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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)

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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)


How Does Obesity Affect Sexual Function?

Jun 27, 2017

How Does Obesity Affect Sexual Function?

Obesity rates are increasing around the world. In fact, an estimated 1 billion people are considered overweight, and 300 million are obese.

Past research has shown an association between obesity and sexual problems. But just how does obesity contribute to sexual dysfunction? To address this question, researchers reviewed scientific databases and published their findings in Sexual Medicine Reviews.

They explained several ways extra weight might lead to sexual problems:

  • Biological mechanisms. Having excess fat tissue can disrupt hormonal and chemical processes needed for good sexual function. For example, fat tissue may be linked to lower levels of an enzyme needed for the production of nitric oxide, an important neurotransmitter for erections.
  • Comorbidities. Many obese people also have conditions that can cause sexual dysfunction, including metabolic syndrome, diabetes, and heart disease. For instance, men with diabetes are more likely develop erectile dysfunction (ED) than non-diabetic men. And they often start having trouble with erections at an earlier age. Diabetic women often have trouble with desire, arousal, and vaginal lubrication.
  • Psychological and emotional factors. In many cultures, “thin is in.” Obese men and women might be viewed as unattractive and are often the subject of cruel jokes and discrimination, which can damage their body image and self-esteem. Their ability to participate in everyday activities might be restricted by their weight. Or, they may shy away from socializing or seeking sexual partners. Overall, depression and anxiety related to obesity can take a toll on sexual health.

Often, a combination of factors is involved. For example, an obese man with ED might feel self-conscious about his weight and his erection troubles. He may also feel anxious about his attractiveness and about pleasing his partner. Thus, both physical and psychological factors can contribute to his ability to perform sexually.

Can weight loss help? It might. Following a healthy diet and exercising regularly can help lower one’s risk for diabetes and heart disease, which in turn could improve sexual function. Studies of bariatric surgery and sexuality have had encouraging results.

The review authors called on healthcare providers and therapists to address sexual health concerns in overweight and obese patients.

“Not only might they – in a non-castigating and supporting manner – point out the biological and psychological effects that decrease the desire for sexual engagement and sexual response, but they also are well-positioned to discuss other health-related complications from obesity,” the authors wrote.


Sexual Medicine Reviews

Rowland, David L, PhD, et al.

“Sexual Function, Obesity, and Weight Loss in Men and Women”

(Full-text. Published online: April 26, 2017)


Benzocaine Wipes Might Help Men with Premature Ejaculation

Jun 13, 2017

Benzocaine is a local topical anesthetic commonly used to treat pain or itching. Previous studies have tested topical anesthetics before, but those therapies were not found to be effective.

This study involved 21 men with premature ejaculation who were in heterosexual, monogamous relationships. Fifteen of them were assigned to use benzocaine wipes; the rest used placebo wipes with no anesthetic. The men also answered questions about their sexual function.

After two months, the men using the wipes saw improvements in their ejaculatory time, with many of them taking two minutes or longer to climax. These men also said they could better control their ejaculation and felt less sexual distress and more sexual satisfaction when compared to the placebo group.

"This study is encouraging in demonstrating a new and innovative way to reduce the symptoms of premature ejaculation," said AUA spokesperson Tobias S. Köhler, MD, MPH, FACS. "Premature ejaculation can cause a variety of issues related to negative feelings and emotions that can lead to problems with sexual relationships. This data shows topical 4% benzocaine wipes is a promising therapy to treat the most common form of sexual dysfunction among men."

While the study results are encouraging, benzocaine is still not an approved treatment for PE. Men who have trouble with ejaculation should see their urologist.

The study was funded by the Veru Healthcare, the manufacturer of the benzocaine wipes.


American Urological Association

“Study Demonstrates Effectiveness of Topical 4% Benzocaine Wipes to Improve Symptoms of Premature Ejaculation”

(Press release. May 13, 2017)

“'Special wipes' may curb premature ejaculation”

(May 16, 2017)

HealthDay via Renal & Urology News

“Topical 4% Benzocaine Wipes Can Reduce Premature Ejaculation Symptoms”

(May 18, 2017)

The Journal of Urology

Shabsigh, Ridwan, et al.

“PD69-02 Double-Blind, Randomized Controlled Trial of Topical 4% Benzocaine Wipes for Management of Premature Ejaculation: Interim Analysis”

(Abstract. April 2017)

Mayo Clinic

“Benzocaine (Topical Application Route)”

(Last updated: March 1, 2017)

« Previous 1 2 (page 2 of 2)


Yoga May Help Prostate Cancer Patients Cope with Radiation Side Effects

May 24, 2017

Yoga May Help Prostate Cancer Patients Cope with Radiation Side Effects

Men coping with side effects from prostate cancer treatment might want to consider taking a yoga class.

In a recent study, men who practiced yoga while receiving external beam radiation therapy became less fatigued than men who didn’t. Their sexual and urinary function remained stable, too.

External beam radiation therapy uses high-energy beams to weaken cancer cells’ ability to divide and grow. While the therapy is effective, many men experience side effects, including fatigue, sexual problems (such as erectile dysfunction), and trouble with urination.

Fifty men with localized prostate cancer participated in the study. (Their cancer had not spread to other parts of the body.) All of them underwent external beam radiation therapy for six to nine weeks. During this time, twenty-two men attended yoga classes twice a week. Twenty-eight did not.

The men in the yoga group practiced the Eischens type of yoga, which focuses more on energy than other types. Each 75-minute session included a variety of poses in sitting, standing, and reclining positions. The men used props, and poses were modified as needed.

Shortly before the study began and throughout the study period, all the men completed questionnaires designed to assess their levels of fatigue, sexual function, urinary function, and quality of life.

The men had similar levels of fatigue at the start of the study. Over time, however, the men in the yoga group had less fatigue while the men who did not practice yoga became more fatigued.

“Levels of patient-reported fatigue are expected to increase by around the fourth or fifth week of a typical treatment course, but that did not happen in the yoga group,” lead researcher Neha Vapiwala, MD, an associate professor of radiation oncology at the Perelman School of Medicine at the University of Pennsylvania said in a news release.

“Both the severity of the fatigue as well as the patients’ ability to go about their normal lives appeared to be positively impacted in the yoga group,” Dr. Vapiwala added.

Erectile function appeared to be somewhat better for the yoga group, too. The research team used the International Index of Erectile Function (IIEF) questionnaire to assess this aspect of the men’s sexual health. The IIEF is scored on a 1 – 25 point scale. Men with scores under 12 points are usually diagnosed with moderate to severe ED. In this study, scores for men in both groups were around 11 points starting out. Over time, scores for the men in the yoga group stayed roughly the same, but men in the non-yoga group saw their scores decrease.

Urinary function seemed to be better for men in the yoga group, too. It’s possible that strengthening pelvic floor muscles through yoga could help both sexual and urinary function, Dr. Vapiwala suggested.

As treatment continued, both groups of men improved in their emotional well-being, although this result happened more quickly for the yoga group.

The study was published online by the International Journal of Radiation Oncology, Biology, and Physics in March as an article in press.



Preidt, Robert

“It's Yoga to the Rescue for Prostate Cancer Patients”

(April 13, 2017)

International Journal of Radiation Oncology, Biolog7, and Physics

Ben-Josef, Avital Mazar, DMD, E- RYT, et al.

“Impact of Eischens Yoga During Radiation Therapy on Prostate Cancer Patient Symptoms and Quality of Life: A Randomized Phase II Trial”

(Article in press. Abstract. Published online: March 30, 2017)

Mayo Clinic

“External beam radiation for prostate cancer”

(May 18, 2016)


Mulcahy, Nick

“Really, Men With Prostate Cancer Do Yoga”

(April 18, 2017)

Penn Medicine News

“Clinical Trial Shows Benefit of Yoga for Side Effects of Prostate Cancer Treatment”

(News release. April 6, 2017)

MacMillan, Amanda

“Yoga May Help the Side Effects of Cancer Treatment”

(April 10, 2017)


Survey: Condom Use Rates are Low in the U.S.

May 09, 2017

Survey: Condom Use Rates are Low in the U.S.

Only one in four Americans between the ages of 18 and 44 used a condom the last time they had sex, according to a recent survey.

Condom use among people at high risk for HIV is also low, the survey revealed.

Condoms are known to reduce the risk of unplanned pregnancy and transmission of sexually transmitted infections (STIs), like HIV, chlamydia, and syphilis. But how prevalent is condom use?

Researchers analyzed data from the National Survey of Family Growth, which has been collecting information on marriage, divorce, family life, and reproductive health in the United States since 1973. For this study, the researchers focused on the 2006 – 2010 and 2011 – 2013 survey cycles.

In particular, the researchers looked at data for heterosexuals between the ages of 18 and 44 who had had vaginal or anal sex within the year before their survey interview. In total, the respondents included 13,588 women and 10,904 men, and answers pertained only to their last sexual encounter.

They also considered “HIV-related sexual risk behaviors,” which included sex with four or more opposite-sex partners, sex in exchange for money or drugs, sex with an injection drug user, sex with an HIV-positive partner, and sex with a partner who had had other partners. Men who had sex with men and women who had sex with men who had sex with men were also considered at higher risk.

Overall, the rate of condom use was just under 25%. For those who reported at least one risky behavior, the rate was 34%.

