Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus.

The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.

Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin.

BACKGROUND: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin. OBJECTIVE: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD). METHODS: The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts. RESULTS: A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor. CONCLUSIONS: These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments.

Female Sexual Dysfunction as Measured by Low Sexual Frequency is Associated With Lower Socioeconomic Status: An Analysis of the National Health and Nutrition Examination Survey (NHANES), 2007-2016.

BACKGROUND: Female sexual dysfunction (FSD) is a complex disorder of biopsychosocial etiology, and FSD symptoms affect more than 40% of adult women worldwide. AIM: In this cross-sectional study, we sought to investigate the association between FSD and socioeconomic status (SES) in a nationally representative female adult population. METHODS: Economic and sexual data for women aged 20-59 from the 2007-2016 National Health and Nutrition Examination Survey, a United States nationwide representative database, was analyzed. Poverty income ratio (PIR), a ratio of family income to poverty threshold, was used as a measure of SES, and low sexual frequency was used as a measure of FSD. The association between FSD and SES was analyzed using survey-weighted logistic regression after adjusting for relevant social and gynecologic covariates, such as marital status and history of pregnancy, as well as significant medical comorbidities. OUTCOMES: We found that FSD, as measured by low sexual frequency, was associated with lower SES. RESULTS: Among the 7,348 women of mean age 38.4 (IQR 29-47) included in the final analysis, 26.3% of participants reported sexual frequency of 0-11 times/year and 73.7% participants reported sexual frequency >11 times/year. Participants of PIR <2 were 92% more likely to report sexual frequency ≤11 times/year than those of PIR ≥2 after adjusting for demographics, social history, gynecologic history and significant medical conditions (OR = 1.92; 95% CI = 1.21-3.05; P < .006). CLINICAL IMPLICATIONS: The evaluation and treatment of FSD may benefit from a comprehensive approach that takes SES into account. STRENGTHS & LIMITATIONS: This study is limited by its cross-sectional design, but it is strengthened by a large, nationally representative sample with extensive, standardized data ascertainment. CONCLUSION: Lower SES and lower sexual frequency are directly correlated among female adults in the United States; future studies should focus on social determinants of health as risk factors for FSD. Kim JI, Zhu D, Davila J, et al. Female Sexual Dysfunction as Measured by Low Sexual Frequency is Associated With Lower Socioeconomic Status: An Analysis of the National Health and Nutrition Examination Survey (NHANES), 2007-2016. J Sex Med 2022;19:90-97.

Pharmaceutical and Energy-Based Management of Sexual Problems in Women.

This article summarizes and critiques the evidence for use of available pharmacotherapies (vasoactive, psychoactive, and hormonal medications) and energy-based therapies (laser, radiofrequency, shockwave, and neurostimulation) for treatment of female sexual dysfunction. The enthusiasm with which energy-based treatments for sexual dysfunction have been adopted is disproportionate to the amount of data currently available to support their clinical use. Pharmacotherapy for female sexual dysfunction has considerably more research evidence to justify its use. Patients must be empowered to make an informed, autonomous determination as to whether the risk/reward ratio favors the use of pharmacotherapy, energy-based therapy, or some other treatment intervention.

A Call to Update Standard of Care for Children With Differences in Sex Development.

For years, physicians have debated how best to care for children with differences in sex development (DSD, also termed intersex). Stories of suffering of adults who underwent early surgical intervention for DSD have led many health organizations to call for deferral of unnecessary procedures. While some have instituted full deferral of cosmetic procedures, standard of care remains an interdisciplinary team approach informed by parents' wishes. As the medical community hesitates to institute full deferral, citing absence of long-term data, legislation restricting early procedures is mounting. This article highlights recent data from the DSD-LIFE Study and considers whether and to what extent they support deferral.

Traditional Chinese herbal medicine-potential therapeutic application for the treatment of COVID-19.

