Search Results (262)

Background: Infectious proctitis remains an underrecognized entity, although sexually transmitted diseases, especially bacterial infections, exhibit a marked increase in their incidence. Methods: Here, we report a case of a 44-year-old man who presented to the emergency department with lower abdominal and rectal pain, tenesmus, fever and night sweats for the past 6 days. Results: The computed tomography initially revealed a high suspicion of metastatic rectal cancer. The endoscopic findings showed a 5 cm rectal mass, suggestive of malignancy. The histologic examination showed, however, no signs of malignancy and lacked the classical features of an inflammatory bowel disease, so an infectious proctitis was further suspected. The patient reported to have had unprotected receptive anal intercourse, was tested positive for Treponema pallidum serology and received three doses of intramuscular benzathine penicillin G. A control rectosigmoidoscopy, imaging at 3 months and histological evaluation after antibiotic treatment showed a complete resolution of inflammation. Conclusions: Syphilitic proctitis may mimic various conditions such as rectal cancer or inflammatory bowel disease and requires a high degree of suspicion. Clinicians need to be aware of infectious proctitis in high-risk populations, while an appropriate thorough medical history may guide the initial diagnostic steps. Full article

Background/Objectives: The male prepuce that covers the glans penis is richly innervated by low-threshold mechanoreceptors, which form cutaneous end-organ complexes (Meissner, Pacinian and Ruffini corpuscles) and mucous end-organ complexes (especially Krause-like corpuscles). The mechanosensory inputs from these formations are the beginning for spinal reflexes that regulate movements of intercourse and erection and, therefore, are required for sexual function. The study was aimed at analyzing the age-dependent changes in prepuce innervation. Methods: Here we used immunohistochemistry to investigate whether the innervation of the male prepuce undergoes age-dependent changes, analyzing subjects aged 4 months to 61 years. Results: Abundant Meissner corpuscles and Krause-like corpuscles were regularly found whose morphology, size, and topography were variable and were not correlated with age; however, Ruffini’s and Pacinian corpuscles were scarcely observed. The earliest evidence of Meissner corpuscles was observed at 4 months, and thereafter they undergo significant age-dependent variations in density. Until the age of 20 years increases progressively, remains stable until 40 years, and then the density decreases. Meissner’s corpuscle index paralleled that of density. Regarding Kause-like corpuscles already resemble the skin of 4-month-old subjects and from the age of 3 years they can be identified at all ages. Its density significantly increased until 10 years and then remained stable. Conclusions: Present results state that the mechanosensory innervation of the human foreskin reaches its maximum value around the age of 20, remains stable during adulthood and decreases with maturity. These findings contribute to a more complete understanding of foreskin innervation and add to the scientific knowledge base surrounding the potential harm of removing a richly innervated structure. Full article

Stealthing, the nonconsensual removal of a condom during sexual intercourse, is a prevalent yet underreported form of sexual misconduct, particularly among college students. This white paper examines the legal landscape, gaps in responses, and the burden of stealthing on college students. It presents actionable strategies for college campuses to combat stealthing, including updating policies, enforcing a zero-tolerance policy, training staff, providing survivor-centered support services, integrating cultural competency, and ensuring transparent enforcement of processes. These strategies aim to empower college campuses to prevent and reduce stealthing, promote informed consent, and enhance survivor support. Full article

Introduction: Sexual and reproductive health is a critical aspect of medical education, yet significant knowledge gaps persist even among future healthcare professionals. This study aimed to evaluate the knowledge, behaviors, and attitudes of Romanian medical students regarding sexually transmitted infections (STIs) and contraceptive practices. Materials and Methods: A cross-sectional observational study was conducted on 510 undergraduate medical students, using a validated 30-item online questionnaire assessing socio-demographic data, sexual behaviors, STI knowledge, and attitudes towards sexual health. Descriptive statistics, chi-square, and Spearman correlation tests were used to analyze the data. Results: Participants demonstrated a good understanding of common STI pathogens and transmission routes, with 99.02% identifying unprotected vaginal intercourse as a risk factor. However, only 58.82% correctly identified Chlamydia trachomatis, and awareness of less common pathogens remained low. Long-term complications such as infertility (85.29%) and cervical cancer (87.25%) were well recognized, although misconceptions about STI severity persisted, with over 40% believing that STIs are not dangerous because they are treatable. Male students reported earlier sexual debut and more frequent high-risk behaviors, while females were more likely to consult specialist doctors and receive HPV vaccination. The level of knowledge correlated positively with parental education and faculty program. Conclusions: Despite generally high awareness of STI-related topics, considerable gaps and misconceptions persist among Romanian medical students. These findings highlight the need for comprehensive, structured sexual health education integrated into medical curricula to ensure future healthcare providers are well-equipped to promote public health. Full article

