (Followers: 3)
The Journal of Dermatology     Hybrid Journal   (Followers: 4)
The Rose Sheet     Full-text available via subscription   (Followers: 2)
Vestnik dermatologii i venerologii     Open Access  
Veterinary Dermatology     Hybrid Journal   (Followers: 8)

           

Similar Journals
Journal Cover
Journal of Sexual Medicine
Journal Prestige (SJR): 1.435
Citation Impact (citeScore): 3
Number of Followers: 6  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1743-6095 - ISSN (Online) 1743-6109
Published by Elsevier Homepage  [3207 journals]
  • Obituary for Marcel Waldinger
    • Abstract: Publication date: Available online 11 July 2019Source: The Journal of Sexual MedicineAuthor(s): Chris G. McMahon
       
  • Functional Magnetic Resonance Imaging Detects Between-Group Differences in
           Neural Activation Among Men with Delayed Orgasm Compared with Normal
           Controls: Preliminary Report
    • Abstract: Publication date: Available online 11 July 2019Source: The Journal of Sexual MedicineAuthor(s): Ryan Flannigan, Linda Heier, Henning Voss, J. Levi Chazen, Darius A. PaduchAbstractBackgroundMechanisms underlying delayed orgasm (DO) are poorly understood; however, known effects of psychotropic medications on sexual function provides a rationale for aberrant central nervous system signaling as a cause.AimTo compare brain activation between men with normal orgasm and those with lifelong DO during sexual stimulation using brain fMRI algorithms.MethodsThree subjects with self-reported life-long DO and 6 normal controls were included in this study. The International Index of Erectile Function, Male Sexual Health Questionnaire, and self-reported time to orgasm were used to assess sexual function. Subjects underwent a 3-T fMRI study while viewing 3 video clips: a neutral control (NC), a positive emotional control (EC), and a sexual condition (SC). Each video sequence was repeated 5 times, with 50-second clips presented in a randomized fashion. fMRI data were analyzed in a block design manner to determine areas of differential brain activation between groups. The Allen Brain Atlas of gene expression in the human brain was used to identify signaling pathways in the areas of differential fMRI activation between the DO and control groups.OutcomesThe primary outcome was differential activation of fMRI neural activation between groups.ResultsAnalysis of differential activation in the SC compared with the NC and EC revealed increased activation in the right frontal operculum (P = .003), right prefrontal gyrus (P = .003), and inferior occipital gyrus (P = .003). Increased activation in the right fusiform gyrus of the occipital lobe and the right hippocampus (P = .0004) was seen in the DO group compared with controls. Using the Allen Atlas of Human Brain Expression, we identified corresponding neurotransmitter receptors to this region, including adenosine receptors, muscarinic and nicotinic cholinergic receptors, cannabinoid receptors, and dopamine receptors, among others.Clinical ImplicationsLifelong DO in men may be due to abnormal neurotransmitter signaling leading to poor progression of arousal due to aberrant processing of sexual cues. Identification of neurotransmitter pathways by fMRI will aid the development of pharmacotherapeutic agents.Strengths & LimitationsStrengths of this study include the novel application of functional neuroimaging to investigate the pathogenesis of DO. Limitations include the small sample size, making this study exploratory in nature.ConclusionThis study revealed differences in brain activation on visualization of sexual stimuli in men with a history of DO compared with controls. Identified regions are rich in numerous neurotransmitter receptor subtypes and may be amenable to pharmacologic targeting to identify novel therapies for these men.Flannigan R, Heier L, Voss H, et al. Functional Magnetic Resonance Imaging Detects Between-Group Differences in Neural Activation Among Men with Delayed Orgasm Compared with Normal Controls: Preliminary Report. J Sex Med 2019:XX;XXX–XXX.
       
  • Testosterone Levels Are Not Associated With Magnitude of Deformity in Men
           With Peyronie’s Disease
    • Abstract: Publication date: Available online 11 July 2019Source: The Journal of Sexual MedicineAuthor(s): John P. Mulhall, Kazuhito Matsushita, Christian J. NelsonAbstractIntroductionThere are some data suggesting that there is a relationship between the magnitude of Peyronie’s disease (PD)–associated penile curvature and low serum testosterone.AimTo evaluate the relationship between PD associated penile deformity and total testosterone (TT) and free testosterone (FT) levels.MethodsWe identified patients diagnosed with PD who had early morning TT measurements. Because laboratories have different reference values, we analyzed testosterone values 2 ways, as raw values and as standardized values (TT and FT values converted into z-scores for each laboratory). Deformity assessment was conducted during an intracavernosal injection–induced rigid erection. The association between T levels and magnitude of penile curvature was analyzed in a number of ways. First, an independent measure t-test tested differences in curvature degree by TT groups (low T:
       
  • Acceptance and Commitment Therapy to Increase Adherence to Penile
           Injection Therapy-Based Rehabilitation After Radical Prostatectomy: Pilot
           Randomized Controlled Trial
    • Abstract: Publication date: Available online 2 July 2019Source: The Journal of Sexual MedicineAuthor(s): Christian J. Nelson, Rebecca M. Saracino, Stephanie Napolitano, Hayley Pessin, Joseph B. Narus, John P. MulhallAbstractIntroductionDespite the importance of using penile injections as part of a penile rehabilitation program, men have difficulty complying with these programs.AimTo test a novel psychological intervention based on Acceptance and Commitment Therapy for erectile dysfunction (ACT-ED) to help men utilize penile injections.MethodsThis pilot randomized controlled trial (RCT) recruited men who were beginning a standard care (SC) structured penile rehabilitation program following radical prostatectomy. The SC program instructed patients to use penile injections 2 to 3 times per week. Participants were randomized to SC+ACT-ED or SC+enhanced monitoring (EM). Over 4 months, patients in the SC+ACT-ED group received SC plus 4 ACT sessions and 3 ACT phone calls; those in the EM group received SC plus 7 phone calls from an experienced sexual medicine nurse practitioner. Participants were assessed at study entry and at 4 and 8 months. For this pilot study, the goal was to determine initial efficacy (ie, effect sizes, where d = 0.2 is small, d = 0.5 is medium, and d = 0.8 is large).Main Outcome MeasurePrimary outcomes were feasibility and use of penile injections. Secondary outcomes were ED treatment satisfaction (ie, Erectile Dysfunction Inventory of Treatment Satisfaction, or EDITS), sexual Self-Esteem and Relationship (SEAR) quality, sexual bother (SB), and prostate cancer treatment regret.ResultsThe 53 participants were randomized (ACT, n = 26; EM, n = 27). The study acceptance rate was 61%. At 4 months, the ACT-ED group utilized more penile injections per week (1.7) compared to the EM group (0.9) (d = 1.25; P = .001) and was more adherent to penile rehabilitation compared to the EM group (ACT, 44%; EM, 10%; relative risk [RR], 4.4; P = .02). These gains were maintained at 8 months for injections per week (ACT, 1.2; EM, 0.7; d = 1.08; P = .03) and approached significance for adherence (ACT, 18%; EM, 0%; P = .10). At 4 months, ACT-ED, compared to EM, reported moderate effects for greater satisfaction with ED treatment (d = 0.41; P = .22), greater sexual self-esteem (d = 0.54; P = .07) and sexual confidence (d = 0.48; P = .07), lower sexual bother (d = 0.43; P = .17), and lower prostate cancer treatment regret (d = 0.74; P = .02). At 8 months, moderate effects in favor of ACT-ED were maintained for greater sexual self-esteem (d = 0.40; P = .19) and less treatment regret (d = 0.47; P = .16).Clinical ImplicationsACT concepts may help men utilize penile injections and cope with the effects of ED.Strengths and LimitationsStrengths include use of an innovative intervention utilizing ACT concepts and pilot RCT. Limitations include the pilot nature of the study (eg, small samples size, lack of statistical power).ConclusionACT-ED is feasible and significantly increases the use of penile injections. ACT-ED also shows promise (moderate effects) for increasing satisfaction with penile injections and sexual self-esteem while decreasing sexual bother and prostate cancer treatment regret.Nelson CJ, Saracino RM, Napolitano S, et al. Acceptance and Commitment Therapy to Increase Adherence to Penile Injection Therapy-Based Rehabilitation After Radical Prostatectomy: Pilot Randomized Controlled Trial. J Sex Med 2019; XX:XXX–XXX.
       
  • Activity-Based Training Alters Penile Reflex Responses in a Rat Model of
           Spinal Cord Injury
    • Abstract: Publication date: Available online 2 July 2019Source: The Journal of Sexual MedicineAuthor(s): Casey J. Steadman, Robert F. Hoey, Lynnette R. Montgomery, Charles H. HubscherAbstractIntroductionMultisystem functional gains have been reported in males with spinal cord injury (SCI) after undergoing activity-based training (ABT), including increases in scoring of sexual function and reports of improved erectile function.AimThis study aims to examine the effect of daily 60-minute locomotor training and exercise in general on sexual function in a rat SCI contusion model.MethodsMale Wistar rats received a T9 contusion SCI. Animals were randomized into 4 groups: a quadrupedal stepping group (SCI + QT), a forelimb-only exercise group (SCI + FT), a non-trained harnessed group (SCI + NT), and a home cage non-trained group (SCI + HC). The 2 non-trained groups were combined (SCI) post hoc. Daily training sessions were 60 minutes in duration for 8 weeks. Urine samples were collected during bi-weekly 24-hour metabolic cage behavioral testing. Latency, numbers of penile dorsiflexion, and glans cupping were recorded during bi-weekly penile dorsiflexion reflex (PDFR) testing. Terminal electromyography (EMG) recordings of the bulbospongiosus muscle (BSM) were recorded in response to stimulation of the dorsal nerve of the penis (DNP).OutcomesABT after SCI had a significant effect on PDFR, as well as BSM EMG latency and burst duration.ResultsSCI causes a significant decrease in the latency to onset of PDFR. After 8 weeks of ABT, SCI + QT animals had a significantly increased latency relative to the post-SCI baseline. BSM EMG response to DNP stimulation had a significantly decreased latency and increase in average and maximum amplitude in SCI + QT animals. SCI animals had a significantly longer burst duration than trained animals. Time between PDFR events, penile dorsiflexion, glans cupping, and urine testosterone were not affected by ABT.Clinical ImplicationsABT has a positive influence on sexual function and provides a potential therapy to enhance the efficacy of current sexual dysfunction therapies in the male SCI population.Strengths and LimitationsSeveral significant small improvements in sexual function were found in a clinically relevant rat model of SCI using a readily available rehabilitative therapy. The limited findings could reflect insensitivity of the PDFR as a measure of erectile function.ConclusionsThese results indicate that task-specific stepping and/or loading provide sensory input to the spinal cord impacting the neural circuitry responsible for sexual function.Steadman CJ, Hoey RF, Montgomery LR, et al. Activity-Based Training Alters Penile Reflex Responses in a Rat Model of Spinal Cord Injury. J Sex Med 2019; XX:XXX–XXX.
       
