bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pathways to Prevention program: nutrition as prevention for improved cancer outcomes
Authors: Hiatt Robert A , Clayton Margaret F , Collins Karen K , Gold Heather T , Laiyemo Adeyinka O , Truesdale Kimberly Parker , Ritzwoller Debra P
Published: May 2023

Adequate nutrition is central to well-being and health and can enhance recovery during illness. Although it is well known that malnutrition, both undernutrition and overnutrition, poses an added challenge for patients with cancer diagnoses, it remains unclear when and how to intervene and if such nutritional interventions improve clinical outcomes. In July 2022, the National Institutes of Health convened a workshop to examine key questions, identify related knowledge gaps, and provide recommendations to advance understanding about the effects of nutritional interventions. Evidence presented at the workshop found substantial heterogeneity among published randomized clinical trials, with a majority rated as low quality and yielding mostly inconsistent results. Other research cited trials in limited populations that showed potential for nutritional interventions to reduce the adverse effects associated with malnutrition in people with cancer. After review of the relevant literature and expert presentations, an independent expert panel recommends baseline screening for malnutrition risk using a validated instrument following cancer diagnosis and repeated screening during and after treatment to monitor nutritional well-being. Those at risk of malnutrition should be referred to registered dietitians for more in-depth nutritional assessment and intervention. The panel emphasizes the need for further rigorous, well-defined nutritional intervention studies to evaluate the effects on symptoms and cancer-specific outcomes as well as effects of intentional weight loss before or during treatment in people with overweight or obesity. Finally, although data on intervention effectiveness are needed first, robust data collection during trials is recommended to assess cost-effectiveness and inform coverage and implementation decisions.
(016) Pharmacological Treatment of Men with Compulsive Sexual Behaviour Disorder - Randomized, Double-blind, Placebo-controlled Trial of Paroxetine and Naltrexone
Authors: Lew-Starowicz M , Draps M , Kowalewska E , Obarska K , Kraus S , Gola M
Published: May 2023

Introduction

Psychotherapy is considered as first-line therapy for compulsive sexual behaviour disorder (CSBD). “Off-label” use of selective serotonin reuptake inhibitors and opioid antagonists was reported as effective but the evidence-based data on pharmacological interventions remains very scarce.

Objective

The purpose of the study was to compare safety and efficacy of naltrexone and paroxetine in the treatment of CSBD.

Methods

Double-blind, randomized study comparing naltrexone, paroxetine and placebo was performed in a group of 73 treatment-seeking, heterosexual males meeting the ICD-11 criteria of CSBD. During 5 months treatment, the safety and efficacy of the medication was assessed by clinical examinations and clinical scales including Sexual Addiction Screening Test (SAST), Hypersexual Behavior Inventory (HBI), the Brief Pornography Screen (BPS), as well as in the Ecological Momentary Assessment.

Results

Symptoms of CSBD significantly improved in all three treatment arms but receiving active treatment was related to better satisfaction with the therapy and self-reported decrease of problematic sexual behavior. Sexual and porn craving decrease was pronounced the most in the paroxetine group. Adverse effects were relatively seldom and mild. All-cause discontinuation rate was 15.1%.

Conclusions

The study has shown that paroxetine and naltrexone represent safe treatment options for CSBD male patients. However, due to mixed results, their clinical efficacy should be confirmed in future trials that should also include women and non-heterosexual groups of patients.

Disclosure

No
(021) Sexual Function in Patients with Major Depressive Disorder before and after Treatment with Selective Serotonin Reuptake Inhibitor (SSRI)
Authors: Weber S , Weber S K , Frøkjær V G , Armand S , Nielsen J , Knudsen G M , Jørgensen M B , Stenbæk D S , Giraldi A
Published: May 2023

Introduction

Major Depressive Disorder (MDD) is closely associated with sexual dysfunction, which may worsen during treatment with SSRIs due to side-effects of pharmacological treatment. This can potentially aggravate the depressed state or result in non-compliance with the treatment. Currently, little is known about the interplay between effects of SSRI treatment, patient characteristics and sexual function.

Objective

To examine the association between sexual function and the severity of MDD in drug-naïve patients compared to healthy controls and how treatment with SSRIs affects sexual function over time in individuals with MDD. Interaction with gender and treatment response was examined.

Methods

In 92 patients with MDD, we measured MDD severity with Hamilton Depression Rating Scale (HDRS) and level of sexual function with the Changes in Sexual Function Questionnaire (CSFQ) at baseline and 4, 8, and 12 weeks after initiating treatment with escitalopram. Baseline sexual function was compared to sexual function of 73 healthy controls.

Results

Patients had worse sexual function at baseline than healthy controls, which was not associated with severity of MDD. Patients’ sexual function improved significantly during treatment. Improvement in sexual function was coupled with amelioration of symptoms of depression, but treatment response groups did not predict change in sexual function. Gender had no effect on sexual dysfunction symptoms during treatment.

Conclusions

Sexual dysfunction was strongly associated with MDD and improved in parallel with improvement in overall symptoms of depression across a standard 12-week SSRI antidepressant treatment.

