Saturday 11 October 2014

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Wednesday

Morning

08:00 - 08:35
SLAMS symposium (in Spanish/Portuguese) - part 1 - Lecture: History of sexology – Sexual medicine in Latin America

Location: Comandatuba Room 2+3
Chairs: Edgardo Becher (Argentina) & Sidney Glina (Brazil)

Opening

Edgardo Becher (Argentina) & Sidney Glina (Brazil)

Lecture: History of sexology – Sexual medicine in Latin America

Alain Giami (France)


08:35 - 09:35
SLAMS symposium (in Spanish/Portuguese) - part 2 - Round table

Location: Comandatuba Room 2+3
Chair: Alejandro Carvajal (Colombia)

Basic research for Peyronie’s Disease

João Afif Abdo (Brazil)

New therapeutic approaches

Julio Ferrer (Colombia)

Controversies in surgery

Celso Gromatzky (Brazil)

Discussion


09:35 - 10:10
SLAMS symposium (in Spanish/Portuguese) - part 3 - Point counterpoint: Changes in lifestyle: Do they improve sexual dysfunctions?

Location: Comandatuba Room 2+3
Chair: Adrian Momesso (Argentina)

Pro

Juan Uribe (Colombia)

Con

Eduardo Bertero (Brazil)

Coffee break


10:10 - 11:20
SLAMS symposium (in Spanish/Portuguese) - part 4 - Clinical cases: Androgen deficiency in the aging male – Male sexual dysfunctions

Location: Comandatuba Room 2+3
Chair: Geraldo Faria (Brazil)

Clinical case

Carlos Da Ros (Brazil)

Clinical case

Archimedes Nardozza (Brazil)

Clinical case

Ernani Rhoden (Brazil)


11:20 - 13:30
SLAMS symposium (in Spanish/Portuguese) - part 5 - SBRASH symposium

Location: Comandatuba Room 2+3
Chair: Iracema Teixeira (Brazil)

Implications in the Queer theory in sexuality

José Jorge Serapião (Brazil)

The exercise of sexual rights in clinical practice

Itor Finotelli Jr. (Brazil)

Sexuality abused and its implications in the sexual adult life

Raquel Simone Varaschin (Brazil)

Break


09:00 - 12:30
ISSWSH symposium - Update in the management and treatment of female sexual dysfunction – 2014

Location: São Paulo Room
Chair: Sue Goldstein (USA)

Introduction

Sue Goldstein (USA) & Sharon Parish (USA)

Update in epidemiology, classification, screening, questionnaires

Sharon Parish (USA)

State of art in women's sexual health diagnostics

Irwin Goldstein (USA)

GSM (formerly VVA) and treatment

Sharon Parish (USA)

Androgen and therapy: safety, efficacy and practical considerations

Sharon Parish (USA)

Contraception and sexual function

Irwin Goldstein (USA)

Coffee break

Management of sexual pain conditions

Irwin Goldstein (USA)

Update in non-hormonal therapies for female sexual dysfunction

Irwin Goldstein (USA)

Sex therapy in the clinic

Sue Goldstein (USA)

OTC therapies: sexual enhancement products

Sue Goldstein (USA)

Q&A, Wrap up


09:00 - 10:10
Chinese sexual medicine symposium - part 1 - ED, PE and hypogonadism

Location: Transamérica Auditorium
Chairs: Hui Jiang (China) & Bang-Ping Jiann (Taiwan)

Introduction

Run Wang (USA)

Welcome

Edgardo Becher (Argentina) & Sidney Glina (Brazil)

Current status of ED research in China

Yutian Dai (China)

Advances of PE diagnosis and treatment in China

Xuejun Shang (China)

Current progress on treatment and diagnosis of late onset hypogonadism

Xiangming Mao (China)


10:25 - 11:20
Chinese sexual medicine symposium - part 2 - Reconstructive surgery for male genitalia

Location: Transamérica Auditorium
Chairs: Chunhua Deng (China) & Thomas I.S. Hwang (Taiwan)

Microsurgery in male reproductive medicine

Kai Hong (China)

Repair and reconstruction on external genital organs

Zhong Wang (China)

Peyronie's disease and surgery: A world survey on the surgical practice in PD care

Eric Chung (Australia)


11:20 - 12:30
Chinese sexual medicine symposium - part 3 - New technology and practice information

Location: Transamérica Auditorium
Chairs: Jihong Liu (China) & Xinhua Zhang (China)

Sexual medicine practice in Hong Kong

Edmond Wong (Hong Kong)

New surgical procedures developed in China for circumcision

Philip S.H. Li (USA)

Advance in prostatitis diagnosis and treatment in China

Bing Gao (China)

Low-energy shock wave therapy and its application to erectile dysfunction

Zhong Cheng Xin (China)

Closing remarks

Hui Jiang (China)


Afternoon

13:30 - 14:30
SLAMS symposium (in Spanish/Portuguese) - part 6 - ABEIS symposium

Location: Comandatuba Room 2+3
Chair: Leonardo Eiras Messina (Brazil)

Testosterone replacement therapy in Brazil: How to adapt the different available treatments

João Luiz Schiavini (Brazil)

Premature ejaculation: Improving adherence to treatment

Diogo R. Mendes (Brazil)

Female sexuality: Efficient pharmacological treatment to stimulate women’s sexual life?

José Carlos Riechelmann (Brazil)


14:30 - 15:45
SLAMS symposium (in Spanish/Portuguese) - part 7 - ASESA symposium: Results with Dapoxetine for PE treatment. New treatments in ED

Location: Comandatuba Room 2+3
Chairs: Maria Luisa Calle Rodriguez (Spain) & Joaquin Carballido (Spain)

ASESA

Nuno Louro (Portugal)

ASESA

Juan Ignacio Martinez Salamanca (Spain)

ASESA

Rafael Prieto Castro (Spain)

ASESA

Ana Puigvert Martinez (Spain)

Coffee break


15:45 - 16:30
SLAMS symposium (in Spanish/Portuguese) - part 8 - Round Table: Female sexuality

Location: Comandatuba Room 2+3
Chair: Carmita Abdo (Brazil)

Drug treatment for female sexual dysfunctions

Gerson Lopes (Brazil)

Psychosocial aspects in female sexuality

Lucia Pesca (Brazil)

Does physiotherapy improve female sexual dysfunctions?

Monica Santos Lopes (Brazil)

Discussion


16:30 - 16:50
SLAMS symposium (in Spanish/Portuguese) - part 9 - Point counterpoint: Should we do penile rehabilitation after radical prostatectomy?

Location: Comandatuba Room 2+3
Chair: Fernando Facio (Brazil)

Pro

Amado Jose Bechara (Argentina)

Con

Adolfo Casabé (Argentina)


13:00 - 13:40
Mental health symposium - part 1 - Sex therapy – why, how and when?

Location: São Paulo Room
Chairs: Carmita Abdo (Brazil) & Stanley Althof (USA) & Annamaria Giraldi (Denmark)

The importance of the correct assessment for sexual therapy

Eusebio Rubio-Aurioles (Mexico)

Sex therapy versus personal or couple therapy: when to use one and/or the other?

Carmita Abdo (Brazil)


13:40 - 16:00
Mental health symposium - part 2 - Sex therapy for special conditions

Location: São Paulo Room
Chairs: Carmita Abdo (Brazil) & Stanley Althof (USA) & Annamaria Giraldi (Denmark)

Therapy for dysfunctions, gender dysphoria and paraphilia

Veronica Delgado-Parra (Mexico)

Psychological treatment of delayed ejaculation

Stanley Althof (USA)

Psychological/Behavioral approaches to female genital pain disorders

Romulo Aponte (Venezuela)

Break

Sex therapy with cancer survivors

Victoria Bertolino (Argentina)

The impact of depression on sexual function

Annamaria Giraldi (Denmark)


16:00 - 16:40
Mental health symposium - part 3 - Sex therapy in the future – what is new?

Location: São Paulo Room
Chairs: Carmita Abdo (Brazil) & Stanley Althof (USA) & Annamaria Giraldi (Denmark)

Effectiveness and evidence for sexual therapy

Marita McCabe (Australia)

New therapies for sexual dysfunctions: Mindfulness

Agnes Kocsis (United Kingdom)


13:00 - 14:10
Prosthetic urology symposium with extensive use of videos sponsored by the ISSM Video Journal of Prosthetic Urology - part 1 - The routine implant

Location: Transamérica Auditorium
Chair: Steven Wilson (USA)

Welcome and introduction of speakers

Steven Wilson (USA)

Tips of penescrotal IPP

Steven Wilson (USA)

How to make a 40 year old surgery better

Andrew Kramer (USA)

Tips of infrapubic IPP

Paul Perito (USA)

Tips of perineal & scrotal AUS

Ouida Lenaine Westney (USA)

Infrapubic phalloplasty

Sung Hun Park (Korea)


14:10 - 15:00
Prosthetic urology symposium with extensive use of videos sponsored by the ISSM Video Journal of Prosthetic Urology - part 2 - Complications of the routine implant

Location: Transamérica Auditorium
Chair: Steven Wilson (USA)

Crossover & perforation

Steven Wilson (USA)

Urethral injury during IPP: a new repair

Paul Perito (USA)

IPP & the unhappy patient

Sidney Glina (Brazil)


15:00 - 15:55
Prosthetic urology symposium with extensive use of videos sponsored by the ISSM Video Journal of Prosthetic Urology - part 3 - Peyronie's Disease and implants

Location: Transamérica Auditorium
Chair: Steven Wilson (USA)

IPP & modeling

Wayne Hellstrom (USA)

IPP & scratch technique

Paul Perito (USA)

IPP & plication

Ronny Tan (Singapore)

Plaque incision & grafting with IPP

Rafael Carrion (USA)

Penile lengthening with IPP

Omid Sedigh (Italy)


15:55 - 17:00
Prosthetic urology symposium with extensive use of videos sponsored by the ISSM Video Journal of Prosthetic Urology - part 4 - The complicated implant

Location: Transamérica Auditorium
Chair: Steven Wilson (USA)

How to make your own surgical videos

Andrew Kramer (USA)

IPP & grafting in corporal fibrosis

Omid Sedigh (Italy)

Ancillary (cosmetic) procedures with IPP

Rafael Carrion (USA)

SST & cylinder erosions

Steven Wilson (USA)

Ectopic reservoir placement

Steven Wilson (USA)


17:00 - 18:00
JSM session - How does the DSM V affect sexual medicine?

Location: Comandatuba Room 2+3
Chair: Irwin Goldstein (USA)

Purpose of updating the DSM men's sexual health

Eusebio Rubio-Aurioles (Mexico)

Women's sexual health/ISSWSH response

Sharon Parish (USA)


Evening

18:00 - 19:00
President's address & opening ceremony

Location: Comandatuba Room 2+3

19:00 - 20:00
Welcome reception & official opening technical exhibition

Location: Comandatuba Room 1

Thursday

Morning

07:45 - 08:30
Sponsored symposium

Location: Comandatuba Room 2+3

08:30 - 09:00
Master lecture 1 - Delayed ejaculation/Anorgasmia

Location: Comandatuba Room 2+3
Chairs: Miguel Rivero (Argentina) & Ege Can Serefoglu (Turkey)

Delayed ejaculation/Anorgasmia

Emmanuele Jannini (Italy)


09:00 - 09:30
Master lecture 2 - Sexual consequences of STI's

Location: Comandatuba Room 2+3
Chairs: Adrian Momesso (Argentina) & Yacov Reisman (The Netherlands)

Sexual consequences of STI's

Philip Kell (United Kingdom)


09:30 - 10:00
Master lecture 3 - Infertility and sexuality: Effect on the couple

Location: Comandatuba Room 2+3
Chairs: Victoria Bertolino (Argentina) & Natalio Cruz Navarro (Spain)

Infertility and sexuality: Effect on the couple

Lucia Lara (Brazil)


10:00 - 10:30
Coffee break

Location: Comandatuba Room 1

10:30 - 11:00
Point counterpoint 1 - Is there a true association between BPH/LUTS and ED?

Location: Comandatuba Room 2+3
Chairs: Edgardo Becher (Argentina) & Archimedes Nardozza (Brazil)

Pro

Anthony Bella (Canada)

Con

Andrea Salonia (Italy)


10:30 - 11:30
Moderated posters 1 - ED surgical

Location: São Paulo Room
Chairs: Laurence Levine (USA) & Ronny Tan (Singapore)

Does early insertion of a malleable prosthesis still allow later upsizing of cylinders in patients with ischaemic priapism? (#101)

F. De Luca (United Kingdom)
show abstract

101

Does early insertion of a malleable prosthesis still allow later upsizing of cylinders in patients with ischaemic priapism?

De Luca, F1; Zacharakis, E2; Kuehhas, F1; Spilotros, M1; Garaffa, G1; Raheem, A1; Ralph, D1; Muneer, A3

1: St. Peter's Andrology Centre and Institute of Urology, University College London, London, United Kingdom; 2: Guy’s Hospital, King’s College London; 3: University College London, London, United Kingdom

Objective: The aim of this study was to assess whether a delayed exchange to an inflatable implant allows upsizing of the cylinders in patients who have undergone early insertion of a malleable prosthesis for refractory ischaemic priapism

Material and Methods: Over a 30 month period 10 patients with ischaemic priapism underwent an early (within 2 weeks) insertion of a malleable (Coloplast Genesis®) penile implant. The mean age was 41.3 years (range 26-58yr) and the mean duration of priapism was 188 h (range 98-336 h). The aetiology was sickle cell disease (2 patients), idiopathic (4 patients), intracavernosal injection(1 patient) and antipsychotic agents (3 patients). Following a median period of 130.5 days (range 85-157 days) all of these patients underwent exchange of the malleable implant to a 3 piece inflatable (AMS 700® or Titan Coloplast®) prosthesis. The size of the cylinders was recorded at each operation and compared.

Results: At the time of exchanging from a malleable to inflatable, a median upsize in the length of the cylinders of 1 cm in either one or both corporal bodies (range 0-3 cm) was recorded. Although 5 patients had deliberate downsizing at the initial operation due to a previous Winter or T shunt or both. The mean IIEF-5 score prior the first operation was 24 (range 20-25). Three months after the initial insertion of malleable penile implant the satisfaction rate according to the IIEF-5 score was 80%. Three months following the exchange the patient satisfaction rate increased to 90%.

Conclusion: Insertion of a malleable penile prosthesis is an acceptable option for patients with refractory ischaemic priapism. Upsizing of the cylinders is still possible regardless of deliberate cylinder downsizing or whether the cylinders have been sized to the corporal tips.

Disclosures:

Work supported by industry: no.

Concomitant IPP and Virtue® Male Sling placement utilizing a single incision (#102)

H. Ayoub (USA)
show abstract

102

Concomitant IPP and Virtue® Male Sling placement utilizing a single incision

Ayoub, H1; Wang, R2; Westney, O1

1: MD Anderson Cancer Center, Houston, USA; 2: UTHealth, Houston, USA

Purpose: We sought to describe an alternative technique for placement of an inflatable penile prosthesis (IPP) and a quadratic male bulbourethral sling (Virtue®) through single perineal incision. Our group previously reported on concomitant implantation of an IPP and two-arm transobturator male sling through a single perineal incision. We herein report on a technique adapted to the Virtue® male sling for the treatment of post prostatectomy incontinence and erectile dysfunction.

Methods: IPP insertion proceeds through a 4cm perineal incision with dissection of the perineal-scrotal fat until both corpora cavernosa are identified and Buck’s fascia is uncovered bilaterally. A 1.5 cm vertical corporotomy is performed between four 2-0 PDS pre-placed stay sutures in each corporal body. Proximal and distal dilation followed by corporal measurements are completed in the standard fashion and the corresponding cylinders are implanted. After closure of the corporotomies, the transversalis fascia at the external inguinal ring is perforated inferior and medial to the spermatic cord with Metzenbaum scissors through the same perineal incision, which can be further extended should the external ring prove difficult to reach. The reservoir is then placed with a rubber-coated ring forceps in the space of Retzius which is developed bluntly with an index finger with the aid of a baby Dever retractor. The pump is then placed in the left dependent scrotal dartos pouch, with standard tube connecting. 

The Virtue® sling placement then follows after adequate exposure of the bulbospongiosus muscle is completed. While preserving the muscle, dissection is carried bilaterally to identify the inferior rami. 2-0 Prolene figure-of-eight afferent limb anchoring stitches are placed into the periosteum of the inferior rami bilaterally.  The transobturator arms are passed using a J hook introducer to a previously marked location 2 cm inferior to the adductor longus tendon. The pre-pubic arms are brought through skin 2 cm above the symphysis pubis and lateral to the midline bilaterally.  The afferent limb sutures are brought through the mesh just superior to the intersection of the mesh body and afferent limbs. The sling is then tensioned under cystoscopic guidance providing both direct compression and urethral elevation.

Conclusions: Concomitant placement of an IPP and virtue male bulbourethral sling is an efficient and safe for the simultaneous treatment of post prostatectomy incontinence and impotence. The utilization of a single incision is a novel approach for dual implantation of these devices and may decrease the recovery time by eliminating the penoscrotal incision.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

show poster

Venous leakage treatment revisited-pelvic venoablation using aethoxysclerol under air block technique and valsalva maneuver (#103)

R. Herwig (Austria)
show abstract

103

Venous leakage treatment revisited-pelvic venoablation using aethoxysclerol under air block technique and valsalva maneuver

Herwig, R1; Sansalone, S2

1: Vienna International Medical Clinic, Vienna, Austria; 2: Dept of Experimental Medicine and Surgery University Tor Vergata, Rome, Italy

Objective: We evaluated the effectiveness of pelvic vein embolisation with aethoxysclerol in aero-block technique for the treatment of impotence due to venous leakage in men using sildenafil for intercourse. The aim of the procedure was to reduce or eliminate the use of sildenafil.

Methods: A total of 49 patients with veno-occlusive dysfunction, severe enough for the need of PDE5 inhibitors for vaginal penetration, underwent pelvic venoablation with aethoxysklerol. The mean patient age was 53.5 years. Venous leaks were identified by Color Doppler Ultrasound after intracavernous alprostadil injection. Under local anesthesia a 5F-Angioport was inserted antegrade into the deep dorsal penile vein. The pelvic venogram obtained with deep dorsal venography was included. Aethoxysklerol 3% as sclerosing agent was injected after air-block under valsalva manoeuver in three consecutive steps. A 5F-angiography catheter was placed in the vein of major outflow from the penis. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Additionally, a prae- and posttherapeutical IIEF-5 score was performed.

Results: At a 12 month follow-up 40 out of 49 patients (81.63%) reported to have erections sufficient for vaginal insertion without the use of any drug or additional device. 4 (8.16%) patients did not report any betterment.

Follow up Color Doppler Ultrasound revealed a new or persistant venous leakage in 8 (16.33%) of the patients. No serious complications occurred.

Conclusions: Our new pelvic venoablation technique using aethoxysklerol in air-block technique was effective, minimally invasive, and cost-effective. All patients were able to perform sexual intercourse without the previously used dosage of their PDE5 inhibitor. This new method may help in patients with contra-indications against PDE5 inhibitors, in patients who can not afford the frequent usage of expansive oral medication or those who do not fully response to PDE5-inhibitors.

Disclosures:

Work supported by industry: no.

Initial experience with inverted-Y reduction scrotoplasty: A technique for management of the excess scrotum during placement of inflatable penile prosthesis (#104)

D. Martinez (USA)
show abstract

104

Initial experience with inverted-Y reduction scrotoplasty: A technique for management of the excess scrotum during placement of inflatable penile prosthesis

Emtage, J1; Martinez, D1; Yang, C1; Baumgarten, A1; Hakky, T1; Parker, J1; Carrion, R1

1: University of South Florida, United States

Objectives: Erectile dysfunction is common and placement of inflatable penile prosthesis (IPP) is a urologic surgery that dramatically aids in the management of this condition. A number of individuals undergoing IPP placement have a severely redundant scrotum that can cause functional discomfort, pain or even limited cosmetic outcome post-operatively. We present our initial experience with a novel technique entitled ‘Inverted-Y reduction scrotoplasty’ for the management of the excess scrotum during simultaneous placement of IPP.

Materials & Methods: We perform IPP placement via a penoscrotal approach. A ventral phalloplasty is performed using our previously described method in order to remove the redundant penoscrotal web invariably found in these patients. The IPP is inserted using the standard, widely described protocol. We position the pump for the prosthesis in the most dependent portion of the scrotum after making a longitudinal incision through the dartos layer. For closure, we begin by performing an inverted-Y re-approximation of the dartos. The overlying skin is closed in the same fashion. The result is cephalad retraction of the scrotum and a resultant reduction in overall scrotal sac dimensions.

Results: At our institution, we have performed inverted-Y reduction scrotoplasty with simultaneous placement of IPP in a total of seven patients. After several months follow up, all patients have excellent cosmetic and functional outcomes. To date, there have been no known complications associated with the inverted-Y reduction scrotoplasty.

Conclusions: Inverted-Y reduction scrotoplasty is a safe and feasible technique that can be performed with simultaneous IPP placement to improve cosmesis and decrease functional discomfort and pain post-operatively. The added surgical time is minimal and our outcomes to date have been excellent. When added to IPP placement, this procedure can lead to improved quality of life for patients with concurrent erectile dysfunction and a redundant scrotum.

Disclosures:

Work supported by industry: no.

show poster

Surgeon selection for penile implant procedure remains internet driven (#105)

Andrew Kramer (USA)
show abstract

105

Surgeon selection for penile implant procedure remains internet driven

Kramer, A1

1: University of Maryland School of Medicine, United States

Objective: The goal of the study is to understand the evolving patient-centered selection process of penile implant surgery. Patients with erectile dysfunction who are considering implant surgery increasingly utilize internet, phone consultation, referrals, word of mouth, and logistical considerations, but the priority placed in each of these methods remains to be studied and analyzed.

Materials and Methods: Surveys were used with 300 consecutive patients in one practice between 1/7/10 and 6/1/14 to consider their choices with regard to surgeon preference. They were asked a series of questions to assess their decision process in choosing where to get the implant done, and asked whether they assessed one surgeon, or “shopped” and considered multiple surgeons. If several surgeons were considered, they were queried as to how the decision was made, and what was most influential in making that decision.

Results: Among survey respondents, 24% of patients considered one surgeon, overwhelming due to referral patterns and proximity to that practice. 76% considered multiple surgeons. Internet was the decisive factor in 68%, the most cited resource was Google, then YouTube as search engines. Forums were a 2nd internet influence, the most utilized were FrankTalk.com, then HealthBoards.com. The 3d largest internet influence was physician-rating sites, such as Healthgrades, Vitals, Wellness, and UCompareHealth.com. Next in importance to patients was physician personality based on phone consultation, in 16%. For the remainder, cost was a decisive factor in 8%, location in 6%, and word of mouth for 4%.

Conclusion: Physician selection is evolving as information is more accessible via the internet. The ability to create an internet presence and create patient comfort with phone calls remains most influential to patients in choosing an implant surgeon.

Disclosures:

Work supported by industry: no.

Maximal penile length and girth restoration combined with penile prosthesis implantation without grafting: “the modified sliding technique” (#106)

F.E. Kuehhas (Austria)
show abstract

106

Maximal penile length and girth restoration combined with penile prosthesis implantation without grafting: “the modified sliding technique”

Kuehhas, FE1; Egydio, P2

1: Medical University of Vienna, Austria; 2: Centre for Peyronie’s Disease Reconstruction, Sao Paulo

Objective: To present a modification of the so called “sliding technique” for the restoration of penile length and girth for patients suffering from penile shortening and erectile dysfunction.

Material and Methods: Between January 2013 and January 2014, 143 patients underwent our modified “sliding technique“ for penile length and girth restoration with concomitant penile prosthesis implantation without any graft. . All patients had severe ED associated with penile shortening with or without curvature, inability to have sexual intercouse and consecutive dissatisfaction with their sexual life.

Results: The mean age at the time of surgery was 56 years (range, 40- 72). The etiology of penile shortening and narrowing were: Peyronie´s disease, post radical prostatectomy, post brachytherapy and external radiotherapy, post intracavernous injection therapy, post penile fracture, post redo-hypospadias repair and post priapism in 53.8%, 14.7%, 7%, 21%, 2.1%, 0.7% and 0.7% of cases. Mean deviation of the penile axis was 45° (range, 0- 100). Postoperative hematoma were seen in 24.5% on the base of penile shaft however spontaneous absorption resolved without any additional drainage. Laminar superficial hematoma on pubic area was seen in the majority of the cases and absorption was seen in 2 to 3 weeks. Temporary partial glans numbness was reported in 5%, however it vanished with the course of the follow-up. Glans sensitivity, ability to achieve orgasm and ejaculation were preserved. The penile axis was straightened in all cases. Our approach led to a mean penile length gain of 3.1 cm (range, 2-7).  All patients resumed sexual intercourse and were able to perform satisfactory sexual intercourse. No penile prosthesis infection was observed.

Conclusion: Our modification of the “sliding technique” is safe and effective and are associated with reduced operative times, less cost and low infection rate.

Disclosures:

Work supported by industry: no.

Surgical technique for removal of retained rear tip extenders (#107)

M. Bickell (USA)
show abstract

107

Surgical technique for removal of retained rear tip extenders

Khurgin, J1; Bickell, M2; Garber, B3

1: Johns Hopkins Hospital, USA; 2: Einstein Medical Center, USA; 3: Hahnemann University Hospital, USA

Objective: Retained rear tip extenders (RTE) during inflatable penile prosthesis (IPP) explantation can be a problematic portion of the surgery. RTE removal remains an imperative step, as failure to remove all foreign material can compromise the success of future implantation. In an infected IPP, failure to remove a RTE may lead to continued infection. We review several techniques for RTE extraction, including the preferred technique of a high volume implant urologist at our institution.

Material and Methods: A thorough review of the literature was carried out, using keywords “Rear Tip”, “Rear Tip Extender(s)”, “Retained Component(s)” and “Technique” with “Penile Prosthesis” and “Penile Prosthetic”. We compared the findings in the literature to the surgical experience of a high volume implant urologist at our institution.

Results: Several surgical techniques have been described in the literature for the removal of RTE. These include: blind extraction with a Kelly forceps or similar instrument; cavernosal endoscopy with a flexible or semirigid cystoscope and alligator graspers; and use of a Brooks corporal dilator or similarly elliptically-shaped instrument to create a suction effect with the RTE. Our preferred technique uses a long nasal speculum deployed into the corporotomy, allowing direct visualization of the RTE. A long Kocher forceps is then used to extract the RTE. This technique has proved to be successful when other techniques have failed. In addition, it does not rely on a specific orientation of the RTE as other techniques do and causes minimal trauma to the surrounding tissue.

Conclusion: Removal of retained RTE during IPP explantation surgery is imperative. Several surgical techniques have been described in the literature. We detail our preferred technique, using a long nasal speculum for direct visualization and use of a Kocher clamp to grab and extract.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

The ED care pathway for patients considering penile implants (#108)

Chris Nelson (USA)
show abstract

108

The ED care pathway for patients considering penile implants

Nelson, C1; Hill, R2; Hakim, L3; Burnett, B4; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States; 2: American Medical Systems, United States; 3: Cleveland Clinic, United States; 4: Johns Hopkins Medical Institutions, United States

Objectives: The typical treatment algorithm for erectile dysfunction (ED) starts with a trial of phosphodiesterase type 5 inhibitors (PDE5i), followed by one or more “second line” therapy options such as Vacuum Erection Devices (VED) and/or injection therapy. Often it is only after all of these options fail that penile implants are given serious consideration. We conducted two patient research studies, in part, to explore the typical care pathway of patients exploring the option of a penile implant.

Material and Methods: Two separate IRB approved patient research studies were conducted. The first study was a quantitative survey of 257 men who had attended American Medical System (AMS) sponsored Patient Education Seminars on ED. The research assessed men at three time points: 1-2 months post-seminar (n=43), 3-6 months post-seminar (n=80), and 12-16 months post-seminar (n=134).  Survey length was approximately 30 min. Respondents answered questions on their ED history, the seminar itself, activities since the seminar, therapies tried and relative satisfaction, and potential barriers to penile implants.  The second study was also a quantitative survey of approximately 30 min in length. This study sample (n=61) consisted of men who had a recommendation from a urologist to receive a penile implant.  Half of this sample (n=31) had implant surgery, while the other half (n=30) decided not to receive an implant. The primary purpose of the study was to better understand the differences between these two groups.

Results: On average, patients receiving a penile implant had been suffering from ED for 6-7 years.  Similarly, those patients considering an implant but not yet receiving one had been suffering for 5-6 years. The vast majority of men had tried a PDE5i (95%) and a second line treatment (65%), while reporting significant dissatisfaction with both a PDE5i (55%) and a second line treatment (75%).  Those men who had not received an implant tended to utilize more second line therapies. In the group of men in the second study who had implant surgery (n=31), 42% stated that they should have had the implant surgery earlier.

Conclusions: The ED care pathway can be a long and frustrating journey for patients and their partners.  It is important for physicians to recognize the risk of treatment fatigue as patients move through a series of less than satisfying options before deciding on the more permanent and invasive implant solution.

Disclosures:

Work supported by industry: yes, by American Medical Systems (industry initiated, executed and funded study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

show poster

The prognostic factors for the efficacy of low-intensity shock wave therapy for erectile dysfunction (#109)

S. Hisasue (Japan)
show abstract

109

The prognostic factors for the efficacy of low-intensity shock wave therapy for erectile dysfunction

Hisasue, S1; China, T1; Ide, H2; Shirai, M1; Abdelhamed, A1; Matsushita, K1; Yamaguchi, R2; Muto, S2; Wakumoto, Y1; Tsujimura, A1; Horie, S1

1: Juntendo University, Japan; 2: Teikyo University, Japan

Objective; Phosphodiesterase type 5 inhibitors (PDE5i) revolutionized the treatment of erectile dysfunction (ED). However, even in vasculogenic ED patients, one fifth of them showed poor response to PDE5i. Recently low-intensity shock wave therapy (LI-SWT) has been reported to be effective in 60% of patients. The goal of this study is to evaluate the efficacy of LI-SWT and the prognostic factors for its efficacy for ED patients in Japan.

Material and Method; This study included 58 patients with ED history for more than 6 months, sexual health inventory for men (SHIM) score of ≤ 12 without PDE5i, erection hardness score (EHS) grade 1 or 2, mean penile circumferential change (MPCC) by erectometer assessing sleep related erection of <25mm, and non-neurological pathology. Patients were treated by a low energy shockwaves generator (ED1000, MEDISPEC, MD, USA); 3-minute application of 300 shock waves (intensity of 0.09 mJ/mm2) in 5 different anatomical sites of penis. After the baseline assessment, treatment was done twice a week for 3 weeks (6 times), no treatment for 3 weeks, and twice a week for 3 weeks (6 times) again. Total of 12 shock wave treatments were applied. SHIM score and EHS with or without PDE5i, MPCC were assessed at baseline, 1, 3, and 6 months following the termination of LI-SWT. Student’s t-test was used to assess the improvement of erectile function. Logistic regression analysis was done for the multivariate analysis for the efficacy of LI-SWT using the parameters of age, free testosterone level, body mass index, ED history, baseline MPCC, and comorbidities.

Result(s); Of 57 patients who assigned for LI-SWT trial, 56 patients were analyzed. Median age was 64 years and median ED duration was 3 years. One, 3 and 6 months after LI-SWT, each of SHIM and EHS with and without PDE5i were significantly increased (p<0.001). MPCC was also improved increased from 13.1 mm to 20.2 mm after LI-SWT (p<0.001). In the multivariate analysis, age and concomitant comorbidities number were the statistically significant predictors for the efficacy of LI-SWT.

Conclusion; The current study showed the efficacy and feasibility of LI-SWT for ED patients in Japan. The multivariate analysis for the efficacy of LI-SWT showed that age and concurrent comorbidities were significant predictors. Older ED patients with several comorbidities should be informed about the less responsiveness to LI-SWT before the treatment.

Disclosures:

Work supported by industry: no.

show poster


10:30 - 11:30
Podium 1 - Basic science

Location: Transamérica Auditorium
Chairs: Ganesan Adaikan (Singapore) & Julio Ferrer (Colombia)

Icariside II ameliorates erectile function in a rat model of bilateral cavernous nerve injury: Implications for activation of endogenous stem cells (#001)

Zhong Cheng Xin (China)
show abstract

001

Icariside II ameliorates erectile function in a rat model of bilateral cavernous nerve injury: Implications for activation of endogenous stem cells

Xu, Y1; Guan, R1; Lei, H1; Li, H1; Gao, Z1; Xin, Z1

1: Andrology Center, Peking University First Hospital, Peking University, Beijing, China

Objective: Activation of endogenous stem cells (ESCs) might help conservation intrinsic healing capacity of a healthy organism as well as rejuvenation of damaged erectile function. The aim of this study is to investigate the feasibility and mechanism of incariside II (ICA II) in the treatment of ED in a rat model of bilateral cavernous nerves (CN) injury.

Methods: sixty newborn male rats were intraperitoneally injected with 5-ethynyl-2-deoxyuridine (EdU; 50 mg/kg) for the purpose of tracking putative ESCs. Eight weeks later, forty-eight rats underwent CN crush injury and were randomized into gavage feeding of solvent (vehicle group), ICA II 0.5, ICA II 1.5 or ICA II 4.5 mg/kg/day. Twelve animals underwent sham surgery, received vehicle treatment and served as sham group. Treatment was continued for 4 weeks followed by a wash-out period of 72 h.

Results: Daily gavage feeding of ICA II resulted in a significant improvement of erectile function compared to vehicle group. ICA II treatment partially prevented schwann cell demyelination, SMC loss and collagen deposition in the penis. More EdU-positive cells differentiated into Schwann cells and MSCs in ICA II treated rats than in vehicle controls. In addition, the trend of p38 mitogen activated protein kinase (MAPK) MAPK activaty between groups was similar as that of EdU-positive cells. All these changes were caused by ICA II in a dose-dependent manner.

Conclusion: ICA II can ameliorate ED following CN injury by promoting regeneration of nNOS-positive nerves and SMCs in the penis. The underlying mechanism might be due to p38 MAPK activation which could prevent schwann cell demyelination and promote EdU-positive cells (putative ESCs) differentiation.

Disclosures:

Work supported by industry: no.

Cell stretching – The putative mechanism of penile traction; An in-vitro cellular analysis (#002)

L. De Young (Canada)
show abstract

002

Cell stretching – The putative mechanism of penile traction; An in-vitro cellular analysis

De Young, L1; Chung, E 2; Brock, G1

1: Canada; 2: Australia

Introduction: Penile traction therapy (PTT) has gained considerable popularity as a non-invasive treatment option in Peyronie's disease (PD), used to improve penile curvature and maintain penile length. The exact mechanism of action of penile traction devices remains unknown. Previously, work on penile plaque cells has shown that stretch induces a decrease in smooth muscle alpha-actin and an increase metalloproteinase 8 (MMP8). The effect of the stretching on extracellular matrix (ECM) components may play an important role on plaque remodeling.

Methods: The third passage of primary cell cultures derived from Peyronie's plaques were sub-cultured on BioFlex-ProNectin plate and the sub-confluent cells were exposed to A Flexecell FX-500 tension plus system sinusoidal strain of 18% at 1 Hz for 48 hours. Cell culture medium and cellular extracts were analyzed by enzyme-linked immunosorbent assay (ELISA) and Western blot for inflammatory cytokines, collagen, metalloproteinase, and tissue inhibitors of metalloproteinases (TIMPs) expression.

Results: The alteration of inflammatory cytokines IL-6, TGF-B, VEGF was measured among the stretched compared to non-stretched cells. Clear evidence of a treatment effect on these cytokines was measured, supporting a cellular basis to its action. Most striking was the alterations in MMP-8 and other MMP levels consistent with tissue remodeling.

Conclusion: This unique dynamic study of penile plaque-derived cells cultured in a mechanical environment provides strong evidence for the use of penile traction devices in Peyronie's disease appearing to facilitate plaque remodeling. Further work to define time course, extent of stretch and other parameters optimizing traction use, is currently ongoing.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Hemolysis contributes to PDE5 dysregulation and priapism in sickle cell bone marrow transplanted mice (#003)

H. Matsui (USA)
show abstract

003

Hemolysis contributes to PDE5 dysregulation and priapism in sickle cell bone marrow transplanted mice

Matsui, H1; Sopko, N1; Hannan, J1; Hsu, L2; Berkowitz, D1; Champion, H3; Burnett, A1; Bivalacqua, T1

1: Johns Hopkins School of Medicine, United States; 2: University of Illinois, United States; 3: University of Pittsburgh Medical Center, United States

Objectives: Mechanisms responsible for “nitric oxide (NO) imbalance" in reference to deranged NO signalling, in sickle cell-associated priapism are not fully elucidated. We have hypothesized that reduction in endothelial-derived NO causes phosphodiesterase type 5 (PDE5) dysregulation and thus enhanced corporal smooth muscle relaxation and priapism.  Hemolysis that occurs in sickle cell anemia is associated with steady state increases in plasma cell-free haemoglobin, overproduction of reactive oxygen species (ROS) and endothelial dysfunction. Our objective was to determine if acute hemolysis would result in NO/cGMP/PDE5 dysregulation, overproduction of ROS, and thus cause priapism in a sickle cell bone marrow transplanted mice. 

Material and methods: Three groups were used: 1) wild type (WT), 2) sickle cell homozygotes (Sickle), and 3) WT mice transplanted with bone marrow (BMT) from Sickle mice which is known to cause direct hemolysis of blood and cause the mice to have a Sickle phenotype.  All groups underwent cavernous nerve stimulation (CNS) to assess erectile function. The frequency of erectile responses (erections/hr) pre- and post-stimulation was determined.  Penile constitutive nitric oxide synthase (NOS), protein kinase G (PKG) and PDE5 activities as well as ROS (luminol activity) generation were determined. 

Results: Erectile responses to CNS were significantly enhanced (P<0.05) in Sickle and BMT Sickle mice when compared to WT.  Sickle and BMT Sickle mice demonstrated spontaneous erections pre- and post-stimulation that were significantly (P<0.05) increased. Sickle and BMT Sickle mice had significant reductions in penile constitutive NOS, PKG, and PDE5 activities at a time when ROS generation was significantly increased (P<0.05) compared to values obtained in WT mice penes.  

Conclusions: The priapic activity in BMT Sickle mice can be attributed to NO/PDE5 dysregulation and is consistent with data obtained from transgenic Sickle mice.  The present data suggest that direct hemolysis of Sickle hemoglobin and thus overproduction of ROS generation may be an etiological causes of endothelial NO imbalance with direct effects on PDE5 regulation in the penis.  These molecular findings in a new animal model of BMT Sickle mice suggest that global dysregulation of endothelial-derived NO occurs in sickle-cell disease related priapism, further highlighting the importance of NO in maintaining penile vascular homeostasis.

Disclosures:

Work supported by industry: no.

Injection of BDNF transfected MSCs is a potential therapeutic measure for neurogenic erectile dysfunction (#004)

X. Wang (China)
show abstract

004

Injection of BDNF transfected MSCs is a potential therapeutic measure for neurogenic erectile dysfunction

Wang, X1; Shen, H2

1: Huashan Hospital, Fudan University, China; 2: Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, Shanghai, China

Objective: To investigate the effect of intracavernosal injection with brain-derived neurotrophic factor (BDNF) transfected mesenchymal stem cells (MSCs) on the nerve regeneration and recovery of erectile function after cavernous nerve injury (CNI).

Material and Method: We established a stable MSC cell line that overexpresses BDNF. The expression levels of BDNF and Vascular endothelial growth factor A (VEGF-A) in the BDNF-MSC and MSC cell lines were detected by western blot. Elisa kits were used to estimate the BDNF and VEGF-A concentration in the cell supernatant. 120 SD rats of 3-month-old were divided randomly into 4 groups. Group1 had a sham operation without cavernous nerve manipulation. The other 3 groups underwent bilateral CNI. Group 2 (Control group) had no further manipulation. Group 3 (MSC group) and Group 4 (BDNF-MSC) were treated by intracavernosal injection with MSCs or BDNF transfected MSCs respectively before the abdomen was closed. Erectile function was assessed by cavernosal nerve electrostimulation 12 weeks after operation. The penile tissues were then collected for immunohistochemical staining to detect inducible nitric oxide synthase (iNOS) expression levels.

Results: The MSCs demonstrated a spindle-shaped morphology and green fluorescence detection showed that BDNF overexpression MSC cell line was successfully established. Western blot analysis indicated that both BDNF and VEGF-A increased in the BDNF-MSC cell line compared with MSC cell line. Compared with MSC, higher concentration of BDNF and VEGF-A was also detected in BDNF-MSC supernatant by enzyme-linked immunosorbent assay (ELISA). After nerve crushing, the functional evaluation of the control group at 3 months showed a lower mean maximal intracavernous pressure (ICP) with CN stimulation, at 35.47±13.16 cmH2O, than that of the sham group, at 102.20±15.61 cmH2O. Meanwhile, the ICP of BDNF-MSC group was significantly higher than the controls, at 66.04±15.33 cmH2O. Histological analysis with staining of iNOS showed a significant change in the morphology of penile smooth muscle cells. The number of positively stained penile smooth muscle cells tended to increase after treatment with BDNF-MSC.

Conclusion: Our study validates that intracavernous injection with BDNF-transfected MSCs can enhance the therapeutic effect of MSCs for the treatment of erectile dysfunction in an animal model.

Disclosures:

Work supported by industry: no.

Tadalafil ameliorates metabolic syndrome-induced alterations in visceral adipose tissue and liver: An experimental study in the rabbit (#005)

Mario Maggi (Italy)
show abstract

005

Tadalafil ameliorates metabolic syndrome-induced alterations in visceral adipose tissue and liver: An experimental study in the rabbit

Vignozzi, L1; Cellai, I 1; Comeglio, P1; Filippi, S2; Mello, T3; Morelli, A4; Galli, A3; Bani, D5; Maggi, M6

1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of NEUROFARBA and of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 3: Gastroenterology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Italy; 5: Department of Experimental and Clinical Medicine, University of Florence, Italy; 6: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Italy

Objective: Development of “brown-like” adipocytes within white visceral adipose tissue (VAT) has potential antiobesity effects. Genetic manipulation of cGMP formation suggests a role for this pathway in preadipocytes (PAD) commitment towards a brown phenotype. The aim of this study was to investigate the effect of tadalafil on metabolic syndrome (MetS)-induced VAT dysfunction.

Material and Method: We used a non-genomic, high- fat diet (HFD)-induced  rabbit model of MetS, with or w/o tadalafil  Rabbits fed a regular diet were used as controls.

Results: In HFD-induced rabbit model of MetS, in-vivo treatment with the PDE5 inhibitor, tadalafil (by increasing cGMP signaling), completely normalized HFD-induced increase of VAT mass and morphological alterations (adipocyte hypertrophy and hypoxia), triglycerides levels. Tadalafil also significantly increased brown adipocyte marker, UCP1, expression in VAT. HFD-induced increase in circulating level and liver expression of TNFα were also decreased by in-vivo tadalafil dosing. We then studied the adipogenic capacity of VAT preadipocytes (rPADs) isolated from rabbits fed a HFD (with or w/o tadalafil). Comparative gene expression analysis in rPADs demonstrated that in vivo tadalafil dosing dramatically increased the expression of genes related to brown-differentiation (UCP1, TMEM26, PGC 1β, BMP4, CIDEA) and mitochondrial biogenesis (TFAM, NRF1) in rPAD, whilst genes related to white adipocytes differentiation (HOXC9) were significantly reduced. Also in-vitro treatment with tadalafil, in HFD-rPAD induced the expression of genes related to brown differentiation  (UCP1, TMEM26). By using transmission electron microscopic images analysis in rPAD, we found that HFD-induced mitochondrial morphological abnormalities (reduced size, loss of mitochondrial cristae, an increased matrix density) were all counteracted by in-vitro tadalafil dosing.

Conclusions: Tadalafil dosing in a MetS rabbit model ameliorates liver and VAT MetS-induced alterations. This could reflect the ability of tadalafil to restore insulin sensitivity in VAT unable to finalize its storage function, counteracting MetS-induced liver alterations.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Androgens positively regulate no-mediated relaxant pathway in rat clitoris (#006)

Mario Maggi (Italy)
show abstract

006

Androgens positively regulate no-mediated relaxant pathway in rat clitoris

Vignozzi, L 1; Filippi, S2; Cellai, I3; Comeglio, P 3; Corno, C3; Corcetto, F3; Maggi, M3

1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences and Department of NEUROFARBA, University of Florence, Florence, Italy; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy

Objectives: Female sexual response is the result of a complex interplay between central and peripheral mechanisms . Hormonal regulation of female sexual excitement is poorly understood. To evaluate sex steroid regulation of the NO-dependent relaxant and RhoA/ROCK contractile pathways in clitoris.

Material and Methods: Subgroups  of  ovariectomized  rats were or left untreated or supplemented with estradiol, progesterone, testosterone (T) and T plus the aromatase inhibitor, letrozole. mRNA expression (qRTPCR)  of  genes of the relaxant NO-signaling,  and  genes of the contractile RhoA/ROCK pathway in clitoris.

Results:  In- vivo treatment with T increased clitoris eNOS, nNOS, sGC1a3, sGC1b3, PDE5, PKG1 mRNAs, that were all further increased by cotreatment with letrozole. T also increased ROCK2mRNA. E2-supplementation increased RhoA and ROCK2 expression. All NO-signaling genes, and ROCK2 resulted positively associated with T plasma level , while E2 level was positively associated with RhoA, ROCK2  and sGC1a3. When T and E2 (ROCK2 determinants at univariate analysis) were introduced as covariates in a multivariate model, only the association between E2 and ROCK2 was confirmed. To further investigate the effect of T and E2, in isolated rat clitoris smooth muscle cells (clitSMC) we studied migration, as a read-out of RhoA/ROCK activity. E2 increased clitSMC migration, and the selective RhoA /ROCK inhibitors. Also T increased clitSMC migration. Letrozole pretreatment abrogated T-induced migration. The non aromatizable androgen, DHT, reduced clitSMC chemotaxis even below untreated cells.

Conclusions: Our data demonstrate that T improves the NO-mediated signaling, whilst E2 stimulates the contractile RhoA/ROCK signaling in clitoris .

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.


10:30 - 11:15
Workshop 1 - Maximizing the potential of your abstracts and papers

Location: Ilhéus + Una Room
Chair: John Mulhall (USA)

How to write an attractive paper

John Mulhall (USA) & Alan Shindel (USA)

How to write an attractive abstract

Alan Shindel (USA)


11:00 - 11:30
Point counterpoint 2 - Persistent genital arousal disorder in women: Mental or Body

Location: Comandatuba Room 2+3
Chairs: Carmita Abdo (Brazil) & Annamaria Giraldi (Denmark)

Mental

Agnes Kocsis (United Kingdom)

Body

Irwin Goldstein (USA)


11:30 - 12:30
Podium 2 - Desire & arousal

Location: Comandatuba Room 2+3
Chairs: John Dean (United Kingdom) & Shari Goldfarb (USA)

Persistent genital arousal disorder (PGAD): Experience with management in 35 consecutive cases (#007)

Irwin Goldstein (USA)
show abstract

007

Persistent genital arousal disorder (PGAD): Experience with management in 35 consecutive cases

Gagnon, C1; Minton, J1; Goldstein, I2

1: San Diego Sexual Medicine, United States; 2: Alvarado Hospital, United States

Objectives: Persistent genital arousal disorder (PGAD) is a rare, unwanted and intrusive sexual dysfunction associated with excessive and unremitting genital arousal and engorgement without sexual interest, with no recognized safe and effective evidence-based treatment. Characteristics of women with PGAD were assessed. 

Methods: A retrospective clinical chart review was performed on the last 35 women assessed for PGAD.

Results: Women (age 46+/-18) had symptoms of PGAD for 17+/-16 years, appearing secondary to increased peripheral sensory afferent input and an under inhibited central sexual arousal reflex center falsely interpreting excess peripheral sensory information as sexual arousal, leading to spontaneous arousal, orgasm and a short refractory period post-orgasm. Conditions resulting in increased peripheral sensory afferent input: altered pre-menopausal hormone integrity, hormonally mediated provoked vestibulodynia; altered menopausal hormone integrity, genitourinary syndrome of menopause; increased nerve fiber density, genetic susceptibility with elevated levels of nerve growth factor substances; injury to or irritation of pudendal nerves transmitting pain and other sensations; abnormal response of tissues to Candida infection, recognized or non-specific allergies; lichen sclerosus or lichen planus; vulvar granuloma fissuratum; peri-urethral glans pathology; clitorodynia; pelvic congestion syndrome; S2 Tarlov cyst; high tone pelvic floor dysfunction. Reducing excess peripheral sensory input with sex therapy/counseling, pelvic floor, pharmacologic, device and surgical treatments, and increasing inhibitory regulation of the uninhibited central sexual reflex center kept the PGAD manageable.

Conclusions: PGAD is not so rare: an estimated 20% of healthcare providers at numerous sexual meetings have claimed caring for individuals with PGAD.  PGAD can be managed so that afflicted women have normal life quality. Patients diagnosed with PGAD and managed successfully are no longer suicidal or bothered/distressed after treatment(s).  PGAD seems to be caused by a combination of excess peripheral afferent stimulation from irritated genital, pudendal nerve, pelvic floor tissues or sacral nerve roots and a central sexual reflex that has limited central inhibition.  PGAD may be lifelong, some women do not know any other form of sexual arousal, or acquired after living many years with no hint of PGAD symptoms. The persistent genital arousal usually does not resolve with orgasm.  PGAD can also occur and be managed successfully in men.

Disclosures:

Work supported by industry: no.

Open cross-sectional study of the clinical types of sexual dysfunction, personality traits and psychological status in women with infertility (#008)

N. Stenyaeva (Russia)
show abstract

008

Open cross-sectional study of the clinical types of sexual dysfunction, personality traits and psychological status in women with infertility

Stenyaeva, N1; Chausov, A1; Chritinin, D2; Sukhikh, G1

1: Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation, Russia; 2: I.M.Sechenov First Moscow State Medical University

Objective: To assess the clinical types of sexual dysfunction, personality traits and psychological status in infertile women.

Material and Methods: A cross-sectional study of mental and sexual health was conducted in women with infertility. The inclusion criteria were primary infertility and the presence of sexual partner. The data of 157 patients within the main treatment group of infertility were assessed according to the ICD-10. Patients completed the Symptom Checklist 90-R (SCL-90-R), the Munich Personality Test (MPT) and the Female Sexual Functioning Index (Russian version) (FSFI). The control group consisted of 53 healthy women.

Results: There were revealed significant inverse correlation between association the pairs of domains the FSFI questionnaires and SCL-90-R: Desire – Obsessive-Compulsive (r = -0,2, p = 0,04), Desire - Interpersonal Sensitivity (r = -0,2, p = 0,045) , Desire - Depression (r = -0,3, p = 0,003), Desire - Psychoticism (r = -0,3, p = 0,004), Arousal - Obsessive-Compulsive (r = -0,2, p = 0,04) , Arousal - Depression (r = -0,2, p = 0,015), Arousal - Psychoticism (r = -0,2, p = 0,03), Orgasm - Depression (r = -0,2, p = 0, 04). There were revealed in the clinical group significant inverse correlation between associations of the pairs of domains the FSFI questionnaires and the MPT Desire – Extraversion (r=-0,2, p=0,049), Desire – Esoteric Tendencies (r=-0,3, p=0,003), Arousal - Frustration Tolerance (r=0,4, p=0), Arousal - Esoteric Tendencies (r=-0,2, p=0,036), Lubrication - Esoteric Tendencies (r=-0,3, p=0,003), Orgasm - Esoteric Tendencies (r=-0,3, p=0,005), Satisfaction - Esoteric Tendencies (r=-0,2, p=0,03), Pain - Orientation towards Social Norms (r=-0,2, p=0,045). There were also revealed significant direct correlation between associations of  the pairs of domains Desire - Frustration Tolerance (r=0,4, p=0), Arousal - Extraversion (r=0,24, p=0,01), Lubrication - Frustration Tolerance (r=0,2, p=0,03), Satisfaction – Extraversion (r=0,3, p=0,03).

Conclusions: The study showed that sexual dysfunction in the form of reduced desire, arousal, orgasm disorders in patients with infertility were associated with symptoms of depression, obsessive-compulsive, interpersonal isolation, or sensitivity, as well as with personal characteristics as esoteric tendencies, introversion, reduced tolerance to frustration. Dyspareunia phenomena were more pronounced at low orientation to social norms.

Disclosures:

Work supported by industry: no.

Sexual function in gender match after kidney transplantation (#009)

J. Herrera-Caceres (Mexico)
show abstract

009

Sexual function in gender match after kidney transplantation

Magana, J1; Herrera, J2; Gabilondo, B1; Hernandez, M1; Castillejos, R2

1: Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; 2: Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico

Objectives: To analyze sexual function among men and women after kidney transplantation by gender match in patients who received grafts from living donors.

Materials and Methods: Prospective study from March 2012 to May 2014. Using the Female Sexual Function (FSF) and the International Index of Erectile Function-15 (IIEF-15) questionnaires, sexual function was assessed in patients who received a kidney allograft from a living donor the day before surgery and every month after surgery for 6 months.

Results: After a 2 year follow up 54 patients were included.  At six months, we saw a significant difference in satisfaction (p=0.003) and excitation (p=0.055) in 16 women who received an allograft from men; they seem to have a better score in these areas when compared with other gender match groups.

Conclusions: Women who received a kidney allograft from men seem to have better satisfaction and excitation from baseline and compared with other gender match groups six months after surgery.

Disclosures:

Work supported by industry: no.

A randomized, single center, single-blind, crossover thermographic study to evaluate the effect of 1000 mcg of topical alprostadil cream compared to an over-the-counter marketed lubricant (#010)

Sue Goldstein (USA)
show abstract

010

A randomized, single center, single-blind, crossover thermographic study to evaluate the effect of 1000 mcg of topical alprostadil cream compared to an over-the-counter marketed lubricant

Goldstein, I1; Gagnon, C2; Minton, J2; Morris, D3; Goldstein, S2

1: Alvarado Hospital, United States; 2: San Diego Sexual Medicine, United States; 3: WebbWrites, United States

Objectives: Women have more sexual dysfunction than men, yet there are no FDA-approved drugs for bothersome sexual desire, arousal  or orgasm disorders.  Study drug efficacy for the treatment of peripheral genital arousal may be assessed by measuring improvement in genital blood inflow using a non-invasive technique such as Forward Looking InfraRed (FLIR) thermography.  Alprostadil is a vasoactive compound, increasing intracellular cAMP and activation of protein kinase A, resulting in genital smooth muscle relaxation, vulvovaginal vasodilation and enhanced genital secretion.  A prospective, randomized, single center, single-blind, crossover thermographic study was performed to evaluate the effect on peripheral genital arousal of 1000 mcg of topical alprostadil cream (Femprox) compared to an over-the-counter (OTC) lubricant.

Methods:  In this proof-of-concept study, 10 healthy premenopausal women (mean age 32+/-12 years) were topically administered study drug to their clitoris and anterior vaginal wall.  Continuous temperature monitoring of the vestibule, clitoris and vulva was conducted for 30 minutes before and 60 minutes post-application in subjects watching a non-sexual (travel) film. After each application subjects completed questionnaires assessing genital sensations and maximum intensity and duration of effect; adverse events were recorded.

Results: In all subjects topical alprostadil cream induced a statistically significant increase in temperature of the vestibule, clitoris and vulva relative to the OTC lubricant.  Sustained statistically significant treatment differences occurred at 11 minutes post-application for the vestibule, 19 minutes for the clitoris and 9 minutes for the vulva and maintained for the duration of the assessment.  Six of the ten women reported being aware/conscious of genital sensations with the topical alprostadil cream and not the OTC lubricant, consistent with concordance of physiological and subjective assessments.  Discordence was noted in 30% who reported being aware/conscious of genital sensations with both treatments and 10% who reported not being aware/conscious of genital sensations with either.  No adverse events were reported.

Conclusion: Topical alprostadil cream administered to healthy premenopausal women induced statistically significant sustained increases in genital temperatures of the vestibule, clitoris and vulva within 20 minutes relative to OTC lubricant.  Further studies are planned.

Disclosures:

Work supported by industry: yes, by Apricus Biosciences (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Female arousal and orgasmic complaints in a diverse cancer population treated with Zestra®: A topical applied blend of botanical oils (#011)

Michael Krychman (USA)
show abstract

011

Female arousal and orgasmic complaints in a diverse cancer population treated with Zestra®: A topical applied blend of botanical oils

Krychman, M1; Kellogg, S2; Damaj, B3; Hachicha, M3

1: OBGYN, United States; 2: PHD,CRNP, CST, USA; 3: Innovous Pharmaceuticals

Objective: Arousal and orgasmic changes are as a result of cancer treatments. Presently, there is no Food and Drug Administrative approved products presently available for female sexual orgasm dysfunction (FSOD) many troubled women opt for over the counter (OTC) products in an attempt to enhance orgasmic responsivity and improve sexual satisfaction.

Materials/Methods: We present a case series of 10 women who presented with self reported delayed arousal and poor orgasmic response and decreased orgasmic intensity.

Results: Patient demographics included median age of 55.4 years. The following malignancies were represented in this small case series: Breast, rectal, uterine, and ovarian  and lung. One woman was single and another was divorced whereas 8 were married. All women were sexually active with a functional partner. All patients were diagnosed with vulvar vaginal atrophy and were placed on local moisturizers and lubricants to help mitigate these symptoms. Four patients were on concurrent minimally absorbed local vaginal hormones (3 Estradiol cream, 1 DHEA suppositories). Seven out of 10 women had laboratory blood testing. Most women had normal hormones though the majority had testosterones in the lower one third. All women had estradiol levels in the menopausal range.  Patients were evaluated and assessed using a standardized protocol (previously described by a sexual medicine gynecologist. All patients reported efficacy with respect to improved intensity of orgasmic response, and decreased latency of time to orgasms after use of the non-prescription product, Zestra®, a proprietary blend of botanical oils and extracts, with subjective improvement in orgasmic intensity and decreased latency to orgasm for select patients. In addition all reported improved sexual satisfaction at the 4-week follow up visit.

Conclusion: Treatment for malignancy affects the genital arousal and orgasmic function. There are several OTC products that purport to improve sexual satisfaction for women. All women treated in this case series reported increased intensity of orgasmic response and decreased latency to orgasm with the use of Zestra ®, a mixture of arousal oils and extracts. Further randomized clinical trial study with standardized screeners and questionnaires with set endpoints is necessary to establish the generalizability of these preliminary case findings.

Disclosures:

Work supported by industry: yes, by Innovous Pharmaceuticals (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

The Viveve system is a non invasive treatment for vaginal introital laxity that improve sexual function in adult female subject (#012)

Michael Krychman (USA)
show abstract

012

The Viveve system is a non invasive treatment for vaginal introital laxity that improve sexual function in adult female subject

Krychman, M1

1: OBGYN, United States

Objective/ Introduction:  Many women suffer from sexual complaints as a direct result of changes in the integrity of vaginal introitus. The Viveve System is a safe effective treatment of the Vaginal Introital laxity that demonstrates improved sexual function in adult female subjects.

Material and Methods:  The Viveve System is a monopolar radiofrequency system that uses surface cooling and radiofrequency (RF) energy delivery to provide a non-surgical and minimally invasive approach to create heat within the submucosal layers of vaginal tissue while keeping the surface cool. During the Viveve Procedure™, coolant is delivered to the membrane of the Viveve treatment tip. The RF technology creates a reverse thermal gradient, which heats the deeper tissue at a higher temperature while the coolant protects the surface epithelium. The Viveve System consists of the following components: A Console containing the Radiofrequency Generator, a Cooling Module with Cryogen Canister Port, a Hand piece Assembly with attached cables, Treatment Tip, a Return Pad Electrode and a Cable. 

Results:  To date, over 414 tips have been sold, and over 300 procedures performed in approved areas (Canada, Japan and Hong Kong). In addition the procedure has CE mark and European approval.  Eight additional machines are presently on back order.  Initial clinical studies have shown safety and efficacy and further randomized sham controlled research  is  planned for this office based 20-30 minute  outpatient procedure  which is gaining popularity amongst health care professionals and women 

Conclusions:  The Viveve Procedure remains a viable treatment for women who have sexual complaints as a result of vaginal introital changes in the genitopelvic matrix.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.


11:30 - 12:30
Moderated posters 2 - Basic science 1

Location: São Paulo Room
Chairs: Kwangsung Park (Korea) & Ricardo Reges (Brazil)

Hypoactive sexual desire disorder: Tibolone and Tribulus terrestris are really effective? (#110)

G. Silva (Brazil)
show abstract

110

Hypoactive sexual desire disorder: Tibolone and Tribulus terrestris are really effective?

Silva , G1; Lima, S1; Guazzelle, R1; P, S1; Yamada, S1; Martins, C1

1: Santa Casa de São Paulo Medical School, Brazil

Introduction: The hypoactive sexual desire disorder/low-sexual desire (HSDD) is a common complaint among women during the climacteric period and is thus frequently encountered in the primary care provider and OB/GYN practices. Causes of low sexual desire may be hormonal, neurologic, vascular, psychologic, or a result of illness/surgery or medications. Tribulus terrestris is a plant of India, recommended in the treatment of infertility, low libido and impotence in men. Tibolone, a synthetic progestin, have used in the treatment of climacteric complaints, with positive effects on sexual function and good tolerability.

Objective: To study the effects of Tribulus terrestris and Tibolone in post menopause women with HSDD.

Methods: This is a prospective, randomized, double blind study with 66 postmenopausal women with HSDD. Women were allocated randomly into three groups: Control Group (n = 20) received placebo; Tribulus group (n=22) received 750 mg/oral administration/day; and Tibolone group (n=24) 1.25 mg/oral administration/day. The Female Sexual Quotient (Quociente Sexual Feminino - QS-F) was applied to evaluate the sexual function, before and after 90 days of treatment. The women considered as being post-menopausal were those with amenorrhea ≥ 1 year and FSH ≥30mUI/mL. All patients signed a voluntary informed consent form prior to participating in this study, which was approved by the Medical Ethics Committees at the Faculty of Medical Sciences at Santa Casa de São Paulo and the Foundation for Research Support of the State of São Paulo (FAPESP).

Results: In Groups Control Tribulus all patients completed the study; in Tibolone Group four women did not complete it, three due to side effects. In Tribulus and Tibolone Groups there was a significantly improvement after treatment in all domain evaluated. In the Control Group there was improvement statistically significant in domains: desire and interest, and capacity of arousal; in relation to total score the Control Group presents lower statistic significantily. At baseline, all groups showed an unfavorable-regular pattern, and after 90 days treatment the Control Group kept the same pattern, Tribulus Group changed to a regular-good pattern and Tibolona Group to a good-excellent pattern.

Conclusion: There are only modest evidence-based no pharmacologic treatment options and no approved pharmacologic options for the treatment of HSDD. Tribulus terrestris and Tibolone may be evaluated as a good therapeutic option for post menopause women with HSDD/low sexual desire.Despite these treatment limitations, health care providers can address many of the sexual health concern of post menopause women. 

Disclosures:

Work supported by industry: no.

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The universal math evidenced by the geometrical analysis of penile congenital curvature (#111)

E. Da Silva (Brazil)
show abstract

111

The universal math evidenced by the geometrical analysis of penile congenital curvature

Da Silva, E1; Ruellas, T1; Barrela, M1; Damiao, R1

1: Rio de Janeiro State University, Brazil

Objective: To evaluate whether the congenital ventral penile curvature presents a mathematical pattern related to golden spirals.

Materials & Methods: A case control study was designed. Five patients who presented congenital ventral penile curvature consisted the case group and three patients who presented acquired penile curvature (Peyronie’s disease) composed the control group. Penile photographs were taken during the prostaglandin (PGE-1) induced erection test, according five-line Kelâmi’s protocol. And thus penile curvature pictures were tested for equiangular spiral. In cases with positive relationship, the existence of a relation to the golden spiral – type of equiangular spiral – was also checked.

In order to check the described mathematical relationships, the following programs were used: Wolfram CDF Player (Logarithmic Spiral) and PhiMatrix. The Wolfram program generated logarithmic spirals equivalent to the penile curvature with its appropriate mathematical values. The PhiMatrix program, which builds any golden spirals from golden rectangles, was used to check whether the spiral, besides being equiangular, is also a golden one.

Results: In all cases (100%) of congenital ventral penile curvature an equiangular spiral was found, and, furthermore, was also a GOLDEN one. On the other hand, acquired penile curvatures presented no specific pattern.

Conclusion: There is a mathematical pattern in the congenital ventral penile curvature and it is related to a GOLDEN spiral. The results offer the math algorithm for the potential use on the fields of surgical reconstruction procedures, regenerative medicine, tissue engineering and robotics.

Disclosures:

Work supported by industry: no.

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Nanotechnology improved stem cell therapy in erectile dysfunction in post radical prostatectomy animal model (#112)

Run Wang (USA)
show abstract

112

Nanotechnology improved stem cell therapy in erectile dysfunction in post radical prostatectomy animal model

Lin, H1; Dhanani, N 1; Tseng, H ; Souza, G ; Wang, R2

1: University of Texas Medical School at Houston, United States; 2: University of Texas Medical School at Houston and MD Anderson Cancer Center, United States.

Objective: Recently, intracavernous injection (ICI) of stem cells has shown some therapeutic potential for erectile dysfunction (ED). However, most stem cells were washed out immediately due to the communication between corpus cavernosum (CC) and the blood circulation. Keeping stem cells in the CC after ICI maybe the key step for successful stem cell therapy for ED. We investigated a novel nanotechnology to improve stem cell therapy in an animal model.

Material and Methods: Adipose-derived stem cells (ADSCs) were isolated from the inguinal fat tissue of adult male Sprague–Dawley (SD) rats and cultured in DMED/F12 medium. Magnetic nanoparticles were added to ADSCs. CellTracker™ Green CMFDA (5-Chloromethylfluorescein Diacetate) was used to track ADSCs present in the CC. ED animal models were created by bilateral cavernous nerve crush (BCNC) injury and randomly assigned into three groups. Group A: ADSCs ICI. Group B: ADSCs with nanoparticle ICI. Group C: ADSCs with nanoparticle ICI + magnet probes. Rats were sacrificed at day 1, 3, 5 and 9 after ICI, respectively. Rat penis was harvested for tracking ADSCs by immunofluorescence.

Results: Our in vitro study showed that ADSCs with nanoparticles promoted cell aggregation with the use of a magnet probe. In vivo study with the immunofluorescence confirmed that ADSCs with nanoparticle were successfully maintained in CC with the use of magnet probes for up to 9 days; while most ADSCs were washed out in other groups in day 1 and 3 after ICI.

Conclusions: Magnetic nanoparticle is a novel technology to improve ADSCs therapy for ED in animal model.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Effect of hyperglycemia on the expression of aquaporins in rat vagina (#113)

Run Wang (USA)
show abstract

113

Effect of hyperglycemia on the expression of aquaporins in rat vagina

Jiang, R1; Wang, R2; Lin, H3; Yang, L4

1: Department of Urology, Affiliated Hospital, Luzhou medical college, China; 2: Division of Urology, University of Texas Medical School at Houston and MD Anderson Cancer Center; 3: Division of Urology, University of Texas Medical School at Houston, United States; 4: Department of Urology, Affiliated Hospital, Luzhou medical college, China.

Objective: A common female sexual dysfunction caused by hyperglycemia is vaginal lubrication difficulty. Vaginal lubrication may be related to transudation of fluid. Aquaporins (AQPs) are key membrane proteins that transport water through biological membranes. The objective of this study is to investigate the expression of AQP0, 5, 6, 10, 11 and 12 in vaginal tissue of diabetes mellitus rats.

Material and Methods: 8-week-old female Sprague-Dawley rats (n=24) were randomly divided into group A (12-week-old diabetic rats, n=6), group B (12-week-old non-diabetes control, n=6), group C (14-week-old diabetic rats, n=6) and group D (16-week-old non-diabetes control, n=6). The level of vaginal lubrication and the expression of AQP0, 5, 6, 10, 11 and 12 in vaginal tissue of rats were determined.

Results: The level of blood glucose was significantly increased in group A and group C compared with those in group B and group D (P<0.05). Vaginal lubrication was significantly lower in group A (2.12±1.41) and group C (2.64±0.88) than in group B (4.21±0.86) and group D (4.41±0.77) (P<0.05), respectively. The protein expressions of AQP0, 5, 6, 10, 11 and 12 in vaginal tissue were significantly lower in group A and group C than in group B and group D (P<0.05) determined by immunohistochemical study and/or Western blot, respectively.

Conclusions: Decreased vaginal lubrication in diabetic rats after electro-stimulation may be related to decreasing of the expression of AQPs in vaginal tissue.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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3D bioprinting PCLScaffolds for tissue engineering applications (#114)

Kwangsung Park (Korea)
show abstract

114

3D bioprinting PCLScaffolds for tissue engineering applications

Park, K1; Hwang, I1; Lee, H1; Park, J1; Park, S2

1: Department of Urology, Chonnam National University Medical School, Sexual Medicine Research Center, Chonnam National University, Gwangju, Korea; 2: Nano Convergence & Manufacturing Systems Research Division, Korea Institute of Machinery & Materials (KIMM), Daejeon, Korea

Objective(s): To investigate in vitro evaluation of a polycaprolactone (PCL) scaffold fabricated by 3D printing technique for tissue engineering applications in the field of sexual medicine.

Material and Method(s): Polycaprolactone (PCL) scaffold was fabricated by 3D bioprinting system. 3D printed scaffold has interconnected structure for cell ingrowth within scaffold. Stand thickness/period of scaffold was controlled by temperature, velocity, and pressure. Scaffolds were placed in six-well plate and seeded with human aortic smooth muscle cell (hSMC) at 5 x 105 cells per scaffold. Seeded and control scaffolds were cultured under static conditions for up to 4 weeks. The ability of these scaffolds to support smooth muscle cell growth was investigated in vitro.

Result(s): We fabricated three different groups (strand thickness/strand period); 300/150 um, 300/300 um, and 300/450 um.  3D scaffolds were characterized by SEM images and porosity measurement.

SEM images showed the surface morphology of PCL scaffold, and hSMC cells covered all the surface of the scaffold. Immunofluorescent staining images of α-smooth muscle actin on hSMC cells/scaffolds confirmed that the cells remained viable and proliferated throughout the time course of the culture.

Conclusion(s): This is a preliminary study showing that 3D printed PCL scaffolds could be used for tissue engineering applications in the field of sexual medicine.

Disclosures:

Work supported by industry: no.

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Therapeutic potential of adipose-derived stem cells based micro-tissues in a rat model of post-prostatectomy erectile dysfunction (#115)

Zhong Cheng Xin (China)
show abstract

115

Therapeutic potential of adipose-derived stem cells based micro-tissues in a rat model of post-prostatectomy erectile dysfunction

Xu, Y1; G, R1; Lei, H1; Li, H1; Wang, L1; Gao, Z1; Song, W1; Xin, Z1

1: Andrology Center, Peking University First Hospital, Peking University, Beijing, China

Objective: Stem cells (SCs) show significant benefits in the treatment of post-prostatectomy erectile dysfunction (ED). However, the low retention rate of the tranditional single cell strategy at the injection sites limits its therapeutic potential.The aim of this study is to investigate the feasibility and mechanism of ADSCs based micro-tissues (MTs) in the treatment of ED in a rat model of bilateral cavernous nerves (CN) injury.

Materials and Methods: ADSCs labeled with 5-ethynyl-2-deoxyuridine (EdU) were used to generate MTs with hanging drop method. 10 Sprague-Dawley (SD) rats underwent sham sugery and intracavernous (IC) injection of PBS (the sham group). Another 70 rats underwent bilateral CN crush and were then treated with PBS (n=10, the crush group), dissociated ADSCs (n=30, the ADSCs group), and MTs (n=30, the MTs group) respectively. At day 1, 3, 7, 14 (n=5) and 28 (n=10) postsurgery, specimens were harvested for histology. At day 28, 10 rats in each group were examined for erectile function before tissue harvest.

Results: Three-day old MTs became stable and expressed NGF, VEGF, CXCR4, Wnt5a, and ColⅣ. More EdU+ ADSCs retained in the CC in the MTs group than that in the ADSCs group. IC injection of MTs resulted in significant restoration of the erectile function and histopathological changes compared to the ADSCs group.

Conclusion: IC injected MTs resulted in a better restoration of erectile function than tranditional single cell strategy. The underlying mechanisms of recovery appear to involve enhanced cellular retention in the penis and up-regulation of some paracrine factors.

Disclosures:

Work supported by industry: no.

Estrogen mediates metabolic syndrome-induced erectile dysfunction: A study in the rabbit (#116)

Mario Maggi (Italy)
show abstract

116

Estrogen mediates metabolic syndrome-induced erectile dysfunction: A study in the rabbit

Vignozzi, L1; Filippi, S2; Cellai, I 3; Comeglio, P3; Morelli, A4; Maggi, M3

1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences and Department of NEUROFARBA, University of Florence, Florence, Italy; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine,University of Florence, Florence, Italy

Objective: ERα is critical in mediating the harmful effects of hyperestrogenism in fetal or neonatal life on the developing penis. In contrast, little is known on the impact of an excess of estrogens on penile function in adulthood. The aim of this study was to investigate the effect of estrogens on metabolic syndrome (MetS)-associated erectile dysfunction (ED), in an animal model of MetS.

Material and Methods: To understand the role of sex steroid milieu, we treated subgroups of MetS rabbits with either testosterone (T) or tamoxifen, a classical ERs antagonist. We evaluated acetylcholine (Ach)- penile responsiveness as well as the expression of genes related to penile smooth muscle relaxation and contractility.

Results: MetS was associated to  elevated  estradiol  (E2)  and low T levels. E2, but not T, was independently and  negatively associated with  genes able to affect penile erection. Smooth muscle-related markers decreased as a function  of  E2 and were positively associated with all the variables investigated. Increasing  concentrations of circulating  E2 were negatively associated with Ach-induced relaxation. In HFD rabbits, in- vivo T dosing significantly improved MetS, and normalized circulating E2. Conversely, in-vivo tamoxifen dosing reduced visceral adiposity and partially restored T level. Ach-induced relaxation was severely impaired by HFD and significantly restored, up to the control level, by both tamoxifen and T. In rabbit smooth muscle cells culture 17 β estradiol significantly reduced the expression of αSMA, SM22 and PDE5.

Conclusions: Tamoxifen reverted completely these effects. In conclusion,  HFD-induced ED is more associated with a high estradiol, than to a low T, milieu.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Sex steroid hormone and its relation with body mass index, waist circumference, body fat and visceral fat (#117)

S. Cedres (Uruguay)
show abstract

117

Sex steroid hormone and its relation with body mass index, waist circumference, body fat and visceral fat

Cedres, S1; Goñi, M1

1: Uruguay

Obesity is an issue that is increasingly affecting ageing men. With ageing, there is a decline in androgens as well. Visceral fat more than body fat is closely related to lifestyle related diseases such us hypertension, diabetes, hyperlipidemia and hypogonadism. Cross-sectional data suggest that it is associated with decreased production of testosterone. It has been hypothesized that there is increased aromatization of testosterone to estradiol and alteration of the hypothalamic-pituitary-adrenal axis in obese ageing men.