Background/Objectives: Stress urinary incontinence (SUI) is a common condition affecting sexual function, exercise activities, and quality of life, accompanied by psychological distress. The treatment of SUI includes conservative and surgical treatment which comprises tensions-free vaginal tapes in the form of retropubic (TVT) and transobturator tape (TOT or TVT—O). The TVT procedure is considered the gold standard, but the TOT procedure is a safe alternative due to a lower rate of bladder and bowel complications. The aim of this study is to evaluate the long-term effects of the surgical treatment of the TOT procedure after 36 months of follow-up on the sexuality of women with SUI. Methods: In the long-term evaluation, 3 years after surgery, 45 women with medical records sufficient for analysis participated in the project. The international standardized Female Sexual Function Index (FSFI) self-administered questionnaire was completed three times: before the surgery, 12 months after surgery, and 3 years after surgery. Results: Domain scores for arousal, lubrication, orgasm, and total score were lower in the follow-up group than before and after the surgery. The pain domain was the highest in the after-surgery group, slightly lower in the before-surgery group, and the lowest in the follow-up group. All the abovementioned differences were statistically significant. Conclusions: Three years after the surgical treatment of SUI, the results of our study patients deteriorated, especially in arousal, lubrication, and orgasm assessments, compared to outcomes 12 months after the procedure. In addition, the total FSFI score was lower 36 months after the surgery than the year before the surgery and lower than before the procedure. Also, pain during intercourse was more frequently reported, as opposed to the result year after the surgery, which was lower than before the operation. Full article

Adolescents’ health risk behavior may have a longstanding impact on their later adult life and health. The aim of this cross-sectional study is to report on health risk behaviors and sexual attitudes in a sample of Mongolian adolescents (N = 312) in light of their levels of social support and well-being. Measurements were derived from the Health Behavior in School-aged Children (HBSC), including substance use and sexual behavior, whereas social support from parents and peers was measured with the Multidimensional Scale of Perceived Social Support (MSPSS). Student well-being was evaluated using the WHO Well-Being Questionnaire (WBI-5). The frequency of current smokers was 13.1% (boys: 18.9%, girls: 10.2%; χ² = 4.61, Phi = −0.12, p = 0.032). The prevalence rate of current alcohol consumption was 11.2% (boys: 14.2%, girls: 9.7%; χ² = 1.38, Phi = −0.07, p > 0.05), similar to the nationwide results. The percentage of students who have ever had sexual intercourse was 6.4 (12.4% of boys and 3.4% of girls, χ² = 9.33, Phi = 0.17, p = 0.006), similar to Central Asian countries included in the HBSC survey. Boys were more likely to associate sexual activity with self-esteem, intimacy with a partner, and positive perceptions among peers. Conversely, girls expressed greater concern about the negative consequences of sexual activity, such as STDs and pregnancy. Social support from the family played a protective role in frequencies of smoking and drinking. However, levels of the social support subscales did not differ by the students’ relationship status or previous sexual intercourse. These results suggest that there is a need for a complex prevention program to avoid increases in Mongolian adolescents’ smoking and drinking and promote their healthy sexual attitudes and behavior. Full article

