On Thursday, October 8, at the 27th Annual SMSNA Fall Scientific Meeting, Drs. Amy Pearlman and Kevin Chu engaged in a lively debate about whether sexual health professionals should prescribe GLP-1 medications.

Dr. Pearlman argued that sexual health professionals should prescribe GLP-1s. She cited a systematic review of 10 studies showing that GLP-1s may improve erectile dysfunction (ED), likely indirectly through weight loss. Dr. Pearlman also presented a case in which fertility improved with GLP-1 use. Other data showed that men with diabetes who were taking semaglutide experienced improvements in ED, while the same was not observed in men without diabetes. Maintaining a healthy weight and muscle mass can contribute to overall sexual health and vitality. Dr. Pearlman pointed out that many of the necessary procedures are already in place and may simply need to be adapted. She asked Dr. Chu: If sexual health professionals already prescribe treatments for conditions associated with metabolic disease, why shouldn't they treat metabolic disease itself?

Dr. Chu argued that sexual health professionals should not prescribe GLP-1s. He explained that ED is often the "canary in the coal mine" for other health concerns. However, most sexual medicine professionals do not directly manage conditions such as hypertension or cardiovascular disease. Dr. Chu noted that the same studies Dr. Pearlman cited could also support his argument, as the evidence remains inconclusive about whether GLP-1s improve ED or fertility. He also raised concerns about adverse events that may be beyond a sexual health professional's scope of practice, potentially creating additional burdens for both providers and patients. Instead, he recommended a multidisciplinary approach in which specialists work together to manage ED, ejaculatory disorders, and underlying metabolic conditions.

Should GLP-1 prescribing become part of sexual medicine practice, or is it best left to other specialists?

On Thursday, October 8, at the 27th Annual SMSNA Fall Scientific Meeting, Drs. Kate Adams and Amy Hoover discussed how mental health practitioners and pelvic floor physical therapists (PTs) can work together to support sexual health. Drs. Adams and Hoover presented a case study of a woman who struggled with penetrative sex, tampon use, and pelvic exams. Using this case as an example, they explained how pelvic floor PTs can determine whether the pelvic floor muscles are tight or weak, which can affect sexual function. PTs primarily aim to address the patient's chief complaint, which may include sexual pain or incontinence. They can use several tools, such as dilators, vibrators, biofeedback, and electrical stimulation, to help improve blood flow, stretching, and muscle strength.

Beyond physical symptoms, a heightened nervous system may also contribute to pelvic floor dysfunction. The brain and pelvic floor are closely connected. If a person has experienced negative events resulting in hypervigilance, their pelvic floor muscles may become tighter and more rigid. Calming these responses may help relax the pelvic floor. In the case study, the patient struggled with anxiety, fear, avoidance, trauma, and sexual confidence. The PTs determined that she would struggle with stretching and muscle exercises but was able to connect with her breathing.

Drs. Adams and Hoover were able to treat the patient by addressing the full picture. Mental health professionals can help address nervous system-related elements of pelvic floor dysfunction that hinder sexual wellness. PTs can help address body confidence concerns and other pelvic floor-related issues that may affect mental health through negative feedback loops. Drs. Adams and Hoover emphasized the importance of time, patience, and education in helping the patient adapt to treatment and home exercises. Through gradual treatment and patient education, the woman was eventually able to tolerate dilators, use tampons, and complete a pelvic exam.

Drs. Adams and Hoover recommended shifting the focus to how a patient's brain and environment may be interfering with sexual function.

On Thursday, October 8, at the 27th Annual SMSNA Fall Scientific Meeting, Aleece Fosnight, MSPAS, PA-C, CSE, MSCP, IF, HAES, explained the evidence supporting interventions that can be individualized for each menopausal person. Fosnight invited attendees to consider menopausal sexual function differently. All systems interact to create sexual function, and nonhormonal strategies can help target the "bottleneck" that may be preventing satisfying sex. She emphasized that menopause care is outcome-specific and that not every nonhormonal treatment will be beneficial for everyone.

Fosnight encouraged providers to ask better questions when taking a patient's history. Was there a medication change? Are there new or existing symptoms? What kind of distress may be causing problems, and which symptoms do not need to be addressed immediately? She explained that if an intervention is beneficial to the patient, it should be considered in treatment recommendations. For example, sleep is important for everyone, but weight gain is not a concern for every woman. Fosnight also reminded attendees that nonhormonal pharmacological treatments should be prescribed for specific conditions, such as hypoactive sexual desire disorder and genitourinary syndrome of menopause.

Fosnight encouraged providers to let what is truly bothering their patients guide treatment decisions. Pelvic floor therapy may work for one woman, but not for everyone. Improving sleep may also benefit some women without making a noticeable difference for others. Her final recommendation for providers was to ask what changed, find the bottleneck, match the intervention, and measure what matters. Outcomes should reflect the patient's specific goals.

On Thursday, October 8, at the 27th Annual SMSNA Fall Scientific Meeting, Dr. Nahid Punjani highlighted differences in life expectancy between men and women, both in the United States and across the globe. His data showed that women tend to live longer than men. He says that introducing a Men's Health Program or an Office of Men's Health may encourage greater engagement between men and the healthcare system. Men's health has fewer dedicated resources within the US government than women's health. A centralized Office of Men's Health would combine resources from other projects related to men's health, creating opportunities to improve men's life expectancy.

Dr. Punjani says this difference may be related to men's and women's healthcare habits. Men tend to use healthcare services and obtain health insurance less often than women. They also tend to sleep less, smoke cigarettes and consume alcohol more often, and visit the doctor less frequently. According to Dr. Punjani, rates of drug- and alcohol-induced diseases are significantly higher in men than in women.