Objective: To examine the relation of obesity (body mass index (BMI) > 30 kg/m2), of central obesity (waist circumference > 100 cm), of body fat (> 20%) and of visceral fat (> 10%) to change in sex steroid hormones in men.

Methods: One hundred men with complete anthropometry and sex hormone level were included betwen April and July of 2008 from consulting in Uruguay. Free and total testosterone (FT and TT), were assessed at 10:00 AM. Health behaviours and medical history were obtained by structured interview. Body Composition Monitor was used to define the visceral and body fat. It estimates the percentage by the Bioelectrical Impedance method along with the electric resistance, weight, age and gender information. The dual energy x ray absorptiometry method uses two different frequency X rays and rates of absorption of the body to determinate the value based on the difference between the two. Repeated measures regression was used to describe trends in steroid hormones in relation to obesity status, adjusting for age, smoking, alcohol, chronic illness, and physical activity.

Results: Visceral fat rather than body fat or BMI was associated with decreased levels of total and free testosterone.

Conclusions: Viseral Fat may predict greater decline in testosterone levels with age than central obesity or body mass index. Further studies in this field are recommended to evaluate the clinical impact of nutricional factors in sex hormones.

Disclosures:

Work supported by industry: no.

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Light-controlled relaxation of the penile corpus cavernosum using the novel nitric oxide releaser NOBL-1 (#118)

Y. Hotta (Japan)
show abstract

118

Light-controlled relaxation of the penile corpus cavernosum using the novel nitric oxide releaser NOBL-1

Hotta, Y1; Ieda, N1; Nakagawa, H1; Kimura, K1

1: Nagoya City University, Japan

Objective. Nitric oxide (NO) is very important for the initiation and maintenance of penile erection. NO is typically produced by nerve or endothelial cells; however, NO production requires sexual arousal or shear stress. These conditions may be impaired in some cases such as spinal cord injury or atherosclerosis. Therefore, controlling NO production may be very useful as therapy for erectile dysfunction (ED). Here, we focused on a novel blue light-controllable NO releaser called NOBL-1 and investigated whether we could control relaxation of the corpus cavernosum smooth muscle.

Materials and Methods. Male adult Wistar-ST rats were used in this study. The glans, urethra, blood vessels, and tunica albuginea were carefully removed from each penis and placed in chilled Krebs solution, a strip of corpus cavernosum was prepared, and an isometric tension study was performed. After pre-contraction with noradrenaline (10 μM) and the addition of NOBL-1 (1 μM or 10 μM), the response of the corpus cavernosum smooth muscle to irradiation with blue light (470–500 nm) was measured and recorded.

Results. The corpus cavernosum smooth muscle that had pre-contracted with noradrenaline relaxed in response to blue-light irradiation at both doses of NOBL-1. The relaxing response to blue light at 10 μM NOBL-1 was larger than that at 1 μM. In addition, after irradiation was stopped, relaxation at both concentrations of NOBL-1 disappeared and tension returned to that before irradiation.

Conclusions. This study demonstrated control of relaxation of the corpus cavernosum smooth muscle using NOBL-1, a novel blue light-controllable NO releaser. Although further in vitro and in vivo studies are needed to prove its potential for ED therapy, our results suggest that NOBL-1 may be a useful tool for penile rehabilitation.

Disclosures:

Work supported by industry: no.

show poster

Penis rupture – a topic for interdisciplinary consideration (#119)

R. Herwig (Austria)
show abstract

119

Penis rupture – a topic for interdisciplinary consideration

Herwig, R1; Bayerl, M1

1: Vienna International Medical Clinic, Vienna, Austria

Objective: The purpose of the interdisciplinary cooperation between urological surgery and physics is the development of a physical simulation tool to be used by surgeons in order to give prognosis of possible penis rupture at a certain degree of deviation of the penis and to take prophylactic action.

Materials and Methods: For the physicist it was the first challenge to translate the human organ of the penis into a physical model. Starting and marginal parameters had to be defined, whereby some of them had to be proceeded on the assumption, as physical data of the human living tissue have rarely been measured up to now, such as, f.i. the modulus of elasticity of the tunica, the mass of the penis in erect state and the maximum stress, the tunica can be subdued to. The algorithm and its dependencies had to be developed.

Results: This paper is a first step of mathematical-physical simulation with the assumption of a 100 % filled rigid penis. The calculation (see Fig. 1) gives proof of the hypothesis that the fibre-load-angle of the penis is 12 degree (see Fig . 2), much less than 30 degrees, which was the assessment of the authorities of urology up to now.

Conclusion: Physical simulation is able to provide the surgeon with a simple instrument to calculate and forecast the risk of the individual patient, based upon dependencies of geometry of the differential geometrical body of the penis.

Fig. 1:
Abstract 119
Fig. 2:
Abstract 119

Disclosures:

Work supported by industry: no.


11:30 - 12:30
Podium 3 - Peyronie's disease

Location: Transamérica Auditorium
Chairs: Fernando Facio (Brazil) & Wayne Hellstrom (USA)

The effects of four different suture materials on penile tissue of rats (#013)

Ege Can Serefoglu (Turkey)
show abstract

013

The effects of four different suture materials on penile tissue of rats

Tuken, M1; Altinay, S1; Temiz, M1; Cakir, O1; Alkan, S1; Semercioz, A1; Serefoglu, E1

1: Bagcilar Training and Research Hospital, Turkey

Introduction: Although several types of suture materials are being used for correction of penile curvatures, to the best of our knowledge, there are no studies in the literature about the effects of these materials on penile tissue.

Materials and Methods: A total of 30 male Sprague-Dawley rats were divided into 5 groups. After anesthesia, an abdominal wall incision was made and the proximal side of the right cavernosal body was sutured with 5/0 sutures (group 2: polyethylene terephthalate [ETB], group 3: polypropylene [PRL], group 4: polyglactine [VCR], group 5: polydioxanone [PDS]). An identical needle (3/8-13 mm cutting) without any suture material was passed through cavernosal bodies in the sham group (group 1). After 3 weeks, all rats were sacrificed and penile tissues were examined by the same pathologist to assess the level (0-3) of inflammation, granuloma formation and fibrosis.

Results: Kruskal-Wallis test revealed that there was statistically significant difference among five groups regarding inflammation, granuloma formation and fibrosis levels (p<0.01 for all)(table 1). The groups were further compared with Mann Whitney U test (table 2). The level of inflammation, granulation and fibrosis in the PRL group was not different than the SHAM group. Although the levels of granuloma and fibrosis in the PDS group were also similar to the SHAM group, inflammation level was significantly higher. The inflammation, granuloma formation and fibrosis levels were the highest in the ETB group. VCR caused similar levels of granuloma formation and fibrosis to ETB.

Conclusion: PRL suture is associated with the least histopathological changes in the penile tissue. However, non-absorbable nature of this suture may cause discomfort among patients who palpate the knots. PDS, which is a monofilament synthetic absorbable suture, can be a reasonable alternative to PRL as it caused similar levels of granuloma and fibrosis.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

The use of tunica albuginea crural graft for severe penile curvature due to Peyronie´s disease: 10 years follow up (#014)

Claudio Teloken (Brazil)
show abstract

014

The use of tunica albuginea crural graft for severe penile curvature due to Peyronie´s disease: 10 years follow up

Teloken, C1; Dal'Asta, I1; Coelho, L1; Graziottin, T1

1: UFCSPA - Federal University, Brazil

Introduction: Management of severe penile deformity due to Peyronie’s disease is surgically challenging. Various surgical techniques and graft materials have been used; however most of them exhibited suboptimal long-term results, especially with regard to curvature recurrence and erectile dysfunction. We first described the use of autologous tunica albuginea retrieved from the crura as a graft material – TACRUG - and present herein the long-term follow-up results.

Methods: We conducted a chart review of patients with preserved erectile function or erectile dysfunction (ED) responding to PDE-5 inhibitors who had undergone plaque incision and graft with crural tunica albuginea for stable penile deformity precluding vaginal intercourse. The TACRUG is obtained through a 3-cm longitudinal perineal incision. A longitudinal segment of tunica in the anterior aspect the corpus cavernosum 2mm larger than the defect is delimited with methylene blue, preserving the cavernous artery entry point, and carefully removed. A segment of tunica from the contralateral corpus cavernosum may also be retrieved if necessary. The corpus caversonum then is closed with continuous 4-0 polyglactin suture.

Results: One hundred and forty eight  patients with a mean follow up of 6 years  (range 3 to 11) were included in this analysis. Mean age was 54 years (range 42 to 75). Intraoperative penile straightening was obtained in all cases. Curvature recurrence requiring surgical intervention occurred in 8 % of the patients. Penile shortening was observed in 9%, and 15% patients reported glans numbness. Forteen percent developed postoperative ED, all of which responded to oral PDE-5 inhibitors. Twenty eight percent of individuals who preoperatively responded to PDE-5 inhibitors became unresponsive. Overall, 12.8% patients subsequently underwent penile prosthesis implantation. Eighty nine percent of patients classified the long term postoperative result as excellent or satisfactory.

Conclusions: The autologous tunica albuginea crural graft is easily obtained, does not carry the risk of rejection or transmission of infectious diseases and affords satisfactory long-term results, without added costs. Despite the lack of a control group, based on our experience and in comparison to published data, the tunica albuginea crural graft is associated with less curvature recurrence and does not lead to increase risk of ED than other graft material.

Disclosures:

Work supported by industry: no.

Ventral intralesional verapamil injections for Peyronie's disease: Feasability and safety (#015)

John Mulhall (USA)
show abstract

015

Ventral intralesional verapamil injections for Peyronie's disease: Feasability and safety

Berookhim, B1; Chevinsky, M1; Jakubowski, C1; Larish, Y 1; Nelson, C1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States

Objective: To report our initial experience with ventral intralesional verapamil injections (ILI) for Peyronie’s Disease (PD).

Methods: We analyzed prospectively gathered data from an institutional database pertaining to PD patients. For the purposes of this analysis, inclusion criteria included men (i) with uniplanar curvature (ii) who had curvature assessment (CA) with the assistance of intracavernosal injection and developed at least an 80% rigid erection (iii) who underwent 6 ILI (10mg verapamil in 5ml saline) and (iv) had an end of treatment CA at least 3 months after treatment completion. Ventrally located plaques were treated similarly to dorsal, with special attention paid to avoid midline injection directly into the urethra.

Results: 154 men met all criteria. 144 (93%) had dorsal ILI and 10 (7%) underwent ventral ILI. Mean duration of PD was 8±18 months and 3±2 months (p=0.46) while mean age was 55±8 and 59±7 years (p=0.16) respectively. Comorbidity profiles were similar in both groups. Mean baseline curvature was 38±15 degrees and 39±11 degrees (p=0.96) respectively. No significant difference existed in change in curvature between groups (see Table, p=0.33). Those who improved in the ventral ILI group had higher mean baseline curvature (51±7 degrees) compared to those who remained stable or worsened (30±7 degrees, p=0.04). Ventral ILI patients reported rare self-limiting hematuria and occasional blood at the urethral meatus at procedure completion, with a penile ecchymosis rate identical to dorsal ILI patients. There were no reports of urinary clot retention, penile hematoma or delayed urinary symptoms suggestive of urethral stricture.

Conclusions: Ventral ILI is a safe procedure. Changes in curvature with ventral injections are similar to those seen with those administered dorsally, with 40% demonstrating clinical improvement. Given our initial data, ILI should be considered in men with ventral plaques.

Abstract 015

Disclosures:

Work supported by industry: no.

The chronology and severity of penile sensory changes after plaque incision and grafting surgery for Peyronie's disease (#016)

Raanan Tal (Israel)
show abstract

016

The chronology and severity of penile sensory changes after plaque incision and grafting surgery for Peyronie's disease

Tal, R1; Deveci, S1; Choi, J1; Mulhall, J1

1: Memorial Sloan-Kettering Cancer Center, United States

Objective: Besides changes in erectile function, Plaque incision and grafting surgery (PIGS) for PD when performed dorsally, is known to be associated with penile sensory loss. Rates of sensory changes have been cited at 0-12%. This analysis was conducted to define the rate, chronology and predictors of this problem.

Material and Methods: The study population consisted of men who (i) had dorsal PIGS (ii) at least 6 months follow-up. Patients are followed up in the office at 1 week, 1 and 6 months and by phone at 12 months and later if continued problems exist. Penile sensation was graded on visual analog 0-10 point scale, where 10 was perfect sensation and 0 total loss of sensation. Sensation loss degree was defined as extensive if circumferential, patchy if diffuse and focal if small and confined to one area of the penile shaft. Using multivariate analysis, predictors of sensation loss were sought including: patient age, diabetes presence, duration of PD, duration of operation.

Results: 60 patients were analyzed. Mean age = 52±20 years, mean follow-up of 16±11 months. Mean duration of PD at time of PIG surgery = 18±11 months. 10% had diabetes preop with a mean HBA1C = 7.2±1.8%. Mean duration of self-reported stability = 8 months. 75% of patients had curvature alone, while the remainder had associated indentations or hourglass deformity. Mean baseline primary curvature = 64±28 degrees. All patients were capable of sexual intercourse pre-operatively with or without erectogenic aids. Mean duration of operation = 3.5±1.8 hours. 20% had any sensation loss at 1 week, 20% at 1 month and 7% at 6 months. Severity presented in Table. 2/60 patients had some sensation loss at 1 year and a single patient at 2 years continued to have extensive sensation loss on the glans and distal shaft.  Only duration of operation was a predictor, with duration >4 hours being predictive of sensation loss at 6 months, OR 2.1, 95% CI 1.2-3.0 (p<0.01).

Conclusions: Sensation loss is not uncommon after PIG surgery. It decreases in frequency and severity with time with only rare cases occurring beyond 12 months. Longer operations are more likely associated with sensation loss, likely related to difficult neurovascular bundle elevation.

Disclosures:

Work supported by industry: no.

Selection criteria used to guide surgical approach for management of Peyronie's Disease: A single institution experience (#017)

Laurence Levine (USA)
show abstract

017

Selection criteria used to guide surgical approach for management of Peyronie's Disease: A single institution experience

Papagiannopoulos, D1; Yura, E1; Levine, L1

1: Rush Univeristy Medical Center, United States

Objective: Peyronie’s disease (PD) is manifest by a fibrotic plaque within the tunica albuginea of the penis. For select patients, several surgical techniques are available. In an attempt to guide operative selection, we report our series of penile straightening procedures for PD spanning six years, with the following selection criteria. Patients with satisfactory erections and curvature < 60 degrees and no hinge effect were treated with tunica albuginea plication (TAP). Those with satisfactory erections and curvature > 60 degrees and/or hinge effect were treated with partial plaque excision and grafting (PEG). Patients with unsatisfactory erections were treated with placement of inflatable penile prosthesis (IPP).

Methods: We retrospectively reviewed all patients who underwent penile straightening procedures for PD between 2007 and 2013. Work-up involved a history, physical exam, and a duplex ultrasound.  When possible, the Peyronie’s Disease Questionnaire (PDQ) was employed to assess bother and distress associated with PD. Objective outcomes and patient satisfaction were assessed post-operatively

Results: A total of 389 patients underwent penile straightening procedures for correction of PD by one surgeon between 2007 and 2013.  Of these patients, 29%, (n=114) received primary TAP, 40% (n=158) primary PEG, and 30% (N=114) IPP. Mean follow-up was 17 months. There was a significantly higher incidence of DM within the IPP group (P<0.01). The PDQ showed no difference in emotional status or bothersome score between groups. Patients with less satisfactory erectile function were more likely to undergo IPP placement (p<0.01). Those with superior erectile function, a hinge effect or severe curvature were more likely to undergo PEG (p<0.01). In the presence of a calcified plaque, PEG and IPP placement were significantly more common than TAP (PEG p< 0.01, IPP p=0.04). Regardless of surgical modality, there were no significant differences in satisfactory rigidity, residual bothersome curve, or ability to engage in intercourse.

Conclusion: Patient experience with post-surgical rigidity, ability to engage in intercourse, and residual bothersome curve was not statistically different across the three groups. These results support the use of our selection criteria, even in the face of patient preference. The primary factors that compromised patient adherence to our treatment algorithm were fear of length loss or hesitance to pursue IPP placement.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Intraplaque injection of tiocolchicine and verapamil in Peyronie´s disease patients: A prospective randomized single-blind comparative study (#018)

Sidney Glina (Brazil)
show abstract

018

Intraplaque injection of tiocolchicine and verapamil in Peyronie´s disease patients: A prospective randomized single-blind comparative study

Toscano Jr, I1; Rezende, M1; Mello, L1; Pires, L1; Paulillo, D1; Glina, S2

1: Hospital Ipiranga, Brazil; 2: Hospital Ipiranga / Instituto H.Ellis, Brazil

Objective: To compare the effects of tiocolchicine or verapamil intraplaque injection on plaque size, sexual function and penile curvature in Peyronie’s Disease (PD) patients.

Materials & Methods: A prospective randomized single-blind study involving 25 patients treated with intraplaque tiocolchicine or verapamil injection between June 2008 and September 2012. All patients had been suffering from PD for up to 18 months. Cases with less than 3-month progression, history of trauma or history of surgical PD correction were excluded. Patients were treated weekly in 7 consecutive consultations. The parameters considered were IIEF (International Index of Erectile Function), sonographic measurement of plaque size and photograph-based measurement of penile curvature.   

Results: Twenty-five patients were randomly assigned to treatment with tiocolchicine (13) or verapamil (12). Mean penile curvature was 46.7° and 36.2° (p=0.019), and 50.4° and 42.08° (p=0.012) before and after treatment with tiocolchicine and verapamil, respectively. Penile curvature improved in 69% and remained stable in 23% of tiocolchicine-treated patients, while 66% improvement with 33% stability was documented in patients treated with verapamil. The mean IIEF scores (sexual function) increased from 16.69 to 20.85 (p=0.23) and decreased from 17.50 to 16.25 (p=0.58) in tiocolchicine- and verapamil-treated patients, respectively. Plaque size decreased in 61%, increased in 23% and remained unchanged in 15% of tiocolchicine-treated patients. Plaque size decreased in 8% and remained unchanged in 83% of patients in the verapamil group. No adverse effects were observed following tiocolchicine treatment.

Conclusions: Tiocolchicine injection improved penile curvature, increased IIEF scores and reduced plaque size in DP patients. Tiocolchicine was more effective than verapamil, with improvement in IIEF scores and reduction in plaque size, despite the lack of statistical significance. Tiocolchicine and verapamil had similar effects on penile curvature. No significant adverse effects were observed in this study.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.


11:30 - 12:30
Instructional course 1 - Basic sexual therapy for physicians

Location: Ilhéus + Una Room
Chairs: Stanley Althof (USA) & Luis Alberto Finger (Argentina)

Dealing with sexuality in our patients with chronic disease & cancer

Woet Gianotten (The Netherlands)

Sex therapy approaches to the treatment of ejaculatory disorders

Stanley Althof (USA)

Sexual therapy for women with problems of desire

Kevan Wylie (United Kingdom)


Afternoon

12:30 - 14:00
Lunch break

Location: Comandatuba Room 1

14:00 - 15:30
Round table 1 - Outcomes of Peyronie's disease treatment

Location: Comandatuba Room 2+3
Chairs: Chris McMahon (Australia) & Claudio Teloken (Brazil)

PD pharmacotherapy and traction therapy

Ronny Tan (Singapore)

New horizons - CCH for PD

Wayne Hellstrom (USA)

Surgical treatment of PD - Indications and options

Laurence Levine (USA)

Outcomes from surgical treatment of PD

Giulio Garaffa (United Kingdom)


14:00 - 15:00
Podium 4 - Psychotherapy

Location: São Paulo Room
Chairs: Tamara Melnik (Brazil) & Eusebio Rubio-Aurioles (Mexico)

A neurocognitive model for psychogenic erectile dysfunction (#019)

Romulo Aponte (Venezuela)
show abstract

019

A neurocognitive model for psychogenic erectile dysfunction

Aponte, R1

1: Unidad de Estudios y Terapia Cognitiva y Sexual, Venezuela

Objective: Sexual tipping point model demonstrates both the mental and physical contributors to sexual function and dysfunction. Cognitive factors such as negative sexual automatic thoughts have been identified in patients suffering erectile dysfunction. The aim of this study and review is to propose an integrative model to understand how psychological-cognitive-factors could impact the molecular substratum of erectile dysfunction.         

Methods: Cognitive rehearsal was applied to fifty patients to identify cognitions in sexual situations. Sexual Health Inventory for Men (SHIM) was applied to evaluate self confidence in obtaining and maintaining an erection. Additionally, urological and hormonal screening was performed. A review of the literature concerning cognitions, central and peripheral neural pathways and neurotransmitters involved in cavernous vasoconstriction leading to psychogenic erectile dysfunction was performed.
Results: At the cognitive rehearsal all 50 patients (100%) had erectile failure anticipatory thoughts. At SHIM, sample evidence showed 38 (76%) very low or low and, 12 (22%) moderate self confidence to obtain and maintain erection. None of them showed high self confidence. Urological and hormonal screening was normal. Sexual negative cognitions, located at the prefrontal cortex, impact via corticalstriatumthalamic pathway the amygdale, the hypothalamus, the main modulator of the sympathetic system, and the locus ceruleus, the main norepinephrine nucleus at the central nervous system. Dendrites from the hypothalamus connect to the sympathetic chain and dendrites from the locus ceruleus project to the spinal cord modulating the peripheral response and affecting autonomic activity. The sympathetic system projects to α 1 adrenoreceptors at cavernous vascular smooth muscle  through  post ganglionar fibers  whose neurotransmitter is norepinephrine,  increasing  intracellular calcium concentration,  leading to constriction  of the penile vascular system and blocking  the erectile response.

Discussion: Negative sexual cognitions and low sexual self confidence found in this study is probably associated to central and peripheral neural pathway activation and norepinephrine liberation at the penis, blocking the erectile mechanism. Anxiety and depression neurocognitive models have been well documented. Anticipatory thoughts of threat are idiosyncratic to anxiety.  These cognitions located at the prefrontal and cingulate cortex increased amygdale activity associated to anxiety symptoms. Cognitive triad, distortions maladaptive schemas are idiosyncratic to depression. Dysfunctional prefrontal cortex, associated to poor control over stimulus incites aberrant limbic system activity in depressed patients.

Functional MRI is needed to confirm this hypothesis.

Conclusion: Anticipatory negative thoughts of failure to obtain or maintain erection and low sexual self-confidence almost surely activate central and peripheral neural pathways in psychogenic erectile dysfunction.

Disclosures:

Work supported by industry: no.

Brazilian men reporting themselves as black skinned color are at risk for genital dysmorphic disorder (#020)

R. Barboza (Brazil)
show abstract

020

Brazilian men reporting themselves as black skinned color are at risk for genital dysmorphic disorder

Barboza, R1; Da Silva, E1; Ruellas, T1; Damião, R1

1: Rio de Janeiro State University, Brazil

Objective: The vast majority of countries around the world can be considered phallocentric societies as evidenced by the high prevalence of sexual taboos and myths. Anthropologically, the myth of the larger penile size associated to Afro-Americans is a vestige of the African slavery in America.  Despite regional differences among human penile size were previously evaluated objectively, we also aimed to assess subjectively their self-perception of penis size and skin color.

Material and Method: Five hundred and two volunteers were interviewed. The IMAGE questionnaire was used to evaluate genital self-perception and its implication on quality of life.  Subjects were required to self-report as Caucasian, Afro-Brazilian or others. Finally, flaccid penis size was measured with an anthropometric ruler supported on the dorsal penis surface in maximum manual traction, depressing the fat against the pubic bone (RLTmax). When genital dysmorphic disorder was suspected, a mental health team provided additional support.

Results: One hundred thirty four (26.9%) men reported themselves as black skinned color, 224 (44.6%) as white skinned color and 143 (28.5%) as uncategorized. Their respective age mean were 54.9 ± 13.9 years old,  55.6 ± 15.6 years old and  54.1 ± 15.7 years old  (p=0.652). While the mean penile length of the self-reported black skinned people was 15.3 ± 4.0cm and the RLTmax was 16.4 ± 1.7cm (p=0.004), the mean reported by the white skinned people was 14.3 ± 3.0cm and the RLTmax of 15.8 ± 1.6cm (p<0.001). Men reported as Afro-Brazilians presented a mean of 6mm larger penis (RLTmax) than Caucasians in both subjectively (p=0.007) and objectively (p<0.001). Men tended to underestimate their penis size. However, Afro-Brazilians presented tendency to overestimate their penis size (32.6% x29.3%, p=0.045) and this influenced negatively their body image and health related quality of life. 

Conclusion: Brazilian men reporting themselves as black skinned color are at risk for genital dysmorphic disorder.

Disclosures:

Work supported by industry: no.

The sexual education in Latin-America – A preliminary evaluation (#021)

Raquel Simone Varaschin (Brazil)
show abstract

021

The sexual education in Latin-America – A preliminary evaluation

Varaschin, R1; Baigorri, G; Rivero, M

1: Centro Integrado de Psicologia, Brazil

Introduction: The sexual education has shown the maintenance of negative aspects in the sexual development when this sexual education sustains repression entail in the manifestation of female sexuality. It also reveals the mith of the human male as machine-man. For this reason and in order to identify more suitable instruments of intervention for sex education in developing satisfactory behaviors, attitudes and emotional and sexual response, a Latin America research was conducted, with an initial collaboration between Brazil and Argentina (Chapter of Sexual Medicine – SAU).

Materials and Methods: A survey with 17 questions idiomatically adapted to each country, using a structured self-administered questionnaire, non-probability random sample, in a cross-sectional analysis

Results: The research was set up with 537 people (16-73 years old), 59.03% females, 36.41% had a university degree, 87.10% were heterosexual, and 33.40% had no stable relationship. From the analyzed group, 67.94% received sexual education, most of them from an educational institution. The result of the education received was unsatisfactory for 27.34% of the interviewees; and those who rated it as satisfactory, considered it important to prevent STDs/HIV, undesired pregnancy, sexual abuse and sexual violence, or according to them, it improved care and their enjoyment of their sexuality.

Conclusions: These results underlie the need for an active participation of government authorities and scientific societies in sex education programs aimed to all ages; and especially at parents, educators, health professionals and communicators. They are the instruments for the realization of an adequate lifelong intervention, formal or informal, comprehensive and continuous constitution of a healthy sexuality. They are also the instruments for the development of the quality of life through the exercise of human and sexual rights.

Disclosures:

Work supported by industry: no.

The impact of interferon therapy on the sexual function of hepatitis C male patients (#022)

A. Mahran (Egypt)
show abstract

022

The impact of interferon therapy on the sexual function of hepatitis C male patients

Abdel Hafez, K1; Kamel, S1; Abdel Aal, A1; Mansour, E1; Mahran, A1

1: Assuit University Hospital, Egypt

Objective: To evaluate the impact of interferon therapy on male sexual function.

Material and methods:  One hundred patients suffering from hepatitis C infection were included in the study. Fifty two (52%) patients were receiving interferon and forty eight (48%) patients were not receiving interferon. All participants underwent history taking including IIEF-5 score, general and local examination, assessment of hormonal profile and pharmacopenile duplex Doppler ultrasonography.

Results: The IIEF-5 score of the non-interferon treated group (18±6.5) was significantly higher than the interferon treated group (12±4.5) (P= 0.022). Moreover, IIEF-5 score showed significant negative correlation with the duration of interferon therapy (r=-0.366, P=0.01). Forty (76.9%) patients on interferon reported low or absent sexual desire compared to twenty two (45.8%) patients of non-interferon treated group (P= 0.001).

Total testosterone among interferon treated patients (188 ± 0.32 ng/dL) was significantly lower than non-interferon treated patients (270 ± 0.52 ng/dL) (P= 0.001). Similarly, free testosterone level among interferon treated patients (3 ± 0.22 ng/dL) was significantly lower than non-interferon treated group (7 ± 2.3 ng/dL) (P= 0.05). Furthermore, there was statistically significant negative correlation between duration of interferon therapy and serum levels of total and free testosterone (r= - 0.326, P=0.001; r= - 0.252, P=0.01 respectively).

Serum estradiol level among interferon treated patients (80 ± 3.3 pg/ml)  were significantly higher than non-interferon treated patients (58 ± 2.3 pg/ml) (P= 0.01). Moreover, serum level of estradiol was significantly correlated to the interferon therapy duration (r=0.337, P=0.002).

Serum prolactin level showed no significant difference between the interferon treated (13 ± 1.3 ng/ml) and the non-interferon treated groups  (12 ± 1.5 ng/ml) (P=: 0.59). However, the serum prolactin level was positively correlated to the interferon therapy duration (r=0.421, P=0.03).

As regards penile duplex results, thirty eight (73%) patients on interferon showed vasculogenic erectile dysfunction compared to  thirty two (66.7%) patients not receiving interferon (P=0.11). Twenty two (42.2%) patients on interferon showed veno-occlusive dysfunction which was significantly higher than non-interferon group (16.6%) (P=0.03). On the other hand, eighteen (37.5%) patients of the non-interferon group showed mixed vasculogenic erectile dysfunction which was significantly higher compared to eight (15.4%) patients on interferon therapy (P=0.05).

Conclusion: Interferon had negative impact on male sexual function. Men on interferon showed loss of desire, lower IIEF-5 score, lower total and free testosterone levels and higher estradiol level compared to those not receiving interferon. However, interferon did not affect penile hemodynamics.

Disclosures:

Work supported by industry: no.

Female sexual function and its associations in a Brazilian sample (#023)

B. Lucena (Brazil)
show abstract

023

Female sexual function and its associations in a Brazilian sample

Lucena, B1; Abdo, C2

1: Brazil; 2: University of Sao Paulo, Brazil

Objectives:  (1) assess female sexual functioning, depression, and anxiety; (2) verify the association between female sexual dysfunction (FSD), depression, and anxiety; and (3) identify the variables associated with the sexual domains: desire, arousal, orgasm, and pain during intercourse.

Material and Methods: 110 healthy women (age: 18-61, mean: 38.5 years) among those waiting for gynecological routine consultations was randomly selected for this research. The patients were asked to fill sociodemographic questionnaire, Female Sexual Quotient (FSQ), Beck Depression Inventory (BDI-II), and the Beck Anxiety Inventory (BAI).

Results: The analysis of the responses show that 36 (32.7%) women present sexual desire inhibitions; 16 (14.5%) have arousal problems; 35 (31.8%) have orgasm difficulties; 31 (28.2%) report pain during intercourse; and 39 (35.5%) exhibit overall FSD. Depression and anxiety are present in 26 (23.6%) and 37 (33.6%) patients respectively. Low sexual desire is associated to depression, anxiety, education level, body issues, masturbation, and sexual education; arousal is connected to depression, anxiety, age, education level, body issues, sex-related fears, and sexual education; orgasm difficulties is related to depression, anxiety, education level, body issues, sex-related fears, sex-related shame, masturbation, and sexual education; pain during intercourse is associated with depression, monetary income, education level, and sex education. Regression models were used to identify the most significant variables for each domain, resulting in sexual desire being inhibited by the presence of depression; excitation levels being impaired by low education levels and the increase of age; ability to achieve orgasm being hindered by low education levels, anxiety, and sex-related fears; and pain during intercourse increasing with lower education levels and depression.

Conclusion: Numerous variables influence female sexual response, depression and anxiety being especially detrimental to sexual functioning. What is more, while depression is more harmful in the early stages of sexual response (desire and arousal), anxiety is the main influence on the orgasm phase.

Disclosures:

Work supported by industry: no.

Effect of isoflavone and/or counseling on sexual function during the menopausal transition: A pilot study (#024)

H. Fleury (Brazil)
show abstract

024

Effect of isoflavone and/or counseling on sexual function during the menopausal transition: A pilot study

Fleury, H1; Abdo, C1

1: ProSex - Program of Studies in Sexuality, University of Sao Paulo Brazil

Objective: To compare the effect of isoflavone with or without counseling on sexual function.

Material and Method: In a pilot study with 24 women aged 40 to 52 years (mean 44.4 years), the participants were randomized to receive 120 mg isoflavone (Glycine maxima) daily (n=10) or 120 mg isoflavone daily plus counseling (n=14).

The counseling model consisted of 16 weekly sessions of 90 minutes each. The thematic planning of these sessions was as follows: sexual function, communication and sexual intimacy, sexual self-image, female sexuality, menopausal transition/menopause, the woman’s psychosocial role, and marital relationship. The Female Sexual Function Index (FSFI) was obtained at baseline and 16 weeks later.

This project was approved by the Internal Review Board of the University of São Paulo.  Each of the patients signed an informed consent form prior to being admitted to the study.

The groups were compared using the Kruskal-Wallis test and the chi-square test of homogeneity. Spearman’s rank correlation coefficient was calculated to evaluate whether there was any correlation among sexual function domain scores. Repeated-measures analyses of variance (ANOVA) were used to evaluate whether there was any interaction effect between variables. When statistically significant differences were found, Tukey’s multiple comparisons were performed.

Results: There were no statistically significant differences between the groups at baseline. Mean overall FSFI tended to increase with the combination of isoflavone plus counseling (p=0.036). Statistically significant differences were found in the overall sexual function score and in its domains of desire, orgasm and satisfaction (p<0.05). Desire improved in both groups (p=0.038); orgasm decreased in the isoflavone group and increased with the isoflavone plus counseling combination (p=0.039) and a similar trend was found for satisfaction (p=0.034).

Conclusions: The overall FSFI and its domains improved significantly with the combined therapy. Isoflavone alone did not significantly improve sexual function. The continuity of the study points to a counseling group for women with this profile, aiming to confirm or not the results of the combined therapy.

Disclosures:

Work supported by industry: no.


14:00 - 15:30
Instructional course 2 - Addressing sexuality in the elderly couple

Location: Transamérica Auditorium
Chairs: Juza Chen (Israel) & John Dean (United Kingdom)

Changes in sexual functioning and its association with relationship functioning in old age

Marita McCabe (Australia)

Our aging female patients and sexuality

Michael Krychman (USA)

Our aging male patients and sexuality

Prithy Ramlachan (South Africa)

Dementia and sexuality

Woet Gianotten (The Netherlands)


14:00 - 14:45
Workshop 2 - Alternative management of hypogonadism

Location: Ilhéus + Una Room
Chair: Tarek Anis (Egypt)

Tamoxifen

Emmanuele Jannini (Italy)

DHEA and others

Mario Maggi (Italy)


14:45 - 15:30
Workshop 3 - Diagnostic strategies for the ED patient

Location: Ilhéus + Una Room
Chair: Ilan Gruenwald (Israel)

Mental

Stanley Althof (USA)

Body

Natalio Cruz Navarro (Spain)


15:00 - 15:30
Humor session

Location: São Paulo Room
Chair: Edgardo Becher (Argentina)

Humor session

Ira Sharlip (USA)


15:30 - 16:00
Coffee break

Location: Comandatuba Room 1

16:00 - 17:30
Round table 2 - Sexual orientation and gender identity

Location: Comandatuba Room 2+3
Chairs: Maria Luisa Banfi (Uruguay) & Alan Shindel (USA)

Body uneasiness in gender dysphoria

Giovanni Castellini (Italy)

Sexual orientation and gender identity

Michael Krychman (USA)

New surgical approaches in gender dysphoria

Javier Belinky (Argentina)


16:00 - 17:30
Moderated posters 3 - Other aspects of sexual medicine 1

Location: São Paulo Room
Chairs: Stanley Althof (USA) & Michal Lew-Starowicz (Poland)

Effect of nerve-sparing during radical prostatectomy on recovery of urinary continence in patients with preoperative erectile dysfunction (#120)

J. Lee (Korea)
show abstract

120

Effect of nerve-sparing during radical prostatectomy on recovery of urinary continence in patients with preoperative erectile dysfunction

Park, Y1; Hong, S1; Lee, J2; Kim, S2; Hwang, T2; Kim, C3

1: Seoul St. Mary's Hospital, The Catholic University of Korea, Korea South; 2: Seoul St. Mary's Hospital, The Catholic University of Korea, Korea, South; 3: Asan Medical Center, University of Ulsan

Objectives: To assess whether nerve-sparing radical prostatectomy (nsRP) is associated with improved recovery of urinary continence compared with non-nerve-sparing procedures (nnsRP) in organ-confined prostate cancer patients with preoperative erectile dysfunction.

Materials & Methods: A total of 360 patients (International Index of Erectile Function-score <17) with organ-confined prostate cancer were treated with NSRP or NNSRP in our institution. Patients who received neoadjuvant or adjuvant androgen deprivation therapy or had a history of prostate-related surgery were excluded. Recovery of urinary continence was assessed at 0, 1, 3, 6, 12 months, respectively. Postoperative recovery of continence was defined as no pads/day. Association between nerve-sparing status and urinary continence was assessed by univariate and multivariate Cox regression analysis after controlling for known predicting factors.

Results: At a mean follow-up of 22.5 months (range 6-123), 279 patients (77.5%) recovered urinary continence. Recovery of urinary continence was reported from 74.6 and 86.4% of patients after nnsRP and nsRP at 12 months, respectively (p=0.022). All groups had comparable perioperative criteria without significant preoperative morbidities. On univariate Cox regression analysis, age>70yrs, ASA score, and nerve-sparing status were significantly associated with recovery of urinary continence. On multivariate analysis, age>70yrs (HR 1.254, 95% CI 1.002-1.478, p=0.026) and nerve-sparing status (HR 0.713, 95% CI 0.548-0.929, p=0.012) were independently associated with recovery of urinary continence.

Conclusions: Patients with preoperative erectile dysfunction have higher chances of recovering urinary continence after nsRP. Whenever oncologically and technically feasible, a nerve-sparing procedure should be attempted irrespective of preoperative erectile function.

Disclosures:

Work supported by industry: no.

show poster

Training, attitude and practice of Brazilian residents about sexuality: Preliminary results (#121)

M. Ribeiro (Brazil)
show abstract

121

Training, attitude and practice of Brazilian residents about sexuality: Preliminary results

Vieira, T1; Souza, E2; Silva, I3; Torloni, M2; Ribeiro, M2; Nakamura, M2

1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil

Objectives: To assess the training, attitude and practice of Brazilian OB-GYN residents about sexuality.

Material and Methods: Cross-sectional study conducted between March/May 2014 with 198 residents enrolled to participate in a free, 20-hours online course about sexuality for medical doctors. Before starting the course, participants were asked to answer an on-line self-responsive questionnaire to assess their previous sexology training during medical school and residency as well as their attitude and practice up to that moment. 

Results: The mean age of the participants was 27.9 ± 2.2. Most were female (87.4%), catholic (66.7%), single (78.3%) and had graduated in the last 5 years (91.4%). The participants were from 21 different residency programs, most of which were located in Sao Paulo. Almost half of the participants were in their 2nd (25.8%) or 3rd (23.7%) year of residency, while 22.7% were in their 1st year, 14.0% in their 4th and 13.1% were in their 5th or 6th year of residency. Most (63.1%) of the residents stated that they did not have any classes about sexology in medical school, while 28.3% reported having ≤ 6 hours of training on this topic. Almost half of the participants (49.0%, n= 97) stated that up to that moment, they had received no formal training about sexology during their residency while 28.8% had received up to 6 hours of training. The main motives to enroll in the online sexology course were to acquire/improve their knowledge about sexology (68.2%) and because of personal interest on the topic (30.0%). Only 5.0% of the respondents routinely asked their patients about their sexual health. Over half of the participants (51.0%) said that they did not feel competent or confident to answer their patients´ questions and 55.1% stated that because they lacked knowledge about sexuality, they would try to minimize the patient´s sexual complaints and change the topic.

Conclusions: According to our preliminary results, Brazilian OB-GYN residents enrolling in an online sexuality course have had little previous formal training on sexuality, feel insecure and avoid dealing with these questions in their clinical practice. There is a clear need for additional training in sexuality among Brazilian residents. 

Disclosures:

Work supported by industry: no.

show poster

Female sexual function of overweight women with gestational diabetes mellitus (#122)

M. Ribeiro (Brazil)
show abstract

122

Female sexual function of overweight women with gestational diabetes mellitus

Ribeiro, M1; Nakamura, M2; Scanavino, M3; Torloni, M2; Mattar, R.2

1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil

Introduction: Obesity and Gestational Diabetes Mellitus (GDM) are increasing worldwide and may alter female sexual function. We hypothesize that among GDM women in the last trimester of pregnancy, those with excess body fat would have worse female sexual function scores than normal weight women. Our aim was to assess the sexual function of overweight compared to normal weight women with GDM, in the same gestational age.

Patient and Methods: This was a cross-sectional survey involving 143 Brazilian women with GDM, in the third trimester of pregnancy: 76 were overweight (pre-pregnancy body mass index-BMI≥25.0 Kg/m) and 67 were normal weight (BMI 18.5–24.9 Kg/m). Participants were recruited from March2010 to April2013 at the antenatal clinic of a single public tertiary teaching institution. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. Women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The Chi-square and Student’s t tests were used to compare variables between the two groups. P < 0.05 was considered significant.

Results: The main characteristics of the participants were similar among normal and overweight women. Most were married, catholic, multipara, employed and had at least 9 years of formal education. The mean total FSFI score of the 143 GDM was 23.3±8.6. A total of 46 overweight women scored ≤ 26 on the FSFI compared to 28 of the normal weight women (60.5% versus 41.8%, respectively, P = 0.038). Mean desire domain scores were significantly lower in overweight compared to normal weight patients (3.4±1.2 versus 4.0±1.4, P = 0.007). The proportion of overweight women reporting problems in desire (domain score ≤5) was significantly higher than normal weight women: 48.7% versus 28.3%, respectively (P = 0.021). Overweight women also had significantly lower scores for the lubrication domain, compared to normal weight women (3.8±2.0 versus 4.5±1.6, respectively, P = 0.023)

Conclusion: According to our results, being overweight seems to affect the sexual function of women with GDM during the last trimester of pregnancy, as measured by the FSFI questionnaire.

Disclosures:

This study was funded by a grant from FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670-4 and 12/50225-6

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Female sexual function and quality of life of pregnant women – Preliminary results (#123)

M. Ribeiro (Brazil)
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123

Female sexual function and quality of life of pregnant women – Preliminary results

Ribeiro, M1; Nakamura, M2; Scanavino, M3; Torloni, M2; Forte, B.2; Mancini, P2; Mattar, R1

1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil

Objectives: Pregnancy is a risk factor for female sexual dysfunction symptoms and may also affect the woman’s quality of life. The aim of this survey was to evaluate the association between sexual function and quality of life among Brazilian pregnant women in the third trimester of pregnancy.

Patient and Methods: Cross-sectional study conducted between March 2012 and February 2014 at the antenatal clinic of a public teaching hospital, with 89 healthy pregnant women, between 28 and 40 weeks’ gestation. The Female Sexual Function Index (FSFI) was used to assess sexual function; women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The World Health Organization Quality of Life-Bref (WHOQoL-Bref) questionnaire was used to assess quality of life; the final scores ranges from 0 to 100, with higher scores indicating better quality of life. Student´s t test was used to compare mean WHOQoL-BREF scores between the women with and without sexual dysfunction symptoms. 

Results: Mean age of the 89 participants was 28.1 ± 5.6 years and mean gestational age was 34.1 ± 3.3 weeks.  A total of 56 women (62.9%) had sexual dysfunction symptoms (FSFI ≤ 26). Women in this group had significantly lower scores on the quality of life test than women without sexual dysfunction symptoms (58.8 ± 14.8 versus 66.9 + 10.7, respectively, p=0.006). The mean scores of women with sexual dysfunction symptoms were significantly lower than those of women without these symptoms, in all domains of the WHOQoL-BREF including physical health (53.4 ± 15.7 versus 60.7 ± 14.9, p=0.030), psychological health (63.8 ± 17.8 versus 71.3 ± 11.3, p=0.028), social relationships (63.5 ± 18.1 versus 72.7 ± 14.7, p=0.013) and environment (54.4 ± 17.9 versus 62.9 ± 13.1, p=0.017).

Conclusion: There is a high prevalence of sexual dysfunction symptoms in healthy Brazilian women in the third trimester of pregnancy, and these women are significantly more likely to have a worse quality of life than those without sexual dysfunction symptoms.  

Disclosures:

This study was funded by a grant from FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670-4, 12/50225-6 and 12/11787-9.

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Evaluation of a workshop course of human sexuality through a curriculum for professional competences in medical students of the UAQ (#124)

P. González Ortega (Mexico)
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124

Evaluation of a workshop course of human sexuality through a curriculum for professional competences in medical students of the UAQ

González Ortega, P1; Villaseñor Cuspinera, N1; Sánchez Fernández, L1; Ávila Morales, J1; Leo Amador, G1

1: Universidad Autonoma de Queretaro, Mexico

Objective: Evaluate the workshop course of human sexuality with a curriculum for professional competences in medical students of the UAQ.

Material and Method: Design of experimental study, by means of an educational intervention of workshop focused on human sexuality based on the theory of the Holon’s. Knowledge, skills, attitudes and satisfaction were evaluated by the workshop course through four instruments ad hoc applied before and after the educational intervention participants. With the respect to cognitive competences used a knowledge exam designed exclusively for the training workshop, evaluating the dimensions: General knowledge of sexuality, reproductivity, gender, eroticism and affection Holon´s. To assess the competency of skills, applied a check list, checking the development of the skills: correct positioning of the condom, application of the eligibility criteria for planning familiar and identification of myths of the sexuality. With regard to the attitudes, to measure these attitudes were items of the validated instrument “Attitudes to sexuality of others” of Alvarez Gayou, 2001.Also developed a satisfaction survey of the workshop on sexuality; to do so, was used the modified instrument of Gil Perez et al., 2010.

All designed instruments were validated through three rounds of the six experts from the areas of knowledge: Bioethics, Gynecology, Sexology and Educational Research. He piloted was developed in similar natural group of students from the bachelor of dentistry, with applications test and retest within eight days, calculating a Cronbach alpha ≥ 0.08.

 Information analysis was carried SPPS ver.19, using simple descriptive statistics and “t student” to measure the effect of the intervention at two times, prior to the workshop and subsequent.

Results: The findings for competences, showed significant results: knowledge= 8.562, p=.000; Skills t = -5.913, p= .000 and attitudes t=7.13, p= .000.

The satisfaction of the workshop on sexuality: satisfaction with the course (98%); satisfaction for the teachers (99%); satisfaction with competency-based methodology (98%) and satisfaction with the development of competences (97.4%).

Conclusions: Students of medicine, at some point will be counselors or sex educators, and educational intervention shows that it modified an attitude favorably to that is conducive to the respect, openness and tolerance to valid sexual practices that other develop. Finally, is important to incorporate sexuality education for physicians as a subject in their curriculum to strengthen their academic formation.

Disclosures:

Work supported by industry: no.

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A long-term follow-up study after sex reassignment surgery with metoidioplasty in female-to-male transsexuals: Chinese experience (#125)

Z. Hui (China)
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125

A long-term follow-up study after sex reassignment surgery with metoidioplasty in female-to-male transsexuals: Chinese experience

Hui, Z1

1: Shenzhen Hospital, Peking University, China

Introduction: Transsexualism is a serious gender identity disorder which should receive appropriate therapies including sex reassignment surgery (SRS) in order to make the patients’ anatomic characteristics congruent with his/her psychological identity. Since the first SRS performed in 1986 in China, thousands of transsexuals have successfully transformed their gender identity through this procedure. However, there remains a lack of long-term follow-up studies after sex reassignment, especially in female-to-male (FTM) transsexuals in China.

Objectives: To evaluate the consequences of metoidioplasty among female-to-male transsexuals and provide data on quality of life, sexual and mental health after SRS.

Material and Method: A single-center, cross-sectional study among 10 female transsexuals currently undergoing long-term hormonal therapy, 8-12 years after SRS. Among the 10 patients who had undergone metoidioplasty, most are able to urinate while standing without further penile reconstruction. Both prior to and following SRS, all patients self-reported physical, mental and sexual health using the Life Satisfaction Scales, Minnesota Multiphasic Personality Inventory(MMPI), and a newly constructed specific questionnaire.

Results: Compared with the preoperative MMPI results, the 10 FTM transsexuals scored significantly better on self-perceived physical and mental health. The majority of them reported a significant improvement in the quality of physical, mental and sexual health after SRS. Most patients were satisfied with their masculine morphology, and were pleased with the ability to urinate while standing after metoidioplasty. For FTM patients, this ability is perceived as a highly essential male characteristic, and was achieved without penile reconstruction, which has higher rates of complication. Therefore, the results suggest Metoidioplasty is a recommendable alternative phalloplasty for female transsexuals.

Conclusion: Results of the follow-up study indicate FTM transsexuals generally have a good quality of life and experience satisfactory sexual and mental health after SRS. Metoidioplasty is an appropriate choice in certain female transsexuals.

Disclosures:

Work supported by industry: no.

Quality of life and sexual health in men with prostate cancer undergoing radical prostatectomy (#126)

A. Naccarato (Brazil)
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126

Quality of life and sexual health in men with prostate cancer undergoing radical prostatectomy

Naccarato, A1; Souto, S1; Ferreira, U1; Denardi, F1

1: UNICAMP, Brazil

Objective: To evaluate the relationship between quality of life(Qol), erectile function and the use of group psychoterapy in pacientes with prostate cancer(PCa) undergoing radical prostatectomy(RP).

Material and Methods: Sixty patients undergoing RP between 2002 and 2007, 30 of those had group psychoterapy two weeks before and 12 weeks after surgery. They were evaluated in 2012 for erectile function (IIEF), Qol (SF-36 short form); and ICQI-SF and ICQI-OAB for urinary incontinence.

Results: Among the 60 patients 65% accepted the disease and 20% reported concern. The 30 patients who underwent group psychoterapy had better scores in IIEF-5, in satisfaction with life in general, satisfaction with sexual life, satisfaction in the partner relationship; and better results of SF-36, excepting two domains: bodily pain and role emotional. There were significant correlations between IIEF-5 and perception of disconfort (p=0.030), Physical functioning (p= 0.021), Physical Component (p= 0.005) and Role Emotional (p= 0.009) in patients undergoing group psychoterapy. In patients who did not undergo group psychoterapy there were significant correlations between ICQI-OAB and perception of disconfort (p= 0.025),  Social functioning (p=0.052) and Role Emotional (p=0.034); between ICQI-SF and perception of disconfort (p=0.0001).

Conclusion: Group psychoterapy has a positive impact on the Qol of patients and the erectile function. Further studies are necessary to identify the impact  of self-perception and self-knowledge in the postoperative manegement of RP.

Disclosures:

Work supported by industry: no.

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Clinical study on the treatment of lifelong premature ejaculation with paroxetine hydrochloride and tamsulosion (#127)

Y. Li (China)
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127

Clinical study on the treatment of lifelong premature ejaculation with paroxetine hydrochloride and tamsulosion

Li, Y1

1: Daping Hospital, Third Military Medical University, China

Background and objective: To evaluated the efficacy and safety of paroxetine and hydrochloric tamsulosin for the treatment of PE together and alone, and assessed the serum concentration of 5-HT in the PE diagnosis and judgement of treatment efficacy.

Methods: 225 cases of men with lifelong PE were included in this study. The patients were randomized divided into three groups. Group A were given paroxetine hydrochloride 20 mg/d for 8 weeks; Group B were given tamsulosion 0.2 mg/d for 8 weeks; Group C were given paroxetine hydrochloride and tamsulosion at the same dosage as above for 8 weeks. The effects and adverse events were evaluated by the overall change and folds increase in average IELT and the mean change in all four measures of the premature ejaculation profile (PEP). Blood sample was got from the candidates before and after treatment. The plasma concentration of 5-HT was measured by ELISA.

Results: The reliable data from 198 patients were achieved. The mean IELT after treatment were significantly improved in all groups .group C was increased for 8.15 min after treatment. The increased folds of mean IELT in group C (8.02 folds) was significantly higher than that in group B(1.98 folds)and group A(6.92 folds)P<0. 001).The mean PEP scores were significantly improved in all groups after treatment.  Group C have more significant improvements than that in group A and B. The mean plasma concentration of 5 - HT in group A,B,C before treatment was significant lower than that in normal control group(P<0.001). The mean plasma concentration of 5 - HT in group A and C was significant improved (P<0.001) and there is no significant difference between group A and C after treatment (P>0.05). The plasma concentration of 5 - HT in group B did not change after treatment (P>0.05).

Conclusions: Paroxetine hydrochloride combined with tamsulosion produce more better therapeutic effects and could be a priority selection for the treatment of primary PE. The plasma concentration of 5 - HT can be used as the objective diagnostic index of primary PE, and to some extent, it is meanful for the assessment of treatment effect of SSRIs.

Disclosures:

Work supported by industry: no.

Response profiles to men undergoing blinded spermatic cord blocks for chronic orchalgia (#128)

John Mulhall (USA)
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128

Response profiles to men undergoing blinded spermatic cord blocks for chronic orchalgia

Deveci, S1; Heck, M2; Tal, R3; Mulhall, J3

1: Medical School of Acibadem University, Turkey, Memorial Sloan Kettering Cancer Center, New York; 2: Memorial Sloan Kettering Cancer Center, New York; 3: Memorial Sloan Kettering Cancer Center New York

Objective: Chronic orchalgia is a crippling disorder for some men. Spermatic cord denervation (SCD) surgery is effective in carefully selected patients. It is recognized that some men with this condition do not have scrotal pathology and have a large psychological overlay. It is our practice to conduct blinded sperm cord blocks (SCB) to define the etiology of the condition and the potential for success with SCD surgery.

Materials: The study population included men who (i) had unilateral orchalgia of ≥6 months (ii) had no scrotal content structural abnormalities on examination or scrotal ultrasound (iii) had no varicocele and (iv) had pain confined solely to the scrotum. Demographic, comorbidity data and physical characteristics were recorded. Two SCB were administered within 1 month of each other. One was local anesthetic (LA, 0.5% bupivacaine) and the other normal saline (NS, 10mls each). The patient was blinded as to which agent was being administered. Pain was graded on a 0-10 point pain scale. Duration of relief after SCB was measured in minutes.

Results: 32 men with mean age = 42±21 years were analyzed. Mean duration of pain = 14±64 (6-120) months. 6 men were post-vasectomy, 4 had a history of chronic epididymitis, 4 had scrotal trauma preceding pain onset and 18 had not risk factor identified. Mean baseline pain = 6±3 (3-10); after LA 2.5±3.5 (0-8); after NS 4±5 (2-9) (p<0.01). In response to LA, 94% had at least a 4 point decrease in pain (mean duration 2.5 hours), but 2/32 (6%) had no significant pain reduction. In response to NS, 88% had no significant pain reduction, but 4/32 (12%) had >4 point reduction in pain (duration of relief 1-48 hours). Of the latter 4 patients, three also had a significant response to LA. All vasectomy and chronic epididymitis patients had a positive response to LA and a negative response to NS. All patients with a negative response to LA and positive response to NS belonged to the group with no identifiable risk factors for orchalgia.

Conclusions: While SCB with local anesthetic is valuable, the addition of patient blinding using saline injections may select out those patient with a psychological overlay to their orchalgia. This maneuver may, in turn, aid in the selection of those patients most likely to respond to SCD surgery. 

Disclosures:

Work supported by industry: no.

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Characterization of patients with gender dysphoria followed at a tertiary hospital: A reflection on their experiences (#129)

M. Lerri (Brazil)
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129

Characterization of patients with gender dysphoria followed at a tertiary hospital: A reflection on their experiences

Lerri, M1; Romão , A1; Nadai, M1; Santos, M2; Rosa-e-Silva, A1; Reis, R1; Lara, L1

1: Faculdade de Medicina de Ribeirão - Universidade de São Paulo (FMRP-USP), Brazil; 2: Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - Universidade de São Paulo (FFCLRP-USP)

Objective: To present the social, emotional and affective aspects of patients with gender dysphoria, assisted in the clinic for Study of Human Sexuality (AESH)-Faculty of Medicine of Ribeirão Preto-University of São Paulo.

Methods: We used a semi-structured questionnaire to access socio-demographic and emotional aspects. The risk for anxiety and depression was accessed by using the Hospital Anxiety and Depression Scale (HAD).

Results: Forty transsexual with a mean age of 27(18-59) years participated in this study. Of these, 33(82.5%) are male to female (MtF) and 7(17.5%) are female to male (FtM). Twenty-six (6%) are white, and 14(35%) are black. As for origin, 39(97.5%) are from the of São Paulo state, and 1(2.5%) from Minas Gerais state. Thirty-four (85%) had middle school and 6(15%), higher education. Thirty-four (85%) are receiving US$324.74 to 1,620,00/monthly and 6(15%) are unemployed. The use of alcohol, cocaine, marijuana and cigarette is reported by 22(55%) patients. Thirty-six (90%), reported self-medication with hormones. The main reason for searching for AESH was to initiate hormone therapy. The first sexual intercourse occurred between 8 and 15 years for 25(62%) patients. Regarding the affective life of the 23(58%) patients who reported having a partner, 6(26%) are trans-men and 17(74%) are trans-women. Thirty-five (88%) patients reported feeling socially discriminated, 24(68%) felt discrimination at work, 10(28%) at family, and 7(20%) reported discrimination in healthcare units. The prevalence of suicide attempts is high in this sample. Twenty-nine (73%) reported one or more attempts. The motivating factors for suicide attempts were verbalized by patients as: discrimination in 23(48%), non-acceptance of family in 13(28%) and non-acceptance of their body in 12(26%). The attempts occured at age of 10 to 25 years in 24(60%) and at 26 to 31 years old in 5(13%). Thirty-eight (95%) of patients were at risk for depression. Regarding the average, 30(75%) patients were at risk for anxiety.

Conclusion: transgender people live in poor social and emotional conditions and are exposed to social and familial prejudices, as well as prejudices at work, that may impair their quality of life. This may explain the high prevalence of suicide attempts in this population. Expand knowledge to identify variables related to poor quality of life in this population is crucial to outline specific medical and psychological interventions. Also, effective public policies are required to promote health and well-being for transsexuals.

Disclosures:

Work supported by industry: no.

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Barebacking behavior and personality among sexually compulsive individuals seeking treatment in São Paulo, Brazil (#130)

M. Amaral (Brazil)
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130

Barebacking behavior and personality among sexually compulsive individuals seeking treatment in São Paulo, Brazil

Amaral, M1; Scanavino, M1

1: Department and Institute of Psychiatry. Clínicas’ Hospital. School of Medicine. University of São Paulo (FMUSP), Brazil

Objectives: Investigate the association between barebacking behavior - intentional unprotected anal intercourse among men who have sex with men (MSM), and personality traits in 69 individuals in Sao Paulo, Brazil who sought treatment and met the criteria for compulsive sexual behavior.

Material and Methods: Participants underwent psychiatric evaluation, interview for defining the intentional condomless sex, and completed self-report instruments, including the Temperament and Character Inventory of Cloninger and Sexual Compulsivity Scale (SCS) of Kalichman and Rompa.

Results: Twenty-five (36%) reported intentional anal intercourse with casual partners, of whom 84% were gay and 16% bisexual (p = 0.03). The mean of sexual compulsivity showed associated with men who engage in barebacking (p = 0.01). Men who reported barebacking scored significantly higher on temperament dimension novelty seeking (p = 0.003) and scored significantly lower on character dimension self-directedness (p < 0.001). The variables self-directedness remained significantly associated with the outcome variable barebacking behavior in the multiple logistic regression analysis (p = 0.001).

Conclusions: Sexually compulsive individuals who engage in barebacking presented lower self-directedness than the group who not engage in barebacking, which means less autonomy regarding life itself. To the best of our knowledge, it is a first finding considering barebacking behavior in sexually compulsive men.

Disclosures:

Work supported by industry: no.

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Patient reported outcomes after metoidioplasty (#131)

F.E. Kuehhas (Austria)
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131

Patient reported outcomes after metoidioplasty

Kuehhas, FE1; De Luca, F2; Spilotros, M 2; Richardson, S2; Garaffa, G2; Ralph, D2; Christopher, N2

1: Medical University of Vienna, Austria; 2: St. Peter's Andrology Centre and Institute of Urology, University College London, London, United Kingdom

Objective: To analyze patient reported outcomes after metoidioplasty in female-to-male gender reassignment surgery. Metoidioplasty is requested by patients because it is perceived to preserve sexual sensation, allow them to void standing and have minimal scarring with the appearance of a small but cosmetically acceptable penis.

Material and Methods: All patients who underwent metoidioplasty, between 1999 and 2014, were retrospectively analyzed and patient reported outcomes were evaluated through a non-validated questionnaire, which was designed in cooperation with trans-gender patients.

Results: 48 patients were identified of which 3 were lost to follow-up and 1 underwent gender reversal to female. The response rate to the questionnaire was (21/48) 44% of which 17/48 (35%) still had just a metoidioplasty. Mean age at the time of surgery was 37.8 years. Mean follow-up was 49.3 months. The complication rate was 59% (55% urethral fistulae or strictures, 25% infected testicular prosthesis, 20% other). Most patients (29/48, 60%) were content with the metoidioplasty but 12 (25%) went on to have a full size phalloplasty with a further 3 (6%) requesting a phalloplasty. Of the phalloplasties, 5 were radial forearm flap, 6 were abdominal flap and 1 was a Gillies phalloplasty. The mean length of the metoidioplasty was 3.8cm (range 2-5cm). Looking at just the 17 metoidioplasty patients, sexual function was very good with patients being satisfied or partially satisfied with erection quality (94%), masturbation (100%) and orgasm (100%). Desire for sexual intercourse was high (88%) but ability to penetrate was low (24%). Voiding function was much poorer in contrast, with patients being satisfied or partially satisfied with ability to void standing (47%), confidence using a public urinal (12%) and satisfaction voiding standing (71%). Spraying of urine was a feature in 59%. Cosmesis was moderate with patients being satisfied or partially satisfied with cosmetic appearance (77%) and penis length (71%). 94% were happy with the pre-operative information given but only 82% would recommend this operation to a friend and only 71% would do the operation again given current knowledge.

Conclusion: Metoidioplasty results in good patient reported outcomes with respect to sexual function and cosmesis but much poorer voiding outcomes than perceived.  Comprehensive preoperative information on the procedure and expected result is critical to patient satisfaction.

Disclosures:

Work supported by industry: no.

Profile of women with anorgasmia: a restrospective analysis (#132)

M. Lordello (Brazil)
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132

Profile of women with anorgasmia: a restrospective analysis

Lordello, M1; Ambrogini, C1; Fanganiello, AL1; Araújo, T1; Zaneti, M1; Veloso, L1; Piccirillo, L1; Crude, B1; Silva, I1

1: Unifesp, Brazil

Aim: Describe the profile of women who sought for outpatient treatment, complaining about anorgasmia, from June 2012 to June 2014.

Material and methods: The sample included 32 women, aged between 22 and 62 years old, sexually active, who performed medical, psychological and physiotherapy assessment at Aphrodite Project.  Were assessed the following aspects at their medical record: age, scholarity, relationship status, religion, psychiatric history, sexual violence, sexual response cycle and masturbation.

Results: Most of women with anorgasmia have between 20 and 30 years (34,5%), with a reduction of this percentage over the years. From 31 to 40 years (28,1%), from 41 to 50 years (25%), from 51 to 60 years (9,3%) and over 61 years (3,1%).  They have primary anorgasmia (59,4%) most of all, situational (28,1%) and secondary (12,5%). The majority of them have at least, complete high school (81,2%) and are married or in a consensual marriage (43,9%), followed by those who date (34,3%). The catholic religion is the most present among these women (43,9%). Most of  them don't have psychiatric disorders (47%), followed by those who had at least one depressive episode (28,1%).  Regarding to sexual violence, 75% mentioned never having gone through such experience.  Regarding to sexual response cycle, 46,8% present desire always or occasionally; sexual arousal always 56,3% and occasionally 31,2%.  Most of women don't practice masturbation or rarely practices it (56,3%) and 25% often practice, although don't achieve orgasm with the partner.

Conclusions: According with this profile, we can conclude that age is a significant parameter in anorgasmia, because the dysfunction decreases with increasing age, it shows the importance of experience and learning in capacity of achieve orgasm.  Psychiatric disorders and sexual violence are not among the main factors that predispose women to anorgasmia.  These women present, most of time, a sexual response cycle preserved, with normal desire and arousal, lacking only orgasm.  Finally, the absence of masturbation is directly linked to the inability to achieve orgasm.

Disclosures:

Work supported by industry: no.

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Sexual function of Brazilian female adolescents and young adults managed in a family planning clinic (#133)

M. Negri (Brazil)
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133

Sexual function of Brazilian female adolescents and young adults managed in a family planning clinic

Negri, M1; Ribeiro, M1; Nohara, I1; Moraes, P1; Torloni, M1; de Souza, E1; Guazzelli, C1

1: Universidade Federal de São Paulo, Brazil

Objectives: The sexual function of female adolescents and young adults is still under investigation. Our aim was to assess the sexual function of Brazilian female adolescents compared to young adults.

Patient and Methods: This cross-sectional study involved 199 sexually active Brazilian females: 128 adolescents (13-19 years) and 71 young adults (20-25 years). Participants were recruited from September 2012 to September 2013 at a public university family planning clinic. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. Women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The Chi-square and Student’s t tests were used to compare variables between the two groups. P < 0.05 was considered significant.

Results: Most participants were single, catholic and had between 8 and 12 years of formal education. The mean age of the girls was 17.4 ± 1.5 vs 22.1 ± 1.8 years (P<0.0001), for adolescents and young adults, respectively. Mean age at first sexual intercourse was 14.8±2.0 vs 16.3 ± 2.2 years (P<0.0001) for adolescents and young adults, respectively. Most of them reported having had intercourse with 2 or more partners (46% adolescents versus 71.8% young adults, P=0.001). The mean total FSFI scores of the 199 participants was 26.5 ± 5.9 and 39.7% of them were at risk for sexual dysfunction symptoms. A total of 49 adolescents scored ≤ 26 on the FSFI compared to 30 young adults (38.3% versus 42.3%, respectively, P=0.651). Young adults had significantly lower mean total scores, compared to adolescents female (23.6 ± 6.2 versus 26.6 ± 5.7, P=0.001). The young adults group also had significantly lower scores for the sexual satisfaction domain, compared to the adolescents group (4.6 ± 1.5 versus 5.1 ± 1.1, P =0.008, respectively).

Conclusion: There is a high prevalence of sexual dysfunction symptoms among Brazilian female adolescents and young adults and they are significantly more likely to be at risk for sexual dysfunction than the female adolescents. However, adolescents have significantly higher overall and sexual satisfaction domain FSFI scores than young adults.

Disclosures:

Work supported by industry: no.

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16:00 - 17:30
Instructional course 3 - Technical pearls of PP surgery

Location: Transamérica Auditorium
Chairs: Celso Gromatzky (Brazil) & Steven Wilson (USA)

The 6 essential steps assuring trainees can safely perform a penile implant

Gerald Brock (Canada)

Managements of infectious and non-infectious complications of penile implants

Rafael Carrion (USA)

The three "P's" of advanced penile implant usage: Peyonie's, phalloplasty, and priapism

Giulio Garaffa (United Kingdom)


16:00 - 16:45
Workshop 4 - Management of sexual function in patients with cancer

Location: Ilhéus + Una Room
Chair: Andrea Salonia (Italy)

Female cancer and sexual function

Luca Incrocci (The Netherlands)

Rehabilitation of sexual function after radical prostatectomy - What is the optimal clinical management?

Jens Sonksen (Denmark)


16:45 - 17:30
Workshop 5 - A structured sexual interview

Location: Ilhéus + Una Room
Chair: Eusebio Rubio-Aurioles (Mexico)

Challenges in the sexual health interview

Sharon Parish (USA)

The Sexual Status and the Sexual Tipping Point Model®

Eusebio Rubio-Aurioles (Mexico)


Friday

Morning

08:30 - 09:00
Master lecture 4 - Is there an increased CV risk in patients on TRT?

Location: Comandatuba Room 2+3
Chairs: John Dean (United Kingdom) & Luiz Otavio Torres (Brazil)

Is there an increased CV risk in patients on TRT

Mario Maggi (Italy)


09:00 - 09:30
Master lecture 5 - Sexual issues in SCI women

Location: Comandatuba Room 2+3
Chairs: Kwangsung Park (Korea) & Lucia Pesca (Brazil)

Sexual issues in SCI women

Michal Lew-Starowicz (Poland)


09:30 - 10:00
Master lecture 6 - Nitric oxide in the penis: Scientific discoveries and clinical applications

Location: Comandatuba Room 2+3
Chairs: Ganesan Adaikan (Singapore) & Juza Chen (Israel)

Nitric oxide in the penis: Scientific discoveries and clinical applications

Arthur Burnett (USA)


10:00 - 10:30
Coffee break

Location: Comandatuba Room 1

10:30 - 11:00
Point counterpoint 3 - 90 degree penile curvature: Patch or corporoplasty?

Location: Comandatuba Room 2+3
Chairs: Guillermo Gueglio (Argentina) & Sudhakar Krishnamurti (India)

Patch

Arthur Burnett (USA)

Corporoplasty

Wayne Hellstrom (USA)


10:30 - 11:30
Moderated posters 4 - Psychotherapy

Location: São Paulo Room
Chairs: Chris Nelson (USA) & Sharon Parish (USA)

Military sexual trauma in male military personnel (#134)

S. Wilcox (USA)
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134

Military sexual trauma in male military personnel

Wilcox, S1; Schuyler, A1; Campbell, S1; Redmond, S1

1: University of Southern California, United States

Objective: To assess the rate of military sexual trauma (MST) in a nation-wide sample of male military personnel and evaluate the impact of MST on psychosocial functioning and quality of life (QOL). Research on sexual trauma and victimization has historically focused on women, who have been more likely to report such experiences. While rates of sexual trauma and victimization are lower in men, it still exists and the subsequent impact on psychological and physical functioning can be severe. Military personnel often under report psychological problems and the sensitive nature of MST in men is predicted to further reduce reported rates in military personnel, in addition to the complexities of assessing MST. Further, men with MST are more likely to report comorbid mental health diagnoses and are nearly three times more likely to report PTSD than men without MST.

Material and Methods: This exploratory study used data from a larger study on sexual functioning problems in military populations age 40 and younger. This sample consisted of 367 male military personnel aged 18-40 years. Process modeling was performed to examine the psychosocial processes by which MST can influence QOL. We predicted that MST would be associated with reduced mental health outcomes, which would be associated with lower QOL.

Results: Results show high rates of MST in male military personnel and indicate the negative association MST can have on mental health outcomes and QOL.

Conclusions: This study underscores the importance of assessing MST in men (in addition to women). While men are less likely to report MST, there may be many unreported cases that are significantly impacting psychosocial functioning and QOL. Strategies aimed at reducing MST in both men and women can significantly improve the readiness of military populations.

Disclosures:

Work supported by industry: yes, by California Community Foundation - Iraq Afghanistan Deployment Impact Fund (industry funding only - investigator initiated and executed study).

Sexuality and depression among pregnant women with recurrent spontaneous abortion (#135)

M. Francisco (Brazil)
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135

Sexuality and depression among pregnant women with recurrent spontaneous abortion

Francisco, M1; Mattar, R1; Nakamura, M1

1: UNIFESP, Brazil

Objective: To analyze, among pregnant women with a history of recurrent spontaneous abortion (RSA), symptoms of depression, sexual behavior, emotional support from the partners and the interrelationships between these factors.

Methods: This was a prospective case-control study, being the first group of RSA and the second by primigravidae. It has been used the Beck Depression Inventory (BDI), the Female Sexual Function Index (FSFI) and two more questionnaires, one about emotional aspects resulting from sexual intercourse during pregnancy and another about the emotional and social support offered by the partner. To compare quantitative variables with normal distribution, it has been used the Student t test, and categorical variables were compared using the chi-square test or Fisher's exact test. The statistical significance was set at p <0.05.

Results: The BDI showed approximately twice the incidence of depression in the group RSA. Regarding sexual function, the average scores of the FSFI were lower for the group RSA, and only under the desire (average 3.4 ± 1.3 for the RSA group and 3.7 ± 1.1) was not statistically significant (p = 0.003). We have realized that, regardless of the pregnant woman having or not having RSA history, the higher the depression score, the lower the sexuality score.

Conclusions: RSA pregnant group often experience depression twice and more impaired sexual function. There is an inverse association between depression and sexual function / emotional support from the partner and direct association between emotional support and sexual function.

Disclosures:

Work supported by industry: no.

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Comparison of traditional female sexual function Index score versus adapted score for postmenopausal Latin-American women (#136)

G. Silva (Brazil)
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136

Comparison of traditional female sexual function Index score versus adapted score for postmenopausal Latin-American women

Silva , G1; Lima, S1; Reis, BF2; Bernardo, B2; Macruz, C2

1: Santa Casa de São Paulo Medical School, Brazil; 2: São Paulo Medical School, Brazil

Introduction: When using the FSFI, the currently acceptable cutoff value for diagnosing Sexual Dysfunction (SD) in women between 18 and 74 years of age is ≤ 26.5. Nevertheless, this index can yield SD rates varying from 22 to 50% in fertile women, which would then lead to the inappropriate conclusion that the majority of fertile and healthy women in their fourth decade of life have SD. For this reason, there has been some debate about considering the ideal total score as ≤ 23. In fact, in a study with pre-menopausal women of Latin origin not using oral contraceptives, an FSFI score ≤ 23 was considered as the cutoff value for diagnosing them as having SD. Therefore, considering studies and the fact that we have also been evaluating a post-menopausal female cohort of Latin origin, we used as a cutoff value FSFI ≤ 23 and we also calculated the SD rates in our study considering the traditional cutoff value of FSFI ≤ 26.5.

Objective: To compare the traditional Female Sexual Function Index versus adapted score for postmenopausal Latin-American women.

Methods: This is a case-control study. The group consisted of post-menopausal women that usually seek treatment at the Endocrine Gynecology Clinic at the Santa Casa de São Paulo Medical School at and at the Basic Health Units (Vila Barbosa, Vila Dionísia and Vila Santa Maria) participating in the Family Health Program promoted by the local municipal health authorities in São Paulo, in the period between February 2011 and February 2013. The study was conducted in accordance with the Declaration of Helsinki. All patients signed a voluntary informed consent form that was approved by the Medical Ethics Committees at the Faculty of Medical Sciences at Santa Casa de São Paulo .The women considered as being post-menopausal were those with amenorrhea ≥ 1 year and FSH ≥30mUI/mL. The MetS diagnosis was determined by the ATP III. The sexual function was performed by using the FSFI. These are indicative of  SD risk when their values are less than or equal to 26.5 points – in post-menopausal women, the cutoff value FSFI <23 was also considered. We used the cutoff value ≤23, and we also calculated the SD rates while considering a cutoff value of FSFI ≤26.5.

Results: When we used a cutoff value of FSFI < 23 for determining the presence of SD, we observed that 18.4% of the patients in the Control Group and 57.4% in the MetS Group showed that disorder. When we used a cutoff value of 26.5, 48.2% of the patients in the Control Group and 83.3% in the MetS Group were diagnosed with SD. The prevalence of SD was greater in the MetS Group than in the Control Group, either when using cutoff values of 23 or 26.5(57.4% versus 18.4%; FSFI <23: 83.3% versus 48.2%).