Younger people were more likely to use condoms, the researchers noted, perhaps because public health campaigns promoting safe sex are often targeted to this age group. “Continued efforts are needed for sexual health promotion in older individuals,” they wrote.

Condom use was also higher among single respondents; 51% of single men and 37% of single women said they had used a condom the last time they had had sex. The rate for married or cohabitating men was 16%; for women, it was 13%. Couples in committed relationships might be less likely to use condoms because they are trying to conceive, using other forms of birth control, or in monogamous relationships.

Regardless of marital status, healthcare providers should counsel patients on condom use, especially if they engage in high risk sexual behaviors, the authors said, explaining that women should be able to negotiate condom use if necessary.

The researchers also expressed concern that condom use was lower for those who had anal sex. People may not think they need condoms for anal sex, since it cannot lead to pregnancy. But they might not know that STIs can still be spread through anal sex.

The researchers acknowledged some limitations. For example, respondents who did not use condoms at their last sexual encounter could still be regular condom users.

Still, the authors saw a need for continued education on condom use, especially people at risk for HIV, those who engage in anal sex, and those with many sex partners.

The study was published last month in the Journal of Sexual Medicine.


Centers for Disease Control and Prevention/National Center for Health Statistics

“About the National Survey of Family Growth”

(Page last updated: May 13, 2016)

The Journal of Sexual Medicine

Nasrullah, MD, MPH, PhD, et al.

“Factors Associated With Condom Use Among Sexually Active US Adults, National Survey of Family Growth, 2006–2010 and 2011–2013”

(Full-text. April 2017)


Americans Are Having Less Sex Nowadays

Apr 25, 2017

Americans Are Having Less Sex Nowadays

A new study in the Archives of Sexual Behavior has found that Americans are having less sex than they did two decades ago. And partnered people – those who are married or living together - have seen a significant decline in sexual frequency.

The findings are based on data from the General Social Survey (GSS). Started in 1972, the GSS tracks sociological trends in the United States, addressing topics like crime, finances, civil liberties, and stress. This particular study involved 26,620 Americans who participated in the survey between 1989 and 2014.

Overall, the study found that during between 2010 and 2014, Americans had sex nine fewer times each year compared to the period of 1995 to 1999. This was the case for all genders and races and in all areas of the country. Educational level and work status did not appear to make a difference either.

Other key findings include the following:

·         The largest drop in sexual frequency occurred among people in their 50s, those who had children in school, and those who did not watch pornography.

·         Millennials and the following generation (iGen or Generation Z) had less sex than their counterparts born in the 1930s did at the same age.

·         On average, twentysomethings had sex over 80 times each year. This rate fell to about 60 times for people in their mid-40s and 20 times for those in their mid-60s.

·         Respondents had sex most often around age 25. After that, frequency decreased by about 3.2% each year.

·         Sexual activity declined for partnered people, which “[reduces] the marital/partnered advantage,” the authors wrote.

“These data show a major reversal from previous decades in terms of marriage and sex,” lead author Jean M. Twenge said in an interview with San Diego State University. Dr. Twenge is a professor of psychology at that school.

“In the 1990s, married people had sex more times per year than never-married people, but by the mid-2000s that reversed, with the never-married having more sex,” she added.

Why are Americans having less sex? The study didn’t specify a cause, but the authors did suggest some possibilities, including more time with other forms of entertainment, like social media and technology. Depression might also be a factor, especially when antidepressants can have sexual side effects.

The study authors also explained that fewer Americans are in couples nowadays and single people tend to have sex less often.

Interestingly, longer work hours and use of pornography were not associated with a decline in sexual activity, according to the study. In fact, respondents who worked longer hours tended to have more sex.


Archives of Sexual Behavior

Twenge, Jean M., et al.

“Declines in Sexual Frequency among American Adults, 1989–2014”

(Published online: March 6, 2017)

National Opinion Research Center (NORC) at the University of Chicago

“About the GSS”

The New York Times

Haag, Matthew

“It’s Not Just You. Americans Are Having Less Sex.”

(March 8, 2017)

San Diego State University

Jacobs, Gina

“New Study Shows Americans are Having Sex Less Often”

(March 7, 2017)

Washington Post

Bahrampour, Tara

“Americans are having less sex than they once did”

(March 7, 2017)


BPH Drugs Associated with Higher Risk of Depression and Self-Harm but Not Suicide

Apr 12, 2017

BPH Drugs Associated with Higher Risk of Depression and Self-Harm but Not Suicide

Men who take certain medications for an enlarged prostate or hair loss could be at higher risk for depression and self-harm, according to new research published in JAMA Internal Medicine.

However, they are not at higher risk for suicide, the study suggests.

The drugs in question are known as 5-alpha-reductase inhibitors (5ARIs) and are often prescribed for each condition. Two examples are finasteride and dutasteride.

When a man has an enlarged prostate (also called benign prostatic hyperplasia or BPH) the tissue of his prostate gland grows inward. Sometimes, it grows so much that it squeezes the urethra, making urination difficult.

Interest in 5ARIs and men’s mental health has been present for several years, with both the U.S. Food and Drug Administration (FDA) and Health Canada expressing concerns. But little was known about the potential link.

For this study, researchers used medical databases to identify 93,197 men in Ontario who had filled a prescription for an 5ARI between 2003 and 2013. All of the men were over 66 years old.

The researchers then identified an equal number of men of the same age who had not filled a 5ARI prescription. These men matched the first group in age, health status, and use of other medications.

They found that the men who took 5ARIs were at higher risk for self-harm during the first 18 months after they started the drug. This risk appeared to drop after the 18-month point.

Similarly, the men who took 5ARIs were also at higher risk for depression.

After 18 months, depression risk decreased, although it was still higher than the depression risk among men who didn’t take 5ARIs.

While the study shows an increased risk for self-harm and depression, the overall risk is actually quite low. Lead author Dr. Blayne Welk of Ontario’s Western University and the Institute for Clinical Evaluative Sciences told Reuters Health that “you’d need 470 men to take this medication for a full year to have a new case of depression.”

Overall, the study authors concluded that the benefits of 5ARIs “likely” outweigh the risks. However, men taking these medications should be aware of these side effects and seek help immediately should they start feeling depressed.

“The relatively small magnitude of these risks should not dissuade physicians from prescribing these medications in appropriate patients. This research may help physicians counsel patients on the risks of 5ARIs,” the authors wrote.


JAMA Internal Medicine

Welk, Blayne, MD, MSc, et al.

“Association of Suicidality and Depression With 5α-Reductase Inhibitors”

(Full-text. March 20, 2017)

Reuters Health

Seaman, Andrew M.

“Prostate, hair loss drugs tied to mental health risk, but not suicide”

(March 21, 2017)


Past Childhood Experiences Could Influence Sexual Satisfaction in Adulthood

Mar 29, 2017

Past Childhood Experiences Could Influence Sexual Satisfaction in Adulthood

When someone has a sexual problem, it’s not unusual for there to be lots of factors involved. There could be a medical issue, relationship strain, or miscommunication between partners. Sometimes, events that take place during childhood come into play.

Many sex therapy patients work through past childhood sexual abuse. But can other childhood experiences add to sexual problems? Recently, scientists addressed this in relation to sexual satisfaction in the Journal of Sexual Medicine.

The researchers focused on what they called cumulative adverse childhood experiences (CACEs). While such experiences do include sexual abuse, they also include other negative experiences caused by adults:

·         Physical abuse – slapping, burning, hitting, kicking, pushing, and shoving

·         Psychological abuse – ridiculing, humiliating, making the child feel unimportant

·         Psychological neglect – ignoring the child

·         Physical neglect – shutting the child in a room for a long duration, refusing to provide food, clean clothing, baths, and medical care

Witnessing violence between parents (or caretaking adults) and bullying by other children also fall into the CACE category.

Three hundred seven people took part in the study. All of them were sex therapy clients and their average age was 38 years. Fifty-five percent were women. The participants were seeking help for a variety of sexual issues, including low desire, erectile dysfunction, premature ejaculation, and problems with orgasms and sexual pain.

The group completed a number of medical questionnaires designed to assess CACEs (experiences before age 18), psychological health, and relationships. The participants’ feelings about their own sexual relationships were evaluated with a tool called the Global Measure of Sexual Satisfaction (GMSEX). Scores on this questionnaire can range from 5 to 35. Higher scores on the GMSEX mean greater sexual satisfaction.

The researchers found that 58% of the women and 52% of the men had at least four types of CACEs. Sexual satisfaction was similar for both men and women, with average GMSEX scores of 21 points.

The results could help sex therapists better understand their patients’ backgrounds, the authors suggested, noting that a “one-size-fits-all approach to sexual difficulty treatment, especially in CACE survivors, might not be optimal.”

They added that future research could concentrate on how CACEs affect the sex lives of couples as well as individuals.


The Journal of Sexual Medicine

Bigras, Noémie, MA, et al.

“Cumulative Adverse Childhood Experiences and Sexual Satisfaction in Sex Therapy Patients: What Role for Symptom Complexity?”

(Full-text. Published online: February 12, 2017)


About 2 in 3 Women Would Take a Sex Health Drug

Mar 21, 2017

About 2 in 3 Women Would Take a Sex Health Drug

Are women interested in sexuality-boosting medication? And if so, what results would they like to see? These questions and more were the focus of a survey published recently in the Journal of Sexual Medicine.

