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Abstract: Sexual dysfunction can adversely affect the quality of life, self-confidence, and interpersonal relationships. Some studies reported a relationship between vitamin supplementation and sexual health. This systematic review aimed to evaluate the effect of vitamins on female and male sexual function. All relevant English and Persian articles published in English databases (Medline, Scopus, Cochrane Library, Web of Sciences, Psycho-Info, and Proquest) and Farsi databases (SID and Magiran) until July 2020 were searched. The Cochrane Handbook for Systematic Reviews of Interventions was used for assessing the risks of bias. A total of 11 randomized controlled trials (RCTs) on 337 women, 472 men, and 35 couples were included. One study reported that vitamin D 300000 IU supplement administrated twice through intramuscular injection (at the beginning and after four weeks) had a significant effect on female sexual function (p0.05). A study reported the significant effect of niacin (vitamin B3) 1500 mg daily for 12 weeks on erectile function (p=0.004). The results showed that vitamins A, C, and E had no significant effect on male and female sexual function. The conduction of trials with long-term interventions is recommended to reach a more definitive conclusion about the effect of vitamins on sexual function.

A multicenter, cross-sectional study was conducted to assess the sexual function of women survivors of hematologic malignancy after autologous hematopoietic stem cell transplantation (AHSCT), and to compare it with that of healthy women controls. Fifty-six sexually active women survivors of hematologic malignancy who underwent AHSCT were recruited through convenience sampling, as well as 60 healthy women. Demographic and clinical data questionnaires and the Female Sexual Function Index (FSFI) were completed. Survivors had a median age of 44 years and a median time since transplant of 3 years, while 48.2% had Hodgkin Lymphoma. Survivors reported an average level of sexual dysfunction, with a total score mean ± SD = 22.51 ± 8.95. The best sexual functioning domain was “pain” and the most affected was “orgasm”. There was a statistically significant association between survivors’ sexual function and age (p < 0.0005) in both the unifactorial and the multifactorial analysis. In addition, there was a statistically significant association between survivors’ sexual function and functional status (p < 0.0005), menopausal status (p < 0.0005), the presence of children (p = 0.002), education (p < 0.0005), and diagnosis (p < 0.0005). Healthy women had statistically significantly higher scores in all FSFI subscales (p < 0.0005). Women survivors of hematologic malignancy, treated by AHSCT, had impaired sexual function, implying the need to implement regular sexual health assessment in survivorship care.

Summary Objectives We aimed in the current cross-sectional study to evaluate rates and patterns of SD among drug naive women with mild to moderate depression against those receiving escitalopram. Study design Group (A) included 120 females diagnosed with mild to moderate depression. Group (B) served as controls included 60 age-matched volunteers. Main outcome measures Female participants were evaluated by the validated Arabic female sexual function index (ArFSFI), perceived stress situation scale (PSS), patient health questionnaire-9 scale (PHQ-9) and center for epidemiological studies-depression scale (CES-D). Results The study demonstrated that females with mild to moderate depression treated with escitalopram had better sexual function than those who were drug naive. Additionally, treated females got better scores of PSS, CES-D and PHQ-9 compared to those who were drug naive. The PSS and the CES-D and the PHQ-9 scales negatively correlated with the domains of desire, pain, arousal, lubrication, orgasm, satisfaction and total score of FSFI. Finally, a linear regression analysis after adjustment of FSFI as a dependent variable had revealed that the PSS scale, the PHQ-9 scale and the international index of erectile function-5 were significant independent predictors of the affected females’ sexual function. Conclusion Escitalopram is associated with lesser risk of SD in females with mild to moderate depression.

Background The use of surgical clips for athermal dissection of the lateral prostatic pedicles and ligation during pelvic lymph node dissection (PLND) while performing robotic-assisted radical prostatectomy (RARP) has been the gold standard. Clips are used to prevent thermal injury of the unmyelinated nerve fibers and lymphceles, respectively. Objective To compare oncological and functional outcomes of a new technique of clipless, lateral pedicle control and PLND with RARP with bipolar energy (RARP-bi) versus the standard RARP technique with clips (RARP-c). Design, setting, and participants A retrospective study was conducted among 338 men who underwent RARP between July 2018 and March 2020. Surgical procedure RARP-c versus RARP-bi. Measurements We prospectively collected data and retrospectively compared demographic, clinicopathological, and functional outcome data. Urinary as well as sexual function was assessed using the Expanded Prostate Cancer Index for Clinical Practice, and complications were assessed using Clavien-Dindo grading. Multivariable regression modeling was used to examine whether the technical approach of RARP-bi versus RARP-c was associated with positive surgical margins (PSMs) or sexual and urinary function scores. Results and limitations A total of 144 (43%) and 194 (57%) men underwent RARP-bi and RARP-c, respectively. Overall, there were no differences in functional and oncological outcomes between the two approaches. On multivariable regression analysis, the RARP-bi technique was not associated with significant differences in PSMs (odds ratio [OR] = 1.04, 95% confidence interval [CI] 0.6–1.8; p = 0.9), sexual function (OR = 0.4, 95% CI 0.1–1.5; p = 0.8), or urinary function (OR = 0.5, 95% CI 0.2–1.4; p = 0.2). The overall 30-d complication rates (12% vs 16%, p = 0.5) and bladder neck contracture rates (2.1% vs 3.6%, p = 0.5) were similar between the two groups. There was no difference in lymphocele complications (1.4% vs 0.52%, p = 0.58). All complications were of Clavien-Dindo grade I–II. Conclusions Despite the concerns for an increased risk of nerve injury secondary to the use of bipolar energy for prostatic pedicle dissection, we demonstrate that this technique is oncologically and functionally similar to the standard approach with surgical clips. There was no difference in complications or lymphocele formation for techniques with versus without clips. Patient summary We describe a modified technique for prostatic pedicle dissection during robotic-assisted radical prostatectomy, which utilizes bipolar energy and is associated with shorter operative time, without compromising functional or oncological outcomes.

Background Survivors of prostate, bladder, and colorectal cancer endure many sexual side-effects of treatment that negatively impact their relationships and diminish their quality of life. Multiple barriers exist in addressing men's sexual concerns in oncological care. Objective To describe barriers of sexual recovery in men with prostate, bladder, and colorectal cancer. Methods We searched PubMed for peer-reviewed, English-language articles published from 1999 to 2019 using the following search terms: “prostate cancer,” or “bladder cancer,” or “colorectal cancer,” and “male,” and “sexual function,” or “sexual barrier” or “sexual dysfunction.” Criteria for inclusion consisted of peer-reviewed articles (review, cross-sectional, longitudinal, interventional, or pilot studies) addressing sexual issues in men with a history of prostate, bladder, or colorectal cancer. Results Barriers to sexual recovery in men with prostate, bladder, and colorectal cancer include psychosocial barriers such as the feeling of loss, grief, depression and anxiety, the poor utilization, and excessive cost of pro-erectile aids, a diminished sense of masculinity and reluctance to seek help for sexual problems, as well as poor couple coping. Barriers in healthcare also exist, as healthcare providers often do not effectively address sexual issues due to poor communication, lack of comfort in discussing sexual issues, time constraints, and patients’ hesitation to initiate discussions on sexual dysfunction. Patients with stomas and gay, bisexual, and queer men face additional challenges in their recovery of sexual intimacy. Barriers to sexual recovery are present in men during all stages of cancer and all modalities of treatment including surgery, radiation, or androgen deprivation therapy. Conclusion There are multiple overlapping psychosocial and healthcare system barriers to sexual recovery after prostate, bladder, and colorectal cancer treatment. Oncological providers must be cognizant of these complex barriers so they can facilitate patients’ access to resources needed for successful sexual recovery after genitourinary cancer treatment. Evidence based interventions, such as couple psychosexual counseling and peer support should be implemented via multidisciplinary care.

Sexual health concerns are prevalent and distressing in oncology patients and survivors. While urologic cancers are more prevalent in men, women often have more advanced disease at initial diagnosis, require more advanced surgical resection, and experience higher postoperative complication rates, as well as morbidity and mortality. Women with urologic cancers undergo treatment that is highly likely to impact their sexual function and well-being, however, attention to sexual recovery in this patient population has been limited. Barriers to sexual recovery in women with urologic cancers are biopsychosocial in nature and include complications related to treatment procedures, cancer-related distress, sexual anxiety and avoidance, partner and relational dynamics, and sexual communication skills. Healthcare providers do not adequately address sexual difficulties for these patients and their partners. Sexual minority women and transgender patients with urologic cancer have unique psychosocial and sexual health needs though, due to a lack of research, these remain poorly understood. More research is needed to pinpoint the sexual health needs of this specific oncology population and to explore how various treatment options, such as pelvic organ-sparing cystectomy, can impact sexual health outcomes. Evidence-based and multidisciplinary oncologic and survivorship care, which includes licensed mental health providers, certified sex therapists, and other sexual health experts, is essential for assisting women in their sexual recovery following urologic cancer.

