Cosmetic penile enhancement procedures: an SMSNA position statement.

BACKGROUND: Penile cosmetic enhancement procedures have been performed for many years with varying success. However, they have historically been relegated to niche areas of sexual medicine, with limited data, and have not achieved mainstream adoption. More recently, the topic has been increasingly discussed within academic congresses due to availability of novel techniques, therapies, and procedures. Given their distinctive nature, the Sexual Medicine Society of North America (SMSNA) felt that it was pertinent to develop formal position statements to help guide both patients and sexual medicine providers on the current state of the scientific literature and to give recommendations for future research. AIM: The study sought to provide an evidence-based set of recommendations for injection and surgical procedures designed to lengthen, augment, or otherwise cosmetically enhance the penis. METHODS: A review was performed of all scientific literature listed in PubMed from inception through December 2023 relating to penile cosmetic enhancement procedures. Only invasive (injection/surgery) therapies were included due to their distinct risk-benefit profile compared with more conservative treatments (eg, vacuum erection devices, penile traction devices). Similar therapies were categorized, with pertinent data summarized and used to help create relevant position statements. All statements were expert opinion only and were based on analyses of the potential risks and benefits of the specific therapies. OUTCOMES: A total of 6 position statements were issued relating to 5 distinct sexual medicine cosmetic enhancement procedures. RESULTS: A consensus opinion was reached by SMSNA leadership on the state of injection/surgical penile cosmetic enhancement procedures as of 2024. Key topic areas addressed included injectable soft tissue fillers, suspensory ligament division, graft-and-flap procedures, silicone sleeve implants, and sliding/slicing techniques. Distinct recommendations were tailored to each therapy and were based solely on the current state of the literature. It is anticipated that future studies will further inform position statements and will lead to ongoing modifications. CLINICAL IMPLICATIONS: The current position statements provide both patients and clinicians evidence-based, expert recommendations on best practices relating to penile cosmetic enhancement procedures. STRENGTHS AND LIMITATIONS: Strengths include the use of an expert panel of sexual medicine clinicians, consensus design, and summary of existing literature. Limitations include expert opinion and limited research on the topic. CONCLUSION: The current SMSNA position statements provide evidence-based, consensus opinions on the appropriate role for penile augmentation and cosmetic procedures in 2024.

Sexual Medicine Society of North America (SMSNA)/American Urological Association (AUA) telemedicine and men's health white paper.

PURPOSE: The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care. LITERATURE SEARCH STRATEGY: A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.

Healthy Sexuality for Sex Offenders.

PURPOSE OF THE REVIEW: This review will examine the current, although limited, literature on the development of healthy sexuality for sex offenders, as well as some of the related controversies surrounding sex offender specific therapies. RECENT FINDINGS: Over the last decade, the definition of healthy sexuality has remained elusive while the boundary delineating unhealthy sexuality has radically changed. These changes are not reflected in current approaches to sex offender treatment which continue to focus on suppression of offenders' sexuality. Our attention to the management of sexual behaviors has led to a diminished, and perhaps impoverished, curiosity and understanding of what is driving problematic sexual behavior and also moves us further from an understanding of what leads to "healthy" sexual behavior. It is our contention that a consideration of sex offending behavior through the lens of early childhood trauma will lead to an improvement in our ability to assist these offenders in the development of sexually happier and more fulfilling lives while being able to function within the parameters of society's standards for legal behavior. The sex positive perspective of sex therapy will allow for a broader consideration of what defines and promotes healthy sexual behavior in an offender population.

Existential Issues in Sexual Medicine: The Relation Between Death Anxiety and Hypersexuality.

INTRODUCTION: Current sex therapy and sexual medicine protocols often ignore the existential dilemmas associated with sexual dysfunction and other problematic sexual problems. This oversight is especially apparent when assessing and treating the controversial phenomenon of hypersexuality, or "sexual addiction." A deeper understanding of the existential concept of death anxiety could offer an alternative treatment paradigm that might lead to a more effective treatment outcome. AIM: To explore the relation between the existential phenomenon of death anxiety and hypersexuality (ie, sexual addiction) and present an evaluation and treatment paradigm that is rooted in existential psychotherapy, a form of psychotherapy that is a deeply life-affirming and dynamic approach to therapy that focuses on concerns rooted in the individual's existence. METHODS: A review of the literature focusing on the topics of hypersexuality, death anxiety, and existential psychotherapy was undertaken and a treatment paradigm is offered. MAIN OUTCOME MEASURES: Current treatment protocols for hypersexuality and sexual addiction were reviewed, as were current concepts in existential therapy. These were integrated into an assessment and treatment paradigm. RESULTS: Although sexual medicine and traditional sex therapy techniques can often alleviate sexual suffering, there are times when a more in-depth psychotherapy is needed to get to the root cause and ultimate assuagement of the presenting sexual symptoms. Existential psychotherapy is one such form of treatment that allows clinicians to probe the subterranean depths of the human psyche and make meaning of one's sexual behavior and its vagaries. CONCLUSION: Although certainly not all cases of hypersexuality are precipitated by a confrontation with mortality and death, there are cases in which sex is imbued with meaning as an antidote to the fear of death. Existential therapy is a form of treatment that could be particularly effective in many of these cases. Watter DN. Existential Issues in Sexual Medicine: The Relation Between Death Anxiety and Hypersexuality. Sex Med Rev 2018;6:3-10.