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    Inovacion en jugetes sexuales en medicina

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    Inovacion en jugetes sexuales en medicina

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    44 views8 pages

    The Sextech Industry and Innovative Devices For Treating Sexual Dysfunction

    Uploaded by

    Así Te Amas
    Inovacion en jugetes sexuales en medicina

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    © All Rights Reserved
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    WIR: Your Sexual Medicine Journal ARTICLE wor. nature.com/ijie (Check x updaton The sextech industry and innovative devices for treating sexual dysfunction Shelly Varod @'™ and Rafi J. Heruti'? {© The Author(s), under exclusive licence to Springer Nature Limited 2023 Since the digital revolution, there has been a notable Increase in the use and popularity of sex toys and innovative sexual devices, Which can be attributed to advancements in technology. The sex toys industry strives to improve sexual experience, pleasure and sexual health, and to address sexual dysfunction through devices and technology. With the growth of this industy, new products that are considered “smart sexual devices” have gradually entered the market. Smart sexual devices feature wireless connectivity to ‘a smartphone application that allows the user to control the device's features and provide personal or sexval data about thelr sexual experiences. Other smart devices have sensors and are able to collect physical data during usage. With the aid of this data, Individuals may be able to understand their sexual behavior and arousal better, resulting in improved sexual experience or the ‘overcoming of sexual dysfunction. The present article aims to explore the potential applications of technology-based devices, and smart sexval devices, in the treatment of male sexual dysfunctions, including premature ejaculation (PE), and delayed ejaculation (0B), as well as female sexual dysfunction (FSD), such as sexual arousal disorder and female orgasmic disorder. Furthermore, we ‘examine the advantages and disadvantages of these devices. Given the limited literature available on this subject and the absence of controlled studies, we conduct a narrative review of the existing scientific research on technological and smart sexual devices. |UIR: Your Sexual Medicine Journal, https://dol.org/10.1038/s41443-023-00731-3 INTRODUCTION One of the most common motivations for people to engage in sexual activity is pleasure [1,2]. Sex toys and devices can enhance: and diversify sexual pleasure while introducing new possibilities and excitement into sexual play [3,4]. Although many sex toys are intended to enhance pleasure, other devices are considered therapeutic due to their ability to increase arousal levels, stimulation, and sexual activity [5]. The first modem electric vibrator was not intended as a sex device (5, 7] and was marketed for yearsin newspaper ads as a medical device for various medical conditions and household appliances [7]. In the 1960s, vibrators were primarily sold for sexval pleasure in adult stores, erotic boutiques, and in-home parties [8,9]. However, due to the digital revolution, sexvalty elated products became widely available for cline purchase [10]. Over the years, vibrator use has become increasingly common among men, women, and couples {11-13} Research has found that vibrators are effective as. sex aid devices for weating erectile dysfunction, ejaculatory dysfunction, and anorgasmia [4]. In recent years, sexual aid devices have become increasingly advanced thanks to technological revolution. This has resulted in wireless sex toys, also known as telediidonic toys [15]. The sextech industry encompasses various sexuality technology-based ventures [16] such as web-based applications, platforms, or devices, aimed at enhancing or facilitating sexual experiences [17]. It is worth noting that precise scientific definition of the sextech industry is cutrentl lacking. Tis industry 's considered a highly profitable market, with an estimated value in the billons of dollars [18]. The COVID-19 pandemic and subsequent lockdown policies resulted in an increased prevalence of technology-based sexual interactions [19-21]. New forms of sextech continue to emerge in recent years [17]. To determine the effectiveness of technological and smart sexval aid devices in treating male and female sexual dysfunctions, we reviewed research-based sexual aid devices. A device is considered smart If t possesses features such as wireless connectivity that allows it to be controlled or transfer data via a smartphone app [22]. Our objective is to educate healthcare professionals about the latest technological features in sexual devices and how they can be utilized to help patients gain insights into their physiological responses and improve sexual function and pleasure. ‘METHOD For this narrative review, we utilzed a comprehensive search strategy to gather relevant information about the use of sexual devices and smart Sexual devices as 2 treatment, or part of a treatment program for sexual medicine, for individuals with sexual dysfunction. Our search involved ‘reviewing published journal articles and professional guidelines available In PubMed. We used various keywords such as “smart sexual device’, “smart device for sexual dysfunction’ “sexual devices’ “sexual device with sensors, “Sex toys with app’, “vibrator for women’, “vibrator for women arousal disorder’, “vibrator use for women orgasm’, “vibrator use for sexual Gysfunctions", “sexual aid for men sexval dysfunction’, and “sexual aid devices". To ensure a comprehensive search, we also utlized tools such as Ehcitcom and ConnectedPaper.com. Using these tools, we rephrased the keywords as research questions and applied them to find additional scientific articles related to our topic of interest. This allowed us to identify ‘Sowa! enabitaton