Sexual health is a central component of wellbeing, identity, and intimate relationships, yet it remains insufficiently addressed in cancer care. Cancer treatments disrupt sexual functioning through interacting physical, hormonal, psychological, and relational mechanisms, leading to persistent and often under-recognized sexual dysfunction among survivors. To synthesize current evidence on cancer-related sexual dysfunction, assessment strategies, and therapeutic interventions, with a focus on gender differences, tumor-site specificity, and implications for sexual medicine practice. This narrative review integrates evidence from population-based studies, clinical guidelines, and systematic reviews addressing sexual dysfunction across cancer types. Gender-specific patterns and biopsychosocial mechanisms were examined to inform assessment and management within sexual medicine and survivorship care. Women commonly experience multidimensional and frequently "invisible" sexual difficulties, including reduced desire and arousal, orgasmic dysfunction, dyspareunia, vaginal atrophy, body image disturbance, and fertility-related distress. Men more often present with overt functional impairments, particularly erectile and ejaculatory dysfunction following prostate and other male cancer treatments. Existing assessment tools capture selected aspects of sexual function but often fail to reflect the full biopsychosocial complexity of post-cancer sexuality. Effective management requires integrated interventions combining medical and pharmacological therapies, physical rehabilitation, psychosexual and couples counseling, and structured communication models. Tailored, gender- and tumor-specific approaches embedded within multidisciplinary survivorship pathways are essential, including culturally competent care for sexual and gender minority patients. Sexual dysfunction is a prevalent and clinically relevant consequence of cancer. Comprehensive assessment and personalized, multidisciplinary interventions are essential components of high-quality sexual medicine care for cancer survivors.
The World Health Organization estimates that one in eight people around the world is living with a psychiatric disorder. An under-recognized consequence of psychiatric disorders is the detrimental impact they may have on sexuality. Psychotropic medications to treat psychiatric disorders can also have a significant, negative effect on sexual functioning. This review is a consensus International Consultation on Sexual Medicine (ICSM) report developed to outline and describe these impacts. The committee members first discussed the structure of the manuscript. Literature searches were conducted for each section, seeking key words related to sexual dysfunction and each specific psychiatric condition and for psychiatric medications and classes of drugs. A modified Delfi approach was used when making decisions on content and recommendations. The content and recommendations were presented at ICSM where experts across the field of sexual medicine provided feedback. These comments were reviewed by the co-chairs of the 24 committees for discussion and feedback. In relation to psychiatric disorders and sexual dysfunction, there are two primary themes evident in the literature, (1) there are significant methodological weaknesses, and (2) the prevalence of sexual dysfunction across all psychiatric disorders is generally high and elevated compared to controls (when available). Additionally, sexual dysfunction associated with psychotropic medications is a frequent treatment-emergent side effect, for antidepressants ranging from 25% to 80% and for antipsychotics ranging from 16% to 60% depending on the underlying mechanism of action of a particular medication. Sexual dysfunction is also associated with many of the co-morbid conditions related to a psychiatric diagnosis. The committee outlined three recommendations which highlight the importance of assessing for sexual dysfunction in those who report psychiatric disorders, evaluating sexual dysfunction across treatment while treating these disorders with psychotropic medication, and recognizing that the causes of sexual dysfunction are often multi-factorial.
