bluuebunny/crossref_metadata_2025_split huggingface dataset:
(234) TWENTY-TWO TECHNIQUES TO IMPROVE SEXUAL DESIRE IN WOMEN
Authors: Brendler J 
Published: December 2024

Abstract

Introduction
Hypoactive sexual desire that generates distress is the most common problem in women in sexology offices. It is important for sexologists to be aware of the numerous techniques already published in order to choose the best techniques for each person.

Objective
List the Cognitive Behavioral and Sexual Therapy techniques that can be used for hypoactive Sexual Desire in women.

Methods
Literature review was carried out on Cognitive Behavioral Line and Sexual Therapy techniques from the last 70 years using English and Portuguese language databases.

Results
Twenty-one published techniques were found, namely: 1) Improving self-esteem; 2) Support; 3) Clarification: about spontaneous and responsive sexual desire, as well as sexual response and sexuality, etc.; 4) Use cognitive restructuring to undo myths, beliefs and taboos and eliminate anti-sexual thoughts; 5) Prohibited coitus; 6) Non-demanding touch with Sexual Fantasy stimulation; 7) Focusing Sensations I; 8) Focusing sensations II; 9) Kegel exercise; 10) Non-demanding coitus; 11) Distract yourself from what distracts you or Distraction from Distraction; 12) Improve communication between the couple; 13 Improve sexual intimacy; 14) Invest in the relationship; 15) Negotiate the division of domestic tasks; 16) Identify with the role of “sexual woman” as you identify with other roles; 17) Invest in yourself; 18) Invest in and validate the partner’s behavior; 19) Sexual Menu Technique based on thinking about sex and romance at least three times a day; 20) Anticipate sexual activity in your mind; 21) Use full attention or Mindfulness; 22) use Diaries to detect “erotic events”.

Conclusions
We found Twenty-one psychotherapeutic techniques published in English (the majority) and Portuguese within the Cognitive Behavioral and Sexual Therapy Line. This set of techniques will help sexologists improve sexual desire and, as a consequence, women’s sexual health and quality of life.

Disclosure
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(028) ANALYZING GOOGLE SEARCH TRENDS FOR “VAGINAL ESTROGEN” AND ITS RELATIONSHIP TO MEDICAL RECOMMENDATIONS FOR POST-MENOPAUSAL WOMEN
Authors: Hammad MAM , Chawareb EA , Nakamura H , Miller J , Kadakia Y , Lee J , Yih JM , Yafi FA , Chang OH 
Published: December 2024

Abstract

Introduction
Over two million women reach menopause each year in the United States, subsequently creating a demand for medical symptomatic relief. This can come in many forms, ranging from topical treatments to oral hormone therapy. It is important to examine closely the popularity and awareness of these different types of treatment options in the U.S. to fully gauge how sexual healthcare is administered to women. The study focuses on vaginal estrogen treatment, specifically its relevance to post-menopausal women over the years, through Google search trends and rising literature recommendations.

Objective
Our study aims to investigate the correlation between Google search trends for the term "vaginal estrogen" and the rising literature recommendations of vaginal estrogen for postmenopausal women.

Methods
We conducted a retrospective analysis of Google search trends data for the term "vaginal estrogen" and other related words. The word “weather” (a term that is consistently searched) was used as a control to compare against when analyzing the trends. We simultaneously examined medical recommendations in major urology societies’ websites and social media forums for vaginal estrogen in the context of post-menopausal symptom management. Time series analysis (a 6-month simple moving average) and statistical modeling were employed to evaluate the trends and relationships between these variables.

Results
Our results reveal a positive correlation (R2 = 0.721) between the increasing search interest in "vaginal estrogen" and the number of articles on this treatment option among post-menopausal women. While it may or may not be causative, it suggests that there is a growing interest in this treatment from the public. With the recent increase in physician recommendations to include vaginal estrogen as part of the treatment regimen for post-menopausal women, we found an increasing public awareness and interest in this treatment option.

