Erectile Difficulties Research Articles

Factors associated with sexual quality of life among men living with HIV.

This study aims to assess the prevalence of sexual difficulties and identify factors associated with the Sexual Quality of Life (SQoL) among people living with HIV (PLWHA). The study included 107 heterosexual men and 474 men who have sex with men (MSM) from five countries. Participants self-reported variables related to physical and mental health, as well as HIV-related parameters. Erectile or ejaculation difficulty, as well as low sexual desire, were investigated. SQoL was measured using the PROQOL-SexLife questionnaire. Most of participants reported low sexual desire, predominantly among MSM. Among MSM, living with a partner and healthcare satisfaction were associated with SQoL scores in POP dimension, while consistent condom use, cardiovascular complications, and being single were associated with SQoL scores in STI dimension. Viagra use, anti-cholesterol treatment, and living with a partner were associated with SQoL scores in DIS dimension. Among heterosexual men, employment and African origin were associated with SQoL scores in the POP dimension. Alcohol consumption was associated with SQoL scores in STI dimension. This study underscores the importance of non-clinical determinants when assessing SQoL among PLWHA, emphasizing psychological factors and the perceived quality of healthcare. Tailored interventions should incorporate these findings to enhance overall SQoL outcomes.

Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomized controlled trials.

The health benefits of regular aerobic exercise are well established, although there is limited high-quality evidence regarding its impact on erectile function. To determine the effect of aerobic exercise on erectile function in men and to identify factors that may influence this effect. This systematic review and meta-analysis included randomized controlled trials that evaluated the effects of aerobic exercise on erectile function via the Erectile Function domain of the International Index of Erectile Function (IIEF-EF). The mean difference in IIEF-EF scores between the aerobic exercise and nonexercising control groups was estimated by a random-effects meta-analysis. Meta-regression was used to evaluate the association of moderator variables on meta-analysis results. The IIEF-EF score is reported on a 6-30 scale, with higher values indicating better erectile function. Among 11 randomized controlled trials included in the analysis, aerobic exercise resulted in statistically significant improvements in IIEF-EF scores as compared with controls, with a mean difference of 2.8 points (95% CI, 1.7-3.9; P < .001) and moderate heterogeneity among studies (I2= 53%). The effect of aerobic exercise on erectile function was greater in men with lower baseline IIEF-EF scores, with improvements of 2.3, 3.3, and 4.9 points for mild, moderate, and severe erectile dysfunction, respectively (P = .02). The meta-analysis results were not influenced by publication bias or individual study effects. Health care providers should consider recommending regular aerobic exercise as a low-risk nonpharmacologic therapy for men experiencing erectile difficulties. The primary strength of this review was the generation of level 1 evidence on a topic of general interest regarding sexual health in men. However, the included studies evaluated diverse groups, which may complicate data interpretation for specific segments of the population. Regular aerobic exercise can improve the erectile function of men, particularly those with lower baseline IIEF-EF scores.

The Pornography Industry's Disinformation Campaign Against Addiction Recovery Resources

As pornography became increasingly popular online, many unsuspecting consumers reported adverse effects. These included sexual dysfunctions, such as lack of response with real partners, delayed ejaculation, erectile difficulties, and sexual compulsivity. Some pornography consumers began congregating in online self-help portals (forums and websites) to assist one another in quitting or reducing problematic pornography use. The popularity of the self-help resources and their potential to dampen the profits of a lucrative industry resulted in disinformation campaigns run by individuals connected to the pornography industry. In this article, I examine how a paper containing significant inaccuracies about the people organising the online recovery forums passed the peer-review process while failing to disclose the author’s conflicts of interest. The author of the case study has documented affiliations with a major pornography company, MindGeek (the owner of Pornhub). Somehow, it passed peer review, lending it a false halo of credibility. Pornography industry-connected individuals then repeatedly exploited it, for example, on social media and Wikipedia, to discredit pornography self-help recovery resources.