While sex health drugs like Viagra have been available for men for several years, medications for women are fairly new. Generally, women’s sexual problems have been treated with counseling and therapy.

In August 2015, the U.S. Food and Drug Administration (FDA) approved flibanserin (Addyi) for the treatment of hypoactive sexual desire disorder (HSDD). Women with HSDD struggle with low libido that can’t be explained by another medical condition or a medication they’re taking. The situation causes great distress and can affect a woman’s personal relationships.

Despite its goal of improving sexual desire in women with HSDD and increasing the number of positive sexual encounters, flibanserin has not been widely used. This study assessed women’s feelings about sexuality boosting medication.

The researchers surveyed 159 women in Switzerland. The women ranged in age from 18 to 73 years with an average age of 32 years. They answered a wide range of questions about their sex lives, relationships, and personalities. They also answered questions on their willingness to take a sex health drug and what they would expect from such a medication.

Sixty-one percent said they were open to the idea, and women with poorer sexual function were more likely to feel this way. Of those who would not take a sex health drug, 45% said they did not want to use a medication for sexual purposes and 35% said they were satisfied with their level of sexual desire, so they would have no need for a drug.

When asked which particular aspects of sex they would like to see enhanced, orgasm frequency and intensity were the two top responses. Increased desire was another concern. Overall, about three-quarters said they would like to improve their sexual satisfaction and almost half hoped they could have more fun during sex.

The researchers found that women who were more conscientious were less willing to take a sex health drug, in contrast to less conscientious women who were more willing. The latter group might have had a “more flexible and spontaneous mindset,” the authors noted.

The researchers were unsure whether medications for sexual problems would become the norm, however.

“In recent decades, the female sexual dysfunction treatment paradigm has been mostly limited to cognitive-behavioral psychotherapy, and according to our study data, it is still doubtful whether expanding it to include drug treatment would provide additional benefits,” they wrote.


The Journal of Sexual Medicine

Gutsche, Melanie, MSc and Andrea Burri, PhD

“What Women Want—An Explorative Study on Women's Attitudes Toward Sexuality Boosting Medication in a Sample of Swiss Women”

(Full-text. Published online: January 24, 2017)


After-Sex Antibiotic Could Reduce STI Rates

Mar 07, 2017

After-Sex Antibiotic Could Reduce STI Rates

Taking the antibiotic doxycycline within 72 hours of condomless sex might reduce the risk of sexually-transmitted infections (STIs) in men who have sex with men (MSM), according to a new study.

The findings, presented last month at the 2017 Conference on Retroviruses and Opportunistic Infections in Seattle, found that risk was cut by 47%. But the researchers cautioned that more study is needed before this strategy can be recommended to doctors and patients.

The study involved 232 MSM who did not have HIV, but were taking on-demand medications for HIV prevention. Half of the men were instructed to take two 100-mg pills of doxycycline within 72 hours of having sex without a condom, not exceeding 6 pills per week. The other half did not take doxycycline. All of the men were given condoms and received safe sex counseling. Every eight weeks, they were tested for HIV, gonorrhea, chlamydia, and syphilis. The median follow-up time was 8.7 months.

Overall, 73 patients contracted a bacterial STI – 28 in the doxycycline group and 45 in the non-treatment group. 71% of the STIs were asymptomatic, which means that the men did not have any symptoms, nor did they feel sick.

Seven of the men in the doxycycline group developed chlamydia infections, compared to 21 in the non-treatment group. Three men taking doxycycline developed syphilis, compared to 10 in the non-treatment group.

Rates of gonorrhea were not much different between the groups, with 25 men in the doxycycline group and 22 in the non-treatment group developing infections.

Side effects did not appear to be a problem for either group, although more men in the doxycycline group experienced gastrointestinal pain, nausea, or vomiting.

There is still more to learn about the protocol, however. Scientists are not sure how well the strategy would work over a longer term. Also, it is unclear whether antibiotic resistance would be a problem and, if so, to what extent.



Newman, Emily

“Research shows 47% reduction in STIs among gay men who took doxycycline after sex”

(February 16, 2017)

Conference on Retroviruses and Opportunistic Infections 2017

Molina, Jean-Michel, et al.

“On Demand Post Exposure Prophylaxis with Doxycycline for MSM Enrolled in a Prep Trial”

(Abstract 91LB. Presented February 16, 2017)

Medscape Medical News

Boerner, Heather

“Antibiotics After Sex Nearly Halves Incidence of STIs”

(February 16, 2017)


FDA Approves Intrarosa for Sexual Pain in Postmenopausal Women

Feb 21, 2017

FDA Approves Intrarosa for Sexual Pain in Postmenopausal Women

Postmenopausal women who experience moderate to severe pain during intercourse may have a new treatment option.

Last November, the U.S. Food and Drug Administration (FDA) approved a drug called Intrarosa (prasterone) for sexual pain caused by vulvar and vaginal atrophy (VVA) due to menopause.

When a woman goes through menopause, her body starts producing less estrogen, a hormone that keeps the vagina and vulva healthy. In particular, estrogen helps keep the vagina flexible and lubricated during sex.

For many women, declining estrogen levels bring about cellular changes to the vagina and vulva, leaving them dry and brittle. With poorer lubrication and less elasticity in the vagina, intercourse can become uncomfortable or painful.

The active ingredient in Intrarosa is the hormone dehydroepiandrosterone (DHEA), which changes to estrogen. The drug is administered as a daily vaginal insert. In general, women are advised to place one insert into the vagina each night at bedtime, using a special applicator.  

The effectiveness of Intrarosa was tested in two 12-week clinical trials of 406 postmenopausal women between the ages of 40 and 80 who had moderate to severe pain during intercourse. The women were randomly assigned to try Intrarosa or a placebo insert. Those who used Intrarosa reported less severe sexual pain.

The most common side effects were vaginal discharge and an abnormal Pap smear.

Women who have vaginal bleeding should talk to their doctor before using Intrarosa. In addition, women who have a history of breast cancer should not use Intrarosa at all.

The FDA warns that while Intrarosa contains DHEA and has been approved to treat sexual pain in postmenopausal women, other products containing DHEA, such as dietary supplements, have not.

“The efficacy and safety of those products have not been established for diagnosing, curing, mitigating, treating, or preventing of any disease,” the agency said in a press statement.


Mayo Clinic

“DHEA – Background”

(Last updated: July 1, 2014)

MedPage Today

Walker, Molly

“FDA Approves Intrarosa for Sexual Symptoms of Menopause”

(November 17, 2016)

“Vulvar and Vaginal Atrophy”

(June 26, 2013)

U.S. Food and Drug Administration

“FDA approves Intrarosa for postmenopausal women experiencing pain during sex”

(News Release. November 17, 2016)

"Full Prescribing Information”

(Revised: November 2016)


Heat-activated Penile Implant Could Be Available in 5 – 10 Years

Feb 07, 2017

Heat-activated Penile Implant Could Be Available in 5 – 10 Years

Scientists have created a heat-activated penile implant that, in time, could be an additional option for men with erectile dysfunction (ED).

ED – the inability to get and keep an erection firm enough for sex - is a common problem for men, especially as they get older. It is often a complication of other medical conditions, like diabetes or heart disease. Men may also develop ED after cancer treatment or an injury to the genitals.

Several ED treatments are available, including oral medications like Viagra, Levitra, and Cialis. However, these medications do not work for all men, and some patients cannot take them because of interactions with other drugs. Injections, suppositories, vacuum devices are alternatives, but they aren’t suitable for all men.

When these ED treatment options aren’t viable, many men turn to penile implants. Nowadays, the most popular type of implant an inflatable device. Spongy tissue in the penis is replaced with cylinders. When a man wants an erection, he activates a special pump in the scrotum, which fills the cylinders with fluid. When he is finished with sexual activity, he can deactivate the pump and the penis goes flaccid again.

While effective, inflatable implants require a rather complicated surgical process because they have separate components. Placing the heat-activated implant could be simpler, scientists say.

The new implant is made from a nickel-titanium alloy called Nitinol, a flexible metal with other medical applications. For example, stents – tubes used to keep arteries open – are sometimes made of Nitinol.

Nitinol’s chemical properties allow it to “remember” a different shape and assume that shape when heated. In the case of a penile implant, a man would wave a remote-control device over his penis when he wanted an erection. The device would heat the implant to a temperature just a few degrees above the man’s normal body temperature, causing the implant to expand in length and girth. The device would then be deactivated when desired.

Study co-author Brian Le of the University of Wisconsin-Madison and his colleagues are now working on the remote-control device. If further studies and trials are successful, the implant could be available in five to ten years.

“We’re hoping that, with a better device, a better patient experience, and a simpler surgery, more urologists would perform this operation, and more patients would want to try the device, “Dr. Le said in a university press release.

Results of the scientists’ work with a Nitinol prototype implant were published online in September in the journal Urology.


University of Wisconsin-Madison

Smith, Susan Lampert

“Heat-activated penile implant might restore sexual function in men with E.D.”

(December 28, 2016)


Le, Brian, et al.

“A Novel Thermal-activated Shape Memory Penile Prosthesis: Comparative Mechanical Testing”

(Full-text. Published online: September 14, 2016)


Radiation to Penile Bulb Might Result in Severe ED, Study Suggests

Jan 24, 2017

Radiation to Penile Bulb Might Result in Severe ED, Study Suggests

Erectile dysfunction (ED) is a common side effect of radiation therapy for prostate cancer. However, new research suggests that avoiding the penile bulb – the base of the penis – during treatment might decrease ED severity.

