bluuebunny/crossref_metadata_2025 huggingface dataset:
Unpacking Altercasting in Role Theory: The Biden Administration's Policy of Altercasting Germany into a Faithful Ally Role in Relations with China
Authors: Oppermann Kai
Published: March 2024

The article contributes to scholarship on symbolic interactionist role theory in Foreign Policy Analysis, focusing on the concept of altercasting. Altercasting refers to verbal and non-verbal state behaviors in a role relationship to cast another state into roles that are complementary to its own roles. The article suggests putting more attention on the agency of the actor “doing” the altercasting to gain a better understanding of how altercasting works. To this purpose, the article develops a framework to unpack the agency of the altercasting actor. The framework addresses the preconditions for actors to engage in altercasting, the interplay of altercasting with domestic politics, and the available altercasting techniques. The article illustrates this framework in a case study on the efforts of the Biden administration to altercast Germany into a “faithful ally” role vis-à-vis China when the new German government transitioned into office in late 2021. Building on evidence from expert interviews among the U.S. foreign policy community, the case study demonstrates that the Biden administration had clear role expectations of Germany and understood the balance of opinion between the German coalition parties. The Biden administration used the altercasting techniques of self-presentation, signaling approval, and disapproval and making direct behavioral demands.
Habitat suitability maps for Australian flora and fauna under CMIP6 climate scenarios
Authors: Archibald Carla L , Summers David M , Graham Erin M , Bryan Brett A
Published: March 2024

Background

Spatial information about the location and suitability of areas for native plant and animal species under different climate futures is an important input to land use and conservation planning and management. Australia, renowned for its abundant species diversity and endemism, often relies on modeled data to assess species distributions due to the country’s vast size and the challenges associated with conducting on-ground surveys on such a large scale. The objective of this article is to develop habitat suitability maps for Australian flora and fauna under different climate futures.

Results

Using MaxEnt, we produced Australia-wide habitat suitability maps under RCP2.6-SSP1, RCP4.5-SSP2, RCP7.0-SSP3, and RCP8.5-SSP5 climate futures for 1,382 terrestrial vertebrates and 9,251 vascular plants vascular plants at 5 km2 for open access. This represents 60% of all Australian mammal species, 77% of amphibian species, 50% of reptile species, 71% of bird species, and 44% of vascular plant species. We also include tabular data, which include summaries of total quality-weighted habitat area of species under different climate scenarios and time periods.

Conclusions

The spatial data supplied can help identify important and sensitive locations for species under various climate futures. Additionally, the supplied tabular data can provide insights into the impacts of climate change on biodiversity in Australia. These habitat suitability maps can be used as input data for landscape and conservation planning or species management, particularly under different climate change scenarios in Australia.
The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya
Authors: Mujwara Deo , Kelvin Elizabeth A , Dahman Bassam , George Gavin , Nixon Daniel , Adera Tilahun , Mwai Eva , Kimmel April D
Published: March 2024

HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared with provider-administered testing only [standard-of-care (SOC)] among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n = 150; SOC arm, n = 155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared with SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$39.28) versus SOC (I$10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.
Complex clinical encounter series: osteoporosis presenting during pregnancy and lactation: wait and reassess
Authors: Kovacs Christopher S
Published: March 2024

Vignette

Two months after her first pregnancy, a 35-yr-old exclusively breastfeeding woman bent to move her baby in the car seat and experienced sudden, severe pain from 5 spontaneous vertebral compression fractures. Genomic screen was negative but she had mild ankylosing spondylitis previously well controlled on etanercept. She was vegetarian with a high phytate intake. A lactation consultant had advised her to pump and discard milk between feeds, leading her to believe she produced twice as much milk as her baby ingested. She presented with a LS Z score of −3.6 and a TH Z score of −1.6. After 6 mo postweaning, she was treated with teriparatide (14 mo intermittently over 18 mo) and ultimately achieved a 50% increase in LS bone density and an 8% increase in TH bone density. Her fragility is explained by normal lactational bone loss amplified by excessive milk production and phytate-induced impairment of intestinal calcium absorption, ankylosing spondylitis, and the bend-and-lift maneuver. The marked increase in bone density resulted from the combined effects of spontaneous recovery and pharmacotherapy. Spontaneous recovery of bone mass and strength should occur during 12 mo after weaning in all women, including those who have fractured.
Pollen diet diversity across bee lineages varies with lifestyle rather than colony size
Authors: Devkota Kedar , dos Santos Charles F , Souza-Santos Patrick D , Ramos Jenifer D , Otesbelgue Alex , Mishra Binayak Prakash , Almeida Eduardo A B , Blochtein Betina
Published: March 2024

