Maca (Libido)

Background: Paraneoplastic limbic encephalitis (PLE) with anti-Ma2 antibodies is a rare immune-mediated disorder associated with testicular cancer, particularly in young males. While neurological manifestations are well documented, hypothalamic-pituitary dysfunctions remain underreported. We present a case of anti-Ma2 PLE associated with testicular cancer together with a systematic review of PLE associated with testicular cancer, selectively restricted to anti-Ma2 positive cases and focusing on hypothalamic-endocrine involvement. Case presentation: We describe a 21-year-old male diagnosed with anti-Ma2 PLE and intratubular germ cell neoplasia of the right testis. He underwent orchifunicolectomy and immunosuppressive therapy with neurological improvement. Four years later, he developed new-onset temporal seizures, decreased libido, and a polyuria-polydipsia syndrome. Dynamic endocrine testing, including a water deprivation test and copeptin measurement, supported a diagnosis of partial central diabetes insipidus (CDI). Methods: A systematic literature review was performed in accordance with PRISMA guidelines. PubMed was searched using predefined keywords without time restriction. Studies reporting PLE associated with testicular tumors in humans with confirmed anti-Ma2 antibody positivity were included. Results: Eleven studies were included, reporting a total of 38 patients with anti-Ma2-associated PLE and testicular cancer. Hypothalamic or diencephalic involvement was described in 16 patients (42.0%), while endocrine manifestations were explicitly reported in four cases. Only two previous reports mentioned CDI, without detailed diagnostic evaluation. Conclusions: This study highlights the importance of recognizing hypothalamic-endocrine manifestations in PLE. In patients presenting with polydipsia and polyuria, CDI should be carefully differentiated from primary polydipsia using dynamic testing. Hypothalamic involvement may emerge years after tumor treatment, warranting long-term endocrine surveillance. On-demand testosterone for the treatment of female sexual dysfunction: a systematic review. Yin LB(1), Bernardino RM(2)(3), Pace K(1), Mansouri S(1), Kaushal S(

2. Sex Med Rev. 2026 Jan 5;14(1):qeag014. doi: 10.1093/sxmrev/qeag014. On-demand testosterone for the treatment of female sexual dysfunction: a systematic review. Yin LB(1), Bernardino RM(2)(3), Pace K(1), Mansouri S(1), Kaushal S(1), Cockburn JG(2), Fleshner NE(2). Author information: (1)Temer

INTRODUCTION: Sexual function during breastfeeding is a clinically significant but under-researched aspect of postpartum health. Hormonal, physical, psychological, and social changes may influence women’s sexual function, affecting marital satisfaction and quality of life. This systematic review aimed to synthesize evidence on sexual function in breastfeeding women and the factors contributing to its variations. METHODS: A comprehensive search was conducted in Persian (SID, MAGIRAN) and international databases (Medline, Scopus, Web of Science, Science Direct, Cochrane Library, Google Scholar) for studies published between 2010 and 9 August 2025. Quantitative and qualitative studies reporting on sexual function, psychological, emotional, and physical effects, and quality of life in breastfeeding women were included. Methodological quality was assessed using the NICE checklist, which was selected due to its comprehensiveness and applicability to both quantitative and qualitative studies, while other common tools such as JBI and Cochrane Risk of Bias exist. Following screening, 22 studies were included. Narrative synthesis was used to address heterogeneity in study designs, outcomes, and populations. RESULTS: Findings indicate that breastfeeding is associated with changes in sexual function, including decreased libido, vaginal dryness, dyspareunia, and reduced sexual satisfaction, with prevalence estimates ranging from 60% to 80% across studies. Hormonal factors, particularly increased prolactin and decreased estrogen, contributed significantly during the early postpartum months. Psychological factors such as stress, postpartum depression, and body image concerns also affected sexual function. Social and relational factors, including partner support and cultural expectations, moderated these effects. Notably, some women reported positive experiences, such as increased emotional intimacy and improved relationship satisfaction, particularly when adequate social and psychological support was available. CONCLUSION: Sexual function during breastfeeding results from a complex interplay of hormonal, psychological, social, and relational factors. Although many women face c

OBJECTIVE: To identify key elements for screening kidney deficiency pattern (KDP) through a systematic review and Delphi methodology to detect high-risk KDP groups. METHODS: We first conducted a systematic review to extract kidney system patterns and then performed four rounds of the Delphi. After the third round, two face-to-face consensus meetings were held to finalize the consensus. The English version of the KDP Screening Questionnaire (KDPScreenQ) was developed through agreement between a bilingual physician and the research team. RESULTS: A systematic review identified 35 studies that predominantly focused on KDP, KDP-Yin, and KDP-Yang. Twenty-two common symptoms were reported in five or more studies. A panel of ten experts, including specialists in internal medicine and diagnostics, participated in all four rounds of the Delphi process. The final KDPScreenQ comprises 20 key elements. Key elements for KDP include lassitude; weakness, and pain in the lumbar region and knee joints (four items); reduced libido or sexual dysfunction; tinnitus or deafness; urinary incontinence (two items); thinning and loss of hair; forgetfulness; loose teeth and weak gums. Key elements for KDP-Yin include heat sensation in the palms and feet; a sensation of heat and tightness in the chest (particularly in the afternoon); night sweats; and dry mouth. Key elements for KDP-Yang include aversion to cold; edema; early morning diarrhea; and loose stools. CONCLUSION: The KDPScreenQ is a fundamental tool for standardizing KDP differentiation, serving both to screen patients with KDP and to track their long-term prognosis. This questionnaire will next be used in a prospective observational study to determine cut-off values.

