bluuebunny/crossref_metadata_2025_split huggingface dataset:
(233) REGULAR DILATION AND SEXUAL ACTIVITY SHOW LESS RISK FOR VAGINAL NARROWING AND SHORTENING AFTER RADIOCHEMOTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER
Authors: Dr. Kathrin Kirchheiner , Dr. Alexandru Zaharie , Dr. Stéphanie Smet , Dr. Sofia Spampinato , Dr. Richard Pötter , Dr. Christian Kirisits , Dr. Maximilian Schmid , Dr. Kari Tanderup , Dr. Astrid A De Leeuw , Dr. Ina M Jürgenliemk-Schulz , Dr. Remi A Nout 
Published: July 2023

Abstract

Objectives
Radiochemotherapy for cervical cancer has a substantial risk to cause long-term vaginal stenosis (shortening/narrowing), due to irreversible fibrotic changes and can cause dyspareunia in many cancer survivors. Clinical recommendations for aftercare include vaginal dilation with cylinders; sexually active patients with partners are encouraged to engage in intercourse involving penetration. However, the evidence for prevention is limited.
Aim of this report is to evaluate the association between regular vaginal dilation, sexual activity and vaginal stenosis in locally advanced cervical cancer patients after definitive radiochemotherapy and image-guided adaptive brachytherapy from the prospective, international, longitudinal EMBRACE I study (www.embracestudy.dk).

Methods
Physician-assessed vaginal stenosis (CTCAE v.3), vaginal dilation and patient-reported sexual activity (EORTC QLQ CX24) were assessed at baseline, every 3 months in the 1st year, every 6 months in the 2nd and 3rd year and yearly thereafter. For this longitudinal analysis, a subgroup of patients was selected with at least 3 follow-ups with information on vaginal dilation and sexual activity. Regular dilation was defined if reported in ≥50%, irregular/no dilation if reported in &lt;50% of follow-ups. The same method was applied to sexual activity. Actuarial estimates of vaginal stenosis G≥2 were calculated with Kaplan-Meier method; group comparisons evaluated with the log-rank test.

Results
The EMBRACE I study recruited 1416 patients overall (2008-2015); the subgroup of patients for this longitudinal evaluation included 821 patients, with a median follow-up of 61 months. Of those, 296 (36%) reported regular dilation; this was associated with a significantly lower risk of vaginal stenosis G≥2 at 5 years, p=0.023 (figure A). 381 patients (46%) reported regular sexual activity; this was associated with a significantly lower risk of vaginal stenosis G≥2 at 5 years, p≤0.001 (figure B).

Conclusions
These long-term data support clinical recommendations for regular dilation and/or sexual activity after radiotherapy.

Conflicts of Interest
The authors have no conflict of interest to declare.
(99) SEXUALITY, THE ULTIMATE ‘EXPOSURE OR ESCAPE’ FOR PATIENTS WITH BODY DYSMORPHIC DISORDER
Authors: Dr. Rieky Dikmans , Rachel van Loenen , Dr. Staphanie Both , Dr. Maarten van Westen , Dr. Nienke Vulink 
Published: July 2023

Abstract

Objectives
In body dysmorphic disorder (BDD), anxiety for judgement of appearance plays a major role and is especially difficult in contact with others. In sexual engagement this is unavoidable. It is also known that sexuality is an essential part of quality of life and that for both healthcare providers and patients it is still a difficult topic to address. To date, there is no clear insight in how BDD interacts with sexuality. The aim of this study is to get a better understanding on how patients with BDD experience sexuality.

Methods
In the outpatient setting of the psychiatry department of the Amsterdam University Medical Center 15 patients (of mixed gender and sexual preference) underwent a semi-structured interview conducted by two researchers. The analyses took place by open coding and the results were discussed by all researchers involved.

Results
Sexuality is strongly influenced by the presence of BDD. During intercourse patients are trying to navigate on a vulnerable tension field that is created by opposite motives and feelings (such as avoidance versus willingness to engage or arousal versus disgust). Their sexuality is surrounded by rituals where there is little room for spontaneity. The success of the sexual experience depends mainly on the pleasure of the other person and can be immediately interrupted by a tactile or visual confrontation with the respective BDD focus. In the continuous stream of negative thoughts, there is either little contact with the body or it rather serves as a functional instrument that is used to get out of their head. All patients agree that discussing sexuality and using bodily exercises are important.

