Sexual medicine reviews最新文献

{"title":"Vulvodynia across preconception, pregnancy, and postpartum: a narrative review.","authors":"Marta Henriques-Costa, Carolina Coimbra, Joana Lima-Silva","doi":"10.1093/sxmrev/qeag019","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag019","url":null,"abstract":"<p><strong>Introduction: </strong>Vulvodynia is a common condition affecting reproductive-aged women, with lifetime prevalence estimates ranging from 8% to 28%. However, despite its significant impact on sexual and reproductive health, evidence regarding pregnancy in women with vulvodynia remains scarce.</p><p><strong>Objectives: </strong>This review aims to synthesize the available evidence on the bidirectional relationship between vulvodynia and the reproductive continuum-including preconception, pregnancy, childbirth, and the postpartum period-examining both how these stages influence the course of vulvodynia and how vulvodynia affects sexual function, psychological well-being, and obstetric outcomes, across diverse reproductive events, as well as approaches to multidisciplinary management.</p><p><strong>Materials and methods: </strong>A comprehensive literature search was conducted using PubMed, the Cochrane Library, and Google Scholar, using predefined search terms.</p><p><strong>Results: </strong>Available evidence has not demonstrated a direct impairment of biological fertility in women with vulvodynia, although pain, anxiety, and sexual avoidance may contribute to delayed conception. Symptom evolution during pregnancy is highly variable: while some women experience improvement, others report persistent or worsening pain. Vulvodynia is associated with increased fear of childbirth, challenges with pelvic examinations, and reduced sexual function. Data on delivery outcomes are heterogeneous; although current evidence has not identified a clear contraindication to vaginal birth, some observational studies have reported higher rates of cesarean delivery, often associated with maternal anxiety or maternal request rather than documented obstetric indications. Postpartum symptom trajectories are likewise variable, with some women improving and others experiencing persistent pain, particularly after perineal trauma.</p><p><strong>Conclusions: </strong>Although evidence is limited, current data highlight the need for individualized follow-up and a multidisciplinary approach for pregnant women with vulvodynia. Further research is required to establish more consistent clinical recommendations.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual health framing sexual medicine: toward a more humanistic framework.","authors":"Faysal El Kak, Annamaria Giraldi","doi":"10.1093/sxmrev/qeag016","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag016","url":null,"abstract":"<p><p>Sexual medicine has advanced substantially through pharmacological, hormonal, and surgical innovation, enhancing the management of sexual dysfunction. Yet its clinical paradigm remains predominantly biomedical, often privileging physiological restoration over holistic well-being. This editorial argues that sexual medicine should be explicitly grounded in a sexual health framework informed by justice, rights, and pleasure. Drawing on the World Health Organization's multidimensional definition of sexual health and contemporary transdisciplinary scholarship, we propose a shift from a pathology-centered \"repair model\" to a patient-centered model of flourishing. Justice necessitates equitable, culturally responsive care across gender, orientation, identity, and socioeconomic contexts. Rights affirm sexuality as integral to autonomy and human dignity. Pleasure, long marginalized in clinical discourse, should be recognized as a legitimate and measurable health outcome. Integrating these principles into education, clinical metrics, and practice standards is essential for achieving comprehensive, ethically grounded sexual care aligned with contemporary public health and human rights frameworks.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historical perspectives in contemporary body image counseling: a clinical framework for contextualizing masculine body dysmorphic concerns.","authors":"Or Friedman, Yuval Paniri, Miri Mizrahi Reuveni, Eitan Lavon, Arnon Afek, David Maiershon","doi":"10.1093/sxmrev/qeag018","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag018","url":null,"abstract":"<p><strong>Introduction: </strong>Male body dysmorphic disorder (BDD) focused on genital concerns remains significantly under-recognized despite affecting 2.5% of adults and up to 15% in appearance-focused medical settings. Contemporary therapeutic approaches often fail to address the cultural construction of masculine body ideals, potentially leading to frequent misdiagnosis and inappropriate treatment.</p><p><strong>Objectives: </strong>To develop an evidence-informed clinical framework integrating historical morphometric data from Western sculpture with contemporary body image counseling approaches for men with genital size anxiety.</p><p><strong>Methods: </strong>We synthesized historical morphometric evidence from 24 museum-quality sculptures (600 BCE-1822 CE), contemporary prevalence data on male BDD and genital size anxiety, current treatment guidelines, and theoretical frameworks from medical anthropology and cultural psychology. Digital morphometric measurements were conducted using ImageJ software following established clinical protocols.