To evaluate the efficacy of nonablative capacitive-resistive monopolar radiofrequency on sexual function and vaginal health in postmenopausal women with genitourinary syndrome of menopause. This was a single-blind, randomized, controlled clinical trial. The participants were randomly assigned to receive six weekly sessions of capacitive-resistive monopolar radiofrequency (n=32) or sham treatment (n=30). Sexual function was assessed using the Female Sexual Function Index (FSFI) and vaginal health was assessed using the Vaginal Health Index (VHI). The estrogenic status was determined by vaginal cytology, which involves calculating the proportions of basal, intermediate, and superficial cells. Assessments were conducted at baseline, post-treatment, and 12-week follow-up. Compared with the control group, the intervention group showed significantly greater improvements in the Female Sexual Function Index and Vaginal Health Index at post-treatment and at the 12-week follow-up. FSFI mean changes were 5.86 versus 1.33 at posttreatment ( P <0.001) and 4.41 versus -0.41 at 12-week follow-up ( P =0.011). VHI mean changes were 4.75 versus -0.03 at post-treatment ( P <0.001) and 6.90 versus -0.66 at follow-up ( P <0.001). The effect sizes were moderate to large for the FSFI (Cohen's d >0.77, 95% CI, 0.25-1.29) and large for the VHI ( d >3.49, 95% CI, 2.68-4.28). No significant changes were observed in estrogenic status, and no adverse events were reported. Capacitive-resistive monopolar radiofrequency significantly improved sexual function and vaginal health in women with genitourinary syndrome of menopause, thereby supporting its use as a safe, nonhormone treatment option.

Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy, disproportionately affecting women. Despite excellent survival outcomes, DTC treatment, particularly long-term thyrotropin (TSH) suppression therapy, has been associated with differences in psychological well-being and sexual function. Although the association between thyroid dysfunction and female sexual dysfunction (FSD) is well-established, limited data exist regarding FSD in premenopausal women with DTC. To investigate the presence and severity of depressive symptoms and FSD in premenopausal women with DTC and examine their association with thyroid hormone levels and thyroid autoimmunity. This cross-sectional study included 110 premenopausal women with DTC on stable TSH suppression therapy, stratified into three groups by TSH level (<0.1, 0.1-0.5, and 0.5-2.5 mIU/mL), and 40 healthy controls. Sexual function and depressive symptoms were assessed using the Female Sexual Function Index (FSFI) and Beck Depression Inventory-II (BDI-II), respectively. Thyroid function tests, thyroid antibodies, and sex hormones were evaluated. Correlation and logistic regression analyses were performed. Women with DTC showed higher rates of sexual dysfunction and depressive symptoms than controls (FSD 53.6% vs. 10%; depressive symptoms 65.5% vs. 15%), with the greatest impairment under stronger TSH suppression. Increased BDI-II scores were inversely correlated with FSFI total and subdomain scores (desire, satisfaction, pain). TSH levels were positively associated with FSFI scores, while free thyroxine and free triiodothyronine showed inverse correlations with satisfaction and lubrication. Elevated thyroglobulin antibody levels were associated with higher depression scores. Multivariable models were adjusted for age. Covariates included body mass index, risk of recurrence, disease duration, TSH, free thyroxine, free triiodothyronine, thyroglobulin antibody, total testosterone, prolactin, and BDI-II. Logistic regression analysis showed that suppressed TSH and higher BDI-II scores were independently associated with higher odds of FSD. Sexual dysfunction and depressive symptoms were more frequent in women with DTC than in healthy controls; moreover, among women with DTC, the greatest deterioration was seen in those receiving stronger TSH suppression. These findings highlighted the need for comprehensive care that includes psychological and sexual health assessment in the long-term management of women with DTC.

Post-pubertal outcomes in patients with cloacal malformations: Colorectal, urological, and gynaecological function with patient-reported sexual outcomes.