Sexual dysfunction (SD) is widely reported by cancer survivors. However, this is an issue underestimated by doctors and the contribution of anticancer therapies for the development of SD in cancer survivors is understudied and poorly understood. Sexual function involves the activation of a neurovascular system that leads to penile erection in males and clitoral engorgement in females. Anticancer therapies can cause damage to the neurovascular circuit responsible for normal sexual function and thus, individual or combined therapies could play a role in the development of SD in all types of cancer survivors and not only those affected by genital cancers. In this review, the pathophysiology of SD and possible mechanisms underlying SD induced by anticancer therapies will be discussed. The effects of chemotherapy, radiotherapy and surgical interventions on the vasculature and nerves as well as their effects on sex hormones and inflammatory processes could link the biological effects of these interventions with SD. In conclusion, this review reports evidence that, despite psychological aspects and the disease itself, anticancer therapies are able to induce direct and indirect effects in males and females that could lead to SD in cancer survivors even after the end of the treatment.

RESUMEN Antecedentes: Las quejas por sintomatología de genitales externos y flujo genital ocupan del 15 al 30% de los motivos de consulta en el área de ginecología y obstetricia. Objetivo: Determinar la relación entre los síntomas de infección del tracto genital y la función sexual en mujeres que acuden al Consultorio Obstétrico Integral de la Mujer (en adelante COIM), Quito, 2022. Diseño metodológico: estudio cuantitativo-analítico de corte transversal, con 245 mujeres que acudieron a la consulta ginecológica. Se aplicaron los siguientes instrumentos: un formulario para las variables sociodemográficas y ginecológicas, y el cuestionario validado EVAS-M para medir la función sexual. La codificación de los datos y el análisis estadístico se realizó con el programa SPSS 25. Los resultados describen frecuencias, porcentajes, promedios y desviación estándar. Para contrastar la hipótesis se empleó el Test de Chi cuadrado de Pearson. La significancia estadística fue de 0,05. Resultados: las edades están comprendidas entre los 18 - 77 años. Los síntomas genitales más prevalentes fueron la picazón o prurito (43,7%), el flujo genital (35,5%) y el dolor (25,7%). El 40,4% de las pacientes obtuvo un sumatorio total o menor de 38 puntos, lo que significa que presentan una probable disfunción sexual. Conclusiones: se determinó una correlación estadísticamente significativa entre dos síntomas de infección del tracto genital [ardor (p Symptoms of genital tract infections and sexual function in women attending the Consultorio Obstétrico Integral de la Mujer, Quito, 2022 ABSTRACT Background: complaints due to external genitalia symptoms and genital discharge occupy 15-30% of the reasons for consultation in the gynaecology and obstetrics area. Objective: to determine the relationship between symptoms of genital tract infection and sexual function in women attending the Consultorio Obstétrico Integral de la Mujer (hereafter COIM), Quito, 2022. Methodological design: quantitative-analytical cross-sectional study, with 245 women attending the gynaecological clinic. The following instruments were applied: a form for sociodemographic and gynaecological variables, and the validated EVAS-M questionnaire to measure sexual function. Data coding and statistical analysis were performed with SPSS 25. Results describe frequencies, percentages, averages, and standard deviation. Pearson's Chi-square test was used to test the hypothesis. The statistical significance was 0,05. Results: ages ranged from 18 - 77 years. The most prevalent genital symptoms were itching or pruritus (43,7%), genital discharge (35,5%) and pain (25,7%). 40,4% of the patients scored a total score or less than 38 points, meaning that they have probable sexual dysfunction. Conclusions: a statistically significant correlation was determined between two symptoms of genital tract infection [burning (p &nbsp

Aims This study aimed to explore experiences of women with urinary incontinence (UI) according to the Roy Adaptation Model (RAM). Methods A phenomenological design was used in this study, and its conceptual framework was formed by the RAM. The sample was composed of 12 women with UI. Face-to-face in-depth interviews were conducted according to data collection tools. Semi-structured interviews were recorded in audio-recording device. Thematic approach was used to assess the data. Results The average age of the women was 52.77 +/- 7.32 years, seven women had menopause, eight had vaginal birth. According to the thematic approach, four main themes emerged: physiological mode, self-esteem mode, role function mode, and interdependence mode and they had difficulties in this regard. Conclusions The results show that women cannot adapt to the problem of incontinence according to the dimensions of RAM. These factors are important to consider when developing strategies to address UI, diagnosis, and treatment.

Summary Purpose The aim of this study was to investigate the relationships between hypogonadism and sexual functioning in males with and without type II diabetes based on the moderating roles of marital status, the level of education, and age. Specifically, the predictive role of hypogonadism on the explanation of sexual functioning was investigated. Method The participants included 229 males with and without type II diabetes. A demographic questionnaire, the International Index of Erectile Function (IIEF), and (2) the Testosterone Level Test (TLT) were used in this study. Results Patients with type II diabetes had significantly lower testosterone levels, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall sexual satisfaction than individuals in the control group. The erectile function, orgasmic function, sexual desire, intercourse satisfaction, and the overall sexual satisfaction had significant positive relationships to the total testosterone level in this sample. The total testosterone level explained 39% of the overall sexual function variation in the present study. Conclusion Patients with type II diabetes have higher hypogonadism and a lower sexual functioning than healthy individuals, and there is a significant linear relationship between the total testosterone level and sexual functioning in males.

Summary Background Religion may play a major role for medical students with regard to their own sexuality, but also to their future sexual counseling. We aimed to examine sexual function, attitudes and behaviors in male medical students, and to investigate the relationship between sexuality and religiosity dimensions. Method This was a cross-sectional study. A total of 146 male medical students (mean age of 22.2 years) were surveyed using the International Index of Erectile Function and the Arabic Religiosity Scale. Results Students who had higher religiosity levels had lower number of sexual partners, tended to believe that a man should have sex with only one partner and only after marriage, were more likely to regret “very much” their first sexual experience and less likely to use pornography. After controlling for confounding variables, only alcohol use and perception of the first sexual experience contributed significantly to students’ sexual function, while overall religiosity did not contribute to sexual function. Conclusion Making young medical students aware of their own attitudes towards sexuality and of the fact that these attitudes would be shaped by preconceived religious beliefs can represent a first step towards successfully preparing students for future sexual counseling and attitudes toward patients.

CONTEXT: The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh's micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump. OBJECTIVE: To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options. EVIDENCE ACQUISITION: The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included. EVIDENCE SYNTHESIS: The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh's micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being. CONCLUSIONS: Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods. PATIENT SUMMARY: We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh's micrographic surgery could be used for smaller lesions. ispartof: EUROPEAN UROLOGY OPEN SCIENCE vol:40 pages:58-94 ispartof: location:Netherlands status: published

SUMMARY OBJECTIVE: This study was conducted to examine the effect of women’s unmet family planning needs on their sexual functions during the COVID-19 pandemic period. METHODS: A cross-sectional study was conducted with 319 women of childbearing age across Turkey between April and May 2021. Data were obtained through online questionnaires using the “Survey Form” and the Female Sexual Functıon Index. RESULTS: It was observed that 46.77% of the participants had difficulty in accessing the family planning method, the most used family planning method during the pandemic period was the withdrawal method with 52.35%, and there was a significant difference between them and the pre-pandemic method (p

Context Endothelial progenitor cells (EPCs), which are involved in the mechanisms of vascular repair and sexual function, are decreased in diabetic women compared with general population. Objective This work aimed to investigate the circulating levels of EPCs and the change in sexual function during the menstrual cycle in women with type 1 diabetes (T1DM) compared with healthy women. Methods This case-control observational study was conducted at the Unit of Endocrinology and Metabolic Diseases at University Hospital “Luigi Vanvitelli’’ of Naples. Participants included 36 women with T1DM and 64 age-matched healthy controls. EPCs were quantified by flow cytometry and sexual function was assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale. All assessments were made at the follicular, ovulatory, and luteal phases of the same menstrual cycle. Main outcome measures included differences in EPCs levels and sexual function between patients and controls. Results Compared with controls, women with T1DM showed significantly lower levels of both CD34 + (P Conclusion Women with T1DM show lower levels of EPCs during the menstrual cycle compared with controls. EPCs count predicts sexual function in this selected population.

