Journal of Sexual Medicine最新文献

{"title":"Effect of nebivolol on erectile function: a systematic review and meta-analysis of randomized controlled trials.","authors":"Youyi Lu, Lin Li, Qi Li, Guoqin Sun","doi":"10.1093/jsxmed/qdae189","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae189","url":null,"abstract":"<p><strong>Background: </strong>Historically, β-blockers have been associated with erectile dysfunction (ED). Nebivolol, a third-generation β-blocker, may have had no negative effect on erectile function because of its vasodilating properties. However, the evidence level was considered either as low or very low.</p><p><strong>Aim: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of nebivolol on erectile function.</p><p><strong>Methods: </strong>All published RCTs were searched through PubMed, Cochrane Library, Web of Science, and Embase until October 2023. Review Manager version 5.3.0 was used for statistical analysis. Sensitivity analyses were performed by excluding each study using Stata 17 software.</p><p><strong>Outcomes: </strong>The primary outcome was the International Index of Erectile Function (IIEF)-5 score. We excluded publication types, including letters, reviews, and meta-analyses.</p><p><strong>Results: </strong>We identified four RCTs in this meta-analysis. All included studies compared the effects of nebivolol vs metoprolol on erectile function. Eight parallel groups with 397 individuals reported IIEF-5 scores. A random-effect model revealed that the IIEF-5 score was significantly higher in the nebivolol group (MD 1.81, 95%CI 0.95-2.68, P < .0001, I2 = 99%). We conducted a sensitivity analysis by removing each individual study and observed that there was no significantly different result. Furthermore, we conducted a prespecified subgroup analysis based on the dosage of metoprolol, patients with ED at the time of enrollment, and disease type. Subgroup analysis revealed that heterogeneity significantly decreased, and the result of the IIEF-5 score was stable and consistent.</p><p><strong>Clinical implications: </strong>Our results provides stronger evidence that nebivolol significantly reduced the risk of ED occurrence or progression.</p><p><strong>Strengths and limitations: </strong>Our meta-analysis included high-quality RCTs and conducted a predetermined subgroup analysis. However, the main limitations are the limited number of included studies and their heterogeneity.</p><p><strong>Conclusion: </strong>Our meta-analysis provided stronger evidence that nebivolol significantly reduced the risk of ED occurrence or progression compared with metoprolol, irrespective of whether the patient had ED or not. This meta-analysis could serve as an important reference for future studies in this field.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between sexual activity frequency and depression in women: insights from the NHANES data.","authors":"Xu Wu, Hui Gao, Yuyang Zhang, Xiansheng Zhang","doi":"10.1093/jsxmed/qdae181","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae181","url":null,"abstract":"<p><strong>Background: </strong>Existing research is very limited in providing nationally representative data on the relationship between sexual activity and depression in U.S. female adults aged 20-59 years, particularly with regard to marital status differences.</p><p><strong>Objectives: </strong>Our specific objective was to explore the relationship between sexual activity and depression in adult women in the United States.</p><p><strong>Methods: </strong>We conducted a study utilizing depression and sexuality data from the U.S. National Health and Nutrition Examination Survey (NHANES) for women aged 20-59 years between 2007 and 2016. Subsequently, we used survey-weighted logistic regression models to examine the relationship between low-frequency sexual activity and the risk of depression. To further explore the effects of different stratification factors on the relationship between low-frequency sexual activity and depression, we conducted subgroup analyses based on age, race, marital status, poverty-to-income ratio (PIR), education level, BMI, hypertension, diabetes mellitus, smoking, trouble sleeping, and urine Leakage. In addition, sensitivity analysis and smoothed curve fitting were performed to ensure the reliability of the results.</p><p><strong>Main outcome measure: </strong>Sexual activity was assessed by sexual frequency, ≤11 sexual encounters in a 12-month period were categorized as low-frequency sexual activity; depression was diagnosed by the Patient Health Questionnaire (PHQ-9, ≥10 scores).</p><p><strong>Results: </strong>From the 2007 to 2016 NHANES, a total of 6061 participants were enrolled in the study. Of these participants, 1869 (30.84%) reported a sexual frequency of 0-11 times/year categorized as low-frequency sexual activity. After adjustment for the full covariates, the risk of depression was found to be higher in low-frequency sexual activity participants (sexual frequency ≤ 11) compared to normal-frequency sexual activity participants (sexual frequency > 11) (OR = 1.37, 95 % CI: 1.08, 1.73; P = 0.010), this association varied according to marital status.