INTRODUCTION: Sexual health, including sexual desire in its two dimensions (solitary and dyadic), is a crucial component of overall well-being. In transgender and gender diverse (TGD) individuals, sexual desire may be further modulated by gender-affirming therapies (GATs). However, empirical appraisal of sexual desire across different domains in TGD individuals remains limited. OBJECTIVES: To compare sexual desire between TGD individuals and the general population, and to examine the associations between sexual desire, age, and GAT. METHODS: A preregistered systematic review and meta-analysis, retrieving literature from three databases (PubMed, Scopus, and EMBASE). Six studies reporting population means by the Sexual Desire Inventory were finally included (TGD individuals, n = 1940). First, population means were derived within TGD individuals either assigned male (AMAB) or female (AFAB) at birth. Comparisons with reference means from the general population (n = 79.423) were made through Cohen's d. Associations with age, exposure to GAT, and duration of GAT were evaluated through meta-regression analyses. RESULTS: AMAB (n = 1105) and AFAB (n = 835) TGD individuals reported significantly lower levels of sexual desire compared to the general population (solitary: Cohen's d = -0.53 to -0.57; dyadic: d = -0.76 to -1.27; total: d = -0.35 to -0.53; all P < .001). Solitary sexual desire was not significantly associated with age (β = 0.178, P = .587) or GAT (β = 10.168, P = .303). In contrast, dyadic sexual desire and total sexual desire were positively associated with exposure to GAT (dyadic: β = 30.201, P < .001; total: β = 42.823, P < .001). Older TGD individuals reported lower dyadic sexual desire (β = -0.404, P = .033) and were less likely to report increases in dyadic or total sexual desire following GAT (interaction terms, dyadic: β = -0.601, P = .014; total: β = -0.946, P < .001). No significant difference was found in sexual desire between AMAB and AFAB TGD individuals (solitary: β = -0.068, P = .962; dyadic: β = -3.186, P = .360; total: β = -5.505, P = .402). CONCLUSION: TGD individuals exhibit reduced sexual desire compared to the general population, particula

The ability to have sex without having an unintended pregnancy is a key motivator for contraceptive use, yet factors related to patients' sexual lives are critically understudied in contraceptive decision-making. We report the first systematic review and meta-analysis examining the extent to which a contraceptive method's effect on a satisfying sexual life results in contraception discontinuation or switching. We searched for relevant qualitative and quantitative literature published during 2004-2023 in 9 databases and included 64 studies, comprising a total of 125,586 participants and corresponding to at least 52,705 discontinuers in need, aged 12-54 and surveyed in clinical or public health settings in diverse global contexts. Our main outcome measures were discontinuation or switching of modern contraceptive methods (excluding condoms) while in need. A meta-analysis of 25 studies indicated that sex life concerns as a reason for contraceptive discontinuation have an overall prevalence of 5% (95% CI: 0.03, 0.08; I2 = 94%, τ2 = 1.31; Q = 381, p < 0.001). Sub-group meta-analyses and follow-up meta-regressions do not support any differences based on the hormonal content of the contraceptive method, the specific contraceptive method type, or the specific type of sex life reasons. Sex life reasons are important, common reasons for contraceptive discontinuation. Their prevalence is comparable to other reasons for discontinuation, such as cost or access. Future research should investigate impacts of contraceptive methods on sex life more directly and clinicians should include counselling on a method's sexual acceptability as part of the wider conversation on common contraceptive side effects. Plain Language Summary: This study explored how the effect of a contraceptive method on people's sex lives might make them decide to stop or change the method. We analysed data from 64 studies conducted globally between 2004 and 2023, involving over 125,000 participants. We found that about 5% of people who discontinued contraception while still needing it did so for reasons related to their sex life. These reasons included decreased libido, discomfort during sex, or concerns ab

OBJECTIVE: To conduct a systematic review and meta-analysis of treatments for female sexual desire, arousal, and orgasmic dysfunction in patients without sexual pain conditions. DATA SOURCE: MEDLINE, Embase, Web of Science, Cochrane Library, PsycINFO, and ClinicalTrials.gov. METHODS OF STUDY SELECTION: Following the initial search in December 2024, a total of 8994 abstracts were screened, 278 full-text articles were reviewed, and 36 studies met criteria for data abstraction including a patient population with female sexual dysfunction (FSD) of desire, arousal, and/or orgasm (DAO) and outcome measures including the Female Sexual Function Index (FSFI), its DAO subscales, and the Female Sexual Distress Scale (FSDS). Studies including patients with sexual pain conditions were excluded. Two reviewers independently conducted each phase. TABULATION, INTEGRATION, AND RESULTS: Of the 36 studies, 26 were RCTs and 10 were single-arm trials. Ten studies evaluated cognitive behavioral therapy (CBT), 24 investigated medication therapy, and 2 investigated devices. Meta-analyses were conducted for mindfulness-based CBT, flibanserin, and bremelanotide. Mindfulness-based CBT significantly improved total FSFI and subscales of desire, arousal, and orgasm. Conversely, flibanserin improved total FSFI and desire while bremelanotide improved total FSFI and its desire and arousal subscales. No studies directly compared CBT to pharmacotherapy. CONCLUSION: In this systematic review of treatments of females with sexual DAO dysfunctions without pain, we found that CBT improves DAO; flibanserin improves desire; and bremelanotide improves both desire and arousal; and all 3 treatments reduce distress. Our findings align with previous literature and expand upon it to include multiple treatment modalities. This broader perspective offers a starting point for clinicians, including gynecologists, who frequently serve as the first point of care for FSD. Conclusions regarding most other treatments could not be drawn due to limited numbers of studies of FSD excluding pain, heterogeneous terminology for DAO disorders, and varying outcome measures across studies.

BACKGROUND: Impaired sexual functioning is one of the consequences of obesity with hormonal disorders involving testosterone. AIM: To explore the link between obesity and sexual desire, to assess how changes in body weight affect sexual desire, and to examine the role of testosterone in these changes in obese and overweight men. METHODS: The systematic review was conducted in PubMed. Studies involving obese/overweight men that reported different libido levels or changes after weight loss interventions were included. Meta-analysis and meta-regression were performed. RESULTS: The search identified 2259 studies, of which 28 met the eligibility criteria. Most studies focused on weight-loss interventions (n = 21, 77%), with 13 studies investigating the effect of bariatric surgeries. Testosterone levels were reported in 14 studies. The studies encompassed a total population of 18 653 people, including 10 356 obese and overweight men. Of the 28 identified studies, 15 indicated a potential association between BMI, waist circumference, and sexual desire. Effect size meta-analysis (calculated using data from four studies presenting results before and after bariatric surgery) suggests that an increase in the International Index of Erectile Function sexual desire domain was very strongly associated with changes in a patients' weight resulting from bariatric surgery (d = 1.22, 95% CI 0.41-2.03, P = 0.003). The meta-analysis of four studies, presenting results before and after diet intervention, showed a strong impact of weight loss on an increase of the Sexual Desire Inventory (SDI), (d = 1.16, 95% CI 0.44-1.88, P = 0.002) The meta-regression revealed a significant association between the level of sexual desire on the SDI and the magnitude of BMI changes before and after dieting interventions (R2 = 77.97%; P = 0.002). The meta-analysis of plasma total testosterone levels from studies that present results before and after selected diets showed a strong impact of diet on the increase in testosterone levels after interventions (d = 1.39 95% CI 0.86-1.92; P < 0.001). There was a significant impact of the level of plasma total testosterone on the variance of sexual desire in the

