Faculty Bibliography

INTRODUCTION/BACKGROUND:There is a need for state-of-the-art information in the area of sexually transmitted infections (STIs) in relation to sexual function. There are an estimated 60 million people living with and 340 million with treatable STIs. Surveys show sexual problems to be as high as 35% for men and 55% for women; however, there is little research directly assessing relationships between infection and sexual function. AIM/OBJECTIVE:To show that STIs are associated with (and may cause) sexual dysfunction. Conversely, sexual dysfunction can increase patients' risk of STI acquisition. In men, erectile dysfunction (ED) associated with condom use may lead to unsafe sexual practices and, hence, STI acquisition. The role of various therapies including phosphodiesterase type 5 inhibitors in the treatment of ED in positive men taking social drugs will be explored. METHODS:To provide state-of-the-art knowledge concerning sexual function and STIs, representing the opinions of five experts from four countries developed in a consensus process and encompassing a detailed literature review over a 2-year period. MAIN OUTCOME MEASURE/METHODS:Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS:This article highlights major factors causing the spread of STIs and suggests management interventions to prevent further spread of HIV/STIs, focusing on the juxtaposition between STIs and sexual functioning. Women's unique vulnerabilities to HIV/STIs (biological and physiological issues, gender-based violence, gender inequity) and their impact on women's sexual function are reviewed. Similarly, men's unique vulnerabilities to HIV/STIs including condom use, disclosure, voluntary counseling and testing, multiple concurrent sexual partners, and recreational drug use--particularly in homosexual men--are explored, as is the association of prostatitis and sexual function. Lastly, the article reviews the relationship between circumcision and sexual dysfunction. CONCLUSIONS:A multidimensional approach to achieve optimal treatment outcomes should be embraced.

PURPOSE OF REVIEW/OBJECTIVE:Therapies for the treatment of severe male factor infertility have advanced well beyond our knowledge of the conditions we are treating. An intact Y chromosome is necessary for optimal spermatogenesis. It is imperative for the clinician to understand the molecular basis and clinical implications of anomalies that might afflict the Y chromosome. RECENT FINDINGS/RESULTS:The molecular geography of the Y chromosome has recently been described, allowing correlations to be made to various clinical states of severe spermatogenic compromise. Microdeletions of parts of the Y chromosome are found in a small number of men with spermatogenic failure involving, predominantly, three regions termed AZFa, AZFb, and AZFc. SUMMARY/CONCLUSIONS:It is necessary that a Y chromosomal microdeletion assay be carried out prior to any intervention using ejaculated sperm or prior to any surgical procedure to try to find spermatozoa in an azoospermic man.