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Cell Biochemistry and Biophysics Jun 2024Erectile dysfunction (ED), which is defined as the inability to attain and maintain a satisfactory penile erection to sufficiently permit sexual intercourse, is a... (Review)
Review
Erectile dysfunction (ED), which is defined as the inability to attain and maintain a satisfactory penile erection to sufficiently permit sexual intercourse, is a consequence and also a cause of cardiometabolic disorders like diabetes mellitus, systemic hypertension, central obesity, and dyslipidemia. Although there are mounting and convincing pieces of evidence in the literature linking ED and cardiometabolic disorders, impairment of nitric oxide-dependent vasodilatation seems to be the primary signaling pathway. Studies have also implicated the suppression of circulating testosterone, increased endothelin-1, and hyperactivation of Ang II/ATIr in the pathogenesis of ED and cardiometabolic disorders. This study provides comprehensive details of the association between cardiometabolic disorders and ED and highlights the mechanisms involved. This would open areas to be explored as therapeutic targets in the management of ED and cardiometabolic disorders. It also provides sufficient evidence establishing the need for the management of cardiometabolic disorders as an adjunct therapy in the management of ED.
PubMed: 38907942
DOI: 10.1007/s12013-024-01361-2 -
Journal of Robotic Surgery Jun 2024The purpose of the study was to compare the protective effects of robotic rectal cancer surgery (RRCS) and laparoscopic rectal cancer surgery (LRCS) on urinary and... (Meta-Analysis)
Meta-Analysis Review
The purpose of the study was to compare the protective effects of robotic rectal cancer surgery (RRCS) and laparoscopic rectal cancer surgery (LRCS) on urinary and sexual function of patients. We conducted a systematic search in the PubMed, Web of Science, Cochrane Library, and Embase for studies comparing the impact of RRCS and LRCS on urinary function and sexual function. The International Prostate Symptom Score (IPSS), the five-item version of the International Index of Erectile Function (IIEF-5) and the Female Sexual Function Index(FSFI) were used to evaluate the urinary function and sexual function of patients. A total of 13 studies comprising 1964 patients were included in this meta-analysis, including 3 randomized controlled trials, 5 retrospective cohort studies, 3 prospective cohort studies, and 2 propensity score-matched studies. Nine hundred and fifty-nine patients underwent RRCS and 1005 patients underwent LRCS. Statistical analysis of the IPSS scores indicated urinary function was significantly better in the RRCS group than in the LRCS group at 3, 6 and 12 months postoperatively [mean difference (MD), - 1.06, 95% CI - 1.85 to - 0.28; and MD, - 0.96, 95% CI - 1.60 to - 0.32; and MD, - 1.09, 95% CI - 1.72 to - 0.46]. Statistical analysis of the IIEF-5 scores indicated male sexual function was significantly better in the RRCS group than in the LRCS group at 3, 6 and 12 months postoperatively (MD, 1.76, 95% CI 0.80 to 2.72; and MD, 1.83, 95% CI 0.34 to 3.33; and MD, 1.05, 95% CI 0.09 to 2.01). Statistical analysis of the FSFI scores indicated female sexual function was significantly better in the RRCS group than in the LRCS group at 6 and 12 months postoperatively (MD, 2.86; 95% CI 1.38 to 4.35; and MD, 4.19; 95% CI 1.85 to 6.54). RRCS is more favorable than LRCS in preserving the urinary and sexual function of patients with rectal cancer.
