Sexual Medicine最新文献

{"title":"Erectile dysfunction in primary care: practice patterns, barriers, and opportunities-narrative review.","authors":"Hossein Saadat, Michael L Pianezza, Dean Elterman","doi":"10.1093/sexmed/qfag033","DOIUrl":"10.1093/sexmed/qfag033","url":null,"abstract":"<p><strong>Introduction: </strong>Erectile dysfunction (ED) is a common but often underdiagnosed and undertreated condition. It affects 20% to 57.8% of men, with prevalence increasing with age. Despite established guidelines, inconsistencies in assessment and management persist in primary care.</p><p><strong>Objectives: </strong>To assess whether primary care ED management aligns with guidelines or reveals gaps causing underdiagnosis and undertreatment.</p><p><strong>Methods: </strong>Comprehensive literature search was conducted in PubMed, MEDLINE, TRIP, and Google Scholar for studies published between January 2001 and December 2024. Search terms included: ED, primary care, family physician, practice patterns, barriers, and management. Inclusion criteria were: studies focusing on primary healthcare providers' practice patterns in the assessment and management of ED; studies examining barriers faced by primary care providers; and studies involving specialized care if findings were transferable to primary care. Review articles, case reports and very small case series (<10 participants) were excluded. Data were extracted on participant characteristics, management strategies, practitioner attitudes, comfort levels, and barriers to care. Methodological quality was assessed using critical appraisal principles.</p><p><strong>Results: </strong>Eleven studies met criteria: Seven cross-sectional surveys, two qualitative focus groups and two referral audits. Active discussion of ED occurred in 10% to 38% of encounters. Key barriers included limited training, time constraints, embarrassment, and unclear clinical roles. Standardized tools/questionnaires were under-utilized. Referral audits showed 26% to 37% of patients could have been managed in primary care. Evidence demonstrated low confidence, knowledge gaps and inconsistent adherence to guidelines.</p><p><strong>Conclusion: </strong>ED is common but often under-assessed and under-managed in primary care. Studies show limited proactive patient-provider communication, inconsistent diagnostic approaches, poor adherence to guidelines, and frequent premature referrals. Failure to initiate discussions about ED further contributes to underdiagnosis and delayed recognition of related conditions such as cardiovascular and metabolic diseases.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag033"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of Thai version of female sexual function index for a Thai population.","authors":"Kwanchanok Homsangpradit, Chanakarn Charoenphan, Ornanong Chanajarunwit","doi":"10.1093/sexmed/qfag037","DOIUrl":"10.1093/sexmed/qfag037","url":null,"abstract":"<p><strong>Background: </strong>The lack of a valid and reliable Thai version of the Female Sexual Function Index (FSFI) applicable across relationship statuses and sexual orientations represents an important gap in Thailand.</p><p><strong>Aim: </strong>This study aimed to develop and validate a Thai version of the FSFI (FSFI-TH) for use among Thai women with varied marital statuses and sexual orientations.</p><p><strong>Methods: </strong>A total of 243 women aged 18-66 years (mean age 31.96 ± 9.78 years) participated in the study. The FSFI-TH was developed through forward translation, back translation, expert committee review, and a pilot study. Reliability was assessed using Cronbach's alpha coefficients and test-retest reliability with intraclass correlation coefficients. Validity was evaluated on aspects of content and construct validity.</p><p><strong>Outcomes: </strong>The primary outcomes were the psychometric reliability and validity of the FSFI-TH.</p><p><strong>Results: </strong>Item-Objective Congruence demonstrated good content validity, with linguistic refinements informed by the pilot study. The FSFI-TH showed strong internal consistency, with Cronbach's alpha values above .80 for the total scale and most domains. Construct validity assessed using principal component analysis revealed a five-factor structure, with the Desire and Arousal domains loading onto a single factor.