Since the rise of freely accessible pornographic streaming websites, pornography consumption has become widespread and normative worldwide. In Flanders, early exposure-before age 13-has tripled over the past decade, and frequent use, particularly among young men, is common. While pornography consumption may support body satisfaction, self-exploration, and self-esteem, evidence on its effects on sexual development and sexual well-being remains limited. Public debates are polarized, swinging between moral panic and denial of potential risks. Care providers and helplines increasingly report young people struggling with pornography-related concerns, such as self-perceived porn-induced sexual dysfunctions. Adolescents and young adults from diverse backgrounds express a clear need for guidance in navigating sexually explicit media, particularly when communication with parents, teachers, or health care providers is difficult. This project aims to generate evidence-based insights into the complex relationships between pornography consumption, sexual development, and sexual well-being among young people. By producing actionable knowledge, it seeks to inform education, prevention, and care practices that help adolescents and young adults navigate sexually explicit media in ways that promote healthy and inclusive sexual well-being within Flanders' ethnically and sexually diverse society. The project consists of four interconnected work packages: (1) examining pornography in relation to societal norms and inequalities, (2) exploring pornography within family-based sexual development, (3) investigating pornography's role in health care contexts, and (4) developing evidence-based pornography literacy tools for education and prevention. A mixed methods approach will combine systematic scoping reviews, a nationally representative survey, laboratory studies, qualitative interviews and focus groups, and co-creation with key societal stakeholders. The project received funding from Research Foundation - Flanders in 2024, and researchers were appointed between September and November 2024. Scoping reviews began in January 2025 and concluded in October 2025. A large-scale survey will be conducted between January and March 2026, followed by subsequent stages of analysis, dissemination, and valorization, concluding in 2028. Although empirical results are not yet available, the project will deliver new evidence on how pornography consumption shapes sexual development and sexual well-being across diverse contexts. It will produce practical outputs for education, health care, and policy, and contribute to reducing stigma and misinformation around pornography use. By addressing pornography as a multifaceted social and sexual phenomenon, this multidisciplinary research will advance scientific understanding and promote more inclusive, evidence-based approaches to sexual health education, care, and policy.
Sexual medicine has advanced substantially through pharmacological, hormonal, and surgical innovation, enhancing the management of sexual dysfunction. Yet its clinical paradigm remains predominantly biomedical, often privileging physiological restoration over holistic well-being. This editorial argues that sexual medicine should be explicitly grounded in a sexual health framework informed by justice, rights, and pleasure. Drawing on the World Health Organization's multidimensional definition of sexual health and contemporary transdisciplinary scholarship, we propose a shift from a pathology-centered "repair model" to a patient-centered model of flourishing. Justice necessitates equitable, culturally responsive care across gender, orientation, identity, and socioeconomic contexts. Rights affirm sexuality as integral to autonomy and human dignity. Pleasure, long marginalized in clinical discourse, should be recognized as a legitimate and measurable health outcome. Integrating these principles into education, clinical metrics, and practice standards is essential for achieving comprehensive, ethically grounded sexual care aligned with contemporary public health and human rights frameworks.
Disorders of chronic illness and certain cancers are common and can pose a substantial burden to the individual and their sexual partners. This manuscript reviews the substantial impact of chronic illness and cancer on sexual function from the perspectives of patients, partners, and healthcare providers. Convened by the Fifth International Consultation on Sexual Medicine, a multidisciplinary panel conducted a narrative review of current literature and expert consensus. The findings highlight both the direct and indirect effects of chronic diseases, breast and gynecological cancers, and oncological treatments on sexual health and relationships, emphasizing the importance of recognizing and addressing these issues to optimize care for individuals and their partners. Narrative review of the existing literature and consensus recommendations from the expert panel. The direct and indirect impact of chronic disease and cancers and the impact of associated treatment interventions on sexual function and relationships is considerable. An understanding of the impact of chronic illness and cancers, and the related treatment of such can aid clinicians and researchers in providing optimal care to the individual and their partner(s).
