Early and late implications of COVID-19 on male reproductive health: 3 years of data.

INTRODUCTION: COVID-19 (coronavirus disease 2019), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), has significantly affected global health. Research has shown that the virus can be found at high concentrations in male gonadal tissue. Yet, the virus's long-term implications on male reproductive health remains relatively unclear. OBJECTIVE: A comprehensive narrative review of published literature regarding COVID-19's short- and long-term implications on male reproductive health. METHODS: A literature search of the PubMed and EMBASE databases was performed for articles ranging from November 2019 to August 2022. Studies that focused on the impact of COVID-19 on male reproductive health were selected for review. Studies were included if they were written in English and reported semen analyses, pathologic gonadal tissue analyses, serum androgen assays, or a combination of these in patients with COVID-19. Moreover, literature was included on COVID-19 vaccinations' impacts on male reproductive health. Case reports and other narrative reviews were excluded from this review. RESULTS: SARS-CoV-2 has been detected in cadaveric testicular tissue during the initial stages of infection in fatal cases of the disease, demonstrating marked inflammatory changes and decreased spermatogenesis in patients with COVID-19. Several studies have revealed a negative impact on androgens during acute illness and in the ensuing months, but data on the recovery of androgen levels are confounding and limited in scope. COVID-19 does have significant negative impacts on bulk semen parameters, as confirmed in studies comparing pre- and post-COVID-19 semen samples. Vaccination is a valuable tool for protecting patients from the negative impacts of the virus and has been shown to have no negative impact on male reproductive potential. CONCLUSION: Given the virus's impacts on testicular tissue, androgens, and spermatogenesis, COVID-19 can negatively affect male reproductive health for an extended period. Therefore, vaccinations should continue to be recommended to all eligible patients.

Surgeon variations in the perioperative evaluation of penile prosthesis patients.

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 penile implant surgeons (87.0%) assess patients' grip strength before surgery and 96.5% discuss patients' expectations before surgery. Less than half (42.6%) ask patients about their sexual orientation. Only 49.6% obtain a psychiatric history but 68.7% evaluate the impact of sexual function on patient self-esteem. A minority (35.5%) ask about the intended use of the implant and 63.5% commonly ask about partner sexual function. Few (26.1%) implanters regularly ask about the type of sexual activity patients engage in (i.e., oral, vaginal, anal). Postoperatively, 95.6% of implanters ask about patient satisfaction but only 67.2% routinely assess partner satisfaction. Only 18.6% of implant surgeons use a questionnaire to evaluate postoperative satisfaction. Penile prosthetic urologists can improve the consistency of assessment of patients' sexual orientation, intended use of the implant, type of sexual activity, and partner sexual function and satisfaction.

Male Sexual Health Related Complications Among Combat Veterans.

INTRODUCTION: With improved armor and combat trauma care, more male service members in the 21st century are surviving devastating injuries to their genitourinary (GU) system. The impact of these injuries can have long lasting effect on their sexual function and fertility status. OBJECTIVES: To review the current literature on sexual health-related complications and fertility implications among male service members sustaining combat related injuries. METHODS: We performed a literature search that included male sexual health complications and combat injuries using PubMed and Google Scholar. We reviewed the impact of traumatic injuries to the pelvis and perineum on sexual function and fertility, and we also discuss sexual dysfunction from posttraumatic stress disorder (PTSD) and traumatic brain injuries (TBI). RESULTS: Injuries sustained during combat are usually polytraumatic, especially in recent conflicts with improvised explosive devices. The majority of GU combat injuries involve the scrotum, testes, and penis resulting in lasting structural dysfunction. PTSD is associated with higher levels of erectile dysfunction, hypoactive sexual desire, and premature ejaculation. Overall, veterans diagnosed with PTSD had a higher risk of developing sexual dysfunction. Veterans with TBI experience sexual health complications, such as decreased libido, difficulties with arousal maintenance, and the ability to achieve orgasm. Combat related injuries can have significant fertility implications on service members as they typically serve in their peak fertility years. CONCLUSIONS: Traumatic GU injuries, PTSD, TBI, and associated endocrine dysfunction can all contribute to sexual dysfunction among combat veterans. Given the complex nature of sexual dysfunction in this population, these patients are best managed by a multidisciplinary team. Castillo O, Chen IK, Amini E, et al. Male Sexual Health Related Complications Among Combat Veterans. Sex Med Rev 2022;10:691-697.

