Journal of Sexual Medicine最新文献

{"title":"Are patients undergoing intralesional collagenase Clostridium histolyticum injection therapy for Peyronie's disease compliant? A 7-year analysis from a tertiary care men's health center.","authors":"Supanut Lumbiganon, Hana Nakamura, Muhammed A M Hammad, Elia A Chawareb, Faysal A Yafi","doi":"10.1093/jsxmed/qdaf051","DOIUrl":"https://doi.org/10.1093/jsxmed/qdaf051","url":null,"abstract":"<p><strong>Background: </strong>Peyronie's disease (PD) involves the formation of fibrous scar tissue in the penis, causing pain, deformity, and significant psychological and sexual distress. Intralesional injection of collagenase Clostridium histolyticum (CCH) has emerged as a promising non-surgical treatment, though patients may experience complications and require multiple clinic visits.</p><p><strong>Aim: </strong>This study aims to evaluate patient compliance with CCH therapy, compare outcomes between compliant and non-compliant groups, and identify reasons for non-compliance.</p><p><strong>Methods: </strong>This IRB-approved retrospective study analyzed patients with PD between 2017 and 2023. Patients were evaluated by a fellowship-trained andrologist. Patients who elected to have intralesional CCH were initially offered four cycles of treatment, with compliance defined as completing at least four cycles or achieving satisfactory results with fewer cycles.</p><p><strong>Outcomes: </strong>Data on demographics, disease characteristics, treatment modalities, compliance, and outcomes were extracted from electronic medical records, and causes of non-compliance were identified. Outcomes and complications were compared between compliant and non-compliant groups.</p><p><strong>Results: </strong>Two hundred and ninety-two PD patients elected to have an intralesional injection of collagenase CCH. Among these, 51.4% completed four treatment cycles, 14.7% received more than four cycles, and 33.9% received fewer than four cycles. The overall compliance rate for injection therapy, including those satisfied with fewer cycles, was 70.89%. Mean pre-treatment curvature for 292 patients was 46.77 ± 14.26 degrees. Compliant patients showed a greater percent of curvature reduction (median 44.44 (IQR 34.17) vs 33.33 (IQR 44.17), P = .034) and less post-treatment curvature in degree (median 25.00 (IQR 17.02) vs 30.00 (IQR 23.75), P = .032) compared to non-compliant patients. Common reasons for incomplete treatment included adverse effects (15.1%), early satisfaction with results (14.1%), and unknown factors (45.4%).</p><p><strong>Clinical implications: </strong>Compliance with CCH therapy for PD significantly impacts treatment outcomes. Healthcare providers should address factors contributing to non-compliance. Qualitative studies are recommended to gain deeper insights into non-compliant patients.</p><p><strong>Strengths and limitations: </strong>This study analyzed compliance in a large cohort of PD patients and compared outcomes between compliant and non-compliant groups. However, missing data in the non-compliant group and the bias between compliant and non-compliant patients in this retrospective study are major notable limitations.</p><p><strong>Conclusion: </strong>Overall compliance rate for CCH injection therapy was 70.89%. Greater curvature reduction was demonstrated in compliant patients. Common reasons for incomplete treatment included adverse effect","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":"22 5","pages":"794-798"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056837","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":"Impact of female sexual dysfunctions on women undergoing pipelle endometrial biopsy and endocervical curettage for abnormal uterine bleeding: a prospective cross-sectional study.","authors":"Sevim Baltali, Ayşegül Ercan, Gonca Ceylan Kavsut, Rabia Göldağı, Gülen Kavsa, Elvan Çiftçi, Mehmet Baltali","doi":"10.1093/jsxmed/qdaf037","DOIUrl":"10.1093/jsxmed/qdaf037","url":null,"abstract":"<p><strong>Background: </strong>Endometrial and endocervical biopsy sampling provides critical information for diagnosing and planning treatment in cases of abnormal uterine bleeding or suspected gynecological conditions. However, documented failure rates of up to one-third due to difficulties accessing the uterine cavity or insufficient histological sampling might have considerable clinical consequences.</p><p><strong>Aim: </strong>To assess the impact of female sexual dysfunction (FSD), depression, and anxiety on additional analgesic requirements (AAR), procedure failure (PF) due to endometrial inaccessibility, and biopsy failure (BF) among women undergoing pipelle endometrial biopsy and endocervical curettage (PEB- ECC).</p><p><strong>Methods: </strong>This prospective study collected data through face-to-face interviews with 417 women who underwent PEB-ECC between November 2022 and 2023. Anxiety and depression were evaluated using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI), respectively. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria were used to assess FSD and its related components. Age, body mass index, and educational level were considered potential confounders.