Background: “Chemsex” involves the intake of a range of drugs (e.g., synthetic cathinones, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL), ketamine, methamphetamine, “poppers”, type V phosphodiesterase (PDE) inhibitors, MDMA/ecstasy, cocaine, cannabis, and occasionally a few other molecules as well, to enhance and prolong sexual experiences. This paper aims to provide an overview of the clinical pharmacology of the vast range of drugs that are being used for chemsex with a focus on both the medical and psychopathological disturbances that they can produce. Methods: A narrative literature review was conducted using Pubmed, Scopus, and Web of Science databases. A total of 273 papers published up to January 2025 were screened; articles were selected based on relevance to chemsex/sexualized used behaviour and related substances. Both human and preclinical studies were considered. Results: The use of stimulants is likely related to the need to increase as much as possible both sexual arousal and performance but also to increase social interactions. Furthermore, the empathogenic/entactogenic activities of some MDMA-like “love drugs” facilitate the occurrence of “feeling closer/more intimate” emotional sensations, and GHB/GBL may provide the user with a subjective sensation of disinhibition, hence facilitating condomless meetings with a higher number of random partners. Conversely, ketamine may be used to both enjoy its psychotropic dissociative characteristics and facilitate the potentially painful receptive anal intercourse and/or fisting experiences. Most typically, these drugs are consumed in combination, with polydrug exposure possibly facilitating the occurrence of serotonergic syndrome, seizures, drug–drug pharmacokinetics’ interaction, and sympathomimetic overstimulation. Following these polydrug exposures, a range of psychopathological conditions have at times been reported. These issues may lead to misuse of opiates/opioids, gabapentinoids, and/or antipsychotics. Conclusions: Further actions should aim at reducing the stigma that prevents individuals from accessing necessary healthcare and support services. A multidisciplinary approach that combines medical, psychological, and social support remains key to managing the complex challenges posed by chemsex-related drug use. Full article

Objectives: We aimed to study the efficacy of fractional CO₂ laser for genitourinary syndrome of menopause (GSM) symptoms in breast cancer (BC) survivors through a randomized, sham-controlled study, followed by an open-phase study assessing the impact of additional treatments. Methods: BC survivors with GSM were randomized to receive either three sessions of intravaginal CO₂ laser or sham treatment every 3–4 weeks. The laser’s energy was 45–60 mJ/pixel. Outcomes were compared one month following the last session. Participants initially receiving laser treatment were offered three more sessions, while those receiving sham had six laser sessions in an open-label study. Results: Thirty-four BC survivors were randomized to laser (n = 19) or sham (n = 15) treatments. Dyspareunia and intercourse dryness scores improved in both groups one month post-treatment, without a significant advantage of laser over sham. The laser treatment resulted in a reduction in daily dryness (−1.30 ± 0.55, p = 0.017), an increase in vaginal hydration (3.24 ± 1.13, p = 0.004), and an increase in Vaginal Health Index (VHI) (2.26 ± 0.50, p < 0.001). Most participants (18/19 and 9/15, respectively) opted to continue laser treatments after unblinding, resulting in 27 patients receiving six laser treatments. Increasing the number of laser treatments was associated with a constant improvement in Visual Analogue Score (VAS) scores for dyspareunia, intercourse dryness, daily dryness, burning, discomfort, itch, and average VAS, as well as pH, VHI, and hydration. Conclusions Three fractional CO₂ laser treatments for BC survivors reduced daily dryness but did not improve dyspareunia and sexual dryness when compared to sham in this randomized trial. Increasing the number of treatment sessions seemed to improve outcomes; however, it remained clinically insufficient, even after six treatments. Full article

Background and Objectives: Lumbar spinal stenosis (LSS) is a leading cause of back surgery in elderly individuals. Additionally, LSS can result in buttock pain; abnormal sensations; or even loss of sensation in the thighs, feet, legs, and buttocks, as well as potential loss of bowel and bladder control. As a further consequence, sexual activity is impaired. However, there is limited information on sexual function in patients undergoing LSS surgery, in general, and among male patients, in specific. Accordingly, the aim of this study was to investigate the effect of LSS surgery on sexual function in male patients over 50 years. Materials and Methods: Participants were fifty male patients with LSS aged 50 years and older who underwent LSS surgery at the Imam Reza Hospital in Kermanshah from March 2024 to the end of 2024. To assess sexual performance over time, participants completed the International Index of Erectile Function (IIEF-15) questionnaire both before LSS surgery and six months after LSS surgery. For pre–post comparison, we used paired t-tests. Results: Compared to the pre-surgery stage, six-month post-surgery improvements were erectile function (+21%; Cohen’s d: 1.40), orgasmic function (+35.1%; Cohen’s d: 1.49), sexual desire (+27.3%; Cohen’s d: 1.48), intercourse satisfaction (+14% Cohen’s d: 0.77), overall satisfaction (+34.6% Cohen’s d: 1.74), and overall sexual function (+25.3%; Cohen’s d: 1.48). Conclusions: Among a sample of male patients aged 50 years and older, LSS surgery improved all dimensions of sexual satisfaction, including orgasmic, erectile, and sexual functions; sexual desire; intercourse satisfaction; and overall satisfaction. Medical doctors treating males with LSS might consider informing their patients about the favorable effects of LSS surgery on sexual life and sexual satisfaction. Full article

