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Sexuality and Disability Dec 2023Participation in sexual medicine research may depend on a patient's willingness to speak openly about sex, sexual function, or other sensitive topics. These topics may...
Participation in sexual medicine research may depend on a patient's willingness to speak openly about sex, sexual function, or other sensitive topics. These topics may be difficult or uncomfortable to talk about, and this discomfort may be further amplified when a patient comes from a cultural background that stigmatizes open conversation about sex and sexuality. We used qualitative analysis to better understand the intersection between cultural identity, the experience of sexual dysfunction as a side-effect of pelvic radiotherapy, and willingness to communicate about sexual dysfunction with healthcare providers, in Cuban American women in Miami, Florida. Doing so, we found four unique themes among Cuban American participants regarding the intersection of national identity, Hispanic identity, Catholic religion, and their experience of radiotherapy-related sexual dysfunction: , and . These themes, a reflection of the cohort's shared identity, were found to have an effect on participant views of sexual health, romantic relationships, coping strategies, and relative comfort discussing problems with intercourse. These cultural values served as barriers to openly discussing sexual dysfunction with not just medical providers and research teams but also their partners, families, and friends. In order to encourage Cuban American participation in sexual medicine studies, future research should evaluate strategies to overcome these barriers.
PubMed: 38948491
DOI: 10.1007/s11195-023-09812-z -
Journal of Pharmacopuncture Jun 2024Nitric oxide is the most important mediator of penile erection after the onset of sexual excitement. It activates cyclic guanosine monophosphate (cGMP), increasing...
The Effect of the Combination of Ginseng, Tribulus Terrestris, and L-arginine on the Sexual Performance of Men with Erectile Dysfunction: a randomized, double-blind, parallel, and placebo-controlled clinical trial.
OBJECTIVES
Nitric oxide is the most important mediator of penile erection after the onset of sexual excitement. It activates cyclic guanosine monophosphate (cGMP), increasing penile blood flow. Most pharmaceutical medications prevent enzyme phosphodiesterase type 5 (PDE-5) from breaking down cGMP, thus keeping its level high. However, due to the adverse effects of pharmacological therapies, herbal drugs that improve sexual function have gained attention recently. This study aimed to investigate the combined effects of , , and L-arginine amino acid on the sexual performance of individuals with erectile dysfunction (ED) using the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire.
METHODS
Over three months, 98 men with erectile dysfunction were randomly assigned to receive either 500 mg of herbal supplements or placebo pills. Each herbal tablet contained 100 mg of protodioscin, 35 mg of ginsenosides, and 250 mg of L-arginine.
RESULTS
The results showed that the changes in the average scores of ILEF-5 within each group before and after the intervention indicated that all parameters related to the improvement of sexual function in patients with erectile dysfunction improved in the herbal treatment group (p < 0.001). The herbal group significantly improved IIEF-5 scores in non-diabetics (p < 0.05). However, there was no significant difference in the changes of IIEF-5 scores between the two intervention and control groups in diabetic patients.
CONCLUSION
In conclusion, , , and L-arginine have properties that increase energy and strengthen sexual function, making them suitable for patients with sexual disorders.
PubMed: 38948316
DOI: 10.3831/KPI.2024.27.2.82 -
Sexual Medicine Jun 2024Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual...
BACKGROUND
Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual dysfunction often remains underdiagnosed and unaddressed among BC survivors.
AIM
The study sought to evaluate the sexual function of postmenopausal BC survivors compared with postmenopausal women without BC.
METHODS
This case-control study included 178 postmenopausal BC survivors (stages I-III), 45 to 70 years of age, with amenorrhea for ≥12 months and sexually active. They were compared with 178 women without BC, matched (±2 years) for age and time since menopause in a 1:1 ratio. Sexual function was evaluated using the Female Sexual Function Index (FSFI), which consists of 6 domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), with a total score ≤26.5 indicating risk of sexual dysfunction. Statistical analysis included Student's test, chi-square test, and logistic regression (odds ratio [OR]).
OUTCOMES
Evaluation of sexual function in postmenopausal women treated for BC.
