Treatment Of Male Sexual Dysfunction Research Articles

Trends, safety, and efficacy of wearable male sexual devices.

The prevalence of male sexual dysfunction (MSD) increases with age, with >50% of men aged >40years reporting erectile dysfunction (ED). In recent years, wearable male sex devices (WMSDs) have been increasingly utilized by patients and recommended by sexual medicine clinicians. This study seeks to investigate the safety and efficacy of products currently marketed for the treatment of MSD. Available products for WMSDs were reviewed by analyzing product websites, forums, advertisements, and clinical recommendations. Qualitative comparisons were based on patient reviews, cost, and specific features. Investigatory evidence and Food and Drug Administration status were also reviewed. Additionally, Google Trends was used to determine the popularity of devices over time. Eight WMSDs for the treatment of MSD and enhancement of sexual pleasure were reviewed. Constriction bands, such as the Maintain Ring Loop, Eddie by Giddy, and Xialla, have shown significant benefits in clinical trials and were the most popular devices among patients. Smart devices can provide real-time feedback on erectile quality and/or sexual performance. Similar to the RigiScan, the Adam sensor provides feedback on erectile quality while monitoring changes in penile tumescence during sleep with additional analysis available through a mobile application. Neuromodulation devices such as the Morari Patch and vPatch/in2 Patch use electrical stimulation to delay ejaculation and improve sexual function. The FirmTech Performance Ring uses sensors to track the vital signs of erectile fitness with clinical trials ongoing. Overall, this review describes the available investigatory evidence for a range of WMSDs and highlights the potential benefits and limitations of these devices in treating MSD and enhancing sexual pleasure. Further research is needed to evaluate the effectiveness of these devices and to determine which ones may be the most suitable for individual patients.

(PM-04) EFFECTS OF VIBRATORY STIMULATION AND VACUUM ERECTION DEVICE IN THE TREATMENT OF MALE SEXUAL DYSFUNCTIONS: A LITERATURE REVIEW

Abstract Introduction Erectile dysfunction, premature ejaculation, retrograde ejaculation, delayed ejaculation, anejaculation, painful ejaculation, anorgasmia, hematospermia and low sexual desire are the main male sexual dysfunctions. The 2022 European Association of Urology recommends the use of vibratory stimulation and vacuum erection devices in the treatment of male sexual dysfunctions (mainly anejaculation and erectile dysfunction), both as adjuvant therapy and as combination therapy with other interventions. The objective of the study was to verify if there is scientific evidence for the use of vibrating stimulation and the vacuum erection device in male sexual dysfunctions that allow clinical indication in an effective and safe manner. Methods Literature review by searching for scientific articles in the Pubmed database of the National Library of Medicine published in the last 10 years, including randomized clinical trials, meta-analysis studies, pilot studies, systematic literature reviews and guidelines. Results As a result 1,230 articles on male sexual dysfunction. After screening, 16 studies were selected that are part of this research, seven articles on vibratory stimulation and nine on vacuum erection devices. Conclusion This review suggests that vacuum erection and vibratory stimulation devices, as they offer low risk, minimal side effects, are accessible and cost-effective compared to other approaches, are promising devices for the non-invasive treatment of male dysfunctions. sex. Other studies with greater methodological rigor are needed. Descriptors Vibratory stimulation; sexual dysfunction; penis vibrator; male sexual dysfunction; vacuum erectile; vacuum erection; Peyronie's disease Financing No conflict.

(251) Exploring Trends, Safety, and Efficacy of Wearable Male Sexual Devices: Revolutionizing Intimacy

