Telemedicine gained wide acceptance during the COVID-19 pandemic, as it was deemed critical for patient care when lockdowns were implemented worldwide. While there is evidence to suggest that urology patients were receptive to telemedicine, no systematic review has been done to date on andrology patients and their perception of telemedicine. Three electronic databases, PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients "wishing for telemedicine consultation", "preferring telemedicine over in person", "accepting the current telemedicine arrangement", "having needs addressed with teleconsultation", or "willingness to do a teleconsultation". Of the 1128 retrieved abstracts, 56 underwent full-text review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. Video visits were evaluated in 5 studies, telephone encounters were analyzed in 2 studies, and both methods were examined in 1 randomized control study. Three studies showed that andrology and sexual medicine are compatible with telemedicine, with few 30- and 90-day in-person revisit rates. Telemedicine was shown to save an average cost of US$149-$252 per patient, and 8 studies that directly assessed andrology patient perceptions of telemedicine showed that most patients had a "positive perception."Pooled analyses of the positive responses to telemedicine were 68.7% (95% CI, 49.4%-83.1%, P = 0.057), and those of patients who recommended telemedicine were 65.1% (95% CI, 18.4%-93.9%, P = 0.577). While the percentage of patients recommending telemedicine was high among studies using videoconferencing, the percentage dropped in studies using telephone visits only. The difference between recommending video and telephone practices was statistically significant, with 84.6% pooled proportion for recommending video practice compared to 38.9% pooled proportion for recommending telephone practice, P = 0.035. In the telephone-only encounters, up to 27.1% of patients preferred in-person visits, as security and privacy of any mode of telecommunication were of concern. Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. These results suggest that telemedicine will likely continue to play a pivotal role in andrology and sexual medicine practices.

The Sandra R. Leiblum Presidential Lecture, delivered by the president at the time of the annual meeting, is named for the first president of the International Society for the Study of Women’s Sexual Health (ISSWSH), who passed away tragically in 2010. I was pleased to present this address at the ISSWSH Annual Meeting on March 6, 2023, in St Louis, Missouri, and to share it with our Sexual Medicine Reviews readers. Welcome to St Louis, founded in 1764 as a French fur-trading village by Pierre Laclede, who named the city “St Louis” for King Louis IX. It is famous for its beer, baseball, and the Blues hockey team. Foods invented here include the hamburger, the hot dog, peanut butter, iced tea, the club sandwich, cotton candy, and the ice cream cone—all of which premiered at the 1904 World’s Fair. As St Louis was the western-most city in the new territory in 1803 with the Louisiana Purchase, it became known as the “gateway to the west,” perpetuated today by the famous Gateway Arch. When Irwin and I moved from Boston to San Diego, we drove for 2 days to get to St Louis and bought a National Parks Pass, and the Gateway Arch was my first national park ever.

Erectile dysfunction (ED), for multifactorial reasons, is one of the biggest current quandaries among men worldwide and results in other complications such as reduced quality of life of the patient and his sexual partner, impotence, and psychiatric problems. Understanding of disease etiology, penile anatomy, erectile physiology, therapeutic mechanisms, and effective molecular pathways all play key roles in determining a therapeutic approach. This project is based on the study of topical minoxidil's effectiveness in treating ED. To perform a comprehensive overview of the subject, we performed a triple-keyword combination search to assess recent studies of ED. The most common formulation used in these studies was 2% minoxidil solution. Except for cases studied in paralytic patients, topical treatment with minoxidil appears to elicit a mild erectile response; however, this finding is insufficient to confirm the effectiveness of this topical treatment. Although evidence to confirm the therapeutic properties of minoxidil in ED is limited, combination therapy and the use of modern formulations of minoxidil are promising options for treating ED in the future.

