Sexual medicine reviews最新文献

{"title":"Online sexual health interventions for breast cancer survivors: a systematic review of program features and sexual outcomes.","authors":"Baran Bagheri, Lida Moghaddam-Banaem, Seyed Ali Azin, Ali Asghar Safaei, Shahpar Haghighat","doi":"10.1093/sxmrev/qeag031","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag031","url":null,"abstract":"<p><strong>Introduction: </strong>Online-based interventions offer a promising solution to the numerous obstacles associated with delivering sexual health services to breast cancer survivors. It is most effective to implement online services that are grounded in scientific evidence and tailored to their specific needs.</p><p><strong>Objectives: </strong>This systematic review primarily aimed to analyze the features of online interventions tailored for individuals with breast cancer, with a secondary focus on examining their impact on sexual outcomes.</p><p><strong>Methods: </strong>A systematic search of articles was conducted in seven databases (PubMed, Scopus, Embase, Web of Science, Cochrane SID, and MAGIRAN), using the terms breast cancer, survivor, sexual health, internet intervention, and application software, with no time restriction up to June 30, 2025. Twelve eligible articles were included. The quality of the studies was assessed using the Mixed Methods Appraisal Tool, and the risk of bias for randomized controlled trials was evaluated using the Cochrane tool.</p><p><strong>Result: </strong>Although there is a diverse range of content used in delivering interventions, the predominant approaches encompass educational initiatives, interactive techniques, cognitive behavioral therapy, acceptance and commitment therapy, personalized information, and self-help strategies. Most studies have reported positive effects of online interventions on sexual health.</p><p><strong>Conclusion: </strong>This systematic review shows that online interventions have features that can help improve the provision of sexual health services and be effective in improving the sexual health of breast cancer survivors.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 3","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536987","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":"Feminist perspectives on labiaplasty: liberation, objectification, or medicalization of normal anatomy?","authors":"Amta Azeem, Aviral C Sharma, Avini Sharma, Hannah Kim, Annie Dai, Hanyu Zhong, Jose Marco Garchitorena, Ibrahim Omari","doi":"10.1093/sxmrev/qeag045","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag045","url":null,"abstract":"<p><strong>Introduction: </strong>Labiaplasty has expanded worldwide, provoking debate over whether it reflects women's liberation, reinforces objectifying beauty norms, or medicalizes normal vulvar variation. Clinicians lack integrative guidance linking outcomes with feminist ethical analysis.</p><p><strong>Objectives: </strong>To synthesize evidence on labiaplasty through feminist frameworks of liberation, objectification, and medicalization; evaluate functional, sexual, and psychological outcomes; and propose a clinical framework centered on relational autonomy and non-pathologizing education.</p><p><strong>Methods: </strong>A narrative review of peer-reviewed literature (2002-2025) was conducted using PubMed and Google Scholar, with screening of relevance based on predefined thematic domains including motivations, outcomes, sociocultural influences, and ethics. Empirical studies on motivations, outcomes, and educational interventions were included as clinical evidence, while feminist theoretical and ethical analyses were used for interpretive synthesis. Data were synthesized thematically along three axes: Liberation/autonomy, objectification/sociocultural pressure, and medicalization of normal anatomy.</p><p><strong>Results: </strong>Utilization of labiaplasty has increased markedly, including in adolescents, although population-level rates remain underreported. Patients commonly endorse overlapping functional, aesthetic, and psychosexual motivations; many have labial dimensions within published normative ranges. Prospective cohorts and meta-analyses show high satisfaction and improvement in pain, functional symptoms, genital self-image, and sexual function, with low rates of major complications or long-term sensory loss when nerve-sparing techniques are used. However, elevated body-image distress and clinically significant body dysmorphic disorder (BDD) occur in a substantial subset. Media, pornography, and clinical marketing narrow perceptions of \"normality,\" while language and diagnostic labels can pathologize benign variation.</p><p><strong>Conclusions: </strong>Labiaplasty sits at the intersection of liberation, objectification, and medicalization: Many patients experience benefit, yet decisions are shaped by sociocultural forces that constrain autonomy and recast normal anatomy as abnormal. The proposed L.A.B.I.A. framework (legal safeguards, autonomy assessment, body-image/BDD screening, informed consent and non-pathologizing education, and aftercare) offers clinicians an ethically grounded approach to counseling, patient selection, and follow-up while underscoring the need for education and policy that normalize vulvar diversity.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 3","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397846","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":"Ancient South Asian traditions and the cultural foundations of sexual medicine: from kāma to clinical care.","authors":"Pramod Krishnappa","doi":"10.1093/sxmrev/qeag040","DOIUrl":"10.1093/sxmrev/qeag040","url":null,"abstract":"<p><strong>Introduction: </strong>Contemporary sexual medicine increasingly recognizes the need to move beyond a narrow biomedical model and incorporate culture, dignity, pleasure, relationships, and patient context.