Abstract Introduction The prevalence of male sexual dysfunction (MSD) increases with age, with greater than 50% of men aged over 40 years reporting erectile dysfunction (ED). In recent years, wearable male sex devices (WMSDs) have been both increasingly utilized by patients and recommended by sexual medicine clinicians. Objective This study seeks to investigate the safety and efficacy of products currently marketed for the treatment of MSD. Methods Available products for WMSDs were reviewed by analyzing product websites, forums, advertisements, and clinical recommendations. Qualitative comparisons were made based on patient reviews, cost, and specific features of each device. Investigatory evidence and FDA status were also reviewed (Figure 1). Additionally, Google Trends was used to determine the popularity of different devices over time (Figure 2). Results Eight WMSDs for the treatment of MSD and enhancement of sexual pleasure were reviewed. Constriction bands, such as the Maintain Ring Loop, Eddie by Giddy, and Xialla, have shown significant benefits in clinical trials and were found to be the most popular devices among patients. Smart devices can provide real-time feedback on erectile quality and/or sexual performance. Similar to the Rigiscan, the ADAM sensor provides feedback on erectile quality while also monitoring changes in penile tumescence during sleep with additional analysis available through a mobile application. Neuromodulation devices like Morari Patch and vPatch/in2 patch use electrical stimulation to delay ejaculation and improve sexual function. The FirmTech Performance Ring uses sensors to track the vital signs of erectile fitness with clinical trials ongoing. Conclusions Overall, this review describes the available investigatory evidence for a range of WMSDs and highlights the potential benefits and limitations of these devices in treating MSD and enhancing sexual pleasure. Further research is needed to evaluate the effectiveness of these devices and to determine which ones may be the most suitable for individual patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Charles A Loeb, MD - None relevant Muhammad A M Hammad, MBBCh - None relevant David W Barham, MD - None relevant Jake Miller MD - None relevant Kirsten Young, MS - None relevant Rainey Horwitz, MD – Paid collaboration with FirmTech on Instagram Eliad Amini, BS - None relevant Mai Xuan Nguyen, BS - None relevant Nitish Nag, MD, PhD - None relevant Lawrence Jenkins, MD – None relevant Amy M Pearlman, MD – Consultant for/received grant funding from Boston Scientific; consultant for Endo Pharmaceuticals; consultant for FirmTech; investor in ByteMD; influencer in Urology Times Faysal A Yafi, MD – Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(354) Revolutionizing Intimacy: Exploring Trends, Safety, and Efficacy of Wearable Male Sexual Devices

Abstract Introduction The prevalence of male sexual dysfunction (MSD) increases with age, with greater than 50% of men aged over 40 years reporting erectile dysfunction (ED). In recent years, wearable male sex devices (WMSDs) have been both increasingly utilized by patients and recommended by sexual medicine clinicians. Objective This study seeks to investigate the safety and efficacy of products currently marketed for the treatment of MSD. Methods Available products for WMSDs were reviewed by analyzing product websites, forums, advertisements, and clinical recommendations. Qualitative comparisons were made based on patient reviews, cost, and specific features of each device. Investigatory evidence and FDA status were also reviewed (Figure 1). Additionally, Google Trends was used to determine the popularity of different devices over time (Figure 2). Results Eight WMSDs for the treatment of MSD and enhancement of sexual pleasure were reviewed. Constriction bands, such as the Maintain Ring Loop, Eddie by Giddy, and Xialla, have shown significant benefits in clinical trials and were found to be the most popular devices among patients. Smart devices can provide real-time feedback on erectile quality and/or sexual performance. Similar to the Rigiscan, the ADAM sensor provides feedback on erectile quality while also monitoring changes in penile tumescence during sleep with additional analysis available through a mobile application. Neuromodulation devices like Morari Patch and vPatch / in2 patch use electrical stimulation to delay ejaculation and improve sexual function. The FirmTech Performance Ring uses sensors to track the vital signs of erectile fitness with clinical trials ongoing. Conclusions Overall, this review describes the available investigatory evidence for a range of WMSDs, and highlights the potential benefits and limitations of these devices in treating MSD and enhancing sexual pleasure. Further research is needed to evaluate the effectiveness of these devices and to determine which ones may be the most suitable for individual patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Charles A Loeb, MD - None relevant Muhammad A M Hammad, MBBCh - None relevant David W Barham, MD - None relevant Jake Miller MD - None relevant Kirsten Young, MS - None relevant Rainey Horwitz, MD – Paid collaboration with FirmTech on Instagram Eliad Amini, BS - None relevant Mai Xuan Nguyen, BS - None relevant Nitish Nag, MD, PhD - None relevant Lawrence Jenkins, MD – None relevant Amy M Pearlman, MD – Consultant for/received grant funding from Boston Scientific; consultant for Endo Pharmaceuticals; consultant for FirmTech; investor in ByteMD; influencer in Urology Times Faysal A Yafi, MD – Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

Comparing Western and traditional Chinese medicine for male sexual dysfunction: can Klotho represent a silk road?

