Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function.

PURPOSE OF REVIEW: Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies. RECENT FINDINGS: Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation. SUMMARY: Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.

Comparing the effects of retention or resection of the Denonvilliers' fascia on urinary and sexual functions in men who underwent laparoscopic radical.

Currently, colorectal cancer has the third highest incidence worldwide. As its incidence is increasing, focus on quality of life after laparoscopic radical resection for colorectal cancer has also increased. This study aimed to compare the effects of retention or resection of the Denonvilliers'fascia on urinary and sexual functions in men who underwent laparoscopic radical resection for rectal cancer. Relevant national and international literature databases, including China Knowledge Network, PubMed, Cochrane Library, and Excerpta Medica Database, were searched according to the established retrieval scheme. Review Manager 5.3 was used to analyze data, and the correct effect model was selected based on heterogeneity. In total, 22 studies involving 2255 patients were included in the meta-analysis. The studies were categorized into the experimental and control groups. The incidence of urinary dysfunction was lower in the experimental group than in the control group at 1 and 6 months postoperatively. In terms of sexual function, the experimental group had lower rates of erectile and ejaculatory dysfunctions than the control group at 1, 3, and 6 months and 1 year postoperatively. However, the experimental group had a longer operation time than the control group. No significant differences in incidence of postoperative complications, intra-operative blood loss, and number of lymph nodes dissections were observed between the two groups. Overall, laparoscopic radical resection for rectal cancer with preservation of the Denonvilliers' fascia has been proven effective in improving postoperative urinary and sexual functions in men without affecting the number of lymph nodes dissected and enhancing postoperative quality of life.

Enhancing sexual health in primary care: Guidance for practitioners.

Sexual health is an integral aspect of overall health and well-being and is fundamental to the sustainable development of societies worldwide. The World Health Organization (WHO) defines sexual health as 'a state of physical, emotional, mental, and social well-being in relation to sexuality'. However, addressing sexual health has been afforded low priority in primary healthcare systems. Primary care practitioners (PCPs), who play a crucial role in providing comprehensive care to communities, receive little training on screening and managing individuals with sexual health problems. The scope of services ranges from education, prevention and screening, to management of sexual health matters. Patients with noncommunicable diseases (NCDs), such as stroke, cancer, heart disease and diabetes, are at increased risk for sexual dysfunction, possibly because of common pathogenetic mechanisms, such as inflammation. This is of considerable importance in the sub-Saharan African context where there is a rapidly increasing prevalence of NCDs, as well as a high burden of HIV. Strategies to improve the quality of sexual health services in primary care include creating a safe and non-judgemental practice environment for history-taking among gender-diverse populations, utilising effective screening tools aligned with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for sexual dysfunctions. In particular, the International Consultation on Sexual Medicine (ICSM -5) diagnostic and treatment algorithm can empower primary care providers to effectively address sexual dysfunctions among patients and improve the quality of care provided to communities regarding sexual and reproductive health.

The erectile and ejaculatory implications of the surgical management of rectal cancer.

Colorectal cancer is a significant cause of cancer-related deaths worldwide. Although advances in surgical technology and technique have decreased mortality rates, surviving patients often experience sexual dysfunction as a common complication. The development of the lower anterior resection has greatly decreased the use of the radical abdominoperineal resection surgery, but even the less radical surgery can result in sexual dysfunction, including erectile and ejaculatory dysfunction. Improving the knowledge of the underlying causes of sexual dysfunction in this context and developing effective strategies for preventing and treating these adverse effects are essential to improving the quality of life for postoperative rectal cancer patients. This article aims to provide a comprehensive evaluation of erectile and ejaculatory dysfunction in postoperative rectal cancer patients, including their pathophysiology and time course and strategies for prevention and treatment.

Protective effect of laparoscopic functional total mesorectal excision on urinary and sexual functions in male patients with mid-low rectal cancer.