Conclusions
Our study demonstrates a noteworthy connection between the rising medical recommendations for vaginal estrogen in the management of postmenopausal symptoms and the growing search interest for the term "vaginal estrogen" on Google. The data underscores that the medical community's endorsement of vaginal estrogen is fostering greater awareness and acceptance of this therapy among post-menopausal women. Further research is needed to determine its equal accessibility to all patients.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(030) HUUDDII: THE CLITORAL SUCTION DEVICE
Authors: Paulsen O , Dann J , Rubin R 
Published: December 2024

Abstract

Introduction
Clitoral blood flow plays an important role in female sexual arousal and overall sexual satisfaction. Typically, sexual arousal results in smooth muscle relaxation and arterial vasodilation within the clitoris. The result is an increase in blood flow and intra-cavernous pressure leading to tumescence and extrusion of the glans clitoris. Several health conditions can impact this mechanism, leading to decreased sexual desire, arousal, orgasm, and satisfaction. Huuddii is a simple, hands-free, disposable product that fits over the clitoris and improves sexual function by combining initial gentle suction and frictional force that stimulates the clitoris and activates the sexual arousal cascade. Huuddii underwent a multicenter non-significant risk clinical and over-the-counter (OTC) label comprehension 510 k study for FDA approval in 2004-2005. The label comprehension test portion of the study was designed to test subject’s ability to correctly self-select for use of this product to treat symptoms related to female sexual dysfunction and understand and correctly use the product as outlined in the consumer instruction guide. The clinical portion of the study was designed to test the safety and efficacy of the device in an OTC environment.

Objective
To assess the clinical efficacy, safety, and user-friendly nature of Huuddii in improving female sexual function with the goal of OTC FDA approval.

Methods
Objective data was collected using the Female Sexual Function Index (FSFI). Subjects completed an FSFI questionnaire as a baseline and after device utilization. Subjective data was collected using the Sexual Life Quality Questionnaire (SLQQ) and Female Intervention Efficacy Index (FIEI). The SLQQ and FIEI were completed post-intervention.

Results
Our objective results as measured by the FSFI revealed that individual success was achieved in “overall improvement in sexual function” in 87% of subjects. Percentages for the following sub-domains of “desire,” “arousal,” “lubrication,” “orgasm,” “satisfaction,” and “pain” were 63%, 92%, 82%, 84%, 79%, and 55%, respectively. Subjective result, 87% of subjects who completed the SLQQ reported improved sexual quality of life and satisfaction while wearing Huuddii. Results of the FIEI demonstrated a 74% improvement in lubrication, 82% increase in genital sensitivity, 66% increase in pleasure associated with intercourse, 63% improvement in orgasm, and 82% increase in overall sexual satisfaction. Ninety-two percent (92%) of subjects claimed they would like to continue using the device after the study was completed.

Conclusions
Huuddii is a safe, simple, disposable, non-invasive suction cup that assists in achieving and maintaining clitoral tumescence, increases blood flow to the clitoris, and ultimately enhances female sexual function.

Disclosure
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(037) CATCHING THE CURVE: LEVERAGING DISEASE PHASES FOR OPTIMAL COLLAGENASE THERAPY IN PEYRONIE’S PATIENTS
Authors: Saffati G , Orozco Rendon D , Hinojosa-Gonzalez DE , Kronstedt S , Khera M 
Published: December 2024

Abstract

Introduction
In the United States, collagenase clostridium histolyticum (CCH) injections are widely used as a treatment for patients with Peyronie’s disease (PD). While CCH is an approved treatment for PD, it is unclear from existing evidence if initiating this intervention during the acute phase vs the later chronic phase leads to different outcomes.

Objective
We sought to investigate the effectiveness and safety of CCH treatment in patients with PD, comparing outcomes between those in the active versus stable phase of the disease.