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.

Men's age determines sexual and reproductive health services utilisation in Ekiti State, Nigeria

ObjectiveSexual and reproductive health services are majorly patronised by women leaving -out the men, hence men's opinions are not usually known or reflected. Therefore, in this study, men's opinion on determinants of Sexual and Reproductive Health (SRH) service utilisation among men were established. This was done in a bit to plan specific and attractive sexual and reproductive health services for men MethodsA cross-sectional quantitative study was conducted among 339 men between the ages of 18 and 65 years. Study participants were selected at household level from twelve communities using multistage and systematic sampling. Data were collected with the aid of structured questionnaire. Data were analysed with SPSS IBM statistics version 26 and the statistical significance was set at p-value < 0.05. ResultsOnly 18 % had previously utilised SRH services. Age was the only predisposing characteristic found to be associated with SRH service utilisation (p = 0.02) while distance of hospitals to participants’ residence and distance of hospitals to participants’ office were enabling characteristics found to be significantly associated with SRH service Utilisation (p = 0.00 and p = 0.04), respectively. Prevention and treatment of HIV (p = 0.03) and prevention and treatment of male sexual dysfunction (p = 0.01) were the need-based characteristics associated with SRH service utilisation. Binary logistic regression analysis showed that only age (OR = 1.40, 95 % C. I=1.03–1.90, p = 0.03) was the significant determinant of SRH service Utilisation with middle-aged men utilising SRH services more than other age groups. ConclusionThe utilisation of SRH services by men in this study was poor and this was majorly due to barriers that were service provision related. The study established that age is a major determinant of SRH utilisation by men. Age is an important factor while establishing SRH services for men, hence the need to set up specific MSRH services that are age appropriate and appealing to men.

Efficient extraction of quassinoids and alkaloids from Eurycoma longifolia Jack roots using natural deep eutectic solvents and microwave-assisted extraction

Eurycoma longifolia Jack (EL) extracts have immunomodulatory and anti-inflammatory effects and are utilized in the treatment of male sexual dysfunctions. Water-based extraction methods for hydrophobic and bioactive components of EL are often inefficient and energy-intensive. Therefore, this study aimed to develop an efficient and environmentally friendly method for extracting EL quassinoids and alkaloids using natural deep eutectic solvents (NADESs) and microwave-assisted extraction (MAE). The NADES-based MAE method employed an optimized NADES comprising choline chloride, citric acid, glucose, and water (CCGW). CCGW provided higher extraction yields of eurycomanone (EU, 1.608 ± 0.004 mg/g) and 9-methoxy-canthin-6-one (9MCO, 0.3022 ± 0.0007 mg/g) than water-based extraction under optimal MAE conditions, as determined using Box–Behnken Design of Response Surface Methodology. CCGW effectively extracted both polar quassinoids and less-polar alkaloids from EL roots. While concentrated NADES had an impact on RAW264.7 cell viability, the use of diluted CCGW did not enhance the cytotoxicity of both EU and 9MCO compared to their preparation in water. The anti-inflammatory activity of 9MCO, prepared in diluted CCGW, was equivalent to that of the compound prepared in water. The cytotoxicity of both compounds in Vero cells was higher when coupled with CCGW than their preparation in water. The NADES-based MAE method is an efficient approach for extracting bioactive components from EL.

Online ejaculation training programs promote non-evidence-based treatment of male sexual dysfunction.

