bluuebunny/crossref_metadata_2025_split huggingface dataset:
(007) Gendered Differences in Sexual Expectation: The Implications of Power Differentials on Condom Usage in Heterosexual Relationships
Authors: Snow G , Sampath A , Higashi K , Roberts J 
Published: May 2023

Abstract

Introduction
Sexuality is an important facet of every individual’s identity and overall wellbeing; despite this, gender-based discrepancies exist in relation to expectations of and experiences with sexual activity. In a longitudinal study conducted in 2013, 62% of boys reported expecting sexual pleasure from intercourse, compared with only 30% of girls (Missari, 2013). Furthermore, a 2007 study discovered that women generally prioritize their male partners’ pleasure instead of their own (Tolman, et. al).

Objective
Given an understanding of these existing trends, this study was developed to analyze contrasting attitudes about condoms and experiences with condom usage between men and women on a college campus.

Methods
A mixed-methodology approach was utilized, consisting of a survey (n=580), focus group discussions with select survey participants (n=16), and one-on-one interviews (n=30). Each element aimed to ascertain predominating student perceptions surrounding condoms and their role in sexual intercourse and to determine if these varied between men and women.

Results
Survey data revealed that 51.8% of men vs. 45.7% of women reported that they had never refused to engage in sexual activity when their partner refused to use a condom. Furthermore, women in 56.3% of focus group discussions reported that they believed men found condoms to be “uncool” or make sex “less enjoyable”, with 18.8% of focus groups involving statements that women felt guilty for diminishing their male partner’s experience. In no focus group conversations did men report feeling guilt related to their female partner’s experience. Interview data revealed that 47.8% of women reported a sense of individual responsibility to get STI tested and initiate condom use conversations, compared to only 28.6% of male respondents.

Conclusions
These data reveal discrepancies in reported self-efficacy between men and women, as well as a general tendency for women to view condoms more positively and consequently advocate for their use more often. Usage in heterosexual relationships, however, appears to be influenced by women’s deference to their male partners’ preferences. This indicates a power differential between men and women that dictates the practices adhered to within sexual relationships. Subsequent interventions should look to examine how these differing perceptions are developed, and which factors can combat the prioritization of male sexual preferences, as well as promote the comfort and pleasure of all partners during sexual intercourse.

Disclosure
No
(011) Beneficial Effects of Vaginal Prasterone (DHEA) on the Vaginal Histology of Women with GSM Beyond the Epithelium
Authors: Bouchard C , Ouellet J , Coté I , Dumas M , Dury A 
Published: May 2023

Abstract

Introduction
There is mounting evidence that androgens play an important role, together with estrogens, in the maintenance of genitourinary health.

Objective
Vaginal prasterone was used to characterize the histological changes associated with the dual androgen - estrogen stimulation of the vaginal wall in the treatment of the genitourinary syndrome of menopause (GSM). Since prasterone is converted to androgens which are subsequently aromatised in estrogens, a group of patients on aromatase inhibitors (AI) was included to isolate changes attributable to androgens.

Methods
Vaginal biopsies and vulvar pictures were collected before and after 12 weeks of treatment with 6.5 mg intravaginal prasterone daily (Intrarosa®). Eight women with GSM were recruited, including two breast cancer survivors on AI.

Results
Following treatment, the epithelium showed striking histological improvements, regaining thickness, ridges, active proliferation and glycogen synthesis. In the lamina propria, treatment led to increases in elastin content and nerve endings density. Visual evaluation of the vulva showed reduction of the redness and inflammation in the vestibule and the urethral meatus as well as a relaxation of the vaginal entrance. All observations were consistent between the groups with and without AI.

Conclusions
Data presented here are believed to be the first demonstration of the beneficial effects of androgens deep into the lamina propria of GSM patients both together with or independently from estrogens. Tissue changes observed could help understand some of the GSM symptomatology improvements observed before on dyspareunia and other sexual function parameters. While further studies are warranted to better understand how androgens and estrogens work synergistically in the treatment of GSM, the data presented here strongly suggest that prasterone has deep beneficial impacts on the urogenital tissue.