The shift to a pollen diet and the evolution of more highly organized societies, i.e., eusocial, were key milestones in bee diversification over their evolutionary history, culminating in a high dependence on feeding broods with a large variety of floral resources. Here, we hypothesized that obligatory eusocial bees have a wider diet diversity than their relatives with solitary lifestyles, and this would be related to colony size. To test both hypotheses, we surveyed diet breadth data (palynological analysis) based on the Shannon–Wiener index (Hʹ) for 85 bee taxa. We also obtained colony size for 47 eusocial bee species. These data were examined using phylogenetic comparative methods. The results support the generalist strategy as a derived trait for the bee taxa evaluated here. The dietary diversity of eusocial bees (Hʹ: 2.1, on average) was 67.5% higher than that of noneusocial bees (Hʹ: 1.21, on average). There was, however, no relationship between diet breadth and colony size, indicating that smaller colonies can harvest a pollen variety as diverse as larger colonies. Taken together, these results provide new insights into the impact of lifestyle on the diversity of collected pollen. Furthermore, this work sheds light on an advantage of living in more highly structured societies irrespective of the size of the colony.
Functional response of Franklinothrips vespiformis (Thysanoptera: Aeolothripidae) to eggs and nymphs of Bemisia tabaci (Hemiptera: Aleyrodidae)
Authors: Schoeller Erich N , Hogan Joshua , McKenzie Cindy L , Osborne Lance S
Published: March 2024

The Middle East Asia Minor 1 biotype of Bemisia tabaci Gennadius (Hemiptera: Aleyrodidae) is a greenhouse and field crop pest of global significance. The objective of this study was to assess the potential of the generalist predatory thrips, Franklinothrips vespiformis Crawford (Thysanoptera: Aeolothripidae), as a biological control agent for B. tabaci. This was achieved by determining the functional responses of F. vespiformis larvae and adults to the egg and nymphal stages of B. tabaci under laboratory conditions. Analyses consisted of 10 replicates of each predator and prey stage combination on bean leaf discs for a 24-h period. Following logistic regression analyses to determine the functional response type exhibited, response parameters were estimated with nonlinear least squares regression using Roger’s equation. Results showed that F. vespiformis larvae and adults exhibited a Type II functional response when feeding on immature B. tabaci. The handling times (Th) of F. vespiformis larvae and adults were magnitudes higher for B. tabaci nymphs than they were for eggs, which were in part driven by the higher attack rates (a) observed on eggs. The maximum attack rate (T/Th) for B. tabaci eggs and nymphs exhibited by first-stage larvae, second-stage larvae, and adult F. vespiformis increased with increasing predator age. Results from this study suggest that F. vespiformis larvae and particularly adults are promising biological control agents for B. tabaci and are efficient predators at both low and high prey densities.
Two new species of brush-tailed mouse, genus Calomyscus (Rodentia: Calomyscidae), from the Iranian Plateau
Authors: Rezazadeh Elham , Zali Hessamodin , Ahmadzadeh Faraham , Siahsarvie Roohollah , Kilpatrick C William , Norris Ryan W , Aliabadian Mansour
Published: March 2024

The monogeneric family Calomyscidae includes the brush-tailed mice, genus Calomyscus, which have a Palearctic distribution ranging from the Hindu Kush Mountains in western Pakistan to the eastern Mediterranean region. Zagros Mountains—stretching from northwest to south of Iran—was assumed for long as the range of a single species, Calomyscus bailwardi; however, recent studies revealed considerable heterogeneities among the geographical populations presumably referring to the persistence of undescribed diversity. One such group from the western Zagros Mountains has recently been recognized as C. behzadi Akbarirad, Dezhman, Aliabadian, Siahsarvie, Shafaeipour, and Mirshamsi, 2021. Using molecular, morphometric, geometric morphometric, and karyotypic data, we examine the divergence of 2 additional groups from western Iran and name these as new species. The first of these species is distributed in the northern Zagros and western Alborz Mountains in northwestern Iran was recovered as the sister species to C. urartensis from the South Caucuses. The second species from a single locality in the central Zagros Mountains was clustered closely with C. grandis from the western Alborz Mountains. Morphologic analyses, karyological features, and genetic distances disentangled these 2 new species from their sister species.
(019) Penile Augmentation by Division of the Suspensory Ligament of the Penis and Autologous Fat Injection
Authors: Abdel Raheem A , Fathy Soliman I , Hafez K
Published: March 2024

Introduction

Penile size dissatisfaction is a problem which is more prevalent than what is perceived, it is not taken seriously by healthcare professionals. It is reported that 45% of men are unhappy with their penile size. Most men are too ashamed to seek professional help so they go to online sites that promote fake pills, creams, lotions, or try to solve the problem themselves (DIY Penile enlargement) which causes significant complications or undergo high risk procedures without proper counselling.

Objective

The aim of this study was to evaluate the outcome of penile augmentation surgery by division of the suspensory ligament of the penis with insertion of silicon buffer for flaccid length enhancement plus liposuction and autologous fat injection for penile girth enhancement.