  • Does Chronic Hyperglycemia Affect Female Rat Sexual Behavior'
           Differences in Paced and Non-Paced Mating
    • Abstract: Publication date: Available online 2 July 2019Source: The Journal of Sexual MedicineAuthor(s): Abigail K. Hernández-Munive, Daniela Rebolledo-Solleiro, Alonso Fernández-GuastiAbstractIntroductionDiabetes mellitus has been associated with sexual dysfunction; however, in women this relationship is controversial. A study using a model of type 2 diabetes mellitus (DM2) failed to find a reduced receptivity in the non-paced mating (NPM), but the appetitive aspects of female sexual behavior have not been evaluated, for example, in the paced mating (PM) paradigm.AimTo evaluate all components of female sexual behavior (in NPM and PM) in a model of DM2 using ovariectomized (OVX) (treated with steroids) or intact female rats (non-OVX) in natural proestrus.MethodsNeonatal females (3–4 days) were administered streptozotocin (STZ, 70 mg/kg, intraperitoneally) or citrate buffer. At week 8, a glucose tolerance test was performed. At week 10, half of the females were OVX, and in the other half (non-OVX) the estrous cycle was monitored. At the twelfth week, the sexual behavior tests were conducted; OVX females were treated with estradiol benzoate (10 μg, −24 hours) and progesterone (3 mg, −4 hours), whereas the non-OVX were evaluated on vaginal proestrus.Main Outcome MeasuresWe registered in NPM and PM receptivity (lordosis quotient and intensity), as well as the number of proceptive and aggressive behaviors. Additionally, in PM we calculated the percentage of exits and the return latencies after receiving stimulation and the time the female remained in the male's compartment.ResultsThe STZ-treated females presented glucose intolerance and were hyperglycemic. Neonatal STZ treatment provoked changes in the females' sexual behavior depending on the paradigm and the hormonal condition. In the NPM, STZ-OVX females had decreased lordosis quotient and intensity and increased aggression, whereas, in the STZ-non-OVX females, there was a decrease in proceptivity; such changes were not observed in PM. Regardless of whether the STZ-treated females were OVX, they failed to perform the pacing behavior.Clinical ImplicationThese data support the idea that chronic mild hyperglycemia, like that observed in DM2 (which represents 90% of the clinical cases), provokes marginal changes in most aspects of female sexual behavior.Strengths & LimitationsThe main strength of this work is the evaluation of consummatory and motivational aspects of female sexual behavior in a model of DM2. The main limitation is the duration of the experimental design that does not resemble the course of the disease in humans. No histologic or biochemical analyses were performed.ConclusionThese results suggest that chronic hyperglycemia produces decreases in sexual behavior.Hernández-Munive AK, Rebolledo-Solleiro D, Fernández-Guasti A. Does Chronic Hyperglycemia Affect Female Rat Sexual Behavior' Differences in Paced and Non-Paced Mating. J Sex Med 2019;XX:XXX-XXX.
       
  • Can Botulinum-A Toxin Be Used to Delay Ejaculation: Results of an
           Ejaculation Model in Male Rats
    • Abstract: Publication date: Available online 2 July 2019Source: The Journal of Sexual MedicineAuthor(s): Şakir Ongün, Selin Acar, Pelin Koca, Mehmet Uzut, Ahmet Adil Esen, Nergiz Durmus, Omer DemirAbstractIntroductionAlthough premature ejaculation (PE) is the most common sexual dysfunction in young men, its true pathophysiology has not yet been clearly elucidated.AimTo investigate the quantitative changes that occurred in an ejaculation model induced by para-chloroamphetamine (PCA) after botulinum-A toxin injection into the bulbospongiosus (BS) muscle in rats.MethodsA total of 21 male rats weighing 300 to 350 grams were used in the study. The animals were divided into 3 groups: control, 1 unit of botulinum-A toxin injected, and 5 units of botulinum-A toxin injected. The botulinum-A toxin was percutaneously injected into the BS muscle, and the experiment was carried out 96 hours (5 days) after the injection.Main Outcome MeasureThe seminal vesicle (SV) was cannulated, and the BS muscle was dissected and connected to an amplifier (Biopac; Goleta, CA) to record the pressure and electromyography measurement. The ejaculation parameters were obtained after the PCA injection.ResultsThe ejaculation latency time of the group receiving 5 units of botulinum-A toxin was statistically significantly longer (1092 ± 657 seconds) compared to the control group (298 ± 81 seconds) and the group receiving 1 unit of botulinum-A toxin (439 ± 100 seconds) (P = .003). Furthermore, the BS EMG area under the curve values for the group receiving 5 units of botulinum-A toxin were significantly lower (7.4 ± 1.2 V/s × 10–4) than those of the control group (13.6 ± 4.0 V/s × 10–4) and the group receiving 1 unit of botulinum-A toxin (13.6 ± 5.0 V/s × 10–4) (P = .009). No statistically significant difference was found between the groups in terms of the basal SV pressure, number of SV phasic contractions, maximum amplitude of the SV phasic contraction, and intervals between the SV phasic contractions and the BS muscle contractions.Clinical ImplicationsBotulinum-A toxin injection is a potential treatment option for PE and should be further investigated by future clinical studies.Strengths and LimitationsEase of administration and prolonged duration of botulinum-A toxin are advantages of the existing treatment options. The risk of anejaculation due to the dosage should be kept in mind.ConclusionsInjection of botulinum-A toxin into the BS muscle in rats significantly delayed the ejaculation latency time and affected the expulsion phase.Ongün S, Acar S, Koca P, et al. Can Botulinum-A Toxin Be Used to Delay Ejaculation: Results of an Ejaculation Model in Male Rats. J Sex Med 2019; XX:XXX–XXX.
       
  • Prevalence and Determinants of Problematic Online Pornography Use in a
           Sample of German Women
    • Abstract: Publication date: Available online 2 July 2019Source: The Journal of Sexual MedicineAuthor(s): Andreas M. Baranowski, Romina Vogl, Rudolf StarkAbstractAimTo investigate problematic online pornography use in women, an issue that has rarely been tackled to date.MethodsWe used the data from a comprehensive, cross-sectional survey of a self-referred sample of 485 German women to examine the relationships between problematic online pornography consumption and a range of sexual behaviors, trait sexual motivation, and motives for pornography use.ResultsApproximately 3% of our sample had problematic pornography use. In multivariate analysis, problematic use was significantly associated with the overall time spent viewing online pornography, greater sexual motivation, and greater emotional avoidance. Our data also indicate that the influence of sexual motivation on problematic pornography use is mediated by the amount of time spent watching online pornography.Clinical TranslationIdentifying these predictors for problematic use is important for specific prevention programs for women at risk of pathological use.Strengths & LimitationsThis study is one of the first to show that women also experience problematic online pornography use and identifies risk factors for problematic behavior. The weakness of this study is that as in all studies on sexuality, people who are interested in the topic and are comfortable talking about it are more likely to participate, thus rendering the sample nonrepresentative.ConclusionBased on our findings, approximately 3% of women experience problems associated with engaging in online pornography consumption.Baranowski AM, Vogl R, Stark R. Prevalence and Determinants of Problematic Online Pornography Use in a Sample of German Women. J Sex Med 2019;XX:XXX–XXX.
       
  • Pain: Patients Supplement Clinician Prescribed Management
    • Abstract: Publication date: Available online 2 July 2019Source: The Journal of Sexual MedicineAuthor(s): G. Bachmann
       
  • Responder Analyses from a Phase 2b Dose-Ranging Study of Bremelanotide
    • Abstract: Publication date: Available online 2 July 2019Source: The Journal of Sexual MedicineAuthor(s): Stanley Althof, Leonard R. Derogatis, Sally Greenberg, Anita H. Clayton, Robert Jordan, Johna Lucas, Carl SpanaAbstractBackgroundResponder analyses are used to determine whether changes that occur during a clinical trial are clinically meaningful; for subjective endpoints such as those based on patient-reported outcomes (PROs), responder analyses are particularly useful.AimTo identify the minimal clinically important difference (MCID) for selected scores on questionnaires assessing female sexual functioning and to use these differences to analyze the response in a large, controlled, phase 2b, dose-finding study of bremelanotide in premenopausal women with hypoactive sexual desire disorder (HSDD) and mixed HSDD/female sexual arousal disorder (FSAD).MethodsThe responder analyses were performed for the change from baseline to end of study for a total of 7 endpoints. Each PRO endpoint was assessed using at least 1 of 4 types of responder analyses: a planned analysis anchored to MCIDs based on expert estimates (historical anchors); post hoc analyses based on self-reported global benefit; receiver operating characteristic (ROC) curves; and cumulative distribution function. The prespecified analysis groups were all female sexual dysfunction (FSD)-based diagnoses (all study participants), those with HSDD alone, and a combined group of those with FSAD alone plus those with mixed HSDD/FSAD. Post hoc analyses were also performed for subjects with mixed HSDD/FSAD with a primary diagnosis of HSDD.OutcomesMCIDs based on the ROC curves for changes in Female Sexual Function Index–desire domain, Female Sexual Distress Scale–Desire/Arousal/Orgasm (FSDS-DAO) total score, FSDS-DAO item 13 and 14 scores, and number of satisfying sexual events.ResultsOutcomes matched those based on input from clinical experts. For all 7 endpoints, responder rates at the 1.75 mg dose in the overall modified intention-to-treat population achieved statistical significance compared with placebo (P ≤ .03).Clinical ImplicationsThese responder definitions were subsequently used in the bremelanotide phase 3 registration studies (RECONNECT) that evaluated the safety and efficacy of the bremelanotide 1.75 mg subcutaneous dose in premenopausal women with HSDD.Strengths & LimitationsMCIDs for this study were based on changes from a single-blind phase to account for changes due to the placebo effect. These analyses were restricted to a study population composed only of premenopausal women with a clinical diagnosis of HSDD and/or FSAD and were based on data from the same clinical trial.ConclusionBremelanotide was safe and well tolerated and demonstrated significant improvement in efficacy vs placebo in the phase 2b trial. The multiple responder analyses offer a valuable approach for determining clinically important effects of bremelanotide for HSDD and FSAD.Althof S, Derogatis LR, Greenberg S, et al. Responder Analyses from a Phase 2b Dose-Ranging Study of Bremelanotide. J Sex Med 2019;XX:XXX–XXX.
       
  • “To Shave or Not to Shave”: Pubic Hair Removal and Its Association
           with Relational and Sexual Satisfaction in Women and Men
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Paul Enzlin, Kaat Bollen, Sofia Prekatsounaki, Liesbeth Hidalgo, Leen Aerts, Jan DeprestAbstractBackgroundPubic hair removal (PHR) is a widespread practice that entails certain health risks; however, there remains a lack of scientific information on the prevalence and antecedents of PHR, as well as on its association with sexual behavior and relational satisfaction.AimsTo explore women’s and men’s attitudes regarding PHR and their PHR practices and the associations with demographic, relational, and sexual characteristics.MethodsA total of 2,687 men and 1,735 women living in Flanders (the Northern part of Belgium) completed an online survey. Participants ranged in age from 15 to 60+ years; they self-identified as heterosexual, bisexual, or homosexual and reported various relationship statuses.Main Outcome MeasuresDemographic items (ie, age, religion, partner relationship status), sexuality-related items (ie, sexual activity, sexual orientation, age at first intercourse, number of sexual partners), PHR items (ie, reasons, inclination to have or not have sex after PHR, perceived partner preferences, partner’s PHR), and relationship satisfaction, assessed with the Maudsley Marital Questionnaire.ResultsFewer men (39.1%) than women (80.3%) reported (partially) removing their pubic hair. In both men and women, the practice was associated with age, sexual activity, relationship status, and partner’s PHR practice and expectations. In men, sexual and relationship satisfaction were correlated with their partner’s PHR practices and whether these were in line with the men’s expectations. In women, sexual and relationship satisfaction were mostly correlated with whether both partner’s expectations were met. Although both men and women reported that the reasons for PHR were related to their sexual experiences and to their partner’s preference, only women reported that PHR was a way to enhance feelings of femininity. Finally, the reasons for not engaging in PHR were related to partner preferences and side effects.ConclusionPHR is a widespread practice and seems strongly associated with personal, partner-related, sexual, and relational factors. Strategies to prevent men and women from being confronted with health risks should take all these factors into account.Enzlin P, Bollen K, Prekatsounaki S, et al. “To Shave or Not to Shave”: Pubic Hair Removal and Its Association with Relational and Sexual Satisfaction in Women and Men. J Sex Med 2019;16:954–962.
       