Radical cystectomy (RC) has historically been the standard treatment for muscle-invasive bladder cancer (MIBC); nonetheless, it is associated with a high morbidity and mortality, with complication rates often exceeding 60%, a relatively high 90-day mortality rate, as well as a significant impact on quality of life (QoL). This substantial burden has generated increasing interest in effective bladder-sparing alternatives. Among these approaches to bladder preservation, trimodal therapy (TMT), comprising maximal transurethral resection of bladder tumour (TURBT) followed by concurrent chemotherapy and radiotherapy (chemoRT) using radiosensitising agents, has become a guideline accepted alternative to RC in appropriately selected patients with MIBC. Additional bladder-sparing strategies, such as TURBT monotherapy or TURBT followed by systemic therapy and surveillance in those patients achieving a complete clinical response, may be alternatives in select settings, although data are limited. Appropriate surveillance after a bladder-sparing approach is paramount to offer timely salvage RC when needed, occurring in approximately 11-16% of contemporary TMT cohorts. QoL outcomes consistently favour TMT over RC, particularly in preserving urinary and sexual function. Severe treatment-related toxicity with TMT is uncommon, with Grade ≥3 adverse events occurring in <10% of cases. In conclusion, bladder-sparing approaches offer a suitable alternative to RC in appropriately selected patients with MIBC, incorporating multidisciplinary care and a commitment to lifelong surveillance.

Transurethral ultrasound ablation (TULSA) is an MRI-guided thermal therapy that enables focal or whole-gland ablation of prostate tissue using real-time MR thermometry and feedback control. It is an emerging treatment option for carefully selected patients with localized prostate cancer, particularly when preservation of urinary and sexual function is an important clinical priority. However, TULSA is not yet an established equivalent to radical prostatectomy or radiation therapy, because available clinical data on long-term oncologic control remain limited. Radiologists should therefore understand both its potential role and the limitations of the current evidence. Multiparametric MRI plays a central role throughout the TULSA workflow, including lesion localization, assessment of extraprostatic extension and seminal vesicle invasion, evaluation of critical periprostatic structures, and identification of calcifications that may interfere with ultrasound transmission. Immediately after treatment, contrast-enhanced MRI is used to assess the non-perfused ablation zone, whereas serial imaging demonstrates progressive volume reduction and tissue remodeling. Interpretation may be challenging because inflammation, vascular changes, coagulative necrosis, and anatomical distortion can mimic or obscure residual disease. This pictorial essay provides a practical review of patient selection, treatment planning, post-treatment assessment, and imaging pitfalls after TULSA, based on institutional experience with more than 100 cases.

Histological study to assess CO2 laser therapy for the treatment of vaginal atrophy.

Integrated perioperative host-response optimization improves functional recovery and survival after ultra-low anterior resection: A randomized controlled trial.

Consumer-directed female technology ("femtech") is rapidly expanding into pelvic floor and sexual health, yet clinicians have limited guidance on the safety, efficacy, and appropriate use of these products. The objective of this review is to summarize currently marketed female technology products relevant to pelvic floor disorders, sexual function, and vaginal health, and to highlight key evidence, limitations, and implications for clinical practice. This is a narrative review of commercially available technologies for urinary incontinence, sexual dysfunction, and vaginal health. Product categories include external and intravaginal pelvic floor muscle training devices, vibrators, and dilators for sexual function and pain, regenerative medicine interventions such as platelet-rich plasma injections, sexual wellness applications, and direct-to-consumer vaginal microbiome testing platforms. Pelvic floor devices and in-office energy therapies offer nonsurgical options for urinary incontinence, but high-quality, independent long-term data are scarce, and costs are often substantial. Sexual wellness devices, including vibrators and dilators, are increasingly recognized as therapeutic tools but are variably supported by clinical research. Early studies of platelet-rich plasma suggest potential benefit for sexual function, yet protocols and outcomes remain heterogeneous. Digital applications and microbiome tests expand access and patient engagement but frequently lack rigorous validation and may raise concerns regarding privacy, equity, and interpretation of results. Female technology offers novel opportunities to address pelvic floor and sexual health outside traditional care pathways. Urogynecologists should be familiar with these products, provide balanced counseling on benefits, risks, and cost, and advocate for independent trials to define their role within evidence-based care.

