Controversies in Sexual Medicine Should Nerve-Sparing Procedures Be Reserved to Men Only? Yoram Vardi, MD,* Andrea Salonia, MD, † Lior Lowenstein, MD, MS, ‡ Elizabeth R. Mueller, MD, MSME, ‡ Annamaria Giraldi, MD, § and Ellen Laan, PhD ¶ *Neuro-Urology Unit, Rambam Medical Center and Technion Faculty of Medicine, Haifa, Israel; † Department of Urology University Vita-Salute San Raffaele, Milan, Italy; ‡ Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Loyola Medical Center, Chicago, IL, USA; § Sexological Clinic, Department of Psychiatry, Rigshospitalets, Copenhagen, Denmark; ¶ Department of Sexology and Psychosomatic Gynecology, Academic Medical Center, University of Amsterdam, The Netherlands DOI: 10.1111/j.1743-6109.2008.00995.x Vardi Y, Salonia A, Lowenstein L, Mueller ER, Giraldi A, and Laan E. Should nerve-sparing procedures be reserved to men only? J Sex Med 2008;5:2259–2263. Key Words. Nerve-sparing; Female Sexual Function; Surgery I n men, especially in prostate cancer surgery, the issue of preservation of erectile function has undergone an incredible revolution over the past 20 years, mainly with advances in nerve-sparing (NS) procedures and minimally invasive tech- niques. NS prostatectomy is a widely performed operation and has become a routine procedure in patients with localized prostatic cancer. Recently, the same principles are applied in cystoprostatec- tomy surgeries with encouraging results [1]. It is logical to speculate that the so-called “nerve- sparing operation” in women who undergo pelvic or genital procedures should have the same atten- tion and concern as in men. The overall number of reports about the postoperative anatomy and pathophysiology of women’s sexual function or dysfunction is increasing, but data are still restricted. Although significant anatomic and embryological parallels exist between men and women, the multifactorial nature of female sexual dysfunction (FSD) is clearly distinct from that of men. From a clinical viewpoint, deficits in genital sensation are probably responsible for some cases of postoperative FSD. This month, controversies in sexual medicine deal with this exciting topic concerning the current or future place of nerve preservation during female pelvic surgeries. Yoram Vardi, MD To preserve or not to preserve the nerves: is that the question? Hopefully it is not. Pelvic NS procedures have become the “to do surgery” for men with pelvic cancers. Prostate cancer patients represent the paradigmatic condi- tion with the peremptory goal of achieving ideal “trifecta” outcomes (namely cancer control, urinary continence, and potency) after any surgical procedure [2]. How do we achieve that? By rigor- ously preserving the neurovascular bundles, thus making sure that the patients receive an NS procedure. Only with such a surgical approach, objectively improved nocturnal erections and phar- maceutically unassisted erectile function will be objectively retrieved after a period of oral com- pounds [3]. However, even more recently, the “male pelvic health” concept created a new attitude toward conceiving surgery: NS is always the best option for preserving men’s integrity; therefore, it is really interesting to read about newly developed procedures within surgical fields previously scarcely debated or not at all. In this scenario, © 2008 International Society for Sexual Medicine J Sex Med 2008;5:2259–2263 2259