I. Goldstein's research while affiliated with Vibra Hospital of San Diego and other places

Publications (139)

Article
Introduction In 2012, Komisaruk and Lee introduced the concept that a bothersome women's sexual health issue associated with catastrophization and suicidal ideation, currently defined as Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD), could be mediated by sacral radiculopathy from Tarlov cysts in the cauda equina. To more...
Article
Introduction Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) is characterized by persistent, distressing genital arousal sensations for > 3 months and may include other genito-pelvic dysesthesia. PGAD/GPD is associated with biopsychosocial triggers, originating in any of 5 regions: end organ; pelvis/perineum; cauda equina;...
Article
Introduction Complete vestibulectomy with vaginal advancement flap (CVVAF) for the treatment of neuroproliferative vestibulodynia (NPV) involves excision of the 1:00 to 11:00 region surrounding the urethral meatus and introitus, allowing the vagina and urethral meatus to be anastomosed to the vulva. The vestibule, however, extends above the urethra...
Article
Introduction The endodermal vestibule epithelial surface is very thin (∼ 50 um) and unlike the ectodermal vulva has no protective keratinized stratified squamous epithelium, therefore the vestibule is particularly susceptible to injury as a reaction to allergy, inflammation, or trauma. In some women these injuries result in excess mast cell and ner...
Article
Introduction Clitorodynia is a bothersome genito-pelvic dysesthesia characterized by atypical sensations such as burning, stinging, and/or sharp pain confined to the glans clitoris, common clitoral shaft and/or prepucial (hood) area that may be constant, intermittent or occurring only when provoked. Clitorodynia, like other genito-pelvic dysesthesi...
Article
Introduction Neuroproliferative vestibulodynia (NPV), characterized in 2004, is associated with increased density of mast cells and nerves as demonstrated by immunohistochemical staining of multiple regions of excised vestibular specimens, showing it to be a field disease. It has been reported that 16% of women experience persistent entrance dyspar...
Article
Introduction In 2010, low-intensity shockwave therapy (LiSWT) was first described for used on the flaccid penis as a novel and minimally invasive regenerative treatment for men with ED. A standardized protocol for use of LiSWT either in the flaccid or erect state has not yet been established. Erect penile LiSWT, in contrast to flaccid penile LiSWT,...
Article
Introduction IPP infections occur in approximately 1% of cases. The fundamental principle for treatment has always been surgical removal of all components. Explantation/reimplantation surgery, however, may be unsuccessful, require additional surgeries, and/or result in poor patient satisfaction, reduced penile sensation, and decreased penile length...
Article
Introduction The most commonly treated sexual dysfunctions in men are erectile dysfunction, Peyronie's disease, premature and delayed ejaculation, and decreased sexual desire. While urologists have expertise treating these sexual dysfunctions, there are unusual sexual health concerns in men that can prove a management quandary to many clinicians. T...
Article
Introduction Erectile dysfunction (ED) is usually a symptom of another medical condition. People with poor overall health are more likely to develop severe form of coronavirus disease 2019 (COVID-19) and may have unwanted symptoms such as ED. COVID-19-related stress, anxiety, and depression can also impact sexual health and possibly lead to ED. The...
Article
Introduction The vestibule is an endodermal tissue located on the skin surface between Hart's line at the inner aspect of the labia minora (ectoderm), and the hymen, at the vaginal opening (mesoderm). The vestibule contains the urethral meatus and minor and major vestibular glands. The vestibule releases mucinous lubrication during sexual arousal t...
Article
Introduction Neuroproliferative vestibulodynia (NPV) is a poorly understood chronic debilitating sexual pain condition associated with severe vestibular allodynia and hyperalgesia. In patients with NPV, histopathology of surgical specimens from the usual posterior and right and left anterior locations (1:00 - 11:00 o'clock) has shown high densities...
Article
Introduction Surgeons performing complete vestibulectomy with vaginal advancement flap reconstruction for suspected neuroproliferative vestibulodynia (NPV) take into consideration the need for acute pain relief in the early postoperative period as well as risks for persistent post-operative opioid use. Post-operative acute pain has traditionally be...
Article
Introduction There are various treatment options for patients with ED and comorbid BPH-LUTS. Relevant clinical practice guidelines are available to help and guide physicians in making appropriate disease management decisions. However, real-world evidence comparing health-related outcomes between patients treated with tadalafil and those who did not...
Article
Introduction Testosterone Undecanoate (TU) Capsules (Jatenzo, Clarus Therapeutics) was FDA-approved as a testosterone replacement therapy (TRT) for adult males with primary or secondary hypogonadism in 2019. We have now over 100 patients using TU capsules. The capsule is an oral self-emulsifying drug delivery system that is a highly lipophilic prod...
Article
Introduction The most commonly treated sexual dysfunctions in men are erectile dysfunction, Peyronie's disease, premature and delayed ejaculation, and decreased sexual desire. While urologists have expertise treating these sexual dysfunctions, there are unusual sexual health concerns in men that can prove a management quandary to many clinicians. T...
Article
Introduction In 2010, low-intensity shockwave therapy (LiSWT) was first described for used on the flaccid penis as a novel and minimally invasive regenerative treatment for men with ED. A standardized protocol for use of LiSWT either in the flaccid or erect state has not yet been established. Erect penile LiSWT, in contrast to flaccid penile LiSWT,...
Article
Introduction Surgeons performing complete vestibulectomy with vaginal advancement flap reconstruction for suspected neuroproliferative vestibulodynia (NPV) take into consideration the need for acute pain relief in the early postoperative period as well as risks for persistent post-operative opioid use. Post-operative acute pain has traditionally be...
Article
Introduction Neuroproliferative vestibulodynia (NPV) is a poorly understood chronic debilitating sexual pain condition associated with severe vestibular allodynia and hyperalgesia. In patients with NPV, histopathology of surgical specimens from the usual posterior and right and left anterior locations (1:00 - 11:00 o'clock) has shown high densities...
Article
Introduction Low systemic estradiol values (<10 pg/ml) experienced by menopausal women are associated with multiple symptoms including hot flashes, night sweats, insomnia, mood changes/irritability, vaginal dryness, dyspareunia, dysuria, low libido, reduced arousal/orgasm, cognitive changes, weight gain and slowed metabolism. Intramuscular estradio...
Article
Introduction Testosterone Undecanoate (TU) in capsule form (Jatenzo, Clarus Therapeutics) was FDA-approved as a testosterone replacement therapy (TRT) for adult males with primary or secondary hypogonadism in 2019. We have now over 100 patients using TU capsules. The capsule is an oral self-emulsifying drug delivery system that is a highly lipophil...
Article
Introduction The vestibule is an endodermal tissue located on the skin surface between Hart's line at the inner aspect of the labia minora (ectoderm), and the hymen, at the vaginal opening (mesoderm). The vestibule contains the urethral meatus and minor and major vestibular glands. The vestibule releases mucinous lubrication during sexual arousal t...
Article
Full-text available
Introduction: Cligosiban is an orally administered, centrally penetrant oxytocin receptor antagonist being developed to treat premature ejaculation (PE). Aim: To determine the efficacy of 3 dose levels of cligosiban caplets to prolong intravaginal ejaculation latency time (IELT) and improve patient-reported outcomes in men with lifelong PE. Met...