BACKGROUND: Urinary and sexual dysfunctions are among the most common complications in rectal cancer surgery. This study aimed to investigate the protective effect of laparoscopic functional total mesorectum excision (TME) on urinary and sexual functions in male patients. METHODS: A total of 248 male patients with mid-low rectal cancer were recruited in this study between February 2017 and July 2020. To overcome selection bias, we performed a 1:1 match using six variables, including age, BMI, ASA score, tumor distance, clinical T stage, and tumor size. The urinary function was assessed by the International Prostate Symptom Score (IPSS), sexual function was assessed by a 5-item version of the International Index of Erectile Function (IIEF-5) and ejaculation grading at postoperative 3 and 12 months. RESULTS: 79 patients received functional TME surgery (FTME group), and 169 patients received routine TME surgery (RTME group). After the propensity score, 79 pairs were balanced and analyzed. Patients in the FTME group showed a lower IPSS score and higher IIEF-5 score than patients in the RTME group at postoperative 3 and 12 months. The incidence of ejaculation dysfunction for patients in the FTME group was lower than patients in the RTME group at postoperative 3 and 12 months. CONCLUSION: Laparoscopic functional total mesorectal excision was beneficial to faster recovery of urinary and sexual function for patients with rectal cancer, and it could be used as a superior surgical technique for pelvic autonomic nerve preservation in mid-low rectal cancer.

[Radiation-induced sexual toxicity]. / Toxicité sexuelle induite par la radiothérapie.

Oncosexuality has recently become a new supportive care mission. Sexual morbidity is, routinely, underestimated and must be questioned. We report here the most frequent disorders for men and for women, how to prevent them and how to treat them.

Transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic partial or radical nephrectomy: a preliminary study.

BACKGROUND: With the development of minimally invasive technology, more and more people pay attention to aesthetics of the wound after operation. This study is aim to introduce a new surgical technique of transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic partial or radical nephrectomy and evaluate the safety, feasibility and clinical effect. METHODS: Eleven patients who underwent 3D laparoscopic partial nephrectomy (n = 7) or radical nephrectomy (n = 4) and NOSES were included in this study. The surgical procedures and techniques, especially the NOSES operation, are reported in detail. In addition, the basic clinical data, perioperative related data, perioperative complications were analyzed. RESULTS: All 11 patients were performed successfully without conversion to open surgery. The mean total operative time was 133 (84, 150) min. NOSES time was 15 (13, 16) min, and the postoperative hospital stay was 5 (5, 5) d. The mean visual analogue score (VAS) was 3 (2, 4) point and 1 (0, 1) point at 24 h and 48 h after operation, respectively. No patient had recurrence, metastasis and death during the follow-up period of 3 to 17 months. The median Vancouver Scar Scale (VSS) was 1 (1, 1) point. The mean of Female Sexual Function Index (FSFI) was 21.60 (20.20, 21.60), 21.80 (19.80, 21.80) respectively between preoperative and postoperative 3 months, which has no statistical difference (P = 0.179). There was no statistical difference in the Pelvic Floor Distress Inventory-short form 20 (PFDI-20) score between preoperative and postoperative 3 months (P = 0.142). CONCLUSIONS: Transvaginal NOSES is safe and feasible in 3D laparoscopic partial or radical nephrectomy. Furthermore, it results in low incision-related pain without affecting the pelvic floor and sexual function.

Guideline No. 422d: Menopause and Sexuality

Provide strategies for improving the care of perimenopausal and postmenopausal women based on the most recent published evidence. Perimenopausal and postmenopausal women. Target population will benefit from the most recent published scientific evidence provided via the information from their health care provider. No harms or costs are involved with this information since women will have the opportunity to choose among the different therapeutic options for the management of the symptoms and morbidities associated with menopause, including the option to choose no treatment. Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002­2020, and MeSH search terms were specific for each topic developed through the 7 chapters. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). physicians, including gynaecologists, obstetricians, family physicians, internists, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; pharmacists; medical trainees, including medical students, residents, fellows; and other providers of health care for the target population.

A state-of-art review on the preservation of sexual function among various minimally invasive surgical treatments for benign prostatic hyperplasia: Impact on erectile and ejaculatory domains.