Disclosure

Yes, this is sponsored by industry/sponsor: The Lundbeck Foundation alliance BrainDrugs, Sahakian: Lundbeck Foundation

Clarification

Industry funding only - investigator initiated and executed study

Any of the authors act as a consultant, employee or shareholder of an industry for: FREYA, Novo Nordic
(029) Frequent Pornography Consumption is Linked to Poor Body Satisfaction and Consequently to Poor Sexual Functioning in Heterosexually-identified Men Who Endorse Masculinity Ideologies
Authors: Komlenac N , Hochleitner M
Published: May 2023

Introduction

In Western societies, men may frequently receive messages about ideals of an often unattainable male body through visual media, including pornography. Additionally, men may hold traditional masculinity beliefs that idealize slender and muscular male bodies.

Objective

The current study analyzed whether pornography consumption was associated with men’s body satisfaction. Additionally, it was analyzed whether the endorsement of masculinity ideologies was a vulnerability factor that makes men more or less susceptible to pornography’s influence on body satisfaction. The study further analyzed whether body satisfaction in turn predicted men’s experiences of distressing sexual problems.

Methods

An online questionnaire study was conducted among 261 self-identified heterosexual young men (Mage = 24.4, SD = 3.5) at an Austrian medical university. The questionnaire contained questions about frequency of pornography consumption, body satisfaction, and distressing sexual problems. Endorsement of masculinity ideologies was assessed with the Male Role Norms Inventory–Short Form. A structural equation model was calculated to test whether the frequency of pornography consumption predicted body satisfaction, and whether body satisfaction in turn predicted distressing sexual problems. Men’s endorsement of masculinity ideologies was considered as a moderator for the effect of pornography consumption on body satisfaction.

Results

A structural equation model (χ2(30) = 39.3, p = .119; χ2/df = 1.3; RMSEA = .035, 90%CI = .000 – .062; CFI = .941; SRMR = .029) revealed that for most men pornography consumption was not associated with body satisfaction. However, there was a negative association between pornography consumption and body satisfaction for men who strongly endorsed the masculinity ideology of men needing to always be the dominant. Poor body satisfaction in turn was significantly associated with the experience of distressing erectile difficulties, ejaculation sooner than desired, or diminished intensity of orgasmic sensations.

Conclusions

This study reveals the importance of body satisfaction for sexual functioning in young heterosexual-identified men. Thus, clinicians who treat sexual problems in young men should address their clients’ or patients’ body satisfaction. Empowering men who endorse masculinity ideologies to challenge norms for an “ideal” male body, as depicted in most pornography, may be an important component of such interventions.

Disclosure

No
(069) Increased Risk of Major Adverse Cardiovascular Events in Testosterone Deficient Men and in Men Receiving Testosterone Replacement Therapy
Authors: Mann U , Bal D , Brar R , Patel P
Published: May 2023

Introduction

Testosterone deficiency (TD) has been shown to be associated with cardiovascular risk factors and an increased risk of cardiovascular events. Conversely, literature surrounding testosterone replacement therapy (TRT) and major adverse cardiovascular events (MACE) is conflicting. Currently, the Food and Drug Administration requires warnings regarding a possible increased cardiovascular risk for TRTs.

Objective

This study sought to investigate the association between TD and MACE. It also sought to investigate the association between TRT and MACE using a large population based database. The hypotheses were that TD men will have a higher risk of MACE, while men receiving TRT will also have a higher risk of MACE compared to controls.

Methods

A propensity-weighted, retrospective cohort study was conducted by accessing provincial health administrative databases. Eligibility criteria included men 18 years and older, with no prior TRT or MACE, who had at least 1 year of provincial health coverage from their index date between April 1st, 1995 to December 31st, 2018. TD was defined as men who had a serum testosterone level between 57-300 ng/dL. TRT was defined as having at least two testosterone prescriptions filled within one year (including capsules, gels, patches, and/or injections). MACE was defined as myocardial infarction, coronary revascularization procedures, ischemic stroke, or hospitalizations for heart failure. Controls were assigned a pseudo-index date at random based on the frequency distribution of index dates in the study group. Logistic regression model that included age, socioeconomic status, index year, diabetes, hypertension, dyslipidemia and renal disease was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score. A cox proportional hazard model was used to examine our primary outcome of time to a MACE.

Results

Among 7918 men with TD and 442286 controls, men with TD were associated with a 87 % higher risk of a MACE (Hazard Ratio 1.76, 1.63 – 1.89) in unweighted and 21% higher risk (Hazard Ratio 1.27, 1.16 – 1.39) in weighted analyses. Among 6893 men receiving TRT and 415377 controls, men receiving TRT were associated with a 76% higher risk of a MACE (Hazard Ratio 1.76, 1.63 – 1.89) in unweighted and 26% higher risk (Hazard Ratio 1.27, 1.16 – 1.39) in weighted analyses.

Conclusions

This study demonstrates that both TD men and men receiving TRT had a higher risk of MACE as compared to controls. Whether TRT itself increases the odds of MACE requires further elucidation. Our study is limited by its retrospective nature and inability to capture for all confounders.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(099) Dual Effect of a Serotonin and Dopamine Reuptake Inhibitor (IP2018), and the Search for a Depressive Rat Model with Erectile Dysfunction
Authors: Comerma Steffensen S G , Gutierrez E , Fais R , Peters D , Olesen C , Wegener G , Simonsen U
Published: May 2023

Introduction

In patients with major depressive disorder, up to 68% present with comorbid sexual dysfunction, which resolves in only 5% to 30% of patients treated with antidepressants. Several groups of antidepressants negatively affect sexual function.

