The sextech industry and innovative devices for treating sexual dysfunction.

Since the digital revolution, there has been a notable increase in the use and popularity of sex toys and innovative sexual devices, which can be attributed to advancements in technology. The sex toys industry strives to improve sexual experience, pleasure and sexual health, and to address sexual dysfunction through devices and technology. With the growth of this industry, new products that are considered "smart sexual devices" have gradually entered the market. Smart sexual devices feature wireless connectivity to a smartphone application that allows the user to control the device's features and provide personal or sexual data about their sexual experiences. Other smart devices have sensors and are able to collect physical data during usage. With the aid of this data, individuals may be able to understand their sexual behavior and arousal better, resulting in improved sexual experience or the overcoming of sexual dysfunction. The present article aims to explore the potential applications of technology-based devices, and smart sexual devices, in the treatment of male sexual dysfunctions, including premature ejaculation (PE), and delayed ejaculation (DE), as well as female sexual dysfunction (FSD), such as sexual arousal disorder and female orgasmic disorder. Furthermore, we examine the advantages and disadvantages of these devices. Given the limited literature available on this subject and the absence of controlled studies, we conduct a narrative review of the existing scientific research on technological and smart sexual devices.

[SPINAL CORD INJURIES DUE TO VIRAL INFECTIONS].

INTRODUCTION: Spinal cord injury (SCI) etiology can be either traumatic or non-traumatic. Non-traumatic SCI is of growing importance, with studies indicating increased incidence, partly because of population aging. Approximately 9% of these injuries are secondary to an infectious cause. SCI has significant implications on the patient's quality of life. A successful rehabilitation process focuses on maximizing independence and setting achievable goals according to the patient's needs and desires. The medical staff should be familiar with the natural history of such injuries while taking into consideration the existing support systems available to the patient and minimizing the damage to life cycles as best possible with the aid of a transdisciplinary team approach. In this article, we will review the main viral causes of SCI injury. We will discuss the epidemiology, clinical aspects and the unique meanings of this subgroup in the rehabilitation process.

[CONVERSION REACTION AS A MOTOR DISABILITY: DIAGNOSIS, TREATMENT AND REHABILITATION THERAPY].

INTRODUCTION: The Rehabilitation Medicine specialists are frequently confronted with paralyzed patients due to a conversion-somatoform etiology. This article describes our model of diagnosing, treating and rehabilitating these patients.

Post irradiation myelopathy: from the physiatrists' point of view.

We describe two patients who developed a severe spinal cord damage long time after cessation of irradiation therapy. The various and unique rehabilitation medicine aspects are discussed and the literature is surveyed.

Surrogate partner therapy: ethical considerations in sexual medicine.

INTRODUCTION: Surrogate partner therapy (SPT) is a controversial and often misunderstood practice. AIM: The aim of this study was to review the history and evidence-based literature regarding SPT, describe and provide a model for ethical SPT practice, and present two case examples illustrating ethical concerns. METHODS: Literature review and report of clinical experience were the methods used. MAIN OUTCOME MEASURE: Results of literature review and clinical experience were assessed for this study. RESULTS: Sex therapy pioneers Masters and Johnson introduced surrogacy in sex therapy; however, there is a lack of published evidence supporting treatment efficacy and ethico-legal questions have limited the practice from becoming a common intervention. SPT can be an effective intervention that may enhance sexual medicine practice. However, SPT must be offered according to legal, professional, and ethical standards. CONCLUSIONS: Sexual medicine practitioners should consider SPT based on the ethical paradigms offered, and sex therapy practices utilizing SPT should collect and publish outcome data.

Erectile dysfunction is associated with severe retinopathy in diabetic men.