Disclosure
Yes, this is sponsored by industry/sponsor: Endoceutics
Clarification: Industry initiated, executed and funded study
Any of the authors act as a consultant, employee or shareholder of an industry for: Endoceutics
(019) Complete Sub-Epithelial Vestibulectomy: Refinement of Surgery for Neuroproliferative Vestibulodynia
Authors: Yee A , Goldstein S , Goldstein A , Goldstein I 
Published: May 2023

Abstract

Introduction
Complete vestibulectomy (CV) was first described by Goldstein and Marinoff, detailing an excision 3 mm cephalad to the hymen and caudad to Hart’s line. A vaginal advancement flap (VAF) to cover the defect left by excised vestibule was also described. Since neuroproliferative vestibulodynia is a field disease, The CV with VAF surgery has become widely utilized practiced by sexual medicine surgeons to treat neuroproliferative vestibulodyniaby surgeons practicing sexual medicine. However, the depth of dissection for the vestibular mucosal excision (VME) was not clearly defined. To gain a better appreciation for appropriate depth of the VME during CV with VAF, we have reviewed the results of immunohistochemical staining (IHC) of excised vestibular specimens (n=564) since 2019. In all cases, tissue depth of the excess positive CD117 and PGP9.5 staining, consistent with excess mast cells and nerves respectively, were &lt; 600 μm (0.6 mm) from the epithelial surface.

Objective
Our objective is to describe safety and efficacy of vestibulectomy surgical technique modifications made in 2021 based on this finding.

Methods
We refined the CV and VAF surgery based on the observation that the IHC pathology resides very close to the vestibular epithelium. This modification has been termed complete subepithelial vestibulectomy (CSEV). These modifications keep the VME thickness as close as possible to 1-2 mm. Liposomal bupivicaine (20 ml) is injected subcutaneously throughout the vestibule to hydrodissect the mucosa. The lateral border at Hart’s line and medial border 3 mm cephalad to the hymen is incised. The mucosal surface of the vestibule is grasped with an atraumatic vascular clamp and dissected sharply with the tissue stretched over a finger to maintain a very thin VME. Excised specimens are sent for IHC staining. Patients who underwent CSEV with VAF surgery from 2021 onward were followed for ≥ 6 months.

Results
A total of 13 individuals (mean age 29 ± 8yrs) underwent CSEV with VAF, with a mean follow-up of 8 ± 4 months. Photomicrographs of surgical specimen confirmed the thickness to be approximately 1-2 mm (Fig 1). Blood loss was minimal, &lt;100 ml in 11/13. Post-operative use of narcotics was minimal with all patients reporting less than 5 oxycodone 5mg tablets used. At 6 months post-op, 10/13 reported their vestibulodynia was much better/better based on PGI-I.

Conclusions
We report CSEV as a refinement of the Goldstein/Marinoff procedure. The depth of dissection and thickness of VME was 1-2 mm with this new procedure. Early results in our small case series show excellent vestibulodynia resolution and reduced pain medication requirements post-operatively. To date, the success rate of CSEV is equivalent to the outcomes from previous vestibulectomy series, ~77%, with minimal less operative blood loss.

Disclosure
No
(067) False Positive Pap Smear as The First Sign of Genitourinary Syndrome of Menopause
Authors: Dominguez-Bali A , Baqer A , Sharma R , Hassan Z , Marquez L , Dominguez-Bali C 
Published: May 2023

Abstract

Introduction
Around 2010, we started to realize in our centers that we were receiving an increasing number of perimenopausal women with abnormal Pap smears (cervical dysplasia), going from ASCUS to low-grade squamous intraepithelial lesions or high-grade squamous intraepithelial lesions with or without positive HPV. With no previous history of cervical abnormality and almost all of them in a long-term stable sexual relationship with a maximum of 1 or 2 sexual partners. After talking with our pathologist, we asked if vaginal atrophy could produce such results. He answered affirmatively and provided us with a few recent articles that describe such findings. As an advocate for hormone replacement therapy, we decided to start using local vaginal estrogen for several months and then repeat the Pap smears. We were able to confirm that inclusively with those cases diagnosed with high-grade squamous intraepithelial lesions, the next Pap smear after the treatment with local estrogens was totally normal. The situation has been repeated in more than 96% of cases in around 1500 patients in the same conditions for the last 12 years.

