Sexual Medicine最新文献

{"title":"Systematic review and meta-analysis of risk factors for erectile dysfunction after stroke: a Mendelian randomization approach.","authors":"Cheng Su, Si Chen, Zhong Tang, Haifeng Chang, Ming Chu","doi":"10.1093/sexmed/qfag027","DOIUrl":"10.1093/sexmed/qfag027","url":null,"abstract":"<p><strong>Background: </strong>Erectile dysfunction (ED) is a common yet underrecognized complication in male stroke survivors, severely impairing quality of life and interpersonal relationships. Observational studies on post-stroke ED risk factors are limited by confounding and reverse causation, leaving causal determinants unclear.</p><p><strong>Aim: </strong>This study integrated systematic review, meta-analysis, and two-sample Mendelian randomization (MR) to comprehensively identify and validate causal risk factors for post-stroke ED, addressing critical gaps in causal inference for this clinically relevant complication.</p><p><strong>Methods: </strong>For the systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Library, and Web of Science (inception to March 2025) for observational studies investigating associations between risk factors and post-stroke ED. We pooled effect sizes using random-effects models (R version 4.3.2, metafor package v4.4-0) and assessed heterogeneity via the I<sup>2</sup> statistic. For MR, we used genome-wide association study summary statistics from public consortia (UK Biobank, FinnGen, MEGASTROKE; European ancestry only) to select genetic instrumental variables for candidate risk factors, applying inverse-variance weighted, MR-Egger, weighted median, MR-PRESSO, and multivariable MR methods to infer causality and assess pleiotropy. All statistical analyses were conducted in R version 4.3.2, with MR analyses implemented via the TwoSampleMR package v0.5.6 and MR-PRESSO package v1.0.</p><p><strong>Outcomes: </strong>Age, hypertension, and diabetes were significantly associated with post-stroke ED.</p><p><strong>Results: </strong>A total of 123 studies were initially identified through the database search. After screening the titles and abstracts, 47 studies were selected for full-text review. Finally, 21 studies met the inclusion criteria and were included in the systematic review. Age (pooled OR = 1.05, 95% CI: 1.03-1.07, <i>P</i> < .001; I<sup>2</sup> = 62%), hypertension (OR = 1.68, 95% CI: 1.42-1.98, <i>P</i> < .001; I<sup>2</sup> = 45%), and diabetes (OR = 1.82, 95% CI: 1.55-2.14, <i>P</i> < .001; I<sup>2</sup> = 58%) were significantly associated with post-stroke ED. Funnel plot analysis and Egger's test revealed no significant publication bias for the meta-analyses of age (Egger's <i>P</i> = .22), hypertension (Egger's <i>P</i> = .35), and diabetes (Egger's <i>P</i> = .19). MR analysis (12 valid IVs; 16 initially identified SNPs were excluded due to linkage disequilibrium (r<sup>2</sup> > 0.01) and confounder associations) confirmed causal relationships: hypertension (IVW beta = 0.32, <i>P</i> = .002), diabetes (IVW beta = 0.41, <i>P</i> < .001), and age (IVW beta = 0.18, <i>P</i> = .04). No significant pleiotropy (MR-Egger intercept <i>P</i> > .05; MR-PRESSO global test <i>P</i> > .05 for all exposures) or heterogeneity (Cochran Q test <i>P</i> > .05) was detected. Multivariable MR analys","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag027"},"PeriodicalIF":2.4,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869402","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":"Investigating the impact of ALI on erectile dysfunction in American men: a cross-sectional study using NHANES data.","authors":"Shengyin He, Simin Wang, Yi Dai, Luo Yang","doi":"10.1093/sexmed/qfag030","DOIUrl":"10.1093/sexmed/qfag030","url":null,"abstract":"<p><strong>Background: </strong>Inflammation and nutritional status may contribute to erectile dysfunction (ED), but the association between the Advanced Lung Cancer Inflammation Index (ALI) and ED has not been well characterized.</p><p><strong>Aim: </strong>To examine the association between ALI and ED in US men and to explore the within-sample discriminatory ability of ALI for ED status.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of 3735 men from the National Health and Nutrition Examination Survey (NHANES) 2001-2004. ALI was calculated from body mass index, serum albumin, and the neutrophil-to-lymphocyte ratio. Survey-weighted multivariable logistic regression was used to assess the association between ALI and ED, with subgroup analyses to explore potential effect modification. Nonlinearity was evaluated using smoothed curve fitting and a 2-piece linear regression model. Within-sample discrimination was descriptively assessed using survey-weighted receiver operating characteristic curve analysis in randomly split subsets from the same dataset.