Methods

A retrospective audit of patient outcomes after surgical Penile Augmentation (PA) at one centre, over a 5.5 year period. 560 patients had division of the suspensory ligament of the penis with insertion of silicon buffer with liposuction and autologous fat injection. The following data was collected: - Pre and post-operative flaccid penile length and girth. - Patient reported satisfaction rates. - Complications.

Results

560 patients were included in this study, the mean patient age was 38 (24–72). The Mean follow up duration was 6 (3-12) months. The mean increase in flaccid length was 3.8 (1.5-6) cm. The mean increase in girth was 4.2 (2.5-5.5) cm. The patient reported satisfaction rates were 85%. No serious adverse events were encountered; the following complications were recorded: partial fat absorption occurred in 120 patients (21.4%) and was managed by fat top up. Phimosis occurred in 20 patients (3.5%) and was manged conservatively in all but 2 patients who required a circumcision, hard fat lumps occurred 30 patients (5.3%) and was managed by in office needling. Migration of fat in the scrotum occurred in 40 patients (7.1%) and was managed conservatively in all but 5 patients who required surgical removal of the fat lumps, infection of the silicon buffer occurred in 6 patients (1.07%) and was managed by removal of the silicon buffer, discomfort from the silicon buffer occurred in 5 patients (0.89%) and was managed by removal of the silicon buffer.

Conclusions

Penile enlargement by division of the penile suspensory ligament and injection of autologous fat is a safe and effective procedure which is associated with high patient-satisfaction rates.

Disclosure

No.
(027) The Prevalence of Female Sexual Dysfunction in Patients with Irritable Bowel Syndrome (IBS)
Authors: Abdoly M , Esmaeeli B
Published: March 2024

Introduction

Irritable bowel syndrome is a functional disorder in the digestive system that is defined by specific intestinal-gastric symptoms. A combination of psychological and organic causes are involved in its creation and continuation. A wide range of psychological disorders and personality traits have been reported in patients with irritable bowel syndrome; But one of the consequences and complications of this syndrome can be the effect on sexual performance.

Objective

In this study, the frequency of each of women's sexual dysfunction, including hypo active sexual desire and arousal disorder, orgasm dysfunction and pain during sex, and the level of satisfaction in sex were compared with the control group. The relationship between the severity of each of these sexual disorders and the severity of symptoms of irritable bowel syndrome has been investigated.

Methods

In this study 300 patients with irritable bowel syndrome presentation has compared with control group by using FSFI (Female Sexual Function-Index) standard questionnaire which its validity and reliability were assessed and demographic questionnaire.

Results

Examining the dimensions of sexual desire in two groups showed that the frequency and intensity of sexual stimulation and satisfaction with it in women with irritable bowel syndrome is significantly lower than the control group. The number of orgasms and intensity of orgasm experienced and satisfaction with it in women with irritable bowel syndrome is significantly lower than in the control group. Examining the dimensions of sexual satisfaction in two groups showed that the level of closeness with a sexual partner in women with irritable bowel syndrome is significantly lower than in the control group. Based on the results, there is a significant relationship between the score of sexual pleasure and sexual satisfaction and the severity of irritable bowel syndrome symptoms.

Conclusions

The results of this research showed that symptoms of irritable bowel syndrome can have significant effects on sexual performance and relationship satisfaction in women. Since women are exposed to more psychological stressors compared to men, and on the other hand, psychological factors can aggravate the symptoms of irritable bowel syndrome, the doctor's attention to sexual problems in women can improve the health and quality of life of affected patients.

Disclosure

No.
(065) A Randomized, Single-Dose, Bioavailability and Safety Study on Novel SDS-089 Nasal Vardenafil 4mg Spray Solution in Comparison to Oral Vardenafil Tablet 10 mg in Healthy Volunteers
Authors: Professor E , Zanardo D , Rodne L , White S
Published: March 2024

Introduction

Oral phosphodiesterase type 5 inhibitor (PDE5i) is recognized as an effective first-line medical therapy for males with erectile dysfunction. However, oral PDE5i drug adherence and satisfaction rates were not high due to the need for oral ingestion, lack of sexual spontaneity, and delay in time to clinical effect. Hence, a nasal delivery of PDE5i drug may circumvent these limitations.

Objective

To assess the bioavailability and safety profile of SDS-089 nasal Vardenafil spray compared to oral Vardenafil 10mg tablet.

Methods

Following approval from Institutional Review Board and Biosafety Committee (FB18/IRB/099), 13 subjects out of the 32 healthy volunteers met the study criteria and were randomized to receive SDS-089 nasal Vardenafil spray (4 mg) or oral Vardenafil tablet (10 mg). The vardenafil HCl formulation SDS-089 was prepared with the active pharmaceutical ingredient meeting the United States Pharmacopeia (USP) standard (batch 1704002361). Blood tests were conducted on the subjects to evaluate Vardenafil drug bioavailability and treatment-related adverse events (TRAEs) data was collected.

