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The journal of sexual medicine
Blackwell Pub
The journal of sexual medicine

Blackwell Pub

1743-6095

The journal of sexual medicine/Journal The journal of sexual medicine
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    Botox for Erectile Dysfunction

    Engy HabashyTobias S. K?hler
    3页
    查看更多>>摘要:Botulinum neurotoxin (BoNT) is a neurotoxic protein produced by Clostridium botulinum (gram-positive bacillus) and other clostridia species. It blocks the release of acetylcholine from nerve endings at the neuromuscular junction, thereby causing paralysis. The toxin's clinical relevance was recognized as the causative etiology of Botulism in 1897. It was first used to treat a medical condition in the 1980s as an alternative to strabismus surgery. Since its discovery, BoNT has been utilized in multiple medical fields, including but not limited to ophthalmology, dermatology, neurology, and urology. There is enthusiasm within the sexual medicine community about the utility of BoNT in treating male sexual dysfunction. Yet, despite its long track record of safety and efficacy in other areas, its use for treating sexual dysfunction has not been fully explored. Onabotulinumtoxin A (Botox; Allergan Pharmaceuticals, Parsippany, NJ) is the most extensively studied BoNT-A formulation and is FDA approved within the United States to treat multiple pathologies. The mechanism of action, safety profile, and temporal effect of BoNT-A have led to its appeal for use in treating lower urinary tract disorders. In 2011, BoNT-A was approved for treating detrusor overactivity (DO) in patients with neurologic conditions like spinal cord injury and multiple sclerosis. In 2013, the FDA expanded the indication for the use of BoNT-A to patients with non-neurogenic overactive bladder (OAB) syndrome.3 The use of BoNT-A for other urologic conditions is considered “off-label.” Despite its favorable safety profile, providers using BoNT-A should be aware of its local (mild) side effects such as urinary tract infection and urinary retention, as well as potential, systemic (significant) side effects like muscle weakness and respiratory difficulties.

    Erectile Functioning as a Risk Factor for Committing a Sexual Offense?

    Peer BrikenDaniel Turner
    3页
    查看更多>>摘要:Zhang et al describe the ethical dilemma associated with penile prosthesis implantation in men with a history of sexual offending. Focused mainly on penile prosthetic implantation, they suggest practical guidelines including a standardized questionnaire to screen for sexual violence and sexual addiction. However, a positive screening does not preclude a patient from surgical management of ED. What they suggest is that sexual counseling and psychiatric evaluation is rather aimed at reducing future risk of sexual violence through the assessment of psychosocial factors associated with the offense. The purpose of this commentary is to take a few steps back and examine the implicit presumptions that might be underlying these published guidelines. To be clear, these presumptions were not explicitly stated by Zhang et al1 but are rather hypotheses of the authors of this commentary. Benefitting from the interesting considerations of Zang et al1 we want to further discuss the risk posed by erectile functioning in men who have previously committed a sexual offense or might be at risk to do so. We start each of our hypotheses with a statement on which we then take a critical stance.

    Can Treating Male Sexual Dysfunction Destabilize a Couple’s Harmony?

    Daniela Wittmann
    2页
    查看更多>>摘要:When men come to us with sexual difficulties, we offer them methodologies that will help. We assume that in helping the man, we will help the partner, and the couple’s sex life will be salvaged. But is that always true? How many of us have heard a wife of a prostate cancer patient react with frustration to our offer of Erectile Dysfunction (ED) treatments to him because it assumed that continued penetrative sex was of interest to her? A hypogonadal man, treated with testosterone, may feel rejuvenated, and excited about rekindling a sexual relationship. His male partner with diabetes who has low desire and erectile dysfunction himself may become distressed because of changes in sexual expectations. While these scenarios are not typical, they are by no means rare, and, frankly, we don’t ask often enough. Without realizing it, we may be destabilizing couples’ relationships by triggering sexual problems that had not been present prior to our intervention.

    Choking Autoerotic Asphyxiation: For a Reconfiguration of Discourses Around Breath Play

    Daniel CardosoPhD
    4页
    查看更多>>摘要:With this commentary, I wish to address a 2-fold issue around the topic of autoerotic asphyxiation (AeA): (i) that the historical trend towards the pathologization of kink and other forms of sexuality considered ‘Other’ is particularly salient in the case of AeA and is potentially harmful for AeA practitioners; (ii) that the medical-izing terms used to describe the phenomenon (including, precisely, “autoerotic asphyxiation”, can be seen as both cause of, and caused by, a disconnect between research on the topic and the community within which the practice exists. As a caveat, though that are references to partnered practices, I will focus on non-partnered practices in order to keep the focus on the auto- aspect of AeA. From the early 1980’s to the present, only a few studies focus on Autoerotic Asphyxiation; it is beyond the scope and ability of this commentary to include all the work conducted, but I have sought to diversify and ensure current relevance of the sources used, including one of the most recent books on the topic1 and literature reviews/epidemiological retrospectives. In this literature, and as Sauvageau2 notes, numbers are often hyperbolized (or, at best, extrapolated from 40-something year old data!), as is the case with an often-repeated, but baseless, statistic that speaks of 500-1000 deaths caused by AeA per year, in Canada.

