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Genetic Vitamin D Deficiency Associated with Low Testosterone

Jun 12, 2019

Genetic Vitamin D Deficiency Associated with Low TestosteroneMen with genetic vitamin D deficiency could be at greater risk for low testosterone, according to a recent study in the Journal of Clinical Endocrinology & Metabolism.

The finding is based on a study of 4,254 Chinese men whose genetic information was available through an additional study.

Vitamin D is essential for skeletal health, as it absorbs calcium, one of the primary components of bones. Vitamin D also helps nerves, muscles, and the immune system work properly.

Testosterone is predominantly a male hormone, although women’s bodies produce it in smaller amounts. It’s responsible for most masculine traits, like facial hair, a deeper voice, and increased muscle mass. It also fuels a man’s libido and helps with erections.

Men with low testosterone often feel tired, moody, and less interested in sex. (Learn more about low testosterone here.)

Past research has linked vitamin D deficiency has been linked to low testosterone, although it’s unclear why. In January 2018, a study in the International Journal of Endocrinology suggested that taking vitamin D supplements might improve sexual health.

What makes the current study from China different is that the study subjects had genetic vitamin D deficiency. “Whether vitamin D supplementation can raise androgen [e.g., testosterone] levels merits further investigation in long-term randomized control trials,” the authors wrote.

They explained that their study included only Asian men. Men from other backgrounds might not have the same results.

Men who are concerned about their vitamin D levels, testosterone levels, or sexual health are encouraged to see their healthcare provider.

Check out these links for more information:

Low Testosterone Could Be Linked to Vitamin D Deficiency

Vitamin D and Erectile Dysfunction


International Society for Sexual Medicine

“Vitamin D Important for Men’s Sexual Health, Study Finds”

(April 2, 2018)

The Journal of Clinical Endocrinology & Metabolism

Chen, Chi, et al.

“Causal link between vitamin D and total testosterone in men: A mendelian randomization analysis”

(Abstract. Published: March 21, 2019)

Mayo Clinic

“Vitamin D”

(October 18, 2017)

Medline Plus

“Vitamin D”

(Page last updated: May 9, 2019)

Medscape Medical News

Harrison, Pam

“Low Vitamin D Tied to Testosterone Dip in Healthy Men”

(May 27, 2015)

Renal and Urology News

Akirov, Amit, MD

“Genetically Determined Low Vitamin D Concentrations Associated With Low Testosterone Levels”

(April 24, 2019)


Not Having Sex? You’re Far From Alone

Jun 05, 2019

Not Having Sex? You’re Far From AloneTwenty-three percent of Americans had no sex at all in the past year, according to a recent Washington Postreport.

This percentage is the highest in 30 years, a 4% increase from 1989, thePost said.

The data comes from the General Social Survey (GSS), a project conducted by the National Opinion Research Center at the University of Chicago.

Younger people in particular seem to be having less sex. In 18- to 29-year-olds, the percentage of people not having sex rose from 14% in 1989 to 23% in 2018.

The change was most dramatic for men aged 18 to 30. In 1989, roughly 15% of men reported having no sex during the previous year. In 2018, the rate was 28%. (The 2018 rate for women in that age group was 18%.)

What’s behind “the Great American Sex Drought”? It’s hard to say, exactly, but the Post offered some explanations:

  • People are aging. While many people enjoy sex well into their golden years, others struggle with sexual dysfunction and health conditions that can make sex difficult, like diabetes, heart disease, and arthritis. Also, older people don’t always have partners.
  • Younger people aren’t always pairing off. Many people spend their twenties working on their careers and don’t marry or commit to long term relationships until they’re older.
  • Technology gets in the way. Emails, texts, videos, games, and other forms of electronic networking and entertainment can be distracting, taking couples’ minds off of sex and intimacy. (This 2014 blog post explains these trends more.)

The recent survey results aren’t the first time scientists have found reduced sexual frequency. In 2017, a study in the Archives of Sexual Behavior reported on GSS survey results from 2010 to 2014. During that time, Americans had sex nine fewer times annually than they did from 1995 to 1999. In addition, millennials (born between 1981 and 1996) and Generation Z (born between 1997 and 2012) had less sex than people the same age did during the 1930s.


Pew Research Center

Dimock, Michael

“Defining generations: Where Millennials end and Generation Z begins”

(January 17, 2019)


“Americans Are Having Less Sex Nowadays”

(April 25, 2017)

Holohan, Meghan

“America is in a 'sex drought' and here's why it matters”

(April 12, 2019)

Washington Post

Ingraham, Christopher

“The share of Americans not having sex has reached a record high”

(March 29, 2019)


Peyronie’s Disease: RestoreX Traction Device Investigated With Injection Therapy

May 28, 2019

Researchers wanted to know how men would fare using a combination of CCH therapy and RestoreX traction. They designed a study involving 113 men with Peyronie’s disease who were divided into three treatment groups:

  • Group 1 (52 men) received CCH injections alone.
  • Group 2 (45 men) received CCH injections and used a traction device other than the RestoreX device.
  • Group 3 (16 men) received CCH injections and used the RestoreX device.

The men ranged in age from 49 to 65. The researchers measured penile curvature and length before the study began and periodically throughout.

Overall, Group 3 (CCH injections and RestoreX) saw the greatest improvements in their Peyronie’s symptoms. Their average curvature improvement was 33.8 degrees, compared to 20.3 degrees for Group 1 (CCH alone) and 19.2 degrees for Group 2 (CCH plus another traction device). They also had greater gains in length, with an average of +1.9 centimeters compared the -0.7 centimeters for Group 1 and -0.4 centimeters for Group 2.

Group 3 used their devices for shorter daily periods as well. Their average use was 0.9 hours a day, while the other groups’ average was 1.9 hours.

“Group 3 was 6.9 times more likely to achieve ≥20° curvature improvement, and 3.5 times more likely to achieve ≥50% curvature improvement, and 10.7 times more likely to experience ≥20% length improvement,” the authors wrote.

“These findings represent the greatest overall curvature improvement achieved using any adjunctive therapy with CCH reported to date,” they added. However, they called for further research to validate their results.

The study was published online in April 2019 as an article in press.


The Journal of Sexual Medicine

Alom, Manaf, MBBS, et al.

“Efficacy of Combined Collagenase Clostridium histolyticum and RestoreX Penile Traction Therapy in Men with Peyronie’s Disease”

(Full-text article in press. Published online: April 4, 2019)

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After ADT, Testosterone Levels Don’t Always Recover

May 21, 2019

Researchers investigated this issue in a recent Journal of Sexual Medicine study. They collected data from 307 men who underwent ADT. The men’s average age was 65 years, and they had spent an average of 17 months on ADT.

The research team took note of the men’s testosterone levels at baseline (before they started ADT) and 24 months after the men finished ADT.

Total testosterone is measured in nanograms per deciliter (ng/dL). For this study, a measurement above 300 ng/dL was considered normal. Castrate level was defined as a measurement less than 50 ng/dL.

The men’s average baseline testosterone was 379 ng/dL. Twenty-four months after ADT finished, 8% of the men were still at castrate level. For 76% of the men, testosterone levels had returned to normal, and 51% of the men saw their levels return to baseline.

Recovery to normal levels was less likely for men who had baseline levels below 400 ng/dL and those who had ADT for over six months. Recovery occurred more slowly for men over age 65 and those who had been on ADT for longer durations.

The study authors recommended that doctors talk to their prostate cancer patients about testosterone levels before ADT begins, noting that “it is still difficult to estimate individualized chances of recovery.”


American Cancer Society

“Hormone Therapy for Prostate Cancer”

(Last revised: July 18, 2018)

The Journal of Sexual Medicine

Nascimento, Bruno MD, et al.

“Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy for Prostate Cancer”

(Full-text. Published online: May 9, 2019)

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Healthcare Providers Need to Consider Needs of Transgender Adolescents

May 14, 2019

Some children who show signs of gender dysphoria undergo hormone therapy to “put off” the effects of puberty (and the development of secondary sex characteristics, like breasts or facial hair). This gives them more time to decide whether they want to transition or not. However, the authors noted that this approach is not always appropriate.

“Some youth find that their dysphoria abates as puberty starts, making it important to allow initial pubertal changes to occur,” they wrote. “On the other hand, some youth may find their gender dysphoria increases with puberty, corroborating the need for further care.”

It’s also important for healthcare providers to consider the needs of nonbinary youth, the authors stated.Nonbinary is a term that describes a gender identity other than male or female. For some, nonbinary means that a person doesn’t identify as either gender. Or, it could mean that a person identifies as both male and female.

“[A]ccessing optimal individualized care may be difficult for certain populations, making it important that generalists are supported to increase their capacity to care for youth with gender dysphoria and to liaise with other professions to support families,” the authors said.


Canadian Medical Association Journal via Eurekalert

“Managing gender dysphoria in adolescents: A practical guide for family physicians”

(Press release. January 21, 2019)

Abrams, Mere, MSW, ASW

“What Does It Mean to Identify as Nonbinary?”

(October 20, 2017)

Medscape Medical News

MacReady, Norra

“PCPs Should Ask Adolescents Directly About Gender, Experts Say”

(January 23, 2019)

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Prostate Cancer Survivors and Partners Want Information on Sexual Recovery

May 07, 2019

  • Knowing about sexual side effects before treatment. Many participants said they hadn’t been counseled about the sexual impact of treatment.

“My doctor was great about a lot of information, but that particular piece [around sexual side effects] was not really addressed,” said one patient in a focus group.

  • Communication between partners. The need for better communication within a couple was a common concern, with partner involvement encouraged.

“My doctors were very good about looking at my wife and saying, you know “What are your questions, what are your concerns,” and so that was really helpful to us,” a patient remarked.

  • Acknowledging partners’ needs. Some female partners said they were as interested in sex, but reluctant to say so “for fear of being negatively judged.”
  • Need for support and counseling. Most couples felt that support groups and counseling could be beneficial.

“You feel comfortable when you know that there is somebody else going through the same thing that you are going through. I think that helps,” said one partner in a couples’ focus group.

  • Need to tailor support for same-sex couples. Gay participants stressed the importance of addressing their needs, which might be different from those of heterosexual men and couples. For example, couples who engage in anal sex may need to adjust their roles as the insertive or penetrated partner.

Most participants felt that web-based support would be a good idea for couples coping with sexual changes after prostate cancer treatment, although some said they would prefer separate content for patient and partners. The researchers are currently testing a web-based tool for this purpose.

The study was published online in March as an article in press in Sexual Medicine.


Sexual Medicine

Mehta, Akanksha, MD, MS, et al.

“What Patients and Partners Want in Interventions That Support Sexual Recovery After Prostate Cancer Treatment: An Exploratory Convergent Mixed Methods Study”

(Full-text. Published online: March 1, 2019)

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Study Analyzes Sexual Dysfunction in Female Adult Entertainers

May 01, 2019

Almost a quarter of female adult entertainers have some degree of sexual dysfunction, according to a recent anonymous survey.

This rate is lower than the estimated 43% sexual dysfunction rate for women in the United States, the researchers noted.

Adult entertainment is a broad industry that includes the making of pornographic films. Actors in such films may be expected to perform sex acts as part of their professional activities. Until this study, it was unclear to what extent female adult entertainers experienced sexual problems.

In collaboration with the Free Speech Coalition and the North American Trade Association of the Adult Industry, researchers sent anonymous online surveys to a group of female adult entertainers. They compiled the results from 96 respondents.

The women’s ages ranged from 20 to 66, with an average of 34 years. They all had biological vaginas. In other words, they had not undergone male-to-female gender affirming surgery. About 15% of the women had gone through menopause.

In general, the women said their personal sex lives were more satisfying than their professional sex lives.

The survey included an assessment tool called the Female Sexual Function Index (FSFI), which is commonly used in studies of women’s sexual problems. Women whose FSFI scores are 26.55 points or less are considered to be at risk for sexual dysfunction. Just under a quarter of the women fell into this category, reporting less personal sexual satisfaction, less frequent sex, and fewer satisfying sexual encounters than women without sexual dysfunction.

“This trend suggests that engaging in professional sex work is not strongly associated with FSD [female sexual dysfunction] in these women; biopsychosocial factors, which drive FSD in the general population, may be driving FSD in entertainers as well,” the authors wrote.

“Given the explosive growth of pornography production and use in the Internet age, there is an imperative to study the impact of pornography, not only on those who consume it but also on the growing population of men and women in front of the camera,” they added.

The study was published online in the Journal of Sexual Medicine in April 2019.


The Journal of Sexual Medicine

Dubin, Justin M. MD, et al.

“Evaluation of Indicators of Female Sexual Dysfunction in Adult Entertainers”

(Full-text. Published online: April 4, 2019)


Penile Sensitivity Ratio Could Standardize Assessment

Apr 25, 2019

For each man, the scientists used a vibrating handheld device to evaluate sensitivity in several areas: the left index finger, the glans (tip) of the penis, the shaft of the penis, and each thigh. Applying the device directly to the area, the researchers gradually increased the vibration until the man said he could feel the sensation. Vibrations were then decreased until the man no longer felt them.

The two values for each area were averaged for the final PSR reading. The researchers determined that the glans/finger was the best ratio to use. A higher PSR value was associated with less sensation.

They found that PSR values tended to be higher for older men and men with diabetes and lower for men with Peyronie’s disease. But they found no associations between PSR values and ejaculatory disorders.

The authors noted that while the information is helpful, more research is necessary.

“It was beyond the scope of our current study to define normal or ‘healthy’ PSR values. However, we did find that there was a significant difference between those with and those without reported diminished sensitivity,” they wrote.

They added that the biothesiometry is a “rapid, cost effective, non-invasive, painless” procedure that can be done in a doctor’s office.

The study was published online in February in the Journal of Sexual Medicine.


The Journal of Sexual Medicine

Wiggins, Adam, BS

“The Penile Sensitivity Ratio: A Novel Application of Biothesiometry to Assess Changes in Penile Sensitivity”

(Full-text. Published online: February 14, 2019)

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Prostate Cancer Survivors Need Sexual “Support”

Apr 14, 2019

Despite the high rate of sexual dysfunction, however, 56% of the men said they were not offered support to help them. Younger men were more likely to be offered support than older men.

In addition, 81% of the men who had had surgery were offered support, compared to just 35% of the men who underwent radiotherapy.

Sexual problems don’t always occur immediately.

“For some men, it can be months before any erection problems are experienced following their treatment, especially if they’re received radiotherapy,” explained Heather Blake of Prostate Cancer UK, one of the study’s funders, in an interview with the University of Leeds.

She added, “By this stage, follow up appointments may have reduced, with far fewer opportunities to raise any late side effect issues.”

Ms. Blake stressed the importance of communication between patients and doctors to address erectile dysfunction after prostate cancer treatment.

The study was published in January in The Lancet Oncology. The Movember Foundation also funded the research.


American Cancer Society

“Hormone Therapy for Prostate Cancer”

(Last revised: July 18, 2018)

The Lancet Oncology

Downing, Amy, PhD, et al.

“Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study”

(Abstract. Published: January 31, 2019)

Medscape Medical News

Harrison, Pam

“Good QOL, but Sexual Dysfunction Common After Prostate Cancer”

(February 5, 2019)

Prostate Cancer Foundation

“Erectile Dysfunction”

University of Leeds

“Inadequate support for sexual dysfunction in prostate cancer patients”

(February 2, 2019)

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FDA Approves Testosterone in Pill Form

Apr 10, 2019

FDA Approves Testosterone in Pill FormThe U.S. Food and Drug Administration (FDA) has approved an oral form of testosterone therapy for some men with hypogonadism (low testosterone).

Jatenzo is a capsule, offering men an alternative to testosterone preparations that are injected or applied directly to the skin.

The drug is approved only for men whose ability to produce testosterone is caused by medical conditions like Klinefelter syndrome and pituitary gland tumors. It is not approved for men who experience natural declines in testosterone as they age.

“It’s important to emphasize that this drug should not, like other testosterone treatments, be used to treat older men with ‘age-related hypogonadism,’” said Dr. Hylton V. Joffe of the FDA’s Center for Drug Evaluation and Research in a press release.

He added, “The benefits of testosterone therapy, including Jatenzo, have not been established for this use, and Jatenzo’s effects on raising blood pressure can increase the risks of heart attack, stroke, and cardiovascular death in this population.”

In a four-month clinical trial of 166 men, 87% of the men taking Jatenzo saw their testosterone levels reach a normal range, the FDA reported.

The most commonly reported side effects were headache, increased red blood cell count, higher prostate-specific antigen levels, decreased HDL (“good”) cholesterol, high blood pressure, and nausea.

In accordance with FDA rules, Jatenzo comes with a boxed warning on its label. Boxed warnings let consumers know about potentially life-threatening risks associated with a certain drug.

There are concerns that Jatenzo could cause dangerous spikes in blood pressure, increasing the risk for heart attack, stroke, and deaths related to heart disease. Before prescribing Jatenzo, doctors should make sure a patient’s blood pressure is under control, the FDA said. Blood pressure should also be checked regularly.

Please see these links to learn more about hypogonadism and testosterone replacement therapy:

Low Testosterone

What Should Men Know About Topical Testosterone?

