BACKGROUND: Effective emotional regulation (ER) skills are important for sexual function, as they impact emotional awareness and expression during sexual activity, and therefore, satisfaction and distress. Emotion regulation interventions may offer a promising approach to improve sexual health. Web-based emotion regulation may be a therapeutic strategy for men and women with sexual health concerns. Nevertheless, there is a scarcity of intervention trials investigating its effects in this context, much less using the internet.
OBJECTIVE: This study aims to investigate the effects of a web-based emotion regulation training program for sexual function in both men and women.
METHODS: The participants were recruited based on their self-reported sexual problems, which for men was defined by a score of <25 on the International Index Erectile Function (IIEF) and for women by a score of <26.55 on the Female Sexual Function Index (FSFI). The final sample included 60 participants who were randomized to either a web-based emotion regulation training for sexual function or to a waitlist control group. The treatment consisted of an 8-week web-based emotion regulation training for sexual function. The participants were assessed at baseline, post intervention, and the 3-month follow-up.
RESULTS: Of the 60 participants included, only 6 completed all 3 assessment points (n=5, 20% in the treatment group and n=1, 5% in the waitlist control group) after receiving the intervention. At follow-up, there were no significant differences between groups in any measure. Among the intervention completers, large-to-moderate within-group effect sizes were observed between the assessment points on measures of emotion regulation, depression, lubrication, orgasm, thoughts of sexual failure, and abuse during sexual activity. The adherence rate was very low, limiting the generalizability of the findings.
CONCLUSIONS: Participants who completed the intervention showed improvements in both sexual function domains and emotion regulation. Nonetheless, due to a high dropout rate, this trial failed to collect sufficient data to allow for any conclusions to be drawn on treatment effects.
BACKGROUND: ClinicalTrials.gov NCT04792177; https://clinicaltrials.gov/study/NCT04792177.

UNASSIGNED: Prolonged and excessive use of alcohol can affect the sexual function. The occurrence of sexual dysfunction has adverse psychological and interpersonal consequences.
UNASSIGNED: To assess the occurrence and correlates of sexual dysfunction in individuals suffering from alcohol dependence.
UNASSIGNED: Seventy male subjects hospitalized in a tertiary care hospital for treatment of alcohol dependence syndrome with simple withdrawal symptoms were included in the study with their informed consent. Their sexual function was evaluated utilizing a 14-item changes in sexual functioning questionnaire.
UNASSIGNED: According to the findings of the current study, sexual dysfunction is quite prevalent in alcohol-dependent people (75.7%). Erectile dysfunction was the most common disorder, followed by diminished sexual desire and early ejaculation.
UNASSIGNED: Alcohol-dependence patients have a high prevalence of sexual dysfunctions. In routine clinical practice, this may be overlooked. Clinicians must be made aware of the frequent occurrence of sexual disorders in alcohol dependence patients.

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.

UNASSIGNED: Erectile dysfunction (ED) is a common cause of sexual disorders in men with limited treatment options. This study aimed to determine the efficacy of low-intensity extra corporal shockwave therapy (LI-ESWT) in patients suffering from ED.
UNASSIGNED: A single-group, pre-test, and post-test pre-experimental study were conducted. Thirty-one ED patients were prospectively selected according to the eligibility criteria. In each session, 3000 shocks were applied at 5 points over the penis. Eight sessions were delivered in total with a 2-3-day interval. The patient\'s condition was assessed using the International Index of Electric Function (IIEF-5) questionnaire at baseline and one month after the last treatment session. Paired t-test was used to determine the difference between the pre-test and post-test.
UNASSIGNED: Mean age of the patients was 44.6 (± 14.70) ranging from 25 to 78 years. The majority of them were married (83.9%) and service providers (51.6%). We have also found 51.6% overweight, 9.7% obese, 48.4% diabetic, 45.2% hypertensive, 12.9% with enlarged prostate, 45.2% smoker, 25.8% alcoholic, and 71% with sleep disturbances. During the pre-test, 9.7% had severe ED and 51.6% had moderate ED. After the treatment, no patients were found with severe ED, and few of them had moderate ED (9.7%). The mean difference in IIEF-5 score during the pre-test and post-test was statistically significant (p= < 0.001).
UNASSIGNED: The study showed efficacy of LI-ESWT in a subset of patients with ED. Future studies with larger sample size, placebo group, and longer follow-up periods are recommended.