Recurrent urinary tract infection (rUTI) is a significant public health problem in women. General measures to prevent recurrence include behavioral changes and increased fluid intake, cranberry ingest, use of methenamine hippurate, antibiotic prophylaxis, D-mannose, probiotics, or vaccines. We conducted a literature review of the latest updates on preventing rUTI in December 2024. The search concluded with 27 articles that fulfilled our inclusion criteria. Our review demonstrated that behavioral changes such as correct genital hygiene, avoiding postponing micturition or defecation, urinating after sexual intercourse, and ingesting 1.5–2 L of water could prevent rUTI. The ingestion of cranberries reduces the risk of symptomatic, culture-verified urinary tract infections in women with rUTIs. Methenamine hippurate is an alternative to antibiotics to avoid rUTI. Estrogen reduces rUTI in women with hypoestrogenism. Limited evidence supports using D-mannose, probiotics, and vaccines to prevent rUTI. In conclusion, after successful treatment of the acute episode, preventative measures are needed to reduce rUTI frequency and morbidity according to each patient’s characteristics and preferences. Full article

Background/Objectives: Female sexual dysfunction (FSD) involves persistent issues with desire, arousal, orgasm, or pain during intercourse. The Female Sexual Function Index (FSFI), a validated 19-item questionnaire, is widely used to assess FSD. Childbirth, particularly vaginal delivery with perineal trauma, can increase FSD risk, with 41–83% of women affected at six months postpartum. However, early postpartum FSD remains underexplored. This study examines FSD risk factors in first-time mothers delivering vaginally, using longitudinal FSFI assessments before and after the delivery. Methods: A prospective observational study was conducted involving 80 primiparous women who delivered vaginally. The FSFI questionnaire was provided before childbirth and three months postpartum. We compared the group of women who developed early FSD after delivery (N = 45) with those with a normal FSFI score (>26.6). Results: Three months after vaginal delivery, participants exhibited a significant decrease in overall FSFI scores (−9.61 [95%CI: −11.6; −7.6]; p = 0.008). A total of 45 patients (56.2%) developed early FSD. Marital status emerged as a significant factor, with marriage acting as a protective factor (OR 0.27 [95%CI 0.05–1.24]; p = 0.044). Clitoral and periclitoral tears were associated with a higher risk of FSD than high-degree perineal lacerations (OR 3.02 [95%CI 1.56–6.24]; p = 0.021). Conclusions: At three months post vaginal delivery, primiparous women face a relevant risk of developing transient sexual dysfunction. Marital status and type of perineal tears are identified as key factors influencing postpartum sexual function. Further research is warranted to explore these factors comprehensively and provide timely clinical and psychological support to couples navigating the challenges of early family life. Full article

Human papillomavirus (HPV) infection poses significant public health issues for both men and women. Recent studies have brought attention to the substantial impact of HPV-linked cancers in men despite historically focusing more on its effects on women. It was revealed that in 2019, HPV was the root cause of approximately 70,000 cancer cases in men. Modes of transmission for HPV include sexual contact, encompassing various practices such as vaginal, anal, and oral intercourse, as well as the use of sexual devices. Moreover, HPV-associated cancers are becoming increasingly common in men, with anal, penile, and oral cancers being the most prevalent. Although the human body can clear HPV infection in about 90% of cases, it’s crucial to take preventive measures to lower the risk of transmission and developing cancer. Using condoms, quitting smoking, and male circumcision are identified as essential factors in preventing HPV among heterosexual couples. However, the most promising preventive measure is HPV vaccination. There are ongoing discussions regarding its protective efficacy and cost-effectiveness; vaccinating boys before their sexual debut presents a compelling rationale. The existing literature primarily focuses on HPV-linked cancer in women and lacks a comprehensive review of the development and prevention methods specifically related to HPV-related cancers in men. This review strives to bridge this gap by offering a detailed overview of HPV-linked cancers in males, particularly anal, penile, and head & neck cancer. It will cover important aspects of prevention and treatment strategies to provide valuable information for public health initiatives and clinical practice. Full article