  • Sexual Dysfunction and Reproductive Concerns in Young Men Diagnosed With
           Testicular Cancer: An Observational Study
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): L. Ljungman, L.E. Eriksson, K.E. Flynn, J.R. Gorman, O. Ståhl, K. Weinfurt, M. Wiklander, C. Lampic, L. WettergrenAbstractIntroductionThe survival rates for testicular cancer are excellent; still, there is a lack of knowledge regarding important survivorship issues, such as sexual dysfunction and reproductive concerns.AimThe aim of this study was to investigate the prevalence and predictors of sexual dysfunction and reproductive concerns and the potential association between these issues in young men ∼2 years after a diagnosis of testicular cancer.MethodsData were collected from 111 men (response rate = 50%) diagnosed with testicular cancer at age 16–39. Patients were identified via the Swedish National Quality Registry for Testicular Cancer and approached with a survey, including standardized measures of sexual function, reproductive concerns, body image, and health-related quality of life. The survey was sent to participants approximately 2 years after their cancer diagnosis. Clinical variables were collected from the registry. Predictors were identified by multivariable linear regression analyses.Main Outcome MeasuresThe main outcomes were sexual function, assessed with the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction measure version 2.0, and reproductive concerns, assessed with the Reproductive Concerns After Cancer scale.ResultsSexual dysfunction was reported by 26% of men, and a high level of reproductive concerns was reported by 28%. Lower satisfaction with sex life was associated with older age (β = −0.41), negative body image (β = −0.42), not having a partner (β = 4.8), and dissatisfaction with sex life before cancer (β = 8.31). Negative body image was associated with reproductive concerns in the dimensions of fertility potential (β = 0.06), partner disclosure (β = 0.08), and child’s health (β = 0.07), whereas having had fertility preservation predicted higher levels of concerns with regard to personal health (β = 0.52) and achieving pregnancy (β = 0.53). Clinical variables did not predict either sexual function or reproductive concerns.Clinical ImplicationsOur results show that the majority of young men diagnosed with testicular cancer do not report sexual dysfunction or reproductive concerns 2 years after diagnosis. A sizeable minority, however, does report dysfunction or reproductive concerns, which should be recognized in the follow-up care of this population.Strengths & LimitationsA strength of the study is the use of high-quality registry data and validated instruments. The lack of Swedish norms for sexual function and reproductive concerns is a possible limitation.ConclusionA subgroup of young men treated for testicular cancer report sexual dysfunction or reproductive concerns approximately 2 years after diagnosis. Factors associated with these issues seem to mainly be psychological, rather than medical, nature.Ljungman L, Eriksson LE, Flynn KE, et al. Sexual Dysfunction and Reproductive Concerns in Young Men Diagnosed With Testicular Cancer: An Observational Study. J Sex Med 2019;16:1049–1059.
       
  • Sexual Dysfunction and Satisfaction in Kidney Transplant Patients
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Renato Lains Mota, Rita Fonseca, José Carlos Santos, Ana Mateus Covita, Nicole Marques, Patricia Matias, Hélder Simões, Catarina Ramos, Domingos Machado, Jorge CardosoAbstractIntroduction10% of the world’s population suffers from chronic kidney disease. Kidney transplants provide an improvement in the quality of life of those patients. Sexual dysfunction is common after kidney transplantation, and its etiology is presumed to be multifactorial. It has a negative impact on sexual satisfaction and health-related quality-of-life. The integration of a new organ into the body can imply an adjustment of body image, which may eventually have a negative influence on intimacy and sexual behaviors.AimTo evaluate male sexual function, sexual satisfaction, and body image satisfaction among a convenience sample of patients who have had a kidney transplant.MethodsThis is a cross-sectional study that included 460 patients, from a single healthcare center, who had undergone a kidney transplant procedure>4 weeks ago. A total of 112 respondents (mean = 55.5 years, SD = 11.4) answered the questionnaires properly.Main Outcome MeasuresAll recruited patients answered a self-reported sociodemographic questionnaire, in addition to the International Index of Erectile function, the New Scale of Sexual Satisfaction, the Brief Symptom Inventory, and the Body Image Scale.ResultsA correlation was found between sexual function and sexual satisfaction (r = 0.598, P < .001, n = 112), as well as between body image satisfaction and sexual function (r = −0.193, P = .042, n = 112). The length of time after a kidney transplant (≤ or>36 months) was not associated with a difference in sexual functioning or sexual satisfaction.Clinical ImplicationsThis study showed the obvious implications of sexual function on sexual satisfaction, which should alert healthcare professionals to the importance of identifying and managing sexual dysfunction in patients with chronic kidney disease, to optimize their global and sexual health satisfaction.Strength & LimitationsThis study identified a high prevalence of sexual dysfunction among kidney transplant recipients. This should reinforce the need for the medical community to evaluate the quality-of-life domains of patients with chronic disease. There is still a lack of information concerning any longitudinal evaluation of kidney transplant patients’ sexual function and the effects that this surgery has on sexuality.ConclusionsThis study corroborated the severe effects that kidney transplant patients often report regarding their sexuality. Among the patients who participated in the study, sexual function proved to be relevant in relation to sexual satisfaction.Mota RL, Fonseca R, Santos JC, et al. Sexual Dysfunction and Satisfaction in Kidney Transplant Patients. J Sex Med 2019;16:1018–1028.
       
  • Should We Tailor the Clinical Management of Erectile Dysfunction According
           to Different Ages'
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Paolo Capogrosso, Eugenio Ventimiglia, Luca Boeri, Edoardo Pozzi, Francesco Chierigo, Nicolò Schifano, Costantino Abbate, Rayan Matloob, Francesco Montorsi, Andrea SaloniaAbstractIntroductionThe impact of erectile dysfunction (ED) on patients’ sexual satisfaction and mood profile could differ across different ages.AimTo investigate the relationship between erectile function (EF), sexual satisfaction, and mood status among patients seeking medical help for ED.MethodsData from 765 patients presenting at a single center for ED were analyzed. Patients were categorized as young (≤50 years), middle-aged (>50 and ≤65 years), and old (>65 years) individuals and completed the International Index of Erectile Function (IIEF) and the Beck’s Inventory for Depression (BDI).Main Outcome MeasuresThe IIEF overall satisfaction and intercourse satisfaction domain scores and the BDI score were used to investigate sexual life satisfaction and depressive symptoms (defined as BDI> 11) across ages and according to ED severity. Linear and logistic regression analyses assessed the relationship between satisfaction scores and the risk of depressive symptoms with age and EF.ResultsMedian (interquartile range) age at first assessment for ED was 50 (38, 59) years. Compared with older men, young and middle-aged patients showed significantly higher IIEF-OS and IIEF– Intercourse Satisfaction scores for increasing IIEF-EF scores. Older men showed no difference in terms of satisfaction scores for mild ED and normal EF status. At linear regression analysis, both IIEF-EF and age were significantly associated with sexual satisfaction (all P < .0001). The interaction term between age and EF was also significant, suggesting that the older the patients, the higher the feeling of sexual satisfaction for the same EF status (P = .004). Overall, 25% of patients reported depressive symptoms. Logistic regression analysis showed a 40% risk of depressive symptoms for patients
       
  • Are There Differences in Brain Morphology in Patients with Lifelong
           Premature Ejaculation'
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Hasan Anil Atalay, Ali Riza Sonkaya, Sait Ozbir, Mehmet Gokhan Culha, Burak Degirmentepe, Recep Bayraktarli, Lutfi CanatAbstractIntroductionEven though lifelong premature ejaculation (PE) is highly prevalent, few studies have investigated the neural mechanisms underlying PE.AimThis study aimed to investigate whether patients with lifelong PE exhibit macrostructural or microstructural alterations of the parts of the brain involved in the male sexual response.Materials and MethodsWe enrolled 42 healthy participants and 54 lifelong PE patients. Lifelong PE was diagnosed according to the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculation latency time (IELT). We compared measures of cortical morphology, such as volumes of gray matter, white matter, cerebellum volumes, and subcortical structures (ie, amygdala, caudate, hippocampus, globus pallidus, putamen, and thalamus) between the groups using a voxel-based morphometry method from whole-brain T1-weighted magnetic resonance imaging. Moreover, we evaluated the relationships between the relevant cerebral alterations and the severity of symptoms obtained from participants via self-reported questionnaires.Main Outcome MeasuresCerebral macrostructural and microstructural alterations were assessed in PE patients and controls, along with the correlation of caudate nucleus changes in PE patients with clinical data (including the PEDT and the IELT).ResultsThe mean volume of the caudate nucleus was significantly larger in the lifelong PE patients compared with healthy controls (P = .048). Moreover, caudate nucleus volume was positively correlated with PEDT score (r = 0.621; P = .0179) and negatively correlated with the IELT (r = −0.592; P = .0101). However, cortex morphology and the other subcortical volumes were not significantly different between the 2 groups (P> .05).Clinical ImplicationsMicrostructural alterations in deep gray matter nuclei might be a useful parameter for studying the mechanism of the neurobiology underlying PE.Strengths and LimitationsThere are few studies examining microstructural changes in PE patients. This study furthers our understanding of the etiology of PE. Limitations include the small sample, which limits our ability to make an absolute determination as to whether such subcortical changes are the cause or the consequence of lifelong PE.ConclusionsWe found a significant difference in caudate nucleus volume between patients with PE and healthy controls. In addition, the caudate nucleus volume was positively associated with the severity of PE symptoms. More extensive and possibly longitudinal studies are needed to improve our understanding of the mechanism of the neurobiology underlying PE.Atalay HA, Sonkaya AR, Ozbir S, et al. Are There Differences in Brain Morphology in Patients with Lifelong Premature Ejaculation' J Sex Med 2019;16:992–998.
       
  • Pregnancy and Sexual Relationships Study Involving wOmen and meN (PASSION
           Study)
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Denicia S. Dwarica, Gretchen G. Collins, Colleen M. Fitzgerald, Cara Joyce, Cynthia Brincat, Mary LynnAbstractIntroductionSexual satisfaction is believed to decrease during pregnancy; however, the effect of pregnancy on the sexual relationship in a couple is not well studied.AimTo assess for sexual dysfunction in heterosexual couples during pregnancy.MethodsWe performed a cross-sectional study of heterosexual pregnant women in the third trimester and their cohabitating partners.Main Outcome MeasuresSexual satisfaction in heterosexual couples during pregnancy was assessed with a self-reported questionnaire, the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) questionnaire.ResultsA total of 53 couples met eligibility criteria, and nearly all of those approached participated (52 of 53 couples). All couples were enrolled at or after 35 weeks’ gestation. The mean age was 29.0 ± 6.4 and 31.3 ± 6.9 years for women and men, respectively. 60% of couples were married, and the remainder were cohabitating and in a committed relationship. When analyzing the results of the GRISS questionnaire for both partners, a significant difference was seen in mean avoidance of sex between women and men (3.31 vs 2.63; P = .047) and non-sensuality (3.54 vs 2.75; P = .040). Women reported more of a decrease in communication about sex when compared with their partners (3.79 vs 3.23; P = .047). Vaginismus was more problematic during pregnancy than before (mean = 4.17), and frequency of intercourse was decreased (mean = 4.93) based on calculated GRISS scores.Clinical ImplicationsPregnant couples reported decreased frequency of intercourse and more pain with intercourse in women. Women were more likely to avoid intercourse and reported more problems with communication regarding sexual needs.Strength & LimitationsThis study is the first to assess both partners in pregnancy. Due to the nature of the study, we were unable to assess other factors affecting the relationship that may result in sexual dysfunction, there was no control group, and the results are limited to heterosexual couples.ConclusionOverall sexual satisfaction and function were not problematic for these couples during pregnancy based on the GRISS scale.Dwarica DS, Garbe Collins G, Fitzgerald C, et al. Pregnancy and Sexual Relationships Study Involving WOmen and MeN (PASSION Study). J Sex Med 2019;16:975–980.
       
