Yacov Reisman

Flare Health

Finasteride and dutasteride, synthetic 5α-reductase inhibitors (5ARIs) are recommended in many guidelines for the treatment of benign prostatic hyperplasia/lower urinary tract symptoms and alopecia despite a variety of side effects like sexual, neurological, psychiatric, endocrinological, metabolic and ophthalmological dysfunctions and the increase...

Post-orgasmic illness syndrome (POIS) is a rare, but debilitating cluster of symptoms, occurring after ejaculation with unknown mechanism and uncertain treatment. To the best of our knowledge, this study, which is thought to be the first in the literature, is aimed to investigate the practice patterns of sexual medicine experts towards POIS. Worldw...

Introduction Animal models are frequently used for translational research in Peyronie’s disease (PD). However, due to lack of availability of guidelines, there is some heterogeneity in study design, data reporting, and outcome measures. Aim This European Society for Sexual Medicine consensus statement aims to provide guidance in utilization of ani...

Objectives Low sexual desire is the most common sexual complaint in women. As a result, many women suffer from sexual dissatisfaction and related distress which often negatively interferes with their quality of life. Currently, limited drug treatments are available globally to treat women with Female Sexual Interest & Arousal Disorder (FSIAD). As a...

Introduction Low female sexual desire (HSDD) is one of the most common sexual complaints in women. As a result, many women suffer from sexual dissatisfaction and related distress, which often negatively interferes with their quality of life. Little is known about the underlying biological mechanism of low desire, but it is conceivable that sexual f...

Introduction Low sexual desire is the most common sexual complaint in women. As a result, many women suffer from sexual dissatisfaction and related distress which often negatively interferes with their quality of life. Currently, limited drug treatments are available globally to treat women with Hypoactive Sexual Desire Disorder/Female Sexual Inter...

Background: Androgen deprivation therapy (ADT) for prostate cancer (PCa) is accompanied by side effects affecting health-related quality of life (HRQL). Objective: To assess the effects of the fetal estrogen estetrol (E4) on symptoms related to estrogen and androgen deficiency, and on HRQL measured using the validated Functional Assessment of Ca...

Introduction Gout is the most prevalent inflammatory crystal arthropathy worldwide and is a chronic disease requiring strict, lifelong adherence to drug therapy and healthy lifestyles. Gout has a heavy burden on the patient's sexual health, owing to the associated inflammatory status, long-term complications, and chronic pain; however, the effects...

Samenvatting Hoewel patiënten en hun partners de wens hebben dat de arts het gesprek over hun seksualiteit initieert, blijven seksualiteit en intimiteit in de behandelkamer toch vaak buiten beschouwing. Dat komt vooral door gebrek aan scholing en training. Volgens de visie van de European Union of Medical Specialists (EUMS) dient iedere praktiseren...

Background: Post-SSRI sexual dysfunction (PSSD) is a set of heterogeneous sexual disorders, that may arise during the administration of antidepressant Selective Serotonin Reuptake Inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitor (SNRIs) and may persist after their discontinuation. PSSD is commonly associated with sexual proble...

Finasteride is a 5α-reductase inhibitor (5ARI) medication commonly used in the treatment of benign prostatic hyperplasia (BPH) and male androgenic alopecia (AGA). Medical management of both conditions with finasteride or dutasteride, another 5ARI, has been generally successful and well tolerated; however, the influx of reported adverse effects has...

Antidepressant treatment with SSRIs and SNRIs can have negative influences on all stages of the sexual response cycle. In some individuals, the impairments in sexual functioning and sexual satisfaction continue long after the medication is stopped, for which the term “Post-SSRI Sexual Dysfunction” (PSSD) is used to describe this disorder. PSSD is u...

Post-Orgasmic Illness Syndrome is a rare disorder causing a debilitating cluster of flu-like and allergic-type symptoms that occur immediately or within minutes or hours after ejaculation. Symptoms occur after partnered sex, solo masturbation, or spontaneous ejaculation and can last from 2 to 7 days. The condition is chronic and the onset pattern c...