Purposefully reducing the frequency of ejaculation, coined "semen retention", and the similar practice of "NoFap", have been popularized on social media. They are frequently accompanied by unsubstantiated claims of health benefits. Their increasing popularity has led to the emergence of online courses claiming to teach these techniques. The goal was to characterize the landscape of courses offering ejaculatory training. A systematic Google search was performed using terms related to ejaculation training to identify training programs. Information regarding instructor credentialing, type and duration of courses, costs, and claims of medical benefits were extracted. Eleven ejaculation training courses were identified with 10 instructors (two courses named the same coach). Costs varied from $5 to $147 per week or a $20 to $199 one-time payment. None of the course instructors claimed standardized credentials in the fields of medicine or mental health. Seven instructors (70%) solely cited their own personal experience as their qualifying credentials. Courses claimed to improve erectile dysfunction, premature ejaculation, porn addiction, sexual performance anxiety, testosterone levels, and/or depression. Ejaculation training programs are costly, readily available online, and provided by instructors with no medical background. Despite no scientific evidence, these courses claim to improve various aspects of men's health and can be potentially damaging financially, physically, and mentally to participants.

The sextech industry and innovative devices for treating sexual dysfunction.

Since the digital revolution, there has been a notable increase in the use and popularity of sex toys and innovative sexual devices, which can be attributed to advancements in technology. The sex toys industry strives to improve sexual experience, pleasure and sexual health, and to address sexual dysfunction through devices and technology. With the growth of this industry, new products that are considered "smart sexual devices" have gradually entered the market. Smart sexual devices feature wireless connectivity to a smartphone application that allows the user to control the device's features and provide personal or sexual data about their sexual experiences. Other smart devices have sensors and are able to collect physical data during usage. With the aid of this data, individuals may be able to understand their sexual behavior and arousal better, resulting in improved sexual experience or the overcoming of sexual dysfunction. The present article aims to explore the potential applications of technology-based devices, and smart sexual devices, in the treatment of male sexual dysfunctions, including premature ejaculation (PE), and delayed ejaculation (DE), as well as female sexual dysfunction (FSD), such as sexual arousal disorder and female orgasmic disorder. Furthermore, we examine the advantages and disadvantages of these devices. Given the limited literature available on this subject and the absence of controlled studies, we conduct a narrative review of the existing scientific research on technological and smart sexual devices.

(016) The Effect of Phosphodiesterase-5-inhibitor on Female Sexual Function: A Systematic Review and Meta-analysis

Abstract Introduction The link between the attainment of healthy sexual function and a high quality of life in women is well established. However, while the management of male sexual dysfunction has been afforded huge research and development, far less time and effort has been lent in the achievement of successful remedies for females experiencing sexual dysfunction. The use of oral phosphodiesterase type 5 (PDE5) inhibitors, such as Sildenafil, has been the mainstay of treatment for male sexual dysfunction for the last two decades. PDE5 inhibitors have been shown to initiate penile erection, through smooth muscle relaxation and the subsequent increase in intracellular cGMP levels. PDE5-containing cells, similar to those found in the penis, have also been confirmed within the clitoris. No previous pooled analysis has been performed, looking at the possible effect of PDE5 inhibitors on female sexual function, in a population comprising of heterosexual cisgender population. Objectives We aimed to perform a systematic review and meta-analysis of the best possible available studies, to evaluate the efficacy and safety of PDE5 inhibitors versus placebo when used in an exclusively female population. Methods We conducted a comprehensive search of electronic databases (MEDLINE, PubMed, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar, Web of Science, EBSCO Host, TRIP and Epistemonikos), identifying studies comparing the PDE5 inhibitors versus placebo, and the resultant effect on female sexual function. The Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modelling was used to calculate pooled outcome data. Results Searches of electronic databases resulted in 67 articles, from which 13 randomised control trials (RCTs) met the eligibility criteria, enrolling a total of 1605 patients. The use of PDE5 inhibitor was associated with a significantly improved orgasm satisfaction (P=0.01), increased sexual arousal (P=0.02), increase in sexual satisfaction (P=0.007) when compared to placebo. The use of PDE5i was also found to have a significant association with the incidence of headaches (P&amp;lt;0.0001) and flushing (P&amp;lt;0.00001). Conclusions Our meta-analysis demonstrated that the use PDE5 inhibitor was associated with a significantly higher attainment of orgasm satisfaction, sexual arousal, and sexual satisfaction when administered to a solely female population, when compared with placebo. However, the use of PDE5 inhibitors was also associated with a significantly increased risk of headache and flushing. Further large-scale high-quality RCTs are required in order to further evaluate the potential role of PDE5i’s in women, particularly in those suffering from significant sexual dysfunction. These future studies should focus on a more homogenous patient group, with stricter definitions of inclusion criteria. Disclosure

