The Journal of Sexual Medicine

The challenge of resident education in urologic surgery programs is to overcome disparity imparted by diverse patient populations, limited training times, and inequalities in the availability of expert surgical educators. Specifically, in the area of prosthetic urology, only a small proportion of programs have full-time faculty available to train residents in this discipline.

To examine whether a new model using yearly training sessions from a recognized expert can establish a successful penile prosthetics program and result in better outcomes, higher case volumes, and willingness to perform more complex surgeries.

A recognized expert conducted one to two operative training sessions yearly to teach standardized technique for penile prosthetics to residents. Each session consisted of three to four operative cases performed under the direct supervision of the expert. Retrospective data were collected from all penile prosthetic operations before (February, 2000 to June, 2004: N = 44) and after (July, 2004 to October, 2007: N = 79) implementation of these sessions.

Outcomes reviewed included patient age, race, medical comorbidities, operative time, estimated blood loss, type of prosthesis, operative approach, drain usage, length of stay, and complications including revision/explantation rates. Statistical analysis was performed using Student's t-tests, Fisher's tests, and survival curves using the Kaplan-Meier technique (P value ≤ 0.05 to define statistical significance).

Patient characteristics were not significantly different pre- vs. post-training. Operative time and estimated blood loss significantly decreased. Inflatable implants increased from 19/44 (43.2%, pre-training) to 69/79 (87.3%, post-training) (P < 0.01). Operations per year increased from 9.96 (pre-training) to 24 (post-training) (P < 0.01). Revision/explantation occurred in 11/44 patients (25%, pre-training) vs. 7/79 (8.9%, post-training) (P < 0.05).

These data demonstrate that yearly sessions with a recognized expert can improve surgical outcomes, type, and volume of implants and can reduce explantation/revision rates. This represents an excellent model for improved training of urologic residents in penile prosthetics surgery.

Sexual dysfunction (SD) affects at least a third of adult women worldwide which makes it a public health concern. Given the complexity of both psychological and biological pathology associated with these conditions, a multidisciplinary approach has been advocated. However, there is a limited amount of literature examining a multidisciplinary treatment approach to a couple's sexual and psychological functioning. This program, emphasizes treatment of the couple. This program includes a multidisciplinary team consisting of psychologists, gynecologists, urologists, dieticians, physical therapists, yoga instructors, and nurses. Our group collaborates in the care of each couple; working together to participate in the diagnosis and treatment of their sexual dysfunction. The treatment approach is a biopsychosocial model. Our couples attended weekly lectures on the follow topics: communication, female sexual functioning, male sexual functioning, stress management, chemistry of love, pelvic floor physical therapy, healthy diet, sexual aids, and gaining momentum. They also received counseling from a dyad therapist team. additionally, the couple was responsible for completing weekly homework consisting of sensate focus exercises and other gestures to help them engage with one another. In therapy sessions, communication and visualization exercises were also utilized.

This study prospectively followed couples pre- and post-attendance of a six-week sexual wellness treatment program (SWP) at a single academic medical center.  The following outcomes were used: (1) sexual functioning (2) relationship satisfaction (3) mood stability.

The study was approved by the IRB. Couples attending the six-week multidisciplinary SWP, were consented and then completed surveys both pre-treatment and at the end of treatment. Surveys administered included the Dyadic Adjustment Scale (DAS), Sexual Functioning Profile (PROMIS), and International Index of Erectile Dysfunction (IIEF) for men only. 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. The program included weekly didactic sessions following an initial evaluation. Didactics included cognitive behavioral sex therapy with an attending (psychologist, psychiatrist or gynecologist) paired with a trainee (psychiatry, psychology or gynecology resident or a medical student), and home assignments.

There were 85 respondents – 42 men, 43 women. Mean age was 49.82 years (Range 25-77). Most frequently reported SD were hypoactive sexual desire (32.2%), erectile dysfunction (21.4%), dyspareunia (14.3%), and female orgasmic disorder (10.7%). controlling for patients’ sex and baseline PHQ severity, all DAS measurements increased from baseline.  The largest improvement was on the total DAS score which increased by approximately 5.18 (95% CI: 2.55 – 7.81) points.  Similarly, the PROMIS global satisfaction with sex life score, erectile function score, and interest in sexual activity score significantly increased from baseline while the vaginal discomfort score significantly declined from baseline.  Overall, the global satisfaction with sex life score increased from baseline by approximately 5.57 (95% CI: 3.03 – 8.10) points.  Among male participants, the IIEF erectile, sexual, and satisfaction scores increased from baseline.  On average, men reported a 4.33 (95% CI: 0.04 – 8.62) point increase in their IIEF erectile score from baseline.