Results

All 13 subjects completed the study. Based on the drug pharmacokinetics data, SDS-089 nasal spray was shown to have a faster onset and achieve optimal dose with a lower amount of drug compared to oral formulation. Of the 42 recorded TRAEs, 33 TRAEs were associated with the nasal spray, and 9 TRAEs were related to oral drugs. Transient headache is the most common TRAE in the nasal group and was very tolerable. The reported headaches showed no relationship with Cmax (peak concentration) and AUC0-inf (the total drug exposure across time) based on the Vardenafil drug levels.

Conclusions

SDS-089 nasal spray formulation Vardenafil HCl at 4 mg successfully achieved a similar Cmax with that of oral Vardenafil 10 mg tablet, and while it appeared to have more TRAEs, these were transient and well-tolerated by the subjects.

Disclosure

Yes, this is sponsored by industry/sponsor: LTR Pharma.

Clarification: Industry funding only - investigator initiated and executed study.
(106) Stem Cell Therapy Leads to an Increase in Testosterone Levels in Infertile Men
Authors: Popova A , Shatylko T , Gamidov S , Silachev D , Sukhikh G
Published: March 2024

Introduction

Sexual dysfunction is frequently encountered in infertile males. This may be related to psychosexual aspects of infertility and to some common factors of pathogenesis, such as hypogonadism. For example, many patients with non-obstructive azoospermia (NOA) have low testosterone levels, which may lead to low sex drive, erectile dysfunction and metabolic abnormalities later in life. Patients with NOA typically undergo surgical sperm retrieval procedures, which may lead to further decrease in androgen production, which may be transient or even permanent in some cases. Stem cell therapy is an investigative mode of treatment for patients with NOA, but its influence on Leydig cell function is currently unknown.

Objective

To assess the impact of stem cell therapy on testosterone levels in men.

Methods

Sixty patients with NOA were included in this study. All of them underwent unsuccessful MicroTESE more than 12 months prior to the inclusion in order to justify the use of stem cell therapy. Multipotent mesenchymal stromal cells (MMSC) were derived from healthy donor placenta following physiologic childbirth. MMSC product was used for systemic and local treatment via intravenous and intratesticular injection, respectively. Endocrine profiling was performed at baseline and 3 months after the procedure.

Results

Median testosterone level prior to MMSC therapy was 8.7 nmol/l (interquartile range [IQR]: 4.2–12.1), and 3 months after it was 12.3 nmol/l (IQR: 8.8–16.3) (p < 0.00001). This may be related to an increase in luteinizing hormone levels from 6.4 mIU/ml at baseline (IQR: 3.6–11.3) to 9.6 mIU/ml (IQR: 5.2–14.1) (p = 0.00026). Paradoxically, follicle-stimulating hormone levels declined from 12.5 mIU/ml (IQR: 4.7–24.7) to 7.4 mIU/ml (IQR: 4.2–12.3) (p < 0.00001). Prior to MMSC therapy 43 patients (71.7%) had testosterone levels lower than 12 nmol/l, after MMSC therapy 24 patients (40%) had testosterone levels lower than this threshold. Thirty patients (50%) and 14 patients (23.3%) had testosterone level below 8 nmol/l before and after MMSC therapy respectively.

Conclusions

MMSC therapy may increase testosterone levels in patients with NOA, though the exact mechanisms and its possible impact on quality of life should be elucidated.

Disclosure

No.
(132) Vertical Fracture of the Penis: A Rare Entity
Authors: Deshpande A , Gupte D
Published: March 2024

Introduction

Penile fracture is not an uncommon occurrence. It is a serious injury involving the rupture of the tunica albuginea in the erect state of the penis. While most cases are transverse fractures occurring during coitus, we present a rare case of a “vertical” penile fracture, the second reported in English literature.

Objective

To document a rare case of penile fracture i.e. a vertical penile fracture and its management.

Methods

A 33-year-old man presented to the emergency room of the hospital past midnight. He experienced sharp excruciating pain while attempting to penetrate vagina in a rear entry position. He gave a history of popping sound followed by detumescence, and increasing swelling of penis with discoloration and curvature. The pain continued though reduced in severity over time. The patient was evaluated under the guidance of consultant urologist (Author 2). Magnetic resonance imaging reported suspected vertical tear in tunica albugenia and also suspected urethral injury.

Results

Emergency surgery revealed a vertical long tunica albugenia tear along with corpora spongiosal tear and intact urethral mucosa. The tunica albugenia tear was primarily repaired. Good erectile function was reported by the patient, and normal sexual activity resumed after 6 weeks.