</p><p><strong>Clinical implications: </strong>Our findings have important clinical implications and suggest that clinicians should pay attention to the mental health of female patients with low-frequency sexual activity and screen depressed patients for sexual activity.</p><p><strong>Strengths & limitations: </strong>Our study is the large, nationally representative study to assess the relationship between low-frequency sexual activity and depression in women aged 20 to 59 years. However, the cross-sectional study design was unable to demonstrate a causal relationship between low-frequency sexual activity and depression.</p><p><strong>Conclusion: </strong>In conclusion, our study demonstrates a significant association between low frequency of sexual activity and risk of depression in a population of women aged 20 -59 years in the U.S, which may be bidirectional.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between remnant cholesterol and low testosterone in adult males.","authors":"Zhaoxiang Wang, Liwen Shen, Menghuan Wu, Qichao Yang","doi":"10.1093/jsxmed/qdae180","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae180","url":null,"abstract":"<p><strong>Background: </strong>Remnant cholesterol (RC) is the cholesterol of triglyceride-rich lipoproteins, which has a high degree of atherogenic effect.</p><p><strong>Aim: </strong>This study investigates the association between RC and low testosterone in male adults in the United States.</p><p><strong>Methods: </strong>Data were drawn from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 and 2015-2016 cycles, focusing on males aged over 20. RC was measured as the difference between total cholesterol (TC) and the sum of high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c). Analyses between RC and low testosterone included logistic regression, subgroup assessment, smooth curve fitting, and mediation analysis.</p><p><strong>Outcomes: </strong>Low testosterone was defined by a serum testosterone level below 300 ng/dL in male adults.</p><p><strong>Results: </strong>Out of the 2248 participants, 442 exhibited low testosterone levels. Those deficient in testosterone demonstrated notably higher RC levels (P < 0.001). A direct relationship between RC and low testosterone was evident (OR = 1.02, 95% CI: 1.01-1.03, P < 0.001), and smooth curve fitting revealed a linear trend. Subgroup analysis did not identify any special populations. Moreover, body mass index (BMI) and HOMA-IR was found to partially mediate this relationship.</p><p><strong>Clinical implications: </strong>Evaluating low testosterone in individuals with high RC levels can be beneficial. Similarly, monitoring lipid profiles, particularly RC levels, in patients with low testosterone might be important for preventing cardiovascular diseases.</p><p><strong>Strengths & limitations: </strong>This study uses data from NHANES, which is nationally representative and has a large sample size. However, the causal relationship needs further investigation due to the cross-sectional design of this study.</p><p><strong>Conclusion: </strong>This nationwide study provides initial evidence of a close correlation between RC and the risk of low testosterone.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel algorithm-based risk classification for vascular damage in men with erectile dysfunction.","authors":"Federico Belladelli, Francesco Cei, Edoardo Pozzi, Alessandro Bertini, Christian Corsini, Massimiliano Raffo, Fausto Negri, Giacomo Musso, Riccardo Ramadani, Francesco Cattafi, Luigi Candela, Luca Boeri, Alessia d'Arma, Francesco Montorsi, Andrea Salonia","doi":"10.1093/jsxmed/qdae176","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae176","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Penile dynamic color doppler duplex ultrasound (CDDU) is a relevant tool in assessing men with suspected vasculogenic erectile dysfunction (V-ED).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To investigate (1) factors potentially associated with V-ED to define risk classes useful in predicting V-ED; (2) the response to phosphodiesterase type 5 inhibitors (PDE5i); and (3) the onset of incident major cardiovascular (CV) events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cohort of men with ED and without known concomitant CVD was grouped into: patients undergoing CDDU (N. 301) and patients not undergoing CDDU but prospectively monitored for incident major CV events after initiating PDE5i (N. 127). Logistic regression and Chi-square Automatic Interaction Detectors (CHAID) methodology were employed to identify potential predictors and develop a novel risk classification system. Receiver operating characteristic (ROC) curves and decision curve analysis was performed to assess its accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Factors associated with V-ED useful to develop a novel risk classification system predicting incident major CV events and PDE5i response.