Erectile dysfunction is recognized as one of the complications of diabetes mellitus. To date, a wide gap of knowledge is present on the efficacy of pharmacological treatments of diabetes mellitus on erectile function, acting not only through metabolic control. Similarly, the effects of different diet regimens on erectile dysfunction are still debated.We aimed to explore the effects of diet and antihyperglycemic drugs, considering both old and novel therapeutic approaches, on erectile function.We performed a systematic review, following the PRISMA guidelines. The research was conducted on studies reporting erectile dysfunction assessment in subjects with diabetes and the relationship with diet and antihyperglycemic drugs.The Mediterranean diet was effective in most studies for the protection of erectile function. Furthermore, antihyperglycemic drugs seem to show an overall protective role on erectile function.Although encouraging results are present for all classes of antihyperglycemic drugs, several studies are needed in humans, mainly on acarbose, pioglitazone, dipeptidyl-peptidase-4 inhibitors, and sodium-glucose cotransporter-2 inhibitors.

Female genitourinary treatments in aesthetics utilize energy-based treatments and other non-invasive modalities. These include CO2 and Er:YAG lasers, radiofrequency (RF), high-intensity focused electromagnetic energy (HIFEM), hyaluronic acid (HA) injection, platelet-rich plasma (PRP), and silicone thread treatments with an objective to treat sexual dysfunction and symptoms of genitourinary syndrome associated with menopause (GSM), which include atrophic vaginitis, urinary incontinence, and vulvovaginal laxity that is characterized by vaginal dryness, thinning of the epithelium, laxity, prolapse, incontinence, dyspareunia, and increased bacterial infections. The body of evidence is growing for the use of these modalities to improve signs and symptoms of GSM and sexual function, as well as rejuvenate the appearance of external female genitalia. We reviewed the currently available modalities in this rapidly advancing area of expertise.

Purpose Endometriosis affects the quality of life, sleep, and sexual life of patients due to pain. This study compared the scores of endometriosis patients in these three areas before and after surgery. Methods Patients between the ages of 18–60 with a prediagnosis of endometriosis were enrolled. Postoperative histopathological diagnosis of endometriosis was confirmed in all patients. This study included 56 patients who completed pre- and postoperative (three months) evaluation of quality scale questionnaires: a visual analog scale for pelvic pain, the Pittsburgh Sleep Quality Index, Morningness-Eveningness Questionnaire, Endometriosis Health Profile-30 Questionnaire, and Female Sexual Function Index were administered prior to and three months after each patient’s surgery. Results Among the 56 female patients included in this study, statistically significant improvement statistically significant improvement was observed in pain scores, quality of life, sexual function, and sleep of all patients regardless of endometriosis stage. Conclusion Endometriosis is a disease that progresses, with increasing pain scores; it has negative effects on the quality of life, sexual function, and sleep of patients. Surgical or medical treatment can be performed considering the complaints and fertility status of the patients.

Purpose The aim of this study was to evaluate in a population of patients with erectile dysfunction (ED): (a) the prevalence of a previously unknown endocrine/glycemic disorders; (b) the correlation between ED severity and endocrine/glycemic disorders. Methods 1332 patients referred for ED from 2013 to 2020 were included. The ED diagnosis was made using the International-Erectile-Function-Index-5 questionnaire. ED severity was considered according to presence/absence of spontaneous erections, maintenance/achievement deficiency. All patients were subjected to search for sociodemographic and clinical characteristics: age, ethnicity, marital status, previous use of PDE5i, previous prostatectomy, diabetes mellitus (DM), prediabetes, endocrine dysfunctions. Results The mean ± SD age was 54.3 ± 13.7 years. The 19.1% (255/1332) of patients were already in treatment for prediabetes/diabetes or endocrine dysfunctions. Among the remaining 1077, the prevalence of previously unknown endocrine and glycemic disorders was 30% (323/1077). Among them, 190/323 subjects (58.8%) were affected by hypogonadism, with high estradiol level observed in 8/190 (4.2%). The prevalence of new glycemic alterations was 17.3% (56/323) [specifically, 32/56 (57.1%) DM, and 24/56 (42.9%) prediabetes]. A thyroid dysfunction was observed in 40/323 subjects (12.3%) and hyperprolactinemia in 37/323 (11.5%). Patients with new diagnosis of DM showed more severe form of ED compared to the total group {difficulty in the achievement of erection: 46/56 [82.2%, vs 265/1332 (19.9%), p p Conclusion ED is an early marker of endocrine/glycemic disorder, and a previously unknown dysfunction was found in more than a quarter of patients. A newly diagnosed DM is associated with ED severity, especially in elderly man and in presence of hypertension.

Background: Sexual functions in women with lymphedema secondary to breast cancer surgery have not been investigated sufficiently. This study aimed to compare patients with and without lymphedema af...

Low prolactin levels have been found to impair libido and arousal, as well as to reduce wellbeing in young women.The aim of this study was to investigate whether drug-induced hypoprolactinaemia affects male sexual function and depressive symptoms.The study population consisted of three groups of young and middle-aged men. Two groups were treated with dopamine agonists because of previous hyperprolactinaemia but differed in current prolactin levels, which were3ng/ml (n=12; group 1) or within the reference range (3-20ng/ml) (n=20; group 2). The control group (group 3) included 24 dopamine agonist-naïve normoprolactinaemic men. During the study, doses of dopaminergic agents in group 1 were reduced by 25-50% compared to doses before the start of the study. Circulating levels of prolactin, testosterone, free calculated testosterone, dehydroepiandrosterone-sulphate, oestradiol and gonadotropins were measured upon enrolment in the study and six months later. Moreover, at the beginning and the end of the study, all men enrolled completed questionnaires assessing sexual functioning (IIEF-15) and depressive symptoms (BDI-II).Group 1 differed from groups 2 and 3 in domain scores for sexual desire and erectile function, and in the overall BDI-II score. It was also characterised by lower levels of total testosterone and calculated free testosterone. Reduction of drug doses normalised sexual desire and erectile function, reduced BDI-II scores and increased prolactin as well as total and free calculated testosterone. Groups 2 and 3 did not differ from each other in sexual functioning, depressive symptoms or hormone levels.The results obtained indicate that men with dopamine agonist-induced hypoprolactinaemia are characterised by impaired sexual functioning and reduced wellbeing. These disturbances are a consequence of subnormal prolactin levels and do not seem to reflect adverse effects of dopamine agonists.

Infertility is disproportionately associated with distress in women, yet there has been limited research focusing on sexual function in this population. Two hundred and thirty women with infertility who were attempting to conceive without medical assistance were recruited via social media. Women completed the Fertility Quality of Life, Revised Dyadic Adjustment Scale, Female Sexual Functioning Index, State-Trait Anxiety Inventory, and Patient Health Questionnaire. Over half of the women with infertility met the clinical cut-off for sexual dysfunction. Sexual function was positively associated with relationship adjustment and infertility-related quality of life and negatively associated with anxiety and depression. Sexual function moderated the relationship between time trying to conceive and psychological outcomes. These findings highlight several domains of sexual functioning that could be manipulated via psychological interventions to potentially improve distress among women struggling to conceive.

Objective: Female sexual dysfunction is a common condition that negatively impacts the psychological health and quality of life of the affectedindividuals. Therefore, this study aims to assess sexual function changes in women using hormonal and non-hormonal contraceptives.Methods: We assessed 380 women who visited three Family Health Centers in Manisa, Turkey. Female Sexual Function Index (FSFI) andBeck Depression Inventory (BDI) questionnaires were used to get data. Regression and correlation analyses were applied to determine therelationship and level of sexual function of participants.Results: According to FSFI cut-off score ≤26.55, the prevalence of female sexual dysfunction (FSD) was determined in 35.4% and 48.0% of sexualfunction changes and FSFI score was found 26.5±4.3 and 27.1±4.1 in women using non-hormonal and hormonal contraceptives. In regressionanalysis, women having higher education, satisfied with their sexual life, and women stating that their husband satisfied with non-hormonalcontraceptive usage had high score in FSFI. Of those women, 6.6% scored ≥17 on the BDI.Conclusion: The use of hormonal and non-hormonal contraceptives is important for the improvement sexual quality of women planningappropriate initiatives. Therefore, healthcare practitioners and providers should assess women’s risk factors for FSD, arrange for extra follow-upand assist with early diagnosis and treatment to improve women’s sexual life.