Conclusions

This case report emphasizes the need for clinicians to be aware of and consider this uncommon entity, “Vertical Tunica Albugenia tear” while managing penile fractures. The utilization of MRI imaging of the penis can provide valuable insights into the pattern and extent of the injury, aiding in appropriate management decision. Surgical intervention within 6–8 hours of the injury offers excellent result and preserves sexual function without complications.

Disclosure

No.
(153) Laparoscopic Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Penile Length Preservation After 10 years Follow Up
Authors: Mondaini N
Published: March 2024

Introduction

The preservation of the full dimensions of the penis is an important consideration for improving patients' compliance for the treatment after prostatectomy. We performed twenty laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) in order to preserve the full length of the penis and to improve patients' satisfaction in 2013.

Objective

Objective of the study is to evaluate the ten years follow up of this unique series in the world. Oncological and functional results were analyzed.

Methods

From June 2013 to June 2014, 20 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis) and RP laparoscopic. Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each 1 year thereafter. The main outcome measures were biochemical recurrence-free rate, penile length, and quality of life.

Results

15 patients mean age 71 range 66–75 were reached at the 10-year follow-up-1 died of acute infarction 10 years after surgery, 1 died of disease 7 years after surgery; 3 lost to followup. Partners had mean age 60 with range 37–71 years. Mean preoperative PSA 9.3 (6.3–13.7) at 10 years 0.08 (range 0.01–1.2); Pre-surgical IIEF 11 (range 9–14) to 10 years 23 (range 22–25). 10-year partner satisfaction rating had increased from 8 post-surgical to 7. Penis size unchanged after 10 years: surgery day 9 cm (range: 8.5–9.5) at 10 years 8.8 range (8–9.5).

Conclusions

In our cases, the simultaneous extraperitoneal laparoscopic surgery of radical prostatectomy and penile prosthesis implantation is an interesting option to offer to selected and highly motivated patients. Preservation of the size of the penis, the possibility of resuming normal sexual activity 21 days after surgery, partner satisfaction and oncological safety with a 10-year follow-up make it a surgical technique to be proposed in clinical practice if performed by a team with experience in prosthetic surgery.

Disclosure

No.
(179) Sexual Dysfunctions in Infertile Tunisian Women
Authors: Souayeh N , Bettaieb H , Rouis H , Mbarki C , Hsayaoui N
Published: March 2024

Introduction

Once perceived as a source of pleasure and enjoyment, sexuality has evolved for infertile couples, focusing primarily on a purely procreative objective. Infertility has a direct impact on a woman's sex life, calling into question her femininity and causing significant alterations in the components of her sexual response.

Objective

The aims of our study were to assess the frequency of sexual dysfunction in Tunisian women facing infertility and to identify the aspects of their sexuality most affected.

Methods

This was a prospective, cross-sectional, and descriptive study, including a sample of 200 Tunisian infertile women, followed up in a Tunisian Assisted reproduction center over a three-month period, from November 24, 2022 to February 24, 2023. To assess the different dimensions of sexuality in infertile women, we used the Arabic version of the FSFI (female sexual function index)

Results

The mean age of our women was 30 ± 4 years. The majority had a university educational level (80%), an urban origin (87%), an average socio-economic level (63%), and no medical or gynecological surgery history (62%). Most partners (67%) had no sexual dysfunction (SD). The most frequent male SD was premature ejaculation, observed in 14% of cases. As regards the etiology of infertility, most cases were classified as unexplained (28%), while the remainder were linked to female causes, dominated by PCOS (40%). The majority of women had initially discussed the subject of sexuality (72%) with their partners. In our sample, the mean FSFI score was 20.74, with extremes ranging from 2 to 35.4. The prevalence of female sexual dysfunction (FSD) was 82%. The areas most affected were sexual satisfaction (50%), reaching orgasm (45%), as well as lubrication (44%) and arousal (44%). Lower educational level, secondary infertility, contraceptive use, and a long history of fertility treatment as well as the presence of sexual dysfunction in the male partner, were found to be associated with sexual dysfunction in women suffering from infertility, yet no significant correlation was established.

Conclusions

Infertility is associated with high rates of sexual dysfunction. Thorough counseling and continuing support of infertile women is therefore indicated.

Disclosure

No.
(214) Urethral and Vaginal Injuries Caused by Insertion of Foreign Objects for Sexual Stimulation: A Literature Review of Sexual Emergencies in Males and Females
Authors: Usuga D , Cuascud T , Dominguez-Bali A
Published: March 2024

Introduction

Foreign body genital tract injuries involve injuries to the male or female reproductive organs, including the vagina and urethra, often requiring urgent care from medical professionals. These injuries are associated with autoerotic stimulation, psychiatric disorders, curiosity, self-harm, or lack of knowledge of safe sexual practices. Early diagnosis and management in the emergency department (ED) are crucial to prevent irreversible damage and potential life-threatening complications. This review aims to comprehensively examine sexual emergencies caused by foreign body genital tract injuries, specifically focusing on vaginal and urethral injuries, while also highlighting common complications and contributing factors.