Male Sexual Health Related Complications Among Combat Veterans.

INTRODUCTION: With improved armor and combat trauma care, more male service members in the 21st century are surviving devastating injuries to their genitourinary (GU) system. The impact of these injuries can have long lasting effect on their sexual function and fertility status. OBJECTIVES: To review the current literature on sexual health-related complications and fertility implications among male service members sustaining combat related injuries. METHODS: We performed a literature search that included male sexual health complications and combat injuries using PubMed and Google Scholar. We reviewed the impact of traumatic injuries to the pelvis and perineum on sexual function and fertility, and we also discuss sexual dysfunction from posttraumatic stress disorder (PTSD) and traumatic brain injuries (TBI). RESULTS: Injuries sustained during combat are usually polytraumatic, especially in recent conflicts with improvised explosive devices. The majority of GU combat injuries involve the scrotum, testes, and penis resulting in lasting structural dysfunction. PTSD is associated with higher levels of erectile dysfunction, hypoactive sexual desire, and premature ejaculation. Overall, veterans diagnosed with PTSD had a higher risk of developing sexual dysfunction. Veterans with TBI experience sexual health complications, such as decreased libido, difficulties with arousal maintenance, and the ability to achieve orgasm. Combat related injuries can have significant fertility implications on service members as they typically serve in their peak fertility years. CONCLUSIONS: Traumatic GU injuries, PTSD, TBI, and associated endocrine dysfunction can all contribute to sexual dysfunction among combat veterans. Given the complex nature of sexual dysfunction in this population, these patients are best managed by a multidisciplinary team.

Attitudes, Beliefs, and Willingness Toward the Use of mHealth Tools for Medication Adherence in the Florida mHealth Adherence Project for People Living With HIV (FL-mAPP): Pilot Questionnaire Study.

BACKGROUND: Antiretroviral (ART) adherence among people living with HIV (PLWH) continues to be a challenge despite advances in HIV prevention and treatment. Mobile health (mHealth) interventions are increasingly deployed as tools for ART adherence. However, little is known about the uptake and attitudes toward commercially available, biprogrammatic mobile apps (ie, designed for both smartphone and short message service [SMS] messaging) among demographically diverse PLWH. OBJECTIVES: The Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative pilot study that aimed to determine the acceptability of a commercially available, biprogrammatic mHealth intervention platform to ensure medication adherence and gauge the current attitudes of PLWH toward current and future mHealth apps. METHODS: A predeveloped, commercially available, biprogrammatic mHealth platform (Care4Today Mobile Health Manager, Johnson & Johnson, New Brunswick, NJ) was deployed, with self-reported ART adherence recorded in the app and paper survey at both short term (30-day) or long-term (90-day) follow-ups. Consented participants completed baseline surveys on sociodemographics and attitudes, beliefs, and willingness toward the use of mHealth interventions for HIV care using a 5-point Likert scale. Chi-square tests and multivariate logistic regression analyses identified correlations with successful uptake of the mHealth platform. RESULTS: Among 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of which 54% (n=47) successfully connected to the platform. Of the 87 agreeing to use the mHealth platform, we found an approximate 2:1 ratio of persons agreeing to try the smartphone app (n=59) versus the SMS text messages (n=28). Factors correlating with mHealth uptake were above high school level education (adjusted odds ratio 2.65; P=.05), confidence that a clinical staff member would assist with mHealth app use (adjusted odds ratio 2.92, P=.048), belief that PLWH would use such an mHealth app (adjusted odds ratio 2.89; P=.02), and ownership of a smartphone in contrast to a "flip-phone" model (adjusted odds ratio 2.80; P=.05). Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via an app (80.4% users versus 64.7% nonusers), although not significantly different among the user groups (P=.06). In addition, 34.8% (n=16) of mHealth users reported a theoretical "daily" interest and 68.2% (n=58) of non-mHealth users reported no interest in using an mHealth app for potentially tracking alcohol or drug intake (P=.002). CONCLUSIONS: This commercially available, biprogrammatic mHealth platform showed feasibility and efficacy for enhanced ART and medication adherence within public health clinics and successfully included older age groups. Successful use of the platform among demographically diverse PLWH is important for HIV implementation science and promising for uptake on a larger scale.