Sexuality is an important component of human life that can be experienced and expressed in various ways. The interplay of biological, psychological, and social elements has an impact on sexuality. Because sexuality is a multi-causal, multidimensional complex phenomenon, sexual health and dysfunction should be addressed through a multidisciplinary b...

Introduction Patients with Peyronie's disease may experience significat distress. The choice of treatment depends on a variety of factors, including the stage of the disease, the presence of pain, severity and direction of the curvature, penile length and the quality of erectile function. Aim To review the evidence associated with surgical treatme...

The objective of this study is to characterize the standard perioperative practices of penile prosthetic surgeons. A 24-question survey was sent to prosthetic urologists which assessed surgeon demographic and practice information, preoperative evaluation including assessment of sexual history, and postoperative assessment. The majority of surveyed...

Over the past few years, an increase use of low-intensity shockwave therapy (LISWT) for the treatment of erectile dysfunction (ED) has been observed. However, many controversies in the scientific literature about its efficacy still exist. We aimed to investigate changes in the pattern of usage and attitudes toward LISWT for ED among experts over th...

Introduction Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far. Aim To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendati...

Background: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin. Objective: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal...

Introduction Penile traction therapy (PTT) aims to non-surgically reduce curvature, enhance girth, and recover lost length. Available clinical practice guidelines however lack clear recommendations regarding their use. Aim To present a comprehensive review and recommendation regarding the available evidence to the use of PTT in Peyronie's disease...

Restriction measures enacted during the COVID-19 pandemic had severe effects on male sexual and reproductive health. We aimed to investigate the real-life impact and perception of sexual function in 2020 in Italy, as the first Western country experiencing a national lockdown by measuring relative search volume for keywords pertaining to sexual heal...

Post-orgasmic illness syndrome (POIS) is a rare condition that includes a cluster of post-ejaculatory symptoms with debilitating physical and psychological consequences. The prevalence and incidence of POIS remain unknown as well as the pathophysiology of the syndrome, and there are no well-studied recognized treatment modalities. The current retro...

Background Androgen deprivation therapy (ADT) for prostate cancer with luteinizing hormone-releasing hormone (LHRH) agonists can be improved. Objective To assess safety, the frequency and severity of hot flushes (HFs), bone health, and antitumor effects of high-dose estetrol (HDE4) when combined with ADT. Design, setting and participants A phase...

Introduction Sexual dysfunctions (SDs) have been frequently reported among male partners of infertile couples due to psychogenic, relational and/or organic issues related with the inability to conceive. Likewise, male infertility (MI) could be a consequence of sexual dysfunctions. Aim To review the evidence on the prevalence and treatment of male...

Given that sexual pleasure is a core component of sexual health, devices that are designed to enhance and diversify sexual pleasure are particularly useful in clinical practice. Despite their growing popularity and widespread use in various biopsychosocial circumstances, many taboos still seem to exist, as indicated by the paucity of scientific lit...

Men’s Health is a urological subspecialty that is at the forefront of innovation, but little data exist evaluating the attitudes that andrologists have toward the current treatment modalities available for managing Men’s Health conditions. A survey of 37 questions asking what providers would choose as treatment for common conditions was distributed...

Male sexual dysfunctions include problems regarding lack of sexual desire or difficulties in different phases of sexual response (e.g. erectile disorder, premature ejaculation, delayed ejaculation) that cause significant distress. Sexual dysfunctions are very prevalent worldwide, constituting a major public health problem. Causes for sexual dysfunc...

Introduction Rodent animal models are currently the most used in vivo model in translational studies looking into the pathophysiology of erectile dysfunction after nerve-sparing radical prostatectomy. Aim This European Society for Sexual Medicine (ESSM) statement aims to guide scientists toward utilization of the rodent model in an appropriate, ti...

Background Opportunities and pitfalls of e-health have been described and assessed in various health domains, but in the field of sexual health, the respective literature is limited. Aim The aim of this document is to present the European Society of Sexual Medicine’s (ESSM) current position statement on e-sexual health. Methods This statement art...