Objective

1. Provide a comprehensive review of foreign body genital tract injuries presenting in ED's at national and international levels. 2. Highlight ED management and common complications associated with these emergencies. 3. Improve medical management, enhance understanding of causative factors, and promote patient education to prevent recurrence.

Methods

A literature review was conducted using PubMed and Google Scholar databases. Search terms included "foreign body," "sexual," "masturbation," "vagina," and "urethra." Out of 53 articles published between 1985–2023, 16 met the inclusion criteria for analysis, focusing on injuries involving the urethra or vagina and autoeroticism.

Results

The review included 141 cases of genital injuries caused by foreign body insertion during sexual activities. Males accounted for 128 cases, females for 12, and one was a transgender female. Various foreign bodies, such as silverware, glass, batteries, rings, tubes, and beads, were found to have caused injuries and complications. Surgical management was indicated in 19 cases, non-surgical management in 7, while the approach in 115 cases remained unknown.

Conclusions

The literature review serves as a crucial reminder of the potential dangers of foreign body insertion during sexual activities. It calls for increased awareness, improved clinical recognition, and better patient education to safeguard individuals from these preventable injuries. By understanding and addressing this issue, healthcare professionals and the broader community can work together to reduce the incidence of genital injuries related to foreign body insertion and enhance overall patient safety and well-being.

Disclosure

No.
(217) Report of Surgical Treatment Using Allogenic Dermal Graft Penoplasty to Treat Premature Ejaculation
Authors: Jang S
Published: March 2024

Introduction

Premature ejaculation is the major factor that causes low satisfaction of sexual intercourse. Ejaculation time is determined by various factors including such as psychological, habitual and physical factors, sensitive penile shaft and glans.

Objective

This study aimed to report the effectiveness and the safety of newly adopted surgical treatment using allogenic dermal graft.

Methods

We had performed Dermal graft surgery for treating premature ejaculation in 56 men who have short time ejaculatory problems within 5 minutes on average. We adopted a pre-pubic minimal incision and dissected penile shaft and pre-pubic space. Inserted graft materials were Allograft dermis which were fixed at the Buck's fascia. Glans sulcus was dissected from 8 o’clock to 4 o’clock and the thin strip shaped graft was fixed at the dissected space of glans sulcus. Vibratory sense of glans and penile shaft was estimated by biothesiometry and ejaculatory time was surveyed at both preoperative and postoperative status (5month~18month).

Results

48 patients answered that their ejaculatory time was considerably delayed. And 7 patients slightly delayed. Among them, 1 man answered that there was no surgical effects despite of slightly being reduced penis sense. Following being asked raising their frequency of sexual intercourse, 1 man with no surgical effect was considerably improved in delaying the ejaculatory time. Among 136 cases, the inflammation on wound site occurred in 2 patients fully recovered in 2 weeks. No other complication occurred.

Conclusions

The surgical treatment using allogenic dermal graft is very effective in treating premature ejaculation. And this surgical procedure is very safe without no series complication.

Disclosure

No.
(227) Vaginismus - Current State of Knowledge
Authors: Laskowska A , Gronowski P
Published: March 2024

Introduction

Vaginismus is defined as a penetration disorder in which any form of vaginal penetration is often painful or impossible. It has traditionally been referred to as an involuntary contraction of the pelvic floor muscles due to actual or anticipated pain associated with vaginal penetration. Vaginismus is predominantly unknown among clinicians and women. Vaginismus causes women to feel pain, fear and anxiety with penetration attempts. It is a poorly understood and underdiagnosed condition, for which many women do not gain support. This is due to the lack of knowledge of the condition, for the shame and embarrassment felt by vaginismus sufferers which means many do not discuss the issue.

Objective

Vaginismus is commonly experienced medical issue, affecting about 1–7% of the female population worldwide. Female pain is often viewed not as a medical fact, but as a misimpression or misinterpretation of bodily events. Vaginismus is not the only condition that has been placed in context of neglect. Other sexual pain disorders, such as vestibulodynia, vulvodynia and dyspareunia, have also been met with doubt and disbelief. An examination of the disbelief surrounding female reportage of their own bodily events will not only be beneficial in terms of perception of vaginismus, but also for general women’s health.

Methods

This systematic review will provide an assessment of the current state of vaginismus. The following databases has been searched from the study inception to July 2023: the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, MEDLINE, Embase, Scopus, Web Of Science, ProQuest, ScienceDirect, UpToDate, Polish Medical Bibliography and consultations of Polish specialists and discussion forums of patients have been used.