</p><p><strong>Outcome: </strong>Outcomes included the necessity for additional analgesics during the surgical process, PF attributed to challenges in accessing the uterine cavity, and BF resulting from inadequate histological sampling.</p><p><strong>Results: </strong>A BAI score > 9, age ≥ 55 years, and the presence of FSD were independent predictors of AAR during PEB-ECC. PEB-ECC sampling failed in 71 women (17.0%), with PF in 7 (1.7%). Univariate analysis showed that only genito-pelvic pain/penetration disorder was associated with PF. Age ≥ 55 years and FSD were significant predictors of BF. Female orgasmic disorder was associated with BF as a component of FSD.</p><p><strong>Clinical implications: </strong>Our findings highlight the significance of FSD in influencing the success of endometrial and endocervical biopsy sampling, which gynecologists and anesthesiologists should consider before and during the procedure.</p><p><strong>Strengths and limitations: </strong>This study is the first to assess the impact of FSD on the success of PEB-ECC procedures. Intercultural variation exists in the prevalence and predictors of FSD; therefore, our findings should be interpreted cautiously. Validation studies remain warranted. We evaluated the presence and components of FSD during the interviews rather than its severity; the low response rate (417 [25.3%]) might have impacted the results.</p><p><strong>Conclusion: </strong>Despite sufficient sedation/analgesia, FSD significantly influenced AAR, PF, and BF in women undergoing PEB-ECC. Anesthesiologists and gynecologists should consider additional factors to improve the success of sampling procedures.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"731-738"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651981","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":"Exploring pain perception and depression in vulvodynia: the role of catastrophizing and pain acceptance.","authors":"Spinoni Marta, Cucurachi Giorgia, Porpora Maria Grazia, Grano Caterina","doi":"10.1093/jsxmed/qdaf046","DOIUrl":"10.1093/jsxmed/qdaf046","url":null,"abstract":"<p><strong>Background: </strong>In the context of vulvodynia, a gynecological disorder characterized by chronic vulvar pain affecting an estimated 10% of women, with significant impacts on sexual health, mental well-being, and productivity, the Common-Sense Model of Illness Self-Regulation, a well-established framework for understanding the impact of illness perceptions and coping strategies on mental health, has not yet been empirically tested.</p><p><strong>Aim: </strong>We aimed to explore whether illness perceptions and pain-specific coping strategies-namely, pain catastrophizing and chronic pain acceptance-influence the relationship between vulvar pain severity and depression in women with vulvodynia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted on a total of 119 women with reporting diagnosis of vulvodynia.</p><p><strong>Outcomes: </strong>Through an online questionnaire, we assessed demographic and clinical characteristics, vulvar pain severity, illness beliefs, pain catastrophizing, pain acceptance, and depressive symptoms.</p><p><strong>Results: </strong>The path analysis showed that vulvar pain positively influences directly illness perceptions (β = .56, P < .001) and depressive symptoms (β = .24, P < .001). Negative perceptions of the illness were significantly associated with increased pain catastrophizing (β = .66, P < .001), and decreased pain acceptance (β = -.59, P < .001), resulting in heightened depressive symptoms (β = .33, P < .001, β = -.27, P < .001, respectively).</p><p><strong>Clinical implications: </strong>Interventions that challenge negative illness perceptions and promote more positive views could reduce maladaptive coping strategies, enhance pain acceptance, and ultimately diminish psychological distress.</p><p><strong>Strengths and limitations: </strong>This study's strengths lie in its foundation on a theoretical, well-established model and the use of validated measures. However, the cross-sectional design precludes concluding causality between predictor and outcome variables, and the clinical information was self-reported and could not be verified with medical records.</p><p><strong>Conclusions: </strong>The findings underscore the importance of targeting illness perceptions and coping strategies in shaping psychological outcomes for women with vulvodynia.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"851-858"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665343","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":"Preliminary analysis of the Female Genital Self-Image Scale (FGIS-4) and the Male Genital Self-Image Scale (MGIA-5) in an international sample of adults with spina bifida.","authors":"Devon J Hensel, Tori Sciara, Rosalia Misseri, John S Wiener, Joshua D Roth, Konrad M Szymanski","doi":"10.1093/jsxmed/qdaf033","DOIUrl":"10.1093/jsxmed/qdaf033","url":null,"abstract":"<p><strong>Introduction: </strong>Common chronic health conditions associated with spina bifida (SB) may impact sexual health among adults in this population, including genital self-image (GSI), but no studies explore this topic.