bluuebunny/crossref_metadata_2025_split huggingface dataset:
(023) Disinformation on pornography effects on erectile function led to iatrogenic Reboot/NoFap "treatment"
Authors: Prause N 
Published: May 2023

Abstract

Introduction
Dozens of studies concluded that pornography does not cause erectile dysfunction. A laboratory study (2022) studying actual partners reported that partners who reported viewing more pornography in their daily life also reported higher sexual arousal to the real partner. Similarly, the partner being manually stimulated in that study exhibited higher galvanic skin response/arousal associated with increased sexual arousal when more pornography had been viewed in their daily life. Yet, most sex addiction therapists and Reboot/NoFap coaches claim that their clients’ sexual dysfunctions are caused by pornography viewing. Qualitative interviews with followers of Reboot/NoFap found that the framing of pornography as an “addiction” by these groups was actually maintaining clients’ distress. This raised the possibility that disinformation from these “treatments” regarding sexual functioning actually was the cause of ED.

Objective
Examine whether engagement with Reboot/NoFap “treatments” might actually be causing or perpetuating sexual arousal problems attributed to pornography viewing.

Methods
Data were collected via (1) a pre-registered, online survey and (2) scrape of the Reboot/NoFap “support” group /r/NoFap. Men (n = 693) who had heard of Reboot. The Reddit scrape included 1,219 unique users and 10,971 unique r/NoFap posts. 2.3% of users had to be excluded for spontaneously posting that they were under age 18 due to not documenting parental knowledge, consent, or assent to post. Posts were subjected to a sentiment analysis, a form of natural language processing.

Results
Survey: Those who personally participated in Reboot/NoFap treatments were significantly younger, more sex negative, and sexually less experienced than those who chose not to participate. Those who participated the most in /r/NoFap forum, paradoxically, reported significantly more symptoms of erectile dysfunction, depression, and anxiety. They also were more likely to report being told to “kill or harm” themselves in the support subreddit /r/NoFap and reported more suicidal ideation at their last relapse. Erectile difficulties were predicted by respondents’ anxiety symptoms, and that relationship was not mediated or moderated by their pornography viewing. The strongest predictor of identifying as a pornography addict in this sample was higher narcissism. Reddit scrape: The users who posted over time in r/NoFap, on average, included the same or more posts containing sad, angry, disgusted, or fear words. Emotions in the post were not predicted by the support (upvotes, comment count) received.

Conclusions
Treatments that conceptualize pornography as causing erectile dysfunction appears to paradoxically cause distress and erectile problems to worsen.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Mind Measures LLC
(027) Quality of Life, Including Sexual Life of Transgender People in Poland
Authors: Zborowska K , Bijoch J , Skrzypulec-Plinta V , Jorg D 
Published: May 2023

Abstract

Introduction
The shaping of human identity in the relationship between the mind and the body and the importance of this relationship for becoming a sexual being are elements of everyone's life, but in the case of transgender people this path is particularly complicated.

Objective
The main aim of the study was to analyze the relationship between the quality of life and sexual life in relation to the process of diagnosis and treatment of transgender people.

Methods
104 transgender people were enrolled in the study, including 66 transgender men and 38 transgender women. The study was conducted in two medical centers. The research tool used in the study was the original questionnaire and the Life Satisfaction Scale (SWLS), the Sexual Satisfaction Questionnaire (KSS).

Results
In the study, all transsexual persons had complete medical and psychological diagnostics necessary to confirm the diagnosis. The average duration of the diagnostic process was 6 to 12 months among the surveyed people (N = 42; 40,4%). Transgender persons also defined the duration and time of implementation of the "real life" test. The analysis of the research material shows that the vast majority of respondents started the "real life" test before starting the diagnostic process and its average duration during the diagnostic process was from 3 to 6 months. All medical services in the field of diagnostic and laboratory tests as well as medical procedures related to surgical gender correction cover from own resources. Medical procedures in the field of intramuscular injections are not carried out as part of primary health care, but are carried out in their own scope, usually independently after the previous instruction by persons unprofessional prepared for that. Studies have also shown that health-related aspects including reproductive health are not addressed in the transgender group by the attending physicians. The vast majority of information about transgender is searched on the Internet, and not by doctors as a professional source of information. Half of the transgender examined had suicidal ideation (N=58%) and 11% of those attempted suicide. The mean value of life satisfaction (SWLS) in the study group was 25,4 (SD=4,3; min.=12, max.=33). The Mann-Whitney U test showed that the examined transgender people differ in the average result obtained in the SWLS scale (U = 723,5; p = 0,.000270). The average raw result obtained in the KSS scale for the whole examined group is 32.88 (SD=3.28; min.=20, max.=39).