Male Sexual Dysfunction

Male sexual dysfunction is a series of conditions, most notably including erectile dysfunction (ED), Peyronie’s disease (PD), and premature ejaculation (PE), defined by impaired sexual functioning. The prevalence of male sexual dysfunction increases with age and is relatively high with greater than 50% of men aged 40 to 70 describing some degree of erectile dysfunction. Risk factors for male sexual dysfunction include age, diabetes mellitus (DM), cancer, stroke, hypertension, penile trauma, depression, anxiety, and disturbance in central serotonin neurotransmission and 5-HT postsynaptic receptor functioning. Sexual questionnaires including the International Index of Erectile Dysfunction, Sexual Health Inventory for Men, and the Premature Ejaculation Diagnostic Tool are useful in screening for these disorders. Focused history and physical can establish diagnoses. For a condition to be diagnosed as male sexual dysfunction, the patient or their partner must view their sexual functioning as impaired. Treatment of male sexual dysfunction is etiology dependent. For ED, first-line therapy is a phosphodiesterase-5 inhibitor or mental health care for psychogenic ED. More complicated cases may be treated with injections, surgery, or shockwave therapy. PD is either treated with medications for pain management, collagenase clostridium histolyticum injection, corpoplasty, plication, or shockwave therapy. PE may be treated behaviorally or with SSRIs as first line medication.

Brain and testicular metabonomics revealed the protective effects of Guilingji on senile sexual dysfunction rats

Ethnopharmacological relevanceGuilingji (GLJ), which has been used to treat male diseases in China for centuries, contains 28 Chinese herbs and was previously established as an effective treatment for male sexual dysfunction. However, its mechanism of action remains unclear. Aim of the studyTo explore the efficacy and mechanism of action of GLJ in improving senile sexual dysfunction (SSD) in aging rats. Materials and methodsAn aging rat model of SSD was induced by the subcutaneous injection of d-galactose (300 mg⋅kg-1) and used to analyse the effects of GLJ (different concentrations of 37.5, 75, and 150 mg⋅kg-1) on the mating of aging rats. At the end of the 8th week, histopathological analysis of testicular tissues, assessment of the hypothalamic-pituitary-gonadal (HPG) axis hormone levels in serum or brain, and metabonomics analysis of the brain and testicular tissue with liquid chromatography–mass spectrometry was performed to explore the mechanism of action of GLJ. ResultAfter treatment with GLJ, the mount and ejaculation latency levels were increased in the treatment group than those in model group (P < 0.05), moreover, the testicular morphology was improved. Gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) levels in rats were also improved significant (P < 0.05) compared with those in the model group. Furthermore, the metabonomics results in the testicular and brain tissue showed that GLJ improved SSD by adjusting amino acid and lipid metabolism. ConclusionThis study integrated the complementary metabolic profiles of the target tissues. GLJ might affect SSD rats by regulating amino acid and lipid metabolism and may modulate sensitivity to the signaling pathway in the HPG axis. This study provides an essential basis for the broad clinical application of GLJ.

Clinical Pharmacokinetic Evaluation of Optimized Liquisolid Tablets as a Potential Therapy for Male Sexual Dysfunction.

The study aimed at developing a liquisolid tablet (LST) containing tadalafil (TDL) and dapoxetine (DPX) with improved bioavailability as a potential therapy for male sexual dysfunction. A mixture of nonvolatile solvents, namely PEG 200 and Labrasol®, was utilized to prepare LSTs that were assessed for their quality characteristics. The Box–Behnken design (BBD) was employed to statistically explore the effect of the formulation factors on the quality attributes of LSTs. Furthermore, an in vivo pharmacokinetic study was carried out for the optimized LST in comparison with the marketed tablets on healthy human volunteers. The optimized LST revealed acceptable quality limits with enhanced dissolution for both APIs. The pharmacokinetic parameters after oral administration of the optimized LST indicated that the Cmax of TDL in LSTs was 122.61 ng/mL within 2h compared to the marketed tablets, which reached 91.72 ng/mL after 3 h, indicating the faster onset of action. The AUC was improved for TDL in LST (4484.953 vs. 2994.611 ng/mL∙h in the marketed tablet) and DPX in LST (919.633 vs. 794.699 ng/mL∙h in the marketed tablet). This enhancement in bioavailability potentially minimizes the associated side effects and improves the treatment of male sexual dysfunction, particularly for diabetic patients.