Topics: Humans; Robotic Surgical Procedures; Rectal Neoplasms; Laparoscopy; Male; Female; Postoperative Complications; Sexual Dysfunction, Physiological; Urination; Erectile Dysfunction
PubMed: 38907844
DOI: 10.1007/s11701-024-02019-0 -
American Family Physician Jun 2024
Topics: Humans; Female; Postmenopause; Sexual Dysfunction, Physiological; Estrogen Replacement Therapy; Middle Aged
PubMed: 38905548
DOI: No ID Found -
The Primary Care Companion For CNS... Jun 2024
Topics: Humans; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Male; Female; Sexual Dysfunctions, Psychological; Adult; Middle Aged
PubMed: 38905514
DOI: 10.4088/PCC.23lr03697 -
Medicine Jun 2024Flibanserin, approved for the treatment of hypoactive sexual desire disorder (HSDD) in females, has demonstrated diverse therapeutic and adverse effect (AE) prospects in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Flibanserin, approved for the treatment of hypoactive sexual desire disorder (HSDD) in females, has demonstrated diverse therapeutic and adverse effect (AE) prospects in the extant randomized controlled trials (RCTs). This meta-analysis aimed to characterize the outcomes of flibanserin use in these patients comprehensively.
METHODS
RCTs involving women with HSDD receiving flibanserin in the intervention arm and placebo in the control arm were sought after throughout the electronic databases. The primary outcomes were the changes from baseline in satisfying sexual events (SSE) per month and sexual desire score per month measured using an electronic diary (eDiary).
RESULTS
From 478 initially screened articles, data from 8 RCTs involving 7906 women with HSDD were analyzed. In premenopausal women, flibanserin 100 mg was superior to placebo in improving the number of SSE per month (mean difference, MD 0.69, 95% CI [0.39, 0.99]), eDiary sexual desire score (MD 1.71, 95% CI [0.43, 2.98]), Female Sexual Function Index (FSFI) desire domain (FSFI-d) score (MD 0.30, 95% CI [0.29, 0.31]), FSFI total score (MD 2.51, 95% CI [1.47, 3.55]), Female Sexual Distress Scale-Revised (FSDS-R) Item 13 score (MD -0.30, 95% CI [-0.31, -0.29]), and FSDS-R total score (MD -3.30, 95% CI [-3.37, -3.23]). Compared to placebo, a higher number of premenopausal women using flibanserin 100 mg achieved improvements in the Patient's Global Impression of Improvement score (OR 1.93, 95% CI [1.58, 2.36], P < .00001) and responded positively at Patient Benefit Evaluation (PBE) (odds ratio, OR 1.76, 95% CI [1.34, 2.31], P < .0001). Postmenopausal women receiving flibanserin 100 mg also benefited in terms of the number of SSE per month, FSFI-d and total scores, FSDS-R Item 13 and total scores, and PBE response. Although flibanserin use was associated with higher risks of dizziness, fatigue, nausea, somnolence, and insomnia, these adverse events were mild in nature; the serious AEs and severe AEs were comparable between the flibanserin and placebo groups.
CONCLUSION
While flibanserin has demonstrated efficacy in the treatment of HSDD in both pre- and postmenopausal women, its therapeutic advantages may be overshadowed by the higher likelihood of AEs.
Topics: Female; Humans; Benzimidazoles; Libido; Premenopause; Randomized Controlled Trials as Topic; Sexual Dysfunctions, Psychological; Treatment Outcome
PubMed: 38905407
DOI: 10.1097/MD.0000000000038592 -
Journal of Behavioral Addictions Jun 2024Many individuals with substance use disorders (SUDs) present with co-occurring mental health disorders and other addictions, including behavioral addictions (BAs)....
BACKGROUND AND AIMS
Many individuals with substance use disorders (SUDs) present with co-occurring mental health disorders and other addictions, including behavioral addictions (BAs). Though several studies have investigated the relationship between SUDs and BAs, less research has focused specifically on compulsive sexual behaviour (CSB). Given that poly-addiction can hinder treatment outcomes, it is necessary to better understand the impact of co-occurring CSB and SUD. Therefore, the current study aimed to 1) determine the rate of CSB in a sample seeking treatment for SUDs, 2) identify demographic and clinical correlates of co-occurring CSB, and 3) to determine if co-occurring CSB impacts treatment outcomes for SUD.
METHODS
Participants were 793 adults (71.1% men) ranging in age from 18-77 (M = 38.73) at an inpatient treatment facility for SUDs who were assessed for CSB upon admission into treatment. Participants completed a battery of questionnaires upon admission and at discharge to assess psychological and addiction symptoms.