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The new classification defines patients as follows: Very Low Risk [age &lt; 53, body mass index (BMI) &lt; 25 Kg/m2], Low Risk (age &lt; 53, BMI &gt; 25 Kg/m2, non-smokers), Moderate Risk (age &gt; 53, non-smokers), High Risk (age &lt; 53, BMI &gt; 25 Kg/m2, smokers), and Very High Risk (age &gt; 53, smokers). Multivariable logistic regression analysis highlighted age, BMI, and smoking as significant predictors of V-ED. CHAID methodology yielded a risk classification system with an accuracy of 0.79. Notably, \"Very High Risk\" class was associated with a significantly increased risk of incident major CV events [odds ratio (OR) 4.00, 95% confidence interval (CI) 1.06-15.08, P &lt; .05]. Moreover, patients belonging to \"Very High Risk\" and \"High Risk\" classes were also associated with diminished PDE5i response. At Kaplan-Meier analysis, men belonging to \"Very High Risk\" class depicted a notable risk of incident major CV events (P = .03).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;We propose a novel risk classification system which may have some clinical value in tailoring patients at significantly higher risk of V-ED. Although preliminary, current findings also suggest that the novel risk classification system could help tailoring men at potential increased risk of incident major CV events and those not responding to PDE5i.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;This study introduces a novel user-friendly risk stratification tool for V-ED, emphasizing the need for CV screening and alternative therapies for higher-risk groups. A limited number of events in the cohort with follow-up for major CV events and response to PDE5is constrains the interpretation of the results. Current findings need an external validation cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients with ED catego","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A detailed analysis of the penile fibro-vascular assembly.","authors":"Geng-Long Hsu, Hong-Chiang Chang, Eugen Molodysky, Chih-Yuan Hsu, Mang-Hung Tsai, Jue-Hawn Yin, Ming-Tsun Chen","doi":"10.1093/jsxmed/qdae177","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae177","url":null,"abstract":"<p><strong>Background: </strong>Although various compartments of the human cardiovascular system have been thoroughly elucidated, the penile fibrovascular assembly remains an exception that has yet to be fully explored; therefore, this gap in our understanding prompts us to conduct further investigations.</p><p><strong>Aim: </strong>This study revisits the penile-fibro-vascular assembly to determine whether it constitutes an independent vascular compartment within the human body.</p><p><strong>Methods: </strong>The penile-fibro-vascular assembly was meticulously examined in 23 male human cadavers. The loupe-assisted observation was used to compare the size of bilateral penile arteries, conspicuously addressed at the hilum, and to isolate erection-related vascular channels meticulously with a loupe, as extensively as possible. Additionally, a comprehensive library was analyzed, including 801 cadaveric images, 1001 sets of dual cavernosographies, 11 spongiosographies, 7 Magnetic Resonance Imaging (MRI)/computed tomography (CT) cavernosographies, 61 Doppler's sonographies, and 15 selective internal pudendal arteriographies. Hemodynamic phenomena were observed both intra-corporeally and extra-corporeally in patients who underwent penile venous stripping (n = 501), coil embolization (n = 6), and pudendal arterial stenting (n = 5).</p><p><strong>Outcomes: </strong>This study confirms the existence of an independent penile fibro-vascular hydraulic environment within the human cardiovascular system.</p><p><strong>Results: </strong>The human penis contains an independent bi-layered fibrovascular assembly. Anatomical symmetry of bilateral arteries is rare on the arterial side. On the venous drainage side, there is one deep dorsal vein (DDV), two cavernosal veins, and four para-arterial veins, contrary to the conventional understanding of only a single DDV between the tunica albuginea and Buck's fascia. The penile venous drainage blood ultimately returns to pulmonary circulation.</p><p><strong>Clinical implications: </strong>Penile vascular surgery, particularly penile venous stripping, is shown to be the most physiologically appropriate method for restoring erectile function; contrarily, erection-related arterial stents, or venous embolization do not offer similar benefits.</p><p><strong>Strengths and limitations: </strong>This study's strength lies in its extensive analysis of a large repository of anatomical, physiological, radiographic imaging, and clinical vascular data; however, its retrospective nature represents a limitation.</p><p><strong>Conclusion: </strong>This study demonstrates that the penile fibro-vascular assembly functions as an independent vascular system, substantially making it the last vascular compartment to be disclosed in the human body.