(023) Disinformation on pornography effects on erectile function led to iatrogenic Reboot/NoFap "treatment"

Abstract Introduction Dozens of studies concluded that pornography does not cause erectile dysfunction. A laboratory study (2022) studying actual partners reported that partners who reported viewing more pornography in their daily life also reported higher sexual arousal to the real partner. Similarly, the partner being manually stimulated in that study exhibited higher galvanic skin response/arousal associated with increased sexual arousal when more pornography had been viewed in their daily life. Yet, most sex addiction therapists and Reboot/NoFap coaches claim that their clients’ sexual dysfunctions are caused by pornography viewing. Qualitative interviews with followers of Reboot/NoFap found that the framing of pornography as an “addiction” by these groups was actually maintaining clients’ distress. This raised the possibility that disinformation from these “treatments” regarding sexual functioning actually was the cause of ED. Objective Examine whether engagement with Reboot/NoFap “treatments” might actually be causing or perpetuating sexual arousal problems attributed to pornography viewing. Methods Data were collected via (1) a pre-registered, online survey and (2) scrape of the Reboot/NoFap “support” group /r/NoFap. Men (n = 693) who had heard of Reboot. The Reddit scrape included 1,219 unique users and 10,971 unique r/NoFap posts. 2.3% of users had to be excluded for spontaneously posting that they were under age 18 due to not documenting parental knowledge, consent, or assent to post. Posts were subjected to a sentiment analysis, a form of natural language processing. Results Survey: Those who personally participated in Reboot/NoFap treatments were significantly younger, more sex negative, and sexually less experienced than those who chose not to participate. Those who participated the most in /r/NoFap forum, paradoxically, reported significantly more symptoms of erectile dysfunction, depression, and anxiety. They also were more likely to report being told to “kill or harm” themselves in the support subreddit /r/NoFap and reported more suicidal ideation at their last relapse. Erectile difficulties were predicted by respondents’ anxiety symptoms, and that relationship was not mediated or moderated by their pornography viewing. The strongest predictor of identifying as a pornography addict in this sample was higher narcissism. Reddit scrape: The users who posted over time in r/NoFap, on average, included the same or more posts containing sad, angry, disgusted, or fear words. Emotions in the post were not predicted by the support (upvotes, comment count) received. Conclusions Treatments that conceptualize pornography as causing erectile dysfunction appears to paradoxically cause distress and erectile problems to worsen. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Mind Measures LLC

(308) Oxytocin Troches as an Adjunctive Intervention to Conventional Testosterone and Erectile Dysfunction Medication for Men with Sexuality Concerns

Abstract Introduction Oxytocin (OT), a peptide hormone, is known to be involved in social interaction and the pleasure we derive from it is produced from the posterior pituitary. This neurotransmitter has a potential role in love, female reproductive functions, and social bonding. OT is released by both males and females, during skin to skin contact sexual arousal and orgasm/ejaculation (1,2). OT effects on the brain are dependent on its interactions with sex homes such as estrogen, progesterone, testosterone, and corticosterone. Oxytocin levels are implicated in male sexual responsivity. Oxytocin biological effects may include decrease social anxiety, increased pair bonding, intimacy and closeness enhance sexual receptivity, enhance perineal contractility, enhances pair bonding, nurturing, trust “cuddle hormone, increased intensity of orgasm in men and women, decreased latency to orgasmic release, increased pleasurable sensations and increased sexual desire and lubrication. Oxytocin troches have been used as an off label investigational compounded oxytocin as an adjunctive therapy for men’s sexual health. Objective We report the preliminary responder analysis results of a random retrospective survey on users of this medication. Methods A random convenience sample of 26 men from 5 centers ( Hawaii, Washington, Portland, Salt Lake City and Tulsa) who tried compounded oxytocin were surveyed. Surveys were anonymous, and participation was voluntary and uncompensated. Doses of Sublingual oxytocin were to be titrate up from 25 international units (IU) for optimization, but not to exceed 100 IU) Results Fourteen out of 26 participants (56%) were considered responders. Mean age was 43 and range was 22-77. Eighty-six of the participants had used between 50 IU and 100 IU and 50% were on TRT replacement whereas 57% were on Erectile medications. Only 21% were on both ED medications and TRT replacement. 86% of responders reported enhanced intimacy and connection with their partners, 100% would recommend the product to their friends. 93% of users planned to continue the medication. 86% noted increased overall pleasure and sexual satisfaction. 86% reported improved overall quality of their orgasm. There were no adverse events reported. Responders reported positive feedback which included: longer lasting before orgasmic release, increased nipple sensation, improved control with premature ejaculation, improved feelings during climax and increased ejaculate volume. Conclusions Oxytocin compounded troches appear to be a helpful addition to a preexisting treatment paradigm for erectile difficulty or testosterone replacement. This is a preliminary report with small numbers, and further larger randomized clinical trials are warranted and planned. Disclosure No