Conclusion: As proposed in previous studies, we believe that a less rigorous cutoff value is more appropriate for the Brazilian population, considering that the percentage of the population affected by SD is very high and incompatible with what we observed during the interviews. An important hypothesis would be the existence of socio-cultural and religious variables, which are difficult to measure statistically. New studies are needed in order to demonstrate the reason why the total FSFI score obtained from our sample was lower than expected, similarly to what was observed in the studies mentioned in the literature. Althought the FSFI is the most widely used scale to assess SD in women, adaptation to other cultures is necessary.

Disclosures:

Work supported by industry: no.

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Sexual function in schizophrenia (#137)

D. Lin (USA)
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137

Sexual function in schizophrenia

Lin, D1; Snyder, C; Concepcion, E; Colon-Vilar, G

1: Mount Sinai Beth Israel, United States

Objective: This study surveys patients with schizophrenia or schizoaffective disorder, to understand the relationship between sexual function and treatment with antipsychotic medication. The study compares patients on single versus multiple antipsychotics as well differences between first and second generation agents.

Material and Method: Patients diagnosed with schizophrenia or schizoaffective disorder at Beth Israel Medical Center are eligible. Once patients are evaluated to ensure they meet enrollment criteria and are consented, they are administered the Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and either the International Index of Erectile Function for men, or the Female Sexual Function Index for women. Inclusion criteria include age 18-65, able to participate in a structured interview, fulfill DSM-IV criteria for Schizophrenia or Schizoaffective disorder, and on stable doses of one or more antipsychotic medications for at least six weeks. Exclusion Criteria include patients taking Selective Serotonin Reuptake Inhibitors (SSRIs), and inability to provide informed consent.

Results: Presently, data suggests sexual function is impaired secondary to antipsychotic use. Further extrapolation of data is pending further enrollment.

Conclusions: Preliminary results point to better sexual function with certain second generation antipsychotics. It also appears that patients on single antipsychotic may have better sexual function than patients on multiple agents.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Attachment styles, sexual concerns and their relation to sexual behavior (#138)

K. Brenk-Franz (Germany)
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138

Attachment styles, sexual concerns and their relation to sexual behavior

Brenk-Franz, K1; Strauß, B2

1: Institute of General Practice & Family Medicine, University Hospital Jena, Germany; 2: Department of Psychosocial Medicine and Psychotherapy, University Hostpital Jena, Germany

Background: Attachment Theory provides a useful view on human sexuality. It affords the reflection of different facets of human sexuality from a developmental perspective and offers approaches of explanation for interindividual differences in sexual concerns and behavior.

Purpose: The purpose of the study was the question, whether different styles of attachment are associated with interindividual differences in sexual concerns and behavior.

Methods: The relations between adult attachment and sexuality were examined in a sample from Germany. Participants completed self-report scales of Attitudes Related to Sexual Concerns Scale (ASC-Scale, Cowden & Koch 1995; German: FSB; Brenk-Franz, Strauß, 2014), Multidimensional Sexuality Questionnaire (MSQ, Snell, Fisher & Walters, 1993; German: MFS; Brenk-Franz & Strauß, 2014) and Questionnaire on Sexual History and Sexual Behavior (FSGSV; Brenk-Franz & Strauß, 2014). The Attachment styles were measured by the Bielefeld Partnership Expectations Questionnaire (BFPE, Höger & Buschkämper, 2002).

Results: 261 women and men at the age of 16 to 68 were included in a German cross-sectional study. There were significant differences in kind of sexual concerns in dependence of the attachment styles. Adults with insecure attachment reported higher sexual concerns with body image, commitment, sexual communication, performance and sexual self-understanding than persons with secure attachment. Adults with secure attachment reported a higher trust in close relationships, a higher sexual-esteem and internal-sexual control, a minor preference for one-night-stands or extra-relationship sexuality. In contrast, adults with an insecure dismissing attachment reported the earliest sexual maturity and the earliest time in sexual intercourse. Adults dismissing attachment preferred more one-night-stands and sexual activities in extradyatic relationships, but reported a minor sexual satisfaction Ambivalent attachment was associated with more aversive sexual feelings and cognitions.

Discussion: These findings support the strong association between attachment and sexuality. The sexual relationships of ambivalent attached individuals tend to be organized around the hyperactivation of their attachment system, which causes them to be chronically dependent on others. They use sex to reduce insecurity and establish intense closeness, while also having feelings of external-sexual control. On the other hand, in line with their goal of deactivating attachment concerns, dismissing individuals find close sexual relationships uncomfortable. Based on their general discomfort with intimacy and a desire to avoid closeness they prefer sexual relationships without commitment and have the tendency to focus on their own sexual needs.

Disclosures:

Work supported by industry: no.

The binomial sexuality and childbirth: Mutual repercussions (#139)

M. Madi (Brazil)
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139

The binomial sexuality and childbirth: Mutual repercussions

Madi, M1; Nakamura, M2; Vieira, T2

1: Universidade Federal de São Paulo, Brazil; 2: Universidade Federal de São Paulo

Objective: Assess sexual function of pregnant women during the first prenatal consultation and correlate with their opinion about impacts of vaginal birth (with or without episiotomy) or cesarean on sexuality.

Method: Cross-sectional study with low-risk pregnant women conducted by Universidade Federal de São Paulo/UNIFESP, during their first prenatal consultation. Data collection included 30 pregnant women in the 2nd or 3th trimester, over 18 years old, and in a relationship with the same partner for at least 6 months. Pregnant women with clinical/obstetrical complications that contraindicated sexual activity were excluded. The questionnaire applied contained 35 questions, including socioeconomic profile, opinion on the possible pelvic floor and sexuality modifications due to childbirth, and the Sexual Coefficient female version (QS-F) - a validated instrument to evaluate sexual satisfaction. Pregnant women were divided into 3 groups (G1/G2/G3) according to QS-F and the results were compared (G1: excellent; G2: good; G3: null to regular sexual satisfaction). To compare means and the homogeneity of the proportions the non-parametric test of Kruskal-Wallis and Fisher's extract test were used respectively. The significance level used for the tests was 5%.

Results: Average age was about 29.3 (± 5.1), they had 2.1 (± 1.2) pregnancies (considering the current) and 1.2 (± 1.4) previous births. In G1, 75% had at least 11 years of education, higher than the G2 and G3 (p=0, 003). Unlike G2 and G3, where the partner takes more initiative to sex, in G1 58,6% of the initiative comes from both in the same proportion (p=0, 041). 56.7% had never talked about sex with any health professional. The next results had no statistical difference between the groups: only 10% considered that vaginal birth with episiotomy could interfere with sex after the postpartum period, 3.3% would request cesarean to avoid vaginal changes. Grading assignments considering a 0 to 10 scale: fear of labor pain was 5.7 (± 3.4); concern about parturition and newborn vitality: 5.6 (± 3.8); fears of episiotomy: 3.3 (± 3.3) and fear of vaginal structural changes: 3.1 (±3.6).

Conclusions: Results underscore a maternal concern centered on childbirth and newborn vitality. The fact that 56,7% had never talked about sex with health professional, even those with more schooling and better sexual satisfaction, makes the prenatal consultations an even more important and essential moment, not just to inform and clarify pregnancy changes and childbirth itself but also for the obstetricians to expose the topic of sexuality.

Disclosures:

Work supported by industry: no.

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Preliminary data on the efficacy of psychoeducational intervention on sexual health and sexual difficulties in individuals with psychotic or mood disorder (#140)

M. Scanavino (Brazil)
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140

Preliminary data on the efficacy of psychoeducational intervention on sexual health and sexual difficulties in individuals with psychotic or mood disorder

Vieira, J1; Silva, G1; Carmo, I1; Neto, M1; Amaral, M1; Sant, R1; Scanavino, M1

1: Hospital das Clinicas - FMUSP, Brazil

Objectives: To assess the effectiveness of psychoeducational intervention on sexual health and sexual difficulties in individuals with psychotic or mood disorders in an experimental model of day hospital.

Methods: This interventional study in an experimental model of day hospital, comprising three group approaches (sexual psychoeducational, neurocognitive rehabilitation, fitness) with minimal crossed effect between them, twice a week, unchanged drug regimens and without exposure to other interventions, along 10 weeks. In this work, we analyzed data on sexual health. The first nine patients diagnosed with psychotic or mood disorder according to the Structured Clinical Interview for DSM-IV (SCID-CV), formed the first group who underwent assessments before and after the intervention, with the measure Knowledge about Human Sexuality and Sexual Health and the measure Arizona Sexual Experience. The sexual psychoeducational approach consisted of 10 sessions of 60 minutes weekly, on sexual health.

Results: Seven men and two women, whose the mean age was 39.6 (SD = 11.0) years and 14.9 years of education (SD = 5.0), whose two completed the high school and seven started the college but did not finish. There were seven singles and two divorced. Six met criteria for schizophrenia and three for mood disorder. Regarding knowledge about sexuality, there was no difference (p> 0.05) when comparing the mean score at time 2 vs. time 1 in total sample, nor in the group diagnosed with schizophrenia and the group diagnosed with mood disorder. For symptoms of sexual dysfunction, the comparison of mean scores at time 2 vs. time 1 showed no difference in the total sample, but showed a trend towards difference (p = 0.06) among those diagnosed with mood disorder (M = 21.7, SD = 2.1 vs. M = 25.0,. SD = 3,6).

Conclusions: The intervention was not effective for changing the sexual knowledge, which can be explained by the difficulty in acquiring new information by individuals with schizophrenia. The improvement in sexual difficulties after the psychoeducational intervention is consistent with previous studies.

Disclosures:

Work supported by industry: no.

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Fears and myths during pregnancy and their impact on sexual activity: a systematic review of the literature (#141)

M. Ribeiro (Brazil)
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141

Fears and myths during pregnancy and their impact on sexual activity: a systematic review of the literature

Ribeiro, M1; Mattar, R2; Nakamura, M3; Torloni, M2; Scanavino, M4; Horta, A2

1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil; 4: University of São Paulo Medical School (FMUSP), Brazil

Objectives: Myths and fears about potential harms of sexual activity on the pregnancy or the fetus may affect the couple’s sexuality and relationship. We conducted a systematic review of the literature to assess fears and myths related to sexual activity during pregnancy in different cultural contexts.

Patient and Methods: Medline electronic database was searched from 2004 to 2014, without language restrictions for publications on fears or myths related to sexual activity during pregnancy. The following key-words were used: “sexual behavior” or “coitus” or “sexuality” and “pregnancy” or “pregnant women” or “gestation”. A specific data extraction form was created to extract the following information from each included study on i) design, ii) participant characteristics, iii) fears and myths. The search was completed by screening the reference lists of publications selected for full text reading. The process of study selection and extraction was performed by two independent reviewers; disagreements were discussed until consensus was reached.

Results: The search strategy yielded 594 references. After primary screening of titles and abstracts, 18 studies were selected for full text reading, 11 were excluded because they lacked information about sexual myths in pregnancy and 7 were included. Three additional studies were identified in the reference lists of the included manuscripts. In total, ten studies (conducted in Nigeria, China, Thailand, Egypt, Iran, Portugal and Croatia) were included. Fears of harming the fetus, of abortion, of preterm labor or rupture of membranes were reported by women and their partners as reasons to avoid sexual activity, in all ten studies. Additional reported reasons to forgo sexual intercourse during pregnancy included: fear of sin due to perception of the fetus as a third person; avoidance of adultery and of rupturing the hymen of a female fetus, as well as blindness and suffocation of the baby (Iran); bleeding and infection (Nigeria, China, Thailand, Iran, Croatia) as potential results of coitus and the belief that breast massages can lead to preterm labor (Egypt). Reported reasons to increase or maintain sexual activity in pregnancy included to keep the husband, to maintain marital harmony (Nigeria) and to facilitate labour in late pregnancy (Nigeria and Egypt).

Conclusion: Our findings indicate that myths and fears may affect the couple’s sexual life and vary in different cultures.

Disclosures:

This study was funded by a grant from FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670-4 and 12/50225-6

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The features of motivational sphere in infertile women (#142)

N. Stenyaeva (Russia)
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142

The features of motivational sphere in infertile women

Stenyaeva, N1; Chritinin, D2; Sukhikh, G1

1: Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation, Russia; 2: I.M. Sechenov First Moscow State Medical University

Objective: To study the features of value-motivational sphere in women with infertility.

Subjects and Metods: 157 women (average age 33.38 ± 4.96) had primary infertility, and 53 fertile women (average age 32.26 ± 34.86) were studied as the group of comparison. Criteria for exclusion were mental diseases (schizophrenia, schizotypical and delusional disorders, affective mood disorders, epilepsy, etc.). Motivational orientations in interpersonal communication were investigated, as well as the features of value orientations, and motivational-require mental sphere area.

Results: According to the Test of humorous phrases (THP), 69.8% of women with infertility demonstrated social motives. They were characterized by paying high personal importance to "gender relationship" and decreased importance to the motive of self-preservation. The Rokich technique revealed in this group the leading value of the physical and mental health (U = 34.5, p < 0.05), indicating the motivations shift towards the goal to become healthy. Among the values – goals specific material values and values of personal life were prevailing. Among the most important instrumental values in women with infertility there were social values of communication and acceptance of other people.  The results of studies showed domination of need to reach a certain result, as well as high scores on the scales of "altruism" and "friendship" demonstrating the needs for communication, assistance and help to other people. Women in the two groups showed statistically significant differences in motivational orientations to communication (U = 45.5, p ≤ 0.01). The infertile women were focused more on the "compromise" in their interpersonal communications, as well as on the harmony in relationship in general.

Conclusion: Infertility leads to disruption of normal social functioning of a woman and her emotional state, which affects the value-motivational sphere of personality and leads to the shifts of motives, needs and values. Infertile women’s motives are shifted to the goal of "health". These women are characterized by the social orientation of values and needs; apparent need for physical and emotional affinity with the beloved and family; low motivations for high social or career status and self-affirmation; motivational orientation towards compromise and communicational harmony; and by unsatisfied need for safety.

Disclosures:

Work supported by industry: no.

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Prevalence of zoophilia in Czech sado-masochistic community (#143)

K. Bártová (Czech Republic)
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143

Prevalence of zoophilia in Czech sado-masochistic community

Binter, J1; Schejbalova, A1; Bártová, K1; Varella Vanletova, J2; Krejcova, L1; Weiss, P3; Kleisner, K4; Keil, P5; Klapilova, K1

1: Faculty of Humanities, Charles University in Prague, Czech Republic; 2: Center for Theoretical Studies, Chares University & the Academy of Sciences of the Czech Republic, Prague, Czech Republic; 3: 1st Medical Faculty, Charles University, Prague, Czech Republic; 4: Department of Philosophy and History of Science, Charles University, Prague, Czech Republic; 5: Department of Ecology and Evolutionary Biology, Yale University

Sexual contact with animals – zoophilia has been rarely studied. The most famous are studies by Kinsey (1948, 1953) who identified 8% and Hunt (1974) who identified 2-5% prevalence of zoophilic behavior. Williams & Weinberg (2003) reported that in the USA the prevalence is around 5%. Sandabba (2002) focused on the prevalence in Sado-Masochistic (S-M) community and identified prevalence of 7,5% (12 of 164 respondents).

We have analyzed data from dating questionnaires available online from 3,734 members of the largest Czech S-M community (altogether more than 17 thousand members) divided into four categories: dominant men (N = 1,496; mean age = 34.7, ± SD ± 9.0), submissive men (N = 1,572; 32.2 ± 8.9), dominant women (N = 140; 30.6 ± 8.9), and submissive women (N = 526; 29.9 ± 9.2). The questionnaires were not designed by researchers but by members of the community to find an appropriate partner. The questionnaire had two parts A) yes/no questions about general dimensions of preferences and practices (e.g., beating, bestiality) and B) specific activities for each general dimension (e.g., beating by hand, oral sex with a horse) scaling form 1 = never wanted even to try, to 5 = insisting on such practices.

The prevalence of the general dimension of zoophilia among all groups together was 7.32%. In dominant men it was 6.1% (91 out of 1,496), in submissive men 9.1% (143 out of 1,572), in dominant women 3.6% (5 out of 140), and in submissive women 10.6% (55 out of 526). Also we have found that submissive members tended to be more likely to perform bestiality than dominants (χ²=9.882, p=0.002). Also, we have found a positive correlation between preferences for zoophilia and dominance in dominants (r = 0.061, p = 0.005) and submissiveness in submissive members (r = 0.146, p < 0.001). Preference for bestiality was also associated with activities that include contact with waste products of human metabolism – urine, excrements and vomit. Therefore, we suggest the reason to have sexual contact with animals in S-M community is related to induction of negative emotions (disgust, fear, shame) that can, in some cases, increase sexual excitement, as lately suggested by de Jong (2012, 2013) and others.

Disclosures:

Work supported by industry: no.

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10:30 - 11:30
Podium 5 - Epidemiology

Location: Transamérica Auditorium
Chairs: Emmanuele Jannini (Italy) & Juan Uribe (Colombia)

Weaker masturbatory erection may be a sign of early cardiovascular risk associated with erectile dysfunction in young men without sexual intercourse (#025)

Y. Huang (China)
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025

Weaker masturbatory erection may be a sign of early cardiovascular risk associated with erectile dysfunction in young men without sexual intercourse

Huang, Y1; Chen, B1; Ping, P1; Chen, X1; Wang, H1; Huang, Y1

1: School of Medicine, Shanghai Jiao Tong University, China

 

Objectives. To evaluate the young men presenting weaker masturbatory erection with no sexual intercourse (WME-NS) and verify if this cohort have early cardiovascular risks associated with ED.

Material and Methods. Male subjects aged 18-40 years with WME-NS were screened by analyzing detailed sexual intercourse and masturbatory history. The age-matched ED and non-ED population were identified by using International Index of Erectile Function-5 (IIEF-5). All subjects with acute and/or chronic diseases (including diagnosed hypertension and diabetes) and long-term pharmacotherapy were excluded. Nocturnal penile tumescence and rigidity (NPTR), systemic vascular parameters and biochemical indicators related to metabolism were assessed. Comparison analysis and logistic regression analysis were conducted among WME-NS, ED and non-ED population.

Results. In total,78 WME-NS cases (mean 28.99±5.92 years), 179 ED cases (mean 30.69±5.21 years) and 43 non-ED cases (mean 28.65±4.30 years) were screened for analysis. Compared with non-ED group, WME-NS group had higher prevalence of early ED risk factors including endothelial dysfunction, insulin resistance, high level of glycosylated serum protein and abnormal NPTR. Multivariable-adjusted logistic regression analysis showed endothelia dysfunction (odds ratio: 8.83 versus 17.11, both P<0.001) was the independent risk factor for both WME-NS and ED.

Conclusions. Weaker masturbatory erection may be a sign of early cardiovascular risk associated with ED in young men without sexual intercourse. More studies are warranted to elucidate the clinical benefits by targeting these formulated strategies.

Disclosures:

Work supported by industry: no.

Factors correlating with sexual interest and function in long-term colorectal cancer survivors (#026)

H. Ayoub (USA)
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026

Factors correlating with sexual interest and function in long-term colorectal cancer survivors

Ayoub, H1; You, Y2; Cao, H1; Hu, C1; Bailey, C3; Chang, G1; Feig, G1; Rodriguez-Bigas, M1; Skibber, J1; Westney, L1

1: MD Anderson Cancer Center, United States; 2: MD Anderson Cancer Center, United States ; 3: MD Anderson Cancer Center

Purpose:  Long-term sexual dysfunction after multimodality treatment of rectal cancer occurs in roughly 40% of patients, irrespective of gender. We sought to evaluate the factors influencing the quality of sexual function as reported on a colorectal cancer specific quality of life instrument.

Materials and Methods: Colorectal Cancer (CRC) patients alive > 5 years from their diagnosis were identified from our Tumor Registry. Demographics, tumor characteristics and treatment details were extracted. Patients were mailed a standardized survey - European Organization for Research and Treatment of Cancer (EORTC) CRC disease specific module (CR29). Responses to items in the CR29, generic sexual interest and gender specific sexual function (impotence and dyspareunia), were extracted and analyzed. Univariate and multivariate analysis (logistic and linear) was performed to examine the relationship between clinical treatment factors [extent/location of surgical resection (abdominal, distal rectal or anus), lifetime chemotherapy, lifetime XRT and presence of an ostomy] and sexual interest/function.  A two tailed p < 0.05 was considered statistically significant.

Results: Of 830 responders, 671 (81%) completed the sexual items.  The mean age was 55.9 (SD, 11.6) years with a mean time from diagnosis of greater than 10 years.  In males, decreased sexual interest correlated with younger age (p<0.001). Impotence was associated with a permanent ostomy (p=0.0045), radiation (p=0.0003), current cancer (p=0.0103) and younger age at cancer diagnosis (p=<0.001).  In female survivors, sexual interest was negatively impacted by permanent ostomy, radiation and younger age of diagnosis but positively related to marriage (0.0001). In univariate analysis, dyspareunia was associated with surgery type (0.0012), permanent ostomy (0.0025), history of radiation therapy (0.0025), prior chemotherapy (0.0061), older age (0.0405) and marital status (<0.0001).  Marriage was predictive of dyspareunia (p=0.001). 

Conclusion:

Both permanent ostomy and radiation correlated with impotence and dyspareunia.  Determinants of sexual interest varied tremendously based on gender.  Younger patients had more complaints regarding level of sexual interest.  Due to the cross-sectional nature of this study, we cannot determine the relationship to baseline.  Additionally, historical and present frequency of sexual activity is unknown.

Disclosures:

Work supported by industry: no.

Sexual function recovery in kidney transplant donors and receptors after a year of follow-up (#027)

J. Herrera-Caceres (Mexico)
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027

Sexual function recovery in kidney transplant donors and receptors after a year of follow-up

Magaña-Rodríguez, J1; Herrera-Caceres, J1; Davila, F1; Rodríguez-Covarrubias, F1; Gabilondo-Pliego, B1; Castillejos-Molina, R1

1: INCMNSZ, Mexico

Objective: The study aims to analyze the change in sexual function among men before and up to one year after a renal transplant. Secondary analysis aims to compare sexual function dynamics to donor nephrectomy patients.

Material & Methods: We prospectively included renal transplant patients and kidney donors from July 2011 until March 2014. A basal evaluation of sexual function was performed as well as a monthly follow-up up to one year from surgery. We used the IIEF questionnaire for sexual evaluation. We also obtained demographic information from patients.

Results: We included 52 male kidney transplant patients and 12 male donors. Transplanted kidneys were either form living or cadaveric donors. Mean age was 34.48 (SD 12.97) years old for receptors and 37.82 (SD 9.15) years old for donors.

Abstract 027

Before transplantation, all IIEF domains except for overall satisfaction were worse in the receptors. One year after surgery none of the individual domains showed a statistically significant difference. It is important to mention that since the first month (p= 0.55) and after a year from transplantation, there was no difference in glomerular filtration rate (p= 0.85)

Conclusions: Before the transplant, kidney receptors have a worse sexual function in comparison to healthy individuals, such as kidney donors. Interestingly, just after a month after the surgery the difference among groups disappeared. By one year receptors seems to have a better improvement, although this did not reach statistical significance, perhaps due to the sample size.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Exploration of the association between chronic periodontal disease and erectile dysfunction from a population based view point (#028)

C. Tsao (Taiwan)
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028

Exploration of the association between chronic periodontal disease and erectile dysfunction from a population based view point

Tsao, C1; Liu, C2; Cha, T1; Hsu, C3

1: Depertment of Surgery, Division of Urology, Tri-Service General Hospital, Taipei, Taiwan; 2: Department of Nutritional Science, Fu Jen Catholic University, New Taipe, Taiwan; 3: Graduate Institute of Biomedical Informatics, Taipei Medical Unversity, Taipei, Taiwan

Objective:

Several cross-sectional studies have indicated an association between chronic periodontal disease (CPD) and cardiovascular disease and metabolic syndrome. Erectile dysfunction (ED) also shares pathological mechanisms with these diseases. Using a nationwide population-based dataset, we examined the association between ED and CPD, and assessed the effect of dental extraction (DE) on ED prevalence in different aged CPD populations in Taiwan.

Material and Methods:

The study population and matched controls for this case–control investigation were taken from the Longitudinal Health Insurance Database (LHID2000). The LHID2000 includes all the original claims data and registration files for 1,000,000 individuals randomly sampled from the 2000 Registry for Beneficiaries (n = 23.72 million) of the Taiwan National Health Insurance (NHI) program. A matched case–control study of ED was conducted in Taiwan. Cases included ED patients ≥ 20 years of age and < 80 years of age diagnosed with ED for the first time (International Classification of Disease, 9th edition, Clinical Modification (ICD-9-CM code 607.84) during visits to ambulatory care centers (including the outpatient departments of hospitals or clinics) between 1996 and 2008. DE procedures (ICD-9-CM codes 23.0, 23.09 & 23.19) were traced prior to the ED diagnosis date.

Result:

We identified 5,105 patients with ED and randomly selected 10,210 patients as controls. Of these patients, 2,617 (17.09%) were diagnosed with CPD according to the index data: 1,196 (23.43%) in the ED group and 1,421 (13.92%) in the control group. After adjusting for comorbid factors, patients with ED were more likely to have been diagnosed with prior CPD than controls (OR = 1.79, 95% CI = 1.64-1.96, p < 0.001). Moreover the association was much stronger in the populations aged less than 30 years (OR = 2.13, 95% CI = 1.23-3.70, p < 0.001) and more than 59 years (OR = 2.27, 95% CI = 1.99-2.59, p < 0.001).

Conclusion:

Dental extraction (DE) seems attenuate damage to the penile endothelial beds caused by CPD-related inflammation, and overcame the process of ED in the middle-aged and older populations.

Disclosures:

Work supported by industry: no.

Female sexual dysfunction risk factors in diabetic women (#029)

A. Mahran (Egypt)
show abstract

029

Female sexual dysfunction risk factors in diabetic women

Moubasher, A1; Mahran, A1; Asham, R1; Zakaria, M1; Abdel Rahman, G1

1: Assuit University Hospital, Egypt

Objective: To assess the risk factors of developing female sexual dysfunction (FSD) among women with diabetes mellitus (DM).

Material and methods: This study included 100 sexually active diabetic women and age matched 100 healthy women served as control. All participants underwent full history taking, general and genital examination and glycated hemoglobin (HbA1c) level. Sexual function was evaluated by the Arabic version of the Female Sexual Function Index (FSFI).

Results: FSFI score was significantly lower in patients (25.39 ± 3.25) compared to control (28.84 ± 4.26) (P=0.000). There was a significant negative correlation between FSFI score and HA1c (P=0.016, r=-0.239). HA1c level was negatively correlated to arousal (P=0.000, r=-0.383) and lubrication (P=0.05, r=-0.197). As regards the type of DM, FSFI full score was significantly lower in patients with type II DM (25.02 ± 3.21) compared to type I DM (26.51 ±3.19) (P=0.047). Desire domain score in type II DM patients (3.50 ± 0.61) was significantly lower than type I DM patients (3.96 ± 0.57) (P=0.001). Similarly, arousal domain score was significantly lower in type II group (4.01 ± 0.84) compared to type I group (4.48 ± 0.76) (P=0.016). On the contrary, no significant correlation was detected between FSFI score and age (P=0.813, r=-0.024), duration of DM (P=0.808, r=0.025), waist circumference (P=0.292, r=-0.106) and Body Mass Index (P=0.292, r=-0.106).  As regards DM complications, patients with nephropathy or retinopathy had lower FSFI score compared to those without (P=0.008, P=0.042 respectively). Moreover, patients with associated hypertension showed lower FSFI compared to those without hypertension (P=0.014).

Conclusion: Poor glycemic control in diabetic women is a risk factor for developing FSD. Type II DM seems to have a greater negative impact on female sexual function than type I DM.  Patients with diabetic nephropathy or retinopathy are at  risk of developing FSD. Hypertension is a risk factor for FSD in diabetic women.

Disclosures:

Work supported by industry: no.

The impact of genital image and sexual anxiety on erectile dysfunction among male military personnel (#030)

S. Wilcox (USA)
show abstract

030

The impact of genital image and sexual anxiety on erectile dysfunction among male military personnel

Wilcox, S1; Latham Davis, T2; Redmond, S1

1: University of Southern California, United States; 2: Emory University, United States

Objective: To assesses the relationships between male genital image satisfaction (MGIS), sexual anxiety (SA), and erectile dysfunction (ED) in a sample of male military personnel between 18 and 40 years of age. In military populations under 40, rates of ED are as high as 15.7% in those without posttraumatic stress disorder (PTSD) and over 80% in male veterans with PTSD. Both physical and psychological (body image, sexual anxiety) factors contribute to sexual functioning problems (SFP), including ED. Body image concerns are associated with more SFPs in both men and women. The military culture is masculine in nature and young male military personnel are at risk for SFPs, which can negatively impact quality of life. Over a third of young military personnel (age 40 and younger) report experiencing some level of ED. Preoccupation with body image, particularly genitals, is a distraction that can influence SA and impact SFPs. The purpose of this study is to determine wither sexual anxiety mediates the relationship between male genital image satisfaction and erectile dysfunction in male military personnel aged 18 to 40 years.

Material and Methods: This exploratory study used data from a larger study on SFPs in military populations age 40 and younger. This sample consisted of 367 male military personnel aged 18-40 years. Process modeling using mediation analysis was performed to examine the effects of MGIS on ED with SA as an intermediate variable. We predicted that SA would mediate the relationship between MGIS and ED.

Results: There were significant direct effects of MGIS on ED (b=-.14, CI[-.23, -.04], p<.01) and SA (b=-.23, CI[-.34, -.12], p<.001). There was a significant direct effect of SA on ED (b=.29, CI[.20, .39], p<.001). There was a significant indirect effect of MGIS on ED through SA (b=-.07, CI[-.14, -.01] p<.01). Analyses controlled for age, marital status, education, and race.

Conclusions: This study underscores the complex etiological basis for SFPs and highlights the importance of considering psychological contributors to SFPs, such as SA and MGIS. Those with ED may benefit from psychological interventions to address MGIS and SA. Furthermore, interventions addressing MGIS and SA may also be preventative. Strategies aimed at reducing SA may be useful in improving ED in young military populations and are worth considering as compliments to strategies that improve sexual functioning.

Disclosures:

Work supported by industry: yes, by California Community Foundation - Iraq Afghanistan Deployment Impact Fund (industry funding only - investigator initiated and executed study).


10:30 - 11:15
Workshop 6 - Sexual side effects of psychotropic meds

Location: Ilhéus + Una Room
Chair: Fernando Bianco (Venezuela)

Antidepressants and human sexual response

Eusebio Rubio-Aurioles (Mexico)

Antipsychotics and human sexual response

Michal Lew-Starowicz (Poland)


11:00 - 11:30
Point counterpoint 4 - Sexual (erectile?) dysfunction: can it be prevented?

Location: Comandatuba Room 2+3
Chairs: Alejandro Carvajal (Colombia) & Ira Sharlip (USA)

Pro

Sidney Glina (Brazil)

Con

John Mulhall (USA)


11:30 - 12:30
Podium 6 - Androgens

Location: Comandatuba Room 2+3
Chairs: Mohit Khera (USA) & Ernani Rhoden (Brazil)

Cardiovascular risk associated with testosterone boosting medications: a meta-analysis of the available evidence (#031)

Mario Maggi (Italy)
show abstract

031

Cardiovascular risk associated with testosterone boosting medications: a meta-analysis of the available evidence

Corona, G1; Maseroli, E2; Rastrelli, G2; Isidori, A3; Maggi, M2

1: Endocrinology Unit, Italy; 2: Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy; 3: 3Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

Introduction. Recent reports significantly halted the enthusiasm regarding androgen boosting, suggesting that testosterone supplementation (TS) increases cardiovascular (CV) events. The aim of this study is to meta-analyze all available evidence on the effect of TS on male CV events.

Methods An extensive Medline Embase and Cochrane search was performed. All randomized controlled trials (RCTs) comparing the effect of TS vs. placebo on different CV outcomes were included

Results Out of 2747 retrieved articles, 75 were included in the study. In addition, one completed but still unpublished study was also considered. Retrieved trials included 3040 TS treated and 2468 placebo treated men for a mean duration of 34 weeks. Our analyses, performed on the largest number of studies collected so far, indicate that TS is not related to any increase in CV risk even when composite (HR=1.01[0.58;1.78]; p=0.97]) or single adverse events were considered. In RCTs performed in subjects with metabolic derangements a protective effect of TS on CV risk was observed (HR=0.19[0.04;0.85]; p=0.03).

Conclusion Present systematic analysis does not support a causal role between TS and  adverse CV events. Our results are in agreement with a large body of literature from the last twenty years supporting TS of hypogonadal men as a valuable strategy in improving a patient's metabolic profile, reducing body fat and increasing lean muscle mass, which would ultimately reduce the risk of heart disease.

Disclosures:

Work supported by industry: no.

Treatment of male hypogonadism with injectable testosterone undecanoate: outcome meta-analysis study (#032)

Mario Maggi (Italy)
show abstract

032

Treatment of male hypogonadism with injectable testosterone undecanoate: outcome meta-analysis study

Corona, G1; Maseroli, E2; Maggi, M3

1: Endocrinology Unit, Italy; 2: Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy ; 3: Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy

Objective. Injectable testosterone undecanoate (TU) is a long acting testosterone (T) (from 10 to 14 weeks) formulation available for the treatment of male hypogonadism since 2003 in several countries. The aim of this study is io assess the efficacy and safety of injectable TU by meta-analyzing available evidence.

Methods An extensive Medline Embase and Cochrane search was performed. All uncontrolled and placebo-controlled randomized clinical trials (RCTs) evaluating the effect of injectable TU on different outcomes were included.

Results Out of 98 retrieved articles, 33 were included in the study. Among those, 11 were placebo-controlled RCTs. Injectable TU was significantly associated with a reduction of fat mass and HbA1c in both controlled and uncontrolled trials, in particular when hypogonadal subjects were enrolled. Similar results were observed for the improvement of sexual function. In addition, TU ameliorated several other outcomes including blood pressure, lipid profile, waist circumference and BMI in uncontrolled studies but these data were not confirmed in placebo-controlled trials. The treatment was well tolerated and no risk of prostate cancer or cardiovascular disease observed. 

Conclusion Injectable TU is a safe and effective treatment for male hypogonadism. The possibility of a four time a year, therapeutic intervention frees the patient, at least partially, from having a chronic condition, maintaining a positive, active role in self-caring and helping hypogonadal men to keep his condition in long-way perspective.

Disclosures:

Work supported by industry: no.

Use of a novel subcutaneous Needle-Free technique to deliver testosterone in hypogonadal men (#033)

J. Marotte (USA)
show abstract

033

Use of a novel subcutaneous Needle-Free technique to deliver testosterone in hypogonadal men

Marotte, J1; Stout, R2; Alobuia, W3; Frazier, R1

1: Conway Urology, United States; 2: Bioject Inc., United States; 3: University of Arkansas for Medical Sciences, United States

Objectives: A proof-of-concept study was performed to assess the potential and efficacy of needle-free injection as a modality for Testosterone Replacement therapy (TRT). We hypothesize that needle-free delivery of testosterone in TRT would address the major limitations of the currently marketed modalities while providing a normal range of blood testosterone level with very minimal to no fluctuations in levels.

Methods: Fourteen men were confirmed to have had at least two prior blood levels documenting hypogonadism (T <300ng/dl) were enrolled in an IRB-approved prospective trial of a needle-free injection of testosterone cypionate for TRT. All subjects were instructed on the correct way to use the needle-free device to administer 25mg of the commercially available 100mg/ml testosterone cypionate in cottonseed oil daily, via subcutaneous delivery in the abdominal area. Blood level of testosterone was taken by the clinical staff at 6 hours post injection on Day 1, days 2, 7, 14 and 30. After successfully increasing and maintaining testosterone levels at physiologic levels in all 14 subjects throughout the first 30 days, the study was continued to determine efficacy at day 60 and day 120 using a 50mg every other day dosing with weekends off. Primary endpoints were testosterone levels, with secondary endpoints determined using subjective clinical improvement by the Aging Male Score (AMS) questionnaire.

Results: The study data are extremely promising. 12 of 14 subjects had normal T levels by day 4 (mean 487ng/dL), with all 14 subjects having normal levels with a mean of 658ng/dL at day 14. Mean testosterone levels at day 30 were 842ng/dL for all 14 participants.  At days 60 and 120, mean testosterone levels in the 12 men who continued the study were 707ng/dL and 549ng/dL respectively with no supra or sub-physiologic levels at day 120. No adverse events were recorded and very low pain scales were reported throughout the study period. All the subjects had a greater than 50% objective improvement in their AMS scores, and were very pleased with their treatment.

Conclusion: We report the first study to demonstrate that needle-free delivery of testosterone is efficacious and maintains normal ranges of testosterone blood levels during TRT, while eliminating the potential for the many risks and side effects associated with the currently available treatment modalities. The elimination of adverse side effects and risks of interpersonal transfer and toxicity, coupled with the advantages of self administration, consistent maintenance of normal blood testosterone levels and pain-free delivery are evidence of the efficacy and great potential afforded by this novel design/use of needleless delivery of testosterone in testosterone replacement therapy.

Disclosures:

Work supported by industry: .

Beneficial effects of long-term testosterone replacement therapy (TRT) with testosterone undecanoate (TU) in hypogonadal men with cardiovascular diseases (CVD) in an observational registry study (#034)

F. Saad (Germany)
show abstract

034

Beneficial effects of long-term testosterone replacement therapy (TRT) with testosterone undecanoate (TU) in hypogonadal men with cardiovascular diseases (CVD) in an observational registry study

Saad, F1; Haider, A2; Doros, G3; Traish, A4

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: BU School of Public Health, USA; 4: BU School of Medicine, USA

Objective: To assess effectiveness and safety of long-term treatment with testosterone undecanoate (TU) injections in hypogonadal with a history of cardiovascular diseases.

Material and Methods: 68 hypogonadal men with a previous diagnosis of coronary artery disease (CAD; n=40) and/or a myocardial infarction (MI; n=40) and/or stroke (n=6) received TU injections for up to 7.

Results: Mean age was 60.76±4.94 years. 68 men were included for 3 years, 59 for 4 years, 54 for 5 years, 44 for 6 years, and 28 for 7 years. Declining numbers reflect the nature of the registry (patients are included after receiving 1 year of TRT) but not drop-out rates. Testosterone levels rose from 10.21±1.43 nmol/L to trough levels (measured prior to the following injection) between 15 and 19 nmol/L. Weight (kg) decreased progressively from 115.07±13.71 to 92.5±9.64. Waist circumference (cm) decreased from 112.07±7.97 to 99.89±6.86. BMI (kg/m2d) decreased from 37.27±4.45 to 30.14±3.21 (p<0.0001 for all). Weight loss was 17.05±0.57%. Fasting glucose decreased from 108.74±17.08 to 96.0±1.92 mg/dl, HbA1c from 7.81±1.17 to 6.2±0.62% (p<0.0001 for both). Lipids (mg/dl): Total cholesterol (TC) decreased from 304.66±34.09 to 189.32±9.68, LDL from 184.28±37.51 to 134±27.91, triglycerides from 308.38±56.3 to 187.71±8.67 (p<0.0001 for all), and HDL increased slightly. The TC:HDL ratio declined from 5.16±1.55 to 3.15±0.87 (p<0.0001).

Systolic BP decreased from 167.82±11.01 to 142.36±10.62, diastolic BP from 102.28±8.23 to 81.25±8.07 mmHg (p<0.0001 for both). Pulse pressure declined from 65.54±5.24 to 61.11±4.66 (p<0.0001). Liver transaminases (IU/L): Aspartate aminotransferase (AST) decreased from 42.18±14.11 to 22.14±3.23, alanine aminotransferase (ALT) from 42.62±15.49 to 20.18±2.72 (p<0.0001 for both). C-reactive protein (CRP) declined from 4.08±4.73 to 0.44±0.6 mg/L. IIEF-EF increased from 21.25±4.69 to 25.93±3.55, change from baseline: 4.21±0.33. Minimum number of injections was 13, maximum 30. In no patient TRT was discontinued or interrupted. No cardiovascular events were reported during the observation time.

Conclusions: All changes were more pronounced with increasing obesity grade. All changes were in a clinically meaningful magnitude and sustained for the full observation period. T therapy seems to be an effective approach to achieve sustained weight loss in obese hypogonadal men, thereby potentially reducing cardiometabolic risk.

Disclosures:

Work supported by industry: yes, by Bayer Pharma AG (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Testosterone replacement therapy in men undergoing active surveillance for prostate cancer (#035)

John Mulhall (USA)
show abstract

035

Testosterone replacement therapy in men undergoing active surveillance for prostate cancer

Berookhim, B1; Krishnan, R2; Nelson, C1; Mulhall, JP2

1: Memorial Sloan Kettering Cancer Center, United States; 2: Memorial Sloan Kettering Cancer Center

Objective: With increasing experience with testosterone replacement therapy (TRT) for men undergoing prostatectomy for prostate cancer (CaP), attention has turned to TRT in patients undergoing active surveillance (AS). We report our experience with TRT in patients on AS.

Material and Methods: An IRB approved retrospective review was performed on all patients with a prior diagnosis of CaP opting for AS and presenting with signs and symptoms consistent with hypogonadism (HG) to a single urologist specializing in andrology. All patients had final surgical pathology reports available for review and had baseline testosterone (TT) labs performed before 11 A.M., with repeat lab testing performed to confirm initial results. Patients with low or borderline TT levels (<300 ng/dL) and the presence of symptoms of hypogonadim were offered TRT after extensive counseling. Patients with LH levels in the normal laboratory range were offered clomiphene citrate (CC). Those who failed to achieve therapeutic TT levels (goal 600 to 800 ng/dL) on CC, or who opted against CC were offered transdermal testosterone (TDT) or intramuscular testosterone (IMT). Repeat hormonal evaluation, PSA, hemoglobin and hematocrit values were obtained at 6 weeks after initiation of therapy, and TRT doses were titrated as needed.  Labs were monitored every 3 months for the 1st year, 6 month for 2 years and then annually.

Results: A total of 11 patients met inclusion criteria. Mean age at start of TRT was 66 years. Mean PSA at baseline was 3.7 ng/mL (range 0.4-8.2).  All patients had Gleason 6 CaP. CaP stage was cT1c in 10 patients and cT2c in 1. Mean TT prior to initiating TRT, and while on treatment, was 237 ng/dL (range 93-396) and 603 ng/dL (range 463-807) , respectively.  2 patients were on CC, 8 on TDT, and 1 on IMT. Mean follow up on TRT was 26 months (range 6-101). Mean PSA at last follow-up was 5.6 ng/mL (range 1.1-11.4).  No patient had grade or stage progression of CaP on TRT. 2 patients discontinued TRT, either on advice of outside physician or due to anxiety.

Conclusion: In a small population of patients, TRT is safe in patients on AS for CaP, with no evidence of grade or stage progression noted on approximately 2 year follow up. Further study with longer follow up is necessary to confirm safety of TRT in selected men with untreated CaP.

Disclosures:

Work supported by industry: no.

Prevalence and characteristics of low serum testosterone levels in men with type 2 diabetes mellitus naïve to injectable therapy (#036)

F. Borges Dos Reis (Brazil)
show abstract

036

Prevalence and characteristics of low serum testosterone levels in men with type 2 diabetes mellitus naïve to injectable therapy

Polzer, P1; Ni, X1; Borges Dos Reis , F2

1: Eli Lilly and Company, United States; 2: Eli Lilly and Company, Brazil

Objectives: Male hypogonadism is defined by low serum testosterone (T) levels and associated clinical symptoms, and observed at elevated prevalence among men with type 2 diabetes mellitus (T2DM). This post hoc study assessed the association of low T levels with baseline characteristics of diabetic men in a phase 3 randomized clinical trial of the once weekly GLP-1 receptor agonist dulaglutide versus metformin.

Materials and Methods: Men were ≥18 yrs of age with T2DM, treatment naïve or on 1 oral antihyperglycemic medication at ≤50% of the recommended maximum daily dose, and had screening HbA1c 6.5% - 9.5%. Low total T (TT) was defined as <300 ng/dL. Free T (FT) was calculated using the Vermeulen equation. Two-sample t-test and Fisher’s exact test were used to compare T subgroups.  Pearson’s correlation coefficients were calculated between T and continuous variables. Men receiving T replacement (n=3) were not analyzed.

Results: 101 men (32.4%) had low TT and 211 (67.6%) had normal TT; mean age was 56.7 and 56.0 years, respectively (p=.82), and HbA1c was 7.6% in both groups (p=1.0). Men with low TT had higher BMI (34.6 vs. 30.8 kg/m2, p<.001), higher weight (107.1 vs. 92.7 kg, p<.001), and lower insulin sensitivity (HOMA2-%S, 40.8 vs. 52.8, p=.008). Among men reporting a lack of energy, mean energy levels were lower among men with low TT (p=.044). Statin use was more prevalent among men with low TT (52.5% vs. 28.0%; p<.001) and a history of cardiovascular disease was more prevalent in men with low TT (17.8% vs. 10.9%; p=.107). Both TT and FT correlated negatively with BMI, weight, and lack of energy, and positively with HOMA2-%S (all p<.05)

Conclusions: In men with T2DM naïve to injectable therapy, approximately one-third (n=101) had untreated low TT, with 3 additional men receiving T replacement. Men with low TT were of similar age and had comparable HbA1c relative to men with normal TT, but had higher BMI and weight, and reduced insulin sensitivity. Low T correlated with patient-reported lack of energy. These data support Endocrine Society Guidelines for measuring T levels in men with T2DM. Further study is needed to evaluate the role of T replacement in T2DM.

Disclosures:

Work supported by industry: yes, by Eli Lilly and Company (industry initiated, executed and funded study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.


11:30 - 12:30
Moderated posters 5 - ED medical, diagnosis and epidemiology

Location: São Paulo Room
Chairs: Irwin Goldstein (USA) & Andrea Salonia (Italy)

Adjuvent Tadalafil polytherapy in Tamsulosin nonresponders with LUTS/BPH (#144)

V. Bhatia (UAE)
show abstract

144

Adjuvent Tadalafil polytherapy in Tamsulosin nonresponders with LUTS/BPH

Bhatia, V1

1: Al Ain Cromwell Hospital, Al Ain, UAE, United Arab Emirates

Objective: Alpha 1 adrenoreceptor antagonists including Tamsulosin have been used as a safe and effective first line therapeutic option for vast majority of patients with Lower urinary tract symptoms/Benign Prostate Hypertrophy(LUTS/BPH).A minority of these patients may not have satisfactory clinical response to these drugs.Daily Tadalafil has been approved for the treatment of patients with LUTS/BPH with or without Erectile Dysfunction (ED).This study evaluates the role of daily Tadalafil & Tamsulosin polytherapy in Tamsulosin monotherapy non responders.

Material & Methods: The study comprised 36 males above 50 years of age with LUTS/BPH who had previously received daily Tamsulosin 0.4mgm for 8 weeks or longer with unsatisfactory clinical response. Additional inclusion criteria were International Prostate symptom score (IPSS) of 15 or higher, QoL score of 3 or greater, Qmax from 5-15ml/sec, prostate volume on transrectal ultrasound exceeding 20ml and post void residual urine less than 100 ml. Twenty one patients had coexisting ED with median International Index of Erectile Function (IIEF-5) score of 14.2.Patients were prescribed daily oral Tadalafil 5mgm (9am) and Tamsulosin 0.4 mgm(9pm) for 8 weeks.

Results: Thirty one patients completed the study. The median reduction in IPSS was 5.8 with greater reduction in storage symptoms over voiding symptoms (3.4/2.1) .The average increase in IIEF-5 score was 5.6 with reduction in QoL of 1.4. After 2 months of combined therapy none of the patients wanted to discontinue therapy either due to lack of efficacy or adverse effects.

Conclusion: Patients with LUTS/BPH showing poor response to daily Tamsulosin monotherapy may benefit from additional daily Tadalafil polytherapy with improvement in both LUTS and ED with no additional side effects.

Disclosures:

Work supported by industry: no.

Salvage penile linear shock wave therapy for poor responders to conventional erectile dysfunction management (#145)

V. Bhatia (UAE)
show abstract

145

Salvage penile linear shock wave therapy for poor responders to conventional erectile dysfunction management

Bhatia, V1

1: Al Ain Cromwell Hospital, Al Ain, UAE, United Arab Emirates

Objective: Erectile dysfunction(ED) is a widespread malady and conventional treatment options include oral Phosphodiesterase 5 inhibitors(PDE5i), Intracavernosal vasoactive agent injection(ICI),Vacuum Constrictive Device(VCD) and intraurethral alprostadil   (MUSE). It is estimated that 25-30 % of ED patients may have an unsatisfactory erectile response to these modalities. Penile linear shock wave therapy (LSWT) is a recent noninvasive therapy utilizing low intensity shock waves to stimulate penile angiogenesis and improve erectile function.This study evaluates the safety and efficacy of LSWT by Renova device in ED patients with poor response to PDE5i,ICI,VCD and MUSE.

Material & Methods: The study comprises 26 males above 50 years with moderate to severe ED with mean International Index of Erectile Function (IIEF) score of 13.6.Coexisting comorbidities included Diabetes (32%), Hypertension (38%) and Dyslipidemia (42%). Duration of ED ranged from 10-18 months. The previous treatments used by these patients included on demand PDE5i(19),ICI with Alprostadil(4),VCD(2) and MUSE(1).All these patients opted to discontinue these regimen due to unsatisfactory erectile improvement or side effects, These patients were treated with LSWT by Renova device with four weekly outpatient sessions without any analgesia or preparation. LSWT was applied to four anatomical sites (right, left crura, and right,left corpus cavernosum) at 300 shocks per minute ,total 5000 shocks per session. Patients were followed up at 1 and 3 months after the last session.

Results: At one month follow up statistically significant improvement in IIEF was recorded in 19 patients (73%) from mean score of 13.6 at baseline to 19.2.The improvement was maintained at 3 months .No side effect was noted. Overall 92% patients expressed satisfaction with LSWT irrespective of the clinical outcome.

Conclusion: LSWT appears to be a safe and effective non invasive, office based therapy in the management of difficult to treat poor responders to prior treatment of ED .

Disclosures:

Work supported by industry: no.

Screening for metabolic syndrome and hypogonadism in men with erectile dysfunction (#146)

Bang-Ping Jiann (Taiwan)
show abstract

146

Screening for metabolic syndrome and hypogonadism in men with erectile dysfunction

Jiann, B1

1: Kaohsiung Veterans General Hospital, Taiwan

 

Objectives: Erectile dysfunction (ED) is a portal to men’s health. We assess the prevalence of metabolic syndrome (MetS) and testosterone levels in men presenting with erectile dysfunction (ED).

Methods and Materials: The information of ED patients was collected by Kaohsiung Veteran Hospital from Dec. 2010 to Jul. 2011. Male subjects presenting to urological outpatient clinics with ED were screened for MetS. Blood sampling was used for quantifying total testosterone (TT) level, fasting glucose (FBG), triglycerides (TGs), total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C). Criteria for MetS followed the rules set by International Diabetes Federation (IDF). Erectile function was assessed by the Sexual Health Inventory for Men (SHIM). All the participants signed the written inform consent to join the study. The Independent Review Board reviewed and approved the study.

Results: A total of 1640 subjects completed the study with data eligible for analysis from 2009 to 2013 with a mean age of 52.4 ± 13.5 yrs (19–88) and a mean TT of 4.4 ± 1.9 ng/mL (0.2–15.4). Of 1640 subjects with ED, 27.2% (447/1640) met the criteria of MetS. The prevalence of MetS increased with the increase of age and reached plateau after age group of 40-49. Subjects with MetS had a higher BMI, a higher prevalence of hypogonaidsm and worse lipid profiles and erectile function than those without MetS. Of 1383 subjects with T levels, 36.5% (505/1383) had hypogonadism (defined by TT <3.48 ng/mL). Serum TT levels decreased as the number of MetS components increased after adjustment for age. Compared with eugonadal subjects, hypogonadal subjects were older in age and had a higher prevalence of MetS and its individual components. The TT levels had significantly negative correlation with age, waist circumference and TGs in multiple logistic regression analysis.

Conclusions: Mets is commonly seen in men with ED and is associated with low TT levels. Of metabolic syndrome components, central obesity and TGs have negative correlation with TT levels in ED subjects in multivariate analysis.

Disclosures:

Work supported by industry: no.

show poster

Correlation between erectile function and endothelial function evaluated using finger artery stiffness (#147)

K. Kobayashi (Japan)
show abstract

147

Correlation between erectile function and endothelial function evaluated using finger artery stiffness

Kobayashi, K1; Tanaka, G1; Takayanagi, A1; Matsuda, Y1; Masumori, N1

1: Sapporo Medical University School of Medicine, Japan

Objective(s): Previous reports have suggested that erectile dysfunction and cardiovascular disease should be regarded as two different manifestations of the same systemic disorder. A dysfunctional endothelium contributes to cardiovascular events. Vasculogenic erectile dysfunction is also associated with impaired endothelial function. Clinical manifestations of these events rarely appear simultaneously because the arteries supplying various areas have different sizes. For example, the finger artery is smaller than the penile artery. Therefore, impaired endothelial function of the finger artery may predict erectile dysfunction (ED). We investigated the correlation between erectile function and endothelial function evaluated using little finger arterial stiffness.

Material and Method(s): We assessed erectile function and endothelial function in 43 male participants. Erectile function was using the 5-item version of the International Index of Erectile Function (IIEF-5). ED severity was classified into five categories based on the IIEF-5 scores. Endothelial function was assessed by little finger arterial stiffness. The novel finger arterial elasticity index was calculated based on the compliance index from the finger photoplethysmogram while occluding the finger. Spearman’s rank correlation coefficient was used to identify the relationship between erectile function and endothelial function.

Result(s): The median age of the participants was 65 years (range: 50-75). The degree of ED was severe, moderate, mild to moderate, mild and no ED for 14 (32.6%), 11 (25.6%), 3 (7.0%), 10 (23.3%) and 5 (11.6%) participants, respectively. There was a correlation between erectile function and endothelial function (correlation coefficient=0.402, p<0.01).

Conclusion(s): Erectile function was correlated with endothelial function by assessing little finger arterial stiffness. Little finger arterial endothelial dysfunction might be considered an early marker of erectile dysfunction.

Disclosures:

Work supported by industry: no.

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Association of serum testosterone with erectile function in young ED men without androgen deficiency (#148)

Y. Huang (China)
show abstract

148

Association of serum testosterone with erectile function in young ED men without androgen deficiency

Huang, Y1; Chen, B; Ping, P; Chen, X; Wang, H; Huang, Y

1: School of Medicine, Shanghai Jiao Tong University, China

Objective. The aim of this study was to examine the association of erectile function with serum testosterone in young ED patients without androgen deficiency.

Material and Methods. Consecutive men aged 20-40 years presenting with the complaints of erectile problem were included in this study. General health questionnaire and demographic data were collected in all subjects. International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Grade Scores (EHGS) were used to assess erectile function. Androgenic profile (total (TT), free (FT) and bio-available (BT) testosterone and sex hormone binding globulin (SHBG)), inflammation factor, lipid profile and glycometabolic indicators were tested in fasting blood sample. Linear regression analyses were used to analyze the association of testosterone as independent factors with erectile function as dependent factor.

Results. A total of 140 cases (mean age 30.56±4.81 years) were enrolled for analysis. In all regression models (age-adjusted to multivariable), FT was associated with IIEF-5 (r=0.202 to 0.204) and EHGS (r=0.224 to 0.213); and TT (r=-0.299 to -0.257), FT(r=-0.214 to -0.205), BT(r=-0.229 to -0.221), and SHBG(r=-0.222 to -0.148) were significantly inversely correlated with hs-CRP values. TT (r=0.179) and BT (r=0.170) positively correlated with EHGS in age-adjusted model but not in multivariable model. TT, BT and SHBG were not related with IIEF-5 in any regression models.

Conclusions. Only free testosterone level positively correlated with erectile function in young ED men and androgen levels were significantly inversely associated with hs-CRP in this population. Young men with ED should be screened for free testosterone level and inflammation markers.

Disclosures:

Work supported by industry: no.

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Erectile dysfunction and its relation with risk factors for vascular disease (#149)

S. Cedres (Uruguay)
show abstract

149

Erectile dysfunction and its relation with risk factors for vascular disease

Cedres, S1

1: Uruguay

Background: The prevalence of erectile dysfunction (ED) and associated risk factors has been described in many clinical settings (1), but there is little information regarding men seen by internal medicine physicians.

Objectives: To evaluate erectile dysfunction (ED) using a validated self-administered 5-item questionnaire (5-item version of the International Index of Erectile Function [IIEF-5]) in the internal medicine practice, to correlate it with risk factors for vascular disease an to determinate the sildenafil use and its effectiveness.

Materials and Methods: We studied patients consulting internal medicine physicians for 3 months. Participants completed a full medical history including alcohol consumption, smoking, physical activity, hypertension, physical examination for calculation of BMI, and measurement of fasting blood glucose and lipid levels. ED was defined by the 5-item version of the International Index of Erectile Function (IIEF-5). It was stratified as complete (4 or less), severe (5 to 10), moderate (11 to 14), mild (15 to 18), or none (19 to 20). Men were also asked about use of Sildenafil.

Results: A total of 132 men responded to the questionnaire. 81% of men < 50 years were sexually active compared with 16% of men > 80 years. 62% sexually active men reported severe (34,5%), or moderate (51,6%) or mild (13,9 %) ED. The prevalence of complete ED increased with age, rising from 32.2 % in the 40-49 age group to 67.9% in the 70-79 age group. Only 19.3 % of men with ED had received treatment. The response to sildenafil deteriorated with age and increasing degree of ED. Odds ratios for having DE were significantly higher in men with smoking (1.96), physical inactivity (1.28), hypertension (2.04) and abnormal fasting blood glucose.

Conclusions: This study confirms the strong correlation between ED and some comorbidities. With an ageing population, erectile dysfunction may become a significant health problem. Health care providers should plan their resources accordingly.

Disclosures:

Work supported by industry: no.

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Lifestyle and erectile dysfunction: A meta-analysis of population-based studies (#150)

J. Qi (China)
show abstract

150

Lifestyle and erectile dysfunction: A meta-analysis of population-based studies

Cui, R1; Wu, Y1; Qi, J1; Bai, Q1; Fu, Q2

1: XinHua Hospital, China; 2: Shanghai 6th Hospital, China

Objectives: Erectile dysfunction (ED) is defined as the inability to attain and/or maintain an erection sufficient for sexual intercourse. Smoking, alcohol, and exercise have long been regarded as risk factors for ED. The aim of this meta-analysis was to evaluate the associations between smoking, alcohol intake, and exercise with the incidence of ED.

Material and Methods: Relevant articles, up to December 2012, were searched using the Medline, PubMed, and the Cochrane Library database. The search combined randomized, controlled clinical trials that were performed on healthy populations and that assessed smoking, alcohol, or aerobic exercise for men with ED. ED was defined using the International Index of Erectile Function Index-5 (IIEF-5) or a single question about each patient’s ability to maintain an erection. Data on participants’ age, bad habits, drug use, and concomitant diseases (such as hypertension) were also collected and analyzed.

Results: Six randomized controlled studies were identified and reviewed. The combined population included 17,893 patients. Results showed that smoking is an important risk factor for ED [odds ratio (OR) = 1.21 (95% CI 1.11-1.31)], low or moderate drinking may reduce ED [OR = 0.82 (95% CI: 0.72-0.93)], and a lack of exercise can increase the risk of ED [OR = 1.34 (95% CI: 1.12-1.60)].

Conclusions: Sexual function may benefit from exercise and low or moderate drinking, while it might be adversely affected by both current and past smoking habits. Large amounts of drinking are associated with increased ED incidence. More randomized controlled studies in this area are warranted.

Disclosures:

Work supported by industry: no.

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Prevalence of erectile dysfunction in Egyptian men with metabolic syndrome (#151)

A. Swidan (Egypt)
show abstract

151

Prevalence of erectile dysfunction in Egyptian men with metabolic syndrome

Hatem, A1; Eid, A2; Swidan, A2; Salama, N3

1: Faculty of medicine, university of alexandria, Egypt; 2: Faculty of medicine, University of Alexandria, Egypt; 3: Faculty of Medicine, University of Alexandria, Egypt

Objectives: Determination of the potential effect of metabolic syndrome (MetS) on erectile function in Egyptian men and description of the sociodemographic characteristics of these men.

Material and Methods: A cohort of 220 patients presenting to Alexandria urology department ages between 30 and 75 years were prospectively assessed and divided into two groups. Group I (n=110) diagnosed with MetS and mean age of 55.4 years. Group II controls (n=110) subjects with no MetS and mean age 53.5 years. Patients filled the International Index for Erectile Function (IIEF) questionnaire, Medical, personal history and BMI data were tabulated. Presence of metabolic syndrome was determined when three or more of the five risk factors were present according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP)-III.

Results: In the study groupI 82(74.5%) of the patients had ED. Of these, 19 (17.3 %) had mild, 25 (22.7%) had moderate and 38 (34.5 %) had severe ED. and 38(34.5%) of patients without metabolic syndrome had ED. Of these, 22 (20 %) had mild, 10 (9.1 %) had moderate and 6(5.5 %) had severe ED. (P < 0.001; odds ratio 5.549; 95% CI 3.101 –9.928). Patients with metabolic syndrome had lower IIEF-EF domain scores than controls. Logistic regression analysis for the study group revealed that abnormal FBG was the most important criteria for ED (OR 1.013, 95% CI 1.004-1.022; P = 0.007) while on T Ed positively correlated to FBG, HDL, triglycerides and blood pressure (p<0.001).

Conclusions: Metabolic syndrome is a potential risk factor for ED in Egyptian men. Patients with metabolic syndrome should be questioned about ED. The diabetic patients are the most risky for ED.

Disclosures:

Work supported by industry: no.

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The relationship of carotid artery plaque with erectile dysfunction (#152)

J. Lee (Korea)
show abstract

152

The relationship of carotid artery plaque with erectile dysfunction

Lee, J1

1: National Police Hospital, Korea, South

Objective: Erectile dysfunction (ED) and carotid artery disease are known predictors of cardiovascular disease. However, little is known regarding the relationship of carotid artery disease with ED. Elucidation of the relationship of ED with carotid plaque would be helpful in comprehensive and detailed management in ED patients. Therefore, we evaluated the relationship of carotid artery disease with and ED.

Material and Methods: We enrolled 799 men who had participated in a health examination. During this examination, they received an international index of erectile function-5 (IIEF), a carotid duplex ultrasound, and a full metabolic work-up. The plaques were classified into three groups according to the severity of plaque size (absence: ≤1 mm, mild: 1.1–2.0 mm, and moderate to severe: ≥ 2.1 mm). Additionally, we classified ED as normal, mild, mild to moderate, moderate, and severe for IIEFs of > 21, 16–21, 11–16, 7–11, and ≤ 7, respectively. We investigated the relationship between carotid artery plaque with ED using the Spearman correlation test, the Mantel-Haenszel Extension test, and logistic regression analyses.

Results: The median age was 57 years, and the median IIEF were 15. The IIEF showed a significant negative linear correlation with maximum intima-media thickness (max IMT) (correlation coefficient = -0.132, P < 0.001). Additionally, there was a significant increase in the severity of ED with increased the severity of plaque size (P trend < 0.001). There was a greater likelihood of having moderate ED in the moderate and severe plaque size groups when compared to the absence of plaque group, after adjusting for age and components of metabolic syndrome (odds ratio [OR] = 1.672, P = 0.021).

Conclusions: In this study, the IIEF were significantly correlated with increased plaque size. Our data indicates the potential role of ED as predictors of carotid artery plaque.

Disclosures:

Work supported by industry: no.

Detection of a tadalafil analogue as an adulterant in a dietary supplement for erectile dysfunction (#153)

Edgardo Becher (Argentina)
show abstract

153

Detection of a tadalafil analogue as an adulterant in a dietary supplement for erectile dysfunction

Ulloa, J1; Sambrotta, L1; Redko, F1; Mazza, O1; Garrido, G1; Becher, E1; Muschietti, L1

1: University of Buenos Aires, Argentina

Introduction: Cases of adulteration of dietary supplements with tadalafil, sildenafil and vardenafil, or their unapproved analogues have been reported worldwide. Mainly, the presence of the latter represents a serious health risk to consumers as their efficacy and toxic effects have not been assessed and may result in unpredictable adverse effects.

Aim: To investigate the suspected adulteration with synthetic PDE-5 inhibitors in a dietary supplement marketed in Argentina for the treatment of erectile dysfunction (ED).

Methods: The content of the capsules of the dietary supplement (Sample A) was analysed by Thin Layer Chromatography (TLC) and High Performance Liquid Chromatography (HPLC-DAD). From the organic extract of sample A, a major compound was purified by column chromatography (CC).  The isolated compound was identified by proton nuclear magnetic resonance (1H NMR) and carbon NMR (13C NMR), heteronuclear single quantum correlation (HSQC), distortionless enhancement by polarization transfer (DEPT 135), Electrospray ionization-Mass Spectrometry (ESI-MS); and Ultraviolet (UV) and Infrared (FT-IR) spectroscopy.

Main Outcome Measure: Proof of adulteration of herbal products with synthetic PDE-5 inhibitors.

Results: By TLC and HPLC analysis, a major compound was detected in sample A organic extract.  The purification of this extract by CC led to the isolation of a pure compound which was identified according to its spectral data as (6R,12aR)-2-amino-6-(1,3-benzodioxol-5-yl)-2,3,6,7,12,12a-hexahydropyrazino [1’,2’:1,6] pyrido [3,4-b] indole-1,4-dione or aminotadalafil.

Conclusions: An unapproved PDE-5 inhibitor analogue, which was identified as aminotadalafil, has been detected in a dietary supplement. This study represents the first report in Latin America and one of the few independent studies of an adulteration with an unapproved PDE-5 inhibitor of an herbal product for ED treatment.

Disclosures:

Work supported by industry: no.

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11:30 - 12:30
Podium 7 - Sexual pain, identity & relationship

Location: Transamérica Auditorium
Chairs: Alessandra Graziottin (Italy) & Raquel Simone Varaschin (Brazil)

Development and validation of the PROMIS vulvar discomfort with sexual activity scales (#037)

K. Weinfurt (USA)
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037

Development and validation of the PROMIS vulvar discomfort with sexual activity scales

Flynn, K1; Weinfurt, K2; Lin, L3; Jeffery, D4; Reese, J5; PROMIS Sexual Function Domain Group,

1: Medical College of Wisconsin, United States; 2: Duke University; 3: Duke Clinical Research Institute; 4: Department of Defense; 5: Johns Hopkins University

Objective: Vulvar discomfort can severely compromise women’s sexual function and satisfaction, but there are no well-recognized comprehensive self-report measures that include assessment of vulvar discomfort. We sought to address this gap in version 2.0 of the PROMIS® Sexual Function and Satisfaction (SexFS) measure.

Material and Methods: Seventeen candidate items were first generated from literature review, patient focus groups and clinician input; cognitive interviews with patients then evaluated comprehension of the question stems and response options. After modifications to define labia and clitoris within each item, items were administered online to a random sample of 1686 English-speaking adult women in the U.S. through GfK’s KnowledgePanel®. Psychometric analyses included assessing unidimensionality using confirmatory factor analysis (CFA) and item response theory (IRT) modeling (Graded Response Model).

Results: Based on individual item frequencies, of all adult women in the U.S. who were sexually active in the past 30 days, 13% had experienced labial discomfort, 10% had experienced clitoral discomfort, and 11% were bothered by labial or clitoral discomfort during sexual activity. While some CFA fit statistics were acceptable for a unidimensional model, there was a significant amount of local dependence (LD) suggesting that items referencing labial discomfort were distinct from those referencing clitoral discomfort. To further inform our decision regarding dimensionality, we sought input from several clinicians who treat sexual dysfunction in women, who advised that the specificity of the 2-factor approach had greater utility. The final 2 scales each included 4 items, with 2 items assessing pain and 2 items assessing discomfort. In the full sample, the two scales were highly correlated (Pearson’s r= 0.77), but among women reporting any vulvar discomfort, these domains were moderately correlated (Pearson’s r=0.50), supporting the notion that these are empirically unique dimensions.

Conclusion: The PROMIS SexFS Vulvar Discomfort With Sexual Activity–Clitoral and Vulvar Discomfort With Sexual Activity–Labial scales had excellent psychometric properties and are brief enough for a range of clinical and research uses. These measures are important complements to existing vaginal discomfort and lubrication scales to allow a comprehensive assessment of female sexual function.

Disclosures:

Work supported by industry: no.

Group therapy focused on psychodrama for patients with genito-pelvic pain/penetration disorders: a qualitative study (#038)

A. Fanganiello (Brazil)
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038

Group therapy focused on psychodrama for patients with genito-pelvic pain/penetration disorders: a qualitative study

Fanganiello, A1; Lordello, M1; Ambrogini, C1; Zaneti, M1; Araújo, T1; Veloso, L1; Piccirillo, L1; Crude, B1; Silva, I1

1: Unifesp, Brazil

Main: Assess the effectiveness of a group therapy using psychodrama techniques in women with Genito-pelvic Pain/Penetration Disorders, who can't have penetration, seeking outpatient care for treatment.

Methods: This qualitative study selected 20 women between 23 and 45 years of age who could not have penetration for psychological reasons, selected by International Classification Diseases, tenth edition (ICD 10) criteria. They went  through 12 weekly psychodrama group therapy treatment sessions and four monthly maintenance sessions.

Results: From 20 women, 5 (25%) reached total penetration, 2 (10%) reached partial penetration, 6 (30%) had penetration with finger or dildos, 3 (15%) could touch their exterior genitalia and 4 (20%) dropped out before the end of the 12 sessions.

Conclusion: The Group Therapy focused on psychodrama was effective for women with penetrations difficulties raising emotional issues relevant to the management of this sexual dysfunction. Except for those 4 patients who abandoned the treatment, all participants had improved their sexual condition, even those who have not obtained as a result total vaginal penetration.

Disclosures:

Work supported by industry: no.

Effectiveness of physiotherapy treatment in disorders of vaginal penetration (#039)

C. Ambrogini (Brazil)
show abstract

039

Effectiveness of physiotherapy treatment in disorders of vaginal penetration

Veloso, L1; Bentes, L1; Laviola, B1; Ambrogini, C1; Lordello, M1; Embiruçu, T1; Zaneti, M1; Fanganiello, A1; Silva, I1

1: Unifesp, Brazil

Objective: Verify the effectiveness of physical therapy treatment in patients with disorders of penetration.

Material and Methods: This is a retrospective study analyzing the charts of patients attending at the physiotherapy sector of Female Sexuality Ambulatory in the period 2010-2013. In the present study were included that patients whose main complaint was unable to have vaginal penetration during  sexual intercourse. Werw collected data as: marital status, length of union, educational level, incidence of psychological disorder, history of sexual trauma, religion, number of physical therapy sessions and treatment outcome. The treatment of physiotherapy was based on the desensitization of the pelvic and perineal areas, digital vaginal introduction, and manual techniques of myofascial release and stretching of the pelvic floor musculature. The success of treatment was verified by the ability of the patient to be able to complete sexual intercourse including penetration of the penis.

Results: The sample consisted of 20 patients. The mean age was 31 (± 10.8) years; 95% of patients were in a stable relationship with a mean time of union of 6 (± 6.9) years; 40% of patients had college education; the predominant religions were catholic (45%) and evangelical (40%); 25% of patients had a history of depression and 30% reported some type of trauma or sexual abuse. The average number of sessions was 14.9 (± 9.4). In this study, 70% of patients were satisfied with the treatment and were considered cured, two of them became pregnant. On the other hand, 30% of the sample had their treatment discontinued by several issues, therefore, it was not possible to assess the final outcome of the treatment.

Conclusion: The physiotherapy treatment can be effective in treating patients with complaints of inability to vaginal penetration, but more studies assessing physiotherapy interventions and with representative samples are needed.

Disclosures:

Work supported by industry: no.

Outcomes of gender dysphoria treatment for trans men and trans women in the UK National Health Service (#040)

John Dean (United Kingdom)
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040

Outcomes of gender dysphoria treatment for trans men and trans women in the UK National Health Service

Quick, L1; Morris, R1; Morris, M1; Dean, J1

1: Devon Partnership NHS Trust, United Kingdom

Objectives: To assess treatment outcomes for trans men and trans women who complete a Gender Dysphoria Care Pathway based upon World Professional Association for Transgender Health (WPATH) Standards of Care, Version 7 (SoC v7), 2011.

Material and Methods: The Laurels Clinic of Gender and Sexual Medicine is a multi-disciplinary clinical service commissioned by the UK National Health Service (NHS). It delivers a range of interventions for the treatment of gender dysphoria directly, or commissions them from other providers. The care pathway is based upon the WPATH SoC v7. For trans men, this typically includes assessment, psychological therapies, virilising endocrine therapies, male chest reconstructive surgery and genital reconstructive surgery with phalloplasty. For trans women, this typically includes assessment, psychological therapies, epilation of facial hair, speech and language therapy, feminising endocrine therapies, augmentation mammaplasty and genital reconstructive surgery with vaginoplasty. Treatment is state-funded through the NHS. All patients completing the care pathway at least six months earlier and who had genital surgery (trans men and trans women) or chest surgery only (trans men) were identified from a database of all previous service users; the total study population comprised 37 trans men and 65 trans women. They were sent an invitation to complete an on-line questionnaire. This was completed by 20 (54%) trans men and 23 (35%) trans women. Trans people may avoid contacts that remind them of their gender past, affecting the study response rate.

Results: Improved psychological and emotional well-being was reported by 100% of trans men and 89% of trans women. Improved social well-being was reported by 100% of trans men and 89% of trans women. Stable or improved physical health was reported by 91% of trans men and 74% of trans women. 96% of trans men and 71% of trans women were in employment, training or had permanently retired.

Conclusions: There are very few studies of gender dysphoria treatment outcomes; most studies focus on regret following surgery. This survey demonstrates that trans people experienced improved psychological, emotional and social well-being, and stable or improved physical health after participation in a WPATH SoC v7-based care pathway; the great majority live productive lives, integrated within society, after treatment.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

The efficacy of a sexual health education Intervention for male rectal cancer patients (#041)

Chris Nelson (USA)
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041

The efficacy of a sexual health education Intervention for male rectal cancer patients

Nelson, C1; Schuler, T1; Philip, E1; Mulhall, J1; Jandorf, L2; Reiner, A1; Baser, R1; DuHamel, K1

1: Memorial Sloan Kettering Cancer Center, United States; 2: Mount Sinai School of Medicine, United States

Objective(s): Male rectal cancer patients show high rates of sexual dysfunction following treatment. We pilot tested a sexual health education intervention and hypothesized that the intervention would improve sexual function and psychosocial adjustment compared to usual care (UC).

