Sexual medicine has advanced substantially through pharmacological, hormonal, and surgical innovation, enhancing the management of sexual dysfunction. Yet its clinical paradigm remains predominantly biomedical, often privileging physiological restoration over holistic well-being. This editorial argues that sexual medicine should be explicitly grounded in a sexual health framework informed by justice, rights, and pleasure. Drawing on the World Health Organization's multidimensional definition of sexual health and contemporary transdisciplinary scholarship, we propose a shift from a pathology-centered "repair model" to a patient-centered model of flourishing. Justice necessitates equitable, culturally responsive care across gender, orientation, identity, and socioeconomic contexts. Rights affirm sexuality as integral to autonomy and human dignity. Pleasure, long marginalized in clinical discourse, should be recognized as a legitimate and measurable health outcome. Integrating these principles into education, clinical metrics, and practice standards is essential for achieving comprehensive, ethically grounded sexual care aligned with contemporary public health and human rights frameworks.

Female sexual dysfunction is common, distressing, and notoriously difficult to treat. In the last two decades, short-course ("on-demand") testosterone (T) regimens-delivered sublingually, intranasally, inhaled, topically, or intramuscularly-have been explored as rapid-acting prn enhancers of female libido. The objective of this study is to quantify efficacy, safety, and pharmacokinetics (PK) of short-term T therapy (prn) in women with sexual dysfunction. PRISMA 2020 guidelines for systematic reviews were followed. Twelve RCTs and five PK studies (n = 940) were identified via Embase/MEDLINE/Web of Science (inception-March 2025). Outcomes included desire/arousal scores, satisfying sexual events (SSE), pharmacokinetics, and adverse events. Risk of bias was assessed using the Cochrane risk-of-bias tool. Although absolute serum T excursions differ widely across formulations, most achieve supra-physiological free-T peaks within 15min and return to baseline within 2-6h. There is mixed evidence that this window coincides with maximal central arousal effects. However, when combined with phosphodiesterase-5 or 5-HT1A agonists, there tends to be improved genital vasocongestion and sexual satisfaction. Adverse events were mild but tended to be common. Short-term T therapy combined with phosphodiesterase-5 inhibitors or 5-HT1A agonists may be benefit select subgroups of women with sexual dysfunction with a favorable short-term safety, however, sample sizes remain small and further research is required.Registration: This study was registered in PROSPERO: CRD42024615106.

Declining sexual desire is one of the most common and distressing symptoms of menopause and has significant implications on sexual satisfaction and overall well-being. Though declining ovarian function and sex hormone levels characteristic of menopause may contribute to low desire, some menopausal women report stable or even increased desire since the onset of menopause, suggesting that biological, psychological, and social factors are also relevant. This scoping review synthesized existing research examining these biopsychosocial factors associated with desire in menopause. Following best practices for scoping reviews, comprehensive searches were conducted in PubMed and PsycINFO in July 2025, for articles examining sexual desire in menopause. Quantitative studies were included if they examined peri- or postmenopausal women, measured sexual desire as a distinct construct, and examined desire in relation to a biological, psychological, or social construct. A total of 818 articles were reviewed, with 31 meeting inclusion criteria. Data were extracted and thematically synthesized across the three biopsychosocial domains. Biological factors most relevant to sexual desire include other domains of sexual dysfunction, as well as genitourinary syndrome of menopause, particularly pain with intercourse and vaginal dryness. Other symptoms of menopause, namely sleep disruptions and poor general health are also associated with declines in desire. Psychological factors, especially anxiety and depression, strongly predicted decreased desire. Although less researched, poor body image and negative attitudes about sex appear to impact desire. Social factors such as relationship dissatisfaction and relationship length tend to correlate with declines in desire. Sexual desire in menopause reflects a complex interplay of biological, hormonal, and social influences that extend beyond declining ovarian function and hormones. A biopsychosocial framework is essential for advancing research and holistic care to support menopausal women with low desire.