</p><p><strong>Clinical implications: </strong>The FSFI-TH is a valid and reliable instrument for assessing sexual function among Thai women.</p><p><strong>Strengths and limitations: </strong>A key strength of this study is the inclusive applicability of the FSFI-TH across diverse relationship statuses and sexual orientations. However, the limited representation of postmenopausal women means that its applicability in this group should be interpreted with caution.</p><p><strong>Conclusion: </strong>The FSFI-TH is a valid and reliable instrument for measuring multidimensional aspects of sexual function in Thai women.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag037"},"PeriodicalIF":2.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding health care practitioners' criteria regarding the decision to treat men with premature ejaculation.","authors":"Paraskevi-Sofia Kirana, Zsuzsanna Mirnics, David L Rowland","doi":"10.1093/sexmed/qfag036","DOIUrl":"10.1093/sexmed/qfag036","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The extent to which health care practitioners (HCP) follow clinical practice guidelines (CPG) regarding diagnostic criteria can affect treatment outcomes, yet little is known about the factors HCPs take into consideration regarding their decision to treat men with symptoms of premature ejaculation (PE), a field where professional definitions vary considerably.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To describe HCP priorities regarding the use of PE diagnostic criteria in their decision-to-treat and, further, to assess whether HCP characteristics regarding specialization, professional identity, and experience impact decision-making priorities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 228 professionally-trained medical and mental health specialists responded to online and in-person invitations to complete a survey regarding their criteria and approaches for deciding whether to treat men with complaints of PE. Included were items pertaining to professional identity and experience, along with analyses of 5 items focusing on the use of professional guidelines for diagnosing PE, the role of ejaculatory latency (EL), ejaculatory control, and bother/distress, the method of assessing bother/distress, and understanding the role of anxiety in the diagnostic process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome: &lt;/strong&gt;HCPs' priorities regarding diagnostic criteria for PE, including whether professional identity, specialization, and clinical experience might have affected their priorities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the respondents, 42.5% identified with a mental health/therapy background; 57.5% with a medically-oriented background. Overall, 66.7% of HCPs used professional guidelines 70% of the time or more, with 33.3% using them half the time or less; 75% preferred either ISSM and DSM-5 guidelines. Furthermore, 61.6% indicated that the decision to treat did &lt;i&gt;not&lt;/i&gt; consider EL at all, as long as other PE symptoms were present; and only 13.6% used a 1 min threshold. Bother/Distress and anxiety were explored in-depth by 81.5% and 78.5 of respondents, respectively. HCP characteristics regarding professional identity, specialization in sexual health, and clinical experience with PE had only weak effects on diagnostic strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implication: &lt;/strong&gt;HCPs demonstrated a patient-centric rather than a criterion-centric approach regarding their decision to treat men with PE symptomology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;This study provided a rare in-depth view regarding the priorities of HCPs in their strategy for accepting patients for PE treatment. Limitations included a sample that was selective, not only due to the forums and networks from which they were drawn but also in terms of their Western geo-cultural origin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Consistent with a patient-centric approach, HCPs dealing with men with PE generally follow the spirit of the professional diagnostic guidelines although not ","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag036"},"PeriodicalIF":2.4,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of PEYRO-Q: a novel multidimensional patient-reported outcome measure for Peyronie's disease.","authors":"Andrea Cocci, Mattia