Phenylethanol glycosides from Cistanche tubulosa improved reproductive dysfunction by regulating testicular steroids through CYP450-3β-HSD pathway.

Cistanche tubulosa (Schenk) R. Wight has been used frequently in traditional folk medicine for treatment of male sexual dysfunction (MSD). Phenylethanol glycosides, the main components of C. tubulosa, possess a variety of pharmacological activities due to their multiple properties. However, the underlying mechanism by which phenylethanol glycosides from C. tubulosa (CPhGs) regulates testicular steroids has not been elucidated to date. This study is to determine whether CPhGs promotes the reproductive functions of mice through CYP450-3β-HSD pathway of testosterone synthesis. The major compositions of C. tubulosa (CPhGs) were quantified by high performance liquid chromatography (HPLC). The model of reproductive injury in mice were induced by injection of hydrocortisone (HCT). Different doses of CPhGs (72, 145 and 289mg/kg) and testosterone propionate (TP, positive control drug) were administrated intragastrically for 14d. The reproductive functions (erectile incubation period, capture and ejaculation incubation period, number of captures and ejaculations) and organ weights (testicle, epididymis, seminal vesicle and penis) were then determined. The levels of luteinizing hormone and testosterone in serum were quantified by radioimmunoassay. The key enzymes in testosterone synthesis pathways such as steroidogenic acute regulatory protein (StAR), cytochrome P450 cholesterol side chain cleavage enzyme (P450scc/CYP11A1) and 3β-hydroxysteroid dehydrogenase (3β-HSD) in the testis were assessed by immunofluorescence (IF) staining or/and Western blot (WB) analysis. The results illustrated that the low dose of CPhGs (72mg/kg) had no significant protective effect against the reproductive injury caused by HCT, while the moderate dose of CPhGs (145mg/kg) improved the damaged reproductive ability and the declined levels of luteinizing hormone and testosterone in the model mice (P<0.001, P<0.05, respectively). In particular, high dose of CPhGs (289mg/kg) was most effective in improving HCT-induced changes in body weight (P<0.01), reducing the incubation period of the erectile (P<0.001), capture (P<0.05) and ejaculation (P<0.01), and increasing the number of captures and ejaculations (P<0.01, P<0.05, respectively). The weights of testcle, epididymis, seminal vesicle and penis (P<0.001, P<0.01, P<0.01, P<0.001, respectively) were improved by high dose of CPhGs. The levels of testosterone and its upstream luteinizing hormone were up-regulated by high dose of CPhGs (P<0.001). Meanwhile, the expressions of the key steroidogenic enzymes including CYP11A1 and 3β-HSD were significantly up-regulated after CPhGs treatment (P<0.001), demonstrated that CPhGs exerted the effect through enhancing testosterone biosynthesis via CYP450-3β-HSD pathway. CPhGs could significantly protect against HCT-induced deleterious reproductive dysfunction and testis injury. The protective effects were exerted by up-regulating synthesis of testosterone via the CYP450-3β-HSD pathway in Leydig cells.

Statistical Mediators of the Association Between Mindfulness and Sexual Experiences in Men with Impaired Sexual Function.

Mindfulness-based therapy has shown promise as a treatment for female sexual dysfunction and has the potential to be an efficacious treatment for male sexual dysfunction. However, there has been little empirical evidence regarding the mechanisms through which mindfulness may improve sexual experiences, especially for men. Recent theoretical reviews have suggested potential mediators that may explain the beneficial effects of mindfulness on symptoms of male sexual dysfunction, including reduced avoidance of sex, reduced distraction during sex, and/or reduced activation of negative sexual schemas. We attempted an initial statistical test of these factors as potential mediators of the association between trait mindfulness and multiple sexual outcomes (sexual function, sexual satisfaction, and sexual distress) using a cross-sectional correlational design. A total of 163 men with self-reported current impairments in one or more aspects of sexual function completed self-report scales using a secure online survey. Bivariate correlations indicated that mindfulness was significantly associated with sexual satisfaction, sexual distress, and premature ejaculation, but not other aspects of sexual function. Sexual avoidance statistically mediated the link between mindfulness and sexual satisfaction, both distraction and activation of negative schemas statistically mediated the link between mindfulness and premature ejaculation, and all three factors statistically mediated the link between mindfulness and sexual distress. These results generally supported previous theoretical work and have implications for future treatment outcome research.