There is a strong association between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and sexual dysfunction. While transurethral resection of the prostate (TURP) is considered the standard BPH treatment, it is however associated with a high rate of erectile and ejaculatory dysfunctions. Over the past decade, new and novel minimally invasive BPH therapies have been shown to improve various parameters of voiding domains while minimizing adverse sexual effects. These minimally invasive BPH therapies can be largely be divided into those with cavitating technology (Rezum, Histotripsy, Aquablation), intra-prostatic injections (Botulinum neurotoxin Type A, Fexapotide Triflutate, prostate specific antigen-activated protoxin PRX-302), and mechanical devices which include intraprostatic stents (Urospinal 2™, Memotherm™, Memokath™, and Allium triangular prostatic stent™) and intraprostatic devices (iTIND™, Urolift™), as well as prostatic artery embolization. Published literature on these technologies showed reasonable preservation of erectile function with limited data reported on ejaculatory domain. Further validation of the performance of these novel minimally invasive treatment options for LUTS due to BPH in well-designed and multi-centre studies are desired, to evaluate their role (or lack of such a role) in clinical practice and whether these BPH therapies can provide equivalent standard or better than TURP.

Initial single centre experience of Aquablation of the prostate using the AquaBeam system with athermal haemostasis for the treatment of benign prostatic hyperplasia: 1-year outcomes.

PURPOSE: Aquablation using the AquaBeam system combines real-time image guidance and robotics to enable precise and heat-free removal of prostatic tissue with a high velocity water jet. The aim of this study is to report the outcomes of Aquablation up to 1 year in a single centre within the UK employing an athermal approach to haemostasis. METHODS: Fifty-five consecutive men underwent Aquablation between September 2017 and December 2018 (as part of OPEN WATER trial). Standard Aquablation was performed with the AquaBeam system (PROCEPT® BioRobotics) with 2 passes of Aquablation followed by bladder washout with application of continuous bladder irrigation via a catheter on a continuous traction device. Patients were followed up at 3 and 12 months. The data were prospectively collected on patient demographics, uroflowmetry, prostate volume, International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) and International Index of Erectile Function (IIEF-15). RESULTS: The mean age was 64.1 ± 7.9 years. Operating time was 26.9 ± 9.2 min. Mean prostate volume decreased from 58.2 ± 23.9 cc to 33.2 ± 12.9 cc (p < 0.0001). There were significant improvements at the 12 month follow-up in maximum urinary flow rate (9.9 ± 5.1 ml/s vs. 23.9 ± 11.6 ml/s), IPSS (21.7 ± 7.4 vs. 6.1 ± 4.2) and quality of life score (4.8 ± 1.1 vs. 1.4 ± 1.4) (p < 0.0001). There was no significant change in IIEF-15 and MSHQ-EjD scores. There were 8 (14.5%) Clavien grade 2 or higher complications. CONCLUSION: Our single centre experience suggests Aquablation using an entirely athermal approach is a safe cavitating procedure resulting in significant LUTS improvement comparable to standard cavitating procedures with greater preservation of sexual function.

Which Anatomic Structures Should Be Preserved During Aquablation Contour Planning to Optimize Ejaculatory Function? A Case-control Study Using Ultrasound Video Recordings to Identify Surgical Predictors of Postoperative Anejaculation.

OBJECTIVE: To identify key anatomic structures that should be preserved to decrease postoperative anejaculation after Aquablation. METHODS: We conducted a case-control study design using patient data and operative video logs from Aquablation clinical trials. Cases were sexually active participants with functional baseline ejaculation and postoperative anejaculation. Controls were sexually active participants with functional baseline ejaculation and no postoperative decline in sexual function. Each case was matched to 1 or 2 controls. Video logs from the procedure were scored for: verumontanum cut coverage, penetration of ejaculatory ducts, depth of cut below the verumontanum, angle offset of verumontanum to centerline of protection zone, number of passes, and intraprostatic calcifications. Conditional logistic regression was used to calculate univariate odds ratios relating anatomic findings to case/control status. RESULTS: We identified 24 cases and 27 controls. In univariate analysis, predictors of postoperative anejaculation were: penetration of the ejaculatory ducts (odds ratio [OR] 8.6 [95% CI 1.09-67.5], P = .041) and depth below the verumontanum (OR 1.92 [1.1-3.3], P = .015). CONCLUSION: Violation of anatomic structures involved in ejaculation during the Aquablation procedure increases the risk of postoperative anejaculation. More careful attention to these structures during contour planning may further improve ejaculatory function after Aquablation.