To systematically review the current literature on gynecologic function and dysfunction in transmasculine and gender-diverse individuals in the context of testosterone therapy, with a focus on menstrual suppression, contraceptive needs, pelvic pain, vulvovaginal changes, and sexual health. PubMed, Embase, and Web of Science databases were searched through September 2025 using search terms related to transmasculine individuals, assigned female at birth, reproductive organs, and testosterone and gender-affirming hormone therapy. No restrictions on publication year were applied. Studies were included if they reported on the impact of exogenous testosterone on gynecologic or sexual (dys)function and contraceptive use and choices, in transmasculine and gender-diverse individuals. Only original human research studies were eligible. Studies focusing on fertility, reproductive outcomes, malignancy, histology, animal models, or individuals with differences of sex development were excluded. All included studies were critically appraised using Joanna Briggs Institute quality assessment tools, and findings were synthesized narratively. Fifty-seven studies were included. Testosterone was generally effective in achieving menstrual suppression, although breakthrough bleeding and ovulatory activity occurred in a substantial proportion of individuals. Contraceptive needs were frequently unmet, partly due to misinformation and provider-related barriers. Pelvic pain was commonly reported, with varied etiologies. While testosterone often increased sexual desire, dyspareunia and genital discomfort were frequently described. Vaginal microbiome alterations and epithelial changes were observed, although their clinical implications remain unclear. Testosterone-based gender-affirming hormone therapy has diverse effects on gynecologic function in transmasculine and gender-diverse individuals, including both physiologically expected as well as underexplored effects. Clinicians should adopt an individualized and affirming approach to care, while further research is needed to understand long-term outcomes, improve assessment tools, and close gaps in inclusive gynecologic healthcare.

Erectile dysfunction and antihypertensive therapy: A critical reappraisal.

The temporary implantable nitinol device (iTIND) has emerged as a minimally invasive surgical technique aimed at improving symptoms while preserving erectile and ejaculatory function. Although functional outcomes and safety have been extensively studied, no previous research has specifically evaluated patient satisfaction and treatment regret. To assess functional outcomes, treatment satisfaction, and decision regret in patients undergoing iTIND implantation in a real-life multicenter setting. We retrospectively analyzed prospectively collected data from 140 patients treated with iTIND at 7 institutions between January 2022 and December 2023. Baseline evaluations included International Prostatic Symptom Score (IPSS), International Prostatic Symptom Score-quality of life (IPSS-QoL), urinary peak flow (Qmax), post voiding residual (PVR), and International Index of Erectile Function score (IIEF5). Antegrade ejaculation was recorded before and after treatment. Adverse events and retreatments were monitored. At 12 months, decision regret was assessed using the validated Decision Regret Scale (DRS). Logistic regression a less absolute shrinkage and selection operator models were applied to identify predictors of high regret (DRS >25). Median age was 52 years and median prostate volume was 30 mL. All procedures were successfully completed with same-day discharge. Functional outcomes significantly improved: IPSS decreased from 20 to 10 (p < 0.001), QoL from 4 to 2 (p < 0.001), Qmax increased from 8.5 to 13 mL/s (p < 0.001), and PVR from 52.5 to 20 mL (p = 0.013). Erectile function remained stable (IIEF5: 24 vs 26, p = 0.38), and antegrade ejaculation was preserved in most patients (78% vs 81%). At 12 months, 32% of patients (45/140) experienced high regret, while 68% (95/140) reported low regret. In multivariate analysis, early complications and retreatments were strong predictors of regret, whereas lower baseline Qmax was protective. iTIND provides significant clinical improvement with preservation of sexual function in men with LUTS/BPO. However, approximately one-third of patients reported high regret at 12 months, mainly linked to complications and retreatments. These findings stress the importance of integrating patient-reported outcomes, including regret, into the evaluation of minimally invasive therapies.