Sexual and reproductive healthcare needs of Iranian men: A cross-sectional study.

Background The sexual and reproductive health (SRH) needs of men have received little attention in Iran's healthcare system. Developing appropriate strategies to meet men's needs requires careful assessment and recognition of their health needs.ObjectiveThe objective of this study is to assess men's SRH needs and satisfaction with received services.Materials and MethodsThis descriptive cross-sectional study was conducted with 1068 adult men aged between 20 and 60 years in Ahvaz in 2014. For obtaining the SRH services needs of men, in addition to the self-reported felt needs, expressed needs and unmet needs, a need assessment was also done using a questionnaire that was developed for the research; its validity and reliability were assessed.ResultsThe men's perceived, expressed and unmet needs for SRH services were, priority-wise, screening and diagnosis of male genital cancers (63.3%), receiving contraceptive methods (36%), diagnosis, and treatment of male sexual dysfunction (86.9%), respectively. Preventing sexually transmitted disease/AIDS (72.1%), using contraceptives correctly (39.5%), and resisting peer pressure (86.6%) were, respectively, the first felt, expressed, and unmet skills men needed. The results of multivariate logistical regression showed that there was a significant statistical correlation between men's SRH needs and their socio-demographic factors (age, marital/educational status, income) ().ConclusionIranian men have many unmet SRH needs. Felt and expressed SRH needs were different. Educational and counseling services are as important as clinical services.

The Use of Stromal Vascular Fraction in the Treatment of Male Sexual Dysfunction: A Review of Preclinical and Clinical Studies.

Stem cell therapy using stromal vascular fraction (SVF) is a promising treatment modality. SVF is comprised of a mixture of adipose-derived stem cells, endothelial precursor cells, and immune modulatory cells that act synergistically to facilitate angiogenesis and epithelial cell differentiation. This makes SVF an attractive option for men's sexual disorders that require reconstitution of vasculature and endothelial lining, namely erectile dysfunction (ED) and Peyronie's disease (PD). The objective of this study was to compare and contrast the available literature regarding the use of SVF in the treatment of male sexual dysfunction. A literature review was performed in PubMed with the keywords "stromal vascular fraction" and/or "erectile dysfunction" and/or "Peyronie's disease" and/or "sexual dysfunction." The main outcome measure for preclinical studies was erectile function, as measured by changes in intracavernous pressures, and results of histopathologic analysis of corporal tissue. Clinical endpoint analysis in humans included various patient questionnaires. For ED, there were 5 preclinical studies included in the analysis, with 1 Phase 1 clinical trial in humans. Major limitations of both the preclinical and clinical studies included the absence of SVF component analysis, and short duration of follow-up. Despite a paucity of preclinical studies, there was a single clinical study assessing the efficacy of combination SVF and shock wave therapy in the treatment of PD. Limitations of this study included an absence of a control group and the use of subjective data. Preclinical and clinical data in the use of SVF for the treatment of male sexual dysfunction is deficient. Even though multiple medicinal disciplines are studying the use of SVF on a myriad of pathologies, further investigative work elucidating the mechanism and potential adverse effects of SVF need to be performed before clinical trials are undertaken. Haney NM, Gabrielson A, Kohn TP, Hellstrom WJG. The Use of Stromal Vascular Fraction in the Treatment of Male Sexual Dysfunction: A Review of Preclinical and Clinical Studies. Sex Med Rev 2019;7:313-320.

A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada.