Dr. Punjani says urologists and other healthcare providers are stewards of care because when men come into the office with penile or sexual dysfunction concerns, providers have an opportunity to direct them to appropriate care. Conditions like erectile dysfunction (ED) are associated with cardiovascular disease. If a man presents with ED, he may also have underlying health issues that could reduce his life expectancy.

In the age of artificial intelligence and the internet, patients will likely come to their provider with a preconceived idea of what their lesions, rashes, discoloration, ulcers, irritation, or changes in skin texture mean. Providers should be prepared to not only confirm or deny their patients’ assumptions but also explain what the patient is experiencing and help provide next steps. This article intends to parse through the various skin conditions patients could present with.

Sexual aids, also known as sex toys, have been used clinically and personally by both men and women throughout history. Earliest accounts of sex toys include phallic-looking devices made of wood or stone. While commonly discussed in the context of pornography and women’s spaces, men also benefit from sexual aids, and their providers should be knowledgeable about how they can have satisfactory sex.

Peyronie’s disease (PD) occurs in up to 18% of men and is characterized by the development of fibrous plaque on the tunica albuginea in the penis. This plaque, often caused by microtrauma from surgery, sex, or other experiences, can cause the penis to curve or deform when erect.

Pelvic surgery is an option for patients who may have cancer or other issues in the bowel, urinary system, reproductive system, or prostate. The pelvic region – including the pelvic floor muscles (PFMs) – consists of structures important to bowel, urinary, and sexual function. Any trauma to the area, including surgery, may cause postoperative dysfunction and therefore worsen the patient’s quality of life immediately following surgery.

Peptides are naturally occurring chains of amino acids, which have been used for health and wellness treatments. The current most popular peptides are glucagon-like peptide 1 class (GLP-1s), although gonadotropin-releasing hormone (GnRH) agonists and antagonists have been in use for prostate cancer management since the 1980s and 2000s, respectively.

On Friday, May 15, during the SMSNA 31st Annual Scientific Program at AUA, a debate ensued involving Drs. Jeffrey Loh-Doyle and Niki Parikh, where they considered whether penile implants should be placed in anticoagulated patients.

Dr. Loh-Doyle, with the counterpoint of view, acknowledges that implants can still be placed in patients on anticoagulants with few adverse events, but states plainly that it should not be done. He says those who operate on anticoagulated patients are more aware of the potential adverse events that could happen, which may skew results. Dr. Loh-Doyle states the chance of a post-operative hematoma may be high, with one study suggesting anticoagulants should be restarted as soon as possible after penile surgery. Several other studies have instead proved this wrong, Dr. Loh-Doyle says. He states that a cardiologist appointment and diagnosis should take priority. He says penile implants are elective and should be treated as such if there is time for it.

Dr. Parikh, with the pro point of view, states there is a clear correlation between erectile dysfunction and cardiovascular disease. She says the risk of complications with stopping anticoagulants can be fatal. Several studies have looked into the potential negative effects of anticoagulants with inconclusive results. Dr. Parikh states that in her study, those with anti-coagulated systems and coagulated patients actually performed better than the control. She states part of what brought success was keeping the IPP partially inflated post-op and returning the patient to a high-volume physician.

Should anticoagulated patients be operated on?

On Friday, May 15, during the SMSNA 31st Annual Scientific Program at AUA, Dr. Jessica Yih discussed alternative options for the treatment of low sexual desire in both men and women.

Dr. Yih stresses that low libido and hypoactive sexual desire disorder (HSDD) are extremely common. This can be related to testosterone; however, testosterone may not always be effective in treating these sexual dysfunctions.

Dr. Yih discussed the potential negative side to GLP-1 receptor agonists, as they may impair sexual function across multiple areas, especially low libido and orgasmic disorder. This is likely due to rapid weight loss and serotonergic effects of these medications. '

Scream creams and vaginal estrogen are useful but should be used carefully in treating non-libido-related sexual dysfunction first. Scream creams have inconsistent dosages and may be more difficult to come by.

Bremolanotide is historically used to treat women. However, more men are approaching their clinicians to ask about it. Unfortunately, the intranasal formulation was barred for use with men by the FDA; however, it could be helpful in creating sexual desire and arousal for men and women of all ages. Flinbanserin is approved for HSDD in premenopausal women, but with further investigation may be useful in the future.

Dr. Yih urges clinicians to consider patients' current medication when diagnosing and treating sexual dysfunction. Be aware of GLP-1 medications, be careful with scream creams and vaginal estrogen so as to target their non-libido-related sexual dysfunction, and start prescribing bremolanotide to all patients.

On Friday, May 15, during the SMSNA 31st Annual Scientific Program at AUA, Dr. Carolyn Salter discussed lesser-used hormone therapies for sexual function.

Dr. Salter discussed DHEA with regard to the previous controversy, as brought forth by the FDA, and concerns over testosterone and body composition changes. Tests in both young and older men have shown DHEA can be effective in short-term use cases, although not much research has been conducted. 5 alpha reductase inhibitors may worsen sexual dysfunction and do not improve testosterone levels.

SARMs are currently not FDA-approved and are designed to mimic testosterone. SARMs have had significant patient satisfaction and public interest, despite adverse effects and increased risk for infertility, body composition changes, and lack of improvement.

Dr. Salter does not recommend 5-alpha reductase inhibitors and advises caution with regard to SARMs and DHEA.