There is no ideal treatment for Peyronie's Disease (PD) since every patient has different needs with varying perceived risks versus benefits of individual treatment options, coupled with the degree of impact relating to PD on sexual function and beyond. The 5th International Consultation on Sexual Medicine (ICSM) guideline on PD provides an update to the previous ICSM with an aim to provide a clinical framework and best-evidenced consensus recommendations to assist clinicians in managing PD. Available literature was reviewed, and a modified Delphi consensus was undertaken by leading sexual medicine experts to achieve a set of Quality of Evidence and strength of recommendations. This guideline was developed as an authoritative best-evidenced consensus incorporating state-of-the-art knowledge and contemporary literature. A total of thirty-one recommendations were made on PD guidelines. New updates to the 4th ICSM on PD have been made in definition, pathophysiology, and treatment strategies. The presence of penile pain with erection could occur in the chronic phase due to torque or stretch on the penile scar and surrounding tissue. Oral therapy works best during the acute phase and should be provided concurrently with other treatment modalities. Penile traction therapy can reduce penile deformity as monotherapy or may be offered as part of a multimodal therapy approach. There is no convincing evidence supporting cellular-based therapy. The type of plication procedure used depends on the surgeon and patient preference, although excision of the tunica followed by plication may have a higher complication rate. There is currently no ideal graft, and graft contracture can occur postoperatively. Adjunctive procedures such as penile modeling, tunical plication, plaque incision/excision and grafting can be performed when penile deformity and/or penile curvature persist following penile prosthesis implantation. The management of PD should be individualized based on the patient's needs and preferences while balancing the benefits and risks of each treatment option.

Orgasm experience is associated with greater sexual and relational well-being within couples' relationships. In the context of a partnered sexual relationship, this dimension of the sexual response has been mainly studied from an individualistic perspective, with few studies adopting a dyadic approach. This scoping review aims to review and synthesize the literature that has examined orgasm as a predictor of sexual and relational well-being in dyadic contexts. Following the Preferred Reported Items for Systematic Reviews and Meta-Analyses-Scoping Review guidelines, a database search was conducted on EBSCOhost, Web of Science, Scopus, PubMed, and SciELO databases using key terms related to "orgasm" and "dyadic." A total of 280 articles were identified, and 9 fulfilled eligibility criteria and were included in this review. All studies sampled couples using a dyadic design. All studies employed cross-sectional designs and predominantly reflected different-gender/sex heterosexual couples, and all participants were cisgender. Findings showed that orgasm is consistently linked to both sexual and relational well-being in dyadic contexts. Orgasm frequency and its subjective experiences were associated with individual and partner sexual satisfaction, with some effects mediated by sexual communication. Relational outcomes were also shaped by the importance attributed to orgasm and by the (mis)perception of the partner's orgasm. Notably, gendered patterns emerged, particularly within different-gender/sex couples, highlighting the centrality of women's orgasm in shaping both partners' wellbeing. Future research might focus on orgasm as a dyadic experience, include individuals with diverse gender identities and sexual orientations, and adopt daily-diary designs to capture the unique orgasm experiences as they unfold in couples' daily lives.

The lower urinary tract injury, although often not life-threatening, can result in devastating long-term morbidity and, in some cases, permanent disability. Male genital trauma adversely affects male sexual function. This 5th International Consultation on Sexual Medicine guideline on male genitalia trauma evaluates urologic trauma literature to guide clinicians in the best-evidenced management with specific emphasis on preservation and optimization of male sexual function. A systematic literature search was conducted to identify relevant English-language publications and contemporary guidelines using the PubMed database (search dates January 1, 1990 to June 1, 2024) on the following terms: "trauma," "penis," "urethra," "testis," and "scrotum." The available literature was discussed, and selected articles with the highest evidence available were used to create consensus guideline statements, categorized based on the Grading of Recommendations Assessment, Development and Evaluation system. In the absence of sufficient evidence, additional information was provided as a Clinical Principle or Expert Opinion. Fourteen recommendations are provided with corresponding levels of evidence and grades of recommendation. Treating clinicians should be mindful that both the male genitalia trauma itself and treatment outcomes invariably affect various male sexual functions. Optimal treatment of male genitalia trauma is essential and should incorporate patient tolerances, needs, and preferences to minimize long-term sexual dysfunction.