Results

Vaginismus influences the quality of life, in the most serious form it can result in unconsumated marriage, sterility and thus can lead to the separation of a couple. When adequately approached, the problem can mostly be solved. Treatment often involves multimodal approaches such as education, medication, cognitive behavioral therapy, physical therapy and possibly surgery.

Conclusions

Vaginismus is a common and significant sexual problem that causes distress and frustration for both partners. There are women for whom vaginismus is a serious problem and who are not able to cope with the situation without professional help of specialists. Deepening the specialists knowledge in this field is essential for successful treatment. Vaginismus is a well recognized clinical condition associated with non-consummation and considerable distress in women. It has received little scientific attention, and further well designed studies are needed.

Disclosure

No.
(229) Late Life Male Virgins: Exploring the Psycho-Social-Sexual Consequences of Sexual Inexperience in Cisgender American Males Seeking Sex Therapy
Authors: Cuascud T
Published: March 2024

Introduction

Reports on past studies about male sexuality, as it compares to women’s, indicate that men have higher sex drives, more positive attitudes toward casual or uncommitted sexual encounters, being more eager to engage in a variety of sexual activities, having more positive emotional responses to intercourse and having higher value regarding sexual experience and activity than women. Although the literature and cultural norms have perpetuated the myth of the sexual male, there is a dearth of literature regarding male virginity, specifically, late life male virginity, and its impacts on psycho-social-sexual health.

Objective

To investigate the experiences of later in life male virgins and the effects of their sexual status on their psycho-social-sexual health. To provide new insight into late life male virgins' assumptions, feelings, and gender role expectations and their perceptions on how those impact their attainability of sexual interactions and romantic relationships. To increase awareness among clinicians regarding the need for targeted interventions for late life male virgins in clinical practice.

Methods

This exploratory qualitative research was based on the case studies of five cisgender heterosexual men in the United States of America, who were late life virgins at the time of the study (defined as men 45 years and older, with no previous sexual experiences or interactions with the opposite sex) who sought Sex Therapy and Surrogate Partner Therapy to assist in their objective to acquire social and sexual skills with the goal of having their sexual debut.

Results

The common themes that stemmed from the case studies revealed that: 1) although the men in the study were able to achieve academic and professional status, they felt flawed and out of the norm due to their virginity status; 2) all the men hid their sexual inexperience from peers and family due to shame and fear of negative consequences to their reputation and even professional loss; and 3) made evident the challenges these men face while navigating social and sexual experiences later in life; 4) underscored the damaging effects of myths, stereotypes and societal expectations around male sexuality; and 5) highlighted the lack of information, education and therapeutic tools that could help guide late life male virgins in their pursuit to exercise their sexuality.

Conclusions

The study provides a greater understanding of the challenges and issues late life male virgins face in their quest to reach their sexual debut and live satisfactory sex lives that meet their particular needs. The themes offer guidance for the development and implementation of sex therapy interventions that will help this specific cohort, as well as directions for future research.

Disclosure

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(244) Optimization of Sperm Retrieval in Non-Obstructive Azoospermic Patients using Conventional TESE
Authors: Abdel-Fattah M , Alzahrani T , Abdel-Fatah M , Aljohani M , Abolhasan A , Eltholoth H , Amer A
Published: March 2024

Introduction

Sperm retrieval in NOA patients remain to be the only hope for these patients for fatherhood using assisted reproductive techniques. Micro-TESE is the gold standard with the best retrieval rate. Microsurgical facilities are not available at every center and conventional TESE techniques are not standardized between different centers.

Objective

Our aim is To improve the spermatogenic function of NOA patients to enable the appearance of sperm in their ejaculate or to improve the chances of a successful retrieval from the testis for ICSI and To optimize and standardize our conventional TESE technique

Methods

Over last 7 years 94 cases of NOA patients were subjected to conventional TESE. We Exclude the cases of Obstructive Azoospermia, Cases with abnormal chromosomal analysis were referred for higher center for genetic counselling and diagnosis. Laboratory workup including at least two semen samples, hormonal valuation (FSH, LH, Prolactin, Testosterone) and chromosomal analysis (Karyotyping and Testing for Y chromosome micro-deletions. Pre-TESE medical Treatment: included Clomiphene citrate: 50 mg OD for 3–6 months, Anti-oxidant therapy (Vitamin E 200mg BID and Vitamin C, 1 gm, OD). 6 biopsies from each testis: upper pole 2(medial &Lateral), mid zone 2 (medial & Lateral), lower pole 2(medial &Lateral). Separate biopsy from each testis was sent for definitive histopathological correlation. Experienced embryologist attends each procedure examining each biopsy until sperms are retrieved. Samples taken were centrifuged and re-examined at lab for any missed sperm

Results

sperm retrieval was successful in 38patients (40.4%). All cases were done as day case No single case of wound infection or intra-testicular hematoma.Post-operative pain was tolerable and managed by paracetamol ±NSAID Negative cases for sperms were continued on higher dose of CC and referred for microTESE