</p><p><strong>Methods: </strong>This editorial reflects on ancient South Asian traditions, including kāma, the Kāmasūtra, epics, temple art, Ayurveda and culturally embedded sexual beliefs, and interprets their relevance to modern clinical care.</p><p><strong>Results: </strong>South Asian traditions historically framed sexuality as relational, moral, social, reproductive, spiritual, and pleasure-oriented. These traditions remain relevant because many patients continue to experience sexual distress through ideas of shame, masculinity, fertility, marital duty, semen anxiety, and family expectation. Clinical examples include unconsummated marriage, masturbation myths, Dhat syndrome, and misuse of traditional claims by social media influencers.</p><p><strong>Conclusion: </strong>Ancient traditions should neither be romanticized as medical science nor dismissed as mythology. Their greatest value lies in promoting culturally literate, evidence-based, compassionate, and patient-centred sexual medicine.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 3","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362425","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":"A critical analysis of the quality of testosterone therapy randomized controlled trials.","authors":"Thiago P Furtado, Luis F Novaes, Jose M Flores, John P Mulhall","doi":"10.1093/sxmrev/qeag064","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag064","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, the utilization of testosterone (T)s testing and prescriptions has experienced a significant surge. As a result, the market for testosterone therapy (TTh) has increased dramatically with the surge of T products undergoing trials. Our aim was to undertake a critical analysis of randomized controlled trials (RCTs) that focused on TTh, specifically with an emphasis on the quality of the trials and their delineation of adverse events (AE).</p><p><strong>Methods: </strong>A literature review of PubMed was conducted to identify RCTs using TTh, excluding non-English, animal, or female-based studies. Trials were assessed for sample size, duration, pre-, and post-treatment T levels, adverse event definitions. We also assessed the reported rates of polycythemia (PCT), gynecomastia (GYN), major adverse cardiovascular events (MACE), and obstructive sleep apnea (OSA).</p><p><strong>Results: </strong>Thirty RCTs met the inclusion criteria, with a median study sample size of 76 and median follow-up of 8 months. The present analysis reveals that TTh trials are highly heterogeneous in both reporting of definitions and rates of AEs, such as PCT, GYN, and MACE. Among the included trials, 83% measured hematocrit (HCT) levels, but only 23% reported baseline values, with a median baseline HCT of 43% and an on-treatment median of 45%. GYN was reported in 17% of the RCTs, though none detailed the grade of GYN. MACE were reported in only 20% of the trials, with varying definitions. OSA was mentioned as an AE in 33% of trials, but only three reported incidence rates.</p><p><strong>Discussion: </strong>This analysis highlights the suboptimal reporting of AE outcomes in TTh RCTs. These findings underscore the need for a greater level of standardization in such trials.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 3","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814084","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":"Shared and unique therapeutic mechanisms in BDSM practices and empirically supported PTSD psychotherapies.","authors":"Avery Jasudowicz, Tierney Lorenz","doi":"10.1093/sxmrev/qeag073","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag073","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma-exposed individuals increasingly describe consensual BDSM (bondage/discipline, dominance/submission, sadism/masochism) practices as salutary and, at times, intentionally therapeutic. However, the field lacks an organizing theoretical framework for how BDSM practices may engage mechanisms targeted by empirically supported treatments (ESTs) for posttraumatic stress disorder (PTSD), particularly PTSD related to sexual trauma.</p><p><strong>Methods: </strong>This narrative review synthesizes clinical and empirical literatures on BDSM, trauma play, and \"gold-standard\" PTSD interventions to map convergent and divergent mechanisms of change.</p><p><strong>Results: </strong>We present evidence that BDSM scenes and dynamics may engage core mechanisms of existing PTSD ESTs, including negotiated safety, graded exposure to feared cues, emotion regulation, cognitive reappraisal/rescripting, agency and boundary restoration, shifts in self-concept, and corrective relational experiences (both dyadic and communal). We additionally highlight mechanisms with unique features in BDSM contexts-cathartic release, non-verbal/somatic processing, and liberation-oriented engagement with constructs of power and systemic oppression-and discuss how these \"BDSM mechanisms\" may address recent critiques of PTSD ESTs.</p><p><strong>Discussion: </strong>Clinical implications include incorporating kink practices into assessment and case formulation; supporting culturally humble, stigma-free inquiry; and clarifying when kink-related practices function as safety behaviors versus supporting therapeutic exposures. We conclude with a research agenda emphasizing longitudinal, controlled tests of \"kink-concurrent\" trauma treatment, mechanism-focused measurement, and mixed-method designs to evaluate outcomes spanning PTSD and sexual wellbeing.