RESULTS
Postmenopausal BC survivors showed poorer sexual function in the desire domain ( .002). No significant differences were observed between groups in the other FSFI domains and total score ( .05). Postmenopausal BC survivors had a higher prevalence of risk of sexual dysfunction (64.6% with a total score ≤26.5) compared with the control group (51.6%) ( .010). Adjusted risk analysis for age and time since menopause revealed a higher risk of sexual dysfunction in BC survivors compared with women without cancer (OR, 1.98; 95% confidence interval, 1.29-2.96; .007). Among BC survivors, the use of hormone therapy was associated with a higher risk of sexual dysfunction (OR, 3.46; 95% confidence interval, 1.59-7.51; .002).
CLINICAL IMPLICATIONS
Postmenopausal BC survivors should be regularly assessed before and throughout treatment to enable the early detection and diagnosis of sexual dysfunction.
STRENGTH AND LIMITATIONS
The main strength is that this study might contribute to a better understanding of sexual function in postmenopausal BC survivors compared with women without BC. The main limitation is that while the FSFI is a valid and reliable tool for the evaluation of female sexual function, it does not allow a comprehensive diagnosis of sexual dysfunction, as it is not applicable to partners.
CONCLUSION
Compared with postmenopausal women without BC, postmenopausal BC survivors face a higher risk of sexual dysfunction, especially when treated with adjuvant hormone therapy.
PubMed: 38948072
DOI: 10.1093/sexmed/qfae035 -
Cureus May 2024This report presents a case of ipsilateral foot drop and erectile dysfunction following the use of a traction table during intramedullary femur fixation. The patient, a...
This report presents a case of ipsilateral foot drop and erectile dysfunction following the use of a traction table during intramedullary femur fixation. The patient, a 39-year-old male, underwent surgery for a femur fracture using an intramedullary nail and was positioned on a traction table during the procedure. Post-operatively, he developed foot drop and erectile dysfunction. Neurological examination revealed peroneal nerve injury as the likely cause of the foot drop. The erectile dysfunction was attributed to pudendal nerve injury. Various treatment options were considered, including physical therapy for foot drop and phosphodiesterase inhibitors for erectile dysfunction. In conclusion, this case underscores the importance of recognizing and addressing potential complications associated with traction table use in orthopedic procedures, particularly concerning neurological sequelae and sexual dysfunction.
PubMed: 38947702
DOI: 10.7759/cureus.61316 -
Andrology Jul 2024Cardiovascular disease induces erectile dysfunction modulated by endothelial nitric oxide synthase enzyme and an impaired ejection fraction that restricts penis vascular...
Erectile dysfunction in cardiovascular patients: A prospective study of the eNOS gene T-786C, G894T, and INTRON variable number of the tandem repeat functional interaction.
BACKGROUND
Cardiovascular disease induces erectile dysfunction modulated by endothelial nitric oxide synthase enzyme and an impaired ejection fraction that restricts penis vascular congestion. However, the mechanisms regulating endothelial dysfunction are not understood.
OBJECTIVES
Exploring the functional impact of endothelial nitric oxide synthase genetic polymorphisms on erectile dysfunction and drug therapy optimization in high-risk cardiovascular disease patients.
MATERIALS AND METHODS
Patients with erectile dysfunction symptoms and candidates for andrology therapy were included (n = 112). Clinical data and endothelial nitric oxide synthase rs1799983 (G894T) and rs2070744 (T-786C), genotyped by fluorescence polarization assays, were registered. The 27-bp variable number of the tandem repeat polymorphism in intron 4 (intron4b/a) was analyzed by polymerase chain reaction-restriction fragment length polymorphism. Association analyses were run with the R-3.2.0 software.