</p><p><strong>Results: </strong>Historical sculptures demonstrate mean phallus-to-height ratios of 0.0285 ± 0.0061, significantly smaller than contemporary measurements (0.0403-0.0567). This 29%-50% proportional difference provides quantitative evidence consistent with the cultural relativity of masculine ideals. We present preliminary considerations for integrating historical psychoeducation within established cognitive-behavioral therapy frameworks.</p><p><strong>Conclusions: </strong>Historical contextualization offers a pragmatic perspective requiring empirical validation through controlled trials before clinical implementation. The morphometric findings document substantial variation in masculine representation across historical periods, which may be relevant for understanding contemporary body image concerns.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internet-based cognitive behavioral therapy, web-based counseling, and online/digital psychoeducation for male sexual dysfunction: a systematic review.","authors":"Arya Srisadono, Muhammad Adamas, Cennikon Pakpahan, Camil C Branco","doi":"10.1093/sxmrev/qeag020","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag020","url":null,"abstract":"<p><strong>Introduction: </strong>Male sexual dysfunctionhas a substantial impact on psychological well-being and intimate partner relationships. The expanding availability of digital health services has enabled online interventions, such as internet-based cognitive behavioral therapy (ICBT), digital psychoeducation, and web-based counseling, to emerge as alternatives to conventional therapies.</p><p><strong>Objective: </strong>To evaluate the effectiveness, feasibility, and acceptability of digital and online interventions for male sexual dysfunction, and to synthesize evidence from randomized, non-randomized, and observational studies on clinical outcomes and patterns of digital engagement.</p><p><strong>Methods: </strong>This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted across several databases using predefined keywords. Eligible studies included randomized controlled trials, experimental studies, and analytical observational studies published between 2007 and 2024. Extracted data comprised country, participant characteristics, type and duration of intervention, control conditions, outcome measures, and main findings. The primary outcome was improvement in erectile/sexual function using certain parameters, while secondary outcomes included relationship satisfaction, anxiety, and depression.</p><p><strong>Results: </strong>Of 2482 records identified, and 21 met the inclusion criteria. Overall, web-based ICBT and psychoeducational interventions improved erectile function and sexual satisfaction compared with control conditions. Most interventions lasted 6-12 weeks and incorporated therapist feedback or automated systems. Remission rates for erectile dysfunction ranged from 20% to 30%; however, participant adherence was low (<60%). Several studies also reported reductions in performance anxiety and improvements in sexual confidence, with no serious adverse effects.</p><p><strong>Conclusion: </strong>Online interventions are promising approaches for managing male sexual dysfunction. Nevertheless, low adherence rates and heterogeneity in intervention formats remain major challenges. The findings also suggest heterogeneous benefits of digital interventions, alongside improved accessibility, reduced stigma, and increased engagement in help-seeking among men with sexual dysfunction. Future research should prioritize strategies to enhance adherence, integrate mobile health technologies, and assess long-term outcomes through large-scale clinical trials.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic applications of phosphodiesterase inhibitors in male reproductive health: narrative review.","authors":"Yashas Kiran Ninjoor, Vanishree Vasave Madhvacharya, Sandhya Kumari, M R Nagaraja, Jagadish P C, Dagur Singh Hanuman, Eerappa Rajakumara, Suranga P Kodithuwakku, Satish Kumar Adiga, Kshitish K Acharya, Guruprasad Kalthur","doi":"10.1093/sxmrev/qeag023","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag023","url":null,"abstract":"<p><strong>Introduction: </strong>Phosphodiesterases (PDEs) are a family of enzymes that regulate intracellular levels of cyclic nucleotides, such as cyclic adenosine monophosphate and cyclic guanosine monophosphate. PDEs are considered key modulators of cellular signaling processes, including those governing male reproductive health. Owing to the pivotal role played by PDEs in male reproductive health, pharmacologic inhibition of PDEs has gained substantial attention in improving male reproductive health. However, despite the potential therapeutic application of PDE inhibitors (PDEis) in this field, a comprehensive understanding remains limited of the PDE subtype-specific actions in male reproductive tissues, the potential off-target effects, and the long-term safety of PDE inhibition, emphasizing a critical gap in current knowledge. A systematic evaluation of existing evidence on the role of PDEs, as well as the therapeutic application of PDEis and their safety, is necessary for a better understating in the context of male reproductive and sexual health.