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may influence reward-related and sexual behaviors. To synthesize evidence from preclinical and clinical studies evaluating the impact of GLP-1 RAs on libido and sexual function in both women and men. A structured synthesis of published studies examining GLP-1 RAs in relation to sexual behaviors, libido, and sexual parameters was performed using PubMed. In animal models, the GLP-1 RA exendin-4 administration suppressed sexual interaction behaviors in a brain region-specific manner, particularly within the laterodorsal tegmental area, posterior ventral tegmental area, and nucleus accumbens shell, while activation of the nucleus of the solitary tract reduced pre-sexual, sexual, and post-sexual behaviors accompanied by elevated corticosterone and altered monoamine turnover. These findings suggest diminishing sexual motivation and performance in rodents through neuroendocrine and stress-related mechanisms. In humans, evidence remains mixed. Pharmacovigilance analyses from the FDA Adverse Event Reporting System revealed reports of erectile dysfunction, decreased libido, and orgasmic dysfunction among GLP-1 RA users, but disproportionality analyses indicated insignificant associations. A social media-based netnographic analysis of user posts found self-reported reductions in substance use and compulsive behaviors, with variable effects on libido-ranging from enhancement attributed to weight loss and improved body image to decreased desire in others. A randomized, double-blind crossover trial in healthy lean men demonstrated that dulaglutide had no effect on sexual desire, hypothalamic-pituitary-gonadal axis hormones, or semen parameters, suggesting no direct impairment of male sexual or reproductive function. However, recent clinical case reports have identified possible female sexual side effects. Collectively, preclinical evidence supports inhibitory effects of GLP-1 receptor activation on sexual motivation, whereas human findings are limited and reveal heterogeneous outcomes possibly influenced by gender, metabolic status, GLP-1 RA drug type, and psychosocial factors. Further mechanistic and controlled clinical studies are warranted since there seems to be a divergence between preclinical and clinical data.
Primary healthcare is located close to the population and is key to providing health promotion and disease prevention interventions, which are important strategies to achieve universal health coverage. Population-oriented interventions provided by primary healthcare have been reported as effective, but research has not presented a global overview of their characteristics yet. Therefore, the purpose of this scoping review of reviews is to map population-oriented health promotion and disease prevention interventions within primary healthcare. Four databases (MEDLINE, Web of Science, PsycInfo, and CINAHL) were searched for various types of reviews (systematic reviews, scoping reviews, realist reviews, rapid reviews, realist synthesis, narrative reviews, critical reviews, and other types of reviews if they provided enough information about a systematic approach) published in English from inception to 2022. Reviews were included and data extracted if their results sections reported on articles meeting our inclusion criteria about participants, concept, context, and type of evidence source. The analysis entailed summarising extracted data for some items while items with more extensive information underwent a qualitative content analysis. Of 9,254 screened reviews, 310 reviews containing 2,426 articles meeting the predetermined inclusion criteria were included. Interventions were provided globally, but most were provided in the Region of Americas (n = 974) followed by the European Region (n = 596). The interventions targeted different areas, where the most common areas were: Cardiovascular disease/diabetes; Perinatal and child health; Sexual and reproductive health; Cancer; and Mental health. The most common intervention components were Counselling/Education followed by Screening, and Referral/Invitation. The most common actor was a General Practitioner, the most common setting was a Primary Care Clinic, and the largest target group was Adults. However, there were differences regarding intervention components, actors, target groups and setting across the target areas. This scoping review provides a comprehensive overview of population-oriented preventive and health promoting interventions that have been provided in primary healthcare. Most health promotion and disease prevention interventions are delivered within clinical settings, often on an individual basis. The results can be used by various types of stakeholders for further development of interventions, planning of implementations, and as an indication for future research focus. The online version contains supplementary material available at 10.1186/s12875-026-03337-y.
Locating health research on bisexual and pansexual (bisexual+) populations is challenging, as the data are usually collated with data for additional sexual minority and gender identities. To improve the findability of health research on bisexual+ populations, this study sought to develop a sensitivity-maximizing PubMed search filter for bisexuality. Using the relative recall method for the development and validation of search filters, we used PubMed, CitationChaser, and Covidence to search for and screen studies. To be included, studies had to report bisexual/pansexual-specific data and be MEDLINE-indexed with a PubMed Identifier (PMID). Of 291 eligible records, 252 had PMIDs; these records constituted the gold standard set used to develop the search filters. Combinations of search terms were tested against the gold standard set. Sensitivity and number needed to read (NNR) were calculated for each combination. Two search filters are presented. The sensitivity-maximizing search retrieved 100% of the gold standard set, with an NNR of 129.85. The optimized search retrieved all but one of the gold standard articles (99.60%), with an NNR of 74.88. Two PubMed search filters are presented for bisexual+ populations. These filters were validated using the relative recall method against a gold standard set derived from citing and cited references of systematic reviews on bisexual+ health. Use of the sensitivity-maximizing search filter is recommended for exhaustive searches, while the optimized filter is considered more appropriate for nonexhaustive searches.