Objectives Mindfulness-based approaches to treatment of sexual dysfunction associated with vulvar pain appear promising, but little is known about the specific processes of mindfulness in sexual interactions or if mindfulness may be of particular benefit to women who experience pain associated with sexual activity. This study aimed to examine the associations between sexual mindfulness and sexual function and distress among women who currently experience pain with sexual activity as compared to women who do not. Methods Women over the age of 18 were invited to complete an online survey, including measures of mindfulness in sexual activity, pain associated with sexual activity, sexual function, and sexual distress. Of the participants, 134 (42.1%) were experiencing pain and 184 (57.9%) were pain free. Results Higher levels of mindfulness during sexual activity were associated with greater sexual functioning and less sexual distress both among women with and without pain. However, the association between Observing skills and sexual functioning among women with pain was weaker if the capacity for nonreactivity was low. Sexual mindfulness contributed significantly to the explanation of sexual function and distress in both groups. Of the mindfulness facets, Acting with awareness consistently contributed, beyond the other facets, to the explanation of sexual outcomes. Conclusions The capacity to stay mindful in sexual interactions appears to be important to sexual functioning both among women who experience pain with sexual activity and among women who do not. These findings encourage further examination of the role of mindfulness and its facets in sexual outcomes.

OBJECTIVES: To quantify the severity of urinary and sexual dysfunction, and to evaluate the relationship between urinary and sexual dysfunction, injury, and treatment factors in patients with pelvic fracture. DESIGN: Prospective cohort study. SETTING: Level 1 trauma center.Patients/Participants: 113 patients with surgically treated pelvic fracture (65.5% OTA/AO 61B fractures; 7 open fractures; 74 men). INTERVENTIONS: Surgical pelvic stabilization. MAIN OUTCOME MEASURES: Short Form-36 Health Survey (SF-36) and International Consultation Incontinence Questionnaire (ICIQ) responses were collected at baseline, 6 months and 1, 2 and 5 years. Patients were scored on symptoms of voiding and incontinence, and filling (for women), to derive urinary function. Sexual function was scored as a single domain. Both genders reported urinary and sexual bothersome symptoms. Regression analysis was used to isolate the importance of predictive factors on urinary and sexual function, urinary and sexual bother, and their impact on quality of life. RESULTS: Patients with pelvic fracture have significant urinary and sexual dysfunction, which is sustained or worsens over time. Male urinary function was predicted by Injury Severity Score (p=0.03) and 61C fracture (odds ratio (OR): 3.23, p=0.04). Female urinary function was predicted by urinary tract injury at admission (OR: 7.57, p=0.03). Neurologic injury and anterior fixation were identified as significant predictors for male sexual function and sexual bother, while urological injuries were important in predicting female urinary and sexual bother (p

BACKGROUND: Radical cystectomy (RC) has the potential for profound changes to health-related quality of life (HRQOL). OBJECTIVE: To evaluate a broad range of HRQOL outcomes in a large RC cohort. DESIGN, SETTING, AND PARTICIPANTS: A single-center prospective study enrolled RC patients from 2008 to 2014. We collected 14 separate patient-reported outcome measures at the presurgical visit and at 3, 6, 12, 18, and 24 mo after RC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: To visualize the patterns of recovery over time across domains, we used generalized estimating equations (GEEs) with nonlinear terms. Given substantial differences in patient selection for the type of urinary diversion, we separately modeled longitudinal HRQOL within conduit and continent diversion groups. The mean pre-RC scores were compared to illustrate the baseline HRQOL differences between diversion groups. RESULTS AND LIMITATIONS: The analyzed cohort included 411 patients (n = 205 ileal conduit, n = 206 continent diversion). At baseline, patients receiving continent diversion reported better mean physical (p < 0.001), urinary (p = 0.006), and sexual function (p < 0.001), but lower social function (p = 0.015). After RC, GEE modeling showed physical function scores decreasing 5/100 points by 6 mo, and subsequently stabilizing or returning to baseline. By 12 mo, social function improved by 10/100 points among continent diversions, while remaining stable among ileal conduits. Global quality of life exceeded baseline scores by 6 mo. Sexual function scores were low before RC, with limited recovery. Psychosocial domains were stable or improved, except for 10/100-point worsening of body image among ileal conduits. CONCLUSIONS: RC patients reported favorable HRQOL recovery within 24 mo in most areas other than body image (ileal conduits) and sexual function (both). Importantly, large measurable decreases in scores were not reported by 3 mo after RC. These contemporary outcomes and the excellent locoregional control provided by RC further support it as the gold standard therapy for high-risk bladder cancer. PATIENT SUMMARY: We review quality of life in the 24 mo following radical cystectomy. Large decreases in health-related quality of life were not reported, with most areas returning to, or exceeding, baseline, except for sexual function and body image.

Background Cloacal exstrophy (CE) is the most severe end of the Exstrophy-Epispadias Complex malformations spectrum. Improvements in postnatal management and well-established operative techniques have resulted in survival rates approaching 100%. This systematic review aims to define the prevalence of long-term active medical problems affecting CE patients after the first decade of life. Methods PubMed/Medline, Embase, Scopus, and ISI Web of Knowledge databases were used for the literature search. Original articles related to medical, surgical, and psychosocial long-term problems in CE patients >10 years of age were included in the study. Quality assessment of the articles was performed through the Newcastle-Ottawa Scale. Prevalence estimates and 95% CI were assessed for each outcome. Results Twelve studies were included. The most common long-term active problems identified were: urinary incontinence with a prevalence ranging from 9.1% to 85%; sexual function issues related to vaginal anomalies with a prevalence ranging from 8.3% to 71.3%, and uterine anomalies, with a prevalence from 14.3% to 71%; gender identity issues in 46, XY patients raised female had a prevalence from 11.1% to 66.7%. There is no documented history of paternity. Impairment of ambulatory capacity was recorded in 13.8% of patients. Only one paper studied psychological well-being, reporting significantly higher levels of depression among gender reassigned patients. Conclusions Teenagers and adults born with CE have well defined long-term problems compared to the general population. Recognition and expert management are crucial to improve care and quality of life during and after the transition into adulthood.

Stress urinary incontinence (SUI) related to pelvic organ prolapse represents a common condition that negatively impacts female sexual activity. Laparoscopic pelvic organ prolapse surgery (POPs) and the anterior repair with a trocar-less trans-vaginal mesh (TTMs) represent two different surgical techniques to treat SUI secondary to POP. This study aimed to report the results of these techniques comparing the sexual and functional outcome improvement.Fifty-nine sexually active female patients, complaining of urodynamic stress incontinence, were enrolled in this prospective study, and simply randomized in two groups: 29 POPs and 30 TTMs. All patients were studied at baseline and 6 months after surgery. Preoperative evaluation included medical history, urodynamic test, Female Sexual Function Index (FSFI), and pelvic magnetic resonance defecography. Six months after surgery, all patients completed the FSFI and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and were investigated with a uroflowmetry test with post-void residual volume (PVR).At 6 months after surgery, 87% of POPs patients and 79% of TTMs subjects resulted dry. No statistically significant results were obtained in terms of urinary outcomes between the two surgical groups. Regarding sexual function, POPs group exhibited a significant greater improvement of global FSFI (mean: 27.4; SD: 4.31) compared to TTMs group (mean FSFI: 23.56; SD: 2.28; p-value ≤ 0.0001).Our results indicated that POPs and TTMs lead to satisfactory and safe functional outcomes with a good recovery of urinary continence. Furthermore, POPs, when compared to TTMs, led to a greater improvement of sexual function.

To assess the effectiveness of psychosexual education on promoting sexual function and genital self-image and reducing sexual distress through e-learning among women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.Randomized controlled trial.Imam Khomeini Hospital "Pelvic Floor Clinic" in Tehran.Thirty-eight 15- to 49-year-old women with MRKH syndrome who had undergone surgical or nonsurgical vaginal reconstruction techniques more than 6 months before the intervention were assigned to 2 parallel intervention and control groups of 19 each.Psychosexual education was delivered through e-learning for the intervention group over an 8-week period, with no limitations of time and space. Sexual function, genital self-image, and sexual distress were evaluated at baseline, and at 4 and 8 weeks after the intervention.The data collection tools included the Persian version of the Female Sexual Function Index, Female Genital Self-Image Scale, and the Revised Female Sexual Distress Scale.The between group mean differences of sexual function, genital self-image, and sexual distress after 4 weeks (-1.2 [95% CI, -2.1 to -0.1], P = .025; -1.9 [95% CI, -2.9 to -0.9], P.001; 4.2 [95% CI, 2.0-6.4], P.001, respectively), as well as after 8 weeks (-1.8 [95% CI, -3.1 to -0.5], P = .009; -3.0 [95% CI, -4.5 to -1.5], P.001; 6.7, 95% CI, 3.9-9.6], P0.001, respectively) after baseline were significant.Psychosexual education improved sexual function and genital self-image and reduced sexual distress in women with MRKH syndrome. Therefore, using this approach, we can raise individuals' sexual knowledge and skills and correct their sexual beliefs and attitudes.