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 3","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070198","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":"New regenerative interventions and treatment targets in sexual medicine: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024).","authors":"Barbara M Chubak, Chun Wai Chan, Jawad Feghali, Serkan Karakus, Edoardo Pozzi, Natesh Prabhu, Omer A Raheem, Ahmed I El-Sakka","doi":"10.1093/sxmrev/qeag048","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag048","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the array of regenerative interventions seeking to reverse the causes and provide curative treatment for male and female sexual dysfunctions that have been studied and are available for purchase within the medical marketplace, including their treatment targets, mechanisms of action, and outcomes data, with particular attention to the context in which they are applied.</p><p><strong>Methods: </strong>A committee of experts conducted a comprehensive, review of the relevant literature, focusing on publications since the topic of novel treatment targets was last addressed by the International Consultation on Sexual Medicine.</p><p><strong>Results: </strong>Since the ICSM 2010, cell- and energy-based regenerative medical interventions have grown in popularity, with their therapeutic promise and availability in the medical marketplace outpacing the conduct of research to support their use as treatments for sexual dysfunction. While clinical trials and the test of time suggest they are generally safe and well-tolerated, the published studies that consider the efficacy of stem cell, platelet rich plasma, electrical stimulation, photobiomodulation, radiofrequency, laser, and shockwave therapies for sexual health problems suffer from significant methodological limitations. The evidence is strongest for low-intensity shockwave treatment of the penis for erectile dysfunction, followed by vaginal CO2 laser treatment for genitourinary syndrome of menopause, but is not sufficiently robust to reach consensus agreement regarding their clinical recommendation at this time.</p><p><strong>Discussion: </strong>Cell- and energy-based regenerative medical treatments have enormous popular appeal, but at present the scientific evidence for their use to treat sexual problems is insufficient to reach a consensus agreement regarding their clinical use. Future studies should not only consider clinical questions of indication, dosage, and efficacy, but also explore the practical bioethics of conducting translational research within the international medical marketplace.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 3","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081935","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":"Vulvodynia across preconception, pregnancy, and postpartum: a narrative review.","authors":"Marta Henriques-Costa, Carolina Coimbra, Joana Lima-Silva","doi":"10.1093/sxmrev/qeag019","DOIUrl":"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":3.0,"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":"Mapping the evidence on sexual desire and sexual interest in transgender populations: a scoping review.","authors":"Noor Banihashem Ahmad, Jaime L Ragos, J Conrado, Alexandra N Drian, Jayden Berdugo, Fiona Wardrop, Prema Kondragunta, Alyssa A Grimshaw, Rachel Rubin","doi":"10.1093/sxmrev/qeag041","DOIUrl":"https://doi.org/10.1093/sxmrev/qeag041","url":null,"abstract":"<p><strong>Introduction: </strong>Research on sexual desire is limited and inconsistent for transgender populations. This scoping review consolidates findings and clarifies measurement practices, associations, and prevalence for sexual desire in this population. The objective of this scoping review is to map how sexual desire and low sexual desire are measured and defined in transgender populations using validated instruments, including whether distress or impairment is assessed, and to identify limitations of cisgender-validated tools.</p><p><strong>Methods: </strong>A scoping review following PRISMA-ScR guidelines was registered on the Open Science Framework (https://osf.io/wh2uf/overview). An exhaustive search of ten databases was conducted in October 2025 to identify literature on SD among transgender individuals. Two reviewers independently screened records, and a third resolved conflicts. Data were extracted using a standardized Qualtrics form and synthesized narratively with tabular support; methodological quality was assessed using Johanna Briggs Institute tools.</p><p><strong>Results: </strong>Of 3780 records screened, 20 studies met inclusion criteria. All used cisgender-validated instruments, mostly treating desire as a continuous variable. Only four assessed distress. Cross-sectional studies found transgender participants scored between cisgender men and women. Longitudinal studies showed early desire decreases in trans women and early increases in trans men following gender-affirming hormone therapy, later stabilizing in both groups. Desire showed inconsistent associations with surgeries, relationship status, body image, gender dysphoria, mood, and sexual history.</p><p><strong>Conclusion: </strong>Sexual Desire in transgender populations is predominantly measured using instruments validated for cisgender individuals, with low desire treated as a functional dimension rather than as a distress-based disorder. Few studies assessed distress alongside low desire. Desire patterns appear dynamic across medical transitions, particularly with hormone initiation, and are variably influenced by psychosocial factors. Development of gender-inclusive, validated measurement tools is urgently needed to distinguish normative variability from clinically significant disturbances and improve care.