BackgroundThe development of recurrent ischemic priapism (RIP) is associated with mental health disorders, psychiatric medications, and substance use, but the temporal relationship between the onset of RIP and the development of these risk factors is poorly understood.AimThis study aimed to investigate the chronology of psychosocial and substance use risk factors relative to the initial clinical presentation of RIP.MethodsWe conducted a retrospective cohort study of 73 adult patients diagnosed with RIP at a single academic center, identified via manual chart review of the electronic health record. Patients presenting with RIP between 2004 and 2020 were included, with data collection extending to 2025 to ensure a minimum follow-up of nearly 5 years for all participants to minimize censoring bias and capture delayed risk factor onset.OutcomesThe date of the first RIP presentation (index event) was compared to the first documented date of several risk factors, including anxiety, depression, psychiatric medication use, and substance use.ResultsIn the overall cohort, there was no statistically significant difference in the proportion of any risk factor developing before versus after the onset of RIP. Further, in a sub-analysis of 35 patients with sickle cell disease (SCD), a higher proportion of patients initiated psychiatric medication after the onset of RIP, although this was not statistically significant (P = .0522). No other factors reached statistical significance in the SCD sub-analysis.Clinical implicationsThe findings suggest that RIP may be a psychologically traumatic event that contributes to the development of the same psychosocial risk factors it is associated with.Strengths and limitationsThe primary strength of this study is its novel investigation into the temporal relationship between RIP and psychosocial risk factors, supported by a design that ensured a minimum follow-up period of over 4 years for all participants. Limitations are primarily related to its retrospective, single-center chart-review design.ConclusionOur findings suggest a complex, potentially bidirectional relationship that highlights the need for integrated mental health screening for all patients with RIP, particularly for the high-risk SCD population.

BackgroundThe Female Sexual Function Index (FSFI) is widely used to assess female sexual function, but its applicability in Lebanon is limited due to linguistic and cultural barriers.AimThis study aimed to develop and validate a Lebanese Arabic version of the FSFI (FSFI-LB) to improve accessibility for clinical and research use.MethodsA study was conducted with 119 Lebanese women between April 2023 and June 2024 at Hôtel-Dieu de France Hospital, Beirut. The FSFI was translated, back-translated, and psychometrically validated using exploratory factor analysis, Cronbach’s alpha, test–retest reliability, and factor correlations.OutcomesThe FSFI-LB showed excellent internal consistency (Cronbach’s alpha = 0.973) and test–retest reliability (r = 0.9997), with a Kaiser–Meyer–Olkin value of 0.925 and significant Bartlett’s test of sphericity (P < .001). Test–retest reliability was assessed in a subsample of 42 participants after 4 weeks and demonstrated high consistency across all domains (r > 0.99) and total scale reliability (r = 0.9997).ResultsA six-factor model was retained for the FSFI-LB, aligning with the original FSFI, with the pain domain showing the weakest correlations with other domains. The questionnaire included English translations alongside Arabic terms for improved comprehension.Clinical TranslationThe FSFI-LB is a reliable tool for assessing female sexual function in Lebanon, ensuring cultural and linguistic sensitivity for diverse populations.Strengths and LimitationsThe study’s strengths include robust psychometric validation and the adaptation of a widely used instrument. The limitations include the focus on a specific Lebanese population, which may limit generalizability to other Arabic-speaking communities.ConclusionThe FSFI-LB is a valid and reliable tool for assessing female sexual function, contributing to the development of culturally appropriate measures in sexual health research and clinical practice.