Material and Method(s): Patients who had completed treatment for rectal cancer were randomized to (1) UC: consisted of a referral to a sexual medicine clinic and supplying the American Cancer Society booklet, “Sexuality for the Man with Cancer” and (2) Intervention: composed of UC plus four 1-hour sexual health education sessions and three follow-up telephone calls with a psychologist who discussed strategies to maximize compliance with treatment, reduce anxiety, and increase partner communication. Assessments were completed at baseline (pre-intervention), 4 months (m), and 8m. Outcome variables included: International Index of Erectile Function (IIEF), Sexual Self-Esteem and Relationship Questionnaire (SEAR), Sexual Bother Questionnaire (SB), and Impact of Events Scale (IES-R). Considering the pilot nature of this data, if differences were not significant, treatment effects were assessed by Cohen’s d effect size (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect).

Result(s): 71 men were randomized. Most were diagnosed with Stage III cancer. Treatment included surgery, chemotherapy, and radiation. Men in the intervention group improved compared to UC in: IIEF Erectile Function Domain at 4m (p=0.02) and 8m (p=0.04); Sexual Desire Domain at 4m (p=0.001) and 8m (p=0.03); and Overall Satisfaction Domain at 4m (p=0.04) and 8m (p=0.06). Effect sizes ranged from d=0.59 to d=1.37. These men also improved compared to UC on SB at 4m (p=0.02, d=-1.44) and 8m (d=-0.20), for SEAR Total scores at 4m (d=0.25) and 8m (d=0.56), and for the IES-R Total scores at both 4m (d=-0.33) and 8m (d=-0.65).

Conclusion(s): In the male rectal cancer population, pilot data support the utility of a brief sexual health education intervention in improving erectile function, libido, sexual satisfaction, while reducing sexual bother.  

Disclosures:

Work supported by industry: no.

Acceptance and commitment therapy for adherence to an erectile rehabilitation program (ERP) after radical prostatectomy (RP) (#042)

Chris Nelson (USA)
show abstract

042

Acceptance and commitment therapy for adherence to an erectile rehabilitation program (ERP) after radical prostatectomy (RP)

Nelson, C1; Pessin, H1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States

Objective(s): Intracavernosal injection therapy (ICI) is the cornerstone of many erectile rehabilitation programs (ERP). However, compliance with ICI is historically low. This RCT tested a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) to help men overcome barriers to using ICI.

Material and Method(s): Men were recruited when starting an ERP and randomized to ERP+ACT or ERP+Enhanced Monitoring (EM).  ERP+ACT received ERP plus 7 ACT sessions. ERP+EM received ERP plus 7 calls from a nurse practitioner. Assessments were at entry, 4 months (m), and 8m. The primary outcomes were feasibility, number of penile injections/week (verified by syringe count), and compliance (≥2 injections/week). Secondary outcomes were: ED treatment satisfaction, sexual self-esteem, sexual bother, and prostate cancer treatment regret. If differences were not statistically significant, effect sizes (d) are reported (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect).  

Result(s): 63 subjects were randomized (ACT n=32, EM n=31). The mean age was 60±7 years. The acceptance rate was 72%. At 4m, the ACT group utilized more injections/week vs. the EM group (1.73 vs. 0.95, p<0.01). Subjects in the ACT group were more compliant with ICI vs. the EM group (50% vs. 10%, p=0.01).  The ACT group reported greater satisfaction with ED treatment (d=1.01, p=0.09), greater sexual self-esteem (d=0.72, p=0.02), lower sexual bother (d=0.48, p=0.20) and lower prostate cancer treatment regret (d=1.21, p=0.02). At 8m, the ACT group continued to utilize more injections/week vs. the EM group (1.20 vs. 0.70, p=0.03). The ACT group also continued to report greater satisfaction with ED treatment (d=0.61, p=0.15), greater sexual self-esteem (d=0.69, p=0.05), and lower prostate cancer treatment regret (d=0.93, p=0.02).

Conclusion(s): Data suggest ACT is feasible, while increasing ICI use and compliance with an ERP. Data also indicate ACT increases ED treatment satisfaction and sexual self-esteem, while reducing sexual bother and prostate cancer treatment regret.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.


11:30 - 12:30
Instructional course 4 - Premature ejaculation: Update on management

Location: Ilhéus + Una Room
Chair: Amr El-Meliegy (Saudi Arabia)

Etiology and diagnosis

Ege Can Serefoglu (Turkey)

Psychological treatment

Stanley Althof (USA)

Pharma treatment

Chris McMahon (Australia)


Afternoon

12:30 - 14:00
Lunch break

Location: Comandatuba Room 1

12:45 - 13:45
Sponsored lunch symposium

Location: Comandatuba Room 2+3

14:00 - 15:30
Round table 3 - New pharma compounds for FSD

Location: Comandatuba Room 2+3
Chairs: Gerson Lopes (Brazil) & Sharon Parish (USA)

The evolution of the concepts and treatment of female sexual dysfunctions

Carmita Abdo (Brazil)

Central acting agents

Annamaria Giraldi (Denmark)

Peripherally acting agents

Irwin Goldstein (USA)


14:00 - 15:30
Moderated posters 6 - Other aspects of sexual medicine 2

Location: São Paulo Room
Chairs: Alejandro Carvajal (Colombia) & Eusebio Rubio-Aurioles (Mexico)

Perceptions and attitude towards the treatment of PE with traditional medication vs western medication: The result of SCOPE (Sexual Concerns On Premature Ejaculations) (#154)

M. Lam (United Kingdom)
show abstract

154

Perceptions and attitude towards the treatment of PE with traditional medication vs western medication: The result of SCOPE (Sexual Concerns On Premature Ejaculations)

Lam, M1; Loh, J2; Siaw, M3; Lim, L3; Razack, A4; Ong, T4; Lee, E3

1: University of Leicester, United Kingdom; 2: University of Southampton, United Kingdom; 3: Monash University, Malaysia; 4: Department of Surgery, University of Malaya, Kuala Lumpur

Objective: Premature Ejaculation (PE) is a commonplace medical condition affecting both men and their sexual partners in approximately 30% of the general population. The objective of this study aims to identify the perceptions and attitudes of treatment seeking preference between traditional and western medications in a rapidly developing and diverse socio-economic Asian country.

Methods: The study population was obtained primarily from both urological and non urological clinics in an urban tertiary hospital. Convenience sampling was employed and the participants completed a non-validated questionnaire which recorded their perception towards PE and the different treatment modalities. Demographical details of age, gender, income brackets and education backgrounds were also identified.

Results: A total sample population of 1541 subjects (792 males and 749 females) were enrolled into this study. Of which, 80.1% of the sample population agreed that PE is a condition treatable with medications. A huge majority of participants (95.5%) would readily accept any treatment interventions offered to them as they view it as necessary (92.2%). Despite such perception, only 79.5% of subjects would accept western medicine as their first line choice of therapy with only 88% believing it to be effective. It is noteworthy that 63.4% of the respondents would also readily accept traditional medications as an alternative remedy for PE.

Conclusion: This study has identified that majority of the respondents are keen and accepting in seeking medical treatment for PE. The general consensus agrees that western medication would yield promising results and is viewed as the first choice in PE management. As with most Asian communities, most of the participants are also open to the idea of using traditional medications as an alternative or adjunct in the treatment of PE. As such, further studies should be done to examine the different compounds that have been used traditionally and clinicians should address the risk of drug interactions and adverse effects through focused patient education.

Disclosures:

Work supported by industry: no.

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Effect of chronic skin diseases on female sexual function in upper Egypt (#155)

H. Abdel Hafez (Egypt)
show abstract

155

Effect of chronic skin diseases on female sexual function in upper Egypt

Abdel hafez, H1; Abdel Motalab, A1; Ismail, S1

1: Assiut University Hospital, Egypt

Objectives: Female sexual dysfunction in chronic diseases has become a popular and important health concern in recent years.  Dermatological diseases can have a significant impact upon sexual function. The aim of this study was to investigate sexual function in females with chronic dermatologic diseases in upper Egypt, for the first time to the best of our Knowledge.

Material and Methods: A total of 100 female patients with chronic dermatological problems and 100 healthy volunteers as age-matched control group were enrolled in the study. The validated Arabic version of Female Sexual Function Index (FSFI) was used to assess female sexual function. The cut-off score to define sexual dysfunction on the total FSFI score was obtained from a validation study that determined a total score below 26.55 to denote sexual dysfunction.

Results: This study included 100 patients (71 with vitiligo and 29 with psoriasis), their age ranged from 18 to 50 years with mean ± SD 36.11 ± 9.12 and 100 healthy control their age ranged from 18 to 50 years with mean ± SD 33.79 ± 8.17. Mean duration of the disease was 6.21 ± 6.50. Percentage of involvement ranged from 3-90% with mean ± SD 39.51 ± 28.11. Fifty two percent of the patients proved to have sexual dysfunction. Total FSFI score was not significantly decreased in patients versus control. However, there was statistically significant difference in some of its domains as lubrication, satisfaction and pain (p<0.05). Age of the patients showed negative correlation with desire, arousal, lubrication, orgasm, satisfaction and the total FSFI. Also,  the duration of the disease showed negative correlation with arousal, orgasm, satisfaction and total FSFI. However, the percentage of involvement of the disease showed no correlation with total FSFI or individual domains.

Conclusion: Sexual health is affected in female patients with chronic dermatological diseases. These patients need for physicians to implement attention on the impact of their diseases on sexual health in order to provide a better quality of life.

Disclosures:

Work supported by industry: no.

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Association between alexithymia and sexual self-efficacy in patients with erectile dysfunction and premature ejaculation (#156)

Itor Finotelli Jr. (Brazil)
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156

Association between alexithymia and sexual self-efficacy in patients with erectile dysfunction and premature ejaculation

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: Alexithymia is characterized by the difficulty in identify and describe emotions, lack of fantasies and cognitive style externally oriented. Researches associate negative influences of this condition in the sexual function. The objective for this study was to investigate such influences in the men sexual self-efficacy.      

Methods: Fifty-six (56) patients, who have been treated in a private clinic in Sao Paulo, Brazil, were assisted and, thirty-one (31) patients were diagnosed with premature ejaculation (PE) and twenty-five (25) with erectile dysfunction (ED). The ages vary between twenty (20) and fifty-eight (58) years old (M=32.61; SD=9.87), fifty-seven percent (57%) were single, thirty-six percent (36%) married and seven percent (7%) divorced. The majority of seventy-five percent (75%) of the participants had a Bachelor degree or equivalent. For this measurement, the Toronto Alexithymia Scale (TAS-26) and Sexual Self-Efficacy – Erectile Function (SSES-E) that evaluate the sexual function and dimensions denominated as obtaining and maintaining an erection, were used.

Results: No differences in the score for TAS-26 were found among subjects with PE and ED. For the SSES-S, the subjects with PE had higher scores compared to the subjects with ED in the total score and in the obtaining dimension. No differences were found in the maintaining dimension, which was expected because none of the dysfunctions is capable of providing favorable states for the erectile maintenance. For association between the instruments, moderate negative correlations were found only in the dimensions. In this case, the ability of sexual self-efficacy in behaviors on the erectile maintenance was compromised due to the high scores in the TAS-26 dimensions related to the difficulty in identify/describe feeling and distinguish bodily sensations, and the inability of expressing and understand emotions. This situation can compromise behaviors for the continuity of the erection, i.e. the communication about the way to stimulate; the capability of sexual attraction; the diversity of stimuli, besides penetration; the non-anxiety or fear during sexual activity; among others.

Conclusions: Related to alexithymia, the inability to identify feelings and the lack of ability to express emotions keep the negative association in the self-efficacy connected to erectile maintenance behaviors. This association can implicate in the clinical management of male sexual dysfunctions.

Disclosures:

Work supported by industry: no.

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The influence of marital myths when comparing clinical and non-clinical subjects (#157)

Itor Finotelli Jr. (Brazil)
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157

The influence of marital myths when comparing clinical and non-clinical subjects

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: Different social instances estipulate to a subject how one should act socially. These expectations are described by beliefs and attitudes connected to different social practices. Such beliefs may influence the way an individual behaves. The objective was to compare influences of marital beliefs in individuals with and without relationship complaints.

Methods: The sample was composed by sixty (60) participants, who have been treated in a private clinic and sixty (60) participants from a private university, both in Sao Paulo, Brazil. The clinical sample was composed by patients with marital complaints. The ages vary between twenty-one (21) and sixty-two (62), (M=30.30; SD=10.11), gender and type of sample do not vary according age. In order for the data to be collected, a questionnaire based in the book Marital Myths, from Arnold A. Lazarus, which contains twenty-four (24) myths related to marital practices. These myths were transformed in items and the score of the questionnaire was designated the greater the amount of claims, the higher one's belief.

Results: Differences were found in the score of the samples, in this case, the clinical participants confirm more myths compared to the university ones. Comparing items, two (2) had significant differences. In the search for dimensions, factorial analysis for main components and varimax rotation extracted three (3) dimensions which were denominated as Crisis Situation, Relationship Maintenance and Trust. Only the Relationship Maintenance dimension presented significant differences in the score of the sample, presenting higher score for the clinical participants.    

Conclusions: To assess the beliefs of an individual regarding marital relationship may represent an aspect to be intervened in people who seek processes of marital psychotherapy. In the research, the clinical sample presented higher frequency of the myths compared to the sample of individual without any marital complaints. These myths were connected to aspects of relationship maintenance. The results also presented the feasibility of using and the construction of scales to assess the beliefs of the individual regarding marital relationship.

Disclosures:

Work supported by industry: no.

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Comprehensive care for rape victims: Adherence to HIV/STD prophylaxis and to laboratory follow up at the Rape Victim Care Center, School of Medicine, University of São Paulo, Brazil (#158)

I. Nisida (Brazil)
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158

Comprehensive care for rape victims: Adherence to HIV/STD prophylaxis and to laboratory follow up at the Rape Victim Care Center, School of Medicine, University of São Paulo, Brazil

Nisida, I1; Boulos, M2; Atui, F3; Diegoli, C4; Segurado, A5

1: Rape Victim Care Center, Division of Infectious diseases, Hospital das Clínicas da FMUSP, Brazil; 2: Rape Victim Care Center, Division of Infectious Diseases,Hospital das Clínicas da FMUSP, Brazil; 3: Colorectal Surgery, Hospital das Clínicas da FMUSP, Brazil; 4: Gynecology, Hospital das Clínicas da FMUSP, Brazil; 5: Division of Infectious Diseases, Hospital das Clínicas da FMUSP, Brazil

Objective: To identify factors associated with completion of prophylactic interventions for rape victims in a tertiary university care setting. 

Methods: We conducted a retrospective medical chart review of patients who attended NAVIS (Rape Victim Care Center, School of Medicine, University of São Paulo) from 2001 to 2009. All patients were referred to NAVIS after having showed up at the emergency room of a tertiary university hospital in São Paulo, up to 72 hours after SA. All eligible patients were prescribed HIV/STD chemoprophylaxis (anti-retroviral drugs, ceftriaxone, metronidazole, azithromycin), hepatitis B immunization and submitted to a laboratory screening and follow-up (lab FU) that consisted of detection of anti-HIV, hepatitis B and C and syphilis antibodies. The study outcome – adherence to chemoprophylaxis and lab FU was classified as: incomplete (G1); complete chemoprophylaxis (G2) (patients treated as recommended for more than 30 days); and complete prophylaxis and lab FU (G3) (patients who completed chemoprophylaxis and hepatitis B immunization, and underwent 2 lab screenings on days 60 and 180 after SA. Using the Chi-square test patients from G2 and G3 were compared to those in G1 in regard to independent variables of interest that included: age, gender and SA characteristics [(known or unknown perpetrator), anatomical site (vaginal, oral or anal penetration)].

Results: 136 of 274 patients were eligible for HIV/STD prophylaxis: 109 (80.2%) female and 27 (19.8%) male; 103 (75.7%) over 14 years old. As far as the study outcome is concerned, 42 patients (30.9%) were classified in G2 and 59 patients (43.4%) in G3. Oral penetration was associated with complete chemoprophylaxis (p<0.001), whereas anal and oral penetration (p<0.001) and report of ejaculation (p<0.001) with completion of both chemoprophylaxis and lab FU. No patient tested positive for HIV infection on day 180.

Conclusion: Our results highlight factors associated with complete adherence to chemoprophylaxis, hepatitis B immunization and lab FU in rape victims assisted in a university care center in São Paulo. Special attention in future studies is warranted to the assessment of multidimensional barriers to completion of these prophylactic interventions, in order to enhance their effectiveness.

Disclosures:

Work supported by industry: no.

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Long-term erectile function outcomes in patients submitted to either trans-urethral resection (TURP) or holmium laser enucleation of the prostate (HoLEP) (#159)

P. Capogrosso (Italy)
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159

Long-term erectile function outcomes in patients submitted to either trans-urethral resection (TURP) or holmium laser enucleation of the prostate (HoLEP)

Capogrosso, P1; Boeri, L1; Serino, A1; Colicchia, M2; Ventimiglia, E1; La Croce, G2; Castagna, G1; Russo, A1; Damiano, R3; Montorsi, F1; Salonia, A1

1: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; 2: Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; 3: Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy

Objectives: Assess long-term predictive factors of erectile function (EF) outcomes in patients treated with HoLEP vs TURP for bladder outlet obstruction associated with benign prostate hyperplasia (BPH).

Methods: Data from 99 patients submitted to HoLEP and 102 patients submitted to TURP with a minimum 5-yr follow-up (FU) were analyzed. All patients completed a remembered (= targeting EF related to a date preceding surgery) and a real-time (= targeting EF over the 4 weeks prior to survey)IIEF-EF domain. Both a remembered and a real-time IPSS were also completed. Logistic regression models tested the association among potential clinical predictors and postoperative IIEF-EF scores [also considering Minimal Clinically Important Differences (MCIDs) criteria] in both groups.

Results: HoLEP patients showed higher preop prostate volumes than TURP patients [65.7 (34.3) vs 56.6 (23.3) ml; p=0.03). At long-term FU, post IPSS significantly improved after HoLEP [23.1 (7.5) vs 6.3 (5.4)] and after TURP [22.1 (6.2) vs 7.39 (5.5)], respectively (all p=0.001). A significant improvement was observed for irritative and obstructive symptoms in both groups (all p<0.001), without inter-groups differences. IIEF-EF values were significantly lower after surgery, without inter-groups differences [HoLEP: 24.27 (7.4) vs 17.1 (10.7); p=0.001; and, TURP: 22.6 (8.9) vs 13.6 (10.7); p=0.001]. Conversely, as a whole only 14 (7%) patients improved their EF after surgery, irrespective of type of surgery [7 (7.1%) vs 7 (7.0%)]. A significant improvement according to MCIDs criteria was observed in 12 (5.9%) patients. At MVA, preop IIEF-EF emerged as an independent predictor for either a postop improvement or a decrease of IIEF-EF for TURP patients (OR: 0.83; p=0.02; OR:1.1; p=0.01, respectively). Conversely, age at FU (OR:1.19; p<0.01) and preop IIEF-EF (OR:1.14; p=0.01) were associated with a decrease of postop IIEF-EF in HoLEP patients. TURP patients showed higher rates of overall postop complications than HoLEP patients [23.2% vs 6.1%; p=0.001].

Conclusions: Long-term FU data showed no differences between HoLEP vs TURP in terms of EF and urinary symptoms improvements after surgery. Preoperative EF emerged as an independent predictor of EF maintenance after both types of procedures.

Disclosures:

Work supported by industry: no.

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Autoimmune diseases are highly comorbid in patients with Peyronie's disease - Results of a cross-sectional real life study among caucasian-european men (#160)

P. Capogrosso (Italy)
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160

Autoimmune diseases are highly comorbid in patients with Peyronie's disease - Results of a cross-sectional real life study among caucasian-european men

Ventimiglia, E1; Colicchia, M2; Capogrosso, P2; Serino, A2; Boeri, L2; Castagna, G2; La Croce, G2; Russo, A1; Castiglione, F2; Montorsi, F1; Salonia, A2

1: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; 2: Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy

Objectives: We sought to investigate autoimmune diseases’ prevalence in a cohort of patients seeking medical help for sexual dysfunction, focusing on those complaining of Peyronie’s disease (PD).

Methods: Complete sociodemographic and clinical data from 1140 consecutive patients presenting for new-onset sexual dysfunction (Jan 2010 – June 2013) were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI) as a continuous or a categorized variable (0 vs 1 vs ≥2). Categorized measured body mass index (BMI) cut-offs were used as proposed by the NIH. All patients completed the International Index of Erectile Function (IIEF) domains. Autoimmune diseases were assessed through a comprehensive history examination and stratified according to ICD-9 classification.

Results: Of 1140, ED and PD were diagnosed in 665 (58.3%) and in 148 (13%) men, respectively. Of all, 34 (3%) patients had a confirmed diagnosis of  autoimmune disease. Among PD patients, 14 (9.5%) presented with an autoimmune disorder; conversely, non-PD patients did present an autoimmune disease in a significantly lesser amount of cases [20/992 (2%); c2: 24.7; p <0.001]. Patients with PD were older (mean (SD) age: 57.2 (13.1) vs 47.5 (15.6) years; p<0.001) as compared with non-PD individuals. Conversely, the two groups did not differ in terms of CCI, continuous or categorized BMI. At univariable analysis, cigarette smoking (OR: 1.54; p=0.04) was significantly correlated with PD. At multivariable analysis, age and a history of autoimmune disease achieved independent predictor status for PD (OR: 1.05; p<0.01, and OR: 5.74; p<0.001), after accounting for patient age, CCI, BMI and autoimmune diseases.

Conclusions: Autoimmune diseases emerge as highly comorbid with PD in a large cohort of individuals seeking medical help for sexual dysfunction in the real life setting.

Disclosures:

Work supported by industry: no.

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A geometric model of plaque incision and graft for Peyronie’s Disease with geometic analyses of different techniques (#161)

A. Miranda (Brazil)
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161

A geometric model of plaque incision and graft for Peyronie’s Disease with geometic analyses of different techniques

Miranda, A1; Sampaio, F2

1: Ipanema Federal Hospital, Brazil; 2: Urogenital Research Unit, State University of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil

Objective: To analyze the geometric and mechanical consequences of plaque incision and graft (PIG) on penile rectification surgery.

Material & Methods: A tridimensional penile simile model with a curvature of 85o was created to test all of the most common PIG techniques. PIG with double-Y, H-shape and Egydio techniques were used to rectify the curved penile model. The results that differed from a rectified cylinder shape were highlighted.

Results: All of the analyzed techniques created a geometric distortion that could be linked to poor surgical results. We suggest a new technique to resolve these abnormalities.

Conclusions: Current techniques designed to correct penile deviation using PIG present geometric and mechanical imperfections with potential consequences to the postoperative success rate. The new technique proposed in this report could be a possible solution to solve the geometric distortion caused by PIG.

Disclosures:

Work supported by industry: no.

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Efficacy of extended intralesional verapamil therapy for Peyronie's disease in early responders (#162)

John Mulhall (USA)
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162

Efficacy of extended intralesional verapamil therapy for Peyronie's disease in early responders

Berookhim, B1; Larish, Y 1; Chevinsky, M 1; Jakubowski, C 1; Jamzadeh, A 1; Nelson, C1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States

Objective: To report our experience using a total of 12 intralesional verapamil injections (ILVi), among men with a good response following the initial 6 ILVi for treatment of Peyronie’s disease.

Methods: The study population consists of men (i) with palpable penile plaque (ii) uniplanar penile curvature and (iii) who underwent 6 ILVi (10 mg verapamil in 5 ml saline) every 2 weeks. All patients were evaluated with a penile injection assisted deformity assessment (DA) at baseline. Those reporting improvement after 6 ILVi had a repeat DA within 2 weeks, and when clinical improvement was documented were offered an additional course of 6 ILVi. ILVi 7-12 were administered identically to the first 6 ILVi. A final end of treatment DA was conducted 3 months after last ILVi (number 12).

Results:  123 men had 6 ILVi. Mean duration of PD was 4±3 months. There was a non-significant mean 2.1 degree increase in curvature from baseline (35.0±18.3) to 6 injections (37.2±20.1, p=0.19). 30 (24%) had a >10 degree decrease, 53 (43%) were unchanged (<10 degrees increase/decrease), 40 (33%) >10 degree increase.

17 patients (10%) had documentable improvement after 6 injections and proceeded to 12 ILVi. Mean age = 51±12 years and the mean number of months with PD at the time ILVi was commenced = 4±4 (range 2-14) months. Following 6 ILVi, there was a significant reduction in mean degree curvature (41 to 30.0, p=0.05).  9 (53%) had a >10 degree decrease, 5 (29%) were unchanged (<10 degrees increase/decrease), 3 (18%) >10 degree increase. There was a mean reduction in curvature between 6 and 12 treatments of 3.8 degrees (30 to 26.2, p=0.28). 6 (35%) had a >10 degrees decrease, 7 (41%) were unchanged (<10 degrees increase/decrease), 4 (24%) >10 degree increase. Overall, among those patients who opted for 12 ILVi, there was a significant reduction in curvature from baseline to 12 injections (41 to 26.2, p=0.01, mean reduction=14.7).  9 (53%) had a >10 degree decrease, 4 (24%) were unchanged (<10 degrees increase/decrease), 4 (24%) >10 degree increase.

Conclusions: Among patients with demonstrated improvement following an initial course of 6 ILVi, one third will appear to experience further improvement with an additional 6 ILVi. Consideration should be given to a longer course of treatment for those men considered early responders to ILVi.

Disclosures:

Work supported by industry: no.

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International multicenter psychometric evaluation of patient reported outcome data for the treatment of Peyronie’s disease (#163)

V. Kueronya (Austria)
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163

International multicenter psychometric evaluation of patient reported outcome data for the treatment of Peyronie’s disease

Kueronya, V1; Miernik, A2; Kojovic, V3; Hatzichristodoulou, G4; Egydio, P5; Tosev, G6; Falcone, M7; Djordjevic, M3; Schoenthaler, M2; Fahr, C2; De Luca, F8; Kuehhas, F9

1: Medical University of Vienna, Department of Obstetrics and Gynecology 2 Medical University of Freiburg, Department of Urology; 2: Medical University of Freiburg, Department of Urology; 3: School of Medicine, University of Belgrade; 4: Technical University of Munich, Rechts der Isar Medical Center, Department of Urology; 5: Centre for Peyronie’s Disease Reconstruction, Sao Paulo; 6: Medical University of Heidelberg, Department of Urology; 7: Medical University of Turin, Department of Urology ; 8: Institute of Urology, University College London; 9: Medical University of Vienna, Department of Urology

Objective: To compare patient reported outcomes for the Nesbit procedure, plaque incision and grafting, and the insertion of a malleable penile implant following surgical correction of the penile curvature.

Material and Methods: A retrospective review was performed regarding men who underwent surgical correction of PD between January 2010 and December 2012 at six international centres. Patient functional outcomes and satisfaction were evaluated with a non-validated questionnaire. Furthermore, clinical data were retrospectively analyzed.

Results: The average response rate to the questionnaire was 70,9%, resulting in a study cohort of 206 patients. The Nesbit procedure, plaque incision with grafting, or implantation of a malleable penile prosthesis was performed in 50, 48, and 108 individuals, respectively. Overall, 79.1% reported a subjective loss of penile length due to PD (range 2.1-3.2 cm), preoperatively. Those patients treated with a malleable penile implant reported the greatest subjective penile length loss, due to PD.  A subjective loss of penile length of >2.5 cm resulted in reduced preoperative sex ability. Postoperatively, 78.0%, 29.2% and 24.1% patients in the Nesbit, grafting, and implant groups reported a postoperative, subjective loss of penile length (range, 0.4-1.2cm), with 86.3%, 78.6%, and 82.1% of the patients in each group, respectively, being bothered by loss of length.

Conclusion: Penile length loss due to PD affects the majority of patients. Further penile length loss due to the surgical correction leads to bother among the affected patients, irrespective of the magnitude of the loss. The Nesbit procedure was associated with the highest losses in penile length. In patients with PD and severe erectile dysfunction, a concomitant lengthening procedure may be offered to patients to help overcome the psychological burden caused by the loss of penile length.

Disclosures:

Work supported by industry: no.

The Nesbit procedure for Peyronie’s Disease: Six year follow up (#164)

F. De Luca (United Kingdom)
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164

The Nesbit procedure for Peyronie’s Disease : Six year follow up

Yap, T1; Raheem, A1; Spilotros, M1; De Luca, F1; Handalage, C1; Lucky, M1; Imbeault, A1; Muneer, A1; Christopher, N1; Garaffa, G 1; Ralph, D1

1: University College Hospital, United Kingdom

Objective: When treating Peyronie’s disease by plaque incision and grafting, the initial results are favourable, but at 5 years up to 67% of patients have deteriorated, usually due to erectile dysfunction (ED). Is this due to the type of operation or the disease itself? To answer this question we have therefore evaluated the six year outcome of the Nesbit procedure for Peyronie's Disease.

Material & Methods: Between 2006 and 2008, 116 patients underwent the Nesbit procedure (90 patients with Peyronie's disease and 26 controls with congenital curvature). Data was collected for risk factors of ED including diabetes, hypertension & hypercholestrolemia and the presence of residual curvature, penile shortening and sexual function (using the IIEF-5 questionnaire and objective use of PDE5 inhibitors).  The congenital group was used as controls as they had no pre-operative ED or risk factors. Fisher's exact test and unpaired t-tests were used to compare scores between groups as appropriate.

Results: Median follow-up was 78 months for all patients. Mean age of the Peyronie’s group was 57 (range 29 - 75), and 24 (range 16 -36) in the congenital group. Penile shortening > 1cm and residual curvature (> 30 degrees) was reported in 61% and 6% of Peyronie's patients (no significant difference with control group, p = 1.0). Pre-operative ED was present in 16% of Peyronie’s patients and new-onset ED requiring PDE5 inhibitors occurred in a further 7% at 3 months and 16 % at 6 years post op. At 6 years, 14% of men with pre-op and new onset ED had progressed from medication to injectables. The most significant risk factor in Peyronie’s patients for developing pre & post-op ED was hypertension (p < 0.05 compared to non ED patients). At 6 years, the mean IIEF-5  in the Peyronie’s patients was 16 and significantly lower than the controls at 25 (p <0.05).

Conclusion: The Nesbit operation may cause penile shortening and result in a residual curvature, but this occurs equally in both Peyronie’s Disease and controls. However, erectile dysfunction is common in Peyronie’s disease and deteriorates with time. As the control patients did not develop ED, the disease and not the type of operation is the likely cause. This difference is likely due to associated co-morbidities especially hypertension in the older Peyronie's group. This long term data will help with counselling and decision-making in men requiring surgical intervention.

Disclosures:

Work supported by industry: no.

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Medical sex therapy: A novel certification program that incorporates both sexual medicine and sex therapy training and didactic learning (#165)

Michael Krychman (USA)
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165

Medical sex therapy: A novel certification program that incorporates both sexual medicine and sex therapy training and didactic learning

Krychman, M1; Lee, S2

1: OBGYN, United States; 2: Sex Therapist, USA

Objective: Sexual Medicine is considered a multidisciplinary field of study. Many organizations focus on either the psychological training or medical expertise yet the integration of both facets to adequately train sexual health care specialists is often lacking.

Materials/Methods. The Florida Postgraduate Sex Therapy Training Institute of has developed an integrated program entitled, “Medical Sex Therapy.” The course consists of two 60 -hour courses which include didactic and interactive learning from an experienced sex therapist and a sexual medicine physician. The core curriculum is comprehensive and covers both male and female sexual function and dysfunction as well as paraphilia, sexual compulsivity, gender and orientation and unconventional sexual practices. Case presentation and hands on study is an integral part of the course work. The participant is required to review current sexual medicine and sex therapy research literature and preform detailed case study supervision with an expert accredited supervisor.  Once completion of the program, the participant may be certified in the state of Florida as a certified Sex Therapist. Medical Sex Therapy credits and supervision hours are fully accredited towards certification by the American Association of Sex Educators, Counsellors and Therapists (AASECT).

Results: To date, fifty-three health care professionals, from the following specialties: Ob/GYN, nurse practitioners, psychiatry, psychology, psychotherapy, marital counselling have attended the program, twenty have completed certification and ten are completing additional hours to fulfil AASECT certification. 

Conclusion: In order to best serve the client with sexual problems a multifaceted approach is often warranted. Didactic learning, case training, education and supervision in sexuality are necessary for comprehensive care of these complex patients.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Risk factors for diseases sexually transmitted infections (STIs) and its association with sexual behaviors in students of the Faculty of Medicine of the Universidad Autonoma de Queretaro (UAQ) (#166)

P. González Ortega (Mexico)
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166

Risk factors for diseases sexually transmitted infections (STIs) and its association with sexual behaviors in students of the Faculty of Medicine of the Universidad Autonoma de Queretaro (UAQ)

González Ortega, P1; Villaseñor Cuspinera, N1; García Gutiérrez, M1; Ávila Morales, J1; Leo Amador, G1

1: Universidad Autonoma de Queretaro, Mexico

Objective: To determine risk factors for diseases sexually transmitted infections (STIs) and its association with sexual behaviors in students of the Faculty of Medicine of the Universidad Autonoma de Queretaro(UAQ).

Material and Method: Observational study, involving students of medicine and Dentistry of the UAQ on a voluntary basis and with informed consent. The determination of the risk factor for STDs was made with the application of a questionnaire which evaluates sexual risk factors, consists of 9 items: homosexuality, multiple partners of the participant and his/her respective partner, sex with sex workers, exercising prostitution, bisexuality, use of the sharps, injecting drug user and the frequency of the use of the condom, and their theoretical basis is the standard official Mexican 003-SSA2-1993 criteria of opt-out for blood and organ donation. In addition, Hidalgo-San Martin et.al. 2003 validated instrument is used to measure social and personal sexual behaviors. The dimensions evaluated for social sexual behaviors: fantasy, search, image, casual dating and formal courtship. For social sexual behaviors were analyzed: external contact, Self-eroticism sensations, not genital intimate contact and intimate genital contact. The data processing was performed using SPPS, presenting the information in descriptive statistics and contingency tables. The association between variables was analyzed with Chi-square test and logistic regression was done.

Results: 648 students, of whom 445(68.6%) of medicine and 203 (31.4%) of dentistry. The average age was 20.6 years. Women represented by 374(57.7%) and the male 274(42.3%). Risk factors were assessed by gender, by determining Odds Ratio (OR) and Chi square. The significant results were:  multiple couples OR 2.92, CL (1.84-4.63) p =. 000; Prostitution OR 8.35, CL (1-185.12), p =. 019 and bisexuality OR. 2.90, CL (1.36-6.27), p =. 002. The significant social sexual behaviors were: Fantasy OR 2.53, CL (1.20-3.46), p =. 004; Image OR 6.47, CL (3.57-11.93), p=0.000; Dating casual OR 1.75, CL (1.05-2.92), p = .022.  Significant body sexual behaviors: Contact external OR 1.6, CL (1.02-2.77), p =. 030; Auto sexual sensations OR 4.5, CL (2.58-8.23), p =. 000 and intimate genital contact OR 1.56, CL (1.11-2.20), p =. 007.

X 2 test (Statistically significance p value <0.05) and 95% CL.

The risk factors for STDs were associated with: fantasy, image, casual dating, external contact, and genital contact.

Conclusions: There are differences in sexual behaviors between men and women, which should be considered for the design and implementation of educational strategies in sexual health focus to STD prevention.

Disclosures:

Work supported by industry: no.

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Proposal for an instrument for characterization of sexual experiences in childhood and / or adolescence (ICSECA) of individuals with compulsive sexual behavior (#167)

M. Scanavino (Brazil)
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167

Proposal for an instrument for characterization of sexual experiences in childhood and / or adolescence (ICSECA) of individuals with compulsive sexual behavior

Dos Reis, S1; Scanavino, M1

1: Institute of Psychiatry (IPq) of the Clínicas' Hospital of the University of São Paulo Medical School (FMUSP), Brazil

Objectives: One of the etiological factors of Compulsive Sexual Behavior (CSB) is Child Sexual Abuse (CSA). The consequences on mental health are directly related to the type of violence, the victim's reaction, characteristics of the abuse (duration, frequency, time, age, onset of abuse, type of kinship, type of sexual experiences, number of abusers), but there is a lack of measures to specific evaluation of individuals with CSB who suffered CSA in childhood. We aim to develop an instruments for the characterization of sexual experiences suffered in childhood and / or adolescence to specific evaluation in adults with CSB.

Method: A literature search was performed in the following databases: Pubmed, Lilacs and Scielo, with keywords: compulsive sexual behavior, sexual addiction, child sexual abuse, measures, scale and instruments, all of 1985/2014, in English and Portuguese. After deleting those papers unrelated to the topic, 25 articles were analyzed for the development of the instrument.

Results: The following aspects were considered most relevant: quantitative aspects (number of episodes, number of abusers, period in childhood and / or adolescence); qualitative aspects (age of victim, age of the abuser, bond, type of abuse (without contact or penetration)); experiential aspects ( past sexual experiences, past and present feelings  about the episode; if it was revealed; if it was the host family, if it was a traumatic experience; or involving seduction). All these aspects were investigated if the participant reported has had sexual experience before age 13 with someone at least 5 years older; and / or has had between 13 and 18 years with someone at least 10 years older. Based upon those aspects we drafted o the Instrument consisting of 25 closed questions for self-fulfillment.

Conclusion: There is a diversity of qualitative, quantitative and experiential aspects that should be investigated in order to characterize the experience of CSA in a sample of individuals with CSB. The characterization of CSA may facilitate investigations on the connections between sexual experiences in childhood and adolescence and mental and sexual health in adulthood of individuals with CSB.

Disclosures:

Work supported by industry: no.

show poster

Neuropsychological aspects about decision-making and cognitive flexibility of 25 patients with compulsive sexual behavior (CSB) and 25 controls (#168)

M. Scanavino (Brazil)
show abstract

168

Neuropsychological aspects about decision-making and cognitive flexibility of 25 patients with compulsive sexual behavior (CSB) and 25 controls

Messina, B1; Scanavino, M1

1: IPQ-HCFMUSP, Brazil

Objectives: There are few studies on Neuropsychological aspects of patients with compulsive sexual behavior (CSB), and the results are controversial. We aim to investigate through the Iowa Tests Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST), respectively, the Decision Making and Cognitive Flexibility, of 25 patients with CSB and 25 controls.

Methods: 25 men with CSB, after being diagnosed to 52.7 F Excessive sexual appetite (ICD-10), and sexual addiction (Goodman), underwent to neurocognitive assessment by neuropsychologist who applied the IGT and the WCST. They also answered the Sexual Compulsivity Scale (SCS).

Results: The patients presented higher scores (M = 28.4, SD = 7.07) than controls (M = 15.8, SD = 5.8) (P . <0.001) in the SCS. Regarding Decision Making (IGT), patients had lower scores (M = 13.2, SD = 25.81) than controls (M = 25. 12, SD = 24.0) (P = 0.04) in the variable Trend General (TG), as well as the first block of the analysis by segments (5 blocks), patients presented a tendency to scoring lower (M = -5.28 ; SD = 5.4) than controls (M = -1.12, SD = 5.8) (P = 0.006); suggesting an initial process of taking more impulsive decision.

Conclusions: The results suggest more impulsive decision making in patients with CSB when comparing with controls.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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14:00 - 15:30
Instructional course 5 - Patient selection and monitoring of TRT

Location: Transamérica Auditorium
Chairs: Ernani Rhoden (Brazil) & Luiz Otavio Torres (Brazil)

Laboratory diagnosis of testosterone deficiency

Jacques Buvat (France)

Metabolic and vascular risk factors

Miguel Rivero (Argentina)

TRT in the obese patient

Mario Maggi (Italy)

CV safety issues

Abraham Morgentaler (USA)


14:00 - 14:45
Workshop 7 - A step by step tutorial on PD surgery

Location: Ilhéus + Una Room
Chair: Guillermo Gueglio (Argentina)

A step by step tutorial on PD surgery: Incision and grafting

Wayne Hellstrom (USA)

New insights into tunical plication strategies

Laurence Levine (USA)


14:45 - 15:30
Workshop 8 - Penile duplex ultrasound

Location: Ilhéus + Una Room
Chair: Lawrence Hakim (USA)

How to diagnose penile vascular disease by duplex Doppler ultrasound

Chris McMahon (Australia)

Penile Duplex Doppler Ultrasound (PDDU) – keys to proper diagnosis, standardization and success

Suresh Sikka (USA)


15:30 - 16:00
Coffee break

Location: Comandatuba Room 1

16:00 - 17:00
Round table 4 - History of ISSM

Location: Comandatuba Room 2+3
Chairs: Sidney Glina (Brazil) & Chris McMahon (Australia)

The surgeon, the organizer,and the scientist

Ronald Lewis (USA) & Ira Sharlip (USA)

Jurassic Park in Latin America: the lost meetings

Edgardo Becher (Argentina)


16:00 - 17:00
Podium 8 - ED surgical

Location: São Paulo Room
Chairs: Rafael Carrion (USA) & Claudio Teloken (Brazil)

The Carrion Cast: An update on the usage of the intracorporal antimicrobial doped spacer for the treatment of penile implant infection (#043)

D. Martinez (USA)
show abstract

043

The Carrion Cast: An update on the usage of the intracorporal antimicrobial doped spacer for the treatment of penile implant infection

Martinez, D1; Alhammali, E1; Emtage, J1; Parker, J1; Carrion, R1

1: University of South Florida, United States

Objectives: Since the inception of the penile prosthesis, infection has always been a significant risk. With the advent of antibiotic coated implants the rate has decreased to 1-3%, and with the “no touch technique”, 0.7%. Despite this, infection is still a reality, and a devastating complication; resulting in a decrease in penile size, increase in pain, and loss of sexual function. We present our updated series of the “Carrion Cast”, antimicrobial spacer that maintains size while treating infection, bridging the gap between explantation and reimplantation.

Materials and Methods: From May 2012 to February 2014, 9 cases have been performed using high purity CaSO4 mixed with antimicrobials for the management of infected penile prosthesis in patients who are not candidates for immediate salvage. All cases had either already failed an immediate salvage and/or presented with bacteremia/septicaemia. 5 were Coloplast Genesis Semirigid Penile Prosthesis (SRPP), 2 were Coloplast Titan Inflatable Penile Prosthesis (IPP), and 2 were narrow SRPP’s, sizes ranging from 17cm to 23cm. All cases underwent complete removal of prosthetic material and modified “Mulcahy Salvage” wash. The amount of CaSO4 used varied, depending on the volume of corpora (20-30cc, split between the two corpora). Serum calcium, vancomycin and tobramycin levels remained stable while the cast was palpable within the corpora.

Results: Time to reimplantation varied (6-18 weeks), but most at 6 weeks, the time it takes for the cast to dissolve. All patients were able to have a prosthesis replaced: 1 SRPP, 3 IPP’s, 2 narrow SRPP’s, and 1 narrow IPP, with sizes ranging from 17cm to 20cm; 2 cases are still pending reimplantation. The mean loss of penile prosthesis length was only 1.1cm, meaning the average percent of penile length maintenance was 95%.

Conclusions: Penile prosthesis infection is devastating. Thanks to the “Mulcahy Salvage Protocol”, most cases can be immediately reimplanted. These cases, however, can be technically challenging, carry a higher rate of reinfection, and some patients are too sick for an immediate salvage. Thus, many infected implants undergo explantation and are left with a scarred, severely shortened penis, and inability to perform coitus. Thanks to the “Carrion Cast”, our small, yet growing series shows that they can be bridged with this antimicrobial-doped spacer, and reimplanted at 6 weeks, maintaining their penile length by 95%. Albeit a small series at this time, the “Carrion Cast” provides hope to this subset of patients that would otherwise be left in a terrible predicament.

Disclosures:

Work supported by industry: no.

“Just the tip”: Closed suction drain cultures after penile implant surgery with prolonged drains (#044)

D. Martinez (USA)
show abstract

044

“Just the tip”: Closed suction drain cultures after penile implant surgery with prolonged drains

Martinez, D1; Wallen, J1; Kongnyuy, M1; Emtage, J1; Carrion, R1; Parker, J1

1: University of South Florida, United States

Objectives: Closed suction drains have been used in penile prosthesis surgery for some time to prevent hematoma formation. Among some surgeons, there is a concern that these foreign bodies may increase the risk of infection by allowing retrograde migration of bacteria from the skin into the wound.  We present the culture results of these to assess for bacterial colonization after 72 hours of drain placement

Materials and Methods: In the past, we have presented our series of drains status post placement of an inflatable penile prosthesis. It consisted of approximately 100 drains left in for at least 72 hours, and none have experienced an infection to date. The last 5 drains removed have had two portions sent for anaerobic and aerobic culture, the distal tip and a section 1cm deep to the skin. An alcohol pad was first used to sterilize the skin, and all drains were removed in standard fashion.

Results: All 5 patients had their drains in place for 72 hours. None had any evidence of a hematoma at the time of drain removal. All 5 distal drain tips showed no evidence of bacterial growth. Only one of the four distal drain sections, 1cm from the skin, showed 2 colony forming units (CFU) of Staphylococcus (coagulase negative). The other 4, at 1cm from the skin, showed no growth after 48 hours.

Conclusions: Hematoma formation after penile prosthetic surgery can cause patient discomfort, prolonged postoperative recovery time, and may even act as a medium for potential bacterial proliferation. Postoperative drain placement for only 24 hours has been shown to decrease the rate of hematoma formation while not increasing the risk of infection. In our series of prolonged drainage of at least 72 hours, none have developed infections. Opponents of drain placement endorse the argument that there exists a hypothetical risk that the longer the drain is left in place, the higher the likelihood that bacteria may contaminate the surgical site possibly compromising the implant. We now present our initial series of drain sections, at different distances from the skin, sent for culture. Even after a prolonged period of time, the drain portions within the surgical site, in close contact with the prosthetic, do not show any evidence of bacterial colonization, even the sections close to the skin. While drain placement is still a surgeon preference, these results further supports the safe usage of closed suction drains in penile prosthetic surgery for the prevention of hematoma formation.

Disclosures:

Work supported by industry: no.

Improved infection outcomes after mulcahy salvage procedure and replacement of infected IPP with malleable prosthesis (#045)

M. Gross (USA)
show abstract

045

Improved infection outcomes after mulcahy salvage procedure and replacement of infected IPP with malleable prosthesis

Gross, M1; Eid, J2; Yang, C3; Simon, R3; Martinez, D3; Carrion, R3; Perito, P4; Levine, L5; Greenfield, J6; Munarriz, R1

1: Boston University Medical Center, United States; 2: Advanced Urological Care, United States; 3: University of South Florida, United States; 4: Perito Urology, United States; 5: Rush University Medical Center, United States; 6: Urology Associates of North Texas, United States

Objective: Since its introduction in 1996, Mulcahy salvage has significantly improved outcomes for removal and replacement of infected IPPs. Long-term follow-up data of Mulcahy salvage shows an infection-free rate of 82%. Since 2002, 55 patients have undergone Mulcahy salvage with IPP removal and replacement with malleable prosthesis at our institutions. Of these patients, 51 (93%) have remained infection free postoperatively. Additionally, 14 of these 55 patients have undergone subsequent malleable replacement with IPP. Our objective was to review the successful outcomes of this innovative variant of the salvage procedure.

Materials & Methods: This is a retrospective multi-institution study of 55 patients who underwent Mulcahy salvage with IPP removal and replacement with malleable prosthesis. Patients’ operative notes and charts were extensively reviewed to compile study data.

Results: Between 2002 and 2014, 55 patients underwent infected IPP removal and replacement with malleable prosthesis via Mulcahy salvage. Average age was 58, range 26 to 79. Average operative time was 169 minutes, range 79 to 264. Postoperative follow-up ranged from 2 weeks to 84 months. Forty-one of 55 patients retained malleable prosthesis, 14 patients subsequently underwent replacement with IPP. This occurred on average 7.7 months after Mulcahy salvage, range from 2 to 29 months. Four patients had persistent infection after Mulcahy salvage with malleable and underwent explant.

Conclusion: Mulcahy salvage procedure and replacement of IPP with malleable prosthesis has an improved infection-free rate of 93% when compared to the 82% infection-free rate after IPP removal and replacement. Additionally, 14 of the 55 patients who remained infection free were able to successfully undergo subsequent removal of malleable prosthesis and replacement with IPP an average of 7.7 months later.

Disclosures:

Work supported by industry: no.

Key factors and influencers impacting the penile implant decision (#046)

Chris Nelson (USA)
show abstract

046

Key factors and influencers impacting the penile implant decision

Nelson, C1; Hill, R2; Hakim, L3; Burnett, B4; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States; 2: American Medical Systems, United States; 3: Cleveland Clinic, United States; 4: Johns Hopkins Medical Institutions, United States

Objectives: For men with erectile dysfunction (ED), the decision to have penile implant surgery can be a difficult one. However, little is known about how men make this decision. We conducted two quantitative studies to explore the primary factors and relative influencers in the decision to move forward (or not move forward) with a penile implant.  

Material and Methods: Two separate IRB approved patient research studies were conducted. The first study was a quantitative survey of 257 men who had attended American Medical System (AMS) sponsored Patient Education Seminars on ED. The research assessed men at three time points: 1-2 months post-seminar (n=43), 3-6 months post-seminar (n=80), and 12-16 months post-seminar (n=134).  Survey length was approximately 30 min. Respondents answered questions on their ED history, the seminar itself, activities since the seminar, therapies tried and relative satisfaction, and potential barriers to penile implants.  The second study was also a quantitative survey of approximately 30 min in length. This study sample (n=61) consisted of men who had a recommendation from a urologist to receive a penile implant.  Half of this sample (n=31) had implant surgery, while the other half (n=30) decided not to receive an implant. The primary purpose of the study was to better understand the differences between these two groups.

Results: The primary factors across both study which lead to an implant were: 1) belief that it is the best solution for them, 2) trust and confidence in their urologist, and 3) a supportive spouse/partner.  Factors deterring patients from an implant included: 1) hope that a better solution exists, 2) concern about pain and other surgical side effects, and 3) concern about the reaction of their partner. Interestingly, the relative influence of key players in the decision was similar when comparing implanters vs. non-implanters: urologist (36% vs. 29%), the spouse/partner (23% vs. 27%), and the patient himself (34% vs. 29%).       

Conclusions: It is important for physicians treating ED to understand the dynamics behind a patient’s decision related to a penile implant. Both the urologist and the spouse/partner hold about the same relative influence as patient in this decision.   

Disclosures:

Work supported by industry: yes, by American Medical Systems (industry initiated, executed and funded study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

MRI analysis of architectural changes of the retropubic space and relevant structures post radical prostatectomy: Implications for penile prosthesis reservoir placement (#047)

John Mulhall (USA)
show abstract

047

MRI analysis of architectural changes of the retropubic space and relevant structures post radical prostatectomy: Implications for penile prosthesis reservoir placement

Sullivan, JF1; Foran, P1; Nelson , C1; Akin , O1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center

Objective: Insertion of a three-piece inflatable penile prosthesis (IPP) is commonly performed in men post radical prostatectomy (RP). The traditional reservoir placement in the space of retzius can result in damage to bladder, bowel and femoral vessels. In this study using pre and post operative magnetic resonance imaging (MRI) we aimed to assess the effects of RP on pertinent retropubic anatomy with respect to IPP placement.

Methods and Materials: Endorectal MRI studies in men with prostate cancer were reviewed. Inclusion criteria: (i) availability of pre and post operative MRI from single institution, (ii) post RP MRI (>6 months), (iii) no pre or post RP pelvic surgery or radiation. All scans were performed on a 3 Tesla system with T1 and T2 weighted images reviewed using axial and sagittal planes. Pertinent landmarks were evaluated by 2 independent readers, blinded to clinical and pathological data. All measurements were defined by an experienced radiologist. Measurements included (i) distance from external inguinal ring (EIR) to external iliac vein (EIV) (ii) superior aspect of pubic symphysis (PS) at midline to bladder and (iii) EIR to nearest bladder point. Correlation was measured between bladder volume and (iii). For distances (i) and (iii) bilateral measurements were obtained and data averaged as no significant differences were observed. Maximal post operative scar thickness in the retropubic space was quantified. Repeated measure t-test was used to assess differences in pre and post operative values.

Results: 22 patients were included in the analysis. Operative approach: open retropubic 64%, laparoscopic / robotic  36%. Both pre and post operative scans were reviewed. Mean pre and post operative measurements are reported (cm): (i) EIR to EIV: pre op 3.00 (1.94-3.83); post 2.95 (1.94-3.76), (ii) EIR to the nearest point of the bladder: pre op 2.62 (1.47-3.92); post 2.75 (2.10-4.10), superior aspect of PS to nearest point of bladder (midline): pre op 1.05 (0.56-1.82); post 1.09 (0.69-1.62). No significant differences were observed. Post operative midline retropubic scar thickness range 0.55-1.01cm. A significant difference was observed in mean scar thickness in open 0.55cm vs laparoscopic 0.28cm approaches (p=0.04)

Conclusions: In this study we have attempted to highlight the changes in the architecture of the retropubic space post RP. Patients undergoing a laparoscopic procedure have significantly less post operative scarring in this region. Although not currently routine, reviewing MRI prior to IPP placement may aid in pre operative planning, selection of appropriate prostheses and reservoir placement location.

 

Disclosures:

Work supported by industry: no.

Utilization of pre-operative penile stretch test as a predictor of erection and total implant length (#048)

H. Ayoub (USA)
show abstract

048

Utilization of pre-operative penile stretch test as a predictor of erection and total implant length

Ayoub, H1; Westney, O1; Perito, P2

1: MD Anderson Cancer Center, Houston, USA; 2: Perito Urology, Florida, USA

Objectives: Prediction of the erection and total corporal length prior to inflatable penile prosthesis (IPP) surgery is of great benefit to both the surgeon and the patient. For the patient, estimation of the post-operative result is helpful in creating realistic expectations. The ability to accurately calculate the range of the total implant length utilizing a penile stretch test could focus the amount of inventory shipped for an individual procedure.   Thus, we sought to determine whether a formula based on the pre-operative stretch length could reliably predict the total corporal length.

Methods: Fifty-three consecutive virgin IPP patients were performed by a single surgeon over 30 days. All patients received a Coloplast Titan® IPP through an infrapubic approach. In all patients, a pre-operative stretch test was performed using Furlow along the dorsal aspect of the penis from the mons pubis to the tip of the glans. Intraoperatively, the same measurements were repeated after induction of normal saline artificial erection and after implantation and inflation of the device. Formulas based on the stretch test were constructed to predict the total device length [stretch test + (x%) stretch test].  Descriptive statistics, paired significance testing and linear regression were performed using Stata 13.

Results: In comparing the three penile measurements, the stretch test and the post-implant measurement were not statistically different (p-value=0.3878). The artificial erection length was statistically different from both penile stretch and post-implant lengths (p< 0.0001). On linear regression, all measurements demonstrated a significant linear relationship with the overall implant length with inflated post-implant length having the highest correlation. The linear formula, stretch test + (0.35) stretch test, predicted the total device length within the range [stretch test (cm) to calculated value (cm)]  in 96% of cases. (Table I) Rear tip extenders, primarily 1 cm, were utilized in 25 cases (47.2%). No total implant length was less than the pre-operative stretch test. 

Conclusion: The preoperative stretch test demonstrated a high correlation with post-implant erection length and total IPP device length in this pilot dataset.  The formula for estimating total device length will need to be verified prospectively to determine its reproducibility. 

Table I: Correlation between predictive formulas and final implant length

Abstract 048

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.


16:00 - 17:00
Round table 5 - Hormones and womens sexuality: Contraception and sexuality, menopausal women and HRT

Location: Transamérica Auditorium
Chairs: Annamaria Giraldi (Denmark) & Monica Lijtenstein (Uruguay)

Contraception

Susan Kellogg-Spadt (USA)

Menopause

Victoria Bertolino (Argentina)

Hormones, menopause and oncology

Alessandra Graziottin (Italy)


16:00 - 16:45
Workshop 9 - ICI program: Drugs and combinations

Location: Ilhéus + Una Room
Chair: Eduardo Bertero (Brazil)

Intracavernous injection therapy for ED: Indications and contra-indications, complications and treatment

Hossein Sadeghi-Nejad (USA)

Intracavernous injection therapy for ED: What is the best dose and mixture (combination) for my patient? How I manage the medication in my practice? Drop out rates and complications

Ricardo Munarriz (USA)


17:00 - 18:30
ISSM business meeting

Location: Comandatuba Room 2+3

Saturday

Morning

07:45 - 08:30
Sponsored breakfast symposium

Location: Comandatuba Room 2+3

08:30 - 09:00
Master lecture 7 - Hypersexuality/Sexual addiction

Location: Comandatuba Room 2+3
Chairs: Romulo Aponte (Venezuela) & Eli Coleman (USA)

Hypersexuality/Sexual addiction

Kevan Wylie (United Kingdom)


09:00 - 09:30
Master lecture 8 - Postorgasmic illness syndrome

Location: Comandatuba Room 2+3
Chairs: Stanley Althof (USA) & Juan Uribe (Colombia)

Postorgasmic illness syndrome

Chris McMahon (Australia)


09:30 - 10:00
Master lecture 9 - Permanent adverse effects after 5ARI treatment

Location: Comandatuba Room 2+3
Chairs: Sharon Parish (USA) & Lucia Pesca (Brazil)

Permanent adverse effects after 5ARI treatment

Mohit Khera (USA)


10:00 - 10:30
Coffee break

Location: Comandatuba Room 1

10:30 - 11:00
Special lecture - The road to ICSM 2015

Location: Comandatuba Room 2+3
Chairs: Sidney Glina (Brazil) & Chris McMahon (Australia)

The road to ICSM 2015

Gerald Brock (Canada)


10:30 - 11:30
Moderated posters 7 - Basic science 2

Location: São Paulo Room
Chair: Ronald Lewis (USA)

Efficacy of pioglitazone on erectile function recovery in a rat model of post-prostatectomy erectile dysfunction (#169)

Ronny Tan (Singapore)
show abstract

169

Efficacy of pioglitazone on erectile function recovery in a rat model of post-prostatectomy erectile dysfunction

Aliperti, L1; Tan, R1; Lasker, G1; Hagan, S2; Hellstrom, JA1; Gokce, A1; Trost, L3; Kadowitz, P1; Sikka, S1; Hellstrom, W1

1: Tulane University School of Medicine, United States; 2: Tulane University School of Medicine, United States School of Medicine; 3: Mayo Clinic, United States

Objectives: To examine the effect of pioglitazone on erectile function (EF) in a rat model of post-prostatectomy erectile dysfunction (ED).

Methods: Twenty adult rats were divided into four groups: a) sham, b) control - bilateral cavernosal nerve crush injury (BNCI), c) BNCI + low-dose pioglitazone (PioL) and d) BNCI + high-dose pioglitazone (PioH). Sham and control rats were administered phosphate buffered saline, while PioL and PioH rats received 0.65 and 6.5 mg/kg of pioglitazone, respectively. All treatments were administered by oral gavage for 14 days.  Following treatment, animals underwent surgery for endpoint cavernosal response to define hemodynamic parameters of erectile function reported as the ratio of intracavernosal pressure to mean arterial pressure (ICP/MAP). Corporal tissue was retrieved for histologic and molecular analysis.

Results: Animals treated with pioglitazone experienced dose-dependent improvements in ICP/MAP, with PioH achieving results similar to sham:  sham 0.774; BCNI 0.421; PioL 0.616; PioH 0.758 (p=0.0006). PioH animals demonstrated increased expression of eNOS and nNOS, while both PioL and PioH had increased staining for anti-smooth muscle actin antibody and non-significant increases in cGMP.

Conclusion: Pioglitazone improves EF in rats undergoing BNCI via a nitric-oxide mediated pathway.

Disclosures:

Work supported by industry: no.

show poster

Peripheral effects of opiates agonist in isolated corpus cavernosum (#170)

R. Rodrigues (Brazil)
show abstract

170

Peripheral effects of opiates agonist in isolated corpus cavernosum

Rodrigues, R1; de Oliveira, M2; Antunes, E1; De Nucci, G1; Mónica, F1

1: UNICAMP, Brazil; 2: UNIVAP, Brazil

Objective: The peripheral effects of opiates in the corpus cavernosum (CC) are controversial, since both detumesce and priaprism were observed. To date, there are no studies that evaluated the role of opiate system in isolated CC. The aim of this work was to assess the peripheral effects of opiates in isolated CC from rats (RCC).

Material and Methods: Concentration-response curves to fentanyl,  loperamide and endomorphin-1 were carried out in the absence and presence of the non-selective opiate antagonist (naloxone 10 µM), selective µ-opiate antagonist (ciprodime 100 nM), soluble guanylyl cyclase inhibitor (ODQ 10 µM), nitric oxide synthase inhibitor (L-NAME, 100 µM) or potassium channel blockers (glibenclamide 10 µM, tetraetylammonium 1 uM, apamine 100 nM and charybdotoxin 100 nM) in tissues pre-contracted with phenylephrine (PE, 10 µM). In vivo assay was realized by determining basal and stimulated intracavernous pressure (ICP) before and after intracavernosal infusion of fentanyl (4 µg/kg, 5 min). Immunohistochemical analysis for µ and δ- opioid receptors was also carried out.

Results: Immunohistochemical analysis revealed the expression of µ and δ- opioid receptors in nerve fibers of RCC. The µ-opiate agonists (n=5) fentanyl, loperamide and endomorphin-1 produced concentration-dependent relaxation with values of Emax of 110 ± 3%; 105 ± 3%; 57 ± 2% and pEC50 of 5.81±0.06; 4,94±0.04; 5,57±0.07 (n=5), respectively. Naloxone did not alter the relaxation induced by µ-opiate agonists, while the selective µ-opiate antagonist ciprodime caused a 1.7-fold and 1.5-fold (P<0.05) on the relaxation induced by fentanyl and loperamide. The potassium channel blockers significantly reduced the values of pEC50 relaxation of fentanyl 5.57 ± 0.03 and loperamide (4.39 ± 0.04). Neither L-NAME nor ODQ altered the relaxation induced by opioids agonists. Intracavernosal infusion of fentanyl increased the basal ICP on 3.8 ± 0.5 mmHg and stimulated ICP (from 36,5 ± 2,8 to 48,6 ± 4,5, P<0.05).

Conclusions: Opioids receptors are expressed on RCC and their agonists induced relaxation. However, further studies should be carried out in order to verify whether these receptors have any role on the neurotransmitters release and thus on erectile function.

Disclosures:

Work supported by industry: no.

show poster

Nonalcoholic steatohepatitis as a novel player in metabolic syndrome-induced erectile dysfunction: An experimental study in the rabbit (#171)

Mario Maggi (Italy)
show abstract

171

Nonalcoholic steatohepatitis as a novel player in metabolic syndrome-induced erectile dysfunction: An experimental study in the rabbit

Vignozzi, L1; Filippi, S2; Comeglio, P1; Cellai, I3; Sarchielli, E4; Morelli, A4; Rastrelli, G1; Maneschi, E3; Galli, A5; Vannelli, G4; Saad, F6; Mannucci, E7; Adorini, L8; Maggi, M1

1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences and Department of NEUROFARBA, University of Forence, Italy ; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Italy; 5: Gastroenterology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 6: Global Medical Affairs Men’s Healthcare, Bayer Pharma AG, Berlin, Germany; 7: Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Italy; 8: Intercept Pharmaceuticals, New York, USA

Objectives: A pathogenic link between erectile dysfunction (ED) and metabolic syndrome (MetS) is now well established.  Nonalcoholic steatohepatitis  (NASH),  the hepatic hallmark of MetS, is regarded as an active player in the pathogenesis of MetS-associated cardiovascular disease. The aim of this study was aimed at evaluating  the relationship between MetS-induced NASH and penile dysfunction.

Material and Methods:  We used a non-genomic, high- fat diet (HFD)-induced  rabbit model of MetS, and treated  HFD  rabbits with testosterone (T), with the farnesoid X receptor agonist obeticholic acid (OCA), or with the anti-TNFa mAb infliximab. Rabbits fed a regular diet were used as controls.

Results:  Liver histomorphological and gene expression analysis demonstrated NASH in HFD rabbits. Several genes related to inflammation  (including TNFa), activation of stellate cells, fibrosis, lipid metabolism  parameters were negatively associated to maximal acetylcholine (Ach)-induced–penile relaxation. When all these putative  liver  determinants of penile Ach responsiveness were tested as covariates in a multivariate model, only the association between hepatic TNFa expression and Ach response was confirmed. Accordingly, circulating levels of TNFa were increased in HFD  rabbits. T and OCA in HFD  rabbits  both  reduced TNFa liver expression and plasma levels, with a parallel increase of penile eNOS expression  and Ach-responsiveness. Also neutralization of TNFa with  infliximab treatment normalized HFD-induced hypo-responsiveness to Ach, as well as responsiveness to vardenafil, a PDE5 inhibitor.

Conclusions: MetS-induced NASH in HFD rabbits plays an active role in the pathogenesis of ED, through TNFa,  as indicated by treatments reducing liver and circulating  TNFa  levels, or neutralizing TNFa action, which improve Ach-penile responsiveness in HFD rabbits.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Metformin in vitro and in vivo increases adenosine signalling in rabbit corpora cavernosa (#172)

Mario Maggi (Italy)
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172

Metformin in vitro and in vivo increases adenosine signalling in rabbit corpora cavernosa

Vignozzi, L1; Filippi, S2; Comeglio, P1; Cellai, I3; Morelli, A4; Rastrelli, G5; Maneschi, E 1; Mannucci, E6; Maggi, M3

1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences and Department of NEUROFARBA, University of Forence, Italy ; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Italy; 5: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence,Italy; 6: Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Italy

Objective: In subjects with erectile dysfunction responding poorly to sildenafil, metformin was reported to improve erections. The aim of this study was to investigate metformin's mechanism of action on erectile function, focusing on adenosine  (ADO) and nitric oxide  (NO) signaling in an animal model of high fat diet (HFD)-induced metabolic syndrome.

Material and Methods: In vitro contractility studies were used to investigate the effect of in vivo and ex vivo metformin administration on ADO-or acetylcholine  (Ach)-induced relaxation of penile strips from HFD, as compared  to animals fed a regular diet (RD). We evaluate also the expression of genes related to penile smooth muscle relaxation and contractility.

Results:  Expression of ADO receptor type 3 (A3R), ADO deaminase  (ADA), AMP deaminase type 1 (AMPD1)  and 2 (AMPD2)  was decreased in HFD, as compared to RD. Accordingly, in HFD the ADO relaxant effect was potentiated as compared to RD. In vivo metformin treatment in both RD and HFD significantly increased the ADO relaxing effect, although to a different extent. In penile strips from HFD, in vivo metformin normalized  A3R,  ADA  and  AMPD1, further decreased  AMPD2, increased dimethylarginine-dimethylamino-hydrolase and restored impaired Ach-induced relaxation. Ex vivo metformin time-and dose-dependently increased the relaxant effect of ADO in RD. The potentiating effect of metformin on ADO-induced relaxation was significantly reduced by pre-incubation with NOS inhibitor L-NAME.  Interestingly, in vivo testosterone supplementation in HFD rabbits increased penile expression of eNOS, AMPD2 and  restored metformin’s potentiating effect on ADO induced relaxation, up to RD level.

Conclusions:  In conclusion, metformin in vivo and ex vivo increases ADO signalling in CC, most probably interfering with NO formation and ADO breakdown.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Excessive fructose administration from childhood may induce oxidative stress via the AGE-NADPH oxidase pathway, resulting in erectile dysfunction in adult rats (#173)

Y. Hotta (Japan)
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173

Excessive fructose administration from childhood may induce oxidative stress via the AGE-NADPH oxidase pathway, resulting in erectile dysfunction in adult rats

Hotta, Y1; Nakamura, D1; Yahagi, R1; Kataoka, T1; Maeda, Y1; Kimura, K1

1: Nagoya City University, Japan

Objective: Fructose is widely used in many sweets and beverages. Excessive fructose administration induces oxidative stress via the activation of NADPH oxidase by advanced glycation end products (AGE). However, it is unknown how excessive fructose administration from childhood affects erectile function in adulthood. In this study, we investigated the relationship between excessive fructose administration and erectile dysfunction in rats.

Materials and Methods: Four-week-old male Wistar-ST rats were divided into three groups: control, 5% fructose, and 10% fructose. Control rats were given normal water, while those in the treatment groups were given 5% or 10% fructose water to drink at libitum for eight weeks. After eight weeks, the levels of blood glucose (BG) and serum bioavailable testosterone (bio-T) were measured, and erectile function was assessed. Serum bio-T levels were measured by UPLC/MS/MS. Erectile function was evaluated by gauging changes in the intracavernous pressure (ICP)/mean arterial pressure (MAP) ratio under stimulation of the cavernous nerve. mRNA expression of receptor for AGE (RAGE) and NADPH oxidase 1, 2, and 4 in the corpus cavernosum (CC) of the animals was measured by real-time PCR analysis. ANOVA and Bonferroni’s multiple t-test were used for statistical analysis.

Results: No intergroup difference was observed in the body weight of the animals. BG levels in the 5% and 10% fructose groups were higher than those in the control group. ICP/MAP ratios of the fructose-treated animals were significantly lower (p < 0.05) than those of the control animals. Bio-T levels in the fructose-treated animals were lower (in a dose-dependent manner) than those in the control animals ( p < 0.05; 10% fructose group). Moreover, mRNA expression of RAGE and NADPH oxidase 1, 2, and 4 in the CC of the fructose-treated animals was dose-dependently higher than that in the control animals.

Conclusions: Excessive administration of fructose from childhood may induce erectile dysfunction in adult rats because of the production of oxidative stress via the AGE-NADPH oxidase pathway.

Disclosures:

Work supported by industry: no.

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Decreased basal levels of neurotrophic factors and impaired neurite outgrowth in major pelvic ganglia from type 2 diabetic rats with erectile dysfunction (#174)

Trinity Bivalacqua (USA)
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174

Decreased basal levels of neurotrophic factors and impaired neurite outgrowth in major pelvic ganglia from type 2 diabetic rats with erectile dysfunction

Hannan, J1; Musicki, B1; Liu, X1; Burnett, A1; Bivalacqua, T1

1: Johns Hopkins School of Medicine, United States

Objectives: Type 2 diabetes is a common disorder that causes progressive damage to the autonomic nervous system leading to erectile dysfunction (ED).  Furthermore, obese diabetic men have significantly worse ED outcomes following radical prostatectomy (RP) than men without diabetes. This study aimed to characterize the basal levels of neurotrophic factors and neurite outgrowth in the major pelvic ganglia (MPG) of a high fat diet/low dose streptozotocin (STZ)-induced type 2 diabetic rat model. 

Material and methods: Male Sprague-Dawley rats were fed a high-fat diet (60% Kcal) for two weeks followed by 2 low dose injections of STZ (20 mg/kg) to induce diabetes.  Rats were continuously fed the high fat diet and assessed at 3 and 5 weeks after diabetes induction.  Control rats were fed a normal chow diet.  Blood glucose was recorded and erectile function was assessed by measuring the ratio of intracavernosal pressure to mean arterial pressure (ICP/MAP) after cavernous nerve stimulation.  MPGs were collected and gene expression analysis by qPCR was performed for neurotrophic factor 3 (NT3), nerve growth factor (NGF), glial-derived neurotrophic factor (GDNF) and brain derived neurotrophic factor (BDNF).  Additional MPGs (n=4/group) were cultured in reduced growth factor matrigel for 48h and neurite growth was measured. 

Results: Blood glucose was elevated 3 and 5 weeks following diabetes induction compared to controls (215±13, 223±12, 76±1.8 mg/dl, respectively; p<0.05). Erectile function was significantly decreased in all diabetic rats compared to controls (6V, ICP/MAP: 3wk 0.55±0.093; 5wk 0.51±0.088; Con 0.84±0.027; p<0.05). There was a slight decrease in the gene expression of NT3, NGF, GDNF and BDNF after 3 weeks of diabetes. After 5 weeks of diabetes, NT3, NGF and BDNF was significantly lower than controls (p<0.05). MPG neurite outgrowth was significantly decreased in type 2 diabetic rats after 3 and 5wks compared to controls in sham (3wk: 224±19μm; 5wk: 190±24μm; Con: 315±8μm, p<0.05).  

Conclusions: Neurotrophic factors are significantly decreased in MPGs from early type 2 diabetic rats and may contribute to decreased neuronal outgrowth. These deficits in neurotrophic factors may help explain why diabetic men have less erectile function recovery following RP and increasing neurotrophic growth factors may have therapeutic benefit in the treatment of diabetic peripheral neuropathy.

Disclosures:

Work supported by industry: no.

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Lower gap between ideal and actual partners (GIAP) in relationship and sexual hierarchy predicts relationship satisfaction in heterosexuals, but in homosexals only sexual GIAP matters (#175)

J. Varella Valentova (Czech Republic)
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175

Lower gap between ideal and actual partners (GIAP) in relationship and sexual hierarchy predicts relationship satisfaction in heterosexuals, but in homosexals only sexual GIAP matters

Varella Valentova, J1; Varella, M2

1: Charles University in Prague, Czech Republic; 2: University of Brasilia, Brazil

Objectives: Sexual and romantic relationships are usually initiated through mutual attraction, which is, at least to some point, set by individual partner preferences. Nevertheless, ideal partner preferences and actual mate choices can differ to some degree. In general, it is expected that higher Gap between Ideal and Actual Partner (GIAP) can negatively influence relationship satisfaction, regardless of gender and sexual orientation. We tested whether the level of dominance in actual relationship and sexual activity, and also whether the GIAP in dominance influences the current relationship quality.

Material and Methods: Coupled Czech and Brazilian 514 women (459 heterosexual), and 297 men (168 heterosexual) between 18 and 40 years filled in online questionnaires, where they reported their age, length of the current relationship, sexual orientation, Dyadic Adjustment Scale (DAS), their ideal preferences for dominance in relationship and sex, and their actual dominance in relationship and in sex with the current partner. We computed absolute differences between preferred and actual dominance and regressed them on DAS.

Results: In heterosexual men, lower GIAP in relationship and sex and also lower actual dominance predicted increased relationship satisfaction. In heterosexual women, controlled for age, lower GIAP in both relationship and sex, and also lower relationship duration predicted increased DAS. In both homosexual men and women, only lower GIAP in sexual dominance predicted increased DAS.

Conclusions: As predicted, smaller GIAP in relationship and sexual dominance increased perceived overall relationship quality in heterosexual men and women. However, in homosexuals only GIAP in sexual dominance did so, which suggests that how they resolve the same-sex intercourse is more decisive for them than relationship hierarchy. Thus, sexual orientation matters when it comes to sexual dominance and relationship satisfaction. Furthermore, more submissive heterosexual men but heterosexual women in shorter relationships reported greater relationship satisfaction. These results held across the ethnically distinct populations, which adds support to a more universal pattern in romantic relationship dynamics.

Disclosures:

Work supported by industry: no.

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Spider venom toxin Tx2-6 from Phoneutria nigriventer induces priapism even after cavernousal denervation in mice (#176)

L. Troncone (Brazil)
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176

Spider venom toxin Tx2-6 from Phoneutria nigriventer induces priapism even after cavernousal denervation in mice

Ravelli, K1; Ramos, A1; Gonçalves, L1; Magnoli, F1; Troncone, L1

1: Instituto Butantan, Brazil

The Phoneutria nigriventer spider toxin Tx2-6 causes priapism in humans and mice. NO-Synthase inhibitors abolish toxin-induced priapism as well as all the other symptoms of intoxication.