[Total mesorectal excision with preservation of Denonvilliers' fascia (iTME) based on membrane anatomy].

Total mesorectal excision (TME) has been advocated as the golden standard of mid-low rectal cancer surgery for nearly 30 years. However, the complication of postoperative urinary and sexual dysfunctions due to intraoperative nerve injury has yet to be improved. Based on the concept of membrane anatomy, we carried out a systematic study on the important membrane anatomical structure anterior to the rectum--Denonvilliers' fascia. From multiple aspects including anatomy, physiology, histochemistry and surgical practice, we verified the importance of Denonvilliers' fascia for TME surgery in prevention of intraoperative nerve injury and postoperative urogenital dysfunction. Moreover, based on anatomical study of the surgical marker line of Denonvilliers' fascia (Wei's line) and surgical plane, we proved that total mesorectal excision with preservation of Denonvilliers' fascia (iTME) was feasible and practical. Therefore, we conducted a large multicentric randomized controlled trial (RCT). The mid-term result demonstrated that compared with traditional TME surgery, iTME was more effective in reducing the incidence of postoperative urinary and sexual dysfunctions in male patients with mid-low rectal cancer, without sacrifice of short-term tumor radical outcome. We believe that the final RCT result of iTME, based on membrane anatomy, will provide solid evidence for the update of concepts of rectal cancer surgery.

Is Low Inferior Mesenteric Artery Ligation Worthwhile to Prevent Urinary and Sexual Dysfunction After Total Mesorectal Excision for Rectal Cancer?

BACKGROUND/AIM: We studied the role of high or low inferior mesenteric artery (IMA) tie on defecatory, sexual and urinary dysfunctions in patients who underwent laparoscopic TME for early rectal cancer. PATIENTS AND METHODS: Forty-six consecutive patients undergoing curative laparoscopic resection for pT2N0M0, rectal adenocarcinoma from February 2013 to March 2019 were enrolled into this prospective randomized open label parallel trial to have a laparoscopic TME with a high (Group 1) or low IMA ligation (Group 2). Demographic data and information on symptoms and comorbidity, intra- and post-operative outcomes and defecatory, sexual and urinary functions before and after surgery according to the validated International quality of life questionnaires. RESULTS: A significant difference in postoperative total score of FIQL scale, Jorge-Wexner incontinence score and Agachan-Wexner constipation score were observed between the high and low tie groups at 1, 6, and 12 months after surgery. ICIQ-UI short form, FSFI, and IIEF demonstrated at 1, 6 and 12 months, the scores were significantly higher for patients of Group 1 as compared to those of Group 2. CONCLUSION: A low IMA ligation permits a better fecal continence, less abdominal pain, and less genito-urinary and sexual dysfunctions in patients submitted to TME for rectal cancer.

Vascular Surgeons' Views on Ejaculation Disorders After Abdominal Aortic Surgery: Results of a Dutch Survey.

BACKGROUND: The aim of this study is to evaluate vascular surgeons' knowledge and appreciation of ejaculatory dysfunction after open aortic aneurysm repair and the knowledge of possible nerve-preserving techniques. METHODS: A Dutch national survey was conducted on sexual counseling in the case of open aortic surgery. For this purpose, a designed questionnaire based on a review of the literature in the field and on other surveys aiming to analyze care for sexual health by medical specialists was used. RESULTS: The response rate was almost 60%. All responders were familiar with the occurrence of postoperative neurogenic complications. Sixty percent preoperatively informs their patients, but only one-third inquires whether such complications have occurred postoperatively. Most respondents estimated the incidence of postoperative neurogenic complications due to dissection of the periaortic tissues between 5% and 25%. Almost 75% take nerve anatomy into consideration when exposing the abdominal aorta, but only 29% mention the correct structures, and only 37% mention possible correct nerve-sparing techniques. CONCLUSIONS: Dutch vascular surgeons are well aware of the occurrence of postoperative sexual disorders after infrarenal aortic reconstruction. A gap in knowledge of pathophysiology and anatomy exists. Furthermore, a significant part of vascular surgeons seems to lack skills in sexual counseling. Therefore, more education should be offered during vascular surgical training. WHAT THIS ARTICLE ADDS: This article addresses iatrogenic neurogenic complications affecting sexual health following open aortic surgery. It opens the discussion on possible gaps in modern training of vascular surgeons and on sexual health in relation to postoperative quality of life and shared decision-making.