Objective

The present study investigated whether a newly developed amine transport inhibitor, IP2018, improves depression and erectile function in the same dose range.

Methods

The dose-dependent effect of IP2018 in two different mouse models for depression, the mouse forced swim test (mFST) and mouse tail suspension test (mTST), is reported. In male Wistar, Sprague Dawley and the depressive rats (Flinders Sensitive Line (FSL) and Flinders Resistant Line (FRL)), increases in intracavernosal pressure (ICP) and mean arterial pressure (MAP) were measured, and the ratio ICP/MAP was used as a measure of erectile function. We investigated whether IP2018 induces changes in ICP or flow and whether IP2018 facilitates suboptimal increases in ICP induced by cavernosal nerve electrical stimulation. The late IP2018 procedure was performed in the rest of the rats to evaluate their erectile function.

Results

We found that infusion of IP2018 dose-dependently improved mFST and was more potent than citalopram. At the same time, higher doses of IP2018 were required to obtain effect in the mTST model, and IP2018 was equipotent to citalopram. Infusion of low doses of IP2018 dose-dependently increased the number and the duration of spontaneous erections. At the highest dose of IP2018, the increases in the number and duration of spontaneous erections were similar to the effect of the lowest dose, and the increases in flow were 5 times higher. IP2018 (1-30 μM) caused small relaxations in isolated corpus cavernosum strips. FSL and FRL rats showed a diminished ICP/MAP compared to Sprague Dawley control rats.

Conclusions

IP2018 is more potent or has a similar effect to the well-known antidepressant drug citalopram in mouse models for depression. The potent effect of IP2018 on erectile function in anaesthetized rats suggests that IP2018 in the same dose range has positive effects on both depression and erectile function. FSL/FRL rats appear to allow the study of drug effects on both depression and sexual function in one animal model.

Disclosure

Yes, this is sponsored by industry/sponsor: Initiator Pharma A/S

Clarification

Industry funding only - investigator initiated and executed study

Any of the authors act as a consultant, employee or shareholder of an industry for: Initiator Pharma A/S
(114) Initial Safety Outcomes for Rigicon Infla 10® Inflatable Penile Prosthesis
Authors: Wilson S , Rossello M , Wen L , Maria P , Antonini G , Carajal A , Ralph D , Carrion R , Caravajal A , Perito P , Chung E
Published: May 2023

Introduction

A new three-piece inflatable penile prosthesis was introduced in 2019. The Rigicon Infla10® has been implanted in 26 centers by 103 physicians. Clinical investigation for FDA approval in United States will begin in late 2022.

Objective

We report initial survival from explantation and revision rates for infection, mechanical failure and medical problems. Data was obtained from analysis of Patient Information Forms (PIFs) submitted to the manufacturer. Patient information data was omitted prior to analysis.

Methods

319 patients implanted from 1/06/2019 to 12/31/2021 were followed to analyze device durability from revision/removal and rates of reoperation for infection, mechanical failure or medical reason.

Results

Mean follow-up was 21.2 months with a range of 5-36 months. Mean age was 58.5. 4.38% required removal/revision. Mechanical failure was 2.5%. There were no infections reported and only two (0.6%) medical problems (component out of place). One Peyronie's patient required revision for inadequate straightening (0.03% Three patients (0.9%) requested device removal for dissatisfaction. A total of 95.6% of Rigicon Infla10® was free from explant or revision 13 months from the original implant date. Kaplan Meier analysis revealed cumulative survival of the device at 12, 24 and 36 months was 95.6%, 94.7% and 95.7% until surgical invention.

Conclusions

While this is a retrospective study derived from volunteered Patient Information Forms, we believe the vast majority of the early Rigicon Infla10® performed prior to 1/2022 were included in the analysis. Early results show initial durability from re-operation equivalent to contemporary, devices.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Rigicon, Boston Scientific, Coloplast.
(120) Examining And Safety and Side Effects of Platelet-Rich Plasma Versus Placebo in a Phase III Clinical Trial in the Management of Erectile Dysfunction
Authors: Zucker I , Efimenko I , Molina M , Ibrahim E , Masterson T , Ramasamy R
Published: May 2023

Introduction

Restorative therapies are advertised as a cure for erectile dysfunction (ED) despite lack of data. One such therapy is platelet-rich plasma (PRP). PRP is created through centrifugation of autologous blood and separation of the platelet rich layer containing cytokines and growth factors involved in wound healing. We are conducting an ongoing, single center, prospective, one-to-one randomized, double blind, placebo controlled clinical trial assessing the safety and efficacy of PRP for ED (NCT04396795. Registered April 3, 2020). To reduce the variability in PRP concentration inherent to most PRP systems, we are using the Arthrex angel, the only system with an optical sensor to tailor PRP dose.

Objective

To assess the safety of injecting intracavernosal PRP in men with ED.

Methods

We retrospectively reviewed our clinical safety and adverse events data from September 2020 to May 2022. Patients receive either two injections of PRP or saline (placebo) four weeks apart. Patients were observed immediately post injection for adverse events. Additionally, patients were evaluated at 1-, 3- and 6-month periods. Finally, a Doppler ultrasound was completed at 6 months after last injection to assess for any structural or vascular changes to penis. For this analysis, we did not unblind patient groups. We report data from men who have received any injection with PRP or placebo and compared group A and B. We assessed statistical significance through t-test, where alpha=0.05.