</p><p><strong>Objectives: </strong>This narrative review aims to critically synthesize and highlight the current evidence on the function of PDEs in male reproductive organs and evaluate the clinical applications of PDEis as therapeutic agents in male reproductive health and sexual medicine.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed and Scopus to identify the expression and function of PDEs in male reproductive organs and the use of PDEis for the treatment of erectile dysfunction and reproductive cancer and for the improvement of male fertility.</p><p><strong>Results: </strong>PDEs of different families are expressed in a tissue-specific manner in the testis, epididymis, prostate gland, seminal vesicle, and penis, indicating their significant role in male reproductive health. Inhibitors of PDEs, even though popularly known for their therapeutic role in treating erectile dysfunction, have exhibited a promising role in the treatment of prostate cancer, testicular cancer, testicular function enhancement, and sperm motility improvement.</p><p><strong>Conclusions: </strong>PDEis have a promising role in improving male reproductive and sexual health. However, the lack of studies addressing their long-term health effects and safety limits their routine therapeutic applications for improving male reproductive health. Future systematic clinical trials and mechanistic studies can certainly illuminate the possible role of PDEis in improving male reproductive health.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric disorders, psychopharmacology and sexual dysfunction from the fifth international consultation on sexual medicine (ICSM 2024).","authors":"Christian J Nelson, Anita H Clayton, Michal Lew-Starowicz, Richard Balon, Wafaa Eltantawy, Flavia Glina, Paraskevi-Sofia Kirana","doi":"10.1093/sxmrev/qeag017","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag017","url":null,"abstract":"<p><strong>Introduction: </strong>The World Health Organization estimates that one in eight people around the world is living with a psychiatric disorder. An under-recognized consequence of psychiatric disorders is the detrimental impact they may have on sexuality. Psychotropic medications to treat psychiatric disorders can also have a significant, negative effect on sexual functioning.</p><p><strong>Objective: </strong>This review is a consensus International Consultation on Sexual Medicine (ICSM) report developed to outline and describe these impacts.</p><p><strong>Methods: </strong>The committee members first discussed the structure of the manuscript. Literature searches were conducted for each section, seeking key words related to sexual dysfunction and each specific psychiatric condition and for psychiatric medications and classes of drugs. A modified Delfi approach was used when making decisions on content and recommendations. The content and recommendations were presented at ICSM where experts across the field of sexual medicine provided feedback. These comments were reviewed by the co-chairs of the 24 committees for discussion and feedback.</p><p><strong>Results: </strong>In relation to psychiatric disorders and sexual dysfunction, there are two primary themes evident in the literature, (1) there are significant methodological weaknesses, and (2) the prevalence of sexual dysfunction across all psychiatric disorders is generally high and elevated compared to controls (when available). Additionally, sexual dysfunction associated with psychotropic medications is a frequent treatment-emergent side effect, for antidepressants ranging from 25% to 80% and for antipsychotics ranging from 16% to 60% depending on the underlying mechanism of action of a particular medication. Sexual dysfunction is also associated with many of the co-morbid conditions related to a psychiatric diagnosis.</p><p><strong>Conclusion: </strong>The committee outlined three recommendations which highlight the importance of assessing for sexual dysfunction in those who report psychiatric disorders, evaluating sexual dysfunction across treatment while treating these disorders with psychotropic medication, and recognizing that the causes of sexual dysfunction are often multi-factorial.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How sexual health becomes marginalized in long-term care: a scoping review of multi-level barriers.","authors":"Aysu Yıldız Karaahmet, Shahla Shafaati Laleh","doi":"10.1093/sxmrev/qeag022","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag022","url":null,"abstract":"<p><strong>Introduction: </strong>Sexual health is a fundamental component of quality of life across the life course; however, it remains largely neglected in institutional care settings for older adults. In nursing homes and long-term care facilities, sexual health is frequently constrained by a range of individual, institutional, sociocultural, and ethical factors, which are often examined in isolation within the existing literature.