Cin, Routh TLV Medial Canter, Tel Av, lsael School of Medicine, Tel Aviv Unies, Tal Avy el “ematt shelyvaredieqraiicom Received: 26 December 2022 Revised: 14 June 2023 Accepted: 23 June 2023, Published online: 06 July 2 and analyze a broader range of Ierature related to the use of smart sexual ‘devices 35 9 weatment for sexual dysfunction. Our last date of search was March 30, 2023. Sexual devices for pleasure and therapeutic use Pleasure is the most common motivation for sexual behavior {1, 2) Research reveals that individuals engage in sexual activity for several reasons. Some are physical such as stress reduction, physical attraction land secking new experiences, whereas others are emotional, such 25, seeking love, commitment, or even as a way of expressing oneself (1). Sex toys can enhance pleasure, satisfaction and sex pay in all genders (3,4. ‘These products are used for sola selkpleasure or for use during sexual ‘activity with a partner. Vibratory sex toys and devices possess the potential to elicit 9 diverse range of physical sensations in erogenous regions including the vagina, ltors, pens, and rectum [5], Each device is enginogred to generate diferent sensations such as vibrations, pulsations. suction, pressure, and other effects. Furthermore, beyond simply providing pleasure, certain vibratory sexual devices have been dassied a5 sex aids due to theit ‘capacity to enhance physical and sexval arousal during sexual actWvity, potentially prolonging or augmenting any stage of the sexuakresponse ‘cle (5, 231 OF the devices aimed at sexual health, a few have been ‘ranted clearance from the US Food and Orug Administration (FDA) for medical treatments. One such device isthe Viberect(Reflexonic, Frederick MD, USA), 2. penile vibratory stimulation device (PV) [24]. The more technologically advanced version isthe Viberect-X3 designed to aid men after spinal coed injury with cjculation [25-27]. Another devi isthe Eros ‘tora Therapy Device (Eros therapy device; UroMetrics, Ing St Paul, MN, USA) 28, 25] designed to aid women with sexual arousal dysfunction and has beon the subject of several research studies [30-32]. Both devices will be discussed in more detail in the following sections. Healthcare professionals in the field of sexual health recommend the use of soxual aid devices 2s apart of counseling treatment for sexual dysfunctions, with the requirement that such devices are personalized to address the individual therapeutic needs ofthe patient [5, 23,33, From electronic massagers to smart devices A brief historical overview of the modern vibrator as @ medical aid traces back to the avantion of the electric vibrator, in the 18805, by English physician Joseph Mortimer Granvile. ts primary purpose was to alleviate nervous problems in both men and women (6, 7). Doctors used electric massagers from the late eighteenth century until the 1920s to teat hysteria, a condition related to women's physical concerns and menstrua- tion (34). However, more recent research by Lieberman and Schatzberg challenged the notion that hysteria was treated by stimulating women’s ‘genitalia (35). From the 1900s and 1930s, the electrical vibrators were marketed to women as household appliances and to men as clectro- therapeutic devices capable of treating various diseases (7,36) ‘Until the late 1940s, they were sold through maikorder catalogs, door to-door sales, and drug stores. According to Lieberman (7, in 1915 the ‘American Medical Association (AMA) criticized the use of vibrators as medical devices. Despite this, vibrators continued to be marketed as medical devices 7]. n the foliowing yeas, vibrators have been sold for Sexual pleasure (8}. To purchase such products, poople had to vistt adult stores or attend in-home parties (8,9. After the internet revolution, the sole of sex products became openly marketed online (10). The use of vibrators has become increasingly prevalent among men and women for both solo and partnered sexual actwvitis [11-13]. Furthermore, in adcition| to their function to increase pleasuxe and improve sexual function, sexual devices have been recognized as having therapeutic properties that can ‘also be used medically to treat sexual dysfunction [7,8]. A narrative review ‘of the current evidence on vibratory stimulation concluded that it has ‘evidence-based support for the treatment of various dysfunctions such as sexual desire and anorgasmia in both men and women as well as erectile ‘ysfunction in men (14). ‘The advent of the digital revolution in 2010 brought about significant technological advancements [12]. These technological advancements have ‘extended t0 the realm of sexual experiences with the introduction of ‘wearable sex toys, aie pulsation devices for clitoral stimulation that can be Controlled via phone applications, telediidonic toys (wielessly connected 8x toys, and even sex robots [12, 15, 37]. The outbreak of the COVID-19, vieus in ¢arly 2020, in addition to social distancing guidelines and home confinement measures. had @ profound impact on people's sexual behavior worldwide, leading to an increased prevalence of technological SPRINGERNATURE sexual devices [19]. The scope of this phenomenon includes sexual Dbchaviors that involve sex toys and technology-based sexual activities (20) ‘The lockdown periods resulted in reduced sexual activity, particularly ‘among singles or individuals bving away from their partners [20], A survey Conducted in Australia to assess the impact of lockdown measures on Ssenual practices and reproductive health revealed an increase in solo Sexual activity with or without sex toys [20 ‘A web-based survey was conducted in the United States in 2020, to investigate how the COVD-19 pandemic affected people's intimate lives. The survey found that one infve participants expended thelr sexual activities during the pandemic [21]. While on lockdown, respondents engaged in ‘technologically-based Sexual behaviors such as sharing. nude. photos, watching