Self-Injectable Testosterone Now Available

Testosterone Therapy Impedes Diabetes Progress, Study Finds


“FDA approves new oral testosterone capsule for treatment of men with certain forms of hypogonadism”

(New release. March 27, 2019)

“A Guide to Drug Safety Terms at FDA”

(November 2012)

Medscape Medical News

Brooks, Megan

“FDA OKs Jatenzo Oral Testosterone Replacement for Certain Forms of Hypogonadism”

(March 27, 2019)


Sex Health Drugs are Expensive. What Can Consumers Do?

Apr 02, 2019

Sex Health Drugs are Expensive. What Can Consumers Do? Are prescription drug prices too high in the United States?

If you said yes, you’re in good company. In a recent survey by the Henry J. Kaiser Family Foundation, 79% of respondents said they thought drug costs were “unreasonable.” Just 17% thought prices were “reasonable.”

The 1,440 respondents answered the survey questions by telephone over a ten-day period in February. Forty-two percent of the respondents were age 65 or older.

Almost a quarter of the people who took prescription drugs said they had difficulty paying for them.

Affording medications for sex health issues can be particularly troublesome. Many drugs are not covered by insurance plans or Medicare, so some consumers pay out of pocket or just don’t take the drug at all because of costs.

In December 2018 a Journal of Sexual Medicine study reported that, depending on the type of pharmacy dispensing the medication, a prescription for sildenafil [the active ingredient in the erectile dysfunction (ED) drug Viagra] could cost anywhere from $48 to $500. (See more details about the study, along with price ranges for other ED drugs, here.)

Addyi, a drug for women with hypoactive sexual desire disorder (HSDD) had a price cut last year, from $800 to $400 for a monthly prescription, according to Bloomberg. The price was further lowered to $99 for women without insurance coverage, but even that cost could be beyond the reach of the average consumer.

While generics usually cost less, they can still be quite expensive.

Why do prescriptions cost so much? Drug manufacturers set their own prices and raise them regularly, experts say, because rules in the United States allow it. High demand can drive up the prices. Patent rules and complex negotiations between drug manufacturers and insurers are also involved with pricing.

Lowering drug costs may seem daunting, there are steps consumers can take to get keep more money their wallet:

  • Ask your doctor if there are non-drug alternatives. For example, men with erectile dysfunction might see their erections improve by managing related health conditions, like diabetes and heart disease.
  • Ask about generics. These drugs are usually less expensive.
  • Ask your health insurance company whether certain drugs can be purchased with lower copays. You might also ask if you can save money by ordering prescriptions by mail or through a preferred pharmacy.
  • Contact the drug manufacturer and ask about special programs for consumers who cannot afford their medication. Some companies offer coupons and discounts. (Your pharmacist might have this information, too.)
  • Check with your state government to see if there are any pharmaceutical assistance programs available to you.


“5 Ways to Lower Drug Costs”

(April 21, 2017)

“How to Pay Less for Drugs”

(April 21, 2017)

“Why Our Drugs Cost So Much”

(May 1, 2017)

Koons, Cynthia

“Drugmaker Revives Female Libido Pill at Half the Price”

(June 11, 2018)

Blumberg, Yoni

“Here’s why many prescription drugs in the US cost so much—and it’s not innovation or improvement”

(January 14, 2019)

Health Affairs

Hernandez, Immaculada, et al.

“The Contribution Of New Product Entry Versus Existing Product Inflation In The Rising Costs Of Drugs”

(January 2019)

The Journal of Sexual Medicine

Mishra, Kirtishri, MD, et al.

“Variability in Prices for Erectile Dysfunction Medications—Are All Pharmacies the Same?”

(Full-text. December 2018)

Kaiser Health News

Andrews, Michelle

“The High Cost Of Sex: Insurers Often Don’t Pay For Drugs To Treat Problems”

(February 19, 2019)

Kirzinger, Ashley, et al.

“KFF Health Tracking Poll – February 2019: Prescription Drugs”

(March 1, 2019)

“Poll: Nearly 1 in 4 Americans Taking Prescription Drugs Say It’s Difficult to Afford Their Medicines, including Larger Shares Among Those with Health Issues, with Low Incomes and Nearing Medicare Age”

(Press release. March 1, 2019)

“Does Medicare Cover Erectile Dysfunction Treatments?”

(October 8, 2018)

“For Erectile Dysfunction Drugs, It Pays to Shop Around”


Testosterone Therapy Impedes Diabetes Progress, Study Finds

Mar 26, 2019

At the eight-year point, glucose regulation had returned to normal for 90% of the treatment group. In contrast, 40% of the untreated group had developed type 2 diabetes.

The men who received testosterone saw improvements with their fasting glucose, cholesterol, and triglyceride levels, but levels worsened for the men in the untreated group.

The men in the testosterone group also had improved scores on the Aging Males’ Symptoms (AMS) scale (an assessment tool used to measure health-related quality of life in aging men) compared to the men who did not undergo testosterone therapy.

Mortality rates and incidence of nonfatal heart attacks were higher for the men in the untreated group.

"Long-term [testosterone therapy] completely prevents prediabetes progression to [type 2 diabetes] in men with hypogonadism and improves glycemia, lipids, and AMS score,” the study authors concluded.

They added, “[Testosterone therapy] holds tremendous potential for the large and growing population of men with prediabetes and hypogonadism.”


Centers for Disease Control and Prevention

“Prediabetes: Your Chance to Prevent Type 2 Diabetes”

(Page last reviewed: June 21, 2018)

Diabetes Care

Yassin, Aksam, et al.

“Testosterone Therapy in Men With Hypogonadism Prevents Progression From Prediabetes to Type 2 Diabetes: Eight-Year Data From a Registry Study”

(Abstract. March 2019)

HealthDay News via

“Testosterone Therapy in Hypogonadism Can Prevent Progression to T2DM”

(March 15, 2019)


Tucker, Miriam (Curator)

“Testosterone therapy halts progression to T2D in men with hypogonadism”

(March 13, 2019)

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Peyronie’s Disease: Treatment Priorities May Guide Intralesional Injection Choice

Mar 20, 2019

Currently, four substances are used for intralesional injections: collagenase Clostridium histolyticum (CCH), hyaluronic acid, verapamil, and interferon α-2b. However, the effectiveness of these substances had not been compared using standardized assessment methods.

In the review paper, experts analyzed eight studies involving 1,050 men who had received intralesional injections for Peyronie’s disease. On average, the men’s ages ranged from 52 to 58 years. The research team focused on two outcomes – changes in penile curvature and erectile function – that took place between each study’s beginning and conclusion.

CCH and interferon α-2b appeared to be most effective for reducing penile curvature. But hyaluronic acid seemed to be best for erection problems. While the researchers did not specifically analyze side effects of each medication, they noted that a “low number” were reported.

Because of the ways the studies were designed, the researchers were unable to compare other treatment outcomes, such as pain, plaque size, and satisfaction with treatment. They recommended more clinical trials in this area.

“Urologists should discuss medical therapy with patients before surgical correction, as well as the target of improvement they expect to obtain,” the study authors wrote.

Note: Guidelines provided by the American Urological Association do not support the use of hyaluronic acid or verapamil for treatment of Peyronie’s disease. In addition, use of CCH and interferon α-2b is moderately recommended based on limited evidence.


The Journal of Sexual Medicine

Russo, Giorgio Ivan, MD, PhD, et al.

“Comparative Effectiveness of Intralesional Therapy for Peyronie’s Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis”

(Full-text. Published online: January 25, 2019)

Urology Care Foundation

“What is Peyronie’s Disease?”

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Sexual Problems Can Persist Two Years After Colorectal Cancer Diagnosis

Mar 12, 2019

Through questionnaires and phone interviews, the participants shared information about their sexual health, cancer treatment, any ostomy procedures, and fecal incontinence. They also described any discussions about sexual health that they’d had with their oncology team.

Overall, 54% of the participants said they felt less sexual desire. Sixty-one percent had intercourse less frequently, and 48% had fewer orgasms. About 60% reported having intercourse within the previous two weeks. Problems with desire and orgasm were more common for rectal cancer patients. People who were still experiencing fecal incontinence at the two-year follow up point tended to have more sexual issues.

Most of the respondents (89%) said they were satisfied with how often they hugged and kissed their partner, and 77% were satisfied with their intercourse frequency.

Sexual health discussions with providers were not common, however. Only 20% of men and 11% of women had had such a discussion. About a third of rectal cancer patients had had this conversation, compared to 11% of colon cancer patients.

“These results highlight the need for specific and effective sexual rehabilitation interventions, especially for patients with fecal incontinence and rectal cancer,” the authors wrote.

They also recommended “improved information delivery” from healthcare providers to colorectal cancer patients regarding sexuality.


American Cancer Society

“Treating Colorectal Cancer”

“What Is Colorectal Cancer?”

(Last revised: February 21, 2018)

The Journal of Sexual Medicine

Almont, Thierry, MSc, PhD, et al.

“Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study”

(Full-text. January 2019)


“Colon and rectal cancer”

(Reviewed: January 19, 2018)

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Supplements, Heart Disease, and Erectile Dysfunction

Mar 04, 2019

First, ED is often an early sign of heart disease. For example, men with coronary artery disease (a type of heart disease) have atherosclerosis – hardening of the arteries – which narrows blood vessels and makes it harder for blood travel around the body. Arteries in the penis are small and among the first to be affected by atherosclerosis. And since an erection depends on good blood flow to the penis, erectile dysfunction (ED) can result.

Second, as with heart disease, many people buy supplements and products that claim to improve sexual function. But such claims are not always backed by scientific evidence. In addition, supplements are not always approved by regulatory agencies like the U.S. Food and Drug Administration (FDA). Some contain undeclared ingredients that can cause dangerous interactions with other drugs.

Most likely, better sex can be achieved without the use of supplements. Treating underlying conditions like diabetes and heart disease, fostering better communication with partners, getting regular exercise, and eating healthy foods can all contribute to better sexual health. A doctor can provide the best guidance on one’s personal situation.

To learn more about sexual health supplements, please see the following links:

What’s Really in Your Dietary Supplement?

FDA Issues Supplement Warnings

ED and Sexual Enhancement Products

The Dangers of Over-the-Counter Male Enhancement


American College of Cardiology

“Most Vitamin, Mineral Supplements Not Shown to Lower Heart Disease Risk”

(Press release. May 29, 2018)

International Society for Sexual Medicine

“What is the link between erectile dysfunction (ED) and coronary artery disease?”


Kantor, Elizabeth D., PhD, et al.

“Trends in Dietary Supplement Use Among US Adults From 1999-2012”

(October 11, 2016)


Labos, Christopher, MD CM, MSc, FRCPC

“Supplements and CVD: Why Negative Data Don't Dampen Sales”

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Treating Peyronie’s Disease with Penile Stretching

Feb 24, 2019

The study authors looked at research on traction therapy alone and in conjunction with other Peyronie’s treatments, like injections and surgery.

“[Penile traction therapy] has been successful in primary penile lengthening and curvature correction in the acute phase of [Peyronie’s disease],” they concluded. It might also help preserve penile length in men who undergo surgery. More research is needed on traction therapy combined with injections, however.

Traction devices are easy to find and use, the authors noted. But they may not be appropriate for all patients, and it is still not clear how long the devices should be used for best results. More study is recommended before traction therapy can be considered a “standard of care,” the researchers explained.

Less is known about VEDs to treat Peyronie’s disease. Studies of the approach after radical prostatectomy (surgical removal of the prostate gland) and before penile implant procedures suggest that VEDs may be effective, but further research is necessary.

“More basic and clinical research is required to clarify the role of penile stretching in [Peyronie’s disease], but with existing trials and research ongoing, the potential is encouraging,” the authors wrote.

The study was published online in Sexual Medicine Reviews in January 2019 as an article in press.


Sex Health Matters

“Peyronie’s Treatments – Traction Therapy and VEDs”

(July 10, 2014)

“Traction Therapy for Peyronie’s Disease”

Sexual Medicine Reviews

Cowper, Matthew G., BS, et al.

“Penile Stretching as a Treatment for Peyronie’s Disease: A Review”

(Full-text article in press. Published online: January 4, 2019)

Urology Care Foundation

“What is Peyronie’s Disease?”

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Prostate Cancer is a “Couples Disease,” Scientists Say

Feb 18, 2019

  • Sexuality. Many partners felt that the man’s survival was more important than his sexual functioning. Often, patients felt frustrated by sexual limitations, but partners still felt love and intimacy regardless.

We’ve come to an arrangement now with our sex life that we’re quite happy to have a cuddle and you know we get on well; we’re good mates and that’s what counts.

  • Knowledge. Some partners said they were unsure of what to expect from the man’s diagnosis and treatment and felt “in the dark.” The information they did receive tended to be “generalized and scaled down.”

I was pretty upset…I asked the doctor what is this gonna do to his sex life…and he never really addressed it.

I definitely think…some-where in those early stages… [if someone] suggested…seeing someone or seeing a counsellor, it would have made a big difference for me…for both of us.

  • Isolation. The possible loss of their significant other was a source of great stress for partners. And the time partners spent caregiving left little time and for themselves.

I got very sad to see him like that, but I tried to be strong and say, “I think that the last thing he wants is to see that someone feels defeated, right? I put my pains aside…I had to shower him. I had to change him. I had to help him in all that I could, right?

I was extremely afraid of hurting [patient], and I was afraid of hurting myself as well. I was so focused on him that, in a way, I forgot myself. In retrospect, I have cried very little (tearful).

  • Togetherness. In time, some partners felt closer to their significant others after the cancer diagnosis. Communication and acceptance played key roles in this togetherness.

We have said many times that we have been blessed. We have a wonderful family. We have gone together and been married for over fifty years. We just feel very blessed that the Lord has given us these wonderful kids and grandkids. He (her husband) has said many times, “If I die tomorrow, I will have lived a wonderful life.” And that is really how I feel, too.

“Findings from this review may serve to increase the shared decision-making process between the patient, his partner, and the healthcare provider,” the authors concluded.


Urologic Nursing via Medscape

Hammond, Andrew and Kristen Montgomery

“Systematic Review and Thematic Synthesis of Quality of Life in Partners of Patients With Prostate Cancer”

(Full-text. July-August 2018)

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Clomiphene Citrate Might Preserve Fertility in Men with Low Testosterone

Feb 12, 2019

In contrast, clomiphene citrate works by increasing luteinizing hormone and follicle-stimulating hormone amounts in the testes, stimulating testosterone and sperm production.

The Sexual Medicine Reviews study, published online in December 2018, examined medical literature related to clomiphene citrate, testosterone, and fertility in men.

The researchers found that the clomiphene citrate generally relieved low testosterone symptoms and improved erectile function and bone density. There was less known about effects on fertility rates, although a meta-analysis of the few existing studies revealed “significant improvement.”

There was also little data on the side effects of clomiphene citrate. Headache, dizziness, and gynecomastia (breast enlargement) have been reported.

“Despite these reports, [clomiphene citrate] is generally considered to be safe and well tolerated,” the authors wrote.

They added that clomiphene citrate “should remain in the armament of urologists treating hypogonadal men.” (Note: Hypogonadism is the medical term for low testosterone.)


International Society for Sexual Medicine

“Can testosterone replacement therapy (TRT) make a man infertile?”

“How is low testosterone treated?”

Sexual Medicine Reviews

Wheeler, Karen M., MD, PHD, et al.

“Clomiphene Citrate for the Treatment of Hypogonadism”

(Full-text. Published online: December 3, 2018)

You and Your Hormones (Society for Endocrinology)

“Follicle stimulating hormone”

(Last reviewed: February 2018)

“Luteinising hormone”

(Last reviewed: February 2018)

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How Does Testicle Removal Affect a Man’s Sex Life?

Feb 05, 2019

The study involved 2,479 testicular cancer survivors in Denmark. Ninety-three had had both testicles removed, and 126 had received contralateral (affecting the opposite testicle) radiotherapy for germ cell neoplasia in situ (TC + GCNIS). The remaining 2,260 men had been treated for unilateral testicular cancer and served as a comparison group. Overall, a median of 17 years had elapsed since the men’s cancer diagnosis.

The men completed questionnaires that assessed their erectile function, anxiety and depression symptoms, and fatigue.

Ninety-five percent of the men in the bilateral group received testosterone replacement therapy, compared to 5% of the unilateral group and 51% of the TC + GCNIS group.

About a quarter of the men in the bilateral group had erectile dysfunction. Rates were lower in the unilateral (18%) and TC + GCNIS (17%) groups. Anxiety rates were 32%, 20%, and 26%, respectively. Scores on the fatigue assessment were similar for the three groups.

“Our findings suggest that [bilateral testicular cancer] survivors in the present cohort were sufficiently treated with [testosterone substitution] to avoid [sexual dysfunction],” the authors wrote.

They added, “The findings are reassuring and provide a basis for a positive message in relation to future sexual life in counseling young men who undergo treatment for [bilateral testicular cancer].”

They also recommended further research on anxiety risk in this population.

The study was published online in November 2018 in European Urology Focus.


American Cancer Society

“What Is Testicular Cancer?”

(Last revised: May 17, 2018)

American Society of Clinical Oncology

“Testicular Cancer: Treatment Options”

(Approved: November 2017)

European Urology Focus

Bandak, Mikkel, et al.