Results

In total, 60 trial patients were included, 28 in group A and 32 in group B. There was no difference in pain with injection 1 (p=0.69) or injection two (p=0.99) (table 1). In each group, no major adverse events were recorded. In group A, only 1 minor adverse event, new penile plaque, was found (4.3%). This is similar to group B, where only 1 minor adverse event was reported (4.3%). No other minor adverse events were reported.

Conclusions

PRP appears safe to inject intracorporeally in patients with ED in our ongoing randomized placebo-controlled trial. Efficacy could not be assessed at this time. However, our study can help counsel patients on the side effects and complications associated with PRP.

Disclosure

No
(134) Development of a Multidisciplinary Step-Care Management Algorithm and Surgical Outcomes of PGAD/GPD Patients with Tarlov Cyst-Induced Sacral Radiculopathy
Authors: Goldstein I , Kim C , Komisaruk B , Kim N , Goldstein S , Yee A
Published: May 2023

Introduction

Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) is characterized by persistent, unwanted genital arousal and/or other genito-pelvic dysesthesia, including burning, itch, pain in the clitoris/penis, mons pubis, vulva/scrotum, vagina, urethra, perineal region, bladder, and/or rectum. Patients with PGAD/GPD are significantly bothered/distressed and catastrophization and suicidal ideation are common. In 2012 Komisaruk reported that PGAD/GPD could be mediated by Tarlov cyst-induced sacral radiculopathy. In 2016 we developed a multidisciplinary step-care management algorithm with specialists in sexual medicine, spine surgery, sex therapy, physical therapy, and neurophysiology to diagnose Tarlov cyst-induced sacral radiculopathy.

Objective

To utilize a novel multidisciplinary step-care management algorithm to identify PGAD/GPD patients with Tarlov cyst-induced sacral radiculopathy who could benefit from Tarlov cyst spine surgery, and to evaluate the long-term safety and efficacy of the surgery.

Methods

Clinical data were collected on PGAD/GPD patients who underwent Tarlov cyst spine surgery between 2016 and 2020 with at least 1-year follow-up. The management algorithm used to identify and treat Tarlov cyst-induced sacral radiculopathy involves: detailed psychosocial assessment and medical history; non-invasive assessments for sacral radiculopathy; targeted diagnostic caudal epidural injection that results in temporary clinically significant reduction of PGAD/GPD symptoms; and surgical intervention with Tarlov cyst spine surgery. Treatment outcome was based on the validated patient global impression of improvement (PGI-I) measured at intervals post-operatively.

Results

Ten patients (8 women, 2 men), mean age 40 years (range 19 - 66), met inclusion criteria. Patients were discharged the same day or following morning post-operatively. No serious complications occurred. Follow-up was >12 months (range 13 - 22 months). Seven (70%) patients reported post-operative clinical improvement on PGI-I at last follow up: two patients reported “very much better”, three patients reported “much better” and two patients reported “little better”. Two patients had no improvement. Only one patient was much worse, however we believed that the PGI-I score of 6 reflected the worsening of the PGAD/GPD condition and not a specific result of the surgical procedure.

Conclusions

Distressing PGAD/GPD symptoms can be caused by Tarlov cyst-induced sacral radiculopathy. This case series with long-term follow-up demonstrates that spine surgery effectively treats PGAD/GPD patients with Tarlov cyst-induced sacral radiculopathy established by a multidisciplinary step-care management algorithm. Imbricating the Tarlov cyst using minimally invasive spine surgery techniques was associated with clinical improvement in 70% of these select patients.

Disclosure

No
(139) Intraoperative Glanspexy During Complex Repair of Peyronie’s Disease
Authors: Mossack S , Roadman D , Levine L
Published: May 2023

Introduction

Peyronie’s disease (PD) is a disorder marked by the formation of a fibrous plaque in the tunica albuginea often causing a penile deformity. Surgical correction remains the gold standard of treatment for PD. The choice of procedure depends on various factors including erectile function, degree of penile curvature, hinge effect, and patient preference. We have found that men undergoing surgical correction of PD had intraoperative identification of a glans tilt or floppy glans, which was not recognized preoperatively.

Objective

Our aim was to analyze a large PD database to review the results after a glanspexy was performed in men undergoing partial plaque excision and grafting (PEG), tunica albuginea plication (TAP) or inflatable penile prosthesis (IPP) with straightening maneuvers.

Methods

A retrospective analysis was performed on all patients who presented with PD and were subsequently treated with a surgical procedure that included a glanspexy from 2016-2021. Demographics, comorbidities, erectile function (ED), PD characteristics, physical exam, penile duplex ultrasound findings, and surgical outcomes were obtained. Patients were tracked longitudinally, and subsequent interventions and outcomes were collected. All glanspexies were performed using the same surgical technique, where the glans was secured over the tips of the corpora cavernosa using several 4-0 Monocryl sutures between the glans and the tunica albuginea contralateral to the tilt through a subcoronal incision.