  • Masturbatory Behavior in a Population Sample of German Women
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Andrea Burri, Ana CarvalheiraAbstractBackgroundHuman masturbation is and has been a very heatedly and controversially discussed topic in human sexuality. Studies investigating aspects of human masturbatory behavior and female sexual pleasure remain scarce. This lack of knowledge opens the door to further controversies and misconceptions.AimTo conduct an explorative study on female masturbatory behavior to gain more insight into this nonreproductive sexual behavior and provide an empiric basis for future research.MethodsA total of 425 German women (mean age 26.6 years), 61.4% of whom were in a committed relationship, completed a comprehensive 76-item online survey consisting of study-specific, self-constructed questions and validated and standardized questionnaires.Main Outcome MeasureCorrelation and comparative analyses were performed. Results are presented numerically as means and percentages.ResultsThe majority (94.5%) of women indicated having masturbated at least once in their life, with a mean age at first masturbation of 14 years. 85.9% of women described masturbation as “genital self-stimulation until reaching orgasm.” The majority of women reported masturbating 2 or 3 times a week (26.8%) or once a week (26.3%). Factors independently associated with masturbation frequency were relationship status, orgasm frequency, openness to new experience, and body acceptance. Almost all women (91.5%) reported masturbating also when in a relationship. For the 5.5% of women who had never engaged in autoerotic stimulation, the 2 main reasons were “I hardly every feel sexual desire” and “sex is a partner-only thing.” 7.6% reported never experiencing an orgasm during masturbation, whereas 50.3% indicated that they always reached orgasm during autostimulation. The reasons cited for engaging in masturbation were manifold, ranging from sexual desire to relaxation and stress reduction. The most common fantasy included the partner; however, 20.7% fantasized about being “defenseless,” and 8.7% thought about a “disturbing” scenario that they chose not to elaborate further.Clinical ImplicationsFor many women, masturbation does not represent “a partner substitute” to seek sexual pleasure, but rather is a stress coping and relaxation strategy.Strengths & LimitationsThis is one of the very first studies to provide more in-depth insight into a variety of aspects related to female masturbation. The representativeness of the data is limited to this particular sample of German women.ConclusionOur findings highlight the huge diversity in terms of masturbation frequency, motivations, styles, and preferences that can be observed in this particular population sample of German women.Burri A, Carvalheira A. Masturbatory Behavior in a Population Sample of German Women. J Sex Med 2019;16:963–974.
       
  • Society Page
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s):
       
  • Clinically Meaningful Change in Sexual Desire in the Psychosexual Daily
           Questionnaire in Older Men from the TTrials
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Alisa J. Stephens-Shields, Christina Wang, Peter Preston, Peter J. Snyder, Ronald S. SwerdloffAbstractBackgroundA recent study of older men participating in the Testosterone Trials (TTrials) defined a clinically meaningful change in the Psychosexual Daily Questionnaire (PDQ) question 4 in hypogonadal men age ≥65 years. This study defines clinically meaningful change in the same population for sexual desire assessed by PDQ question 1.AimTo determine a clinically meaningful change in the answers to question 1 of the PDQ in hypogonadal older men.MethodsParticipants in the Sexual Function Trial of the TTrials were randomly divided into a training and test set. Anchor-based methods, including regression analysis, receiver operating characteristic curves, and empirical cumulative distribution functions, were used to determine a clinically meaningful change on question 1 in the training set, and the selected threshold was evaluated in the test set for an effect of testosterone treatment.ResultsA clinically meaningful increase in question 1 of the PDQ was determined to be ≥0.7 points.Clinical ImplicationsQuestion 1 of the PDQ can be used to assess sexual desire in response to testosterone treatment.Strengths & LimitationsData were obtained from a single large study of older hypogonadal men.ConclusionClinically meaningful improvement of sexual desire is a change of ≥0.7 in the score of question 1 of the PDQ.Stephens-Shields AJ, Wang C, Preston P, et al. Clinically Meaningful Change in Sexual Desire in the Psychosexual Daily Questionnaire in Older Men from the TTrials. J Sex Med 2019;16:951–953.
       
  • Erratum
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s):
       
  • Anatomic Basis and Clinical Effect of Selective Dorsal Neurectomy for
           Patients with Lifelong Premature Ejaculation: A Randomized Controlled
           Trial
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Nejdet Karsiyakali, Selcuk Sarikaya, Omer Faruk Karatas
       
  • Contemporary Landscape and Strategies to Engage Women Urologists in
           Treatment of Male Sexual Function
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Kadee E. Thompson, Melissa R. Kaufman
       
  • Editorial Commentary on "Erectile Dysfunction: An Umbrella Review of
           Meta-Analyses of Risk Factors, Treatment, and Prevalence Outcomes"
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Selahittin Çayan
       
  • Free Bipedicled Radial Forearm and Posterior Interosseous Artery
           Perforator Flap Phalloplasty
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Edward De Wolf, Karel Claes, Casper E. Sommeling, Dries Opsomer, Mario Cherubino, Salvatore Vieni, Stan Monstrey, Salvatore D’ArpaAbstractIntroductionThe free radial forearm (FRFA) flap is universally still considered as the gold standard technique in penile reconstruction. Typically, a considerably large flap is required, often involving almost the entire circumference of the forearm. Partial necrosis may occur at the distal-most (dorsoradial) part of the flap as a result of insufficient perfusion.AimTo describe a new technique using the posterior interosseous artery (PIOA) to supercharge FRFA phalloplasty.MethodsIn a 12-month period, all patients having FRFA flap phalloplasty were enrolled. Perioperative, after complete flap dissection, an indocyanine green perfusion scan was performed. In case of insufficient perfusion at the distalmost part of the flap, a supramicrosurgical anastomosis was performed between the FRFA pedicle and the PIOA (artery only).Main Outcome MeasuresStudied outcomes included the rate of marginal necrosis, surgical time, postoperative posterior interosseous nerve damage and urethral complications (fistula, stenosis or necrosis).ResultsA total of 27 FRFA flap phalloplasties was performed. Anastomosis of the PIOA was needed in 15 cases. No marginal necrosis was observed in these cases. There were no cases of postoperative posterior interosseous nerve damage. There were no significant differences in urethral complications (fistula, stenosis or necrosis) between the 2 groups.Clinical ImplicationsIn selected cases where insufficient perfusion of the dorsoradial part of the flap is present, patients may benefit from arterial supercharging to prevent postoperative marginal necrosis.Strength & LimitationsStrengths include a single surgeon, thus lending continuity of skill and technique, a consecutive series, and 100% short-term follow-up. Limitations include single institution series and a limited number of patients.ConclusionArterial supercharging is effective in improving perfusion of large FRFA flaps used in phalloplasty when dorsoradial hypoperfusion is detected on an indocyanine green perfusion scan. It is a technically challenging addition to the standard technique because of the small size of the vessels, the close relationship between the PIOA and the posterior interosseous nerve, and the vulnerability of the newly constructed intra-flap anastomosis.De Wolf E, Claes K, Sommeling CE, et al. Free Bipedicled Radial Forearm and Posterior Interosseous Artery Perforator Flap Phalloplasty. J Sex Med 2019;16:1111–1117.
       
  • Comparison of Long-Term Results and Couples’ Satisfaction with Penile
           Implant Types and Brands: Lessons Learned From 883 Patients With Erectile
           Dysfunction Who Underwent Penile Prosthesis Implantation
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Selahittin Çayan, Ramazan Aşcı, Ozan Efesoy, Mustafa Suat Bolat, Erdem Akbay, Önder YamanAbstractIntroductionNo study has compared surgical outcomes and couples’ satisfaction among the 3 types of implants, with all brands available on the markets.AimsTo compare long-term complications, mechanical reliability, and couples’ satisfaction with penile implant types and brands in patients who underwent penile prosthesis implantation. We also investigated whether there are risk factors that might predict couples’ dissatisfaction.MethodsThis retrospective study included 883 patients with erectile dysfunction who underwent penile prosthesis implantation. Of the patients, 349 had malleable penile implant, 26 had 2-piece implants, and 508 had 3-piece implants.Main Outcome MeasureCouples’ satisfaction after surgery was evaluated with the modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Surgical outcomes, mechanical reliability, and couples’ satisfaction were compared according to type and brand of the penile implants in all patients.ResultsThe mean age and follow-up period of the patients were 57.74 ± 9.59 years and 67.81 ± 49.11 months, respectively. The couples’ satisfaction rates were significantly higher in the 3-piece implant group than in the malleable group (P < .001), but there was no significant difference between the 2-piece and 3-piece implant groups. There was no difference in terms of couples’ satisfaction according to the brand of the implants. Of the patients who had malleable implants, 27 (7.7%) underwent 3-piece penile prosthesis implantation due to dissatisfaction; however, only 1 (0.2%) of the patients with a 3-piece implant was switched to a malleable implant (P < .001). The highest rate of revision surgery due to penile corporal perforation was in the malleable group (2.6%), whereas the highest rate of revision surgery due to penile implant malfunction occurred in the 3-piece implant group (5.5%) (P = .021 and .001, respectively). To analyze risk factors, using multivariate analysis, presence of complication was the only predictor that might cause couples’ dissatisfaction (P = .003).Conclusions3-piece and 2-piece implants have higher couples’ satisfaction rates than the malleable implant. Brands of implants did not have any effect on the couples’ satisfaction. Regarding detail of the complications, the 3-piece implant has a lower rate of penile corporal perforation and a higher rate of penile implant malfunction than the malleable implant. Patients with erectile dysfunction who need a penile implant should be informed about surgical outcomes, brands, and types of penile implants. Prosthesis choice should be customized to individual patient’s expectations/conditions and tailored accordingly.Çayan S, Aşcı R, Efesoy O, et al. Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation. J Sex Med 2019;16:1092–1099.
       
  • Motor Function and Perception of Health in Women with Provoked
           Vestibulodynia
    • Abstract: Publication date: July 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 7Author(s): Ingrid Næss, Helena C. Frawley, Kari BøAbstractBackgroundProvoked vestibulodynia (PVD) is a prevalent and disabling condition in women that may be associated with reduced quality of life and impairment of physical functioning.AimTo investigate whether women with PVD have different motor functions, posture and breathing patterns, and whether they perceive their physical health differently, compared with asymptomatic controls.Methods and Main Outcome MeasureThe Standardized Mensendieck Test (SMT) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were used to assess differences between 35 women with PVD and 35 healthy controls.ResultsThere were no statistically significant differences in any of the 5 motor domains of the SMT between the women with PVD and those without PVD: standing posture, 4.0 (0.6) vs 5.0 (0.6); gait, 4.7 (0.6) vs 4.8 (0.6); movement, 4.8 (0.8) vs 5.1 (0.6); sitting posture, 4.7 (1.0) vs 4.9 (0.8); respiration, 4.7 (1.0) vs 4.7 (0.9). Women with PVD scored significantly lower in all domains on the SF-36 (adjusted Bonferroni P = .002) except physical functioning.Clinical ImplicationsGiven the lack of difference in the SF-36 physical functioning domain and in all 5 domains of the SMT between women with PVD and those without PVD, the value of interventions focusing on general physical function is unclear.Strengths & LimitationsA study strength is the use of an assessor-blinded case-control design, trained physiotherapists to conduct the tests, and valid and reliable outcome measures. A limitation is the homogeneity of the sample of young nulliparous women, which limits the generalizability of our findings to other study populations.ConclusionYoung nulliparous women with PVD did not score differently from a group of healthy controls on assessment of overall physical functioning or on standing posture, gait, movement, sitting posture, and respiration. However, the score for perception of general health was lower in the women with PVD compared with controls.I. Næss, H.C. Frawley, K. Bø. Motor Function and Perception of Health in Women with Provoked Vestibulodynia. J Sex Med 2019;16:1060–1067.
       