(029) Frequent Pornography Consumption is Linked to Poor Body Satisfaction and Consequently to Poor Sexual Functioning in Heterosexually-identified Men Who Endorse Masculinity Ideologies

Abstract Introduction In Western societies, men may frequently receive messages about ideals of an often unattainable male body through visual media, including pornography. Additionally, men may hold traditional masculinity beliefs that idealize slender and muscular male bodies. Objective The current study analyzed whether pornography consumption was associated with men’s body satisfaction. Additionally, it was analyzed whether the endorsement of masculinity ideologies was a vulnerability factor that makes men more or less susceptible to pornography’s influence on body satisfaction. The study further analyzed whether body satisfaction in turn predicted men’s experiences of distressing sexual problems. Methods An online questionnaire study was conducted among 261 self-identified heterosexual young men (Mage = 24.4, SD = 3.5) at an Austrian medical university. The questionnaire contained questions about frequency of pornography consumption, body satisfaction, and distressing sexual problems. Endorsement of masculinity ideologies was assessed with the Male Role Norms Inventory–Short Form. A structural equation model was calculated to test whether the frequency of pornography consumption predicted body satisfaction, and whether body satisfaction in turn predicted distressing sexual problems. Men’s endorsement of masculinity ideologies was considered as a moderator for the effect of pornography consumption on body satisfaction. Results A structural equation model (χ2(30) = 39.3, p = .119; χ2/df = 1.3; RMSEA = .035, 90%CI = .000 – .062; CFI = .941; SRMR = .029) revealed that for most men pornography consumption was not associated with body satisfaction. However, there was a negative association between pornography consumption and body satisfaction for men who strongly endorsed the masculinity ideology of men needing to always be the dominant. Poor body satisfaction in turn was significantly associated with the experience of distressing erectile difficulties, ejaculation sooner than desired, or diminished intensity of orgasmic sensations. Conclusions This study reveals the importance of body satisfaction for sexual functioning in young heterosexual-identified men. Thus, clinicians who treat sexual problems in young men should address their clients’ or patients’ body satisfaction. Empowering men who endorse masculinity ideologies to challenge norms for an “ideal” male body, as depicted in most pornography, may be an important component of such interventions. Disclosure No

The Role of Non-penetrative Partnered Sex Activities in the Associations Among Erectile Difficulties, Sex and Relationship Satisfaction in Men Aged 50+

Objectives This study examined the associations among erectile difficulties, sexual satisfaction, and relationship satisfaction, and whether there is a buffering effect of non-penetrative partnered sex on relationship satisfaction in men aged 50+ who report erectile difficulties. Methods An analysis of survey data from 431 Czech men (aged 50–96, Mdn = 64). Results Engagement in non-penetrative partnered sex did not moderate the relationship between erectile difficulties and sexual and relationship satisfaction, but it was linked to higher sexual and relationship satisfaction. Conclusions The buffering effect of non-penetrative practices for the link between erectile difficulties and relationship satisfaction has not been supported.

Difficulties in Emotion Regulation and Sexual Functioning in Sports Practitioners: A Pilot Study

Emotion regulation is a transdiagnostic process strongly related with emotional difficulties, which may interfere with sexual functioning. Little is known about this association in athletes. The current study examined differences in difficulties in emotion regulation in sports practitioners with and without sexual difficulties. A total of 174 athletes (64 women and 110 men) completed a web-survey, answering a sociodemographic information questionnaire, the Difficulties in Emotion Regulation Scale – Short Form, and the Female Sexual Functioning Index/the International Index of Erectile Function. Results suggested that 34 women (53.1%) experienced sexual difficulties and 40 men (35.1%) reported erectile difficulties. Women with sexual difficulties revealed greater difficulties in goal-directed behavior. Men with erectile difficulties revealed greater lack of emotional awareness and clarity, more difficulties in goal-directed behavior (focusing on relevant information and ignoring distractors) and impulse control, and higher nonacceptance of emotions. Overall, current findings enhance the role of difficulties in emotional regulation in sexual functioning in male and female sports practitioners.