</p><p><strong>Aim: </strong>The primary aim of this study was to provide a preliminary psychometric assessment of the four-item Female Genital Self-Image Scale (FGSIS-4) and the five-item Male Genital Self-Image Scale (MGSIS-5) for use among adults with SB. A secondary aim was to describe the association of GSI with key demographic, health, and sexual experience characteristics.</p><p><strong>Methods: </strong>An international online survey collecting background and clinical data was administered to adults with SB over 12 months. We assessed internal consistency, construct validity, and convergent validity for GSI. Bivariate regression was used to explore the individual associations of each variable with the FGSIS-4 and MGSIS-5.</p><p><strong>Outcomes: </strong>GSI was measured using the 4-item Female Genital Self-Image Scale (FGSIS-4) and the 5-item Male Genital Self-Image Scale (MGSIS-5); sexual function measures (sexual desire and overall satisfaction) from the Female Sexual Function Index and the International Index of Erectile Function; and health-related quality of life with Quality of Life Assessment in Spina Bifida for Adults.</p><p><strong>Results: </strong>Participants (N = 217 women and N = 146 men) were primarily heterosexual and had a median partial-to-full college education. Half of all the participants were in a relationship and living independently. A third of both men and women were community ambulators, and a quarter of both reported full genital sensation. About half of the sample (women: 47.1%; men: 46.2%) reported clean intermittent catheterization (CIC). Both scales demonstrated good internal reliability (FGSIS-4: 0.845; MGSIS-5: 0.877) and a single-factor construct structure. Higher FGSIS-4 and MGSIS-5 scores correlated positively with sexual desire overall sexual satisfaction, health-related quality of life, and urinary continence but did not vary with using CIC.</p><p><strong>Clinical implications: </strong>Because GSI negatively impacts sexual health and sexual function, clinicians treating patients with SB should consider discussing GSI as part of routine care.</p><p><strong>Strengths and limitations: </strong>Although this research measured women's and men's GSI behavior in a large international sample of adults with SB, it is limited by its cross-sectional and retrospective design, as well as by its non-clinical convenience sample.</p><p><strong>Conclusion: </strong>The FGSIS-4 and MGSIS-5 show preliminary desirable psychometric properties for the measurement of GSI in the SB population.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"877-887"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634959","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":"Mechanical failure of inflatable penile prostheses: time to failure and reasons for replacement.","authors":"Ryan Griggs, Gerard Henry, Valeria Vasylieva, Edward Karpman","doi":"10.1093/jsxmed/qdaf053","DOIUrl":"10.1093/jsxmed/qdaf053","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in the composition material, pump design, and infection retardant coatings, inflatable penile prosthetics (IPPs) remain prone to mechanical failure.</p><p><strong>Aim: </strong>To distinguish IPP mechanical failure etiologies and time to failure among the 2 most common manufacturers: American Medical Systems/Boston Scientific (BSCI) and Coloplast (CP).</p><p><strong>Methods: </strong>A retrospective chart review of 2 high-volume IPP surgeon revision and virgin cases was conducted from January 2018 to September 2023. Mechanical revision indications were stratified by brand and component location (pump, tubing, cylinder, and reservoir), while non-mechanical revision cases and those with missing data were excluded. Subgroup analysis regarding the cylinder rupture rate between BSCI controlled-expansion (Cx) ≤18 vs ≥21 cm devices was also performed. Categorical variables were assessed with chi-square or Fisher exact analysis, while continuous variables were evaluated with Student and Mann-Whitney U tests. The log-rank test was used to compare BSCI component-specific survival.</p><p><strong>Outcomes: </strong>Outcomes included time to failure, site-specific mechanical failure location in IPPs among BSCI and CP devices, and cylinder rupture rate among ≤18 vs ≥21 cm BSCI (Cx) cylinders.</p><p><strong>Results: </strong>We identified a total of 410 cases: 220 BSCI and 190 CP devices. One hundred twenty-nine were revisions. Seventy-two met the inclusion criteria (63 BSCI and 9 CP). BSCI mechanical failures included: cylinder rupture, 26/63 (41.3%), tubing fracture, 7/63 (11.1%), reservoir rupture, 3/63 (4.8%), cylinder aneurysm, 6/63 (9.5%), and pump failure, 21/63 (33.3%). Coloplast mechanical failure included: tubing fracture 7/9 (77.8%), while reservoir rupture and cylinder aneurysm each were 1/9 (11.1%). Time to mechanical failure was a median of 48 and 41 months, respectively, for BSCI and CP devices.</p><p><strong>Clinical implications: </strong>Mechanical failure site distribution between device manufacturers is significant and should be considered during primary and revision cases.