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EDITORIAL: Growing Up and Seeking Guidance
1515
EDITORIAL Growing Up and Seeking Guidance
This is the 30th anniversary of the first meeting on microvascular arterial bypass surgery for vasculogenic impotence [1] organized by Adrian Zorgniotti [2]. Four years after that first meeting, enough growth had taken place in the field for Zorgniotti’s group to form what has become the International Society for Sexual Medicine (ISSM), founded in 1982. This 28th issue of The Journal of Sexual Medicine ( JSM) highlights both the development of the field and the growth of our society and its journal, with an exponentially growing role for the ISSM for basic scientists, clinical researchers, educators, and clinicians in the field of sexual medicine. So where do JSM readers and writers turn for information as this field matures? Growing up as children, when we are looking for authority figures, we turn to our parents. They provide discipline when we are young, guidance during our growing years, and a sounding board as we strive for our independence. Where does this young field of sexual medicine find support and guidance? Who provides the foundation on which to grow? The ISSM has stepped up to the parenting role for the field. With the publication of “Standard Practice in Sexual Medicine” as the culmination of lengthy meetings by the standards committees chaired by Hartmut Porst (men) and Annamaria Giraldi (women), the ISSM has allowed a solid, evidence-based floor to be laid on which this field can continue to grow. Of course the foundation under that floor remains the JSM, starting with the first issue four years ago this month that published summaries from the International Consultation on Sexual Medicine in Paris. What does this mean to JSM readers? What does this mean to sexual medicine practitioners and researchers? This means that the ISSM can provide a methodological framework with which future definitions and standards can be consensed—and this is a reality, not just a concept. So here comes the fairy tale. Once upon a time, the ISSM Standards Committee met in a far away place. It was the summer of 2006. The subcommittee on ejaculatory dysfunctions discovered that there was a need for a contemporary, evidence© 2008 International Society for Sexual Medicine
based definition of premature ejaculation (PE) [3–7]. This was reported by the Standards Committee, whose Chairman discussed this need with the President of the ISSM. The ISSM went seeking a fairy godmother to support a special consensus meeting to define PE. Fortunately for both President Ira and the ISSM, a fairy godmother offered to pay for the costs of the meeting even though she knew (well, he) that she would not be allowed to participate. So in the fall of 2007, under the chairmanship of Hartmut Porst, 21 people were invited to participate in the ISSM Ad Hoc Committee for the Definition of Premature Ejaculation. A special panel of leaders in sexual medicine was asked to put forward names of experts in PE to study the literature and propose a new evidence-based definition. Invitees had to be considered experts by at least two members of the nominating panel, and could not be employed by industry. The group was mixed to provide a balance of geography, gender, and personal opinion, with John Dean chosen to serve as facilitator. Over the course of one industrious weekend, the participants developed an evidence-based definition of lifelong PE. While the fairy godmother was excited, the magic wand was not yet stilled. President Ira asked Chris McMahon, Marcel Waldinger, and Stan Althof to complete the project by writing the official committee report. As all good parents do, the ISSM wanted only the best results, so the report was sent to five additional experts for suggestions and constructive criticism. After further revision and approval by the entire Ad Hoc Committee, the Executive Committee of the ISSM was sent the report for its endorsement. The JSM is pleased to be able to share with you in this issue the report in its entirety. And those people interested in a contemporary, evidence-based definition of PE lived happily ever after! Although this is a simplistic telling of how the PE report came about, it is a case in point for the development of future guidelines in the area of sexual medicine. When regional bodies attempt to establish international standards, they traditionally have not been accepted throughout J Sex Med 2008;5:1515–1517
1516 the world. Because of the multicultural and multidisciplinary nature of the ISSM, the society is poised perfectly to develop multicultural, evidence-based, consensus guidelines in different aspects of the field. In 2004 the JSM was given the privilege of publishing summaries from the International Consultation on Sexual Medicine. The next consultation, in 2009, will be cosponsored by the ISSM, with summaries again to be published in your JSM. The ISSM is the appropriate body to define international standards in sexual medicine. And thank you to our current and future fairy godmothers. July is traditionally a time when we offer thanks, as well, to our reviewers from the past 12 months. Without the time committed by these faithful men and women, your JSM would not be the quality journal that it is. The true fairy godmothers of the JSM