Abstract Introduction Testosterone physiology in women remains poorly understood despite more than 80 years of clinical knowledge. Longstanding gender biases and the misconception that testosterone is primarily a male hormone have contributed to its underrecognition in women. Testosterone is, however, the most abundant biologically active sex steroid in women and plays important roles across multiple physiological systems throughout the lifespan. Methods A comprehensive literature search was conducted in PubMed and Scopus for studies published from January 1974 to December 2025. Three authors independently screened articles using predefined inclusion and exclusion criteria. This narrative review included experimental, observational, and clinical studies evaluating endogenous testosterone production, regulation, and physiological functions in women, with emphasis on musculoskeletal, metabolic, cardiovascular, neurological, reproductive, genitourinary, and sexual health. Results Endogenous testosterone in women arises from ovarian, adrenal, neural, and peripheral conversion pathways and persists after menopause. Physiologic testosterone levels contribute to bone maintenance, muscle mass, metabolic homeostasis, endothelial function, cognition, mood regulation, sexual function, and reproductive physiology. Testosterone concentrations vary with age, reproductive status, hormonal milieu, and other physiologic factors, complicating the interpretation of circulating levels and their relationship with clinical outcomes. Emerging evidence also suggests potential roles in neuroprotection, immune modulation, pelvic floor integrity, and fertility, although the strength of evidence varies across physiologic domains. Discussion Testosterone is an important yet underrecognized component of female physiology, with effects extending beyond sexual function. A broader understanding of endogenous androgen physiology provides important context for female sexual and reproductive health and highlights the interconnected nature of androgen signaling across physiologic systems. Further research is needed to better characterize testosterone physiology in women, standardize its assessment, and clarify the clinical significance of alterations in endogenous androgen levels.
Abstract Introduction Peptide-based therapies are increasingly used in urology and sexual medicine, although adoption is often influenced by off-label prescribing, direct-to-consumer promotion, and limited long-term safety data. We review mechanisms, clinical evidence, dosing, safety, and regulatory status of these agents. Methods A structured search of PubMed, Scopus, and Google Scholar identified studies of peptide-based therapies in sexual medicine. Search terms included Bremelanotide, Melanotan II, Kisspeptin, Oxytocin, PnPP-19, Gonadorelin and growth hormone secretagogues, including GHRP-2, GHRP-6, Ibutamoren, Ipamorelin, Tesamorelin, Sermorelin, and CJC-1295. Of 725 records, 76 studies met inclusion criteria. Findings were synthesized narratively given heterogeneity across studies. Results Peptides reviewed act through diverse mechanisms, including central modulation of desire and arousal, stimulation of the hypothalamic–pituitary–gonadal and growth hormone axes, and nitric oxide–mediated effects on erectile physiology. Bremelanotide and Tesamorelin are the most clinically established agents, with defined dosing and regulatory approval for selected indications. Kisspeptin shows early promise but remains investigational. Growth hormone secretagogues reliably increase growth hormone and insulin-like growth factor 1 concentrations; however, evidence for improved sexual function, physical performance, or quality of life remains limited. Melanotan II, Ibutamoren, CJC-1295, and related agents remain accessible through unregulated markets, raising concerns about product quality, dosing variability, and incompletely characterized adverse effects. Oxytocin has biologic plausibility but limited efficacy data, whereas PnPP-19 remains preclinical. Gonadorelin was Food and Drug Administration approved but is no longer manufactured. Across peptide classes, safety data are limited by short follow-up, small samples, and incomplete assessment of cardiovascular, metabolic, and oncologic outcomes. Discussion Peptide-based therapies in urology and sexual medicine show selective therapeutic potential, but most remain insufficiently validated for clinical use. Clinicians should distinguish approved therapies from investigational and nonregulated compounds and counsel patients regarding uncertain benefit, potential harm, and risks of unsupervised use. Randomized trials with standardized dosing and long-term safety assessment are needed before broader adoption.