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.

BACKGROUND: A very small number of studies have indicated that azoospermia or negative testicular sperm extraction (TESE) outcomes are linked to depression or erectile dysfunction. However, the data are often weak, conflicting and gathered with non-validated questionnaires. Hence, we performed a cross-sectional study of 44 men with non-obstructive azoospermia. Levels of self-esteem and the quality of the couple\'s sex life and overall relationship were assessed with validated questionnaires before and after the TESE procedure as a function of the TESE outcome.
RESULTS: A positive TESE outcome (n = 24) was associated with a statistically significant increase in self-esteem (particularly with regard to family aspects), sexual health and couples\' adjustment quality. In contrast, a negative TESE outcome (n = 20) was associated with statistically significant decreases in self-esteem, erectile function, intercourse satisfaction, orgasmic function, couples\' adjustment quality and all aspects of the couple\'s relationship (consensus, cohesion, satisfaction and affection).
CONCLUSIONS: For men with non-obstructive azoospermia (NOA), negative TESE outcomes may have a negative impact on self-esteem and the quality of the couple\'s sex life and overall relationship. This should be borne in mind when counselling men with NOA and their partners to (ideally) help them to cope with and decrease the harmful impacts of azoospermia and negative TESE.
UNASSIGNED: INTRODUCTION: Quelques études concernant l’azoospermie ou les résultats négatifs de l’extraction de sperme testiculaire (TESE) montrent que ces résultats peuvent être liés à la dépression ou aux dysfonctions érectiles. Cependant, les données sont souvent faibles, contradictoires et recueillies à l’aide de questionnaires non validés. Nous avons donc réalisé une étude transversale auprès de 44 hommes atteints d’azoospermie non obstructive (ANO). Les niveaux d’estime de soi et la qualité de la vie sexuelle du couple et de la relation globale ont été évalués à l’aide de questionnaires validés avant et après la procédure TESE en fonction du résultat de la TESE. RéSULTATS: Un résultat positif de TESE (n = 24) a été associé à une augmentation statistiquement significative de l’estime de soi (en particulier en ce qui concerne les aspects familiaux), de la santé sexuelle et de la qualité de l’adaptation du couple. En revanche, un résultat négatif de TESE (n = 20) a été associé à une diminution statistiquement significative de l’estime de soi, de la fonction érectile, de la satisfaction des rapports sexuels, de la fonction orgasmique, de la qualité de l’adaptation du couple et de tous les aspects de la relation de couple (consensus, cohésion, satisfaction et affection).
CONCLUSIONS: Chez les hommes atteints d’ANO, une TESE négative peut avoir un impact négatif sur l’estime de soi et la qualité de la vie sexuelle et de la relation globale du couple. Il convient de garder cela à l’esprit lors du conseil aux hommes atteints d’ANO et à leurs partenaires afin de les aider (idéalement) à faire face aux impacts néfastes de l’azoospermie et de la TESE négative et à les réduire.