Conclusions

Though of low-evidence, empiric Pre-TESE enhancement of spermatogenesis should be attempted whenever possible and after proper patients counselling. This systematic anatomical approach for biopsies yielded high SRR compared to other conventional TESE. Exact localization of + ve testicular site and side If patient needed Re-do TESE for more sperms in the future. Although micro TESE remains to be the best modality for SR in NOA, in our hands and in canters without Micro-TESE facilities, applying this standardized technique with pre-operative hormonal manipulation yields accepted rate of sperm retrieval

Disclosure

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(285) Heme-Binding Protein 1 Delivered via Pericyte-Derived Extracellular Vesicles Improves Neurovascular Regeneration in a Mouse Model of Cavernous Nerve Injury
Authors: Yin G , Ock J , Limanjaya A , Kwon M , Suh J , Ryu J
Published: March 2024

Introduction

As a peripheral nerve injury disease, cavernous nerve injury (CNI) caused by prostate cancer surgery and other pelvic surgery causes organic damage to cavernous blood vessels and nerves, thereby significantly attenuating the response to phosphodiesterase-5 inhibitors.

Objective

Here, we investigated the role of heme-binding protein 1 (Hebp1) in erectile function using a mouse model of bilateral CNI, which is known to promote angiogenesis and improve erection in diabetic mice.

Methods

To investigate the efficacy and mechanism of Hebp1 in restoring erectile function in CNI-induced ED mice, we injected recombinant mouse Hebp1 protein into the penis of CNI-induced ED mice. Detailed mechanisms were assessed using Signaling Explorer Antibody Arrays on penile tissue from CNI-induced ED mice; MPG tissue and Schwann cells were cultured in the presence of 2.5 μg/ml LPS.

Results

We found a potent neurovascular regenerative effect of Hebp1 in CNI mice, demonstrating that exogenously delivered Hebp1 improved erectile function by promoting the survival of cavernous endothelial-mural cells and neurons. We further found that endogenous Hebp1 delivered by mouse cavernous pericyte (MCP)-derived extracellular vesicles promoted neurovascular regeneration in CNI mice. Moreover, Hebp1 achieved these effects by reducing vascular permeability through regulation of claudin family proteins.

Conclusions

Our findings provide new insights into Hebp1 as a neurovascular regeneration factor and demonstrate its potential therapeutic application to various peripheral nerve injuries.

Disclosure

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Characteristics of systemic testosterone therapy for female hypoactive sexual desire disorder—a claims database analysis
Authors: Agrawal Pranjal , Lee Yeonsoo Sara , Grutman Aurora J , Dumas Kathryn , Kohn Taylor , Kohn Jaden , Yee Alyssa M , Clifton Marisa
Published: March 2024

Background

Testosterone therapy (TTh) is recommended for postmenopausal women with hypoactive sexual desire disorder (HSDD); however, there remain insufficient data to support use of TTh in premenopausal women with sexual dysfunction.

Aim

In this study, we used a large national database to evaluate prescribing trends of TTh for women with HSDD.

Methods

We conducted a cohort analysis of information from electronic health records acquired from the data network TriNetX Diamond. The study cohort consisted of women 18-70 years of age with a diagnosis of HSDD. We analyzed trends of testosterone prescriptions, routes of testosterone administration, and coadministration of testosterone with estrogen.

Outcomes

Despite an increase in rates of testosterone prescriptions for HSDD, there remains a high degree of variability in the duration of treatment, route of administration, and coadministration of estrogen with significant underprescription of testosterone.

Results

Our query of the TriNetX database led to the identification of 33 418 women diagnosed with HSDD at a mean age of 44.2 ± 10.8 years, among whom 850 (2.54%) women received a testosterone prescription. The testosterone prescriptions were highly variable with regard to duration and route of administration and coadministration with estrogen. For all patients until 2015, the prevalence of testosterone prescriptions for HSDD showed a positive quadratic relation was observed. Since 2015 a linear increase in prevalence was observed, with the highest rate of increase for patients aged 41-55 years.

Clinical Implications

The findings of this study reveal a significant need for further research investigating the optimal use of TTh to enhance the sexual health of women with HSDD, and further studies on the long-term effects of testosterone use must be undertaken to ensure that patients have access to safe and effective treatment.

Strengths and Limitations

Limitations to this study include patient de-identification and lack of availability of testosterone dosage data. However, this study also has many strengths, including being the first, to our knowledge, to characterize the prescribing trends of testosterone for women with HSDD.

Conclusion

Testosterone therapy should be considered as a potential therapy for premenopausal female patients with HSDD. Further studies on the long-term effects of testosterone use must be undertaken to address disparities in the management of HSDD and to ensure patients can access treatment.