Results

A total of 97 glanspexies were performed in conjunction with an operation for PD. IPP with glanspexy (49.5%) was the most common procedure performed followed by PEG with glanspexy (36.1%) and TAP with glanspexy (14.4%). Post-operatively, there were no patient complaints or physician identification of irregularities pertaining to glans position or sensitivity. 6 patients required a reoperation after their initial PD procedure, however, none of the indications were related to the glanspexy portion of the procedure. There was one patient who sustained partial glans necrosis following complex reconstruction including extensive plaque incision with grafting, IPP and glanspexy.

Conclusions

Glanspexy using 4-0 Monocryl suture on a TF needle appears to be a safe, easy and effective technique for the treatment of a glans tilt or floppy glans identified during the surgical management of PD.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(157) Advanced Practice Providers Deliver Equivalent Outcomes with CCH Injection for Peyronie’s Disease
Authors: Carlson S , Tentis E , Nelson K , Reza Roshandel M , Alom M , Helo S , Tobias K , Matthew Z
Published: May 2023

Introduction

Independently performed procedures by well-trained advanced practice providers (APP) facilitate access to specialized care. We sought to compare outcomes between physicians and APPs with intralesional collagenase clostridium histolyticum (CCH).

Objective

Compare outcomes of CCH injections based on injection provider. Outcomes included curvature improvement and adverse events.

Methods

Men receiving CCH between 2014-2021 at our institution by four physicians and four APPs were included in an IRB-approved database. CCH was delivered as a series of 8 injections per protocol. Patient demographics, procedural-related adverse events, and curvature changes were recorded. The “APP-ratio” is defined as percentage of total injections administered by an APP per patient.

Results

After excluding patients who did not complete the entire CCH course or return for final assessment, 150/406 patients were analyzed. Mean baseline penile curvature was 66.2° (SD 23). Mean absolute and percent improvements in curvature were 21.7° (SD 18) and 33% (SD 27). The mean APP ratio was 69%, and 133 patients (89%) had at least 25% of their injections performed by an APP. There was no significant difference (p=0.65, p=0.39) in absolute or relative curvature improvement based on the APP-ratio [Figure 1]. There was also no difference in adverse events (pain, swelling, and hematoma).

Conclusions

In our high-volume CCH practice, APPs achieve the same outcomes and safety compared to physicians. Greater training efforts expand access to care for patients with PD.

Disclosure

No
(179) Incidence of Fertility Preservation Procedures in Prepubertal and Pubertal Individuals with Cancer
Authors: White J , Ory J , Ramasamy R
Published: May 2023

Introduction

Fertility Preservation (FP) for children and adolescents with cancer is underutilized. In prepubertal individuals, ovarian and testicular tissue can be frozen; however, this is still considered largely experimental.

Objective

Identify trends of FP in prepubertal individuals in the United States.

Methods

We performed a retrospective study of prepubertal children with cancer identified through the Pediatric Health Information System from 2011 to 2020. Children who underwent a testicular or ovarian biopsy were included. Any patients with testicular or ovarian malignancy, or other diagnoses which may have required a gonadal biopsy were excluded.

Results

A total of 418 boys under 13 and 333 girls under 12 who underwent a gonadal biopsy were identified. There was a total of 66929 new cancer diagnoses in girls and 86001 new cancer diagnoses in boys during this time. The most common cancer diagnosis was hematologic in both boys (50.96%) and girls (36.64%). A concurrent procedure at time of gonadal biopsy was performed in 84% of boys and 62% of girls, with line insertion being the most common. The only predictive variable of receiving a gonadal biopsy was increasing year. Overall, only 0.04% of children had a gonadal biopsy for FP during this time period.

Conclusions

Gonadal biopsy rates have increased in prepubertal children with cancer, presumably for FP. While recent international guidelines support FP in this group, our findings highlight the need to establish protocols and tracking for FP procedures in the US.

Disclosure

No
(209) Sexual Knowledge, Attitude and Practices in Women Attending OBG Out Patient Department and Its Effect on Sexual Dysfunctions
Authors: Mishra B , Sujatha M S , Rao S T S
Published: May 2023

Introduction

In India, despite significant advances in the prevention and treatment of sexual dysfunctions, the majority of these have focused on male sexual dysfunction disorders. There is still a paucity of literature that adequately explains the relationship between sexual knowledge and attitudes of women and female sexual dysfunctions. Furthermore, physiological events such as pregnancy, childbirth, breastfeeding, menopause, and ageing have a significant impact on sexual well-being, particularly when co-morbid psychiatric illnesses are present. The prevalence of these interactions and their relationship with female sexual dysfunctions are being explored which have consequences in the prevention and treatment of female sexual dysfunctions

Objective

1. To assess sexual health knowledge and attitudes regarding sexual practices in women attending Obstetrics and Gynecology Out Patient Department. 2. To assess presence and extent of sexual dysfunctions in these women 3. To evaluate for presence of co-morbid psychiatric conditions

Methods

Hospital based cross-sectional study with a sample size of 220 women in the category of pregnant, nulliparous and perimenopause/ menopause/ post menopause with age range from 18 to 65 years. Pregnancy carrying high risk and women nearing term were excluded from the study. After a detailed history regarding their socio-economic data, each of them were handed out questionnaires. The SKAQ-II (Sexual knowledge and attitude questionnaire), which was standardized using Indian population assessed their sexual knowledge and attitude, the Female Sexual Functioning Index scale (FSFI) evaluated sexual dysfunction and the presence of psychiatric comorbidities was assessed with the M.I.N.I PLUS scale.