are the reviewers. Many have spent hours making sure that the review provided to the author will contain the kinds of constructive criticisms to allow the author the opportunity to make the original manuscript into an outstanding article. We are working with the publisher to award reviewers with Continuing Medical Education credits, based on the quality of review, but this is not yet in place. In the meantime, the editorial team would like to express our sincere appreciation for reviewers’ time, commitment, and caring, as well as to our faithful readers. In particular, I would like to recognize Emmanuele Jannini, Gerry Brock, Hartmut Porst, and Andrea Salonia who were our leading reviewers this year. We would also like to thank Cindy Meston for her service to the JSM as Associate Editor and welcome Caroline Pukall in her stead. One intention of the JSM editorials is to highlight selected articles in the JSM in both male and female sexual dysfunction, in part to show the critical role played by your journal in the field of sexual medicine. While all of the accepted manuscripts in the JSM are important, there are two articles in this issue that are both novel and clinically relevant in sexual medicine. In the first manuscript by Abdo et al. entitled “Sexual Satisfaction among Patients with Erectile Dysfunction Treated with Counseling, Sildenafil, or Both,” the authors examined three months of erectile dysfunction management in 117 men by pharmacologic intervention alone, psychologic intervention alone, or both. Using the Male Sexual Quotient and the Sexual Health Inventory, the authors were able to show a significant benefit to multidisciplinary, bio-psycho-social erectile dysfunction treatment. I J Sex Med 2008;5:1515–1517
Editorial believe this to be an important contribution to the field where collaborative therapeutic intervention with patients not only makes common sense, it now makes scientific sense [8,9]. The second manuscript by Hayes et al. is entitled “Risk Factors for Female Sexual Dysfunction in the General Population: Exploring Factors Associated with Low Sexual Function and Sexual Distress.” The authors performed a multivariate analysis for the first time in a large nationally representative population, the risk factors and sexual distress associated with the desire, arousal, and orgasm components of female sexual dysfunction. Relationship factors were more important to low desire than age or menopause. Physiological and psychologic factors were more important to low orgasmic and low arousal function than relationship factors. Sexual distress was associated with depression and inversely associated with better communication of sexual needs. This manuscript goes well beyond reporting the simple prevalence of a sexual dysfunction and sets a new standard for epidemiologic studies in sexual medicine [10–15]. Fairy godmother or not, the JSM is your journal. You can rely on it to provide you with state of the art, evidence-based reading material on a regular basis. Your job is simple: read the JSM, write for the JSM, review for the JSM. This is YOUR journal, and you do not need a fairy godmother to ensure that the JSM continues. Irwin Goldstein, MD Editor-in-Chief References
1 Lewis R, Wagner G. History of the International Society of Sexual Medicine (ISSM)—The beginnings. J Sex Med 2008;5:740–5. 2 Lizza EF. Adrian Walton Zorgniotti (1925–1994): Renaissance urologist. J Sex Med 2005;2:272–7. 3 Shabsigh R, Rowland D. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision as an appropriate diagnostic for premature ejaculation. J Sex Med 2007;4:1468–78. 4 Waldinger MD, Schweitzer DH. The DSM-IV-TR is an inadequate diagnostic tool for premature ejaculation. J Sex Med 2007;4:822–3. 5 Segraves R, Balon R, Clayton A. Proposal for changes in diagnostic criteria for sexual dysfunctions. J Sex Med 2007;4:567–80. 6 Shabsigh R. Diagnosing premature ejaculation: A review. J Sex Med 2006;3:S318–23. 7 Sharlip ID. Guidelines for the diagnosis and management of premature ejaculation. J Sex Med 2006; 3:S309–17.
Editorial 8 Perelman MA. A new combination treatment for premature ejaculation: A sex therapist’s perspective. J Sex Med 2006;3:1004–12. 9 Titta M, Tavolini IM, Moro FD, Cisternino A, Bassi P. Sexual counseling improved erectile rehabilitation after non-nerve-sparing radical retropubic prostatectomy or cystectomy—Results of a randomized prospective study. J Sex Med 2006;3:267–73. 10 Hayes RD, Bennett C, Dennerstein L, Gurrin L, Fairley C. Modeling response rates in surveys of female sexual difficulty and dysfunction. J Sex Med 2007;4:286–95. 11 Hayes RD, Bennett CM, Fairley CK, Dennerstein L. What can prevalence studies tell us about female sexual difficulty and dysfunction? J Sex Med 2006; 3:589–95.
1517 12 Clayton AH. Epidemiology and neurobiology of female sexual dysfunction. J Sex Med 2007;4(4 suppl):260–8. 13 Parish WL, Laumann EO, Pan S, Hao Y. Sexual dysfunctions in urban China: A population-based national survey of men and women. J Sex Med 2007; 4:1559–74. 14 Pescatori ES, Giammusso B, Piubello G, Gentile V, Farina FP. Journey into the realm of requests for help presented to sexual medicine specialists: Introducing male sexual distress. J Sex Med 2007;4:762–70. 15 Graziottin A. Prevalence and evaluation of sexual health problems—HSDD in Europe. J Sex Med 2007;4:S211–9.