OBJECTIVE: Erectile dysfunction (ED) and retinopathy are prevalent in diabetic men. However, the association between ED and diabetic retinopathy (DR) with relation to DR severity levels has never been studied. MATERIALS AND METHODS: For this cross-sectional study, data were obtained prospectively at the retina clinic of a tertiary medical center. The study group included men with proliferative diabetic retinopathy (PDR) or with severe nonproliferative diabetic retinopathy (NPDR). The control group included diabetic men without retinopathy or with mild NPDR. All men had type 2 diabetes mellitus. All men filled in the Sexual Health Inventory for Males questionnaire (SHIM) to detect significant ED. Significant ED was defined as SHIM questionnaire score <17. RESULTS: The cohort included 102 diabetic men: 64 (62.7%) men in the study group and 38 (37.3%) men in the control group. Mean age for the entire cohort was 64.0 ± 8.2 years, and mean diabetes duration was 14.5 ± 8.9 years. Mean SHIM score for the entire cohort was 11.4 ± 6.5, and 75 (73.5%) men had significant ED. Men in the study group had higher prevalence of significant ED compared with men in the control group (87.5% vs 50.0%; P <.0001), as well as lower mean SHIM questionnaire scores (9.5 ± 5.4 vs 14.7 ± 6.9; P <.0001). Binary logistic regression analysis and linear regression analysis showed that significant ED and SHIM scores, respectively, were associated with DR severity (P = .001 for both), independent of age, diabetes duration, ischemic heart disease, cerebrovascular disease, hypertension, hyperlipidemia, and smoking. CONCLUSIONS: Significant ED is associated with DR severity independent of age, diabetes duration, macrovascular comorbidities, and cardiovascular risk factors.

Posttraumatic symptoms, marital intimacy, dyadic adjustment, and sexual satisfaction among ex-prisoners of war.

INTRODUCTION: The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on marital intimacy and sexual satisfaction has been examined in several studies. Nevertheless, the toll of war captivity on marital intimacy in relation to dyadic adjustment and sexual satisfaction remains unknown. In particular, the mediating role of marital intimacy in the relationship between PTSD symptoms and dyadic adjustment and between PTSD symptoms and sexual satisfaction has not yet been systematically explored thus far. Aims. This study aimed to examine the interrelationships of PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy among ex-prisoners of war (ex-POWs). METHODS: A sample of Israeli veterans ex-POWs (ex-POWs: N = 105) from the 1973 Yom Kippur War and a matched comparison group of veterans who participated in the same war but were not held captive (control: N = 94) were compared in the study variables. MAIN OUTCOME MEASURES: The PTSD inventory, dyadic adjustment scale, index of sexual satisfaction, and capacity for intimacy questionnaire. Results. Findings revealed that ex-POWs reported higher levels of PTSD symptoms and lower levels of dyadic adjustment and sexual satisfaction than comparable controls. There were also differences between the groups in the pattern of relations between PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy. Finally, for ex-POWs, marital intimacy partially mediated the relationships between PTSD symptoms and dyadic adjustment and sexual satisfaction outcome measures. CONCLUSIONS: PTSD symptoms are implicated in marital problems of ex-POWs. A significant relationship was found between the traumatized ex-POW's capacity for intimacy and both their sexual satisfaction and dyadic adjustment.

Depressive symptoms and erectile dysfunction in men with coronary artery disease.

OBJECTIVES: To study the association between erectile dysfunction (ED) and depressive symptoms in men with coronary artery disease (CAD). A cross-sectional analysis of data obtained during a prospective study was carried out. METHODS: A cohort of men undergoing coronary angiography filled-out the sexual health inventory for males (SHIM) and the mental health inventory 5 (MHI5) questionnaires for detection and severity assessment of both ED and depressive symptoms. CAD documented by coronary angiography was defined as > or = 50% stenosis in at least one of the major epicardial coronary arteries. RESULTS: Overall, 242 men, with a mean age of 63.7 +/- 12.0 years, were included in the study. ED and depressive symptoms were found in 76% and 47.9% of men, respectively, whereas 94 (38.8%) men suffered from both. The prevalence of diabetes mellitus and the mean age were significantly higher, whereas the mean MHI5 scores were significantly lower, in the group with ED than that without. ED was associated independently with age (P <.0001) and depressive symptoms (P = .007), but not with the number of obstructed coronary arteries, history of diabetes mellitus, hypertension, or smoking. After controlling for age and diabetes mellitus, the scores of SHIM were positively correlated with MHI5 scores (r = .14; P = .03). CONCLUSIONS: These results validate the high prevalence of both ED and depressive symptoms in men with CAD. ED in men with CAD might be associated with age and depressive symptoms.

Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum.

INTRODUCTION: Both chronic periodontal disease (CPD) and erectile dysfunction (ED) are associated with cardiovascular disease and its risk factors, including smoking and diabetes mellitus. However, the association between ED and CPD has never been studied. AIM: To study the association between ED and CPD. MAIN OUTCOME MEASURES. Prevalence of ED, prevalence of CPD, ED severity. METHODS: The study population consisted of 305 men who filled the Sexual Health Inventory for Men (SHIM) questionnaire in order to detect ED and assess its severity, and underwent a pair of standardized posterior dental bitewing radiographs in order to detect CPD. SHIM questionnaire scores 21 or less represented ED. Alveolar bone loss of >or=6 mm represented CPD. RESULTS: The mean age of included men was 39.5 +/- 6.7 years. Overall, 70 (22.9%) men had ED and 13 (4.3%) had CPD. CPD was significantly more prevalent among men with mild ED (P = 0.004) and moderate to severe ED (P = 0.007) in comparison to men without ED. CONCLUSIONS: ED might be associated with CPD. These preliminary findings are consistent with theories that associate these conditions with systemic inflammation, endothelial dysfunction, and atherosclerosis.

[Sexual dysfunction and coronary artery disease in adult women].

BACKGROUND: The prevalence of sexual dysfunction in adult women with coronary artery disease (CAD) has seldom been studied, and the association between sexual dysfunction severity and with CAD severity has never been studied. AIM: To study the prevalence of sexual dysfunction and its severity by CAD severity in adult women. METHODS: Adult women undergoing coronary angiography at the Tel Aviv Medical Center completed a sexual questionnaire titled Female Sexual Function Index (FSFI). Scores of 23 or lower in this questionnaire were consistent with sexual dysfunction. The cohort was divided into three groups: 1. Women without CAD. 2. Women with one vessel disease. 3. Women with two or more vessel disease. CAD was defined as one or more coronary artery stenosis of 50% or more, and/or history of myocardial infarction. The prevalence of sexual dysfunction and cardiovascular risk factors was compared between these groups. RESULTS: The study included 104 adult women (age range: 42-92 years; mean age: 11.2 +/- 68.7 years). Sixty-five (62.5%) ,women had one-vessel disease (n = 27) or more (n = 38). Overall, 39 (37.5%) women had no coronary stenosis and/or history of myocardial infarction. Most women (n = 68; 65.4%) had no sexual activity. Among the 36 sexually active women, 11 (30.6%) women had a normal sexual function. Normal sexual function was two-times more prevalent in women without CAD relative to women with CAD (7.7% vs. 15.4%; p = 0.049). These findings were not statistically significant following adjustment for age. The odds for normal sexual function were low as more coronaries were stenotic, but these findings were not statistically significant. CONCLUSIONS: A trend towards association between CAD severity and sexual dysfunction severity in adult women has been demonstrated for the first time. Sexual dysfunction and lack of sexual activity are very common among adult women with CAD. There is a negative association between the number of coronary arteries involved and normal sexual function, but this trend should be studied in a larger cohort.

[Ethical issues concerning surrogate assisted sex therapy].

Sex therapy, by definition, is a couple therapy as well as behavioral therapy by origin. As such, practicing a series of exercises is an essential part of the therapy. Masters and Johnson, in their book "Human Sexual Inadequacy", wrote that "one cannot learn about sexuality in any practical way without actually experiencing intimate behavior with a partner". This ethical approach directed them to develop the therapeutic method of working with surrogate partners, as they thought all people are entitled to receive therapy, if they so wish, including people without partners. Surrogate is a form of mentoring; this is a one-on-one relationship that allows practicing classic behavioral methods such as gradual progress, breaking the task into small goals, onsite feedback, rehearsals, role-play, modifying the environment, etc. The content and the skills that are practiced are related to sexual dysfunction as well as social, couple and intimate skills. The lack of those critical skills prevents the clients from fulfilling their wish to develop social or intimate relationships in which they will be able to accomplish their sexuality. Ethical procedures should be strictly kept in order to protect the clients and the surrogates, in a three-way therapeutic team, working together to reach the goals of the therapy. During the therapy process a weekly meeting is held between the therapist and the client, between the therapist and the surrogate and, only then, between the surrogate and the client. At the end of the therapy process the relationship between the client and the surrogate is terminated, completely. In this article, the authors illuminate the complexity of this therapy process, as well as dealing with some of the ethical issues that are raised. The article also identifies types of patients who can benefit from surrogate therapy.