Results

93% of the women had an adequate amount of knowledge regarding sexual practice and 83.2% had liberal attitude. Level of sexual knowledge and attitude was positively correlated with presence of sexual dysfunction, with the prevalence of latter being 65.5% with 63% of pregnant women having sexual dysfunction and 77.8% of menopausal women having sexual dysfunction. Rural women had lower levels of sexual knowledge and conservative attitude towards sexual practice, leading to more sexual problems. Around one-fourth of women reported psychiatric morbidities with majority suffering from depression.

Conclusions

Women with greater sexual knowledge and a liberal mindset towards sexual practices tend to have lower levels of sexual dysfunction. Rural women tended to have lower levels of sexual knowledge and poor attitude towards sexual practice. There was no association found between religious attitudes. Most dysfunctions were reported by the menopausal age group. Sexual issues were more common in the domains of desire, lubrication, orgasm and pain. A positive correlation was noted between sexual dysfunction and kind of housing, leading to lack of intimacy being an important contributing factor.

Disclosure

No
(238) TikTok as a Source of Information Regarding Premature Ejaculation: a Qualitative Assessment
Authors: Bernstein A , Loloi J , Babar M , Zhu M , Winokur N , Wysocki M , Labagnara K , Cohen S
Published: May 2023

Introduction

Patients are increasingly looking to social media platforms for sources of medical information. TikTok is one of the newest social media platforms primarily geared towards younger audiences.

Objective

This study aimed to evaluate the quality of information regarding premature ejaculation (PE) on TikTok.

Methods

The term “premature ejaculation” was searched on TikTok in May 2022. The first 40 top videos that met inclusion criteria were included. Videos were sorted as reliable or unreliable based on accuracy of video content by three reviewers. Relevant user metrics were collected for each video, including: number of likes, shares, followers of user, video length, source of upload and speaker type. Quality of information was numerically evaluated using Patient Education Materials Assessment Tool (PEMAT) and 5-point modified DISCERN validated tools with mean scores obtained from the three reviewers.

Results

Eight videos were categorized as reliable and 32 videos were categorized as unreliable. Mean number of “likes” per video was higher in the reliable versus unreliable group (1,238 vs. 126, p < 0.018). Accounts posting reliable videos had higher mean number of followers versus unreliable (55,050 vs. 12,042, p = 0.025). The majority of unreliable videos (75%) were posted by self-identified patients or individual users versus 12.5% of reliable videos. 62.5% of reliable videos were posted by individual physicians or physician groups, versus 6.3% of unreliable videos. Few overall videos mentioned indications for PE treatment, types of treatment, or value of psychological intervention (12.5%, 15%, 22.5% and 5.0% respectively.) Video length and number of shares did not differ between groups. Reliable videos had a higher DISCERN (2.7 vs. 0, p < 0.001) and PEMAT (73.0 v. 45.1, p < 0.001).

Conclusions

Quality of information regarding premature ejaculation on TikTok is low with a significant percentage of videos on this topic fraught with inaccurate information. Given TikTok’s prominence as a social media platform primarily geared towards younger audiences, we emphasize a need for improvement in the quality of information available regarding premature ejaculation and its management.

Disclosure

No
(268) Does Medical School Prepare Doctors to Treat Sexual Health?
Authors: Kenya S , Young B , Carrasquillo O
Published: May 2023

Introduction

Sexual function is a normative process warranting the equal attention of preventive and treatment services throughout the lifespan. Despite growing recognition of the value of human sexuality in clinical settings, there is no standardized sexual wellness curriculum universally administered in medical schools. Accordingly, many current and future physicians feel underprepared when taking care of patients’ sexual health needs.

Objective

Assess and strengthen sexual health knowledge among medical students in Miami.

Methods

In February 2020 and March 2021, medical students at a large university in South Florida requested a brief sexual health workshop to enhance their knowledge in this domain of patient care. The workshop provided an introductory overview of the physiology of sexual pleasure and functioning. The curriculum was developed and taught by an associate professor of medicine who directs the university’s sexual wellness consortium and is formally certified as a clinical sexologist. Prior to the workshop, a brief survey was conducted to understand medical students’ experience with sexuality education and identify gaps in training. Post workshop another survey was administered evaluating content as well as instructor proficiency.

Results

Among 62 participants who completed a pre-workshop survey, less than 30% reported being trained to query patients on sexual dysfunction, and just 8% were trained to assess sexual satisfaction. In the post workshop survey, 95% of participants believed the workshop increased their knowledge of sexual functioning and its physiologic markers and nearly all would also recommend the session to other students.

Conclusions

Increased sexual health training in medical schools has the potential to better prepare future physicians to serve patients’ diverse sexual health needs and improve patient outcomes.

Disclosure

No
(296) Variations in the Retail Price of Human Chorionic Gonadotropin in the United States
Authors: Miller J , O'leary M , Schneider D , Loeb C , Jenkins L , Yafi F
Published: May 2023

Introduction

Urine-derived human chorionic gonadotropin (HCG) remains a popular treatment for hypogonadotropic hypogonadism and induction of spermatogenesis or puberty in select patients. Shortages in both brand name and generic HCG, and the resulting increases in prices, have raised barriers in the treatment of patients.