Traditional Chinese Medicine (TCM) is a complete medical system that has evolved over millennia to include practices and procedures such as acupuncture, herbal medicine, manual therapies, nutrition, and mind-body therapies such as qi gong. In modern-day China and other Asian countries, TCM is a medical subspecialty utilized alongside western biomedicine. During the current Coronavirus Disease 19 (COVID-19) pandemic, TCM and TCM herbal medicine is being used and a number of single herbs and combination formulas have significant bioactivity and therapeutic potential. The purpose of this paper is to highlight the use of TCM in the treatment of COVID-19. This commentary provides the reader with a concise background on COVID-19 and summarizes TCM concepts including identification, pattern diagnosis, and treatment principles commonly used for the treatment of viral influenza-like diseases. It also highlights some of the challenges and potential for using TCM in an integrated medical setting.

The Resilient Child: Sex-Steroid Hormones and COVID-19 Incidence in Pediatric Patients.

Coronavirus disease-2019 (COVID-19), a disease caused by Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has become an unprecedented global health emergency, with fatal outcomes among adults of all ages in the United States, and the highest incidence and mortality in adult men. As the pandemic evolves there is limited understanding of a potential association between symptomatic viral infection and age. To date, there is no knowledge of the role children (prepubescent, ages 9-13 years) play as "silent" vectors of the virus, with themselves being asymptomatic. Throughout different time frames and geographic locations, the current evidence on COVID-19 suggests that children are becoming infected at a significantly lower rate than other age groups-as low as 1%. Androgens upregulate the protease TMPRSS2 (type II transmembrane serine protease-2), which facilitates efficient virus-host cell fusion with the epithelium of the lungs, thus increasing susceptibility to SARS-CoV-2 infection and development of severe COVID-19. Owing to low levels of steroid hormones, prepubertal children may have low expression of TMPRSS2, thereby limiting the viral entry into host cells. As the world anticipates a vaccine against SARS-CoV-2, the role of prepubescent children as vectors transmitting the virus must be interrogated to prepare for a potential resurgence of COVID-19. This review discusses the current evidence on the low incidence of COVID-19 in children and the effect of sex-steroid hormones on SARS-CoV-2 viral infection and clinical outcomes of pediatric patients. On reopening society at large, schools will need to implement heightened health protocols with the knowledge that children as the "silent" viral transmitters can significantly affect the adult populations.

Historical and Ethical Perspectives on Vulvoplasty.

INTRODUCTION: Surgical and other procedures to alter the shape of the female external genitalia, especially the labia minora, are increasingly popular and controversial worldwide. OBJECTIVES: This article aims to delineate and complicate the medical and moral controversy around these vulvoplasty procedures, by describing how female genital aesthetics, their interpretation, and alteration vary over time, space, and culture. METHODS: The history of the Hottentot Venus is used as a pivot about which to consider current biomedical, anthropological, and ethical literatures regarding female genital appearance and its manipulation. Intersectionality describes how different systems influence each other to affect the agency of certain individuals or groups, and is therefore an ideal analytic method for biopsychosocial concerns of sex and informed consent. RESULTS: The 19th century anatomic study and display of Sarah "Saartjie" Baartman, the Hottentot Venus, defined a European vulvar ideal by demonstrating its opposite. Today, the ideal appearance of the labia minora is variable across cultures and nationalities, and various mechanical and surgical manipulations are sought or imposed upon women to bring their bodies into conformity with these ideals. CONCLUSION: For European audiences, Baartman exemplified a stereotypical association between genital appearance, sexual availability, and accessibility as a biomedical subject. These logical linkages were a by-product of sexist, racist, and colonial ideologies that have since fallen out of favor. However, their genital effects continue to influence bioethical considerations of genitoplasty into the present day. Chubak B. Historical and Ethical Perspectives on Vulvoplasty. Sex Med Rev 2020;8:542-547.

Traditional Chinese Medicine for Sexual Dysfunction: Review of the Evidence.