Background: Endometriosis stage is not directly related to the burden of symptoms, and recurrence of symptoms occurs frequently. It is suggested that symptoms are associated with psychological distress, as in depression and anxiety disorders. Our aim was to explore the strength of the associations between endometriosis and depression or anxiety and to review correlating factors. Materials and Methods: A literature search was carried out using the electronic databases Embase, PubMed, Web-of-science, and PsycINFO. Search terms related to depression, anxiety, and endometriosis were combined resulting in 1,837 records. Articles were included when describing an association between patients with endometriosis and symptoms of depression or anxiety assessed by validated tools, structured psychiatric interviews, or a documented diagnosis. With 47 articles a systematic qualitative review was performed. Seventeen studies were eligible for meta-analysis. Results: Endometriosis patients experienced significantly more symptoms of depression (standardized mean difference [SMD] of 0.71 (95% confidence interval [CI] 0.36-1.06)) and anxiety (SMD 0.60 (95% CI 0.35-0.84)) compared with healthy controls, but no differences were found comparing endometriosis patients with other chronic pelvic pain patients (SMD -0.01 [95% CI -0.17 to 0.15] for depression and SMD -0.02 [95% CI -0.22 to 0.18] for anxiety). Besides the effect of pain, other correlating factors included age, quality of life, quality of sleep, fatigue, sexual function, gastrointestinal symptoms, comorbidity, self-esteem, emotional self-efficacy, coping style, social adjustment, pain imagery, and pain sensitization. Conclusion: This systematic review supports the assumption that symptoms of depression and anxiety occur frequently in endometriosis patients and are related to chronic pain. Correlating factors should further be investigated.

Background We conducted a questionnaire-based study of pouch function, quality of life, sexual function, and fertility among patients who had undergone ileal pouch anal anastomosis (IPAA) in childhood and who are now over 18 years old. Methods A consecutive series of patients were asked to complete the following questionnaires: Pouch Function Score (PFS), Short Form 36 (SF-36), International Index of Erectile Function (IIEF) (males), and Female Sexual Function Index (FSFI) (females). Fertility in females was also assessed. Data are quoted as a median (SD). Results Of 144 patients who had IPAA, 101 were eligible, and 70 responded. Mean age at surgery was 14 years, and mean current age is 26 years. Most patients had either ulcerative colitis or familial adenomatous polyposis. The questionnaire was completed by 38/70 (54%). Median PFS score was 6 (5). SF-36 were lower than previous reports. Median FSFI was 30 (7.6), 84% of possible maximum. Median IIEF was 69, 92% of possible maximum. Successful conception was reported in 5/7 women who had tried. However, there were several miscarriages and two surgical emergencies during pregnancies. Conclusions IPAA can be performed in childhood with similar pouch function to reported adult series. Quality of life appears poorer, but sexual function is maintained. There may be an association with adverse events in pregnancy.

The new coronavirus disease 2019 (COVID-19) is a major health problem with a high rate of spread. We aimed to investigate herein the effects of the COVID-19 outbreak on depression and sexual dysfunction in patients with epilepsy.One hundred and sixteen epilepsy patients admitted to our hospital from October-November 2019 were evaluated for sexual functions and depression using the Arizona Sexual Experiences Scale (ASEX) and Beck Depression Scale, respectively. These scales were re-applied in June 2020 and July 2020 to assess the impact of the outbreak on sexual function and depression in the same group of patients. The demographic and clinical characteristics of the patients were recorded and analyzed in SPSS.During the pandemic period, the total Beck Depression Scale values increased significantly in the patients with epilepsy compared to the pre-pandemic period (The COVID-19 outbreak caused an increase in the tendency to depression in epilepsy patients and has also had a negative effect on sexual function. During public health outbreaks, clinicians should focus not only on seizure control in patients with epilepsy but also on their mental health.La nouvelle maladie à coronavirus 2019 (COVID-19) est un problème de santé majeur avec un taux de propagation élevé. Nous visons à étudier ici les effets de l’épidémie de COVID-19 sur la dépression et la dysfonction sexuelle chez les patients atteints d’épilepsie.Cent seize patients atteints d’épilepsie admis dans notre hôpital d’octobre à novembre 2019 ont été évalués pour les fonctions sexuelles et la dépression en utilisant respectivement l’échelle des expériences sexuelles de l’Arizona (ASEX) et l’échelle de dépression de Beck. Ces échelles ont été réappliquées en juin 2020 et juillet 2020 pour évaluer l’impact de l’épidémie sur la fonction sexuelle et la dépression dans le même groupe de patients. Les caractéristiques démographiques et cliniques des patients ont été enregistrées et analysées dans SPSS.Pendant la période pandémique, les valeurs totales de l’échelle de dépression de Beck ont augmenté de manière significative chez les patients atteints d’épilepsie par rapport à la période pré-pandémique (L’épidémie de COVID-19 a provoqué une augmentation de la tendance à la dépression chez les patients épileptiques et a également eu un effet négatif sur la fonction sexuelle. Pendant les flambées de santé publique, les cliniciens devraient se concentrer non seulement sur le contrôle des crises chez les patients atteints d’épilepsie, mais aussi sur leur santé mentale.

Background: Diabetic nephropathy (DN) can affect quality of life (QoL) because it requires arduous lifelong management. This study analyzed QoL differences between DN patients and patients with other chronic kidney diseases (CKDs). Methods: The analysis included subjects (n = 1,766) from the KNOW-CKD (Korean Cohort Study for Outcomes in Patients with Chronic Kidney Disease) cohort who completed the Kidney Disease Quality of Life Short Form questionnaire. After implementing propensity score matching (PSM) using factors that affect the QoL of DN patients, QoL differences between DN and non-DN participants were examined. Results: Among all DN patients (n = 390), higher QoL scores were found for taller subjects, and lower scores were found for those who were unemployed or unmarried, received Medical Aid, had lower economic status, had higher platelet counts or alkaline phosphatase levels, or used clopidogrel or insulin. After PSM, the 239 matched DN subjects reported significantly lower patient satisfaction (59.9 vs. 64.5, p = 0.02) and general health (35.3 vs. 39.1, p = 0.04) than the 239 non-DN subjects. Scores decreased in both groups during the 5-year follow-up, and the scores in the work status, sexual function, and role-physical domains were lower among DN patients than non-DN patients, though those differences were not statistically significant. Conclusion: Among the DN subjects, socioeconomic factors were strong risk factors for impaired QoL, as were high platelet counts, high alkaline phosphatase levels, and clopidogrel and insulin use. Clinicians should keep in mind that the QoL of DN patients might decrease in some domains compared with that in patients with other CKDs.