</p><p><strong>Objectives: </strong>This scoping review aimed to map the barriers affecting the sexual health of older adults living in nursing homes and long-term care facilities and to examine how these barriers interact across multiple levels, contributing to complex and reinforcing mechanisms within institutional care contexts.</p><p><strong>Methods: </strong>A scoping review methodology was employed in accordance with the Joanna Briggs Institute framework and reported following the PRISMA-ScR guidelines. Systematic searches were conducted in MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, ASSIA, and relevant grey literature sources. Qualitative, quantitative, and mixed-methods studies addressing barriers to sexual health among older adults in institutional care settings were included. Data were charted and synthesized thematically.</p><p><strong>Results: </strong>Nineteen studies met the inclusion criteria. Four interrelated themes were identified: (1) individual-level barriers, (2) institutional and environmental barriers, (3) sociocultural barriers, and (4) ethical and legal barriers. The findings indicate that these barriers do not operate independently; rather, individual vulnerabilities are often amplified through institutional regulations and ethical uncertainties, while sociocultural norms and family expectations further legitimize restrictive practices. This interaction contributes to the systematic marginalization of sexual health within long-term care environments.</p><p><strong>Conclusions: </strong>The review highlights that barriers to sexual health among older adults in institutional care are shaped by interacting and mutually reinforcing processes, rather than isolated factors. Addressing sexual health in nursing homes therefore requires approaches that move beyond single-level interventions and consider the relational and systemic nature of these barriers. Future research should focus on empirically testing these mechanisms and developing multi-level, person-centred interventions to support sexual health in long-term care settings.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive behavioral therapy-based interventions for problematic pornography use: a scoping review.","authors":"Graziele Zwielewski, Valter Machado, Andreia A Fiamoncini, Ana Luísa Quinta-Gomes, Roberto M Cruz","doi":"10.1093/sxmrev/qeag027","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag027","url":null,"abstract":"<p><strong>Introduction: </strong>Problematic pornography use (PPU) has attracted increasing interest due to its reported associations with psychological distress, sexual difficulties, and relationship concerns in a subset of users. Several psychotherapeutic interventions have been proposed. Still, there is no widely accepted, evidence-based, standardized protocol for its treatment.</p><p><strong>Objective: </strong>This scoping review aimed to identify and synthesize intervention protocols based on cognitive behavioral therapy (CBT) for the treatment of PPU, published between 2019 and 2024.</p><p><strong>Methods: </strong>A systematic search was conducted in the PubMed, Scopus, and PsycINFO databases, using predefined terms such as \"cognitive behavioral therapy,\" \"pornography,\" \"PPU,\" and \"problematic pornography use.\" Empirical studies presenting CBT-based protocols for PPU, published in English, Portuguese, or Spanish between 2019 and 2024, were included. Two independent reviewers conducted double-blind screening of the studies, with discrepancies resolved by consensus. Extracted data included participant characteristics, study design, intervention components, session structure, and outcomes.</p><p><strong>Results: </strong>The initial search identified 437 studies. After removing duplicates and full-text screening, 11 studies met the inclusion criteria. Interventions varied in therapeutic approach, including CBT alone, ACT, mindfulness-based practices, and hybrid protocols, integrating CBT techniques with ACT-based or mindfulness-based strategies. Delivery modalities included in-person (n = 5), online (n = 5), and mixed (n = 1). Most protocols addressed emotional regulation, cognitive restructuring, craving management, and relapse prevention. Although all studies reported reductions in the frequency of PPU and associated symptoms, interventions that combined CBT with other techniques tended to report larger effect sizes. No studies reported complete abstinence, and there were high dropout rates in self-guided interventions.</p><p><strong>Conclusions: </strong>Despite promising findings, current CBT-based protocols for treating PPU lack standardization and methodological rigor. The field would benefit from consensus on diagnostic criteria, therapeutic goals, outcome measures, and additional randomized clinical trials that integrate mental health and sexual health.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interplay between testosterone and depression: bridging research, clinical applications, and health: a narrative review.","authors":"Megan C Abadom, Emmanuel Nyong, Beatriz S Hernandez, Gal Saffati, Niki Parikh, Mohit Khera","doi":"10.1093/sxmrev/qeag024","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag024","url":null,"abstract":"<p><strong>Introduction: </strong>Over the past decade, the global burden of depression has increased and remains higher in women than in men. Emerging evidence suggests that low testosterone is linked to depressive symptoms in both sexes, raising important questions about its causal role and potential as a therapeutic target.