</p><p><strong>Outcomes: </strong>Outcomes were the association between ALI and ED and the within-sample discriminatory ability of ALI for ED status.</p><p><strong>Results: </strong>The weighted prevalence of ED was 28.2%. Higher ALI was associated with lower odds of ED. In continuous analyses, ALI remained inversely associated with ED after multivariable adjustment (odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.21-0.52; <i>P</i> < .001), and the association persisted in further adjusted models (OR = 0.38, 95% CI: 0.19-0.74; <i>P</i> = .014; OR = 0.46, 95% CI: 0.25-0.84; <i>P</i> = .033). A nonlinear association was observed, with an inflection point at ln-ALI = 1.912. Below this threshold, ln-ALI was inversely associated with ED (OR = 0.21, 95% CI: 0.11-0.39; <i>P</i> < .001), whereas no statistically significant association was observed above the threshold (OR = 2.51, 95% CI: 0.72-8.80; <i>P</i> = .150). The area under the curve was 0.85 (95% CI: 0.83-0.87) in the training subset and 0.83 (95% CI: 0.81-0.86) in the validation subset.</p><p><strong>Clinical implications: </strong>ALI may serve as an accessible correlate of ED status in population-based settings; however, its predictive utility requires longitudinal validation.</p><p><strong>Strengths and limitations: </strong>Strengths include the use of a nationally representative sample and survey-weighted analyses incorporating nonlinear modeling and discrimination assessment. Limitations include the cross-sectional design, self-reported ED, possible residual confounding, and the use of NHANES 2001-2004 data, which may limit direct applicability to contemporary populations.</p><p><strong>Conclusion: </strong>Higher ALI was associated with lower odds of ED among US men. The observed receiver operating characteristic findings reflect within-sample discrimination only and require cautious interpretation.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 4","pages":"qfag030"},"PeriodicalIF":2.4,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869425","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 of a clinical scoring system to predict response to low-intensity shock wave therapy in clinically diagnosed vasculogenic erectile dysfunction: a prospective, non-randomized, single-arm, interventional study.","authors":"Hakan Anıl, Ali Yıldız, Ayşe Nur Topuz, Mehmet Vehbi Kayra, Sinan Sözütok, Adem Altunkol, Ergün Alma, Mustafa Topuz, Yıldırım Bayazıt","doi":"10.1093/sexmed/qfag025","DOIUrl":"10.1093/sexmed/qfag025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Erectile dysfunction (ED) is a prevalent condition, with vasculogenic ED being the most common subtype, primarily related to endothelial dysfunction and cardiovascular risk factors. Low-intensity extracorporeal shock wave therapy (Li-ESWT) has emerged as a promising non-invasive treatment option. However, predictors of treatment response remain poorly defined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To identify clinical and vascular predictors of treatment success following Li-ESWT in patients with vasculogenic ED and to develop a novel, practical, and non-invasive scoring system to predict therapeutic response.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective study included 219 men aged 18-80 years with vasculogenic ED between January 2024 and January 2025. All patients underwent Li-ESWT (18 000 pulses over 3 weeks). Clinical and vascular parameters, including age, ED duration, body mass index, presence of cardiovascular risk factors, diabetes mellitus (DM), carotid intima-media thickness (cIMT), flow-mediated dilation rate (FMD), and prior phosphodiesterase type 5 inhibitor (PDE5i) response, were recorded. Treatment success at 6 months was defined as an increase of ≥1 point in the erection hardness score or ≥5 points in the International Index of Erectile Function-5 EF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The primary outcome was treatment success at 6 months after Li-ESWT. Secondary outcomes included the development and validation of a predictive scoring system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Treatment success rate was 66.2% (145/219). Independent predictors of treatment success were absence of DM (odds ratio [OR] = 2.67, &lt;i&gt;P&lt;/i&gt; = .012), ED duration &lt;36 months (OR = 2.23, &lt;i&gt;P&lt;/i&gt; = .026), cIMT &lt;0.8 mm (OR = 2.04, &lt;i&gt;P&lt;/i&gt; = .042), prior PDE5i benefit (OR = 2.47, &lt;i&gt;P&lt;/i&gt; = .016), FMD ≥5% (OR = 2.57, &lt;i&gt;P&lt;/i&gt; = .012), age &lt;65 years (OR = 2.28, &lt;i&gt;P&lt;/i&gt; = .032), and presence of cardiovascular risk factors (OR = 2.23, &lt;i&gt;P&lt;/i&gt; = .036). A scoring system incorporating these 7 variables achieved an area under the curve of 0.819 (95% confidence interval [CI] 0.762-0.877). Using a cut-off of 4.5 points, the sensitivity was 73% and the specificity was 77% (&lt;i&gt;P&lt;/i&gt; &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;This scoring system may help clinicians identify patients most likely to benefit from Li-ESWT, optimize patient selection, and improve individualized treatment strategies in vasculogenic ED.