Rezūm water vapor thermal therapy (WVTT) is a safe and effective treatment for lower urinary tract symptoms/benign prostatic hyperplasia (BPH) in patients with prostate sizes between 30 and 80 cm3 and preserves sexual function. However, its effect on sexual function in patients with large prostate volumes (≥80 cm3) is unknown. This systematic review aims to assess the association of prostate size with sexual function outcomes in lower urinary tract symptoms/benign prostatic hyperplasia patients after treatment with WVTT. Medline and Embase were searched (2013-2024) to identify articles reporting sexual function outcomes for both average (≤80 cm3) and large gland (>80 cm3) patients within the same study at baseline and ≥12 months. Adverse events impacting sexual function, postoperative benign prostatic hyperplasia medication usage, and baseline/≥12-month data for sexual function outcomes were extracted in DistillerSR. Outcomes were summarized for each subgroup (average gland, large gland). ROBINS-I was used to assess risk of bias, and the Grading of Recommendations, Assessment, Development and Evaluation system was used to assess certainty of evidence. Of 394 articles, 4 were included. Corresponding to three distinct studies reporting sexual function outcomes at baseline and ≥12 months post-WVTT (306 average and 85 large gland patients at baseline). Scales included International Index of Erectile Function (IIEF)-15, IIEF-5 (Sexual Health Inventory for Men-SHIM), IIEF-Ejaculatory Function (EF) Domain, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD) Bother, and MSHQ-EjD Function. At follow-up, all three studies reported no clinically significant associations between sexual function outcomes and prostate size for large gland and average gland patients. Despite limited studies reporting sexual function outcomes in both average and large gland patients, this systematic review showed there was no clinically meaningful association between prostate size and erectile or ejaculatory function at ≥12 months after WVTT.
Exposure to adult sexual assault and child sexual abuse leaves survivors with questions about meaning and the process of meaning-making following sexual abuse may influence survivors' recovery. Insight in meaning-making following sexual abuse and survivors' perceptions of the role of meaning-making in recovery informs professionals involved in their care. This scoping review and meta-synthesis of qualitative, mixed methods, and review studies aims to explore survivors' experiences of meaning-making following sexual abuse. We searched six databases: PsycInfo, Ovid Medline ALL, Ovid Evidence-Based Medicine Reviews, PTSDpubs, and Web of Science, and screened 2,158 deduplicated references for inclusion. We followed PRISMA 2020 guidelines for reporting of the systematic search. We integrated findings of the included studies using reflexive thematic analysis. Seventy-four studies were included in the review. Methodological approaches included selecting participants based on experiencing resilience and recovery following sexual abuse or participants receiving professional support, and focusing on the role of time, specific survivor actions, specific abuse or post-abuse contexts or cultural contexts. Twelve themes were generated, reflecting experiences of meaning-making following sexual abuse: reframing the abuse, moving from shame towards self-acceptance, understanding one's own beliefs, reorienting towards religion and spirituality, helping others, connecting with a peer group, building supportive relationships, a secret (not) to be disclosed, recognizing positive change, engaging in activism, honoring strengths and hope, and living with triggers. We grouped the themes into three overarching themes: a changed self, reshaping relationships with others, and mapping out a future self and world. Experiences of meaning-making involve turning points and transitions, e.g., from receiving to providing support, from retelling to reframing, and deliberate acts of self-care. Our findings suggest that the process of meaning-making following sexual abuse operates at existential, cognitive, emotional, motivational, social, and bodily levels. Attending to these multilayered meanings can facilitate interdisciplinary collaboration and expand professionals' insight into their roles and responsibilities in trauma-informed care. Efforts to prevent sexual abuse and mitigate its long-term effects should include strengthening peer and community support, fostering cultural connectedness, and promoting social change.