BACKGROUND: Thyroid disorders are common endocrine conditions impacting multiple organs, including the reproductive system and often lead to sexual dysfunction. These effects can vary by gender; for example, women with hypothyroidism frequently experience reduced libido. Low thyroid hormone levels are also linked to vaginal dryness, causing discomfort, especially during intercourse. This study aims to assess the global prevalence of sexual dysfunction in women with thyroid disorders. METHODS: Systematic searches were performed across electronic databases, including PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar, to retrieve studies reporting the prevalence of sexual dysfunction in patients with thyroid disorders up to February 8, 2024. Inclusion criteria comprised studies that reported on the prevalence of female sexual dysfunction (FSD) in patients with thyroid disorders and studies published in English available full text. Exclusion criteria included case studies, intervention studies, studies with incomplete information, repeated studies and those not written in English. Cross-sectional studies were the primary study design included. Data were analyzed using the Comprehensive Meta-Analysis software (Version 2). RESULTS: Analysis of nine studies, involving a total sample size of 1013, found an overall prevalence of sexual dysfunction in women with thyroid disorders to be 44.8% (95% CI: 33.8-56.2). Given the substantial reporting of sexual dysfunction among women with either hypothyroidism or hyperthyroidism, subgroup analyses were conducted. The prevalence of sexual dysfunction was 41.8% (95% CI: 26.3-59) among women with hypothyroidism and 59.6% (95% CI: 50.5-68.1) among those with hyperthyroidism. CONCLUSION: The notable prevalence of sexual dysfunction in women with thyroid disorders highlights the for increased awareness among this population. Targeted awareness initiatives may help mitigate the occurrence of sexual dysfunction and its adverse effects, improving overall quality of life for affected women. CLINICAL TRIAL NUMBER: Not applicable. © 2024. The Author(s).

The viral hemorrhagic fevers Lassa fever (LF) and Ebola virus disease (EVD) have been documented to cause long-term health problems in survivors. Limited studies have noted the presence of adverse reproductive health outcomes, including menstrual irregularities and pregnancy loss, after recovery from infection. The objective of this systematic review and meta-analysis is to summarize existing knowledge surrounding reproductive health in female survivors of LF and EVD. Literature was gathered from PubMed, Embase, Ovid Medline, Cumulative Index of Nursing and Allied Health (CINAHL) Complete, Web of Science, and Global Health databases and subsequently reviewed in Covidence. Included studies described at least one reproductive health outcome in women after recovery from EVD or LF. Thirteen studies were identified in the systematic review, all of which only discussed reproductive health in EVD survivors. No studies of reproductive health among survivors of LF were identified. The included studies were conducted in Guinea, Sierra Leone, and Liberia, and they reported irregular menstruation, pregnancy loss, decreased libido, pelvic inflammatory disease, sexual dysfunction, female reproductive odor, and genital problems/infections among survivors. In a meta-analysis of nine studies, 14.0% of female EVD survivors experienced any adverse reproductive health outcome. However, there was significant heterogeneity among the included studies. This study highlights the health problems faced by female EVD survivors and underscores the need for more research surrounding the effects of viral hemorrhagic fevers on women's health.

BACKGROUND: Sexual fantasies may enhance sexual desire and reduce sexual distress by redirecting focus toward emotionally salient and arousing imagery. Despite promising evidence, few experimental studies have tested whether repeated engagement in sexual fantasies can improve sexual functioning, reduce sexual distress and reduce cognitive distractions during sexual activity. OBJECTIVES: This randomized controlled trial tested the preregistered hypotheses that a four-week sexual fantasy task increases sexual desire, reduces sexual distress, and reduces worries with body image and performance during sexual activity. Two exploratory objectives were also examined: (1) whether sexual pleasure would increase, and (2) whether partner-focused vividness of imagination would be enhanced. METHOD: Sixty heterosexual adults with an opposite-sex partner in the past four weeks were randomly assigned to either a sexual fantasy group (n = 30), instructed to write erotic narratives at least twice weekly, or a control group (n = 30), instructed to write a non-sexual positive narrative about dining with friends. Analyses followed an intention-to-treat approach. OUTCOMES: Sexual function, sexual pleasure, sexual distress, sexual worries, partner-focused imagination vividness. RESULTS: Repeated-measures ANOVAs revealed significant Group × Time interactions for all (preregistered) and exploratory outcomes. Only participants in the sexual fantasy group showed increases in sexual desire, pleasure, and partner-focused imagination vividness along with reductions in sexual distress and worries. CLINICAL IMPLICATIONS: Findings suggest that structured sexual fantasy engagement can enhance key aspects of sexual functioning and well-being, for example, by shifting attention from negative cognitive patterns to vivid, emotionally positive erotic imagination. STRENGTHS AND LIMITATIONS: The study has the strength of being a randomized controlled trial with preregistered hypothesis; however, it was conducted with a relatively small convenience sample. CONCLUSION: Sexual fantasy exercises may serve as a brief, home-based intervention to improve sexual well-being. Future research should examine long-