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased walking pace reduces the rate of erectile dysfunction: results from a multivariable Mendelian randomization study.","authors":"Yuekun Fang, Shengyi Chen, Chenxiao Huang, Xinmin Deng, Rui Lai, Xiaofeng Lv, Bin Cheng","doi":"10.1093/jsxmed/qdae178","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae178","url":null,"abstract":"<p><strong>Background: </strong>Previous observational studies have identified a potential association between walking and the risk of erectile dysfunction (ED); however, the causal relationship between them remains unclear.</p><p><strong>Aim: </strong>This study aims to explore the causal relationship between walking and ED using Mendelian randomization (MR).</p><p><strong>Methods: </strong>MR analysis was conducted using genome-wide association study (GWAS) data related to walking pace. The inverse variance weighted (IVW) method was used as the primary MR analysis method. To supplement the IVW results, two additional MR methods were used: MR-Egger and weighted median (WM). Sensitivity analyses were performed to assess heterogeneity and pleiotropy. Furthermore, multivariable MR (MVMR) analysis was employed to evaluate the causal relationship after adjusting for potential confounding factors.</p><p><strong>Outcomes: </strong>The moderating effects of different walking phenotypes on ED.</p><p><strong>Results: </strong>According to the IVW method, genetically predicted walking pace was found to have a reverse causal relationship with the risk of ED (OR: 0.24; 95% CI: 0.12-0.51). Similar causal effects were observed using the other two MR methods, with statistical significance found in the WM method and validation through sensitivity analyses. Furthermore, MVMR analysis confirmed that the protective effect of increased walking pace on reducing the risk of ED remained significant even after adjusting for potential confounders.</p><p><strong>Clinical implications: </strong>Encouraging men to engage in brisk walking could be an effective strategy for reducing the incidence of ED.</p><p><strong>Strengths and limitations: </strong>This study utilized large-scale GWAS summary data on walking and ED and employed a two-sample, multivariable MR design to minimize confounding factors and reverse causation, enabling the derivation of credible causal effects. It is essential to obtain GWAS data from other populations and replicate this MR analysis to validate the results, as well as conduct further research to explore the underlying mechanisms.</p><p><strong>Conclusion: </strong>The results of this study suggest that there is an inverse causal relationship between walking pace and ED risk, and brisk walking may be an independent protective factor against ED.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient satisfaction study for the new Rigicon Infla10 inflatable penile prosthesis including single surgeon safety and outcomes data.","authors":"Naci Burak Cinar, Ali Saribacak, Britney L Atwater, Martin S Gross, Steven K Wilson, Melih Culha","doi":"10.1093/jsxmed/qdae168","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae168","url":null,"abstract":"<p><strong>Background: </strong>Rigicon is a newer inflatable penile prostheses (IPP) manufacturer that has produced the Infla10 IPP for countries outside the United States (US) since 2019, with Food and Drug Administration studies for approval of Infla10 in the US presently underway.</p><p><strong>Aim: </strong>This study aims to report the first patient satisfaction, efficacy, and safety from revision data for the newly available Rigicon Infla10 IPP.</p><p><strong>Methods: </strong>A single surgeon's first 58 patients who underwent Rigicon Infla10 IPP implantation between 2019 and 2023 were included. Most patients (70%) received the Infla10 X (girth expansion) cylinder, and 30% received the Infla10 AX (length and girth expansion) model. Follow-up ranged from 4 to 42 months (median 19 months).</p><p><strong>Outcomes: </strong>Outcomes measured were intraoperative and postoperative complications as well as patient-reported satisfaction.</p><p><strong>Results: </strong>Reoperation was required in 5 patients (8.6%). Complication rates were 1.7% urethral erosion (n = 1), 1.7% infection requiring explant (n = 1), and 5% mechanical malfunction due to tubing breakage at pump junction (n = 3). The tubing issue was addressed by the manufacturer, resulting in no additional mechanical concerns. Kaplan-Meier analysis demonstrated rates of cumulative survival of the device at 12, 24, and 36 months were 96.6%, 93.8%, and 78.2%, respectively. Overall, 53 patients (91.4%) were satisfied at 6 months postoperatively and would recommend the procedure. Diminished satisfaction was due to perceived penile shortening in 3 patients (5.1%) and difficulty learning pump cycling in 2 patients (3.4%).</p><p><strong>Clinical implications: </strong>This single surgeon series demonstrates high rates of patient satisfaction with appropriate early safety from revision.</p><p><strong>Strengths and limitations: </strong>Limitations include the retrospective nature of this study and short-term follow-up. Additional prospective studies incorporating a larger number of patients are warranted.