Methods
We performed an IRB-approved single-center retrospective study from 2009-2023 on patients with CCH injections for PD. Clinical and demographic information was extracted from patient medical records. Patients were stratified into two groups based on the phase of their disease at the time of treatment: active (acute) phase or stable (chronic) phase. Both groups were compared Pearson's Chi-square or Fisher's exact tests for categorical data.

Results
This study included 169 patients with a mean age of 57.9 (SD: 8.63). The patient cohort is summarized in Table 1. Of these, 144 and 25 patients received CCH in the chronic and acute phases, respectively. No significant difference was observed between the change in curvature of the active and stable phase (-7.4 [SD:14.73] vs. -7.82 [SD:16.04], p = 0.37, respectively). No significant difference was observed in curve improvement between the two phases (p = 0.864), indicating that treatment was equally effective in both phases. More patients in the stable phase had progression to surgery (p = 0.032). In terms of side effects, the incidences of bruising (p = 0.368), swelling (p = 0.811), pain (p = 0.846), hematoma (p = 0.479), and fracture (p = 0.457) did not differ significantly between the active and stable phases. The chi-square test results for new ED and loss of length should be interpreted cautiously due to small size cell counts.

Conclusions
These results suggest that CCH injection is a viable treatment option for PD patients in both the active and stable phases, with comparable efficacy in improving penile curvature deformity. Further prospective studies with larger sample sizes are warranted to validate these findings.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast, Halozyme Investor: Sprout.
(039) THE EFFICACY AND SAFETY OF OFFICE-BASED PENILE PLICATION
Authors: Parikh N , Premo H , Ziegelmann M 
Published: December 2024

Abstract

Introduction
Penile plication is an excellent approach for patients with congenital penile curvature and Peyronie’s disease. Beginning in March of 2023, patients who were candidates for penile plication were offered the procedure in the operating room under general anesthesia or in the office setting with no sedation. Fourteen patients opted for the procedure in the clinic.

Objective
We therefore sought to assess patient responses and experience after undergoing surgery in the clinic setting.

Methods
Fifteen patients, ages ranging from 21 to 74 were seen in clinic for penile plication surgery. Exclusion criteria included patients younger than 18 years and preoperative systolic blood pressure greater than 160. One patient was noted to have a systolic blood pressure over 200 and thus was unable to have the procedure. Five patients had a penile plication for congenital curvature, eight patients for Peyronie’s disease, and 1 patient had a release of a previously placed palpable plication suture. Degree of curvature, direction of curvature, presence of secondary curvature, presence of hinge defect, and indentation were not considerations in patient selection. Three patients were on anticoagulation, which was held prior to surgery. Twelve patients underwent a ventral approach and two a degloving approach.

Results
Patients are allowed and encouraged to eat and drink prior to the procedure. All patients were given a preoperative antibiotic, normally either Bactrim or ciprofloxacin prior to the procedure and 20 mg of oral versed. They were then taken to the in-office procedure room after consent was obtained. The procedure room contains a television for patients to watch. At the end of the procedure, an Exparel block was performed. Patients are then prepped and draped in standard sterile fashion. A dorsal penile nerve block and circumferential block were utilized at the beginning of the case. A catheter is not placed to help reduce patient discomfort. Alprostadil is injected to help identify curvature. Ten patients were noted to have dorsal, 2 patients’ ventral, and 2 patients’ lateral curvature with degree of curvature ranging from 30 to 60 degrees. Eight patients had a secondary curvature identified. Total number of plication sutures utilized ranged from 2 to 8. All procedures were successfully conducted, and patients discharged home. Patients were then contacted to determine their experiences with the procedure. Only seven patients were able to be reached. One patient did have a vasovagal response in the procedure room, but this resolved with a small snack. Average intraoperative discomfort was rated as a 2/10 and was mainly present during the initial block. All patients stated that they would choose this surgical approach again and have noted clinically significant improvement to their curvature.