pornography, participating in cybersex, and recording themselves ‘masturbating. Additionally, some individuals veported visting “cam” sites a6 Performers or customers, utilzng sexual behavior tracking applications, and Incorporating advanced sexual technologies like teedidonic devices and vitual realty pornography [21]. A more recent study by Gesselman et al found that camming, sexually oxplict roleplaying video games, and using teleclidonics were relatively common emerging forms of sextech (17), This study also revealed thatthe majority of sex technology users ware men, younger in age, sexual minoities, with higher incomes, and identified with a ‘mote religious belie system. ‘The technology behind smart sexual devices ‘Smart sexual davies’ of sex toys’ functionality is derived from ther ability ta.connect toa smartphone application [2]. The technological component ofthese devices incorporates loT (internet of Things), which facilitates the interconnection of physical objects with other systems and devices, a5 wall the gathering and exchanging of data through Bluetooth Low Energy (BLE) for Wil [22]. Many smart devices also include computer software applications (also referred {0 as apps; some designed for self ‘monitoring and self quantification of sexual and reproductive activites and functions [38] and others to provide educational programs fer the treatment of sexual dysfunction such as PE [33]. When registering for @ smart sex device application, users may be required to provide personal information (2). In addition to this, certain devices possess the capability to gather physical information about » user's sexual actives through the device's sensors or biofeedback (40,41. The collected data is often utlized to provide users with personalized reports, such as their bodily responses and measure their sexual experiences]. The Lioness vibrato, for example (buhich will be discussed in the following section In further deta), has an app, which allows the female user to monitor her pelvic floor movements 40). Moreover, in some sex aid devices, the smartphone application enables users to engage in sexual play with their partners, even when separated by dlstance, by activating the loT device [22] Advanced devices for treating male sexual dysfunction Several advanced sexu aid devices address sexual dysfunction in men, Most devices focus on the tveatmant of PE diagnosed according to the ‘American Psychiatric Association (APA) as a persistant or recurrent pattern of ejaculation occurring during partnered sexual activity within ~1 min following vaginal penetration and before the individual wishes it [42] In adition, delayed ejaculation is diagnosed by the APA as a marked delay In gjaculation characterized by inftequency or absence of ojaculation during sexuel experience [42]. though penile vibrators have been studied and available for use in men with sexual dysfunction since the 1970s, there 's sell limited scientific literature about men's sexual aids (43). in recent years, few research studies about technological and smart sexual devices have been published, These devices have various technological features that can aid inthe treatment of sexual dysfunction, as presented in Table 1 Penile vibratory stimulation (PVS) device ViberectX3 (Reflexonic in Frederick, MD, USA) [25], isa technologically advanced penile PVS (penile vibratory stimulation) device designed to aid ‘men with conditions such as anejaculation, particularly after spinal cord Injury patients (26, 27]. The device has two builtin vibrating pods that can Simultaneously stimulate the dorsum and frenulum of the glans penis, To use the davice, it must be placed against the penis glans between the vibrating pads, which provide mechanical stimulation to induce «ejaculation (271. The Viberect-X3 was evaluated for its efficacy and safety in Inducing eaculation in patients with spinal cord injury. The study involved 30 male participants with spinal cord injury who ware enrolled in the Male Fertility Research Program [27]. The inclusion criteria forthe study required UIR: Your Seauel Medicine Journal Table 1 Feature Viberect x3. Type Vibratory medical device for ejaculatory dysfunction/or sperm retrieval Material ‘Medical grade slicone and ABS plastic App No Biofeedback No Vibration/Suetion/ ‘Adjustable frequency of vibrations Yacuum Power Source Rechargeable battery Remote Control No Handsfeee No that the participants were unable to ejaculate through sexual intercourse ‘or masturbation. Additionally, participants with injuries below the T10 level were excluded from the study a the ejaculatory response to PVS relies on Bn intact spinal reflex ac above this level. ll participants received one tal Of PVS using the Viberect 2 device and had undergone one or more previous tals with an alternate device [27 ‘Al participants with spinal cord injury at the TS level or above were iven medication (nifedipine sublingual) in dose range of 10-40 mg to ‘manage autonomic dysfelieie, The ViberectX3 device wos used at the on-agjustable manufacturer settings of 4mm ampitude and 70-100 He [271 The PVS session consists of 2-5 min intenals of stimulation, followed by 1-2min rest periods. This was repeated for up to thre intervals of ulaGon oF unt ejaculation occurred. Blood pressure was monitored at ‘ein intervals throughout the procedure. Any adverse symptoms, such as penile bleeding or edema, were manitored (27) According tothe study, 23 but ofthe 30 patients (76.7%) ware able to achieve eaculation with the use of the Viberec-X3 device during the PVS procedure. I is noteworthy that fo adverse symptoms were reported, and all patients tolerated the procedure well. Additionally there were no malfunctions reported with the Viberect x3 device during the study. Technological masturbation aid device ‘A new Cognitive Behavioral therapy method for PE was examined in a randomized controlled tral (ICT) involving the use of Sphincter Control Training (SCT) with variation