Reboot/NoFap Participants Erectile Concerns Predicted by Anxiety and Not Mediated/Moderated by Pornography Viewing

“Reboot” coaches claiming to treat pornography addiction increasingly claim to treat erectile dysfunction (ED). They view ED as due to pornography viewing. However, anxiety has long been the best predictor of ED. We hypothesized that those involved in Reboot treatments would report erectile difficulties predicted by anxiety symptoms and not pornography viewing. Six-hundred and sixty-nine participants familiar with Reboot treatments completed a series of online questionnaires. Among those who participated in Reboot treatments, anxiety symptoms predicted ED. Pornography viewing frequency did not mediate or moderate this relationship. Licensed providers should work to dispel this apparent health disinformation by life “Reboot” coaches.

Prevalence and Correlates of Sexual Aversion: A Canadian Community-Based Study

BackgroundSexual aversion (SA) is a chronic difficulty impacting sexual, relational and psychological wellbeing. Yet, there is a dearth of studies exploring its prevalence and associated factors. AimTo estimate the prevalence of SA and examine its correlates among a community sample of Canadian adults. MethodsA large web-based sample of the Quebec (Canada) adult population (n = 1,935) completed an online survey on sexual wellbeing. Prevalence rates were estimated for SA and other sexual difficulties. Multivariate logistic regression analyses were used to identify correlates of SA. OutcomesDemographics (eg, gender, employment status), self-reported experiences of sexual difficulties (low sexual desire and arousal, vaginal dryness, pain during sexual intercourse, erectile difficulties, premature or delayed ejaculation, and orgasm difficulties), and markers of psychosexual wellbeing (eg, psychological distress, performance anxiety) according to the presence or absence of SA were assessed. ResultsThe prevalence of SA was 9.7% (95% CI: 8.5–11.2) in the present sample (6.9% [95% CI: 5.1–8.9] in men, 11.3% [95% CI: 9.4–13.4] in women and 17.1% [95% CI: 9.4–27.4] in nonbinary and/or trans individuals). The multivariate logistic regression model explained 31% of the likelihood of experiencing SA. SA was related to psychological distress (aOR: 1.77, 95% CI: 1.33–2.38), sexual satisfaction (aOR: .59, 95% CI:.49–0.70), sexual performance anxiety (aOR: 2.08, 95% CI: 1.45–2.98), and discomfort with sex-related information (aOR: 1.02, 95% CI: 1.01–1.04) Clinical implicationsSeveral psychosexual correlates of SA were documented and could be targeted by practitioners during the assessment and treatment of individuals living with SA. Strengths and limitationsThe study's strengths include its large, gender diverse sample and use of comprehensive diagnostic criteria for SA. Probability-based sampling methods and longitudinal studies should be conducted to address the current study's limitations. ConclusionSA research is critical to document its prevalence in different sociodemographic groups, explore additional intrapersonal and interpersonal mechanisms involved in SA etiology, and ensure that the needs of people living with SA are met with tailored interventions.David Lafortune, Éliane Dussault, Mathieu Philibert, Natacha Godbout. Prevalence and Correlates of Sexual Aversion: A Canadian Community-Based Study. J Sex Med 2022;19:1269–1280.

Time to presentation of Peyronie's Disease in the era of injections and information