J Sex Med 2008;5:1515–1517
EDITORIAL Growing Up and Seeking Guidance
This is the 30th anniversary of the first meeting on microvascular arterial bypass surgery for vasculogenic impotence [1] organized by Adrian Zorgniotti [2]. Four years after that first meeting, enough growth had taken place in the field for Zorgniotti’s group to form what has become the International Society for Sexual Medicine (ISSM), founded in 1982. This 28th issue of The Journal of Sexual Medicine ( JSM) highlights both the development of the field and the growth of our society and its journal, with an exponentially growing role for the ISSM for basic scientists, clinical researchers, educators, and clinicians in the field of sexual medicine. So where do JSM readers and writers turn for information as this field matures? Growing up as children, when we are looking for authority figures, we turn to our parents. They provide discipline when we are young, guidance during our growing years, and a sounding board as we strive for our independence. Where does this young field of sexual medicine find support and guidance? Who provides the foundation on which to grow? The ISSM has stepped up to the parenting role for the field. With the publication of “Standard Practice in Sexual Medicine” as the culmination of lengthy meetings by the standards committees chaired by Hartmut Porst (men) and Annamaria Giraldi (women), the ISSM has allowed a solid, evidence-based floor to be laid on which this field can continue to grow. Of course the foundation under that floor remains the JSM, starting with the first issue four years ago this month that published summaries from the International Consultation on Sexual Medicine in Paris. What does this mean to JSM readers? What does this mean to sexual medicine practitioners and researchers? This means that the ISSM can provide a methodological framework with which future definitions and standards can be consensed—and this is a reality, not just a concept. So here comes the fairy tale. Once upon a time, the ISSM Standards Committee met in a far away place. It was the summer of 2006. The subcommittee on ejaculatory dysfunctions discovered that there was a need for a contemporary, evidence© 2008 International Society for Sexual Medicine
based definition of premature ejaculation (PE) [3–7]. This was reported by the Standards Committee, whose Chairman discussed this need with the President of the ISSM. The ISSM went seeking a fairy godmother to support a special consensus meeting to define PE. Fortunately for both President Ira and the ISSM, a fairy godmother offered to pay for the costs of the meeting even though she knew (well, he) that she would not be allowed to participate. So in the fall of 2007, under the chairmanship of Hartmut Porst, 21 people were invited to participate in the ISSM Ad Hoc Committee for the Definition of Premature Ejaculation. A special panel of leaders in sexual medicine was asked to put forward names of experts in PE to study the literature and propose a new evidence-based definition. Invitees had to be considered experts by at least two members of the nominating panel, and could not be employed by industry. The group was mixed to provide a balance of geography, gender, and personal opinion, with John Dean chosen to serve as facilitator. Over the course of one industrious weekend, the participants developed an evidence-based definition of lifelong PE. While the fairy godmother was excited, the magic wand was not yet stilled. President Ira asked Chris McMahon, Marcel Waldinger, and Stan Althof to complete the project by writing the official committee report. As all good parents do, the ISSM wanted only the best results, so the report was sent to five additional experts for suggestions and constructive criticism. After further revision and approval by the entire Ad Hoc Committee, the Executive Committee of the ISSM was sent the report for its endorsement. The JSM is pleased to be able to share with you in this issue the report in its entirety. And those people interested in a contemporary, evidence-based definition of PE lived happily ever after! Although this is a simplistic telling of how the PE report came about, it is a case in point for the development of future guidelines in the area of sexual medicine. When regional bodies attempt to establish international standards, they traditionally have not been accepted throughout J Sex Med 2008;5:1515–1517
1516 the world. Because of the multicultural and multidisciplinary nature of the ISSM, the society is poised perfectly to develop multicultural, evidence-based, consensus guidelines in different aspects of the field. In 2004 the JSM was given the privilege of publishing summaries from the International Consultation on Sexual Medicine. The next consultation, in 2009, will be cosponsored by the ISSM, with summaries again to be published in your JSM. The ISSM is the appropriate body to define international standards in sexual medicine. And thank you to our current and future fairy godmothers. July is traditionally a time when we offer thanks, as well, to our reviewers from the past 12 months. Without the time committed by these faithful men and women, your JSM would not be the quality journal that it is. The true fairy godmothers of the JSM are the reviewers. Many have spent hours making