Purpose There have been few studies using mindfulness-based stress reduction (MBSR) to improve sexual function in Asian women with breast cancer. This study aimed to evaluate the impact of mindfulness intervention on female sexual function, mental health, and quality of life in patients with breast cancer. Methods Fifty-one women with breast cancer were allocated into 6-week MBSR (n=26) sessions or usual care (n=25), without differences in group characteristics. The research tools included the Female Sexual Function Index (FSFI), the Depression Anxiety Stress Scales-21 (DASS-21), and the EuroQol instrument (EQ-5D). The Greene Climacteric Scale (GCS) was used to verify the foregoing scale. The effects of MBSR were evaluated by the differences between the post- and pre-intervention scores in each scale. Statistical analyses consisted of the descriptive dataset and Mann-Whitney ranked-pairs test. Results Although MBSR did not significantly improve sexual desire and depression in patients with breast cancer, MBSR could improve parts of female sexual function [i.e., Δarousal: 5.73 vs. -5.96, Δlubrication: 3.35 vs. -3.48, and Δsatisfaction: 8.48 vs. 1.76; all p

Objective: To determine long-term outcomes of a randomized trial (BIOPEX) comparing biological mesh and primary perineal closure in rectal cancer patients after extralevator abdominoperineal resection and preoperative radiotherapy, with a primary focus on symptomatic perineal hernia. Summary Background Data: BIOPEX is the only randomized trial in this field, which was negative on its primary endpoint (30-day wound healing). Methods: This was a posthoc secondary analysis of patients randomized in the BIOPEX trial to either biological mesh closure (n = 50; 2 dropouts) or primary perineal closure (n = 54; 1 dropout). Patients were followed for 5 years. Actuarial 5-year probabilities were determined by the Kaplan-Meier statistic. Results: Actuarial 5-year symptomatic perineal hernia rates were 7% (95% CI, 0-30) after biological mesh closure versus 30% (95% CI, 10-49) after primary closure (P = 0.006). One patient (2%) in the biomesh group underwent elective perineal hernia repair, compared to 7 patients (13%) in the primary closure group (P = 0.062). Reoperations for small bowel obstruction were necessary in 1/48 patients (2%) and 5/53 patients (9%), respectively (P = 0.208). No significant differences were found for chronic perineal wound problems, locoregional recurrence, overall survival, and main domains of quality of life and functional outcome. Conclusions: Symptomatic perineal hernia rate at 5-year follow-up after abdominoperineal resection for rectal cancer was significantly lower after biological mesh closure. Biological mesh closure did not improve quality of life or functional outcomes.

Background Significant risk of bias and limitations in outcome selections in trials evaluating conservative treatments for the management of Pelvic Organ Prolapse (POP) have been highlighted and preclude comparability of outcomes, synthesis of primary studies and high quality evidence. Objectives As systematic review of the reported outcomes is the first step in the process of development of a Core Outcome Set (COS), we aimed to systematically review reporting of outcomes and outcome measures in Randomised Control Trials (RCTs) on conservative treatments for POP and develop an inventory of them for consideration as core outcome and outcome measures sets. We evaluated methodological quality, outcome reporting quality and publication characteristics and their associations among published RCTs. Study Design: Systematic review of RCTs identified from the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and MEDLINE (Pubmed). RCTs evaluating the effectiveness of conservative interventions for the management of POP were considered for inclusion. Outcomes and outcome measures were obtained from the RCTs and an inventory was created. Outcomes were grouped in domains and themes. Methodological quality, outcome reporting quality and publication characteristics were evaluated and statistically analysed. Results Twenty-five trials (3179 women) were included and reported 31 outcomes and 50 outcome measures. Reporting rates of the outcomes investigated ranged between 4% and 56%. The most commonly reported outcome domains were patient reported symptoms, stage of POP expressed as POP-Q stage, and quality of life. Univariate analysis demonstrated no significant correlations of methodological and outcome reporting parameters. Conclusions There is a need to increase comparability of RCTs. Reporting standardized outcomes included in a COS for conservative interventions for POP will facilitate the comparability across RCTs. While the process of developing COS is in progress, we propose the interim use of the three most commonly reported outcomes in each domain: patient-reported outcomes (symptom distress including bowel and urinary symptoms, sexual function), stage of prolapse and quality of life parameters using validated questionnaires (Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire/Health related quality of life (PFIQ-7/HRQOL) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7).

Aim of the work To investigate the sexual dysfunction in systemic lupus erythematosus (SLE) patients and its relation to physical fitness and other disease parameters. Patients and methods The study included 47 SLE females and 47 matched healthy controls. SLE disease activity index (SLEDAI) and systemic lupus international collaborative clinics damage index (SLICC DI) were assessed. Physical performance of the patients was assessed by the grip ability test (GAT), gait velocity test, Jebsen hand function test, fatigue severity scale (FSS) and the modified health assessment questionnaire (mHAQ). Sexual dysfunction of the patients was assessed by the sexual function index (FSFI). Depressive disorders of the patients were assessed by Beck depression inventory. Results The mean age of the patients was 28.7 ± 7.2 years and disease duration 4.4 ± 2.9 years. GAT was significantly lower (43.65 vs 70.00; p = 0.001), and FSS higher (6.5 vs 1; p = 0.001) in patients compared to control. The total FSFI was significantly lower (23.41 vs 29.60; p = 0.001) and all domains scores were significantly lower except the pain domain (p = 0.001). Beck depression inventory score was higher in patients (13.29 vs 12.74; p = 0.365). SLE females with prescribed corticosteroids and azathioprine had significantly lower FSFI as compared to those without while FSFI score was higher in those receiving hydroxychloroquine. The FSFI significantly correlated with C4 level (r = 0.328, p = 0.024 and inversely with, SLEDAI (r = −0.07, p = 0.001), FSS (r = −0.54, p = 0.001), mHAQ (−0.37, p = 0.01) and with Beck depression inventory (r = −0.57, p = 0.001). Conclusion Married female patients with SLE revealed a higher degree of sexual dysfunction of all domains except pain.

Purpose of review Many surgical treatment options are available for patients who present with benign prostatic obstruction (BPO). This article reviews the current treatment options available and distinguishes them based on five clinical considerations: antithrombotic therapy, sexual function preservation, ambulatory procedures, anesthesia-related risks and duration of catheterization. Recent findings A comprehensive review of the literature was performed on 10 BPO procedures. Laser enucleation of the prostate (LEP), bipolar plasma transurethral vaporization of the prostate and photoselective vaporization (PVP) of the prostate reduces the risk of bleeding, which is recommended for anticoagulated men. Ejaculatory function is more likely to be preserved following transurethral incision of the prostate, Rezūm, Aquablation, UroLift and iTind. Same-day discharge is possible for LEP, PVP and prostatic arterial embolization (PAE). For patients with high anesthesia-related risks, procedures compatible with local anesthesia (UroLift, Rezūm, iTind and PAE) should be favored. Catheterization duration is shorter with UroLift, PVP and LEP. Summary BPO treatment options are growing rapidly. The optimal procedure for a given patient is based on factors such as associated risks, recovery and expected outcomes. Besides prostate volume, the clinical considerations in the present article can help elucidate the best surgical BPO treatment option for each patient based on their values, preferences, and risk tolerance.

Introduction Factors influencing patient behavior regarding risk of prostate cancer (PCa) and outcomes of PCa treatments are poorly understood. Similarly, how PCa treatments affect patient sexual function and sense of their masculinity has not been fully investigated. A better understanding of the relationship between sex and gender for patients with PCa could significantly improve their care and quality of life. Objectives To review how concerns about sex and gender influence men's attitudes toward PCa screening, diagnosis, and treatment. To explore how PCa influences sexual function and self-perceived masculine identity. To examine contexts for PSA screening for transgender individuals. Methods We reviewed biomedical and sociological literature exploring the impact of PCa on patient sexual function and self-perceived masculinity using OVID, PubMed, and other databases. We similarly reviewed how masculine gender norms influence patient willingness to engage with PCa screening, diagnoses, and treatment. Results Gender norms and sexual function concerns influence patient engagement in all aspects of PCa care. This includes PSA screening, digital rectal examinations, active surveillance, and androgen deprivation therapy (ADT) amongst others. ADT is particularly challenging to sexual function, self-esteem, and masculine identity. Our research suggests that sex and gender are not separate concepts, but rather tightly intertwined, particularly when dealing with the realities experienced by patients with PCa. Conclusion Interventions to help patients deal with the challenges of PCa and its treatment are likely to be most effective if they concurrently address patients’ sexual needs and understanding of gender norms. PSA screening should be considered for transgender individuals who are at greater risk of cancer and on long-term hormone therapy. More research is needed on how concerns over sex and gender influence PCa screening, diagnosis, and treatment. There is also a need for long term data on the oncological outcomes of prolonged exposure to hormone therapy for patients who are transgender. Muermann MM, Wassersug RJ. Prostate Cancer From a Sex and Gender Perspective: A Review. Sex Med Rev 2021;XX:XXX–XXX.