The study, sponsored by the Institute of Cancer Research (ICR) in London, focused specifically on image-guided radiation therapy (IGRT). This type of therapy uses images of the prostate to help doctors pinpoint exactly where the radiation should be targeted, improving the accuracy of the treatment.

Could aiming for – or avoiding – certain areas affect a man’s erections after treatment? Researchers turned to a larger study on prostate cancer (the CHHiP trial) to learn more.

They looked at data from a subgroup of 182 men who had localized prostate cancer. (Localized means that prostate cancer cells had not spread to other parts of the body.) None of the men had ED before undergoing IGRT. Between 35 and 55 months after treatment, the men completed questionnaires related to their sexual health and erections.

The scientists also wanted to know how much radiation each man had received on his penile bulb. This information was available for 90 men.

Forty-one men from this group had severe ED after IGRT. They also had the highest amounts of radiation directed at the penile bulb.

The findings suggest that avoiding the penile bulb during IGRT would have sexual benefits for men with localized prostate cancer. However, the results need to be validated with more research, the authors said.

“While finding new and better treatments for men with prostate cancer is important, it’s also essential that we find ways of diminishing the side-effects of these treatments,” said researcher David Dearnaley in an ICR news article.

Professor Dearnaley is Professor of Uro-Oncology at the ICR and Consultant Clinical Oncologist at The Royal Mardsen hospital

He added, “Erectile dysfunction can be very distressing for the patients I deal with every day. If doctors can plan radiotherapy treatment so that it avoids the penile bulb – the area at the base of the penis – we may have a real chance of reducing the severity of erectile dysfunction in these patients.”

The study was published in the International Journal of Radiation Oncology in October 2016.


American Cancer Society

“Radiation therapy for prostate cancer”

(Last revised: March 11, 2016)

“Bulb of penis”

(Reviewed: March 31, 2015)

The Institute of Cancer Research

“Avoiding penile bulb with radiotherapy could save men with prostate cancer from harmful side-effects”

(November 28, 2016)

International Journal of Radiation Oncology

Murray, J., et al.

“Effect of Dose and Image Guided Radiation Therapy (IGRT) on Patient-Reported Sexual Function in Prostate Radiation Therapy”

(Full-text. October 1, 2016)

Memorial Sloan Kettering Cancer Center

“Image-Guided Radiation Therapy”

(Last updated: April 21, 2016)

Prostate Cancer News Today

Fernandes, Joana, PhD

“Prostate Radiation Therapy Induces Changes in Penile Bulb, Causing Erectile Dysfunction”

(December 5, 2016)


What Should Physical Therapists Know About Female Sexual Pain?

Jan 09, 2017

What Should Physical Therapists Know About Female Sexual Pain?

Understanding the biopsychosocial aspects of sexual pain could help physical therapists treat women, according to a recent study in Sexual Medicine Reviews.

Female sexual pain is a common – but complex - problem for women. Physical causes can include gynecological, urinary, gastrointestinal, and muscular problems. Sometimes, a combination of these factors leads to sexual pain.

Cultural and religious beliefs may also be involved. Women may not feel comfortable with the ideas of discussing or treating sexual pain. Healthcare providers may feel uncomfortable too, and they might not refer patients to appropriate specialists.

The study authors pinpointed several areas to consider when assessing and treating female sexual pain.

First, a complete physical examination that includes the vaginal, rectal, vulvar, and anal areas is essential. Other medical conditions, such as hormonal and autoimmune disorders should also be evaluated.

Providers should also consider how the central nervous system responds to the anticipation of pain. If a woman perceives a threat to her body, her central nervous system may react with a “protective pain response that is unrelated to the health of the pelvic muscles, skin or the visceral systems and might be the driving force in the perpetuation of hypersensitivity,” the authors explained.

Second, it is important for patients to feel some hope that their pain can be successfully treated. Choosing certain words to describe the pain, such as persistent instead of chronic is one approach.

Third, taking a complete patient history can provide helpful clues that can inform treatment. “Through a careful history, the clinician might be able to identify personal challenges or threats that were present for the patient when the pain began,” the authors noted. A number of validated assessment tools can be used as well.

Fourth, patients can benefit from understanding pain biology and, in turn, re-think their responses to pain and become less fearful. “Educating patients about pain can change their pain levels more than any current modality for persistent pain,” the authors wrote.

They suggested that physical therapists undergo further training in these areas so that they can address the many complexities of female sexual pain.


Sexual Medicine Reviews

Vandyken, Carolyn, PT, Cred MDT, CCMA (Acup) and Sandra Hilton, PT, DPT, MS

“Physical Therapy in the Treatment of Central Pain Mechanisms for Female Sexual Pain”

(Published online: August 3, 2016)


Kink-oriented Individuals Address Healthcare Concerns

Dec 19, 2016

Kink-oriented Individuals Address Healthcare Concerns

Individuals who engage in kink sexual behaviors can have special healthcare needs, but they may not always see a doctor because of the stigma associated with kink sexuality, experts report.

The word kink is used to describe sexual activities outside the mainstream. These activities can include bondage, discipline, domination and submission as well as sadism and masochism. Sometimes the acronym BDSM is used to refer to these activities.

Kink sexual practices often involve power roles, with one participant taking a dominant or “top” role, while the other is in a more submissive or “bottom” position. Activities are always between consenting adults, and the specifics are usually negotiated between partners. However, some activities, such as punching or whipping, can cause injury or increase the risk of sexually-transmitted infections or blood-borne illnesses.

Seeking care for kink-related health concerns can be a challenge for those who participate. Recently, a team of healthcare providers and researchers formed the Kink Health Project to learn more about the kink community and their experience with medical care in the San Francisco Bay area.

The team conducted focus groups and interviews with 115 kink-orientated individuals between the ages of 23 and 69. The participants’ average age was 46 years. Forty-four percent of them had seen a doctor for a kink-related issue. Among those who had a primary doctor, only 38% had revealed their kink orientation to that doctor.

Bruising and open wounds were some of the more common kink-related health concerns. For example, one participant mentioned using a knife to scratch his partner, causing moderate bleeding. Others reported having multiple partners and non-traditional social structures, such as non-monogamous relationships, that healthcare providers might not understand.

Often, participants preferred to seek medical advice within the kink community rather than from a doctor. Many were afraid of being judged for their behavior. Some would lie to doctors about the source of their concerns. For example, one man told his doctor that his bruises were caused by rugby.

Fear of being investigated for abuse was a serious concern among the participants. “I know that what I’m doing is safe and consensual,” one woman explained, “but I worry if I ever went to the doctor and was covered with bruises they would not understand that they were consensual behaviors.”

However, many participants reported positive experiences with their doctors. One woman described her OB/GYN, who was open to explaining what types of kink activities would be safe during pregnancy.

The authors acknowledged that their findings may not apply to all everyone who engages in kink behaviors. “San Francisco is well known for its sexual open-mindedness, and we could have encountered different results if we had conducted the study in other parts of the United States or in other nations,” they wrote.

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


The Journal of Sexual Medicine

Waldura, Jessica F., MD, et al.

“Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients”

(Full-text. First published online: October 27, 2016)


Study Examines Body Esteem in Female Survivors of Childhood Sexual Abuse

Dec 06, 2016

Study Examines Body Esteem in Female Survivors of Childhood Sexual Abuse

Body esteem tends to be lower in women who have been sexually abused as children, experts say. And this lower esteem can lead to more inhibited sexual responses.

Similar to self-esteem, body esteem refers to how people feel about their body. Do they feel attractive and healthy? Or do they find fault with certain body parts? These are common questions, but for women with a history of childhood sexual abuse, body esteem is particularly important. Studies have shown that women in this category feel less attractive than women without a history of abuse.

A new study, recently published in the Journal of Sexual Medicine, examined how body esteem influenced feelings about sex in women with and without a history of childhood sexual abuse.

Two hundred twenty-two women participated in the study. One hundred thirty-nine of them had a history of childhood sexual abuse, defined as any unwanted sexual contact before the age of 18. The remaining 83 women had not experienced sexual abuse as children. The women ranged in age from 18 to 64; their average age was 34 years.

The participants completed several questionnaires concerning their experiences with childhood sexual abuse, depression, body esteem, and feelings about sex.

When compared to the women who had not been abused, those with an abuse history were more likely to feel depressed and have significantly lower body esteem, especially in terms of sexual attractiveness. They also tended to feel more inhibited about sex.

It’s possible that the abused women had lower body esteem because they associated specific body parts with the abuse, the authors noted.

They added that women who have experienced sexual abuse often feel anxious and fearful in sexual situations, which might prompt them to “avoid the threat.”

The authors acknowledged some limitations in their research. For example, they did not assess to what degree a woman’s religious beliefs affected her attitudes toward sex. They also did not know if women received counseling for childhood sexual abuse before the study.

Comparing these results to those of women who had been abused (but not sexually) during childhood might provide further insights, they said.

The authors also suggested that healthcare providers who work with adult survivors of childhood sexual abuse consider building positive body esteem into their treatment plans.