    Functional Magnetic Resonance Imaging Studies in Sexual Medicine: A Primer

    Colleen Mills-FinnertyEleni FrangosKachina AllenBarry Komisaruk...
    17页
    查看更多>>摘要:Background: Over the past 30 years, functional magnetic resonance imaging (fMRI) has emerged as a powerful tool to non-invasively study the activity and function of the human brain. But along with the potential of fMRI to shed light on neurological, psychiatric, and psychological processes, there are methodological challenges and criticisms. Aim: We herein provide an fMRI primer designed for a diverse audience, from the neuroimaging novice to the experienced user. Methods: This primer is structured as follows: Part 1: Overview: “What is fMRI and what can it tell us?.” Part 2: Basic fMRI principles: MR physics, the BOLD signal, and components of a typical scan session. Part 3: Basic fMRI experimental design: why timing is critical, and common sources of noise in the signal. Part 4: Basic fMRI analysis methods: software, the 3 stages of data analysis (preprocessing, individual, and group level), and a survey of advanced topics and methods including connectivity, machine learning, and assessing statistical significance. Part 5: Criticism, crises, and opportunities related to power of studies, computing requirements, logistical, and interpretational challenges, and methodological debate (assessing causality, circular correlations, and open science best practices). Outcomes n/a Clinical Translation: fMRI has primarily been used in clinical research to elucidate the brain correlates of sexual behavior. The translational potential of the method into clinical practice has not yet been real-izedfMRI has primarily been used in clinical research to elucidate the brain correlates of sexual behavior. The translational potential of the method into clinical practice has not yet been realized Strengths and Limitations: fMRI is a useful and powerful tool for understanding the brain basis of human sexuality. However, it is also expensive, requires extensive methods expertise, and lacks the precision needed to be immediately translatable to clinical practice. The recency of the method, need for basic research, technical limitations, as well as inherent variability in individuals brain activity also impact the pace at which fMRI for sexual medicine can move from the scanner to the clinic. Conclusion: This primer provides the novice an understanding of the appropriate uses and limitations of fMRI, and for the experienced user, a concise update on current issues and methodological advances.

    Professional Help-Seeking in Men Experiencing Sexual Problems — The Role of Sexual Identity and Minority Stress

    Bartosz GrabskiKrzysztof KasparekKarolina KoziaraMagdalena Mijas...
    8页
    查看更多>>摘要:Background: Only a minority of men experiencing sexual problems will seek professional help and the proportion of gay or bisexual men can be even lower. Aim: To investigate if sexual identity and minority stress are related to professional help-seeking in Polish gay and bisexual men. Methods: Sexual identity was measured with the standard question: “Do you consider yourself to be heterosexual, gay, or bisexual?” Men who provided a complete set of answers to the study tools and replied “yes” to the question: “Have you ever had a problem with sexual functioning that lasted at least several months?” were included (Ntotal =644, Nstraight = 203, Ngay = 324, Nbi = 117). A simple question on help-seeking was: “Did you seek professional assistance then?” Other data were gathered with the use of a self-constructed questionnaire. Minority stress processes, that is, internalized homophobia, expectations of rejection, and identity concealment, were measured with the subscales of the Sexual Minority Stress Scale. Bivariate analyses and multivariate logistic regressions were performed to test the statistical significance of sexual identity and minority stress processes as predictors of professional help-seeking. Outcomes: Contacting a specialist when experiencing a sexual problem. Results: A total of 84.5% of all men did not seek professional help. Gay identity (OR = 0.58, P = .045), as opposed to bisexual identity, was significantly related to reduced odds of consulting a specialist. Age (OR = 1.03, P = .005), number of doctor’s visits per year (OR = 1.51, P < .001), and a psychiatric diagnosis (OR = 1.65, P = .043) were positively related to help-seeking behaviors. Identity concealment significantly decreased the likelihood of consulting a specialist (OR = 0.94, P = .017). Clinical Translation: Specialists need to be aware that gay identity and identity concealment may prevent a proportion of men from seeking their help and thus should be publicly explicit about their inclusive and nonpatholo-gizing approach to sexual diversity. Strengths and Limitations: The major strengths of the study include the use of a relatively large sample size and data from the little recognized Polish context characterized by a predominantly hostile anti-LGBT social climate, and exploration of a neglected topic of substantial significance at the public and individual levels. The major limitations are the use of nonprobability sampling, cross-sectional self-report design, and a single question to capture the presence of sexual problems with no measurement of associated distress. Conclusion: Gay men are at risk of avoiding help-seeking when experiencing sexual problems because of identity concealment.