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths & limitations: &lt;/strong&gt;The study is strengthened by its prospective design, relatively large sample size, and inclusion of vascular function parameters (FMD, cIMT). Limitations include the lack of external validation and the absence of penile Doppler ultrasound confirmation in all patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study identified key demographic and vascular predictors of Li-ESWT response and introduces a novel, non-invasive clinical scoring system with strong predictive accuracy. This too","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 3","pages":"qfag025"},"PeriodicalIF":2.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842519","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":"Efficacy and safety of collagenase <i>Clostridium histolyticum</i> in men who have sex with men.","authors":"Jake A Miller, Muhammed A Moukhtar Hammad, Lucas G C R de Amorim, Laura Angulo-Llanos, Helen L Bernie, Jeremiah R Dallmer, Grace M Garrett, Gal S Grunhaus, Beatriz S Hernandez, Tung-Chin Hsieh, Bruce R Kava, Mohit Khera, Thomas A Masterson, Vi Nguyen, Thairo A Pereira, Daniela O Rendon, Max D Sandler, Dan V Tran, Faysal A Yafi","doi":"10.1093/sexmed/qfag028","DOIUrl":"10.1093/sexmed/qfag028","url":null,"abstract":"<p><strong>Background: </strong>While prior studies have demonstrated that men who have sex with men (MSM) may disproportionately experience distress due to Peyronie's disease (PD), limited evidence exists regarding the outcomes of these men when treated with collagenase <i>Clostridium histolyticum</i> (CCH) injections.</p><p><strong>Aim: </strong>To investigate the outcomes of MSM undergoing CCH injections for PD.</p><p><strong>Methods: </strong>A retrospective analysis was performed for 790 patients undergoing CCH injections for PD at 5 academic centers within the United States, including data pertaining to demographic information, sexual orientation, penile curvature characteristics, treatment characteristics, and treatment-related outcomes.</p><p><strong>Outcomes: </strong>The impact of sexual orientation on treatment-related satisfaction, efficacy, and complication rates.</p><p><strong>Results: </strong>Of the 399 patients meeting the final inclusion criteria, 6.51% (<i>N</i> = 26) self-identified as MSM. The median absolute reduction in penile curvature was 15 degrees (interquartile range: 5-20 degrees), with 70.0% (<i>n</i> = 206) reporting feeling satisfied with their treatment. Men who have sex with men patients were noted to have higher rates of corporal fracture following treatment (11.5% vs. 1.36%, <i>P</i> = .011), though sexual orientation was not associated with statistically significant changes in treatment satisfaction, penile curvature reduction, or rates of complications requiring operative intervention.</p><p><strong>Clinical implications: </strong>An improved understanding of the outcomes of MSM receiving CCH injections may improve counseling regarding and management of PD for a vulnerable population of patients.</p><p><strong>Strengths and limitations: </strong>This study offers some of the first data examining outcomes for PD in MSM patients. However, the retrospective and multicohort nature of the study, as well as its small cohort size, may result in impactful bias.</p><p><strong>Conclusion: </strong>In our trial, MSM patients receiving CCH were with similar treatment efficacy, treatment satisfaction, and rates of operative complications, suggesting that CCH is an efficacious and safe treatment for MSM patients.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 3","pages":"qfag028"},"PeriodicalIF":2.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842475","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":"Correlatıonal effect of sexual myths on sexual qualıty of lıfe in pregnancy: a cross-sectıonal study.","authors":"Gizem Citak, Tugce Gorucu","doi":"10.1093/sexmed/qfag023","DOIUrl":"10.1093/sexmed/qfag023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sexual myths during pregnancy can shape women's beliefs about sexuality, increase anxiety, and reduce sexual satisfaction, thereby negatively affecting sexual quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study examined the relationship between sexual myths prevalent during pregnancy and women's sexual quality of life using a