Introduction and Hypothesis Female urinary incontinence (UI) has a negative impact on sexual function and sexual quality of life (QoL) in women. But there is still no consensus on the type of UI or the prevalence of sexual dysfunction (SD). The aim of the study was to evaluate sexual disorders in women with overactive bladder (OAB) compared to patients with urinary stress incontinence (SUI) and healthy controls. Materials and Methods 106 women presenting to a urogynecological outpatient clinic (referral clinic) were investigated using standardized questionnaires and the Female Sexual Function Index (FSFI-d). All 65 incontinent women underwent a full urodynamic examination; the controls (31) were non-incontinent women in the same age range who came for routine check-ups or minor disorders not involving micturition or pelvic floor function. Women with mixed urinary incontinence, a history of previous medical or surgical treatment for UI, recurrent urinary tract infections, previous radiation therapy or pelvic organ prolapse of more than stage 2 on the Pelvic Organ Prolapse Quantification (POP-Q) system were excluded. Results 100 questionnaires could be evaluated (94.3%). Thirty-four women had urinary stress incontinence, 35 had OAB, 31 were controls. Mean age was 56 years, with no significant differences between groups. The scores of the questionnaire ranged from 2 to 35.1 points. The median score of OAB patients was significantly lower (17.6) than the median score of the controls (26.5; p = 0,004). The stress-incontinent women had a score of 21.95, which was lower than that of the controls but statistically non-significant (p = 0.051). In all subdomains, the OAB patients had lower scores than the stress-incontinent women and significantly lower values than the control group. Most striking was the impairment of \"sexual interest in the last 4 weeks\". The figure for \"none or almost no sexual activity\" was 80% for the OAB group, 64.7% for the group of stress-incontinent women and 48% for the control group. Incontinence during intercourse was reported by one OAB patient and 4 stress-incontinent women but did not occur in the control group. Conclusions There is a high prevalence of SD in women with urinary incontinence. Patients with OAB reported a greater negative impact on sexual function and had significantly lower scores for the FSFI questionnaire than patients with stress incontinence or controls.
Einleitung und Hypothese Die weibliche Harninkontinenz wirkt sich negativ auf die Sexualfunktion und die sexuelle Lebensqualität von betroffenen Frauen aus. Aber es herrscht immer noch kein Konsens über die Auswirkungen der Art der Harninkontinenz auf die Prävalenz von sexuellen Funktionsstörungen. Ziel dieser Studie war es, sexuelle Funktionsstörungen bei Frauen mit überaktiver Blase zu evaluieren im Vergleich zu Patientinnen mit Stressharninkontinenz sowie einer gesunden Kontrollgruppe. Material und Methoden 106 Frauen, die an eine urogynäkologische Ambulanz überwiesen wurden, wurden mithilfe standardisierter Fragebögen und der deutschsprachigen Fassung des Female Sexual Function Index (FSFI-d) untersucht. Bei allen 65 inkontinenten Frauen wurde eine vollständige urodynamische Untersuchung durchgeführt, die Kontrollgruppe (31) bestand aus nicht inkontinenten Frauen desselben Alters, die sich wegen einer Routineuntersuchung oder kleineren Beschwerden, die nicht im Zusammenhang mit Harnentleerung oder Beckenbodenfunktion standen, vorstellig wurden. Frauen mit gemischter Harninkontinenz, medizinischen oder chirurgischen Inkontinenzbehandlungen in der Anamnese, wiederholten Harntraktinfekten, einer früheren Radiotherapie oder einem Beckenorganvorfall von mehr als Stadium II (bewertet mit dem [POP-Q] Beckenorgan-Prolaps-Quantifizierungssystem) wurden nicht in die Studie aufgenommen. Ergebnisse Es konnten insgesamt 100 Fragebogen evaluiert werden (94,3%). 34 Frauen litten an Belastungsharninkontinenz, 35 hatte eine überaktive Blase/Dranginkontinenz, 31 Frauen dienten als Kontrollgruppe. Das mittlere Alter betrug 56 Jahre, und es gab keine signifikanten Unterschiede zwischen den Gruppen. Die erzielte Punktzahl für den Fragenbogen reichte von 2 bis 35,1 Punkten. Die Durchschnittswerte der Patientinnen mit überaktiver Blase waren signifikant niedriger (17,6) als die durchschnittliche Punktzahl der Kontrollgruppe (26,5; p = 0,004). Die Punktzahl der Gruppe mit Belastungsharninkontinenz betrug 21,95, was auffällig war im Vergleich zur Kontrollgruppe. Trotzdem war dieser Unterschied nicht statistisch signifikant (p = 0,051). Patientinnen mit überaktiver Blase wiesen in allen Teilbereichen geringere Werte als Frauen mit Belastungsharninkontinenz und signifikant niedrigere Werte als die Kontrollgruppe auf. Am auffälligsten war die Beeinträchtigung von „sexuellem Interesse in den vergangenen 4 Wochen“: 80% der Patientinnen kreuzten „keine oder fast keine sexuelle Aktivitäten“ an, bei Frauen mit Belastungsharninkontinenz waren es 64,7% und bei der Kontrollgruppe 48%. Eine Patientin mit überaktiver Blase und 4 der Frauen mit Belastungsharninkontinenz, aber keine der Frauen in der Kontrollgruppe vermeldeten Inkontinenz während des Geschlechtsverkehrs. Schlussfolgerungen Obwohl es eine hohe Prävalenz an sexuellen Funktionsstörungen bei Frauen mit Harninkontinenz gab, wiesen Patientinnen mit überaktiver Blase eine stärkere negative Auswirkung auf die Sexualfunktion auf und hatten signifikant niedrigere Werte beim FSFI-Fragenbogen als Frauen mit Belastungsharninkontinenz oder Frauen aus der Kontrollgruppe.

