Résumé Contexte Le syndrome de la détumescence rigide (STR) fait le sujet de plusieurs discussions en ligne concernant les dysfonctions sexuelles. Cette entité est. mal définie et peu reconnue. Nous ...présentons dans cet article une revue de la littérature sur la présentation clinique, le diagnostic, les mécanismes physiopathologiques et les stratégies de thérapeutique du STR. Matériel et Méthodes La revue de la littérature a été réalisée selon les recommandations PRISMA. En cherchant sur MEDLINE, CENTRAL, PASCAL et google scholar les termes « hard, flaccid et syndrome », on a identifié 16 articles publiés entre 2018 et février 2019. Après la revue des références des articles et le triage des doublons, 7 articles ont été retenus. Résultats Il s’agit d’une pathologie acquise, chronique et douloureuse, caractérisée par une verge semi rigide à l’état flaccide avec une perte de rigidité lors des érections. Les patients souffrent de troubles sensitifs péniens et érectiles avec une contracture permanente des muscles pelviens ainsi que des troubles urinaires et psychologiques. Les symptômes sont aggravés par la position debout. La notion de traumatisme de la base de la verge est. rapportée par la majorité des patients. Ce traumatisme semble entrainer une altération des structures nerveuses et vasculaires péniennes à l’origine des troubles sensitifs et érectiles. Ces derniers créent des troubles émotionnels avec une stimulation sympathique réactionnelle qui engendre une contraction surajoutée des muscles pelviens et qui empire les symptômes. Le diagnostic est. clinique et les examens paracliniques sont normaux. Le traitement est. multimodal, il englobe les thérapies comportementales, la prise en charge des altérations psychologiques et de la douleur, afin d’agir sur la contraction des muscles pelviens et sur le stress associé à la dysfonction érectile. Conclusion Le syndrome de la détumescence rigide reste peu connu et mal défini dans la pratique clinique. Une approche thérapeutique multimodale parait la plus adéquate actuellement. Des études supplémentaires sont nécessaires afin de mieux cerner cette entité dans le but d’améliorer sa prise en charge.
The premature ejaculation diagnostic tool （PEDT） is a brief diagnostic measure to assess premature ejaculation （PE）. However, there is insufficient evidence regarding its validity in the new ...evidence-based-defined PE. This study was performed to evaluate the validity of PEDT and its association with IIEF-15 in different types of evidence-based-defined PE. From June 2015 to January 2016, a total of 260 men complaining of PE and defined as lifelong PE （LPE）/acquired PE （APE） according to the evidence-based definition from Andrology Clinic of the First Affiliated Hospital of Anhui Medical University, along with 104 male healthy controls without PE from a medical examination center, were enrolled in this study. All individuals completed questionnaires including demographics, medical and sexual history, as well as PEDT and IIEF-15. After statistical analysis, it was found that men with PE reported higher PEDT scores （14.28 ± 3.05） and lower IIEF-15 （41.26 ± 8.20） than men without PE （PEDT： 5.32 ± 3.42, IIEF-15：52.66 ± 6.86, P 〈 0.001 for both）. It was suggested that a score of 〉9 indicated PE in both LPE and APE by sensitivity and specificity analyses （sensitivity： 0.875, 0.913; specificity： 0.865, 0.865, respectively）. In addition, IIEF-15 were higher in men with LPE （42.64 ± 8.11） than APE （39.43 ± 7.84, P 〈 0.001）. After adjusting for age, IIEF-15 was negatively related to PEDT in men with LPE （adjust r = -0.225, P 〈 0.001） and APE （adjust r = -0.378, P 〈 0.001）. In this study, we concluded that PEDT was valid in the diagnosis of evidenced-based-defined PE. Furthermore, IIEF-15 was negatively related to PEDT in men with different types of PE.
Objective
To identify atypical masturbatory behaviors (AMB) and to reveal their effects on both sexual and masturbational erection hardness in men with erectile dysfunction (ED).
Methods
Patients ...with ED and healthy controls were questioned about their masturbation habits. Accordingly, “rubbing in a prone position,” “pressure on penis,” and “masturbation through clothes” were included in the traumatic masturbation syndrome (TMS) group. Erection hardness score (EHS) is used to measure the erectile functions during masturbation (mast), foreplay (presex), and sexual intercourse (sex), separately.