Conclusions
The diagnosis and treatment process determines the quality of life, sexual satisfaction of transgender people. Support for the transgender family determines their assessment of life satisfaction. In Poland, there is no standard of care for transgender people and there is no discussion of reproductive health.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Medical University of Silesia
(042) Inflatable Penile Prosthesis Placement In Transgender Neophallus Using Novel Human Cadaver Pericardium (Tutoplast®) Graft Sock Technique
Authors: Mehr J , Blum K , Green T , Panchapakesan K , Freet D , Wang R 
Published: May 2023

Abstract

Introduction
Placement of an inflatable penile prosthesis (IPP) in a transgender patient’s neophallus carries unique considerations versus cis-gender IPP in mitigating infection, erosion, and overall complication rates. Traditionally, the IPP implants used in cis-males are also employed in transmasculine patients. However, there are unique challenges in the transmasculine population, with one of the most significant being the lack of anatomical corpus cavernosum and crura for cylinder placement and anchoring. To account for this, multiple grafting approaches and materials have been utilized in IPP neophallus placement with the goal of facilitating cylinder anchoring and stability. Here we detail our experiences using a novel grafting approach with Tutoplast® pericardium graft in a “sock” and “cap” technique in IPP placement in a transgender neophallus.

Objective
Our objective is to evaluate postoperative satisfaction and device functionality in patients undergoing transgender neophallic IPP placement using our technique.

Methods
We describe our experience and surgical technique in IPP neophallus placement utilizing a single cylinder with novel distal and proximal cylinder human cadaver pericardium (Tutoplast®) graft.

Results
We performed neophallus IPP placement with this novel grafting technique, with operative images and graft details shown below. Patients had no complaints post-operatively, with cylinder and pump found to be in good position at first post-operative visit 6 weeks following surgery. There was no difficulty with urinating through the neophallus. All patients report continued satisfaction with device as well as ability to perform penetrative intercourse with device activated. All patients reported satisfaction and no complications at last follow-up (range: 3.5 months to 13 months), with all patients possessing continued satisfactory erectile function. One patient noted occasional mild pain in neophallus that self-resolves and does not cause any concern.

Conclusions
In neophallus IPP placement, the anatomical differences compared to cis-gender IPP operations require unique considerations such as cylinder grafting material selection for proximal cylinder fixation and mitigation of device erosion rates. Utilizing human cadaver pericardium (Tutoplast®) graft in distal and proximal cylinder coverage shows positive preliminary outcomes in our patients.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific and Teleflex.
(058) Does Ecstasy Have Treatment Potential in Female Sexual Dysfunction? A Systematic Review of Effects on the Female Sexual Response Cycle
Authors: Dubinskaya A , Suyama J , Anger J , Eilber K 
Published: May 2023

Abstract

Introduction
Female sexual dysfunction (FSD) is a highly prevalent and distressing condition, yet limited treatment modalities have been established and incorporated into clinical practice to address this condition. 3,4-Methylenedioxy-methamphetamine (MDMA, ‘Ecstasy’ or ‘Molly’) is a psychostimulant affecting central serotonin, dopamine, and norepinephrine neurotransmission. These same neurotransmitters play important roles in sexual function which suggests that MDMA has potential to be utilized as a novel treatment strategy for FSD.

Objective
The purpose of this systematic review is to evaluate effects of MDMA on different domains of female sexual response cycle.

Methods
We conducted a systematic review on the effects of MDMA on the various domains of the female sexual response cycle. PubMed, MEDLINE, and EMBASE were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms, including “MDMA” or “ecstasy” in combination with “desire,” “arousal”, “lubrication”, “orgasm”, “pleasure”, “libido,” were utilized. Inclusion criteria for this review were: MDMA was used by study subjects, sexual outcomes in at least one domain of female sexual cycle were described and measured, and the manuscript was written in English between January 2000 to June 2022. Case reports and studies that did not address conditions of interest were excluded from analysis.

Results
We identified a total of 175 studies. Of these, six studies including 155 women met our inclusion and exclusion criteria. Four of the six studies, including one randomized control study, reported increased sexual desire with MDMA use. Arousal and lubrication were improved in three of four studies but were not affected based on one randomized control study. Orgasm after using MDMA was delayed or difficult to reach, but more intense and pleasurable if achieved.