cross-sectional, correlational design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Conducted between January and April 2025, this study included 332 pregnant women attending the obstetrics outpatient clinic and wards of a university hospital. Data were collected through face-to-face interviews using a Personal Information Form, the Sexual Myths Scale, and the Sexual Quality of Life Scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The primary outcome was sexual quality of life, assessed in relation to the level of endorsement of sexual myths during pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sexual myths varied significantly according to age, education, occupation, spouse's occupation, marital duration, and pregnancy planning (&lt;i&gt;P&lt;/i&gt; &lt; .05). Sexual quality of life was also significantly associated with these variables and with pre-pregnancy pain during intercourse (&lt;i&gt;P&lt;/i&gt; &lt; .05). A strong negative correlation was found between overall sexual myths and sexual quality of life. While the \"sexual orientation\" subscale showed a positive correlation, the subscales of gender, age and sexuality, sexual behavior, masturbation, and sexual violence were negatively correlated with sexual quality of life (&lt;i&gt;P&lt;/i&gt; &lt; .005).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;Midwives should provide evidence-based education and counseling to address sexual myths, thereby supporting healthier sexual experiences and improving well-being during pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;This study is among the first to systematically examine this relationship; however, its cross-sectional design limits causal inference, and the findings may not be generalizable beyond the study population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Integrating sexual health education into routine prenatal care may enhance women's sexual quality of life during pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlight: &lt;/strong&gt;This study is the first in the Central Black Sea Region of Türkiye to examine the impact of sexual myths on pregnant women's sexual quality of life.Sexual myths were found to be &lt;b&gt;negatively correlated&lt;/b&gt; with sexual quality of life, indicating that false beliefs increase anxiety and reduce satisfaction during pregnancy.Sociodemographic factors such as &lt;b&gt;age, education, occupation, marital duration, and pregnancy planning&lt;/b&gt; significantly influenced both sexual myths and sexual quality of life.The findings emphasize the importance of &lt;b&gt;evidence-based sexual health education and counseling&lt;/b&gt; by midwives to dispel myths and promote healthier sexual experiences during pregnancy.Integrating sexual health education into prenatal care can","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 3","pages":"qfag023"},"PeriodicalIF":2.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780146","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":"A retrospective-present-day analysis on acquired premature ejaculation.","authors":"Stanley E Althof, David L Rowland, Philippe Cote-Leger","doi":"10.1093/sexmed/qfag020","DOIUrl":"10.1093/sexmed/qfag020","url":null,"abstract":"<p><strong>Background: </strong>Men with acquired premature ejaculation (APE) develop the condition after a period of normal ejaculatory function. This is the first article to focus on the developmental course of APE.</p><p><strong>Aim: </strong>To retrospectively detail the developmental course of foreplay duration, ejaculatory latencies over multiple partnered sexual activities, and changes in PE symptomology in men with APE from age of sexual debut to the present.</p><p><strong>Methods: </strong>From March 2024 through February 2025, 411 volunteers, aged 18-80 years, responded to an online sexual health and behavior questionnaire posted on multiple social media platforms. These men also met the preliminary qualifying criteria of having PE based on responses to an abridged Premature Ejaculation Diagnostic Tool (PEDT) and meeting other inclusion criteria. Of these, 77 men (mean age = 40 years, range 19-66) met the criterion of having APE as their symptoms developed only after an extended period of normal ejaculatory control.</p><p><strong>Outcome: </strong>Significant changes in partnered ejaculatory latencies from the men's sexual debut to the present are reported.