The Journal of Sexual Medicine

Kilimnik, Chelsea D., MSc and Cindy M. Meston, PhD

“Role of Body Esteem in the Sexual Excitation and Inhibition Responses of Women With and Without a History of Childhood Sexual Abuse”

(Full-text. First published online: September 27, 2016)


Survey Addresses Patients’ Views on Sexual Health

Nov 22, 2016

Survey Addresses Patients’ Views on Sexual Health

How important is sexual health and satisfaction to a person’s quality of life? The answer depends on age, gender, sexual activity status, and overall health, according to a new study in the Journal of Sexual Medicine.

Sexual dysfunction - such as erectile dysfunction (ED) in men and painful intercourse for women – are common, especially for people with medical conditions like diabetes, heart disease, cancer, high blood pressure, depression, and anxiety. But sexual problems aren’t always discussed during doctor’s appointments. Some assume that doctors or patients will bring up the subject if it’s really important.

The importance of sex to one’s overall well-being hasn’t been widely studied by medical researchers. A group of American scientists decided to learn more.

They asked 3,515 people to complete an online questionnaire. The group was almost equally split between men and women, and their average age was 49.

Importance of Sexual Health

Among the entire group, about 43% of the women and 62% of the men said that sexual health was important to their quality of life. Participants who were in better overall health tended to rate sexual health as important, too.

Respondents who were not sexually active were less likely to consider sexual health to be highly important.

The researchers also examined how specific health conditions (arthritis, rheumatism, cancer, heart disease, depression, anxiety, diabetes, and high blood pressure) affected the respondents’ views. However, none of these conditions influenced the ratings.

Sexual Satisfaction

What factors contributed to satisfaction with one’s sex life? To find out, the authors analyzed information from the 55% of the men and 45% of the women who said they’d been sexually active within the last month. Findings were based on scores on one portion of the questionnaire designed to evaluate sex life satisfaction.

They found that people in their mid-to-late thirties were the most satisfied with their sex life. After age 70, satisfaction rates decreased. Health status was also an important factor, as people who rated their overall health as excellent were more satisfied than those who said they were in fair or poor health.

Certain health conditions did influence satisfaction with one’s sex life. High blood pressure was the biggest factor for women. For men, depression and anxiety had the greatest impact on satisfaction.

The authors pointed out that physical health isn’t the only factor that determines satisfaction with one’s sex life. Beliefs on what makes a satisfying sex life are quite personal, they noted.

Race was a factor only for men. Latino and Hispanic men were more likely to say sexual health was highly important, and black men had better scores on the sex life satisfaction assessment.

The survey results can be useful for healthcare providers, the authors explained, recommending that practices have “resources in place” to address patients’ sexual health issues.

“These resources should be available for all patients across the lifespan,” they added.   


The Journal of Sexual Medicine

Kathryn E. Flynn, PhD, et al.

“Sexual Satisfaction and the Importance of Sexual Health to Quality of Life Throughout the Life Course of U.S. Adults”

(Full-text. Published online: September 23, 2016)


Can Disclosing a Sexual Assault Help a Woman’s Sexual Functioning?

Nov 08, 2016

Can Disclosing a Sexual Assault Help a Woman’s Sexual Functioning?

It’s not uncommon for women to have sexual problems after a sexual assault. However, new research suggests disclosing the assault to someone might alleviate those problems to some extent.

Experts estimate that between 13% and 45% of women will be the victim of an adult sexual assault (ASA) at some point in their lives. ASA is defined as “any unwanted or non-consensual sexual experience” occurring after age 14.

But not all women tell others about their assault. Some worry that others won’t believe them or that they’ll be blamed for what happened.

Some women find that their sexual interest wanes after ASA. They might have trouble becoming aroused or reaching orgasm. Or sex might be painful. These issues might last for years.

Researchers from the University of Washington in Seattle wanted to know more about how disclosing an assault might affect a woman’s sexual health later on. They recruited 652 women between the ages of 21 and 30 to participate in an online survey. About three-quarters of the women had experienced a sexual assault. Of these, 83% had disclosed the assault to someone.

The scientists found that disclosing the assault could indirectly help with sexual function by lessening the impact of trauma symptoms. It’s possible that exposure to positive sexual experiences could create a “corrective learning experience” for the women, in which they can focus on the positive aspects of sex.

More research is still needed, the authors added. Future studies might focus on ASA victims’ feelings about non-penetrative sexual activities, such as oral sex. They might examine whether the time frame between assault and disclosure plays a role or how the reactions to the disclosures might ultimately affect the women.


The Journal of Sexual Medicine

Staples, Jennifer M., MS, et al.

“Sexual Assault Disclosure and Sexual Functioning: The Role of Trauma Symptomatology”

(Full-text. Published online: August 30, 2016)


FDA Announces New Testosterone Labeling Rules

Nov 01, 2016

FDA Announces New Testosterone Labeling Rules

Labels on all testosterone products must now include information about the risk of abuse, according to a ruling issued by the U.S. Food and Drug Administration (FDA) last week.

The agency explained that the labeling change stems from published literature and case reports on the abuse of testosterone and other anabolic androgenic steroids.

Produced by the testes, testosterone is an important hormone for men. It creates and maintains many of their masculine characteristics, including facial hair, muscle mass, and a deep voice. It is also involved with sex drive and erections.

Doctors may prescribe testosterone when men’s bodies don’t produce enough of it on their own. For example, certain genetic conditions, chemotherapy, infection, and injury to the testes can all affect a man’s testosterone production. Currently, the FDA approves the use of testosterone for men in these situations.

However, testosterone levels naturally decline as men get older. As a result, men may feel weak, fatigued, and irritable. They may also lose interest in sex and have problems getting erections. Sometimes, doctors prescribe testosterone to treat these symptoms.

Some men abuse testosterone, taking more than the recommended dose and/or taking it with other anabolic androgenic steroids. Some athletes and bodybuilders take testosterone or other drugs to enhance their performance.

The FDA reports that testosterone abuse can damage the heart, brain, liver, and the endocrine system. It may also affect a man’s mental health.

“Reported serious adverse outcomes include heart attack, heart failure, stroke, depression, hostility, aggression, liver toxicity, and male infertility,” the FDA said in a press statement, adding that men undergoing withdrawal from testosterone may have symptoms such as “depression, fatigue, irritability, loss of appetite, decreased libido, and insomnia.”

The FDA also advised healthcare providers to measure a man’s testosterone if they suspect he is abusing the hormone.


Rettner, Rachel

“Prescription Testosterone Gets New Warning”

(October 25, 2016)


MD Magazine

Black, Ryan

“FDA Announces Stern New Warning Labels for Testosterone Treatments”

(October 25, 2016)



Brooks, Megan

“FDA Adds New Warnings to All Testosterone Product Labels”

(October 25, 2016)



Clarke, Toni

“U.S. FDA adds abuse warning to prescription testosterone”

(October 25, 2016)


U.S. Food and Drug Administration

“FDA approves new changes to testosterone labeling regarding the risks associated with abuse and dependence of testosterone and other anabolic androgenic steroids (AAS)”

(Press statement. October 25, 2016)


Women’s Sexuality Affected by Body Image and Relationship Quality, Study Says

Oct 18, 2016

Women’s Sexuality Affected by Body Image and Relationship Quality, Study Says

A woman’s acceptance of her body and the quality of her relationship with her sex partner may influence her overall sexual function, according to a new study.

Researchers from Germany noted that good sexual health involves a person’s “emotional, mental, and social well-being” and is so much more than simply physical function. To learn more, they designed a study to examine the roles of body image and partnership quality.

The participants were 2,685 women age 35 or under who were medical students in Germany, Austria, and Switzerland. Their average age was 24 years. Each woman completed an anonymous online questionnaire and answered questions about their age, weight, relationship status, partnership quality, physical health, smoking status, alcohol use, history of pregnancy, and use of birth control pills.

The assessment included the Female Sexual Function Index (FSFI), a tool that is often used in medical research on female sexuality. The FSFI includes questions on a woman’s experiences with desire, arousal, vaginal lubrication, sexual satisfaction, pain, and orgasm during the previous four weeks. Lower scores on the FSFI correspond with poorer sexual function.

Also included was a questionnaire called the Self-Acceptance of the Body Scale, designed to help researchers learn about a person’s feelings about his or her own body. The woman were asked to rate their agreement with certain statements, such as “I would like to change certain parts of my body” and “I am satisfied with my appearance.”

The women categorized their relationship status using one of four terms: enamoredness, love, friendship, or conflicted.

Ninety-two percent of the women had been sexually active within the previous four weeks and almost three-quarters of them had been in a steady relationship during the previous six months. Based on FSFI scores, about 39% could be considered to have a sexual dysfunction. However, some experts feel that FSFI scores are not useful for women who are not sexually active. With this in mind, the researchers based their analysis only on sexually active women.

In this group, women who were in a steady partnership and had greater body self-acceptance tended to have higher FSFI scores. Those who called their relationship “enamored” or “loving” had the highest FSFI scores of all.

Single women and those who classified their sexual relationships as “friendship” or “conflicted” had lower FSFI scores.

While a cause and effect relationship could not be determined from the data, the researchers suggested that good relationships and positive body self-acceptance could act as “buffers” in certain situations. For example, single women and those in conflicted relationships might have better sexual function if they have a high degree of body self-acceptance. And having a good, steady relationship might contribute to better sexual function in women with low body self-acceptance.