To evaluate the feasibility, safety, and short-term functional outcomes of adding bladder neck opening and ventral adenoma vaporization to ejaculatory hood (EH)-sparing photoselective vaporization of the prostate (PVP), aimed at preserving antegrade ejaculation in patients with benign prostatic obstruction (BPO). This retrospective, single-center pilot study included 27 patients with BPO who underwent PVP at our institution with the purpose of preserving ejaculatory function. EH was defined as the area within approximately 1 cm proximal and lateral to the verumontanum, which was preserved during bladder neck opening and ventral adenoma vaporization to create an unobstructed cavity from the prostatic apex to the bladder neck. The primary endpoint was the preservation of antegrade ejaculation at 3 months postoperatively. At 3 months postoperatively, 26 (96%) of 27 patients had preserved antegrade ejaculation, and one (4%) patient was suspected of retrograde ejaculation. The median International Prostate Symptom Score decreased from 21 to 7, and the quality-of-life score decreased from 5 to 2. Further, the maximum flow rate increased from 5.4 to 14.3 mL/s, and the postvoid residual urine volume decreased from 72.5 to 0 mL (all p < 0.001). The median prostate volume decreased from 60 to 24 mL, and Clavien-Dindo grade III or higher adverse events were not observed. EH-sparing PVP with bladder neck opening and ventral adenoma vaporization was feasible and safe in the short term and was associated with preserved antegrade ejaculation and improved urinary outcomes in patients with BPO. Further prospective studies with validated sexual function assessment and longer follow-up are necessary to confirm these findings.

Cosmetic rhinoplasty may influence psychosocial well-being; however, evidence regarding postoperative sexual function remains mixed. This study evaluated changes in female sexual function, depressive symptoms, and self-esteem before and 6 months after primary cosmetic rhinoplasty in sexually active married women. This prospective cohort enrolled married women (22-48 years) undergoing primary cosmetic rhinoplasty by a single surgeon. Participants completed the Female Sexual Function Index (FSFI), Patient Health Questionnaire-9 (PHQ-9), and Rosenberg Self-Esteem Scale (RSES) preoperatively (T0) and at 6 months (T1). Categorical shifts between T0 and T1 were analyzed using the McNemar test (two-sided p<0.05). Of 70 enrolled women, 64 completed follow-up (mean age 35 ± 6 years). Sexual function improved, with FSFI increasing from 24.20 ± 7.75 to 27.22 ± 6.84 (p=0.021) and a shift toward higher FSFI categories (high function: 21.9-37.5%, p<0.001). Depressive symptoms decreased, with PHQ-9 falling from 8.81 ± 6.34 to 4.97 ± 3.96 (p<0.001) and an increased proportion classified as nondepressive (31.3-56.3%, p<0.001). Mean RSES increased from 22.86 ± 6.79 to 24.61 ± 5.57 (p=0.113), while the proportion with high self-esteem rose from 53.1 to 65.6% (p<0.001). Primary cosmetic rhinoplasty was associated with improved depressive symptom burden and favorable shifts in sexual function categories at 6 months, with mixed findings for self-esteem. Psychosocial outcomes should be interpreted within a biopsychosocial framework, supporting structured preoperative psychological assessment and referral when indicated. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Acquired vaginal obliteration, or agglutination, is a condition where the vaginal walls are fused above the hymen and is associated with inflammatory skin conditions or iatrogenic causes. In this video, we present a 60-year-old patient who presented with dyspareunia and was found to have agglutination of the vaginal walls thought to be secondary to a combination of lichen sclerosus and vaginal laser therapy. The goal for vaginal reconstruction is to restore a patent vaginal canal. When the vaginal epithelium is present but adherent as in the case of vaginal agglutination, the surgery is focused on separating the planes of the anterior and posterior vaginal epithelium. Additional techniques such as vaginoplasty with use of grafts and flaps may be used to provide the additional tissue to substitute as vaginal epithelium. Preoperatively, the patient presented with a vaginal length of 1cm and a genital hiatus of 1cm. With our technique, we restored the vaginal length to 9cm and the genital hiatus to 4cm without any intraoperative or postoperative complications. Management of vaginal agglutination depends on the etiology and the goals of care. This video illustrates an individualized and minimally invasive treatment approach to restoring vaginal length and sexual function.