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: Hypoactive Sexual Desire Disorder (HSDD) is a common sexual problem of women which has negative impacts on their health and quality of life. Given the side effects of pharmacologic interventions, it would be beneficial to patients trying to find new options based on herbal medicine.
OBJECTIVE: To evaluate efficacy of carrot seed on sexual dysfunction of women with HSDD compared with placebo.
METHODS: In this randomized double-blind clinical trial, 68 participants randomly assigned to the intervention group which took 500 mg carrot seed three times a day for 12 weeks versus placebo. Participants in two groups filled Female Sexual Function Index (FSFI) questionnaire at baseline, week six and 12. Repeated measure analysis of variance (ANOVA) test was used for statistical analysis.
RESULTS: Thirty women in carrot seed group and thirty women in placebo group completed 12 weeks of the study. In general, carrot seed compared to placebo improved the total score of FSFI 7.329 ± 0.830 (p < 0.001), desire 4.1±0.7 (p < 0.001), lubrication 4.7±0.4 (p = 0.019), arousal 4.1±0.08 (p < 0.001), satisfaction 4.8±1.1 (p < 0.001), orgasm 3.9±0.9 (p < 0.001) and pain 5.4±1(p < 0.001). No adverse event was reported in this study.
CONCLUSIONS: Women with HSDD may benefit from six weeks\' treatment with carrot seed for improvement of sexual dysfunction. Further large clinical studies are warranted to confirm efficacy of this herbal drug.

Postorgasmic illness syndrome (POIS) is a rare syndrome of unknown etiology where patients experience distressing physical and psychological after ejaculatory sequelae.
To better characterize the epidemiology, symptomatology, disease course, and treatment of POIS, with specific interest placed on examining relationships between disease presentation and measures of disease burden.
A 30-item questionnaire was distributed to an online community of patients with POIS from June 2019 to January 2020. We assessed diagnostic criteria and clusters of symptomatology described in prior studies. Outcome measures include self-reported measures of symptom severity, disease burden, and behavioral changes. Statistical correlations were assessed with Pearson\'s chi-squared (χ2) and ordinal regression analyses.
The main outcome measures of this study are self-reported measures of symptom severity, disease burden, and behavioral changes.
The sample consisted of 302 men (mean age: 32.6 ± 11.4 years, mean age of onset: 19.1 ± 7.8 years) with 89% satisfying ≥3 diagnostic criteria. Common symptoms were difficulty concentrating (254, 84%), extreme fatigue (250, 83%), irritability (225, 74%), and muscle weakness (212, 70%). Common symptom clusters were general (219, 72%), muscle (137, 45%), and head (93, 31%). Common behavioral modifications were avoiding masturbation (215, 71%), schedule changes (213, 71%), and abstinence (186, 62%). Head and throat symptom clusters demonstrated worse disease burden outcomes. Professional medical advice was sought by 51% of participants. Attempted treatments included pharmacotherapy, vitamins, supplements, and herbs with variable efficacy.
This study further characterizes POIS, including how patients respond to the condition, how it is treated in the community, and presentations that may be associated with more severe disease.
This is the largest study to date that concerns patients suffering from POIS and includes a diverse, global population. Limitations include that the survey was only administered in English and within 1 online community, that results were self-reported, and that the response rate was low (32%).
Characterizing symptom cluster, but not number of diagnostic criteria, may offer prognostic value, and investigation to elucidate pathophysiology and potential treatments for POIS is necessary. Natale C, Gabrielson A, Tue Nguyen HM, et al. Analysis of the Symptomatology, Disease Course, and Treatment of Postorgasmic Illness Syndrome in a Large Sample. J Sex Med 2020;17:2229-2235.