Conclusions
In this first qualitative study on sexuality in a diverse group of BDD patients, it became clear that sexuality is a topic full of tension. Sexuality should have a part in the treatment of patients with BDD.

Conflicts of Interest
There are no conflicts of interest.
(262) DOES SEXUAL CREATIVITY ENHANCE SEXUAL AND RELATIONSHIP SATISFACTION? EXAMINING THE EFFECT OF WEEKLY CREATIVE SEXUAL TASKS IN MONOGAMOUS LONG-TERM RELATIONSHIPS
Authors: Tabea M Zorn , Lena Feilhauer , Elina Juhola , Ralf Cox , Prof. Peter J de Jong , Charmaine Borg 
Published: July 2023

Abstract

Objectives
Research has only recently started to investigate how sexual passion and satisfaction can be maintained in a monogamous long-term relationship. The challenge lies in the familiarity and comfort that frequently turn into sexual boredom and predictability, leading partners to desire less mechanical and routine sex. Since sexual novelty has been positively related to sexual and relationship satisfaction, we tested the effect of including weekly sexual creativity in couples' sex lives

Methods
As part of the study, we introduced a definition of sexual creativity as sexual activity that is new, pleasurable, and safe for all parties involved. The experimental group had to plan at least one sexually creative activity per week for one month, while the control group planned sex as usual. Both groups received weekly instructions in which the experimental group got a theme with examples to stimulate creativity. There were weekly questionnaires and a follow-up two weeks after the intervention.

Results
In a preliminary analysis, scores of 114 monogamous couples that had been together for at least 1.5 years were analyzed on their development of sexual satisfaction, relationship satisfaction, sexual boredom, sexual novelty, sexual communication, sexual frequency, sexual desire, and importance of sex at baseline, post-intervention, and follow-up. Results showed no differences between the groups. However, sexual satisfaction and sexual novelty significantly increased for both groups over time and remained at the increased level at follow-up.

Conclusions
Our results raise questions about how to effectively manipulate sexual creativity in an experimental setup as our two tested groups might have been too similar which might have hindered the finding of positive effects of the intervention. Nevertheless, our study gives first indications for the effectiveness of having participants regularly plan sexual activity. In general, we achieved high adherence opening up new research directions for experimentally testing a sexual intervention with couples in real life.

Conflicts of Interest
None
(89) GENDER-BASED DIFFERENCES ABOUT THE PSYCHOLOGICAL WELL-BEING OF THE ITALIAN BI+ POPULATION: AN EXPLORATORY EMPIRICAL RESEARCH
Authors: Dr. Paolo Antonelli , Dr. Francesco Fantacci , Dr. Lorenzo Borrello , Dr. Anna Russo , Dr. Elisabetta Muto , Dr. Daniel Giunti , Dr. Cristiano Scandurra 
Published: July 2023

Abstract

Objectives
(1) to explore possible differences between Bi+ cisgender and transgender people in terms of identity affirmation, social support, and psychological well-being; (2) to test the mediating role of identity affirmation in the relationship between perceived social support and psychological well-being.

Methods
497 Italian Bi+ individuals (362 cisgender and 135 transgender), aged 14 to 61, participated in an online survey. Gender differences in main variables were tested with the T-test for independent samples, while the mediation model was tested with the SPSS PROCESS macro with bias-corrected bootstrapping and 95% confidence intervals. This analysis was controlled for gender (cisgender vs transgender).

Results
(1) Bi+ transgender participants showed lower levels of perceived social support, environmental mastery, positive relations, purpose in life, self-acceptance and global psychological well-being than Bi+ cisgender counterparts, while Bi+ transgender participants showed higher levels of identity affirmation than Bi+ cisgender counterparts.(2) Perceived social support was positively associated with both identity affirmation and psychological well-being and identity affirmation was positively associated with psychological wellbeing. As identity affirmation was included as a mediator, there was a significant overall effect, while the direct effect remained significant, indicating a case of partial mediation. Indeed, the indirect effects showed that identity affirmation significantly mediated the relationship between perceived social support and psychological wellbeing. Gender was a significant control variable, indicating that being Bi+ cisgender was most strongly associated with psychological well-being than being Bi+ transgender.