“Sexual Function and Quality of Life in a National Cohort of Survivors of Bilateral Testicular Cancer”

(Full-text article in press. Published online: November 24, 2018)

International Society for Sexual Medicine

“How might removal of one or both testicles affect a man’s sex life?”

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Peyronie’s Disease Surgery: Can Penile Length be Preserved?

Jan 29, 2019

So how does surgery affect penile length? A team of scientists reviewed a number of medical studies to find out about the latest developments. They published their findings in the journal Sexual Medicine Reviews.

Here are some of the highlights:

  • Plication procedures. These approaches straighten the penis by suturing the side of the penis without plaques. There is usually a minimal amount of shortening; men with severe curvature might have greater length loss.
  • Plaque incision or partial excision and grafting. For this technique, the surgeon makes an incision directly in the plaque(s) and straightens the penis. Then, the surgeon covers the area with graft material. This approach can restore length, but some men have erectile dysfunction afterward.
  • Penile implantation with size restoration. In implant procedures, paired cylinders are placed in the chambers of the penis that fill with blood during erections. These can be manually inflated for an erection. The previously described techniques above can be used at the same time to lengthen the penis to its pre-Peyronie’s length (plaque incision with graft or other techniques), but there could be complications.

Men should understand the pros and cons of their surgery options and discuss their concerns with their surgical team.

The study authors recommended that the more complex procedures be conducted by experienced surgeons only.

To learn more about Peyronie’s disease, please see these links:

Peyronie’s Disease (overview of causes, diagnosis, and treatment)

What is the Curve? The Emotional Impact of Peyronie’s Disease

Peyronie’s Disease – Talking to a Healthcare Provider


Mayo Clinic

“Peyronie’s disease – Diagnosis and treatment”

(August 7, 2017)

Sexual Medicine Reviews

Barrett-Harlow, Brittani, MD, et al.

“New Developments in Surgical Treatment for Penile Size Preservation in Peyronie’s Disease”

(Full-text. Published online: October 6, 2018)

Urology Care Foundation

“What is Peyronie’s Disease?”

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Hormone Kisspeptin Linked to Sexual Arousal

Jan 22, 2019

Twenty-nine healthy men participated in the study, visiting a clinic twice. At the first visit, the men received kisspeptin intravenously. When they returned, they received a placebo infusion. In this way, the scientists could compare the results with and without the hormone. The men did not know whether they were getting the hormone or the placebo.

During both visits, each man went into an MRI scanner and watched a series of images. Some images were sexual (e.g., pornography), some were negative (e.g., a car crash) and some were neutral (e.g., a cup). The researchers observed the men’s brain activity during each image series.

The men also completed assessment questionnaires related to sexual health.

The scientists discovered that kisspeptin increased activity in brain areas linked to sexual arousal. They also found that the men experienced less sex aversion during this time. Negative mood was decreased.

“Our findings suggest kisspeptin can actually influence entire networks of the brain…and this is linked to subsequent sexual and emotional function,” said lead author Dr. Alexander Comninos in a press release.

“Taken together, these findings provide the scientific basis to investigate kisspeptin-based treatments in patients with psychosexual and mood disorders, which are both huge health issues, and frequently occur together,” he added.

The study was published in October 2018 in JCI Insight.



Kritz, Fran

“New Study Investigates Hormone That Could Improve Mood and Sexual Desire”

(October 19, 2018)

Hormone Health Network

“What is Kisspeptin?”

Imperial College London

Wighton, Kate

“Hormone alters male brain networks to enhance sexual and emotional function”

(October 18, 2018)

JCI Insight

Comninos, Alexander N., et al.

“Modulations of human resting brain connectivity by kisspeptin enhance sexual and emotional functions”

(Full-text. First published: October 18, 2018)

Society for Endocrinology


(Last reviewed: February 2018)

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Want to Increase Your Penis Size? There Could Be Complications

Jan 15, 2019

The men’s average age was 47 years. They had undergone penile enlargement procedures elsewhere but went to the researchers’ clinic for help afterward.

Some of the men had injected fillers (such as silicone, saline, fat, or animal tissue) into their penis, either on their own or with a doctor’s advice. Others had silicone implants.

Swelling, infection, gangrene, abscesses, penile shortening, and erectile dysfunction (ED) were some of the more commonly reported complications.

Ten of the patients had corrective surgery, during which surgeons removed the filler materials. This approach did help both appearance and function, but even after correction, the men’s penises were not restored to their original condition before the men had the enlargement procedures.

Often, men who seek penile enlargement procedures don’t realize that their penis is within the normal size range, the authors said. They recommended counseling before any procedure.

They added that they did not have information on the satisfaction rates of penile enlargement procedures, as their goal was to describe possible complications.

In addition to complications, penile enlargement surgery has been linked to one death.

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Vapers Beware: E-Liquids Could Contain Erectile Dysfunction Drugs

Jan 08, 2019

Men who take nitrates to treat health conditions like high blood pressure, high cholesterol, or heart disease should not take PDE5 inhibitors. The interaction of these drugs can cause a dangerous drop in blood pressure.

Consumers are typically unaware that the HelloCig e-liquids contain these drugs because product packaging does not list them with the ingredients.

HelloCig’s marketing materials may also be misleading. The FDA reported that the E-Cialis HelloCig E-liquid is advertised with the image of a Cialis bottle and pills. Consumers may think that using the e-liquid could help men with ED, but this is not true.

In October, the FDA contacted HelloCig and requested that the company recall the products. As of mid-December, HelloCig had not responded.

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Stigma, Body Image Concerns May Affect Sexuality in People With Focal Dystonia

Dec 31, 2018

Overall, 45% of the patients with cervical dystonia met the criteria for sexual dysfunction. In the blepharospasm group, the rate was 39%. Only 24% of the control group had sexual dysfunction. Depressed participants tended to have poorer function, but length and severity of disease did not seem to affect sexuality.

Among the cervical dystonia group, almost a quarter said their sex lives were worse because of the dystonia.

The authors explained that focal dystonia patients “often suffer from stigmatization, embarrassment, and social phobia. Self-perceived stigma can be a major source of disability and might deteriorate factors such as self-confidence and body image, crucial for sexual well-being.”

They added that other factors influence sexual function as well, including relationships with partners. However, they did not know to what extent such factors affected the study findings.

They recommended more research on mood disorders and how to address them in dystonia patients.

The study was published in October 2018 in the journal Neuropsychiatric Disease and Treatment.


Mayo Clinic


(August 10, 2018)

Neuropsychiatric Disease and Treatment

Marek, M., et al.

“Sexual dysfunction in cervical dystonia and blepharospasm”

(Full-text. Published: October 26, 2018)

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Study Examines Sexuality in People with Dementia

Dec 24, 2018

In the dementia group, 46% of the men and 18% of the women were considered sexually active, defined as having had sex with a partner at least once during the previous year. Among participants with partners, 59% of the men and 51% of the women were sexually active. In an age 80 to 91 subgroup, over 40% of the men and women with dementia were having sex.

About a third of the men and 10% of the women with dementia had a sexual problem, but only 17% of the men and 1% of the women spoke to a doctor about it.

Low interest in sex, erection problems, poor vaginal lubrication, and orgasm difficulties were some of the most common sexual dysfunctions noted among all participants. Sexual activity became less frequent as cognitive abilities declined.

About 10% of the whole group said they felt frightened or threatened by their partner, and the authors called for greater recognition and assessment of elder abuse.

Knowing more about sexuality in older adults, especially those with dementia, is important for healthcare providers and caregivers, the authors noted.

“In the next 30 years, more than 80 million people in the U.S. will be 65 or older. A growing number of people with dementia live at home, cared for by a spouse who, like doctors and society more generally, don’t have the knowledge they need to manage the sexual aspects of life with a person with dementia,” lead author Dr. Stacy Tessler-Lindau said in a University of Chicago Medicine report.


Journal of the American Geriatrics Society

Lindau, Stacy Tessler, MD, MAPP, et al.

“Sexuality and Cognitive Status: A U.S. Nationally Representative Study of Home‐Dwelling Older Adults”

(Full-text. First published: September 12, 2018)

Science Daily

“The link between cognitive function and sexuality in older adults”

(Press release from the American Geriatrics Society. September 12, 2018)

University of Chicago Medicine – At The Forefront

Carlton, Kat

“New study first to report sexual behavior norms among U.S. adults with dementia living at home”

(September 13, 2018)

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Breast Cancer Treatment Could Preserve Ovarian Function

Dec 18, 2018

Two hundred eighteen women were divided into two treatment groups. One group (113 women) had standard chemotherapy. The other group (105 women) received goserelin injection in addition to chemotherapy.

After analyzing five years of follow-up data, the researchers determined that 23% of the women in the goserelin + chemotherapy group had become pregnant. Only 12% of the women who received chemotherapy alone had done so.

In addition, the women in the goserelin + chemotherapy group had better five-year survival rates. At that point, 88% of those women were alive and disease-free. In the standard chemotherapy group, the rate was 79%.

“Goserelin protects the ovaries from the effects of chemotherapy, reducing the risk for early menopause,” said lead researcher Dr. Halle Moore in a press release. “By getting these injections, more women became pregnant without negatively affecting their health or their chances of surviving their cancer.”

“Our final results show a means to improve quality of life for young women with hormone-receptor negative breast cancer. If they want to be mothers, they can improve their chances safely and effectively,” she added.

The findings were published in October in the Journal of the National Cancer Institute.


American Cancer Society

“Breast Cancer Hormone Receptor Status”

(Last revised: September 25, 2017)

Journal of the National Cancer Institute

Moore, Halle C.F., MD, et al.

“Final Analysis of the Prevention of Early Menopause Study (POEMS)/SWOG Intergroup S0230”

(Abstract. October 27, 2018)

SWOG Cancer Research Network

“Hormone Injections Reduce Early Menopause”

(October 27, 2018)

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What’s Really in Your Dietary Supplement?

Dec 11, 2018

The agency does maintain a Tainted Supplements database – a record of “potentially hazardous products with hidden ingredients” that are marketed as dietary supplements.

It’s important to know that the FDA cannot test every dietary supplement on the market, and there might be products in the tainted category that are not included in the database. Consumers should always use caution and consult with their doctor before using them.

In a recent study published in JAMA Network Open, experts analyzed ten years of data (2007 – 2016) from the Tainted Supplements database. They identified 776 adulterated dietary supplements, which contained ingredients that were not FDA-approved. Most of the time, these ingredients were not listed on the label.

Almost 46% of these products were marketed for sexual enhancement. Of these, over 80% contained sildenafil and/or a structural analogue of it (a very similar compound.) Sildenafil is the active ingredient in the erectile dysfunction (ED) drug Viagra.

Some products contained other ED medications. Tadalafil (the active ingredient in Cialis) was found in 20% of the sexual enhancement products. Vardenafil (Levitra) was present in 1%.

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Man Develops Red-Tinted Vision After Sildenafil Overdose

Dec 04, 2018

After the red tint continued for two days, the man went to an urgent care clinic for treatment. Eventually, doctors diagnosed him with persistent retinal toxicity.

Using adaptive optics (AO) and optimal coherence tomography (OCT) tests, experts at the New York Eye and Ear Infirmary of Mount Sinai Medical Center determined that there was damage specifically in the cones of the man’s retinas, which process color vision.

Despite treatment, the man’s vision had not improved a year later.

In a press statement, lead researcher Richard Rosen, MD, Director of Retina Services at New York Eye and Ear Infirmary of Mount Sinai warned against using more medication than necessary.

"People live by the philosophy that if a little bit is good, a lot is better. This study shows how dangerous a large dose of a commonly used medication can be," he said.



“Irreversible damage to color vision linked to popular erectile dysfunction drug”

(Press release. October 1, 2018)

European Pharmaceutical Review

Farooq, Iqra

“Sildenafil could be linked to irreversible colour vision damage”

(October 2, 2018)

Mayo Clinic

“Pulmonary hypertension”

(December 28, 2017)

Medscape Medical News

Kelly, Janis C.

“High Dose of Sildenafil Tied to Long-term Retinal Damage in Case Report”

(October 2, 2018)

Retinal Cases & Brief Reports

Yanoga, Fatoumata, MD, et al.

“Sildenafil Citrate Induced Retinal Toxicity—Electroretinogram, Optical Coherence Tomography, and Adaptive Optics Findings”

(Abstract. October 2018)


“What are cones in our eyes?”

(Reviewed: September 18, 2017)

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FDA Approves HPV Vaccine For Adults

Nov 26, 2018

People who have already been exposed to some HPV types covered by the vaccine will not be protected from those types. However, the vaccine will still protect them from the types they have not been exposed to.

In other words, if a person has already been exposed to two covered HPV types at the time of vaccination, he or she will still be protected from the remaining seven types.

FDA approval of Gardasil 9 in older adults is based on a study of about 3,200 women aged 27 through 45. Researchers monitored the women’s health for an average of three and a half years after vaccination. Over that time, Gardasil 9 was 88% effective in preventing persistent HPV infections, genital warts, and cervical cancer related to the 9 HPV types covered. The vaccine was also effective against precancerous lesions on the vulva, on the cervix, and in the vagina.

Approval for men was inferred from this study of women, as well as other studies of men.

“[This] approval represents an important opportunity to help prevent HPV-related diseases and cancers in a broader age range,” said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research.

“The Centers for Disease Control and Prevention has stated that HPV vaccination prior to becoming infected with the HPV types covered by the vaccine has the potential to prevent more than 90 percent of these cancers, or 31,200 cases every year, from ever developing,” he added.


Centers for Disease Control and Prevention

“What is HPV?”

(Page last reviewed: December 13, 2016)

Live Science

Nemo, Leslie

“The HPV Vaccine Was Just Approved for Adults Up to Age 45. Should They Get It?”

(October 9, 2018)

Medpage Today

Ingram, Ian

“FDA OKs HPV Vaccine for Adults Up to Age 45”

(October 7, 2018)

The New York Times

Grady, Denise and Jan Hoffman

“HPV Vaccine Expanded for People Ages 27 to 45”

(October 5, 2018)

U.S. Food and Drug Administration

“FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old”

(News release. October 5, 2018)

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Could Erectile Dysfunction Be Genetic?

Nov 19, 2018

The researchers discovered that 26% of the men had a genetic variation in the SIM1 region and determined that these men were at higher risk for ED.

Next, the research team looked at the genetic information for a group 222,358 ED patients through UK Biobank, an international resource. The results in this group were similar to those of the first group.

The genetic variations might influence the way the SIM1 gene works, leading to sexual dysfunction, the study authors explained.

In a press statement, lead author, Eric Jorgenson, PhD called the findings “an exciting discovery” that might lead to further research on “genetic-based therapies.”


Kaiser Permanente

“First Genetic Risk Factor for Erectile Dysfunction Identified”

(Press release. October 8, 2018)

Proceedings of the National Academy of Sciences of the United States of America

Jorgenson, Eric, et al.

“Genetic variation in the SIM1 locus is associated with erectile dysfunction”

(Full-text. Published online: October 8, 2018)

U.S. National Library of Medicine – Genetics Home Reference

“SIM1 gene”

(November 7, 2018)

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One in Three Male Childhood Cancer Survivors Has Erectile Dysfunction, Study Finds

Nov 13, 2018

The study participants had all been treated for childhood cancer at the St. Jude Children’s Research Hospital in Memphis, Tennessee. Their average age was 31 years, and they had been diagnosed with cancer at least 10 years before the study began.

The men completed questionnaires to assess their sexual function, psychological distress, body image dissatisfaction, and health-related quality of life.

Men with ED were more likely to have low testosterone, low lean muscle mass, and poor body image.

Fortunately, many of these risk factors can be modified. Some men can undergo testosterone replacement therapy if their hormone production slows down. Exercise might strengthen men with low mean muscle mass. Men with body image concerns may benefit from counseling or sex therapy.

More research is needed to validate the findings, the authors said. But in the meantime, healthcare providers are encouraged to consider men’s sex lives after childhood cancer.

“The fact that ED is being reported by 29% of our sample, essentially that's 3 out of 10 men. This strongly suggests that assessment of sexual functioning be included as part of the clinical interview," co-author James L. Klosky, PHD, ABPP told Medscape Medical News.


Homer, Cassie

“Childhood cancer survivors may be at increased risk for erectile dysfunction”

(October 4, 2018)

JAMA Oncology

van Iersel, Laura, MD, et al.

“Erectile Dysfunction in Male Survivors of Childhood Cancer”

(Full text. October 4, 2018)

Medscape Medical News

Lowry, Fran

“Erectile Dysfunction Common in Childhood Cancer Survivors”

(October 15, 2018)

“Male Childhood Cancer Survivors May Face Sexual Problems, Infertility as Adults”

(March 20, 2018)

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Electrical Nerve Stimulation Might Help Women with Sexual Problems

Nov 07, 2018

They first tested the procedure on female rats. They discovered that when stimulated, more blood flowed to the rats’ genitals.

Next, the researchers recruited nine women with sexual dysfunction for a pilot study. None of the women had bladder conditions.

The women attended 12 stimulation sessions spaced an average of 13 days apart. Each session lasted for a half hour. Six of the women received stimulation on their genitals, and three on their ankle.