Alcohol has been a central part of human culture for millennia and is closely linked to sexual behavior, a relationship portrayed in both negative and positive terms, from impaired performance to enhanced desire. Its influence on male sexual function is complex, shaped by biological, psychological, and social factors, as well as patterns and levels of consumption. This review aims to summarize current evidence on the effects of acute and chronic alcohol consumption on male sexual function, highlighting mechanisms, patterns of use, and clinical implications. A PubMed search using MeSH terms and keywords related to alcohol and male sexual dysfunction (SD) yielded 599 articles. Relevant studies were selected for inclusion in this non-systematic narrative review, integrating findings from epidemiological, experimental, and clinical research. Alcohol exerts complex pathophysiological and psychological effects-ranging from cardiovascular, hormonal, and neurological alterations to cognitive, emotional, and behavioral changes-that together shape its multifaceted impact on male sexual function. Social and cultural factors may further modulate this relationship. Light-to-moderate intake can have neutral or modestly protective effects on erectile function and may facilitate sexual activity. In contrast, heavy or binge consumption is consistently associated with erectile dysfunction, may contribute to ejaculatory disorders, and is linked to a reduced overall sexual quality of life. Chronic alcohol abuse, as seen in Alcohol Use Disorders (AUD), exacerbates sexual impairment through physiological toxicity, psychosocial stressors, and psychiatric comorbidities, while SD can, in turn, promote maladaptive drinking behaviors, creating a bidirectional relationship. Alcohol's impact on male sexual function is dose- and context-dependent. While moderate intake appears benign, excessive consumption leads to significant SD that might, in turn, contribute to AUD. The systems sexology framework provides a holistic lens to understand how 4 interrelated domains (mind, body, experience, and society) interact in shaping alcohol-sex relationship, informing prevention and therapeutic strategies.
Declining sexual desire is one of the most common and distressing symptoms of menopause and has significant implications on sexual satisfaction and overall well-being. Though declining ovarian function and sex hormone levels characteristic of menopause may contribute to low desire, some menopausal women report stable or even increased desire since the onset of menopause, suggesting that biological, psychological, and social factors are also relevant. This scoping review synthesized existing research examining these biopsychosocial factors associated with desire in menopause. Following best practices for scoping reviews, comprehensive searches were conducted in PubMed and PsycINFO in July 2025, for articles examining sexual desire in menopause. Quantitative studies were included if they examined peri- or postmenopausal women, measured sexual desire as a distinct construct, and examined desire in relation to a biological, psychological, or social construct. A total of 818 articles were reviewed, with 31 meeting inclusion criteria. Data were extracted and thematically synthesized across the three biopsychosocial domains. Biological factors most relevant to sexual desire include other domains of sexual dysfunction, as well as genitourinary syndrome of menopause, particularly pain with intercourse and vaginal dryness. Other symptoms of menopause, namely sleep disruptions and poor general health are also associated with declines in desire. Psychological factors, especially anxiety and depression, strongly predicted decreased desire. Although less researched, poor body image and negative attitudes about sex appear to impact desire. Social factors such as relationship dissatisfaction and relationship length tend to correlate with declines in desire. Sexual desire in menopause reflects a complex interplay of biological, hormonal, and social influences that extend beyond declining ovarian function and hormones. A biopsychosocial framework is essential for advancing research and holistic care to support menopausal women with low desire.