Lo Re, Marta Pezzoli, Javier Romero-Otero, Juan Ignacio Martinez Salamanca, Nicolas Mourel-Journel, Paul Neuville, Antoine Faix, Sam Ward, Koenraad Van Renterghem, Georgios Hatzichristodoulou, Daniar Osmonov, David Ralph, Anna Cadenar, Marco Falcone, Giorgio Ivan Russo, Carlo Bettocchi, Giovanni E Cacciamani, Nicola Mondaini, Marta Skrodzka, Edoardo Pozzi, Andrea Salonia","doi":"10.1093/sexmed/qfag034","DOIUrl":"10.1093/sexmed/qfag034","url":null,"abstract":"<p><strong>Background: </strong>Peyronie's disease (PD) is a condition with significant physical, sexual, and psychological impact that is not fully captured by existing Patient-Reported Outcome (PRO) instruments.</p><p><strong>Aim: </strong>To develop and preliminarily validate the PEYROnie's disease Questionnaire (PEYRO-Q), a novel multidimensional PRO questionnaire designed to provide a comprehensive and inclusive assessment of PD.</p><p><strong>Methods: </strong>A prospective multicenter study was conducted between April and July 2025, enrolling 206 adult patients with PD. The PEYRO-Q, developed in accordance with COSMIN guidelines, includes 10 domains and 12 items assessing deformity severity and stability, pain, penile shortening, sexual function, erectile function, psychological distress, and sexual avoidance. Content validity was established through expert panel review. Internal consistency was evaluated using Cronbach's alpha, while test-retest reliability was assessed over a 2-week interval. Exploratory Factor Analysis (EFA) with promax rotation was performed to investigate the underlying structure.</p><p><strong>Outcomes: </strong>Primary outcomes were internal consistency, test-retest reliability, and factor structure of the PEYRO-Q.</p><p><strong>Results: </strong>The study population had a median age of 62 years, with most patients reporting moderate penile curvature and long-standing disease stability. The PEYRO-Q demonstrated excellent internal consistency (Cronbach's α = 0.90) and test-retest reliability (α = 0.89-1.00; Intraclass Correlation Coefficient, ICC up to 0.99). EFA supported a three-factor structure explaining 62.2% of total variance, corresponding to clinical/functional burden, disease perception and evolution, and psychological/behavioral impact. Moderate correlations between domains (eg, erectile aid use and psychological distress, r = 0.41) confirmed related but distinct constructs. The questionnaire allowed detailed and inclusive profiling of sexual function and psychological burden.</p><p><strong>Clinical implications: </strong>The PEYRO-Q offers a practical, inclusive, and comprehensive tool for assessing PD burden in both clinical practice and research settings.</p><p><strong>Strengths & limitations: </strong>Strengths include the multidimensional and inclusive design, strong psychometric performance, and multicenter prospective validation. Limitations include the predominantly Italian cohort, lack of longitudinal responsiveness data, absence of direct comparison with existing instruments, and limited clinical characterization such as plaque localization.</p><p><strong>Conclusion: </strong>The PEYRO-Q is a reliable and clinically relevant PRO instrument for PD, warranting further validation to confirm responsiveness and cross-cultural applicability.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag034"},"PeriodicalIF":2.4,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13181750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial activation and stress index is independently associated with arteriogenic erectile dysfunction: a cross-sectional study.","authors":"Chuan Xu, Yuyang Zhang, Xu Wu, Guodong Liu, Hao Geng, Dongdong Tang, Xiansheng Zhang","doi":"10.1093/sexmed/qfag035","DOIUrl":"10.1093/sexmed/qfag035","url":null,"abstract":"<p><strong>Introduction: </strong>Arteriogenic erectile dysfunction (AED) is the vascular subtype of erectile dysfunction and is closely linked to endothelial dysfunction. The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase (LDH), creatinine, and platelet count, has been recognized as a surrogate marker of endothelial injury in several vascular-related conditions. The aim of this study is to explore the association between EASIX and AED.</p><p><strong>Methods: </strong>In this cross-sectional study, 193 men were enrolled, including 94 patients diagnosed with AED and 99 controls. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5), nocturnal penile tumescence and rigidity, and color duplex Doppler ultrasonography. EASIX was calculated as LDH × creatinine/platelet count. Multivariate logistic regression analysis was performed to evaluate the association between EASIX and AED after adjusting for potential confounders. Receiver operating characteristic (ROC) curve analysis was conducted to assess diagnostic performance.</p><p><strong>Results: </strong>EASIX levels were significantly higher in the AED group compared to controls (1.13 [0.72-1.55] vs. 0.79 [0.58-1.01], <i>P</i> < .001). In multivariate logistic regression analysis adjusting for age, body mass index, smoking status, metabolic parameters, testosterone levels, and comorbidities, EASIX remained independently associated with AED (OR 1.339, 95% CI 1.239-1.448, <i>P</i> < .001). When analyzed by quartiles, participants in the highest EASIX quartile had a significantly increased likelihood of AED compared with the lowest quartile (<i>P</i> < .001). A significant negative correlation was observed between EASIX and IIEF-5 score (r = -0.291, <i>P</i> = .004). ROC analysis demonstrated that EASIX had moderate diagnostic performance for identifying AED (AUC 0.728, 95% CI 0.656-0.799), which was higher than LDH (AUC 0.680) and creatinine (AUC 0.689).</p><p><strong>Conclusion: </strong>EASIX was significantly associated with AED and demonstrated moderate diagnostic performance. Prospective studies are warranted to validate its clinical applicability.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag035"},"PeriodicalIF":2.4,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13181756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Not enough\" vs. \"never perfect\": a qualitative analysis of penile enlargement surgery intentions in heterosexual and homosexual men.","authors":"Boqiang Zhang, Tie Li, Bin Lei","doi":"10.1093/sexmed/qfag024","DOIUrl":"10.1093/sexmed/qfag024","url":null,"abstract":"<p><strong>Background: </strong>Psychological motivations for penile enlargement surgery (PES) remain understudied, particularly across different sexual orientations.</p><p><strong>Aim: </strong>This study explores the psychosocial drivers of PES intentions among heterosexual and homosexual cisgender men.</p><p><strong>Methods: </strong>Twenty-four cisgender men (12 heterosexual, 12 homosexual) who had undergone or recently consulted for PES were interviewed using semi-structured protocols. Data were analyzed via thematic analysis, guided by the Push-Pull Theoretical Model. Push factors refer to internal pressures that motivate individuals to seek PES, while pull factors involve external influences.</p><p><strong>Outcomes: </strong>Distinct motivational pathways toward PES were identified based on sexual orientation.</p><p><strong>Results: </strong>Two shared pull factors, physiological safety concerns and social exposure risks, were evident across groups. However, push factors varied: heterosexual men emphasized partner-driven pressures such as sexual performance anxiety, masculine adequacy concerns, and partner-related comparison. Homosexual men highlighted community-driven influences, including body image anxiety, perfectionistic enhancement culture, and peer-based comparison norms. These findings reveal two diverging logics: relational adequacy versus visual optimization.</p><p><strong>Clinical translation: </strong>Tailored psychological screening and counseling strategies should consider the influence of sexual orientation and underlying motivational logic.</p><p><strong>Strengths and limitations: </strong>This study addresses a gap in male body image and LGBTQ+ surgical intention literature. Limitations include a modest, urban-leaning sample and a focus on intention rather than postoperative outcomes.</p><p><strong>Conclusion: </strong>Sexual orientation significantly shapes men's motivations for PES, with heterosexual men driven by partner-related anxiety and homosexual men influenced by community-based ideals. Understanding these distinctions is critical for ethical and effective clinical intervention.