Objectives: to investigate if cavernousal denervation abolishes the toxin-induced priapism, the role of NO signaling in this process using the NO-sensitive fluorescent dye DAF-FM, and nitrite assay method of Griess;

Methods: mice penis samples were incubated in the presence of the NO-sensitive fluorophore DAF-FM and observed with a confocal fluorescence microscope before and after the addition of Tx2-6 toxin as well as L-NAME and Sodium Nitropruside (SNP) controls; total nitrites were assayed by the Griess method in control and toxin-exposed penile sections and controls; cavernosal nerve excision/denervation performed in mice was confirmed by histological assessment of fibrosis (Mason’s trichromic staining) immunohistochemical staining for synaptophysin, and failure in fertilizing female mice; toluidine blue staining was also performed;

Results: normal tissues controls treated with L-NAME, SNP and saline showed a steady increase in fluorescence and tissue incubated with toxin showed the same trend as well; production of nitrites assayed by the Griess method also failed to detect toxin-induced increases while NPS caused a dose-dependent increase and L-NAME a small decrease. Denervated mice showed intense fibrosis of the cavernousal tissue as well as absence of synaptophysin IHC staining; surprisingly mice showed toxin-induced priapism when tested 30 or 60 days after denervation; while sham-operated mice presented full priapism denervated animals showed partial priapism possibly due to the fibrosis.

Discussion: confocal DAF-FM imaging showed remarkable NO-related staining of mastocytes (confirmed by toluidine blue staining) but failed to show NO-related fluorescence in cavernousal tissue (possibly given to the high auto-fluorescence of this tissue) but the absence of nitrite accumulation after toxin cast doubts on the involvement of NO signaling; most importantly, these results reveal that erection caused by Tx2-6 toxin might not be depend on penile nerves integrity and opens a new perspective for the treatment of erectile dysfunction.

Disclosures:

Work supported by industry: no.

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Open comparative cross-sectional study of frequency and structure of sexual dysfunction in patients of the gynecological clinic and women with infertility (#177)

N. Stenyaeva (Russia)
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177

Open comparative cross-sectional study of frequency and structure of sexual dysfunction in patients of the gynecological clinic and women with infertility

Stenyaeva, N1; Chausov, A1; Chritinin, D2; Sukhikh, G1

1: Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation, Russia; 2: I.M.Sechenov First Moscow State Medical University

Objective: To assess the features of sexual function in fertile women routinely visiting gynecological clinic, and women suffering from infertility.

Material and Method: In this open-label, cross-sectional study in 2 cohorts we compared the features of sexual function in patients in the gynecological clinic and women with infertility. The inclusion criteria were the reproductive age and the presence of sexual partner. The group 1 included 829 fertile women at the age of 31.42 ± 6.37. The group 2 included 157 patients with infertility at the age of 33.38 ± 4.96 years. They were assessed with the Female Sexual Functioning Index (Russian version) (FSFI). P values of less than 0.05 were significantly considered. Additionally, women answered the questions: Do you think that you have a sexual problem? Are you ready to consult a doctor to solve sexual problems?

Results: There was no significant difference between two groups in desire, lubrication, pain and the sum domains scores of the FSFI. We found significant difference between the two groups of FSFI arousal component score (4,34+1,19 vs 4,71+0,85), orgasm (4,38+1,31 vs 4,80+1,49), and satisfaction (4,48+1,73 vs 4,72+1,30). 17.78% in the group 1 vs. 11.46% in the group 2 believed that they had sexual dysfunction, 26.78% in the group 1 vs. 22.93% in the group 2 were not sure with their answers. 25.75% vs. 12.10% were ready to consult a sexologist, 26.54% vs. 22.93% doubted with their answers.

Conclusion: It is known that the notion of normal sexual function varies widely. Personal satisfaction of sexual needs and sexual function are not always comparable with the results of its assessment with the questionnaires. The infertility in marriage creates a long stressful situation for the spouses, causes severe mental trauma resulting in personal, family, social maladjustment and promotes the formation of borderline mental disorders and sexual dysfunction. However, our study showed that women, who are actively struggling with infertility, are better adapted to the sexual life in comparison with another patients of gynecological clinic. The study allowed to reveal latent sexual dysfunction, which manifests with disturbances of sexual function components, but a woman does not fully realize the problem and is not ready to actively attempt to solve it. Interestingly, infertile women showed normal sexual function which seems a compensatory answer to reproductive disorders.

Disclosures:

Work supported by industry: no.

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Effect of soluble guanylate cyclase modulators, BAY 60-2770 and BAY 41-2272 in isolated corpus cavernosum from normotensive and spontaneously hypertensive rats (#178)

C. Estancial (Brazil)
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178

Effect of soluble guanylate cyclase modulators, BAY 60-2770 and BAY 41-2272 in isolated corpus cavernosum from normotensive and spontaneously hypertensive rats

Estancial, C1; Antunes, E1; Rodrigues, R1; Barbosa, A1; Mónica, F1

1: UNICAMP, Brazil

Objective: This study is aimed to verify the effect of soluble guanylate cyclase (sGC) modulators, BAY 60-2770 (activator) and BAY 41-2272 (stimulator) in isolated corpus cavernosum (CC) from normotensive (WKY) and spontaneously hypertensive rats (SHR).

Material and Methods: Concentration-response curves to BAY 60-2770 (0.01-10 µM) and BAY 41-2272 (0.01-10 µM) were carried out in the absence and in the presence of sGC inhibitor (ODQ, 10 µM) in tissues pre-contracted with phenylephrine (PE, 10 µM). Potency (pEC50) and maximal response (Emax) values were calculated. In vivo assay was realized by determining basal and stimulated intracavernous pressure (ICP) before and after intracavernosal injection of BAY 60-2770 (350 ng/Kg) or BAY 41-2272 (350 ng/Kg). Protein expression for α1 (Anti-sGC  α1 –subunit, 1:500 and beta-1 Anti-sGC β1-subunit, 1:1000) subunits were also assessed. The experimental protocols were approved by the Animal Ethical Committee of UNICAMP (2721-1).

Results: BAY 60-2770 and BAY 41-2272 produced concentration-dependent relaxation in isolated CC from WKY (pEC50: 7.01± 0.45 and 6.05 ± 0.10; Emax: 99± 13 and 76 ± 4 %, n=5-7, respectively) and SHR (pEC50: 6.99 ± 0.15 and 6.11 ± 0.16; Emax: 95 ± 5 and 87 ± 6 %, n=5- 7, respectively). Whereas the addition of ODQ produced a 7-fold rightward shift (P<0.05) in BAY 41-227-induced relaxation, the pEC50 values of BAY 60-2770 was shift by 5-fold to the left. Protein levels for α1 and β1 subunits of sGC did not differ between WKY and SHR. BAY 60-2770 augmented ICP by  25,9 % at 16 Hz only in CC from WKY. BAY 41-2272 did not alter ICP in CC from WKY or SHR.

Conclusion: BAY 41-2272 and BAY 60-2770 relaxed corpus cavernosum from hypertensive rats and may constitute a therapeutic option for the treatment of erectile dysfunction. Soluble guanylate cyclase modulators have been proposed as pharmacological tools to differentiate the oxidative state of sGC. In the present study we may speculate that sGC is not oxidized in CC from SHR, as the relaxing response induced by BAY 41-2272 or BAY 60-2770 in CC from SHR did not differ from that of WKY.

Disclosures:

Work supported by industry: no.

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10:30 - 11:30
Podium 9 - ED epidemiology

Location: Transamérica Auditorium
Chairs: Eduardo Bertero (Brazil) & Luiz Otavio Torres (Brazil)

256-slice spiral CT angiography in arterial erectile dysfunction: A penile hemodynamic study (#049)

M. Shen (China)
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049

256-slice spiral CT angiography in arterial erectile dysfunction: A penile hemodynamic study

Shen, M1; Sun, Y2; Pu, J2; Qin, Y1; Jiang, Z3; Yu, J1; Wang, X1

1: Department of Andrology,Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China; 2: Department of Radiology,Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China; 3: Department of Andrology, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China;

Objective: To investigate the diagnostic significance of 256-slice spiral CT angiography in arterial erectile dysfunction.

Methods: Thirty-two adult male patients suspected with arterial erectile dysfunction (study group) and twenty adult male subjects with normal erectile function (control group) underwent 256-slice spiral CT angiography of the lower abdomen. Three-dimensional images of the penile vessels were reconstructed from 256-slice spiral CT angiography data. Perfusion parameters of the arteries in bilateral cavernous bodies of the penis, including time-to-peak (TTP; the time from the start of injection until maximum contrast enhancement is reached), blood flow (BF; measured blood flow per 100 grams of penile cavernous tissue per minute), and blood volume (BV; measured volume of blood per 100 grams of penile cavernous tissue) were recorded and statistically analyzed.

Results: There were no significant differences in TTP, BF and BV between bilateral cavernous body arteries of the penis in the control group (P > 0.05). The continuity of bilateral cavernous body arteries was traceable on 256-slice CT angiography images. The continuity of bilateral cavernous body arteries was also observed on the reconstructed three-dimensional images of the penile vessels. Unilateral cavernous body artery stenosis was observed on CT images of 26 cases from the study group (among them left side were 16 cases and right side were 10 cases). Discontinuous or incomplete unilateral cavernous body artery was observed on the reconstructed three-dimensional images of the penile vessels of these 26 cases. There were significant differences in TTP, BF and BV between bilateral cavernous body arteries in these 26 cases (P < 0.01). TTP, BF and BV were also significantly different between stenotic cavernous body arteries of the study group and the control group (P < 0.01). Other there were 6 cases bilateral cavernous body artery stenosis was observed in the study group. Noncontinuity or incompleteness of bilateral cavernous body arteries was also traceable on reconstructed three-dimensional images of the penile vessels of these 6 cases.

Conclusion: The use of 256-slice spiral CT perfusion imaging technique three-dimensional image reconstruction and analysis of the relevant parameters of the blood vessels of the penis is a new `diagnosis method for arterial erectile dysfunction.

Disclosures:

This work is supported by the National Natural Science Foundation of China, No. 81160080 (industry funding only - investigator initiated and executed study).

Association of catechu nut chewing with risk of erectile dysfunction (#050)

Bang-Ping Jiann (Taiwan)
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050

Association of catechu nut chewing with risk of erectile dysfunction

Jiann, B1

1: Kaohsiung Veterans General Hospital, Taiwan

Objectives: Catechu nut chewing is a common habit in Taiwan and is reported to increase the risk for oral malignancy and diabetes and metabolic syndrome. Our study was the first study to investigate the association between catechu nut chewing and the risk of erectile dysfunction (ED).

Methods and Materials: Male subjects with age between 40 to 70 years were screened for the habit of catechu nut chewing when they visited the Provincial Public Health Centers for a routine physical checkup from 2010 to 2011 in Taiwan. Erectile function was assessed by the Sexual Health Inventory for Men (SHIM).

Results: A total of 1581 subjects completed the study with data eligible for analysis. Among the 1581 subjects, 712 (45.0%) reported a history of catechu nut chewing and 869 (55.0%) subjects did not who served as the control group. Subjects who reported a history of catechu nut chewing were younger in age, had a higher body mass index, were associated with a higher frequency of smoking and drinking, and had a higher prevalence of DM and hypertension (p < 0.05). ED was reported in 62.4% (444/712) of subjects with a history of catechu nut chewing, significantly higher than that in 51.4% (447/869) of controls (p <0.001). Subjects who had chewed catechu nut for > 3 yrs reported a higher prevalence of ED (65.8% [373/567]) than those for ≤ 3 yrs (51.5% [34/66]) (p = 0.022). In the receiver operating characteristic (ROC) curve, the risk of ED significantly increased when cumulative exposure of catechu nut chewing reached 27.5 (p = 0.001) Subjects with a history of catechu nut chewing had an increased risk for ED (OR = 1.72; 95% CI: 1.36–2.18), diabetes mellitus (OR = 1.60; 95% CI: 1.10–2.33), hypertension (OR = 1.46; 95% CI: 1.12–1.89) and obesity (OR = 1.31; 95% CI: 1.00–1.71), after adjustment for age, smoking and drinking habit (p <0.05).

Conclusion: Our results showed that catechu nut chewing is an independent risk factor for ED, diabetes mellitus, hypertension and obesity with a dose-dependent effect.

Disclosures:

Work supported by industry: no.

Subsequent cardiovascular diseases and mortality in men presenting with erectile dysfunction (#051)

Bang-Ping Jiann (Taiwan)
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051

Subsequent cardiovascular diseases and mortality in men presenting with erectile dysfunction

Jiann, B1

1: Kaohsiung Veterans General Hospital, Taiwan

 

Objectives: Erectile dysfunction (ED) is seen as a precursor of cardiovascular diseases (CVD). The aim of this study was to investigate the incidence of CVD in men presenting with ED and their cause of mortality.

Methods and Materials: Consecutive patients who presented with ED and did not have CVD from 1999 to 2011 were enrolled into the study. A telephone structured interview by a trained nurse was conducted to collect the information. Besides, chart review was done for all participants. The Institutional Review Board at our institution reviewed and approved the study protocol.

Results: From 1999 to 2011, a total of 4713 patients presented with ED at our institution. Of 4713 patients, 7.4% (347) had CVD with a mean age of 66.1 yrs and 92.6% (4366) did not have CVD with a mean age of 58.4 ± 14.1 years. Response rate of telephone interview was 43.0% (1475/3427). After excluding subjects with an age <40 years (N = 484) and who did not have any follow-up visit or could not reach by interview (N = 409), a total of 3473 subjects’ data eligible for analysis who had a mean age of 62.2 ± 11.2 years (40-91) and a mean follow-up of 82.5 ± 51.8 months (1-173). Of 3473 subjects, 9.1% (316) developed with subsequent CVD with an incidence of 3.3%, 7.3%, 10.3% and 12.4% for the age group of 40-49, 50-59, 60-69, and ≧70 age group, respectively. The ED-CAD temporal relationship was 58.7 ± 36.4 months (1-170). Independent risk factors for CAD in ED patients include age, diabetes, hypertension and dyslipidemia. Of the 3801 subjects, 7.7% (293) expired and the major causes of mortality in ED patients were malignancy (2.7%), infection (1.5%) and CVD (1.0%).

Conclusion: Of the cohort, the incidence of subsequent CVD in men with ED was 9.1% with an interval of 58.7 months. The independent risk factors for developing CVD in men with ED include an older age, DM, hypertension and dyslipidemia. Malignancy, infection and CVD constitute the main cause of mortality in men with ED.

Disclosures:

Work supported by industry: no.

Sexual dysfunction in cirrhotic male and female patients (#052)

J. Herrera-Caceres (Mexico)
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052

Sexual dysfunction in cirrhotic male and female patients

Herrera-Caceres, J1; Nava-Sanchez, J1; Flores-Rodríguez, J1; Magaña-Rodríguez, J1; Villeda-Sandoval, C1; Torre-Delgadillo, A1; Castillejos-Molina, R1

1: INCMNSZ, Mexico

Objectives: The aim of the study is to analyze de the prevalence of sexual dysfunction in men and women with different stages of liver cirrhosis as well as the related risk factors for such condition in this population

Material & Methods: We did a prospective evaluation including patients from the "Liver and Urology Clinic" from our institution. Evaluation included demographics, a sexual function assessment (IIEF and IFSF) and a depression questionnaire (Beck Questionnaire). We analyzed prevalence and associated risk factors.

Results: We included 145 patients (65% female), mean age was 50 (range 20-80) years old. Mean IIEF score was 42.46 (22% no-ED, 18% mild-ED, 16% mild-moderate ED, 14% moderate ED, 30% severe ED), IFSF 29.71 (55.9% score less than 26.55, with sexual dysfunction), 75% were married or in a stable relationship and 43.4% had a negative Beck score for depression. Male patients without a stable partner had lower scores in IIEF (p=0.029), in female it was the other way around (p=0.017). Presence of depression showed no statistical difference. Child-Pugh scores (ChP), either ChP A or B as cut-offs were not statistically different. On the other hand, patients with a MELD score of less than15 had higher IIEF scores (56.5 vs 29.6, p=0.004). Neither viral nor alcoholic etiology had statistical differences. Albumin <3 gm/dl (45.3 vs. 16.5, p=0.002) and creatinine <1.2 were associated with lower IIEF scores (43.8 vs. 23.5, p=0.033). Neither bilirrubin levels, ascites, history of liver encephalopathy, coagulopathy nor thrombocytopenia showed an association that reached statistical significance. Individual domains analyses showed that patients with a ChP <7 (ChP A) had better performance in terms of intercourse satisfaction (p=0.001), orgasm (p=0.05), desire (p=0.03) and erectile function (25.2 vs. 13.1, p=0.002), but not in overall satisfaction (p=0.503). For female patients, the only individual domain with statistical difference was orgasm, favoring patients with a ChP >7 (0.24 vs. 1.6, p=0.012).

Conclusions: Factors associated with lower IIEF score in cirrhotic patients are a non-stable relationship (58 vs. 39.9), MELD >15 (56.5 vs. 29.6), albumin <3 and creatinine >1.2 (43.8 vs. 23.6). Only 22% of patients did not have ED. For female patients, a stable partner was associated with higher IFSF scores (35.2 vs. 20.6). For individual domains, ChP scores had significant repercussion in intercourse satisfaction, orgasm, sexual desire and erectile function, but not in overall satisfaction.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Radiotherapy for stage I-II testicular seminoma: a prospective evaluation of short-term effects on body image and sexual function (#053)

Luca Incrocci (The Netherlands)
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053

Radiotherapy for stage I-II testicular seminoma: a prospective evaluation of short-term effects on body image and sexual function

Wortel, R1; Ghidey Alemayehu, W1; Incrocci, L1

1: Erasmus MC, The Netherlands

Objective: Orchiectomy followed by infradiaphragmatic radiotherapy is a commonly used treatment for Stage I-II testicular seminoma. Long-term effects on body image and sexual function have been reported, however few  data are available on the short-term effects of orchiectomy and radiotherapy for testicular seminoma. These patients are usually of reproductive age and are frequently sexually active, therefore prospective data on the short-term effects of treatment on body image and sexual function are also needed. The aim was to prospectively evaluate the short-term effects of orchiectomy and radiotherapy on body image and sexual function in testicular seminoma patients.

Materials and Methods: Questionnaires on body image and sexual function were prospectively distributed to all patients treated between 1999-2013. The baseline questionnaire prior to radiotherapy was returned by 161 patients; 133(82%) returned the second after 3 months, 120 (75%) completed the questionnaire after 6 months.

Results: Median age was 36 years (range 18-70), median follow-up was 55 months (range 3-148). After orchiectomy 61% found their body had changed, 48% expressed concerns about fertility. Six months after radiotherapy the quality of erections was significantly decreased compared to prior radiotherapy (p=0.016). At six months, 23% reported a decrease in sexual interest, -activity and pleasure and 45% reported adverse effects on their sexual life. Changes in body image were significantly associated with a decrease in sexual interest, -pleasure and erectile function. The number of sexually active patients remained stable at 91%.

Conclusions: Short-terms effects of treatment included fertility concerns and changes in body image. Also reported erectile rigidity was significantly decreased after six months, as were sexual interest, -activity and –pleasure. Changes in body image were associated with sexual dysfunction and the disease and the treatment had adverse effects on sexual life. Body image and these aspects of sexual functioning should be addressed at an early stage after treatment for testicular seminoma in order to offer adequate treatment and counselling.

Disclosures:

Work supported by the Dutch Society for Sexual Medicine (NVVS) (funding only - investigator initiated and executed study).

What a difference a decade makes: analysis of factors influencing urinary symptoms and erectile function from data collected during prostate cancer awareness weeks in 2003 versus 2011/2012 (#054)

N. Stone (USA)
show abstract

054

What a difference a decade makes: analysis of factors influencing urinary symptoms and erectile function from data collected during prostate cancer awareness weeks in 2003 versus 2011/2012

Poage, W1; Stone, N2; Leapman, M3; Crawford, E1; Tawari, A3

1: Prostate Conditions Education Council / University of Colorado HSC, United States; 2: Prostate Conditions Education Council / Mount Sinai, United States; 3: Mount Sinai, United States

 

Objective:  To investigate changes in clinical and demographic characteristics influencing urinary symptoms and erectile function from a large prostate cancer screening cohort in 2003 vs. 2011/2012.    

Materials and Methods:  We analyzed data obtained from questionnaires completed during the nationwide Prostate Cancer Awareness Week (PCAW) initiative.  We compared baseline serum testosterone, PSA, AUASS, SHIM and significant clinical covariates between the cohort of patients screened in 2003 and those in 2011-2012.  Men with incomplete or missing AUASS or SHIM were excluded.   Analysis of variance (ANOVA) was utilized to investigate differences for continuous variables, and Chi-square analyses were conducted for dichotomous covariates.  Linear and multivariate binary regression models were constructed to assess significant predictors of changes in urinary, sexual function, and serum testosterone levels.

Results: Among 25,390 men screened in 2003 and 2011/2012, 16,808 were included in this analysis.   8,133 men were screened in 2003 (mean age 59.5 versus 61.8 years, p<0.001) compared with 8,675 in 2011/2012; proportion of African-American respondents increased from 14.6% to 17.9% (p<0.001).  Mean PSA increased from 1.72 ng/mL in 2003 to 2.83 ng/mL (p=0.011) in 2011 and 2012, while serum testosterone decreased from 419.4 ng/dL to 359.8 ng/dL (p<0.001). In a linear regression model incorporating age and significant clinical and demographic covariates, increasing BMI (p<0.001), serum HDL, LDL and total cholesterol (p<0.001), dietary fat content (p<0.027), and type II diabetes (p=0.003) independently influenced serum testosterone levels.  The mean AUASS was unchanged between 2003 and 2011/12 (6.87 versus 6.97, p=0.258) while mean SHIM declined in this interval from 18.1 to 16.3 (p<0.001).  In a linear regression model, SHIM was influenced by BMI (p<0.001), frequency of exercise (p=0.039), AUASS (p<0.001), and age (p<0.001). 

Conclusion: Changes in testosterone and erectile function were observed in the 2003 vs. 2011/2012 screening interval that may reflect the contribution of obesity and lifestyle-related factors. 

Disclosures:

Work supported by industry: no.


10:30 - 11:15
Workshop 10 - Medical sexual issues for non-medical therapists

Location: Ilhéus + Una Room
Chair: Hossein Sadeghi-Nejad (USA)

Drug interventions for sexual problems; integrating sex therapy and pharmacotherapy

John Dean (United Kingdom)

Latrogenic sexual dysfunction - what non medical therapist should know

Yacov Reisman (The Netherlands)


11:00 - 11:30
Point counterpoint 5 - Sex rehab after RP: Is it really justified?

Location: Comandatuba Room 2+3
Chairs: Anthony Bella (Canada) & Raanan Tal (Israel)

Pro

John Mulhall (USA)

Con

Landon Trost (USA)


11:30 - 12:30
Podium 10 - ED medical therapy

Location: Comandatuba Room 2+3
Chairs: Guillermo Gueglio (Argentina) & Ricardo Munarriz (USA)

Empirical vs risk-based approach to intracavernosal injection therapy: A prospective study (#055)

Trinity Bivalacqua (USA)
show abstract

055

Empirical vs risk-based approach to intracavernosal injection therapy: A prospective study

Segal, R1; Le, B2; Burns, K2; Burnett, A2; Bivalacqua, T2

1: Chesapeake Urology, U.S.A.; 2: Johns Hopkins Hospital Brady Urological Institute, U.S.A.

Objectives: Intracavernosal injection (ICI) therapy is widely used for ED. Employing it in practice is largely empirical and has not been validated with evidence-based approaches.  This study compares two strategies for ICI to determine whether a risk-based approach is more efficacious, increases satisfaction and/or results in fewer treatment complications.
Methods: After obtaining IRB approval, a prospective database of patients enrolled in the ICI program at the Johns Hopkins Hospital from May 2012-present was amassed. Demographic information, treatment outcomes and subjective patient evaluations of sexual function (IIEF, QEQ, SQoL and EDITS questionnaires) were obtained at baseline, 3 and 6 months. Two approaches were compared. Group 1 consisted of empiric ICI treatment.  Patients were treated with Prostaglandin E1 10mcg, irrespective of ED etiology or severity, and only if poor response noted at test injection, then initiated on bimix or trimix. Group 2 was a risk-based approach, where using an algorithm that factored in: organic vs. neurogenic ED, number of ED risk factors, prostatectomy, nerve-sparing status, time from surgery and radiation status, patients were treated with either bimix, low- or high-dose trimix.  Dose titration was permitted in both groups.  Statistical analysis was carried out using t-test and chi-squared analysis.

Results: 175 patients were enrolled (57 in Group 1, 118 in Group 2) with 3 and 6 month f/u at 57% and 35% respectively, and similar between groups.  Baseline patient characteristics and sexual function questionnaire responses were similar between groups 1 and 2, (mean age 61.9 vs. 61.3 p=0.66, IIEF-EF 8.1 vs. 6.9 p=0.28, and SQoL 37.7 vs. 39.2 p=0.71), though Group 1 reported higher quality erections at baseline (QEQ 14.3 vs. 7.3 p=0.05) and had a lower proportion of post-prostatectomy patients 54.4% vs. 74.6% (p=0.02).  In both groups, quality of erections (QEQ) improved with treatment (mean 10.78 vs. 56.76, p<0.05), SQoL improved (38.41 vs. 50.25, p<0.05), and IIEF-EF improved (7.51 vs. 18.48, p<0.05).  However, between groups at 3 and 6 months, there were no statistically significant differences in responses for IIEF, QEQ, SQoL or EDITS, and no difference in failure or medication switch rates. There were no significant differences in complication rates, though at 3 months group 2 reported a higher incidence of priapism and pain (23% vs. 7.4% p=0.08).

Conclusions: Both approaches resulted in significant improvements across multiple domains of sexual function. Complications rates, satisfaction and efficacy overall were similar between both approaches.

Disclosures:

Work supported by industry: no.

Initial clinical experience of linear focused, low intensity shockwave for treatment of ED patients with different severity symptoms (#056)

Natalio Cruz Navarro (Spain)
show abstract

056

Initial clinical experience of linear focused, low intensity shockwave for treatment of ED patients with different severity symptoms

Cruz, N1; Martin Morales, A2

1: Andromedi Sevilla, Spain; 2: IUAMS Malaga, Spain

Objective: The aim of this clinical experience was to assess the feasibility of   the application of Linear-Focused Low Intensity Shockwaves (Renova Direx Group) as an alternative or complementary treatment for Vascular ED patients with different degrees of symptom severity.

Material and methods: The treatment was offered in a routine natural way in 2 medical centers: 46 patients in Malaga (Serie A), and 35 in Seville (Serie B). The treatment is composed of 4 weekly sessions (20 minutes each), in which shockwaves were applied, into 4 areas; right and left crura, and right and left corpus cavernosum, with 900 shockwaves in each site (Total 14400). No need for anesthesia, sedation or painkillers. The evaluation was done using the IIEF-EF, SEP and GAQ at baseline visit and 1and 3 months post treatment.

Results: Average IIEF-EF increased significantly from 19.94 and 14,03 at baseline to 23.92 and 18.53 at 3 months post treatment. A number of patients stopped using PDE-i: 30,77 % and 23,53 % respectively. SEP 2 increased from 88,89 % and 43,48% to 100% and 66,67%. SEP 3 increased from 38,89 % and 27,59 % to 78,75% and 57,89%. Use of PDE5-I for sexual intercourses was reduced from 77,78 % and 85,19 %  to 53,85 and 35,29 % at 3 months post treatment. No side effects were recorded.

Conclusions: The results of both series at 3 months show a consistent and global improvement in IIEF-EF, SEP 2 and SEP 3 parameters. The outcome of the treatment is related to the baseline symptoms severity, meaning that in average, patients with more severe ED symptoms will improve, but will not reach the final level of improvement that can be obtained by mild to moderate patients .In our experience the Linear-Focused Low Intensity Shockwave treatment is a valid alternative or complement to current available treatments.

Disclosures:

Work supported by industry: no.

Safety and efficient duration of linear focused shockwave treatment for erectile dysfunction – A 12 months follow-up pilot study (#057)

Yacov Reisman (The Netherlands)
show abstract

057

Safety and efficient duration of linear focused shockwave treatment for erectile dysfunction – A 12 months follow-up pilot study

Reisman, Y1

1: Dutch Center Sexual Medicine, Netherlands

Objective: The aim of this pilot study was to assess the safety, effectiveness and sustainable results of the Linear Focused Shockwave system Renova, for the treatment of Vascular Erectile Dysfunction patients.

Material and methods: Renova is a system that uses a Linear Low Intensity Shockwave technology. We have treated 20 patients with Vasculogenic ED; with an averaged International Index of Erectile Function (IIEF-EF) score of 12.35±3.16 (Range 7-18). The protocol consisted of 4 weekly sessions, in which a total of 3600 shockwaves were applied, divided into 4 areas; right and left crura, and right and left corpus cavernosum, 900 shockwaves in each site. The following questionnaires were used: IIEF-EF, Sexual Encounter Profile (SEP) and Global Assessment Question (GAQ), at baseline visit and 1, 3, 6 and 12 months post treatment. Success was defined as an increase in score from baseline to the 6 months post treatment follow-up, according to Minimal Clinical Improvement Criteria (Rosen et al.).

Results: At the 6 months follow-up, 18 patients out of 20 showed success (90%). Out of these 90%, 83.3% (15 patients) sustained the positive outcome for a period longer than 12 months after the end of treatment. The average IIEF-EF increased significantly from 12.35±3.16 at baseline to 20.65±2.64 at 6 months post treatment, and was 18.65±2.56 at the 12 month follow-up. Four patients (20%) who were non-responsive to Phosphodiesterase type 5 Inhibitors (PDE5i) at baseline became responsive after the treatment, and 2 patients (10%) successfully stopped using PDE5i. Majority of patients completed the last follow-up with an average of 14.5±1.08 months duration from the end of treatment. Among the successful patients, the average IIEF-EF score increase was 8.3 points. No side effects were reported.

Conclusions: With a success rate of 90% after 6 months, and an 83.3% sustainable positive effect after 1 year, the results of this pilot study suggest that this treatment is probably effective for at least 1 year. No anaesthesia or analgesia was needed, and no adverse effects were recorded, making it a potential good alternative for current available treatments.

Disclosures:

Work supported by industry: yes, by Direx (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

The role of early patient tailored penile rehabilitation in patients post radical prostatectomy (#058)

A. Bazo (United Kingdom)
show abstract

058

The role of early patient tailored penile rehabilitation in patients post radical prostatectomy

Goodall, P1; Campain, N1; Bazo, A1

1: Nottingham City Hospital, United Kingdom

Objectives: Erectile dysfunction (ED) post-radical prostatectomy (RP) is a well-acknowledged complication, which varies widely from 20-90% according to the literature. This is despite advances with nerve sparing and robotic techniques. With the detection of prostate cancer in younger men, there is a greater emphasis on appropriate management of ED post RP. It is well documented that early intervention of ED with appropriate management results in a better functional outcome. Despite this there are no national guidelines regarding penile rehabilitation following RP. We retrospectively reviewed patients who had undergone a RP and had been followed-up for a period 2 years with penile rehabilitation to assess their erectile function (EF).

Materials and Methods: 117 patients were retrospectively identified as having undergone a radical RP irrespective of nerve sparing status and open or laparoscopic surgery. All patients were followed-up for at least 2 years in the erectile dysfunction clinic and initially counselled prior or shortly after their surgery. Patients were initially offered vacuum erection device therapy (VED) and trialled on a phosphodiesterase type-5-inhibitor (PDE5-I) if appropriate and followed-up on a 4 monthly basis with management altered accordingly to EF. Patient satisfaction with EF was noted at the time of discharge from clinic.

Results: All patients were started on VED therapy and 107 patients (91.5%) commenced a PDE5-I. Over 2 years 40 patients (34.2%) had stopped using the VED, 65 patients (60.7%) were changed to a different PDE5-I or dose. 60 patients (51.3%) were commenced on penile injection therapy and 4 patients (3.4%) on medicated urethral system for erection (MUSE) therapy. 2 patients (1.7%) underwent penile implant surgery. 23 patients (19.7%) were getting erections without any treatment compared with 73 patients (62.4%) able to get an erection with treatment.

Conclusion: Patients who underwent a period of early patient tailored penile rehabilitation post RP and adhered to treatment for a sustained period had significantly improved EF.

Disclosures:

Work supported by industry: no.

Frequency of intracavernosal injections (ICI) improves erectile function recovery (EFR) following radical prostatectomy (RP) (#059)

Chris Nelson (USA)
show abstract

059

Frequency of intracavernosal injections (ICI) improves erectile function recovery (EFR) following radical prostatectomy (RP)

Nelson, C1; Pessin, H1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States

Objective(s): Penile rehabilitation (PR) is frequently used following RP and intracavernosal injections (ICI) play an important role at many centers. While there is data suggesting participation in a PR program improves long term EFR post-RP, there is little research investigating if frequency of ICI is associated with EFR.

Material and Method(s): Patients included in this analysis started PR using ICI ≤6 months (m) post-RP, had ICI frequency recorded and had erectile function (EF) data available for 12-30m post-RP. ICI frequency was assessed by patient self-report. Nerve sparing was surgeon graded for each nerve on a validated 1-4 point scale: 1-complete preservation, 2-near complete preservation, 3-partial resection, 4-complete resection (score 2-8). Pre-RP EF was graded on a validated 5-point patient-reported scale: 1 (fully rigid) to 5 (no tumescence).  EF post-RP was graded on a percentage patient-reported scale (100% = fully rigid, 60%= adequate for penetration, 0%= no rigidity).  Post-RP response to ICI, PDE5i, and spontaneous erectile rigidity (SER) was assessed. Very poor ICI responders (rigidity ≤ 40%) and excellent PDE5i responders (rigidity ≥ 80%) were excluded.

Result(s): 99 men with a mean age of 59±7 years met eligibility. The mean number of ICI/week was 1.6±0.8. On average, men started ICI 4±2m post-RP. Men reported good EF pre-RP (mean=1.6±1). Mean follow-up time post-RP EF was 22±5m. At follow-up, mean PDE5i EF was 50±26% and mean SER was 31±24%. On univariate analysis, PDE5i EF was related to age (r=-0.33, p=0.001) and ICI/week (r=0.39, p=0.001). SER was related to age (r=-0.24, p=0.02), NSS (r=-0.28, p=0.01) and ICI injections/week (r=0.24, p=0.02).  On multivariable analysis, ICI/week was a strong predictor of PDE5i EF (beta=0.48, p=0.001).  For an increase of 1 injection/week, PDE5i EF increased by 16 percentage points. ICI/week was also a strong predictor of SER (beta=0.31, p=0.01).  For an increase in 1 injection/week, SER increased by 11 percentage points.

Conclusion(s): In those patients pursuing PR, frequency of ICI was a significant predictor of EF recovery. Men in a PR program should be encouraged to inject as frequently as possible.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Adipose derived stem cell therapy for treatment of refractary ED (#060)

A. Skupin (USA)
show abstract

060

Adipose derived stem cell therapy for treatment of refractary ED

Skupin, A1; Herandez-Serrano, R2; Alvarez, N1; Zevallos, B1

1: 3Med Health Institute; 2: WAS, FLASSES, AISM, UCV, WPA

Backround: ED is a sexual pathology caused by numerous comorbidities. In Latin America according to DENSA study, 54 % of the patients in Colombia, Ecuador and Venezuela, were diagnosed with this pathology. The USA National Institute of Health reports that 30 million men experience chronic ED and the incidence of the disorder increased with age. Transient ED and inadequate erection affect as many as 50 % of men between ages of 40-70. Several studies done in rats have shown the effectiveness of mesenchymal stem cells in the treatment of ED. In this study we are working with adipose derived stem cells (ADSc) which are multipotent and exhibit capabilities of differentiation and regeneration of myogenic, neurogenic and vascular cells as well as repair mechanisims that increase the synthesis of NO in the penis.

Methods: A retrospective survey of 82 patients that were treated with ADSc for ED between 2012 and 2014 was done. All of the patients had comorbidities including diabetes, hypertension, coronary artery disease, obesity and consumption of alcohol and tobacco. The StemProCell Protocol was used to harvest, isolate and re-inject the stromal vascular fraction (SVF) into the corpus cavernosum of the men treated. Platelet rich plasma was also isolated and injected with the SVF.

Results: Of the 82 patients that were treated in the clinic, we followed up with 30 patients, of which 42% showed improvement of sexual function of more than 51% after the treatment with ADSc. Of the patients that reported improvement, 60% had hypertension, 36% had DM Type II, 20% were smokers, 53% consumed alcohol and 6% had coronary artery disease.

Conclusions: ADSc is an innovative and new alternative to treat patients with ED, even those with comorbidities. The stem cells can regenerate tissue that has been injured due to vascular disease or compromised by surgical procedures in the penis. There is a surge to create a multicenter prospective study of new cases with an established protocol and classification system that will allow standard research criteria and valid and reliable results.

Disclosures:

Work supported by industry: no.


11:30 - 12:30
Moderated posters 8 - Androgens

Location: São Paulo Room
Chairs: Jacques Buvat (France) & Abraham Morgentaler (USA)

Testosterone replacement therapy in hypogonadal men for improvement of sexual function (#179)

K. Drasa (Albania)
show abstract

179

Testosterone replacement therapy in hypogonadal men for improvement of sexual function

Drasa, K1; Dani, E1; Rusi, R2

1: Central Polyclinic, Albania; 2: Privat Clinic, Albania

Objectives: Testosterone (T) is the most important endogenous sex hormone in the male.Clinical  T deficiency or male hypogonadism can be seen  from puberty until old age. Our study was undertaken to gain insights into improvement in sexual function(SF) and mood in hypogonadal(HG) on T replacement therapy (TRT),based on whether they reached the prespecified threshold of serum T - 300ng/dl.

Materials and Methods: In this DBP controlled 30 weeks(wks) study, enrolled 56 men, aged 38-70Y(mean 52.6+-9.9Y),with T deficiencies (T<300ng/dl).They were screened for morning T .Due to the DB nature of the study the interval injection was 12 wks ,was used according to SPC of the drug and this product through levels of T by 30 wks. Depot T  undecaonate (TU) as NEBIDO  or matching placebo was administered at wk 0,6,8and30.SF and mood changes were assessed by the Psychosexual Daily Questionnaire(PDQ),IIEF-EF,PSA. Analysis of covariance (ANCOVA)with adjustments for baseline PDQ score, age and body mass index (BMI),was used to evaluate change in PDQ scores from baseline as wk 6,18 and 30.

Results: T level improved markedly in the 12 month. TU significantly made numerical improvement  in all PDQ scores(sexual desires ,sexual activity ,percent full erection, erection maintained and positive and negative mood).There was also significant improvement in BMI(0.7kg/m2)and all domains in the IIEF, specially the EF domain of 7.75 point by the end of the 52wk. There was a 25-30%increase in PSA by 30 wks but no rise thereafter. There was only one case of prostate cancer in the placebo cohort.

Conclusion: These data show that symptoms in HG men receiving TRT improved by day15 and continued until day120,even in men with T<300ng/dl, after treatment. Men in TU group achieved maximal effect by 12wk,especially improvement in erectile function, which continued to improved at wk 30 and associated with favorable changes in body( and presumably penile)composition.

Disclosures:

Work supported by industry: no.

Association of vitamin D status, diabetes type 2 and hypogonadism in men with erectile dysfunction: A cross-sectional study (#180)

C. Alvarenga (Brazil)
show abstract

180

Association of vitamin D status, diabetes type 2 and hypogonadism in men with erectile dysfunction: A cross-sectional study

Alvarenga, C1; Guglielmetti , G1; Cezarino , B1; Regina dos Santos, A1; Cury , J 1; Srougi, M 1

1: HCFMUSP, Brazil

Objective: Increasing numbers of men are being diagnosed with low levels of testosterone, associated with erectile dysfunction, loss of sexual desire and decrease of morning erections. The Interrelationships between hormones of the hypothalamic-pituitary-testicular (HPT) axis, hypogonadism, vitamin D, erectile dysfunction and low libido remain unclear. We investigated in this study whether HPT axis hormones, diabetes type 2 and hypogonadism are associated with serum levels of 25-hydroxyvitamin D (25(OH)D) in men with erectile dysfunction.

Design and Methods: A total of 352 men aged 38-84 years are followed at the urological division of the Hospital das Clínicas da USP, from 2012 to 2013, complaining of erectile dysfunction and/ or low libido. Of these 352 men, 52 men presented with hypogonadism (Testosterone (T) levels <300 nmol/l). Testosterone (T), estradiol (E(2), LH, FSH, sex hormone binding globulin (SHBG), 25(OH)D were measured. Free T was calculated from total T, SHBG and albumin. Gonadal status was categorised as eugonadal (normal T/LH), secondary (low T, low/normal LH), primary (low T, elevated LH) and compensated (normal T, elevated LH) hypogonadism. Associations of HPT axis hormones with 25(OH)D were examined using linear regression and hypogonadism with vitamin D using multinomial logistic regression.

Results: The prevalence of hypogonadism among all study participants was 14.7%. Among the diabetic and non-diabetic men the prevalence was 28.3% and 9.4%, respectively (P<0.005) and symptomatic androgen deficiency was associated with diabetes and age (P<0.005). The general prevalence of 25(OH)D deficiency among men with erectile disfunction was 15,6% and among men with hypogonadism men was 34.3% (P<0.005). Among men with hypogonadism, the mean (SD) total testosterone concentration of diabetic and non-diabetic was 192 ng/ml and 242 ng/ml, respectively (P<0.005). In univariate analyses, total T levels were lower (P=0.018) and E(2) and LH levels were higher (P<0.05) in men with vitamin D deficiency (25(OH)D<30 nmol/l). Vitamin D deficiency was also significantly associated with secondary hypogonadism (RRR=1.18, P=0.05). After 6 months of testosterone replacement (injections) median serum testosterone (T) levels increased from pre-treatment levels in all men (T=224 to 804 ng/dL, p<0.05). Despite different serum T levels after 6 months, 44 of 52 men with therapy (84%) reported similar satisfaction levels (qADAM=38).

Conclusion: Hypogonadism is a prevalent disorder among diabetic population with erectile dysfunction. Symptoms of androgen deficiency should be corroborated with testosterone level to establish a multidisciplinary approach for management of hypogonadism. Secondary hypogonadism were associated with vitamin D deficiency. The clinical significance of this relationship requires further studies.

Disclosures:

Work supported by industry: no.

show poster

Weight loss and and reduction of waist size in 237 hypogonadal men with obesity grades I-III under long-term treatment with testosterone undecanoate (TU): Observational data from a registry study (#181)

F. Saad (Germany)
show abstract

181

Weight loss and and reduction of waist size in 237 hypogonadal men with obesity grades I-III under long-term treatment with testosterone undecanoate (TU): Observational data from a registry study

Saad, F1; Haider, A2; Doros, G3; Traish, A4

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: BU School of Public Health, USA; 4: BU School of Medicine, USA

Objective: To assess changes in anthropometric parameters in hypogonadal men under long-term treatment with testosterone undecanoate (TU) injections.

Material and Methods: Single-center, prospective, cumulative registry study of 340 hypogonadal men. 237 men with obesity grade I-III were selected. All men received TU injections for up to 7 years. Measures were taken at each three-monthly visit.

Results: Grade I (n=103, mean age: 58 years): Weight decreased from 102.79 to 85.41 kg. Changes were statistically significant vs. previous year for six years. Change from baseline was -17.27 kg, percent change from baseline -16.81%. Waist circumference (WC) decreased from 104.74 to 95.24 cm. Changes were statistically significant vs. previous year for six years. Change from baseline was -8.93 cm. BMI decreased from 32.85 to 27.65 kg/m2, mean change from baseline -5.5 kg/m2.

Grade II (n=97, mean age: 60 years): Weight decreased from 116.67 to 92.19 kg. Changes were statistically significant vs. previous year for six years. Change from baseline was -25.15 kg, percent change from baseline
-21.52%. WC decreased from 111.97 to 100.96 cm. Changes were statistically significant vs. previous year for five years. Mean change from baseline was -12.53 cm. BMI decreased from 37.33 to 29.88 kg/m2, mean change from baseline –8.06 kg/m2.  

Grade III (n=36, mean age: 60 years): Weight decreased from 128.92 to 100.75 kg. Changes were statistically significant vs. previous year for six years. Change from baseline -29.3 kg, percent change from baseline
-22.79%. WC decreased from 117.56 to 103.63 cm. Changes were statistically significant vs. previous year for six years. Mean change from baseline was -12.93 cm. BMI decreased from 41.99 to 33.23 kg/m2, mean change from baseline -9.59 kg/m2.

Conclusions: All changes were more pronounced with increasing obesity grade. All changes were in a clinically meaningful magnitude and sustained for the full observation period. T therapy seems to be an effective approach to achieve sustained weight loss in obese hypogonadal men, thereby potentially reducing cardiometabolic risk.

Disclosures:

Work supported by industry: yes, by Bayer Pharma AG (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

show poster

Long-term treatment with testosterone undecanoate injections sustainably improves metabolic control and erectile function in hypogonadal men with type 2 diabetes (#182)

F. Saad (Germany)
show abstract

182

Long-term treatment with testosterone undecanoate injections sustainably improves metabolic control and erectile function in hypogonadal men with type 2 diabetes

Saad, F1; Haider, A2; Doros, G 3; Traish, A4

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: BU School of Public Health, USA; 4: BU School of Medicine, USA

Objective: To assess effects of long-term treatment with testosterone undecanoate (TU) injections in hypogonadal with type 2 diabetes.

Material and Methods: Cumulative, prospective, observational registry study of 340 hypogonadal men from a single urological practice. 120 men (35.3%) had T2D. All men received testosterone undecanoate injections for up to 7 years. All men were treated for their T2D by their respective family physician.

Results: Mean age was 60.36±5.02 years. 4/120 men (3%) had normal weight, 9 (8%) were overweight, and 107 (89%) were obese. Testosterone levels rose from 10.0±1.28 nmol/L to trough levels (measured prior to the following injection) between 15 and 18 nmol/L. Weight decreased progressively from 110.37±14.28 to 89.38±9.33 by 21.36±0.73 kg. The proportion of weight loss was -18.24% in the obese, -13.64% in the overweight, and the men with normal weight gained 2.82%. Waist circumference decreased from 109.34±7.97 to 99.89±6.48 by 11.34 cm, BMI (kg/m2d) from 35.57±4.5 to 29.09±2.91 (p<0.0001 for all).

Fasting glucose decreased from 113.45±14.53 to 95.93±2.56 mg/dl, HbA1c from 8.02±0.86 to 5.9±0.45% (p<0.0001 for both). At baseline, 11% of patients were within an HbA1c target of 7%, at the end of the observation time, all patients completing 7 years of treatment had an HbA1c ≤ 7%.  At baseline, 4% of patients were within an HbA1c target of 6.5%, at the end of the observation time, all but one patients completing 7 years of treatment had an HbA1c ≤ 6.5%.  

The lipid pattern improved. The TC:HDL ratio declined from 4.9±1.18 to 2.52±0.56, the TG:HDL ratio from 4.84±1.34 to 2.49±0.54, non-HDL cholesterol from 6.14±0.76 to 2.85±0.41 (p<0.0001 for all).

Systolic BP decreased from 160.48±13.89 to 137.41±7.37, diastolic BP from 96.03±10.65 to 77.17±5.98 mmHg (p<0.0001 for both). IIEF-EF increased from 19.63±4.83 to 26.31±1.54, change from baseline: 5.38±0.31.

Conclusions: All changes were in a clinically meaningful magnitude and sustained for the full observation period. T therapy seems to be highly effective in hypogonadal men with type 2 diabetes, improving both metabolic parameters and erectile function.

Disclosures:

Work supported by industry: yes, by Bayer Pharma AG (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Experience with testosterone undecanoate treatment of hypogonadal men for up to 17 years in an academic andrology setting (#183)

F. Saad (Germany)
show abstract

183

Experience with testosterone undecanoate treatment of hypogonadal men for up to 17 years in an academic andrology setting

Zitzmann, M1; Saad, F2

1: Centre of Reproductive Medicine and Andrology of the University, Germany; 2: Bayer Pharma AG, Germany

Objective: To assess effectiveness and safety of long-term treatment with testosterone undecanoate (TU) injections in hypogonadal men.

Material and Methods: Cumulative, prospective, observational registry study of 422 patients (188 with primary [including 56 Klinefelter’s patients], 125 with secondary hypogonadism and 109 with late-onset (“mixed” or “metabolic” hypogonadism) aged 15 to 72 years (mean 41±12 years) receiving intramuscular injections of 1000 mg of TU during a maximal treatment time of 17 years..

Results: Individual dosing intervals ranged from 10 to 14 weeks Serum T concentrations increased from 5.2 nmol/L to stable trough levels of 12.8 nmol/L within the first year of treatment and further on to levels between 15 and 16 nmol/L thereafter. The proportion of men fulfilling the new Harmonized Criteria for definition of the Metabolic Syndrome decreased from initially 86% to 68% within the first year and further on to 43% within 5 years (Chi-square for trend: p<0.001). During the maximal duration of treatment, an overall favourable change from baseline was visible for a multitude of parameters related to androgen effects/metabolic risk, especially lipid parameters, blood pressure and fasting glucose levels (all with p<0.001 in ANOVAs). Body weight decreased within the first year from 100.9±11.7 to 97.8±10.6 kg and continued to decrease progressively to 86.6±9.3 kg. Prostate size increased from 16.8±5.0 to max 21.2±5.4 ml (p<0.001), PSA levels changed moderately (baseline 1.5±0.4 to max 2.3±0.6 µg/l, p=0.001). No case of prostate cancer was observed. Haematocrit increased significantly during treatment but remained within the normal range (40.5±2.1% to max 47.2±2.5%, p<0.001), except for occasional measurements (maximal value 56.7%). One patient suffered from deep vein thrombosis, one from stroke, two from myocardial infarction. These events were considered unlikely to be directly related to testosterone replacement therapy, as the patients had a respective cardiovascular risk profile but haematocrit was not elevated.

Conclusions: Intramuscular injections of testosterone undecanoate represent a feasible, safe and well tolerated modality of testosterone therapy in hypogonadal men of a wide age range, substantiated by a long experience, facilitating a decrement of metabolic/cardiovascular risk factors.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Weight loss and reduction of waist size in 362 hypogonadal men with obesity grades I to III upon long-term treatment with testosterone undecanoate (TU): Observational data from two registry studies (#184)

F. Saad (Germany)
show abstract

184

Weight loss and reduction of waist size in 362 hypogonadal men with obesity grades I to III upon long-term treatment with testosterone undecanoate (TU): Observational data from two registry studies

Saad, F1; Haider, A2; Yassin, A 3; Doros, G 4; Traish, A5

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: Institute for Urology and Andrology, Germany; 4: BU School of Public Health, USA; 5: BU School of Medicine, USA

Objective: To assess changes in anthropometric parameters in hypogonadal men under long-term treatment with testosterone undecanoate (TU) injections.

Material and Methods: From two cumulative registry studies, 362 men with obesity grade I (BMI 30-34.9), grade II (BMI 35-39.9) and grade III (BMI ≥ 40 kg/m2) were selected. All men received TU for up to 6 years. 

Results: Grade I (n=185, mean age: 58.4±8.0 years): Weight (kg) decreased from 101.88±6.2 to 89.34±6.7. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline was -12.55±0.44 kg, percent change from baseline -12.25±5.76%. Waist circumference (cm) decreased from 107.07±7.57  to 97.09±6.95. These changes were statistically significant for five years compared to the previous year and approached significance at the end of six vs. five years. The mean change from baseline was -9.24±0.3 cm. BMI (kg/m2) decreased from 32.51±1.39 to 28.63±1.92, mean change from baseline -3.99±0.14 kg/m2. Grade II (n=131, mean age: 60.6±5.6 years): Weight (kg) decreased from 117.02±6.99 to 96.78±7.47. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline was -20.67±0.51 kg, percent change from baseline -17.03±5.02%. Waist circumference (cm) decreased from 114.23±7.51 to 102.52±6.5. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline was -12.29±0.33 cm. BMI (kg/m2) decreased from 37.39±1.46 to 31.05±2.02, mean change from baseline -6.58±0.16 kg/m2. Grade III (n=46, mean age: 60.3±5.4 years): Weight (kg) decreased from 129.02±5.67 to 103.33±4.17. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline -27.15±0.74 kg, percent change from baseline -20.99±3.16%. Waist circumference (cm) decreased from 118.41±5.69 to 106.48±4.91. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline was -12.44±0.36 cm. BMI (kg/m2) decreased from 41.93±1.5 to 33.62±1.58, mean change from baseline -8.79±0.23 kg/m2.

Conclusions: All changes were meaningful and sustained for the full observation time. TRT seems to be effective to improve MetS and cardiovascular risk profile in obese hypogonadal men.

Disclosures:

Work supported by industry: yes, by Bayer Pharma AG (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Biochemical clomiphene citrate response in men with hypogonadism based on baseline LH level (#185)

John Mulhall (USA)
show abstract

185

Biochemical clomiphene citrate response in men with hypogonadism based on baseline LH level

Deveci, S1; Mazzola, C2; Logmanieh, N2; Mulhall, J2

1: Medical School of Acibadem University, Turkey, Memorial Sloan Kettering Cancer Research Center, New York; 2: Memorial Sloan Kettering Cancer Research Center, New York

Objectives: Clomiphene citrate (CC) is being increasingly recognized as an effective treatment for men with HG. Prior data suggests men with elevated baseline LH levels may be poor candidates for CC therapy. This analysis was undertaken to analyze response to CC based on baseline LH level.

Materials and Methods: Men with a diagnosis of HG, (2 separate early morning total T levels <300 ng/dl) opting for CC therapy constituted the study population. Patients were sub-divided based on baseline LH level: <5 IU/ml (A), 5-10 (B), >10 (C). Demographic, comorbidity data, physical and laboratory characteristics were recorded. TT and LH levels ≥6 months after commencing CC were used for this analysis. Responders were defined as those achieving a 200 ng/dl increase in TT on treatment combined with a post-treatment TT level ≥400 ng/dl.

Results: 112 patients were included with a mean age = 58±21 years. Mean pre-treatment testicular volume = 15±7.5 mls. Mean baseline and post-treatment T and LH levels are listed in Table 1. The mean change in LH for each group was: A 4.8 (1.2-8.5); B 1.1 (0.5-3.8); C 0.3 (0-1.4) (p<0.01). The mean change in TT for each group was: A 225 (165-622); B 148 (115-322); C 25 (12-110) (p<0.01). 78% in group A were responders, 49% in group B and 12% in group C.

Conclusion: These data indicate that the best biochemical response to CC is in men with baseline LH levels below 5 and that men with baseline LH levels above 10 are generally poor responders.

Abstract 185

Disclosures:

Work supported by industry: no.

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Testosterone replacement therapy (TRT) infrequently used in hypogonadal men (#186)

W. Poage (USA)
show abstract

186

Testosterone replacement therapy (TRT) infrequently used in hypogonadal men

Poage, W1; Nelson, N2; Crawford, E1; Miner, M3

1: Prostate Conditions Education Council / University of Colorado HSC, United States; 2: Prostate Conditions Education Council / Mount Sinai, United States; 3: Brown University, United States

Objectives: Urologists are the primary prescribers of TRT in men with hypogonadism (HG). HG (T<300 ng/dL) is associated with obesity, cardiovascular disease risk factors, diabetes and ED. There are no large population studies that have assessed the use of TRT in these individuals although data is emerging about its benefits in improving lean body mass and decreasing waist circumference.

Materials and Methods: 11,584 men from the general population participated in the Prostate Cancer Awareness Week (PCAW) in 2011 and 2012, a nationwide health screening program, and completed health assessments. Testosterone (T) levels were determined in 4849 (41.9%). Associations for T were compared by ANOVA and chi-square for age, race, fat in diet (FID), exercise amount (Ex), degree overweight (Over), presence of erectile dysfunction (ED) and diabetes, heart disease (HD), heart attack (HA), and increased body mass index (BMI over 30). The effect of multiple variables on T<300 was tested by linear regression.

Results: Mean and median T and age were 358.8 and 326 ng/dL and 61.6 and 62 years, respectively. Lower mean T was associated with older age group (p=0.001) and race, higher FID, low Ex, Over, ED, HA, HD, diabetes, and higher BMI (all p<0.001). On regression analysis only race (p=0.05), FID (p=0.006), BMI (p<0.001), diabetes (p<0.001) and Ex (p<0.001) remained significant. HG was present in 42.8% (table). TRT was used by 304 of the 11,584 participants (2.6%). Mean T for men on TRT was 352 compared to 226.4 ng/dL for HG men not on TRT (p<0.001). TRT was more commonly used in men over 65 years (3.3% vs. 2.6%, p=0.046), BMI ≥ 30 (4.5% vs 2.3%, p<0.001) and ED (6.2% vs. 2.1%, p<0.001). There was no difference in TRT use in diabetic vs. non-diabetic men. TRT use by race was white 3.2%, AA 1.5% and Hispanic 3.9% (p<0.001). Men with HG and higher BMI had mean weight of 241 lbs. compared to 232 lbs for those taking TRT (p=0.001). Diabetes was also less common in HG men on TRT (12% vs. 15.2, p=0.221).

Conclusions: Despite the high frequency of HG (42.8%) in this screening population, TRT was reported to be used only 2.6% of the time. Men with ED had the highest reported use of TRT (6.2%), while use in diabetic men was no different than non-diabetic men. Use of TRT in AA men was half that of others. Urologists involved in men’s health should be aware of the high prevalence of HG and consider the potential benefits of TRT in men, especially those with high BMI, high fat diet, minimal exercise and the presence of diabetes.

Disclosures:

Work supported by industry: no.

Characteristics associated with low testosterone levels in men with type 2 diabetes mellitus previously treated with insulin (#187)

F. Borges Dos Reis (Brazil)
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187

Characteristics associated with low testosterone levels in men with type 2 diabetes mellitus previously treated with insulin

Polzer, P1; Ni, X1; Borges Dos Reis , F2

1: Eli Lilly and Company, United States; 2: Eli Lilly and Company, Brazil

Introduction: Male hypogonadism is defined by low serum testosterone (T) levels and associated clinical symptoms, and has elevated prevalence in men with type 2 diabetes mellitus (T2DM). This post hoc analysis examined baseline associations between low T levels and demographic and disease characteristics in diabetic men previously treated with insulin entering a phase 3 trial of once weekly GLP-1 receptor agonist dulaglutide.

Methods and Materials: Men were ≥18 yrs of age with T2DM, had screening HbA1c 7.0% - 11.0%, and received insulin alone or with oral antihyperglycemic medications (OAMs). Low T was defined as total T (TT) <300 ng/dL or free T (FT) <65 pg/nL, calculated using the Vermeulen equation. A two-sample t-test and Fisher’s exact test were used to compare between T subgroups. Men receiving T replacement (n=11) were not analyzed.

Results: 33.9% of men (n=151) had low TT and 66.1% had normal TT (n=294); mean age was 60.3 and 59.3 yrs (p=.59), and HbA1c was 8.6% and 8.4% (p=.31), respectively. Men with low TT differed from men with normal TT for mean BMI (33.9 vs. 31.0 kg/m2, p<.001), weight (103.8 vs. 93.7 kg, p<.001), proportion with HbA1c >9.5% (21.2% vs. 12.9%, p=.028), and proportion using a phosphodiesterase 5 inhibitor (9.3% vs. 3.4%, p=.014). Men with low versus normal FT (26.4% [n=117] vs. 73.7% [n=327]) were older (63.4 vs. 58.3 years, p<.001), had higher BMI (34.0 vs. 31.3 kg/m2, p<.001), weight (103.1 vs. 95.0 kg, p<.001), and history of cardiovascular disease (40.2% vs. 22.9%, p<.001). Mean HbA1c (8.5% vs. 8.4%, p=.95) and proportion with HbA1c >9.5% (17.1% vs. 15.3%, p=.66) were similar between men with low versus normal FT.

Conclusion: In men with T2DM previously treated with insulin and OAM, about 1/3 had untreated low TT; 11 additional men were receiving T replacement therapy. Men with untreated low TT had greater BMI and weight, and a greater proportion had HbA1c >9.5%. The approximately 1/4 of men with low FT had greater age, BMI, and weight, but similar HbA1c versus normal men. These data support Endocrine Society Guidelines for measuring T levels in men with T2DM, and highlight the need for further study of T replacement in T2DM.

Disclosures:

Work supported by industry: yes, by Eli Lilly and Company (industry initiated, executed and funded study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Clomiphene citrate and human chorionic gonadotrophin are good alternative therapy to testesterone in hypogonadal men seeking fertility (#188)

John Mulhall (USA)
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188

Clomiphene citrate and human chorionic gonadotrophin are good alternative therapy to testesterone in hypogonadal men seeking fertility

Habous, M1; Elhadek, W1; Shamndy, M1; Mahmoud, S1; Abdelwahab, O2; Abdelrahman, Z1; Muir, G3; Mulhall, J4

1: Elaj medical centers, Saudi Arabia; 2: Benha university, Egypt; 3: King's College Hospital; 4: Sexual and and reproductive medicine program, Memorial Sloan Kettering cancer center, NY USA

Introduction: Secondary, or late onset, hypogonadism (LOH) is a common problem in the ageing male population. It is significantly associated with various co morbidities such as obesity, type 2 diabetes, hypertension, osteoporosis and metabolic syndrome. The standard therapy for hypogonadism is testosterone replacement therapy (TRT) which is not suitable for men seeking fertility – a major problem in many men from the Gulf States

Objectives: We wished to compare the efficacy of single agent clomiphene citrate(CC),human chorionic gonadtrophin (HCG), and a combination of the two in  symptomatic patients of LOH wishing to preserve fertility

Patients&Methods: In this unblinded multicentre RCT, a total of 287 hypogonadal patients were randomly enrolled 2:2:1 into 3 groups. Group A (n= 88) were given HCG 5000 international units (i.u) intramuscularly once a week; group Group B (n=82) took CC 50 mg daily, and group C (n=41) took both HCG&CC (our previous standard treatment) A non-randomized control group of consecutive patients (D: n=76) who did not wish to preserve fertility were commenced on Testosterone undecanoate (TU.) All patients had physical examination, T measurements & glycosylated haemoglobin(HbA1c)  at baseline,1 month and 3 months, as  were Quantitative ADAM questionnaire (qADAM) scores. LH and FSH levels were checked at baseline and three months.

Results: The average age of patients were 42 being 47 for TU group, 40 for HCG, 38 for CC and 41 for combination group. The mean body mass index (BMI) of all patients was 30,9 All three treatments increased serum testosterone levels as shown in table 1:

Abstract 188

Significant improvements were seen in the qADAM score in all groups. Improvements were seen in HbA1c and BMI in all groups, although not always reaching significance. The increases in all metrics, while not directly comparable, were similar to those seen in the TU group.

Conclusion: CC and HCG alone or in combination are good alternative therapy in LOH with comparable results and rapid onset subjectively and objectively in hypogonadal men irrespective of their age but the outcome is less in obese patients. These results would suggest a larger RCT between CC, HCG and TRT.

Disclosures:

Work supported by industry: no.

show poster


11:30 - 12:30
Podium 11 - Ejaculation and its associated problems

Location: Transamérica Auditorium
Chairs: Chris McMahon (Australia) & Ana Puigvert Martinez (Spain)

Thyroid dysfunction, serum testesterone and prolactin levels don’t seem to be risk factors in men complaining of premature ejaculation (#061)

John Mulhall (USA)
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061

Thyroid dysfunction, serum testesterone and prolactin levels don’t seem to be risk factors in men complaining of premature ejaculation

Habous, M1; Mahmoud, S1; Abdelwahab, O2; Elhadek, W1; Shamndy, M1; Abdelrahman, Z1; Nelson, C3; Mulhall, J4

1: Elaj medical centers, Saudi Arabia; 2: Benha university, Egypt; 3: Sexual & Reproductive Medicine Program, Memorial Sloan Kettering Cancer Center; 4: Sexual and and reproductive medicine program, Memorial Sloan Kettering cancer center, NY USA

Introduction: Most epidemiological studies suggest that premature ejaculation (PE) also referred to as early ejaculation and rapid ejaculation, may be the most common male sexual disorder. The exact etiology of PE is unknown. Psychological/behavioristic and biogenic etiologies have been proposed.

Objectives: Initial reports indicate that there are hormone differences between men with primary (lifelong) and secondary (acquired) PE.  This study was designed to investigate hormone profiles of these two subgroups.

Methods & Patients: Men who presented to our outpatient clinic with PE were enrolled in this study.  The diagnosis and classification (primary or secondary) of PE was based on patient medical and sexual history according to guidelines of international society of sexual medicine (ISSM) and European association of urology (EAU). Complete physical examination was done and we measured thyroid stimulating hormone (TSH), testosterone (T), and prolactin (P) for all patients. Statistical analyses included descriptive statistics and independent-measures t-test for univariate analyses.  Analysis of covariance was used for multivariable analyses.

Results: 506 men were included in this analysis. The average age of these men was 44±12 years old and the mean body mass index (BMI) was 26.7±5.5. The mean levels of T, TSH, and P for the entire sample was 4.38±1.69, 2.31±3.56, and 10.56±11.04, respectively.  There were 267 men in the primary PE group and 239 men in the secondary PE group. The men with primary PE were significantly younger than those with secondary PE (37±11 vs. 52±12, p=0.001). There were no significant differences in BMI between the groups. On univariate analyses, there was no differences between the primary PE and secondary PE groups in T (4.39±1.66 vs. 4.38±1.84, p=0.94), TSH (2.31±4.89 vs. 2.20±2.07, p=0.76), and P (10.65±8.13 vs. 10.46±13.46, p=0.86).  When controlling for age in multivariable analyses, there continued to be no differences between the two groups (p values ranging from p=0.56 to 0.81).

Conclusion: hormonal profile including T, TSH and P seem to be in the normal range in men with PE and there is no statistical difference in these hormones between primary and secondary PE

Disclosures:

Work supported by industry: no.

“Glass half empty or glass half full". Does the ejaculated volume really matter? (#062)

M. Osta (Brazil)
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062

“Glass half empty or glass half full". Does the ejaculated volume really matter?

Da Silva, E1; Osta, M1; Damião, R1; Real, A1; Barboza, R1

1: Rio de Janeiro State University, Brazil

Objective: Despite the reproductive aspect, ejaculation can be considered as a human sexual behavior and the man’s perception plays an important role on quality of life. We aim to access the impact of the perceived ejaculated volume (PEV) on sexual satisfaction and quality of life.

Material and Methods: Seventy men were invited to answer a quality of life (WHOQoL-Bref) and satisfaction about perceived ejaculated volume (SAPEV) questionnaires. The SAPEV questionnaire is composed of four questions evaluating the self-perception about their normality, changes with aging, satisfaction with PEV, and objective volumetric perception (OVP). Patients were categorized by question 3 (satisfaction), age group, OVP and SAPEV Score (SS) which is composed by 3 questions of the SAPEV. Men with history of prostate or urethral surgeries, diabetes, hypogonadic men or under uroselective alpha-blocker therapy were excluded.

Results: Ten men (14.3%) referred with dissatisfaction about PEV. The mean OVP was 25.3±33.6mL (ranging from 1 to 200mL) and there was no significant difference (p=0.629) between unsatisfied and satisfied groups (17.7±29.5mL, 25.1±35.0mL, respectively). Relationships domain score was 59.3±21.4 and 73.0±22.6 (p =0.01) and the psychological domain score was 70.1±13.1 and 78.9 ±12.4 (p=0.02) for those, respectively. In Group with referred OVP ≥100mL (Group A), the risk to be unsatisfied about PEV was 1.56 (RR, CI 95%) comparing to the 5mL OVP population (group B). The mean age were 43±11 years old and 52±14 years old (p=0,213) and the psychological domain score was 67.6±7 and 80.9±11.1 (p=0.024) for groups A and B respectively. In men aged ≥ 60 years old the OVP mean was 12.69±12.2mL  in contrast with 28.68±36.92mL (p=0.088) of younger population, and the SS 10.0±2.58 vs. 8.81±1.39 (p=0.018). Men with negative perception about the ejaculate (SS ranging from 12 to 15) were significantly older (p<0.05) than the group with positive perception (SS ≤ 9) (mean age 57.7±13.5, 44.2±12.2, respectively). The relationships domain score was 61.57±21.28 and 72.61±24.72 (p=0.16), and the OVP mean was 7.14 ± 5.49 and 26.72 ± 38.54 (p=0.076) for those, respectively.

Conclusion: Men have a propensity to overestimate the ejaculated volume. Perception about ejaculated volume plays an important role on sexual satisfaction and overall quality of life. Furthermore, men over 60 years old are at risk to be dissatisfied regarding their ejaculated volume.

Disclosures:

Work supported by industry: no.

Perceptions and attitude towards PE and treatment seeking behavior: The result of SCOPE (Sexual Concerns On Premature Ejaculations) (#063)

M. Lam (United Kingdom)
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063

Perceptions and attitude towards PE and treatment seeking behavior: The result of SCOPE (Sexual Concerns On Premature Ejaculations)

Lam, M1; Loh, J2; Siaw, M3; Lim, L3; Razack, A4; Ong, T4; Lee, E3

1: University of Leicester, United Kingdom; 2: University of Southampton, United Kingdom; 3: Monash University, Malaysia; 4: Department of Surgery, University of Malaya, Kuala Lumpur

Objective: Premature ejaculation (PE) is a common medical condition affecting men and their sexual partners, affecting up to 30% of general population. The objective of this study is to identify the level of knowledge on PE and the treatment seeking behavior of population in a socio-economically diverse nation in Asia.

Methods: Subjects from both urological and non-urological clinics are recruited to complete non-validated part questionnaires on their perception towards PE and the treatment modalities. The age, gender, income and economic backgrounds were identified.

Results: A total of 1541 subjects (792 men and 749) completed the study, of which 77% believed PE is common and 61% consider it to be a medical condition. More than 80% of the respondents agree PE can negatively affect the quality of life of the sufferers and their partners. A third of the participants find it difficult to discuss issues of PE and 28% would avoid the discussion mainly due to embarrassment (42%). Of the population studied, more than 90% would discuss the dysfunction with their doctors and 80% would accept medicine as the first line treatment.

Conclusion: Sexual dysfunction is a taboo subject in many Asian cultures, and this may lead to poor treatment seeking behavior. Although many understand PE is a prevalent sexual dysfunction with negative impact of sufferers and partner quality of lives, our study revealed embarrassment, avoidance and difficulties in the discussion of the subject matters. We also identify the willingness of subjects to approach physicians and accept medications and the therapeutic modality. Sub-analysis of the population studied may ensure targeted patient educations for clinicians.

 

Disclosures:

Work supported by industry: no.

Silodosin, a highly selective α1A-adrenoceptor antagonist, as a new treatment option for Premature Ejaculation (#064)

Y. Sato (Japan)
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064

Silodosin, a highly selective α1A-adrenoceptor antagonist, as a new treatment option for Premature Ejaculation

Sato, Y1; Nakajima, H1; Nitta, T1; Akagashi, K1; Hanzawa, T1; Tobe, M1; Haga, K1; Uchida, K1; Honma, I1; Otani, T2; Amano, T3; Araki, T4

1: Sanjukai Hospital, Japan; 2: Chibu Rosai Hospital, Japan; 3: Nagano Red Cross Hospital; 4: Araki Kidney & Urology Department Clinic

Objective: We evaluated silodosin, a highly selective α1A-adrenoceptor antagonist, as a new treatment option for PE. Silodosin that is widely used for LUTS, has strong suppressive action on ejaculation. This suppression action may have potential for treating PE. Our preliminary study demonstrated that silodosin had potential for PE treatment (Sato et al. Int J Urol 2012). As a next step, we compared efficacy of silodosin and naftopidil (weak suppressive action for ejaculation among α1-adrenergic receptors) on PE.

Material and Method: Twelve patients who suffered with PE were involved in this study. Definition of PE was “persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration and before the person wishes it” and “Within 3 minute of Intravaginal ejaculatory latency time (IELT)”. Subjects had a mean age of 43 years (range 29-59), reported having had PE for an average of 7.0 years (range 5-15years). Six patients (50%) suffered with ED and had received treatment by phosphodiesterase type 5 inhibitors. Patients administrated silodosin 4 mg and naftopidil 25 mg (1 hours before intercourse) in turn at least 3 times each. IELT, premature ejaculation profile (PEP) item, clinical global impression change (CGIC) in PE and systemic adverse events were evaluated.

Results: 1) IELT: Mean average IELT at baseline, during naftpidil and silodosin-administration were 1.9±1.1, 4.2±3.1 and 9.2±5.7 min, respectively. IELT during silodosin-administration was significantly longer than those at baseline (p=0.0007) and at naftpidil-administration (p=0.005 ). 2) CGIC: Improve rate for PE-related problems compared to pre-treatment condition at silodosin and naftopidil-administration were 83.3% and 41.6 %, respectively. Silodosin significantly improved PE-related problems compared to naftopidil (p= 0.03 by χ2-test). 3) Premature ejaculation profile: Among PEP measure, ejaculation control and satisfaction of sexual intercourse during silodosin-treatment were significantly improved compared to those at base line (p <0.01 for all). 4) Reduced semen volume and orgasm: Eight patients (67%) experienced reduced semen volume at silodosin-administration. However, only three patients (25%) considered reduced semen volume with silodosin as a significant problem.  5) Systemic adverse events: No systemic adverse effects at silodosin and naftpidil-administarion were reported.

Conclusion: Silodosin significantly improved PE-related problems than naftpidil. Silodosin’s safety and clear mechanism for efficacy on PE (suppression for seminal emission but not retrograde ejaculation) are confirmed by large clinical studies for LUTS and well designed-studies with volunteers. According to these favorable aspects and current results suggest the potential of off-label silodosin as a new treatment option for PE.

Disclosures:

Work supported by industry: no.

Controlled clinical study of the effectiveness and adverse effects of imipramine and amoxapine for treatment of retrograde ejaculation (#065)

T. Tai (Japan)
show abstract

065

Controlled clinical study of the effectiveness and adverse effects of imipramine and amoxapine for treatment of retrograde ejaculation

Tai, T1; Nagao, K1; Kobayashi, H1; Tanaka, N1; Nakajima, K1

1: Toho University, Japan

Objective Retrograde ejaculation (RE) is an ejaculation disorder that can cause male infertility. It is defined as a pathological condition in which some or all semen is not emitted despite orgasm. The main cause of RE is believed to be decreased function of the bladder neck due to conditions such as diabetes, pelvic surgery, and drug resistance. Currently imipramine is the drug of choice for treatment of RE, but side effects such as drowsiness sometimes develop. In this controlled clinical study we evaluated the effectiveness and adverse effects of imipramine and amoxapine for treatment of RE.