Conclusions
Penile plication in the clinic setting reduces anesthetic risks as well as costs associated with the operating room. This study shows the safety and feasibility of this approach.

Disclosure
No.
(055) HEAVY METAL EXPOSURE AND ERECTILE DYSFUNCTION: INSIGHTS FROM THE ALL OF US RESEARCH PROGRAM
Authors: Ryan J , Angulo-Llanos L , Yu H , Punnen S , Masterson T 
Published: December 2024

Abstract

Introduction
Erectile dysfunction (ED) has long been associated with cardiovascular disease, a sedentary lifestyle, smoking, obesity, and diabetes. However, the role of environmental factors in ED is still not fully understood. Current literature is unclear on the relationship between heavy metal exposure and ED, despite growing evidence that such exposure can lead to oxidative stress, thereby increasing the risk of various diseases. The All of Us (AoU) Research Program is a prospective clinico-genomic database that focuses on individuals from underrepresented populations.

Objective
We aimed to use the AoU database to examine how high levels of heavy metals in the blood relate to erectile dysfunction.

Methods
AoU release version 7 was analyzed. Men with an EHR-coded diagnosis of ED were included in the analysis. Serum and blood levels of lead, selenium, magnesium, zinc, and copper were analyzed. Patients with elevated heavy metal levels in the blood were defined as those with lead levels above 25 μg/dL, selenium levels above 160 μg/L or 0.1 ppm, magnesium levels above 2.2 mg/dL, zinc levels above 120 μg/dL, and copper levels above 140 μg/dL or ceruloplasmin levels above 40 mg/dL. P-values were calculated using univariate logistic regression and chi-squared tests with Bonferroni correction.

Results
The total cohort of men was 153 582, with 15 523 of them having ED (10.1%). Of these men, 19.2% were Black, 62.9% were White, and 17.9% were of another race. Among men with ED, 66.1% were over 65 years old, 26.8% were 45-64 years old, and 4.4% were 18-44 years old. Patients with elevated lead (OR: 4.58, p &lt; 0.001), zinc (OR: 2.07, p = 0.005), or magnesium (OR: 1.39, p &lt; 0.001) levels were more likely to have ED. However, elevated copper (OR: 0.67, p = 0.005) and selenium (OR: 0.955, p = 0.874) levels were not associated with a higher rate of ED. Overall, men with ED who had elevated heavy metal levels were more likely to have a higher BMI (p = 0.010), be unemployed (p &lt; 0.001), have low income (p &lt; 0.001), rent their homes (p &lt; 0.001), and be older (p &lt; 0.001). There was no significant difference in education status (p = 0.172) or race (p = 0.117).

Conclusions
Using a large prospective database that focuses on underserved populations, our study found that heavy metal levels higher than established cutoffs were associated with higher rates of ED. Lead appeared to have the largest effect on ED rates, while zinc surprisingly had a higher odds ratio of being elevated in patients with ED. These results add to the relatively scant literature on heavy metals' influence on ED. Lastly, our findings suggest that it is important to include heavy metals in the risk assessment for ED.

Disclosure
No.
(118) SURGICAL OUTCOMES OF BENIGN SCROTAL SURGERY PERFORMED UNDER LOCAL ANESTHESIA
Authors: Ko Y , Fidel M , Shah J , Roque C , Patel P 
Published: December 2024

Abstract

Introduction
General and spinal anesthesia are often used to perform benign scrotal surgery. However, these methods yield substantial healthcare costs, potential side effects, and given the benign nature of the conditions, patients often face considerable wait times to receive surgical care. The use of local anesthesia (LA) only has previously been shown to demonstrate satisfactory patient tolerability for scrotal surgery. However, evidence is limited, and further research is required to evaluate its safety.

Objective
We sought to evaluate patient intolerability, intra-operative complications and 4–6-week procedure-related adverse events.