Conclusions
The few studies on the Bi+ community show how it suffers from peculiar risk factors in addition to those common to the entire LGBT+ population. Our innovative research shed a light on gender differences showing a general lower level of psychological well-being of Bi+ transgender people despite a higher level of identity affirmation, maybe consequent to the visibility that this community must actively seek to be recognized.

Conflicts of Interest
Paolo Antonelli, Francesco Fantacci, Lorenzo Borrello, Anna Russo, Elisabetta Muto, and Cristiano Scandurra declare that they have no conflict of interest.
(210) ADAPTING THE SEXUAL SELF-CONCEPT: A USEFUL APPROACH TO IMPROVE SEXUAL FUNCTIONING FOR WOMEN WITH A DIFFERENCE OF SEX DEVELOPMENT?
Authors: Arianne Dessens , Nita de Neve-Enthoven , Nina Callens , Yvonne van der Zwan , Maaike van Kuijk , Chris Verhaak , Katja Wolffenbuttel , Peggy Cohen-Kettenis , Stenvert Drop , Ina Beerendonk , Martine Cools 
Published: July 2023

Abstract

Objectives
Differences of Sex Development (DSDs) are a large group of congenital conditions characterized by an altered development of the internal and external genitalia. Examination of sexual function in relationship to cognitions and emotions that hinder or promote sexuality (i.e. sexual self-concept) may contribute to the development of specific interventions to improve sexual functioning.

Methods
91 women participated in a follow-up study consisting of a standardized gynecological examination and psychosocial assessment of sexual functioning. Outcome measures included genital atypicality at birth,1-3 applied surgical and non-surgical interventions,1-3 Dutch versions of the Female Sexual Functioning Index (FSFI),1-4 Female Sexual Distress Scale-Revised (FDFS-R),1-4 Body Image Scale,1-4 (dis)satisfation with the functionality of the genitalia1-4 and the Women Sexual Self-Concept Scale (WSSCS-D).1-4 Statistics: different types of parametric and non-parametric tests for categorical and continuous variables and principal component analysis.1-4

Results
Many women born with DSD reported sexual problems, in particular women who have undergone extensive genital reconstruction.1,3 Large percentages of women were not in a romantic relationship, had not been sexually active recently or had never been sexually active. Of women who completed the FSFI questionnaire, 66% scored in the rangeof a sexual dysfunction and 41% of women experienced sexually related distress (FDFS-R).1,3 Women with DSD harbored more negative emotions and cognitions regarding their sexuality and were less satisfied with their genitalia. Sexual self-concept was associated with compromised outomes on sexual functioning and distress.1,3,4

Conclusions
Problems in sexual functioning are common among women with DSD. Negative cognitions and emotions related to sexual self-concept probably play a role in their sexual functioning. A cognitive behavioral approach with focus on acceptance and coping with genital variety, explorations of the own sexual needs and adaptation of negative emotions and cognitions into more positive ones, could prove useful in this group.

Conflicts of Interest
The authors declare no conflict of interest.
(156) WHY IS IT SO CHALLENGING TO TALK ABOUT SEX? A QUALITATIVE ASSESSMENT OF FAMILY DOCTORS’ VIEWS ON THE NEEDS AND BARRIERS TO DEAL WITH THEIR PATIENTS’ SEXUAL HEALTH
Authors: Beatriz F Lopes , Inês Tavares , Ana L Q Gomes 
Published: July 2023

Abstract

Objectives
Evidence shows a lack of training on sexuality in both pre and postgraduate Medicine levels, leading to these professionals’ insecurity in dealing with their patients’ sexual problems. Yet, Family Doctors have a central role in the promotion and education for sexual health of the community. The aim of this study is to identify the main needs and barriers identified by Portuguese Family Doctors in addressing sexuality in their professional context; to assess the receptiveness of Family Doctors to using a training program on sexuality.

Methods
We conducted 2 focus groups with 10 Portuguese Family Doctors. Both focus groups had a maximum duration of 90 minutes and were moderated by two project researchers. The inclusion criteria were the ability to give informed consent, being Family Doctors with clinical activity and have Portuguese nationality. Professionals participating in another sexuality research study were excluded. Confidentiality and fundamental ethical requirements were respected. The data collected was processed using Braun and Clarke's thematic content analysis and it was anonymized and analyzed using the NVivo Software.

Results
The results of this study indicated that Family Doctors identified several needs and barriers to the management of sexuality in their professional context, which were informed by both individual and contextual factors. Employing a qualitative methodology enabled us to explore the subjective experiences in dealing with their patients’ sexuality, as constructions dependent on individual context, obtaining in-depth understanding of its complexity.