Material and Methods Eleven men were randomly assigned to one of two groups. We gave amoxapine to group I and imipramine to group II during the first 2-week period and examined adverse effects and semen volume. After a 1-week washout period, the drugs were switched for a second 2-week period. Mean age was 41.0 years (range, 30-52). Disease duration was 3 months to 5 years (average, 1.6 years). The main causes of RE were diabetes (n=8), surgery for rectal cancer (n=2), and retroperitoneal lymph node dissection for testicular cancer (n=1); cause was unknown in four cases. Male infertility was the reason for consultation in 13 cases. The men were provided with a 2.5-cc syringe for self-measurement of semen volume during ejaculation.

Results ED was observed in three patients, but erection hardness was greater than EHS3 after use of PDE5I. In six cases, sperm was found in urine after orgasm. With amoxapine treatment, 14 (77.8%) men were able to ejaculate (average volume, 0.9 [0.1-1.5] cc). Mild drowsiness was noted in four cases. With imipramine treatment, 11 (61.1%) men were able to ejaculate (average volume, 0.57 [0.3-2.0] cc). Mild drowsiness was noted in three cases and severe drowsiness in one case. All men who reported semen emission with imipramine were also able to ejaculate while receiving amoxapine. Semen volume was significantly greater with amoxapine than with imipramine (p <0.001). The incidence of adverse effects was similar for amoxapine and imipramine. Amoxapine was effective for all men who had positive results with imipramine.

Conclusions In the treatment of RE, amoxapine was much more effective than imipramine, and equally safe.

Disclosures:

Work supported by industry: no.

Dapoxetine for premature ejaculation: A rapid evidence assessment (#066)

F. Feys (Belgium)
show abstract

066

Dapoxetine for premature ejaculation: A rapid evidence assessment

Feys, F1; Devroey, D1

1: Vrije Universiteit Brussel, Belgium

Introduction: Premature ejaculation mostly causes a transitory inconvenience for the young, sexually active male. Sometimes, a simple sexological intervention can provide definitive solace. Recently, dapoxetine was approved by the European Medicines Agency (EMA) as an pharmacological agent for the treatment of PE.  The objective of this study was to systematically review the efficacy and harm of dapoxetine.

Methods: We included RCTs that investigated the efficacy of dapoxetine for male PE by comparing to placebo. We searched for both published and unpublished relevant trials using PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials, a clinical trials register (clinicaltrials.gov), the EMA and the FDA websites through december 2013. We evaluated the blinding status of trials with the Cochrane Risk of Bias (ROB) Tool, using the domains of allocation sequence concealment, blinding of participants, healthcare providers and outcome assessors. For the latter 3 ROB domains, we applied additional criteria. Across these domains, studies that scored low risk of bias were judged to be adequately blinded and the remaining studies were judged to be inadequately blinded.

Results: We included 8 studies that involved 6,954 randomized participants; Seven studies had a short duration (6 to 12 weeks). Information on study blinding was mostly absent, many participants dropped out of studies (short (21%) vs long (47%) duration studies) and many conflicts of interests were found. One adequately blinded study reported an orgasm delay with 42 [95% confidence interval (CI) -8, 76] seconds.  For inadequately blinded studies the reported orgasm time was 2.29 [CI 1.37, 3.21] and 1.70 [CI 0.50, 2.90] minutes on dapoxetine and placebo respectively. Risk ratios for the most common adverse events (AEs) were: nausea RR 5.93 [CI 4.31, 8.18], headache RR 1.21 [CI 0.94, 1.55], dizziness RR 3.17 [CI 2.25, 4.47], diarrhoea RR 3.18 [CI 2.06, 4.92]. One study reported substantially more headache RR 5.16, more dizziness RR 7.22 and more diarrhoea RR 11.35.

Conclusions: There is no evidence that dapoxetine is effective. Any irrelevant small ejaculation-time delaying effects seem to result from a placebo effect. The data suggest that dapoxetine may add around 30 seconds to postpone an man's orgasm, but this was not statistically confirmed. Unfortunately, dapoxetine comes with its risks. It has adverse effects and a significant proportion of patients quit dapoxetine early. After quitting, patients may relapse and suffer PE again. Dapoxetine's overall risk/benefit profile is unfavourable.

Disclosures:

Work supported by industry: no.


11:30 - 12:30
Round table 6 - Sexual issues in gay-lesbian patients

Location: Ilhéus + Una Room
Chairs: Michael Krychman (USA) & Ralmer Nochimówski Rigoletto (Brazil)

Assessment and sexual concerns of gay men and lesbian women in a sexual medicine setting

John Dean (United Kingdom)

Prevalence of FSD and MSD in the gay and lesbian population

Alan Shindel (USA)

Promoting sexual health among gay and lesbian Individuals: Treatment considerations

Eli Coleman (USA)


Afternoon

12:30 - 14:00
Lunch break

Location: Comandatuba Room 1

12:45 - 13:45
ISSM journals - Lunch symposium

Location: Comandatuba Room 2+3

14:00 - 15:30
Round table 7 - Managing difficult cases with PP

Location: Comandatuba Room 2+3
Chairs: Gerald Brock (Canada) & Lawrence Hakim (USA)

Saving the cavernous spaces after infection

Rafael Carrion (USA)

SMSNA sponsored lecture: Implant after priapism

Arthur Burnett (USA)

Alternative reservoir placement

Run Wang (USA)

Finding the space in scarred tissue

Steven Wilson (USA)


14:00 - 15:30
Podium 12 - Other aspects of sexual medicine

Location: São Paulo Room
Chairs: Jacqueline Brendler (Brazil) & Alan Shindel (USA)

Improved erectile function recovery after nerve-sparing radical prostatectomy by ink-marked intraoperative frozen section monitoring of the prostate: Results of a prospective single-surgeon series (#067)

G. Hatzichristodoulou (Germany)
show abstract

067

Improved erectile function recovery after nerve-sparing radical prostatectomy by ink-marked intraoperative frozen section monitoring of the prostate: Results of a prospective single-surgeon series

Hatzichristodoulou, G1; Wagenpfeil, S; Weirich, G; Herkommer, K; Kübler, H; Gschwend, J

1: Technische Universität München, Klinikum rechts der Isar, Germany

Objectives: Intraoperative frozen sections (IFS) of the prostate during nerve-sparing radical prostatectomy (nsRP) have been demonstrated effective in reducing positive surgical margins (PSM), and biochemical recurrence. However, its effect on erectile function (EF) recovery has not been assessed so far. The aim of our study was to report for the first time results on EF recovery in patients undergoing IFS of the prostate during nsRP.

Materials and Methods: Patients with organ-confined prostate cancer (PCa) were included in this prospective study independent from other adverse prognostic factors (Bx cores, Gleason, PSA). All pts underwent standardized open nsRP by a single high-volume surgeon (JEG, >2500 RP). Upon prostatectomy, the prostate was ink-marked and both postero-lateral parts (from apex to base) sent for IFS analysis after en-bloc preparation. In case of PSM, additional tissue was partly resected from the prostatic bed along the neurovascular bundles (NVB) corresponding to the PSM. EF recovery was the endpoint and defined as IIEF-5 ≥17. The impact of IFS on EF recovery rates was analyzed with Kaplan-Meier analysis (NCSS version 9, NCSS, Kaysville, Utah, USA).

Results: From April 2008 to May 2012, n=500 consecutive pts were included. Seven and 22 patients were excluded because of neoadjuvant treatment and lymph node positive disease, respectively. PSM in IFS were detected in 137/471 patients (29.1%). After secondary resection 127/137 patients (92.7%) converted to negative surgical margins (NSM). Ten patients (7.3%) showed persistent PSM. EF recovery rates after 12 months were 65.7% vs. 56.1% in pts with primarily and converted NSM, respectively (p=0.786).

Conclusions: IFS of the prostate is highly effective in reducing PSM in pts undergoing nsRP for PCa, independent of adverse pathologic factors. Moreover, secondary partial resection along the NVB does not compromise EF recovery rates when compared to pts with primarily NSM. IFS may be recommended in order to reduce PSM, while increasing the rate of ns procedures and consequently optimizing EF recovery rates.

Disclosures:

Work supported by industry: no.

Frequency of citation errors among male sexual medicine publications in high-impact urology journals (#068)

Landon Trost (USA)
show abstract

068

Frequency of citation errors among male sexual medicine publications in high-impact urology journals

Trost, L1; Mulhall, J2

1: Mayo Clinic, United States; 2: Memorial Sloan-Kettering Cancer Center

Objective: Peer-reviewed publications are currently the optimal method for communicating research findings.  Despite critical appraisals performed by reviewers and editors of manuscript texts, reference citations are frequently under-evaluated.  Our objective was to determine the frequency and types of citation errors present in high-impact urology journals. 

Material and Methods: Recent publications in the area of male sexual medicine from high impact-factor, peer-reviewed urology journals were reviewed to assess the accuracy of citations.  Two articles each were selected from recent issues of the following journals: European Urology, Journal of Urology, BJU International, and Journal of Sexual Medicine. Only original research or meta-analytic studies were included.  All citations within the manuscript text were critically assessed to determine accuracy, relevance to statement referenced, and congruence of reference and textual findings.  Errors in citations were classified as: incorrect (duplicate reference, unrelated reference, unverifiable statement, wrong reference); errors of interpretation (discrepant data or conclusions, overstatement/understatement of findings); or suboptimal (inappropriate reference, reference to review article in lieu of source publication, indirect/inactive website link). 

Results: A combined 468 citations were reviewed from eight articles (March-October 2013). Citations were distributed in the introduction (I-26%), methods (M-19%), results (R-11%), and discussion (D-44%) sections. 145 (31%) errors were identified.  Among errors, suboptimal reference utilization was most common (44%; 64/145), followed by incorrect references (37%; 54/145), and errors of interpretation (19%, 27/145). Error distribution occurred least frequently in the M section with errors in D section commonest (I-30%, M-10%, R-13%, D-47%). No difference in error rates between journals was identified.

Conclusions: Citations errors are common among high impact-factor urology journals.  Although incorrect and suboptimal references are most commonly identified, errors of source data misinterpretation/misrepresentation are not uncommon.

Disclosures:

Work supported by industry: no.

Development and preliminary validation of the PROMIS SexFS version 2.0 (#069)

K. Weinfurt (USA)
show abstract

069

Development and preliminary validation of the PROMIS SexFS version 2.0

Weinfurt, K1; Flynn, K2; Bruner, D3; Cyranowski, J4; Dombeck, C1; Hahn, E5; Jeffery, D6; Lin, L1; Luecht, R7; Magasi, S8; Porter, L1; Reese, J9; Reeve, B10; Shelby, R1; Willse, J7

1: Duke University, United States; 2: Medical College of Wisconsin, United States; 3: Emory University, United States; 4: University of Pittsburgh, United States; 5: Northwestern University, United States; 6: Health Affairs, Department of Defense, United States; 7: University of North Carolina at Greensboro, United States; 8: University of Illinois at Chicago, United States; 9: Johns Hopkins University, United States; 10: University of North Carolina, United States

Objective: To develop version 2.0 of the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Sexual Function and Satisfaction measure (SexFS). The revision was needed to (1) ensure the SexFS was valid across a broad range of patient groups, (2) develop scoring metrics centered around U.S. population norms, (3) expand and improve on the concepts being measured, and (4) minimize differential item functioning (DIF) across important subgroups of respondents.

Material and Methods: Building off version 1.0, version 2.0 included review of extant items, clinical expert discussions (n=15), patient focus groups (11 groups, including diabetes, heart disease, anxiety, depression, LGBT, aged 65+), cognitive interviews (n=48), and psychometric evaluation in a random sample of U.S. adults (2281 males, 1686 females). We examined DIF by gender and sexual activity. We evaluated concurrent validity with the IIEF and FSFI as well as known groups validity by comparing SexFS scores between people who had and had not talked to a doctor about sexual problems in the past year.

Results: The final set of 17 domains includes 11calibrated item banks, and 6 non-calibrated item banks. All domains were reevaluated and improved. New domains included Vulvar Discomfort with Sexual Activity-Clitoral, Vulvar Discomfort with Sexual Activity-Labial, Orgasm-Ability, Orgasm-Pleasure, Oral Discomfort with Sexual Activity, Oral Dryness with Sexual Activity, and Bother Regarding Sexual Function. Several domains (Interest in Sexual Activity, Orgasm, and Satisfaction) had significant DIF, but we were able to identify items in these domains without DIF. Concurrent and known groups validity was supported.

Conclusion: SexFS version 2.0 has several improvements over version 1.0: (1) expanded validity, (2) score norms for sexually active U.S. adults, (3) new domains, and (4) items that statistically work interchangeably for both genders and for individuals across levels of sexual activity. A U.S. Spanish translation is underway.

Disclosures:

Work supported by industry: no.

Impact of transobturator tape surgery on sexual function in female with stress urinary incontinence (#070)

O. Abdelwahab (Egypt)
show abstract

070

Impact of transobturator tape surgery on sexual function in female with stress urinary incontinence

Abdelwahab, O1; Habous, M2; Soliman, T1; Sherif, H1; Gehad, M1; Shamndy, M2; Mulhall, J3

1: Benha university, Egypt; 2: Elaj medical centers, Saudi Arabia; 3: Sexual & Reproductive Medicine Program, Memorial Sloan Kettering Cancer Center

Introduction: Sexual dysfunction is a common condition in females with stress urinary incontinence (SUI). The use of transobturator tape (TOT) has shown favorable clinical outcomes for treatment of SUI, however, the effect on female sexual function remains unclear.

Objectives: To study the effect of TOT used for treatment of female SUI on female sexual function.

Patients and Methods: From 2011-2013, 130 females with SUI underwent TOT surgery (outside in technique). Patients underwent history and physical examination, routine laboratory investigations and complete urodynamic study. All patients were evaluated using the Urogenital Distress Inventory Questionnaire (UDI6) and female sexual function index (FSFI) questionnaire (Arabic versions). 99 patients were sexually active and 31 were not. All patients were evaluated preoperatively and 6 months after TOT. All data collected, tabulated and statistically analyzed.

Results: The mean age of study group was 43.4 years. The mean duration of SIU was 2.5 years. The success rate, defined as cure and improvement was 96.2% (121 cured, 4 improved). Significant improvement in UDI-6 was observed (see Table). 91% of sexually active women achieved significant improvement in the sexual life and FSFI (see Table). No woman experienced postoperative dyspareunia.

Abstract 070

Conclusion: SUI has negative impact on the female sexual life and correction of SUI by TOT had a significant positive impact on sexual life.

Disclosures:

Work supported by industry: no.

Sickle cell disease in priapism: Disparity in care? (#071)

Trinity Bivalacqua (USA)
show abstract

071

Sickle cell disease in priapism: Disparity in care?

Joice, G1; Kates, M1; Sopko, N1; Hannan, J1; Bivalacqua, T1

1: Johns Hopkins School of Medicine, United States

Objectives: To determine the impact of sickle cell disease (SCD) on hospital outcomes among patients admitted for priapism.

Materials and methods: Using the Nationwide Inpatient Sample (NIS), a weighted sample of 12,547 patients was selected with a primary diagnosis of priapism from 2002 – 2011.  Baseline differences for patient demographics and hospital characteristics were compared between SCD and non-SCD patients.  Multivariate analysis was performed to identify the impact of SCD on length of stay (LOS), utilization of penile operations, blood transfusion, and cost.

Results:  The proportion of SCD patients was 21.5%.  SCD patients were younger, more often black, more likely to have Medicaid insurance and treated more frequently in Southern urban teaching hospitals.  SCD was a significant predictor of having a blood transfusion (OR 16.3, p <0.001), and an elongated LOS (OR 1.42, p <0.001).  SCD was associated with less penile operations (OR 0.40, p <0.001).  When SCD patients did have an operation, it was performed later in the admission (mean 0.87 days vs. 0.47 days, p <0.001).  SCD was not a significant predictor of increased cost (OR 1.02, p = 0.869).

Conclusions:  SCD patients represent a demographically distinct sub-group of priapism patients with different courses manifested by longer hospital stays and more blood transfusions.  Moreover, despite evidence that immediate treatment of priapism results in improved erectile function outcomes, SCD patients had less surgical procedures for alleviation of acute priapism events.

Disclosures:

Work supported by industry: no.

Erectile function and health-related quality of life after stroke (#072)

S. Cedres (Uruguay)
show abstract

072

Erectile function and health-related quality of life after stroke

Cedres, S1

1: School of Medicine, UDELAR, Uruguay, Uruguay

Background: Sexual problems and poor quality of life have been a common finding in chronically ill and physically disabled patients such as those with strokes. Previous studies have supported the association between stroke and erectile dysfunction (ED) (1).

Objective: To investigate the health related quality of life (HRQoL) and characteristics of sexual function in patients with stroke 6 month after the hospitalization and to look for the relation with: gender, marital status, severity and nature and topography of stroke, disability, depression and cognitive status.

Methods: Patients were evaluated 6 month after the stroke. HRQoL was measured through the SF-36 questionnaire. ED by the 5-item version of the International Index of Erectile Function . Severity of stroke through Canadian Stroke Scale, Nature and topography according to tomography findings, disability through Bartel Index, Depression according to Hamilton Scale and Cognitive Status through the Mini Mental State Examination de Foldstein.

Results: A total of 31 patients ages from 55 to 78 years were involved The severity of sexual dysfunction increased as the scores of the scales of the SF-36 decreased (chi(2)-test statistic; p<0.001). It was demonstrated a statistic relation (chi(2)-test statistic; p<0.001). between erectile dysfunction and the following characteristics: isquemic stroke, dominant lobule, depression (mild, moderate or severe) and disability (moderated or severe).

Conclusion: Our study findings revealed a great prevalence of ED in stroke patients. We found a clear pattern of negative association between self-perceived sexual function and HRQoL. Post-stroke rehabilitation care helps to improve it.

Disclosures:

Work supported by industry: no.

The reduction corporoplasty: The answer to the unlikely question, “Can you make my penis smaller?” (#073)

D. Martinez (USA)
show abstract

073

The reduction corporoplasty: The answer to the unlikely question, “Can you make my penis smaller?”

Martinez, D1; Emtage, J1; Parker, J1; Carrion, R1

1: University of South Florida, United States

Objectives: Large and/or deformed phalluses secondary to hyperplastic/aneurysmal corpora can occur as a result of different pathological states. This is most commonly seen in recurrent priapism. It occurs secondary to blood pooling in the cavernous sinusoids with resultant hypoxemia, acidemia, and eventual cavernous smooth muscle necrosis with fibroblast proliferation, plaque formation, and collagen deposition. We present a surgical technique for the management of this morphologic sequela, the reduction corporoplasty.

Materials and Methods: A 17-year-old male with a history of sickle cell disease presented with a phallus that was “too large for intercourse”. The patient reported normal erectile function with masturbation, but inability to penetrate his partner due to the size and shape of his phallus. He had a history of three priapismic episodes since 10 years of age, each treated with irrigations in the emergency department. These episodes progressively led to the aneurysmal deformity of his phallus.  Further evaluation included an MRI, which revealed true aneurysmal dilatation of bilateral corpora cavernosa distally, with diffusely hyperplastic tunica. 

Results: The patient was taken to the operating room, and the penis degloved via a circumferential incision. Elliptical cuts were made over the lateral aspects of both corpora, incising a longitudinal ellipse of the aneurysmal corpora. These elliptical wedges of aneurysmal corpora were then removed, and healthy bleeding smooth muscle surrounded by a thick collagen rind was noted. The edges of the elliptical incisions were transversely closed, with 3-0 vicryl sutures in an interrupted, watertight fashion, with the aid of Allice clamps. The phallus was inspected for symmetry, cosmesis, and adequate reduction. The circumcision incision was closed and drains left in place. At the latest follow up of 6 months the patient reports normal erections and successful coitus.

Conclusions: Reduction corporoplasty was performed, and the patient reported intact erectile function without aneurysmal recurrence at 6 months postoperatively. We present this case, the subsequent successful treatment of this debilitating pathology with the surgical technique, reduction corporoplasty. The literature is currently scarce in providing a protocol for managing patients with corporal enlargement. Reduction corporoplasty can optimize sexual function while improving the cosmetic appearance of a deformed phallus such as the one discussed here. 

Disclosures:

Work supported by industry: no.

Preliminary validation of a new measure of oral discomfort with sexual activity: PROMIS-SA (#074)

K. Weinfurt (USA)
show abstract

074

Preliminary validation of a new measure of oral discomfort with sexual activity: PROMIS-SA

Bruner, D1; Flynn, K2; Lin, L3; Reese, J4; Weinfurt, K3; PROMIS Sexual Function Domain Group

1: Emory University, United States; 2: Medical College of Wisconsin, United States; 3: Duke University, United States; 4: Johns Hopkins University, United States

Objective: To develop and begin validation of a measure of oral discomfort with sexual activity (SA). A recent survey indicated that 84% of US adults engage in oral SA.  Some diseases, such as HPV+ head and neck cancers, are related to oral SA, and therapies to treat the disease have the potential to interfere with oral SA.  However, there is a dearth of research in this area, due in part to lack of validated measures.

Material and Methods: The psychometric characteristics of the PROMIS® Sexual Function and Satisfaction Measures were evaluated using data collected from the GfK KnowledgePanel®, a probability-based online panel designed to be statistically representative of the US population. Participants were administered an online survey of ~170 items, which included 11 items on oral discomfort (degree of physical discomfort in the mouth, including pain and/or irritation, during SA) and dryness (lack of saliva in the mouth during SA). Higher scores indicated greater discomfort/dryness. The overall sample was drawn in two phases: first, a nationally representative sample of adults (n=3967; 2281 men, 1686 women), and second, an oversample of individuals (men n=94; women n=133) with mouth discomfort during SA. Analysis of item response included only those who answered something other than “Never” to the item: “In the past 30 days, how often have you had any of the following during SA: dryness, pain, irritation, or other discomfort in your mouth?”

Results: 615 respondents fit inclusion criteria (376 males, 239 females). The unidimensional model fit well, except for significant local dependence among the 3 items about dry mouth—items that also had the lowest factor loadings in the 11-item set. Because dry mouth is an important aspect of oral problems, we created separate subdomains for oral discomfort (6 items) and oral dryness (3 items). The correlation between the subdomains was r = .60, p<.0001.  Cronbach’s Alpha for oral discomfort and dryness were .92 and .85, respectively.  Comparative Fit Index and Tucker-Lewis Index were .99 and .054 for the discomfort subdomain, and >0.99 and <0.01 for the dryness subdomain.

Conclusion: Both oral discomfort and dryness with sexual activity subdomains had excellent model fit.  The final 9-item PROMIS oral sexual activity measure may help fill an important gap in the science by facilitating assessment of an understudied issue.

Disclosures:

Work supported by industry: no.

Learning sexual medicine during undergraduate medicine course contribute to medical professionalism behaviour in medical students (#075)

José Carlos Riechelmann (Brazil)
show abstract

075

Learning sexual medicine during undergraduate medicine course contribute to medical professionalism behaviour in medical students

Riechelmann, J1; Castilho, F1; Cavanha, L1

1: Universidade Cidade de Sao Paulo (UNICID), Brazil

Objective: To evaluate the impact on medical education of students submitted to the first course of sexual medicine inserted into an official undergraduate medical curriculum in Brazil.

Method: Quali-quantitative analysis of discourse, by Lefevre’s “Collective Subject Discourse” (CSD) technique, applied on 154 written responses by 77 students chosen randomly from 400 students who completed the course of sexual medicine between August 2008 and December 2011, offered in the Medical Skills Module, in the sixth semester of a problem-based learning (PBL) medicine course. The module objective was to develop interdisciplinary clinical reasoning skills, taking the context of sexuality as a trigger. Each student answered two questions about their inner perceptions on skills to listening and talking: 1) about the sexuality of the patient, and 2) about their own sexuality. The answers were processed using appropriate software (Qualiquantisoft ®) for the quali-quantitative analysis of discourses and construction of the CSD.

Results: About the ability to listen to patients shall speak about their sexual problems, only 7 students (9.10%) expressed indifference, while 70 (90.9%) showed increased skill. Increased capacity to understand (diagnosis) and talk about the patient's sexual problem was reported by 65 (84.42%). Increased ability to speak about their own sexuality was perceived by 50 (64.94%). Qualitatively, the CSD obtained from central ideas of discourses shows: reduction of afraid to listen and talk about sex and decreased anxiety of working with the sexuality of patients after replacement of sexual myths by scientific knowledge. There was no reports of emotional troubles caused by the course. Feelings of rejection to the course and/or to the teacher were perceived by 4 students (5.19%).

Conclusion: The pioneering experience of learning sexual medicine during an official undergraduate degree in medicine in Brazil has produced at least two major impacts in medical education: 1) significant decrease in anxiety with sexual issues, including own sexuality, and 2) gains medical communication skills, improving the doctor-patient relationship, especially the ability to listen with empathy (not just hearing), the sexual discourse of the patient. This leads us to conclude that learning about sexuality during undergraduate medicine course can contribute significantly to the construction of medical professionalism behaviour in medical students.

Disclosures:

Work supported by industry: no.


14:00 - 15:30
Instructional course 6 - Sexual aspects of incontinence surgery in women

Location: Transamérica Auditorium
Chairs: Sue Goldstein (USA) & Gerson Lopes (Brazil)

Incontinence and overactive bladder

Irwin Goldstein (USA)

Fecal incontinence and sexual dysfunction

Susan Kellogg-Spadt (USA)

The effect of stress urinary incontinence and it's treatment on sexual function

Lior Lowenstein (Israel)


14:00 - 14:45
Workshop 11 - Management of priapism

Location: Ilhéus + Una Room
Chair: Fernando Facio (Brazil)

Epidemiology, physiopathology and diagnosis

Ricardo Munarriz (USA)

Management (medical/surgical) and outcomes

Fernando Facio (Brazil)


14:45 - 15:30
Workshop 12 - Building a prosthetics practice in the social media era

Location: Ilhéus + Una Room
Chair: Carlos Eurico Cairoli (Brazil)

Building a prosthetics practice in the social media era

Andrew Kramer (USA)


15:30 - 16:00
Coffee break

Location: Comandatuba Room 1

16:00 - 17:30
Round table 8 - How does the Pca risk factors affect TRT?

Location: Comandatuba Room 2+3
Chairs: Ernani Rhoden (Brazil) & Andrea Salonia (Italy)

TRT after radiation therapy for prostate cancer

Luca Incrocci (The Netherlands)

Why we must do TRT in symptomatic men after treatment of prostate cancer?

Abraham Morgentaler (USA)

When we should start TRT after a radical

Andrea Salonia (Italy)

How do I control (monitor) patients receiving TRT after prostate cancer treatment

Anthony Bella (Canada)

Is TRT safe to the prostate health?

Luiz Otavio Torres (Brazil)


16:00 - 17:30
Moderated posters 9 - Women's sexual medicine

Location: São Paulo Room
Chairs: Annamaria Giraldi (Denmark) & Sue Goldstein (USA)

Treatment paradigm for women with arousal and orgasmic complaints (#189)

Michael Krychman (USA)
show abstract

189

Treatment paradigm for women with arousal and orgasmic complaints

Krychman, M1; Kellogg, S2; Damaj, B3; Hachicha, M3

1: OBGYN, United States; 2: PHD,CRNP, CST, USA; 3: Innovous Pharmaceuticals

Objective:  Changes in latency and frequency with respect to orgasmic potential are common complaints for women with malignancies and or medical illness.  There is a lack of consensus with respect to treatment paradigm for FSAD and we attempt to present a comprehensive stepwise treatment protocol for FSAD.  

Methods & Materials: Presented here is a revised proposed paradigm for women with changes in arousal intensity and latency.  All patients undergo a comprehensive history and physical examination coupled with a psychosexual and relationship assessment. Hormonal laboratory testing is not mandatory and often done to confirm physical findings.  Patients with orgasmic intensity and latency changes are placed on the sexual arousal paradigm. The paradigm includes: monitoring and modification of potentially offending medications (SSRI, anti-hypertensive) education about sexual anatomy and physiology, self-stimulation with vibrators and Zestra® Feminine Arousal Oils. ZestraÒ has 3-5 minutes onset time and 45 minutes duration of efficacy. Topical hormonal agents including minimally absorbed local vaginal estrogen and testosterone creams may utilize as secondary agents, if not contraindicated. Identify Medications that may negatively impact sexual orgasmic response.    If medication induced FSAD is suspected, a dopamine agonist maybe added or one may suggest changing to a new antidepressant. A pre-coital “antidote” Phosphodiesterase Inhibitors (PDE5I) may also be considered.  Advanced compounded medications including a variety of combinations of: PDE5I, aminophylline, arginine, phentolamine and nitroglycerine maybe applied to clitoral tissues. Aggressive treatment of 5mg daily or precoital 10 mg dose of oral Tadalafil 30-45- minutes prior to coitus.  

Results: Presented is a comprehensive assessment and treatment paradigm to help address orgasmic latency and frequency.   

Conclusions: Orgasmic Intensity and latency are challenging sexual concerns and creative paradigms are needed to address these complex dilemmas

Disclosures:

Work supported by industry: yes, by Innovous Pharmaceuticals (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

show poster

A look at female masturbation: a cross sectional study in university women of the metropolitan area of Bucaramanga, Colombia (#191)

A. Mujica Rodriguez (Brazil)
show abstract

191

A look at female masturbation: a cross sectional study in university women of the metropolitan area of Bucaramanga, Colombia

Guarin Serrano, R1; Mujica Rodriguez, A2; Cadena Afanador, L1; Useche Aldana, B1

1: Colombia; 2: Brazil

Objective: Evaluate the prevalence of female masturbation in college students in the metropolitan area of Bucaramanga, Colombia.  

Material and Methods: A cross sectional study using a self-report questionnaire in a sample of college women, stratified by the size of the institution. We performed a descriptive and inferential analysis. The significance level was established at p<0.05.

Results: We surveyed 1038 women, whose median age was 20, IQR 4. The prevalence of masturbation was of 32.2% and only the 73.1% of them reach an orgasm by this stimulation. One in three women who do not masturbate reported anorgasmia. The activity of masturbation was more frequent in women over 35 years old, with a high socioeconomic strata, who studies and works independently, not religious, or catholic with a low or zero level of religiosity and who auto-identified as bisexual.

Conclusion: It is important to provide education to women from their self-knowledge of the body; with the purpose of improved their awareness about their sexuality and can fully enjoy it.

Disclosures:

Work supported by industry: no.

Risk factors for low sexual interest in young women in stable relationships (#192)

H. Fleury (Brazil)
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192

Risk factors for low sexual interest in young women in stable relationships

Fleury, H1; Abdo, C1

1: ProSex - Program of Studies in Sexuality, University of Sao Paulo Brazil

Objective: The aim of this study was a systematic review of sexual interest in young women in stable relationships.

Material and Method: A systematic literature review of publications reported on MEDLINE via Pubmed, from 1977 to 2013, was performed with the search terms: libido; sexual dysfunctions, psychological; and marital relationship.

Results: The literature search resulted in a total of 884 references. The filter “Adult: 19-44 years” limited to 553 references. Of these, 521 publications were excluded on the basis of their titles and abstracts. A total of 32 publications were included. Most of the articles reported high prevalence of low sexual interest in women from all ages. Younger women presented less sexual difficulties but more sexual distress (personal and relational) than older women. Relationship stability was inversely associated with sexual initiative frequency and partners’ satisfaction. Women dissatisfied with sexual frequency were also more likely to report lower sexual and relationship satisfaction. In stable relationships, sexual satisfaction was negatively correlated with conflict in the relationship, and women engaged in sex with no sexual interest more often than those in short-term relationships. Risk factors for this condition are: relationship stability, low affective satisfaction, and lower valuation of sexual life, medical conditions and their treatments. Some articles pointed that desire discrepancy between partners predicted women lower sexual satisfaction, and this discrepancy is more related to partners’ interaction than an individual problem. These women with low interest report distress because they perceive that this sexual interest decrease affects the partner. Some women attribute this decrease to the marriage institutionalization, over-familiarity with the partner and the de-sexualization of wife, mother, and professional roles.

Conclusions: Physiological, emotional, and sociocultural conditions and relational stability influence sexual interest in young woman in long-term relationships. The knowledge of risk factors for these aspects can contribute for successful treatment and counseling of the young couple.

Disclosures:

Work supported by industry: no.

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Association between alexithymia and female sexual self-efficacy in patients with sexual dysfunctions (#193)

Itor Finotelli Jr. (Brazil)
show abstract

193

Association between alexithymia and female sexual self-efficacy in patients with sexual dysfunctions

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: Alexithymia is characterized by the difficulty in identifying and describing emotions, lack of fantasies and cognitive style externally oriented. Researches associate negative influences of this condition in the sexual function. The objective for this study was to investigate such influences in the women sexual self-efficacy.      

Methods: Thirty (30) patients with sexual dysfunction, who have been treated in a private clinic in Sao Paulo, Brazil, were assisted. The ages vary between eighteen (18) and fifty-six years old (M=30.87; SD=9.28), fifty-seven percent (57%) were single, forty percent (40%) married and three percent (3%) divorced. The majority of eighty-seven percent (87%) of the participants had a Bachelor degree or equivalent. For this measurement, the Toronto Alexithymia Scale (TAS-26) and Sexual Self-Efficacy Scale - Female (SSES-F) that evaluate the sexual function and dimensions denominated as desire-arousal, penetration ability, solitary pleasure and sexual assertiveness, were used. The instruments were individually applied in the initial assessment observing the ethical compliance demanded in the research.       

Results: For associations between the instruments, moderate negative correlations were found for the total score and dimensions. It was observed that the ability to fantasize was the only dimension which was negatively connected in three dimensions to the sexual self-efficacy, in this case, desire-arousal, solitary pleasure and sexual assertiveness. This meant that the ability to fantasize creates favorable states for the manifestation of behaviors related to the expression of desire, openness to sexual stimuli and orientation of such stimuli, further on the possibility of obtaining sexual response in a solitary way.      

Conclusions: Related to alexithymia, the inability to fantasize maintains negative associations in the sexual self-efficacy in behaviors of expression of desire-arousal, both in dyadic sexual practices as in solitary ones. This association demonstrated an important influence of alexithymia in the sexual function, essentially in the initial stages of the tree-phase model of this function. This association can implicate in the clinical management of female sexual dysfunctions.

Disclosures:

Work supported by industry: no.

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Dyspareunia and sexual dysfunction following vaginal delivery in Thai primiparous women with second degree perineal tear: a prospective cohort study (#194)

C. Chayachinda (Thailand)
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194

Dyspareunia and sexual dysfunction following vaginal delivery in Thai primiparous women with second degree perineal tear: a prospective cohort study

Chayachinda, C1; Ungkanungdecha, A1; Veeragul, J1; Jisabai, J1

1: Faculty of Medicine Siriraj Hospital, Thailand

Female sexual dysfunction is increasingly prevalent throughout the whole pregnancy and declines after the delivery. Dyspareunia or sexual pain, a domain of sexual function, is very common among parous women; however, its role remains elusive. 

Objectives: To examine prevalence and associating factors of dyspareunia and to study sexual dysfunction at 3 months, 6 months, 12 months following vaginal delivery among Thai primiparous women with second degree perineal tear.

Materials and Methods: A total of 190 primiparous women with second degree perineal tear were invited into the study on Day 2 post-partum. Dyspareunia and sexual function were assessed among 93 women who came for 3-month visit by using the Thai version of Female Sexual Function Index (FSFI) and visual analogue scale (VAS). FSFI at ≤ 26.55 is considered as having sexual dysfunction. The 6-month and 12-month evaluations were performed by telephone interview. 

Results: The prevalence of dyspareunia at 3-month visit is 30.1% (mild degree 17.2%, moderate to severe degree 12.9%); and those of sexual dysfunction at 3- , 6- and 12-month visits are 66.6%, 28.7% and 14.9%, respectively. Among underweight women (BMI < 18.5 kg/m2), less weight gain appears to be associated with dyspareunia (11.8 ± 4.1 vs 15.4 ± 4.0 kg, p 0.020). After adjusting for age, husband’s age and partnership length, a maternal weight gain of < 14.5 kg (median weight gain) associates with reporting dyspareunia (aOR 3.64, 95% CI 1.33-9.98, p 0.012). Women without dyspareunia at 3-month visit tend to resume normal sexual function quicker than the other group.

Conclusion: Dyspareunia and sexual dysfunction are common conditions among Thai primiparous women with second degree perineal tear. A total weight gain of < 14.5kg appears to be a predictor of the dyspareunia at 3-month visit; and the occurrence is negatively predictive for the resumption of normal sexual function. Despite the spontaneous improvement of both conditions over time, intervention to minimize the sexual pain during the first 3 months may facilitate the return of sexual quality among this population.

Disclosures:

Work supported by industry: no.

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5 Alpha-reductase enzyme deficiency: A new pathophysiology of female hypoactive sexual desire disorder (#195)

Irwin Goldstein (USA)
show abstract

195

5 Alpha-reductase enzyme deficiency: A new pathophysiology of female hypoactive sexual desire disorder

Cohen, S1; Gagnon, C1; Minton, J1; Goldstein, I2

1: San Diego Sexual Medicine, United States; 2: Alvarado Hospital, United States

Objectives: Women with testosterone deficiency syndrome, as defined by the 2001 Princeton Consensus Conference, have persistent symptoms in mood, libido and fatigue in the presence of a low free testosterone with adequate estrogen status. Use of testosterone for treatment of hypoactive sexual desire disorder (HSDD) in women pre-supposes that cytoplasmic enzyme 5 alpha-reductase is functioning and converts free testosterone to the more active androgen dihydrotestosterone (DHT). This study examined a sub-group of women diagnosed with testosterone deficiency syndrome and HSDD who underwent 6 months of testosterone treatment, resulting in increases in total and calculated free testosterone values to the mid to upper tertile range.  These women, however, failed to have their symptoms of testosterone deficiency syndrome ameliorated, with persistent bothersome HSDD, and had no adverse events related to the increased testosterone, such as acne, facial hair or scalp hair loss. Dihydrotestosterone values were measured before and after testosterone treatment.

Methods: An IRB approved retrospective chart review was performed in 31 women examined between 2007-2014 presenting with persistent sexual symptoms despite being treated with testosterone.  Data collected included DHT, testosterone, sex hormone binding globulin and calculated free testosterone values, duration of use and of persistent side effects, and parametric data analysis of psychometrically validated questionnaires.

Results: Mean age was 47 +/- 16 years; mean pre-treated testosterone values were 18+/-6 ng/dl (range 6-82 ng/dl), mean free testosterone values 0.2+/-0.1 ng/dl (ideal value 0.8 ng/dl) and mean DHT values <5 ng/dl (range 4–22 ng/dl). After initial treatments with testosterone, sexual dysfunction persisted with mean treated testosterone values increased to 78+/-17 ng/dl and mean free testosterone values 0.9+/-0.2 ng/dl but mean DHT values remained low at 8+/-4 ng/dl.

Conclusions: A small subset of patients identified with persistent sexual dysfunction while on testosterone treatment, with normal or elevated total and free testosterone values had low DHT values.  The mechanistic hypotheses include persistent endocrine and epigenetic gene expression alterations of the 5AR enzyme. Symptoms have improved by increasing the serum DHT levels to the upper tertile of normal using low dose topical DHT (Andractim). Testosterone treatment is more complicated than just measuring total testosterone.

Disclosures:

Work supported by industry: no.

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Sexual practices and sociodemographic predictors: A population-based study in young women (#196)

V. Piassarolli (Brazil)
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196

Sexual practices and sociodemographic predictors: A population-based study in young women

Piassarolli, V1; Giraldo, P1; Bardin, M1; do Amaral, R1; Mira, T1; Benetti Pinto, C1; Beghini, J1; Polpeta, N1; Miranda, A2; Rett, M3

1: UNICAMP, Brazil; 2: UFES; 3: UFSE

Objective: The present study investigated the prevalence of  dyspareunia in a Brazilian community sample. In addition, the authors assessed the role of sociodemographic predictors in women's sexual practices.

Methods: Population-based study involving 474 Brazilian women with 18-44 years of age, living in Vitória – ES. The sample was stratified by the five regions and the respective Basic Health Units and randomized from the registry of the Family Health Program. After the draw, the residences were located by community health workers and together with research assistants previously trained invited women in their own homes after study objectives were explained. For data analysis we used the Fisher exact test considering significant with p values <0.05.

Results: The average age of participants was 31 years (SD ± 7.68), mostly working out (67%), Catholic (42%), 46% white and 37.3% married or living together with their partner. The frequency of vaginal intercourse 1 to 3x/week was 72.2% with no significant differences between categories of age, education level and family income. The prevalence of receiving oral sex was 67.5%, being statistically significant in younger women (<0.0001), low education level (<0.0001) and low income (<0.0002). In this same profile of women the frequency of dyspareunia was 47.7% and more significant in the group of women with low income and low education levels (0.0042, 0.0306), with 24.6% of penetration pain and 30.6% of deep dyspareunia. There was a minority of women practicing anal sex (23.3%) and no difference between the categories of sociodemographic variables was found.

Conclusions: Significant differences were found when comparing the sexual practices and sociodemographic characteristics among categories of age, education level and family income. Results also indicated that symptoms of dyspareunia and some sexual practices are a significant health concern in Brazil, suggesting that public policies should be developed to promote sexual health.

Disclosures:

Work supported by industry: yes, by FAPESP - São Paulo (no industry support in study design or execution).

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Profile of the female adolescents in use of combined oral contraceptives (#197)

D. Maranhão (Brazil)
show abstract

197

Profile of the female adolescents in use of combined oral contraceptives

Maranhão, D1; Bardauil, V1; Marina, M1; Cardoso, F1; Aldrighi, J1; Coelho, J2; Ribeiro, S2

1: Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil; 2: Faculdade de Ciências Médicas da Santa casa de São Paulo

Objective: This study evaluated the profile of adolescents in use of combined oral contraceptives (COCs) through questionnaires and correlation of the acquired data.

Material and Method(s): A cross-sectional, descriptive, prospective and observational study was conducted through questionnaire answering with 41 girls, aged 12 to 17 years old, which had follow-ups in the Clinic of Pediatric and Adolescent Gynecology of Santa Casa Hospital in São Paulo, Brazil. All the questions made were concerning general characteristics of contraceptive use, knowledge of its functions, dialoguing with parents about sexuality and using barriers methods for prevention of sexually transmitted diseases (STDs). In addition, data such as age, adverse effects, time of administration and frequency of forgetfulness were also evaluated.

Result(s): From analysis, the reason for initiating the use of pill was menstrual irregularities in 55% of the patients. As for side effects (SE), 61% reported suffering negative SE and the classification of SE discomfort level  was directly proportional to age increase (r = 0,340 e p = 0,030).

93% of girls said to be true the sentence “There is a correct way for using COCs”, showing knowledge about the need of a proper use of hormone therapy. However, 76.2% of them had forgotten to take the pill at least once and 60% had reported they do not trust the usage of pill, alone, as a reliable contraceptive method.

The majority of parents was aware and was in favor of COC usage; therefore, omissions were rarely reported. Still, approximately 50% of patients denied receiving sexual orientation from parents, and among those receiving, almost half were exclusively maternal. Simultaneously, results showed that adolescents whose parents participated in sexual orientation showed statistically higher knowledge about the function of COCs (p = 0,042). Out of the total, 32% did not know that COC does not protect against STDs, and approximately 55% were unaware of its function.

Conclusion(s): The lack of knowledge by adolescents regarding the contraceptive function, despite and regardless of the broad access to media they have, arouses questions about the need for greater intervention of health professionals propagating information to this community during its crucial learning stage, promoting health care through prevention.

Disclosures:

Work supported by industry: no.

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The prevalence of dyspareunia in female urology clinic (#198)

Y. Sekiguchi (Japan)
show abstract

198

The prevalence of dyspareunia in female urology clinic

Sekiguchi, Y1; Maeda, Y2; Azekosh, Y1; Kinjo, M2; Fujisaki, A2; Nakamura, R2

1: Womens Clinic LUNA Group, LUNA Pelvic Floor Total Support Clinic, Japan; 2: Womenfs Clinic LUNA Group, LUNA Pelvic Floor Total Support Clinic, Japan

Objective: Integra theory 1) which is the development basis of Tension free Vaginal Tape (TVT) by P.P.Petros referred pelvic floor disorders were one of causes of dyspareunia. Pelvic floor disorders consist of stress urinary incontinence, overactive bladder and pelvic organ prolapse and so on which are treated in female urology clinic.  We conducted a study of the prevalence of dyspareunia in female urology clinic for researching the relation between pelvic floor disorders and dyspareunia.

Material and Method: 747 patients visited first between July 2010 and January 2014. They took the questionnaire included dyspareunia, chronic pelvic pain and lower urinary symptoms. .

Results: There were 105 patients (14%) had dyspareunia. The disease of the initial motive to come the clinic were chronic pelvic pain syndrome/ interstitial cystitis 37 (35.2%), urinary incontinence 15 (14.3%), acute cystitis 14 (13.3%), overactive bladder 12 (11.4%), pelvic organ prolapse 11 (10.5%), female sexual dysfunction 10 (9.5%), hematuria 3 (2.9%), nocturnal enuresis 2 (1.9%) and urinary calculi 1 (1%). Additionally people complained of back pain were 26 (24.8%), that of abdominal pain were 40 (38.1%) and that of pain in the vulva were 49 (46.7%).

Conclusions: 14% of dyspareunia in our study is same as the prevalence of dyspareunia in Europe. 2) It suggested that there were many potential patients with female sexual dysfunction in Japan. The 36.2% of pelvic floor disorders patients included stress urinary incontinence (14.3%), overactive bladder (11.4%) and pelvic organ prolapse (10.5%) has dyspareunia. It was equivalent the probability of dyspareunia with chronic pelvic pain syndrome/interstitial cystitis (35.2%).Therefore dyspareunia related to pelvic floor disorders may exist as same as that of chronic pelvic pain syndrome.

Disclosures:

Work supported by industry: no.

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Does parity affect the sexual function of pregnant women? Preliminary results (#199)

M. Ribeiro (Brazil)
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199

Does parity affect the sexual function of pregnant women? Preliminary results

Ribeiro, M1; Nakamura, M2; Torloni, M3; Scanavino, M4; Mattar, R2

1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil; 4: University of São Paulo Medical School (FMUSP), Brazil

Objectives: Several factors may affect female sexual function during pregnancy. Our aim was to evaluate and compare the sexual function of nulliparous versus multiparous pregnant women.

Patient and Methods: Cross-sectional study conducted between March 2012 and June 2014 at the antenatal clinic of a public teaching hospital. Up to the present, 114 healthy women between 14 and 40 weeks´ gestation were recruited:  55 were nulliparous and 59 were multiparous. The Female Sexual Function Index (FSFI) was used to assess sexual function. Women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The Chi-square and Student’s t tests were used to compare variables between the two groups. P < 0.05 was considered significant.

Results: There were 71 2nd (14-28 weeks) and 43 3rd trimester (28 – 40 weeks) participants. The mean (standard deviation) gestational age of nulliparous and multiparas were similar for 2nd trimester (22.1 ± 2.1 and 21.9 ± 4.5 weeks, respectively) and 3rd trimester (34.5 ± 3.3 and 34.2 ± 3.6 weeks, respectively) participants. Socio-demographic characteristics were also similar. Mean final FSFI scores did not differ significantly between the two groups: 20.5 ± 11.0 vs 22.3 ± 10.1 (p=0.475) for nulliparous and multiparous 2nd trimester participants and 22.1 ± 10.7 vs 25.5 ± 9.6 (p=0.280) for nulliparous and multiparous 3nd trimester participants. A total of 32 nulliparous women had sexual dysfunction symptoms (FSFI score ≤ 26) compared to 23 multiparous pregnant women (58.2% x 40.0%, p=0.060).

Conclusion: According to our preliminary results, the prevalence of sexual dysfunction symptoms, as measured by the FSFI questionnaire, is similar among nulliparous and multiparous pregnant women during the 2nd and 3rd trimesters of pregnancy.

This study was funded by a grant from FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670-4 and 12/50225-6

Disclosures:

Work supported by industry: no.

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Evaluation of sexual function and mood in women with stress urinary incontinence (#200)

Lucia Lara (Brazil)
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200

Evaluation of sexual function and mood in women with stress urinary incontinence

Romão, A1; Lara, L1; Brito, L1; Franceschini, S1; Yamaguti, E1; Rosa-e-Silva, A1; Gorayeb, R1

1: Faculty of Medicine of Ribeirão Preto, Brazil

Objectives: To evaluate the sexual function and mood of women under treatment for urinary incontinence (UI).

Material/Methods: This was a pilot study conducted at the Urogynecology Outpatient Clinic of the University Hospital of Faculty of Medicine of Ribeirão Preto, São Paulo University. Forty five incontinent women were included. Records of sociodemographic data were obtained. The Female Sexual Function Index (FSFI) was used to assess Sexual Function, with a score ≤ 26.55 considered to indicate a risk for sexual dysfunction. The Hospital Anxiety and Depression Scale (HAD) was used to assess mood, with a score > 8 indicating a risk for anxiety and a score > 9 indicating a risk for depression.

Results: All 45 women with a mean age of 48±12.54 years (24-79) completed the two instruments. The mean education level was 7 ± 3.94 years. The analysis of social variables indicated that most women, 29 (64.5%), were Catholic, 23(51%) had no type of remuneration, the mean family income was $ 739.6± 456.5, and 35 (77.8%) were married. The mean relationship time was 21.36 ± 14.83 years (0-56), and the mean number of children was 2.9±1.7.  Regarding sexual function, 33 (73%) had FSFI scores < 26.55. Regarding the type of sexual dysfunction, 18 (40%) reported hypoactive sexual desire, 27 (60%) had arousal dysfunction, 19 (42%) had lack of lubrication, 24 (53%) reported anorgasmia, 22 (49%) had difficulty in engaging in sex, and 27 (60%) had pain during intercourse. Thirty-one women (69%) were at risk to develop anxiety and 23(51%) were at risk of depression.  There were positive correlations for depression with age (p=0.01) and arousal with schooling time (p=0.01). A negative correlations was observed for depression and schooling time (p=0.03), orgasm with income (p=0.006), anxiety and lubrication (p=0.005), and anxiety and satisfaction with the relationship (p=0.02).

Conclusion: Women with UI were at high risk to develop sexual dysfunction and mood disorders. A characterization of these disorders is necessary, as well as multidisciplinary approach for the treatment of these women.

Disclosures:

Work supported by industry: no.

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Sexual function of women under treatment for infertility (#201)

Lucia Lara (Brazil)
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201

Sexual function of women under treatment for infertility

Salomão, P1; Romão , A1; Reis, R1; Navarro, P1; Lerri, M1; Rosa-e-Silva, A1; Ferriani, R1; Lara, L1

1: Faculdade de Medicina de Ribeirão - Universidade de São Paulo (FMRP-USP), Brazil

Objectives: This study aimed to investigate the impact of infertility and the process of assisted reproduction (ART) on female sexual function and to assess the emotional state of infertile women.

Methods: Female sexual function was assessed by the female sexual function index (FSFI) and the Anxiety and Depression Scale (HAD) was used to assess the emotional state of these women.

Results: A total of 109 women aged on average  34.62±4.04(22-42) years participated in this study. Eighty- one (74.30%) were married and 28(25.70%) were in a stable relationship. Eighty-eight (80.73%) were employed. The average length of relationship was 12.03±4.66(2-24) years. The average age at first intercourse was 18.01±3.41(13-33) years, and 69(63.30%) had sexual intercourse 2-3 times/week. Primary infertility was diagnosed in 79(72.48%), and 30(27.52%) had secondary infertility. Seventy-six (69.72%) were nulliparous and 33(30.28%) had had one or more pregnancies. Only 6(5.51%) were receiving psychotherapy. The total score for FSFI was less than 26,55 for 41 (37.62%)  women. The analysis of each FSFI domain showed 37(33.94%) women with hypoactive sexual desire, 21(19.26%) with arousal dysfunction, 13(11,92%) with lack of lubrication, 15(13.76%) with orgasmic dysfunction, 10(9.17%) with lower satisfaction, and 14(12.84%) reported coital pain. Concerning psychological aspects, 38(34.87%) were at risk of anxiety, and 16(14.68%) at risk of depression. Both excitation and lubrication were negatively correlated with the length of the relationship (p=0.004 and p=0.006, respectively). There was a positive correlation between pain and length of relationship (0.004); age (p=0.005), and lubrication and also a positive correlation between excitation and age at first intercourse (p=0.005).

Conclusion: The prevalence of sexual dysfunction in this sample is lower than in the general Brazilian population (49%), suggesting that the diagnosis and treatment of infertility did not impact on sexual function in this population. However, sexual desire disorder was more prevalent in this population. A long-term relationship is a causal factor for lubrication and arousal disorder. This work may guide health professionals to assist infertile couples so that they have a better quality of life.

Disclosures:

Work supported by industry: no.

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Sexual complaints of women diagnosed with breast cancer (#202)

Lucia Lara (Brazil)
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202

Sexual complaints of women diagnosed with breast cancer

Tiezzi, M1; Romão, A1; Tiezzi, D1; de Andrade, J1; Carrara, H1; Lara, L1

1: Faculty of Medicine of Ribeirão Preto, Brazil

Background / Aims: Breast cancer is a malignancy that affects more women in the population. The quality of life can be affected in a general way, involving psychological, sociological, emotional and sexual. Therefore, the objective of this study is to evaluate the sexual complaints and mood in women diagnosed with breast cancer treated at a general hospital.

Material / Methods: This is a pilot study, which evaluated 54 women diagnosed with breast cancer. For evaluation of the Sexual Function was used Female Sexual Function Index (FSFI) with scores ≤ 26.55 regarded risk to sexual dysfunction and mood report used the Hospital Anxiety and Depression Scale (HAD) is the score> 8 meant risk for anxiety and > 9 meant that risk for depression and protocol epidemiological and clinical data.

Results: The mean age of patients was 47.5 ± 8.75 [38-67] years, 48 (88,9%) were white. The average years of education was 7.15 ± 3.83 [2-18] years, the median of family income was $ 1,109.84 ± 1,217.39 [869.50-2,321.33-], the average length of relationship was 20.69 ± 13,23 [0-52] years, the average number of children was 2.3 ± 1,33 [0-6]. Regarding sexual functioning, 43 (79,6%) showed FSFI score ≤ 26,55. Among women who scored FSFI ≤ 26,55, the hypoactive sexual desire disorder was prevalent in 15 (27,8%), 17 (31,5%) had arousal dysfunction, 5 (9,3%) showed lack of lubrication, 12 (22,3%) had anorgasmia, 29 (64,4%) showed difficulties in sexual relationship, and 8  (14,8%) had pain. Considering all sample, 10 (18,5%) women had HAD scores > 9 for the depression domain and 21 (38,9%) women were at a risk for anxiety.

Conclusion: In this pilot study, women with breast cancer are at high risk for sexual dysfunction and anxiety as well as difficulties in sexual relationship. This condition may negatively impact interpersonal relationship and quality of life.

Disclosures:

Work supported by industry: no.

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Prevalence of sexual complaints and epidemiological profile of women with polycycstic ovary syndrome (#203)

Lucia Lara (Brazil)
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203

Prevalence of sexual complaints and epidemiological profile of women with polycycstic ovary syndrome

Lara, L1; Romão, A1; Gorayeb, R1; Tiezzi, M1; Reis, M1; Pandochi, H1; Rosa-e-Silva, A1

1: Faculty of Medicine of Ribeirão Preto, Brazil

Introduction/Objectives: Sexuality is a complex process involving biological, psychological and interpersonal determinants. Impairment of any of these dimensions may interfere with sexuality. Patients with Polycystic Ovary Syndrome (PCOS) presenting biopsychosocial changes may have impaired sexual function. Thus, the objective of the present study was to assess the prevalence of sexual and mood complaints and the epidemiological profile of women under treatment for PCOS at a Teaching hospital in the interior of the state of São Paulo.

Material/Methods: The Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HAD) and a protocol involving epidemiological and clinical data were used to evaluate the women. The instruments were analyzed according to the criteria established by the authors of the Portuguese version.

Results: A total of 101 women were evaluated. Mean age was 31.41 ± 8.32 years [19-50], mean schooling was 11 years ± 4.48 [4-18], mean family income was US$ 763.00 ± 383.90 [173.91 - 1,739.13], mean duration of relationship was 7 ± 8.21 years [0-31], mean number of children was 0.9 ± 1.09 [0-4], and mean BMI was 28.35 ± 7.67 [16.87-49.72]. Most women, 73 (72%) were catholic, and 67 (66.4%) were married. Sixty-six (65%) had a paid job. Fifty six (55%) women had a total FSFI score with a cut-off point of < 26.55. The results for the specific domains were as follows: 40 (39%) had hypoactive sexual desire, 45 (44%) had arousal dysfunction, 32 (32%) had lack of lubrication, 37 (37%) reported anorgasmia, 34 (34%) had difficulties with sexual relations, and 35 (35%) had pain.  Regarding mood disorders, 63 (62%) of the women were at risk for anxiety and 41 (41%) were above the cut-off point 9 for depression.

Conclusion: Results of this study provide evidence that PCOS women are at high risk to develop sexual dysfunction and mood disorder.

Disclosures:

Work supported by industry: no.

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16:00 - 17:30
Instructional course 7 - Non surgical, non pharmacological treatment of ED

Location: Transamérica Auditorium
Chairs: Julio Ferrer (Colombia) & Hartmut Porst (Germany)

Future targets

Arthur Burnett (USA)

Neuromodulating agents

Arthur Burnett (USA)

Vacuum erection therapy: 2014 update or simply vacuum erection therapy

Hossein Sadeghi-Nejad (USA)

LiSWT

Ilan Gruenwald (Israel)


16:00 - 16:45
Workshop 13 - Treatment paraphilias

Location: Ilhéus + Una Room
Chair: Veronica Delgado-Parra (Mexico)

Paraphilias: New concepts, cassification and treatment options

Eli Coleman (USA)

Paraphilic behavior complains to diagnostic claims

Oswaldo Rodrigues Jr. (Brazil)


16:45 - 17:30
Workshop 14 - Practical aspects of vaginal dilators

Location: Ilhéus + Una Room
Chair: Jacqueline Brendler (Brazil)

Practical aspects of vaginal vibrators and dilators

Annamaria Giraldi (Denmark)

Clinical implications for vibrators, dilators

Michael Krychman (USA)


Sunday

Morning

08:00 - 08:30
Lecture by the new ISSM President

Location: São Paulo Room

Counterfeit PDE5 inhibitors pose significant safety concerns

Wayne Hellstrom (USA)


08:30 - 10:00
Take home messages

Location: São Paulo Room
Chairs: Edgardo Becher (Argentina) & Sidney Glina (Brazil)

Women’s sexual medicine

Shari Goldfarb (USA)

Ejaculation

Ege Can Serefoglu (Turkey)

Erectile dysfunction

Landon Trost (USA)

Androgens

Anthony Bella (Canada)

Psychological aspects of sexual dysfunction

Tamara Melnik (Brazil)

Basic science

Ege Can Serefoglu (Turkey)


10:00 - 10:30
Closing ceremony

Location: São Paulo Room

Unmoderated posters

9, 10 and 11 October 2014

09:00 - 17:00
Unmoderated posters

Location: Foyer

Sexual life in elderly male college students – Federal University of Amapa - Brazil (#204)

R. Campos (Brazil)
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204

Sexual life in elderly male college students – Federal University of Amapa - Brazil

Campos, R1; Sena, I1; Silva, K1; Teles Junior, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa UNIFAP, Brazil

Objective: To evaluate sexual life of elderly male students, mainly their quality of sexual life.

Material and Methods: Cross-sectional, descriptive and quantitative study, with 37 male college students between 60 to 75 years old, who answered the Male Sexual Quotient (MSQ), a questionnaire developed and validated nationally used to assess quality of sexual life. Total maximum score is 50 and to obtain MSQ final score, that total maximum score must be multiplied per 2. MSQ covers a range of physical and emotional aspects of sexual experience, including “desire” (item 1), “confidence” (item 2), “foreplay quality” (item 3), “partner satisfaction” (items 3–4), “erection quality” (items 5–7), “ejaculatory control” (item 8), “ability to achieve orgasm” (item 9) and “intercourse satisfaction” (item 10).  Men who didn´t have sexual intercourse in the last six months were excluded. The data were statistically analyzed by using SPSS 21.0. The study was consented by the institutional ethics committee.

Results: Mean QSM score was 68.3 (partially satisfied). In the population studied, 35.1% was classified as “highly satisfied”, 32.4% “partially satisfied”, 24.3% “average”, 5.4% “dissatisfied” and 2.7% “highly dissatisfied”. In the analysis of sexual domain evaluated by QSM, the mean scores were: desire (7.1), confidence (7.0), foreplay quality (6.9), partner satisfaction (13.4), erection quality (13.5), ejaculatory control (5.4), ability to achieve orgasm (8.1), and intercourse satisfaction (6.8). Premature ejaculation, erectile dysfunction and dissatisfaction with sexual intercourse were suggested sexual problems in 10.4% (n=4) of elderly male students. In 13.5% (n=3), there was inability to achieve orgasm and in 8.1% (n=3), hypoactive sexual desire.

Conclusions: Senescence seems to have negative impact on quality of sexual life, but in this research, the marjority of elderly male college students have a sexual life classified as “satisfied”. The least score in sexual domains was control of ejaculation (suggesting premature ejaculation as a common dysfunction) and the best was ability to achieve orgasm. A few male college students seemed to have sexual problems.

Disclosures:

Work supported by industry: no.

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Integrating sexology education into psychiatry residency training: Perspectives from the USA (#205)

D. Lin (USA)
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205

Integrating sexology education into psychiatry residency training: Perspectives from the USA

Lin, D1; Kleinbart, E

1: Mount Sinai Beth Israel, United States

Objective: The presentation will focus on how psychosexual medicine and sexology education can be integrated into psychiatry residency training.

Material and Method: The Psychosexual Medicine Program currently being implemented at Beth Israel Medical Center, Department of Psychiatry and Behavioral Sciences in New York, NY will be described.

Results: The positive impact on the training program and overwhelming support from faculty and residents of the program will be discussed.

Discussion: An argument will be made why it is important to teach sexual medicine in psychiatry residency training and how psychiatrists are uniquely positioned to be good sexologists. It will be recommended that sexual medicine education become an integrated part of psychiatry residency training everywhere in the USA.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Sperm DNA fragmentation in patients with fertility disorders before and after varicocele procedure (#206)

G. Bastidas (Venezuela)
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206

Sperm DNA fragmentation in patients with fertility disorders before and after varicocele procedure

Bastidas, G1; Escovar, P2; Vieira, M3; Sanoja, A2

1: University of carabobo, Venezuela; 2: University of Carabobo, Venezuela; 3: Instituto H. Ellis

It is shown that varicocele causes increased oxidative stress bringing a testicular abnormal chromatin packaging and / or breaks in the Sperm DNA which is associated with a low rate of fertility in vivo and in Vitro.

General Objective: Analyse DNA fragmentation in patients with sperm fertility disorder before and after varicocelectomy.
Materials and Methods: This is a quasi experimental research of pre and post no control group with a field design, the study population consisted of all patients with a history of infertility of 1 year or more of development with clinical varicocele with no other medical history, no smoking, undergoing varicocelectomy in the “Instituto Docente de urologia” of Valencia during the period January to December 2013, The sample was not random type of volunteers made ​​up of 21 patients. As data collection technique was applied direct observation and TUNEL test to measure sperm DNA fragmentation, the data were normally distributed and were analyzed from the hypothesis test for the difference between means.

Results: The average percentage of sperm DNA fragmentation before and after varicocelectomy was 42% ± 24% ± 1.58 and 1.05, showing a statistically significant decrease (P <0.05). Sperm concentration showed no statistically significant difference from pre to post surgery (P> 0.05); motility before and after varicocelectomy averaged 39% ± 3.53 and 54.1 ± 2.66% , demonstrating a statistically significant increase from pre to post surgery (P <0.05). The morphology before and after the recorded varicocelectomy 12.19% ± 1.10 22.04% ± 1.07 and also demonstrating a statistically significant increase from pre-to post-operative (P <0.05).

Conclusions: Following varicocelectomy patients studied showed a significant decrease in the number of sperm with DNA fragmentation, as well as improvements in the parameters of sperm motility and morphology.

Recommendations: longitudinal cutting studies, assessing issues such as fertility in the medium and long term.

Disclosures:

Work supported by industry: no.

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The role of coenzyme Q10 in the treatment of idiopathic male infertility (#207)

H. Julio Junior (Brazil)
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207

The role of coenzyme Q10 in the treatment of idiopathic male infertility

Julio Junior, H1; Cruz, D1; Leite, R1; Schiavini, J1; Damiao, R1

1: Hospital Universitário Pedro Ernesto, Brazil

Objective: To conduct a systematic review of studies published evaluating the role of coenzyme Q 10 in the improvement of sperm parameters and pregnancy rate in patients with idiopathic oligoasthenozoospermia. 

Material and Method: This study was based on a systematic review in the Medline database demonstrating the effect of the exogenous administration of coenzyme Q10 in the treatment of male infertility. Twenty of the thirty-two articles with significant results in this topic were evaluated.

Results: Coenzyme q10 (2,3-dimethoxy-5-methyl-6-deca-69 prenyl-1,4-benzoquinone, CoQ10) is an isoprenylated  benzoquinone which transports electrons from complexes 1 and 2 to complex 3 in the mitochondrial respiratory chain, presenting a crucial role in cellular metabolism, in reduction of free radicals and in stability of the chain. It is metabolized and reduced in the testis to ubiquinol. The late is a strong lipophilic antioxidant, and can recycle and regenerate other antioxidants such as tocopherol and ascorbate. Decreased serum CoQ10 concentrations as well as a decrease in  seminal fluid have been related to oxidative stress. Studies have demonstrated that daily administration of 200 to 300mg of this medication for at least 6 months can improve semen parameters(such as concentration and motility), but there is disagreement regarding the improvement of the fertility rate.

Conclusion: The studies evaluated demonstrated benefit in improving semen parameters in patients with idiopathic oligoasthenozoospermia treated with coenzyme q10 especially in relation to concentration and motility. However, there is still disagreement regarding the improvement of the pregnancy rate with this treatment.

Disclosures:

Work supported by industry: no.

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A ring constriction of the penis: An emergency presentation of an aged man (#208)

Ahmed El-Sakka (Egypt)
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208

A ring constriction of the penis: An emergency presentation of an aged man

Yousef , I1; Ismail , E1; Gomaa, M1; El-Sakka, A1

1: Suez Canal University, Egypt

Objectives: Strangulation of the penis in the aged population although rarely described in medical literature can lead to a wide range of penile vascular and soft tissue injuries. To address this urological emergency condition that necessitates immediate intervention to remove the constricting object and to expectantly prevent disastrous penile complications.

Materials and Methods: We report a case of penile strangulation that presented to our emergency department (ER). A 75-year-old gentleman presented to ER with severe penile swelling and intractable pain. Patient gave a history of a metallic ring insertion over his penis 3 hours before presentation as a mean for masturbation. Subsequently he was unable to remove it due to progressive swelling. On physical examination the penile shaft was edematous and the metallic ring was thick and embedded in the skin at the base of the penis. After failure of several trials with available tools in the emergency department including orthopedic bone-cutting forceps however, unfortunately this was unsuccessful as the blade cannot be inserted under the ring and the tip of the blade was bent without cutting through the ring. We called "Tinsmith" who has different tools that can cut through metal. We used the metal cutter to cut through the ring. Local and general complications of penile strangulation were assessed.  Penile skin bruises, edema, laceration, strangulation and amputation of the penis, urinary obstruction and general complications should be prevented.

Results: Due to the on time removal of the constricting ring the penile edema was dramatically resolved and penile color regained gradually. Apart from minor bruises, penile skin was intact and patient urinated normally.  The patient made an uneventful recovery.

Conclusions: Penile strangulation, though uncommon, can be challenging to manage. Intervention on an emergency bases is important to prevent local and probably general complications. Patients with long term history of penile strangulation or multiple co-morbidities should be monitored more closely for these general complications.

Disclosures:

Work supported by industry: no.

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Penile cancer in patient with a “Bouglou” penile adornment (#209)

R. Campos (Brazil)
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209

Penile cancer in patient with a “Bouglou” penile adornment

Campos, R1; Souza, G1; Pena, L1; Barros, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa, Brazil

Aim: This case discusses the characteristics of the south-american penile adornment “Bouglou” as well as the risk factors for penile cancer at the region.

Methods: Case reports of one man admitted by the Urological public Service.

Results: A 48-year-old afrodescendant man with a painful penile destructive lesion reported that it began as a condiloma at the penile shaft six months before, which grew towards the glans. He tried to treat first immersing his penis in sulfuric acid and after exfoliating it with “Pedra Pome” (a local stone usually used to exfoliate skin), without any lesion improvement. He implanted 3 nodules under the foreskin penile shaft, which he called “Bouglou” adornments, because his wife requested so. He told that this practice was very common at the region. He confirmed that he continued to be promiscuous even married. He also confirmed that sometimes has sexual intercourses with cows and goats. The diagnosis of penile cancer was confirmed after total penectomy.

 Conclusions: In the region, the practice of penile implantation is known as “Bouglou” and the objects usually used as implants are domino fragments and toothbrush handle, in procedures without any hygienic conditions and that almost always result in complications. The implant incisions are often made with lids of sardine cans and it’s very common local bleeding, swelling and infection that need immediate treatment and result in difficult scarring lesions. Other studies suggests that these penile adornments tries to compensate the subjective little size of their penis, their lack of virility and/or their poor sexual performance. Factors related to Zoophilia may favor chronic inflammatory process and, consequently, dysplasia, such as penile contact with animal external genital mucosae, resulting in microtraumas and exposition to animal anogenital secretion, which can be carcinogenetic to human beings. The present study is the first to suggest a possible association between squamous cell carcinoma and the penile adornments. Possibly, uncorrected implanted penile nodules provoke local and repetitive trauma that can elicit chronic inflammation, which can perform a rule in the pathogenesis of carcinoma.

Disclosures:

Work supported by industry: no.

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Inflatable penile prosthesis implant with triangle shape excision and grafting for surgical therapy of Peyronie's disease: A case report (#210)

A. Miranda (Brazil)
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210

Inflatable penile prosthesis implant with triangle shape excision and grafting for surgical therapy of Peyronie's disease: A case report

Miranda, A1; Machado, B2

1: Ipanema Federal Hospital, Brazil; 2: Federal University of Rio de Janeiro, Brazil

Objective: To describe a new technique of plaque excision and grafting and implantation of an inflatable penile prosthesis to correct penile deviation caused by Peyronie disease in a patient with erectile dysfunction

Methods: We here present a case of a 65-year-old man, without comorbidities, who presented with moderate erectile dysfunction and required a phosphodiesterase type 5 inhibitor to have sexual intercourse. He had a dorsal penile deviation of 60° caused by Peyronie disease. The penile plaque had been stable for 1 year. The patient underwent bi-triangular shape plaque excision, followed by grafting with bovine pericardium and implantation of a 3-piece inflatable penile prosthesis.

Results: Complete penile straightening, without mechanical or geometric abnormalities, was achieved using bi-triangular excision and grafting. This novel technique differs from the commonly used double-Y and H-shape techniques, which may generate mechanical or geometric abnormalities. For this new technique, we used a graft of the same size and shape as that used for the double-Y shape technique. Postoperatively, the patient reported being highly satisfied with the results and could perform sexual intercourse naturally.

Conclusion: To our knowledge, this is the first case in the literature in which the previously reported bi-triangular technique was successfully used for penile prosthesis implantation secondary to Peyronie disease, validating our previous measures and findings. This new technique avoids geometric and mechanical abnormalities and may represent a good solution to correct penile deviation for surgeons who are familiar with the double-Y technique.

Disclosures:

Work supported by industry: no.

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Effectiveness of surgical treatment for Peyronie's Disaese (#211)

K. Nagao (Japan)
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211

Effectiveness of surgical treatment for Peyronie's Disaese

Nagao, K1; Tai, T1; Saigou, R1; Tanaka, N1; Kobayashi, H1; Nakajima, K1

1: Toho University, Japan

Objective: In 1996 the Reproduction Center at Toho University Omori Hospital introduced the option of surgical treatment for patients with penile deformity from Peyronie’s Disease. We examined the effectiveness of this treatment at our center.

Methods: We reviewed the clinical records of 156 men with Peyronie’s Disease who underwent surgery at our center during the 17-year period from 1996 to 2013. Mean age was 51.5 years (range 18–80 years). After receiving 6–12 months of conservative therapy, patients underwent surgery consisting of plication and/or grafting. The grafting process utilized saphenous vein and dermis. The inclusion criteria for grafting included absence of diabetes, penile curvature ≥60°, and an overall penile length of ≤10 cm upon traction.

Results: No patient who underwent plication developed adverse effects such as erectile dysfunction, and all retained the ability for normal intercourse. Most patients who received grafts also underwent plication to correct slightly abnormal curvature. Some patients who received dorsal grafts developed reduced erectile functioning but recovered after beginning treatment with phosphodiesterase type 5 inhibitors. Dermal grafting resulted in temporary constriction, which resolved within 1 year after the operation.

Conclusions: During the period studied, plication and grafting (using saphenous vein and dermis) resulted in no significant adverse effects and improved the condition of patients.

Disclosures:

Work supported by industry: no.

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Assessment of the adequacy of sexual behaviors in intellectually disabled: Construction of scale (#212)

Itor Finotelli Jr. (Brazil)
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212

Assessment of the adequacy of sexual behaviors in intellectually disabled: Construction of scale

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: The present research was developed in exploratory with the objective of investigating the structure of a scale for assessment of the adequacy of sexual behaviors in the individuals with intellectual disabilities (ID).

Methods: Ninety-eight (98) parental, which eighty percent (80%) was women with ages varying between thirty-three (33) and seventy-four (74) years old (M=48.24; SD=10.87), being thirty-five (35%) percent with primary school and sixty-five percent (65%) with secondary school. These parents were responsible for individuals with ID, seventy-five percent (75%) of men with ages varying between eleven (11) and thirty-five (35) years old (M=19.77; SD=5.99) lacking any kind of education in fifty-four percent (54%) of the cases. The instrument denominated as Scale for Assessment of the Adequacy of Sexual Behaviors in Intellectually Disabled has thirty-one (31) items that assess the adequacy of the behaviors, i.e, “One masturbates (self-arousal) in private/protected places”, measured in Likert of four points in the categories “never”, “sometimes”, “moderately”, “always”, “once”.       

Results: The factorial analysis by main components with varimax rotation extracted three dimensions capable of explaining fifty-six percent (56%) of variance; the criteria for the extraction was the scree plot, the eigenvalue>1.5 and the retention of three items with equal weight or higher than .3. The internal consistency by alpha Cronbach estimated the accuracy of the instrument in .62, the dimensions remain between .70 and .80. The dimensions were denominated as Adequacy of Sexual Behavior, Orientation and Autonomy, and Discrimination of Public and Private. Such dimensions fulfill the assumptions of higher vulnerability which the population of ID suffers in regards to sexual abuses, social embarrassment and confinement of individuals as realities lived by population and to the declaration of the Sexual Rights proposed by World Association for Sexual Health. The dimensions were capable yet to discriminate characteristics of the sample in regards to gender and schooling.   