Before the study, and again at 6-, 12-, and 18-week follow-up points, the women completed questionnaires to assess their sexual function and overall health.

By the end of the treatment period, eight of the nine women reported sexual improvements, especially in arousal, lubrication, and orgasm.

While the results are encouraging, it’s too early to call neuromodulation a viable treatment for female sexual dysfunction. Additional research using a placebo group is planned.

“This study presents an alternative method for treating female sexual dysfunction that is nonpharmacologic and noninvasive,” said Dr. Priyanka Gupta, one of the investigators, in a University of Michigan report.

“Through studies like this, we can further understand female sexual arousal and offer treatments for a disorder that has very few options,” Dr. Gupta added.

The study was published online in September in the journal Neuromodulation.


Medical News Today

Cohut, Maria

“Sexual function: Electrode stimulation helps women orgasm”

(September 7, 2018)


Zimmerman, Lauren L., MS, et al.

“Transcutaneous Electrical Nerve Stimulation to Improve Female Sexual Dysfunction Symptoms: A Pilot Study”

(Full-text. First published: September 3, 2018)

University of Michigan Health Lab

Malcom, Kelly

“Simple Nerve Stimulation May Improve Sexual Response in Women”

(September 6, 2018)

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Counseling Cancer Survivors With Vaginal Pain

Nov 03, 2018

Vaginal Elasticity

The vagina is a flexible organ, designed to accommodate a penis. But it can lose some of this flexibility after cancer treatment, especially after pelvic floor radiation. Also, some women avoid sex because of pain, resulting in further lost elasticity.

Women may regain some of the flexibility by using dilators – penis-shaped cylinders of various sizes – that stretch the vagina and help women grow accustomed to penetration again. Vaginal stimulation, administered manually or through a vibrator, may also help.

Vaginal Atrophy

In addition to vaginal dryness, other changes to the vagina can occur when estrogen levels decrease. Tissues may become thin and brittle, and the labia might become smaller. Moisturizers and lubricants may help in this case, too.


Healthcare providers and patients don’t always talk about sexual issues. However, nurses can start the conversation using the the PLISSIT model, the authors said.

The acronym PLISSIT is explained as follows:

P – Permission to discuss sexual pain with the patient is requested.

LI – Limited Information is sought.

SS – Specific Suggestions are made.

IT – Intensive Treatment (such as a referral to therapy) is offered.

“Nurses are in an ideal position to address female cancer survivors’ sexual health concerns related to painful vaginal penetration,” the authors wrote. Targeting sexual pain specifically, with an approach like the PLISSIT model, might help nurses “organize their thinking” and offer suitable therapies.


Contemporary OB/GYN

Monson, Nancy

“New counseling model can help minimize vaginal pain in cancer survivors”

(September 11, 2018)


Chism, Lisa Astalos DNP, APRN-BC, NCMP, FAANP and Morris A. Magnan, PhD, MSN, RN

“Talking to cancer survivors about dyspareunia and self-management”

(Full-text. October 2017)

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Fewer Biological Boys Referred to Gender Identity Clinic

Oct 23, 2018

The study discussed the sex ratios of children referred to the Gender Identity Development Services (GIDS), a gender identity clinic in London, United Kingdom. Researchers wanted to know whether more birth-assigned boys or birth-assigned girls were referred to the GIDS and how old they were when referred.

They identified 1,215 children under the age of 12 who had been referred to the GIDS between 2000 and 2017. During that time, 56% of the referred children were biological boys and 44% were biological girls. The children’s average ages at referral were as 9 and 10, respectively.

The researchers questioned whether the numbers of referred biological boys and biological girls changed over the years. So they compared two time periods: 2000-2006 and 2007-2017.

During the first period, 72% of the children were biological boys, but during the second period, the figure decreased to 55%.

The researchers weren’t sure why such a shift occurred. One possible reason, they said, is that there might be “less stigma for birth-assigned girls who are behaviorally masculine compared to birth-assigned boys who are behaviorally feminine, which makes it easier to “come out” as transgender and to seek out mental health care and biomedical treatment.”

The timing of puberty might also be involved, they explained. Since biological girls tend to go through puberty earlier than biological boys, they might become more aware of gender identity before boys do.

For more information about gender dysphoria in children and adolescents, please see the following links:

Gender Dysphoria in Children

Transgender Adolescents and Body Changes

Transgender Youth Need Support

Transgender and Gender Non-Conforming Youth Report Poorer Health

Self-Injury Common Among Transgender Youth


The Journal of Sexual Medicine

de Graaf, Nastasja M. MSc, et al.

“Evidence for a Change in the Sex Ratio of Children Referred for Gender Dysphoria: Data From the Gender Identity Development Service in London (2000–2017)”
(Full-text. Published: September 5, 2018)

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Study: Antidepressant Lurasidone Has Fewer Sexual Side Effects

Oct 16, 2018

For the trial, 109 people took 20 to 60 mg of lurasidone every day. The remaining 100 people took a placebo containing no medication. At the start of the study, the participants completed questionnaires to assess their depression symptoms and sexual function. Six weeks later, they filled out the questionnaires again, so the researchers could follow their progress.

Overall, the people in the treatment group had better sexual function at the end of the study period compared to those in the placebo group. Roughly 2% of the lurasidone group saw their sexual function go from normal to abnormal ranges. In the placebo group, the rate was just over 4%. Also, the amount of medication taken did not appear to affect sexual function.

None of the patients taking lurasidone reported any treatment-emergent adverse events that affected sexuality. In other words, none of them had sexual problems related to the medication.

The authors recommended further research to see whether trials of lurasidone in people with other types of mental health disorders might have similar results.

The findings were published in the September/October 2018 edition of the Journal of Clinical Psychiatry.


The Journal of Clinical Psychiatry

Clayton, Anita H., MD, et al.

“Effect of Lurasidone on Sexual Function in Major Depressive Disorder Patients With Subthreshold Hypomanic Symptoms (Mixed Features): Results From a Placebo-Controlled Trial”

(Full-text. September/October 2018)



(Last revised: April 15, 2018)


Bressert, Steve, Ph.D.

“Hypomanic Episode Symptoms”

(Last updated: February 23, 2018)

Psychiatry Advisor

Pond, Emily

“Lurasidone Effective for Treatment of Depression, Not Associated With Sexual Dysfunction”

(August 30, 2018)

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For Women, Placebo Effect Might Explain Improvement in Sexual Function

Oct 08, 2018

The analysis

Overall, 2,236 study participants received treatment for a sexual problem, and 1,723 received a placebo. In all the studies, the women completed the Female Sexual Function Index (FSFI), a questionnaire designed to assess female sexual dysfunction. Higher scores on the FSFI correspond with better sexual functioning.

The women who received treatment saw their scores increase 5.35 points, which showed improvement. But the women in the placebo groups also had some improvement, with a score increase of 3.62 points.

After examining the data further, the study authors determined that for about two-thirds of the women, results might be explained by a placebo effect.

“Our findings suggest that the current treatments for female sexual dysfunction are, overall, minimally superior to placebo, which emphasizes the ongoing need for more efficacious treatment for female sexual dysfunction,” the authors wrote.


Contemporary OB/GYN

Nierengarten, Mary Beth

“What’s wrong with therapies for female sexual dysfunction?”

(August 9, 2018)

Obstetrics and Gynecology

Weinberger, James M. BS, et al.

“Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis”

(Abstract. August 2018)


“What is the Placebo Effect?”

(Reviewed: February 28, 2018)

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Conversations About Sexuality and Fertility Should Start Early, Experts Say

Oct 03, 2018

The authors recommended that healthcare providers consider three questions.

  • Will the condition or treatment affect sexuality or fertility?
  • Are there ways to preserve sexual function or fertility?
  • What information can be shared?

At first, many families wonder if their child should be told at all, however, research shows that disclosure is important.

The authors also recommended the following:

  • Make time for these conversations so that patients and families can fully absorb information and ask questions.
  • Acknowledge that it’s stressful not knowing what the future holds.
  • Look for “stressors and strengths” – factors that could hinder or help the conversations.
  • Remember the family’s culture, use their native language, and consider what they know (or don’t know) about health and healthcare.
  • Connect patients and families with other people who have had similar experiences.
  • Make sure the discussions are appropriate for the child’s age and stage of development.

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Fistulas Cause Sexual and Emotional Stress in Malawi

Sep 25, 2018

In addition to physical and sexual problems, fistulas can have psychological repercussions as well. In countries like Malawi, sex is important for “marital, social, and economic stability” the study authors explained. Women who cannot have sex may face relationship conflict and even shunning by their community. Some men are unwilling to wait 6 months and are unfaithful.

For the study, 119 women with obstetric vesicovaginal fistulas took part in interviews and underwent pelvic exams before their surgery. The women’s ages ranged from 19 to 53; their average age was 32. About 70% were married.

Thirty-eight percent of the women said they had started having sexual problems after the fistula developed. Some said their partner’s penis could not enter the vagina, others leaked urine or had pain. Over a third were no longer having intercourse. Those who were saw their frequency drop after the fistula developed.

Relationships were also strained. Thirty-seven percent of the women were forced to have intercourse while they had a fistula. For 18%, sexual problems or perceived infertility prompted their partner to take a “co-wife.” Almost half the participants believed that their partners were having sex with other women, and many worried about contracting HIV because of these extramarital relationships.

One hundred fifteen women came back for a follow-up assessment 6 to 12 months after surgery. About a third had tried having intercourse again, and most said sex had returned to what it was like before the fistula.

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FDA: Energy-Based Devices Not Recommended for “Vaginal Rejuvenation”

Sep 18, 2018

“To date, we have not cleared or approved for marketing any energy-based devices to treat these symptoms and conditions, or any symptoms related to menopause, urinary incontinence, or sexual function,” the FDA explained in a July 30, 2018 statement.

“The safety and effectiveness of energy-based devices for treatment of these conditions has not been established,” the FDA added.

However, some manufacturers have been marketing the devices for vaginal rejuvenation. For example, companies may target women who have symptoms of early menopause after breast cancer treatment.

“We are deeply concerned women are being harmed,” said FDA Commissioner Scott Gottlieb, MD in a press announcement.

The FDA contacted seven manufacturers - Alma Lasers, BTL Industries, Cynosure, InMode, Sciton, Thermigen and Venus Concept – about their marketing practices. “All firms are committed to making the required changes,” said FDA Press Officer Deborah Kotz in an email. “We are reviewing the responses and will pursue further actions, if needed.”

Women who experience side effects after undergoing vaginal rejuvenation procedures with energy-based devices are encouraged to notify the FDA.

For more information on genital cosmetic surgery, please see this link:

Genital Cosmetic Surgery for Women


American College of Obstetricians and Gynecologists

“Vaginal ‘Rejuvenation’ and Cosmetic Vaginal Procedures”

(Reaffirmed: 2017)

“FDA Warns Against Use of Energy-Based Devices to Perform Vaginal 'Rejuvenation' or Vaginal Cosmetic Procedures: FDA Safety Communication”

(July 30, 2018)

“Statement from FDA Commissioner Scott Gottlieb, M.D., on efforts to safeguard women’s health from deceptive health claims and significant risks related to devices marketed for use in medical procedures for ‘vaginal rejuvenation’”

(Press announcement. Updated: August 2, 2018)

Medscape Medical News

Brooks, Megan

“FDA Warning About Laser Devices for 'Vaginal Rejuvenation'”

(July 31, 2018)

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Stem Cell Therapy for Men’s Sex Health Needs More Research

Sep 11, 2018

Still, there is more work to be done. The study authors explained that research on SVF for the treatment of men’s sexual problems is “limited” and that “a substantial number” of studies will need to be completed before clinical trials or practice on humans can be considered.

They suggested several areas for future researchers to consider:

  • If SVF is deemed viable, at what point should a doctor suggest it?
  • Can SVF treat severe ED?
  • Can SVF help men who develop ED after prostate cancer surgery?
  • How much will SVF cost?
  • How long does it take to complete SVF treatment?
  • Should any other treatments be done at the same time as SVF?
  • What else can we learn about how SVF works?

“Quality basic science, translational work, and clinical trials will facilitate appropriate standardization of SVF treatment and accelerate approval by regulatory agencies,” the authors concluded.

Note: Experts caution that stem cell therapy is an experimental approach at this time. See the following link for the official statement by the Sexual Medicine Society of North America on stem cell and other experimental therapies here:     


International Society for Stem Cell Research

“Stem Cell Basics”


Stöppler, Melissa Conrad, MD

“Stem Cells”

(Reviewed: September 8, 2016)

Sexual Medicine Reviews

Haney, Nora M., BS, et al.

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

(Full-text. Published online: June 27, 2018)

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Prostate Treatments May Have Sexual Side Effects, But Patients Not Always Aware

Sep 05, 2018

For the study, researchers surveyed 245 healthcare providers who were attending the 2015 World Congress of Endourology in London. Eighty-one percent of the respondents were urologists, specialists that typically treat an enlarged prostate.

The doctors were asked about the treatments they typically prescribed, how often they discussed ED and ejaculatory disorders as side effects, and the alternative treatments they might suggest if patients were concerned about sexual dysfunction.

The three most commonly-used treatments were alpha-blockers (another type of medication), 5-ARIs, and a surgical procedure called transurethral resection of the prostate (TURP).

The survey revealed that many providers don’t discuss sexual side effects with their patients. For instance, only 70% of the doctors said they explained ejaculatory disorders associated with alpha-blockers. About 60% of doctors prescribing 5-ARI therapy covered possible ejaculatory problems. For doctors recommending TURP, the rate was 80%.

In addition, many doctors didn’t discuss alternative treatments if their patients had sexual concerns.

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Ospemifene Leads to Healthier Genitals, Less Pain for Postmenopausal Women

Aug 28, 2018

In the current study, researchers assessed genital changes, along with pain and sexual function, in a group of eight women who took ospemifene for 20 weeks. All the women were postmenopausal, and their average age was 59 years. They reported moderate to severe sexual pain.

Each woman underwent a physical exam. To assess visual changes in the genitals, the researchers used a device called a vulvoscope, which allows users to view magnified images of the vulva on a computer screen. It also takes pictures. The researchers also tested for pain by pressing a cotton swab against different areas of the vulva.

Finally, the women used diaries to record information on their sexual function, including vaginal dryness, use of lubricants, and any pain during foreplay, masturbation, oral sex, and intercourse.

Assessments were made at the start of the study and at the end, after 20 weeks of ospemifene treatment.

From the photographs, the researchers determined that the women’s genitals appeared healthier after taking ospemifene. The women’s pain levels decreased after treatment, too.

After 20 weeks, the women reported having more sex, with less pain during foreplay and intercourse. They used lubricants less often.

The results were promising, but the authors explained that other factors, not just hormones, can be involved with painful intercourse. For example, pelvic floor dysfunction, partner conflict, and depression might play a role, too. Sometimes, sexual pain has more than one cause and may need other treatments, like pelvic floor physical therapy, counseling, or sex therapy.

The authors also acknowledged that their research was limited by a small study sample.


“Osphena Approved to Treat Painful Sex”

(April 9, 2013)

“Ospemifene May Ease Menopause Symptoms Beyond Painful Intercourse”

(November 18, 2014)

“Vulvar and Vaginal Atrophy”

(June 26, 2013)

Sexual Medicine

Goldstein, Sue W., BA, CCRC, CSE, IF, et al.

“Improvements to the Vulva, Vestibule, Urethral Meatus, and Vagina in Women Treated With Ospemifene for Moderate to Severe Dyspareunia: A Prospective Vulvoscopic Pilot Study”

(Full-text. Published online: April 17, 2018)

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Low Testosterone Linked to Chronic Diseases

Aug 21, 2018

For the whole group, about 41% of the men had multimorbidities, with the most common combination being high blood pressure and arthritis. Comorbidity rates increased as men got older. Almost a third of the entire group had low testosterone, defined as levels below 300 ng/dL. 

Multimorbidities were more common in men with low testosterone; however, this finding was stronger for men in the youngest and oldest groups. About 36% of the younger men with testosterone deficiency had multimorbidities compared to just 14% of younger men with normal testosterone levels. In the oldest group, the rates were 75% for men with low levels and 62% for men with normal levels.

The authors stressed the importance of testosterone screening, especially in younger men who have chronic diseases.

They also explained some of the limitations of their research. For example, they were unable to determine whether low testosterone caused an increased risk for multimorbidities or, conversely, if having chronic diseases led to higher risk for low testosterone. Also, they did not know if other health factors, like diet and medications, influenced the results. More research in these areas are warranted, the authors said.


Medical News Today

Paddock, Catherine, PhD

“Why all men 'should be concerned about declining testosterone'”

(April 20, 2018)

Scientific Reports

Peterson, Mark D., et al.

“Testosterone Deficiency, Weakness, and Multimorbidity in Men”

(Full-text. Published: April 12, 2018)

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CPAP Use Linked to Better Sex in Patients with Obstructive Sleep Apnea

Aug 14, 2018

Overall, 182 people (115 men and 67 women) who had just been diagnosed with obstructive sleep apnea, completed a survey about their quality of life. Their average age was 47 years, and about 70% were married.