BACKGROUND: Despite advances in pharmacological interventions for rheumatoid arthritis (RA), a subset of patients continues to experience disease activity, highlighting the need for adjunctive therapeutic strategies. OBJECTIVE: To assess the therapeutic efficacy of paroxetine when administered as adjuvant therapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in patients with rheumatoid arthritis (RA). METHODS: In this randomized, double-blind, clinical trial, one hundred patients were randomized in 1:1 ratio to receive either csDMARDs including methotrexate plus placebo (control group) or paroxetine (paroxetine group). The primary endpoint was the change in Disease Activity Score using 28 joint counts (DAS-28) [Tender joint count (TJC), swollen joint count (SJC), C-reactive protein (CRP), visual analogue scale (VAS)] at three months. Secondary endpoints included multidimensional health assessment questionnaire [morning stiffness (MS), pain, fatigue, physical functioning (PF)]. RESULTS: After treatment, both groups demonstrated significant within-group improvements in TJC, SJC, VAS, and DAS-28, with superior improvements observed in the paroxetine group (p = 0.016, 0.0006, 0.03, and 0.005, respectively). CRP showed no significant change in the control group (p = 0.933). Paroxetine group showed significant reductions in MS, pain, and fatigue (p = 0.024, 0.03, and 0.006, respectively) compared with the control group, while PF were significant within groups but not between groups (p = 0.208). Adverse events were comparable, except for a higher incidence of decreased libido in the paroxetine group. CONCLUSION: Adjunctive paroxetine significantly improved clinical and patient-reported outcomes in mild and moderate RA patients and was generally well tolerated, supporting its potential as an effective adjunctive therapy. The relatively small single-center sample, the exclusion of severe RA patients, the short disease duration, the low seropositivity, absence of mental health assessment, the possibility of overlapping with secondary pain mechanisms (eg, central sensitization or early fibromyalgia features) may limit the generalizability of

BACKGROUND: Vibrators can help treat sexual dysfunction, but views and experiences with vibrator use in the urogynecology population is unknown. OBJECTIVE: To explore and describe the views and experiences of urogynecology patients with sexual dysfunction and pelvic floor disorders with scheduled vibrator use. STUDY DESIGN: We performed a secondary qualitative study on individuals participating in a randomized controlled trial investigating the impact of vibrator utilization on sexual function and pelvic floor disorders. All participants had Female Sexual Function Index scores ≤26.5, indicating sexual dysfunction. Participants completed interviews which were recorded, deidentified, and transcribed. Transcriptions were coded for major themes and subcategories using grounded theory methodology. RESULTS: Twenty participants with mean age 60±12.4 years were recruited and interviewed. 12/20 (60%) were sexually active with a partner. Thematic saturation was reached and 7 major themes emerged: Feelings on Self-Pleasure, Public Perceptions, Sexual Activity Barriers, Partner Influences, Positive Experience with Device, Barriers to Device Use, and Role for Future Use. Participants viewed vibrator use and self-pleasure as a natural process. Some participants expressed guilt with vibrator use from generational, religious, or cultural influences. Participants with partners expressed that their partners were supportive of vibrator use. Positive experiences with scheduled device use included improved self-confidence, elevated mood, improved sleep, and increased relaxation. Participants reported more positive perceptions of sex in general, increased libido, and orgasms. They also reported improvements in urinary incontinence, vaginal dryness, and pelvic pain. Barriers to device use included difficulty finding time or privacy. All participants believed that providers should recommend vibrators as a treatment option for sexual dysfunction and pelvic floor disorders. CONCLUSION: Scheduled vibrator use in urogynecology patients with sexual dysfunction and pelvic floor disorders was associated with positive experiences in sexual function, pelvic floor health, and mood. Patients cons

Background and Objectives: Genitourinary syndrome of menopause (GSM) is a prevalent and distressing condition in postmenopausal women, often leading to sexual dysfunction characterized by vaginal dryness, pain, and reduced libido. While local estrogen therapy remains the standard treatment, due to safety concerns and contraindications, there is growing interest in the exploration of alternative interventions. This study aimed to compare the effectiveness and safety of intravaginal platelet-rich plasma (PRP) therapy versus local hormonal treatment in improving sexual function and vaginal health in postmenopausal women. Materials and Methods: A prospective, controlled clinical trial was conducted between January 2023 and December 2024 across three private gynecology clinics in Timișoara, Romania. Ninety postmenopausal women aged between 50 and 65 years with FSFI scores ≤ 23 were randomized into two groups: one receiving three monthly sessions of autologous PRP and the other undergoing 12 weeks of vaginal estriol therapy. Outcomes were assessed using validated tools-the Female Sexual Function Index (FSFI), the Vaginal Health Index (VHI), the Patient Global Impression of Improvement (PGI-I), and patient satisfaction scores-at baseline, week 6, and week 12. Results: Both of the treatment groups demonstrated significant improvements in FSFI and VHI scores at 12 weeks, with the PRP group showing a slightly higher, though not statistically significant, mean increase in the total FSFI (+10.1 vs. +9.3 points). Clinical gains were also observed in lubrication, elasticity, and dyspareunia. Patient satisfaction was high in both groups (93.3% PRP vs. 88.9% hormonal), and there were no reports of serious adverse events during the study period. The PRP group exhibited fewer side effects, without systemic symptoms, supporting its favorable safety profile. Conclusions: PRP therapy is a well-tolerated, hormone-free treatment that offers clinically meaningful improvements in sexual function and vaginal health, comparable to estrogen therapy. It may be particularly beneficial for women with contraindications to hormones or in advanced postmenopause. Further long-term studies are nee

Current FDA-approved treatments for androgenetic alopecia (AGA) are oral finasteride and topical minoxidil. Topical finasteride offers a potential alternative with similar efficacy and fewer systemic side effects. This study evaluated the effectiveness and safety of combining topical finasteride and minoxidil for male AGA. This 12-week randomized controlled trial divided subjects into two groups which are topical finasteride 0.1%-minoxidil 5% (treatment) and topical minoxidil 5% (control) (NCT05990400, registered 2023-08-04). Hair density, hair diameter, terminal hair rate, and vellus hair rate (assessed using phototrichogram), and the occurrence of side effects (SE) was monitored at four-week intervals. Out of 40 subjects, 2 dropped out in the treatment group. Significant increases in hair density, diameter, and terminal hair rate; and decrease of vellus hair rate were observed at each visit compared to baseline, yet no differences between groups. Systemic SEs included libido reduction (control), mild erectile dysfunction, and chest pain (treatment). Common local SEs (itching, shedding, and dandruff) were similar between groups. One patient (treatment) experienced contact dermatitis. Combining topical finasteride 0.1% with topical minoxidil 5% has similar safety and effectiveness for increasing hair density and diameter in male AGA patients compared to topical minoxidil 5% after 12 weeks of observation. © 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