Conclusions
The information collected will serve as basis for the content development of a training program on sexuality for Family Doctors. We believe that the present study will have ethical, social, and political implications, contributing to the promotion of sexual health among health professionals and the general population.

Conflicts of Interest
The authors report no conflicts of interest.
(236) HELPLINE PARAPHILE: FINDINGS FROM FIRST SPECIALIZED CZECH PHONE HELPLINE FOR PEOPLE WITH PROBLEMATIC SEXUAL INTERESTS AND/OR BEHAVIOURS
Authors: Kateřina Potyszová , Marek Navrátil , Filip Šinkner , Kateřina Klapilová 
Published: July 2023

Abstract

Objectives
In 2020 the Czech primary prevention project Paraphile launched the first Czech crisis intervention phone line targeting men and women with self-identified paraphilic sexual preference and/or individuals at risk of sexual offending (and their close persons). The overall purpose was to reach the target group and encourage further on-site assessment and treatment.

Methods
The PARAPHILE Helpline offers limited (3-5 sessions) crisis counseling via on-line appointment and/or via an anonymized telephone line. One of the main aims of the service is to assess appropriately the clients' needs in the field of sexual medicine and adjust their risk of sexual offending. The trained operators address the client to the appropriate sexology-related care and/or if appropriate to the Prevention Project PARAPHILE contact therapy treatment. Each client underwent a basic screening, which is a 30-item semi-structured interview covering basic sociodemographic characteristics, data on problematic sexual interests and/or behaviors, mental health conditions, basic risk assessment, and basic mapping of clients' motivation to treatment.

Results
Data collection took place between December 2020 and October 2022. A total of 170 calls were made or arranged via online appointment, out of which 24 followed with on-site assessment and treatment. The topics of the Helpline included risky sexual behavior(s), basic psychoeducation regarding paraphilias, problematic online behavior, informative calls from close persons, issues of compulsive sexual behavior, sexual dysfunction, partnership troubles, other mental health issues (e.g. anxiety, depression, psychotic clients).

Conclusions
Individuals at risk of sexual offending and self-identified individuals with paraphilia can be reached through a specialized helpline service and motivated to undergo further assessment and treatment. The helpline also proved to be a significant low-threshold service for this type of clientele.

Conflicts of Interest
There are no Conflicts of Interest.
(45) SHAEER’S TECHNIQUE FOR PENILE PROSTHESIS IMPLANTATION THROUGH A SINGLE MIDLINE CORPOROTOMY
Authors: Prof. Osama Shaeer , Prof. Kamal Shaeer 
Published: July 2023

Abstract

Objectives
With the infrapubic approach for penile prosthesis implantation (IPA), lateral corporotomies carry the risk of injury to the laterally-coursing dorsal nerves. This is one of the reasons why IPA is not widely adopted despite its potential advantages.
We describe for the first time Shaeer’s IPA; a modification of the infra-Pubic approach, whereby malleable penile prosthesis cylinders are implanted through a single midline corporotomy in the bed of the deep dorsal vein. The midline corporotomy spares the laterally-coursing dorsal nerves.

Methods
We compared semi-rigid penile prosthesis implantation via the single-midline-corporotomy infrapubic approach (IPA-S, n=11), to the classic infrapubic approach with laterally placed dual corporotomies (IPA-D, n=11) and to the penoscrotal approach (PSA, n=13). Shaeer’s IPA is performed through the infrapubic incision. A 3-5 cm length of the deep dorsal vein is stripped. A single 3-5 cm midline corporotomy is cut along the bed of the vein. Dilation, sizing and implantation are performed through the single corporotomy on either side of the midline septum. Patients are discharged same day, allowed to bend the implant after 2 weeks, and to commence intercourse after three weeks.

Results
There were no statistically significant differences in age, post-implantation IIEF-5 or satisfaction between the three groups. Average operative time for the IPA-S group was 21.8% shorter than the IPA-D group, and 34.5% shorter than the PSA group. Pain as per the 10-point pain scale was least in the IPA-S group, with a 37.8% difference from the IPA-D group and a 41.9% difference from the PSA group. Those differences were statistically significant. No complications were recorded in the IPA-S group. Infection occurred in one PSA case, and partial hypoesthesia in one IPA-D case.