Results
The data of 448 participants, 266 (59%) from the patient group, and 182 (41%) from the control group were analyzed. The mean ages were 30 years in both groups (p = 0.734). The rate of “rubbing in a prone position” and “penile pressure” while masturbating was higher in patients than the controls (10.2% vs. 6%, p = 0.024 and 8.6% vs. 3.3%, p = 0.0002, respectively). Patients had 2.2‐fold (odds ratio, 2.21; 95% confidence interval, 1.40–3.47; p = 0.001) increased risks of having at least one AMB, compared with controls. In the secondary analysis, the patient group was divided into 2 subgroups according to having TMS (ED + TMS) or not (ED). The percentage of patients with EHS≥3 during masturbation was higher than those during sex and presex in the “ED + TMS” group (60.2%, 38.8%, and 37.2%, respectively, p = 0.0001; n = 98). Comparing the percentage of patients with EHS≥3 during mast, presex, and, sex was found to be similar in the “ED” group (58.9%, 56.5%, and 56%, respectively, p = 0.753; n = 168).
Conclusion
Atypical masturbatory behaviors are more common in young men presenting with erectile dysfunction. These patients have higher erection hardness scores during masturbation compared to partnered sex.
Traditional Chinese medicine (TCM) and Western Medicine both have shown efficacy in treating male sexual dysfunction (MSD). The aim of this perspective paper is to discuss a possible link between ...Western medicine and TCM in the MSD field as represented by the entity of Klotho. Klotho is a recently discovered protein, mainly expressed in the kidney, encoded by the anti-aging gene klotho. Not only is Klotho significantly correlated with the development and progression of kidney diseases and their complications, but increasing evidence indicates that it is also closely related to MSD. A comprehensive search within PubMed database was performed to retrieve available evidence on Klotho's roles, particularly in kidney and in MSD. Indeed, in the TCM theory, the concept of the "kidney" is entirely different from the Western medicine: it is closely related to metabolism and to the reproductive, nervous, endocrine systems, being more than just a urinary organ. According to the "Kidney storing essence (jīng) and governing reproduction" (KSEGR) theory, a cornerstone in TCM, the treatment of MSD mainly consists of restoring the kidney's function. Signs of decreasing kidney essence show a consistent similarity to deficiencies of Klotho, also for what regards the male sexual function. Based on the current evidence, Klotho may represent a potential biological indicator for sexual desire and sexual function and a kind of new scientific Silk Road between TCM and Western medicine for MSD; nevertheless, there is a need to conduct further high-quality research to prove this hypothesis.
Purpose of Review
Semen analysis serves as the initial step in the evaluation of male infertility. However, given the difficulty in interpreting abnormal findings, physicians and patients often ...struggle with understanding the results. In this review, we aim to review the normal physiology of ejaculation and create an accessible resource for interpreting abnormal semen volume, viscosity, liquefaction, pH, appearance, and color.
Recent Findings
Emerging evidence has revealed that men with genitourinary tract infections have a greater number of seminal leukocytes, which may result in clumping of motile sperm and altered morphology. Hence, these patients may have abnormal sperm parameters secondary to their health status. Recent findings have further characterized the semen liquefaction process, suggesting that increased levels of semenogelin and decreased levels of proteases and plasminogen activators (e.g., urokinase and chymotrypsin) may be associated with the failure of semen to convert to a watery consistency.
Summary
This article creates a resource which may be referenced when abnormalities in semen analysis are encountered. We offer a comprehensive overview of normal ejaculation physiology and abnormal variants in male ejaculate volume—including aspermia, anejaculation, retrograde ejaculation, and hypo- and hyperspermia—and their potential etiologies. Additionally, we discuss several processes (infection, inflammation, and dysfunction of male sex glands) which may affect semen viscosity, liquefaction, and pH. Finally, our discussion of the potential colors of male ejaculate is meant to reduce the anxiety of both patient and provider. Through a better understanding of the process and varying characteristics of ejaculation, physicians may adequately counsel their patients on abnormal findings and concerns regarding infertility.
Purpose of Review
Focusing on studies published within the last decade, we review the literature on the seminal microbiome and male factor infertility. We highlight potential mechanisms by which ...microbes may impact fertility and underscore key limitations and clinical implications of these studies.
Recent Findings
The seminal microbiome encompasses a metabolically and phylogenetically diverse group of microorganisms.
Lactobacillus
was consistently associated with normal semen analysis parameters and fertility;
Anaerococcus
was negatively associated with semen quality. These microbes may participate in a complex cross-talk with the host immune system, thereby modulating local and perhaps systemic inflammatory responses, impacting semen quality.
Summary
Research investigating the intersection between the seminal microbiome and male fertility is still in its infancy. Recent investigations have been exclusively cross-sectional, correlational studies, limiting the clinical applicability of published research. Prospective studies with more sophisticated methodologies are necessary.