Helping young women develop a positive body image might ultimately improve their sexual health, the authors wrote.

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


The Journal of Sexual Medicine

Wallwiener, Stephanie, MD, et al.

“Sexual Function Is Correlated With Body Image and Partnership Quality in Female University Students”

(Full-text. Published online: August 26, 2016)


Glaucoma and Erectile Dysfunction (ED) May Be Linked

Oct 04, 2016

Glaucoma and Erectile Dysfunction (ED) May Be Linked

Researchers from the University of British Columbia in Canada have found a link between glaucoma and erectile dysfunction (ED) – the inability to get and keep an erection firm enough for intercourse.

The study, published recently in the Journal of Glaucoma, found that men with glaucoma are over two and a half times more likely to have ED than men without the eye disease.

Glaucoma is the result of damage to the optic nerve, which is connected to the retina. When a person sees an image, the retina sends a message to the brain. The brain uses this information to interpret what is being seen. Glaucoma is often caused by excess fluid at the front of the eye, which increases pressure. But it can also be caused by inflammation and eye injury.

The scientists collected data from 128 men over age 40 who were patients at an ophthalmology clinic. Sixty-one men had open-angle glaucoma, the most common type. The remaining 67 patients did not have glaucoma.

Each man completed a questionnaire called the Index of Erectile Dysfunction (IIEF), which is commonly by scientists to assess sexual function.

Based on IIEF scores, the researchers determined that 40% of the men with glaucoma had ED. Severity of both conditions was correlated – the more severe the glaucoma, the more severe the ED.

The researchers also considered other factors that can contribute to ED, such as diabetes, high blood pressure, high lipid levels, and smoking, but the association between glaucoma and ED remained.

The findings do not mean that glaucoma causes ED or vice versa. It simply means that there is an association.

It was not clear why the two conditions were related, but the scientists thought that inflammation in the blood vessels could be involved. Problems with blood flow can cause problems with the eyes and with erections.


American Academy of Ophthalmology

Boyd, Kierstan

“Causes of Glaucoma”

(December 29, 2015)


Boyd, Kierstan

“What Is Glaucoma?”

(January 10, 2015)


Journal of Glaucoma

Law, Geoffrey BScH, et al.

“Correlation in Severity Between Glaucoma and Erectile Dysfunction”

(Abstract. September 2016)


National Post

Blackwell, Tom

“Glaucoma and impotence unexpectedly linked in new study from UBC”

(August 29, 2016)


Does a Man’s Sexual Interest Affect His Partner’s Sexual Function?

Sep 21, 2016

Does a Man’s Sexual Interest Affect His Partner’s Sexual Function?

How might a man’s sexual issue affect the sexuality of his female partner? It’s a complicated question, but a new study by Italian scientists suggests that the way women perceive their partner’s sexual interest could be a factor.

Past research has focused on sexual problems like erectile dysfunction (ED), premature ejaculation (PE), and delayed ejaculation (DE) and their effects on women’s sexual health. However, for many of these studies, the focus was on diagnosing and treating a man’s sexual problem.

In this study, the researchers wanted to know more about how a man’s sexual factors – considered from a woman’s point of view – might influence female sexual function.

The study involved 156 heterosexual women who had been in a stable relationship during the previous six months. On average, the women were around 47 years old; their partners’ average age was 50. Eighty-three percent of the couples were living together.

Each woman completed a questionnaire called the Female Sexual Function Index (FSFI). This is one of the most common tools used to assess female sexual problems, covering the domains of sexual desire, arousal, vaginal lubrication, orgasm, pain, and overall sexual satisfaction. Higher scores on the FSFI mean better sexual function.

The women also had physical exams and answered questions about their psychological well-being, sexual desire, lifestyles, medications, and relationships with their partners.

About 37% of the women had a partner with a sexual problem. About a third felt their partner had lost his desire for them. Almost a quarter of the partners had ED, 14% had PE, and 8% had delayed ejaculation.

After analyzing the data, the researchers discovered that FSFI scores tended to go down when the couple had disagreements and did not live together. Scores also went down when women had intercourse just to please their partner.

In contrast, FSFI scores generally increased when women had intercourse more often or when they were trying to conceive a child.

Women who perceived low desire in their partner had lower FSFI scores overall as well as in the arousal, lubrication, orgasm, satisfaction, and pain domains. However, no correlation was found between FSFI scores and a partner’s problems with erectile dysfunction, premature ejaculation, or delayed ejaculation.

In addition, women who felt their partner had less sexual interest tended to masturbate more often, have intercourse less often, and feel that the man did not care about the woman’s sexual pleasure.

“It can be speculated that erectile function and ejaculatory behavior are not the most pressing concerns in the perspective of women with [female sexual dysfunction],” wrote the study authors. “Conversely, among factors related to their partner’s sexuality, feeling unloved and/or undesired is the main determinant of sexual impairment.”

The study was published online in July in the journal Andrology.



Maseroli, E., et al.

“Which are the male factors associated with female sexual dysfunction (FSD)?”

(Full-text. First published: July 13, 2016)


Dapoxetine is Safe and Effective for Premature Ejaculation, Study Says

Sep 08, 2016

Dapoxetine is Safe and Effective for Premature Ejaculation

A drug called dapoxetine is a safe, effective method for treating premature ejaculation (PE), according to a team of Turkish researchers.

However, acupuncture could be a viable treatment, too, they noted.

Their study, published online in April in Urologica Internationalis, compared two dose levels of dapoxetine to acupuncture.

PE is one of the most common sexual problems for men. In general terms, it occurs when a man ejaculates before he and his partner wish it to happen. The International Society for Sexual Medicine (ISSM) defines two types of PE. Men with lifelong PE ejaculate within a minute of vaginal penetration and have done so since their first sexual experience. Those with acquired PE typically ejaculate within three minutes of penetration, but have not had the condition all their lives.

The ISSM definition also notes that men with PE are not able to delay the timing of ejaculation and feel distress over their situation.

There are several approaches for treating PE, including medication, sex therapy, and topical treatments that can be applied directly on the penis.

Acupuncture has been practiced in Chinese medicine for over 2,500 years. It involves restoring the balance of energy in the body through the manipulation of tiny needles placed in the skin in certain strategic areas called acupoints. This approach has not been widely studied for treatment of PE.

To learn more, the researchers worked with 120 men with lifelong PE. On average, the participants were in their thirties and had been married for four to five years.

One of the ways experts assess premature ejaculation is by calculating the intravaginal ejaculatory latency time (IELT). Couples measure IELT themselves, using a stopwatch during intercourse.

For this study, men and their partners measured IELT before the study began and again a month later. At these times, the men also completed questionnaires designed to evaluate their ejaculatory function.

The men were randomly assigned to one of four treatment groups. One group took 60 mg of dapoxetine on demand (one to three hours before having sex); another took 30 mg of the drug. A third group had twice-weekly acupuncture sessions. The fourth received “sham” acupuncture, during which a specialist used needles, but did not penetrate the skin. The treatment period lasted for four weeks.

Men who took 60 mg of dapoxetine saw the biggest improvements, with longer IELTs and improved scores on the PE questionnaire. Men who took 30 mg of the drug had the next-best improvements, followed by the men in the acupuncture group and those in the sham group.

Common side effects with dapoxetine included nausea, dizziness, diarrhea, insomnia, and headache.

However, the men who received acupuncture or sham treatment reported no side effects.

The absence of side effects could make acupuncture a “plausible” PE treatment, even if it wasn’t as effective as dapoxetine. But more research is needed, the authors said.

“To the best of our knowledge, this is the first report to compare acupuncture and dapoxetine in the treatment of PE and we think that our results will bring a new perspective to treatment decisions,” they wrote.

It should be noted that dapoxetine is not available in the United States, nor has it been approved for use in that country.  


Urologica Internationalis

Sahin S., et al.

“A Prospective Randomized Controlled Study to Compare Acupuncture and Dapoxetine for the Treatment of Premature Ejaculation”

(Full-text. First published online: April 7, 2016)


Men with Penile Implants Seem Satisfied With Treatment

Aug 16, 2016

Men with Penile Implants Seem Satisfied With Treatment

Men who receive penile implants for erectile dysfunction (ED) appear to be more satisfied with their treatment compared to those who try other therapies, according to a new study published in Andrology.

Men with ED – the inability to get and keep an erection firm enough for intercourse – have a variety of treatment options available to them. This study, conducted by researchers in Turkey, compared the effectiveness of and satisfaction with three types:

·         Oral medication. Drugs called phosphodiesterase type 5 (PDE5) inhibitors are usually the first treatment urologists try with their ED patients. These medications relax smooth muscle tissue in the penis and allow more blood to flow in when a man is sexually stimulated. In this study, the drug tadalafil was used.

·         Self-injection.Sometimes, oral medications either don’t work or aren’t feasible. (For example, men who take nitrates for heart disease should not take PDE5 inhibitors.) In those cases, patients might try self-injection therapy. Men inject medication into the base of their penis shortly before they’d like to have sex. The drug then triggers an erection.

·         Penile implants (prostheses).  If the above methods don’t work out, men may decide to have a penile prosthesis implanted. The penis contains two areas of spongy tissue called the corpora cavernosa, which fill with blood and give the penis the firmness it needs for an erection. In an inflatable implant procedure, these two areas are replaced with two cylinders that can fill with a reserve of saline solution when a man presses on a special pump. (Less often, malleable rods are implanted, allowing the man to raise and lower his penis by hand as needed.)