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333074","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":"Postoperative impact of pelvic organ prolapse and urinary incontinence surgeries on female sexual function measured by validated instruments: a systematic review and meta-analysis.","authors":"Jiawei Ying, Dandan Zheng, Liang Wu","doi":"10.1093/sxmrev/qeag036","DOIUrl":"10.1093/sxmrev/qeag036","url":null,"abstract":"<p><strong>Introduction: </strong>Female sexual dysfunction (FSD) is frequently observed in women with urinary incontinence (UI) and pelvic organ prolapse (POP). Although surgical management of POP and SUI is widely performed, evidence regarding postoperative changes in female sexual function remains inconsistent and sometimes contradictory.</p><p><strong>Objective: </strong>To compare the postoperative effect of POP and UI surgeries on female sexual function and to explore the differential responsiveness of validated assessment tools.</p><p><strong>Methods: </strong>A literature search was conducted in PubMed, Web of Science, the Cochrane Library, and EMbase from database inception to 2025. The studies assessing sexual function using Female Sexual Function Index (FSFI) and PISQ-12, or reporting dyspareunia outcomes were included. Meta-analysis was analyzed by RevMan 5.4.</p><p><strong>Results: </strong>No statistically change was observed between preoperative and postoperative FSFI scores in women undergoing surgery for POP (P = .19), whereas patients treated surgically for SUI demonstrated statistically significant improvement in FSFI scores (P = .02). Among POP procedures, Laparoscopic repair was associated with higher postoperative FSFI scores compared with vaginal surgery (P < .00001). In contrast, no difference in FSFI outcomes was identified between traditional and minimally invasive sling procedures for SUI (P = .11). Assessment using the PISQ-12 revealed significant postoperative improvement in POP and SUI patients (POP:P < .00001; SUI:P = .002), with no difference between surgical approaches or combined procedures. Postoperative dyspareunia rates differed among SUI techniques (P = .04), but not among POP surgeries (P = .29); however, dyspareunia occurred more frequently after POP surgery compared with baseline (P = .002).</p><p><strong>Conclusions: </strong>Surgical management of POP and UI shows a general correlation with improved sexual function scores, the extreme heterogeneity suggests that these pooled estimates should be viewed as broad trends rather than precise clinical benchmarks. The observed differences in FSFI and PISQ-12 scores may reflect differential patterns in detecting functional changes in specific patient groups, though the high variability precludes a definitive hierarchy of instrument sensitivity.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345700","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":"Extracorporeal shock wave therapy in patients with chronic prostatitis/chronic pelvic pain syndrome and erectile dysfunction: a systematic review and meta-analysis.","authors":"Xin Liu, Luqian Ren, Wenrui Huang, Jinshuang Zhang","doi":"10.1093/sxmrev/qeag037","DOIUrl":"10.1093/sxmrev/qeag037","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) frequently coexists with erectile dysfunction (ED) and is associated with substantial impairment in quality of life (QoL). Although extracorporeal shock wave therapy (ESWT) has been investigated as a noninvasive treatment option, its efficacy in this comorbid population remains uncertain.</p><p><strong>Objective: </strong>To assess the efficacy and safety of ESWT for improving erectile function and CP/CPPS-related symptoms in men with CP/CPPS and concomitant ED.</p><p><strong>Methods: </strong>A systematic search was performed up to December 2025 across eight electronic sources (PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed) to identify randomized controlled trials evaluating ESWT in men with CP/CPPS and comorbid ED. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 1.0). Analyzes were conducted in RevMan 5.4, with continuous outcomes reported as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyzes were performed to explore heterogeneity and assess robustness. The GRADE framework was used to rate the certainty of evidence for the primary outcomes.</p><p><strong>Results: </strong>Nine RCTs were included. The pooled effect on erectile function was numerically larger in sham-controlled trials than in active-comparator studies, although the between-subgroup difference was not statistically significant. Overall, pooled analyzes suggested that ESWT was associated with improved erectile function (SMD 0.80, 95% CI 0.31-1.28) and reduced NIH-CPSI total scores (SMD -1.14, 95% CI -1.73 to -0.55). Subgroup analyzes were exploratory and showed no significant between-subgroup differences. Short-term safety reporting suggested that ESWT was generally well tolerated: six of seven RCTs reported no device-related adverse events, while one reported four cases of transient hematuria/hematospermia. GRADE certainty was low across efficacy outcomes and high for safety outcomes.</p><p><strong>Conclusions: </strong>Across randomized trials, ESWT was associated with improvements in erectile function and CP/CPPS-related symptoms in men with CP/CPPS and concomitant ED. Sham-controlled trials may provide more internally valid estimates for erectile function outcomes than active-comparator studies. Improvements in erectile function were generally accompanied by favorable changes in pain, urinary symptoms, and QoL. Although some subgroup strata showed more numerically consistent estimates, no statistically significant between-subgroup differences were identified, and these findings should be considered exploratory. ESWT may represent a potential non-invasive adjunct to standard care, but further sham-controlled trials are needed to strengthen causal inference and clarify optimal treatment protocols.</p>","PeriodicalId":21813,"journal":{"name":"Sexual medicine reviews","volume":"14 2","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228446","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}