The results indicate that a multidisciplinary treatment approach focused on the couple positively impacts multiple aspects of a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function. These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being.

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Concerns about genital self-image (GSI) can influence sexual function and quality of life, and instruments that assess male GSI, such as the Male Genital Self-Image Scale (MGSIS), need to be adapted and validated in different cultures.

To culturally adapt and validate the measurement properties of MGSIS in Brazilian men, according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline, and to create a cutoff point for satisfaction with male GSI.

We assessed the validity of content through a committee of experts and cognitive interviews. The internal consistency and test-retest reliability were assessed using Cronbach’s α and Intraclass Correlation Coefficient (ICC). We also calculate measurement errors using the Bland and Altman graph. The structural validity was investigated through exploratory and confirmatory factor analysis. The hypothesis test for construct validity was assessed using Spearman correlation from MGSIS with the International Index of Erectile Function (IIEF), Body Appreciation Scale (BAS-2) and Rosenberg Self-Esteem Scale (RSES). To create a cutoff point for satisfaction with the GSI, the item response theory and the classic test theory were used.

Male’s (i) GSI, (ii) sexual function, (iii) body appreciation, and (iv) self-esteem were assessed.

In this study, 518 men with a mean age of 33.90 (±13.83) years participated. The Brazilian version of MGSIS demonstrated good content validity and a single factor that explained 64.57% of the variance. Cronbach’s α and ICC values were 0.905 and 0.806, respectively. By assessing measurement errors, we found no systematic bias in the sample. MGSIS showed a moderate to weak correlation with IIEF, BAS-2 and RSES. A cut-off point of 23 in the MGSIS total score was found to rate satisfaction with the GSI.

MGSIS is a valid and reliable measurement instrument for measuring male GSI in Brazil.

This study evaluated the measurement properties of MGSIS according to COSMIN, which is a powerful and useful guideline for measurement properties. However, due to the lack of a gold standard for measuring the GSI, we have not assessed the criterion validity.

MGSIS is valid, reliable and can be useful to assess the GSI and classify the satisfaction with the GSI of Brazilian men.

Endometriosis-associated pain and dyspareunia influence female sexuality, but little is known about men's experiences in affected couples.

To investigate how men partners experience sexuality in partnership with women with endometriosis.

A multi-center case-control study was performed between 2010 and 2015 in Switzerland, Germany, and Austria. 236 Partners of endometriosis patients and 236 partners of age-matched control women without endometriosis with a similar ethnic background were asked to answer selected, relevant questions of the Brief Index of Sexual Functioning and the Global Sexual Functioning questionnaire, as well as some investigator-derived questions.

We sought to evaluate sexual satisfaction of men partners of endometriosis patients, investigate differences in sexual activities between men partners of women with and without endometriosis, and identify options to improve partnership sexuality in couples affected by endometriosis.

Many partners of endometriosis patients reported changes in sexuality (75%). A majority of both groups was (very) satisfied with their sexual relationship (73.8% vs 58.1%, P = .002). Nevertheless, more partners of women diagnosed with endometriosis were not satisfied (P = .002) and their sexual problems more strongly interfered with relationship happiness (P = .001) than in partners of control women. Frequencies of sexual intercourse (P < .001) and all other partnered sexual activities (oral sex, petting) were significantly higher in the control group. The wish for an increased frequency of sexual activity (P = .387) and sexual desire (P = .919) did not differ statistically between both groups.

There is a need to evaluate qualitative factors that influence sexual satisfaction in endometriosis patients.

This is one of the first studies to investigate male sexuality affected by endometriosis. The meticulous verification of diagnosis and disease stage according to operation reports and histology allows for a high reliability of diagnosis. Our men's response rate of almost 50% is higher compared to other studies. Recruiting men through their woman partner may have caused selection bias. The adjustment to the specific situation in endometriosis by selecting questions from the Brief Index of Sexual Functioning and Global Sexual Functioning and adding investigator-derived questions likely influenced the validity of the questionnaires. Despite the fact that both partners of endometriosis patients and of control women largely reported high sexual satisfaction, there are challenges for some couples that arise in the context of a sexual relationship when one partner has endometriosis. Challenges such as sexuality-related pain or a reduced frequency of sexual activities should be addressed by health care professionals to ameliorate any current difficulties and to prevent the development or aggravation of sexual dysfunction.