RESULTS
Rates of CSB were 24%. Younger age and being single were associated with greater CSB. Mental distress and addiction symptoms were higher in participants with CSB. Predictors of CSB severity included greater symptoms of traumatic stress and interpersonal dysfunction. Rates of treatment completion were similar between participants with and without CSB.
DISCUSSION AND CONCLUSIONS
These results highlight several clinical and demographic correlates of CSB amongst individuals in treatment for SUD. However, CSB was not associated with poorer treatment outcomes. Further identifying characteristics associated with CSB can help clinicians identify individuals who may be at higher risk.
Topics: Humans; Adult; Compulsive Behavior; Male; Female; Substance-Related Disorders; Middle Aged; Adolescent; Young Adult; Sexual Behavior; Aged; Inpatients; Treatment Outcome; Comorbidity; Mental Disorders; Behavior, Addictive; Compulsive Sexual Behavior Disorder
PubMed: 38905000
DOI: 10.1556/2006.2024.00035 -
Current Findings and Potential Mechanisms of KarXT (Xanomeline-Trospium) in Schizophrenia Treatment.Clinical Drug Investigation Jun 2024Standard schizophrenia treatment involves antipsychotic medications that target D2 dopamine receptors. However, these drugs have limitations in addressing all symptoms... (Review)
Review
Standard schizophrenia treatment involves antipsychotic medications that target D2 dopamine receptors. However, these drugs have limitations in addressing all symptoms and can lead to adverse effects such as motor impairments, metabolic effects, sedation, sexual dysfunction, cognitive impairment, and tardive dyskinesia. Recently, KarXT has emerged as a novel drug for schizophrenia. KarXT combines xanomeline, a muscarinic receptor M1 and M4 agonist, with trospium, a nonselective antimuscarinic agent. Of note, xanomeline can readily cross blood-brain barrier (BBB) and, thus, enter into the brain, thereby stimulating muscarinic receptors (M1 and M4). By doing so, xanomeline has been shown to target negative symptoms and potentially improve positive symptoms. Trospium, on the other hand, is not able to cross BBB, thereby not affecting M1 and M4 receptors; instead, it acts as an antimuscarinic agent and, hence, diminishes peripheral activity of muscarinic receptors to minimize side effects probably stemming from xanomeline in other organs. Accordingly, ongoing clinical trials investigating KarXT's efficacy in schizophrenia have demonstrated positive outcomes, including significant improvements in the Positive and Negative Syndrome Scale (PANSS) total score and cognitive function compared with placebo. These findings emphasize the potential of KarXT as a promising treatment for schizophrenia, providing symptom relief while minimizing side effects associated with xanomeline monotherapy. Despite such promising evidence, further research is needed to confirm the efficacy, safety, and tolerability of KarXT in managing schizophrenia. This review article explores the current findings and potential mechanisms of KarXT in the treatment of schizophrenia.
PubMed: 38904739
DOI: 10.1007/s40261-024-01377-9 -
Cureus May 2024The aim of this study is to investigate sexual dysfunctions (SDs) and related factors in patients with schizophrenia and bipolar disorder receiving pharmacotherapy.
OBJECTIVE
The aim of this study is to investigate sexual dysfunctions (SDs) and related factors in patients with schizophrenia and bipolar disorder receiving pharmacotherapy.
METHODS
This study included 111 patients. The Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Calgary Depression Scale for Schizophrenia (CDSS) were applied to the schizophrenia, and the Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HAM-D) to the bipolar patient group. The sociodemographic data form and the Arizona Sexual Experiences Scale (ASEX) were applied to both of the patient groups. Blood was drawn from all patients to evaluate the indicated gene polymorphisms and evaluate prolactin levels.
RESULTS
SD was detected in 45.9% (N = 34) of the schizophrenia group, and 59.5% (N = 22) in the bipolar disorder group. SD was significantly higher in elderly patients and patients with a high smoking amount and low education levels. The eNOS -786T>C T allele frequency was found to be significantly higher in patients with SD. The logistic regression analysis determined that eNOS -786T>C CT and TT genotypes increased the risk of SD.