Introduction: A large body of evidence has clearly documented that erectile dysfunction (ED) represents not only a complication of cardiovascular (CV) diseases (CVD) but often an early sign of forthcoming CVD. Areas covered: All the available data from meta-analyses evaluating the association between ED and CV risk were collected and discussed. Sim...

Introduction Radiofrequency (RF)-based treatment has been introduced as an esthetic alternative treatment for various medical indications without the scientific backup of a satisfactory body of evidence. Furthermore, the United States Food and Drug Administration issued a warning regarding the safety of energy-based technologies for indications suc...

Introduction There is a lack of theoretical and empirical knowledge on how sexual desire functions and interacts in a relationship. Aim To present an overview of the current conceptualization and operationalization of sexual desire discrepancy (SDD), providing clinical recommendations on behalf of the European Society of Sexual Medicine. Methods...

Background Laser-based technologies have been commercially marketed as “wonder treatments” without a sufficient and adequate body of evidence. In addition, on July 30, 2018, the U.S. Food and Drug Administration issued a warning regarding the safety of the use of laser-based devices for the following indications: vaginal “rejuvenation” or cosmetic...

Erectile dysfunction (ED), defined as the inability to initiate or maintain an erection sufficient for satisfactory sexual intercourse, is common, particularly in men aged ≥50 years. Existing treatments have significant limitations, and there remains a need for a fast-acting (to facilitate spontaneity during intercourse) and well tolerated local th...

Purpose of Review Because of the sex/gender differences in the manifestation of depression, one can assume the possible existence of gender differences in post-SSRI sexual dysfunction (PSSD). This article tries to summarize the available data on sex/gender differences in PSSD and to evaluate if different approaches in diagnosis or treatment of diff...

The role of testosterone in female sexuality is still controversial. In 2019, a meta-analysis and a Position Statement on testosterone therapy for hypoactive sexual desire disorder in menopausal women and a Position Statement on the potential sexual adverse effects of hormonal contraception have begun to close this gender gap. The only evidence-bas...

Introduction: To date, several aspects of inflatable penile prosthesis (IPP) surgical procedure have been poorly studied. Aim: The aim of this study was to review the evidence associated with IPP implantation and provide clinical recommendations on behalf of the European Society for Sexual Medicine (ESSM). Overall, 130 peer-reviewed studies and...

Introduction: Masculinity and femininity constitute the gender role construct into the general concept of sexual identity. Aim: To investigate the relationships of attachment style, sexual orientation and biological sex with the gender role. Methods: A convenience sample of 344 subjects (females = 207; males = 137) was recruited. Main outcome...

Male hypogonadism (HG) can be defined according to its etiology as primary (pHG) when caused by any diseases affecting the testes, or as secondary (sHG) when due to a pituitary or hypothalamic dysfunction. Both fertility and testosterone (T) can be theoretically restored in sHG by removing the precipitating cause and/or by appropriate endocrine the...

Objectives: To evaluate possible discrepancies between patients' expectations concerning sexual side effects related to prostate cancer treatment, based on the obtained information prior to treatment. Moreover, to determine if demographic or clinical factors may have an effect on the accuracy of patients' expectations concerning sexual side effect...

Introduction: Hormonal contraception is available worldwide in many different forms. Fear of side effects and health concerns are among the main reasons for not using contraceptives or discontinuing their use. Although the safety and efficacy of contraceptives have been extensively examined, little is known about their impact on female sexual func...

Introduction: Metabolically unhealthy obesity (MUHO) is the most important preventable cardiovascular (CV) risk factor. Recently, the significance of metabolically healthy obesity (MHO) as a CV risk factor has raised increasing interest. MUHO is a known risk factor for erectile dysfunction (ED); however, the effect of MHO on ED has barely been inve...

Introduction: Low-intensity shockwave therapy (LISWT) has been investigated for the treatment of uroandrological disorders including erectile dysfunction (ED), Peyronie's disease (PD) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with controversial findings. Aim: To review the evidence on LISWT for ED, PD, and CP/CPPS and provid...