A year later, they answered the questions again, and the researchers analyzed their progress. Two survey items addressed sexual health.

Seventy-two participants were considered CPAP users, wearing their masks for at least four hours every night during the four weeks preceding the 12-month follow up. Non-users wore their mask for less than a half hour nightly during the same time period. (CPAP wearers whose usage fell between the half hour and four-hour benchmarks were not included in the study.)

For all the participants, sexual quality of life was poor as the study began. At the 12-month point, the CPAP users saw improvements, but the non-users had no significant changes. Also, women saw greater improvements than men did; the researchers noted that this finding might have been due to the study design.

Further research might address other types of OSA treatments and their effects on sexual function, the authors said.


JAMA Otolaryngology - Head & Neck Surgery

Jara, Sebastian M., MD, et al.

“Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep Apnea”

(Full-text. July 2018)

Mayo Clinic

“Obstructive sleep apnea”

(March 6, 2018)

“Video: How CPAP controls sleep apnea”

(July 8, 2016)

University of Washington School of Medicine

“CPAP for sleep apnea improves sex for women, but not men”

(News release. May 24, 2018)

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Penile Implants Preferred Over Other ED Therapies

Aug 08, 2018

Using an assessment tool called the Self Esteem and Relationship questionnaire, researchers surveyed 55 ED patients to learn more about their treatment satisfaction. On average, the men were in their 60s.

Eighty percent of the men used oral medications [sildenafil (Viagra) or tadalafil (Cialis)]. Another 4% used self-injection therapy, injecting medicine into their penis whenever they wanted to have an erection. The rest had penile implants.

Men with implants had “significantly better” scores on the questionnaire compared to men who used pills or self-injections. And all of the men in the implant group gave their confidence in their sexual performance the best rating. Only 16% of the men without implants rated their confidence that high.

“Prosthesis patients were also less likely to feel like a failure,” the study authors wrote.

The study findings might prompt urologists to offer implant surgery earlier in the treatment process, the authors said. However, more research is needed to determine which patients would benefit an earlier procedure.

The study findings were presented in May at the American Urological Association’s 113th Annual Meeting in San Francisco, California.


The Journal of Urology

Davuluri, Meenakshi, et al.

“PD18-06 Sexual Satisfaction of Men with Erectile Dysfunction Treated with Penile Prosthesis Versus Medical Treatment Modalities: Are We Waiting Too Long to Implant?”

(Abstract presented at 113th Annual Meeting of the American Urological Association in San Francisco, May 2018)

PR Newswire

“New studies show promise in understanding more about Erectile Dysfunction”

(Press release. May 19, 2018)

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Penile Implants Not Always Covered by Insurance

Jul 31, 2018

They examined insurance records for almost 4,600 cases provided by two manufacturers of inflatable penile prostheses (IPPs). (The data was de-identified to protect the privacy of the patients.) Overall, the men were covered by 374 insurers from January 2016 to September 2017.

About 83% of the men did have insurance coverage for ED. But in this group, 18% had IPP exclusions. This means that the insurance company would not cover IPP procedures, even if it would cover other ED treatments.

Overall, 15% of the men were subject to IPP exclusions.

The researchers also analyzed data from the top 5 health insurance companies in the U.S., which represent about 39% of the health insurance market share in the United States. For all cases, the IPP exclusion rate was 18%.

In addition, coverage from one insurance company could vary from state to state. For example, about 40% of the plans offered by Blue Cross Blue Shield (BCBS) of Texas covered ED treatment, and 56% of all BCBS plans had IPP exclusions. But in North Carolina, 95% of BCBS plans covered ED, and the IPP exclusion rate was just 2%.

“While it is difficult to determine the true coverage rate for ED treatment (and specifically for IPPs) for all men in the US, an appreciable number of men do not have insurance coverage for ED therapy and have exclusions for IPPs,” the authors wrote, adding that prostate cancer survivors in the United States “may be doomed to impotence [erectile dysfunction] based on the lack of federally protected men’s rights and are at the mercy of the insurers which dominate their marketplace.”


The Journal of Urology

Mazur, Donald J., et al.

“Doomed to Impotence: Analysis of Erectile Dysfunction (ED) and Inflatable Penile Prosthesis (IPP) Insurance Coverage from Verification Benefits Databases”

(Abstract. Presented at the 113th Annual Scientific Meeting of the American Urological Association in San Francisco, California on May 19, 2018)

PR Newswire

“New studies show promise in understanding more about Erectile Dysfunction”

(Press release. May 19, 2018)

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In Older Men, Erectile Dysfunction Could Increase Risk for Heart Problems

Jul 25, 2018

After excluding men who had problems with heart disease before the study, the researchers followed 1,757 (average age 69) men for about four years.

During that time, 115 cardiovascular events occurred among the group. These events included heart attacks, strokes, cardiac arrests, and sudden cardiac deaths.

Such events were more common in men with ED, affecting 6.3% of that group compared to 2.6% of the men without ED.

Even when the effects of potential risk factors like smoking and diabetes were removed from the analysis, cardiovascular risk for men with ED was still almost double that of men without ED.

The researchers recommended that men with ED be screened for heart disease and its risk factors.

In a news release, lead author Michael Blaha MD said, “Our results reveal that erectile dysfunction is, in and of itself, a potent predictor of cardiovascular risk. Our findings suggest that clinicians should perform further targeted screening in men with erectile dysfunction, regardless of other cardiac risk factors and should consider managing any other risk factors -- such as high blood pressure or cholesterol -- that much more aggressively.”

The study was published in Circulation, the journal of the American Heart Association, in June 2018.

To learn more about the link between ED and heart disease, please see these links:

ED and Heart Trouble

How Do Certain Diseases Lead to Erectile Dysfunction?


American College of Cardiology

Rubenfire, Melvyn, MD, FACC

“Erectile Dysfunction as Predictor of Future CVD Events”

(June 19, 2018)

American Heart Association

“Erectile dysfunction means increased risk for heart disease, regardless of other risk factors”

(June 11, 2018)


Iftekhar Uddin, S. M., et al.

“Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis”

(Abstract. Originally published: June 11, 2018)

Medscape Medical News

Edwards, Stephanie

“Erectile Dysfunction Linked to Future CVD Events”

(June 11, 2018)

Renal and Urology News

Persaud, Natasha

“Erectile Dysfunction Strongly Predicts Cardiovascular Events”

(June 11, 2018)

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Fewer Men Prescribed Testosterone After FDA Advisory

Jul 17, 2018

Men’s testosterone levels also decline – gradually – as they get older. This is the natural course of aging, but some men start to feel tired, moody, and less interested in sex. Doctors might write prescriptions for these men, too.

In March 2015, the FDA announced changes in testosterone product labeling, specifying that the safety of testosterone in men with age-related hypogonadism was not completely clear, and that doctors should prescribe therapy only to men with certain medical conditions. The FDA was also concerned about an increased risk for heart attack and stroke in some patients, although this determination was controversial.

How much did prescriptions decline after the FDA advisory? Researchers looked at data from men between the ages of 45 and 84 who were prescribed transdermal (applied through a patch on the skin) or injectable forms of testosterone from March 2013 to August 2016. The men were patients at eight hospitals in the Boston area.

In March 2015, roughly 700 transdermal and 200 injectable testosterone prescriptions were written. The numbers fell substantially by July 2016, when fewer than 200 prescriptions for each type were written.

During that time, the number of men seeking help for low testosterone didn’t change significantly. The number of clinical encounters (times that men saw their doctor for a testosterone-related concern) averaged between 300 and 500 per month between March 2015 and December 2016.

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FDA Approves Imvexxy for Treatment of Post-Menopausal Pain

Jul 10, 2018

"Studies have shown that many women are not seeking treatment for VVA and 81% are unaware that VVA is a treatable medical condition and part of a constellation of symptoms associated with loss of estrogens," said Dr. Sheryl Kingsberg, President of the North American Menopause Society, in the press release.

Imvexxy works by bringing a dose of estradiol, a type of estrogen, directly to the vagina. (Doses may be 4 micrograms or 10 micrograms.) According to TherapeuticsMD, women insert one capsule daily for the first two weeks of treatment, then continue doing so just once a week. The capsule dissolves in the vagina.

In trials of Imvexxy, some women saw improvements in sexual pain in about two weeks. The most common side effect was headache.

The FDA requires that Imvexxy labels carry a “black box” warning, which alerts consumers to serious risks, including endometrial cancer, cardiovascular disorders, breast cancer, and probable dementia.

TherapeuticsMD will be conducting a post-approval observational study as instructed by the FDA.


“A Guide to Drug Safety Terms at FDA”

(November 2012)

Medscape Medical News

Brown, Troy, RN

“FDA Approves Imvexxy for Moderate to Severe Dyspareunia”

(May 31, 2018)


Mathias, Tamara

“TherapeuticsMD's therapy for menopause-related condition gets approval”

(May 30, 2018)

“Vulvar and Vaginal Atrophy”

(June 26, 2013)


“TherapeuticsMD Announces FDA Approval of TX-004HR: IMVEXXY™ (estradiol vaginal inserts), the Lowest Dose Vaginal Estrogen Product Approved for the Treatment of Moderate to Severe Dyspareunia, a Symptom of VVA, due to Menopause”

(Press release. May 30, 2018)

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Sex Talks are Challenging for Parents of LGBTQ Teens

Jul 03, 2018

“My challenge around talking about sex is that I have no idea what sex is really like for men, especially gay men,” said one mother.

Another had her bisexual daughter talk to a lesbian friend.

Still another said, “I felt challenged that I’m straight, my daughter is dating a gal, and I didn’t know anything about that. All my sex talks were about how not to get pregnant and how babies are conceived.”

Support for parents is essential, the authors explained.

“We need resources to help all parents – regardless of their child’s sexual orientation or gender identity – overcome the awkwardness and discomfort that can result from conversations about sexual health,” said lead author Michael Newcomb of the ISGMH in a press release.

Adolescents can have concerns about the conversations, too.

Speaking on a related study of LGBTQ teens, ISGMH Research Assistant Professor Brian Feinstein said, “We found that many of the gay and bisexual male youth in our study wanted to be closer to their parents and to be able to talk about sex and dating. However, most of them said that they rarely, if ever, talked to their parents about sex and dating, especially after coming out. And, even if they did talk about sex and dating with their parents, the conversations were brief and focused exclusively on HIV and condom use.”


Northwestern University

Paul, Marla

“Parents struggle to discuss sex with LGBTQ teens”

(April 4, 2018)

Sexuality Research and Social Policy

Newcomb, Michael E., et al.

“‘I Have No Idea What’s Going On Out There:’ Parents’ Perspectives on Promoting Sexual Health in Lesbian, Gay, Bisexual, and Transgender Adolescents”

(Abstract. Published online: March 26, 2018)

Washington Post

Seaton, Jaimie

“Why straight parents struggle to talk to their LGBTQ kids about sex and how to make it easier”

(June 11, 2018)

« Previous 1 2 (page 2 of 2)


Cycling Has No Impact on Women’s Sexual or Urinary Health, Study Finds

Jun 24, 2018

The high-intensity cyclists had better scores on the sexual function assessment. Scores for low-intensity cyclists and non-cyclists were similar, and in general, the cyclists were more sexually active than the runners and swimmers. The types of bikes and terrain did not appear to influence the results.

Both high- and-low intensity cyclists were more likely to have had UTIs, genital numbness, and saddle sores compared to swimmers and runners, even after the researchers considered factors like age, body mass index, and smoking status.

Such genital symptoms can lead to sexual problems later and would not necessarily be reflected on the sexual function questionnaire, the authors pointed out.

They recommended that future research address the link between cycling and UTIs as well as strategies to prevent saddle sores.


The Journal of Sexual Medicine

Gaither, Thomas W. BS, et al.

“Cycling and Female Sexual and Urinary Function: Results From a Large, Multinational, Cross-Sectional Study”

(Full-text. Published online: March 13, 2018)

Sexual Medicine Society of North America

“Practice Safer Cycling to Protect Your Sexual Health”

(July 17, 2012)

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Survey Reveals the Emotional Impact of Prostate Cancer

Jun 19, 2018

Over a third of the men (38%) were in remission at the time of the survey, but for 14%, the cancer had come back at least once.

Follow-up is important for prostate cancer patients, and most the men underwent scans and follow-up tests at least twice a year. The anxiety associated with such testing – wondering whether the cancer would return – can further the emotional impact of the disease.

So can the changes in quality of life. Just over half the men said they had less energy, and 39% were bothered by treatment side effects. Men also expressed concerns that their condition would worsen (38%), that pain prevented them from doing things they enjoyed (34%), and feelings of sadness (33%).

When asked about daily experiences, almost a quarter of the men coped with erectile dysfunction (ED). Back and hip pain, fatigue, and urinary problems were other common effects.

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Lifestyle Changes Might Improve Sexual Health

Jun 10, 2018

For women, physical activity was linked to a lower risk of sexual dysfunction. Following a healthy diet rich in fruits and vegetables seemed to help as well. But the researchers did not find any links among cigarette smoking, alcohol use, and caffeine intake with female sexual health.

Men who smoked were more likely to have erectile dysfunction. Heavier smokers tended to have more severe cases of ED. There was also an association with physical activity. ED was more common in men who exercised less. Moderate alcohol consumption (an average of 8 drinks a week) was associated with lower ED risk, but high intake (an average of 23 drinks a week) was not. Following a healthy diet appeared to be good for erections.

Changing lifestyle habits can improve one’s overall health, which can bring about sexual benefits. For example, low testosterone and obesity can interfere with sexual function. But physical activity can boost testosterone levels and help people lose weight. Similarly, diabetes is associated with sexual problems like ED in men and poor lubrication in women. But physical activity might lessen the effects of diabetes and, in turn, the sexual impact.

The authors noted that the sexual health effects of diet, caffeine, and cannabis were not as widely studied as other lifestyle factors, so their conclusions were “less robust.”

They added that there were fewer studies related to women’s sexual health and premature ejaculation and recommended further study in these areas.


The Journal of Sexual Medicine

Allen, Mark S., PhD and Emma E. Walter, PhD

“Health-Related Lifestyle Factors and Sexual Dysfunction: A Meta-Analysis of Population-Based Research”

(Full-text. Published online: March 6, 2018)

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World’s First Penis and Scrotum Transplant Takes Place in the United States

Jun 04, 2018

Other patients are being considered for similar surgeries, but it takes time to find donated tissue that is a good match in terms of age, skin tone, and immune system. The recipient must take medication so that his body will not reject the donated tissue.

Genital injuries can be devastating for men.

“That injury, I felt like it banished me from a relationship,” the recipient told the New York Times. “Like, that’s it, you’re done, you’re by yourself for the rest of your life. I struggled with even viewing myself as a man for a long time.”

The donor’s family told a Johns Hopkins reporter, “We are all very proud that our loved one was able to help a young man that served his country.”


HUB (Johns Hopkins University)

Nilaweera, Archana

“Johns Hopkins surgeons perform world's first total penis and scrotum transplant”

(April 23, 2018)

Johns Hopkins Medicine

Nitkin, Karen

“First-Ever Penis and Scrotum Transplant Makes History at Johns Hopkins”

(April 23, 2018)

The New York Times

Grady, Denise

“‘Whole Again’: A Vet Maimed by an I.E.D. Receives a Transplanted Penis”

(April 23, 2018)

Shots (NPR)

Harris, Richard

“Veteran Receives Penis Transplant To Repair War Wound”

(April 23, 2018)

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ASCO Guidelines Address Cancer Patients’ Sexual Health

May 28, 2018

Cancer itself -- along with treatments like surgery, radiation, chemotherapy, and hormone therapy -- can lead to a number of sexual health complications.

For example, when women have their ovaries surgically removed, their estrogen levels drop dramatically, leading to vaginal dryness and other menopausal symptoms that affect sexuality. Men who undergo treatment for prostate cancer often struggle with erectile dysfunction (ED) because of nerve damage.

Cancer patients aren’t always aware that cancer treatment may have sexual side effects. And they might not be prepared for subsequent physical and emotional changes for themselves, their partners, and their relationships.

ASCO recommends that healthcare providers initiate discussions of sexual health and dysfunction related to cancer. Such conversations should continue throughout the treatment process and include partners if the patient chooses. In addition, providers should consider patients’ religious and cultural beliefs, literacy levels, and sexual orientation.

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U.S. Preventive Services Task Force Makes Recommendations on Prostate Cancer Screening

May 22, 2018

These latest recommendations apply to all adult men without prostate cancer symptoms or a prior diagnosis of prostate cancer. They also apply to men who are at increased risk for the disease, including African-American men and men with a family history of prostate cancer.

PSA stands for prostate-specific antigen, a type of protein. Blood tests that measure PSA levels are routine for prostate cancer screening. The problem is that while high PSA levels can be a sign of prostate cancer, they can also be caused by other health conditions, like an enlarged prostate (benign prostatic hyperplasia or BPH) or inflammation of the prostate (prostatitis). Also, some men receive false-positive results.

Elevated PSA results can lead to further blood tests, biopsies, and the start of prostate cancer treatment. And while men with prostate cancer may want to be treated right away, that path isn’t always the best one, experts say.