</p><p><strong>Results: </strong>Sexual debut typically occurred around age 19, with PE first reported on average at age 31. Overall, vaginal and anal ejaculatory latencies (EL) at sexual debut were 5.98, 5.01, and 4.7 min, respectively, but the overall, vaginal and anal ELs at the present time were 1.86, 0.97, and 0.75 min (<i>P</i> < .001). Foreplay duration of approximately 12-13 min remained unchanged over the lifespan despite large decreases in ELs. Nearly 34% of the participants reported that their symptomology continued to worsen after it first appeared. <b>Clinical Implications</b>: The data highlight the major differences between present-day partnered sexual behaviors and time spent in foreplay and masturbation compared to sexual activities earlier in life. It suggests that under specific circumstances men have the ability to delay ejaculation.</p><p><strong>Strengths and limitations: </strong>The strength of this article is its developmental perspective in terms of examining the men's past and present sexual behaviors. The major limitations are the retrospective-present-day methodology and recruitment via social media, which could lead to sample biases and reliance on men's recall.</p><p><strong>Conclusions: </strong>This study both confirms the presumed developmental course of ELs in men with APE and adds new insights regarding these men's sexual experiences, including the comparability of their ELs with men having lifelong PE, the relationship between ELs and types of partnered sexual activity, and the lack of association between foreplay duration and EL. It also documents that one-third of men with APE experienced continued deterioration of their condition with age.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 3","pages":"qfag020"},"PeriodicalIF":2.4,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729860","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":"Decreased sexual desire and distress symptoms: an analysis among urban Chinese women.","authors":"Lan Luo, Tong Fu, Jingjing Huang, Huafang Li","doi":"10.1093/sexmed/qfag018","DOIUrl":"10.1093/sexmed/qfag018","url":null,"abstract":"<p><strong>Background: </strong>Despite China's national women's development policies aimed at enhancing female sexual health, research on hypoactive sexual desire disorder (HSDD) remains insufficient, hindering its clinical diagnosis and treatment.</p><p><strong>Aim: </strong>We aimed to explore the primary self-reported contributing factors for decreased sexual desire among Chinese women of childbearing age and to characterize their experiences of sexual distress symptoms.</p><p><strong>Methods: </strong>An online cross-sectional survey was conducted from April to July 2020. A total of 3443 valid responses (valid response rate 82.6%) from adult Chinese women were analyzed.</p><p><strong>Outcomes: </strong>Data included demographics and the Decreased Sexual Desire Screener (DSDS) adapted to assess HSDD symptoms.</p><p><strong>Results: </strong>Respondents were primarily Chinese urban women of childbearing age (median 26, interquartile range 23-30). \"Stress and fatigue\" was the primary self-reported contributing factor to decreased sexual desire (53.6%, n = 1846). The prevalence of this factor remained high after standardization for demographic variables (standardized rates ranged from 50.1% to 55.2%). Furthermore, this factor was more prevalent among women with higher levels of education (compared to \"middle school,\" adjusted ORs ranged from 1.52 to 1.86 across education subgroups). Specifically, intense work pressure was associated with decreased sexual desire attributed to various factors (compared to \"moderate,\" adjusted ORs ranged from 1.29 to 1.86). Overall, 18.8% (n = 648) were not satisfied with their level of sexual desire or interest, 40.2% (n = 1383) were bothered by their decreased sexual desire, and 63.6% (n = 2190) wanted it to increase. A total of 5.7% (n = 195) of our participants were at high risk for HSDD (defined by our criteria).</p><p><strong>Clinical implications: </strong>This study identified key factors influencing decreased sexual desire in Chinese urban women of childbearing age, challenges a simple deficit-based model of HSDD, and highlights a significant unmet need for sexual well-being services.</p><p><strong>Strengths and limitations: </strong>This first large-scale study on the drivers and related distress symptoms of decreased sexual desire in Chinese women addresses a critical knowledge gap. Caution is warranted, however, in interpreting the findings as the cross-sectional design and online sample limit generalizability, and the assessment tools used have not been rigorously validated in a Chinese population.</p><p><strong>Conclusion: </strong>Decreased sexual desire was prevalent in Chinese urban women of childbearing age and was mostly associated with self-reported stress and fatigue, especially work pressure; notably, the majority of Chinese women desired higher level of sexual desire.