Abstract Introduction Male circumcision in minors remains widely practiced in many regions of the world, although its prevalence varies considerably across cultural, religious, and geographic contexts. Beyond its medical dimensions, circumcision is closely linked to religion, culture, masculinity, family identity, and public health agendas. Ethical debates commonly involve tensions between parental authority, bodily autonomy, assent, and children’s rights, particularly because minors are often minimally involved in decision-making processes. Methods A scoping review was conducted to examine ethical, sociocultural, legal, and decision-making dimensions related to circumcision in minors. Literature searches were performed across MEDLINE, Web of Science, Scopus, ProQuest, SpringerLink, CINAHL/EBSCO, SAGE, and Taylor & Francis. Thirty-one eligible studies were included and analyzed using narrative and thematic synthesis approaches. Results Ethical dilemmas surrounding circumcision in minors were found to be highly context-dependent and not ethically interchangeable across all forms of circumcision. Five major contextual typologies were identified: religious circumcision, traditional or rite-of-passage circumcision, therapeutic circumcision, public-health-driven voluntary medical male circumcision (VMMC), and elective or family-preference circumcision. Six major thematic frameworks emerged, including parental authority, constrained adolescent agency, public health versus bodily autonomy, masculinity formation, moral conflict and regret, and healthcare and legal systems as ethical gatekeepers. Circumcision decision-making was shaped by multilayered interactions involving family structures, sociocultural norms, healthcare systems, and public health priorities. Conclusion Ethical interpretations of circumcision in minors cannot be reduced to a simple binary distinction between ethical and unethical practices. Greater recognition of contextual differences and developmentally appropriate assent may support more ethically responsive and culturally sensitive circumcision practices. Policies and clinical guidelines should avoid applying uniform ethical approaches across all circumcision contexts. More context-sensitive frameworks incorporating assent procedures, adolescent involvement, culturally sensitive counseling, and safeguards against coercion may strengthen ethical governance in circumcision practices involving minors. Trial Registration This study was registered in the PROSPERO database (CRD420251074798). URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251074798. Date of registration: September 26, 2025
Abstract Introduction Sexual health is a core component of long-term care for patients with prostate cancer, yet treatment-related sexual dysfunction remains common and existing interventions vary considerably in their definition and delivery. This scoping review aimed to map intervention content, delivery modalities, provider involvement, tailoring approaches, and outcome assessment of sexual health care interventions for patients with prostate cancer, and to identify priorities for future development. Methods A scoping review was conducted using Joanna Briggs Institute methodology. PubMed, Web of Science, Scopus, Embase, APA PsycINFO, the Cochrane Library, ProQuest, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) were searched from inception to August 30, 2025. Studies were screened against prespecified criteria, and relevant data were charted and synthesized descriptively. Results Thirty-one studies published between 2003 and 2025 were included. Most were randomized controlled trials, and the largest number came from the United States and China. Intervention content mainly covered education, psychological support, sexual rehabilitation, symptom management, supportive safeguards, and relationship support. Face-to-face delivery, particularly in individual or dyadic formats, was predominant, although remote and digital approaches were also reported. Intervention delivery commonly involved mental health or psychosexual practitioners, nurses, and physicians. Tailoring was commonly based on patient problems, goals, preferences, psychological status, and clinical or behavioral characteristics. Outcome assessment focused mainly on sexual function and multidimensional prostate cancer-specific measures. Conclusion Sexual health care interventions for patients with prostate cancer have developed into multidimensional approaches, but relational support, adaptive procedures, and implementation pathways remain variably specified. Future progress should focus on earlier integration of sexual health care into prostate cancer care and on implementation-oriented evidence to support sustainable service delivery.
Abstract Introduction Disorders of ejaculation, including premature ejaculation (PE) and delayed ejaculation (DE), are common conditions with a substantial impact on men’s quality of life and their relationships. This review synthesizes the latest findings on their etiology, epidemiology, evaluation, and management. This study aims to present evidence-based recommendations for the definition, classification, and treatment of PE and DE, developed under the guidance of the Fifth International Consultation on Sexual Medicine. Methods A multidisciplinary panel conducted a narrative review of global literature and utilized a modified Delphi method to develop consensus recommendations. Evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results Premature ejaculation is the most frequently reported male sexual complaint, classified into lifelong, acquired, variable, and subjective subtypes. Evidence-based management includes medical therapies such as selective serotonin reuptake inhibitors, topical anesthetics, and psychotherapeutic approaches. Although less common, DE remains under-researched, with limited pharmacological and behavioral treatment options. Definitions for both disorders have evolved to incorporate timing, distress, and control criteria. Conclusion Understanding the pathophysiology and adopting individualized approaches to managing PE and DE can improve patient outcomes. Further research is needed to enhance the evidence-based therapies, particularly for DE.