Treatment for prostate cancer can include radiation, chemotherapy, and surgery, all of which can have negative repercussions, like erectile dysfunction and incontinence.

However, some prostate cancers grow slowly, and some men never need treatment. For these men, undergoing treatment may have consequences that can be avoided.

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Sex Aids Not Always Available at Cancer Centers

May 16, 2018

“The stark absence of sexual aids underscores the cultural taboos around cancer-related sexual dysfunction,” they wrote. “Efforts to improve availability of sexual aids for survivors would likely promote sexual health rehabilitation and validate this under addressed aspect of cancer survivorship.”

The study findings were presented in February at the 2018 Cancer Survivorship Symposium, held by the American Society of Clinical Oncology (ASCO) in Orlando, Florida.

For more information on sexual health following cancer treatment, please see these links:

Sex After Cancer

The Effects of Cancer on Women’s Sexuality

How Does Cancer Affect Men’s Sexual Health?


American Society of Clinical Oncology (ASCO)

Bober, Sharon, et al.

“Availability of therapeutic sexual aids for cancer survivors: A survey of major cancer centers.”

(Abstract presented at ASCO 2018 Cancer Survivorship Symposium, February 17, 2018 in Orlando, Florida)

Stevens, Melinda

“Cancer centers lack aids to improve sexual dysfunction among survivors”

(February 15, 2018)

Medscape Medical News

Pam Harrison

“Despite Need, Cancer Centers Don't Stock Sex Aids”

(February 15, 2018)

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Daily Flibanserin “Generally Safe” for Some Postmenopausal Women, Study Finds

May 08, 2018

However, the FDA has not approved the use of flibanserin by postmenopausal women with HSDD. This study included data on both premenopausal women and naturally postmenopausal women. (The women went through menopause through the typical course of aging, not through medical treatments like surgery.)

The trial included 595 women. Three hundred forty-six women were premenopausal (average age 38), and 259 had finished natural menopause (average age 57). All the women had been in monogamous, heterosexual relationships for at least a year.

All participants took 100 mg of flibanserin every night when they went to bed. During periodic follow-up visits, they completed questionnaires that assessed their sexual distress and sexual function. They were also checked for any adverse events (side effects).

The study was originally designed to last for 28 weeks. However, the study sponsor, the German company Boehringer Ingelheim, stopped their development of flibanserin, so the study ended early. On average, the women participated for about ten weeks, but some went as long as 24 weeks.

In general, the women’s levels of sexual distress decreased while their sexual function improved. About half of the patients said they had received a “meaningful benefit” from flibanserin.

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U.S. House Resolution: Continue Health Coverage for Certain Men with Incontinence and ED

Apr 30, 2018

In his presentation on cancer survivorship at this year’s inaugural AUA Annual Advocacy Summit, which took place in March 2018 in Washington, D.C., Dr. Sadeghi-Nejad requested unwavering support for cancer survivors from the audience of urologists, other medical specialists, allied health professionals, patient advocates, and policymakers. Other SMSNA representatives at the AUA Advocacy Summit included Drs. Ira Sharlip, Run Wang, Arthur Burnett, John Mulcahy, and Eugene Rhee.

Prostate cancer can be treated with chemotherapy, radiation, hormone therapy, and radical prostatectomy (the surgical removal of the prostate). Unfortunately, these treatments can have serious side effects, such as urinary incontinence and erectile dysfunction (ED). Such side effects can be devastating for men and their partners, leading to frustration, depression, and changed relationships.

Currently, Medicare and Veterans’ Administration benefits cover treatments for incontinence and ED, including surgery and penile implants. The resolution aims protect that coverage.

It adds that men who experience incontinence and ED from conditions other than prostate cancer – such as diabetes, heart disease, Parkinson’s disease, and multiple sclerosis – should be equally covered.

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Avoid These Erectile Dysfunction (ED) Products, FDA Warns

Apr 30, 2018

The products’ packaging claims that they are manufactured in India by “Acme Generics.” The name “Sun Pharma” may also appear on the label.

Men who have purchased the drugs should not use them. Those who have taken the drugs and felt ill afterward should call their doctor.

In a statement, the FDA warned that “medications purchased from unapproved and/or unlicensed sources may be dangerous as they can be counterfeit, contaminated, improperly stored and transported, ineffective, and/or unsafe.”

The FDA notes that the same retailer might also be selling an unapproved form of tadalafil, another ED drug that is marketed under the name Cialis.

This is not the first time the FDA has warned about products that claim to treat ED or enhance sexual performance. Supplements targeted in the past have contained dangerous hidden ingredients that aren’t disclosed on the label. In fact, counterfeit versions of Viagra have been found to contain rat poison, borax, pesticides, paint, and printer ink.

ED drugs should always be prescribed by a qualified medical professional. Some men feel embarrassed discussing sexual dysfunction with a doctor. But ED is common and can be a symptom of other illnesses like diabetes and heart disease, so the conversation is important. If a man cannot take pills for ED, there are several other treatment options, including vacuum erection devices, self-injections, and suppositories.

Please see these links to learn more about ED products that are not FDA-approved:

Dangers of Counterfeit ED Drugs

The FDA and Tainted Sexual Enhancement Products

ED and Sexual Enhancement Products


International Society for Sexual Medicine

“How can you tell if a medication is counterfeit?”

“Is it safe to buy erection-enhancing drugs over the internet?”

U.S. Food and Drug Administration

“FDA warns consumers not to use unapproved erectile dysfunction products advertised on the radio”

(March 16, 2018)

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More Americans Having Gender-Affirming Surgery

Apr 18, 2018

For the study, researchers examined information from a national U.S. database that includes 20 years of surgical records.

Almost 38,000 people sought help for gender dysphoria between 2000 and 2014. About 11% of these patients underwent surgery. However, the number increased four-fold during these years.

The researchers also looked at insurance and payment information for the surgeries. During the 2000-2005 period, about half the patients paid for their procedures themselves. In the 2006-2011 period, about 65% did so.

But the rate fell during the 2012-2014 period. In 2014, only 39% paid themselves; the rest had their procedures covered by Medicare, Medicaid, or other insurance.

“As coverage for these procedures increases, likely so will demand for qualified surgeons to perform them,” the study authors wrote.


HUB (Johns Hopkins University)

Tantibanchachai, Chanapa

“Study suggests gender-affirming surgeries are on the rise, along with insurance coverage”

(February 28, 2018)

JAMA Surgery

Canner, Joseph K., MHS, et al.

“Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United States”

(Abstract. February 28, 2018)

Crandall, Marie, MD, MPH

“Trends of Gender-Affirming Surgery Among Transgender Patients in the United States”

(Invited commentary. February 28, 2018)

Washington Post

Nutt, Amy Ellis

“Transgender surgeries are on the rise, says first study of its kind”

(February 28, 2018)

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Scientists Investigate Health Risks of Testosterone Replacement Therapy

Apr 10, 2018

Doctors might prescribe TRT in these situations, but the approach has been controversial, especially for aging men. Past studies have suggested risks to heart health; others have found no risks whatsoever. For the most part, these studies focused on older men.

The current study, published in February 2018 in BJU International, looked at the effects of testosterone therapy in a group of younger, healthier men. In particular, the authors considered the risks of blood clots, cardiovascular events (such as stroke or heart attack), and obstructive sleep apnea (OSA).

Working with a database of military servicemen between the ages of 40 and 60 in the United States, the researchers identified 3,422 men who received TRT between 2006 and 2010. For comparison, they identified 3,422 additional men who did not take testosterone, but who matched the original group in age, race, military rank, marital status, health status, and residential region.

When the researchers compared the two groups, they discovered that the men on TRT went longer without any cardiovascular events and had lower risk for coronary artery disease. Risks of stroke, congestive heart failure, and blood clots were similar between the two groups.

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Women With Breast Implants Warned About Rare Lymphoma

Apr 02, 2018

Of the 414 reported cases, 272 indicated the type of implant used. Of these, 242 cases involved textured implants, and 30 involved smooth ones. Half of the women developed within seven to eight years of implant surgery.

A woman’s risk of developing BIA-ALCL ranges from 1 in 3,817 to 1 in 30,000 if she has textured breast-implants, the FDA said in a press release.

Implants may also be filled with saline or a silicone gel. Of 413 BIA-ALCL cases that reported the type of filling, 234 implants used silicone gel, and 179 used saline.

BIA-ALCL is generally found near the implant, in scar tissue or in fluid. But it can spread to other parts of the body.

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SMSNA Releases Position Statement on Restorative Therapies for Erectile Dysfunction (ED)

Mar 27, 2018

The Sexual Medicine Society of North America (SMSNA) is concerned about the internet promotions and expense of Regenerative/Restorative therapies for Erectile Dysfunction and Peyronie’s Disease. The SMSNA strongly supports advancing health care delivery to patients with sexual dysfunctions, but at the same time wants to warn consumers about the difference between investigational therapies and FDA approved therapies.

"Given the current lack of regulatory agency approval for any restorative (regenerative) therapies for the treatment of ED and until such time as approval is granted, SMSNA believes that the use of shock waves or stem cells or platelet rich plasma is experimental and should be conducted under research protocols in compliance with Institutional Review Board approval.”

The complete Position Statement can be found here.


Childhood Sexual Abuse Linked to Sexual Problems in Women

Mar 26, 2018

It’s not clear exactly why the problems occur, but the researchers suggested several pathways:

  • Women who have been abused might process sexual stimuli differently.
  • They might consider sex in a more negative light, feel more fear and anger during arousal, and feel negatively about their own sexuality.
  • They might have poor body image and low body esteem.
  • They might blame themselves for what happened or feel guilty about their experience.
  • Their sympathetic nervous systems might behave differently, leading to arousal issues.

Women’s experiences with sex therapy might provide some keys to understanding sexual dysfunction in abused women. The reviewers noted that expressive writing during treatment could help women process their experiences, work through their feelings of anger or shame, and develop positive thoughts related to sex.

Mindfulness-based sex therapy, during which women learn to experience sex “in the moment” and focus their attention on intimacy, has also been effective for women with CSA histories, the researchers said.

Still, they added that more research is needed so that healthcare professionals can better understand the link between abuse and sexual dysfunction and tailor treatments for women who have been abused.


Sexual Medicine Reviews

Pulverman, Carey S., PhD, et al.

“The Impact of Childhood Sexual Abuse on Women's Sexual Health: A Comprehensive Review”

(Full-text. First published online: January 19, 2018)

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Male Childhood Cancer Survivors May Face Sexual Problems, Infertility as Adults

Mar 20, 2018

Almost a third of male survivors report at least one sexual problem, the researchers said. Premature ejaculation and ED are the most common, but painful erections and orgasm difficulties are also possible. Such problems can have numerous causes. Here are some examples:

  • Testosterone production. Testosterone, the male sex hormone, is made by the testes. However, if the testes are damaged by radiation or surgery, their output may not be enough. Similarly, radiation to the brain can impair the pituitary gland’s ability to “order” the testes to make testosterone.
  • Damage to pelvic nerves and blood vessels. Damage to these areas could limit a man’s ability to get erections.
  • Negative body image. Cancer treatment may delay puberty for adolescents or leave scars and stretch marks. Feeling “different” from one’s peers can lead to poor self-esteem, depression, and anxiety – all contributing factors to sexual dysfunction.
  • Medication side effects. Drugs used to treat mental health issues may have sexual side effects, such as low libido, ED, and delayed orgasm.

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Inhibition May Hinder Women’s Orgasms

Mar 13, 2018

Sexual inhibition appeared to be the biggest factor affecting orgasms in this group of women. Inhibition was described in two ways. The first was a fear of performance failure. If a woman becomes so preoccupied with pleasing her partner, she could lose focus on her own pleasure. The second was a fear of performance consequences. Worries about pregnancy or sexually-transmitted infections might interfere with orgasm.

The authors noted that the women in this study were all heterosexual, so the study results should be interpreted carefully. It is not known how lesbians’ orgasms might be affected by such psychological traits, but future research may explore this angle further.

They added that the women were also fairly young, so more research involving other age groups could be useful.

Still, the findings can help doctors and therapists who treat women with orgasmic dysfunction. Knowing the reasons behind sexual inhibition, and working on those issues, might lead to greater sexual satisfaction for both women and their partners.

To learn more about women’s orgasms, please see the following links:

Orgasm Problems: What Can Women Do?

How Do Women Feel About Orgasms?

Communication, Sexual Self-Esteem Important for Women’s Orgasms


The Journal of Sexual Medicine

Tavares, Inês M., MSc, et al.

“Sexual Inhibition is a Vulnerability Factor for Orgasm Problems in Women”

(Full-text. First published online: February 4, 2018)

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Special Therapy Addresses Body Image in Breast Cancer Survivors

Mar 06, 2018

The research team tested their program with 194 women and published their findings in January in the Journal of Clinical Oncology.

The women’s ages ranged from 18 to 65. They had all been diagnosed with invasive breast cancer, but the disease had not spread to other parts of the body. All their treatments – surgery followed by chemotherapy and radiation – and had been cancer-free for two years.

The women were randomly assigned to one of two groups.

One hundred thirty-one women attended ReBIC sessions once a week for eight weeks. The therapy included guided imagery, a type of visualization process, during which women used their imagination to process their situation with their senses. The women also shared their feelings and experiences and received information and reading materials related to body image and breast cancer.

The remaining 63 women were given reading materials but did not participate in the group therapy.

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Relaxation Technique Might Improve Arousal in Women

Feb 27, 2018

Researchers noted that low heart rate variability (HRV) has been linked to sexual arousal problems in women. HRV refers to time between heartbeats. If your HRV is low, you might be anxious or stressed. Higher HRV is associated with a more relaxed state.

Past research has shown that autogenic training can improve HRV. Autogenic training is a relaxation technique during which listeners respond to verbal prompts directed at certain parts of body. Listeners might hear, “My right arm is heavy” or “my right arm is warm.” Listeners then imagine these sensations and become more aware of their bodies as they relax.

With the links between autogenic training and HRV in mind, the scientists explored whether this approach could help women with sexual arousal disorders.

They worked with 25 women between the ages of 20 and 44 (average age: 31) who met diagnostic criteria for sexual dysfunction. Almost two-thirds of the women said they were exclusively heterosexual; the rest considered themselves predominantly heterosexual. About half were single and dating. Thirty-six percent were in committed relationships, and the rest were single and not dating.

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Aromatase Inhibitors Linked to Low Sexual Desire, Bowel Problems

Feb 19, 2018

Unfortunately, AIs do have sexual side effects. Estrogen is an important hormone for women’s sexual health, but because AIs greatly reduce the supply, many women experience vaginal dryness, pain during intercourse, and menopausal symptoms.

For a Journal of Sexual Medicine study, researchers wanted to know how AIs affect a woman’s sexual desire, pelvic floor muscles, urinary function, and bowel movements. They also questioned how much AIs might contribute to pelvic organ prolapse, when a woman’s pelvic organs “drop” into her vagina.

They asked 625 women ranging in age from 36 to 96 to complete questionnaires about their health and any sexual distress they might feel. The women had been diagnosed with breast cancer at least ten years earlier, and about 85% had hormone receptor positive cancer. Thirteen percent were still taking an AI or tamoxifen at the time of the questionnaire.

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Why Do Transmen Have Surgery?

Feb 13, 2018

Different avenues have their pros and cons. Phalloplasty usually allows for the implantation of a penile prosthesis, if needed, which can make erections easier. But this approach might result in scarring on the arm or leg. Metoidioplasty has fewer complications, but patients can’t always penetrate a sexual partner.

Healthcare providers counsel patients on their options. However, knowing the motivations of transmen – and their feelings after surgery – could help with the conversations. That’s where this study comes in.

The researchers questioned 21 transmen with an average age of 40 about their reasons for surgery and their experiences afterward.

The top motivation for surgery was confirmation of a masculine self-image, reported as “strong” for all the transmen. All of them felt that surgery helped this reach their goal.

About 95% of the transmen said successful sexual intercourse was important for them. About two-thirds said this goal was achieved.

Participants cited other reasons for choosing surgery, too. Many wanted to stand while urinating, to use the men’s bathroom, and to feel comfortable starting new relationships. Most participants attained these goals.

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Prostate Cancer Treatment Affects Both Patients and Partners

Feb 06, 2018

They found that in addition to erectile dysfunction (ED), low sex drive and difficulties with arousal and orgasm are common in prostate cancer survivors. Partners’ sexual satisfaction often worsens as well. For instance, one study reported that partners rated patients’ erection quality lower than the patients themselves did.

It’s possible that partners may have unrealistic expectations about the patients’ sexual recovery, leading to disappointment over time, the authors explained. However, cancer survival was more important to partners than sexual side effects.

The researchers also found that the mental and physical health of both partners, along with the quality of the communication between them, can affect their relationship satisfaction. When feelings are left bottled up, intimacy can be difficult for both members of the couple.

The way patients perceive their partner’s support may also play a role. Studies suggested that when partners are more cooperative and maintain a positive attitude about sex, it might lessen the sexual impact of prostatectomy.

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Sexual Problems Continue for Young Cancer Survivors

Jan 30, 2018

At the start of the study, almost 58% of the participants had romantic partners, but two years later, the figure dropped to 43%.