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag024"},"PeriodicalIF":2.4,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual health outcomes and biomedical prevention behaviors among men who have sex with men engaging in fisting.","authors":"Tom Carpino, Mark McCormack, Liam Wignall","doi":"10.1093/sexmed/qfag032","DOIUrl":"10.1093/sexmed/qfag032","url":null,"abstract":"<p><strong>Background: </strong>Anal fisting is understudied as a sexual practice despite being a popular activity in kink sexual communities that has potentially significant implications for the transmission of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs).</p><p><strong>Aim: </strong>This study explores the sexual health outcomes and biomedical preventative health behaviors of men who have sex with men (MSM) who engage in fisting (MSMF), examining fisting role (top, bottom, or versatile) and considering HIV pre-exposure prophylaxis (PrEP) and doxycycline post exposure prophylaxis (DoxyPEP); and comparing these to MSM who engage in kink but who do not engage in fisting (MSMK).</p><p><strong>Methods: </strong>A total of 1012 users of a website for MSM seeking kink completed an online survey in July 2024. Alongside sociodemographic factors and health experiences, the survey assessed respondents' experience with fisting and biomedical sexual health prevention practices. Bivariate analyses were conducted between MSMF and MSMK.</p><p><strong>Outcomes: </strong>Understanding the sexual health outcomes and biomedical preventative behaviors of MSMF and MSMK.</p><p><strong>Results: </strong>Within the sample, past-year fisting engagement was 33.5% (<i>n</i> = 339). Human immunodeficiency virus prevalence was higher among MSMF than MSMK (22.1% vs 8.5%); HIV incidence was 5.5% among MSMF compared to 2.7% among MSMK. Biomedical prevention utilization also varied: among HIV-negative participants, PrEP use in the past 12 months was 64.3% among MSMF vs 31.1% among MSMK. Past-year STI testing was more common among MSMF than MSMK (85.7% vs 65.2%, <i>P</i> < .01). MSMF were also more likely to use DoxyPEP (22.1% vs 7.1%, <i>P</i> < .01) and reported greater interest in future DoxyPEP utilization (70.2% vs 61.2%, <i>P</i> < .01).</p><p><strong>Clinical translation: </strong>Public health prevention, education efforts, and clinical guidelines should recognize fisting as a high-impact activity that can influence the syndemics of HIV and other STIs.</p><p><strong>Strengths and limitations: </strong>Fisting is an understudied activity and findings from this study are from the largest data set on MSMF, with data collected after the introduction of HIV pre-exposure prophylaxis and DoxyPEP. The study is cross-sectional, limiting the ability to establish causal relationships, and it is based on self-report data.</p><p><strong>Conclusion: </strong>This study highlights significant group differences in HIV prevalence and incidence, PrEP and DoxyPEP use, and STI testing, suggesting that MSMF may be at higher risk for HIV and other STI acquisition, yet are simultaneously more connected to prevention and care services.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag032"},"PeriodicalIF":2.4,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peyronie's disease in Spain: a prospective study.","authors":"François Peinado-Ibarra, Borja García-Gómez, Manuel Alonso-Isa, Carlos Simón-Rodríguez, Juan García-Cardoso, Josep Torremadé-Barreda, Félix Campos-Juanatey, Rodrigo García-Baquero, Mario Álvarez-Maestro, Esaú Fernández-Pascual, Juan Ignacio Martínez-Salamanca, José Martínez-Jabaloyas, Mariano Rosselló-Gayá, Venancio Chantada, Francisco Cáceres-Rodríguez, Joaquim Sarquella, Eduard Ruiz-Castañé, Enrique Lledó, Manuel Fernández-Arjona, Luis Fiter, José Ramón Cortiñas, Javier Romero-Otero","doi":"10.1093/sexmed/qfag006","DOIUrl":"10.1093/sexmed/qfag006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Peyronie's disease (PD) research has limitations due to heterogeneity in time of presentation, severity, deformity characteristics, and associated conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To provide further insight into clinical characteristics of patients, PD treatments and patient perceptions of outcomes in clinical practice in Spain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 601 men from 15 Spanish andrology centers were included in this observational, prospective multicenter cohort study. Enrolled patients (aged ≥18 years with confirmed PD diagnosis, naïve to specific therapy and without congenital penile curvature) were evaluated by detailed medical