This study aimed to assess the efficacy and safety of Fufang Xuanju capsule in males with late-onset hypogonadism (LOH) complaining of sexual dysfunction during 3 months period. We identified the patients through questionnaires and laboratory examinations. Patients in the treatment group (n = 57) and placebo group (n = 50) received Fufang Xuanju capsules (3.78 g) or placebo capsules daily for 3 months, respectively. After treatment, the plasma total testosterone of both groups sustained, however, libido and erectile dysfunction in patients of the treatment group but not placebo group were significantly improved, measured by elevated scores of International Index of Erectile Function-5. The overall efficacy rate of Fufang Xuanju capsule for LOH was 71.9%. The most striking clinical effects were observed in patients exhibiting mild and moderate erectile dysfunction. No severe adverse effects were observed during the period of study. The remaining parameters such as total prostate-specific antigen, prostate volume and uroflow rate remained stable. Fufang Xuanju capsule proves to be an effective and safe treatment in a short time to alleviate symptoms of sexual dysfunction in LOH patients, especially in those exhibiting mild and moderate erectile dysfunction. Little effect on the level of total testosterone makes it well suitable for LOH patients which have contraindications of testosterone replacement therapy.

BACKGROUND: Sexual health difficulties affect up to 30% of women, with desire and arousal problems being the most prevalent. While cognitive behavioral therapy and mindfulness-based therapy are effective treatments, access is limited by barriers such as specialist shortages, cost, and embarrassment. Web-based interventions offer a potential solution by providing self-paced, cost-effective treatments. eSense, a digital health program, offers cognitive behavioral therapy and mindfulness-based therapy skills targeted to women with low sexual desire, and previous trials find eSense to be highly feasible and efficacious. OBJECTIVE: The goal of the present implementation science study was to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance of Implementation) framework to assess the integration of eSense into several sexual health clinics. We chose the RE-AIM framework because it addresses both dissemination (eg, reach) and implementation of an intervention. METHODS: A total of 14 specialty clinics participated, and we report on the reported experiences of those clinics in implementing eSense. We also examined responses from 12 women on waitlists to receive sex therapy or sexual medicine care. RESULTS: Per clinic outcomes, all aspects of implementation (reach, effectiveness, adoption, implementation, and maintenance) were in the moderate to high range for clinics, reporting that offering eSense helped them overcome negative feelings associated with their long clinic waitlists. The majority expressed a need for eSense and could see how it overcame the limitations of traditional therapy. Nearly all expressed a wish to continue offering eSense to patients after the implementation study was complete. One caveat was that half of the clinics noted cost as a key issue for future implementation, and one-third noted that the administrative burden of implementing eSense as a standard of care may be challenging. For individual users, the majority expressed an interest in knowing more about eSense and a desire to use eSense, though most of these did not complete the program in its entirety. Users experienced a significant improvement in sex-related d

Erratum in J Clin Endocrinol Metab. 2025 Jun 17;110(7):e2433. doi: 10.1210/clinem/dgaf205. CONTEXT: The combined effects of testosterone treatment and lifestyle intervention on sexual function in men at high risk of type 2 diabetes are unclear. OBJECTIVE: To assess the effect of testosterone treatment with a lifestyle intervention in men aged 50 to 74 years at high risk of, or newly diagnosed with, type 2 diabetes (via oral glucose tolerance test). DESIGN: A secondary analysis of the Testosterone for the Prevention of Type 2 Diabetes trial, a double-blind, placebo-controlled trial conducted across 6 Australian centers. INTERVENTIONS: Intramuscular testosterone undecanoate (1000 mg) or placebo, 3 monthly for 2 years alongside a community-based lifestyle program. MAIN OUTCOMES: Sexual function measured using the International Index of Erectile Function (IIEF)-15 questionnaire. RESULTS: Of 1007 participants, 792 (79%) had complete International Index of Erectile Function-15 data. Baseline domain scores were inversely related to age and waist circumference, but unrelated to serum testosterone or estradiol levels. Testosterone treatment improved all 5 International Index of Erectile Function-15 domain scores, with stronger effects on sexual desire and orgasmic function in older men, and sexual desire in men with higher depression scores. Testosterone had no impact on depression. Independent of treatment, reductions in waist circumference were associated with improved erectile function, and reductions in depression scores correlated with better sexual function. Clinically significant improvement in erectile function and sexual desire occurred in 3% and 10% of men, respectively, and was inversely related to baseline function. Clinically significant improvement improvements in erectile function and sexual desire were greater in younger and older men respectively. CONCLUSION: Testosterone treatment enhanced sexual desire and, to a lesser extent, erectile function, particularly in older men and those with higher waist circumference or depressive symptoms. Reduced waist circumference and depression independently improved sexual function. © The Author(s) 2025. Published b

Introduction: LN18178 is a standardized, synergistic combination of Punica granatum fruit rind and Theobroma cacao seed extracts, which has been reported to increase serum testosterone levels in young and aging males. Methods: The present 84-day randomized, double-blind, placebo-controlled study assessed the efficacy of LN18178 on the sexual function of aging male volunteers (age: 40-70 years; serum total testosterone: ≥ 300 ng/dL). The subjects with mild to moderate erectile dysfunction [5-item version of the International Index of Erectile Function (IIEF-5) scores 17-25] and low sexual desire (score < 3 on items 11 and 12 of IIEF) participated in this investigation. One hundred and twenty men were randomly allocated into either the LN18178 or placebo group (n=60); they took either 400 mg of LN18178 or a matched placebo capsule daily with breakfast. Results: Post-trial, the LN18178-supplemented participants reported significant (P < 0.05) improvements in total and domain scores of the Derogatis Interview for Sexual Functioning-Self Reporting Male (DISF-SR-M) questionnaire, as well as substantial improvements in IIEF-5 (International Index of Erectile Function-5) and erection hardness scores (EHS). Comparative analysis also revealed significant improvements in the multi-dimensional fatigue inventory (MFI) and general health survey (GHS) scores. LN18178 supplementation substantially (P < 0.05) increased the six-minute walk distance and hand-grip strength compared to placebo. The participants' hemato-biochemical parameters, urinalysis, and vitals were within the normal range. Conclusion: LN18178 enhances sexual function, libido and improves psychological well-being, as well as neuromotor function and general well-being in aging males. LN18178 supplementation is safe and well tolerated by the participants. © The author(s).