The researchers collected data from 356 men with an average age of 52 years. All of the men had ED.

The participants were divided into four groups and followed these treatment protocols for the next twelve weeks:

·         132 men (37%) took 20 mg of tadalafil twice a week.

·         106 men (30%) took 5 mg of tadalafil once a day.

·         96 men (27%) underwent injection therapy.

·         22 men (6%) underwent implant surgery (inflatable prostheses).

The men completed questionnaires that assessed their erectile function and treatment satisfaction. The satisfaction of the men’s partners was also evaluated.

Overall, the men who had penile implants had more improvement in erectile function than the men who took tadalafil (both groups) and those who used injection therapy.

In addition, the men in the implant group – and their partners – appeared to be more satisfied with their treatment than those in the other groups.

The authors reported that in general, satisfaction rates for penile implants are above 90% for both men and their partners.

However, they added that more research is needed to confirm the results of this study.



Kucuk, E. V., et al.

“Erectile dysfunction patients are more satisfied with penile prosthesis implantation compared with tadalafil and intracavernosal injection treatments”

(Full-text. First published: July 1, 2016)


Older Men May Benefit from Testosterone Treatment

Aug 03, 2016

Older Men May Benefit from Testosterone Treatment

Older men with low testosterone could see improvements in sexual symptoms with testosterone therapy, according to the results of a recent trial.

Men’s testosterone levels gradually decline as they get older. It’s a natural part of aging. But for many men, this hormonal drop leads to fatigue, weakness, and decreased muscle mass. Men might feel moody or depressed.

Their sex lives may also be affected. Men with low testosterone can have low libido and erectile dysfunction (ED).

The trial involved 470 men aged 65 or older who lived in the United States. The participants’ average age was around 71 years old. All of them were experiencing low sex drive and had low testosterone, defined as measurements below 275 ng/dL. In addition, all of the men had regular sexual partners. About 60% of the men were obese and about a third had diabetes. Over 70% of them had high blood pressure.

For the next year, roughly half the group applied a daily dose of testosterone gel to their skin. This dose was adjusted as necessary to keep testosterone levels within the range considered normal for younger men. The other half also received a gel, but it was a placebo and did not contain testosterone. None of the men knew whether they were receiving testosterone or not.

The men’s testosterone levels were checked regularly. They also filled out questionnaires to assess their sexual activities and function.

The researchers found that the men in the testosterone group had more sexual interest, more frequent intercourse, and better erectile function than the men in the placebo group.

These improvements continued through the twelve-month treatment period. Improved desire and more frequent sexual activity seemed to be linked to the degree of testosterone increase.

Still, the researchers did not find a specific threshold measurement for these improvements. In other words, they did not see that a man’s sexual interest and activity got better once his testosterone levels reached a certain measurement point.

The study was first published online in June in the Journal of Clinical Endocrinology & Metabolism.


The Journal of Clinical Endocrinology & Metabolism

Cunningham, Glenn R., et al.

“Testosterone Treatment and Sexual Function in Older Men with Low Testosterone Levels”

(Full-text. First published online: June 29, 2016)


No Connection Found Between Testosterone Therapy and Risk of Aggressive Prostate Cancer

Jul 19, 2016 TRT is a popular approach to treating low levels of testosterone, an important hormone for men. When a man has low testosterone, he may feel tired, weak, and depressed. He may lose interest in sex or develop erection problems.

Sometimes, men have low testosterone because of medical conditions that interfere with its production. But men can also develop low testosterone as a result of normal aging.

That’s because men’s testosterone levels naturally decline as they get older. The goal of testosterone therapy, which can be administered through gels, patches, and injections, is to bring a man’s testosterone levels back to a normal range.

Some experts have been concerned about TRT and prostate cancer risk, as testosterone can fuel the growth of prostate cancer cells.

To learn more, a group of American and Canadian researchers examined data from two Swedish databases related to prostate cancer and prescriptions, including testosterone.

They identified 38,570 cases of prostate cancer diagnosed between 2009 and 2012. They also looked at data from 192,838 men without prostate cancer.

Prescriptions for TRT were filled by 284 men with prostate cancer before their cancer diagnosis. TRT prescriptions were filled by 1,378 men who did not have prostate cancer.

The scientists found no connection between TRT and prostate cancer risk. They did discover that “favorable risk” prostate cancer (disease that is not aggressive and does not necessarily need immediate treatment) was more common among men who had had TRT. But these men may have gone to the doctor more often and had early biopsies, which could have increased the odds of finding cancer earlier.

Results related to aggressive prostate cancer were different, however. Men who had taken testosterone for a year or longer had their risk of aggressive disease cut in half. The researchers did not expect this finding and noted that more study is needed.

“Overall, our study suggests that what is best for men’s health is to keep testosterone levels balanced and within a normal range,” said lead investigator Stacy Loeb, MD, MSc of the NYU Langone Medical Center in a press release.

The findings were presented in May at the American Urological Association’s annual meeting in San Diego, California,


AUA 2016

Loeb, Stacy, MD, MSc, et al.

“Testosterone Therapy and Prostate Cancer Risk”

(Abstract presented at the annual meeting of the American Urological Association, May 9, 2016, San Diego, California)

NYU Langone Medical Center

“Testosterone Therapy Does Not Raise Risk of Aggressive Prostate Cancer, Study Suggests”

(Press release. May 9, 2016)


Men with ED More Likely to Have Hip Fractures, Study Reports

Jul 04, 2016

Men with ED More Likely to Have Hip Fractures, Study Reports

Men with erectile dysfunction (ED) have greater chances of getting a hip fracture than men with normal erections, according to new research out of Taiwan.

It might seem like ED and hip fracture wouldn’t have much in common. But the connection might start with coronary heart disease, which occurs when fat deposits called plaques build up on artery walls, restricting blood flow. Both ED and hip fractures are more common in people with coronary heart disease.

Using information from Taiwan’s National Health Insurance Database, scientists analyzed the medical claims records of over 23,000 men. They identified 4,636 men who were diagnosed with ED between 1996 and 2010. They also chose 18,544 men around the same age to serve as a comparison group. All of the men were age 40 and older; their average age was 58 years.

They discovered that 1.27% of the men with ED later had a hip fracture, compared to 0.75% of the men without ED. And overall, the men with ED were over three times more likely to develop a hip fracture. This likelihood increased with age.

Other medical conditions, like high cholesterol, diabetes, and osteoporosis were more common in the men with ED. About two-thirds of these men had high blood pressure. Rates of testosterone use were also higher in the ED group.

Men with ED tended to develop hip fractures in a shorter amount of time, too. Five years was the average; for men without ED, the average was almost eleven years.

Why did men with ED have a greater risk for hip fracture? The researchers weren’t entirely sure, but suggested that imbalance of hormones, such as testosterone, might be one explanation. Men with low testosterone often develop muscle weakness, which can make them more prone to falling.

Other possible explanations could involve osteoporosis, depression, vitamin D deficiency, and heart disease, the authors noted. But further research is needed.

The authors recommended that men with ED have their bone mineral density checked and be careful about falling, especially if they are over 40 years old.

The study was published online in April in PLOS One.


American Heart Association

“Coronary Artery Disease - Coronary Heart Disease”

(Updated: May 20, 2016)


Wu, Chieh-Hsin, at al.

“Hip Fracture in People with Erectile Dysfunction: A Nationwide Population-Based Cohort Study”

(April 14, 2016)

Renal and Urology News

Persaud, Natasha, et al.

“ED Patients at Higher Risk of Hip Fracture”

(April 26, 2016)


New Research on Adult-Onset Hypogonadism Provides “Conceptual Framework” for Healthcare Providers

Jun 21, 2016

A new literature review published today in Mayo Clinic Proceedings provides some insight into adult-onset hypogonadism (AOH), a condition in which middle-aged and older men have low levels of testosterone.

The research project is the result of a colloquium held in Washington DC last summer by the Sexual Medicine Society of North America (SMSNA). At that meeting, seventeen experts in the fields of men’s health, sexual medicine, urology, endocrinology, and methodology discussed the diagnosis and management of AOH as well as the reasons a physician might consider testosterone therapy for men with AOH.

The goal of the resulting study was to “support health care professionals in the development of a deeper understanding of AOH, particularly in how it differs from classical primary and secondary hypogonadism, and to provide a conceptual framework to guide its diagnosis, treatment, and follow-up.”

Primary hypogonadism occurs when a man’s testes do not function properly and, therefore, cannot produce adequate amounts of testosterone. Secondary hypogonadism is caused by problems in areas of the brain responsible for testosterone production.

A man’s testosterone levels naturally decline as he ages. But declines in testosterone are also associated with other conditions that are common in older men, like metabolic syndrome, diabetes, hypertension, and obesity.

Testosterone levels can also be affected by certain drugs, like anabolic steroids, opioids, tricyclic antidepressants, nicotine, and marijuana.

Men with low testosterone often experience sexual dysfunction, including low libido, erectile dysfunction, or delayed ejaculation. They may also feel fatigued, weak, and depressed.

Treatment of low testosterone sometimes includes lifestyle changes (like losing weight) and managing the comorbidities that could be contributing factors (such as keeping blood sugar under control).