CONCLUSION
In this study, the high rates of SD in patients with schizophrenia and bipolar disorder, and the presence of modifiable factors that influence the presence of SD, suggest that SD should be given more attention in these patient groups. On the other hand, the high rate of SD in patients with the eNOS -786T>C T allele indicates the importance of carrying out new studies investigating the factors affecting the enzyme activity in this genotype. There is a need for more studies on eNOS genotypes and enzyme activites in this area.
PubMed: 38899233
DOI: 10.7759/cureus.60654 -
International Journal of Impotence... Jun 2024Hard-flaccid syndrome (HFS) is a poorly understood condition of male sexual dysfunction (MSD) that has more recently become a new topic of discussion in online forums... (Review)
Review
Hard-flaccid syndrome (HFS) is a poorly understood condition of male sexual dysfunction (MSD) that has more recently become a new topic of discussion in online forums and sexual medicine conferences. There has been limited research looking into HFS and consequently there are no evidence-based guidelines for its work-up and management. In order to identify the current level of understanding of HFS in the sexual medicine community, a survey was distributed at a national urologic conference focusing on pertinent management strategies employed by practitioners, and their own thoughts on HFS. This showed that nearly one-third of those surveyed had never seen HFS in their practice. Of those that had, diagnosis was mainly made via clinical history as well as patient self-diagnosis. Additionally, only about half of the respondents who had seen HFS were confident in its legitimacy as a real medical syndrome. This analysis is one of the first of its kind, and highlights the ongoing lack of familiarity of HFS among the sexual medicine community. There were limitations, most notably its survey format as well as low sample size, however, it importantly emphasizes the critical need for continued education and research into HFS to improve diagnostic accuracy, enhance patient care, and develop effective treatment strategies.
PubMed: 38898174
DOI: 10.1038/s41443-024-00917-3 -
Quality of Life Research : An... Jun 2024Androgen deprivation therapy (ADT) is a cornerstone treatment for advanced and metastatic prostate cancer. Real-world and patient-reported insights into ADT's impact on...
Androgen deprivation therapy in advanced prostate cancer: insights from a real-world patient survey on health-related quality of life and information and communication sources.
PURPOSE
Androgen deprivation therapy (ADT) is a cornerstone treatment for advanced and metastatic prostate cancer. Real-world and patient-reported insights into ADT's impact on health-related quality of life (HRQoL) and communication experiences in healthcare settings remain underexplored. This patient organisation-initiated online survey aimed to assess these aspects.
METHODS
Between December 2022 and August 2023, the patient organisation Think Blue Vlaanderen and the AZ Sint-Jan Hospital (Bruges, Belgium) invited ADT-treated patients to participate in a prospective, online, cross-sectional, patient-reported outcome survey. Demographic, clinical, HRQoL (FACT and EPIC-26), communication sources and information modality data were collected. Descriptive statistics and comparative analyses were applied.
RESULTS
A total of 276/312 (88.5%) participating patients were on ADT at time of survey administration and completion, with the majority receiving a 3-monthly regimen. Sexual HRQoL was low and narrowly distributed (median (IQR): 16.7 (16.7-16.7)), with 84% of patients having erectile dysfunction (ED). Patients finding their ED problematic were more likely to seek pharmaceutical treatment. Hormonal HRQoL was widely distributed (median (IQR): 65 (45-85)), which improved with prolonged ADT duration. Physically active patients reported less lack of energy, but increased hot flashes. Within consistent FACT-G summary scores (median (IQR): 64.50 (54.75-77.00)), improved emotional wellbeing with prolonged ADT was noted. Multidisciplinary communication and multimodal information provision improved patient satisfaction.
CONCLUSION
Patient organisation-initiated surveys offer real-world and patient-reported insights. Patient-tailored HRQoL assessments and longitudinal follow-up, physical activity, and multidisciplinary and multimodal communication approaches are warranted to improve patient-centred care in patients receiving ADT.
PubMed: 38896183
DOI: 10.1007/s11136-024-03712-1