</p><p><strong>Strengths and limitations: </strong>This study adds to the literature indicating when and where mechanical failure occurs in IPPs between the 2 major IPP manufacturers. Collaborative prospective studies would provide a more robust evaluation.</p><p><strong>Conclusions: </strong>The current study provides a breakdown of failure modes for contemporary 3-piece inflatable penile prostheses. Larger series are required to validate findings.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"909-915"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804762","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":"Known limitations and shared prioritization of sexual wellbeing: Response to Letter to the Editor.","authors":"Isabelle S van der Meulen, Marijn Arnoldussen, Anna I R van der Miesen, Sabine E Hannema, Thomas D Steensma, Annelou L C de Vries, Baudewijntje P C Kreukels","doi":"10.1093/jsxmed/qdaf031","DOIUrl":"10.1093/jsxmed/qdaf031","url":null,"abstract":"","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"986-987"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558661","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":"Association of cannabis abuse/dependence on risks of erectile dysfunction and testosterone deficiency using a large claims database analysis.","authors":"Ryan Davis, Jacob Hershenhouse, Marissa Maas, Jeffrey Loh-Doyle, Kian Asanad","doi":"10.1093/jsxmed/qdaf043","DOIUrl":"10.1093/jsxmed/qdaf043","url":null,"abstract":"<p><strong>Background: </strong>Cannabis is widely consumed across the United States; however, studies assessing the association between cannabis use and male sexual health, specifically erectile dysfunction (ED) and testosterone deficiency (TD), have mixed results and small sample sizes.</p><p><strong>Aim: </strong>To evaluate the impact of cannabis abuse/dependence on risks of ED, phosphodiesterase-5 inhibitor (PDE5-i) prescription, TD, and testosterone replacement therapy (TRT) using a population-level analysis.</p><p><strong>Methods: </strong>We sampled men ≥18 years old from the large claims database, TriNetX, in 2025. Patients previously diagnosed with or treated for ED or TD and those with prior prostatectomy were excluded. Patients were split into two cohorts: diagnoses of cannabis abuse/dependence or not. Cohorts were propensity score-matched on 49 pertinent factors. Risk of ED, TD, PDE5-i prescription, and TRT were compared at 3 months-1 year (patients from 2005-2024) and 3-5 years (patients from 2005-2020) from cannabis diagnoses. Subgroups of age younger or older than 40 years were also analyzed. Kaplan-Meier survival analysis was performed to assess differences in time to development of ED and TD.</p><p><strong>Outcomes: </strong>Primary outcomes were risk of diagnosis of ED or TD (testosterone level <300 ng/dL). Secondary outcomes were risk of new prescription of PDE5-i or TRT.</p><p><strong>Results: </strong>Between 2005-2024, 30 964 patients with and 1 473 182 without cannabis diagnoses were identified with 29 442 in each cohort after matching. Between 2005-2020, 17 948 patients with and 839 496 without cannabis abuse/dependence were identified, with 17 211 in each cohort after matching. Cannabis abuse/dependence was significantly associated with ED (0.9% vs. 0.2%, RR = 3.99 [3.05, 5.21]), TD (0.2% vs. 0.1%, RR = 2.19 [1.45, 3.31]), and PDE5-i prescription (0.8% vs. 0.2%, RR = 3.80 [2.86, 5.04]) at 3 months-1 year, and only ED at 3-5 years (1.61% vs. 1.34%, RR = 1.20, 95% CI = [1.01, 1.43]). Kaplan-Meier analysis revealed significantly shorter time to development of ED (HR = 1.65, 95% CI = [1.47, 1.85]) and TD (HR = 1.34, 95% CI = 1.07, 1.69]) associated with cannabis abuse/dependence. No association between cannabis abuse/dependence and TRT was found. In those <40 years old, only ED and PDE5-i were significant at 3 months-1 year, but not at 3-5 years.</p><p><strong>Clinical implications: </strong>Our findings support an association between cannabis abuse/dependence, ED, and TD, which providers may consider when treating patients with these diagnoses.</p><p><strong>Strengths and limitations: </strong>Strengths include having a large, national sample of patients. Limitations include inability to assess dose-dependent relationships and using diagnosis codes as proxies for cannabis use.</p><p><strong>Conclusion: </strong>Cannabis abuse/dependence is associated with increased risk of ED, PDE5-i prescription, and TD.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"711-718"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694472","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":"Exploring subjective and genital sexual response in transgender women upon addition of low-dose testosterone to feminizing gender-affirming hormone therapy: a feasibility study.","authors":"Noor C Gieles, Baudewijntje P C Kreukels, Martin den Heijer, Stephanie Both","doi":"10.1093/jsxmed/qdaf041","DOIUrl":"10.1093/jsxmed/qdaf041","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Transgender women using feminizing gender-affirming hormone therapy who underwent a gonadectomy generally have lower testosterone levels than cisgender women. It is unknown if testosterone supplementation can influence subjective and genital sexual response in transgender women and whether this can be measured using vaginal photoplethysmography.