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Human sexual function is complex and multidimensional, with physiologic and psychological components. The common sexual dysfunctions in men have significant overlap. Low sexual desire in men includes a lack of interest in thinking about sex or in being sexual, alone or with a partner. Sexual health counseling often is helpful. Physicians should prescribe supplemental testosterone only if it is clearly indicated. (Sexual dysfunction is an off-label use of testosterone.) Supplementation is not beneficial for men with a normal total testosterone level. Erectile dysfunction (ED) is the consistent or recurrent inability to attain or maintain a penile erection sufficient for sexual satisfaction. The cause typically is multifactorial. The oral phosphodiesterase type 5 inhibitors are the first-line pharmacotherapies for most patients with ED. Their use is contraindicated in patients taking nitrates. Peyronie disease is an acquired penile abnormality that causes curvature or other deformities of the erect penis. Premature ejaculation is defined as a lack of ejaculatory control that is associated with distress. All pharmacotherapies for premature ejaculation are used off label. First-line treatment options include daily selective serotonin reuptake inhibitors (eg, paroxetine), on-demand clomipramine, and topical penile anesthetics. Psychotherapeutic and physical therapies also have been shown to be effective.

Scrotal and testicular conditions include benign masses, infections, testicular torsion, and testicular cancer. Common palpable benign scrotal masses include spermatocele, varicocele, and hydrocele. Most patients with these masses require no treatment. Some varicoceles are associated with impaired fertility, probably due to an increase in scrotal temperature that leads to testicular hyperthermia, oxidative stress, and reduced spermatogenesis. Patients with documented infertility or scrotal pain should be referred to a urology subspecialist for consideration of surgical management. Epididymitis and epididymo-orchitis are caused by infection with Neisseria gonorrhoeae , Chlamydia trachomatis , or enteric bacteria. Antibiotics and supportive measures (eg, scrotal elevation, bed rest) are recommended for management of acute epididymitis. Testicular torsion is a urologic emergency that requires rapid surgical exploration and orchidopexy to reduce the risk of testicular loss due to ischemia. Salvage rates exceed 90% when surgical exploration is performed within 6 hours of symptom onset. Testicular cancer commonly manifests as a painless, incidentally discovered mass in a single testis. Ultrasonography is recommended to confirm the diagnosis. The recommended primary intervention for a suspected malignant testicular tumor is radical inguinal orchiectomy., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Introduction: The aim of this study is to characterize health related quality of life (HRQOL) in Japanese patients after bladder cancer surgery and to perform cross-cultural comparison between Japanese and American patients., Methods: Firstly, we cross-sectionally assessed HRQOL of 371 patients in Japan using the Bladder Cancer Index (BCI-Japanese). HRQOL of the four groups of patients (native bladder without intravesical therapy, native bladder with intravesicaltherapy, cystectomy with ileal conduit, and cystectomy with neobladder) were assessed. Secondly, we compared the Japanese with the American cohort ( n  = 315) from the original BCI paper. After adjusting for age and gender, the differences in each BCI subdomain score was analyzed., Results: Among Japanese patients, the urinary domain function score was significantly lower among the cystectomy with neobladder group, compared to the cystectomy with ileal conduit group ( p  < 0. 01). Despite this, the urinary bother was comparable between the two groups. Although there were apparent differences between Japanese and American patients, there were few differences in Urinary and Bowel HRQOL. In three of the four treatment groups (other than native bladder with intravesical therapy), Japanese patients were more likely than Americans to report poor sexual function ( p  < 0.05). However, Japanese patients were less likely than Americans to be bothered by their lower sexual function, regardless of treatment ( p  < 0.05)., Conclusions: HRQOL outcomes following treatment of bladder cancer in Japan are comparable to those in the USA, except for sexual functioning and sexual bother. The BCI can be used for cross-cultural assessments of HRQOL in bladder cancer patients., Competing Interests: Dr. Yamada, Dr. Wei, Dr. Takada, Dr. Sato, Dr. Shinohara, Dr. Ogasawara, Dr. Rew, Dr. Murai, Dr. Matsumoto, Dr. Morita, Dr. Minami, Dr. Kiku-chi, Dr. Kashiwagi, Dr. Ito, Dr. Harabayashi, Dr. Fukuhara, Dr. Furumido, Dr. Dunn, Dr. Abe and Dr. Honda have nothing to disclose., (© 2021 – The authors. Published by IOS Press.)

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It is common, affecting at least 12 million U.S. men. The five-question International Index of Erectile Function allows rapid clinical assessment of ED. The condition can be caused by vascular, neurologic, psychological, and hormonal factors. Common conditions related to ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment. Performance anxiety and relationship issues are common psychological causes. Medications and substance use can cause or exacerbate ED; antidepressants and tobacco use are the most common. ED is associated with an increased risk of cardiovascular disease, particularly in men with metabolic syndrome. Tobacco cessation, regular exercise, weight loss, and improved control of diabetes, hypertension, and hyperlipidemia are recommended initial lifestyle interventions. Oral phosphodiesterase-5 inhibitors are the firstline treatments for ED. Second-line treatments include alprostadil and vacuum devices. Surgically implanted penile prostheses are an option when other treatments have been ineffective. Counseling is recommended for men with psychogenic ED.