INTRODUCTION: Despite the growing popularity of traditional Chinese medicine (TCM) in the Western world, biomedical students and practitioners struggle to understand TCM and how it relates to their standard diagnosis and treatment practices. AIMS: To describe the fundamentals of TCM theory and practice relevant to sexual dysfunction; to review and critique the current state of TCM research within Western biomedical literature; and to identify sites for improvement of future research and for collaborative integration of TCM and biomedicine in practice. METHODS: Information about TCM from an insider perspective was obtained from English-language textbooks and lectures intended to teach Western students its theory and practice. PubMed search using Medical Subject Heading terms for Western sexual diagnoses and TCM treatments was performed in April and October 2017 to represent the evidence for TCM in Western biomedical literature. Articles in non-English languages and without human subjects were excluded. MAIN OUTCOME MEASURES: 27 studies were included in this review. The most commonly studied intervention was acupuncture. An equal number of studies addressed sexual dysfunction in men and women, but only women were included in studies of physically passive mindfulness meditation. RESULTS: Compared with Western biomedicine, TCM offers a more interdisciplinary and individualized approach to disease and its treatment. This embrace of individual idiosyncrasy in diagnosis and treatment presents a challenge to Western biomedical research norms that rely almost exclusively on quantitative methods that compare large and homogeneous groups with a fixed diagnosis and treatment regimen. CONCLUSION: TCM offers a very different understanding of the human body, health, and disease from Western biomedicine. There is value in the study and application of these 2 medical systems, particularly for biopsychosocial problems of sexual dysfunction. However, this must be done cautiously, with attention to appropriate study design, to avoid shallow and unscientific cultural appropriation of TCM practices. Chubak B, Doctor A. Traditional Chinese Medicine for Sexual Dysfunction: Review of the Evidence. Sex Med Rev 2018;6:410-418.

An unusual presentation of colon perforation following percutaneous nephrolithotomy.

Colon perforation is a rare but serious complication of percutaneous nephrolithotomy (PCNL), meriting particular attention to its signs and symptoms for prompt diagnosis and treatment. We report an unusual presentation of colon perforation following tubeless PCNL, characterized by sore throat, pneumomediastinum, and neck and shoulder crepitus. In addition to the details of this case, we review the current literature on bowel injury during PCNL and its management.

Informed consent to microsatellite instability and immunohistochemistry screening for Lynch syndrome.

OBJECTIVE: Routine microsatellite instability and immunohistochemistry screening of colorectal cancers can assist in identifying a significant proportion of cancers attributable to Lynch syndrome. This article considers whether it is necessary to obtain patient informed consent for microsatellite instability and immunohistochemistry screening. RESULTS: Although microsatellite instability screening examines genetic features of a tumor, it lacks several important characteristics that typically mandate formal informed consent to genetic testing. Microsatellite instability screening describes discrete tissue samples and does not provide information about the rest of the patient's body or germline. In contrast, immunohistochemistry screening is a proteomic test that may reveal information about the patient's germline. As such, immunohistochemistry screening can be viewed as similar to other forms of genetic testing, in which explicit patient consent is regarded as an ethical prerequisite. CONCLUSION: There is no ethical requirement to obtain explicit informed consent for microsatellite instability screening of colorectal tumor samples for Lynch syndrome. There is support for obtaining patient consent to immunohistochemistry testing, given its similarities with other genetic analyses for which informed consent is typically deemed necessary. Regardless of which screening test is used, it is important to prepare patients and their families for the possibility of a positive screening test.

Impotence and suing for sex in eighteenth-century England.

OBJECTIVES: To explore the individual and social experiences and meanings of impotence in 18th-century England. METHODS: Close reading and period contextualization of various primary source records about impotence, including legal documents from lawsuits for nullity of marriage by reason of impotence, bestselling medical texts, and cheap pornographic pamphlets was done. RESULTS: Contemporary, humoral and mechanical medicine and physiology characterized impotence by various etiologies and patient presentations. This left room for laymen, and especially women, to diagnose and interpret the condition according to their own devices. A matter of public, as well as private, concern, impotence carried with it the meanings of failed masculinity, neglected civic responsibility, foreignness, and Catholicism. CONCLUSIONS: Impotence in 18th-century England served as a catch-all diagnosis for sexual dysfunction and a vehicle through which to address anxieties about the stability of patriarchal power, female deceit, religion, and politics. Today, medicine, physiology, and the disease itself are very different, but the individual and social meanings of impotence remain influential and worthy of consideration.