Conclusions: Weigh up limitations in regards to the size of the sample and, despite that, the results were favorable to the search of evidence of validity of the scale, as its improvement. 

Disclosures:

Work supported by industry: no.

The psychoeducational practice in psychological and sexual therapy for treatment of erectile dysfunction (#213)

C. Miranda do Amaral e Silva (Brazil)
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213

The psychoeducational practice in psychological and sexual therapy for treatment of erectile dysfunction

Miranda do Amaral e Silva, C1

1: IBPEX/UNINTER, Brazil

This case study describes the psychological and educational practice in sex therapy for the treatment of erectile dysfunction in a patient with 22 years old without biological difficulty. Thus, believed to in the proposed of a best intervention and the orientation for new studies.

With detailed analysis of the case, through psychotherapeutic technique, it was observed that the patient had low self-esteem, fear and anxiety related to erectile dysfunction, and mild social impairment, in attempts to launch himself a new sexual conquests. The erection difficulty already him have prejudiced since the first sex intercourse, he believed that it had been late, because of low self-esteem. Of course, the first bad sexual experiences brought the fear of failure and the anxiety of performance, enabling schemes incompetence, as the Cognitive-Emotional Model of Male Sexual Dysfunctions, proposed by Noble (2010). About the patient's personality, it was noticed a very demanding and rational standard, facilitator of negative sexual schemas, full of beliefs and myths, brought by him as conservatives.

Given this context, to think of the psychological and sexual therapy approach was emphasized the increased sexual stimulation through masturbation techniques, remembering that the patient does not have a sexual partner. In addition to providing self-knowledge, these techniques helped in reducing the anxiety of performance and fear of failure. It was emphasized also assertiveness training and social skills, influencing directly the process of self-knowledge, and consequently, improved self-esteem. However, the intervention was still incomplete, 'it jumped' the need for a strategy, even these already described, consolidate themselves on the psychoeducation process. Along with cognitive restructuring, the process is defended on cognitive interventions for the deconstruction of myths and erroneous beliefs, overcoming the sexual ignorance. In this case in special with a high standard of self-demand and a very rational personality, success was evident with 8 psychotherapy sessions. So, thinking in clinical practice, where increasingly the number of young men with sexual dysfunction, especially erectile dysfunction without a history of biological problems and without a partner, it is a good strategic of intervention to be used. Further studies, especially quantitatives can show the effectiveness of the approach.

Disclosures:

Work supported by industry: no.

Quality of sexual life and lower urinary tract symptoms in male college students (#214)

K. Silva (Brazil)
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214

Quality of sexual life and lower urinary tract symptoms in male college students

Silva, K1; Campos, R1; Sena, IS1; Soares, V1; Teles Junior, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa UNIFAP, Brazil

Objective: To analyze the relationship between lower urinary tract symptoms (LUTS) and quality of sexual life in elderly male college students. 

Material and Methods: Cross-sectional, descriptive and quantitative study, with 37 male college students, with ages between 60-75 years old, who answered two questionnaires: one to evaluate the quality of sexual life, the Male Sexual Quotient (MSQ), developed and validated nationally, and the International Prostate Symptom Score (I-PSS), used to evaluate the urinary symptoms (7 questions) and their impact on quality of life in general (1 question). The data were statistically analyzed by using SPSS 21.0, with significance levels set at p<0.05. To verify the correlation between the I-PSS and the MSQ, it is used the Pearson test. The study was consented by the institutional ethics committee.  

Results: Mean MSQ was 68.3, classified as “partially satisfied”. Mean I-PSS was 11, classified as “moderate” LUTS. Ninety-five percent of the men had LUTS. According to I-PSS, 14.2% had “severe” symptoms (I-PSS: 20-35), 37.14% had “moderate” symptoms (I-PSS: 8-19) and 48.57% had “mild” symptoms (I-PSS: 1-7). Regarding to urinary symptoms, the students had incomplete emptying (38%), frequency (73%), intermittency (51%), urgency (57%), weak stream (49%), straining (35%). Only 5.4% affirmed to have nocturia. There is a significant correlation between the two ends: MSQ and I-PSS (Pearson Coefficient= -0.435, with p=0.007).

Conclusion: Nearly all men over 60 years old have lower urinary tract symptoms, although almost 50% have them classified as “mild”. Urinary frequency was the most common symptom reported in this group. In old men, the more intense are the lower urinary tract symptoms, the worse would be their quality of sexual life.

Disclosures:

Work supported by industry: no.

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Sexual function and its relation with stress, depression and anxiety (#215)

S. Cedres (Uruguay)
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215

Sexual function and its relation with stress, depression and anxiety

Cedres, S1; Dartayete, G1

1: Uruguay

Introduction: Sexuality is a psychological construction of the personality resulting from the interaction of organic, factors, congenital characteristics, environmental circumstances and social phenomena, in which the individual develops himself. That is why it has to be dealt with through a multidisciplinary, systemic and holistic approach. This paper was made at Centro Plenus in Uruguay, where there is a multidisciplinary group that gives attention to all those patients that think they have some type of sexual dysfunction..

Objectives: To determine the influence of stress, depression and anxiety on sexual dysfunction METHODS: Of the studied cases, 100 predominantly psychogenic subjects with sexual dysfunction were selected. DASS score was used to determine level of stress, depression and anxiety.

Results: There was a relationship between bad sexual performance with high levels of stress, medium levels of depression and anxiety. Among the results, it was observed more stress in man with high educational level, work with people above, erectile dysfunction for more than 3 month. In women, the high stress was observed when they had teenager sons, low sexual desire for more than 3 month, bad relations with their partner for being unable to respond to the partner’s sexual demand.

Disclosures:

Work supported by industry: no.

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Bouglou: a South-American penile adornment (#216)

R. Campos (Brazil)
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216

Bouglou: a South-American penile adornment

Góes, L1; Campos, R1; Silva, K1; Paes, A1; Teixeira, T1

1: Federal University of Amapa, Brazil

Objective: Discussion of three cases reports of “Bouglou" penile adornments during January to May, 2014, establishing the relationship between this eastward trend with the western cultural practices at the region.

Material and Methods: Literature search for MEDLINE-indexed papers followed by a manual bibliographic review of cross-references. We used as search strategies tools the descriptors: penile adornment and penile pearls. The search was extended to non-MEDLINE references using an Internet-based search engine (Google).

Results: The first case involved a 22-year-old patient, prisoner, who inserted the penile Bouglou in May, forced by older prisoners. The second case was a 19-year-old prisoner, who inserted it a month before, willingly, in order to take part of the prisoners group. He had placed the first Bouglou when he was 16, at the Detention Center for Minors. The bearer had suffered from imminent inflammation and pain and then he sought for medical aid. The third case involved 35-year-old patient, boatman, who search medical help because of an epididymis cyst. The penile Bouglou was inserted during his life to improve sexual performance, although he didn’t have a steady partner. The patient showed no interest in removing them. He also denied sexually transmitted diseases (STDs) and confirmed using condoms in all sexual intercourses.

Conclusions: Penile adornments, which are known as fang muk, bullets, chagon balls, goli or bullet, are quite common in Southeast Asian Countries. They’re made of a sort of materials, including stone, plastic pearls or pieces of domino. At the region, it is known as “Bouglou” and it is made of the similar material registered in the literature. The three cases registered showed that this practice is common among men, especially the incarcerated population. Some cases developed local pain and inflammation, pattern not very common in the literature, considering that most cases runs with no complications. The practice of penile Bouglou is associated to the symbol of manhood and potency, demanding from female partner and better sex performance. The incidence of “Bouglou” at the region reveals the intimate relationship between this practice and the Western’s cultural manifestations. It demonstrates that this phenomenon has been travelling from East to West.

Disclosures:

Work supported by industry: no.

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Priapism refractory to primary management methods associated with terazosin therapy (#217)

D. Martinez (USA)
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217

Priapism refractory to primary management methods associated with terazosin therapy

Emtage, J1; Martinez, D1; Hakky, T1; Carrion, R1; Parker, J2; Hall, M1

1: University of South Florida, United States; 2: niversity of South Florida, United States

Objectives: Ischemic priapism is considered a medical emergency, and alpha-adrenergic blockade is a rare cause. This is due to inactivity of the sympathetic input needed for detumescence. Alpha-blockers are commonly used medications for voiding dysfunction. To date, there have been only two reports in the literature of terazosin-induced priapism and both cases were resolved with irrigation/aspiration or phenylephrine injection. We report the case of a terazosin-associated priapism, refractory to the aforementioned primary management methods.

Materials and Methods: Our patient is a 49-year-old male with a 19-year history of T4 incomplete paraplegia. He has had good sexual function without the use of adjuncts. His bladder has been managed with a sphincterotomy and condom catheter but urodynamic studies showed evidence of outlet obstruction despite recent re-do sphincterotomy. He was then started on a terazosin ramp to 10 mg qhs. While on the 6 mg qhs dose the patient presented with an erection persistent for more than four hours. The patient had no other reason for new-onset priapism and had no other recent medication changes.

Results: The patient was subject to irrigation/aspiration and intra-cavernosal injection of phenylephrine, both were unsuccessful. An attempt at Winter’s Shunt was unsuccessful as well. The patient was therefore taken for the standard Al-Ghorab corpoglandular shunt with the Burnett ‘Snake’ manoeuvre. This allowed for complete detumescence. At 3-month follow up, the patient is doing well and is scheduled for penile implant placement.

Conclusions: Priapism is a rare, but important side effect of alpha-blockers. This is especially important given the increasingly frequent and widespread use of these medications for the management of voiding dysfunction. In this medication class, priapism has been most frequently associated with tamsulosin but the association with terazosin is crucial particularly in clinical settings where terazosin is the only medication available for use. Finally, this report highlights that the resultant priapism may be more resistant to primary treatment methods than previously described and may require aggressive surgical intervention for management.

Disclosures:

Work supported by industry: no.

Alternative technique for vasovasostomy in services that do not have microscopy (#218)

A. Filgueiras Pereira Jr. (Brazil)
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218

Alternative technique for vasovasostomy in services that do not have microscopy

Filgueiras Pereira Jr., A1; Julio Jr, H; Cruz, D; Schiavini, J; damiao, R

1: Universidade do estado do Rio de Janeiro, Brazil

Objective: Demonstrate an effective alternative surgery of vasovasostomy without the use of microscopy in services and hospitals that do not have this technology.

Materials & Methods: Surgeries were performed at the Pedro Ernesto University Hospital, Rio de Janeiro, using the spinal anesthetic method. The surgical technique consisted of longitudinal and bilateral scrotal incision, using surgical magnifying glass with 4x. Polypropylene thread (7.0) was used to perform vasovasostomy with 6 stitches in one plane full thickness.

Results: Eight surgical procedures were performed in a period of 12 months. Seven of these patients (87.5%) had sperm in semen examination postoperatively, demonstrating success of the procedure. Only one patient had no surgical reversal. Among patients who had a successful result, one spontaneous pregnancy(14,28%) in this period. The mean operative time was 150min.

Conclusion: Although best results were obtained using the microscopic approach, vasovasostomy performed under loupe magnification has the advantage of reduced costs and reduced operative time. The benefit of this technique is significant especially in countries and hospitals where the microscope is not available.

Disclosures:

Work supported by industry: no.

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Maternal overweight and sexual function of Brazilian women – Preliminary results (#219)

M. Ribeiro (Brazil)
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219

Maternal overweight and sexual function of Brazilian women – Preliminary results

Ribeiro, M1; Nakamura, M2; Scanavino, M3; Torloni, M2; Forte, B.2; Mattar, R2

1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil

Objectives: Pregnancy and excess adiposity may affect female sexual function. Our aim was to evaluate and compare the sexual function of normal versus overweight pregnant women.

Patient and Methods: Cross-sectional study conducted between March 2012 and February 2014 at the antenatal clinic of a public teaching hospital. Up to the present, 205 healthy women between 14 and 40 weeks´ gestation were recruited:  105 were normal weight and 100 were overweight ((BMI 18.5-24.9 and ≥ 25 Kg/m2, respectively). The Female Sexual Function Index (FSFI) was used to assess sexual function. Women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The Chi-square and Student’s t tests were used to compare variables between the two groups. P < 0.05 was considered significant.

Results: The mean gestational age of 2nd trimester participants was 21.7 ± 4.3 and 22.2 ± 4.0 weeks for normal and overweight women, respectively. The mean gestational age of 3rd trimester participants was 34.8 ± 3.3 and 34.0 ± 3.3 weeks for normal and overweight women, respectively. Socio-demographic characteristics were also similar. Mean final FSFI scores did not differ significantly between the groups: 22.2 ± 10.4 vs 22.0 ± 9.9 (p=0.917) for normal and overweight 2nd trimester participants and 21.9 ± 10.1 vs 19.2 ± 10.4 (p=0.222) for normal and overweight 3rd trimester participants, respectively. A total of 54 normal weight women had symptoms of sexual dysfunction (FSFI score ≤ 26) compared to 79 overweight pregnant women (51.4% x 80.0%, p<0.0001).

Conclusion: According to our preliminary results, the prevalence of sexual dysfunction symptoms, as measured by the FSFI questionnaire, is higher among overweight than normal weigh pregnant women during the second and third trimesters of pregnancy.

This study was funded by a grant from FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670-4 and 12/50225-6

Disclosures:

Work supported by industry: no.

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Quality of sexual life of female college student with comorbidities – Amazonia - Brazil (#220)

I. Sena (Brazil)
show abstract

220

Quality of sexual life of female college student with comorbidities – Amazonia - Brazil

Sena, I1; Silva, K1; Campos, R1; Teles Junior, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa UNIFAP, Brazil

Objective: to evaluate the relationship between quality of sexual life with the presence of comorbidities in female college students.

Materials and Methods: Cross-sectional, descriptive and quantitative study, with 123 sexually-active female college students with age range of 34-79 years old, who answered two questionnaires: one to evaluate the sexual quality of life, the Sexual Quotient – Female Version (SQ-F), developed and validated nationally, corresponding a score of 100 points which higher scores indicate better quality standards of sexual life, and the other an epidemiologic questionnaire, where it was asked for the presence of the following diseases: systemic arterial hypertension (SAH), diabetes mellitus (DM), thyroidopathies, osteoporosis, congestive heart failure (CHA) and depression. The data were statistically analyzed by using SPSS 21.0, with significance levels set at P<0.05. One-way ANOVA test was used for statistical evaluation. The study was consented by the institutional ethics committee.

Results: In the population of n=123 female students, 48.8% had at least one comorbidity. There isn´t significant correlation between worse standards of sexual life and the presence of comorbidities in general (p=0.51): the mean SQ-F score of the students with some comorbidity was 64.8, slightly below comparing with those without disease (mean SQ-F score=67.5), both classified as “regular to good”. Among the comorbidities, the most frequent was SAH (26%), followed by DM (13%) and osteoporosis (14%). The only disease that showed statistically relevance in ANOVA test was DM (p=0.02), with mean SQ-F=53.9, therefore classified as “unfavorable to regular”.

Conclusion: Among all comorbidities studied, the most harmful to female quality of sexual life was DM, the second most frequent in the same research. Probably, the pathophysiology of DM is more related to the dysfunction of the mechanisms of the sexual cycle response, differently of the SAH, which showed higher frequency but no statistical correlation with SQ-F.

Disclosures:

Work supported by industry: no.

show poster

Interdisciplinary model for understanding of sexuality (#221)

F. Viola (Argentina)
show abstract

221

Interdisciplinary model for understanding of sexuality

Viola, F1

1: Facultad de Medicina - UNT, Argentina

Sexuality is the most complex human dimension that exists. This is reflected in the difficulty to approach the subject from both research and clinical applications. The resurgence of the concept of sexual health has caused a more operational outlook on the subject. However, difficulties remain, inherent to the object itself and to related perceptions about this object. These difficulties can be associated with the simplification of sexuality to subjects limited to genital and/or reproductive matters. The complexity of sexuality requires expand consideration.

Objectives: Propose a therapeutic model that we call IFE (idea-fact-event). This model is oriented toward an approach to sexual health as it relates potential sexual behaviors, especially in the effect it produces in people.

Material and Methods: Our proposal’s theoretical basis posits three steps that must be considered in assessing sexual cases:

Idea: - What is patient’s– and therapist’s – idea regarding the case, that led to the inquiry?

Fact: - What do we know about the raised sexual fact, and can the consultant know?

Event: - What was the event’s success, as it is presented to us?

Results: We suggest a model based on explicit graphically overlapping circles. This is to define the problem that arises and, accordingly, to help design the proposed therapeutic therapy. Moreover, the same exercise may be helpful to optimize the therapeutic relationship established.

Conclusions: It is important to understand that the event is significant, and that there is always the possibility of allowing the inclusion of the subject’s idea and knowledge. Understanding this would serve to understand that therapeutic adaptation in the field of sexuality is always associated with the prospect of personal construction of meaning. This model is associated with the concept of sexuality as an integral issue and can provide clues necessary to consider treatment and prognosis.

Disclosures:

Work supported by industry: no.

Quality of sexual life and urinary incontinence in female college students in Amapa-Brazil (#222)

R. Campos (Brazil)
show abstract

222

Quality of sexual life and urinary incontinence in female college students in Amapa-Brazil

Campos, R1; Sena, I1; Silva, K1; Soares, V1; Teles Junior, A1; Paes, A1; Teixeira, T1

1: Federal University of Amapa, Brazil

Objective: to evaluate the correlation between the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) and the Sexual Quotient – Female Version (SQ-F) obtained from the college students.

Materials and Methods: Cross-sectional, descriptive and quantitative study, with 57 female college students who answered two questionnaires: one to evaluate the sexual quality of life, the SQ-F, developed and validated in Brazil, and the ICIQ-SF, used to evaluate the urinary incontinence symptoms and their impact on quality of life. The data were statistically analyzed by using SPSS 21.0, with significance levels set at P<0.05. To verify the correlation between the ICQI and the SQ-F, it is used the Pearson´s chi-square tests. The study was approved by the institutional ethics committee. Women who didn´t have sexual intercourse in the last six months were excluded.

Results: The mean age of the participants was 34-59 years old. The mean SQ-F score was 71.57 (standard deviation – SD – 15.15), and was classified as regular to good. 45.6% of women never leak urine, 17.5% leak urine about once a week or less often, 5.3% two or three times a week, 26.3% several times a day. Thirty-one women reported leak of urine, 59.4% usually leak a small amount, 21.9% a moderate amount and 9.4% a large amount of urine. 90.7% of them leak urine when cough or sneeze, or before them can get to the toilet. 9.3% leak when they are physically active/exercising or when they have finished urinating and are dressed. Using a scale of 0 “not at all” to 10 “a great deal”, leaking urine interferes everyday lives of 0 to 5 in 75.2% of women, whereas in 24.8%, it interferes of 6 to 10. In 68.4% of women that leak a small amount of urine, this interference has an intensity of 0 to 3. But in 66.7% who leak a large amount of urine, this interference had an intensity of 8 to 10. Significant correlation is noticed between two extremities (ICQI-SF and SQ-F), with p=0.01 and correlation coefficient = -0.321.

Conclusion: Leak of urine causes major interference in women’s lives and the symptoms of urinary incontinence exert influence on the sexual quality of life. So, the more intense are the urinary incontinence symptoms, the worst will be the female sexual quality of life.

Disclosures:

Work supported by industry: no.

show poster

Educational program in sexual medicine to internal medical students (#223)

Fernando Facio (Brazil)
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223

Educational program in sexual medicine to internal medical students

Facio, F1; Glina, S2; Torres, L3; Faria, G4; Afif, J5; Abdo, C6

1: FAMERP, Brazil; 2: ABC Medical School, Brazil; 3: Brazil; 4: Inst. Urologia Rio Claro, Brazil; 5: São Paulo, Brazil; 6: USP-SAO PAULO, Brazil

Introduction: We believe that patients expect healthcare providers to be knowledgeable and approachable regarding sexual health. This initial project is a tremendous opportunity to mold the next generation of healthcare providers to view healthy sexuality as a relevant patient concern. The improvement in knowledge on human sexuality of medical students will increase their level and may substantially enhance the capacity of tomorrow’s physicians to provide optimal care for their patients in new possibilities to treatments as new drugs and/or new Procedures.

Methods: The Sexual Society and professional member had the goal of improving academic medical knowledge. They gave a clear demonstration to the students in general, of their limited unfounded notions on the subject of sexual medicine and, at the same time, as sexuality is still a subject full of myths, taboos, bias and misunderstanding, our objective was to provide knowledge about sexuality

Results: Educational Program in Sexual Medicine to internal medical students

Seventy four medical students have participated of this project, they gave back answers about improvement in knowledge, understand and applicable in medical practice. The medical students answered questionnaire before and after about the sexual issue received.   In the evaluation we analyzed a improvement 25% of knowledge and 90% in self trust to discuss sexual behaviors with patients.

Conclusion: As first period of this project we concluded that is very important to  increase professional of the medical students, ED remains underdiagnosed and undertreated because doctor , medical students and professional cannot received information enough in graduate programs in the medical school.

Disclosures:

Work supported by industry: no.

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Review on the role of sexual disorders to increase Iranian divorce rate (#224)

M. Ghorbani (UAE)
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224

Review on the role of sexual disorders to increase Iranian divorce rate

Ghorbani, M1; Foroughi, M2

1: United Arab Emirates; 2: Shahd Baheshti University of Medical Sciences, Iran

Objective: The low rate of divorce has been one of the worthy characteristics of Iranian society in past years. But, rate of official and informal divorces are growing in Iran, so that Iran peoples have forth rank of divorce rate in the world now. Checking of Courts and Health files specifies the main reason of divorces is diagnosed or undiagnosed sexual dysfunction in man or woman or both.

Material and Method: We have studied Sexual Disorders (Including: ED, PE, loss of desire, orgasmic problems, dysparunia, vaginismus)in Iranian divorced couples in the past five years.

In this study, we could check role of general education, sexual health training, aggravating factors (Mental and Physical), age, and duration of marital life in causes of divorce.

Results: This study determined there was no significant difference between educated, literate and illiterate divorced couples about incidence of sexual problems. They have little understanding of their disorders or they don’t know anything about their sexual dysfunction. The most of them can’t specify their problems. More than 50% of them had secondary sexual disorders and they suffered it after marriage.

Conclusions: Cultural and Social subjects, lack of scientific sex education before marital relationship and marriage, absence of continuous sexual health training during marital life, loss of adequate sexual medicine care, increasing opiate users, low knowledge of the medical staff about sexual disorders, social problems and taboos are the main reasons for making sexual crisis in Iranian Society and increasing rate of divorce. Therefore, we need a executive plan to solves mentioned items to reduce divorce rate.

Disclosures:

Work supported by industry: no.

Androgen receptor CAG repeat length polymorphism is associated with risk of metabolic syndrome in a Korean male (#225)

D. Moon (Korea)
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225

Androgen receptor CAG repeat length polymorphism is associated with risk of metabolic syndrome in a Korean male

Bae, Y1; Yoon, C1; Oh, M1; Park, H1; Kim, J1; Moon, D1

1: Korea, South

Objective: The metabolic syndrome (MS) includes a clustering of metabolic derangements and low testosterone levels have been shown to be associated with both components of MS and MS per se. In this study we explored the relationship between androgen receptor (AR) CAG repeat length polymorphism and MS in a Korean male population.

Material and method: The association between AR CAG repeat length polymorphism and metabolic syndrome was analyzed in 144 Korean men (40-80 years old). MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP) criteria (any three or more of thefollowing components were present: abdominal obesity (WC > 102 cm), triglycerides > 150 mg⁄ dL (> 1.7 mmol⁄L), HDL cholesterol < 40 mg ⁄ dL (< 1.04 mmol⁄ L), fasting glucose > 110 mg⁄ dL (> 6.1 mmol ⁄ L), or blood pressure of > 130 ⁄ 85 mmHg). AR CAG repeat length polymorphism was determined by microsatellite fragment sizing and association with clinical factors (MS, age, height, weight, BMI, waist circumference, FBS, total cholesterol, HDL, LDL, triglyceride, HbA1c, sex hormone binding globulin) were analyzed.

Results: Mean age was 56.6±8.4 years. Mean AR CAG repeat length and serum testosterone levels were 20.74±12.5 and 5.5±1.7ng/ml respectively. Twelve men with hypogonadism (serum testosterone level lower than 3.5ng/ml) showed relatively short AR CAG repeat length compared with men with normal serum testosterone level (18.33 vs 20.95, p=0.48). Long AR CAG repeat length is associated with an increase in LDL, triglyceride, and HbAc1 while showing negative correlation with HDL and total cholesterol. Total 113 men had at least 1 component of MS and 27 men were diagnosed with MS (more than 3 components). Men with MS showed relatively longer AR CAG repeat length compared with men without MS (23.3 vs 19.7, p = 0.14). Hypogonadal men showed relatively high risk of MS (OD: 1.656, CI: 0.409-6.709) compared with eugonadal men and in cross-sectional analyses, men with AR CAG repeat length less than 21 combined with hypogonadism showed more increased risk of MS (OR: 2.074, CI: 0.872-4.931).

Conclusion: In conclusion, AR CAG repeat length and hypogonadism seem to be associated with increased risk of MS in Korean male.

Abstract 225

Disclosures:

Supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education(R1304182).

show poster

Perception of patients with vaginismus and strategies in approach (#226)

S. Scalco (Brazil)
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226

Perception of patients with vaginismus and strategies in approach

Scalco, S1

1: UFRGS, Brazil

Introduction: Vaginismus is a sexual dysfunction characterized by contraction of the vaginal muscles, preventing penetration.

Materials and methods: This qualitative and quantitative study reports the perceptions of 29 women with vaginismus, and describes approach strategies. The patients were treated at a private sexology clinic.

Statistical analysis: Continuous variables were expressed as mean and standard deviation or median and interquartile range (25-75 percentiles) and categorical variables by absolute and relative frequencies. Charts and Pareto diagram columns were used for the presentation of some data. The analyses were calculated in Excel 2010 and SPSS software (v. 18.0).

Discussion: When some women narrate partial penetration, they speak of the vagina using distanced, impersonal language, using phrases like "I'm not sure if it entered", in reference to vaginal penetration. After sexual relations – at times up to four years – there is a perception about dysfunction and consequent delay in treatment, which corroborates the lack of an active search for professionals. The patients believe that external factors are an obstacle to the realization of therapeutic exercises, even when those obstacles are not real. The participant-patients improved when therapy became part of therapist-imposed routine, and not a prior motivational drive. Women are recognized as "fragile" in their families of origin, but use authoritarian strategies with their partners. The described "pain" is an irrefutable argument which interrupts intercourse, resulting in a partner who becomes passive and in turn feels disqualified.

Treatment: Therapeutic strategies used with positive results: The word “pain" is not used, substituted with "discomfort“; awareness of a gradual, "step by step“, evolutionary process, using and approach which involves a systematic desensitization; different positioning and relaxation techniques; partner involvement, relieving "responsibility." Therapeutic strategies used with positive results: it not used word “pain" but "discomfort", awareness of gradual process of evolution, the "step by step", systematic desensitization, different possibilities positioning techniques and relaxation, partner involvement, with relief his "responsibility”.

Disclosures:

Work supported by industry: no.

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Evaluation of different sexual domains in adult and elder female college students at Federal University of Amapa-Brazil (#227)

R. Campos (Brazil)
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227

Evaluation of different sexual domains in adult and elder female college students at Federal University of Amapa-Brazil

Campos, R1; Silva, K1; Sena, I1; Teles Junior, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa, Brazil

Objective: To evaluate the different domains of the Sexual Quotient – Female Version (SQ-F) applied to the adults and elder female students.

Materials and Methods: Cross-sectional, descriptive and quantitative study, with 123 female college students who answered a questionnaire to evaluate the sexual quality of life, the SQ-F, developed and nationally validated. Women who didn´t have sexual intercourse in the last six months were excluded. The data were statistically analyzed by using SPSS 21.0, with significance levels set at P<0.05. Analysis of variances (ANOVA) and Pearson´s chi-square tests were used for statistical evaluation, comparing the sexual domains between the two groups of women, adults (34-59 years old) and elder ones (60-79 years old). The study was approved by the institutional ethics committee.

Results: Fifty-seven women have age between 34-59 years old and 66, between 60-79 years old. Domains statistically significant (p<0.05) were: “Foreplay quality” (p=0.001), item 3 of SQ-F, and the “Subjective arousal and harmony with the partner” (p=0.02), items 4 and 5 of SQ-F. In 86% of adult group women, “Foreplay quality” always or almost always stimulate them to continue sexual intercourse, whereas in the elder group, just 51.5% (Pearson´s chi-square test = 0.0001). In domain “Subjective arousal and harmony with the partner”, sixty-five percent of adult group women always or almost always reported being lubricated during sexual intercourse, in contrast to 48.5% of women in elder group (Pearson´s chi-square test = 0.006). In item 5 of SQ-F, forty-three point nine percent of women in the elder group always improve their sexual arousal as their partners´ arousal improve too, whereas it happened just in 35.1% in women of adult group (p=0.01).

Conclusion: Foreplay quality is essential to provide sexual arousal and satisfactory lubrication to sexual relationship. Adult women are strongly stimulated by foreplay quality to keep on having a sexual intercourse. In the elderly women, sexual arousal depends directly from their partners´ arousal and the deficiency of vaginal lubricant is explained mainly by menopause.

Disclosures:

Work supported by industry: no.

show poster

Female arousal and orgasmic complaints in a diverse female population with multiple medical issues treated Zestra®: A topical applied blend of botanical oils (#228)

Michael Krychman (USA)
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228

Female arousal and orgasmic complaints in a diverse female population with multiple medical issues treated Zestra®: A topical applied blend of botanical oils

Krychman, M1; Kellogg, S2; Damaj, B3; Hachicha, M3

1: OBGYN, United States; 2: PHD,CRNP, CST, USA; 3: Innovous Pharmaceuticals

Objective: Arousal and orgasmic changes occur as a result of chronic medical illness and multiple medication treatments. There is no Food and Drug Administrative approved products presently available for female sexual orgasm dysfunction (FSOD) many troubled women opt for over the counter (OTC) products in an attempt to enhance orgasmic responsivity and improve sexual satisfaction.

Materials/Methods: We present a case series of 13 women who presented with self reported delayed arousal and poor orgasmic response and decreased orgasmic intensity who have a multitude of medical illnesses.

Results: Patient demographics 2 premenopausal women and 11 post-menopausal women (median age 57) Total age range was 36-63. The following illnesses: Lowered libido (6), hypothyroidism (5), hypertension (4), depression (2), ADHD (2), migraines (2), narcolepsy (1), Fibromyalgia (1), hypercholesterolemia (1) were represented in this small case series. Patients on average took 3 prescription medications (range 0-8). Three women were single, 2 were divorced whereas 8 were married. All women were sexually active with a functional and available partner. Ten women had laboratory blood testing; all women had normal free testosterones though two out of the ten were in the lower one third of the normative range. Patients were evaluated and assessed using a standardized protocol (previously described by a sexual medicine gynecologist. All patients reported efficacy with respect to improved intensity of orgasmic response, and decreased latency of time to orgasms after use of the non-prescription product, Zestra®, a proprietary blend of botanical oils and extracts, with subjective improvement in orgasmic intensity and decreased latency to orgasm for select patients. In addition all reported improved sexual satisfaction at the 4-week follow up visit.

Conclusion: As women age into the menopausal years, it is not uncommon to have female sexual complaints in association with medical illnesses and their medications to keep disease stable. Medications and medical illnesses e affects the genital arousal and orgasmic function. This small yet diverse subset of women with a variety of medical conditions reported increased intensity of orgasmic response and decreased latency to orgasm with the use of Zestra ®. Further randomized clinical trial study with standardized screeners and questionnaires with set endpoints is necessary to establish the generalizability of these preliminary case findings

Disclosures:

Work supported by industry: yes, by Innovous Pharmaceuticals (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Sexual dysfunction among women receiving maintenance hemodialysis (#229)

M. Menjour (Tunisia)
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229

Sexual dysfunction among women receiving maintenance hemodialysis

Menjour, M1; Khedher, R1; Ben Azzouz, O1; Smaoui, W1; Jbeli, H1; Krid, M1; Ben Fatma, L1; Beji, S1; Zouaghi, K1; Rais, L1; Ben Moussa, F1

1: Rabta Hospital Tunis, Tunisia

Objective: Sexual dysfunction (SD) is common in women hemodialysis. In our country the subject is taboo and its impact remains unknown. The aim of our study is to provide an epidemiological profile of sexual dysfunction in women undergoing hemodialysis.

Methods: We did a cross-sectional study aimed to assess the prevalence and risk factors associated with SD in dialysis women. Eight dialyzed women >18 years old in Rabta hospital were included. SD was assessed using the Female Sexual Function Index.

Results: The mean age of the patients was 61 ± 11 years (42-80 years),   they were all inactive Professional, seven were married and one was widowed, the median dialysis follow-up was 4.5 years. The prevalence SD was 77.8% for all patients. 62.5% of women were postmenopausal and not taking hormone replacement therapy. All patients were hypertensive. The patients with DS were depressed 3 of who had severe anxiety disorders.

Conclusion: The advanced age, menopause, depressive syndrome, sociological and cultural factors seem to be predisposing factors for SD in the dialyzed woman. SD should attract our attention as a clinician so that it is diagnosed and treated to improve the quality of life of patients.

Disclosures:

Work supported by industry: no.

Association between alexithymia and sexual desire in patients with sexual dysfunctions (#230)

Itor Finotelli Jr. (Brazil)
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230

Association between alexithymia and sexual desire in patients with sexual dysfunctions

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Aim: The present study correlated the Sexual Desire Inventory (SDI-2) with the Toronto Alexithymia Scale (TAS-26) in order to estimate the association between alexithymia and sexual desire.

Methods: One hundred and twelve (112) patients, who have been treated in a private clinic in Sao Paulo, Brazil, were assisted and, seventy-eight (78) patients were diagnosed with sexual dysfunction while thirty-four (34) complained about couple issues or a partner with sexual problem. The average age was thirty-three (33) years old for the men and thirty-one (31) for the women. The gender and the type of the complaint did not vary according age. Eighty percent (80%) of the participants had Bachelor degree or equivalent. The instruments were individually applied in the initial assessment observing the ethical compliance demanded in the research.     

Results: Variations were found in the scores for men and women in the total score and dyadic dimension f the SDI-2, further on the total score and one of the dimensions of the TAS-26. This variation indicated that the women had a lower score compared to men concerning desire and higher score concerning negative aspects of focusing on external events and control of emotions. This situation occurred due to the prevalence of complaint about the inhibition of sexual desire. On the other hand, women presented lower desire compared to men in different literature. Moderate negative correlations were estimated between the total score and its dimensions in order to associate the instruments. In this case, the difficulty in fantasizing was negatively associated to sexual desire in dyadic and solitary expressions for both genders. Specifically men, the lack of ability to express thoughts and emotions presented a negative impact in sexual desire in a global way.  

Conclusions: The results provided further evidence of the association of the alexithymia in the sexual behavior, more specifically, in the desire. The difficulty in fantasizing and the lack of ability to express thoughts and emotions, dimensions assessed in the alexithymia, were associated to lower scores in the SDI-2. This evidence supports the importance of considering this capability in humans and complaints related to the sexuality area. 

Disclosures:

Work supported by industry: no.

show poster

lengthening phalloplasty using multi-modality surgical techniques (#231)

A. Helmi (Saudi Arabia)
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231

Lengthening phalloplasty using multi-modality surgical techniques

Helmi, A1; Merdad, T2

1: Prince Sultan Military Medical City; 2: The Man Clinic

Introduction: Lengthening phalloplasty is an operation that aims at increasing the length of the penile shaft. This procedure has been gaining popularity with different surgical techniques  being described to achieve the desired results. We are advocating a unique modified surgical technique with high success rate.

Methods: A retrospective study including consecutive male patients presenting for penile lengthening over the last 9 years. Patients underwent pre-operative andrology and psychological evaluation. The procedure was performed by the same urologist and plastic surgeon simultaneously. A successful surgical outcome is defined as: achieving a lengthening of equal to or more than 3.0 cm.

Results: A total of 45 patients have been included. The age ranged from 27 to 45 years with a median of 33 years. The range of pre-operative penile length in flaccid status was 4.0 to 7.0 cm with an average of 6.5 cm. While the range of pre-operative penile length in erect status was 9.0 to 11.0 cm (average 10.0 cm). The average penile lengthening achieved post-operatively was: 4.35 cm. with a range of 3.8 to 4.9 cm.

There was no major complications or failure of the procedure observed. One patient suffered partial wound dehiscence following return to sexual activity two week after surgery. Patients’ satisfaction with the outcome 6 months following surgery reached 44/45 with one case of dissatisfaction owing to the residual scar.

Discussion: The most popular surgical method used for penile lengthening is release of the suspensory ligament. Our technique differs as it involves urological as well as plastic surgical principles of combining fat reduction, vertical skin lengthening and retro positioning of the skin fold of the root of the penis proximally in order to achieve the maximum length with the safest optimum outcome. The technique will be illustrated by intra-operative edited video and photos.

Conclusion: We have concluded that using our multimodality technique phalloplasty is a safe procedure with 100% surgical success rate in regard to desired length gain and overall patient satisfaction rate of 97% which exceeds the standard procedure.

Disclosures:

Work supported by industry: no.

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Preliminary analysis of the relationship between the degree of penile rigidity and the abscence of nocturnal erection in patients with erectile dysfunction assisted at urology clinic of the Pedro Ernesto University Hospital (#232)

H. Julio Junior (Brazil)
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232

Preliminary analysis of the relationship between the degree of penile rigidity and the abscence of nocturnal erection in patients with erectile dysfunction assisted at urology clinic of the Pedro Ernesto University Hospital

Nunes, J1; Julio Junior, H1; Cruz, D1; Schiavini, J1; Damiao, R1

1: Hospital Universitário Pedro Ernesto, Brazil

Objective: To establish the relationship between the degree of penile rigidity with the absence of nocturnal erections in patients complaining of erectile dysfunction.
Material and Method: This was a cross-sectional study in which 30 patients were analyzed with complaints of erectile dysfunction treated between March 2014 and June 2014 at the Andrology clinic of Pedro Ernesto University Hospital. All patients were evaluated according to the scale of the degree of penile rigidity (Grade 0: flaccid penis; Grade 1: thick penis, but not rigid; Grade 2: penis hard, but not enough to penetrate the vagina; Grade 3: partially rigid, but able to penetrate; Grade 4: completely rigid penis). The absence of nocturnal erections, in this study was based on a subjective analysis.
Results: Of the 30 patients studied, there was a higher prevalence of grade 3 of penile rigidity (36%), followed by grade 2 (33%), grade 1 (28%) and grade 0 (3%). 25% of patients with stiffness Grade 3 reported lack of nocturnal erections. 50% of patients with stiffness grades 1 and 2 reported no nocturnal erection. The patient with grade 0 stiffness showed no nocturnal erection.
Conclusion: In this preliminary evaluation, we observed a direct relationship between the absence of nocturnal erections and a lower degree of penile rigidity during erection. However, this study also presents a reduced number of patients and it will be conducted in order to achieve a total of 200 patients.

Disclosures:

Work supported by industry: no.

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Side effects of the use of transdermal gels and injectable testosterone in the treatment of hypoactive sexual desire disorder in women (#233)

C. Moreira Nis (Uruguay)
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233

Side effects of the use of transdermal gels and injectable testosterone in the treatment of hypoactive sexual desire disorder in women

Moreira Nis, C1; Radesca, D1

1: Clínica Masters, Uruguay

Objective: Testosterone therapy is widely off label prescribed for women with low sexual desire. However, no testosterone product is FDA approved for use in women.

In this study, we briefly share our experience treating hypoactive sexual desire disorder (HSDD) in women using injectable and transdermal gel testosterone. We discuss the adverse reactions, the potential benefits of each therapy and the safety data available on testosterone use in this population.

Material and Method: We designed a descriptive-longitudinal study that takes 52 women ranging in age between 32 and 68 years who received monthly doses of 125 mg of testosterone for a period of up to 4 months. Another homogeneous group of 24 women in the same age range were treated with transdermal testosterone gel, 10 to 15 mg daily, for a period of one month. The results of the adverse effects and the effectiveness of treatment were recorded

Results: The vast majority of women solved their HSDD permanently with each treatment (89% injectable testosterone, 92% testosterone gel). We note that 25% of women who received treatment with injectable testosterone had adverse effects in the first month and that percentage increased as the months passed and it was necessary to stop that treatment. No adverse effects were reported with the use of transdermal testosterone gel.

Conclusion: Transdermal testosterone gel in doses of 10-15 mg per day is the best option for treatment of HSDD.

Disclosures:

Work supported by industry: no.

Transsexualism experienced by adolescents and their families: A literature review (#234)

M. Lerri (Brazil)
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234

Transsexualism experienced by adolescents and their families: A literature review

Lerri, M1; Tiezzi, M1; Romão, A1; Oliveira, M1; Gorayeb, R1; Santos, M2; Lara, L1

1: Faculdade de Medicina de Ribeirão - Universidade de São Paulo (FMRP-USP), Brazil; 2: Faculdade de Filosofia Ciências e Letras de Ribeirão Preto - Universidade de São Paulo (FFCLRP-USP)

Objective: To check the literature about the impact of transsexualism in the adolescent´s and their family´s lives Method: The authors conducted a literature review in PubMed, VHL (Virtual Health Library) and Web of Science databases, crossing the terms "transgender", "family", "adolescents", "transexualism", searching for articles related to transsexuals and their families.

Results: Sixty articles were selected and their abstracts were analysed. Articles that evaluated quality of life of transgender teens and their families were selected for full article access. Seven articles were selected; all of them designed as exploratory descriptive using semi-structured interviews as instrument. We found that, although mentioning transgender teens and their families in the abstract, all the articles were about other sexual minorities’ population and not about the impact of transsexualism in the adolescent´s and their family´s lives. One article examined victimization at school, but showed no correlation with transsexualism. Another article examined victimization at school and negative psychosocial adjustment when participants reached adulthood. The other five articles were about the importance of social acceptance during adolescence in general, as a protective factor against psychological disorders.

Conclusion: Although this is a current discussion in various professional segments, the theme draws attention to the lack of data on the subject. Therefore, there is a clear need for studies that demonstrate the true impact of transsexualism in the adolescent´s life, a period of development marked by profound psychological changes. It is necessary, above all, to assess the family relationship in order to contextualize the behaviour of these vulnerable adolescents with regard to feelings, emotions, ideas, values and goals during this critical period and to enable effective treatment (medical and psychological) for transsexual adolescents and their families.

Disclosures:

Work supported by industry: no.

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Quality of life of transgender patients: the impact of hormonal therapy and sex reassignment surgery (#235)

E. Da Silva (Brazil)
show abstract

235

Quality of life of transgender patients: the impact of hormonal therapy and sex reassignment surgery

Vieira, R1; da Silva, E1; Chalub, M1; Awad, M1; Damião, R1

1: Rio de Janeiro State University, Brazil

Introduction: Transsexualism is defined as the desire to belong to the opposite sex, making the body congruent with the preferred psychological sex through hormonal and surgical treatment. It is characterized by severe psychological suffering and, thus, quality of life (QoL) could be impaired. We aimed to evaluate the impact of sex reassignment surgery on QoL of transgender patients.

Materials and Methods: We analyzed 65 transgender patients, of which 62 were Male-to-Female and 3, Female-to-Male, with a mean age of 35.6 ± 8.6 years and transsexualism was established by a mental health team (psychiatrist and psychologist) in accordance to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) and ICD-10 (International Statistical Classification of Diseases and Related Health Problems) criteria. QoL was assessed by the WHOQoL-Bref (World Health Organization’s Quality of Life) questionnaire. Patients were requested to answer the WHOQoL-Bref questionnaire at the first evaluation, during hormonal therapy, and after sex reassignment surgery were performed.

Results: Body modification due to hormonal therapy only was considered good and the physical domain remained unchanged after sex reassignment surgery (p=0.372). Psychological, social relationship and environment domains improved significantly after sex reassignment surgery (p< 0.001; p=0.021 e p=0.049, respectively).

Conclusions: Body modification due to hormonal therapy causes positive, but moderately impact on the QoL of transgender patients. Sex reassignment surgery has a crucial impact on quality of life of transgender patients.

Disclosures:

Work supported by industry: no.

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Gender non-conforming men and women have higher tendencies for sexual promiscuity (#236)

K. Bártová (Czech Republic)
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236

Gender non-conforming men and women have higher tendencies for sexual promiscuity

Bártová, K1; Binter, J1; Breslerová, K1; Zunová, M1; Varella, M2; Varella Valentova, J3

1: Faculty of Humanities, Charles University in Prague, Czech Republic; 2: University of Brasilia, Institute of Psychology, Brazil; 3: Charles University in Prague and the Academy of Sciences of the Czech Republic, Center for Theoretical Studies, Czech Republic

Objectives: The main aim of this study was to test whether recalled childhood gender-nonconformity (CGN) influences individual sociosexuality, i.e. tendency to uncommitted sexual variability. We hypothesized that increased gender-nonconformity (femininity in men) would decrease sociosexuality in men, but (masculinity in women) increase sociosexuality in women, since sociosexuality is on average higher in men than in women.

Methods: The sample consisted of 248 Czech and Brazilian heterosexual men (mean age = 25.5 years, SD = 4.7), 301 homosexual men (mean age = 26.1 years, SD = 5.4), 475 heterosexual women (mean age = 24.8 years, SD = 4.8) and 118 homosexual women (mean age = 23.9 years, SD = 4.4) under 40 years of age. All participants filled in a standardized questionnaire on CGN and the revised Sociosexual Orientation Inventory (SOI-R with subscales: behavior, attitude and desire). We used partial correlations controlled for age to find associations between participants scores of CGN and SOI-R.

Results: Contrary to our prediction, results showed that the higher gender nonconformity, the higher SOI-behavior (p =.004) and total-SOI-R (p =.019) in heterosexual men, and the higher SOI-behavior (p =.010) and total-SOI-R (p =.016) in homosexual men. In heterosexual women, higher CGN increased SOI-desire (p =.011) and decreased SOI-attitudes (p =.001). Nevertheless, the results applied only to Brazilians, who overall reported lower CGN.

Conclusions: In line with previous research, more masculine heterosexual women reported higher sociosexual desire, which can be explained by androgen effects on sexual libido during early development, together with more masculine socialization and life-style in each culture. On the other hand, more feminine men regardless of their sexual orientation showed higher sociosexuality. We argue that more feminine men, who tend to be higher on social and communicative skills, can use these skills efficiently for flirting and social interactions related to mating, which, in turn, can increase their short-term sexual encounters. Nevertheless, this can be culturally specific, and the feminine-male tactic can work better in contexts where male femininity is relatively rare in the population.

Disclosures:

Work supported by industry: no.

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The importance of an interdisciplinary approach to patients with gender dysphoria and their families: A case report (#237)

M. Lerri (Brazil)
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237

The importance of an interdisciplinary approach to patients with gender dysphoria and their families: A case report

Lerri, M1; Romão , A1; Silva, T1; Santos, M2; Franceschini, S1; Yamaguti, E1; Ferriani, R1; Lara, L1

1: Faculdade de Medicina de Ribeirão - Universidade de São Paulo (FMRP-USP), Brazil; 2: Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - Universidade de São Paulo (FFCLRP-USP)

Objectives: To describe the interdisciplinary intervention used in mediate between the transsexual B (MtF) and her family.

Methods: B is currently 21 years old and was born with male genitalia, but regarded herself as a woman trapped in a male body. At age 18 years, B came to the University Hospital for hormone therapy (HT). She wanted to undergo sex reassignment surgery and was suffering from depressive symptoms since her parents did not accept her condition. B regarded herself as being in a foreign body and wanted her body to conform to her self-image. Her parents were hostile. Her father referred to her as an aberration of nature and was unable to understand why his son had chosen to dress as a woman. Her mother reported not understanding the "choice" made by her child. B insisted it was not a choice, that she was a woman born with the wrong body. The treatment process included an open interview, which was recorded and later analyzed. The theoretical framework supported by the literature highlighted the qualitative and exploratory nature of the approach used.

Results: Analysis of the interview revealed situations during which B felt humiliated and excluded, as well as the prevailing heteronormative position of the family. Family members were prejudiced and discriminatory, possibly due to their lack of knowledge about gender dysphoria. After the welcome by the psychologist, a medical gynecologist explained the biological implications of gender dysphoria to B and her parents and informed them of the need for HT to bring B to an adequate female phenotype. The parents cried a lot and asked for time to think. One month later, they returned and were interested in following the treatment of their daughter. A multidisciplinary team consisting of psychologists, gynecologists, physical therapists and psychiatrists began family therapy, based on guidelines and reflections on the role of the family in understanding and accepting B and to improve their quality of life. During these sessions, the parents showed empathy to the suffering of their daughter, accompanying her on all subsequent visits. B currently maintains a female phenotype, is dating men, and says she is very happy. She is waiting for gender reassignment surgery.

Conclusion: This study shows the effectiveness of interdisciplinary work and the value of including the family in addressing these problems and promoting the well-being of these patients.

Disclosures:

Work supported by industry: no.

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Awareness and knowledge of testicular torsion among male students of Babcock University, Ilisan-Remo, Ogun State, Nigeria (#238)

O. Solademi (Nigeria)
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238

Awareness and knowledge of testicular torsion among male students of Babcock University, Ilisan-Remo, Ogun State, Nigeria

Solademi, O1; Oshiname, F2

1: Adeleke University, Nigeria; 2: University of Ibadan, Nigeria

Objective: Testicular Torsion (TT) poses a serious health challenge to young men and it requires immediate medical attention. The rate of testicular loss dramatically increases if treatment is delayed beyond 4 to 6 hours of onset of symptoms. However studies related to the knowledge and awareness of TT among university students are not common in Nigeria. This study therefore assessed the awareness, knowledge and perception of TT among male undergraduates of Babcock University, Ilisan-Remo, Ogun state.

Material & Methods: A three-stage random sampling technique was used to select 500 male respondents across four faculties in the university. A validated questionnaire was used for collecting quantitative data. Descriptive, Chi-square and ANOVA statistics were used for data analysis.

Results: Respondents’ mean age was 21±3.2 years. Only 28.2% had heard about TT. Friends (10.4%), health workers (9.6%), books (6.0%) and magazine (4.8%) were among the sources of information about TT. Respondents’ overall mean knowledge score was 8.5±4.8; while the mean knowledge score by faculty, were Education & Humanities (8.2±4.9), Law & Security Studies (5.9±3.7), Management & Social Sciences (8.4±4.6), Science & Technology (9.1±5.0) (p<0.05). Fifty-eight percent perceived every male to be vulnerable to testicular pain and/or swelling. Majority (62.0%) perceived testicular pain to be a symptom of testicular disorder, while only 67.6% believed that swelling in the testes should be taken seriously. Few (18.2%) knew that testicular pain and/or swelling could lead to loss of testes. While only 0.4% had ever being diagnosed of having TT; 33.0% had ever experienced testicular pain and/or swelling and only 8.4% had ever visited a hospital immediately. Majority (73.0%) of respondents stated that they would visit the hospital immediately if they experience testicular pain and/or swelling in the future, while 11.6% would wait till the next day before visiting a healthcare facility.

Conclusion: Testicular pain and swelling are perceived by the participants to constitute a major reproductive health problem. Participants’ knowledge of testicular torsion was very low. Public enlightenment especially among males is recommended.

Disclosures:

Work supported by industry: no.

An interdisciplinary approach to treat a women with lifelong vaginismus: A case report (#239)

Lucia Lara (Brazil)
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239

An interdisciplinary approach to treat a women with lifelong vaginismus: A case report

Ramos, L1; Lara, L1; Pandochi, H1; Gorayebi, R1; Rosa-e-Silva, A1; Reis, R1; Romão, A1

1: Faculty of Medicine of Ribeirão Preto, Brazil

Introduction: According to diagnostic criteria, vaginismus is described as an involuntary vaginal muscle spasm that occurs with the attempt to introduce in the vagina: the finger, penis, tampon or speculum, interfering with sexual intercourse. Also, this spasm may occur when the woman anticipates vaginal introduction. Objective: The aim of this study was to demonstrate the interdisciplinary approach to a patient with vaginismus that resulted in an improvement of her quality of life.

Methods: A 32-year-old single woman with completed high education, working at a health care hospital, and lived with her parents, participate in this study. She was referred to the Outpatient Clinic of Human Sexuality due to the impossibility of performing a gynecological exam, as well as difficulty to engage in sex due to pain in an attempt to vaginal penetration. An interdisciplinary plan of intervention was structured, focusing on the reduction of the anxiety associated with sexual contact, as well as to diminish muscle contraction. The patient was monitored over a period of five months. The approach consisted of seven sessions of physiotherapy (one/ week), 40 sessions of psychotherapy of 40 minutes each, and weekly psychotherapy with 12 sessions of one hour each. The clinical management of her signs and symptoms involved the use of therapeutic resources such as: a) health education with information about genital anatomy, sexual response, and sexuality in general; b) information and guidance about the practice of erotic self-stimulation and sensory focalization in order to expand body and sensation awareness; c) relaxing training for physical sensations control triggered by anxiety and stress; d) rehabilitation of pelvic floor muscles; e) cognitive-behavioral techniques in order to induce changes in the dysfunctional thought associated with negative emotions; f) erotic reading in order to stimulate sexual fantasies.

Results: The following results were obtained: expansion of the strategies for coping with anxiety, reduction of the discomfort and pain associated with exercises and sexual contact, reduction of defensive behavior in the  gynecological position, expansion of the self-perception with positive consequences regarding self-concept and self-esteem, and expansion of the perception of sexuality transcending the limits of coitus.

Conclusion: Considering the multifactorial nature of human sexuality, the present report shows contributions of interdisciplinary practice to promote integral sexual health. Interdisciplinary approach is an important resource to promote sexual health beyond the pathological aspect, as such intervention includes sexual education so that individual may experience sexuality in a more complete and satisfactory manner.

Disclosures:

Work supported by industry: no.

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Psychological listening to partners of patients with excessive sexual impulse (#240)

M. Scanavino (Brazil)
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240

Psychological listening to partners of patients with excessive sexual impulse

Henckel, M1; Tanganelli, C1; Scanavino, M1

1: Hospital das Clínicas, Brazil

Objective: develop a research instrument of the major difficulties of partners of individuals with compulsive sexual behavior (CSB), through literature review and interviews of 16 partners.

Material and methods: 1) Literature review through query related articles in Lilacs, SciELO, and PubMed. 2) Psychological interviews of 16 partners in individual 60-minute sessions, focusing on psychological difficulties, along two years.

Results: 1) The search for articles resulted in very few sources for consultation. Observed lack of a literature that addressed the relationship between the partner and the individual with CSB. Among those articles relative to our objective, the following points were raised: major patterns of distress, primarily related to ambivalent emotions and the formation of an ambiguous loss are discussed as well as their implications on interpersonal, conjugal, and sexual life. The main difficulty was to make sense of the problem and share with others. 2) Through visits to partners the following difficulties were observed: the manifestation of an avalanche of emotions such as anger, resentment, ambivalence, guilt; the beginning of a process of elaboration of mourning for the mismatch between expected and experienced marital relationship (loss of confidence); the beginning of a process of redeeming himself.

Both methods gave a research protocol with closed questions assessing the following aspects: discovery and reactions; feelings of betrayal, sadness, shame, hatred; elaboration of mourning; separation; attitudes toward the partner (control; care); attitudes of identification, or compassion with the partner; history repeating in previous relationships; family history.

Conclusion: There is a lack of publications about the difficulties faced by a partner of a sexually compulsive individual. The proposed instrument will facilitate the identification of the major psychological difficulties, adopted attitudes and behaviors developed to deal with the crisis.

Disclosures:

Work supported by industry: no.

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When love is gone: A research in psychoanalysis about the pain of love (#241)

M. Baydoun (Brazil)
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241

When love is gone: A research in psychoanalysis about the pain of love

Baydoun, M1; Andrea Vieira de Medeiros, M2

1: Federal University of Rondônia, Brazil; 2: Federal University of Rondônia

Objectives: The research denominated “When Love is Gone: A Study with Young adults from Porto Velho-RO” has been developed since August 2013 by the Center of Studies and Researches of Subjectivity in the Amazons (CEPSAM). It aimed to shed light on the subjective nuances of the pain resulting from the loss of a beloved due to a separation or break-up. Such pain is psychoanalytically known as the pain of mourning, which sometimes seems to be cureless.

Method: The analysis was developed through a reflexive dialogue between the freudolacanian theories on mourning and melancholia and the case-studies of three subjects who were interviewed separately during three meetings each. The content of the interviews was categorized and interpreted following Bardin’s Content Analysis method. 

Results: The analysis stressed different mechanisms through which the subjects attempted to set themselves free from the excruciating psychic pain resulting from an undesired separation, one of which is to substitute the more profound psychic pain by a superficial physical one, made by mutilation. Sublimation is another way through which some subjects tried to deal with the pain of loss, which indirectly remits to a more structural and old pain: the pain of being- a kind of inherent internal emptiness that everyone tries to eradicate. Hence, an unwanted separation can shatter the fantasies and illusions of a perpetual state of content. As such, a certain period of time is necessary for the subject to uninvest the old fantasies and build new ones.

Conclusion: When love is gone, there is nothing much that a health professional can do in order to gather the scattered pieces of memories and fantasies. The haemorrhage is invisible. Only time will tell when the pain would be cured.  

Disclosures:

Work supported by industry: no.

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Sexual function of Brazilian female adolescents managed in a family planning clinic (#242)

M. Negri (Brazil)
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242

Sexual function of Brazilian female adolescents managed in a family planning clinic

Negri, M1; Ribeiro, M1; Nohara, I1; Moraes, P1; Torloni, M1; de Souza, E1; Guazzelli, C1

1: Universidade Federal de São Paulo, Brazil

Objectives: There are few studies on the sexual function of female adolescents in developing countries and it is unclear what are the most frequent sexual problems in this population. Our aim was to assess the rate of and identify possible risk factors for sexual dysfunction symptoms among Brazilian female adolescents in a family planning clinic.

Patient and Methods: This cross-sectional analytical study involved 128 sexually active female adolescents (13-19 years) who were using contraceptive methods. Participants were recruited from September 2012 to September 2013 at a public university family planning clinic. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. Women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The Chi-square and Student’s t tests were used to compare the characteristics of girls with and without sexual dysfunction symptoms. P < 0.05 was considered significant.

Results: The mean age of the participants was 17.4 ± 1.52 years and most were single, of mixed race, catholic and had between 8 and 12 years of formal education. Mean age at first sexual intercourse was 14.8±2.0 and 46% of them reported having had intercourse with 2 or more partners. The most popular contraceptive methods were condoms (31.25%) and combined oral contraceptives with condom (21.1%). The mean overall FSFI score was 26.6±5.7 and orgasm was the domain with the lowest mean score (3.9 ± 1.6). 38.3% of the adolescents (N=49) had total FSFI scores ≤ 26. Socio-demographic characteristics were similar among girls with and without sexual dysfunction symptoms. Adolescent who were using only condoms had the lowest mean overall FSFI scores (25.7±6.2).

Conclusion: There is a low prevalence of sexual dysfunction symptoms among Brazilian female adolescents, managed at a public family planning clinic. We could not identify risk factors for sexual dysfunction symptoms in this group of young women.

Disclosures:

Work supported by industry: no.

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Perception in relation to the first sexual intercourse at the center of reference and specialization in sexology of the Pérola Byington Hospital (CRESEX) (#243)

G. Silva (Brazil)
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243

Perception in relation to the first sexual intercourse at the center of reference and specialization in sexology of the Pérola Byington Hospital (CRESEX)

Silva , G1; Santana, T2; Monteiro, Q2; Farias, G3; Rossi, M2

1: Santa Casa de São Paulo Medical School, Brazil; 2: Pérola Byington Hospital ; 3: Pérola Byington Hospital

Object: To evaluated the perception in relation to the first sexual intercourse at the CRESEX in January to October of the year 2013.

Casuistic and Methods: We reviewed 50 files of women attended in the clinic of sexology. The interview is a standard questionnaire of the service and the data is about the feelings related to the first sexual intercourse. The possible answers are Poor, Good, or Do not know.

Results: The age group of the study was 6% for women 15-25 years, 30% 26-35 years 24% 36-45 years 28% 46-55 and 12% aged 56 years or older. Feelings related to first sexual intercourse 62% of women chose bad, 36% chose a good alternative and 2% did not know. Regarding the onset of sexual activity, 40% were between 15 and 18 years, 20% between 18 and 21 years, 14% 25-28 years 10% 22-25 years, and 16% above 25 years. 35% of the women interviewed associated the pain as the main factor to have been a bad perception of the first sexual intercourse.

Discussion: The positive or negative expectations about their first sexual intercourse can bring significant changes in the future sexual health of the women. Adolescents due to lack of knowledge, experience and counseling, may face serious health and social problems such as teenage pregnancy and sexually transmitted diseases (STDs). According to the literature, the age of first intercourse has decreased recently. Unwanted pregnancies often force teenagers to unwanted marriage or limit their opportunities for higher education or employment, predisposing them to dependency and decreased quality of life over the long term. To be most effective, sex education programs are necessary through a collaborative process among families, health professionals, educators, government officials and young people themselves. Early sexual intercourse results in high rates of pregnancy and abortion in adolescence, as well as increased risk of STDs. Countries that have sex education programs in educational institutions can achieve better results, with decreased fees. We noted that the vast majority of women studied had sexual initiation in adolescence and most of them had a bad perception of first sexual intercourse and linked this feeling to pain. The data suggest the importance of the implementation of institutional sex education programs, offering expertise to start healthy and pleasurable sexual activities, ensuring the prevention of unwanted pregnancy and STDs. The sex education programs are important to provide teens the knowledge about a healthy start sexual activity, and the prevention of unwanted pregnancy and STDs.

Disclosures:

Work supported by industry: no.

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Asexuality development among middle aged and older men (#244)

Y. Huang (China)
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244

Asexuality development among middle aged and older men

Huang, Y1; Chen, B1; Ping, P1; Chen, X1; Wang, H1; Huang, Y1

1: School of Medicine, Shanghai Jiao Tong University, China

Objectives. To assess erectile function in middle-aged and older men with asexuality status and further analyze their specific reasons for this condition.

Material and Methods. Men who had regular sexual intercourse attempts (sex frequency≥1 time per month) were classified into mild erectile dysfunction (ED), moderate to severe ED and non-ED according to International Index of Erectile Function-5, and men having no sexual intercourse attempts for at least 6 months were defined as having an asexuality status. The risk factors associated with ED were collected in a sample of 1,531 Chinese men aged 40 to 80 years, and the self-report reasons for asexuality were recorded in asexual cohort individually. Comparative analyses and multivariate regression models were conducted among these groups.

Results. The prevalence rates of ED and asexuality status were 49.9% and 37.2%. The asexuality status group had higher risk factors than the moderate to severe ED group in terms of old age (age≥65, adjusted odds ratio (OR): 17.69 versus (Vs.) 7.19), diabetes (crude OR: 2.40 Vs. 2.36) and hypertension (crude OR: 1.78 Vs. 1.72). The specific reasons for the asexuality status were “erectile difficulty” (52.9%), “do not care about sexuality” (53.5%)”, “no longer necessary to have sexuality at this age” (47.7%), “severe stress” (44.4%), “severe fatigue” (26.3%) and “masturbation” (26.9%).

Conclusions. Men with an asexual status suffer from higher risk factors for ED than men with moderate to severe ED. The majority of this asexual status could be attributed to a full ED, although the reasons for this transient asexuality also involved sexual attitudes and interests, sexual partners and masturbation.

Disclosures:

Work supported by industry: no.

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Frequency of nocturnal emissions and its psychological consequences among sexually naïve religious teenagers (#245)

Ege Can Serefoglu (Turkey)
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245

Frequency of nocturnal emissions and its psychological consequences among sexually naïve religious teenagers

Yuruk, E1; Gul, A1; Serefoglu, E1

1: Bagcilar Training and Research Hospital, Turkey

Objectives: To assess the frequency of nocturnal emissions among sexually naïve religious teenagers.

Material and Methods: A questionnaire was developed and administered to students staying in a religious dormitory. Data regarding demographic characteristics, masturbation habit and frequency of nocturnal emissions were collected. Moreover, students were asked about their beliefs regarding masturbation and emissions.

Results: A total of 113 male students with the mean age of 15.88±1.47 (range: 13-20) years were included into the study. Of the students 46 (4.4%) reported that they have never masturbated and 19 (17.3%) have never experienced nocturnal emissions. Nocturnal emission frequency was not correlated with age (p=0.092). Having nocturnal emissions was also not related to the duration since last masturbation (p=0.479). Subjects watching TV more than 3 hours/day had nocturnal emissions more than the ones who watch TV less (p=0.006). Of the subjects, 13.6%, 12.6% and 67% believed that masturbation is good, permissible and sin, respectively whereas 59.1%, 20.4% and 7.5% believed that nocturnal emission is good, permissible and sin, respectively.

Conclusion: Although masturbation and nocturnal emissions are frequent among sexlly naïve religious teenagers, a significant amount of them believe that they are sins. Watching TV seems to be associated with the frequency of nocturnal emissions. Further studies are required to elucidate the mechanism of nocturnal emissions.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Female sexuality: Users’ profile of the family clinic Olímpia Esteves (#246)

J. Rodriques (Brazil)
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246

Female sexuality: Users’ profile of the family clinic Olímpia Esteves

Almeida, M1; Pinto, J1; Ribero, J1; Rodriques, J1; Santos, M1; Schetter, P1

1: Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Brazil

Objective: The Program of Tutorial Education: Women’s Health and Female Sexuality (PET), as the IFRJ’s Research Project, which is linked with the Ministry of Education, has been working with researches and sexual education groups for women. The objective of this work was identify the female population profile that frequents the Family clinic Olímpia Esteves, as the development of their sexuality and create a data bank for researches and activities of extension for the PET group.

Material and Method: It's about quantitative qualitative research, and as a research tool, was used a structured interview. We investigated groups of women by age group, dividing them into four groups (adolescents, adults, pregnant women and post climacteric). The interviews were realized in the Family clinic. For the analysis was used the Collective discourse and as an analysis instrument we used the system QualyQuantiSoft version 1.6c build(2).

Result: It is known that the passage of adolescence and youth for adulthood is, yet, marked by significant and combined changes of personal, social, psychological and physiological order, not always harmonious and peaceful. It’s observed that the majority of the women didn't have the perception of the changes in their bodies in the puberty period that reflects in their low self-esteem as adults. The Women, even feeling a little sexual desire for their partner, make sex for satisfy the partner. Most Women don't follow the Cycle of sexual answer of Master & Johnson.

Conclusion: It was found that among the various data analyzed to find the profile of women's sexuality, they still seek to be loved much more than physical sexual satisfaction seeking greater intimacy and emotional involvement. We verified the need for sex education for these women, in view of that they have no sense of their own sexuality independent of age.

Disclosures:

Work supported by industry: no.

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Workshops on sexuality for elderly women: Sharing experiences and knowledge (#247)

M. Almeida (Brazil)
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247

Workshops on sexuality for elderly women: Sharing experiences and knowledge

Almeida, M1; Pinto, J1; Ribeiro, J1; Rodriques, J1; Santos, M1; Schetter, P1

1: Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Brazil

Objectives: We aim to promote sex education in elderly women participating in our extension project, recognizing the consequences of their relations in the family, employment and society, listening and granting them the word, building spaces for dialogue, both individually as well as group, so that there is a deepening in experience, greater understanding of the issue and a collective exchange of experiences among women themselves, facilitate the acquisition of new concepts, changes in behavior and lifestyle.

Material and Methods: We made a questionary for survey data in order to draw  the profile of the women participants of the workshops, the fellows conducted home visits to the application of research document. Five meetings of two hours each were performed weekly. With an average of twenty participants. The methodology was used with dynamic, video presentations and a space of reflection for women. For the workshops registration we used a Field diary and as evaluation, a qualitative questionary.

Results: It was observed in each workshop, moments of great emotion, sharing experiences of private life. Many women associate happiness with the importance of family, others the beauty, faith, religion, and physical activity. Women showed satisfaction with self-image and declare themselves happy with life. Some admitted that they never used condoms. Those without a steady partner admit the importance of using it, but they said that while they were married, they also didn't use it. As we teach the importance of exercises for the pelvic floor, some declared that they know, but they didn't know their efficacy, perhaps because they had never realize it.

Conclusion: Socializing with other women of the same age was reported as positive thing, as well the exchange of experiences and discussions are relevant to the daily lives of these women. The subjects were seen in a mature and responsible manner, with a look of interest. We realized that the best way to bring knowledge to those women was raising questions and generating discussion among them about the various topics covered.

Disclosures:

Work supported by industry: no.

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Proposal for a psychoeducational intervention on difficulties in romantic relationships, sexual risk behavior and sexual dysfunctions in patients with Severe Mental Illness Rehabilitation Center and Hospital Day (CRHD) IPq-HCFMUSP. (#248)

M. Scanavino (Brazil)
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248

Proposal for a psychoeducational intervention on difficulties in romantic relationships, sexual risk behavior and sexual dysfunctions in patients with Severe Mental Illness Rehabilitation Center and Hospital Day (CRHD) IPq-HCFMUSP.

Vieira, J1; Scanavino, M1

1: Hospital das Clinicas - FMUSP, Brazil

Objective(s): Individuals with Severe Mental Illness (SMI) present difficulty to maintain a main partner, sexual dysfunctions, and to HIV risk behaviors. We aim to develop a specific intervention on sexual health for people with SMI.

Material and Method(s): a literature review was conducted in the following databases: PubMed, SciELO, Google Scholar. For the construction of the proposed psychoeducational intervention 31 articles and 2 books,, 5 manuals and 3 websites (on STD / HIV / AIDS, family planning and prevention strategies) were consulted. Main results of searches:1) a few articles involving specific sexual health interventions for individuals with SMI were found; 2) Those studies described interventions ranging between three and 15 sessions, in mixed or separated by gender groups, which main themes involved sexual anatomy, development of behavior strategies toward romantic encounters, sexually transmitted diseases (STDs), HIV transmission, safer sex practices, negotiation of condom use, sexual response, and contraception. The main methods used were lectures, tests, games, videos, group discussion, strategy training, safer sex workshops and role play.

Result(s): Based on the literature consulted, we drafted an an intervention consisting of 10 sessions of 60 minutes each involving 12 themes, which were organized as: 1st meeting:  (1) the Brazilian Sexual Behavior.. (2) Physiology and Anatomy 2nd meeting: (3) male (Masters and Johnson) and female sexual response (Basson). (4) Sexual dysfunctions; 3rd meeting: (5) STDs / HIV / AIDS transmission and prevention; 4th meeting: (6) Sexual Risk Behavior (7) Contraceptive Methods (8) Working assertiveness in negotiating the use of condoms; 5th meeting: (9) Stigmas: Mental Illness and Sexuality: (10) How to find a romantic partner? ; 6th meeting: (11) Effects of Mental Illness on sexuality (12) Effects of the use of medication on sexuality; 7th meeting: dynamic about relationships; 8th meeting: Review on the previous sessions; 9th meeting: dynamics involving negotiation of condom use; 10th meeting: Revision. The methods are lecture, videos, group discussions, dynamic, and workshop including materials such as rubber penis, etc.. All sessions will be directed by a nurse familiar with Sexual Health.

Conclusion(s): The intervention includes the difficulties on romantic relationships, sexual dysfunctions and sexual risk behaviors for individuals with SMI.

Disclosures:

Work supported by industry: no.

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Sex addiction: Fact or fiction (#249)

D. Lin (USA)
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249

Sex addiction: Fact or fiction

Lin, D1; Bergel, A; Gerz, E

1: Mount Sinai Beth Israel, United States

Objective: To determine whether hypersexual behavior can appropriately be characterized as an addiction, or rather, a symptom or manifestation of a co-existing Axis I or Axis II Disorder.

Material and Method: A literature review is being conducted to explore these opposing viewpoints. Articles published from the year 2000 to present relating to the topic of sex addiction/ hypersexuality/ sexual compulsivity/ impulsivity are reviewed.

Results: The concept of sexual addiction was introduced in the 1970‘s. Two schools of thought have. Proponents of sex "addiction" argue that the neurochemical changes associated with hypersexual behavior are quite similar to that of drug addiction. They argued that sex "addicts" can experience a psychological withdrawal as experienced by those addicted to drugs of abuse. Some proponents of sex addiction even advise a 12-step treatment program. Critics of sex addiction argue that increased sexual activity is a way of alleviating affective symptoms, or is reflective of the impulsivity, associated with concomitant Axis I or Axis II pathology. They postulate that treating the underlying psychiatric disorder would ameliorate hypersexual behavior.

Discussion: Despite standard, and even increasing use of the term "sex addiction" in media and popular culture, mental health professionals remain divided in regards to this subject. The proposed inclusion and subsequent rejection of hypersexual disorder in DSM-V highlights this existing debate. The notion of hypersexual behavior as an addiction warrants further exploration, especially since how it is defined may dictate treatment modality.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Implementation of a multidisciplinary sexual counseling service (#250)

Monica Santos Lopes (Brazil)
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250

Implementation of a multidisciplinary sexual counseling service

Pinto, J1; Santos, M1; Ribeiro, J1; Almeida, M1; Rodrigues, J1; Schettert, P1

1: Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Brazil

Objectives: The "Multidisciplinary Sexual Counseling Service" project aims to guide customers to see themselves as individuals with a focus on developing their sexuality, with sex education actions, emphasizing health promotion through disease prevention and sexuality development. In addition, the project aims to identify partners and resources in the community that can be leveraged by the team of the Clinical School of the Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro (IFRJ) (Federal Institute of Education, Science and Technology) – Realengo Campus.

Material and Methods: The service will be available twice a week. A specific sexuality case history will be held for each user. We will hold a weekly staff meeting in which we will define the best approach strategies and plan the activities to be performed on the day. At first, eight weekly consultations, each of them 40-minute-long, will be available for users originating from established referral and counter referral flows with education and healthcare units.

Results: Since this is a pioneering project, the results will be obtained over the development of the activities, but we already have a set manual, and established Reference and Counter Reference flows with education and healthcare units from the extension activities in sex education for groups of women.

Conclusion: This pioneering proposal goes beyond classes or groups of sex education; it is characterized as a scheduled offer, under the perspective of integral health, to one of the most weakened matters in society, thus taking care of individuals in an equanimous manner.

Disclosures:

Work supported by industry: no.

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Sexual psychotherapy and actual mismatchs (#251)

V. Menezes (Brazil)
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251

Sexual psychotherapy and actual mismatchs

Menezes, V1

1: Consultório de Psicologia Vitória Menezes, Brazil

Objective: To argue the challenges imposed to sexual psychotherapy by the evolution of the social mismatchs. Material and Methods: This is a qualitative etnographic research, based on appointments of the pschotherapist understandings about client’s environment, aggregated during systemic attendance, recorded from 1990 to 2014, at sexual psychotherapy setting, after each consultation.