RESULTS
A significant association between endothelial nitric oxide synthase 786-TT (p = 0.005) and the aa/ac of intron 4 variable number of the tandem repeat (p = 0.02) with higher erectile dysfunction susceptibility was observed in cardiovascular disease patients (60 ± 9 years, 66% severe erectile dysfunction, 56% ejection fraction). After 3-months of phosphodiesterase type 5 inhibitors, erectile dysfunction (International Index of Erectile Function, 50 ± 16 scores, the International Index of Erectile Function-Erectile Function 21 ± 10 scores, p < 0.001) and sexual quality of life (modified Sexual Life Quality Questionnaire 55 ± 23 scores, p < 0.001) had significantly improved. The cardiovascular ejection fraction was influenced positively with better sexual quality of life (0.1941), and also in the endothelial nitric oxide synthase G894-T allele (p = 0.076) carriers, which could merit future analyses. Erectile dysfunction was present as the primary clinical manifestation in 62% of cases, with cardiovascular disease occurring concurrently. Only former smokers and obese subjects debuted prior to cardiovascular disease than to erectile dysfunction.
CONCLUSIONS
Our study provides comprehensive insights into the functional interaction linking endothelial nitric oxide synthase gene polymorphisms, erectile function, and ejection fraction in high-risk cardiovascular disease patients. Future therapeutic strategies could target endothelial nitric oxide synthase activity by including lifestyle changes and epigenetic modulations.
PubMed: 38946584
DOI: 10.1111/andr.13671 -
Acta Dermatovenerologica Croatica : ADC Mar 2024Vulvar lichen sclerosus (VLS) is an inflammatory disease with numerous detrimental characteristics, namely its distressing symptoms, chronic course, sexual dysfunction,... (Review)
Review
Self-perceived Burden, Impairment in Quality of Life and Sexual Functioning, and Further Implications in Patients with Vulvar Lichen Sclerosus: A Narrative Review and Personal Experience.
Vulvar lichen sclerosus (VLS) is an inflammatory disease with numerous detrimental characteristics, namely its distressing symptoms, chronic course, sexual dysfunction, disfiguring anatomical changes, only partial response to treatment, and risk of evolution towards cancer. Interest in the burden of VLS on patient quality of life is fairly recent and only relatively few studies have addressed it so far. In order to focus on the impact of VLS in affected women, an electronic search was performed using the National Library of Medicine PubMed database. All the studies assessing VLS-related suffering and quality of life impairment published in the English literature were analyzed, including controlled studies, case series, and guidelines. The available literature shows that VLS can negatively affect patients' daily lives and significantly impair their physical and social activities, mental health, self-esteem, sexual functioning, and satisfaction. Health-related quality of life impairment among women with VLS is defined as moderate to severe, comparable to that of patients affected with other high-impact chronic skin disorders such as atopic dermatitis, psoriasis, and hidradenitis suppurativa. The symptoms are the main causes of the detrimental effect of VLS. By ameliorating symptoms, treatments are expected to highly improve patient quality of life, especially in case of complete clearance. Treating VLS has a beneficial impact on sexual dysfunction as well, even though dyspareunia appears less responsive than the other disease-related symptoms. In conclusion, the emotional and sexual dimensions are strongly impaired by VLS. Both in clinical practice and in clinical trials, quality of life and suffering should be taken into account and considered as strong conditioning factors in patient well-being. They should also become a measure of therapeutic response in treated patients.
Topics: Humans; Quality of Life; Female; Vulvar Lichen Sclerosus; Self Concept; Sexual Dysfunction, Physiological
PubMed: 38946189
DOI: No ID Found -
The Journal of Sexual Medicine Jun 2024
Topics: Humans; Female; Sexual Health; Male; Sexual Dysfunction, Physiological; Sexual Behavior
PubMed: 38945688
DOI: 10.1093/jsxmed/qdae050 -
The Journal of Sexual Medicine Jun 2024
Topics: Humans; Male; Nitric Oxide; Penis; Penile Erection; Erectile Dysfunction
PubMed: 38945686
DOI: 10.1093/jsxmed/qdae056 -
Radiography (London, England : 1995) Jun 2024Radiotherapy treatment for gynaecological cancer has significant negative effects on sexual wellness and pleasure (1-3). Patients undergoing radiotherapy for...