of Semans “stop-start” technique (the man stimulates his penis, then stops until he feels the urge to ejaculate) (44), and a masturbator aid device (45). The study aims to enhance their knowledge, awareness, and contol of the external urethral sphincter in combination with the masturbation aid device known as Flip Zero (TFZ- 001) (Tenge Co, Lid, a Japanese company) [66] In this study, 46 ‘parcipants were randomly assigned to treatment groups; however, only 35 participants completed all phases and were included inthe final analysis [4]. The age range was 22 to $3 years with a mean of 33.7 years. All participants met the diagnostic critera for PE, according to an intravaginal ejaculatory latency time (ELT) of less than 2min and a Premature Ejaculation Diagnostic Tool (PEDT) score of greater than 11 (45). Study participants were divided into two groups: those without the device (GWT) received Sphincter Control Training (SCT), while those with the device (GWtD) received SCT combined with the Flip Zero (17 in GWiD and 18 in GWD). All participants were in 2 heterosexual relationship fr at least 6 months. Allartcipants were recruited through a health marketing campaign in Spain. Both groups underwent SCT over @ period of 7 weeks, which included four exercises and an educational session [45], The primary outcome measure was the “fold increase” (F) of the IELT, which was calculated by dividing the geometric means of post-treatment IELTs by pre-treatment IELTS. The IELTS were recorded on a weekly basis for 7 weeks, with an additional 2week baseline pariod. Participants also filed out the premature Ejaculation Profile (PEP), which assessed various domains of PE and its treatment ‘After 2 7-wedk exercise program, the GWiO showed a 2,7-fld increase in ELT, while the GWD showed a 13-fld increase in ELT atthe endpoint [45}. The study suggests that combining the SCT exercise program with a masturbation device can lead to more significant improvements in futcome measures for the treatment of PE than using only the SCT ‘xarcise program [4]. More research is needed to determine whether LIR: Your Sexual Medicine Journal ‘Comparison of features among sexual ald devices for men: Vibereet X3, Tenga Flip Zero (TFZ-001), and Myhixe® ‘Tonga Flip Zero (TFZ-001) Myhixet® ‘Masturbator device Talning masturbator device and sjaculation control Thermoplastic Elastomer (TPE) Thermoplastic Elastomer (Silicone) and Silicon 385. No Yes, Play Med® program App No. No Suction Builtin heating and gentle viorations USB cable and charging base Rechargeable and charging cable No No. No. Yes, a hands-free accessory device cognitive behavioral therapy intervention can be 2 real alternative to [pharmaceutical tweatments for PE. Study Imitation Include the lack of 3 follow-up assessment to assess the long-torm effects of the treatment and placebo consol. Specifically, the study did not conduct a 3- to month follow-up assessment. This research was done in colaboration and assistance of Tenga Co, Lid ‘Smart masturbatory device ‘The Myhixel™ device | (Myhixe, “Sevile’, ‘Andalucia’, Spain) [47] is @ technolagieally advanced smart device that has been the subject of several studies examining its effecteness in treating orgasmic disorders. The -Myhixel masturbator device provides the sensation of sexual penetration for overcoming PE [¢7, 48). The device offers three types of masturbation sleeves and a mobile exercise application caled Play MED App to assist ‘men in leaning how to contro! ther ejaculation. Notably, the Myhixel vice does not transfer data from the device to the app a ft does not connect to the app tough Bluetooth oF the internet (27), Inthe ist study conducted on this product, researches tested cognitive behavioral therapy for PE with SCT and Myhixel* med device (43). In this study. ten eatients older than 18 who ft the disonoste enters for PE, including IELT under 2 min, and with a premature ejaculation diagnostic tool (PEDT) score higher than 11, were included. The participants were asked to complete the SCT over 2 period of 7 weeks using the medical device. For this study, each patient's exercise program was developed individually [48], The attile did not provide any additional information regarding the program. Based on geometric mean lELT over the 7-week tueatment period, the outcome increased significantly from 79065 at baseline to.216215 a the end of the treatment patiod, IELT was 2.89-fold increased (F),on average forthe ten participants. At the end ofthe study, six of the ten participants did not meet the PE criteria, According to the ‘researchers, the Fl average IELT forthe participants at the end of treatment ‘was similar to that in other clinical tral with Dapoxetine, the ony effective land safe oral onvlabel teeatment for PE avaiable in many countries, however, this resut was not tested in a comparative trial (4, 'AS a result oftheir research, they concluded that SCT, when combined with the masturbatory device, can be an effective and safe exercise program for patients suffering from PE. Furthermore, compared with oral medications (SSRIs), this treatment for PE has no side effects [48). The researchers did state thot a larger sample size should substantiate these claims. This research was supported by Myhivel yhivel I" was the subject of another research study: a case study that aimed to establish a new CBT, with the device and its app program, as an effective treatment for DE [49]. In this case study, a 36-year-old male diagnosed with acquired DE participated. Tis participant had no history of comorbid mental diagnosis anda non-organic etiology for DE. The average masturbation ejaculatory latency time measured by stopwatch ‘ecorded during 2 weeks was 2605. The participant reported staring & ‘elationship 3 months before the study and. having non-successfl intercourse 12 times (49). During the research, the participant was instructed to use the device until he ejaculated, with all three sleeves. At first, he