Eric Huyghe

Introduction: Extracorporeal shock wave therapy (ESWT) for erectile dysfunction (ED) presents a challenging paradox. While numerous clinical studies, systematic reviews, and meta-analyses have been published, indicating a substantial body of evidence supporting the efficacy and safety of ESWT, significant questions remain. Notably, the American Urological Association (AUA) continues to classify ESWT for ED as investigational (Evidence Level: Grade C), suggesting that the true therapeutic effect o f ESWT may differ considerably from current estimates. This review aims to critically assess the evidence and propose strategies to address this unresolved discrepancy. Data sources: We systematically searched two electronic databases (PubMed and Ovid/Embase) and published systematic reviews on ESWT for ED and compiled a systematic literature review and meta-analysis based on 87 relevant studies. Areas of agreement: There is clear evidence that ESWT for ED is effective and can therefore be a valuable treatment modality in the management of ED. Areas of controversy: Current assessments of ESWT for ED as investigational by, e.g., the AUA may not stem from a lack of clinical studies, insufficient related basic science, or an inadequate number of systematic reviews and meta-analyses. Instead, the deficits lie in the area of the scientific quality of the clinical studies published to date. Growing points: We hypothesize that this unfortunate situation will only change if the following aspects will be rigorously considered in future clinical studies on ESWT for ED: adequate characterization and reporting of extracorporeal shock waves, appropriate handling of missing data and intercurrent events, and comprehensive classification of ESWT in the overall context of the available treatment options for ED. Areas for developing research: We are convinced that the consistent implementation of these aspects will significantly contribute to establishing ESWT as the first truly regenerative therapy in the management of ED. This overall aim justifies the corresponding efforts, for the benefit of our patients.

Breast cancer treatments may have impacts on several aspects of sexual health, including psychological, psychosexual, physiological, physical, and relational. In this study we sought to assess sexual function and sexual frequency in breast cancer patients 2 years after diagnosis. We selected all breast cancer participants from the the French national VIe après le CANcer 2 (VICAN 2) longitudinal study. Data sources included patient and medical questionnaires, along with medico-administrative databases. Outcomes assessed were the dimensions of sexual function and frequency from the Relationship and Sexuality Scale and communication about sexuality with healthcare providers. Out of 1350 participating women, 60.2% experienced a decrease in sexual desire, 61.4% reported a lower frequency of intercourse, and 49.5% faced decreased ability to orgasm. In contrast, 64.8% had engaged in sexual intercourse in the previous 2 weeks, 89.5% were “Somewhat” to “Very much” satisfied with the frequency of intimate touching and kisses with their partner, and 81.6% expressed satisfaction with their intercourse frequency. However, a mere 15% of women discussed sexuality with the healthcare providers. Independent factors associated with increased communication about sexuality included age younger than 50 years (OR = 1.90 95% CI [1.28–2.82], P = .001), being in a partner relationship (OR = 2.53 95% CI [1.28–2.82], P = .003), monthly income above 1,500 euros (OR = 1.73 95% CI [1.15–2.60], P = .009), and absence of diabetes (OR = 6.11 95% CI [1.39–26.93], P = .017). The study findings underscore the need for continuing education in oncosexology and dedicated sexual health interventions that should involve a holistic approach that takes into consideration age, treatments, relationship status, and whether the patient has diabetes. Strengths of the study are the sample size, the national representativeness, and data reliability. However, the cross-sectional design could introduce potential recall, recency, or social desirability biases. Also, social determinants influencing sexual health, such as ethnicity or geographic locations, have not been considered in the analyses. This study revealed that sexual disorders persist 2 years after a breast cancer diagnosis, with a noticeable communication gap regarding sexuality between patients and medical teams. These findings underscore the necessity for tailored sexual health interventions, particularly designed for women who are single, older aged, and diabetes patients.