Objective
Describe these new findings confirmed by a few articles in the pathology field and two articles on estrogen use, in women ranging between the ages of 30-70 years.

Methods
Prospective follow-up of perimenopausal patients with positive Pap smears and very low risk for STDs placed on local and/or systemic vaginal estrogen. A Pap smear was conducted at 4 months and then 1 year after, which was followed by the regular scheme of Pap smear follow-ups.

Results
96.7% of all those patients with the described characteristics were successfully treated with local estrogens. During the study, we realized that the high number of patients who entered after the initial diagnosis of cervical dysplasia in the regular guidelines of colposcopies, biopsies, LEEP excisions, cryotherapy, and due to the persistence of the findings in more than 50% of those cases (because of the persistence of cervicovaginal atrophy) they finished having cone biopsies and/or hysterectomies.

Conclusions
We describe the early finding of another sign of genitourinary syndrome of menopause: false positive cervical dysplasias, secondary to cervicovaginal atrophy, due to the decrease in the level of estrogens that characterized the perimenopause. Also, how the management of local estrogens prevents a great number of interventions and patient procedures, saving billions of dollars per year, taking into account that the number of Pap smears in the named population is around 50-60% of all Pap smears practiced in the total population of women.

Disclosure
No
(071) Vulvo-vaginal Obliteration: Presentation of 6 Cases
Authors: Dominguez-Bali A , Sharma R , Baqer A , Hassan Z , Marquez L , Dominguez-Bali C 
Published: May 2023

Abstract

Introduction
Between December 2018 and July 2022, six cases of vulvovaginal fusion (obliteration) were diagnosed, evaluated, and treated at our centers. Less than 30 cases have been reported according to our reviews of the medical literature. All of the cases presented shared certain features such as more than 2 decades without sex or masturbation, no use of hormone replacement therapy, and a history of chronic urinary tract infections.

Objective
1. Present information from 6 cases of a rare genitourinary disorder, its diagnosis, medical & surgical management, follow-up, and resolution. 2. Place vulvovaginal obliteration or labial fusion as one of the most extreme late consequences of untreated genitourinary syndrome of menopause. 3. Emphasize not only the importance of the use of local estrogen in all women going through menopause but also clarify and promote the importance of the maintenance of penetrative sexual activity in the lives of older women. This can be achieved either naturally or with the use of dilators and sexual toys.

Methods
We analyzed 6 cases of patients with vulvo-vaginal obliteration that presented in our facilities.

Results
Analysis of the 6 cases showed: In 3 out of the 6 cases, the patient didn’t have a partner, while in the other 3 cases, they were not sexually active with their partner in any way. In 2 of the cases, the patient’s main complaint was the inability to urinate due to obstruction of the urethral outlet by a fused labia. In both cases, urinary leakage from overflow was present in the area of the posterior fourchette, along with urocolpos, an extremely distended urinary bladder, bilateral megaureter, and hydronephrosis. The ages of these 6 women were between 72 to 94. The most severe case involved a patient with the longest time without penetration (&gt; 30 years).

Conclusions
Total and partial vulvovaginal obliteration is a disease that hasn’t been commonly described. By obtaining the sexual history of each patient and the practice of geriatric gynecology, we have been able to diagnose this disorder. There is no doubt that vulvovaginal obliteration, also known as labial fusion, is one of the most extreme complications of the genitourinary syndrome of menopause but has not been medically described as part of its findings up till now. The prevention and treatment include not only the local use of estrogen but also the education of the patients on the need to maintain penetrative sexual activity in order to prevent the atrophy of the genitourinary area and maintain its functional ability. This can be done with a partner, penetrative dilators, or sexual toys.