was instructed to move his hand up and down repeatedly to increase the speed, using his stronger hand. After completing this exercise, he was instructed to use his non-dominant hand. Finally, in the last ‘exercise ofthe protocol, he was instructed to masturbate while keeping his, hand til and using only his body to move in the device. After entering the study and completing the S-week program with the Myhixel IF device, SPRINGERNATURE Lioness? Vibrator ‘smart vibrator with precision sensors for biofeedback Body-sae slicone Eros Clitoral Therapy Device Clitoral suction device for Increasing blood flow and sensitivity Bodysafe silicone ioral Therapy Devkce (€ROS-CTD) and Lioness® Vibrator. No ‘Smart pelvic floor muscle training device with blofeedback technology Medical-grade slicone Elvie Trainer Suction-based device for enhancing {arousal and blood flow to the genitals Silicone ting (SofSense™ ting) No Fiera™ Arouser ig ‘SPRINGERNATURE Materials Table 2. Comparison of features among sexual aid devices for women: Fera™ Arouser, Evie Tiaines Eros Yes, Visulizes pelvic floor movement in teal time. Track progress. ‘App Connectivity Yes No. No Biofeedback Vibration vacuum Vibration/Suction! Vacuum Rechargeable through a USB cable AMA batteries Micro USB Charging Cable and a Wireless eroctibantiecc el erie Yes, though Elives app Rechargeable battery through Magnetic Charging Cable Power Source Yes, through Lioness's App No. Remote Contr! Hands Free S.Varod and RU. Hert Myhixel Lube* end Myhixel App, he was able to have intercourse with ejaculation (9). The results ofthe study showed an improvement already after 4 weeks of tretment Inthe lst 2 weeks the case study participant ‘was able to ejaculate inside his partner 100% of the time In less then 15min, The intercourse success rate after completion of the protocol exerci was 81%, The researchers concluded that this treatment might be ‘appropriate for men where the cause of DE is'8 masturbation style that cannot be experienced with a partner through the use of @ hend, mouth, ‘anus, or vagina [49]. The ueatent has advantages suchas being practiced Without 2 partner, being side-effect fre, and not requifng the assistance (of a consultant or specials. However, only one case stu is avaliable as Such, mare research necessary to assess whether this device i effective in treating DE, was sated in Ue research disclaimer thatthe research ‘was not supported by the industry, yet @ consultant employee (parttime OF Tull ime) oF shareholders among the authors (Myhicel, ‘Smart erectile dysfunction sensor device (prototype) [A davelopment and testing of Erectile Dysfunction SENsor (EDSEN), 2 ‘wearable device prototype that uses soft micrtube sensors to monitor ED, was published in 2022 (50). Cunently the device has not been commercialized ot & avaiable for clinical use, yet it demonstates the evelopment of smart devices in diagnosing sewal dysfunction, in particular for ED. The device is designed for home-based monitoring of penile health using a quantitative and convenient method. EDSEN includes 2 wireless wearable detector with a printed circuit board that measures land records the resistance value of the sensors, whichis transfered to an ‘analysis dashboord via Bluetooth, The device can record up to Gh of data land Store it The researchers valdated the method for measuring ED by ‘renting perle models with efferent vel of rigidity and performing tests {50}, They found an exponential relationship between the cicumference and sifess of the penile models and thei mining ratio. EDSEN shows potential for ciating smart wearable devices to moniter penile healt, and further research s planned to measure additonal physiological parameters in the future ‘Advanced devices for treating female sexual dysfunction ‘Several studies have explored the efficiency of advanced and smart sexual devices in relation 10 FSD, including Female Sexual IntoresUArousal Disorder, characterized by a lack or signifcanty reduced sonualintorest or arousal, according tothe APA [2 n addtion, female orgasmic disorder is ened a5 2 marked delay in, marked infrequency of, or absence of ‘orgasm, of marked reduction in. intensity of orgasmic sensations ‘experienced on almost all or all occasions of sexual activity. Table 2 resents 2 description of he technological advancements ofthese devices Sexual aid device with vacuum ‘The EROS Clitoral Therapy Device (EROS-CTD™, UroMetrics, Inc, St. Pau [MN) [30] is designed to increase blood flow to the cltars and enhance women's arousal and orgasm (23). The device utlizes a vacuum feature placed over the citors to help increase blood flow and engorgement. Several studies have Been conducted to evalute the safety and effectiveness of the EROS-CTO device including a study by Billups et al ‘that tested the hypothesis that etoral engorgement enhances sensation, Increases lubrication, and improves sexval arousal (30) ‘The study included 32 women, 9 premenopausal and 11 postmeno- ‘pausal with complaints of sexual dysfunction, and 10 perimenopausal and 2 postmenopausal without concems about sewal funetion (30), In ‘addition, several participants who reported sexwal dysfunction had Previously tied using 2 vibrator to increase stimulation, but did not ‘experience improvement. The study nurse Instructed the participants on the use of EROS-CTD as well as how to adjust and modulate the vacuum to ‘meet thelr individual requirements. The participants were asked to practice at the examination room for 5-10 min and later were examined by the ‘use. Afterwards, they were insuucted to use the device a thle homes, with or without 2 partner, for si times. They were asked to note any changes in their experience, including orgasm, clitoral engorgement ‘rgastnc pan, and vaginal lubrication As soon a5 they used the EROS-CTD forthe fist three times, they had to complete the Female Intervention Efficacy Index (FIED to assess the efficacy of intervention for Female sexual sdysunction (20). Participants were also instructed to use @ stopwatch to measure the length of me at which discomfort occurred, and to release the vacuum 3t that time, forthe last three sessions, and to record the ties that elapsed IR: Your Sexual Medicine Journal Until they experienced sexual pleasure and orgasm [30]. Upon completion ‘of the so at-home sessions, and within 2 months of Beginning the study, 2 second office visit was required for external genital examination. The research report, after dividing the participants into two groups—those ‘with FSD and those without-—found thet the women experienced changes in sensation, lubrication, orgasm, and sexual satisfaction for each group. ‘Therefore, they concluded that the EROS-CTD was safe and effective in improving the symptoms of FSD. In another study that evaluated the effectiveness of the EROS-CTD, the focus was on improving sexual dysfunction in cervical cancer patients who had undergone Radiation Therapy (RT) [22]. Eighteen patients who had reported senual dysfunction related to arousal and/or orgasm after Undergoing radiotherapy for cervical cancer, participated in this study. ‘The eligible patients had no disease recurrence for at least 1 year and were in stable hetoresewual relationships. Exclusion criteria for the study inclided metastatic disease, severe bowel or bladder complications, significant comorbidities, preexisting female sexual dysfunction, sexual trauma or abuse history, and current antidepressant therapy [32] ‘All pationts completed the Fomale Sexial Function Indox to assoss diferent domains of sexual function such as desie, arousal, bbrication, ‘orgasm, satisfaction and pain, Derogatis Interview for Sexual Functioning, ‘and Dyadic Adjustment Scale to asses relationship quality, and underwent 2 physical exam [32]. The device was the only treatment evaluated Patients were trained to use the device in the clinic and at home and instructed to use it four times weekly for 3 months during partnered sex play and selfstimulation. Patients received telephone calls to assess their progress and returned for a final assessment at 3 months. Thirteen women completed the study, and al patients were able to use the CTD without ‘experiencing discomfort or adverse effects. During the 3-month tral none reported any problems or discomfort at any level of suction or skin ination. The study found that at baseline, the median FSFI domain scores were low, indicating significant sexual dysfunction among patients [32] However, after using the CTD for 3 months, there were statistically Significant improvernents in al six domains tested, including sexual desir, arousal, lubrication, orgasm, sexual satisfaction, and pain. Moreover, the time between RT and starting to use the CTD did not have a significant impact on the Improvement in sexual function observed in the patients who used the device. The study also found that after using the CTD for 3 months, statistically significant improvements were observed in the Sexual Cognition and Fantasy domain, This suggests that the CTD may be ‘fective in Improving sexual function in women who experience sexual dysfunction asa result of cervical cancer treatment. ‘Gynecologic exeminations revealed improved mucosal color and moisture, increased vaginal elasticty, and decreased bleoding and Ulceration, indicating an overall improvement in vaginal health. The ‘conclusion of the study suagests that the CTD may be effective in improving sexual dysfunction in patients who have undergone radiation therapy for cervical cancer [32], However, since this was a pilot study, further research Is needed to confirm these findings, The authors suggest that a randomized controlled trial should be conducted to assess the full benefits of this approach, A suction-based sexual aid device “The Fiera™ Arouser (Nelle, Inc, Mountain View, CA, USA) is a wearable sexual wellness device that enhances arousal and pleasure for women by providing gentie suction with vibration forthe clitoris [51]. can improve blood flow and help women feel aroused even before sexual activity (S- ‘The device is recommended by professionals for arousal and female ‘orgasmic disorder (5. ‘Anomblinded,single-site study was conducted to determine the degree ‘of engorgement produced by a Fiera™ device through temperature ‘measurement ofthe external genitalia. The study also aimed to investigate the onset of sexual arousal and the development of sexual desire during ‘this period [52]. The study was conducted with 14 sexuall-active, premenopausal women with @ mean age of 37.1 years. To be eligible for ‘the study, participants had to have a foal score greater than 265 on the FSFI, which is used to evaluate sexual function in women. Additionally, ‘they had to have been sexually active in the 30 days prior to their enrollment. The study inckded a. single-isit_ procedure. that involved establishing baseline temperature using Fiera™ over the clitoris, ‘and measuring temperature change inthe extemal genitalia (clitoris, labia ‘and vestibule). Participants selfsecorded time to onset of sexual arousal ‘during use of Fie™ and at the end of the procedure. The researchers UIR: Your Sexual Medicine Journal S.Varod and RJ, Herat assessed the development of sexual desire using a Likert scale, Results Showed statistically significant increases in temperature in the eters and vestibule folowing the removal of the Fira™ a all time points (52). The temperature increase of the labia was only significant up to 8min. The study participants reported experiencing sexal arousal during use of Fera™, with an average onset time of 52 42min. After using the product, 43% of the women reported feeling in the mood for sex, wile 50% agreed and 73% somewhat agreed. ‘Smart pelvic floor muscle training device ‘The Elie Trainer (Chiao Technology Lid, London, UK) is a home device designed to measure the force generated by the pelvic floor muscles PFM) jn women to aid in correcting their contraction performance [41]. The dovice i eggshaped with 2 tall covered in medical grade-siicone to ‘enhance fit [53] When inserted into the vagina, the Elve Trainer's body les along the longitudinal axs of the vagina, with the width in the frontal plane of the vagina, and the thiceness of the body lies in the midsagital plone of the vagina. Its tail exts the vagina and curls forward to the pubis (53). it uses Bluetooth low energy to wirelessly communicate with its mobile app and provides realtime biofeedback based on the force generated during PFM contraction, indicating corector incorrect performance [53]. ‘sensor within the device measures PFI contraction by changing electrical resistance as pressure deforms it Ths allows the Elvie Trainer to generate rmevies on PFM force generation and task performance through force ‘measurement, task coding, biofeedback, and data logging. The reliability and validity of force measurement and task dotection by the Ehie Trainer, as well a8 two other similar methods—intravagioal dynamometer (WD) and ultrasound (US) imaging, wore measured In 3 cross-sectional observation study. The study recruited 29 participants from ppovic health physiotherapy clinics, who met the inclusion criteria of at least 3 weeks of previous physiotherapist supervised instruction in PFM ‘exercises, Including home training. The women were instructed to perform two sets of three repetitions of rest, PM maximal voluntary contraction (@’VQ), and maximal Valsalva mancwver (MIVM) tasks in’ supine and standing positions, using both the Elie Trainer and intravaginal dynamometer. ‘The study found that the Eivie Trainer device, MVC force, had excellent within-day and good between-day relabilty, but its measurements were significantly lower compared to the intravaginal dynamometer (ND) ‘measure and had a poor relationship with the IVD force outcome [53]. As 3 ‘esi, they concluded thatthe Elvi Trainer can correct the performance of PEM MVC Its important to note thatthe sample size in ths study was rlatvaly smal, which may limit the generalizability ofthese ndings. Additionally, Is worth mentioning that’ this research was funded by Chlaro Technology Ltd. Vibratory device with smart features ‘The Lioness® vibretor 20 (SmartBod Incorporated DBA Lioness, Oakland CA) [40}, isa alustooth biofeedback vibrator with builtin sensors and an intuitive tracking mobile app that can help detect physiological reactions during women's arousal lovels and orgasm. The vibrators sensors, located fon each side of the device, can detect PFM contractions and coliect Physiological data, such as continuous pressure (in grams force), temperature, accelerometer, and gyroscope measurements at a sampling rate of 12 He [54]. Through Bluetooth technology, the vibrator can connect to a secure Intemet server which translates the information from the vibrator to data to the mobile app. The Lioness® vibrators that generates [physiological data allows women to monitor their pelvic floor movements, Visualize their physiological responses, and track their sexual experiences through visual graphs and tables (401. The Loness® vibrator provides an opportunity to examine women's frgasm patterns in a more ecologically valid environment such as thet home [5d]. In a study conducted with the Lioness® vibrator, the vibrator ha been chown tobe capable of detecting orgasm pattems in women in 3 reliable relatively-controied condition. Fifty-four participants received the LUoness Vibrator 20 version and were instructed to use the vibrator inside the vagina without selestimulation. Researchers requested data outputs for each participant for one controlled condition and several orgasm conditions. When undergoing the orgasm conditions, participants were Instructed to selfstimulate until orgasm occurred and to tum off the vibrator for 2min after the orgasm in order to obtain data on their PEM SPRINGER NATURE contractions. The researchers found that each woman exhibited a different patter of PEM contractions during orgasm. They observed and clasified ‘three types of pelvic floor pattems: (1) a “wave.” characterized by a brief burst of pelvic contractions, folowed by a rhythm of tension and release, (2) a “Volcano,” which occurs when the orgasm is preceded by increasing Upward pelvic floor tension, and (3) an “avalanche,” which occurs when higher pelvic floor basal contractions are maintained throughout so stimulation, yet a downward contraction profile occurs during and after the orgasm (54), The researchers reported that due to the device's good test-retest reliability, is possible to detect differences in orgasm patterns in response to treatment for various sexual disorders such as sexual ‘arousal, desice, and orgasm disorders. tis important to note that this study was funded by industry Advantages and disadvantages of ui sexual dysfunction ‘Tho use of vibrators promotes sexual health i both men and women [43 Vibrators have 8 postive impact on women and men’s sexual function, and ‘are considered as useful tools in treating female and male sexual ‘dysfunction (11, 33). In adltton to the previously mentioned findings ‘women who used vibrators had a higher likelinood of having had a ‘gynecologic exam within the past year and of having performed genital selfexamination within the previous month [11]. t was also shown that ‘among men who have used vibrators, especially those who have recently used them, there Is more participation in sexual health promoting behaviors, including testicular sel-exams {121 Wiile vibrators can enhance sexual function for some women, It Is important to note that not all women are comfortable using them [55] ‘Adaitional, adequate hygiene protocols must be followed when using sx toys to avoid negative impacts on genital health outcomes rebted to ‘wlvovaginal products. Research has found that individuals who shared their Sx toys were more lkaly to report diagnoses of bacterial vaginosis (BV) and ‘andi infections as wel as experiencing atleast