</p><p><strong>Conclusion: </strong>While very new in the marketplace, the Infla10 IPP shows promising early satisfaction, efficacy, and safety from revision.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of pelvic arterial stenosis on erectile function: determining the severity threshold for erectile dysfunction.","authors":"Wei-Lun Huang, Sheng-Yung Tung, Chi-Shin Tseng, Tzung-Dau Wang, Wen-Jeng Lee, Jyh-Horng Chen, Yann-Ron Su, Hong-Chiang Chang, Yi-Kai Chang","doi":"10.1093/jsxmed/qdae172","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae172","url":null,"abstract":"<p><strong>Background: </strong>Pelvic arterial (PLA) stenosis is associated with arterial insufficiency of the penis and erectile dysfunction (ED), but the effect of different severities of PLA stenosis on ED remains unclear.</p><p><strong>Aim: </strong>To investigate how different severities of PLA stenosis affect erectile function.</p><p><strong>Methods: </strong>We included patients who visited our clinic for ED and underwent computed tomography angiography (CTA) and dynamic duplex sonography (DUS). The erectile hardness score (EHS), simplified International Index of Erectile Function (IIEF-5), DUS and CTA results, and flow index (FI) calculated from the peak systolic velocity (PSV) and PLA stenosis percentages were analyzed. EHS < 3 was defined as significant ED. PLA stenosis was analyzed by the mean PLA (average of the right and left PLA) and unilateral or bilateral stenoses. According to severity, stenosis was classified as mild, moderate, or severe.</p><p><strong>Outcomes: </strong>Subjective and objective parameters, including the IIEF-5 score, EHS, PSV, and FI, in relation to different severities of PLA stenosis.</p><p><strong>Results: </strong>The study included 182 patients. Vascular parameters such as the mean PSV, PLA stenosis, and FI correlated with EHS and IIEF-5 scores. Receiver operating characteristic analyses for predicting EHS ≥ 3 showed that all vascular parameters had acceptable discriminatory ability. During the analysis performed using the mean PSA stenosis, EHS decreased in patients with mild and severe mean PLA stenosis, although a PSV drop was noted only in severe cases. The proportion achieving EHS 3 significantly dropped in patients with at least mild mean PLA stenosis. Using unilateral or bilateral PLA stenosis, the EHS significantly dropped in patients with severe unilateral and bilateral PLA stenosis, with PSV decreasing on the affected side in severe unilateral stenosis. However, the mean PSV did not drop despite different unilateral stenosis severities. The proportion achieving EHS 3 significantly dropped among patients with at least moderate unilateral PLA stenosis and bilateral PLA stenosis but not in mild unilateral cases.</p><p><strong>Clinical implications: </strong>The severity of PLA stenosis is correlated with the risk of ED.</p><p><strong>Strengths & limitations: </strong>The strength of this study lies in its analysis of the effect of PLA stenosis on erectile function from various perspectives, including unilateral, bilateral, and mean stenosis. However, the absence of validation regarding the outcomes of endovascular therapy is a limitation.</p><p><strong>Conclusion: </strong>Mild mean PLA stenosis and moderate unilateral PLA stenosis are associated with increased risks of ED; however, mild unilateral PLA stenosis does not affect erectile function.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping of functional erectogenic nerves on the rat prostate.","authors":"Selman Unal, Ruifa Mi, Biljana Musicki, Ahmet Hoke, Arthur L Burnett","doi":"10.1093/jsxmed/qdae174","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae174","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Preservation of erectogenic nerves during radical prostatectomy (RP) is hampered by limited understanding of their precise localization, due to their complex, intertwined paths, and the inherent individual variations across patients. Because erection utilizes a subset of cavernous nerves (CNs) that in response to sexual stimuli reveal phosphorylation of neuronal nitric oxide synthase (nNOS) on its stimulatory site Ser-1412, we hypothesized that delineation of nerves containing phosphorylated (P)-nNOS on Ser-1412 would establish the location of functional erectogenic nerves within the periprostatic region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To identify the distribution and quantity of functional erection-relevant ([P-nNOS]-containing) nerves in the periprostatic area and discriminate them among the CNs distribution. We further evaluated whether functional communication exists between contralateral CNs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Young adult male Sprague-Dawley rats underwent electrical stimulation of the CNs to induce penile erection via phosphorylation of nNOS on Ser-1412 (6 V for 2 min, n = 6). No stimulation group served as control (n = 6). The prostate and adjacent structures were collected and processed for whole-mount double-staining with TuJ1 antibody (a pan-axonal marker) and P-nNOS (n = 3 for stimulation, n = 3 for no