Testosterone replacement therapy is currently approved by the U.S. Food and Drug Administration (FDA) for primary and secondary hypogonadism, but not adult-onset hypogonadism. In 2015, the FDA called for labeling changes on FDA-approved testosterone products as well as further research, as concerns had been raised about the therapy and cardiovascular risk.

In the study, the authors discuss research on the safety of testosterone therapy, noting that low testosterone is associated with an increased risk for heart disease.

They added that testosterone treatment does not increase a man’s risk for prostate cancer. Also, there is no evidence showing that testosterone therapy worsens an enlarged prostate or related urinary symptoms.

“Clinical evidence supports the authenticity of [adult-onset hypogonadism] and its health relevance,” the authors wrote in their conclusion.

“Importantly, improved clinical management can be expected to result from ongoing rigorous investigation of diagnostic criteria and demonstration of efficacy and safety of treatments for this syndrome,” they said.

Patients concerned about low testosterone are encouraged to see their healthcare provider for a complete check-up.


Mayo Clinic Proceedings

Khera, Mohit, MD, MBA, MPH, et al. “Adult-Onset Hypogonadism”

(Full-text. June 21, 2016)


Surgeons Perform First Penis Transplant in the U.S.

Jun 07, 2016

Surgeons Perform First Penis Transplant in the U.S.

The operation took about 15 hours and involved over a dozen surgical specialists. But in the end, a medical team from Massachusetts General Hospital in Boston performed the first penis transplant in the United States.

The patient, 64-year-old Thomas Manning, was recovering well when the announcement was made on May 16th. His body was not rejecting the new penis, there were no signs of infection, and blood was flowing properly.

Mr. Manning had had his penis amputated because of penile cancer, which was discovered after a work accident in 2012. Left with a short stump, he had to sit down to urinate and could not perform sexually at all.

His doctors say they are “cautiously optimistic” that he will recover his sexual function eventually. However, his urinary function is expected to return to normal and the penis should look like his natural genitals.

The transplanted penis came from a deceased donor who had the same blood type and skin tone as Mr. Manning.

As a transplant recipient, Mr. Manning will need to take immunosuppression drugs for the rest of his life. These medications ensure that his body does not reject the new penis.

Surgeons Curtis L. Cetrulo, Jr., MD and Dicken S.C. Ko, MD had been studying the feasibility of a penis transplant for over three years, with assistance from urologists, nurses, social workers, psychiatrists, and other professionals at the hospital.

After completing a successful hand transplant, the team began preparing for a penis transplant. They studied the intricate connection of tissues, blood vessels, and nerves, practicing their technique on cadavers.

Genital injuries can be devastating for men, both physically and psychologically. Damage to their “manhood” can make them feel less complete.

“We are hopeful that these reconstructive techniques will allow us to alleviate the suffering and despair of those who have experienced devastating genitourinary injuries and are often so despondent they consider taking their own lives,” said Dr. Cetrulo in a press release.

In his own statement, Mr. Manning said, “Today, I begin a new chapter filled with personal hope and hope for others who have suffered genital injuries, particularly for our service members who put their lives on the line and suffer serious damage as a result.”

He added, “In sharing this success with all of you, it’s my hope we can usher in a bright future for this type of transplantation. Thank you.”

Two other penis transplants have been performed worldwide, but only one has been successful. That patient, a 21-year-old man from South Africa, was able to impregnate his girlfriend just months after surgery.



Goldschmidt, Debra and Nadia Kounang

“Doctors perform first U.S. penis transplant”

(May 16, 2016)

Massachusetts General Hospital

“First Genitourinary Vascularized Composite Allograft (Penile) Transplant in the Nation Performed at Massachusetts General Hospital”

(Press release. May 16, 2016)

“MGH Genito-Urinary Vascularized Composite Allograft (Penile) Transplant FAQs”

“Patient Statement”

The New York Times

Grady, Denise

“Man Receives First Penis Transplant in the United States”

(May 16, 2016)


Anatomy Could Be a Key to Orgasm

May 31, 2016

Anatomy Could Be a Key to OrgasmFor many people, reaching orgasm is one of the goals of a sexual experience. But not everyone gets there, even with the “right” amount of stimulation and excitement. Many factors can be involved, including relationship stress, depression, and side effects of medications. However, a recent study published in Clinical Anatomy suggests that a person’s physical makeup plays a role, too.

Researchers from the Mayo Clinic and the Indiana University School of Medicine reviewed medical studies to see just how anatomy affected orgasms.

In a press release, lead author Dr. Elizabeth Emhardt posed the research question: “Sexual experiences are assumed to be in your control based on your attitude: your confidence, your ability to trust, your openness. What if variations in sexual anatomy actually set the foundation for differences in sexual experience, and we aren't in control of our sexual experiences as much as we once thought?”


Might your anatomy be one key to a satisfying orgasm? (Click to tweet)


The scientists found that for men to achieve orgasm, two types of nervous systems need to be in balance. One is the parasympathetic nervous system (sometimes called the “rest and digest” system), which controls the body’s functions while at rest. The other is the sympathetic nervous system, from which the “fight or flight” response originates. When these two systems are not aligned, men can experience sexual problems, sure as premature ejaculation.

For women, orgasms seem to depend more on physical structures. Many women reach orgasm with stimulation of the clitoris, a small genital organ full of sensitive nerves. The clitoris moves closer to the vaginal wall during sex. But if it doesn’t get close enough, the likelihood of orgasm is reduced.  

Similarly, the size of the clitoris can be important too. Research published in 2014 found that women with a smaller clitoris had more trouble reaching orgasm.

Ultimately, people are individuals with a number of anatomical variations. And orgasms are complex. Couples may need to experiment with different sexual positions and activities to discover what works best for them. Understanding each other’s anatomy may be one place to start.


“Do Differences in Anatomy Matter for Achieving Orgasm?”

(Press release. April 5, 2016)

Clinical Anatomy

Emhardt, E., et al.

“Anatomic variation and orgasm: Could variations in anatomy explain differences in orgasmic success?”

(Full-text. April 4, 2016)

“Parasympathetic vs. Sympathetic Nervous System”

Medical Daily

Dovey, Dana

“The Big O: Physiological Reasons Why You May Have Orgasmic Dysfunction”

(April 8, 2016)

“Size and Location of Clitoris May Affect Orgasm”

(November 12, 2014)


For Certain Men, Testosterone Therapy Might Be Good for the Heart

May 10, 2016

Testosterone replacement therapy might reduce the risk of heart attacks and strokes in older men with both low testosterone and coronary artery disease, a new study finds.

Produced by the testes, the hormone testosterone contributes much to a man’s masculinity. It’s responsible for increased his muscle mass, deeper voice, and facial hair. It’s also important for his sex drive and erections.

As men get older, their testosterone levels naturally drop. The process is gradual, but some men sense the change. They might feel fatigued and moody. Some men start to lose interest in sex.


Testosterone therapy may benefit older men with low testosterone and coronary artery disease. (Click to tweet)


Sometimes, doctors prescribe testosterone for these symptoms. But the practice has been controversial, with some studies showing increased risk of cardiovascular events – stroke, heart attack, and death – in men taking testosterone. Other studies have found no increased risk.

In this study, researchers from the Intermountain Medical Center Heart Institute in Salt Lake City worked with 755 men who ranged in age from 58 to 78. The men had low testosterone and severe coronary artery disease, a condition caused by atherosclerosis (hardening of the arteries). When plaque builds up in the coronary arteries, it becomes more difficult for blood to flow to the heart.

Three groups were formed. One group of men received a high dose of testosterone therapy; another was given a medium dose. The third group did not receive any testosterone.

After a year, 64 men in the non-treatment group had had a cardiovascular event, compared to 12 men in the medium-dose testosterone group and nine in the high-dose group.

After three years, cardiovascular events were experienced by 125 men who were not treated with testosterone, 38 men in the medium-dose group, and 22 men in the high-dose group.

Doctors shouldn’t be changing their patients’ treatment plans quite yet, however.  The scientists stressed that their study was observational and that more research is needed.

The findings were presented last month in Chicago at the American College of Cardiology’s 65th Annual Scientific Session.


Intermountain Healthcare

“New Study Finds Testosterone Supplementation Reduces Heart Attack and Stroke Risk in Men with Heart Disease”

(News release. April 3, 2016)

Feller, Stephen

“Testosterone supplement reduces heart attack risk from heart disease”

(April 4, 2016)


Operative Vaginal Delivery Could Be Linked to Sexual Problems for New Mothers

Apr 19, 2016

Italian scientists decided to investigate the issue further. They wanted to know how three types of delivery affected women’s sexual function: operative vaginal delivery, spontaneous vaginal delivery (done without forceps or vacuum pumps), and caesarian section.

The current study involved 269 women with an average age of 34 who had delivered their first babies by one of the three methods. (In Italy, vacuum extraction is customary in operative vaginal deliveries.)

About three days after childbirth, the women completed a questionnaire about their sexual function during their final trimester of pregnancy. Six months after childbirth, the women answered the same questions about their postpartum period.

Based on their questionnaire scores, about 41% of the women had some degree of sexual dysfunction at the six-month point.

Women who had had operative vaginal delivery were more likely to have trouble with arousal, vaginal lubrication, and orgasm          when compared to those who had undergone caesarian section. They also had more problems with orgasm than those who had had spontaneous vaginal delivery.


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