history and physical examination including plaque characteristics and curvature. Sexual function was assessed by the International Index of Erectile Function-5 and the Peyronie's Disease Questionnaire. The characteristics of treatment used for PD as well as patient subjective outcomes were analyzed in cases involving curvature assessments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The primary outcome was demographic and clinical characterization of PD patients; secondary outcomes included PD treatment used in clinical practice and patient satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The median age (interquartile range, IQR) was 57 (49.0-63.0) years with a median duration of PD of 12 (6.0-18.0) months. There were 246 (41.6%) patients in the acute phase of the disease. The most common nonsurgical treatments were traction therapy (36.0%), collagenase injections (29.3%), and daily tadalafil (22.7%). The most frequently used surgical technique was penile plication (62.3%) followed by grafting and plaque incision (34.0%). The median Peyronie's Disease Questionnaire and International Index of Erectile Function-5 scores were 19.0 (12.0-28.0) and 18.0 (13.0-22.5), respectively. Curvature assessment was performed in 331 patients, using the Kelami test in 316 (96.0%) or intracavernous injection of a vasoactive agent in 143 (45.5%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;Many patients are misdiagnosed, and treatment may take a long time; understanding the profile of PD, as well as satisfaction with real-life treatment outcomes, can aid clinicians in selecting more appropriate treatments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;As a free collaborative registry, not all patient data were collected, and therefore not all data were available throughout the study, and a longer follow-up period would have given us more information to compare the pretreatment and post-treatment situations. However, this study provides a description of clinical characteristics of a large real-world cohort of men with PD from a considerable number of sites nationwide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We found a wide variety of treatments used in clinical practice, including those with poor evidence of efficacy, which suggests the need for a better understanding of PD for developing the most","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag006"},"PeriodicalIF":2.4,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daily tadalafil administration improves cardiac autonomic regulation in men with non-organic erectile dysfunction: a prospective heart rate variability study.","authors":"Görkem Yıldız, Tolga Kunak","doi":"10.1093/sexmed/qfag029","DOIUrl":"10.1093/sexmed/qfag029","url":null,"abstract":"<p><strong>Background: </strong>Non-organic ED patients have cardiac autonomic dysfunction measurable by heart rate variability (HRV). Tadalafil reduces cardiovascular mortality, but exact mechanisms remain unclear.</p><p><strong>Aim: </strong>To evaluate daily tadalafil effects on cardiac autonomic regulation in non-organic ED and identify clinical predictors of HRV response.</p><p><strong>Methods: </strong>In this prospective study, 82 men with non-organic ED (mean age 46.8 ± 5.0 years) received tadalafil 5-10 mg daily. Assessment included International Index of Erectile Function-Erectile Function (IIEF-EF), echocardiography, laboratory tests, and 24-hour Holter ECG. HRV was analyzed via time-domain (standard deviation of NN intervals [SDNN], root mean square of successive differences [RMSSD]) and frequency-domain (low-frequency power [LF], high-frequency power [HF], LF/HF ratio) parameters. Post-treatment recordings were blindly evaluated. Early response to tadalafil was defined as achievement in the severity-adjusted Minimal Clinically Important Difference (MCID) in IIEF-EF or final IIEF-EF score ≥26.</p><p><strong>Outcomes: </strong>Primary: ΔSDNN. Secondary: ΔHF power, ΔLF/HF ratio.</p><p><strong>Results: </strong>IIEF-EF improved significantly (15 to 23, <i>P</i> < .001) and 74.4% were early responders (<i>n</i> = 61). In the overall cohort, SDNN increased (42.39 to 52.39 ms, <i>P</i> < .01), HF power increased (267.86 to 294.44 ms²,<i>P</i> < .001), and LF/HF ratio decreased (2.78 to 2.31, <i>P</i> < .01). Both groups showed HRV improvements without between-group differences (<i>P</i> > .05), suggesting autonomic modulation independent of erectile response. Multivariable regression: diabetes negatively predicted SDNN improvement; higher testosterone, higher baseline IIEF-EF score, and lower BMI predicted greater HF enhancement. Only 1.1% of patients discontinued the treatment (due to dyspepsia).