stimulation), or total nNOS and P-nNOS (n = 3 for stimulation, n = 3 for no stimulation), followed by modified optical clearing and microscopic examination. Nerve quantification was done by systematic counting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Location and quantification of functional erectogenic nerves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the male rat, we obtained a map of P-nNOS-containing nerves in the periprostatic area, which are relevant for penile erection. Only 17.5% of all nerves, and only 28.4% of the total nNOS-containing nerves in the periprostatic region are functionally erectogenic nerves. Furthermore, there is no functional innervation between contralateral (stimulated and non-stimulated) CNs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;This basic science study is expected to provide a foundation for subsequent studies at the human level. Understanding the erection-relevant nerve distribution in the periprostatic area is expected to advance nerve-sparing RP at the human level to improve sexual function outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;This is the first study to describe and quantitate a subset of functional erection-relevant (P-nNOS-containing) nerves in the periprostatic area. Our study differs from previous studies where nerves containing total nNOS were localized without specifying which nerves produce erection. However, because this study comprised a relatively small number of rats, further studies with a bigger sample size or other model animals are warranted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Only a subset of nerve fibers in the periprostatic reg","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic floor muscle activation in response to pressure stimuli applied to the vulvar vestibule: an observational study comparing women with and without provoked vestibulodynia.","authors":"Linda McLean, Flavia Ignacio Antonio, Marina Petter Rodrigues, Caroline Pukall","doi":"10.1093/jsxmed/qdae171","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae171","url":null,"abstract":"<p><strong>Background: </strong>The nature of pelvic floor muscle (PFM) involvement in provoked vestibulodynia (PVD) is poorly understood.</p><p><strong>Aim: </strong>We aimed to determine if PFM electromyographic (EMG) activity in anticipation of or response to pressure applied to the posterior vaginal fourchette differs between those with and without PVD, and if the magnitude of PFM response is associated with pressure pain sensitivity, psychological or psychosexual function.</p><p><strong>Methods: </strong>This was an observational case-control study. Forty-two volunteers with PVD and 43 controls with no vulvar pain participated. Five on-line questionnaires were completed, then participants underwent a laboratory-based evaluation of vulvar pain sensitivity. EMG activation of the PFMs, hip adductor, and upper trapezius muscles was measured before, during, and after pressure stimuli (low, moderate) were applied, in random order, to the posterior vaginal fourchette and the posterior thigh (control site).</p><p><strong>Outcomes: </strong>EMG amplitude of the pubovisceralis (PV), bulbocavernosus (BC), and external anal sphincter (EAS) muscles. Secondary outcomes were EMG activation of the hip adductor brevis and upper trapezius muscles, questionnaire scores reflecting psychological/psychosexual outcomes, pressure pain threshold (PPT) at the vulvar vestibule, pain reported on a tampon test, and heart rate/heart rate variability.</p><p><strong>Results: </strong>Compared to controls, EMG activation of the PV and EAS, but not the BC, was higher in anticipation of the pressure applied to the vaginal fourchette, was higher in all PFMs while the pressure was applied, and remained higher than baseline after the pressure was removed among those with PVD. EMG response amplitudes were modulated by the intensity of the pressure applied, with the largest responses reaching over 40% MVC in the EAS among those with PVD. PFM EMG amplitudes were associated with greater pain sensitivity and lower sexual function, but not with pain catastrophizing, central sensitization, depression, anxiety, or stress.</p><p><strong>Clinical implications: </strong>While some anticipatory activation was observed, EMG responses were primarily observed during and after the application of the pressure. Among those with PVD, digital assessment of PFM tone might reflect PFM responses to pain at the vulvar vestibule, and interventions to reduce local pain sensitivity may be an important first step to successful improvements in vaginal function.</p><p><strong>Strengths and limitations: </strong>This study includes a robust analysis of EMG activation. However, the cross-sectional design precludes the determination of causal relationships.</p><p><strong>Conclusions: </strong>Those with PVD demonstrate higher PFM responses and a higher prevalence of anticipatory activation in the PV and EAS muscles than controls in response to pressure applied at the vulvar vestibule.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}