Aims and objectives: To investigate whether a symposium aimed at healthcare professionals in the uro-oncological field changes knowledge, competence and general practice regarding sexual dysfunction after prostate cancer treatment. Background: Sexual dysfunction is not frequently discussed by healthcare professionals; lack of knowledge and train...

Introduction: The cardiovascular (CV) safety of testosterone replacement therapy (TRT) remains a crucial issue in the management of subjects with late onset hypogonadism. The authors systematically reviewed and discussed the available evidence focusing our analysis on heart related issues. Areas covered: All the available data from prospective obse...

Background Although the pathogenic role of metabolically complicated obesity (MCO) in erectile dysfunction (ED), major adverse cardiovascular events (MACE), and male infertility has been widely studied, that of metabolically healthy obesity (MHO) has been poorly investigated. Aim To assess the role of MHO in the pathogenesis of ED, prediction of M...

Background: Several data have clearly shown that the endocrine system-and androgens in particular-play a pivotal role in regulating all the steps involved in the male sexual response cycle. Accordingly, testosterone (T) replacement therapy (TRT) represents a cornerstone of pharmacologic management of hypogonadal subjects with erectile dysfunction....

Objectives To validate a psychometric instrument, the Masturbation Erection Index (MEI) able to evaluate erectile function (EF) during masturbation. In fact, although the evaluation of EF during masturbation is pivotal in evaluating erectile dysfunction (ED), to date no specific psychometric tools have been developed to measure it both in the routi...

Introduction. Since 2010 some evidence supporting the possible increased cardiovascular (CV) risk related to testosterone treatment (TTh) has created much debate in the scientific community. Based on these results, the US Food and Drug Administration agency has questioned TTh for aging men recognizing its value only for classical hypogonadism due t...

Context Luteinizing hormone-releasing hormone (LHRH) agonists replaced estrogens for endocrine treatment of advanced prostate cancer (PC) because of cardiovascular side effects. The fetal estrogen estetrol (E4) may be safer for PC treatment and is expected to decrease testosterone (T) and prevent estrogen deficiency. Objective To investigate the s...

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...

Introduction: In the case of primary male hypogonadism (HG), only testosterone (T) replacement therapy (TRT) is possible whereas when the problem is secondary to a pituitary or hypothalamus alteration both T production and fertility can be, theoretically, restored. We here systematically reviewed and discussed the advantages and limits of medicatio...

Background: The benefits and risks of long-term testosterone administration have been a topic of much scientific and regulatory interest in recent years. Aim: To assess long-term quality of life (QOL) and sexual function benefits of testosterone replacement therapy (TRT) prospectively in a diverse, multinational cohort of men with hypogonadism....

Introduction: Sexual dysfunctions are well-known side effects of selective serotonin reuptake inhibitor (SSRI) use. Altered libido, erectile dysfunction, vaginal dryness, ejaculatory disorders, and orgasmic problems are frequently reported by patients treated with SSRIs. Moreover, these antidepressant-emergent sexual dysfunctions do not always res...

Introduction: This review was designed to make recommendations on future educational needs, principles of curricular development, and how the International Society for Sexual Medicine (ISSM) should address the need to enhance and promote human sexuality education around the world. Aim: To explore the ways in which graduate and postgraduate medic...

Introduction: Low-intensity extracorporeal shockwave therapy (LI-ESWT) has emerged as a treatment option for male sexual dysfunction. However, results have been contradictory. Aim: To investigate the knowledge, practice patterns, and attitudes regarding LI-ESWT among experts in sexual medicine. Methods: A study-specific questionnaire was handed out...

Cancer is a major public health problem worldwide. Calculating for North-Western Europe, the percentage of cancer in the adult population, for all stages combined (diagnosis through survival), is estimated at 4.4 %. From the perspective of sexuality and intimacy, the partners share much of the damage and disturbance; adding them, approximately 7 %...

In this part, we address various ways of dealing with disturbances of sexuality and intimacy in people with cancer. In the second part, those areas have been approached from the perspective of the diagnostic phase and various treatment strategies. In the third part, they were approached from the perspective of specific cancers. In this fourth part,...