Erratum in Arch Sex Behav. 2025 Feb;54(2):841. doi: 10.1007/s10508-025-03091-9. Low libido is a common and potentially distressing problem among midlife and older women. We recently reported results from a pilot randomized controlled trial of a mindfulness intervention for midlife and older cisgender women with low libido; the purpose of this qualitative investigation is to illustrate women's experiences with being recruited for, enrolling in, and participating in the trial. We conducted individual interviews with a subset of trial participants, some of whom attended a group-based mindfulness intervention and some attended an educational control group (N = 25). We also interviewed participants who were enrolled but did not attend any groups (N = 9). A semi-structured interview guide was developed by the study team. A co-investigator with qualitative research expertise and the primary investigator conducted interviews, which were audio recorded and transcribed. We used a thematic analysis approach to analysis, co-coding a subset of interviews to develop and refine a codebook, then assigning codes to all data. Codes were grouped into subthemes and themes and key insights were extracted. Three key themes emerged from women who attended groups. First, women were interested in the intersection of sexuality and mindfulness. Second, women in both groups valued the sense of community they gained from participating; the interactive nature of sessions contributed to this. Third, experiences with attending groups over videoconferencing software were largely positive. Suggestions for improvement included a better explanation of the randomization process and more didactic information about sexuality and aging in both groups. Non-attendees listed time conflicts as their top reason for not attending. We recommend researchers consider utilizing a group format when designing behavioral interventions for midlife and older women, as this design offers many benefits for participants, but ensuring that a qualified professional is present can ensure information exchanges is evidence-based. In addition, healthcare systems can consider building in opportunities for midlife women to ga

Background/Objectives: Compounded vaginal creams are widely used for conditions such as hormone replacement therapy, vaginal dryness, low libido, vaginal infections, etc. Recent research highlights the potential of using anhydrous bases to extend shelf life, particularly when combined with self-emulsifying and mucoadhesive properties that improve mucosal retention and enhance drug bioavailability. This study provides in vitro and ex vivo evaluation of an anhydrous vaginal base. Methods: Key quality indicators such as irritation potential, leakage potential, pH compatibility, mucoadhesion, and self-emulsification were assessed using the chorioallantoic membrane Hen's Egg Test, MTT assay, texture analysis, and fluorescence microscopy. Results: The anhydrous vaginal base demonstrated high cell viability (>78%) and non-irritant potential (IS = 2.5) in in vitro assays. It maintained physiological vaginal pH (4.56 ± 0.05), showed strong mucoadhesive properties comparable to commercial products, and exhibited minimal leakage. Ex vivo studies confirmed its prolonged retention on vaginal tissues. The anhydrous vaginal base formed stable emulsions upon contact with vaginal fluid simulant, effectively distributing both lipophilic and hydrophilic compounds. Conclusions: Compared to water-containing bases, an anhydrous vaginal base shows advantages: longer retention time and lower leakage; adaptability to varying vaginal fluid levels; and efficient dispersion of both hydrophilic and lipophilic active pharmaceutical ingredients. These features support its potential use in compounded vaginal products, minimizing stability risks and enhancing patient compliance and therapeutic outcomes.

Androgenic alopecia (AGA), commonly known as male pattern baldness (MPB), affects a significant portion of the population, with impacts on self-esteem and quality of life. 5-alpha reductase inhibitors, including finasteride and dutasteride, are widely used treatments that increase hair density by reducing dihydrotestosterone levels. However, their effects on reproductive health remain a concern, particularly in men of reproductive age. This narrative review synthesizes current clinical and experimental evidence on the reproductive effects of 5-alpha reductase inhibitors. Relevant studies were identified through a review of published literature, including randomized controlled trials, observational studies, and mechanistic investigations. Outcomes of interest included sperm parameters, hormonal profiles, sexual function, and potential long-term reproductive effects. Across studies, finasteride and dutasteride were associated with reductions in sperm count (34% with finasteride, 29% with dutasteride), sperm concentration, and motility. Hormonal alterations included, increased testosterone levels, and variable changes in dihydrotestosterone, estradiol, progesterone and androstenedione levels. Findings related to sexual dysfunction were variable, with some demonstrating persistent decreased libido, erectile dysfunction, and reduced penile sensitivity, months to years after discontinuation. Mechanistic studies in rodents revealed significant reductions in the expression of genes critical to spermatogenesis (Dazl, Prm2, Sycp3, Tsga10) and alterations in penile tissue contractility and nitric oxide synthase signaling, providing potential explanations for these reproductive effects. Overall, while 5-alpha reductase inhibitors are effective treatments for AGA, they may adversely affect reproductive parameters in a subset of patients. While current evidence focuses primarily on single drug regimens, the growing use of combination therapies targeting multiple 5-alpha reductase isotypes raises the potential for additive or synergistic reproductive effects. Given the variability in outcomes and limited long-term data, further research is needed to better characterize these r

INTRODUCTION: Goats are an integral part of the livelihoods of South Africans, particularly in the rural communities, yet reproductive inefficiencies (low libido, poor semen quality, uterine infections, postpartum disorders, parasitism, and nutrition gaps) limit their productivity. Most resource challenged farmers resort to the use of ethnoveterinary plants for reproductive health of their goats due to their safety and ease of access; however, there is still a lack of standardization on their safety, dosing and efficacy. AIM: This study aimed to review and document the South African traditional medicinal plants used to enhance reproductive performance in goats. METHODS: The study carried out a narrative review of ethnoveterinary surveys and pharmaco-ethnobotanical literature focused on South Africa, complemented by relevant goat reproduction studies. Our search used various keywords, including "medicinal plants," "goat breeding," "ethnoveterinary," and "medicinal plants" to identify relevant literature in several databases, including Scopus, Web of Science, Access to Global Online Research in Agriculture, and ScienceDirect. Additional searches were conducted using citations found in articles in these databases. The focus was on peer reviewed journals published between the year 2000 and 2025 on South African medicinal plants used to enhance goat reproduction, whether directly or indirectly. OVERVIEW OF KEY INSIGHTS: During the literature review, it was found that among other plants Securidaca longepedunculata Fresen. (violet tree), Moringa oleifera Lam (moringa), Elephantorrhiza elephantina (Burch.) Skeels (elephant root), Kigelia africana (Lam.) Benth. (sausage tree), Aloe ferox Mill., were frequently mentioned. Strong evidence was noted from ethnobotanical use to in vitro/in vivo validation, though limited but growing, especially for anthelmintic and antioxidant actions. CONCLUSION: Based on the literature, it can be concluded that South Africa's ethnobotanical resources hold credible value for improving goat reproduction by acting as antioxidants, regulating hormones, fighting infections, and controlling parasites that affect body condition. However, well-desi