  • Prevalence of Sexual Problems and Associated Distress in Aging Men Across
           4 European Countries
    • Abstract: Publication date: Available online 27 June 2019Source: The Journal of Sexual MedicineAuthor(s): Gert Martin Hald, Cynthia Graham, Aleksandar Štulhofer, Ana Carvalheira, Erick Janssen, Bente TræenAbstractBackgroundAmong older men, comparable cross-cultural investigations of sexual problems and associated distress that also include a multitude of relevant explanatory variables of these sexual problem and related distress are rare in the research literature.AimsTo investigate prevalence rates of sexual problems and associated distress among older men across 4 European countries (Norway, Denmark, Belgium, and Portugal) and assess for associated mental and physical health–related factors.MethodsMultinational cross-sectional questionnaire study using self-report measures.OutcomesPrevalence rates of sexual problems and associated distress levels.ResultsWe found a high prevalence of sexual problems persisting for months or longer across countries, but noted that many affected men experienced minimal or no distress related to these problems. We also found marked cross-cultural differences in reported distress about sexual problems, with southern European men (i.e., Portugal) reporting significantly more distress related to the majority of sexual problems investigated compared with northern European men (i.e., Denmark and Norway). Finally, we identified several relational, physical, and mental health problems associated with the reported number of sexual problems and the distress related to these problems.Clinical ImplicationsWe suggest that healthcare professionals also target distress when considering sexual problems among older men and contextualize these considerations within a multifactorial approach to general health in which (other) mental and physical health factors relevant to these patients’ sexual health and function are also jointly considered.Strengths & LimitationsStrengths of this study include the large sample size, inclusion of participants from 4 European countries, assessment of distress associated with sexual problems, and similar research design and method of data collection across the 4 included countries. Limitations of the study include the cross-sectional design, which precludes causal conclusions; the low response rate in the Portuguese sample; the lack of homosexual participants; and the lack of comprehensive assessments of dyadic factors that may be of relevance to sexual problems and associated distress.ConclusionThis study identified a high prevalence of sexual problems persisting for 3 months or longer among older men across 4 European countries, but also found that many of the men with sexual problems experienced minimal or no distress related to these problems.G.M. Hald, C. Graham, A. Štulhofer, et al. Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries. J Sex Med 2019;XX:XXX–XXX.
       
  • Explorative Prospective Evaluation of Short-Term Subjective Effects of
           Hormonal Treatment in Trans People—Results from the European Network for
           the Investigation of Gender Incongruence
    • Abstract: Publication date: Available online 21 June 2019Source: The Journal of Sexual MedicineAuthor(s): Dennis van Dijk, Marieke J.H.J. Dekker, Elfi B. Conemans, Chantal M. Wiepjes, Eva G.M. de Goeij, Kasper A. Overbeek, Alessandra D. Fisher, Martin den Heijer, Guy T’SjoenAbstractIntroductionAlthough many studies on the short- and long-term effects of hormonal treatment (HT) in trans people focus on objective changes such as body composition or bone density, few studies have evaluated self-reported effects of HT.AimTo evaluate self-reported symptoms during the first year of HT in trans people.MethodsThis study is part of the European Network for the Investigation of Gender Incongruence, a multicenter prospective cohort study. For this study, 205 trans women and 193 trans men from the gender clinics of Amsterdam, Ghent, and Florence, who were>18 years of age and started hormonal treatment were included. Questionnaires, self-developed based on the Menopause Rating scale and clinical experiences, were completed, and changes in symptom scores were analyzed using linear mixed models.Main Outcome MeasuresSelf-reported psycho vegetative symptoms, as well as physical, cognitive, emotional, sexual and genital complaints, and pain were evaluated at baseline and after 3, 6, and 12 months of HT using a 4-point Likert scale (no, mild, moderate, or severe complaints).ResultsIn trans men, with a median age of 23, transient increases were reported in night sweats, weight gain, and clitoral pain. Persistent increases were reported for hot flashes, balding, voice instability, acne, and increase in sexual desire, whereas emotional instability, fear, and menses decreased. For trans women, with a median age of 29, hot flashes, night sweats, fatigue, weight gain, changes in olfactory sense, brittle nails, emotional instability, mood swings, and breast tenderness increased persistently during 12 months of HT, whereas a decrease was observed for balding and sexual desire. Sleeping difficulties decreased temporarily. No changes were observed in palpitations, dizziness, abdominal complaints, anxiety, panic attacks, cognition, and pain, except for clitoral and breast pain.Clinical ImplicationsKnowledge on the occurrence of these self-reported, subjective effects and their course over time may help physicians informing trans people starting with and during HT.Strengths & LimitationsThis study was performed in a large cohort of trans people. The follow-up period was limited to 12 months.ConclusionChanges in self-reported symptoms were mentioned in all investigated areas, except cognition. Most symptoms were as expected and even desired, whereas others may be considered unpleasant by some trans people.van Dijk D, Dekker MJHJ, Conemans EB, et al. Explorative Prospective Evaluation of Short-Term Subjective Effects of Hormonal Treatment in Trans People—Results from the European Network for the Investigation of Gender Incongruence. J Sex Med 2019;XX:XXX–XXX.
       
  • Which Dimensions of Human Sexuality Are Related to Compulsive Sexual
           Behavior Disorder (CSBD)' Study Using a Multidimensional Sexuality
           Questionnaire on a Sample of Polish Males
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of Sexual MedicineAuthor(s): Ewelina Kowalewska, Shane W. Kraus, Michał Lew-Starowicz, Katarzyna Gustavsson, Mateusz GolaAbstractIntroductionHuman sexuality is a multidimensional phenomenon related to several factors, such as self-esteem, awareness of sexual needs, and ability to communicate them to others.AimTo examine the sexual characteristics of patients seeking treatment for compulsive sexual behavior disorder (CSBD)—a clinical diagnosis recently included in the 11th edition of the International Classification of Diseases classification.MethodsWe have investigated the sexual characteristics of 72 Polish men seeking treatment for CSBD compared with 208 men from the Polish general population.Main Outcome MeasuresThe Multidimensional Sexual Questionnaire–PL was used to examine 12 sexual aspects of human sexuality. The severity of CSBD symptoms was assessed using Sexual Addiction Screening Test–PL, and the severity of problematic pornography use was measured by Brief Pornography Screener.ResultsResults show that CSBD patients (when compared with the general population) exhibit higher sexual anxiety, sexual depression, external sexual control, and fear of sexual relationship. Furthermore, CSBD severity is negatively related to sexual esteem, internal sexual control, sexual consciousness, sexual assertiveness, and sexual satisfaction.Clinical ImplicationsOur findings suggest that the impairment of the abovementioned dimensions warrant attention during clinical work and future studies on CSBD.Strengths & LimitationsThis study was limited to men, most of whom self-identified as heterosexual. Future research should include women and non-heterosexual identified individuals.ConclusionSexual esteem, consciousness, assertiveness, satisfaction and internal sexual control are commonly affected among CSBD individuals and should be properly addressed during the clinical interview and treatment intervention.Kowalewska E, Kraus SW, Lew-Starowicz M, et al. Which Dimensions of Human Sexuality Are Related to Compulsive Sexual Behavior Disorder (CSBD)' Study Using a Multidimensional Sexuality Questionnaire on a Sample of Polish Males. J Sex Med 2019;XX:XXX–XXX.
       
  • Vulvodynia, “A Really Great Torturer”: A Mixed Methods Pilot Study
           Examining Pain Experiences and Drug/Non-drug Pain Relief Strategies
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of Sexual MedicineAuthor(s): Judith M. Schlaeger, Heather A. Pauls, Keesha L. Powell-Roach, Patrick D. Thornton, Dee Hartmann, Marie L. Suarez, William H. Kobak, Tonda L. Hughes, Alana D. Steffen, Crystal L. PatilAbstractBackgroundWomen with vulvodynia, a chronic pain condition, experience vulvar pain and dyspareunia. Few studies examine the range and combination of treatment strategies that women are actually using to reduce vulvodynia.AimTo describe pain experiences and pain relief strategies of women with vulvodynia.MethodsConvenience sample, 60 women with vulvodynia (median age 32.5 [interquartile range {IQR} 8.5] years; 50 white, 10 racial/ethnic minorities) completed PAINReportIt and reported use of drugs and alcohol and responded to open-ended questions. Univariate descriptive statistics and bivariate inferential tests were used to describe average pain intensity scores, alcohol use, smoking, number of pain relief strategies, and their associations. Women’s open-ended responses about their pain experiences and drug and non-drug pain relief strategies (NDPRS) were analyzed for patterns.OutcomesOur mixed methods analysis connected data from pain measures, prescribed treatments and self-reported behaviors with women’s free responses. This enabled nuanced insights into women’s vulvodynia pain experiences.ResultsWomen’s descriptions of their pain and suffering aligned with their reported severe pain and attempts to control their pain, with a median pain intensity of 6.7 (IQR 2.0) despite use of adjuvant drugs (median 2.0 [IQR 2.0]), and opioids (median 1.0 [IQR 2.0]). 36 women (60%) used alcohol to lessen their pain. 26 women (43%) listed combining analgesics and alcohol to relieve their pain. 30 women (50%) smoked cigarettes. 54 women (90%) used ≥1 NDPRS. The mean number of NDPRS used was 2.1 ± 1.3 (range 0–6). The 5 most common NDPRS from women’s comments were herbal medicine (40%), acupuncture (27%), massage (22%), hypnosis (15%), and mental healthcare (13%).Clinical ImplicationsSevere pain in women with vulvodynia may be a clinical indicator of those at higher risk of combining prescription pain medications with alcohol, which are all central nervous system depressants and may potentiate overdose.Strengths and LimitationsThis pilot study demonstrated that the mixed methods approach to help understand the complexity of vulvodynia was feasible. We identified data showing a reliance on a high-risk mix of prescriptions and alcohol to reduce vulvodynia pain and a high prevalence of cigarette smoking. However, as a pilot study, these results are considered preliminary; the sample may not be representative. Perhaps only women at the extreme end of the pain continuum participated, or women took the survey twice because identifiers were not collected.ConclusionDespite attempts to reduce pain using multiple therapies, including alcohol, women’s vulvodynia pain is severe and not controlled.Schlaeger JM, Pauls HA, Powell-Roach KL, et al. Vulvodynia, “A Really Great Torturer”: A Mixed Methods Pilot Study Examining Pain Experiences and Drug/Non-drug Pain Relief Strategies. J Sex Med 2019;XX:XXX–XXX.
       
