The use of nutraceutical products to enhance male sexual performance has a long history, especially with regard to the treatment of erectile dysfunction (ED). Alternative treatments for ED are becoming increasingly popular, with growing interest from consumers, as well as increased revenue for manufacturers. Dietary supplements (DSs), which are a mixture of active ingredients, are mainly sold online. In randomized controlled trials, the molecules contained in DSs have demonstrated varying degrees of effectiveness, or even have no evidence to support their use. However, none of the studies carried out provided sufficient evidence to consider these products a first-line therapy. Therefore, the combination of the various active ingredients, especially in relation to the daily dose, leaves doubts about the real effectiveness. In order to evaluate the potential efficacy of DS formulations, we analyzed the products marketed in Italy using a scoring approach. A systematic review of the literature was performed to evaluate the effect of DS and to detect the active ingredients able to improve erectile function-called effective ingredients (EIs)-and their minimal effective daily dose (mED). A metanalysis identified some nutraceuticals, such as Panax ginseng, Tribulus terrestris and L-arginine, that are able to improve male sexual function. Based on the scoring system, 2 (8%) supplements matched with the cluster of higher expected efficacy, 3 (12%) with the lower efficacy cluster and 20 (80%) matched with the criterion of no expected efficacy. DSs marketed in Italy are usually blends of many substances that are frequently employed at a negligible dose or without any evidence.

Erectile disorder (ED) is the continuous or repeated inability to achieve an erection or maintain its firmness for an adequate amount of time during sexual intercourse. Given the importance of utilizing quality clinical practice guidelines (CPGs) for the diagnosis of ED, the research team conducted a scoping review of erectile disorder CPGs to address the questions based on the clinical guideline of the best quality. This scoping review was conducted in five steps: 1 - identification of the research question, 2 - identification of relevant studies, 3 - selection of studies, 4 - data extraction, 5 - summarizing and reporting the results. The initial search yielded 1,888 articles, CPGs and books but after primary and secondary screening by two appraisers, 9 CPGs were extracted. After that, the two appraisers examined the quality of these guidelines using the AGREE II tool. Eventually, 5 CPGs extracted. After reviewing 5 guidelines, 5 questions were answered. Overall, the CPGs had desirable overlap in response to the marked questions; nevertheless, there were some differences in details too. This review shows that the first and foremost principle in examining the affected individuals is taking a complete detailed history, followed by a physical examination and use of relevant questionnaires to complete the information necessary to diagnose the problem. The next step is to perform routine lab tests; hormonal profiles may also be checked, and if necessary, special tests should be performed based on an individual\'s conditions.

OBJECTIVE: Obesity is prevalent and has a negative impact on women\'s health, including sexual dysfunction. Recent review articles suggest improvement in Female Sexual Function Index (FSFI) and proportion of female sexual dysfunction (FSD) among women with obesity after bariatric surgery.
METHODS: We pooled data from 16 observational studies involving 953 women. The study outcomes were mean FSFI scores and proportion of FSD before and after bariatric surgery. We also sub-analyzed whether age and duration of follow-up affected these outcomes.
RESULTS: The mean age of the subjects was 39.4 ± 4.2 years. Body mass index (BMI) showed significant reduction postoperatively (p < 0.0001). Bariatric surgery led to significant improvement in total FSFI score (p = 0.0005), and all sexual domains except pain. Bariatric surgery reduced the odds of having FSD by 76% compared with those who did not undergo operation (OR 0.24, 95% CI = 0.17, 0.33, p < 0.0001). Our sub-analysis demonstrated a significant reduction in the proportion of FSD for patients <40 years of age. The improvement of total FSFI scores and reduction in proportion of FSD remained significant within the first 12 months after surgery. Univariate meta-regression showed that BMI was not a significant covariate for improvement of FSFI scores (β = 0.395, p = 0.1, 95% CI = 0.884, 0.095).
CONCLUSIONS: Bariatric surgery is shown to improve sexual function scores and prevalence of FSD. This is especially significant among women <40 years of age. This benefit remained significant within the first year after surgery. This appears to be an additional benefit for these patients.