Abstract Introduction Lichen sclerosus (LS) is a chronic inflammatory skin condition predominantly affecting the vulva. Studies have shown high rates of sexual dysfunction in patients with LS; however, the sexual effects of the condition are poorly acknowledged. Objectives We sought to identify sexual health consequences among women with vulvar LS through systematic review of available literature. Methods A systematic review of the literature was conducted to find reports on sexual health consequences among women with LS. PubMed, MEDLINE, and Scopus were queried. Included articles were observational studies evaluating women with LS and their sexual health and randomized controlled trials or comparative studies utilizing a validated sexual health measure before intervention among the same population. Articles must have been written in English and published from January 1991 to April 2022. Results The search produced 683 references, including 32 articles that met criteria for full-text review and 20 reported studies that met inclusion criteria. Two studies investigated the impact of LS on interpersonal relationships, 6 studies evaluated sexual symptoms, 16%-60% reported sexual dysfunction, and 22%-56.7% reported dyspareunia. Also described were decreased sexual frequency and satisfaction, negative impact on sexual relationships, and feelings of inadequacy. Eight publications evaluated the Female Sexual Function Index (FSFI); all described studies that demonstrated a central tendency less than 26.55. Four publications evaluated the Female Sexual Distress Scale (FSDS); all demonstrated average scores greater than 12. Two publications evaluated the Female Genital Self-Image Scale (FGSIS), both found decreased scores compared to controls. Four publications evaluated the Dermatology Life Quality Index (DLQI); impact on quality of life was small to very large, with sexual difficulties affecting most study patients. One publication evaluated the Vulvar Quality of Life Index (VQLI); sexuality was the second highest-scoring subgroup. Conclusions Sexual health consequences of LS include sexual pain, dysfunction, and distress; negative genital self-image; and negative impact on sexual relationships. Women with LS experience a negative impact on quality of life, particularly related to sexual functioning.

Journal Article A neurologic excitation/inhibition “faucet model” for orgasm and pain Get access Barry Komisaruk, PhD, Associate Editor, Barry Komisaruk, PhD, Associate Editor Search for other works by this author on: Oxford Academic Google Scholar Maria Cruz Rodriguez del Cerro, PhD, Maria Cruz Rodriguez del Cerro, PhD Search for other works by this author on: Oxford Academic Google Scholar Irwin Goldstein, MD, Editor-in-Chief Irwin Goldstein, MD, Editor-in-Chief Search for other works by this author on: Oxford Academic Google Scholar Sexual Medicine Reviews, Volume 11, Issue 1, January 2023, Pages 1–2, https://doi.org/10.1093/sxmrev/qeac009 Published: 12 January 2023

For several decades, testosterone and its synthetic derivatives have been used for anabolic and androgenic purposes. Initially restricted to professional bodybuilders, these substances gradually became more popular with recreational weightlifters. Considering its increasing prevalence, the consumption of anabolic androgenic steroids (AAS) has become a matter of great concern. Although most side effects are mild and reversible, some of them can cause permanent damage or can be potentially life threatening. To review and summarize medical literature regarding misuse and abuse of testosterone and other androgens, in order to provide evidence-based information on the main topics related to this subject, such as how to identify and how to deal with these patients, and to elucidate the multiple possible adverse effects secondary to this practice. Key studies were retrieved from PubMed (1989-2021) with reference searches from relevant articles. Search terms included "hypogonadism", "anabolic androgenic steroids", "androgens", "misuse AND testosterone", "abuse AND testosterone", and "side effects AND testosterone". There is a significant lack of information in the peer-reviewed literature describing demographic data, implications for different organ systems and the management of current or former AAS users; however, androgen abuse has been already linked to a wide variety of cardiovascular diseases, metabolic, endocrine, neurological, psychiatric and liver disorders. Despite all this, most physicians still feel uncomfortable and hesitate to discuss the issue with patients. The chronic use of high doses of AAS is associated with adverse effects in several organ systems; however, there are still many gaps in our knowledge about the long-term consequences of this practice and how to deal with these patients. Healthcare professionals have a crucial role in combating this public health problem, recognizing and preventing the spread of androgen abuse. Linhares BL, Miranda EP, Cintra AR, et al. Use, Misuse and Abuse of Testosterone and Other Androgens. Sex Med Rev 2022;10:583-595.