Methods
We conducted a retrospective study of patients undergoing the following procedures, 1) hydrocelectomy, 2) spermatocelectomy, and 3) epididymectomy, at a Canadian ambulatory surgical centre from October 2022 to June 2024. LA administration was performed through a spermatic cord block as well as along the median raphe for all procedures. Procedures performed for a large hydrocele or spermatocele where an early block was not possible, were subsequently performed after delivery of the testicle. Baseline characteristics, intra-operative events, and post-operative adverse events were collected.

Results
From October 2022 to June 2024, a total of 72 procedures were performed. Of these procedures, 39% (n = 28) were hydrocelectomies, 33% (n = 24) were spermatocelectomies, and 28% (n = 20) were epididymectomies. The mean patient age was 52.6 ± 14.3 years with a BMI of 31.2 ± 11.1. No procedures were aborted due to patient intolerability nor were there any reported intra-operative complications. At 4-6 weeks post-operative follow-up, no patients sought care from their family doctor with only 1.4% (n = 1) patients requiring an emergency department visit for a wound infection. No patients required hospital admission.

Conclusions
Our early findings demonstrate the safety and feasibility of performing surgical scrotal procedures in an outpatient setting under LA. Safely performing these procedures in an outpatient setting can reduce patient wait times for scrotal surgeries, boost tertiary care centre efficiency, and optimize the use of scarce resources such as operating rooms and inpatient facilities. Further longer-term follow-up is needed to evaluate recurrence rates.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(119) THE COST OF CLOMIPHENE FOR MALE INFERTILITY TREATMENT: REGIONAL PRICE VARIABILITY ACROSS THE UNITED STATES
Authors: Manafi E , Furtado T , Loeb C , Eleswarapu S , Mills J , Andino J 
Published: December 2024

Abstract

Introduction
Clomiphene, known by the brand-name Clomid, is used off-label as empiric medical therapy to improve testosterone and sperm parameters in men. Despite its role in the medical management of male infertility and hypogonadism, this selective estrogen receptor modulator (SERM) is rarely covered by insurance for these indications. Typically taken daily or every other day for 3-6 months, this lack of coverage makes the high and variable prices a barrier to fertility care for many patients.

Objective
This study sought to analyze the price variability of compounded clomiphene and brand name Clomid across the United States and identify regions where patients might face potential undue financial burden based on their geographical location.

Methods
Prices for compounded clomiphene 25 mg-50 mg and brand-name Clomid (50 mg) for 30-day and 90-day supplies were collected from 136 compounding pharmacies nationwide via phone; national retail pharmacy prices were recorded via GoodRx. The weighted average price per pill, minimum, and maximum values for each dosage were calculated. States were categorized into four regions (Northeast, Midwest, West, South) for regional analysis.

Results
The weighted mean price per pill for clomiphene 25 mg, clomiphene 50 mg, and Clomid were $2.21 ± 1.24; $2.60 ± 1.49; and $8.41 ± 1.53, respectively, from compounding pharmacies. In comparison, the national Clomid retail pharmacy average with GoodRx discount was $4.30 ± 0.29. The weighted per-pill averages in each region are presented in Table 1. Compounded clomiphene is a significantly more affordable alternative to the brand-name Clomid given the limited insurance coverage (p &lt; 0.001). Additionally, patients face significantly varying average prices across different regions (p = 0.0441), with particularly higher average prices in the West and Northeast. The least and most expensive prices per pill of brand-name Clomid (without GoodRx) were $7.51 and $10.83 in the Northeast, $4.50 and $13.21 in the Midwest, $6.34 and $11.67 in the South, and $5.16 and $13.44 in the West. The greatest variation was in the Midwest, at $8.71 per pill ($784 for 90 pills). This was followed by the West with a difference of $8.28, the South with $5.33, and the Northeast with $3.32 (Fig. 1).

Conclusions
There are significant differences in the pricing of clomiphene (Clomid) across regions, with some regions experiencing more notable internal variations. These pricing trends could potentially hinder access to treatment and pose substantial obstacles for patients.

Disclosure
No.