Functional hypogonadism in men is a syndrome characterized by low testosterone levels and clinical signs of hypogonadism without organic disease of the hypothalamus-pituitary-gonadal axis. It is most often caused by obesity, diabetes type 2, exogenous steroid abuse, excessive physical exercise, opioid use, co-occurring diseases, and is most prevalent among middle-aged and older men as so-called late-onset hypogonadism. It seems that the most important epidemiological factor causing functional hypogonadism is excess adipose tissue. Obesity is currently one of the most important public health problems and its prevalence is higher in men than in women. Complications of obesity include not only cardiovascular diseases or type 2 diabetes mellitus, but also lead to decreased testosterone levels, reduced libido and erectile dysfunctions, and impaired fertility in men. These disorders in men with obesity are associated with decreased gonadotropins and testosterone secretion due to hyperinsulinemia, hyperleptinemia, chronic inflammation and oxidative stress. Currently, it seems that an important complication of obesity is the deterioration of semen parameters (sperm concentration, motility, and morphology) and reduced fertility. Theoretically, obesity-related functional hypogonadism in men is reversible, so the basis of initial treatment is primarily lifestyle modification and effective treatment of chronic diseases but primarily reducing body fat mass (physical exercise and low-caloric diet). Unfortunately, lifestyle changes are often insufficient to significantly increase testosterone levels and resolve the clinical symptoms of hypogonadism. Because in men seeking fertility conventional testosterone replacement therapy is contraindicated, alternative pharmacological methods, such antiestrogens (selective estrogen receptor modulators and aromatase inhibitors) are often used.

Background/Objectives: Finasteride and dutasteride are 5α-reductase inhibitors that block the conversion of testosterone to dihydrotestosterone, reducing androgenic stimulation of tissues such as the prostate and hair follicles. Used mainly for benign prostatic hyperplasia and androgenic alopecia, finasteride selectively inhibits type-2 5α-reductase isoenzyme, while dutasteride inhibits both type-1 and type-2. Although sexual adverse effects like erectile dysfunction are well-documented, emerging evidence suggests possible neuropsychiatric reactions-including depression, suicidal ideation, and cognitive decline-potentially linked to reduced neurosteroid synthesis, such as that of allopregnanolone. Causality cannot be inferred from spontaneous reporting data. This study aimed to assess pharmacovigilance signals for psychopathological disorders associated with finasteride and dutasteride in the FAERS database. Methods: Cleaned FAERS data referring to years up to 2025 after deduplication were analyzed, excluding non-serious cases and those without the drug as the sole suspect (MedDra 29.0). Reporting Odds Ratios (RORs) with 95% CIs were calculated to compare psychiatric reactions between finasteride and dutasteride. Python 3.11 was used to screen and summarize relevant cases, accounting for differences in total case numbers. Results: This pharmacovigilance study analyzed FAERS data to assess the neuropsychiatric and sexual adverse reactions associated with finasteride and dutasteride. Depression, anxiety, suicidality, and libido-related issues were reported more frequently for finasteride, especially in younger men using low-dose therapy for alopecia. Potential mechanisms include reduced neurosteroid synthesis, androgen/sex-hormone axis disruption, altered hippocampal neurogenesis, and dopaminergic changes. Conclusions: A baseline psychiatric assessment and the regular monitoring of mood, sexual function, and suicidal ideation are recommended. Limitations include under-reporting, reporting bias, and a lack of incidence data. The findings underscore the need for ongoing surveillance and controlled studies to clarify the clinical significance of these signals.

BACKGROUND: History of childhood sexual abuse (CSA) may affect adult male sexual function, yet population-based evidence remains limited. OBJECTIVES: This study aimed to evaluate the associations between a history of CSA and recent sexual function outcomes, specifically self-reported erectile difficulties and decreased libido, and to examine differences by age group and cohabitation status. MATERIALS AND METHODS: We analyzed data from 8837 men aged 18-79 years who participated in the 2023 JACSIS study, a population-based online survey in Japan. CSA before age 18 years was identified using behavior-specific items and two direct screening questions. Outcomes were defined as binary measures of self-reported erectile difficulties and decreased libido. We adjusted for confounding using inverse probability of treatment weighting (IPTW) based on prespecified propensity scores. Effect modification by age group and cohabitation status was tested. Secondary analyses included depression, anxiety, and sleep problems to evaluate the attenuation of associations. RESULTS: Among 8837 eligible men, 667 (7.5%) reported CSA. CSA was associated with significantly higher odds of self-reported erectile difficulties (adjusted odds ratio [aOR] 3.14, 95% confidence interval [CI] 2.61-3.78, p < 0.001) and decreased libido (aOR 2.83, 95% CI 2.37-3.38, p < 0.001). Stratified analyses showed consistent associations across all age groups and cohabitation statuses, with no significant effect modification detected. Simultaneous adjustment for depression, anxiety, and sleep problems attenuated these associations. DISCUSSION: The associations observed across age groups suggest that CSA appears to have a lasting and independent negative impact on male sexual function. These findings imply that the consequences of early trauma may persist throughout adulthood, involving mechanisms beyond concurrent mental health or sleep burdens. CONCLUSION: CSA history is significantly associated with self-reported male sexual difficulties. Integrating trauma-informed care and routine screening for psychological and sleep comorbidities into urological practice is essential for comprehensive patient management. ©