Objective

To determine the variations in the price of HCG therapy within the U.S. and the potential for the undue financial burden on patients receiving HCG therapy.

Methods

Using the GoodRx website, prices of generic HCG, Pregnyl, and Novarel (10,000-unit vial) with and without coupons were recorded. Prices were collected from the most popular retail pharmacies in each state’s most populous zip code. The lowest and highest retail prices were noted for each brand by state and pharmacy.

Results

The mean highest retail prices for generic HCG, Pregnyl, and Novarel were $546.42 ± $64.95, $170.28 ± $76.82, and $387, respectively. The mean lowest retail prices of generic HCG, Pregnyl, and Novarel were $289.68, $113.88 ± $1.29, and $307.31 ± $2.00, respectively. The mean difference between the highest and lowest prices available within the same zip code for generic HCG, Pregnyl, and Novarel were $256.74 ± $64.95, $54.40 ± $76.65, and $79.69 ± $2.00, respectively (Figure 1).

Conclusions

Differences between the highest and lowest prices available for HCG therapy within a set zip code reached $462 per vial, demonstrating the potential for the undue financial burden on patients receiving HCG therapy. Significant changes in the cost of HCG therapy were seen within zip codes as a result of pricing differences between brands and pharmacies. Despite this, there was no significant variation in the lowest price available for generic HCG therapy between states. Given these price variations, providers must be aware of pricing patterns and be able to assist patients as they navigate the financials of these treatments.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma; Clarus Therapeutics; Cynosure; Promescent; Sprout; Viome.
(321) Long-Term Evaluation of Sperm Parameters Following COVID-19 mRNA Vaccination
Authors: Diaz P , Dullea A , Patel M , Blachman-Braun R , Reddy R , Khodamoradi K , Ibrahim E , Bidhan J , Ramasamy R
Published: May 2023

Introduction

Despite the demonstrated safety of COVID-19 mRNA vaccines, potential impact on fertility remains a major concern for vaccine hesitancy.

Objective

We conducted a single-center prospective study to investigate the long-term impact of COVID-19 vaccination on sperm parameters of healthy men. We hypothesized that COVID-19 vaccination (and booster doses) would not negatively impact sperm parameters in the long-term.

Methods

Twelve healthy male volunteers between the ages of 18-50 years old with pre-vaccination semen analyses completed follow-up analyses between September 2021 - March 2022. Participants were required to provide documentation demonstrating at least two mRNA vaccine doses after a minimum of 9 months prior to the first vaccine. Semen analyses evaluated volume, sperm concentration, total motility, and TMSC. The number of days abstinent prior to sample collection was documented during the visit. The primary outcome was median change in the total motile sperm count at least 9 months following fully vaccinated COVID-19 status. Individuals who admitted a history of infertility or previous azoospermia were excluded from study participation. After calculating data distribution on normality test, medians, and interquartile ranges (IQRs) were reported for all variables. The Wilcoxon rank sum test was used to compare pre- and post-vaccination semen parameters. A 2-tailed P < .05 was considered statistically significant.

Results

A total of 12 men volunteered in our study (median age 26 [25 - 30] years. Subjects provided follow-up semen samples at a median of 10.5 months following the second vaccine dose. There were no significant changes in any semen parameters between baseline, 3 months, and 10 months following vaccination. Baseline samples demonstrated median sperm concentrations and TMSC of 29.5 million/cc [9.3 – 49] and 31 million [4-51.3], respectively (Table 1). At follow-up, sperm concentration and TMSC were 43 [20.5 – 63.5] (p=0.050) and 43.5 [8.5 – 102.8] (p=0.407), respectively. Of note, there were no significant changes in semen volume nor total motility (%) for participants at follow-up. Two of the men had semen analyses demonstrating oligospermia at baseline. Of these two men, one was found to be normospermic at follow up from 8 to 25 million/mL, and the other remained oligospermic.

Conclusions

COVID-19 mRNA vaccines and booster doses do not appear to negatively impact the semen parameters of healthy males even 10 months following vaccination. Our study and future studies should add to the growing body of the evidence on the long-term safety of vaccines and potentially decrease vaccine hesitancy.

Disclosure

No
(323) Mechanistic Insights into a Rare Genetic Cause of COVID Orchitis
Authors: Ramsoomair C , Seetharam D , Moorthy B , Zhang F , Ramasamy R
Published: May 2023

Introduction

To date, biomedical efforts against the SARS-CoV-2 virus have mainly focused on mitigating spread and primary infection mortality. While significant strides have been made in community response and vaccine production, post-acute COVID-19 syndromes (Long COVID) are growing in prevalence and becoming an increasing burden on public health. Current evidence suggests COVID-19 can affect the testis and cases of orchitis (testicular pain) appear to present in up to 20% of men with COVID-19. With an aim of uncovering causal mechanisms of COVID-19 sequela outside of pulmonary symptomology, a recent study from our group has identified a nonsynonymous non-frameshift mutation in the NACAD protein associated with COVID-19 orchitis and decreased ACE2 serum levels. NACAD is thought to prevent inappropriate targeting of non-secreted peptides to the endoplasmic reticulum.