  • Prevalence and Psychopathological Determinants of Sexual Dysfunction and
           Related Distress in Women With and Without Multiple Sclerosis
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Giulia Gava, Matteo Visconti, Fabrizio Salvi, Ilaria Bartolomei, Renato Seracchioli, Maria Cristina MeriggiolaAbstractIntroductionSexual dysfunction (SD) is common but still underdiagnosed in women with multiple sclerosis (MS); in fact, the lack of a consistent use of validated diagnostic tools makes the prevalence of SD and related distress difficult to define precisely.AimTo assess the prevalence of SD in Italian women with MS compared with age-matched healthy control subjects (HC) and the association with demographic, psychological, and MS-related characteristics.MethodsThe Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale were administered to 153 women with MS and 153 HC. Demographic, gynecologic, and neurologic data were obtained. Disability was assessed using the Expanded Disability Status Scale. Psychological symptoms were evaluated in MS patients with Profile of Mood State and the Beck Depression Inventory II.Main Outcomes MeasuresPrevalence of SD and sexual distress in women with MS compared with HC.ResultsAmong women sexually active in the last month, we found an increased prevalence of SD in MS patients compared with HC subjects (42.0% vs 16.0%, P = .0001). The prevalence of dysfunctional FSFI global scores (
       
  • Testosterone Deficiency: A Review and Comparison of Current Guidelines
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Jethro C.C. Kwong, Yonah Krakowsky, Ethan GroberAbstractBackgroundThere is much controversy regarding the appropriate evaluation and management of testosterone deficiency (TD).AimTo compare current guidelines on the evaluation and management of TD to provide clarity for patients and clinicians, as well as to highlight areas of controversy.MethodsA literature search of MEDLINE, Embase, Cochrane Library, and various association websites was performed to identify guidelines for TD.OutcomesKey aspects in the approach were compared, with a focus on the biochemical definition (cutoff) for low testosterone (T), principles of management, and recommendations for testosterone therapy (TTh) in special patient populations.ResultsGuidelines from the Canadian Medical Association Journal, American Urological Association, European Association of Urology, Endocrine Society, International Society for Sexual Medicine, and British Society for Sexual Medicine were included for review. Recommendations were generally consistent across guidelines. Key differences include the biochemical cutoff for low T, and recommendations for patients with low to normal T, prostate cancer, or cardiovascular disease. We highlight several case scenarios in which management differs depending on the guideline adopted.Clinical ImplicationsAlthough general diagnostic and management principles are in agreement across the guidelines, notable differences may impact patient diagnosis and eligibility for TTh.Strengths & LimitationsOnly guidelines written in English were included. The quality of the included guidelines was not evaluated, but this was beyond the scope of this review.ConclusionWe highlight the limitations of relying exclusively on guidelines in managing patients with TD.Kwong JCC, Krakowsky Y, Grober E. Testosterone Deficiency: A Review and Comparison of Current Guidelines. J Sex Med 2019;16:812–820.
       
  • The Effect of Early Life Trauma on Compulsive Sexual Behavior among
           Members of a 12-Step Group
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Yaniv Efrati, Mateusz GolaAbstractIntroductionEarly life trauma is at the core of many psychopathologies, including compulsive sexual behavior (CSB). The intermediate processes linking early life trauma and CSB have been less well studied.AimsTo investigate whether impulsiveness, internalizing symptoms, sensation-seeking, and self-criticism mediate the links between early life trauma and CSB.MethodsThe sample comprised 65 Sexaholics Anonymous members and 47 healthy volunteers who completed self-report measures assessing CSB, early life trauma, and the mediating variables.Main Outcomes MeasuresThe main outcome measures were severity of CSB symptoms, impulsiveness, internalizing symptoms, sensation-seeking, self-criticism, and early life trauma.ResultsThe analysis indicated that the total effect of early life trauma on CSB was significant, with more prevalent and severe trauma relating to higher CSB. The analysis also revealed that this effect was significantly mediated by 3 mediation paths—greater sensation-seeking, internalizing symptoms, and self-criticism—and that these measures in turn were associated with higher CSB.ConclusionOur findings provide an opportunity for researchers to gain a better insight into the effect of early life trauma on CSB.Efrati Y, Gola M. The Effect of Early Life Trauma on Compulsive Sexual Behavior among Members of a 12-Step Group. J Sex Med 2019;16:803–811.
       
  • Dietary Modification Is Associated with Normalization of Penile
           Hemodynamics in Rats Fed a High-Fat Diet
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Yun-Ching Huang, Dong-Ru Ho, Jian-Hui Lin, Kuo-Tsai Huang, Chih-Shou Chen, Chung-Sheng ShiAbstractBackgroundDiet is associated with self-reported indices of sexual health. The mechanisms responsible for these changes remain poorly understood.AimTo investigate the hemodynamic and histological impact of dietary change in a rat model of hyperlipidemia-associated erectile dysfunction.Methods40 2-month old male Sprague–Dawley rats were divided into 4 groups. 10 rats were fed a diet of standard chow and served as negative controls (N group). The remaining 30 age-matched rats were divided at random into 3 groups: (i) high-fat diet for 5 months starting at age 5 months (H group); (ii) high-fat diet for 5 months starting at age 4 months followed by 1 month of standard chow (H+N1M group); and (iii) high-fat diet for 5 months starting at age 2 months followed by 3 months of standard chow (H+N3M group). All rats underwent erectile function testing and sacrifice at age 10 months.OutcomesIntracavernous pressure (ICP) and mean arterial pressure (MAP) were measured to evaluate erectile function. Blood samples were collected to measure serum testosterone and lipid levels, and penile tissue specimens were obtained for histological examination.ResultsTotal body weight, low-density lipoprotein, and serum glucose were significantly higher in the H group compared with the N and H+N3M groups. Serum high-density lipoprotein level was significantly lower in the H group compared with the N and H+N3M groups. The mean ICP/MAP ratio was significantly lower in the H group compared with the N and H+N3M groups (0.33 ± 0.05 vs 0.79 ± 0.07 vs 0.73 ± 0.13; P < .05 for both). Markers for intracorporal neuronal nitric oxide synthase and endothelial cells were more weakly expressed in the H group compared with the N and H+N3M groups. There was no significant difference in smooth muscle content among the groups. Mean cavernosal oxidative stress and the apoptotic index were significantly higher in the H group compared with the N and H+N3M groups. No significant between-group differences were noted with respect to serum testosterone; the H group had significantly higher serum glucose and low-density lipoprotein levels, effects that were partially mitigated in the H +N1M and H+N3M groups.Clinical TranslationAdministration of a healthy diet is associated with normalization of functional and histological penile defects associated with a high-fat diet.Strengths & LimitationsMetabolic changes were clearly linked to functional improvements in penile blood flow. Differences between rat and human lipoprotein metabolism are a limitation of this study.ConclusionDietary changes may have positive effects on penile hemodynamics in a rat model of hyperlipidemia-associated erectile dysfunction.Huang Y-C, Ho D-R, Lin J-H, et al. Dietary Modification Is Associated with Normalization of Penile Hemodynamics in Rats Fed a High-Fat Diet. J Sex Med 2019;16:791–802.
       
  • Vaginal Diazepam for Nonrelaxing Pelvic Floor Dysfunction: The
           Pharmacokinetic Profile
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Alyssa M. Larish, Rozalin R. Dickson, Rachel A. Kudgus, Renee M. McGovern, Joel M. Reid, W. Michael Hooten, Wayne T. Nicholson, Lisa E. Vaughan, Tatnai L. Burnett, Shannon K. Laughlin-Tommaso, Stephanie S. Faubion, Isabel C. GreenAbstractBackgroundVaginal diazepam is frequently used to treat pelvic floor tension myalgia and pelvic pain despite limited knowledge of systemic absorption.AimTo determine the pharmacokinetic and adverse event profile of diazepam vaginal suppositories.MethodsWe used a prospective pharmacokinetic design with repeated assessments of diazepam levels. Eight healthy volunteers were administered a 10-mg compounded vaginal diazepam suppository in the outpatient gynecologic clinic. Serum samples were collected at 0, 45, 90, 120, and 180 minutes; 8, 24, and 72 hours; and 1 week following administration of a 10-mg vaginal suppository. The occurrence of adverse events was assessed using the alternate step and tandem walk tests, the Brief Confusion Assessment Method, and numerical ratings. Plasma concentrations of diazepam and active long-acting metabolites were measured. Pharmacokinetic parameters were calculated by standard noncompartmental methods.ResultsThe mean peak diazepam concentration (Cmax) of 31.0 ng/mL was detected at a mean time (Tmax) of 3.1 hours after suppository placement. The bioavailability was found to be 70.5%, and the mean terminal elimination half-life was 82 hours. The plasma levels of temazepam and nordiazepam peaked at 0.8 ng/mL at 29 hours and 6.4 ng/mL at 132 hours, respectively. Fatigue was reported by 3 of 8 participants.Clinical ImplicationsSerum plasma concentrations of vaginally administered diazepam are low; however the half-life is prolonged.Strengths & LimitationsStrengths include use of inclusion and exclusion criteria aimed at mitigating clinical factors that could adversely impact diazepam absorption and metabolism, and the use of an ultrasensitive LC-MS/MS assay. Limitations included the lack of addressing the efficacy of vaginal diazepam in lieu of performing a pure pharmacokinetic study with healthy participants.ConclusionVaginal administration of diazepam results in lower peak serum plasma concentration, longer time to peak concentration, and lower bioavailability than standard oral use. Providers should be aware that with diazepam’s long half-life, accumulating levels would occur with chronic daily doses, and steady-state levels would not be reached for up to 1 week. This profile would favor intermittent use to allow participation in physical therapy and intimacy.Larish AM, Dickson RR, Kudgus RA, et al. Vaginal Diazepam for Nonrelaxing Pelvic Floor Dysfunction: The Pharmacokinetic Profile. J Sex Med 2019;16;763–766.
       
  • Society Page
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s):
       
  • The Contemporary Sex Ratio of Transgender Youth That Favors Assigned
           Females at Birth Is a Robust Phenomenon: A Response to the Letter to the
           Editor Re: “Shifts in Assigned Sex Ratios at Gender Identity Clinics
           Likely Reflect Change in Referral Patterns”
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Kenneth J. Zucker, Doug P. VanderLaan, Madison Aitken
       
  • Shifts in Assigned Sex Ratios at Gender Identity Clinics Likely Reflect
           Changes in Referral Patterns
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Florence Ashley
       
  • Authors’ Reply to the Letter to the Editor: “Sleep and Sexual Arousal:
           A Complex Issue”
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Igor Grabovac, Sarah E. Jackson, Lee Smith
       
  • Sleep and Sexual Arousal: A Complex Relation
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Rui Miguel Costa
       
  • Medicine Without Sexual Medicine Is Not Medicine: An MJCSM and ESSM
           Petition on Sexual Health to the Political and University Authorities
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Emmanuele A. Jannini, Yacov Reisman
       
  • Editorial Comment Regarding "Changes in Female Sexual Function After
           Vaginal Mesh Repair Versus Native Tissue Repair for Pelvic Organ Prolapse:
           A Meta-Analysis of Randomized Controlled Trials"
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Jon Pennycuff, Cheryl B. Iglesia
       
  • Flap Combination Phalloplasty in Female-to-Male Transsexuals
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Yuzaburo Namba, Toshiyuki Watanabe, Yoshihiro KimataAbstractBackgroundAlthough phalloplasty with a free radial forearm (RF) flap is the gold standard for sex reassignment surgery in female-to-male transsexuals, it can result in unsightly scars, lymphedema, and numbness of the hand.AimTo introduce the concept of flap combination phalloplasty and its clinical application.MethodsThis is a retrospective chart review study of patients undergoing phalloplasty using various multiple flaps. Demographic data, surgical data, and outcomes were recorded.OutcomesOf the 15 cases, 5 were urethral fistulas; 4 were venous thrombosis; 2 were urethral calculus; and 1 was a partial flap loss.Results15 patients were included (age range 25–43 years, median 34 years). An RF flap and a deep inferior epigastric artery perforator flap combination were most frequently used. The median operative time for flap combination phalloplasty was 10.5 hours (range 6.5–12.5 hours). There was no total flap necrosis, but there was 1 case of partial flap loss. There were urethral fistulas in 5, venous thrombosis in 4, and urethral calculus in 2 cases.Clinical ImplicationsFlap combination phalloplasty will become the third option when both the RF flap and the anterolateral thigh pedicle flap are not useful.Strength & limitationsFlap combination phalloplasty is a complex operative procedure with a prolonged operative time, but it can provide more flap selection and reduce the morbidity at each donor site. Choosing from many different options can be beneficial to patients.ConclusionFlap combination phalloplasty has a similar complication rate to other procedures and has advantages in terms of flexibility and less donor site morbidity; it may thus be an option when either the RF flap or the anterolateral thigh pedicle flap cannot be used.Namba Y, Watanabe T, Kimata Y. Flap Combination Phalloplasty in Female-to-Male Transsexuals. J Sex Med 2019;16:934–941.
       