BACKGROUND: Persistent genital arousal disorder (PGAD) is an uncommon condition resulting in intrusive, unwanted and distressing symptoms of genital arousal. Presentation can vary and most cases do not have an immediately identifiable etiology.
OBJECTIVE: To present evaluation and treatment recommendations for PGAD from a multidisciplinary perspective and provide case examples.
METHODS: A focused review of the literature on diagnosis, workup, and treatment of PGAD was completed. A case series of 3 varying presentations of PGAD is offered.
RESULTS: PGAD results in high levels of patient distress and is best managed with a multidisciplinary treatment approach. Identification and management of co-occurring symptoms or disease states is imperative, particularly psychologic and psychiatric comorbidities. With appropriate intervention, patients may achieve improvement of their physical symptoms and a decrease in associated psychological distress.
CONCLUSIONS: PGAD is an uncommon and highly distressing condition that requires thoughtful evaluation for appropriate diagnosis and treatment. Multidisciplinary treatment approaches provide the best opportunity to address the needs of patients and optimizing treatment response. Pease ER, Ziegelmann M, Vencill JA, et al. Persistent Genital Arousal Disorder (PGAD): A Clinical Review and Case Series in Support of Multidisciplinary Management. Sex Med Rev 2021;XX:XXX-XXX.

BACKGROUND: Huntington\'s Disease (HD) is a neurodegenerative disorder of which the main symptoms are motor, cognitive and behavioural problems sometimes including sexual dysfunction.
OBJECTIVE: To review the current knowledge on sexual dysfunction in HD.
METHODS: Databases of Pubmed and Scopus were searched. Only original studies performed after 1994 were included (from 1994 a genetic test = proven diagnosis).
RESULTS: 162 publications were found, but only nine met our established criteria. The majority of patients with HD suffer from sexual disorders. The most common are: hypoactive sexual disorder (53-83% of patients), hyperactive sexual disorder (6-30%), erectile (48-74%) and ejaculatory dysfunctions (30-65%), lubrication problems (53-83%), and orgasmic dysfunction (35-78%).
CONCLUSIONS: Results may be biased for several reasons e.g.: social taboos regarding sex lives, medications that affect sexual function, impaired self-awareness of patients, small study samples, a lack of standardised questionnaires, and a focus only on the presence of sexual problems without describing them.
CONCLUSIONS: Sexual disorders in HD are common. This is a problem that is probably underestimated, both by patients/caregivers and physicians, who should focus more on these symptoms in order to improve patient quality of life.

OBJECTIVE: Multiple sclerosis is a neurological disorder-may in some patients have impact on body image; this could contribute to neurological disability, psychological distress, and can reduce quality of life. This review has been conducted on studies investigating the representation of body image.
METHODS: We have researched PubMed and Web of Science databases and included screening references for studies and review articles about this topic. From the initial 316 publications, we included only 9 studies that met the search criteria.
CONCLUSIONS: The results showed that this construct has been little emphasized over time and has a significant impact on the patient.

OBJECTIVE: This study aimed to assess the prevalence of sexual dysfunction and Female Sexual Function Index (FSFI) score in women with infertility.
METHODS: A systematic search of the literature was conducted using PubMed, EMBASE, IBECS, and LILACS. The search was limited to articles published from January 2000 to September 2016, without language restriction. Data were analyzed using Stata 12.0. Random effects meta-analyses in weighted mean difference (WMD) were performed for six comparative studies (infertility versus fertility). Heterogeneity was estimated using I2. Moreover, to explore the heterogeneity sources among the studies, meta-regression analyses were also performed. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation guidelines, and risk of bias, with a graphic funnel.
RESULTS: Meta-analysis was performed in 11 of 13 comparative studies. The result indicated a significant association between an increase in sexual dysfunction and infertility in women (WMD=-0.16, 95% confidence interval=-0.254 to -0.084, p<0.001), and high heterogeneity between studies was noted (I2=98.6%, p<0.000). Meta-regression analysis did not indicate heterogeneity (I2=0.00%). We also performed a meta-analysis of individual FSFI domains in 10 studies. Infertile women had problems with lubrication, orgasm, and satisfaction. Meta-regression analysis also showed that heterogeneity had no influence on the final results of all the analyses.
CONCLUSIONS: Infertility was associated with an increase in female sexual dysfunction. The most affected areas of sexual function were lubrication, orgasm, and satisfaction.