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study aimed to assess the feasibility of measuring changes in subjective and genital sexual response in transgender women who underwent a penile inversion vaginoplasty after testosterone supplementation to physiological female concentrations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Transgender women received daily testosterone 2% transdermal gel, aiming for serum concentrations between 1.5 and 2.5 nmol/L for 12-20 weeks. Vaginal pulse amplitude (VPA) was measured during neutral, erotic fantasy, erotic film, and genital vibration stimulus blocks before and after testosterone supplementation. After each stimulus block, subjective sexual response was assessed. Sexual function, sexual excitability, and VPA measurement experience were assessed using questionnaires.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Change in mean VPA score and subjective sexual response after testosterone supplementation during neutral film, erotic fantasy, erotic film, and genital vibration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight participants were included of whom seven completed the study. VPA during neutral film was significantly higher after testosterone supplementation [estimated ratio 2.7 (95% confidence interval {CI} 1.7-4.3), P &lt; 0.001]. After testosterone supplementation, we observed no change in the degree of VPA response upon exposure to erotic fantasy [estimated ratio 1.4 (95% CI 0.68-2.8), P = 0.372], erotic film [estimated ratio 1.2 (95% CI 0.54-2.8), P = 0.629] and genital vibration [estimated ratio 1.2 (95% CI 0.46-2.9), P = 0.742] compared to before testosterone supplementation. After testosterone supplementation, participants reported significantly stronger feelings of sexual arousal, genital sensations, and positive affect in response to erotic fantasy and erotic film. Finally, there was a significant improvement in sexual function and sexual excitability assessed by questionnaires. VPA measurement was generally well-accepted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;Vaginal photoplethysmography can be used to assess changes in neovaginal perfusion in transgender women.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths & limitations: &lt;/strong&gt;This is the first study assessing genital and subjective sexual response to testosterone supplementation in transgender women. The lack of a placebo condition precludes any clinical conclusions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Vaginal photoplethysmography can be used to assess changes in neovaginal vasocongestion after testosterone supplementation in transgender women. Explorative analyses suggest promising effects on subjective sexual response and a","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"937-944"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658769","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":"Pornography and problematic pornography use: occurrence, patterns, and associated factors in a national gender-based controlled cross-sectional study.","authors":"Rezvan Zarei, Farzane Alidost, Maryam Damghanian, Beáta Bőthe, Farnaz Farnam","doi":"10.1093/jsxmed/qdaf034","DOIUrl":"10.1093/jsxmed/qdaf034","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A study on pornography is vital due to internet accessibility, widespread pornography usage, and a lack of data, especially in non-western countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study estimates the occurrence of pornography use (PU), compares demographic, sexual, and psychological factors between users (PUs) and non-users, and identifies associated factors of PU based on gender. It examines problematic pornography use (PPU), comparing usage patterns between PPUs and non-PPUs, and identifies associated factors of PPU.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In 2021, an online cross-sectional nationwide survey was conducted among 1249 Iranians (865 women, 384 men) in all provinces except one, using a convenience sampling method through social media platforms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Participants were categorized into PUs and non-users based on their pornography use over the past year. PUs were further divided into PPUs and non-PPUs, using the Problematic Pornography Consumption Scale cutoff (&gt;20). The researcher-made questions assessed patterns of pornography use, demographic characteristics, and sexual information; sexual health variables and psychological factors were evaluated by standard scales.