[Incorporating a sexual questionnaire in screening examinations].

Erectile dysfunction (ED) is the inability to attain and/ or maintain an erection sufficient for satisfactory sexual performance. The prevalence of ED among elderly men is 52%, and it is associated with preventable and treatable cardiovascular conditions, such as diabetes mellitus, hyperlipidemia, hypertension and smoking. Treating these conditions may prevent cardiovascular diseases and ED. Nevertheless, large-scale studies regarding the prevalence of ED among young men has never been conducted, although prevention should be performed in younger ages. A unique screening examination, including a sexual questionnaire has been conducted in Israel since 2001. Men who are suspected of ED, according to this questionnaire, are referred to a sexual clinic for consultation and treatment. In this review, we present several studies based on this database. Our main findings: ED is prevalent in young men and is associated with diabetes mellitus, hypertriglyceridemia, sleeping disorders and periodontal diseases. These findings stress the importance of incorporating a sexual questionnaire in screening examinations.

Screening for erectile dysfunction and associated cardiovascular risk factors in Israeli men.

BACKGROUND: Erectile dysfunction is associated with treatable cardiovascular risk factors; therefore, screening for erectile dysfunction and its cardiovascular risk factors is of clinical importance. OBJECTIVES: To detect erectile dysfunction cases and assess their severity among military personnel. METHODS: The Sexual Health Inventory for Men questionnaire was handed out to military personnel aged 25-55 years during routine examinations. RESULTS: A total of 19,131 men with a mean age of 34.0 +/- 7.1 years participated in routine physical examinations during the years 2001-2005. More than half of them (n=9956, 52%) completed the SHIM questionnaire. No significant differences were found between those who completed the SHIM questionnaire and those who did not, in terms of mean age, mean body mass index, and prevalence of cardiovascular risk factors. One out of every four men (25.2%) suffered from erectile dysfunction, which was mild in 18.9%, mild to moderate in 4.4%, moderate in 1.1%, and severe in 0.7%. Even though treatable cardiovascular risk factors were quite prevalent in the study group (45.2% of them suffered from dyslipidemia, 25.6% smoked, 4.2% suffered from essential hypertension, and 1.6% from diabetes mellitus), erectile dysfunction was significantly associated with age and diabetes mellitus alone (P<0.0001). CONCLUSIONS: There is a high prevalence of erectile dysfunction and associated treatable cardiovascular risk factors in Israeli men aged 25-55, especially those with diabetes.

Pure hypertriglyceridemia might be associated with erectile dysfunction: a pilot study.

INTRODUCTION: Unlike the association between erectile dysfunction (ED) and high levels of low-density lipoprotein (LDL) cholesterol, the association between ED and hypertriglyceridemia is still debatable. Aim. To study prevalence and severity of ED in young men with very high levels of triglycerides. MAIN OUTCOME MEASURES: Prevalence of ED, ED severity, total cholesterol levels, LDL cholesterol levels, and triglycerides levels. METHODS: Men who were enrolled went through routine health checks including full lipid profiling and completion of the Sexual Health Inventory for Men (SHIM) questionnaire. Very high levels of triglycerides were defined as >or=500 mg/dL. Very high levels of LDL cholesterol were defined as >or=190 mg/dL. Men with diabetes, ischemic heart disease, high-density lipoprotein (HDL) cholesterol >or=60 mg/dL, and mixed hyperlipidemias were excluded. RESULTS: Included were 88 men, aged 35.9 +/- 7.1 years (range: 25-51 years): 21 men with "pure" severe hypertriglyceridemia (triglyceride levels >or=500 mg/dL and non-HDL cholesterol or=190 mg/dL and triglycerides

The minority of young adult men with sexual disorders seek medical treatment.