Chronic pain conditions can have a pronounced negative impact on sexual function. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), in particular, can cause severe pelvic pain, which can interfere with numerous functions such as urination, sexuality, and overall quality of life. This study aims to determine the impact of CP/CPPS on sexual function and its association with the patient's symptom burden, the full version of the International Index of Erectile Function (IIEF) and Sexual Function Index (SFI) questionnaires and the UPOINT(S) classification. 174 patients with CP/CPPS and predominantly type IIIB prostatitis (87.4%) were prospectively enrolled and received a comprehensive andrological work-up. In addition to laboratory chemical analyses, microbiological processing and semen analysis, a detailed assessment of sexual function and symptom burden was carried out using the International Prostate Symptom Score (IPSS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), IIEF and SFI questionnaires. The NIH-CPSI total score showed a moderate symptom burden with a median of 28 points, while the median IIEF score of 26 points was within the normal range, and the SFI score of 28 points indicated slightly impaired sexual function. In addition, 62.6% of the subjects showed an affected sexual domain in the UPOINT(S) classification. Univariate analysis revealed a significant association (p< 0.05) between IIEF scores and (i) CPSI total score, (ii) the SFI score, (iii) the number of affected UPOINT(S) domains - particularly (iv) the sexual domain (S), and (v) marital status. Multivariate analysis revealed significant associations between IIEF scores and (i) the SFI score, (ii) the UPOINTS total score and (iii) the UPOINTS sexual domain. However, the results of microbiology and inflammatory seminal parameters showed no association with items of sexual function in respective questionnaires. The prevalence of sexual problems was high in CP/CPPS patients in our cohort and it was shown a statistically significant association with (i) the IIEF scores, (ii) the SFI score, (iii) and the NIH-CPSI total score, so routine assessment of sexual function in patients with CP/CPPS seems reasonable.

Testosterone therapy in chronic kidney disease patients: an underutilized resource.

In this cross-sectional study we investigated whether attachment orientation moderated the associations between sexual excitation and inhibition and sexual desire and arousal. A convenience sample of 358 participants (242 women and 116 men; mean age: 37.6 ± 12.0) completed online questionnaires including the Sexual Inhibition/Sexual Excitation Scales-Short Form, the Experiences in Close Relationships scale, the Female Sexual Function Index (women only), and the International Index of Erectile Function (men only). Associations were tested using multiple linear regression analysis. Sexual excitation/inhibition (sexual desire: BSES = .207, p = .044, BSIS1 = -.473, p < .001; sexual arousal: BSIS1 = -.419, p < .001) and attachment anxiety (sexual arousal: BANX = -.207, p < .001) independently predicted part of the variance in sexual desire and arousal. Relationship duration negatively predicted level of sexual desire (B = -.023, p < .001), while male gender positively predicted sexual desire (B = .634, p < .001) and sexual arousal (B = .487, p < .001). The associations between sexual excitation/inhibition and sexual desire and arousal were not moderated by attachment orientation. Further research into the interaction of sexual excitation and sexual inhibition proneness and adult attachment orientation as determinants of sexual desire and arousal seems warranted.

Rezūm water vapor thermal therapy (WVTT) is an effective minimally invasive treatment for benign prostatic hyperplasia (BPH), offering durable symptom relief while preserving sexual function. However, real-world data on predictors of surgical retreatment remain limited. This study evaluates the incidence of surgical re-intervention following Rezūm therapy in a large multi-center cohort and identifies clinical and procedural factors associated with retreatment. A retrospective analysis was conducted using a prospectively maintained registry from two high-volume international centers in Canada and Italy. Men undergoing Rezūm therapy between April 2019 and August 2025 were included. Baseline demographics, comorbidities, functional outcomes, and intraoperative characteristics were compared between patients with and without surgical retreatment. Univariable and multivariable Cox proportional hazards models were used to evaluate predictors of time to re-intervention. Kaplan-Meier estimates were generated for cumulative incidence of retreatment. Among 837 treated men, 43 (5.1%) underwent surgical retreatment over a median follow-up of three years. The cumulative probability of re-intervention was 2.3% at 1 year, 5.3% at 2 years, and 6.9% at 3 years. Most retreatment procedures consisted of GreenLight photovaporization (56%), TURP (20%), or repeat Rezūm (9%). Baseline demographic and clinical characteristics-including age, prostate volume, median lobe presence, medical therapy, and comorbidities-were not significantly associated with retreatment. The only baseline functional measure differing between groups was the BPH Impact Index (BPHII), which was higher among patients who required re-intervention (8.8 vs. 7.5, p = 0.010). In multivariable Cox analysis, BPHII remained independently predictive, with each one-point increase associated with an 18% higher hazard of retreatment (adjusted HR 1.18, p = 0.008). In this large, real-world multi-center cohort, Rezūm therapy demonstrated a low incidence of surgical retreatment for BPH.The BPHII emerged as the only independent predictor of retreatment, suggesting that patient-reported symptom impact may reflect disease severity or treatment resistance. These findings may support preoperative counseling and help guide patient selection for WVTT.