Disclosure
No
(090) Immunohistochemical Staining of Elastin in the Vestibule
Authors: Goldstein I , Yee A , Dury A , Ouellet J , Goldstein S W , Komisaruk B 
Published: May 2023

Abstract

Introduction
The vestibule is an external genital structure lying 90° to the vaginal canal opening. During the thrusting movements associated with penetrative sexual activity, the vestibule undergoes significant stretching during both invagination and evagination. The vestibule also undergoes extreme stretching during childbirth. The rete pegs in the non-keratinized squamous epithelium facilitate the ability of the vestibule to mechanically stretch. More importantly, however, the vestibular lamina propria, with nerves, blood vessels, glands, needs to contain a high density of extracellular matrix (ECM) proteins with stretching capabilities. In particular, the ECM protein elastin endows skin structures with the ability to stretch, recoil, and have elasticity. Elastin has previously been shown to influence mechanical stretching properties of tendons.

Objective
The objective of this study was to examine the density of elastin proteins in the vestibule in reproductive age patients as there are currently limited data.

Methods
A total of 7 reproductive age patients with normal sex steroid hormone values and complaints of entrance dyspareunia were diagnosed with neuroproliferative vestibulodynia and subsequently underwent complete vestibulectomy. Tissue blocks were created from the specimen, and 5 μm sections studied with immunohistochemical staining with primary antibody. Sections were then counterstained with Gill-modified hematoxylin.

Results
In all vestibular specimen, there was very high density of elastin underneath the epithelium in rete pegs and throughout the entire lamina propria (Fig 1). There is a density gradient with the highest density immediately deep to the basement membrane of the epithelium. Elastin fibers were arranged in all orientations: coronal (frontal), sagittal (longitudinal), and transverse (axial) planes.

Conclusions
The high density of elastin fibers in rete pegs and throughout the lamina propria in a multi-planar orientation is suggestive of extreme stretching capability in eugonadal vestibular tissues. The highest density of elastin staining was seen immediately below the basement membrane of the epithelium, which may provide tissue integrity and shear resilience to the epithelial layer. In sex steroid hormone insufficiency states such as menopause or with use of combined hormonal contraceptives, individuals may develop loss of introital elasticity and fissures due to a deficiency of the ECM protein elastin. More research is needed on elastic fiber production, organization, and integration with other cutaneous extracellular matrix proteins, and how they may be affected by sex steroid hormones.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endoceutics, Inc.
(100) The Effect of Oral Contraceptive Pill Type on Vulvovaginal Atrophy
Authors: McMahon L N , Handy A B , Jones A G , Mijares S A , Noon A E , Meston C M 
Published: May 2023

Abstract

Introduction
Oral contraceptive pills (OCPs), which are used by over a quarter of reproductive-age women in the United States (Daniels et al., 2015; Jones et al., 2013), contain either both ethinylestradiol and a synthetic progestin, or solely a synthetic progestin. Through progestin-induced hepatic increases in sex hormone binding globulin (SHBG), OCPs have been found to reduce the number of bioavailable androgens within women’s bodies (Zimmerman et al., 2014). Given that androgens are essential for the maintenance of healthy vaginal tissue (I. Goldstein, 2009), reduced androgen levels may adversely impact the vaginal epithelium in OCP users. While OCPs are indeed associated with symptoms of vulvovaginal atrophy (VVA), such as vaginal pain and vaginal dryness (Battaglia et al., 2012), little is known about how these symptoms may vary based on the androgenicity of OCPs.

Objective
The aim of the present study was to compare rates of VVA among three groups of women: (1) women using OCPs containing low doses (i.e., ≤25 μg) of ethinylestradiol coupled with an androgenic progestin, (2) women using OCPs containing low doses (i.e., ≤25 μg) of ethinylestradiol coupled with an antiandrogenic progestin, and (3) naturally-cycling women (i.e., women with no history of oral contraceptive pill use).

Methods
Participants rated the severity of the following symptoms of VVA on a 4-point Likert-type scale ranging from 0 (mild) to 3 (severe): vaginal dryness, vaginal and/or vulvar irritation/itching, dysuria, and vaginal pain associated with sexual activity. Participants also dichotomously rated the presence or absence of vaginal bleeding associated with sexual activity.