Background/Objectives: Approximately 30% of women experience pelvic pain one year after vaginal delivery, and this increases to 50% during vaginal intercourse. Multimodal physiotherapy is the first-line treatment for myofascial pain of the pelvic floor muscles (PFM), often incorporating emerging technologies like radiofrequency, despite limited evidence supporting its use. The RASDOP study aims to (i) evaluate the effectiveness of multimodal physiotherapy combining therapeutic education, PFM training, and myofascial pain syndrome (MPS) management with or without radiofrequency, in reducing pain and improving sexual function postpartum; and (ii) explore the barriers and facilitators influencing adherence and perceived self-efficacy towards physiotherapy treatment in women with postpartum pelvic pain. Methods: This study employs a randomized clinical trial with a blinded examiner and two parallel groups, followed by a qualitative phenomenological study. A total of 124 postpartum women with pelvic pain (≥4 cm on the visual analogue scale) will be randomized into two groups: a multimodal physiotherapy group (therapeutic education, MPS treatment, and PFM training) and a radiofrequency + multimodal physiotherapy group (same treatment with additional non-ablative radiofrequency). Both groups will receive 12 supervised individual sessions. Assessments will be conducted pre- and post-intervention, and at 3-, 6-, and 12-month stages post-treatment. Primary outcomes include pain intensity and sexual function, while secondary outcomes involve PFM tone, strength, MPS presence, levator ani length, and distress caused by pelvic floor dysfunction. The qualitative study will utilize semi-structured interviews and focus groups analyzed thematically. Results: Radiofrequency is expected to enhance pain relief, sexual function, and PFM relaxation. Insights into adherence and barriers will aid in personalizing physiotherapy interventions. Conclusions: The RASDOP study will provide evidence on the safety and efficacy of radiofrequency in postpartum pelvic pain treatment and shed light on women’s experiences to improve therapeutic outcomes. Full article

Introduction: Sexual frequency is an important indicator of overall health and plays a vital role in various health conditions. There is a wide array of physical and mental health benefits that are associated with sexual activity. Cardiovascular disease (CVD) is the most common cause of mortality each year. The purpose of this study was to explore a connection between CVD and all-cause mortality and if sexual frequency modified this effect. Methods: For this study, we utilized the 2005–2016 National Health and Nutrition Examination Survey (NHANES) and the NDI-linked all-cause mortality data of US adults aged between 20–59 years. Low sexual frequency was determined by individuals who had sexual intercourse less than once a month. Survival curves showed the combined effect of sexual frequency and all-cause mortality, using the Kaplan–Meier product-limit method to estimate the percent survival of the subject at each point in time. Results: For all-cause mortality, the unadjusted hazard ratio (HR) for CVD to no CVD was HR = 5.1. The adjusted HR was elevated HR = 2.3 among individuals who had CVD and low sexual frequency but close to 1.0 among individuals who had a history of CVD but reported moderate-to-high/high sexual frequency after adjusting for demographic and health variables. Conclusions: From a nationally representative sample, our study was the first to demonstrate, in unadjusted and adjusted models, that CVD and low sexual frequency combined have worse outcomes than CVD alone. This finding indicates the need to conduct a sexual history among individuals with CVD or other chronic diseases. Full article

Urinary tract infections (UTIs) represent a prevalent health concern among the female population, with anatomical and physiological determinants such as a shorter urethra and its proximity to the rectum augmenting vulnerability. The presence of Escherichia coli and various other pathogens plays a significant role in the etiology of these infections, which can be aggravated by sexual intercourse and disturbances to the vaginal microbiome. The physiological alterations associated with pregnancy further elevate the likelihood of UTIs, with untreated cases potentially leading to severe complications such as pyelonephritis, preterm labor, and stillbirth. Furthermore, postmenopausal women encounter an augmented risk of UTIs attributable to estrogen deficiency and vaginal atrophy, as well as conditions including pelvic organ prolapse (POP) and urinary incontinence (UI), which hinder optimal bladder functionality. The aforementioned factors, in conjunction with the rising prevalence of cesarean deliveries and catheterization, complicate the management of UTIs. While precise diagnosis is paramount, it remains a formidable challenge, notwithstanding advancements in molecular diagnostic techniques. Management strategies encompass antibiotic-sparing therapies; however, the increasing incidence of multidrug resistance represents an alarming trend. Diverse guidelines from various medical specialties endeavor to standardize treatment approaches, yet significant inconsistencies continue to exist. This study systematically appraises the extant guidelines, evaluating the quality of evidence while identifying areas of agreement and discord to supply practitioners with effective strategies for UTI management. Full article