sure that the review provided to the author will contain the kinds of constructive criticisms to allow the author the opportunity to make the original manuscript into an outstanding article. We are working with the publisher to award reviewers with Continuing Medical Education credits, based on the quality of review, but this is not yet in place. In the meantime, the editorial team would like to express our sincere appreciation for reviewers’ time, commitment, and caring, as well as to our faithful readers. In particular, I would like to recognize Emmanuele Jannini, Gerry Brock, Hartmut Porst, and Andrea Salonia who were our leading reviewers this year. We would also like to thank Cindy Meston for her service to the JSM as Associate Editor and welcome Caroline Pukall in her stead. One intention of the JSM editorials is to highlight selected articles in the JSM in both male and female sexual dysfunction, in part to show the critical role played by your journal in the field of sexual medicine. While all of the accepted manuscripts in the JSM are important, there are two articles in this issue that are both novel and clinically relevant in sexual medicine. In the first manuscript by Abdo et al. entitled “Sexual Satisfaction among Patients with Erectile Dysfunction Treated with Counseling, Sildenafil, or Both,” the authors examined three months of erectile dysfunction management in 117 men by pharmacologic intervention alone, psychologic intervention alone, or both. Using the Male Sexual Quotient and the Sexual Health Inventory, the authors were able to show a significant benefit to multidisciplinary, bio-psycho-social erectile dysfunction treatment. I J Sex Med 2008;5:1515–1517
Editorial believe this to be an important contribution to the field where collaborative therapeutic intervention with patients not only makes common sense, it now makes scientific sense [8,9]. The second manuscript by Hayes et al. is entitled “Risk Factors for Female Sexual Dysfunction in the General Population: Exploring Factors Associated with Low Sexual Function and Sexual Distress.” The authors performed a multivariate analysis for the first time in a large nationally representative population, the risk factors and sexual distress associated with the desire, arousal, and orgasm components of female sexual dysfunction. Relationship factors were more important to low desire than age or menopause. Physiological and psychologic factors were more important to low orgasmic and low arousal function than relationship factors. Sexual distress was associated with depression and inversely associated with better communication of sexual needs. This manuscript goes well beyond reporting the simple prevalence of a sexual dysfunction and sets a new standard for epidemiologic studies in sexual medicine [10–15]. Fairy godmother or not, the JSM is your journal. You can rely on it to provide you with state of the art, evidence-based reading material on a regular basis. Your job is simple: read the JSM, write for the JSM, review for the JSM. This is YOUR journal, and you do not need a fairy godmother to ensure that the JSM continues. Irwin Goldstein, MD Editor-in-Chief References
1 Lewis R, Wagner G. History of the International Society of Sexual Medicine (ISSM)—The beginnings. J Sex Med 2008;5:740–5. 2 Lizza EF. Adrian Walton Zorgniotti (1925–1994): Renaissance urologist. J Sex Med 2005;2:272–7. 3 Shabsigh R, Rowland D. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision as an appropriate diagnostic for premature ejaculation. J Sex Med 2007;4:1468–78. 4 Waldinger MD, Schweitzer DH. The DSM-IV-TR is an inadequate diagnostic tool for premature ejaculation. J Sex Med 2007;4:822–3. 5 Segraves R, Balon R, Clayton A. Proposal for changes in diagnostic criteria for sexual dysfunctions. J Sex Med 2007;4:567–80. 6 Shabsigh R. Diagnosing premature ejaculation: A review. J Sex Med 2006;3:S318–23. 7 Sharlip ID. Guidelines for the diagnosis and management of premature ejaculation. J Sex Med 2006; 3:S309–17.
Editorial 8 Perelman MA. A new combination treatment for premature ejaculation: A sex therapist’s perspective. J Sex Med 2006;3:1004–12. 9 Titta M, Tavolini IM, Moro FD, Cisternino A, Bassi P. Sexual counseling improved erectile rehabilitation after non-nerve-sparing radical retropubic prostatectomy or cystectomy—Results of a randomized prospective study. J Sex Med 2006;3:267–73. 10 Hayes RD, Bennett C, Dennerstein L, Gurrin L, Fairley C. Modeling response rates in surveys of female sexual difficulty and dysfunction. J Sex Med 2007;4:286–95. 11 Hayes RD, Bennett CM, Fairley CK, Dennerstein L. What can prevalence studies tell us about female sexual difficulty and dysfunction? J Sex Med 2006; 3:589–95.
1517 12 Clayton AH. Epidemiology and neurobiology of female sexual dysfunction. J Sex Med 2007;4(4 suppl):260–8. 13 Parish WL, Laumann EO, Pan S, Hao Y. Sexual dysfunctions in urban China: A population-based national survey of men and women. J Sex Med 2007; 4:1559–74. 14 Pescatori ES, Giammusso B, Piubello G, Gentile V, Farina FP. Journey into the realm of requests for help presented to sexual medicine specialists: Introducing male sexual distress. J Sex Med 2007;4:762–70. 15 Graziottin A. Prevalence and evaluation of sexual health problems—HSDD in Europe. J Sex Med 2007;4:S211–9.
J Sex Med 2008;5:1515–1517