Ellen M. Cahill

Nocturnal emissions are a normal biologic function of sexual arousal and ejaculation during sleep, often beginning in puberty. Historically, views on nocturnal emissions have varied, but they are an important aspect of sexual culture, as they may represent one of a person's earliest encounters with sexuality, often beginning during puberty. We sought to characterize the sexual culture views on nocturnal seminal emissions in the early 1900s and compare and contrast that to the views of the modern era as it relates to destigmatization of sexual health. A non-systematic review was performed to characterize historical views on nocturnal emissions, including cultural and religious perspectives. Modern perspectives on social media platform TikTok were also reviewed and compared to historical viewpoints. Throughout history, views on nocturnal emissions have varied, from accepting as a biological function to deeply stigmatized with sinful connotations. There remain medically unfounded claims about nocturnal emissions today highlighting an opportunity for sexual medical care providers to clarify and destigmatize the topic particularly for adolescents who may be most impressionable as they experience nocturnal emissions for the first time.

Introduction: Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) can significantly impair a man’s quality of life. While traditional surgical treatments are effective, they often pose risks to sexual function, particularly in the form of ejaculatory and/or erectile dysfunction. Minimally invasive surgical treatments (MISTs) have emerged as alternative procedures that aim to alleviate LUTS while preserving sexual function. Objective: Investigate the impact of MISTs for BPH on sexual function including erectile and ejaculatory function. Methods: In May 2025, a systematic review and meta-analysis of sexual function outcomes in MISTs was performed using the Ovid, Embase, and Medline/PubMed databases. Articles were included if they were in English, assessed a MIST, and incorporated sexual function outcomes. Articles were excluded if they included pooled analyses, were abstracts without full text, and/or were ongoing incomplete clinical trials. We included studies on water vapor thermal therapy (Rezum), prostatic urethral lift (Urolift), prostatic artery embolization (PAE), temporary implantable nitinol device (iTIND), Optilume BPH catheter system, and transperineal laser ablation (TPLA). Outcomes included erectile function using International Index of Erectile Function (IIEF) scores and ejaculatory function using the Male Sexual Health Questionnaire (MSHQ). Results: The initial search yielded 2646 studies. After screening and full text review, 77 studies met inclusion criteria encompassing a total of 11,477 patients. Based on the pooled analyses, IIEF scores significantly improved after Rezum and Urolift. Urolift significantly improved MSHQ-function and bother scores, while Rezum only improved MSHQ-bother scores. PAE, iTind, Optilume, and TPLA did not significantly impact erectile or ejaculatory function. Conclusions: MISTs are a promising option for management of BPH in patients interested in maintaining sexual function, preserving or even improving erectile and ejaculatory function.

Background: Since its release in 2014, collagenase clostridium histolyticum (CCH) has become the most commonly used injectable therapy for Peyronie’s disease (PD). While some studies have suggested modest improvements in curvature with use of CCH, others have found more significant gains. Aim: To determine predictors of improved curvature in men with PD treated with CCH. Methods: A prospective, sequential database has been maintained of all men with PD undergoing CCH injections since 2014. Clinical characteristics and responses to standardized and nonstandardized questionnaires were collected at baseline, during, and after treatment. Outcomes: Change in curvature was assessed using the “Most Recent” curvature assessment, and statistical analyses were performed to identify factors that correlated with greater curve improvements. Results: A total of 826 men underwent at least one CCH series and comprise the current cohort. Univariate analysis demonstrated associations between greater curvature improvements in patients with more severe baseline curvature (0.5° greater improvement per increase in 1° baseline), hourglass deformities (3-10° greater improvement among moderate/severe men), number of CCH series administered (0-4° per series), strong nocturnal erections (11° higher), greater frequency of intercourse (0.6° per intercourse attempt per month), greater bother and psychological impact (as assessed by the Peyronie’s Disease Questionnaire), and those who used RestoreX (5-20° depending on test). Worse outcomes were observed among men who self-reported decreased motivation (7°) as well as those with pure lateral curvatures (11°). Men who experienced hematomas, a popping sensation, and those with rapid detumescence during treatment also had more significant improvements in curvature (5°). On multivariate analysis, baseline curvature, lateral curve direction, hourglass/indentation deformities, RestoreX use, and suspected controlled penile fracture remained independently associated with better outcomes. Of all the factors assessed, RestoreX use was associated with the largest degree of improvement. Clinical Implications: These findings highlight several potential predictors of improved outcomes with CCH, which may be utilized by providers to help counsel patients deciding on medical versus surgical treatment of PD. Strengths and Limitations: The strengths include the largest single-center prospective database of PD patients undergoing CCH published to date and use of objective and validated instruments to track PD outcomes. Limitations include the single-center nature, diverse patient cohort, and change in CCH technique over time. Conclusion: Several baseline and treatment-related factors correlate with CCH outcomes. These data may assist both patients and providers as they relate to patient selection and counseling. The data also suggest the importance of patient motivation and active participation during the treatment course.