Background Sexual dysfunction is a common side effect of medical therapy for benign prostatic hyperplasia (BPH), whereas prostatic urethral lift (PUL) offers safe and effective relief of lower urinary tract symptoms while preserving sexual function. Objective To compare the long-term impact on sexual health of PUL or daily medical therapy of doxazosin or finasteride alone or in combination in BPH patients. Design, setting, and participants This was a comparative analysis of sexual function outcomes from PUL studies (L.I.F.T. [n = 107], Crossover [n = 42], and MedLift [n = 39]) and the Medical Therapy of Prostatic Symptoms (MTOPS) trial. The men included were sexually active with International Prostate Symptom Score ≥13, Qmax ≤12 ml/s, and prostate volume 30–80 cm3. MTOPS subjects completed the Brief Male Sexual Function Inventory, while PUL subjects completed the International Index of Erectile Function and the Male Sexual Health Questionnaire for Ejaculatory Function. Outcome measurements and statistical analysis Mean percentage changes from baseline in erectile, ejaculatory, and sexual satisfaction domains were compared at 12, 24, 36, and 48 mo. Results and limitations PUL significantly improved erectile function through 24 mo, and ejaculatory function and sexual satisfaction across all time points. Medical therapy did not improve sexual function at any time point. Finasteride significantly decreased erectile function at 48 mo, and combined therapy significantly reduced ejaculatory function at 12 and 24 mo. Comparatively, PUL was superior to finasteride in preserving erectile function at 24 and 48 mo, and superior to doxazosin and combined therapy at 12 mo. PUL outperformed all three medical therapies at all time points in improving ejaculatory function and sexual satisfaction. Limitations include the use of distinct patient-reported questionnaires and narrowed data on comorbidities that influence male sexual function. Conclusions Indirect comparison reveals that PUL is superior to BPH medical therapy in preserving erectile and ejaculatory function and sexual satisfaction. Patient summary In our non–head-to-head study, only patients undergoing PUL for an enlarged prostate experienced improvements in sexual health. Conversely, patients on medical therapy experienced worsening of erectile and ejaculatory function.

Despite the reduction in the incidence of acute rejection, a major risk factor for graft loss, there has been only modest improvement in long-term graft survival. Most cases of kidney graft loss have an identifiable cause that is not idiopathic fibrosis/atrophy or calcineurin inhibitor nephrotoxicity. Distinct immunologic and nonimmunologic factors conspire to lead to a common pathway of allograft fibrosis. It remains plausible that mitigating nonimmunologic damage using strategies proven effective in native kidney disease may yield benefit in kidney transplantation. In this review, we will focus on nonimmunologic aspects of kidney transplant care that may prove to be valuable adjuncts to a well-managed immunosuppression regimen. Topics to be addressed include the roles of hypertension and agents used to treat it, lipid lowering, sodium and water intake, elevated uric acid, metabolic acidosis, and the use of sodium-glucose cotransporter 2 inhibitors on long-term kidney transplant health.

Objective: This study aimed to evaluate the effectiveness of narrative therapy on sexual function and couple burnout in women with skin cancer. Method: The research method was quasi-experimental with a pre-test–post-test design with a control group. Among married women with skin cancer in Mashhad (Iran), 30 available individuals were selected and randomly assigned to experimental and control groups. Narrative therapy was performed in a group of 15 people in nine sessions (experimental group). The Female Sexual Function Index and Couple Burnout Measure were used to collect pre-test and post-test data. Analysis of covariance was used to analyze the data. Results: Group narrative therapy significantly improved reported sexual function (F = 40.90; p = .001) and decreased couple burnout (F = 59.03; p = .001) in women with skin cancer. Conclusions: Narrative therapy seems to effectively improve sexual function and couple burnout in women with skin cancer.

Objective: To evaluate the efficacy and safety of simultaneous administration of dutasteride, tadalafil and solifenacin in the treatment of benign prostatic hyperplasia (BPH) with overactive bladder symptoms and lower urinary tract obstruction in previously unsuccessfully treated men. Methods: Patients in Group A (n=97) received dutasteride 0.5 mg/day, tadalafil 2.5 mg/day, and solifenacin 2.5 mg/day; Group B (n=95) received dutasteride 0.5 mg/day, tadalafil 5 mg/day, and solifenacin 5 mg/day; Group C (n=103) received dutasteride 0.5 mg/day, tadalafil 20 mg/day, and solifenacin 10 mg/day. The functional status of the lower urinary tract was assessed using the International Prostate Symptom Score (I-PSS), Overactive Bladder Questionnaire (OABq), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD) as well as uroflowmetry. Results: The total score of the sexual function remained unchanged in Group B of patients 81.3 points vs. 80.2 points (p>0.05) according to MSHQ-EjD, 61.4 points vs. 51.2 points (p>0.05) according to IIEF data. The total assessment of symptoms of hyperactivity significantly decreased in Group C according to OABq data after the 4th week of the study (17.5 points vs. 26.1 points, p

Context Patients with chronic pelvic pain syndrome (CPPS) may have pain refractory to conventional management strategies. Botulinum toxin A (BTX-A) is a potential therapeutic option. Objective To evaluate the benefits and harms of BTX-A injections in the treatment of CPPS. Evidence acquisition A systematic review of the use of BTX-A in the treatment of CPPS was conducted (PROSPERO-ID: 162416). Comprehensive searches of EMBASE, PUBMED, Medline, and SCOPUS were performed for publications between January 1996 and May 2020. Identified studies were screened and selected studies assessed for quality prior to data extraction. The primary outcomes were improvement in pain and adverse events following treatment. Secondary outcomes included quality of life, global response assessment, sexual function, bowel function, and bladder function. Evidence synthesis After screening 1001 abstracts, 16 studies including 11 randomised controlled trials were identified, enrolling 858 patients and covering a range of CPPS subtypes. Most studies showed high risks of bias and confounding across all domains. A narrative synthesis was performed as heterogeneity of included studies precluded a meta-analysis and calculation of pooled effect estimates of measured outcomes. BTX-A reduced pain significantly in patients with bladder pain syndrome in two studies and in patients with prostate pain syndrome in one study, but no included studies showed benefit for patients with gynaecological pelvic pain. Adverse event reporting was variable and generally poor, but no serious adverse events were described. Conclusions Beneficial effects of BTX-A on pain, quality of life, and functional symptoms were seen in patients with certain CPPS subtypes, but the current evidence level is too weak to allow recommendations about BTX-A use for treating CPPS. Patient summary Botulinum toxin A is used to treat different pain disorders, but current studies are of insufficient quality to determine whether it reduces pain and improves quality of life in patients with chronic pelvic pain. Further research is needed.

Purpose The current randomized, double-blind, placebo-controlled clinical trial addressed the effects on penile erectile function of relatively high daily oral doses (6 g/day) of l-ARG for 3 months (N = 51) compared to placebo (N = 47), in patients with vasculogenic ED, with comparison between mild–moderate and severe vasculogenic ED. Methods The outcome measures included IIEF-6 score and cavernous arteries peak systolic flow velocity (PSV) at dynamic penile duplex ultrasonography (PDU). Results l-ARG supplementation for 3 months significantly increased IIEF-6 score in the overall cohort (p p p = 0.007) vasculogenic ED; PSV was significantly increased in the overall cohort (p p Conclusion The results of the current study demonstrated that supplementation with relatively high doses of l-ARG as a single compound for 3 months significantly improved penile erectile function, assessed by both IIEF-6 score and PSV at dynamic PDU in patients with mild–moderate, and improved IIEF-6 score, but not PSV, in patients with severe vasculogenic ED, therefore suggesting that l-ARG might be an alternative treatment in mild–moderate vasculogenic ED patients experiencing adverse effects or with contraindications for chronic treatment with PDE5i compounds.

Background: Obesity is often associated with multiple negative health-related comorbidities. There is an increased risk of sexual dysfunction in the obese population. Although multiple studies reported significant improvement of these complaints after different bariatric surgeries, there are few studies evaluating the role of laparoscopic sleeve gastrectomy (LSG) on this specific outcome. Objective: This study was conducted to evaluate the effect of LSG on sexual function in male patients with morbid obesity. Patients and methods: This prospective study included 114 morbid obese patients with erectile dysfunction (ED). All patients underwent the conventional LSG. Sexual function was evaluated using the International Index of Erectile Function (IIEF) score before surgery, then after six and 12 months after surgery. The severity of ED was evaluated according to the erectile function component of the same previous score.Results: The one-year % of excess weight loss (EWL) had a mean value of 61.18%. At the same visit, there was a significant improvement in the total IIEF score from 49.04 to 67.88, erectile function from 18.25 to 25.94, orgasm function from 6.99 to 9.41, sexual desire from 7.06 to 9.35, intercourse satisfaction from 9.25 to 13.56, and overall satisfaction from 7.49 to 9.61. A significant positive association was noted between the % EWL and the total IIEF score and its components. Conclusion: LSG led to significant improvement of sexual and erectile dysfunction in obese male patients. Weight loss led to a significant decline in the prevalence of ED, and if the problem did not resolve, its severity would be markedly decreased.