Women were among the participants most likely to experience sexual issues. Other high-risk groups were older patients, those who were married or in a committed relationship, those who had undergone chemotherapy, those with psychological distress, and those with less social support.

Being in a relationship was linked to worse sexual function for women, but relationship status was not a contributing factor for men.

“We concluded that sexual functioning is experienced differently among males and females. For a young woman, especially, a cancer diagnosis can disrupt her body image, the intimacy with the partner and the ability to engage in sex,” lead author Chiara Acquati told the University of Houston, where she is a professor at the Graduate College of Social Work.

She added: “Results from this study emphasize the need to monitor sexual functioning over time and to train health care providers serving young adults with cancer in sexual health. Furthermore, patients should be connected to psychosocial interventions to alleviate the multiple life disruptions caused by the illness and its treatment.”

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Transgender Americans Struggle for Proper Healthcare

Jan 23, 2018

In terms of healthcare, almost a quarter of transgender respondents said they didn’t go to the doctor because they feared discrimination. Twenty-two percent did not have health insurance at the time of the survey.

In 2016, Elizabeth Dietz and Jessica Halem discussed some of the specific barriers transgender individuals face when trying to access healthcare in the AMA Journal of Ethics. Transgender people might not be able to find a specialist in transgender health in their local area. Travel to transgender health clinics can be difficult and expensive. And health insurance plans do not always cover services.

The consequences can be serious. Transgender patients may put off seeing the doctor for a medical need, making their condition more serious. Or, they may seek help through the black market or from well-meaning but unqualified peers online.

Last fall, Dr. Laura Arrowsmith wrote of her experiences as a trans woman seeking healthcare in the Washington Post:

When I began my journey to become my authentic self, my family-practice physician of many years refused to see me. She said that I had lied to her about who I was. This was a shock — but then, I guess I had lied to myself for decades, too. On numerous other occasions I have been refused care by physicians, sometimes because of discrimination and bigotry but at other times because of an expressed concern that “we have no idea how to care for a transgender patient.”

Gender reassignment surgery is one path toward living as one’s desired gender. But, as NPR reports, patients may still develop cancers that largely affect their birth sex. For example, a transman who has had a double mastectomy can still get breast cancer, as some of the original breast tissue remains.

Others decide to keep the reproductive organs they were born with because surgery is so expensive. As a result, some transmen develop gynecological cancers (like ovarian cancer) or need regular Pap screenings for cervical cancer.

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PTSD Linked to Sexual Problems in Midlife Women

Jan 16, 2018

Three types of sexual problems were investigated: vaginal pain with intercourse (which affected 13% of the women), vaginal irritation (32%), and vaginal soreness (7%).

All three problems were more common in women with PTSD.

The scientists also found an association between emotional intimate partner violence and painful intercourse.  Sexual assault, vaginal pain, and vaginal irritation were linked as well.

“Over 20% of midlife and older women in this ethnically-diverse community-based cohort reported clinically significant PTSD symptoms and exposure to interpersonal violence, which contributed to their risk of menopause-related sexual dysfunction,” the authors wrote.

They stressed the importance of screening for PTSD and interpersonal violence in women who are middle-aged and older and the need for “trauma-informed care of genital and sexual health” for women in this age group.

The findings were presented at the annual meeting of the North American Menopause Society in Philadelphia last October.


MedPage Today

Monaco, Kristen

“PTSD Predictor of Midlife Sexual Dysfunction”

(October 17, 2017)

North American Menopause Society

Gibson, Carolyn, PhD, MPH, et al.

“Interpersonal Violence, Posttraumatic Stress Disorder, and Menopause-Related Sexual Dysfunction in an Ethnically-Diverse, Community-Based Sample of Women”

(Abstract S-21. Presented at annual meeting of the North American Menopause Society, October 17, 2017, Philadelphia, Pennsylvania, USA)

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Transgender Men Satisfied with Penile Implants

Jan 09, 2018

Men with severe erectile dysfunction (ED) may opt for an inflatable penile implant if other ED treatments, such as medications, aren’t successful or appropriate. The surgery involves removing the corpora cavernosa and replacing them with cylinders that can be inflated on demand using a special pump that is also implanted into a man’s body. (Read more about penile implants here.)

Researchers wondered how well implants would work for transgender men. They documented the experiences of 247 patients who underwent female-to-male gender reassignment surgery between January 2001 and October 2015. The patients ranged in age from 21 to 69; their average age was 38 years.

All of the men had had a neophallus (a “beginning” penis) surgically created at least a year before their implant surgery. This time frame allowed for physical sensation to build and for any complications to be taken care of.

After implantation, the patients were followed for a median of 20 months.

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Are These Words Forbidden at the CDC?

Jan 02, 2018

The situation was of great concern to medical organizations, including the American College of Obstetricians and Gynecologists (ACOG), whose president, Dr. Haywood L. Brown wrote:

As women's health care providers devoted to maternal and fetal health, our members rely on these words to ensure precision, reasoning and credibility in the provision of care. These reported word restrictions only serve to imperil the CDC’s valued position as a trusted partner in addressing the serious issues facing America’s public health.

On December 17th, the CDC posted the following message from director Dr. Brenda Fitzgerald on its Facebook page:

I want to assure you there are no banned words at CDC. We will continue to talk about all our important public health programs.

You may be understandably concerned about recent media reports alleging that CDC is banned from using certain words in budget documents. I want to assure you that CDC remains committed to our public health mission as a science- and evidence-based institution.

As part of our commitment to provide for the common defense of the country against health threats, science is and will remain the foundation of our work.

CDC has a long-standing history of making public health and budget decisions that are based on the best available science and data and for the benefit of all people—and we will continue to do so.

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Low Desire Common in Midlife Women

Dec 26, 2017

HSDD has been researched in the past, but some of those studies did not use validated assessment tools. For this study, the researchers wanted to know more about the prevalence of HSDD and its effects on women with partners and those without.

The women completed several questionnaires concerning their menopausal status, sexual function, sexual desire, sexual distress, and any symptoms of depression. They also told the researchers about any medications they were taking, as some drugs can have sexual side effects like low desire.

Just over a quarter of the women had not yet reached menopause. Nineteen percent were perimenopausal, which means they were in the midst of the menopausal transition. Fifty-five percent were postmenopausal. About 71% had a regular sexual partner.

Fourteen percent of the participants had moderate to severe depression, and 24% took medications that could affect sexual function.

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Generic Viagra Now Available in United States

Dec 19, 2017

Generic drugs are expected to work the same way and have the same benefits as their brand-name counterparts, according to the U.S. Food and Drug Administration (FDA), which regularly reviews such medications.

One of the generics is manufactured by Teva Pharmaceuticals. Greenstone, a subsidiary of Pfizer, produces the other. (Pfizer also makes brand-name Viagra, which first came on the market in 1998.)

Because of U.S. trademark laws, generic Viagra will not look like the blue diamond-shaped pill that men might be familiar with.

“Generic medicines and brand-name medicines share the same active ingredient, but other characteristics, such as colors and flavorings, that do not affect the performance, safety, or effectiveness of the generic medicine, may be different,” explains the FDA on its website.

The generic drugs are also expected to be less expensive than brand-name Viagra, making them more accessible to men. Brand-name ED drugs are not always covered by health insurance plans and, if they are, there might be steep copays.

For example, HealthDay reported that the wholesale cost for Pfizer’s 50-milligram or 100-milligram versions of Viagra is $61.54 per pill. Greenstone’s generic version will cost between $30 and $35 per pill, although those prices will vary depending on the pharmacies, insurance plans, and copays.

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Drug Found to Clear Genital Psoriasis in Most Patients

Dec 12, 2017

Ixekizumab is currently used to treat psoriasis in general, but the effects on genital psoriasis had not been widely studied.

Funded by Eli Lilly and Company, the ixekizumab trial involved 149 men and women with moderate to severe genital psoriasis. About half were assigned to receive an injection of ixekizumab once every two weeks for twelve weeks. The rest received a placebo injection for the same duration.

Some of the patients started seeing improvements in the first week. After twelve weeks, psoriasis had either cleared or almost cleared for 73% of the patients who received ixekizumab, compared to just 8% of the placebo group. Sixty percent of the treatment group and 8% of the placebo group reported less itchiness.

Seventy-eight percent of the treatment group said that their psoriasis had little or no effect on how often they had sex. For the placebo group, the figure was 21%.

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For Breast Cancer Survivors, Sexual Concerns May Last Years

Dec 05, 2017

For the breast cancer group, an average of three years had elapsed since their cancer diagnosis. Half of the women had had chemotherapy; about three-quarters had undergone radiotherapy. Two-thirds had had breast conserving surgery, and the remainder had undergone mastectomy.

Overall, the breast cancer survivors had poorer sexual health. Twenty-eight percent said they were not sexually active, compared to 20% of the women with no history of breast cancer. The primary reason for sexual inactivity was lack of a partner, followed by lack of interest in sex. Women in the breast cancer group were more likely to report discomfort during intercourse.

Low sexual interest was an issue for both groups, although it was more common among the breast cancer survivors. In fact, about 69% of the survivors and 59% of the women with no history of breast cancer met the criteria for hypoactive sexual desire disorder (HSDD) – low libido accompanied by distress.

“Our results demonstrate that [sexual health] problems persist into [breast cancer] survivorship and differ significantly from the general population,” the authors wrote.

They added that healthcare providers should address sexual health concerns when treating and counseling cancer survivors.

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Poor Health and Lack of Communication Related to Low Sexual Interest, Study Says

Nov 28, 2017

Fifteen percent of the men and 34% of the women said they had lacked sexual interest for at least three months in the past year. Of these, over half of the men the about two-thirds of the women were distressed about their situation. Low sexual interest became more frequent as people got older, although menopause did not appear to play a role for the women.

Participants with physical or mental health problems, such as depression, also reported lower sexual interest, as did those who had been diagnosed with a sexually-transmitted infection (STI) or been forced to have sex against their will.

Relationship factors had an effect, especially for the women. People tended to have lower interest if they had trouble talking about sex with their partner, didn’t share their sexual likes and dislikes, or were unhappy with their relationship. A partner’s sexual difficulties and any mismatch in sexual desire were other factors.

Women who had been pregnant during the past year and those with young children were more likely to report low interest. The researchers noted that fatigue and stress associated with childcare might affect the women’s interest in sex. However, these particular findings did not apply to men.

Also for the women, early sexual experiences had some influence, especially if they had felt pressured by a partner and regretted their decision to have sex.

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Sexual Incontinence Needs Attention, Researchers Say

Nov 21, 2017

Based on their review, the researchers noted the following:

  • Between 2% and 10% of women experience sexual incontinence, with higher rates for women who already have another type of incontinence.
  • Men often have sexual incontinence after radical prostatectomy, the surgical removal of the prostate gland. For example, one study in the review found that 20% to 64% of men had climacturia after this surgery. Some men find that their continence improves over time, however.
  • Scientists aren’t sure exactly why sexual incontinence happens. One possible explanation involves damage to important nerves, particularly the pudendal nerve, which plays roles in both genital sensation and urinary function. Such damage can occur through pelvic surgery or childbirth.
  • Many men and women with sexual incontinence avoid sexual activity because they feel embarrassed, unattractive, or anxious.
  • Sexual incontinence can affect partners and relationships, too. But some people felt their partners were more bothered by it than those partners actually were. In fact, one study found that some men didn’t know their female partner had leaked urine during sex. In the same study, 84% of the women said that their sexual incontinence was a problem, but only 35% of their partners agreed.
  • Men who have sex with men may be more bothered by sexual incontinence and need to make adjustments, especially if they engage in oral sex. (The reviewers found no studies discussing women who have sex with women or heterosexuals and oral sex.)
  • Doctors and patients often don’t discuss incontinence during office visits. The authors suggested that doctors provide relevant information in office waiting rooms or conduct simple screenings.

There are several ways to treat sexual incontinence, the authors wrote. Some are behavioral, like emptying the bladder before sex, wearing a condom, placing a tension loop at the base of the penis, or using a dental dam (a barrier method sometimes used during oral sex). Patients may benefit from pelvic floor physical therapy, which strengthens pelvic floor muscles for better urinary control. Medications and surgery are other options.

Treatment of sexual incontinence may improve sexual satisfaction for both patients and partners, the authors added.


Sexual Medicine Reviews

Melissa H. Mendez, MD, et al.

“Contemporary Review of Male and Female Climacturia and Urinary Leakage During Sexual Activities”

(Full-text. Published online: September 20, 2017)

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Men May Fracture Penis During “Doggy Style” Sex

Nov 14, 2017

Recently, a team of scientists in Brazil set out to learn more about specific sexual positions and penis fracture.

They looked at the medical records of 90 men between the ages of 18 and 66 who had been treated for fractures an emergency department in Rio de Janeiro between 2006 and 2016. Eighty-seven men were heterosexual, and 3 were homosexual.

The men were asked how the fracture had occurred and, if it was the result of sexual activity, what position they were engaged in at the time.

Sixty-nine of the men (77%) fractured their penis during sex. The three gay men had done so during “doggy style” sex. For the rest, the fracture had happened during vaginal intercourse. In this group, just over half were using “doggy style,” 35% were using man-on-top, and 14% were using the woman-on-top position.

Twenty-three of the cases were considered severe. In this group, over half of the fractures occurred during “doggy style” intercourse.

Fourteen men also had injuries to the urethra, the tube that semen travels through during ejaculation.

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What Happens in Women’s Brains During Orgasm?

Nov 07, 2017

They recruited 10 women between the age of 29 and 74 (average age 44) who were willing to have orgasms in a clinical setting. Each woman had a male partner.  The women were asked to have two orgasms, if possible, during a brain scan – one though masturbation and the other by having their partner stimulate them.

During each session, the woman pressed a button to indicate when stimulation began, when the orgasm started, when the orgasm ended, and when she had “recovered” from climax. In a nearby control room, the researchers measured brain activity in 20 second units.

The researchers did not find any significant differences between self- and partner-stimulated orgasms. Generally, the women’s brains gradually became more active as stimulation increased. This activity peaked during orgasm, then declined.

During orgasm, areas of the brain associated with sympathetic activity, pleasure, reward, and addiction were activated. There was also more activity in areas that are thought to raise pain tolerance during orgasm.

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Breast Cancer Has Sexual Impact on Both Survivors and Partners

Oct 31, 2017

The survivors’ average age was 51 years and an average of 38 months had passed since their breast cancer diagnosis. The vast majority of them were married or in a relationship. About two-thirds of the women started having sexual problems during their cancer treatment. Most had gone through menopause; for about half of that group, menopause had been induced by treatment.

The most common sexual dysfunction, affecting 83% of the women, was hypoactive sexual desire disorder (HSDD), a distressing lack of sexual interest. Forty percent had trouble becoming aroused, and a third had pain during intercourse.

Some forms of treatment were associated with specific problems among the women. For example, HSDD was more frequent in women who had had hormone therapy. Immunotherapy, which uses the patient’s immune system to fight cancer, was linked to painful intercourse.

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Vaginal Estrogen Could Be a Menopause Management Option for Women with Breast Cancer

Oct 24, 2017

Women going through natural menopause may decide to try hormone replacement therapy. This is not an option for many breast cancer patients or survivors. However, some may be able to use vaginal estrogen.

ACOG explains that unlike systemic hormone therapy, which can travel throughout the body, vaginal estrogen is a local therapy, applied only to the vagina with a cream, ring, or tablet. As such, little estrogen enters the body at a systemic level. Also, preparations of vaginal estrogen generally have lower doses of the hormone.

Still, ACOG recommends that women try non-hormonal therapies, like vaginal moisturizers or lubricants, first. If those aren’t effective, then vaginal estrogen can be considered under the guidance of a woman’s healthcare team. The lowest effective does should be used, and the course should only last until symptoms improve.

Studies have not found any increased risk of cancer recurrence in women who use vaginal estrogen to manage urogenital symptoms related to menopause, ACOG says. However, more research is needed before vaginal estrogen can be recommended for women who use aromatase inhibitors. Women taking tamoxifen might benefit from a short course of vaginal estrogen.

ACOG added that any woman considering vaginal estrogen should have complete information about the benefits and risks so that she can make an informed decision.


American Congress of Obstetricians and Gynecologists

“The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer”

(Committee Opinion Number 659. March 2016)

“How Menopause Can Happen With Breast Cancer Treatments”

(Last modified: February 17, 2017)

“Vaginal Estrogen”

(Last modified: January 27, 2015)

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Scientists Explore Web-Based Educational Tools for Young Adults with Cancer

Oct 17, 2017

They designed two web-based tools, one focusing on sexuality, the other focusing on fertility. Each tool combined short readings, exercises, photos and other illustrations, and videos featuring peers with cancer who discussed their experiences with the topic at hand. The tools also gave users the option to participate in an online forum, ask questions directly to an expert, and speak to a counselor twice by phone.

The tool was divided into separate modules that became available every ten days. The sexuality and fertility interventions could be completed in 60 and 70 days, respectively.

Twenty-three people between the ages of 18 and 43 tested the program. They had been diagnosed with cancer within the previous five years. About 35% of the participants had lymphoma, the most common type in the group, followed by breast cancer, cervical cancer, cancer of the central nervous system, testicular cancer, and ovarian cancer. All of the participants were from Sweden.