  • A Comparison of Mindfulness-Based Cognitive Therapy Vs Cognitive
           Behavioral Therapy for the Treatment of Provoked Vestibulodynia in a
           Hospital Clinic Setting
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Lori A. Brotto, Sophie Bergeron, Bozena Zdaniuk, Miriam Driscoll, Andrea Grabovac, Leslie A. Sadownik, Kelly B. Smith, Rosemary BassonAbstractIntroductionChronic and distressing genito-pelvic pain associated with vaginal penetration is most frequently due to provoked vestibulodynia (PVD). Cognitive behavioral therapy (CBT) significantly reduces genital pain intensity and improves psychological and sexual well-being. In general chronic pain populations, mindfulness-based approaches may be as effective for improving pain intensity as CBT.AimTo compare mindfulness-based cognitive therapy (MBCT) with CBT in the treatment of PVD.MethodsTo ensure power of 0.95 to find medium effect size or larger in this longitudinal design, we enrolled 130 participants. Of these, 63 were assigned to CBT (mean age 31.2 years), and 67 to MBCT (mean age 33.7 years). Data from all participants who completed baseline measures were analyzed, with intent-to-treat analyses controlling for years since diagnosis.Main Outcome MeasuresOur primary outcome was self-reported pain during vaginal penetration at immediate post-treatment and at 6 months’ follow-up. Secondary endpoints included pain ratings with a vulvalgesiometer, pain catastrophizing, pain hypervigilance, pain acceptance, sexual function, and sexual distress.ResultsThere was a significant interaction between group and time for self-reported pain, such that improvements with MBCT were greater than those with CBT. For all other endpoints, both groups led to similar significant improvements, and benefits were maintained at 6 months.Clinical ImplicationsMindfulness is a promising approach to improving self-reported pain from vaginal penetration and is as effective as CBT for several psychological endpoints.Strength & LimitationsA strength of the present study was the robust sample size (n = 130 women) who had received confirmed clinical diagnoses of PVD.ConclusionThe present study showed mindfulness to be as effective for most pain- and sexuality-related endpoints in the treatment of PVD.Brotto LA, Bergeron S, Zdaniuk B, et al. A Comparison of Mindfulness-Based Cognitive Therapy Vs Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia in a Hospital Clinic Setting. J Sex Med 2019;16:909–923.
       
  • Current Strategies in the Management of Peyronie’s Disease
           (PD)—Results of a Survey of 401 Sexual Medicine Experts Across Europe
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Hartmut Porst, Andrea Burri, European Society for Sexual Medicine (ESSM) Educational CommitteeAbstractIntroductionPeyronie’s disease (PD) is a progressive and devastating penile disorder that often results in severe penile curvature with penile shrinking, making vaginal insertion difficult or even impossible. Until now, in contrast to other penile disorders such as erectile dysfunction, PD is characterized by a paucity of conservative treatment options.AimTo investigate the current status quo in the management of PD across European experts in sexual medicine.MethodsMembers of the European Society of Sexual Medicine and of various andrology and urology societies across Europe, with the majority (78%) being urologists, were contacted via e-mail and newsletters and asked to fill in an online questionnaire. The survey comprised 56 items developed by an expert consensus of the educational committee of the European Society of Sexual Medicine. In the end, 401 participants responded to the entire survey, with 277 reporting treating PD patients themselves and knowing this penile entity very well.Main Outcome MeasuresMain outcome measures include description of current strategies regarding diagnosis and treatment of PD as reported by specialists in this field.ResultsOf the physicians treating PD patients, 94% performed penile palpation, and 74% perform ultrasonography. 45% assessed the degree of penile curvature by means of intravenous drug testing, but only 17% measured it accurately with a goniometer. Penile length, flaccid or in erect state, was measured by only 39% or 25%, respectively. Only 45% assessed testosterone. Primary treatment options were oral (65%), counseling (57%), and topical/local therapy (30%). Among oral drug users, tadalafil 5 mg was the most commonly used (57%), followed by vitamin E (40%). Regarding intralesional therapy, collagenase clostridium histolyticum was the leading drug (34%), followed by calcium channel blockers (17%). Considering surgical procedures, the original Nesbit technique was the preferred procedure (33%). 36% of the specialists expressed their dissatisfaction with the currently available treatment options, and 64% reported the impression that their patients were mostly dissatisfied with the treatment outcomes.Clinical ImplicationsInnovative and presumably multi-modal treatment protocols for PD are urgently needed.Strengths & LimitationsThe survey represents 1 of the largest studies on the management of PD. The results are representative for the standard management of PD mostly among European Urologists with specialization in sexual medicine and may therefore not be generalizable to regions outside Europe or to other physicians treating PD.ConclusionAround one-third of experts and, from their perspective, around two-thirds of patients are dissatisfied with the currently available PD treatment options.Porst H, Burri A, the European Society for Sexual Medicine (ESSM) Educational Committee. Current Strategies in the Management of Peyronie’s Disease (PD)—Results of a Survey of 401 Sexual Medicine Experts Across Europe. J Sex Med 2019;16:901–908.
       
  • Efficacy of Combined Collagenase Clostridium histolyticum and RestoreX
           Penile Traction Therapy in Men with Peyronie’s Disease
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Manaf Alom, Kiran L. Sharma, Amir Toussi, Tobias Kohler, Landon TrostAbstractBackgroundPrevious studies of penile traction therapy (PTT) devices have demonstrated limited/no efficacy when combined with intralesional therapies for Peyronie’s disease (PD). Recently, randomized data have demonstrated the efficacy of a novel PTT device, RestoreX, developed in cooperation with the Mayo Clinic, in men with PD.AimTo assess the safety and efficacy of treatment with the RestoreX device plus collagenase Clostridium histolyticum (CCH) compared with CCH alone and CCH with other PTT devices.MethodsA prospective registry has been maintained of all men undergoing CCH injections for PD between March 2014 and January 2019. Assessments were performed at baseline, during each series, and after completion of treatment. Those completing therapy (8 injections or sooner if satisfied) were categorized into group 1 (CCH alone), group 2 (CCH plus any PTT device other than RestoreX), or group 3 (CCH plus RestoreX).OutcomesChanges in penile length, curvature, and subjective perception and the occurrence of adverse events.ResultsOf 287 men with data on PTT use, 113 had completed therapy with all objective data available and compose the current cohort. Baseline demographic and pathophysiological variables were similar among the 3 groups except penile length and previous PD medications. Following treatment, group 3 demonstrated significantly greater improvements in curvature (mean, 20.3°/31% for group 1, 19.2°/30% for group 2, and 33.8°/49% for group 3), length (-0.7 cm/-4%, -0.4 cm/-2%, and +1.9 cm/+17%, respectively), and subjectively estimated curvature improvement (44%, 32%, and 63% respectively), despite shorter daily PTT use (0.9 vs 1.9 hours/day). Group 3 was more likely than the other groups to experience ≥20°, ≥20%, and ≥50% curvature improvements, ≥1 cm length gain, and ≥20% length improvement. All results were statistically significant for group 3 versus groups 1 and 2, but not between groups 1 and 2, even after controlling for baseline features and isolating a subset of ≥3 hours/day PTT use (group 2). Group 3 was 6.9 times more likely to achieve ≥20° curvature improvement, and 3.5 times more likely to achieve ≥50% curvature improvement, and 10.7 times more likely to experience ≥20% length improvement. Adverse events were similar among the 3 groups.Clinical ImplicationsUse of the RestoreX device enhances mean curvature outcomes by 71% and increases penile length in men with PD receiving CCH therapy.Strengths & LimitationsStudy strengths include a prospective registry, consistent assessments, the largest single-site series with complete posttreatment outcomes reported to date, the largest PTT series reported to date, and a true-to-life clinical design. Limitations include the nonrandomized methodology and single-site setting.ConclusionThe combination of RestoreX and CCH is associated with significantly greater curvature and length improvements compared with CCH alone or CCH with other PTT devices.Alom M, Sharma KL, Toussi A, et al. Efficacy of Combined Collagenase Clostridium histolyticum and RestoreX Penile Traction Therapy in Men with Peyronie’s Disease. J Sex Med 2019;16:891–900.
       
  • Early-life Chronic Stressors, Rumination, and the Onset of Vulvodynia
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Maheruh Khandker, Sonya S. Brady, Sarah A. Rydell, Rachel M. Turner, Pamela J. Schreiner, Bernard L. HarlowAbstractIntroductionVulvodynia is a debilitating, chronic vulvar pain condition. Community-based case-control studies have consistently shown associations between early-life chronic stressors and vulvodynia onset.AimWe examined rumination as a specific stress response involved in the psychobiological mechanism of vulvodynia.MethodsA psychosocial survey with questions specific to early-life traumatic events and rumination were administered to 185 matched case-control pairs of women with and without vulvodynia. Conditional logistic regression was used to examine associations between rumination constructs (ie, total rumination, emotion-focused, instrumental, and searching for meaning) and vulvodynia onset. Conditional logistic regression was also used to determine whether these associations depended on early-life stressors (ie, severity of childhood abuse and of self-reported antecedent traumatic events). Age at interview, antecedent pain disorders, any childhood abuse, and antecedent psychiatric morbidity were included as covariates.Main Outcome MeasuresWe estimated the odds of rumination in relation to the onset of vulvodynia within a community-based and clinically confirmed sample of women with and without vulvodynia.ResultsVulvodynia was associated with the highest tertile of emotion-focused (odds ratio [OR] = 2.1; 95% CI = 1.2, 3.2) and instrumental (OR = 2.1; 95% CI = 1.1, 4.0) rumination. These associations were attenuated after additional adjustment for antecedent psychiatric morbidity. Among women who reported rumination about early-life stressors before vulvar pain in cases or matched reference age in control subjects, those with vulvodynia were>2 times more likely to report the highest tertile of total rumination (OR = 2.3; 95% CI = 1.1, 5.0) compared with those without vulvodynia.Clinical ImplicationsHealthcare providers may be able to identify subsets of women who could benefit from preventive measures before the development of vulvodynia.Strength & LimitationsThis is the first study to use a community-based and clinically confirmed sample of women with and without vulvodynia to examine the associations between rumination about early-life trauma and the onset of vulvodynia. However, as with all retrospective studies, the reporting of information (eg, traumatic events) was subject to recall bias and misclassification.ConclusionOur findings indicate that a prolonged cognitive stress response (ie, rumination) may be 1 important mechanism by which early-life chronic stressors contribute to the onset vulvodynia. Prospective studies are recommended to examine whether and how cognitive, affective, and physiological components of prolonged stress responses interact to influence the development of vulvodynia. Understanding both the psychobiological and behavioral mechanisms may help in addressing and treating individuals to potentially reverse the development of vulvodynia.Khandker M, Brady SS, Rydell SA, et al. Early-life Chronic Stressors, Rumination, and the Onset of Vulvodynia. J Sex Med 2019;16:880–890.
       