Purpose To study sexual function and distress in women with functional hypothalamic amenorrhea (FHA) compared to women with FHA and an underlying polycystic ovary syndrome (PCOS)-phenotype, considering also their psychometric variables. As a secondary aim, we explored the relationship between sexual functioning and hormonal milieu in these women. Methods This is a retrospective cross-sectional study conducted on 36 women with typical FHA and 43 women with FHA + PCOS-phenotype. The following validated psychometric questionnaires were administered: Female Sexual Functional Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Attitude Test (BAT), Bulimia Investigation Test (BITE), State Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Multidimensional Perfectionism Scale (MPS). Available hormones to formulate FHA diagnosis in the standard routine were considered. Results Women with typical FHA reported a significantly lower FSFI total score than women with FHA + PCOS-phenotype (95% CI for median 16–21.3 vs. 21.1–24.1, p = 0.002), whereas the FSDS-R score was similar in the two groups (95% CI for median 6–16 vs. 6–16.3). No statistically significant differences were evident in body attitude, state and trait anxiety, depression, bulimic risk, and perfectionism between the two groups, confirming the two FHA groups were superimposable from a psychometric perspective. State anxiety correlated negatively with the FSFI total score in both typical FHA (rho: − 0.33, p = 0.05) and FHA + PCOS-phenotype (rho: − 0.40, p = 0.009). In the entire study population, a positive correlation was found between luteinizing hormone, androstenedione, and 17ß-estradiol and the total FSFI score (rho: 0.28, p = 0.01; rho: 0.27, p = 0.01, rho: 0.27, p = 0.01, respectively). Conclusion Women with FHA showed a very high rate of sexual symptoms as part of their condition, but those with a typical diagnosis displayed a more severe sexual impairment as compared with the FHA + PCOS-phenotype, in spite of a similar psychometric profile. Sexual distress was equally present in both groups (approximately 4 out of 10 women). Further studies should be designed to investigate the potential role of sex hormones, mainly LH-driven androstenedione, in influencing women’s sexual functioning.

This dyadic study examines the association between an individual’s sexual beliefs – i.e., one’s beliefs about aspects of sexuality that are based on cultural views and previous sexual experience – and their own and their partner’s sexual well-being. Sex and gender diverse couples from the community and online sources, across Portugal, will be recruited to participate in a cross-sectional study that involves completing an online questionnaire. Individuals will be asked to complete the survey independently from their partners. Data collection for this study is ongoing and is being conducted online so that participants can respond at the time and place they deem appropriate, increasing the accessibility of participation and the potential diversity of participants, as well as minimizing possible socially desirable responses.

The sexual response comprises different stages: desire, arousal, orgasm, and resolution (Levin, 2021). The Female Sexual Function Index (FSFI; Rosen et al., 2000) is the widely used scale for assessing the sexual response in women. The FSFI has been translated into multiple languages and validated in different populations, mainly demonstrating strong criterion validity across studies (Neijenhuijs et al., 2019). In Chile, previous studies (Blümel et al., 2004) exhibit several deficiencies and limitations in sampling and analysis procedures. Consequently, the present study aims to address these shortcomings by conducting systematic research using a representative sample, estimating reliability, and including evidence of validity.

The analysis of the long-term efficiency of operative treatment of pelvic prolapse for 156 women in periods ranging from 12 to 24 months was conducted through the questionnaire PISQ-12 (Pelvic Organ Prolapse and Incontinence Sexual Function Questionnaire), recommended for use in clinical practice by the International Urogynecologic Association and adapted by the authors for their work. The method of evaluating the effectiveness of surgical treatment of the pelvis and prostate has been streamlined through the introduction of a system of qualitative analysis of the results of the study of sexual function. found that operational treatments for pelvic prolapse have a positive effect on the sexual function of women. Significant differences in sexual function in the remote postoperative period depend on the type of operational benefit. The best effect with regard to the favorable dynamics of sexual function is achieved after laparoscopic operative treatment of pelvic prolapse compared with vaginal hysterectomy.

Vecmāte Veselības aprūpe Midwifery Health Care Izvēlētā bakalaura darba tēma ir “Seksuālā funkcija sievietēm pirmajā gadā pēc dzemdībām un tās saistība ar apmierinātību partnerattiecībās”. Izvēlētās tēmas aktualitāte pamatojama ar to, ka jebkurā sievietes vecumā seksuālajai veselībai ir svarīga nozīme. Grūtniecības laiks, dzemdības, kā arī pēcdzemdību periods nereti ietekmē attiecības ar partneri, jo sievietei gan bioloģiski, gan psiholoģiski rodas izmaiņas, kas, savukārt, var novest arī pie seksuālās funkcijas izmaiņām. Pētījumi liecina, ka seksuālā funkcija pasliktinās grūtniecības laikā un pēc dzemdībām neatgriežas tās sākotnējā stāvoklī. Veselīga seksuālā funkcija grūtniecības laikā un arī pēc dzemdībām ir viens no pāru attiecību stūrakmeņiem. Pētījumi ziņojuši, ka attiecību problēmas ir saistītas ar seksuālo funkciju sievietēm, un jo sievietes bija mazāk apmierinātas ar savām attiecībām, jo tām bija mazāka dzimumtieksme. Sievietēm pēcdzemdību periodā ir nepieciešama lielāka emocionālā saikne ar savu partneri, ir lielāka vajadzība pēc drošības, kā arī viņas ir jūtīgākas pret savu attiecību kvalitāti. Seksuālās funkcijas izmaiņas pirmajā gadā pēc dzemdībām ir izplatītas, un tam ir ietekme uz partneru dzīves kvalitātēm. Nereti tieši pirmajā gadā pēc dzemdībām pāru attiecības pasliktinās, tādējādi var tikt ietekmēta arī seksuālā funkcija. Tēma ir aktuāla vecmātēm, ginekologiem, ģimenes ārstiem, lai sniegtu atbilstošās rekomendācijas un ieteikumus pacientiem. Bakalaura darba mērķis bija novērtēt sieviešu seksuālo funkciju pirmajā gadā pēc dzemdībām un tās saistību ar apmierinātību partnerattiecībās. Balstoties uz izvirzīto mērķi, tika noteikti sekojoši darba uzdevumi : 1. Noskaidrot sieviešu seksuālo funkciju, tās traucējumus pēc dzemdībām 2. Noskaidrot faktorus, kas veicina apmierinātību/neapmierinātību partnerattiecībās pirmajā gadā pēc dzemdībām 3. Novērtēt apmierinātību partnerattiecībās un tās saistību ar sievietes seksuālo funkciju Bakalaura darbs uzrakstīts uz 41 lpp., tas ietver 1 tabulu, 7 attēlus, darbā izmantoti 35 literatūras avoti, pievienoti 4 pielikumi. Atslēgvārdi – seksuālā funkcija, apmierinātība partnerattiecībās, FSFI, RAS, pirmais gads pēc dzemdībām The topic of the chosen bachelor’s thesis is “Sexual function in women in the first year after childbirth and it’s connection with satisfaction in partnership”. The topic of the chosen topic is justified by the fact that the sexual health of any women at any age is important. Pregnancy, childbirth, as well as the postpartum period often affect the relationship with a partner, because a woman undergoes both biological and psychological changes, which may also lead to changes in sexual function. Studies show that sexual function deteriorates during pregnancy and does not return to it’s previous state after childbirth. Healthy sexual function during pregnancy and after childbirth is one of the cornerstones of a couple’s relationship. Studies have reported that relationship problems are a function of women’s sexual function, and the less satisfied women were with their relationships, the less sex drive they had. Postpartum women need a greater emotional connection with their partner, have a greater need for security, and are more sensitive to the quality of their relationship. Changes in sexual function in the first year after childbirth are common and have an impact on partner’s quality of life. Often, in the first year after childbirth, the relationship between couples deteriorates, and sexual function also be affected. The topic is relevant for midwives, gynaecologists, family doctors in order to provide appropriate recommendations and suggestions to patients. The aim of the bachelor thesis was to evaluate women’s sexual function in the first year after childbirth and it’s relationship with satisfaction in partnerships. Based in the set goal, the following tasks were determined : 1. To clarify women’s sexual function, it’s disorders after childbirth 2. To find out the factors that contribute to satisfaction/dissatisfaction in partnerships in the first year after childbirth 3. To assess satisfaction in partnership and it’s relationship with woman’s sexual function The bachelor's thesis is written on 41 pages, it includes 1 table, 7 figures, used 35 literature sources, added 4 appendices. Keywords – sexual function, satisfaction in relationship, FSFI, RAS, first year after childbirth.