Objective

We hypothesized that a defect in NACAD function/processing will decrease ACE2 serum levels by disrupting extracellular transport and endoplasmic reticulum interaction. We explored whether intracellular levels of ACE2 as well as TMPRSS2 were altered and if cell membrane protein deposition was increased, which may result in more severe effects to SARS-CoV-2 infection.

Methods

We obtained testis biopsies from men undergoing sperm retrieval for infertility. After siRNA NACAD knockdown, we analyzed total ACE2 expression using Western blot and qPCR as well as immunofluorescence/H&E staining for colocalization (with NACAD). Membrane-anchored ACE2 (mACE2) levels were quantified using immunostaining and flowcytometry while secreted ACE2 (sACE2) was analyzed by ELISA and Western blot.

Results

NACAD and ACE2 co-localize in both the Leydig and germ cells. When NACAD is knocked down, primary testes cells show 80% decreased mRNA and 50% total protein levels of ACE2. The secreted ACE2 was also reduced by nearly 50%. However, when we specifically measured the level of mACE2 on the cell surface, we found that the knockdown of NACAD did not lead to reduction.

Conclusions

NACAD likely specifically affects the level of sACE2, which is speculated to act as a protection factor by retaining the virus in serum and reducing cellular entry. While the exact reason for the differential effects of NACAD on mACE2 and sACE2 remain unclear, our data is consistent to other studies, which found a reduction of total ACE2 expression and sACE2 in patients is coupled with worse outcomes in COVID-19. We hope that establishing a relationship between NACAD and ACE2 expression will prove useful not only to elucidate why some men with COVID develop orchitis but, ultimately, why some men develop multiorgan failure with COVID infection whereas most do not.

Disclosure

No
(372) Does Age Predict the Difference in Morning vs Afternoon Testosterone Levels?
Authors: Flores J , Benfante N , Schofield E , Katz D J , Bryson C F , Jamzadeh A E , Nelson C J , Mulhall J P
Published: May 2023

Introduction

It is recommended that serum testosterone (T) level measurement be conducted in the early morning (AM) as T levels decrease in the afternoon (PM) due to the circadian rhythm in T secretion. This rhythm is reported to be blunted in older men.

Objective

This study aimed to define the magnitude and direction of the changes between morning and afternoon T levels across age groups.

Methods

The study population included men who had both AM (before 10 am) and PM (after 2 pm) total T (TT) levels within 3 months of each other. All TT measurements were performed using LCMS. We excluded patients with a prior orchiectomy, with T levels 1000 ng/dL, those with a history of androgen deprivation therapy, and patients on T therapy. Differences in AM and PM TT levels were quantified and stratified by age continuously. We reported the directionality of the changes based on increases or the decreases in T levels between AM vs PM. No difference was defined as a delta T levels between -100 to + 100 ng/dL, changes increasing or decreasing as >100 ng/dL. Correlation of TT difference between AM vs PM levels and age was calculated.

Results

506 men were analyzed. Mean age = 63 ± 12 years. Mean of AM and PM TT levels were 425 ± 164 ng/dL and 397 ± 155 ng/dL, respectively (p < 0.001). While 63% of men had no significant difference (-100 to +100) between AM and PM levels, 24% had a > 100 ng/dl decrease, 13% > 100 ng/dl increase. Overall, 13% had higher PM and 24% lower PM TT levels. Neither AM nor PM TT levels were significantly associated with age. Age was weakly negatively correlated with the change between AM and PM levels (r = 0.10, p = 0.03). That is, the mean difference between AM and PM levels was more pronounced for lower ages and approached zero as age increased.

Conclusions

While age was not associated with mean AM or PM total T levels, this study did find differences in the magnitude of the difference by age.

Disclosure

No
(375) Can Tamoxifen and a PDE5 inhibitor slow the progression of Peyronie’s Disease?
Authors: Megson M , Merrett C , Cellek S , Ralph D
Published: May 2023

Introduction

The available treatments for Peyronie’s Disease as recommended by international guidelines are either surgery or intralesional injection therapy. In recently cell and rat studies it has been shown that using a phosophdiesterase type 5 inhibitor (PDE5i) and a selective oestrogen receptor modulator (Tamoxifen) inhibited myofibroblast transformation and extracellular matrix production.

Objective

The aim of this study is to compare the combination of tamoxifen and a PDE5i versus no treatment or other oral medications in the progression of early Peyronie’s Disease.

Methods

This is a retrospective study of all patients with early Peyronie’s Disease, defined as less than 6 months duration or persistent pain presenting over a 3-year period. Patients were given Tamoxifen 20mg twice daily + Tadalafil 5mg daily for 2 months. The control group either received no treatment or simple oral medication such as Vitamin E. Data retrieved included demographics, duration of disease, change in curvature and pain, as well as further treatment modalities. Assessment of curvature was with photos or an artificial erection test. Data was analysed using the Mann-Whitney Test.

Results

A total of 147 patients were recruited with early Peyronie’s Disease, 102 patients given the active drug combination (median age 49, range 24-71) and 45 controls (median age 55, range 27-76). The results in each group are presented in Table 1. Overall, the patients on Tamoxifen and Tadalafil showed more improvement and less deterioration which was statistically significant (p=0.009)

Conclusions

The combination of Tamoxifen and Tadalafil has been shown to prevent the progression of Peyronie’s Disease in vitro and in this study in patients with early disease. Future prospective studies are warranted to confirm this finding.

Disclosure

No