The impact of primary Sjogren's syndrome on female sexual function.

INTRODUCTION: Sjogren syndrome (SS) is a chronic autoimmune disease that usually affects women more than man with a 9:1 ratio. It leads to a progressive functional impairment of exocrine glands. Tipically, its clinical presentation is characterized by xerostomia and xerophtalmia, but it can also affect, among others, female genital apparatus, causing vaginal dryness and dyspareunia. EVIDENCE ACQUISITION: PubMed and Google Scholar were searched for articles in English indexed from January 1995 to November 2019 to assess evidence on the impact of primary Sjogren's syndrome on female sexual function. Our attention was directed specifically on the quality of sexual life of patients affected by primary SS. EVIDENCE SYNTHESIS: SS is associated with sexual dysfunction and it can significantly worsen patient's quality of life. CONCLUSIONS: The genital disorders secondary to SS can strongly alter the quality of female life both physically and psychologically as they alter sexuality. However, the observation of certain behavioral norms and the use of appropriate local substances can alleviate the symptoms and effectively contribute to reducing the discomfort.

Management of partial vaginal agenesis according to the Wharton-Sheares-George technique - a long-term follow-up.

The purpose of this study was to explore the long-term follow-up of treatment of congenital partial vaginal agenesis using the Wharton-Sheares-George technique. The technique was performed on 52 patients with congenital partial vaginal atresia from January 2009 to December 2017. As a result, the mean operating time of the Wharton-Sheares-George technique procedure was 25.6 ± 2.2 min. The mean estimated blood loss was 16.7 ± 4.7 mL. The average length of stay in hospital for the patients was 2.3 ± 0.2 days. There were no intraoperative and postoperative complications. The median duration of follow-up was 58 months. All of the patients experienced a resumption of menses. The mean vaginal length at 3 months was 7.3 ± 0.8 cm. Vaginal stenosis and adhesion did not occur in any cases during the follow-up. Twenty patients had sexual activities and the mean value of the FSFI questionnaire was 31.2 ± 4.0. Six cases became pregnant. There were four cases who each delivered one child and two cases who both delivered two children.IMPACT STATEMENTWhat is already known on this subject? It has been reported that the Wharton-Sheares-George technique provides, functionally and anatomically, very satisfactory results for the patients with Mayer-Rokitansky-Küster-Hauser syndrome. However, a study of the Wharton-Sheares-George technique in patients with congenital partial vaginal agenesis has not been reported previously in the medical literature.What the results of this study add? Our results have indicated that the Wharton-Sheares-George technique provides short operation time and length of stay, little blood loss intraoperatively, a satisfactory vaginal length and sexual activity in patients with congenital partial vaginal agenesis.What the implications are of these findings for clinical practice and/or further research? The study suggests that the Wharton-Sheares-George technique provides very satisfactory results in function and anatomy for congenital partial vaginal agenesis.

Effect of a structured educational package on women's sexual function during pregnancy.

OBJECTIVE: To explore the effect of a structured educational package based on ADDIE (analysis, design, development, implementation, evaluation) to reduce sexual dysfunction during pregnancy. METHODS: A randomized controlled trial study among pregnant women attending prenatal clinics in Tehran, Iran, from October 2017 to September 2018. The implementation group received the structured educational package; the control group received training on breastfeeding and normal delivery. The outcome measure was changes in total and domain scores of the Female Sexual Function Index (FSFI) questionnaire before and after the intervention; the groups were compared by repeated-measures analysis of variance (ANOVA). RESULTS: Overall, 70 women completed the study: 36 in the intervention group and 34 in the control group. Sexual desire (P=0.019), arousal (P=0.001), lubrication (P=0.001), orgasm (P=0.001), satisfaction (P=0.007), and total FSFI score (P<0.001) improved significantly in the intervention group as compared with the control group. However, there was no difference in sexual pain after the intervention (P=0.78). CONCLUSION: The structured educational package was found to reduce sexual dysfunction by improving knowledge of and attitudes toward the physical and psychologic changes that occur during pregnancy among Iranian women attending routine prenatal care visits as part of a healthcare center's program. Iranian Registry of Clinical Trials: IRCT20140907019077N14.