INTRODUCTION: Antipsychotic-associated sexual adverse drug reactions (ADRs) are well known in clinical practice, although efforts to understand differences between antipsychotics and distinct types of sexual ADRs are limited. OBJECTIVE: The aim of this study was to assess and prioritize the profile of each antipsychotic regarding sexual ADRs reporting, and to account for potential confounders. METHODS: We used VigiBase® to conduct a case/non-case study using a customized clinically guided search strategy of antipsychotic-related sexual ADRs. The reporting odds ratio (ROR) and Bayesian information component (IC) with relevant 95% confidence intervals (95% CIs) were used as disproportionality measures to identify signals of disproportionate reporting (SDRs). Antipsychotics were compared with all other drugs and with thiazides (positive control). Sensitivity analyses included non-serious reports, excluding patients with potentially confounding co-medication(s), excluding adolescent and elderly patients, and including cases with co-reported hyperprolactinemia. Analyses were stratified by sex. Antipsychotics were ranked in terms of clinical priority using qualitative and quantitative criteria. RESULTS: We included 5195 cases of antipsychotic-related sexual ADRs (43.1% serious, median time to onset of 61 days, 36.1% physician-reported). Several SDRs emerged in males (erectile dysfunction [3487 reports; ROR 2.49, 95% CI 2.40-2.57]; priapism [2372 reports; ROR 15.55, 95% CI 14.82-16.32]) and females (decreased libido [373 reports; ROR 1.61, 95% CI 1.46-1.79]) for all antipsychotic classes, except for muscarinic antagonists in females (ROR 0.64, 95% CI 0.55-0.73; IC - 0.65, 95% CI - 0.86 to - 0.45). In both sexes, the highest number of reports were for risperidone, aripiprazole and olanzapine. The SDRs disappeared in the sensitivity analysis including only non-serious cases and cases with co-reported hyperprolactinemia. Sexual ADRs for all antipsychotics were classified as of moderate priority, with the exception of fluspirilene (low priority). CONCLUSIONS: Notwithstanding limitations, including inability to infer causality, these findings raise the hypothesis that sexua

Background/Objectives: Modern diabetes therapy extends beyond glycemic control and increasingly focuses on comprehensive risk reduction to prevent long-term complications, improve quality of life, and reduce premature mortality. Accordingly, modern therapeutic approaches address not only glucose metabolism but also cardiovascular, renal, and metabolic consequences of diabetes. Within this context, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a significant therapeutic class. In addition to their well-known effects on glycemic control and the metabolic-cardiovascular-renal axis, increasing evidence suggests that these agents may exert a range of pleiotropic effects and opening new therapeutic venues, discussed in this review. Methods: A narrative review of the literature was conducted using the PubMed, Scopus, and Google Scholar databases. Publications from 2014 and 2026 were screened using predefined keywords related to GLP-1 RAs and their potential effects across multiple physiological systems and diseases. Notably, more than 80% of the included studies were published between 2020 and 2026, reflecting the recent growth of research in this field. Results: GLP-1 RAs have been associated with beneficial effects across a wide range of conditions, including substance use disorders, mental health disorders, neurodegenerative diseases, obesity-related complications, liver disease, genitourinary disorders, osteoarthritis, and sleep apnea. While they are currently the most effective pharmacological agents for the treatment of obesity, they also significantly reduce hepatic steatosis and are associated with a decreased risk of developing hepatocellular carcinoma. Furthermore, they have also demonstrated positive effects against prostate cancer, polycystic ovary syndrome (PCOS), improved libido and fertility. Conclusions: GLP-1 RAs should no longer be regarded solely as antihyperglycemic agents. Instead, they represent a versatile therapeutic class with expanding clinical relevance across multiple medical disciplines. While current evidence is promising, further large-scale, well-designed clinical trials are required to define their full therapeuti

PURPOSE: Varicocele is a common condition linked to male infertility and testosterone deficiency. Although varicocelectomy is known to improve semen parameters, its effect on testosterone levels in hypogonadal men remains under debate. This systematic review and meta-analysis aimed to evaluate the impact of varicocelectomy on serum testosterone and sexual function parameters in men with hypogonadism. MATERIALS AND METHODS: This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in International Prospective Register of Systematic Reviews (CRD420251016720). A comprehensive literature search was conducted across PubMed, Web of Science, Google Scholar, and ProQuest databases up to March 2025. Studies investigating adults with hypogonadism who underwent varicocelectomy were included. Pooled mean differences (MDs) were calculated using random-effects models. The risk of bias was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Checklist. RESULTS: Eighteen studies comprising 1,225 patients with a mean age ranging from late 20s to mid-40s, mainly reported infertility, erectile dysfunction, or low libido; and microsurgical subinguinal varicocelectomy was the predominant technique. Varicocelectomy led to a significant increase in serum testosterone (MD, 113.87 ng/dL; 95% confidence interval [CI], 103-124.75; p<0.00001). Subgroup analysis revealed sustained hormonal improvement at both <6 and ≥6 months postoperatively. Erectile function scores improved significantly (MD, 3.25; 95% CI, 1.49-5.01; p=0.0003). Luteinizing hormone levels decreased slightly (MD, -0.28 mIU/mL; p=0.04), while follicle-stimulating hormone showed no significant change. CONCLUSIONS: Varicocelectomy has been shown to significantly elevate serum testosterone levels and enhance sexual function in hypogonadal men. These findings underscore the potential role of varicocelectomy as a therapeutic option in the management of hypogonadism.

Congenital aromatase deficiency is an autosomal recessive CYP19A1 loss-of-function disorder that blocks conversion of androgens to estrogens. A man with homozygous CYP19A1 c.628G > A (exon 5) presented with longstanding fatigue, low libido, and desire to maintain fertility. Physiologic estrogen replacement was started with transdermal estradiol 0.0375 mg. After three months of estrogen therapy, the patient reported markedly improved energy and libido. Follow-up evaluation showed a rise in serum estradiol with normalization of gonadotropins, while maintaining spermatogenesis. This case illustrates the essential role of estrogen in male physiology, sexual function, and fertility. Estradiol replacement can alleviate hypoestrogenic symptoms with preservation of spermatogenesis. © 2026 The Authors.