    Sexual Function and Mood Disorders Among Menopausal Women: A Systematic Scoping Review

    Azam RahmaniElahe AfsharniaJulia FedotovaShirin Shahbazi...
    18页
    查看更多>>摘要:Background: Changes in sex hormones during menopause may have detrimental effects on a woman's sexual function and cause mood disorders. The treatment of both conditions is a challenge in gynecology. Aim: To review the published literature on sexual function and mood disorders among peri- and postmenopausal women. Methods: The review is based on the methodological framework of scoping reviews. We searched electronic databases including Medline (PubMed), Scopus, Embase, and Web of Science (WoS). Publications that reported data about the relationship between sexual function and mood disorders among menopausal women were included in the review. The search was not subject to any limitation in terms of time or method. Outcomes: The main outcome measures used for the review were sexual dysfunction and mood disorders. Results: We found 106 total records. After a full-text screening we included 19 studies from 1986 to 2020 based on various methodologies; the majority of the studies16 were cross-sectional. Investigations that addressed the symptoms of mood disorders and some domains of sexual function showed a close relationship between sexual dysfunction and mood disorders among menopausal women. Clinical implications: In clinical practice, it would be appropriate to screen women for at least one mood disorder or sexual dysfunction. If a woman suffers from either, it will be necessary to assess for a further disorder as well. Strengths & Limitations: The review was based on a detailed search of the published literature concerning mood disorders and sexual dysfunction among menopausal women compared to women of reproductive age. Despite the clinical importance of the subject, the number of studies eligible for inclusion in the review are rather small. Further investigation of the topic is clearly warranted. Conclusions: While the association between sexual dysfunction and mood disorders appears to be bidirectional, future studies will have to investigate the specific mechanisms by which sexual dysfunction could lead to mood disorders (or vice versa). Future studies should specifically address sexual dysfunctions and attitudes of partners, BMI, family support, sleep, and multiparity.

    Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery

    Yani P. LatulFenne M. CasteleijnSra E. ZwolsmanJan-Paul W.R. Roovers...
    8页
    查看更多>>摘要:Background: Peri-urethral bulking injections (PBI) gain popularity for the treatment of stress urinary incontinence (SUI), but — in contrast to mid-urethral sling (MUS) surgery — little is known about its impact on sexual function. Methods: This was a secondary analysis of a prospective cohort study that included patients with moderate to severe SUI undergoing either MUS surgery or PBI with polydimethylsiloxane Urolastic (PDMS-U). The validated Dutch and English version of the ‘Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Function Questionnaire — IUGA Revised’ (PISQ-IR) was used to assess sexual function at baseline, at 6 and 12 months of follow-up. For between-group analysis, differences in baseline characteristics were corrected using multivariate analysis of covariance. Outcomes: The primary outcome was the PISQ-IR single summary score of sexually active (SA) women following both procedures, calculated by mean calculation. Secondary outcomes were the PISQ-IR subscale scores of SA and non-sexually active (NSA) women, the proportions of sexual activity and subjective improvement (‘Patient Global Impression of Improvement’ (PGI-I)). Results: A total of 259 women (MUS: n = 146, PBI: n = 113) were included in this study. The PISQ-IR single summary score of SA women improved following both interventions (in the MUS group from 3.2 to 3.4 and in the PBI group from 3.0 to 3.3 after 12 months). After correcting for differences in baseline characteristics, the PISQ-IR summary score at 6 and 12 months was similar for both treatment groups. For SA women, conditionspecific and condition-impact subscale scores significantly improved following both procedures. Clinical implications: In treating SUI, PBI is inferior to MUS surgery. However, there is a need for less invasive strategies, especially for women who are unfit for surgery or have contraindications. Sexual function improves after PBI using PDMS-U, which is relevant for the counselling of women with SUI about available treatment options. Strengths & limitations: Strength: until this study, there was a lack of knowledge about the effects of PBI on sexual function. Limitation: there may be indication bias as we did not perform a randomized controlled trial. Conclusion: PBI using PMDS-U and MUS surgery for the treatment of SUI improve sexual function equally in SA women, mainly by decreasing the condition’s impact on sexual activity and quality.