Given the complexity of the psychological and biological pathologies associated with sexual dysfunction, which affects at least a third of adult women and men worldwide, a multidisciplinary approach ...has been advocated.
To assess sexual functioning, relationship satisfaction, and mood stability pre- and post- treatment at the Loyola University Sexual Wellness Program.
Couples attending the 6-week multidisciplinary Sexual Wellness Program provided consent and completed pre- and post- intervention assessments. Linear mixed effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency.
All patients completed self-reported surveys: Dyadic Adjustment Scale, PROMIS Sexual Function and Satisfaction Measures Brief Profile (Patient-Reported Outcomes Measurement Information), and International Index of Erectile Function.
There were 85 respondents: 42 men and 43 women. The mean age was 49.82 years (range, 25-77). The largest improvement was on the total Dyadic Adjustment Scale score, which increased by approximately 5.18 points (95% CI, 2.55-7.81). PROMIS scores for global satisfaction with sex life, erectile function, and interest in sexual activity significantly increased from baseline, while the vaginal discomfort score significantly declined. Overall the score for global satisfaction with sex life increased from baseline by approximately 5.57 points (95% CI, 3.03-8.10). On average, men reported a 4.33-point increase (95% CI, 0.04-8.62) in their International Index of Erectile Function score from baseline.
A multidisciplinary treatment approach focused on the couple positively affects a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function.
This study is one of the few to document the effects of a multidisciplinary treatment approach for both members of a heterosexual couple-male and female. Limitations include the narrow demographics and lack of a control group in our population. Furthermore, this was completed at 1 academic center.
These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being.
Female sexual pain disorders, although highly prevalent and increasingly studied, remain a distressing complaint for women and their partners. Empirical evidence points to a multifactorial ...conceptualization of the etiology, course, and associated difficulties of sexual pain; thus, treatment options span the medical, pelvic floor rehabilitation psychological and multimodal. Given the interpersonal context in which sexual pain occurs, recent work has underscored the importance of considering the dyadic framework in research and treatment. This review presents understanding from across disciplines focusing on the impact of sexual pain on the woman and the couple, proposed etiologic pathways and risk factors related to its development and course, and current treatment options. Recommendations for research point to an urgency for multidisciplinary exchanges in the development of conceptual models and refinement of targeted interventions.
Purpose of Review
Techniques for phalloplasty and penile prosthesis implantation have been associated with a high rate of complications, but recent advances in surgical options and penile implant ...technology may mark a paradigm shift in the approach to female-to-male genital gender-affirming surgery. This review aims to highlight the current state of research on phalloplasty and penile prosthesis implantation and explores the newest innovations for improving outcomes.
Recent Findings
Multiple techniques for phalloplasty have been described with variable outcomes, complications, and strengths. In addition, the majority of penile prosthesis implants have been designed for cis-male anatomy, and rates of complications have been markedly higher in neophallus implantation. The introduction of two new models specifically designed for the neophallus by Zephyr Surgical Implants in recent years may signal a new horizon for penile prostheses tailored for the neophallus.
Summary
The steady rise in the number of transgender individuals seeking surgical treatment options for female-to-male genital gender-affirming surgery has driven the evolution of techniques for phalloplasty and penile prosthesis implantation. Complications remain stubbornly elevated when compared to cis-male outcomes, but the first penile prosthesis designed for the neophallus offers hope that additional breakthroughs may be forthcoming. Additional studies with standardized outcomes are needed to further evaluate superiority between different techniques and penile prostheses.
Purpose of Review
Infertility is a medical condition in which a couple is unable to conceive after 12 months of attempted conception. Male factor infertility contributes to approximately half of the ...cases of infertility. We highlight the most critical aspects of the updated 2020 AUA/ASRM Guidelines on Male Factor Infertility.
Recent Findings
The updated 2020 AUA/ASRM Guidelines on Male Factor Infertility provides fifty-two practice statements based on varying levels of data and evidence. In addition to the focus on the assessment and management of the male patient, the guidelines also emphasize the associated co-morbidities which may influence fertility. The specific goals of the male factor assessment is to identify possibly correctable etiologies amenable to medical or surgical treatment, possible co-morbid conditions that may require additional attention, or genetic anomalies that might put offspring at risk.
Summary
The overall improvement in diagnostic and therapeutic capabilities has allowed for the improved understanding of specific etiologies that may be underlying male factor infertility. The AUA/ASRM male factor infertility guidelines provide a framework to assess for these etiologies in order to improve the reproductive potential of the infertile male.
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