Fourteen people (11 women and 3 men) signed up to test the sexuality tool. Nine (8 women and 1 man) used the fertility intervention. Overall, 15 participants (“committed users”) completed at least four modules of their chosen tool.

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Prescriptions Too Costly for Many Cancer Survivors

Oct 09, 2017

“Our findings suggest that expansions in health insurance coverage mitigated the effects of growing prescription drug costs to some extent for many individuals with and without a history of cancer,” wrote the study authors.

However, cancer survivors still had higher rates compared to people without a cancer history.

In 2010, 13.8% of cancer survivors could not afford medication during the previous twelve months. This rate had fallen to 8.6% by 2015. But the rates for people without a history of cancer were lower – 11.0% in 2015 and 6.8% in 2015.

Adults age 65 and older appeared to have similar access, regardless of cancer history.

Earlier this year, Kaiser Health News reported that high costs can cause some cancer patients and survivors to put off treatment, take smaller doses of a prescribed drug, or go without medications altogether.

The National Cancer Institute (NCI) notes that financial toxicity (financial distress) is a common problem for cancer patients and survivors. The term refers to more than prescriptions. It encompasses insurance copayments, deductibles, and coinsurance. It can also include loss of wages and lower earning power due to cancer and its treatment.

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Women With Overactive Bladder (OAB) at Higher Risk for Sexual Dysfunction

Oct 02, 2017

The women were divided into two groups based on their menopausal status. One hundred twenty-two women were premenopausal, and the remaining 145 had finished menopause, which was defined as finishing twelve months without a menstrual period. 

The women completed a questionnaire called the Female Sexual Function Index (FSFI). This tool evaluates overall sexual function along with six individual domains: desire, arousal, vaginal lubrication, orgasm, sexual satisfaction, and sexual pain. 

Based on FSFI scores, about 77% of the participants were considered at risk for sexual dysfunction. This figure included 66% of the premenopausal and 86% of the postmenopausal women. 

Severity of OAB was assessed using another questionnaire. Most of the women had severe OAB. 

However, the degree of OAB severity was linked to poorer outcomes on the arousal, lubrication, orgasm, and pain domains of the FSFI for postmenopausal women only, especially if they had urge incontinence (a strong urge to urinate that sometimes results in urine leakage). This correlation was not found for premenopausal women. 

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More Sex Might Mean More Brain Power in Older Adults

Sep 26, 2017

Researchers worked with 73 people between the ages of 50 and 83, with an average age of 62 years. Twenty-eight participants were male; the rest were female. None had a history of dementia, memory impairment, or brain injury.

The participants answered questions about their health and lifestyle, including how often they had sex. (For this study, intercourse, masturbation, petting, and fondling were all considered sexual activities.)

The also completed the Addenbrooke’s Cognitive Examination III (ACE-III). This tool evaluates overall cognitive function by focusing on five specific areas: attention, memory, verbal fluency, language, and visuospatial abilities (perceiving objects and their spatial relationships). Other questionnaires were used to assess social wellbeing.

Ten of the participants – all women – said they never engaged in sexual activity. Among the rest, 26 had sex monthly, and 37 did so weekly. The groups were fairly similar in terms of age, education, heart health, and marital status. They also had similar scores on assessments of depression, loneliness, and quality of life.

On the ACE-III however, those who had sex more frequently had better overall scores, indicating better cognitive function. These participants also had better scores on two subsections of the test: verbal fluency and visuospatial abilities.

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Study Addresses Psychological Aspects of Female Sexual Problems

Sep 19, 2017

The authors discussed two risk factors:

  • Anxiety sensitivity – fear of physiologic reactions caused by anxiety. For example, a woman may become frightened when her heartbeat increases during sex
  • Emotion regulation – ways that people respond to what they are experiencing emotionally

The researchers also looked at psychological distress in light of these risk factors.

They recruited 316 female university students between the ages of 17 and 38 years (average age 19) to complete a group of questionnaires to assess their anxiety sensitivity, depression, stress, emotion regulation, sexual function, sexual quality of life, and sexual experiences.

About 83% of the women were heterosexual, and 46% of the participants were in committed relationships. Nineteen percent said they had been diagnosed with a mental health problem in the past.

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Men with ED May Have Higher Risk of Parkinson’s Disease

Sep 12, 2017

They collected data from the National Health Insurance Research Database, which contains anonymous medical records for most of the Taiwanese population. They identified 3,153 men (average age 57 years) who were first diagnosed with ED between January 1, 2004 and December 31, 2010. Next, they identified a comparison group of 12,612 men (average age 53 years) without ED. The men were followed for an average of 5 to 6 years.

After adjusting for age, health conditions, medications, and other variables, the researchers found that men with ED had a 52% higher risk of developing Parkinson’s disease compared to men without ED.

If men with ED also had diabetes or high blood pressure, their Parkinson’s risk was twice as high.

The authors noted that other studies have shown a higher incidence of ED in their populations. They explained that ED is “a taboo subject in Taiwan” and that many men do not feel comfortable discussing it.

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Emotional Aspects of Sex Important for Midlife Women

Sep 06, 2017

All the women had been sexually active at least once during the previous year and were in varying stages of menopause. About 60% were married or cohabitating.

Desire, vaginal dryness, sexual pain, and orgasm were widely discussed. One 50-year-old woman said, “Desire . . . If I had desire, everything else would fall into place.”

When women were asked what aspects of sex were most important to them, many cited emotional concerns that involved intimacy and connection with their partner, pleasing their partner, and feeling that their partner loved and desired them:

The connection we get with each other . . . just the connection, like our souls or spirits . . . it’s a beautiful feeling for two people to be wrapped up with each other. (51-year-old woman)

But I get enjoyment out of knowing that I’m pleasing my partner, too. That’s satisfying to me. (55-year-old woman)

It makes me feel good to know that my partner is still interested in . . . wanting to have sex at this later time in our life. (58-year-old woman)

On the latter aspect, the authors added, “These women wanted to feel that their partners were not just interested in sex, but interested in sex with them specifically” [emphasis in the original].

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Some Men Regret Prostate Cancer Treatment Decisions

Aug 28, 2017

Another option is active surveillance - monitoring the patient’s condition and providing treatment if it worsens or if symptoms become bothersome. This approach is sometimes called “watchful waiting.” While it may seem counterintuitive to not treat prostate cancer immediately after diagnosis, for some men, the cancer grows so slowly that the side effects of treatment could be more harmful than treating it on an as-needed basis.

The study included 946 men under the age of 75 who had been diagnosed with localized prostate cancer between October 1994 and October 1995. (Localized cancer means that cancerous cells had not spread beyond the prostate gland.) Each man completed a follow-up survey at least 15 years after his treatment.

The researchers found that almost 15% of the men had treatment regrets. This figure represented about 17% of the men who had had radiation, 15% of those who had undergone surgery, and 8% who had had conservative treatment like active surveillance.

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Body Image, Binge Eating, and Sexual Dysfunction in Women

Aug 22, 2017

Similarly, if she feels that she is not thin enough, she may worry that her partner will find her unattractive, leading to sexual anxiety. She may become so preoccupied with her body image that she cannot enjoy the encounter with her partner. In severe cases, she might dissociate, becoming so distracted and detached from the experience that sexual issues persist.

To learn more about these concepts and how they might work together, researchers created a two-hour experiment that measured levels of cortisol – a stress hormone involved with “fight or flight” response – in women watching a sexually arousing video.

Sixty women between the ages of 25 and 35 participated in the study. All the women were heterosexual and had a regular partner. They completed several questionnaires designed to evaluate dissociative tendencies, sexual distress, body esteem, and feelings about food and eating.

Twenty percent of the women were frequent binge eaters; another 35% said they binge ate sporadically. The rest were not binge eaters.

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Rectal Cancer Survivors Can Face Sexual Challenges

Aug 15, 2017

In 2016, the Journal of Sexual Medicine published a study describing the sexual challenges and health-related quality of life among long-term rectal cancer survivors. Researchers surveyed 575 people in the United States. Almost a third (62 women and 119 men) had permanent ostomy procedures; the rest (173 women and 221 men) had undergone anastomosis. All had had surgery at least five years before the survey. The average time since surgery was 12 to 14 years.

Overall, survivors with a permanent ostomy were more likely to have sexual problems than those who underwent anastomosis. For example, about 28% of women in the ostomy group reported vaginal stricture (narrowing) at the time of the survey. For women in the anastomosis group, the rate was 17%. Also at the survey time, 22% of the women who had had an ostomy procedure had vaginal pain; only 12% of the anastomosis women did.

Erection problems were common for men in both groups. Seventy percent of the men in the ostomy group had problems getting an erection after surgery, compared to 59% of the men in the anastomosis group. However, the difference decreased as the years passed. By the time of the survey, the rates were 73% and 69%, respectively.

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Gaming Might Affect Sexual Desire and Ejaculation in Men

Aug 01, 2017

Gaming Might Affect Sexual Desire and Ejaculation in Men

From Tetris to Pokémon to Halo, videogames have been a popular form of entertainment for decades. And during that time, scientists have investigated how playing videogames affects one’s health. But how about sexual health?

In a recent Journal of Sexual Medicine study, experts found that gaming might affect men’s sexual function, in positive and negative ways.

Using social media, researchers recruited 396 men who ranged in age from 18 to 50. On average, the men were about 28 years old. All participants had had intercourse during the previous month; roughly 70% were in stable relationships. About 72% said they were “gamers” - they played videogames for at least an hour every day. The rest spent less time gaming and were considered “non-gamers.”

The men filled out two online questionnaires designed to evaluate sexual health. The International Index of Erectile Function (IIEF) focuses on five aspects: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. It is often used to diagnose men with erectile dysfunction (ED), the inability to get and keep an erection firm enough for sex.

The men also completed the Premature Ejaculation Diagnostic Tool (PEDT). As the name suggests, this questionnaire is used to assess premature ejaculation (PE).  Men with PE climax before they wish to, usually within two minutes of penetrating their partner.

They also answered questions about their relationship status, gaming habits, and sexual activity.

Looking at the IIEF results, the researchers found few differences between gamers and non-gamers for erectile function, orgasmic function, and overall sexual satisfaction. However, non-gamers had slightly better median scores for sexual desire. In other words, they felt slightly more sexual desire than the gamers did.

PEDT results showed that none of the gamers had PE. In contrast, 69% of the non-gamers either had PE or “probable” PE based on their questionnaire scores.

Why was there a connection between gaming and sexual health? It’s possible that videogame “rewards” are related to dopamine levels in the brain, the researchers said. Dopamine is a neurotransmitter involved with forms of pleasure, including ejaculation and orgasm. When gamers do well, their dopamine levels go up.

The study authors also pointed out that “videogame stress” could lead to higher levels of prolactin, which could impair sexual function.

They added that more research is needed to fully understand the association between videogames and sexual health. In time, however, this understanding might help doctors who treat men with PE or low desire.

The study was first published online in June in the Journal of Sexual Medicine.


The Journal of Sexual Medicine

Sansone, Andrea, MD, et al.

“Relationship Between Use of Videogames and Sexual Health in Adult Males”

(Full-text. Published online: June 1, 2017)


“Prolactin blood test”

(Review date: August 7, 2016)

Psychology Today



Cancer Organizations Stress Importance of Comprehensive and Affordable Healthcare

Jul 24, 2017

A group of 33 cancer-related organizations have banded together to support cancer patients and survivors in light of proposed healthcare legislation under debate in the United States.

The organizations include the National Coalition for Cancer Survivorship (NCCS), the American Society for Clinical Oncology (ASCO), and the Association of Oncology Social Work. Groups that support patients with specific cancers, such as the Susan G. Komen organization (breast cancer), the Colon Cancer Alliance, the Lymphoma Research Foundation, and National Brain Tumor Society are also involved. (See the complete list below.)

In particular, the organizations oppose the Better Care Reconciliation Act (BCRA) and its revised version released on July 13th. The organizations are concerned that healthcare coverage will become unaffordable and unattainable for millions of Americans.

The bill proposes cuts to Medicaid, which provides health coverage to low-income patients. It would also limit coverage options for people with pre-existing conditions.

“The Senate’s BCRA, just as the House’s AHCA [American Health Care Act], is a direct threat to America’s 16 million cancer patients and survivors who rely on timely and uninterrupted access to comprehensive and affordable health care,” said NCCS CEO Shelley Fuld Nasso in a press release on July 13th.

“It is time to end this threat that is causing fear and anxiety throughout the cancer community, and work towards bipartisan solutions to strengthen current law,” she added.

In a statement released July 14th, ASCO President Bruce E. Johnson, MD, FASCO discussed some of the reasons the U.S. healthcare debate is so important for cancer patients. “When individuals with cancer do not have adequate health insurance coverage they are diagnosed with more advanced cancers, receive care later in their disease course, have less access to needed medical care, and have worse outcomes than those with better coverage.”

“We urge policymakers to ensure that robust requirements are maintained to ensure that all health plans cover the full scope of services and therapies that cancer patients require,” said Dr. Johnson.

The complete list of organizations is as follows:

  • American Society for Clinical Oncology (ASCO)
  • American Society for Radiation Oncology (ASTRO)
  • Association of Community Cancer Centers (ACCC)
  • Association of Oncology Social Work
  • Blue Faery: The Adrienne Wilson Liver Cancer Association
  • CancerCare
  • Cancer Support Community
  • Children’s Cause for Cancer Advocacy
  • Colon Cancer Alliance
  • Cutaneous Lymphoma Foundation
  • Critical Mass
  • Deadliest Cancers Coalition
  • Fight Colorectal Cancer
  • FORCE: Facing Our Risk of Cancer Empowered
  • Inflammatory Breast Cancer Research Foundation
  • Living Beyond Breast Cancer
  • Lung Cancer Alliance
  • LUNGevity
  • Lymphoma Research Foundation
  • Melanoma Research Alliance
  • National Brain Tumor Society
  • National Breast Cancer Coalition
  • National Coalition for Cancer Survivorship
  • National Comprehensive Cancer Network
  • National Patient Advocate Foundation
  • Oncology Nursing Society
  • Ovarian Cancer Research Fund Alliance
  • Sarcoma Foundation of America
  • Stupid Cancer
  • Susan G. Komen
  • Triage Cancer
  • Us TOO International
  • Young Survival Coalition


American Society for Clinical Oncology

Johnson, Bruce E., MD, FASCO

“ASCO Remains Opposed to Senate Healthcare Bill, Urges Protections for Access to High-Quality Care”

(July 14, 2017)

National Coalition for Cancer Survivorship

“NCCS and 33 Cancer-Related Patient Advocacy and Professional Organizations Jointly Oppose Senate’s Revised BCRA”

(News release. July 13, 2017)


Grayson, Gisele, Alyson Hurt, and Alison Kodjak

“CHART: Who Wins, Who Loses With Senate Health Care Bill”

(June 22, 2017)


Range of Priorities Found in Individuals Seeking Female-to-Male Transition

Jul 11, 2017

Range of Priorities Found in Individuals Seeking Female-to-Male Transition

When people with gender dysphoria decide to undergo a female-to-male transition, there is a large variation in their priorities, according to new research in the Journal of Sexual Medicine.

Gender dysphoria refers to a mismatch between a persons’ birth gender and the gender they identify with. An individual may be born with female reproductive organs, but feel more male then female. Sometimes, people take hormones or undergo surgery to transition to their desired gender.

Surgery for female-to-male transitions involves the creation of male genitalia. There are several different ways to accomplish this, but each technique has its pros and cons. For example, a procedure called metoidioplasty uses tissue from the clitoris to form a penis. Afterward, the patient can usually feel sexual sensations, but may not be able to urinate standing up. Also, the penis may be too small to penetrate a partner during intercourse.

What aspects are most important to patients? To answer this question, researchers surveyed 47 Swedish transmen between the ages of 18 and 52 who were considering surgical transition from female to male.

The participants showed a wide range of preferences. For many, the ability to feel sexual sensations, reach orgasm, and have erections with the new penis was high on the priority list.

Low priority items included removal of the vagina and minimal scarring. Most respondents were not concerned about having a particular size penis (most said “normal”). And the use of human tissue for a new penis did not seem essential.  

The respondents had mixed feelings about urinating while standing. Some rated this attribute as most important, but others considered it less important.

More than half said they would be willing to consider a penis transplant from a deceased person, an approach that is now being investigated. However, many were not sure whether they would be open to immunotherapy, which lowers the risk of transplant rejection.

About three-quarters of the respondents identified themselves as male. For this group, removing the vagina was a priority. This group also emphasized the need for a “passable” penis that would not seem unusual in a dressing room.

The study results could help doctors and surgeons better understand the needs of their female-to-male patients, the authors noted. In turn, surgical procedures might be tailored to patient’s priorities. And patients may have a better sense of their surgical options.

“Patients must always be instructed on all available techniques in current use and their specific benefits and limitations to make an informed choice,” the authors wrote.


The Journal of Sexual Medicine

Jacobsson, Josephine, MD, et al.

“Patients’ Priorities Regarding Female-to-Male Gender Affirmation Surgery of the Genitalia—A Pilot Study of 47 Patients in Sweden”

(Full-text. Published online: May 3, 2017)