Cligosiban is a selective oxytocin receptor antagonist being developed for the treatment of premature ejaculation (PE).

Three clinical studies investigated the pharmacokinetics (including effect of food and formulation), central penetration, safety, and tolerability of single oral doses of cligosiban in healthy subjects.

Study 1 was a double-blind, randomized, placebo-controlled, crossover design in 3 cohorts of 10 subjects each. Single doses of 0.3–2,400 mg cligosiban were administered as aqueous solutions or dispersions under fasting and fed (800 mg only) conditions. Studies 2 and 3 were open-label, randomized, crossover designs in 12 subjects each. Study 2 investigated 800 mg cligosiban administered as capsules and aqueous dispersion under fasting conditions, and capsules under fed conditions. Study 3 investigated 1,600 mg cligosiban administered as caplets and aqueous dispersion under fasting conditions, and caplets under fed conditions.

Blood sampling for cligosiban assay and safety assessments were conducted throughout all studies. Cerebrospinal fluid (CSF) samples for cligosiban assay were collected in study 2.

Cligosiban was rapidly absorbed under fasting conditions with peak concentrations generally occurring within 1–2 hours post-dose regardless of formulation. Maximum observed plasma concentration (Cmax) and area under the concentration time curve extrapolated to infinity (AUC0-∞) increased approximately dose-proportionally from 0.3–10 mg, but sub-proportionally from 30–2,400 mg. Cligosiban exposure was similar when administered as a dispersion or capsule (800 mg) under fasted conditions, but higher (87% increase) when administered as a caplet compared to the dispersion (1,600 mg). Food decreased the rate of absorption for all 3 formulations (median time to Cmax 3–6 hours compared to 1–2 hours fasted) but increased the extent of absorption (Cmax and AUC0-∞ increased by 75–149% and 33–49%, respectively). Cligosiban was detected in CSF at concentrations approximately 40% of unbound plasma concentrations. Cligosiban was well tolerated at all doses.

Cligosiban is well tolerated over a wide dose range, and has the pharmacokinetic properties to be taken as required prior to sexual intercourse in men with PE and to antagonize the oxytocin receptor in the brain and spinal cord.

Three controlled trials show similar toleration and pharmacokinetic data. Cligosiban in CSF indicates its likely presence in all central nervous system tissue. These data need to be investigated and confirmed in multiple-dose studies prior to investigation in phase-II studies in men with PE.

Cligosiban had a good safety/tolerability profile at doses predicted to be therapeutic or supra-therapeutic and a pharmacokinetic profile appropriate for “as-needed” dosing for men with PE.

Sexually transmitted infections (STIs) are major causes of medical and psychological problems globally, while adolescents in South Korea have recently shown rapid changes in sexual behaviors.

We aimed to examine the association between the age of first sexual intercourse and the experience of STIs among adolescents. Additionally, in which specific time period would more likely to get infected from sexual intercourse.

We used data from the 2007–2013 Korea Youth Risk Behavior Web-based Survey. Only adolescents with sexual intercourse experience (N = 22,381) were included, and multiple logistic regression analysis was performed.

One dichotomized measure and one continuous measure were assessed: (i) STIs experience (defined as having had STIs); and (ii) association between STIs experience and absolute age gap (defined as temporal differences between secondary sexual character emergence age and first sexual intercourse age).

Approximately 7.4% of boys and 7.5% of girls reported had STI. For both boys and girls, the chance of experiencing STIs increased as the age of first sexual intercourse decreased (boys: before elementary school [age 7 or under]: odds ratio [OR] = 10.81, first grade [age 7 or 8]: OR = 4.44, second grade [age 8 or 9]: OR = 8.90, fourth grade [age 10 or 11]: OR = 7.20, ninth grade [age 15 or 16]: OR = 2.31; girls: before elementary school: OR = 18.09, first grade: OR = 7.26, second grade: OR = 7.12, fourth grade: OR = 8.93, ninth grade: OR = 2.74). The association between the absolute age gap and STI experience was examined additionally (boys: OR = 0.93, girls: OR = 0.87).

This study shows that earlier initiation of sexual intercourse increases the odds of experiencing STIs. Also as the age gap gets shorter, the odds of experiencing STIs increase. Our study suggests that it is important to consider the time period of first sexual intercourse and to reinforce a monitoring system along with the development of other preventive strategies.