What’s new? News from the Scientific Committee of the European Society for Sexual Medicine

G. Corona
ESSM Scientific Chair

Y. Reisman
ESSM President

The next ESSM meeting is approaching and several news will be presented during the congress. After several years of fruitful collaboration, in 2019 our Society has changed its congress organization, moving from CPO HANSER service to MCI Berlin. This has determined a productive discussion leading to a substantial changes and news for our congress. The number of classic round tables has been reduced whereas the debate sessions (DE) increased. In addition, the format of the debate sessions has been substantially revised. The duration of each DE has been increased from 30 minutes to 60 minutes. At the beginning of the DE, a 5 minutes clinical case will be presented concluding with 3 different questions which will be needed to be answer by the two different opponents. The chairs of the session will guide the match between the two opponent speakers, which will be based on 3 different rounds (one for each question). The speakers will take turns to support their own opinion. At the end of each session the audience will be asked to vote, using the congress app, in order to support the most convincing speaker. A final poll will establish the best speaker and the winner of the match.

The ESSM Scientific committee has selected 8 hot topics for the DE. The first two DE will deal with the use of energy-based technologies including radiofrequency (RF) or laser-based devices for the treatment of female genital pain or vaginal rejuvenation. These treatments have become increasingly popular during the last several years as an aesthetic alternative treatment for various gynecological medical conditions including genitourinary syndrome of menopause (GSM), stress urinary incontinence (SUI), vaginal laxity and sexual health. However, the evidence supporting this approach is conflicting. In addition, the United States Food and Drug Administration (FDA) issued on July the 30th 2018, a warning regarding the safety of energy-based technologies for indications such as vaginal “rejuvenation”, cosmetic vaginal treatment, and vaginal conditions related to menopause, and symptoms of urinary incontinence and sexual function.

Another DE will specifically address the safety of the testosterone treatment (TRT) in subjects with benign prostate hyperplasia (BPH). The prostate safety during TRT still represents a matter of intense debate. Recent data have paradoxically showed that TRT might improve and not worsen low urinary tract symptoms (LUTS), especially in patients with metabolic syndrome. However, the exclusion from the vast majority of the randomized controlled trials (RCTs) of patients with severe LUTS prevents, especially long-term, safety conclusions.

Hypogonadism issue represents the topic of another DE dealing with the efficacy and safety for TRT in men with functional hypogonadism (HG). The concept of a functional HG, in comparison to an organic one, is emerging. In particular, the latter is an irreversible condition, usually characterized by very low T levels, due to some organic damage occurring at any level of the hypothalamus-pituitary testis (HPT) axis, in which the benefit of TRT is well established. Conversely, functional HG – probably the most common and previously referred as age-related or late onset hypogonadism – is a potentially reversible form, with borderline low T levels, mainly associated with sexual symptoms, where the risk/benefit ratio of TRT is more debated.

Premature ejaculation (PE) represents one of the important male sexual complaints derived from the general population. For a long time off-label use of selective-serotonin inhibitors (SSRIs) has been the treatment of choice of this condition. Some years ago, dapoxetine, a short-acting SSRI has been introduced in the market as the first on label treatment for PE. Despite the promising data derived from RCTs, the real life use of this drug has not always confirmed the positive original data. Previous off-label use of topical drugs for the treatment of PE were based on a combination of topical anesthetic, which may be transferred to the partner and result in vaginal numbness. Hence, the patients are usually invited to use a condom after applying the cream on their penises. More recently, a new on label topical drug for the treatment of PE has been introduced in the market. It consist on a combination of lidocaine/prilocaine delivered in a metered dose spray. The drug-distribution and drug-delivery properties allow for reduced hypoesthesia to the penis and reduced time to onset of action without requiring the use of a condom after application. A potential intense DE will eventually establish the best (topical or oral) treatment for PE.

A specific surgical topic will be also covered. Short penis is a quite frequent clinical condition during sexual medicine consultations. Although sometime it reflects only an underlying psychological problem, it can be the result of different surgical approaches including radical prostatectomy or a consequence of some organic conditions such as Induratio Penis Plastica. The surgical and non-surgical approach to the short penis will be intensively discussed and possible psychological underlying factors will be emphasized.

Relational factors, such as long, hostile and more than likely dissatisfying couple bonding, represent a key element in sexual medicine. Over time, everyday stressors can leave couples worn out and uninterested causing them to drift apart eventually leading to the development of sexual impairment. In addition, available data clearly show that sexual dysfunction in one member of the couple induces marked distress in the partner, which in turn can generate sexual dysfunction. The introduction of phosphodiesterase-5 inhibitors (PDE-5is) has theoretically simplify the treatment of erectile dysfunction (ED). However, pharmacological treatment alone does not respond to all the maintaining concurrent factors of ED, including anxiety, loss of self-esteem, depressed mood, couple’s communication problems, relationship problems, or partner’s sexual dysfunction. Similar considerations can be drawn for other male and female sexual complaints. During a specific debate, the two speakers will discuss the role of the best approach when marital problems play a major role in determining the sexual symptom.

The last DE is related to an important female topic dealing with the condition of sexual aversion and asexuality in female. Several psychosocial and organic conditions can result in a reduction of the frequency of women sexual intercourse eventually inducing sexual abstinence. The specific evaluation of all the underlining factors can allow planning specific interventions in order to improve the sexual avoidance. Accordingly, whether sexual pain as a consequence of vaginal dryness in menopausal women represents a crucial issue, the use of topic estrogens can frequently improve to situation. Sexual aversion disorder occurs occasionally in males and much more often in females. It is defined as a persistent or recurrent aversion to and avoidance of all or almost all genital sexual contact with a sexual partner, causing marked distress or interpersonal difficulties. This clinical condition especially when lifelong and generalized is often the result of previous sexual trauma, such as incest, sexual abuse, or rape. Role of sexologist is to adequately address all the possible information in order to adequately support and treat the patient and/or the couple symptom.

The introduction and the modification of the DE does not represent the only news offered this year. Outstanding speakers and scientists will discuss clinical cases during the breaks on January 24th. Congress attendees are requested to register for these great opportunities. More information will be available soon.

Finally, new ESSM statements will be presented as the result of ESSM scientific committee hard work. This year the topic covered include, “Animal model for Peronie’s diseases”, “Male infertility and sexual health”, “Gynecological cancer and sexual health”, “Psychosocial aspects of male sexual dysfunctions”, “Peronie’s diseases surgical approach outcomes and satisfaction”, “Transgender surgery with attention for sexual function and satisfaction”, “The use of traction devices for ED”, and “Digital technologies for research in sexual health”. All ESSM members are invited to the statement presentation joining the discussion for their improvement.

The annual ESSM meeting is approaching, our President, Yacov Reisman, and me, hope to see all of you in Prague enjoying the congress and the city, and participating in the ESSM Statements discussion.