    Sexual Function in Postmenopausal Women With Symptomatic Pelvic Organ Prolapse Treated Either with Locally Applied Estrogen or Placebo: Results of a Double-Masked, Placebo-Controlled, Multicenter Trial

    Klaus BodnerOliver KimbergerRaffaela MorgenbesserWolf Dietrich...
    7页
    查看更多>>摘要:Background: Local estrogen therapy (LET) has beneficial effects on genitourinary atrophy; however it is currently unclear if LET improves sexual function in postmenopausal women with pelvic organ prolapse (POP). Aim: To evaluate if LET vs placebo results in an improved sexual function in postmenopausal women with symptomatic POP. Methods: We performed a secondary analysis of sexual outcomes of a previous randomized controlled trial comparing LET and placebo in 120 postmenopausal women (60/group) with symptomatic POP stage >3 and planned prolapse surgery. Women were randomly assigned to receive local estrogen or placebo cream 6 weeks preoperatively. The effect of therapy vs placebo was assessed with ANOVA with interaction effect of time*group and a multivariable linear regression model was built to assess the impact of different variables on sexual function before therapy. Outcomes: We evaluated the sexual function score in sexually active women of our study population using the German Pelvic Floor Questionnaire at recruitment time and again after 6 weeks of treatment. Results: Among 120 randomized women, 66 sexually active women remained for final analysis. There was no significant difference in the change of the sexual function score over time between the treatment groups (difference in changes in score from baseline to 6 weeks for Estrogen group vs control group was -0.110 with 95% CI -0.364 to 0.144) Multivariable analysis showed that no independent risk factor for unsatisfying sexual function score could be identified. Clinical Implications: Based on our results, LET has no beneficial effect on sexual function in postmenopausal women with POP. Strengths and limitations: Main strength of our study lies in the study design and in the use of a conditionspecific questionnaire. As this is a secondary analysis, this study may be insufficiently powered to identify differences in sexual data between groups. Conclusion: LET had no impact on female sexuality in postmenopausal women with POP.

    Feasibility of Mindful After Cancer: Pilot Study of a Virtual Mindfulness-Based Intervention for Sexual Health in Cancer Survivorship

    Jessica R. GormanJulia H. DrizinEllie SmithStephanie Corey...
    16页
    查看更多>>摘要:Background: Mindfulness-based interventions (MBIs) are increasingly recognized as an effective strategy for supporting female cancer survivors experiencing sexual health concerns. Aim: To examine the feasibility of a sexual health MBI, Mindful After Cancer, which was adapted to meet the needs of breast and gynecologic cancer survivors in a community setting and for delivery via videoconference. Methods: A mixed-methods approach was used to evaluate the acceptability, feasibility, and appropriateness of the 8week virtual MBI. Weekly sessions were 1.5-2 hours in duration and included guided meditations and group discussion about sexuality after cancer and mindfulness in daily life. Home practice activities related to both mindfulness practice and sexual health. Participants completed online surveys at baseline and 1-month post-intervention. A purposive sample of 10 participants were invited to complete a follow-up interview 2-3 months post-intervention. Outcomes: Primary outcomes included both qualitative and quantitative assessments of acceptability, appropriateness, and feasibility of the Mindful After Cancer intervention for sexual health in cancer survivorship. Results: Twenty-two women completed the intervention (Mean age 53.2 years, SD = 9.4, Range= 39-73), with time since diagnosis ranging from 1 to 27 years (Mean 6.0 years, SD = 5.9). Participants completed 6.8 sessions on average (Range = 2 - 8) and 77% reported that the time commitment was manageable. Both qualitative and quantitative findings support the feasibility, acceptability, and appropriateness of the intervention. Clinical Implications: Many cancer survivors experience sexual dysfunction and related distress after diagnosis and well after treatment ends, yet there are few interventions available. Improved access to effective interventions can improve the delivery of survivorship care and patient outcomes. Strengths & Limitations: The sample size is small for this pilot study, and a control group was not included. The intervention was offered over two time periods, one prior to COVID-19 pandemic and one during the pandemic, resulting in both limitations associated with potential differences between the experiences of participants and the opportunity to learn more about the feasibility of the intervention during times of crisis. Conclusion: Results suggest that virtual delivery of the MBI is feasible, acceptable, and appropriate for breast and gynecologic cancer survivors.