INTRODUCTION: The Israel Defense Force (IDF) conducts screening examinations of military personnel aimed at early detection of morbidities, including erectile dysfunction (ED) and other sexual disorders (SDs). Men with SDs are referred to the IDF's sex clinic for consultation. AIM: We present the long-term compliance of military men with SDs to the screening program. MAIN OUTCOME MEASURES: We investigated how many men screened for ED and other SDs turned to the IDF's sex clinic for consultation. METHODS: Subjects 25-50 years old performed screening examinations at the Staff Periodic Examination Center. The Sexual Health Inventory for Men (SHIM) questionnaire was used to categorize ED. The IDF's sex clinic records were investigated. RESULTS: During 2001-2003, 5,836 men completed the SHIM questionnaire. Overall, 1,570 (26.9%) men had low SHIM scores suggesting ED and other SDs. Although only 76 (4.8%) of these men turned to the IDF's sex clinic over these years, more men conferred with the IDF's sexologist every year, and more men were referred by their primary-care physicians to the IDF's sex clinic regardless of their SHIM score. CONCLUSIONS: Screening for SDs in young adult men is not enough; encouraging young adult men screened for SDs to turn to a sex clinic for evaluation is the true challenge. Nevertheless, adding a sexual questionnaire to screening examinations may raise the awareness of sexual issues in both the patients and their primary-care physicians.

The prevalence of erectile dysfunction among hypertensive and prehypertensive men aged 25-40 years.

INTRODUCTION: Erectile dysfunction (ED) and hypertension (HTN) are common and associated among men aged 40-70 years. Data on the prevalence of ED among younger hypertensive and prehypertensive men are limited. AIM: To study the prevalence of ED in a large-scale population of hypertensive and prehypertensive men aged 25-40 years. MAIN OUTCOME MEASURES: ED severity, systolic blood pressures (SBPs), diastolic blood pressures (DBPs), and mean arterial blood pressures (MAPs). METHODS: Israel Defense Force personnel, aged 25 years and older, go through routine health checks at the Staff Periodic Health Examination Center (SPEC) every 3-5 years, including measuring blood pressure and completing the Sexual Health Inventory for Men (SHIM) questionnaire in order to detect HTN and ED, respectively, and assess its severity. Pre-HTN was defined as SBP 120-139 mm Hg or DBP 80-89 mm Hg. HTN was defined as SBP >/or140 mm Hg and/or DBP >or=90 mm Hg. RESULTS: During 2001-2004, an overall of 11,252 men, aged 25-40 years, reported to the SPEC, and 5,860 (52.1%) men filled out the SHIM questionnaire. Among responders to the SHIM questionnaire, 1,278 (21.8%) men had low scores (

Erectile dysfunction severity might be associated with poor cardiovascular prognosis in diabetic men.

INTRODUCTION: Although erectile dysfunction (ED) might be associated with coronary heart disease (CHD), there is no evidence it predicts poor cardiovascular prognosis. On the other hand, an abnormal heart rate profile during exercise stress testing predicts poor cardiovascular prognosis in high-risk patients, such as diabetic men, even in the absence of CHD. AIM: In order to study if ED predicts poor cardiovascular prognosis in high-risk patients, we examined the association between ED and heart rate profile during exercise stress testing in diabetic men with no CHD. MAIN OUTCOME MEASURES: Erectile dysfunction severity, exercise capacity during exercise stress testing, and heart rate decrease after exercise stress testing. METHODS: A retrospective study. The medical charts of diabetic men with vascular ED from a single-sex clinic were reviewed, as well as the medical charts of body mass index (BMI)- and age-matched diabetic men without ED going through routine check-ups. All men underwent routine treadmill stress testing according to the Bruce protocol in order to characterize heart rate profile during exercise. The Sexual Health Inventory for Men (SHIM) questionnaire was used to characterize ED. RESULTS: Included were 18 diabetic men with ED (SHIM questionnaire scores 5-21) and 18 diabetic men without ED (SHIM questionnaire scores 22-25), 40 years of age or older. None of the men had signs of coronary insufficiency during exercise treadmill stress testing. Although the two groups did not statistically differ with respect to the mean age, the mean BMI, the prevalence of cardiovascular risk factors, and the mean exercise treadmill stress testing findings, the SHIM questionnaire scores were significantly associated with low metabolic equivalents (r = 0.51, P = 0.03) and delayed heart rate recovery during the first 2 minutes after exercise (r = 0.55, P = 0.018) only among diabetic men with ED. CONCLUSIONS: Erectile dysfunction severity might be associated with poor cardiovascular prognosis in adult diabetic men with no CHD.