The intersection of culture, history, religion, traditions, laws, political trends, and evolving attitudes affects sexual expression and acceptance or rejection of sexual practices. Clinicians and clinical care are affected by these factors as well, although clinicians are not always aware of the way in which their training, their own experiences and attitudes influence the way in which they approach patients. In this paper, we contextualize and then describe 2 areas of sexual practices and 1 area of sexual difficulty that sexual medicine clinicians encounter in their practice, namely, the practice of female genital mutilation/cutting, penile circumcision, and the experience of unconsummated marriages. Given the emerging knowledge of the socio-cultural aspects of sexual medicine, we conducted a narrative review of the extant literature through wide searches in PubMed, Google, and on global websites relevant to this topic, such as the World Health Organization, the United Nations, and others. The content of this paper was reviewed by all the authors, discussed where disagreements occurred, or additional perspectives were needed, and further literature was incorporated. We describe known practices of female genital cutting/mutilation and penile circumcision, their perceived benefits, and harms, but also with a view to the importance of patient empowerment and respect for self-determination. We discuss unconsummated marriages as the result of often culturally determined insufficient sex education and guidance, as well as clinical resources. We recommend that clinicians approach patients with both curiosity and cultural humility and that the International Society for Sexual Medicine (ISSM) adopt a strong ethical perspective as a part of the ongoing discourse on these practices and experiences.

In experimental sex research, attention to sexual stimuli is considered a well-established indicator of sexual interest, with patterns that differ across sexual orientations. While earlier studies primarily focused on heterosexual populations, recent research has increasingly explored attention in sexual minority individuals (SMIs). Building on the incentive motivation and information processing models of sexual response, it can be hypothesized that differences in the appraisal of sexual stimuli contribute to variations in individuals´ sexual responses, raising the possibility that attention to sexual stimuli may be related to individuals' sexual identities. This scoping review aimed to map the existing literature on attention to sexual stimuli among SMIs and to clarify the relationship between attention to sexual stimuli and sexual identity. A systematic literature search was conducted using PubMed, EBSCOhost, Web of Science, and ProQuest databases, adhering to the PRISMA guidelines for scoping reviews. The search resulted in 1107 records, 56 of which were included in the review. Overall, the results highlight patterns of automatic and controlled attention to sexual stimuli in SMIs. These findings are interpreted as reflecting attention-identity relationships in each sexual minority group. The review also suggests several areas for future research. This review underscores opportunities to improve healthcare for SMIs by clarifying attentional patterns across non-heterosexual orientations and factors related to their sexual self-identification. The findings also offer valuable insights for clinicians in dealing with sexual identity conflicts and advancing sexual minorities´ mental health and well-being.

Blue balls is a mundane complaint that generates substantive popular lore but has little coverage in the sexual medicine literature. To draft a first medical history of relevant nosology and etiology. The Latin, French, German, Dutch, Italian, and English literature was mined. As expected from a period of not only widespread scaremongering concerning masturbation and "semen loss" but also "overly rigid continence," scrotal pain reminiscent of blue balls was well covered between the 1820s and 1920s, under variably inclusive nosologic headings: "hernia seminalis," "orchioncus," "simple spermatocele," "epididymis distensa," "irritable testis," "testicular epilepsy," "testicular neuralgia," "spermatic colic," "stone-ache," "epididymitis sympathica," "epididymitis erotica," "epididymitis antiperistaltica," "paradidymitis erotica acuta," and "epididymo-deferential colic." Even an analogical "ovaralgia erotica" was hypothesized. Observations had the radical potential of supporting poena naturalis (natural punishment) arguments against "too strict" continence and even pro masturbation. This historical push toward concepts of normal and habitual sexuality was fortified by equally tendentious concepts of "constitutional" or "temperamental" predisposition in some men. Yet the clear potential of the diagnosis to moderate strong prevailing sentiments against masturbation remained poorly realized until well into the early 20th century. Discomfort of the blue balls variety widely animated clinical sexual discourse from the early 18th century onward. It specifically informed interlocking, gendered ideas about sexual entitlement expressed in normative frames for sexual habits, eroto-sexual constitution, and behavioral health.