Conclusions
This systematic review demonstrates the need for further investigation of the effect of MDMA on different domains of the female sexual response cycle. While effect on orgasm and desire is more certain based on the available data, there is conflicting evidence about MDMA enhancing sexual arousal. MDMA is illicit and unregulated recreational drug, our findings should be interpreted with caution.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast, Sprout Pharmaceuticals.
(063) Association between Comorbidities and Longitudinal Changes in Total Testosterone among men from the Baltimore Longitudinal Study of Aging
Authors: Carto C , Rahman F , Gurayah A A , Suarez Arbelaez M C , Ramasamy R 
Published: May 2023

Abstract

Introduction
Previous cross-sectional and longitudinal studies have described decreasing testosterone levels with age in men. However, the longitudinal impact of acquired comorbidities in aging males on the relationship between age and testosterone has not been thoroughly investigated.

Objective
In this longitudinal study, we aimed to evaluate the longitudinal association between age and testosterone levels and to investigate the impact of additive comorbidity burden on this relationship. We hypothesized that when controlling for the presence of comorbidities commonly acquired with age, there would be no association between age and serum total testosterone level.

Methods
Participants were selected from the Baltimore Longitudinal Study of Aging. Data was obtained on presence of several comorbidities and total testosterone level during each follow-up visit. All men with diagnosis of prostate cancer or documented use of testosterone replacement therapy during their follow-up period were excluded from analysis. A stepwise regression analysis was performed, including a final multivariate panel regression model in order to determine the impact of age on testosterone level while controlling for individual comorbidities.

Results
A total of 1,784 men were included in this study, with a mean age of 71 years and overall mean testosterone level of 463.2 ng/dL. Participants had an average of 3.23 comorbidities. On multivariable-adjusted panel regression analysis, age was not significantly associated with testosterone decline, while anemia, diabetes mellitus, heart failure, obesity, peripheral artery disease, and stroke were inversely associated with total testosterone level. We report no association between cancer and total testosterone.

Conclusions
In this large longitudinal study, we found that when adjusted for the presence of concomitant comorbidities, age does not predict a significant decline in testosterone level with age. With the overall increase in life expectancy, and the simultaneous rise in the incidence of comorbidities such as diabetes and dyslipidemia, our findings may help optimize screening and treatment for late-onset hypogonadism in patients with multiple comorbidities.

Disclosure
No
(067) Oral Testosterone, Is It Ready for Prime Time? A Meta-analysis of Safety and Efficacy in Men with Testosterone Deficiency
Authors: Miller J , Nguyen T , Loeb C , Khera M , Yafi F 
Published: May 2023

Abstract

Introduction
The prescription rates of testosterone replacement therapy (TRT) have tripled within recent decades. Recently, two novel oral testosterone undecanoate (TU) options have obtained FDA approval and are now commercially available. We present the first meta-analysis analyzing the safety and efficacy of oral TRT in patients with testosterone deficiency (TD).

Objective
To evaluate the safety and efficacy of TU in the treatment of TD

Methods
Pair-wise meta-analyses were performed including randomized, placebo-controlled trials investigating the use of TU. Studies were included for analysis if participants received oral TRT or placebo for a period greater than one month and if adverse effects (AE) or changes in serum total testosterone (TT) were recorded.

Results
Nine studies including a total of 606 patients recorded changes in TT. When separated by population, studies including only men with TD saw improved TT (mean change 1.25 ng/mL, 95% CI: 0.22 to 2.29, I2: 0%). Eight studies including a total of 849 patients recorded rates of AE. There was no statistically significant change in the risk of AE in patients receiving oral TRT compared to placebo (log risk ratio -0.03, 95% CI: -0.08 to 0.03, I2: 0%) [Figure 1].

Conclusions
When separated by inclusion criteria, studies examining men with TD tended to report improved TT levels following treatment with TU compared to placebo. In studies examining the safety of oral TRT, its use was not associated with increased rates of AE when compared with placebo.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma; Clarus Therapeutics; Coloplast; Cynosure; Promescent; Sprout; Viome.
(070) Testosterone Therapy in Men with Klinefelter Syndrome: Analysis of a Global Federated Research Network
Authors: Carto C , Loloi J , Campbell K , Ramasamy R 
Published: May 2023

Abstract

Introduction
Klinefelter syndrome (KS) is a genetic condition in which a male is born with an extra X-chromosome and is one of the on-label indications for testosterone replacement therapy (TRT). The prevalence of testosterone deficiency in men with KS is difficult to predict and not well described in the literature. Furthermore, there is no previous literature detailing the rates of TRT prescription in men diagnosed with KS.