Patient reported outcome measures (PROMs) following colorectal cancer (CRC) treatment have been gaining prominence in addition to oncological outcomes. We have integrated PROMs collection through our nurse-led follow-up (NLFU) clinic of patients undergoing surgical/endoscopic treatment of CRC and report our real-world results. PROMs were collected using the EORTC 29 Questionnaire using a pre-appointment link via NLFU clinic over a period of 18 months since April 2023. The reported outcomes were analysed and correlated with patient demographics, tumour stage, type of procedure and duration since procedure. Tumour site did not influence functional (FS) or symptom (SS) scores. Age demonstrated selective effects: older patients reported better overall functional outcomes but worse urinary-frequency symptoms. Gender did not significantly affect FS or SS. Symptomatic presentation was associated with higher symptom burden, particularly abdominal pain, buttock pain and urinary frequency, while FS remained comparable to screen-detected cases. Most operative approaches produced similar PROMs; however, body image, faecal incontinence and embarrassment differed between specific procedures. Neoadjuvant chemotherapy and tumour stage showed no significant relationships with FS or SS outcomes. Symptom trajectories improved over time, with stool frequency, urinary incontinence, body image and male sexual function varying significantly across follow-up durations, while FS remained stable. Sphincter preservation versus resection revealed worse body image, male sexual function and buttock pain in patients undergoing Abdominoperineal resections (APR). Organ preservation and surgical resection showed broadly comparable PROMs despite differing symptom patterns. PROMs collection is feasible, and outcomes are largely stable across treatments, though symptom burden varies with patient and procedural factors.

Adolescence and young adulthood (AYA) are developmental phases in which individuals establish their identity. A cancer diagnosis during this stage disrupts sexual health, but research remains limited, particularly outside of reproductive-organ cancers. This study examined perceived changes in sexual functioning from pre- to post-diagnosis among survivors and compared their current sexual functioning and satisfaction with matched controls. Dutch-speaking AYA cancer survivors (N = 174; age = 32.7years; 85.6% female) recruited via convenience samplingand N = 348 matched controls completed self-reported measures of sexual functioning [MOS-SF] and satisfaction [GMSEX]. Paired sample t-tests assessed perceived changes in sexual functioning. Repeated measures ANOVAs tested the effects of sociodemographic and cancer-related factors on these variations. Independentsample t-tests compared current sexual functioning and satisfaction between survivors and controls. Survivors reported significant declines in multiple domains of sexual functioning, including interest, arousal, orgasm function, pleasure, and lubrication (women). Greater dysfunction was observed among females, individuals diagnosed in their 30s, those in early survivorship, and those who remained with the same partner. Survivors who had engaged in partnered sexual activity reported less dysfunction than those who had not. Compared with controls, survivors reported significantly greater dysfunction and lower sexual satisfaction, while retrospectively rating their pre-diagnosis sexual functioning as more positive. AYA cancer survivors reported declines in sexual functioning over time, worse outcomes than controls, and more favorable recollections of their pre-diagnosis sexual health, a pattern consistent with response shift. Findings emphasize the need for comprehensive survivorship care that includes routine, proactive sexual health discussions, and tailored interventions responsive to survivors' evolving needs.