one candida infection within the past 6 months [56]. Ris important to note that although most vibrator users id not experience side effects, 2 small percentage reported negative side effets such as genital numbness, pain, of itation (56. ‘Smart sexual devices offer more than vibrations, they come with innovative features that can improve function (53, 5]. For example, the Evie pelvic floor trainer and Lioness vibrator have wireless connectivity to their ‘respective apps and a device biofeedback that helps women understand their physical responses and improve their muscle contrac: tions. With the Elvie Trainer's biofeedback system, women can receive visual feedback on their pelvic loor muscle contractions (411, while the LUoness® vibrator 20's sensors and an intuitive mobile app allows women 1 visualize their physiological reactions during arousal [40]. Overall, these devices offer a ranae of benefits that can helo women better understand ing sex aid devices for sexual experiences. ‘Smart senual devices have many advantages, yet is equally Important to acknowiedge their csadvantages. Privacy breaches may be 3. potential disadvantage of these devices since they collect personal information [57] ‘Once information circulates through networks and applications, it becomes ‘vulnerable to hacking and leakage [571 Data protection has become a critical spect of regulations that gover the collection, storage, and processing of ‘daa by companies that manufacture smart device [571 Various acts, such as ‘the Galfoma Consumer Privacy Act (CCPA) I58] and. the information ‘Commisioners Ofce (CO) in the UK [5], regulate data collection according to each county o stata. Despite these regulations, thore have been incidents (f sensitive information leaks 157]. For example, media reports have Highlighted a data breach in which the sensiive information of usars of 3 smart sex toy was compromised 60). Moreover, there have been instances where sex toy companies have collected user information without their Consent A lawsuit was filed against a company that secretly recorded highly senstve information, including vibration setting, temperature, duration, and frequency, without obtaining the users consent [61]. Remote sexual assault is another rk associated with sex tay devices controlled by apps [2]. When 2 Bluetooth setting s weak, a nearby hacker may hijack the connection and onto the device without the user knowing what has happened. Users may Sssume they have secepted a vibration command from their partner when, F fect the hacker controls the device. DISCUSSION Research on technological sexual aid devices has shown that each device can improve sexual function and dysfunction, such SPRINGER NATURE ‘as PE or DE, as well as women's sexual arousal and female ‘orgasmic disorder [27, 30, 45, 48, 49, 52]. By utilizing biofeed- back or connectivity to apps, these devices can provide physical data to patients and offer several benefits, such as learning about their sexual response cycle, experiencing different sensations, increasing pleasure or arousal, and facilitating the ‘experience or control of orgasm (53, 54]. Women can be helped by the devices as they provide visual charts of their orgasm ‘experience on a mobile app. They also learn how to correct their PFM MVC performance. Nevertheless, there is limited research into the relationship between technological devices and sexual dysfunction. Several studies referred to in this article included a limited number of participants. The effect of sexual function needs to be proven by independent, methodologically sound studies. Several articles presented in this research disclose that the industry sponsored them in their disclaimer [45, 48, 53, 54]. The ability of smart sex aid devices to collect personal data, including users’ personal and sexual information [22, 57] needs to be considered before professionals advise patients to use such devices. With ongoing technological advancements in the sex tech industry, It is crucial for healthcare professionals, including urologists, gynecologists, endocrinologists, sex therapists, and others, to stay informed about the latest developments and research related to treating sexual disorders in both men and women. Keeping up-to-date with these advancements will ensure that patients receive the most effective and appropriate treatments available. ‘CONCLUSIONS Current research has shown that technology and smart devices have the potential to become effective tools in the treatment of various sexual dysfunction in both men and women, but more well designed studies are needed to determine their place and benefits in clinical practice. its also important to note that the above mentioned studies were conducted under the guidance ‘and supervision of healthcare professionals, who frst assess that the patients can fit the treatment and provide explanations ‘about the devices’ use and even exercises for home. It is crucial to remember that individuals with arousal or orgasm disorders may not benefit from smart devices without the help and recommendation of a professional in the field. The combination of both technology and professional guidance may lead to better results, especially after an individual assessment, identi fication of the appropriateness of including such devices in the therapeutic process for the patient, precise instructions, and follow-up meetings. A smart device can be a valuable addition to the treatment of sexual dysfunction, but it is essential that they are used appropriately and under the guidance of a professional DATA AVAILABILITY ‘Allthejouma artes used for this popar were accessed thoush the oie librey of Tel A Univers, fllowing the regulations and guidelines set by the university. Some of he productelated dat used inshs study's avalable on the ficial website and other websites representing these products, These data are freely accesible to anyone REFERENCES 1. 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