  • Testosterone Recovery Profiles After Cessation of Androgen Deprivation
           Therapy for Prostate Cancer
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Bruno Nascimento, Eduardo P. Miranda, Lawrence C. Jenkins, Nicole Benfante, Elizabeth A. Schofield, John P. MulhallAbstractIntroductionAndrogen deprivation therapy (ADT) is frequently used in the treatment of prostate cancer worldwide. Variable testosterone (T) recovery profiles after ADT cessation have been cited.AimTo evaluate T recovery after cessation of ADT.MethodsWe reviewed our institutional prospectively maintained database of patients with prostate cancer who received ADT. Serum early morning total T (TT) levels, collected at baseline and periodically after ADT cessation, were analyzed. Patient age, baseline T level, duration of ADT, and presence of diabetes and sleep apnea were selected as potential predictors of T recovery. 3 metrics of T recovery after 24 months of ADT cessation were analyzed: return to non-castrate level (TT> 50 ng/dL), return to normal (T> 300 ng/dL), and return back to baseline level (BTB). Multivariable time-to-event analysis (Cox proportional hazards), χ2 test, logistic regression model, and Kaplan-Meier curve were performed to define impact of the above predictors on time and chance of T recovery.Main Outcome MeasuresTime and chance of T recovery to non-castrate level (TT> 50 ng/dL), return to normal (T> 300 ng/dL), and return BTB.Results307 men with a mean age of 65 ± 8 years were included. Mean duration of ADT was 17 ± 25 months, and median follow-up was 31 ± 35 months. Mean TT values were 379 ng/dL at baseline and 321 ng/dL at>24 months. At 24 months after cessation of ADT, 8% of men remained at castrate level, 76% returned to TT>300 ng/dL, and 51% had returned BTB. Lower baseline T levels (TT < 400 ng/dL) and ADT duration>6 months were associated with a lower likelihood of recovery to normal TT at 24 months. Age>65 years and receiving ADT for>6 months were significantly associated with a slower T recovery.Clinical ImplicationsT recovery after ADT is not certain and may take longer than expected. Considering the range of side effects of low T, we believe that these findings must be discussed with patients before initiating such therapies.Strengths & LimitationsOur strengths consisted of a relatively large database, long follow-up, and clinically meaningful endpoints. Limitations included the retrospective design of the study.ConclusionT recovery rates after ADT cessation vary according to patient age, ADT duration, and baseline T levels. Approximately one-quarter of patients failed to normalize their TT level, and one-tenth of men remained at castrate levels 24 months after ADT cessation.Nascimento B, Miranda EP, Jenkins LC, et al. Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy for Prostate Cancer. J Sex Med 2019;16:872–879.
       
  • Sexual Quality of Life in Homosexual and Bisexual Men: The Relative Role
           of Minority Stress
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Bartosz Grabski, Krzysztof Kasparek, Łukasz Müldner-Nieckowski, Grzegorz IniewiczAbstractBackgroundMinority stress is an important risk factor for sexual problems in gay and bisexual men. It remains unclear whether and to what extent this stress is associated with the sexual quality of life in these groups.AimTo investigate the significance of minority stress as a factor explaining the sexual quality of life in gay and bisexual men.MethodsThe analysis is based on data collected in an Internet study on the sexuality of Polish gay, bisexual, and straight men. Multiple regression analysis was used to investigate the importance of minority stress in explaining the sexual quality of life in a group of 1,486 non-heterosexual men in the context of other predictors, including demographics, the level of current sexual function, sexual patterns and experiences, and mental and physical health. We used the Sexual Minority Stress Scale based on Ilan Meyer’s Minority Stress Model, with its subscales relating to internalized homophobia, expectation of rejection, concealment, and sexual minority negative events. The level of sexual functioning was evaluated using 2 scales, the International Index of Erectile Functioning and the Premature Ejaculation Diagnostic Tool. Data on the remaining predictors were obtained using a survey that we developed.Main Outcome MeasuresThe men’s sexual quality of life as rated on the Sexual Quality of Life Scale for Men was a dependent variable.ResultsInternalized homophobia (β = −0.28; P < .001) and sexual minority negative events (β = −0.09; P 
       
  • “If Everyone Else Is Having This Talk With Their Doctor, Why Am I Not
           Having This Talk With Mine'”: The Experiences of Sexuality and
           Sexual Health Education of Young Women With Spina Bifida
    • Abstract: Publication date: June 2019Source: The Journal of Sexual Medicine, Volume 16, Issue 6Author(s): Courtney S. Streur, Christine L. Schafer, Valerie P. Garcia, Elisabeth H. Quint, David E. Sandberg, Daniela A. WittmannAbstractIntroductionWomen with spina bifida are sexually active, but most never discuss this topic with providers.AimTo determine what women with spina bifida understand about their sexual health, how they learned about it, what questions they have, and their experiences with their sexuality.MethodsFor this qualitative study, women with spina bifida ages 16 and older without marked developmental delay were individually interviewed. 25 women with spina bifida participated (mean age 27.1 years, range 16–52). Interviews were independently coded for themes by 3 reviewers, using Grounded Theory, with disagreements resolved by consensus.Main Outcome MeasuresWe identified overlapping themes regarding the women’s perception and experience of their sexuality and sexual health education.Results17 of the 25 (68%) participants had been or were currently sexually active. 5 themes emerged regarding their understanding of their sexuality and their sexual experiences: (i) being perceived as asexual, (ii) sources for sex education, (iii) need for spina bifida–specific sex education, (iv) impact of spina bifida–specific features on sexual encounters, and (v) perceived relationship between low sexual self-confidence and risk for sexual assault.Clinical ImplicationsWomen with spina bifida are sexual beings, but they are perceived as asexual by providers, which prevents them from getting adequate sexual health education and leaves them with misconceptions and unanswered questions, as well as vulnerable to sexual abuse.Strength & LimitationsThe strengths of this study include the diversity of women interviewed, including their age, severity of disability, and experiences with their sexuality, as well as the ability to reach thematic saturation. The limitation of this study is that most women received treatment at a single Midwestern tertiary referral center in the United States.ConclusionIncluding sexual health discussions in the usual care of women with spina bifida is critical to enhancing their sexual confidence and experience and preventing sexual abuse.Streur CS, Schafer CL, Garcia VP, et al. “If Everyone Else Is Having This Talk With Their Doctor, Why Am I Not Having This Talk With Mine'”: The Experiences of Sexuality and Sexual Health Education of Young Women With Spina Bifida. J Sex Med 2019;16:853–859.
       
  • Right Ventricular Function and Sexual Function: Exploring Shadows in Male
           and Female Patients With Heart Failure
    • Abstract: Publication date: Available online 24 May 2019Source: The Journal of Sexual MedicineAuthor(s): Konstantinos Koutsampasopoulos, Ioannis Vogiatzis, Antonios Ziakas, Christodoulos Papadopoulos, Konstantinos P. Imprialos, Konstantinos Stavropoulos, Alexandra Katsimardou, Dimitrios Patoulias, Constantinos Bakogiannis, Vasilios Vasilikos, Asterios Karagiannis, Michael DoumasAbstractIntroductionSexual health plays an important role in heart failure (HF) patients, and the relationship between HF and sexual dysfunction is well established; however, the role of right ventricular function in sexual dysfunction has not been investigated sufficiently.AimTo investigate the potential association between right ventricular dysfunction and sexual dysfunction in both male and female patients with HF.MethodsPatients with a clinical diagnosis of HF were evaluated in a cross-sectional study. Patients from the whole spectrum of HF were included in the study, regardless of cause, duration, and classification of HF. Sexual function in men was evaluated with the International Index of Erectile Function and in women with the Female Sexual Functioning Index.Main Outcome MeasuresWe demonstrate that right ventricular dysfunction is associated with worse sexual function in both men and women.Results306 consecutive patients with HF participated in the study. Right ventricular systolic dysfunction ranged from 24.2–39.1% and right ventricular diastolic dysfunction from 16.1–83.1%, depending on the echocardiographic parameter that was assessed. Right ventricular systolic dysfunction assessed by tricuspid annular plane systolic excursion (TAPSE), TAPSE/pulmonary artery systolic pressure ratio, and right ventricular basal diameter was associated with a lower International Index of Erectile Function score (P = .031, P = .009, and P < .001, respectively). Multiple linear regression analysis revealed that erectile function was independently associated only with TAPSE/pulmonary artery systolic pressure ratio and tricuspid late tricuspid diastolic flow velocity wave (β = 32.84, P = .006; and β = −0.47, P = .026, respectively), whereas female sexual function was independently associated only with the early tricuspid diastolic flow velocity/late tricuspid diastolic flow velocity ratio (β= −0.47, P = .026).Clinical ImplicationsOur study demonstrates that right ventricular dysfunction in patients with HF reflects an impaired sexual function status. Physicians should be aware of this association and closely evaluate those patients for sexual dysfunction.Strengths & LimitationsWe innovatively assessed the correlation between right ventricular dysfunction and sexual function using validated questionnaires. The main limitation is the relatively small sample size.ConclusionsOur study provides some new insights into the relationship between sexual dysfunction and right ventricular systolic and diastolic dysfunction in HF patients, also suggesting potential interventions to improve sexual and right ventricular function and prognosis in this population.Koutsampasopoulos K, Vogiatzis I, Ziakas A, et al. Right Ventricular Function and Sexual Function: Exploring Shadows in Male and Female Patients With Heart Failure. J Sex Med 2019;XX:XXX–XXX.
       
  • Impact of Metabolically Healthy Obesity in Patients with Andrological
           Problems
    • Abstract: Publication date: Available online 5 April 2019Source: The Journal of Sexual MedicineAuthor(s): Francesco Lotti, Giulia Rastrelli, Elisa Maseroli, Sarah Cipriani, Federica Guaraldi, Csilla Krausz, Yacov Reisman, Alessandra Sforza, Mario Maggi, Giovanni CoronaAbstractBackgroundAlthough the pathogenic role of metabolically complicated obesity (MCO) in erectile dysfunction (ED), major adverse cardiovascular events (MACE), and male infertility has been widely studied, that of metabolically healthy obesity (MHO) has been poorly investigated.AimTo assess the role of MHO in the pathogenesis of ED, prediction of MACE, and male reproductive health.MethodsA consecutive series of 4,945 men (mean age, 50.5 ± 13.5 years) with sexual dysfunction (SD) (cohort 1) and 231 male partners of infertile couples (mean age, 37.9 ± 9.1 years; cohort 2) were studied. A subset of men with SD (n = 1,687) was longitudinally investigated to evaluate MACE. All patients underwent clinical, biochemical, erectile function, and flaccid penile color Doppler ultrasound (PCDU) assessment. Infertile men also underwent scrotal and transrectal ultrasound; semen analysis, including interleukin (IL-) 8; and prostatitis-like symptom assessment. MHO was defined as body mass index>30 kg/m2 with high-density lipoprotein cholesterol level>40 mg/dL and absence of diabetes or hypertension. The rest of the obesity sample was defined as MCO. MHO or MCO were compared with the rest of the sample, defined as normal weight (NW) individuals.OutcomesClinical, biochemical, erectile, and PCDU assessment in MHO, MCO and NW men in both cohorts; longitudinal MACE incidence assessment in cohort 1.ResultsIn cohort 1, 816 men (16.5%) were obese, 181 (3.7%) were MHO, and 635 (12.8%) were MCO. In cohort 2, 68 men (28.4%) were obese, 19 (8.2%) were MHO, and 49 (21.2%) were MCO. After adjusting for confounders, in both samples, the men with MHO and MCO had lower total testosterone levels and worse PCDU parameters compared with the NW men. However, only MCO men had worse erectile function compared with NW men. In the longitudinal study, both MHO and MCO men independently had a higher incidence of MACE compared with NW men (P < .05 for both). In cohort 2, MHO and MCO men had a larger prostate volume, and MCO men also had higher ultrasound and biochemical (IL-8) features of prostatic inflammation compared with NW men, but no differences in prostatitis-like symptoms or seminal parameters.Clinical implicationsMHO men should be considered at high cardiovascular risk like MCO men and followed-up for erectile dysfunction and prostate abnormalities overtime.Strengths & LimitationsThe study simultaneously examined several endpoints with validated instruments within 2 different male populations, 1 with SD and 1 with infertility. As for limitations, there is no consensus in the scientific community regarding the definition of MHO, and the results are derived from patients with SD or infertility, which could have different characteristics than the general male population.ConclusionMHO is associated with subclinical ED, increased cardiovascular risk, and prostate enlargement.Lotti F, Rastrelli G, Maseroli E, et al. Impact of Metabolically Healthy Obesity in Patients with Andrological Problems. J Sex Med 2019:XX;XXX–XXX.
       
 
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