</p><p><strong>Objective: </strong>To provide a narrative review of the literature on the relationship between testosterone and depression across both sexes, examine underlying neurobiological mechanisms, and assess the efficacy and risks of testosterone replacement therapy (TRT) as a treatment for depressive symptoms.</p><p><strong>Methods: </strong>We conducted a narrative review of PubMed, Medline, and Google Scholar for articles published between 1980 and 2024. Eligible sources included primary research articles, systematic reviews, meta-analyses, and narrative reviews that examined the relationship between testosterone levels, depression, and the effects of TRT on mood regulation. Search terms include low testosterone, hypogonadism, depression, mood disorders, androgen deficiency, TRT, neurotransmitters, and mental health.</p><p><strong>Results: </strong>Low testosterone is associated with depressive symptoms, particularly in hypogonadal men. Testosterone modulates serotonergic, dopaminergic, and GABAergic systems and acts on brain regions involved in mood regulation, including the prefrontal cortex, amygdala, and hippocampus. TRT improves mood, energy, and libido in hypogonadal men, though evidence in eugonadal men and women is mixed. Ethnic and genetic factors, such as androgen receptor Cytosine, Adenine, Guanine (CAG) repeat length, may influence susceptibility and treatment response. Risks of TRT include erythrocytosis, prostate-specific antigen elevation, cardiovascular events, and metabolic changes.</p><p><strong>Conclusion: </strong>Testosterone may play a significant role in mood regulation, and its deficiency may contribute to depressive symptoms. TRT is a promising treatment option for select patients, though it must be personalized and closely monitored to balance therapeutic benefits with potential risks.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic floor modalities for the management of female sexual dysfunction: a narrative review.","authors":"Zubeila Aihemaiti, Diliyaer Dilixiati, Alapati Waili, Atila Abulizi, Chunlin Wang, Bingzhang Qiao, Gulixian Shata, Reziya Dilixiati, Abudureheman Zebibula","doi":"10.1093/sxmrev/qeag025","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag025","url":null,"abstract":"<p><strong>Objectives: </strong>Female Sexual Dysfunction (FSD) affects 40%-45% of women globally, with multifactorial causes including pelvic floor dysfunction and hormonal changes. While hormone therapy and psychobehavioral interventions have demonstrated efficacy, they are often limited by side effects, contraindications, variable adherence, and a lack of standardized protocols. Physical therapy (PT) approaches have emerged as promising non-invasive alternatives or adjuncts, targeting underlying neuromuscular, vascular, and structural mechanisms of FSD. This review focuses on PT approaches, evaluating their mechanisms and clinical outcomes to guide evidence-based practice.</p><p><strong>Methods: </strong>The review followed the PICO framework: Population (women with FSD), Interventions (PT modalities), Comparators (sham/control/alternative treatments), and Outcomes (sexual function scores, pelvic floor muscle parameters, safety). A systematic search was performed in PubMed, Embase, and Web of Science up to April 13, 2025. The search strategy combined relevant MeSH terms and keywords using Boolean operators across three conceptual blocks: including \"Sexual Dysfunction, Physiological\"[Mesh], \"Hypoactive Sexual Desire Disorder\", \"Orgasmic Disorder\" etc., AND \"transcutaneous electrical nerve stimulation\", \"pelvic floor muscle training\", \"gradual dilation,\" etc., AND \"Women\"[Mesh], \"Female,\" \"female patient\" etc. The full search strategy and screening flowchart is available in Supplementary Material. Inclusion criteria: Randomized controlled trials (RCTs), cohort studies, pilot studies, and case reports were included if they involved women with FSD who received PT interventions and reported outcomes related to sexual function. Exclusion criteria: non-PT interventions, non-FSD populations, and non-English publications. Study selection involved two independent reviewers screening titles/abstracts and full texts. Data on study design, population, intervention, outcomes, and key findings were extracted into standardized tables.</p><p><strong>Results: </strong>Forty-nine clinical studies with 2742 participants were included. Electromagnetic therapy, electrical stimulation, Radiofrequency therapy, pelvic floor muscle training, multimodal pelvic floor physical therapy, vibratory stimulation, dilator therapy, and acupuncture all demonstrated potential efficacy in improving FSD-related symptoms, including sexual function, vaginal laxity, pain, and orgasmic function.</p><p><strong>Conclusions: </strong>Numerous physical therapy modalities have demonstrated potential efficacy in improving FSD-related symptoms, although evidence quality varies across interventions. Future large-scale RCTs with standardized protocols are needed to confirm long-term benefits and establish optimal treatment algorithms.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}