BackgroundA high proportion of men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) present with comorbid erectile dysfunction (ED), but evidence-based therapeutic interventions specifically targeting this patient population remain understudied in clinical trials.AimTo assess the efficacy of Ningmitai capsule (NMT), an oral traditional Chinese herbal formulation, combined with sildenafil versus monotherapy in alleviating symptoms among a cohort of participants with CP/CPPS and ED.MethodsA multi-center, randomized clinical trial was conducted from March 2019 to December 2022 at six tertiary hospitals in China. A total of 214 participants diagnosed with CP/CPPS and ED were randomized 1:2:2 to receive orally sildenafil (25 mg, q.n.), NMT (0.38 g × 4 capsules, t.i.d.), or a combination of both for 4 weeks. Validated Chinese version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function-5 (IIEF-5) and the Erection Hardness Score (EHS) questionnaires were administered at baseline, week 2, and week 4.OutcomesThe primary endpoint was the reduction in NIH-CPSI pain domain scores from baseline to week 4.ResultsAll treatment groups exhibited statistically significant decreases in NIH-CPSI total, pain, urinary and quality of life (QoL) domain scores within 2 weeks, with improvements sustained until the end of the treatment. The combination group demonstrated superior pain score reductions versus sildenafil monotherapy at both timepoints (week 2: mean difference [MD] -2.82 ± 3.27 vs. -1.26 ± 3.45, P = 0.043; week 4, MD -3.57 ± 3.50 vs. -1.07 ± 2.94, P = 0.009). Notably, combination therapy achieved greater IIEF-5 score enhancements compared to NMT alone (P < 0.05) and higher responder rates than either sildenafil or NMT monotherapy (P < 0.05). No significant differences were found among the three arms concerning EHS. No adverse events were reported.Clinical ImplicationsNMT-sildenafil combination therapy may serve as a viable alternative to α-blocker-based regimens for CP/CPPS-ED patients, potentially circumventing the orthostatic hypotension risk associated with the concurrent use of phosphodiesterase 5 inhibitors (PDE5i) and α-blockers.Strengths and LimitationsStrengths include a prospective randomized design, which is well controlled. Limitations encompass the absence of placebo control and long-term follow-up.ConclusionNMT-sildenafil combination therapy demonstrates significantly greater benefits of ameliorating pain symptoms and improving erectile function in men with CP/CPPS and ED compared to either monotherapy, with favorable tolerability profiles.RegistrationThe study protocol was reviewed and approved by the institutional ethics committee and was registered at ClinicalTrials.gov (NCT06064448).

BackgroundHyperglycemia can cause endothelial cell (EC) and smooth muscle cell (SMC) death in the penile cavernous tissue of rats and lead to erectile dysfunction (ED).ObjectivesTo investigate the proportions of apoptotic, pyroptotic, and ferroptotic cells among ECs and SMCs in the penile cavernous tissue of type 1 diabetic (T1DM) rats and the mechanism by which icariin (ICA) improves the erectile function of T1DM rats.MethodsA total of 24 9-week-old Sprague–Dawley (SD) rats were randomly divided into 4 groups (n = 6): control group, control + ICA group, diabetic mellitus (DM) group, and DM + ICA group. T1DM rats were generated via the intraperitoneal injection of STZ (45 mg/kg). After 8 weeks, the rats in the control + ICA group and the DM + ICA group were administered ICA (10 mg/kg/d) by gavage for 4 weeks. ROS, MDA, SOD, GSH, SM/C, and NO levels, and GPX4, ACSL4, caspase-1, GSDMD, caspase-3, CD31, α-SMA, and p-eNOS/eNOS expression in penile cavernous tissue and the ICPmax/MAP of 21-week-old rats were detected.ResultsThe percentage of pyroptotic SMCs in penile cavernosum was no statistically significant difference among these groups. Vs control group, the percentages of apoptotic (20.70% ± 1.60%), pyroptotic (21.02% ± 1.97%), and ferroptotic (9.01% ± 2.00%) ECs and the percentages of apoptotic (15.47% ± 1.36%) and ferroptotic (26.33% ± 3.11%) SMCs in the penile cavernous tissue of the DM group were significantly greater. Vs DM group, the percentages of apoptotic (9.13% ± 1.28%), pyroptotic (13.22 ± 1.26%), and ferroptotic (4.01% ± 0.86%) ECs and the percentages of apoptotic (11.60% ± 1.91%) and ferroptotic (12.71% ± 2.92%) SMCs of the DM + ICA group were significantly lower. Vs the DM group, the levels of caspase-1, GSDMD, ACSL4, and ROS were significantly lower in the penile cavernous tissue of the DM + ICA group. Meanwhile, the levels of GPX4 and maximum intracavernous pressure/mean arterial pressure (ICPmax/MAP) were significantly higher.Clinical ImplicationsThe combined inhibition of apoptosis, pyroptosis, and ferroptosis in penile cavernous tissue by ICA provides a theoretical basis for the clinical development of multi-target drugs for the treatment of type 1 diabetes-induced ED.Strengths and LimitationsFurther experiments are required to clarify whether other types of cell death are involved in the loss of ECs and SMCs in the penile cavernous tissue of T1DM rats.ConclusionInhibiting oxidative stress and thereby inhibiting apoptosis, pyroptosis, and ferroptosis in ECs and SMCs of penile cavernous tissue constitute one of the mechanisms through which ICA improves erectile function in T1DM rats.