Results: It is consensual to admit the human sexuality as a biossocial cultural psychological phenomenon. As to biologic point of view, the human being was never been analyzed as nowadays. On the counterpart, the body is suffering as we have never view, because they do not sleep, they have no leisure, they lack training. The investment on his/her and on the other is denied. The exercise of fantasy, obviously, is decreasing. Social network represents the great change in interpersonal communication at present. It moves away who is near, and approaches who is distant. Sons are third rated. Fusion is confounded with intimacy. The World Health Organization alerts that depression in the fifth major public health problem. Sexuality is composed of rubbing and fantasy. Sons as “I want it all now” probably will experience difficulty to discover pleasure, simply due to lack of training. The absence of family may be the item that causes the major prejudice to sexuality. Clients are lost and they look for solutions. These solutions are always searched with the same hurry already familiar to them, with no reflection. And professionals experience also frustration because the apparent (or not) inefficiency on their work and not only derived of a mere repetition of the famous technics of distant 60’s. Sex is much more than performance. Who has lived positive experiences, probably will take profits, finding more easily sexual maturity, because we can not forget that sex is an expression of life. 

Conclusion: Sexual psychotherapy has solid bases, from Sexual Therapy proposed by Master & Johnson, but nowadays it claims to a new, deeper and systemic approach, which must respect the personal “difficulties”  of each couple, as a result of the actual biosocial cultural and psychological context, which requires of professionals an incessant training and qualification to rethink that sex is, today, probably the unique and last opportunity for “no outsourcing” the human being. To live his/her sexuality, the humans need to be fully present, to negotiate, to concede, to fantasy, to gain and to loose, to respond personally to the results. 

Disclosures:

Work supported by industry: no.

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Biological and social profile of victims of sexual violence assisted by the HMIPV (#252)

S. Scalco (Brazil)
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252

Biological and social profile of victims of sexual violence assisted by the HMIPV

Scalco, S1; Grecco, C2; Daniela, K3

1: UFRGS, Brazil; 2: HMIPV, Brazil; 3: UFRGS

Context: sexual violence is a cruel and persistent worldwide epidemic. It occurs in a number of social contexts and its main victims are women and children. SV has a severe impact on quality of life and may have a series of physical, psychological and ethical consequences, so that health services are often involved in the treatment and counseling of its victims. Furthermore, SV perpetuates a violent and patriarchal social culture and is therefore a serious concern at societal level.

Purpose: the goal of the present study was to assess the biological and social profile of victims of SV assisted by a multidisciplinary health team in a public hospital in Porto Alegre, in a service targeted specifically at this population.

Material and Methods: this was a cross-sectional retrospective study. Data were collected using a specially designed questionnaire, based on an instrument used to collect patient data in the hospital’s Gynecology and Obstetrics emergency service, the Pediatric Emergency service and the STD/SV Outpatient Clinic. All women admitted to the hospital between 01/01/2011 and 01/01/2012 were eligible for study participation. Male patients, children below 12 years of age and individuals who were not victims of SV were excluded from participation.

Conclusion: the present study found significant differences between the characteristics of victims of chronic and acute SV which suggested relationships between the age and education of victims and type and duration of the abuse to which they were more vulnerable.

Disclosures:

Work supported by industry: no.

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Impact of sexual activity on HbA1c levels in patients with type 2 diabetes mellitus after penile prosthesis implantation (#253)

R. Talib (Qatar)
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253

Impact of sexual activity on HbA1c levels in patients with type 2 diabetes mellitus after penile prosthesis implantation

Talib, R1; Canguven, O1; Al Ansari, A1

1: Hamad Medical Corporation, Qatar

Objective: According to previous studies, average sexual activity ranks as mild to moderate in terms of exercise intensity. Regular exercise that consists of different types including aerobic and resistance training was found as associated with haemoglobin A1c (HbA1c) reduction in patients with type 2 DM. The objective of this study was to examine the benefits of sexual activity on HbA1c in penile prosthesis implanted patients with type 2 DM.

Material and Methods: Sixty-seven male subjects who had HbA1c levels of  ≥6.5% before and could perform regular sexual activity after the implantations were enrolled. The contribution of sexual activity on glycemic control assessed by HbA1c level as well as age, duration of DM and frequency of sexual activity were evaluated.

Results: Mean age and mean time from the surgery of the study patients was 59.9 years (range: 30-82) and 22.6 months (range: 10-63), respectively. The average of penile prosthesis usage for sexual activity was 9.9 times per month (range: 2-28). Compared with the pre-implantation, the absolute mean change in HbA1c after penile prosthesis implantation was found as -0.2% (p>0.05). This study also revealed that more sexual activity was associated with more reduction in HbA1c.

Conclusion: The present study demonstrated that sexual activity was associated with HbA1c reduction, which is clinically important in patients with type 2 DM after penile prosthesis implantation.

Disclosures:

Work supported by industry: yes, by Hamad Medical Corporation Research Center (industry funding only - investigator initiated and executed study).

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Diagnostic manual for sexology DMS III (#254)

Fernando Bianco (Venezuela)
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254

Diagnostic manual for sexology DMS III

Bianco, F1

1: CIPPSV/IIP, Venezuela

Objectives: To present a Classification of Sex and Sexual Disorders.  THE MDS III 

Methods: Sexology have become an independent field (WAS 1989). One of his areas is Clinical Sexology. We develop from FLASSES (1991) and lately from WAMS (2009) and AISM (2010) a Classification of Sex and Sexual Disorders –MDS III- which started as a work of few and now a large group of clinician are involved. Each disorders was clinically described and tested using an objective Medical History apply in the field of Medical Sexology

Results: A Classification with 18 Codes for the Disorders of the Sex Development Process, 64 Codes for the Disorders of Sexual Function Process and 24 Codes for Others suggested Disorders.

Conclusions: The MDS III so far has proven to open an operative communication between clinicians and will help to do more homogenous research.

Disclosures:

Work supported by industry: no.

Semantic conceptualization related to sexual medicine, sexual therapy, clinical sexology and sexual health. A study in health sciences students of the Universidad de Guadalajara, México (#255)

O. Matsui-Santana (Mexico)
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255

Semantic conceptualization related to sexual medicine, sexual therapy, clinical sexology and sexual health. A study in health sciences students of the Universidad de Guadalajara, México

Matsui-Santana, O1; Villaseñor-Farías, M1; Flores-González, L1; Lomelí-Garza, J1; Cortés-Campos, G1; Guillén-Rico, L1

1: Universidad de Guadalajara, Mexico

The Universidad de Guadalajara, in the state of Jalisco, is the second largest university of Mexico. It has five campuses with an undergraduate medical education program, which comprise a total of 5,587 medical students; plus 1,585 other medical students from a private university which is incorporated to the University of Guadalajara system with the same study program. An obligatory Human sexuality course has been included in this Medical program since 1996, which is shared with other students in health sciences careers. An academic reform of this medical program, starting for the fall semester 2014, has included an additional required course on sexual medicine, exclusively for medical students at the 7th semester.

Objective: The aim of this study is to explore meanings and conceptual conflicts related to sexual medicine among health sciences university students at the campus Guadalajara.

Material & Methods: Application of a questionnaire, which includes stimuli words such as sexual medicine, sexual therapy, clinical sexology and sexual health, was applied to medical students and from other health sciences careers. Stimulus definitions were analyzed using a technique known as semantic networks.

Results: Differences were found by sex, careers and the condition of having taken the introductory course of human sexuality prior to the application of the instrument. As expected, the analysis showed several conflicts for the meanings or concepts for the stimuli words; also they do not have clear which type of professional should attend different sexual health problems.

Conclusion: Concepts related to sexual medicine, sexual therapy, clinical sexology and sexual health, seem to be unclear among medicine students, which stands for needed more specific knowledge, attitudes and skills in sexual medicine for general physicians training in order to be more prepared to meet society demands for their sexual health. These results are needed to elaborate the Sexual Medicine course program for medical students at the Universidad de Guadalajara, Mexico.

Disclosures:

Work supported by industry: no.

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Improvement of metabolic syndrome (MetS) parameters in 362 obese hypogonadal men upon long-term treatment with testosterone undecanoate (TU) injections: Observational data from two registry studies (#256)

F. Saad (Germany)
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256

Improvement of metabolic syndrome (MetS) parameters in 362 obese hypogonadal men upon long-term treatment with testosterone undecanoate (TU) injections: Observational data from two registry studies

Saad, F1; Haider, A2; Yassin, A3; Doros, G4; Traish, A5

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: Institute for Urology and Andrology, Germany; 4: BU School of Public Health, USA; 5: BU School of Medicine, USA

Objective: To assess changes in metabolic syndrome parameters in hypogonadal men under long-term treatment with testosterone undecanoate (TU) injections.

Material and Methods: From two cumulative registry studies, 362 men with obesity grade I (BMI 30-34.9), grade II (BMI 35-39.9) and grade III (BMI ≥ 40 kg/m2) were selected. All men received TU for up to 6 years. 

Results: Grade I (n=185, mean age: 58.4±8.0 years): Glucose (mg/dl) decreased from 107.22±30.2 to 97.87 ±14.42 (p<0.0001), change from baseline -8.37±1.83 mg/dl, HbA1c (%) from 6.58±1.24 to 5.6±0.76, change from baseline -1.05±0.06%. Total cholesterol (TC; mg/dl) decreased from 268.43±44.24 to 191.47±16.8, LDL (mg/dl) from 158.75±32.82 to 116.26±34.65, triglycerides (TG; mg/dl) from 257.49±62.1 to 193.23±29.01. HDL (mg/dl) increased from 46.53±15.93 to 56.09±15.71. The TC:HDL ratio declined from 6.39±2.41 to 3.64±0.87 (p<0.0001 for all). Systolic blood pressure (SBP; mmHg) decreased from 143.96±15.09 to 130.11 ±8.95, diastolic blood pressure (DBP) from 85.54±10.84 to 78.23±5.82. Grade II (n=131, 60.6±5.6 years): Glucose (mg/dl) decreased from 114.17±27.04 to 99.3±11.49 (p<0.0001), change from baseline -14.83 ±2.19 mg/dl, HbA1c (%) from 7.63±1.31 to 5.9±0.73, change from baseline -1.69±0.07%. TC (mg/dl) decreased from 292.23±41.07 to 196.78±19.85, LDL (mg/dl) from 174.5±28.46 to 125.86±35.8, TG (mg/dl) from 292.12 ±61.15 to 194.19±20.66. HDL (mg/dl) increased from 57.35±19.17 to 67.41±18.82. The TC:HDL ratio declined from 5.86±2.76 to 3.2±1.12 (p<0.0001 for all). SBP (mmHg) decreased from 159.15±14.71 to 135.26±10.97, DBP from 95.02±11.86 to 79.66±4.96. Grade III (n=46, 60.3±5.4 years): Glucose (mg/dl) decreased from 115.48 ±23.85 to 96.54±2.9 (p<0.0001), change from baseline -18.48±2.96 mg/dl, HbA1c (%) from 7.57±1.38 to 6.08±0.5, change from baseline -1.61±0.13%. TC (mg/dl) decreased from 306.76±43.03 to 192.23±9.17, LDL (mg/dl) from 190.57±36.6 to 136.24±28.07, TG (mg/dl) from 326.87±60.21 to 194.4±12.59. HDL (mg/dl) increased from 62.76±18.7 to 72.55±13.34. The TC:HDL ratio declined from 5.47±2.57 to 2.75±0.59 (p<0.0001 for all). SBP (mmHg) decreased from 161.04±14.3 to 142.05±9.57, DBP from 97.07±10.91 to 80.89±6.76.

Conclusions: All changes were meaningful and sustained for the full observation time. TRT seems to be effective to improve MetS and cardiovascular risk profile in obese hypogonadal men.

Disclosures:

Work supported by industry: yes, by Bayer Pharma AG (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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A rare case of prolactinoma causing erectile disfunction in a young man (#257)

E. Andrade Dias Coutinho de Souza (Brazil)
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257

A rare case of prolactinoma causing erectile disfunction in a young man

Andrade Dias Coutinho de Souza, E1; Julio Junior, H1; Schiavini, J1; Damião, R1; Cruz, D1

1: UERJ, Brazil

Objective: To report an atypical case of erectile dysfunction secondary to prolactinoma in a young patient. 

Materials and Methods: Retrospective analysis of a patient with erectile dysfunction secondary to a prolactinoma treated at uro-andrology service of Pedro Ernesto University Hospital (RJ), in January 2014. This 43 year old male patient was complaining of erectile dysfunction for seven years, worsening in the last year (IIEF-5: 9). He showed no decrease in libido or other complaints. Physical examination showed galactorrhea in the left breast, without any genital abnormality. An initial evaluation with plasma glucose, lipid profile and total testosterone was started.

Results: Laboratory initial exams showed a decreased level of total testosterone (43ng/mL), therefore others hormonal exams were requested, that revealed an increased level in serum prolactin (1329ng/mL). After that, the patient performed a sella magnetic resonance imaging (MRI) that identified a prominent expansive mass capturing contrast, measuring about 3,2 x 2,7 x 2, 2 cm, with its epicentre in the sella turcica. After diagnosis of prolactinoma, the patient was also referred to endocrinology and neurosurgery for evaluation, beginning clinical treatment with cabergoline 4 times per week. Currently, the patient is still using cabergoline, with improvement of serum prolactin level (200,4ng/mL). However, there has been no improvement in the overall level of testosterone (40ng/mL) and IIEF-5.

Conclusion: In this case the patient received cabergoline with improvement of prolactin, without benefits in the overall level of testosterone and IIEF-5. It is imperative to follow a protocol in the erectile dysfunction complaint, even in young patients, so that atypical cases are not neglected. Clinical treatment is accomplished through the use of dopamine agonists and, if not successful, the treatment can be surgical. If even after treatment hypogonadism persists, the use of testosterone may be necessary.

Disclosures:

Work supported by industry: no.

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Erectile dysfunction and HIV infection (#258)

S. Cedres (Uruguay)
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258

Erectile dysfunction and HIV infection

Cedres, S1; Puppo, D1

1: Uruguay

A high proportion of male patients with HIV infection suffer from sexual dysfunction (erectile dysfunction or low sexual desire) that decrees their quality of life (1).

Objective: To evaluate the degree of sexual dysfunction in a population of men with HIV, and make the correlation with demographic, immunological and treatment characteristics.

Methods: The analyses include 47 men with HIV infection assisted in ambulatory service of the Infection Institute, using an anonymous questionnaire, the International Index of Erectile Function-5 (IIEF-5), and Test of Sexual Desire of Masters & Johnson. Regression analysis was used to determine the correlation among the variables.

Results: The mean age of the patients was 42.13 years; there were 31 cases of erectile dysfunction and 39 cases of low sexual desire.  36 were treated with active antiretroviral treatment (HAART). There was statistically significant correlation between sexual dysfunction and : age, homosexual contact as HIV transmission mode,  symptomatic infection, use of tranquillizers, low cultural level, no stable couple, smokers, CD4 cell count < 200 cells/mm, viral load >30.000 and treatment containing protease inhibitors (PI). (p< 0.05).

Conclusion: The etiology of SD is often multifactorial, and may be caused by endocrinological, psychogenic, neurogenic arteriogenic or iatrogenic abnormalities. Results of this study suggest that erectile dysfunction and low sexual desire are also found in patients who are on HAART, specially if their regimens contain PI. Physicians need to talk about sexual issues with their patients, in order to improve the sexual well being.

Disclosures:

Work supported by industry: no.

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Clinical study of erectile dysfunction using color-flow doppler with intracavernous prostaglandin E1 injection (#259)

T. Yun (Korea)
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259

Clinical study of erectile dysfunction using color-flow doppler with intracavernous prostaglandin E1 injection

Yun, T1; Jeon, H1; Sohn, D2

1: Manomedi urologic Clinic, Korea, South; 2: The Catholic University of Korea

Objective: Doppler evaluation in erectile dysfunction(ED) has a significant role in determining the cause of ED. We evaluate the contributing factors and etiology of ED using penile duplex Doppler ultrasonography

Materials and Methods: We examined 42 patients with ED. All patients were assessed by history, laboratory studies and Doppler sonography after intracavernosal injection of 10 µg PG E1. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were measured. Then ultrasonographic diagnosis of ED were classified as arteriogenic ED and veno-occlusive ED.

Results: The mean age of patient was 47±9.9 years and 41% of the patients had contributing factors (Hypertension 16%; Diabetes 10%).  35% of the patients had vasculogenic impotence (arteriogenic 16%; venogenic 19%).

The mean PSV was 19±3.3cm/sec in arteriogenic, 32±4.3cm/sec in venogenic and 34±2.7cm/sec in normal vascular findings. The mean EDV was 0.9±1.3cm/sec in arteriogenci, 6.0±1.3cm/sec in venogenic and 1.3±1.4cm/sec in normal vascular findings. The mean RI was 0.9±0.06 in arteriogenic, 0.78±0.02 in venogenic and 0.94±0.04 in normal vascular findings.

Conclusion: Penile duplex Doppler ultrasonography may be useful in screening for vasculogenic impotence and establishing appropriate treatment plan.

Disclosures:

Work supported by industry: no.

Prevalence of erectile dysfunction in hemodialysis patients (#260)

M. Menjour (Tunisia)
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260

Prevalence of erectile dysfunction in hemodialysis patients

Menjour, M1; Ben Azouz, O1; Khedher, R1; Smaoui, W1; Ben Fatma, L1; Krid, M1; Zouaghi, K1; Beji, S1; Rais, L1; Ben Moussa, F1

1: Rabta Hospital Tunis, Tunisia

Objective: ED is difficult to diagnose and its prevalence in dialysis patients is unknown. The aim of this study is to determine the prevalence of sexual dysfunction among hemodialysis patients.

Material and Methods: We did a cross-sectional study aimed to assess the prevalence and risk factors associated with ED in dialysis patients. Eighteen dialyzed men >18 years old in Rabta hospital were included. ED was assessed using the abridged version of International Index of Erectile Function already validated in dialysis patients. A descriptive study was performed to identify the factors associated with ED in patients.

Results: The mean age of the patients was 46 ± 13 years (19-68 years) and the median dialysis follow-up was 5.1 years.  All ED was severe. The prevalence ED was 77.8% for all patients. The prevalence of ED was 62.5% in patients younger than 50 years and 90% in those 50 years or older. Three patients had ED before dialysis; they all had a urological disease. All patients with diabetic nephropathy have an ED. 64.2% of patients with ED has a depressive syndrome. Marital status, comorbidity, hemoglobin level, and use of antihypertensive drugs were not significantly different between patients with and without ED. Only 1 patient received treatment for ED and sought a consultation with an urologist.

Conclusion: ED should be screened in all chronic dialyzed because of its negative impact on the lives of patients. Its treatment requires a multidisciplinary approach and adequate psychological support.

Disclosures:

Work supported by industry: no.

The prevalence of erectile dysfunction at a primary healthcare clinic in Kwa Zulu Natal (#261)

Prithy Ramlachan (South Africa)
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261

The prevalence of erectile dysfunction at a primary healthcare clinic in Kwa Zulu Natal

Ramlachan, P1; Lockat, Y; Ross, A; Rungiah, C

1: Newkwa Medical Centre, South Africa

Objectives: The objectives of this study were to determine the prevalence of erectile dysfunction (ED) in men attending a primary healthcare (PHC) clinic in Durban, KwaZulu-Natal, and to document any relationship between ED and age, smoking, economic status and co-morbid conditions.

Design: An observational, descriptive, cross-sectional study.

Setting and subjects: More than 50% of men aged 40-70 years experience some degree of erectile dysfunction. However, no data is available on the prevalence of ED in a primary healthcare (PHC) setting in KwaZulu-Natal. Between February and March 2008, 1 300 questionnaires were distributed to men aged 18 years and older with no exclusion criteria, attending a general PHC clinic.

Outcome measures: Responses were captured using a validated structured questionnaire (International Index of Erectile Function-15).

Results: Eight hundred and three questionnaires were eligible for analysis. The overall prevalence rate of ED was 64.9% (521), of whom 22,5% (117) had mild ED, 30,7% (160) moderate ED, and 46,8% (244) severe ED. Erectile dysfunction increased with age, and there was a strong association between ED and economic status and co-morbid conditions.

Conclusion: The prevalence of ED at this urban PHC clinic was high. Increased awareness by doctors working in the clinic may result in improved assessment and appropriate treatment that will enhance patients’ quality of life.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Clinical analysis of the characterization of magnetic resonance imaging and endoscopic therapy in refractory hematospermia (#262)

Y. Li (China)
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262

Clinical analysis of the characterization of magnetic resonance imaging and endoscopic therapy in refractory hematospermia

Li, Y1

1: Daping Hospital, Third Military Medical University, China

ObjectivesTo assess the etiological diagnostic value of magnetic resonance imaging (MRI) by analysis of the pelvic MRI manifestations or characteristic changes around the ejaculatory duct area and to evaluate the therapeutic effect of transurethral minimally invasive endoscopic treatment in the persistent and refractory hematospermia patients who are ineffective to the conservative treatment.

Methods:The morphological features and characteristic changes around the area of the bilateral seminal vesicles (SVs) and ejaculatory duct (ED) in 76 patients with persistent and refractory hematospermia were retrospectively analyzed. All the 76 patients followed by undergoing transurethral minimally invasive endoscopic examination and treatment. The therapeutic effect was followed up, analyzed and summarized.

ResultsIt was found that 88.2% (67/76) patients with persistent and refractory hematospermia showed typical and characteristic changes in the ED and SVs area including 61.8% (47/76) patients showed the signal intensity changes in seminal vesicle;34.2% (26/76) patients showed significant cystic dilatation(the width of SV is bigger than 1.7cm or the diameter of the inner tubular structure is bigger than 5mm)in unilateral or bilateral SVs, with or without the internal signal intensity changes; 36.8%(28/76) patients showed the formation of cysts in the ejaculatory area such as prostatic utricular cysts in 27.6% (21/76) patients, Müllerian duct cysts in 3.9% (3/76) patients, Ejaculatory duct cysts in 3.9% (3/76) patients, and Seminal vesicle cyst in 1.3% (1/76) patient.11.8% (9/76) patients did not show any obvious abnormal changes in MRI. All the patients were successfully performed transurethral minimally invasive endoscopic. No obvious complications or carcinoma were found during and after the surgeries.The all patients were followed-up for 3-36 months. The hematospermia and related symptoms were disappeared after surgery, except for two patients experienced recurrence of hematospermia after 5 and 11 months, underwent the same treatment and recovered during the followed-up period. The urination and ejaculation are usually as well as before surgery. 97.4% (74/76) patients have normal orgasm and pleasant sensation after surgery, except two old patients complained that slightly decreased.

ConclusionThe three-dimensional MRI has significant etiological diagnostic value and provides reliable information for the subsequent treatment. The transurethral endoscopic technique is a simple, safe, reliable and effective treatment method for the patients with persistent and refractory hematospermia.

Disclosures:

Work supported by industry: no.

Clinical review of patient perceptions in switching from on demand to daily dose Tadalafil for erectile dysfunction (#263)

V. Bhatia (UAE)
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263

Clinical review of patient perceptions in switching from on demand to daily dose Tadalafil for erectile dysfunction

Bhatia, V1

1: Al Ain Cromwell Hospital, Al Ain, UAE, United Arab Emirates

Objective: Phosphodiesterase 5 inhibitors (PDE5i) are the established first line therapy for most cases of erectile dysfunction(ED).It is estimated that 20-30% of ED patients may drop out and discontinue the usage of these drugs. This study aims to evaluate the patient perspective of discontinuation of on demand Tadalafil 20 mgm and switching to daily Tadalafil 5mgm for ED.

Material & Methods: The study comprises 72 men with median age 56 years suffering from ED of average 1.6 years duration. Co-morbidities included-Hypertension(46%),Diabetes(38%),Dyslipidemia(32%) and Smoking(28%)The primary indication for usage of on demand Tadalafil 20 mgm was ED. All the patients had used 20mgm Tadalafil on demand on more than 8 occassions over the last 3 months.

Results: Thirty eight out of 72 men opted to discontinue on demand 20mgm Tadalafil and switch to daily dose 5mgm Tadalafil.A detailed interview was conducted to identify the reasons for this switch over. The salient factors were-1) Unsatisfactory clinical response to on demand dose (42%), 2)Adverse effects with on demand dose(22%), 3)Concomitant improvement in LUTS (44%), 4)Economic factors-daily dose therapy is cheaper than on demand (14%), 5) Freedom of spontaneous sexual activity with daily dose(36%),6) Patient perception of daily dose as a long term cure for ED (26%), 7)Combination of above factors (78%). Overall 76% of patients planned to continue daily dose Tadalafil 5 mgm.

Conclusion: Daily dose Tadalafil 5mgm appears to be preferred by patients over on demand 20 mgm Tadalafil for ED treatment.

Disclosures:

Work supported by industry: no.

Incidence of erectile dysfunction (ED) and ED medication use in a large screening population (#264)

W. Poage (USA)
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264

Incidence of erectile dysfunction (ED) and ED medication use in a large screening population

Poage, W1; Crawford, E1; Stone, N2

1: Prostate Conditions Education Council / University of Colorado HSC, United States; 2: Prostate Conditions Education Council / Mount Sinai, United States

Objectives:  To investigate the factors that influencing erectile function (EF) and ED medication use in men who had health assessment during the nationwide prostate cancer awareness weeks (PCAW) in 2011 and 2012.

Materials and Methods: 9288 men who attended PCAW in 2011-2012 filled out a health assessment which included the 25 point sexual health inventory (SHIM) and ED medication use. Associations between total SHIM score, age, race, exercise frequency, body mass index (BMI), low testosterone (T<300 ng/dL), heart disease (HD) and diabetes (AODM) were tested by ANOVA. The effect of multiple variables on SHIM score was determined by logistic regression. Differences between ED medication use and attendee characteristics was determined by chi-square analysis (Pearson).

Results: The mean age was 62 years (median 61.7, range 19-99), BMI 28.1 kg/m2 (median 27.3, range 12.9-88.4), T 361.1 ng/dL (median 329, range 21-2411) and SHIM score 17.9 (median 20, range 1-25). SHIM score < 17 was present in 3274 (35.2%). SHIM was highest in Blacks (p<0.001), with more frequent exercise (p=0.001), lower BMI (p<0.001), high T (p=0.024), lower age (p<0.001) and absence of HD and AODM (p<0.001).  Linear regression demonstrated only age, HD and AODM (all p<0.001) as significant predictors of higher SHIM. Of the 9288 men, 1817 (18.7%) reported use of ED medication. ED medication use was Viagra 46.8%, Cialis 18.9%, Levitra 6.2%, herbs 7.8%, other 12.6% and combination 7.7%. ED medication was most frequently used by Blacks (22.2% vs 17.9% for White, p<0.001), with increasing age (p<0.001) and in men with AODM (23.2% vs. 18.2%, p<0.001). Men with high BMI or HD did not report higher ED medication use. Of the ED medications Viagra was used more by Whites than Blacks (50.3% vs 33.9%, p<0.001) while the use of herbs was highest in Asians (29.6% vs 10.9% in Whites, p<0.001).

Conclusions: ED medications were used by about 50% of men indicating ED by SHIM score (<17). Viagra was the most frequent medication used and of the ED medications was most often used by Whites. Blacks reported use of ED medication more frequently than other races. Overweight men and those with HD, who have higher frequency of ED, did not report more medication use than men with lower BMI or those without HD.

Disclosures:

Work supported by industry: no.

Minimal clinically important differences (MCIDs) improvement of the IIEF-Erectile Function domain is a proxy of patient weaning from Tadalafil OaD in men with psychogenic erectile dysfunction - Realistic picture from the everiday clinical practice (#265)

P. Capogrosso (Italy)
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265

Minimal clinically important differences (MCIDs) improvement of the IIEF-Erectile Function domain is a proxy of patient weaning from Tadalafil OaD in men with psychogenic erectile dysfunction - Realistic picture from the everiday clinical practice

Capogrosso, P1; Boeri, L1; Colicchia, M1; Ventimiglia, E2; Serino, A1; La Croce, G2; Castagna, G1; Russo, A1; Damiano, R3; Montorsi, F1; Salonia, A1

1: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; 2: Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; 3: Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy

Objectives: Assess efficacy, treatment satisfaction and erectile function (EF) confidence in a cohort of patients with pure psychogenic erectile dysfunction (ED) treated with tadalafil 5mg once daily (Tad OaD).

Methods: Data from 100 consecutive patients seeking first medical help for pure psychogenic ED throughout the last 24 months were analysed. Tadalafil 5mg OaD was prescribed to all patients for not less than 6 months. Patients completed a baseline IIEF before therapy and at survey. Patients were requested to complete a non-validated questionnaire assessing compliance to and subjective satisfaction over the prescribed therapy. Descriptive statistics and logistic regression models tested patients compliance to and efficacy of long-term treatment with Tad OaD [also considering MCIDs criteria].

Results: Overall, 30 (30%) patients refused to answer at the survey. Of the remaining 70 patients, 57 (57%) did use the treatment as prescribed, while 13(13%) patients did not even start the therapy. Thirty (52.6%) of the total amount of patients taking Tad OaD discontinued the therapy at the end of the first 6 months course; conversely, 27 (47.4% )kept taking the drug over the prescribed course. Mean IIEF-EF significantly improved for both groups at FU evaluation (p<0.001). Overall, 32 (60.4%) patients showed a significant improvement also according to MCIDs criteria. Of those patients who tooktadalafilOaD34 (63%) thought to be able to get successful erections dismissing Tad OaD at some point throughout the course of therapy, even with 15 (45.5%)who considered that option after 1 month since therapy began. Younger (≤40 yrs) and healthier patients (CCI<1) thought more often to may dismiss the therapy during treatment (chi2 4.0; p<0.05; chi2 4.191;p=0.04). Conversely baseline IIEF-EF did not influence patient behaviour over treatment drop-off. At multivariate analysis, EF improvement according to MCIDs criteria was significantly associated with patient’s subjective feeling of independence from Tad OaD (OR 6.7; p=0.01).

Conclusions: Our findings showed that Tad OaD significantly improved EF of patients with psychogenic ED. Of all, 63% of patients were confident of having full erections after drug discontinuation. Conversely, almost half of them did not discontinue the therapy after the first prescription of 6 months. MCIDs improvement of IIEF-EF was a proxy of patient weaning from Tad OaD continuous treatment.

Disclosures:

Work supported by industry: no.

show poster

Penile rehabilitation following radical prostatectomy is not common among Japanese Urological Association members (#266)

K. Matsushita (Japan)
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266

Penile rehabilitation following radical prostatectomy is not common among Japanese Urological Association members

Matsushita, K1; Tai , T2; Nagao , K2; Mulhall , J3

1: St. Lukes International Hp / Juntendo University School of Medicine, Japan; 2: Toho University School of Medicine, Japan; 3: Memorial Sloan-Kettering Cancer Center, USA

Objective: Despite the fact that the benefits are still unclear, penile rehabilitation after radical prostatectomy (RP) has become the standard of care for many urologists. Given the lack of definitive proof regarding the benefits, however, a standard program or optimal algorithm does not exist. Furthermore, financial, insurance, and cultural considerations might cause regional differences in the practice of penile rehabilitation. We sought to explore contemporary trends in penile rehabilitation practice patterns of Japanese Urological Association (JUA) members.

Material & Methods: The proprietary questionnaire was comprised of 35 questions that addressed practitioner demographic factors and current practice status regarding rehabilitation. The questionnaire was mailed to all the representatives of urology departments authorized by the JUA.

Results: 376 physicians completed the questionnaire, representing a response rate of 31%. Twenty percent of the responders were members of the Japanese Society for Sexual Medicine (JSSM), 10% had formal sexual medicine specialty training, 68% were urologic oncology specialists, and 91% performed RP. Of the responders, 47% were not aware of the concept of penile rehabilitation and 29% performed some form of rehabilitation. As part of the primary rehabilitation strategy, 97% used phosphodiesterase type 5 inhibitors (PDE5i), 8% used a vacuum device, 13% used intracavernosal injections (ICI), and 2% used intra-urethral prostaglandin. Twenty percent commenced rehabilitation immediately after urethral catheter removal, and 36% within the first three months after RP. 37%, 21%, and 18% ceased rehabilitation at ≤12, 13-18, and 19-24 months, respectively. Six percent rehabilitate all RP patients, 94% only do it with selected patients. For 76%, selection for rehabilitation was dependent upon patient age, 72% upon nerve-sparing status, 70% upon preoperative erectile function, and 39% upon comorbidity. With regard to the primary reason for not performing rehabilitation: 52% said they were not familiar with the concept; 22% said patients could not afford it, and 22% gave another reason. Performing rehabilitation was positively associated with being a member of JSSM (P < 0.001), seeing post-RP patients (P < 0.001), sexual medicine specialty training (P < 0.001), being a urologic oncologist (P = 0.01), performing RP (P = 0.034), and surgeons using the laparoscopic or robotic-assisted approach (P < 0.001).

Conclusion: Among the respondents, penile rehabilitation is not common. The most commonly employed strategy is PDE5i use and ICI were not in common use. Clinicians who are engaged in the field of sexual medicine and see a lot of such patients are more likely to use rehabilitation practice.

Disclosures:

Work supported by industry: no.

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Efficacy study of Iodenafila carbonate in patients with erectile dysfunction carriers of chronic renal failure undergoing hemodialysis (#267)

I. Moreira (Brazil)
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267

Efficacy study of Iodenafila carbonate in patients with erectile dysfunction carriers of chronic renal failure undergoing hemodialysis

Moreira, I1; Cardoso, R1; Silva, B1

1: UFAL, Brazil

Objective: This study aims to evaluate the effectiveness of iodenafila carbonate in patients with erectile dysfunction, heterossexual, with a fixed partner in the last six months, patients with chronic renal failure submitted to hemodialysis.

Material and Methods: 76 patients on hemodialysis for more than six months, older than 18 and who have erectile dysfunction were evaluated in three hemodialysis centers in the State of Alagoas, by applying the International Index of Erectile Function (IIEF-5). Patients included in the study were randomized to receive active medication, lodenafil carbonate (80mg) or placebo and instructed to keep sexual relations twice a week. The revaluation occurred with 7, 14 and 30 days, by IIEF-05 and checked for the presence of side effects. Were available for each patient four boxes, identified by a number corresponding to the patient. In each consultation was given a box containing one blister, consisting of 2 tablets. The patient was instructed to use 1 tablet 1 hour before each intercourse, totaling two sexual relationships during each week. The chi-square test was used to compare the comorbidities, characteristics of the population studied, as well as the relationship between the use of active medication or placebo with the IIEF-05. Values of p <0.05 was considered significant.

Result: The prevalence of effectiveness of iodenafila carbonate in patients with chronic renal failure submitted to hemodialysis was significant (62%). The population studied showed, in general, low side effects. Being 11% of those who partook of the lodenafil carbonate (80mg) have nausea.

Conclusion: The evaluation after the specified period showed that the use of lodenafil at a dose of 80 mg presented a statistically significant improvement in erectile function compared to placebo-treated group.

Disclosures:

Work supported by industry: yes, by Laboratório Cristália (industry funding only - investigator initiated and executed study).

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Role of nocturnal penile tumescence and rigidity in response to daily sildenafil in patients with erectile dysfunction due to pelvic fracture urethral disruption: a single-center experience (#268)

Bing Gao (China)
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268

Role of nocturnal penile tumescence and rigidity in response to daily sildenafil in patients with erectile dysfunction due to pelvic fracture urethral disruption: a single-center experience

Peng, J1; Zhang, Z1; Gao, B1; Cui, W1; Yuan, Y1

1: Peking University First Hospital, China

Introduction: Erectile dysfunction (ED) is common in patients with pelvic fracture urethral disruption (PFUD). ED in these patients is almost organic and in some patients, the disease is refractory to phosphodiesterase type 5 (PDE-5) inhibitors. The selection of optimal therapy is important. The causes of ED have been used as a referred parameter to select therapy; however, the cause may be indefinite. In this retrospective study, we aimed to find an optimal variable to guide therapy choice.

Materials and methods: We included 38 patients with ED due to PFUD who were evaluated subjectively and objectively by the International Index of Erectile Function 5 (IIEF-5), Nocturnal Penile Tumescence and Rigidity (NPTR) test and penile Doppler ultrasonography. 31 patients received daily sildenafil 50mg for 3 months and were followed up. Patients reported successful vaginal penetration and intercourse were considered to respond to daily sildenafil treatment.

Results: In total, 54.8% of patients showed response to sildenafil defined as reporting successful vaginal penetration and intercourse. Patients with neurogenic, arterial and venous ED did not differ in efficiency rates (P=0.587). However, the penile erectile rigidity recorded by NPTR test affected efficiency significantly (P=0.046). Patients with tip rigidity >40% had the highest response rate (76.9%), but the response rate for patients with tip rigidity <20% was only 22.2%.

Conclusion: NPTR recording can reveal resident erectile function in patients with ED due to trauma and is significant for selecting pharmacological treatment as optimal therapy.

Disclosures:

Work supported by industry: no.

Data on the utilization of treatment modalities for erectile dysfunction in Taiwan in the era of phosphodiesterase type 5 inhibitors (#269)

W. Tsai (Taiwan)
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269

Data on the utilization of treatment modalities for erectile dysfunction in Taiwan in the era of phosphodiesterase type 5 inhibitors

Tsai, W1; Jiann, B2

1: Mackay Memorial Hospital, Taiwan; 2: Kaohsiung Veterans General Hospital, Taiwan

Objectives: Oral phosphodiesterase type 5 (PDE5) inhibitors, intracavernosal injection, and penile implants are mainstay treatments for erectile dysfunction (ED). We report utilization data and user characteristics for these modalities in Taiwan between 1999 and 2011. Usage data are important to guide health care expenditure and may help clinicians understand the market and consumer behavior and to identify influencing factors.

Materials and Methods:We collected sales data on the PDE5 inhibitors and medications of intracavernosal injection from Intercontinental Marketing Services Health. The data of penile implants was collected from the local importing company. Demographic and clinical data of patients were obtained retrospectively through medical chart review. The χ2-test was used to compare categorical parameters and analysis of variance (ANOVA) was used to compare numeric parameters.

Results: Between 1999 and 2011, sales of PDE5 inhibitors increased 5.9-fold, whereas those of alprostadil and penile implants remained stable. Discontinuation of treatment with PDE5 inhibitors or intracavernosal injection reached 90% within 3 years of treatment initiation. The age of patients who first received PDE5 inhibitors for ED showed a tendency to decrease over consecutive years, with a mean age of 65.1 years in 1999 and 53.7 years in 2011.

Conclusions:The increasing market for PDE5 inhibitors reflects both their global acceptance as the primary treatment for ED and the growing burden of ED. The mean age of patients who first receive treatment with PDE5 inhibitors has decreased over consecutive years, reflecting increased public awareness and recognition of the advantages of PDE5 inhibitors.

Disclosures:

Work supported by industry: no.

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The NPT in the diagnosis of male erectile dysfunction (#270)

Z. Bing (China)
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270

The NPT in the diagnosis of male erectile dysfunction

Manbo, J1; Liuhong, C1; Bing, Z1; Jun, C1; Tao, Q1; Bo, W1; Xiaoming, L1

1: The Third Affiliated Hospital of Sun Yat-Sen University, China

Objective: To evaluate the application and limitation of nocturnal penile tumescence ( NPT ) in forensic identification for male erectile dysfunction.

Methods: This was a retrospected analysis. From 2006 to 2013, totally 137 men complaining erectile dysfunction came to our department for forensic identification .The relationship between the injured area,the result of NPT and the clinic diagnosis were analyzed.

Results: 75% of pelvic fractures with urethral injury lead to organic ED. results of NPT with organic ED is significant correlation (r = 0.665), the positive rate can reach 100%. There are 8 cases with normal NPT results were diagnosed with organic ED, 1 case of paraplegic, 2 cases of brain injury result in cognitive dysfunction, 5 cases have limitation of length and the angle of erection.

Conclusion: (1) Pelvic fractures with urethral injury are prone to having organic ED. (2) NPT could reflect the penile hardness and is an important tool for forensic identification for male erectile dysfunction, but no help for diagnosis of the length and angle during erection,to improve the level of forensic clinical identification, we need to take comprehensive examination according to the actual condition of patient. (3) ED is a comprehensive diagnosis, basing on penile hardness, erectile angle and penile length.

Disclosures:

Work supported by industry: no.

The sexy singer and dancing sex: relationships between sexuality and musicality in women (#271)

J. Varella Valentova (Czech Republic)
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271

The sexy singer and dancing sex: relationships between sexuality and musicality in women

Varella , M1; Varella Valentova, J2

1: University of Brasilia, Brazil; 2: Charles University in Prague, Czech Republic

Objectives: We aimed to explore whether self-promotion through musicality is related to sexuality in young adult women. We predicted that women more prone to masturbation and intercourse would be more prone to singing and dancing.

Material and Methods: Participants were 40 Czech university students with mean age 22.43 years (SD= 2.42). They answered an anonymous questionnaire about their sexual activities, in particular number of sexual partners, age of first intercourse, masturbation, and vaginal orgasm, actual frequency of masturbation and of sexual activities. They also reported their motivation, frequency and experience of singing and dancing in public, and also the quality of their display. 

Results: Several sexuality measures correlated in the predicted direction with both dancing and singing measures. In particular, women with higher experience with both singing and dancing in public reported higher number of sexual partners, higher frequency of masturbations and lower age of first masturbation and of vaginal orgasm. Lower age of the first vaginal orgasm also negatively correlated with the self-rated quality of singing, and singing creativity. Dancing frequency further correlated with masturbation frequency. Quality of singing correlated with frequency of actual sexual activities, and women with more formal education of singing and dancing reported higher frequency of masturbations and lower age of first masturbation.

Conclusions: Higher sexual libido in women seems to be positively related with singing and dancing proficiency.

Our results indicate that the sexual libido can increase tendency towards self-promoting ornamented activities, as well as self-promoting activities can increase sexual opportunities, desires, and self-esteem. Although more research is needed, encouragement of singing and dancing in women can promote more active sexual life, which might be of interest to counseling professions dealing with frequent low sexual desire and activity in women.

Disclosures:

Work supported by industry: no.

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Improvement of erectile function by testosterone treatment in hypogonadal men are independent of age and sustained for up to 6 years (#272)

F. Saad (Germany)
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272

Improvement of erectile function by testosterone treatment in hypogonadal men are independent of age and sustained for up to 6 years

Saad, F1; Haider, A2; Yassin, A3; Doros, G4; Traish, A5

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: Institute for Urology and Andrology, Germany; 4: BU School of Publica Health, USA; 5: BU School of Medicine, USA

Objective: To assess whether effects of long-term treatment with testosterone undecanoate (TU) injections on erectile function in hypogonadal men are dependent on age.

Material and Methods: 561 hypogonadal men from two urology offices in Germany were enrolled into independent observational registry studies following the same protocol. We performed a pooled analysis of men ≤65 years of age (Group Y) and men >65 years (Group O) of age from both registries. All men received TU injections for up to 6 years. IIEF-EF (maximum score: 30, according to Cappelleri et al., Urol 1999) was assessed at baseline and every 3 months. Our calculations were based on annual averages.

Results: Group Y (n= 450, mean age: 56.10±6.29 years; minimum: 32, maximum: 65): IIEF-EF improved from 14.94±7.34 at baseline to 19.23±5.94 after 1 year, 21.58±5.72 at 2 years, 22.57±5.53 at 3 years, 22.98±5 at 4 years, 23.39±4.96 at 5 years, and 24.21±4.39 at 6 years. Changes were statistically significant vs baseline at each year (p<0.0001) and at 2 years vs. 1 year (p<0.0001), 3 years vs. 2 years (p<0.0001), 4 years vs. 3 years (p=0.0071) and sustained thereafter. The model-adjusted mean change from baseline was 8.53±0.26.

Group O (n=111, mean age: 68.45±2.91 years; min.: 66, max.: 84): IIEF-EF improved from 11.87±7.58 at baseline to 16.79±6.35 after 1 year, 18.71±6.75 at 2 years, 19.46±6.62 at 3 years, 19.95±7.19 at 4 years, 20.16±7.11 at 5 years, and 22.12±6.41 at 6 years. Changes were statistically significant vs baseline at each year (p<0.0001) and at 2 years vs. 1 year (p<0.0001) and sustained thereafter. The model-adjusted mean change from baseline was 8.12±0.59. - A limitation of our study was that we did not record any changes in use of PDE5 inhibitors. At baseline, 55 patients (10%) were on a PDE5 inhibitor.

Conclusions: As expected, erectile function was slightly better in younger hypogonadal men compared to older hypogonadal men. Improvement under long-term testosterone treatment was in the same magnitude in both groups. In younger men, changes occurred over a period of 4 years. In contrast, changes in older men were most pronounced during the first 2 years of treatment. Most importantly, once improvements were achieved, they were sustained for the full observation period. T therapy seems to be effective to improve and maintain erectile function in hypogonadal men, independent of age.

Disclosures:

Work supported by industry: yes, by Bayer Pharma AG (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Improvement of erectile function in hypogonadal men with obesity grades I to III upon long-term treatment with testosterone undecanoate (TU) injections (#273)

F. Saad (Germany)
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273

Improvement of erectile function in hypogonadal men with obesity grades I to III upon long-term treatment with testosterone undecanoate (TU) injections

Saad, F1; Haider, A2; Doros, G3; Traish, A4

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: BU School of Public Health, USA; 4: BU School of Medicine, USA

Objective: To assess erectile function in obese hypogonadal men under long-term testosterone (T) therapy.

Material and Methods: Single-center, prospective, cumulative registry study of 340 hypogonadal men. 237 men with obesity grade I-III were selected. All men received TU injections for up to 7 years. IIEF-EF domain (6 items, maximum score: 30, according to Cappelleri et al., Urol 1999) was filled in at each three-monthly visit.

Results: Grade I (n=103, mean age: 58 years): Mean IIEF-EF improved from 19.76±5 to 25.76±3.43, mean change from baseline: 5.02. The increase was statistically significant vs. baseline each year (p<0.0001) and vs. previous year for the first two years after which it was sustained. In 48% of men, IIEF-EF improved by 1 category, in 21% by 2 and in 4% by 3 categories. 27 men remained within the same category, 3 men’s scores of whom 2 had discontinued T therapy due to a diagnosis of prostate cancer dropped by 1 category. 50% achieved normal erectile function. Grade II (n=98, mean age: 60 years): Mean IIEF-EF improved from 19.98±4.52 to 26.38±1.3, mean change from baseline: 5.1. The increase was statistically significant vs. baseline each year (p<0.0001) and vs. previous year for the first two years after which it was sustained. In 48% of men, IIEF-EF improved by 1 category, in 20% by 2, in 6% by 3 and in 1 man by 4 categories. 22 men remained within the same category despite slight improvements in score, 2 men’s scores of whom 1 had discontinued T therapy due to a diagnosis of prostate cancer dropped by 1 category. 57% achieved normal erectile function. Grade III (n=36, mean age: 60 years): Mean IIEF-EF improved from 20.78±4.3 to 26.88±1.36, mean change from baseline: 5.1. The increase was statistically significant vs. baseline each year (p<0.0001) and vs. previous year for the first three years after which it was sustained. In 56% of men, IIEF-EF improved by 1 category, in 22% by 2 and in 6% by 3 categories. 5 men remained within the same category despite slight improvements in score, 1 man’s score dropped from 26 to 25 changing from “no ED” to “mild ED”. 56% men achieved normal erectile function.

Conclusions: Improvements in erectile function were clinically meaningful and significant during the first 2 to 3 years of T therapy and sustained during the full treatment duration. They were independent of obesity grade. It may be necessary to continue T therapy for 2 to 3 years before an optimal response is achieved.

Disclosures:

Work supported by industry: yes, by Bayer Pharma AG (industry funding only - investigator initiated and executed study). The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Longitudinal changes of free testosterone levels with aging in Japanese men from a community-based longitudinal study (#274)

A. Takayanagi (Japan)
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274

Longitudinal changes of free testosterone levels with aging in Japanese men from a community-based longitudinal study

Takayanagi, A1; Kobayashi, K1; Fukuta, F1; Matsuki, M1; Matsuda, Y1; Masumori, N1

1: Sapporo Medical University School of Medicine, Japan

Objective: It is well known that the male testosterone level is reduced with aging. Although there was a report that evaluated normal free testosterone levels in healthy Japanese men, there has been no report about their longitudinal changes of free testosterone levels. We previously reported the longitudinal changes of sexual function of Japanese men. We concluded that their sexual function declined with aging and erectile rigidity was most correlated with aging. In this study, we evaluated the longitudinal changes of the free testosterone level and its relationship with sexual function in Japanese men.

Material and Method: From 1992 to 1993, we conducted a cross-sectional community-based study on sexual function as well as lower urinary tract symptoms in Japanese men aged 40-79 years. After 15 years, a follow-up study was conducted to determine longitudinal changes of their sexual function. Of the 319 participants in the initial study, 135 participated again in the follow-up study. Sexual function was assessed in the two studies using the same questionnaire and serum free testosterone levels were also measured in both studies.

Result: Of the 135 participants, 127 were eligible for evaluation. The median ages of the participants in the initial and follow-up studies were 57 and 71 years old, respectively. The median free testosterone levels in the initial and follow-up studies were 12.1 pg/ml and 4.1pg/ml, respectively. The free testosterone level decreased in men of each age decade (40s, 50s, 60s and 70s) of the initial study, and the median decreases of free testosterone were 9.0 pg/ml, 7.9 pg/ml, 7.8 pg/ml and 7.9 pg/ml for those in their 40s, 50s, 60s and 70s, respectively. These decreases of free testosterone levels were not significantly different among the age decades (p=0.71). When we evaluated the relationship between decreases of free testosterone levels and decline of sexual function by aging, we could not find a significant relationship between these changes.

Conclusion: We found steadily decreased serum free testosterone levels of Japanese men in all age decades in a community-based longitudinal study.

Disclosures:

Work supported by industry: no.

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Factors affecting adherence to testosterone replacement therapy (#275)

Ege Can Serefoglu (Turkey)
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275

Factors affecting adherence to testosterone replacement therapy

Gul, A1; Berktas, M2; Yuruk, E1; Muslumanoglu, A1; Serefoglu, E1

1: Bagcilar Training and Research Hospital, Turkey; 2: Yeditepe University Pharmacoeconomics and Pharmacoepidemiology Research Center, Turkey

Objectives: In spite of the wide-spread use of testosterone replacement therapy (TRT), there is limited data regarding the patients’ satisfaction and adherence to the treatment. The purpose of this study is to evaluate the factors which may have an impact on patients’ adherence to TRT prescribed for hypogonadism.

Materials and Methods: In this retrospective study, patients who had been prescribed testosterone gel therapy between January and September 2013 were retrospectively evaluated and their demographics were recorded along with their testosterone levels. Afterwards, those patients were reached via telephone and asked whether they still continue TRT and their reasons for quitting treatment were noted.

Results: Of the screened patients, 60 men with a mean age of 40.9±9.9 (range: 21-59) years were prescribed daily transdermal testosterone gel 50 mg during the given period. Baseline total testosterone levels of 50 men (83.3%) were below 2.5 ng/ml. Of the patients, 31 (51.7%) could be reached via telephone and accepted to participate to the study and only 7 (11.7%) were still using TRT. The reasons for quitting TRT were no efficacy (18.3%), physicians’ recommendation (6.7%), deciding to stop after beneficial effect (5.0%) and other reasons (10%). Kaplan Meier estimation revealed that mean time to TRT withdrawal was 5.9±0.9 months. Parametric survival model using Frechet distribution revealed that neither being older than 45 years nor having lower testosterone level has an effect on adherence (P=0.528 and P=0.641, respectively).

Conclusion: Although testosterone gels are frequently prescribed by the physicians, patient adherence is low and being older or having low testosterone level does not affect patients’ satisfaction. Sexual medicine specialists are suggested to evaluate their patients carefully in terms of benefits and risk of TRT before prescribing these gels.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

show poster

Testosterone deficiency in Argentina (#276)

Edgardo Becher (Argentina)
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276

Testosterone deficiency in Argentina

Lopez Silva, M1; Becher , E1; Nolazco, C1; Alvarez Albero, A1; Calabia, P1; Fabre, B1; Grosman, H1; Mazza, O1

1: Hospital de Clinicas Jose de San Martin, Argentina

Objectives: Testosterone Deficiency (TD) is a syndrome that presents with symptoms of hypogonadism and low blood testosterone levels. The primary objective was to establish the incidence of TD in a group of individuals during a prostate awareness week campaign. Secondarily, the predictive potential of the Morley´s questionnaire, the relationship between the severity of prostate symptoms and hormonal values, and the relationship between metabolic syndrome (MS), Body Mass Index (BMI) and lipids with testosterone levels.

Methods: Cross sectional analysis in a group of 474 individuals among 2,906 who attended a prostate awareness week campaign in Buenos Aires, Argentina answered the Morley’s and International Prostate Symptom Score (IPSS) questionnaires, underwent a physical examination and blood levels of sex hormones, lipid profile and Prostatic Specific Antigen (PSA) were measured. The presence of MS was assessed according to the criteria of the ATP III.

Results: Age: 59,26 (31-85)  Incidence of TD was 9.51% . Morley´s Question 1 had greater statistical power to TD (p 0.01). There was no difference in the severity of IPSS (p> 0.05) between groups with normal or low testosterone. The presence of MS was significantly higher (p <0.0001, p <0.01) in the group of patients with lowered testosterone.

Conclusions: In our population we found an incidence of TD 9.51%, a positive relationship between low testosterone and increase in metabolic risk factors. Not all questions which generated a positive Morley´s questionnaire have the same value in predicting low Testosterone.

Disclosures:

Work supported by industry: no.

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A possible relationship between serum sex hormones and lower urinary tract symptoms in men that underwent transurethral resection of prostate (#277)

J. Qi (China)
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277

A possible relationship between serum sex hormones and lower urinary tract symptoms in men that underwent transurethral resection of prostate

Wu, Y1; Wang, W1; Xu, D1; Bai, Q1; Zhang, L1; Gu, Z1; QI, J1

1: Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China

Objective: In this study we searched for a possible relationship between sex hormone levels and the lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) that underwent transurethral surgery.

Material and Methods: The study was conducted in 158 patients who were coming to our hospital for surgery. Clinical conditions were assessed by body mass index (BMI), digital rectal examination, International Prostate Symptom Score (IPSS) and transrectal ultrasonography (TRUS). Sex hormones (including total testosterone (TT), estradiol (E2), progesterone (P), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin (PRL)) and prostate-specific antigen (PSA) were measured before the operation. Correlations were determined using univariate and multivariate regression analysis.

Results: The mean age was 72 ± 9 years. The total IPSS was significantly associated with the TT level (r=-0.206, P=0.01). Other sex hormone levels were not correlated with total IPSS. However, some interesting ratios such as E2/T (r=0.227, P=0.004) and FSH/LH (r=-0.166, P=0.038) were associated with total IPSS. Further analysis showed that the subscore (nocturia) was associated with age (r=0.161, P=0.044), BMI (r=0.210, P=0.008), TT (r=-0.192, P=0.016). Moreover we divided all the patients into two subgroups on the basis of IPSS severity (<20 or >=20). The mean TT level was in the normal range but that it was significantly related to the presence of severe LUTS.

Conclusions: In our study, the severity of LUTS was not associated with serum levels of sex hormones in men that underwent transurethral surgery, except for TT. Endogenous testosterone may play a beneficial role on lower urinary tract function. The potential mechanisms need more additional large studies.

Disclosures:

Work supported by industry: no.

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Luteinizing hormone level predicts the efficacy of testosterone replacement for late-onset hypogonadism (#278)

A. Abdelhamed (Japan)
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278

Luteinizing hormone level predicts the efficacy of testosterone replacement for late-onset hypogonadism

Abdelhamed, A1; Hisasue, S1; Shirai, M1; Matsushita, K1; Kimura, M2; Ide, H2; Muto, S2; Yamaguchi, R2; Tsujimura, A1; Horie, S1

1: Juntendo University, Japan; 2: Teikyo University, Japan

Objective: Several predictors were proposed as the predictors for the efficacy of testosterone replacement (TRT) for late-onset hypogonadism (LOH); however, it is still unclear. In the current study, we evaluated the predictors for the TRT efficacy for LOH.

Materials and Methods: We evaluated the patients who presented at our men’s health clinic between July 2010 and March 2012. Of these patients, 212 with the data available before and after TRT were enrolled into this study. We evaluated free testosterone (fT) level and luteinizing hormone (LH) level in the morning, questionnaires of aging males symptoms scale (AMS), sexual health inventory for men (SHIM), and international prostate symptom score (IPSS). We defined AMS <26 as normalization after TRT, and carried out multivariate analysis using logistic regression for the efficacy of TRT with the parameters of age, fT, LH, IPSS, SHIM, and AMS.

Results: Median age of the patients was 55 years (range: 28 to 81). Mean fT level was 6.14±0.265 pg/ml (mean±SEM) and mean LH level was 6.57±0.477mIU/ml. IPSS, AMS total and each domain score of sexual, somatic, and psychological were significantly improved after TRT.(p<0.001, Student’s t-test) Logistic regression analysis revealed that baseline LH was the significant predictor.

Conclusions: Our study suggested that low LH level seemed to relate to the severity of LOH. The low LH level might predict the low response to TRT for LOH. We should give an attention to the LH level of the patients with LOH symptoms as well as testosterone level.

Disclosures:

Work supported by industry: no.

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Changes of sexual activity, hormones and epileptic seizures in a woman with adrenal adenoma (#279)

V. Matulevicius (Lithuania)
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279

Changes of sexual activity, hormones and epileptic seizures in a woman with adrenal adenoma

Matulevicius, V1; Ostrauskas, R1; Ciaplinskiene, L1

1: Lithuanian University of Health Sciences, Lithuania

Objective: To report a case of androgen secreting adrenal adenoma with clinical manifestations of suddenly appeared amenorrhea, hirsutism, seizures, weight gain and decreased sexual activity before with complete recovery and even increase of sexual activity at 12 months after surgical removal of the tumor.

Material and Methods: Presentation of clinical case with comments. Clinical and laboratory, hormonal and imagine investigations were run as performed usually at Kaunas Clinics. Sexual function was evaluated using The Female Sexual Function Index (FSFI).

Results: Seizures, amenorrhea, weight gain and hirsutism suddenly appeared in 38-year-old fertile woman, followed by decrease of sexual activity. Right adrenal tumor was detected. Plasma concetrations of dehidroepiandrosterone-sulfate (DHEA-S) and testosterone (T) were strongly elevated. Surgical removal of the adenoma was performed what conditioned decrease of DHEA-S, T and other hormones in 2-24 hours for the level of adrenal insufficiency. After 1 month all the hormones returned to normal level and were maintained at this level for 12 months after operation. Menses reappeared in 6 weeks. Seizures has not been presented. Sexual function investigation indicate that woman was at sexual dysfunction risk (FSFI total score26.55) 1 month before the operation (score-19.0) and 1 month after the surgical removal (score-25.0). Women reported the best sexual function 12 months after the operation (score-33.3). Desire, arousal and orgasm scores appears to be increased 6 months after the operation if compared to the situation before the manifestation of the disease, 1 month before the operation and 1 month after the surgical removal. Following the surgery, arousal, lubrication, orgasm and satisfaction scores did not differ during the period from 6 to 12 months. On the long term follow-up after the operation desire score was equal to desire score before the manifestation of the disease.

Conclusions: We discuss the complete recovery of a 38-year-old woman after removal of DHEA-S and testosterone secreting adrenal adenoma. Decreased sexual activity at high endogenous concentrations of DHEA-S, T and increased to higher than predisease level at 12 months after removal of adrenal androgen secreting tumor is suggestive for androgen receptor mediated down and up – regulation of sexual activity in middle-aged women.

Disclosures:

Work supported by industry: no.

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Testosterone therapy and improvement of sexual function in men with parcial androgen decline (#280)

S. Cedres (Uruguay)
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280

Testosterone therapy and improvement of sexual function in men with parcial androgen decline

Cedres, S1; Arroyo, C1

1: Uruguay

Introduction: The decrease of plasma testosterone (T) in old age may be inherent to the aging process or secondary to environmental factors. This is called “PADAM” (Partial Androgen decline in the aging male), defined as bioavailable testosterone (BT) < 0,75 ng/ml(1). The Androgen replacement therapy has demonstrated great improvement of quality of life and sexual function (2).

Methods: We determined plasma T, luteinizing hormone (LH) and calculated the BT of patients that consulted for sexual dysfunction without severe prostatic disease, and not using potentially interfering medications. The aims were to determine the presence of PADAM, to find a relation with chronic illness, to study the changes in sexual function and to determine the presence of adverse effects (benign prostate hyperplasia, polycythaemia, changes liver function tests or in lipids test) after 6 injections of Testosterone enanthate (250 mg) in oil vehicle deep intramuscular. Sexual function was assessed with the International Index of Erectile Function and the Sexual Desire Test at baseline and after treatment.

Results: 92 patients consulted for sexual dysfunction, and 72 had PADAM (mean age 58 years). There were considerable comorbidities: 54/72 (FR=0.75) stress, 51/72 (FR=0.70) type 2 diabetes, 50/72 (FR=0.69) smokers, 48/72 (FR=0.67) social alcohol ingestion, 28/72 (FR=0.39) cardiac failure, 10/72 (FR=0.14) renal insufficiency and 49/72 (FR=0.68) overweight. The duration of sexual complains was on average 2.5 years. 70/72 were hipergonadotropic hipogonadism (high LH). In all patients serum testosterone levels were restored to normal within 4 weeks. All of them reported a significant improvement in all domains of erectile function and sexual desire after treatment (p<0.005 – Wilcoxon pairs range test).

After treatment, no significant changes were noticed in serum PSA, liver function, lipids tests, haemoglobin or haematocrit.

Conclusions: All patients with sexual dysfunction need to be screened for hipogonadism. Testosterone supplementation improves sexual function in all of them.

Disclosures:

Work supported by industry: no.

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Full biochemical diagnosis of hypogonadism at the first visit including LH – Experience of an andropause clinic (#281)

J. Drouin (Canada)
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281

Full biochemical diagnosis of hypogonadism at the first visit including LH – Experience of an andropause clinic

Drouin, J1

1: Laval University Hospital Center, Canada

Introduction: Recommendations have been published on hypogonadism.  However, no international consensus on diagnosis and follow up exist. The andropause clinic in Quebec has decided to establish its own consensus based on Quebec expert opinion from different specialties.  

Current recommendations suggest that a biochemical diagnosis be conducted during the first visit (Total testosterone; TT) and the second visit if TT is moderately low or borderline (TT, Sex Hormone Binding Globulin, calculated Free Testosterone, Luteinizing Hormone [LH] and prolactin in some Bioavailable Testosterone). Serum LH is recommended to distinguish between primary (testicular) and secondary (pituitary-hypothalamic) hypogonadism.  However, clinical observation suggests that the rate of attending a second visit is low and the opportunity to obtain these measures may be missed.

The purpose is to provide physicians with recommendations on procedures for diagnosing hypogonadism using biochemical measurements including LH as soon as the first visit.

Methodology: Ongoing expert meetings from different specialties in Quebec, Canada (family medicine, urologists, endocrinologists, psychiatrists, sexologists, cardiologists and nutritionists) were conducted. The first recommendations were proposed in 2005 and subsequent changes added on a yearly basis.

Result: Expert opinion suggests that biochemical measures traditionally taken during the first and second visits now be combined into the first visit.

Conclusion: To assess biochemical measurements including LH as soon as the first visit ensures that the patient is correctly investigated and will be managed accordingly.

Disclosures:

Work supported by industry: no.

Male patients with hypogonadism at the general hospital (#282)

C. Arroyo (Uruguay)
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282

Male patients with hypogonadism at the general hospital

Arroyo, C1; Cedres, S1

1: Uruguay

Introduction: Hypogonadism is defined as deficient or absent male gonadal function that results in insufficient testosterone secretion ( Free testosterone (FT) ≤7,2  ng/dL between 55-60 years old and  ≤ 5,6 ng/dL in patients > 60 years old,). It can exert diverse effects on the well-being.This condition is fairly common in certain populations (1). Once diagnosed, Hypogonadism is usually easily treated by testosterone replacement therapy. The contraindication are: prostate cancer, severe benign prostate hyperplasia, severe dyslipemia and polycythaemia (2).

Aims: To estimate the prevalence of Hypogonadism in men aged ≥55 years assisted (for any reason) in the Internal Medicine and Urology rooms of the Hospital. A second objective was to correlate the presence of Hypogonadism with select comorbid conditions and symptoms, study the impact on sexual function and verify how many of them could be included in androgen therapy.

Methods: A blood sample was obtained between 8 am and noon and assayed for FT, haematocrit, lipids and liver function test and PSA. Sexual dysfunction, quality of life and comorbid conditions were recorded. All the patients had digital rectal examination by urologist.

Results: Of 52 patients: 27 (RF=0,52) had significantly low FT  levels and another 11 (RF=0,21) had low-normal levels. Only 14 (RF=0,27) had normal level. Odds ratios for having Hypogonadism were significantly higher in men with anemia (1.64), hyperlipidaemia (1.29), diabetes (1.99), chronic renal failure (1.45) and smokers(2.38).  All patients with Hypogonadism had erectile dysfunction, and half of them had quite sexual activity for over a year. The testosterone replacement therapy was contraindicated in 10 patients because of severe urinary symptoms and prostate exam with grade 3 enlarged prostate (in 5 of them prostate cancer was confirmed). No one had hematology contraindications.
Conclusion: We found high prevalence of hypogonadism in hospitalized patient and studied its impact on quality of sex life. We should screen this groups of patients to offer specific treatment.

Disclosures:

Work supported by industry: no.

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Influences of testosterone deficiency for oxidative stress and inflammation markers in castrated rats (#283)

T. Katoka (Japan)
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283

Influences of testosterone deficiency for oxidative stress and inflammation markers in castrated rats

Katoka, T1; Hotta, Y2; Maeda, Y2; Kimura, K1

1: Graduate School of Medical Sciences, Nagoya City University, Japan; 2: Graduate School of Pharmaceutical Sciences, Nagoya City University, Japan

Objective(s): Testosterone deficiency is thought to cause erectile dysfunction by decreasing NO bioavailability. However, the mechanism by which testosterone deficiency affects erectile function is not fully clear. We investigated the effects of testosterone deficiency on oxidative stress and inflammation in the erectile tissues of castrated rats.

Material and Method(s): Male rats were categorized into the following groups: castrated (Cast), castrated with testosterone (3 mg/kg/day) (Cast+T), and sham (Sham). At 4 weeks after the operation, erectile function was evaluated by measurement of ICP/MAP on cavernous nerve stimulation. The relaxation and contractile responses of the corpus cavernosum were measured using an isometric tension study. Measurement of serum sex hormones and asymmetric dimethyl arginine (ADMA), an endogenous nitric oxide synthase (NOS) inhibitor, were performed with UPLC-MS/MS. For structural analyses, rat penises were harvested. Masson's trichrome staining was used to calculate the smooth muscle (SM)/collagen ratio using computer image analysis. Real time PCR was used to determine the expression levels of catalase (CAT), super oxide dismutase (SOD), glutathione peroxidase (GPx), NADPH oxidase-1 (NOX-1), NOX-4, p22phox, inducible NOS (iNOS), interleukin (IL-6), and NF-κB mRNAs.

Result(s): The ICP/MAP ratio was 0.61 ± 0.03 in Sham, 0.26 ± 0.04 in Cast (p < 0.01 vs. Sham) and 0.56 ± 0.06 in Cast+T (p < 0.01 vs. Cast). Relaxation responses induced by acetylcholine were decreased in Cast compared to Sham and Cast+T (p < 0.05). Serum ADMA levels in Cast were significantly higher than in Sham and Cast+T (p < 0.05). The SM/collagen ratio in Cast was significantly lower than in Sham and Cast+T (p < 0.05). CAT, SOD and GPx mRNA expression levels were not significantly different between the three groups (p > 0.05). However NOX-1, NOX-4, p22phox, iNOS, IL-6 and NF-κB mRNA expression levels in Cast were significantly higher than in Sham and Cast+T (p < 0.05).

Conclusion(s): Testosterone deficiency increased oxidative stress and inflammation markers in castrated rats. It caused oxidative stress by up-regulating NOX and p22phox, and it also caused inflammation in the corpus cavernosum.

Disclosures:

Work supported by industry: no.

Effect of putatives inhibitors of phosphodiesterases in corpora cavernosa isolated from rabbit and human (#284)

R. Campos (Brazil)
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284

Effect of putatives inhibitors of phosphodiesterases in corpora cavernosa isolated from rabbit and human

Campos, R1; Lescano, C1; Zaminelli, T1; Rodrigues, R1; Mónica, F1; De Nucci, G1

1: State University of Campinas, Brazil

Objective: Phosphodiesterases inhibitors are the first line medications indicated to treat erectile dysfunction. The aim of this study was evaluate the effects of tadalafil analogues 3-(benzo[d][1,3]dioxol-5-yl)-1-(1H-indol-3-yl)-7-methyl-6,7-dihydro-3H-oxazolo[3,4-a]pyrazine-5,8-dione ( BL 106), 1-(1H-indol-3-yl)-3-(4-methoxyphenyl)-7-methyl-6,7-dihydro-3H-oxazolo[3,4 a]pyrazine-5,8-dione (BL 106-1), 1-(1H-indol-3-yl)-7-methyl-3-phenyl-6,7-dihydro-3H-oxazolo[3,4-a]pyrazine-5,8-dione (BL 106-2), 3-(4-chlorophenyl)-1-(1H-indol-3-yl)-7-methyl-6,7-dihydro-3H-oxazolo[3,4-a]pyrazine-5,8-dione (BL 106-3). On corpora cavernosa tissues and measure the contents of cycle nucleotides in cells lineages.

Material and Methods: Curves concentration response to BL 106 were constructed in isolated rabbit (Rcc) and human corpora cavernosa (Hcc) respectively pre- contracted with phenylephrine (10uM), noradrenaline (3uM). Curves concentration response to BL 106-1, BL 106-2, BL 106-3 were design in Rcc pre contracted with phenylephrine (10uM). Levels of guanosine monophosphate cycle (cGMP) and adenosine monophosphate cycle (cAMP) were measured in T84 cells and Jurkat cells, respectively, after treatment with these analogues (50uM).

Results: The compound BL 106 produced concentration dependent relaxation in Hcc (pEC50: 7.14 ± 0.27; Emax 81±7 n=3) and Rcc (pEC50:6.58 ; Emax 90.2% n=3). The compounds BL 106-01; BL 106-02 and BL 106-03 (0.001-10 μM) produced relaxations in Rcc with pEC50 of 6.07 (n=3), pEC50 of 6.89 (n=2) and pEC50 of 6.54 (n=3), respectively; and Emax values of 83.3% , 86.2%  and 80.1% , respectively. The compound BL 106 (50uM) increased the levels of cGMP in T84 cells in 40% after stimulation with Escherichia coli toxin (STa) (827.22 ± 91.34 cGMP pmol/10min/mg and 587.97 ± 60.86 cGMPpmol /10min/mg; p<0.05; Anova followed by Turkey test). Compounds BL 106-1, 106-2, 106-3 (50uM) did not increase the cGMP contents prior STa stimulation or it absence. BL 106(50uM) increased the levels of cAMP in Jurkat cells in 225% after stimulation with foskolin (50uM) (68.08 ± 9.53, pmol/10min/mg and 21.04 ± 6.28 cAMP, pmol/10min/mg). On the other hand, BL 106-1, BL 106-2 and BL 106-3 did not increased the contents of cAMP.

Conclusion: The four new compounds promoted smooth muscle relaxation in concentration dependent manner and only the compound BL 106 interfered in the levels of cycles nucleotides.

Disclosures:

Work supported by industry: no. The presenter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Serum free testosterone and its relation with erectile function in aging men (#285)

C. Arroyo (Uruguay)
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285

Serum free testosterone and its relation with erectile function in aging men

Arroyo, C1; Cedres, S1; Decia, R1

1: Uruguay

Background: People with low serum testosterona often comlain of erectile dysfunction. (1)

Objectives: To evaluate the relationship between serum free testosterone (FT) and erectile function in aging men at the General Hospital.

Materials and Methods: FT was measured between 8:00 and 10:00 a.m. in all men aged older than 55 assisted (for any reason) in the Internal Medicine and Urology rooms of the Hospital. Low FT was defined as FT lower than 7,2  ng/dL between 55-60 years old and  lower than 5,6 ng/dL in patients older than 60 years old. All the patients included completed the IIEF-5 questionary, which score ranges from 1 to 25 and the ED was classified into five groups according to the scores: severe (1-7), moderate (8-11), mild-moderate (12-16), mild (17-21) and no ED (22-25).

Results: 52 patients were included. The prevalence of all degrees of erectile dysfunction was 43/52 (RF= 0,83). The degree of erectile dysfunction was mild in 7/43, mild to moderate in 10/43, moderate in 14/43  and severe in 12/43.

27/52 (RF=0,52) had significantly low FT  levels and 11/52 (RF=0,21) had low-normal levels.

It was a statistical significance between the presence of low FT and moderate and severe ED (p<0.05, chi-squared test – alpha of 0,05).

Conclusions: We found high prevalence of DE in hospitalized patient. It showed a clear correlation with low FT. We should screen these groups of patients to offer specific treatment.

Disclosures:

Work supported by industry: no.

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The use of erection enhancer drugs in men who seeks an urological private consultation (#286)

F. Glina (Brazil)
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286

The use of erection enhancer drugs in men who seeks an urological private consultation

Rosalino, R1; Glina, F1; Glina, S1

1: Instituto H. Ellis, Brazil

Objective: Evaluate the use of erection enhancer drugs in men who seeked an urological private consultation.

Material and Methods: This research was approved by the Ethical Committee o f our institution. The charts of 438 men (15 to 90 years old, mean age: 50.9 years) who seeked a urological consultation were evaluated retrospectively. Initially was identified if the reason of the initial visit was any sexual dysfunction or any other urological condition. In patients who did not consult because a sexual dysfunction was identified how they considered their sexual function (normal or abnormal) and in every men (sexual complain or urological complain) if they had used any erection enhancer drug (phosphodiesterase type 5 inhibitors – PDE5i or intracavernous injections - ICI).

Results: 269 men ( 15 to 90 years old, mean age 50.9 years) seeked urological consultation because a urological complain (non-sexual complain). 170 of them considered their sexual function as normal, 69 had erectile dysfunction, 5 reported no sexual activity and in 25 charts there were no reference to patient´s sexual function.  Of 170 men with normal sexual function, 31 reported the use of PDE5i, 3 of ICI and 2 of both drugs; of 69 patients with erectile dysfunction, 28 used PDE5e  and 2 ICI.  Of 163 men who attende because of a sexual dysfunction (17 to 86 years old; mean age 50.7 years); 92 used PDE5i, 4 used ICI and 2 used both drugs.

Conclusions: Twenty and one percent of men who seeked a urological consultation and did not complain of erectile dysfunction use some drug to enhance their erectile function.  Forty five percent of men who seeked  a urological consultation and complained of erectile dysfunction use some drug to enhance their erectile function. Among the men who seeked a urological consultation because a sexual dysfunction, 60% already used  some drug to enhance their erectile function .

Disclosures:

Work supported by industry: no.

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Erectile dysfunction in Qatar: Prevalence and risk factors in 1,052 participants—A pilot study (#287)