Modified Extraperitoneal Uterosacral Ligament Suspension in Preventing Cuff Prolapse Risk after Vaginal Hysterectomy; 4 Clamp Method.

Objectives: The extraperitoneal uterosacral ligament suspension (ULS) can be performed during the removal of the uterus in vaginal hysterectomy to prevent cuff prolapse. In this study, we evaluated the modified extraperitoneal ULS technique in terms of preventing cuff prolapse. Methods/Technique: Forty patients with second and third-stage uterine prolapse who were operated were included in the study. During routine vaginal hysterectomy procedure performed on patients, after sacrouterine ligaments which are the first-bites and uteroovarian and round ligaments which are the last-bites have been sutured and knotted, these ligaments were marked with 4-distinct clamps to make the right and left, upper and lower separation. After vaginal cuff was closed the sutures hanged by the clamps were ligated together, and the cuff tissue was stretched to the apical line. Results: According to the POP-Q classification, 22 patients with stage-2 and 18 patients with stage-3 prolapse were operated. During the 2-year follow-up; 4 patients could not be reached and were excluded from follow-up. Five of the remaining 36 patients (13.8%) found to have stage-1 cuff prolapse and 31 (86.1%) of patients had no prolapse. There was no significant decrease in postoperative vaginal length (p [Formula: see text] 0.05). The PISQ-12 sexual function scores was found similar before and after surgery (p [Formula: see text] 0.05). Conclusions: The extraperitoneal ULS is a successful method to prevent cuff prolapse after hysterectomy. Although there are various modified forms of this method, the modified ULS, which we have described as the 4-clamp method, seems to be successful in terms of initial results.

Male and female sexual dysfunction in diabetic subjects: Focus on new antihyperglycemic drugs.

The association between diabetes mellitus (and its micro- and macro-vascular complications) and erectile dysfunction is widely known and the presence of hypogonadism may further complicate sexual dysfunction and quality of life, given the association between hypogonadism and reduced libido, ejaculatory disorders, and depressive symptoms. However, the recent introduction of novel antidiabetic agents with a wide range of mechanism of action may have a significant impact both on male and female sexuality directly (by inducing side effects as urinary tract infections) and indirectly (improving metabolic status and reducing diabetes complications behind sexual dysfunctions). To date only few papers are reporting the sexual effects of these treatments and, often, these are not comparable in their results. Conversely, female sexual dysfunctions are somehow under-investigated. Data on prevalence is heterogeneous and specific pathogenic mechanisms, as well as the burden of psychological factors, are still heatedly debated. The aim of this narrative review is to summarize current knowledge and stressing out the need to diagnose male and female sexual dysfunctions also in light of the impact of treatments with novel antidiabetic agents. This would highlight the still unmet needs for sexual care in a diabetes care setting and could represent an incentive for future discussions, as well as a required theoretical starting point for studies on this subject.

Opioid-induced hypogonadism: Pathophysiology, clinical and therapeutics review.

Opioids are pivotal therapeutics in the management of escalated chronic pain (moderate-severe). In the last two decades, the increased prescription rate and the prolonged usage of opioids shed light on opioid-induced endocrinopathy. Opioid-induced hypogonadism (OHG) results upon long-term opioid therapy. Clinically, patients with OHG are presented mainly by sexual dysfunction and infertility. Opioid clinical use in pain therapy is indispensable. However, the resultant sexual endocrinopathy cannot be overlooked and hence hormonal replacement therapy with regular monitoring of the patients represents a potential therapeutic strategy while avoiding opioids in patients with guaranteed long therapeutic exposure and switching to using low-dose naltrexone as alternative represents a possible prophylactic measure to ensure therapeutic compliance and secure a good life quality of patients.