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;PU was reported by 30.1% of participants (n = 376), including 27.5% of women and 35.9% of men. Logistic regression identified being male, shorter marriage duration, earlier age at first sex, lower religiosity, poorer sexual communication, masturbation, substance abuse, and depression as associated factors for PU. Among PUs, 13% (n = 49) were PPUs, including 10% of women and 17.1% of men. Linear regression identified the following risk factors for PPU: being male, longer marriage duration, masturbation, sexual distress, and pornography use. Conversely, having more children was a protective factor. Compared to non-PPUs, PPUs reported higher pornography consumption, the primary motivation being masturbation, greater usage among close friends, prioritizing pornography over sex with their spouse, negative effects on their sex life, and increased use during the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;Healthcare providers should address modifiable factors related to PU/PPU through early sex education and support. Objective measurements of PPU should be prioritized over subjective perceptions, as many infrequent users feel moral incongruence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;The study's applicability may be limited by imbalanced gender participation, recruitment of married individuals, and a small number of PPUs. However, strengths include standardized assessment tools, gender-based data collection, and anonymous sampling to enhance response accuracy in conservative contexts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Accurate pornography occurrence measurement requires clear definitions, consideration of dropout rates, and consistent time units. Strong corre","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"825-838"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607122","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":"Deep and Superficial Dyspareunia Questionnaire: a patient-reported outcome measure for genito-pelvic dyspareunia.","authors":"Nisha Marshall, Samantha L Levang, Yang Doris Liu, Heather Noga, Catherine Allaire, Melanie Altas, Shauna Correia, Miriam Driscoll, Kirstie Merkt-Caprile, Ria Nishikawara, Rebecca Weaver, A Fuchsia Howard, Jessica Sutherland, Lori A Brotto, Caroline F Pukall, Paul J Yong","doi":"10.1093/jsxmed/qdaf025","DOIUrl":"10.1093/jsxmed/qdaf025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Dyspareunia affects 8%-22% of women worldwide and an unknown number of gender-diverse people. Dyspareunia is commonly categorized into deep and superficial subtypes based on pain location and underlying etiology; however, current assessment tools inadequately differentiate between pain locations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study aimed to develop a patient-reported outcome measure (PROM) that independently assesses deep and superficial dyspareunia and its psychosocial correlates: the Deep and Superficial Dyspareunia Questionnaire (DSDQ).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The DSDQ development stages included item construction, categorization, review/revision, focus groups, cognitive interviews, final review, and factor analysis. Items were developed by reviewing pre-existing measures related to dyspareunia. Constructs of these measures were adapted to create items for the DSDQ. Developed items were categorized according to a conceptual framework. To review items, 4 patient partners, 2 gynecologists, and 1 psychiatrist participated in a modified eDelphi process. Next, 3 patient focus groups (n = 5, n = 3, n = 4), 1 clinician focus group (n = 2), and patient cognitive interviews (n = 15) were conducted over 2 rounds. A qualitative descriptive approach guided interview analysis, which informed DSDQ modifications and generated evidence of validity. Clinician-researchers (n = 4) and patient partners (n = 2) completed the final revision. Lastly, an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) determined the most appropriate factor structure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Generated items, validity, factor structure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifty-nine pre-existing measures were reviewed to generate an initial pool of 163 items. Items created were categorized into domains for characteristics (pain quality, timing, location, and intensity) or psychosocial correlates (impact of pain on cognitions, affect, sexuality, and behavior). The eDelphi modified 40 items, added 23, and excluded 10. After the final review, 175 items were approved for psychometric analysis. The EFA supported a 103-item, 6-factor model. The CFA supported a 45-item, 6-factor model. Factors included: (1) Vaginal Opening Pain; (2) Deep Vaginal/Pelvic/Abdominal Pain; (3) Pain Interference; (4) Affect and Cognitions Related to Provoked Pain; (5) Sexual Distress Related to Sexual Well-being; and (6) Pain Self-efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;The DSDQ will aid diagnosis, treatment, and assessment of dyspareunia changes over time in research and clinical settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;Strengths of this work include DSDQ co-development with patient partners, multidisciplinary clinicians, and researchers, as well as the rigorous mixed-methods development. Limitations include demographic and clinical homogeneity of the patient samples and sample sizes for the EFA and CFA.","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":" ","pages":"767-777"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588071","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}