Male sexual dysfunctionhas a substantial impact on psychological well-being and intimate partner relationships. The expanding availability of digital health services has enabled online interventions, such as internet-based cognitive behavioral therapy (ICBT), digital psychoeducation, and web-based counseling, to emerge as alternatives to conventional therapies. To evaluate the effectiveness, feasibility, and acceptability of digital and online interventions for male sexual dysfunction, and to synthesize evidence from randomized, non-randomized, and observational studies on clinical outcomes and patterns of digital engagement. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted across several databases using predefined keywords. Eligible studies included randomized controlled trials, experimental studies, and analytical observational studies published between 2007 and 2024. Extracted data comprised country, participant characteristics, type and duration of intervention, control conditions, outcome measures, and main findings. The primary outcome was improvement in erectile/sexual function using certain parameters, while secondary outcomes included relationship satisfaction, anxiety, and depression. Of 2482 records identified, and 21 met the inclusion criteria. Overall, web-based ICBT and psychoeducational interventions improved erectile function and sexual satisfaction compared with control conditions. Most interventions lasted 6-12 weeks and incorporated therapist feedback or automated systems. Remission rates for erectile dysfunction ranged from 20% to 30%; however, participant adherence was low (<60%). Several studies also reported reductions in performance anxiety and improvements in sexual confidence, with no serious adverse effects. Online interventions are promising approaches for managing male sexual dysfunction. Nevertheless, low adherence rates and heterogeneity in intervention formats remain major challenges. The findings also suggest heterogeneous benefits of digital interventions, alongside improved accessibility, reduced stigma, and increased engagement in help-seeking among men with sexual dysfunction. Future research should prioritize strategies to enhance adherence, integrate mobile health technologies, and assess long-term outcomes through large-scale clinical trials.
Sexual health is a fundamental component of quality of life across the life course; however, it remains largely neglected in institutional care settings for older adults. In nursing homes and long-term care facilities, sexual health is frequently constrained by a range of individual, institutional, sociocultural, and ethical factors, which are often examined in isolation within the existing literature. This scoping review aimed to map the barriers affecting the sexual health of older adults living in nursing homes and long-term care facilities and to examine how these barriers interact across multiple levels, contributing to complex and reinforcing mechanisms within institutional care contexts. A scoping review methodology was employed in accordance with the Joanna Briggs Institute framework and reported following the PRISMA-ScR guidelines. Systematic searches were conducted in MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, ASSIA, and relevant grey literature sources. Qualitative, quantitative, and mixed-methods studies addressing barriers to sexual health among older adults in institutional care settings were included. Data were charted and synthesized thematically. Nineteen studies met the inclusion criteria. Four interrelated themes were identified: (1) individual-level barriers, (2) institutional and environmental barriers, (3) sociocultural barriers, and (4) ethical and legal barriers. The findings indicate that these barriers do not operate independently; rather, individual vulnerabilities are often amplified through institutional regulations and ethical uncertainties, while sociocultural norms and family expectations further legitimize restrictive practices. This interaction contributes to the systematic marginalization of sexual health within long-term care environments. The review highlights that barriers to sexual health among older adults in institutional care are shaped by interacting and mutually reinforcing processes, rather than isolated factors. Addressing sexual health in nursing homes therefore requires approaches that move beyond single-level interventions and consider the relational and systemic nature of these barriers. Future research should focus on empirically testing these mechanisms and developing multi-level, person-centred interventions to support sexual health in long-term care settings.
Gynecological cancer and related oncological treatments can significantly impair female sexual function, negatively affecting patients' quality of life. However, clinical attention to this issue remains limited, especially in the diverse cultural and healthcare contexts of both Europe and the MENA region. This focused narrative review aims to update and analyze studies published between 2024 and 2025 that investigate sexual function in women with gynecological cancer treated with surgery, chemotherapy, and/or radiotherapy, in order to identify emerging clinical needs. Fifty-seven papers published between January 2024 and February 2025 in Europe and in the MENA region were initially selected as they met established criteria, including the assessment of sexual function as a primary post-treatment outcome. The narrative synthesis included a comparison between geographical and cultural contexts. Given the limited number of eligible studies and the heterogeneity of study designs and outcomes, a narrative synthesis was performed. The review was informed by PRISMA reporting principles, although no formal risk-of-bias assessment was undertaken. Most studies showed a deterioration in sexual function after therapy, often associated with physical symptoms and body image disorders. Across European and MENA contexts, convergent patterns emerged, while region-specific differences were less clearly delineated. The analysis of studies considered highlights the importance of implementing appropriate psychosexual support interventions in cancer follow-up protocols. The findings support the need for early, structured, and multidisciplinary psychosexual interventions. A conceptual psycho-oncological-sexological care model is proposed as a hypothesis-generating framework for future clinical research and practice, aiming not only to address sexual health but also to enhance overall well-being.