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 3","pages":"qfag018"},"PeriodicalIF":2.4,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729777","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":"Puerarin alleviates oxidative stress, mitochondrial dysfunction, and apoptosis in corpus cavernosum smooth muscle cells through AKT/Nrf2/HO-1 pathway activation.","authors":"Yuhang Xi, Guangye Han, Xiangdong Xue, Xinjun Zhang, Xiaojie Li, Guodong Hou, Feng Zhu","doi":"10.1093/sexmed/qfag022","DOIUrl":"10.1093/sexmed/qfag022","url":null,"abstract":"<p><strong>Background: </strong>Although functional abnormalities may precede structural alterations in early erectile dysfunction (ED), progressive corpus cavernosum smooth muscle cells (CCSMCs) apoptosis is a key trigger of corporal tissue damage, indicating the potential significance of improving CCSMCs anti-apoptotic activity for organic ED treatment.</p><p><strong>Aim: </strong>To evaluate the effects and mechanisms of puerarin (PUR) in improving the anti-apoptotic characteristics of CCSMCs.</p><p><strong>Methods: </strong>Rat CCSMCs were extracted and stimulated with transforming growth factor-β1 (TGF-β1) for establishing an in vitro apoptotic model. The cells were pretreated with PUR. The involvement of AKT and nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling cascades was assessed using corresponding inhibitors. Protein kinase B (AKT) silencing was performed to evaluate whether AKT functions upstream of Nrf2/HO-1.</p><p><strong>Outcomes: </strong>Cell viability, proliferation, apoptosis, oxidative stress, mitochondrial function, and protein expression were assessed using Cell Counting Kit-8, 5-ethynyl-2'-deoxyuridine, terminal deoxynucleotidyl transferase dUTP nick end labeling, flow cytometry, reactive oxygen species, malondialdehyde, superoxide dismutase, mitochondrial superoxide (MitoSOX), mitochondrial membrane potential, mitochondrial permeability transition pore assays, and Western blotting, respectively.</p><p><strong>Results: </strong>alpha‑smooth muscle actin (α‑SMA) and desmin were positively expressed in the isolated CCSMCs. PUR was nontoxic at ≤80 μM/L. TGF-β1 exposure significantly impaired CCSMCs' viability and proliferation, induced apoptosis, triggered oxidative stress and mitochondrial dysfunction, and suppressed AKT and Nrf2/HO-1 signaling. PUR pretreatment significantly alleviated these effects. Pharmacological inhibition of the AKT or Nrf2/HO-1 signaling partially reversed this protection, whereas AKT silencing abolished PUR-induced Nrf2/HO-1 activation.</p><p><strong>Clinical translation: </strong>This study provides in vitro evidence that PUR alleviated CCSMCs damage through AKT/Nrf2/HO-1 pathway activation, highlighting the necessity for further in vivo studies to explore its potential role in ED.</p><p><strong>Strengths and limitations: </strong>These findings provide preliminary evidence that PUR protects CCSMCs from oxidative stress, mitochondrial dysfunction, and apoptosis through AKT/Nrf2/HO-1 pathway modulation. However, further in vivo studies are warranted to validate these findings at the cellular level.</p><p><strong>Conclusion: </strong>Puerarin might attenuate TGF-β1-elicited oxidative stress, mitochondrial injury, and apoptosis via AKT/Nrf2/HO-1 pathway activation, indicating its therapeutic potential for ED.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 3","pages":"qfag022"},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13097019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780156","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":"Primary sigmoid vaginoplasty in gender affirmation surgery: technique and outcomes.","authors":"N Arjun, Y S Nataraj, Dinesh Anne, Bhavya Shetty, H K Nagaraj","doi":"10.1093/sexmed/qfag007","DOIUrl":"10.1093/sexmed/qfag007","url":null,"abstract":"<p><strong>Background: </strong>Vaginal canal reconstruction is critical for transgender and gender-diverse individuals assigned male at birth, seeking gender affirmation, but conventional techniques often have limitations in depth and tissue quality.</p><p><strong>Aim: </strong>The aim was to evaluate outcomes of primary sigmoid vaginoplasty as a gender-affirming surgical option for transgender women at a tertiary center.</p><p><strong>Methods: </strong>A prospective review included transgender women operated for primary sigmoid vaginoplasty from 2023 to 2025, with data collected on demographics, perioperative details, complications, and postoperative neovaginal depth; assessment relied on physical examination, preoperative screening, standardized surgical technique, and postoperative follow-up with dilation routines.</p><p><strong>Outcomes: </strong>Primary outcomes were neovaginal depth, maintenance of sexual function, and postoperative complications.