As stated in the introduction, this book consists of five parts each covering a different area. In this first part, we will start with some basic information before we will dive into the sexual consequences of various treatments (in Chaps. 8, 9, 10, 11, 12, and 13) and of the various cancers (in Chaps. 14, 15, 16, 17, 18, 19, 20, 21, 22, and 23). C...

Just as in other areas of life, there are many differences between one group and the other. That goes for society, for health problems and for cancer care. Cancers are different, care systems are different, professionals are different, and patients are different. That is both the bother, the challenge and the spice of our work.

Whereas the former part focused on the various treatment strategies, the focus of this part is on specific cancers.

Cancer and its treatment influence sexuality and intimacy and can do that in many different ways.

This chapter will focus on the various biological elements of sexuality and sexual function.

The previous chapters of this module paid attention to various aspects of preventing sexual decline and of sexual rehabilitation after cancer treatment. This chapter will highlight the potential use and some challenges in the introduction of sexual tools and toys in that process.

To be able to deal with the topic of sexuality after cancer, one needs more than knowledge alone. For proper care, one needs also an amount of skills and a proper attitude.

This series of articles, Standards for Clinical Trials in Male and Female Sexual Dysfunction, began with the discussion of a common expected standard for clinical trial design in male and female sexual dysfunction, a common rationale for the design of phase I to IV clinical trials, and common considerations for the selection of study population and...

The focus of this article, the fourth in the series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, is on aspects of clinical trial design and measurement that are specific to clinical trials for treatments of female sexual dysfunction. Challenges in this area include the limited extent of treatment development and clinical tr...

With the emergence of advanced treatment modalities for cancer, the survival rate of cancer patients has increased, often leading to long-term survival. Many types of cancer have gradually evolved from an acute to a chronic disease, and, with the population growing older, the number of cancer survivors in the population is constantly increasing. Th...

This book provides a wide-ranging overview of the sexual consequences of cancer and its treatment with the aim of equipping physicians and other health care providers with the awareness and knowledge required in order to offer patients effective treatment. While sexuality may not be the primary focus for cancer patients, at some point, whether beca...

The second article in this series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, focuses on measurement of patient-reported outcomes (PROs). Together with the design of appropriate phase I to phase IV clinical trials, the development, validation, choice, and implementation of valid PRO measurements—the focus of the present ar...

This series of articles outlines standards for clinical trials of treatments for male and female sexual dysfunctions, with a focus on research design and patient-reported outcome assessment. These articles consist of revision, updating, and integration of articles on standards for clinical trials in male and female sexual dysfunction from the 2010...

Introduction: Premature ejaculation (PE) is one of the commonest sexual dysfunctions in men. Because the definition of and guidelines for the management of PE have been revised in recent years, our understanding of PE has changed. Aim: To investigate the clinical practice patterns of sexual medicine specialists regarding the diagnosis and treatment...

Androgen deficiency syndrome is a commonly diagnosed condition. The aim of this study was to investigate common clinical practices of specialists in the field of sexual medicine regarding androgen replacement treatment for men and women. Attendees of the 16th Annual Congress of the European Society of Sexual Medicine held in January 2014 in Istanbu...

Introduction: After a century of development in the field of sexology and decades of attempts to establish the field of sexual medicine, the first examination that led to the qualification as Fellows of the European Committee of Sexual Medicine (FECSM) was held in December 2012. Aim: This study aims to describe the first European specialists in...

Low-intensity shockwaves (LISW) are known to produce revascularization and have been in evaluation and in use to treat erectile dysfunction (ED). The present single-arm pilot study is aimed to assess the safety and efficacy of a dedicated shockwave device (Renova) on vasculogenic ED patients. Fifty-eight patients with mild to severe ED were treated...

Introduction: Since 2007, the European Society of Sexual Medicine has held an annual 2-week educational residential program at Oxford. The Oxford School of Sexual Medicine provides knowledge and skills learning opportunities for healthcare professionals. Aim: The aim of the current study was to evaluate the impact of Oxford School courses on the...