The evaluation and treatment of male sexual dysfunction has developed considerably since the release of sildenafil (Viagra®) as a treatment for erectile dysfunction in 1998.1 There is a societal perception that it is important for men to preserve their sexual function and optimize their sexual performance. This perception, coupled with perpetual innovation in male sexual medicine, has led to many treatment options for male sexual dysfunction, including oral therapies for erectile dysfunction, multiple vehicles for hormonal replacement, shockwave therapy, and penile implants for refractory erectile dysfunction. There are fellowships throughout Canada dedicated to the medical and surgical management of male sexual dysfunction. Medical students and residents across many disciplines are routinely exposed to the evaluation and treatment of men with sexual dysfunction. Unfortunately, despite robust clinical and academic interest in male sexual dysfunction, women with sexual complaints have been largely overlooked.2 There have been limited treatment options, few Canadian role models who specialize in female sexual medicine, and little academic activity in the area of female sexual function. Fortunately, over the past decade there has been an increase in the clinical and academic interest in female sexual function. The times appear to be changing. The International Society for the Study of Women’s Sexual Health (ISSWSH) was established in 2001 to serve as a multidisciplinary international community dedicated to advancing the study of female sexuality. There are published guidelines and position papers that reinforce the practical aspects of female sexual dysfunction (FSD) evaluation and management.3 There has been an important increase in research regarding the impact of cancer and its treatment on female sexual function.4 And finally, there are now U.S. FDA-approved therapies for both low desire and sexual pain that will possibly be available in Canada in the future.5–7 The increase in attention to female sexual function over the past decade can be attributed to a number of factors, including the establishment of ISSWSH, new treatments offering hope, an increase in female sexuality research, and broader societal forces promoting equity in medical practice and research. This review provides a practical, evidence-based guide to the evaluation and management of FSD that is adaptable for clinical practice in Canada. For the purpose of this review, the classification of FSD have been divided into four broad categories: sexual pain, low desire, low arousal, and orgasmic dysfunction. These closely mirror the DSM V classifications of FSD, compromised of: genito-pelvic pain/penetration disorder (sexual pain), female sexual interest/arousal disorder (low desire and low arousal), and female orgasmic disorder (orgasmic dysfunction). 8 These classifications have been chosen instead of the DSM classifications, as many patients will not meet strict criteria but will still benefit from evaluation and management. A symptom-based approach is the most effective means to organize the initial medical evaluation and treatment of women with sexual complaints to encourage collaboration and communication between healthcare providers.

A review of the potential of medicinal plants in the management and treatment of male sexual dysfunction.

Male sexual dysfunction is a common disorder that appears to be a consequence of a wide range of physical and psychological conditions. Due to mental stress, insufficient physical exercise and various aetiological factors, human being's life is becoming less pleasant, which leads to incapability to have sexual pleasure. The allopathic drugs used for sexual dysfunction are believed to produce a variety of side effects and affect other physiological processes and, ultimately, general health. Therefore, the search for natural supplement from medicinal plants is being intensified probably because of less side effects availability and affordability. Ethnobotanical surveys have indicated a large number of plants traditionally used as aphrodisiacs but only few of them are scientifically validated for the management and treatment of male sexual dysfunction. This article has summarised the medicinal plants traditionally recommended and scientifically validated for the management and treatment of male sexual dysfunction.

Is the use of plants in Jordanian folk medicine for the treatment of male sexual dysfunction scientifically based? Review of in vitro and in vivo human and animal studies.

Male sexual dysfunction is a serious problem which has an impact on the quality of life. In Jordanian folk medicine, 56 plant species were reported to be used by males to improve sexual potency and as aphrodisiacs. The aim of this study was to search for scientific evidence justifying their folk use. Of the 15 studied plants, only five were found to enhance spermatogenesis. The other 10 were reported to decrease spermatogenesis at least by one study. The majority of the studied plants possessed a protective effect on testis in different in vivo models as well as antioxidant activities. The effect of these plants on steroidogenesis and the hypothalamic-gonadal axis was also reviewed. The effect of only five plants was studied on sexual behaviour enhancement and three of them were active. Three of the four studied plants enhanced erection. The mechanism of action of active constituents isolated from the studied plants was also investigated. In conclusion, many plants used in Jordanian folk medicine decreased or had no effect on spermatogenesis in animal models. These plants have antioxidant and/or adaptogenic effects, and this may result in a beneficial action on male reproductive system.