INTRODUCTION
Radiotherapy treatment for gynaecological cancer has significant negative effects on sexual wellness and pleasure (1-3). Patients undergoing radiotherapy for gynaecological cancers have more sexual dysfunction and experience more sexual and depressive symptoms than those who undergo surgery alone (4). The World Health Organization defines sexual health as a crucial part of health and wellbeing and recognizes the importance of positive and respectful approaches to sexuality, alongside safe and pleasurable sexual experiences free from violence and coercion (5).
METHODS
Taking a sex critical approach to sexual wellness and pleasure, this project aimed to support practitioners to have improved and impactful conversations with people receiving radiotherapy treatment for gynaecological cancers. A series of three professional development workshops were held to explore language, unpack assumptions and develop key competencies for practitioners. A fourth workshop involved co-development of resources for use by other practitioners.
RESULTS
The group united, sharing insights, learning, and developing practices through reflection developing critical awareness about damaging silences around sexual wellness and pleasure. Co-created resources included conversation cards and a poster.
CONCLUSION
The project aimed to build and extend research findings to develop practitioner skills in supporting sexual wellness and pleasure for people receiving gynae-radiotherapy. The study shows the benefits of discussing norms and harms associated with biomedically focused conversations in gynae-radiotherapy to acknowledge diversity and validate concerns about sexual wellbeing and pleasure.
IMPLICATIONS FOR PRACTICE
A sex critical approach to sexual wellness and pleasure should be considered a core principle of care for patients during their treatment for gynaecological cancers. Conversations are a key (free) resource within the practitioner-patient relationship that can address and improve patients' psychosocial wellbeing.
PubMed: 38944580
DOI: 10.1016/j.radi.2024.06.012 -
Surgical Endoscopy Jun 2024Pudendal nerve entrapment (PNE) is an underdiagnosed condition affecting a spectrum of pelvic functions, primarily pain, as outlined by Nantes diagnostic criteria.... (Review)
Review
BACKGROUND
Pudendal nerve entrapment (PNE) is an underdiagnosed condition affecting a spectrum of pelvic functions, primarily pain, as outlined by Nantes diagnostic criteria. Although numerous surgical decompression techniques are available for its management, consensus on efficacy and safety is lacking. This study conducts a systematic review and meta-analysis to assess the efficacy and complication rates of the main surgical decompression techniques.
METHODS
A comprehensive literature search was conducted in PubMed®, Embase®, Web of Science®, and ClinicalTrails.gov® on 19th of April 2023. Initial screening involved title and abstract evaluation, with subsequent retrieval and assessment of abstracts and full-text articles. Studies assessing pain outcomes before and after surgical release of the pudendal nerve were included. Studies without full-text, focusing on diagnostic methods or with outcomes relating solely to LUTS, digestive symptoms, or sexual dysfunction, were excluded. Risk of bias assessement was conducted using the National Institute of Health (NIH) Study Quality Assessment tool. Studies were categorized based on three surgical techniques: perineal, transgluteal, and laparoscopic transperitoneal. Random-effects meta-analysis with subgroup analysis were used. Meta-regression analyses were conducted to investigate the influence of covariates on the observed outcomes.
RESULTS
Nineteen studies, comprising 810 patients, were included. The overall significant pain relief rate across all techniques was estimated at 0.67 (95% CI 0.54 to 0.78) with considerable heterogeneity (I = 80.4%). Subgroup analysis revealed success rate for different techniques: laparoscopic (0.91, 95% CI 0.64 to 0.98), perineal (0.69, 95% CI 0.52 to 0.82), and transgluteal (0.50, 95% CI 0.37 to 0.63). The laparoscopic technique exhibited a complication rate of 16.0%. Meta-regression indicated that patient age and median follow-up significantly influenced outcomes.
CONCLUSION
While comparing surgical techniques is challenging, this meta-analysis highlights important outcome differences. The laparoscopic technique appears most promising for pain improvement. However, the study also emphasizes the need for further robust, long-term research due to significant heterogeneity across studies and prevelent risk of bias. PROSPERO database: CRD42023496564.
PubMed: 38942945
DOI: 10.1007/s00464-024-10990-w