Aims: The Michigan Incontinence Symptom Index (M-ISI) is a validated measure for urinary incontinence. This study evaluates the M-ISI as a screening tool for clinically relevant urinary incontinence in a population-based sample of women., Methods: The Establishing the Prevalence of Incontinence (EPI) Study is a case-control, population-based study that enrolled women ages 35-64, with and without urinary incontinence. The M-ISI is a validated questionnaire with subdomains for stress and urgency urinary incontinence. Two hundred fourteen EPI subjects underwent a clinical evaluation and urodynamic testing to establish the presence and type of urinary incontinence, and also completed the M-ISI. The M-ISI scores were evaluated using receiver operating characteristic (ROC) curves to determine the optimal diagnostic threshold scores above which women were likely to have clinically relevant urinary incontinence., Results: The optimal M-ISI diagnostic threshold scores were determined to be ≥ 3 for the stress urinary incontinence subdomain (area under the curve of 0.79), ≥ 5 for the urgency urinary incontinence subdomain (area under the curve of 0.88), and ≥ 7 for the Total M-ISI score (area under the curve of 0.89). The sensitivity and specificity of the M-ISI questionnaire for stress, urgency, and total urinary incontinence were 77% and 73%, 86% and 76%, and 84% and 75%, respectively., Conclusions: The M-ISI may be used to screen for clinically relevant urinary incontinence with high sensitivity and specificity among women ages 35-64. A brief, self-administered tool such as the M-ISI can help health care providers identify and manage women with urinary incontinence., (© 2014 Wiley Periodicals, Inc.)

Physicians in the United States increasingly care for culturally, linguistically, and educationally diverse immigrants with limited English proficiency. Language barriers contribute significantly to the health disparities experienced by patients with limited English proficiency. Qualified professional interpreters should be used instead of ad hoc interpreters, such as a patient's friend or family member, an untrained bilingual staff member, or a bilingual stranger. Children should not be used as interpreters. Physicians and other health care professionals must be fluent to communicate with patients in another language. Use of electronic translation systems should be avoided. Cultural competence refers to the attitudes, knowledge, and skills needed to work well in cross-cultural situations and effectively provide care to diverse populations. Stereotypes are perpetuated when members of a group are assumed to share cultural values, beliefs, or attitudes. Attempting to memorize a list of what to do and what to avoid when working with any particular group is ineffective. Every patient's culture is multidimensional and dynamic and is not defined by race or language group., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Immigrants and refugees are at risk of infectious diseases (IDs) that are rare in the United States. Screening and treatment before entry into the United States are required for some of these diseases, whereas quarantine is mandated for others. The Centers for Disease Control and Prevention has published specific recommendations for the evaluation and treatment of immigrants and refugees before and after they arrive in the United States. In addition, immigrants and refugees who return to their home countries are at greater risk of IDs than other travelers. Health care professionals are required to report certain IDs to state or local health departments., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Overseas medical screening by panel physicians for conditions that might jeopardize US public health is required for admission to the United States by immigrant visa or refugee status. According to protocols established by the Centers for Disease Control and Prevention, conditions such as active tuberculosis and substance dependence, when detected, prohibit entry to the United States, whereas close medical follow-up after arrival is required for individuals with other conditions. Refugees and asylees should undergo further medical assessment by a US civil surgeon as soon as possible after arrival. Applicants for legal permanent residence in the United States, whether by immigrant visa or adjustment of status, must receive vaccinations comparable to those recommended for citizens. When immigrants and refugees present to a primary care physician, the vaccination process may not be complete, and documentation of the extent to which it is complete might be lacking. Immigrants and refugees may have a variety of unrecognized or untreated musculoskeletal conditions, mental health conditions, infectious diseases, and chronic conditions., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Immigrants leave their homes for unfamiliar destinations in search of better lives for themselves and their families. Many immigrants experience profound loss and emotional distress as they adjust to life in different societies. Despite these challenges, the prevalence of mental health conditions among immigrants is low, whereas children of immigrants have rates equal to those of native populations. The prevalence of mental health conditions is high among refugees, who comprise a specific subgroup of immigrants who have been displaced forcibly and often have experienced severe trauma. Cultural factors, such as stigma and somatization of emotional symptoms, make it less likely that immigrants and refugees from certain groups will ever present to mental health subspecialists. Strong therapeutic relationships, cultural sensitivity, involvement of family members, judicious use of medications, and knowledge of available community resources are important tools that can aid clinicians who treat immigrants and refugees with mental health conditions., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

A variety of penile problems are commonly seen by primary care physicians. This article reviews the diagnosis, evaluation, and management of congenital conditions such as hypospadias, chordee, webbed and buried penis, duplicated urethra, ambiguous genitalia, and micropenis. Acquired emergent conditions, including minor trauma and paraphimosis, are also discussed, with a particular emphasis on initial evaluation and management. Conditions associated with erectile dysfunction, including priapism and Peyronie disease, are reviewed., (Copyright (c) 2010. Published by Elsevier Inc.)