Genitourinary syndrome of menopause (GSM) is a prevalent condition among postmenopausal women, often leading to sexual dysfunction and significantly impacting quality of life. While vaginal estrogen is the standard treatment, alternatives are needed for those who cannot or prefer not to use hormonal therapies. This study aims to evaluate the efficacy of radiofrequency (RF) compared with vaginal estrogen in treating sexual dysfunction in postmenopausal women with GSM. A systematic search was conducted in PubMed, Embase, and Cochrane Library up to June 2025. Only randomized controlled trials (RCTs) comparing vaginal RF to vaginal estrogen in postmenopausal women with sexual dysfunction were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Four RCTs comprising 156 participants were included in the analysis. All trials evaluated sexual function using the Female Sexual Function Index (FSFI), which ranges from 2 to 36, with higher scores indicating better sexual function. The meta-analysis showed that RF improved FSFI total score by 4.85 points compared to vaginal estrogen (95% CI 0.04 to 9.67; P = .05). However, no significant differences were observed in the FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain). RF appears to be a non-hormonal and potentially promising alternative to vaginal estrogen for managing sexual dysfunction in women with GSM, although its long-term durability requires further investigation.
Female Sexual Dysfunction (FSD) affects 40%-45% of women globally, with multifactorial causes including pelvic floor dysfunction and hormonal changes. While hormone therapy and psychobehavioral interventions have demonstrated efficacy, they are often limited by side effects, contraindications, variable adherence, and a lack of standardized protocols. Physical therapy (PT) approaches have emerged as promising non-invasive alternatives or adjuncts, targeting underlying neuromuscular, vascular, and structural mechanisms of FSD. This review focuses on PT approaches, evaluating their mechanisms and clinical outcomes to guide evidence-based practice. The review followed the PICO framework: Population (women with FSD), Interventions (PT modalities), Comparators (sham/control/alternative treatments), and Outcomes (sexual function scores, pelvic floor muscle parameters, safety). A systematic search was performed in PubMed, Embase, and Web of Science up to April 13, 2025. The search strategy combined relevant MeSH terms and keywords using Boolean operators across three conceptual blocks: including "Sexual Dysfunction, Physiological"[Mesh], "Hypoactive Sexual Desire Disorder", "Orgasmic Disorder" etc., AND "transcutaneous electrical nerve stimulation", "pelvic floor muscle training", "gradual dilation," etc., AND "Women"[Mesh], "Female," "female patient" etc. The full search strategy and screening flowchart is available in Supplementary Material. Inclusion criteria: Randomized controlled trials (RCTs), cohort studies, pilot studies, and case reports were included if they involved women with FSD who received PT interventions and reported outcomes related to sexual function. Exclusion criteria: non-PT interventions, non-FSD populations, and non-English publications. Study selection involved two independent reviewers screening titles/abstracts and full texts. Data on study design, population, intervention, outcomes, and key findings were extracted into standardized tables. Forty-nine clinical studies with 2742 participants were included. Electromagnetic therapy, electrical stimulation, Radiofrequency therapy, pelvic floor muscle training, multimodal pelvic floor physical therapy, vibratory stimulation, dilator therapy, and acupuncture all demonstrated potential efficacy in improving FSD-related symptoms, including sexual function, vaginal laxity, pain, and orgasmic function. Numerous physical therapy modalities have demonstrated potential efficacy in improving FSD-related symptoms, although evidence quality varies across interventions. Future large-scale RCTs with standardized protocols are needed to confirm long-term benefits and establish optimal treatment algorithms.