Objective
We aimed to determine the rates of hypogonadism and prescription of TRT in men with KS using a large, federated research database. We hypothesized that men with KS are undertreated for testosterone deficiency with TRT due to a combination of factors including a poor understanding of hypogonadism in this population and neurocognitive issues leading to delay in seeking treatment for hypogonadism.

Methods
We queried TriNetX, a large, multicenter electronic health record database, to identify all men with a diagnosis of Klinefelter syndrome (ICD-10-CM Q98.4) excluding men with prescription of TRT prior to diagnosis of KS or a diagnosis of KS more than 20 years ago. Descriptive analysis on associated comorbidities and demographic characteristics was performed. We then filtered the initial cohort to find men who received a laboratory measurement of testosterone level on the day of diagnosis with KS or later. Prevalence of testosterone deficiency was determined as defined by testosterone level &lt; 300 ng/dl. The primary outcome of the study was prescription of any of the following forms of TRT on the day of diagnosis or later using associated medication codes: testosterone, testosterone 17-phenylpropionate, testosterone enanthate, testosterone cypionate, testosterone undecanoate. Rates of TRT prescription were determined for both the initial cohort and the hypogonadal subgroup.

Results
There were 5,437 total men with diagnosis of KS. A total of 1,581 men with KS received laboratory measurement of testosterone level, 1,113 (70.4%) of whom were hypogonadal. Mean testosterone level in this group was 354 ng/dL [50 – 658]. Of the 1,113 men found to be hypogonadal, only 657 (59.0%) men were given prescription for TRT.

Conclusions
This is the first study to evaluate TRT prescribing habits in men with KS. In this large, retrospective study, TRT was under-prescribed in men with KS. Further studies are needed to corroborate these findings and to evaluate the barriers to receiving care in this population.

Disclosure
No
(082) The Effect of Sex Steroids on RhoA/ROCK Pathway in Rat Distal Vagina
Authors: Cellai I , Comeglio P , Filippi S , Martinelli S , Amore F , Rapizzi E , Maseroli E , Raddi C , Guarnieri G , Cipriani S , Sarchielli E , Morelli A , Rastrelli G , Maggi M , Vignozzi L 
Published: May 2023

Abstract

Introduction
The RhoA/ROCK calcium-sensitizing pathway plays a role in clitoral contractility, and therefore we deemed interesting to investigate its involvement in the vagina.

Objective
The aim of this study was to investigate the sex steroid regulation of the vagina contractility through the RhoA/ROCK pathway, using a validated animal model.

Methods
Ovariectomized Sprague-Dawley rats (OVX) were treated with 17β-estradiol (E2), testosterone (T), with or without letrozole (T+L), and compared with intact animals. Contractility studies were performed on vaginal strips to test the effect of ROCK inhibitor Y-27632 and NO synthase inhibitor L-NAME. In vaginal tissues, ROCK1 immunolocalization was investigated, mRNA expression was analyzed by semi-quantitative RT-PCR, and RhoA membrane translocation was evaluated by Western blot (Wb) analysis. Finally, rat smooth muscle cells (rvSMCs) were isolated from distal vagina of intact animals and the quantification of RhoA inhibitory protein RhoGDI was performed by Wb after stimulation with NO-donor SNP, with or without the soluble guanylate cyclase inhibitor ODQ or the PKGR1 inhibitor KT5823 administration.

Results
The results show that ROCK1 was immunolocalized in the smooth muscle bundles and in the blood vessel wall of vagina, while a weak positivity was detected in the epithelium. Y-27632 induced a dose-dependent relaxation of noradrenaline pre-contracted vaginal strips, decreased by OVX and completely restored by E2, while T and T+L further decreased it even below OVX level increased it. Accordingly, in Wb analysis, compared to controls, OVX significantly induced RhoA activation, as reveled by its membrane translocation, with T reverting it at a level significantly lower than in controls. This effect was not exerted by E2. Abolishing the NO formation via L-NAME increased Y-27632 responsiveness in the OVX+T group; L-NAME had only a partial effect in controls whilst it did not modulate Y-27632 responsiveness in OVX. Finally, stimulation of rvSMCs with SNP significantly increased the RhoGDI protein expression, an effect counteracted by ODQ and, partially, by the protein kinase inhibitor KT5823 incubation.

Conclusions
In conclusion, in vagina androgen administration in OVX functionally decreases RhoA/ROCK activity by hampering RhoA membrane translocation and plays a critical role in the inhibitory mechanism of the smooth muscle distal vagina contractility. Accordingly, androgens, by inhibiting the RhoA/ROCK pathway, could positively contribute to vaginal smooth muscle relaxation, favoring the sexual intercourse.

Disclosure
No