Sexual Medicine

Sexual arousal in women comprises two components: genital arousal and subjective arousal. For some women, genital arousal enhances subjective arousal; for others, the two types of arousal are desynchronous. In this Review, Meston and Stanton describe the mechanisms and the relationship between genital and subjective arousal and consider how they assist in diagnosis and treatment of sexual arousal dysfunction and development of treatments for female sexual arousal dysfunction.

The penis is a diverse and rapidly evolving structure, much more complex than its fundamental function — sperm transfer — would seem to require. In this Review, experts in the field discuss the drivers of penis evolution, and consider how the penis might be an ideal characteristic on which to focus in studies to link phenotype with genotype.

Transgender persons can be affected by sexual dysfunctions before, during, after, because of, and despite therapy. In this Review, experts in the field discuss trans sexuality across the gender dysphoric spectrum, and suggest ways in which trans persons can be supported in their sexuality and sexual function.

In this Review, the authors describe the current preclinical research into stem cell therapy for the treatment and prevention of penile fibrotic disorders, including Peyronie’s disease, urethral stricture and corpora cavernosa fibrosis, and highlight their specific mechanisms of antifibrotic activity.

The re-emerging mosquito-transmitted flavivirus Zika seems to be sexually transmitted and can persist in the male genital tract, presenting as genitourinary symptoms such as haematospermia, prostatitis, painful ejaculation, penile discharge, and oligospermia. In this Review, the authors explain the mechanisms that underlie persistent Zika infections in men and describe why these are crucial to developing guidelines, effective vaccines, and therapies.

Nonoperative management is the only treatment option for Peyronie’s disease in the acute phase of the disease, when surgery is contraindicated. In this Review, Tsambarlis and Levine discuss the oral and topical therapies that have been shown to be efficacious and provide recommendations for their use.

Intracytoplasmic sperm injection (ICSI) is the most widely used method of fertilization in assisted reproductive technology. Here, the authors provide a historical overview of ICSI development, discuss indications for ICSI in both male factor and non-male factor infertility conditions, and describe potential consequences of ICSI for the health of resulting offspring.

The Guttmacher–Lancet Commission’s report on Sexual and Reproductive Health and Rights for All coincides with raised awareness of this topic as a result of global movements such as #metoo. However, weak political leadership, increasing fragmentation of services, and sustained underfunding pose a threat to sexual and reproductive health globally.

Despite its prevalence, sexual pain in women is poorly understood as it exists at the intersection of different biopsychosocial disciplines. In this Review, experts in the field describe how confusion remains at the nosological, aetiological, theoretical, methodological, and treatment levels and how a psychosocial approach can help to overcome this lack of consensus to improve theoretical models and effective treatments.

Although sexual disorders have been widespread for millennia, sexual medicine has historically been an unofficial specialty with no standards of training or recognition. Initiatives from the European Society for Sexual Medicine have sought to cement its role in modern medicine and to encourage and support early-career physicians and sexologists in their chosen specialty.