</p><p><strong>Results: </strong>Thirty patients achieved a mean neovaginal depth of 16 ± 2.0 cm intraoperatively; all maintained sexually functional tissue. There were 2 major complications-1 bowel injury and 1 anastomotic leak-requiring reoperation, with no mortality. Introital stenosis occurred in 10% and was successfully treated with dilation. Average hospital stay was 8 ± 2.1 days, and long-term follow-up confirmed satisfaction with sexual function and depth, without significant odor or excessive secretions.</p><p><strong>Clinical implications: </strong>Sigmoid vaginoplasty offers a reliable approach for achieving functional vaginal depth and patient satisfaction, particularly in individuals with limited penile tissue. Bowel Complications can set in, requiring adequate evaluation, motivation and understanding of the procedure.</p><p><strong>Strengths and limitations: </strong>Strengths include the prospective design and standardized surgical technique, while limitations are the small sample size, single-center scope, and limited follow-up duration for some patients due to geographic constraints.</p><p><strong>Conclusion: </strong>Primary sigmoid vaginoplasty is an effective and dependable surgical option for transgender women, yielding satisfactory depth, appearance, and sexual function but can come with associated bowel complications.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 3","pages":"qfag007"},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13097023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780188","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":"Erectile dysfunction and Peyronie's disease: from biologics to nanomedicine-enabled therapies.","authors":"Aris Kaltsas, Dimitrios Hatzichristou","doi":"10.1093/sexmed/qfag019","DOIUrl":"10.1093/sexmed/qfag019","url":null,"abstract":"<p><strong>Introduction: </strong>Erectile dysfunction and Peyronie's disease are prevalent and frequently coexisting disorders in which guideline-based therapies improve symptoms more reliably than they reverse underlying corporal remodeling or tunical fibrosis. Regenerative biologics and nano-enabled delivery systems aim to intervene upstream in inflammatory and fibrotic pathways by improving local exposure, tissue persistence, and target engagement within the emerging field of regenerative sexual medicine.</p><p><strong>Objectives: </strong>To synthesize current evidence on regenerative biologics and nano-enabled delivery platforms for erectile dysfunction and Peyronie's disease, with emphasis on disease-specific delivery barriers, payload characterization, and translational readiness.</p><p><strong>Methods: </strong>This article was designed as a narrative translational review informed by a scoping search of PubMed/MEDLINE, Embase, and Web of Science (January 2000 to March 2025), supplemented by hand-searching of reference lists. Evidence was synthesized qualitatively by disease context (erectile dysfunction vs Peyronie's disease), payload class, delivery constraints, and translational maturity.</p><p><strong>Results: </strong>For erectile dysfunction, platelet-rich plasma has widespread clinical uptake but remains limited by heterogeneous preparation methods, placebo susceptibility, and rapid corporal washout. Early stem cell studies support feasibility, yet converging mechanistic evidence suggests that paracrine signaling predominates, favoring acellular approaches such as extracellular vesicles (EVs) delivered with hydrogels or engineered nanocarriers. For Peyronie's disease, intralesional collagenase <i>clostridium histolyticum</i> (CCH) remains the current clinical benchmark for plaque-targeted minimally invasive therapy in selected stable disease, whereas platelet-rich plasma and cell/vesicle-based approaches remain investigational. Across Peyronie's disease platforms, dense plaque architecture, restricted diffusion, and calcification constrain intralesional exposure, supporting plaque-confined depots, matrix-interactive materials, and targeted antifibrotic nanomedicines.</p><p><strong>Conclusion: </strong>Regenerative sexual medicine is evolving from empiric biologic injections toward better-characterized, anatomy-aligned, exposure-controlled therapeutic platforms, where durable clinical benefit will depend on sustained target engagement within penile tissues. Near-term progress is most likely through phenotype-enriched early-phase trials with rigorous sham-aware design and objective hemodynamic or imaging endpoints, whereas longer-term translation will depend on standardized potency assays, reproducible manufacturing, and durable penile tissue targeting.</p>","PeriodicalId":21782,"journal":{"name":"Sexual Medicine","volume":"14 3","pages":"qfag019"},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13097027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780139","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}