Results
Women taking androgenic OCPs (n = 50) were significantly more likely to report vaginal bleeding associated with sexual activity than were women in the control group (n = 59), χ2(2, 130) = 9.759, p = .007. One participant (1.69%) in the control reported vaginal bleeding, compared to ten women (20%) in the androgenic group. Three participants (14.28%) in the antiandrogenic group endorsed vaginal bleeding, however this result was not significant. A MANOVA indicated no significant between-group differences for any of the remaining VVA items (i.e., dryness, itching/irritation, dysuria, or pain), F(2, 250) = 1.098, p = .365, and an ANOVA confirmed there were no differences between groups in the total VVA score, F(2) = 2.093, p = .127.

Conclusions
There were elevated rates of vaginal bleeding among OCP users compared to non-OCP users in this sample. This finding could be attributable a range of factors which have previously linked OCP use to vaginal bleeding, such as thinning of the vaginal tissue (Kagan & Rivera, 2018), cervical ectopy (Patil & Sharma, 2017), and thinning of the endometrium (Bright et al., 2011).

Disclosure
No
(103) Olfactory Investigation of the Male is Stimulated by Administration of Dihydrotestosterone and Blunted by Co-administration of Flutamide in Ovariectomized Rats Primed with Estradiol
Authors: Maseroli E , Filippi S , Cipriani S , Maggi M , Vignozzi L 
Published: May 2023

Abstract

Introduction
Although Hypoactive Sexual Desire Disorder (HSDD) is a common condition with a relevant impact on women’s quality of life, approved androgenic formulations for its treatment are lacking. In previous studies, we demonstrated that the administration of Dihydrotestosterone (DHT), a non-aromatizable androgen, in ovariectomized (OVX) Long-Evans rats primed with Estradiol Benzoate (EB), enhanced measures of sexual behavior.

Objective
To further clarify the mechanisms underlying the facilitating action of testosterone on female sexual function by investigating the effect of AR (androgen receptor) activation in a validated animal model.

Methods
After sexual training and hormonal wash-out, OVX Long-Evans rats were treated with different hormonal regimens: oil (O) + O (negative control group), 10 mcg EB+500 mcg Progesterone (P) (positive control group), 10 mcg EB+500 mcg DHT, and 10 mcg EB+500 mcg DHT+10 mg flutamide (FLU), a nonsteroidal AR antagonist (n=4 per group). EB was administered s.c. 48 h, P and DHT s.c. 4 h, and flutamide i.m. 48 and 24h prior to video-recorded sexual behavioral testing sessions. These took place in bisected unilevel pacing chambers, with sexually experienced males. Five testing sessions were conducted every 8 days. The main outcome measures were appetitive behaviors: the number of hops/darts (partial solicitation), full solicitations and olfactory investigations.

Results
A significant difference emerged among the 4 groups for all the outcome measures. Regarding solicitations, animals treated with EB+DHT displayed a higher number of hops/darts and full solicitations than the negative control group (O+O), although significantly lower than the positive control group (EB+P) for hops/darts (p=0.025). As a novel finding, we observed that the stimulating effect of EB+DHT was blunted in rats treated with EB+DHT+FLU, which showed a lower number of behaviors than EB+DHT rats (p=0.014 for hops/darts, and p=0.083, approaching statistical significance, for full solicitations). Interestingly, a significant difference was detected in the frequency of olfactory investigations, with the EB+DHT group displaying a higher frequency not only when compared with O+O rats (p=0.047), but also with EB+DHT rats (p=0.047 for both comparisons). Once again, the co-administration of FLU significantly reduced the stimulating effect (p=0.005 for olfactory investigations for EB+DHT+FLU vs. EB+DHT).

Conclusions
These data, to be confirmed in larger samples, indicate that the positive modulation exerted by androgens on appetitive behaviors, homologous to sexual interest in women, are independent of aromatization. In addition, a specific stimulating effect was detected for olfactory investigations.

Disclosure
No