Many transgender individuals seeking healthcare have had at least one negative experience related to being transgender. As a result, transgender patients may forego seeking healthcare treatment atall, leading to adverse long-term health outcomes. With barriers to care and oftentimes suboptimal care provided to transgender individuals, TranZap, in collaboration with the PROUD Gender Center of NJ, was commenced. To provide a review on the current transgender resources to finding healthcare, and the impetus behind creating a transgender health app to streamline this process. The vision of this app, TranZap, is to empower transgender individuals who are seeking healthcare such that they are better educated and knowledgeable regarding available healthcare providers. With no data available from usual sources, such as Google Scholar, social media, as well as input from the transgender community through social media and word of mouth was utilized to identify the current resources for transgender patients seeking healthcare. This online search was done to identify any type of transgender focused healthcare databases that were community driven. Four resources were identified: TransBucket, TransAtlas, TransHealthCare, and Erin's Informed Consent hormone replacement therapy map of the US. Noting that there are limited resources, an app that is community driven and provides information on all types of healthcare providers, not exclusively surgeons or endocrinologists, was developed. Seeking gender-affirming healthcare providers is a strenuous task filled with uncertainty and few reliable resources. Resources that provide the input of transgender individuals on their experiences with healthcare providers is one step in addressing this issue. Resources, such as TranZap, must be developed to close the gaps in access to healthcare by providing a platform for transgender patients to share experiences about healthcare providers in the hopes that those using the app will be able to find a welcoming gender-affirming provider. Chiang T, Bachmann GA. The TranZap: A Transgender Resource for Identifying Gender-Affirming Providers. Sex Med Rev 2022;10:632-635.

The transmasculine and gender diverse (TMGD) spectrum includes transgender men and non-binary individuals whose sex was assigned female at birth. Many TMGD patients pursue treatment with exogenous testosterone to acquire masculine characteristics. Some may choose to undergo gynecological gender-affirming surgery for total hysterectomy with bilateral salpingectomy and/or bilateral oophorectomy (TH/BSO). The decision to retain or remove the ovaries in the setting of chronic testosterone therapy has implications on reproductive health, oncologic risk, endocrine management, cardiovascular health, bone density and neurocognitive status. However, there is limited evidence on the long-term outcomes from this intervention. Here we review health-related outcomes of oophorectomy in TMGD population treated with chronic testosterone therapy in order to guide clinicians and patients in the decision to retain or remove their ovaries. We conducted a systematic literature review following PRISMA guidelines. MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases were searched for peer-reviewed studies published prior to October 26, 2021 that: (i) included transgender men/TMGD individuals in the study populations; (ii) were full-text randomized controlled studies, case reports, case series, retrospective cohort studies, prospective cohort studies, qualitative studies, and cross-sectional studies; and (iii) specifically discussed ovaries, hysterectomy, oophorectomy, ovariectomy, or gonadectomy. We identified 469 studies, of which 39 met our inclusion criteria for this review. Three studies discussed fertility outcomes, 11 assessed histopathological changes to the ovaries, 6 discussed ovarian oncological outcomes, 8 addressed endocrine considerations, 3 discussed cardiovascular health outcomes, and 8 discussed bone density. No studies were found that examined surgical outcomes or neurocognitive changes. There is little information to guide TMGD individuals who are considering TH/BSO versus TH/BS with ovarian retention. Our review suggests that there is limited evidence to suggest that fertility preservation is successful after TH/BS with ovarian retention. Current evidence does not support regular reduction in testosterone dosing following oophorectomy. Estradiol levels are likely higher in individuals that choose ovarian retention, but this has not been clearly demonstrated. Although bone mineral density decreases following oophorectomy, data demonstrating an increased fracture risk are lacking. No studies have described the specific impact on neurocognitive function, or changes in operative complications. Further research evaluating long-term health outcomes of oophorectomy for TMGD individuals treated with chronic testosterone therapy is warranted to provide comprehensive, evidence-based healthcare to this patient population. Sahil Kumar, Smita Mukherjee, Cormac O'Dwyer, etal. Health Outcomes Associated With Having an Oophorectomy Versus Retaining One's Ovaries for Transmasculine and Gender Diverse Individuals Treated With Testosterone Therapy: A Systematic Review. Sex Med Rev 2022;10:636-647.