Differential effect of supraspinal modulation on the nociceptive withdrawal reflex and pain sensation.

OBJECTIVE: To study whether the nociceptive withdrawal reflex (WR) and pain sensation are differentially affected by supraspinal modulation and to determine the nature of this modulation. METHODS: The WR and pain sensation elicited by electrical stimulation were measured in complete spinal cord injury (SCI) subjects and in intact controls under two different experimental conditions; "facilitation" and "neutral" control. RESULTS: Pain sensation was the same under both conditions, whereas the characteristics of the WR were highly dependent on them. In intact body regions the WR threshold was similar to pain threshold under facilitation but was near pain tolerance in neutral conditions. Furthermore, WR was elicited in 100% of trials under facilitation but only in 57% of trials in neutral conditions. Thresholds of WR in paralyzed regions were significantly higher than in intact regions (p<0.001). The former showed a clear stimulus-response relationship as did pain sensation whereas the WR in intact regions did not. CONCLUSIONS: The WR and pain sensation are differentially affected by supraspinal modulation. The WR is subject to both excitatory and inhibitory influences, depending on the instructions subjects receive. SIGNIFICANCE: The experimental setup and subjects' mental state should be considered when interpreting changes in the WR. Extreme caution should be employed when utilizing reflexive indices as a measure of pain. Verbal report seems a more suitable tool to evaluate pain since it is relatively stable with repeated measurements and in accordance with stimulation intensity.

The prevalence of reversible cardiovascular risk factors in Israelis aged 25-55 years.

BACKGROUND: Coronary heart disease is a major cause of morbidity and mortality worldwide. Early detection of cardiovascular risk factors and intervention may reduce consequential morbidity and mortality. OBJECTIVES: To assess the prevalence of reversible and treatable cardiovascular risk factors among 26,477 healthy Israeli adults: 23,339 men and 3138 women aged 25-55 years. METHODS: We collected data during routine examinations performed as part of a screening program for Israel Defense Force personnel. RESULTS: The three most prevalent cardiovascular risk factors were a sedentary lifestyle (64%), dyslipidemia (55.1%) and smoking (26.8%). Overall, 52.9% of the men and 48.4% of the women had two or more cardiovascular risk factors. Moreover, 52.4% of young adult men and 43.3% of young adult women, age 25-34 years, had two or more reversible cardiovascular risk factors. CONCLUSIONS: In this expectedly healthy population there was a high prevalence of reversible and treatable cardiovascular risk factors in both genders and in young ages. These observations stress the need for routine health examinations and lifestyle modification programs even in the young healthy Israeli population.

Coronary artery disease and risk factors in people with posttraumatic vision loss.

OBJECTIVE: To examine the prevalence of coronary artery disease (CAD) and its risk factors in people with posttraumatic vision loss (PTVL). DESIGN: Cross-sectional, controlled study. SETTING: The general community. PARTICIPANTS: Study groups included 82 subjects with PTVL, 49 siblings, 58 blind subjects with retinitis pigmentosa (RP), and the general population in Israel. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sociodemographic and biomedical data collected by using a structured questionnaire and medical records. RESULTS: The prevalence of CAD among subjects with PTVL (24%) was 2 to 3 times higher than the control groups ( P <.001). However, the prevalence of the CAD risk factors in these subjects was similar to or lower than those in the control groups. For example, significantly fewer subjects with PTVL were physically inactive (16%) than patients with RP (55%, P <.01). The only variable that was significantly associated with CAD prevalence was the cause of blindness-that is, trauma versus disease; the odds of having CAD after traumatic vision loss was 3.75 times higher than after RP. CONCLUSIONS: People with PTVL exhibit elevated rates of risk for CAD similar to those of other groups with physical disability. The traumatic injury that caused vision loss might be an important factor underlying that risk.