</p><p><strong>Clinical implications: </strong>Daily tadalafil treatment may enhance parasympathetic modulation in men with non-organic ED regardless of clinical erectile improvement, suggesting a potential mechanism for its observed cardiovascular benefits.</p><p><strong>Strengths and limitations: </strong>Strengths include rigorous, blinded Holter assessment. Limitations include the lack of a placebo control, short follow-up (28 days), and a small non-responder subgroup.</p><p><strong>Conclusion: </strong>Daily tadalafil enhanced parasympathetic modulation and reduced sympathovagal imbalance independently of erectile improvement.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag029"},"PeriodicalIF":2.4,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of the traditional Chinese medicine chaihu guizhi ganjiang decoction combined with wendan decoction in the treatment of premature ejaculation: an open-label retrospective cohort study on Chinese men.","authors":"Sijia Sun, Zhou Zhao, Shuyi Huang, Li Ling, Dawei Gao, Wenxiu Zhang, Baofang Jin, Dalin Sun","doi":"10.1093/sexmed/qfag031","DOIUrl":"10.1093/sexmed/qfag031","url":null,"abstract":"<p><strong>Background: </strong>Chaihu Guizhi Ganjiang Decoction combined with Wendan Decoction (CGGWD) is used clinically to treat liver depression and spleen deficiency-related premature ejaculation (PE), while clinical evidence and safety are still limited.</p><p><strong>Aim: </strong>To assess the safety and efficacy of the Traditional Chinese Medicine (TCM) formula, CGGWD, in comparison with dapoxetine for PE.</p><p><strong>Methods: </strong>This retrospective study included male PE patients with liver depression and spleen deficiency treated at a prominent academic medical center (November 2021-March 2025). Patients completed a 4-week regimen, with sexual function and systemic symptoms evaluated before and after treatment.</p><p><strong>Outcomes: </strong>Outcomes were determined based on assessment of intravaginal ejaculatory latency time (IELT), Premature Ejaculation Diagnostic Tool (PEDT), Traditional Chinese Medicine Quality of Life Evaluation Scale (CQ-11D), Global Rating of Sexual Satisfaction (GRISS), and Clinical General Impression of Change (CGIC).</p><p><strong>Results: </strong>A total of 226 patients were enrolled in the study, including 165 in the CGGWD group and 61 in the dapoxetine group. After 4 weeks of treatment, the dapoxetine group showed an increase in IELT from 1.5 to 3.0 min, a decrease in PEDT scores from 13 to 9, and a reduction in GRISS scores from 37 to 28 (all <i>P</i> < .05), with a CGIC score of 2. In the CGGWD group, IELT increased from 1.5 to 3.5 min, PEDT scores decreased from 12 to 9.5, and GRISS scores dropped from 36 to 26.5 (all <i>P</i> < .05), also yielding a CGIC score of 2. No significant differences were observed between the 2 groups regarding changes in IELT, PEDT, GRISS, or overall clinical impression (<i>P</i> = .978, .567, .883, and .993, respectively). However, regarding the CQ-11D score, the dapoxetine group remained stable at 24 points, whereas the CGGWD group decreased significantly from 24 to 19 points (<i>P</i> < .05). Furthermore, the incidence of adverse events was significantly lower in the CGGWD group compared to the dapoxetine group (7 cases vs. 29 cases, <i>P</i> < .05).</p><p><strong>Clinical implications: </strong>The TCM formulation, CGGWD, demonstrates both safety and efficacy in the management of PE.</p><p><strong>Strengths and limitations: </strong>This study offers the initial clinical validation of CGGWD for PE but is limited by population selection constraints, potential information bias, and unobserved confounding factors.</p><p><strong>Conclusion: </strong>For Chinese men with liver depression and spleen deficiency PE, CGGWD matches dapoxetine in efficacy but offers superior safety and systemic symptom relief, serving as a safe, effective alternative.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag031"},"PeriodicalIF":2.4,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}