Female sexual dysfunction is common, distressing, and notoriously difficult to treat. In the last two decades, short-course ("on-demand") testosterone (T) regimens-delivered sublingually, intranasally, inhaled, topically, or intramuscularly-have been explored as rapid-acting prn enhancers of female libido. The objective of this study is to quantify efficacy, safety, and pharmacokinetics (PK) of short-term T therapy (prn) in women with sexual dysfunction. PRISMA 2020 guidelines for systematic reviews were followed. Twelve RCTs and five PK studies (n = 940) were identified via Embase/MEDLINE/Web of Science (inception-March 2025). Outcomes included desire/arousal scores, satisfying sexual events (SSE), pharmacokinetics, and adverse events. Risk of bias was assessed using the Cochrane risk-of-bias tool. Although absolute serum T excursions differ widely across formulations, most achieve supra-physiological free-T peaks within 15 min and return to baseline within 2-6 h. There is mixed evidence that this window coincides with maximal central arousal effects. However, when combined with phosphodiesterase-5 or 5-HT1A agonists, there tends to be improved genital vasocongestion and sexual satisfaction. Adverse events were mild but tended to be common. Short-term T therapy combined with phosphodiesterase-5 inhibitors or 5-HT1A agonists may be benefit select subgroups of women with sexual dysfunction with a favorable short-term safety, however, sample sizes remain small and further research is required.Registration: This study was registered in PROSPERO: CRD42024615106.
Posterior urethral valves are the leading cause of congenital bladder outlet obstruction in boys and can result in long-term lower urinary tract dysfunction and reduced quality of life. Sexual and reproductive consequences in this population are poorly described and understood. The purpose of this systematic review (SR) was to assess the long-term sexual functions and fertility outcomes in patients treated in the pediatric age for posterior urethral valve (PUV). A SR was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and Scopus were searched for studies reporting sexual or reproductive outcomes in individuals with a history of PUV. The primary outcomes were prevalence and nature of sexual dysfunctions and fertility issues. Risk of bias was assessed using ROBINS-I or the Newcastle-Ottawa Scale, as appropriate. Eleven studies (2 non-randomized comparative studies and 9 case series) including 2723 individuals met the inclusion criteria. Most patients exhibited preserved erectile function, ejaculatory function was variably reported with most individuals described normal ejaculation. Semen analysis, reported in 7 studies, revealed normal parameters in approximately half of the cohorts, though abnormalities were noted in patients with renal impairment or complex urological histories. Paternity rates varied widely (6%-58%) and were lower in individuals with renal dysfunction or urinary incontinence. Only one study used validated tools to assess quality of life, showing negative impact in domains related to continence and renal status. Most males treated for PUV during childhood reach adulthood with preserved sexual and reproductive potential. Given the heterogeneity and methodological limitations of the current literature, prospective studies using standardized outcome measures are needed to better define long-term risks and inform clinical follow-up.
The nature and classification of dysregulated sexual behaviors remain widely debated. Compulsive Sexual Behavior Disorder (CSBD) and Problematic Pornography Use (PPU) are the two most commonly studied constructs in this area, each carrying significant implications for mental health, interpersonal functioning, and broader well-being. Although scientific output on these topics has expanded rapidly in the past decade, recent reviews have tended to focus on specific subthemes, single constructs, or narrow disciplinary perspectives. Accordingly, this review provides an updated and interdisciplinary overview of empirical and theoretical knowledge. In this narrative review, we summarize current knowledge regarding CSBD and PPU, with contributions from diverse experts across multiple disciplines (e.g., psychology, psychiatry, sexology, addiction science, neuroscience). We provide research and clinical perspectives to ensure a comprehensive and balanced discussion. We extensively summarize eleven key areas, namely historical context, conceptualization and symptomatology, assessment and measurement, epidemiology, co-occurring disorders, etiology, potential negative consequences, intervention, treatment, and policy considerations. Additionally, we consider underrepresented populations and contexts, including adolescents, LGBTQ+ (i.e., lesbian, gay, bisexual, trans, queer, and other diverse identities) individuals, women, and cultural factors. The review concludes with a critical discussion of prevailing controversies, methodological challenges, and key directions for future research. By providing a comprehensive and integrative overview, this work aims to advance scientific discourse, promote interdisciplinary collaborations, inform clinical practice, and support public health initiatives in the field of CSBD and PPU.