Conclusions
“Shaeer’s Single-Midline-Corporotomy Infra-Pubic Approach” is a minimally invasive approach for implantation of the semi-rigid penile prosthesis, avoiding injury of the laterally-coursing dorsal nerves of the penis.

Conflicts of Interest
None
(101) CAVERNOSAL BANDING: A NEW PROCEDURE TO ADDRESSSIGNIFICANT WEAKENING/LOSS OF ALBUGINEA, PARTICULARLY FOLLOWING REITERATED PENILE PROSTHESIS SURGERIES
Authors: Dr. Edoardo Pescatori , Dr. Andrea Loreto , Davide Dell'Orco 
Published: July 2023

Abstract

Objectives
We present an original technique to address loss and/or weakening of albuginea in patients with inflatable penile prostheses.

Methods
A 52 y.o. white male with four former implant surgeries (penoscrotal) reported that upon activation no erection developed, while the scrotum enlarged. MRI disclosed bilateral cylinders extrusion at the site of former corporotomies.
Surgical procedure. Penoscrotal approach: in the extrusion area there was bilaterally a wide loss of albuginea. In the involved area we circumferentially isolated the albuginea dorsally from Buck’s fascia, inclusive of the neurovascular bundle, and ventrally from urethra. We developed some tissue planes to cover the albuginea loss. The old device was removed and replaced with a new AMS 700CX. We measured: circumference of isolated corpora in tumescence state (12 cm), and distance between the limits of the two isolated circumferences -proximal and distal- (5 cm). A 12x5 cm rectangle of Tutopatch® was fashioned. CAVERNOSAL BANDING was achieved transferring the fashioned Tutopatch® rectangle around the isolated albuginea of the two corpora cavernosa. The two short sides were sutured together and to the ventral albuginea, beneath the urethra, and anchoring stitches fixed the patch to the albuginea, to keep it flat (figure). Patient had to daily cycle the device for three months, not exceeding the tumescence status, to allow a sound remodelling process of the graft.

Results
At 3 months control MRI: normal appearance of the inflated cylinders, without bulging. At 5 months from surgery patient is having regular sexual intercourse without any clinical evidence of bulging, with high satisfaction: IIEF score at 1 month= 24; QoLSPP scores: 25 - functional domain, 15 - social domain, 19 - relational domain, 18 - personal domain.

Conclusions
Cavernosal banding with bovine pericardium appears to be a working solution for challenging cases of albuginea loss in patients with penile prosthesis.

Conflicts of Interest
None
(204) ABDOMINOPLASTY AND PENILE PROSTHESIS IMPLANT: A NEW STANDARD APPROACH FOR OBESE PATIENTS?
Authors: Manuel Alonso-Isa , Esther García-Rojo , Elena Peña-Vallejo , Borja García-Gómez , José Medina-Polo , Javier Romero-Otero 
Published: July 2023

Abstract

Objectives
One-third of adult men are obese and profound sexual dysfunction is quite common in this population. A penile prosthesis implant (PPI) has been proven to be an effective option for patients that do not respond to non-surgical treatments. Together with an abdominoplasty, it could be an alternative treatment in obese patients to improve satisfaction and facilitate sexual intercourse. For us, this is the new gold standard.

Methods
We retrospectively reviewed 15 patients from 2016 to 2022 who underwent an abdominoplasty and PPI. Demographic, comorbidities, type of PPI, the perform of other additional techniques, surgery time, complications, and other relevant variables were recorded for analysis.

Results
All patients were obese with erectile dysfunction and 8 suffered from diabetes. 10 inflatable penile prostheses and 5 malleable ones were implanted. Only one device had to be removed due to a prosthesis infection. The mean surgery time was 97 minutes. The mean hospital stay was 3.6 days after surgery. A significant increase in postoperative penile length of 2.8 cm (1.3-4.2cm) and reasonable satisfaction rates (85% in Erectile Dysfunction Inventory of Treatment Satisfaction, EDITS) were achieved.

Conclusions
Abdominoplasty is a safe and reproducible technique that can be performed simultaneously with the placement of a penile prosthesis in selected patients. It is possible to combine it with other surgical techniques. Patients must always be counseled on the expectations and the risk of postoperative complications. However, due to the excellent postoperative results and patient satisfaction, it is the new gold standard for this kind of patient for us.

Conflicts of Interest
The authors have no potential conflict of interest to report.