ABSTRACT Introduction Characterized by acquired fibrosis of the tunica albuginea, Peyronie's disease (PD) can cause penile curvature, pain, and plaque, as well as erectile dysfunction and difficulty with penetration. Using online surveys in 2007-2008, Dibenedetti et al found that the prevalence of PD in adult men in the US was 0.5% based on PD diagnosis; 0.8% based on PD diagnosis or treatment of PD; and 13.1% based on diagnosis, treatment, or any symptom of PD. They found that 68% of patients saw a doctor when they first noticed symptoms, at a mean time to see a doctor of 16.8 (SD = 5.5) months. The other third, or 32%, of patients who sought treatment later in the disease course, had a mean time of 46.2 (SD = 8.4) months. Only 5% of patients presented with current pain, thus in the active phase. Objective Our study investigated how patient presentation for PD changed after two sentinel events: 1) the FDA approval of intralesional injections of collagenase clostridium histolyticum (CCH) in 2013, and 2) the national publicity surge for PD in 2016-2017. We then aimed to compare this data to a prior study by Dibenedetti et al conducted for patients in 2007-2008. Methods Our retrospective, single institution study was conducted as a chart review of patients presenting from 2014 to 2020 with penile curvature, pain, or plaque. Descriptive statistics were used to compile data at the time of initial evaluation by the reconstructive urologist, including patient demographics, pre-treatment assessments, and time to evaluation. Results Our study included 152 adult men, and mean age was 57.9 years old (SD = 8.1) (Table 1). Initial symptoms included penile curvature (87%), pain (30%), and plaque (8%). 38% of patients were in the active phase of PD at time of evaluation. The mean time from onset of symptoms to evaluation by the specialized urologist was 27.5 months (SD = 53.2, range 1 to 360 months) (Figure 1). For the 2/3 of patients, or 68%, who had the shortest time to evaluation, the mean duration of PD symptoms prior to evaluation by a specialized urologist was 10.0 months (SD = 4.6) (Figure 2). For the 1/3 of patients, or 32%, who had the longest time to evaluation, the mean duration of PD symptoms prior to evaluation was 69.7 months (SD = 80.6). Conclusions Over the years, the majority of PD patients are presenting sooner in their PD course. The outlier patients, or those who have suffered from PD for a relatively long time, are also presenting for evaluation and treatment. These trends are likely influenced by the FDA approval of intralesional injections of CCH and by the national media efforts to raise awareness of the underdiagnosed and undertreated disease. Disclosure No

Sexual Function after Burn Injury: “The Bystander Effect” and Other Results from a Survey of Active Medical Providers from the Canadian Burn Association

ABSTRACT Introduction The prevalence of new onset sexual dysfunction amongst burn survivors may be as high as 53%. Unsurprisingly, patients consistently report intimacy and sexual function in romantic relationships as something that lowers their quality of life. Other groups have reported that the topic of sexual health and new onset erectile difficulties was not adequately addressed in 83% of responding patients cared for at major US burn centers. It is unknown how well healthcare providers themselves feel they address the topic of sexual health in patients who survive major burn injuries. Objective The goal of this project was to survey current practice patterns, views and beliefs on sexual function of burn survivors in a population of medical providers providing direct care to patients. Ideally, the goal of this study was to describe existing biases and communication barriers that prevent discussions of sexual function during recovery. The results of this survey will identify blind-spots in the care of burn victims as it pertains to improving their quality of life. Methods A 24-item survey; modified from a survey created by Rimmer et al, 2010, was distributed to active members of the Canadian Burn Association (nurses, physicians and nurse practitioners) across 23 centers. The Survey was divided into 3 sections, aiming to collect information on participant demographics, on how participants’ burn centers address the topic of intimacy and sexuality with burn survivors, and on how individual participants address this important topic. Participation was voluntary, and no personal identifiers were collected. Results 32 health care providers participated in our survey. When asked “Who on your burn team is primarily responsible for discussing sexuality and intimacy with burn survivors and/or partners”, 47% (n=15) and 36% (n=11) of participants indicated that “it is not anyone's responsibility” in respective inpatient and outpatient units. Furthermore, when asked “In your opinion, does your burn team do a good job of addressing sexuality and intimacy with your burn survivors?”, 84% (n=26) participants responded “no”. Conclusions Health care providers are often not addressing sexuality and intimacy in the care of survivors of burn injuries. Multiple barriers work together to inhibit health care providers from initiating these important conversations with patients. This includes a high prevalence of the well-described “bystander effect”, where no single person is responsible for addressing the issue of sexual health. Cultural, gender, and sexual orientation-sensitive education programs and incorporation of sexual health discussions into standardized admission discharge processes should be explored further. Finally, specification of which provider is responsible to initiate and follow-up on discussions of sexuality/intimacy is a specific intervention that can improve the care provided to burn survivors moving forward. Disclosure No

Sexual Difficulties in People 50+: A Content Analysis of Sex-related Queries Posted on Professional Counseling Websites

ABSTRACT Although sexual activity has been found to be both important and challenging for people aged 50+, relatively little is known about the concerns that they have with respect to their sexual lives and how help-seeking behavior manifests on counseling platforms. A sample of 293 sex-related queries that Czechs aged 50+ posted on professional counseling websites were subjected to a quantitative and qualitative content analysis. The majority of posts were written by men and their dominant issues were erectile difficulties, partner’s lack of interest in sex, and drug use/interaction when treating sexual difficulties and other ailments. Using a thematic analysis, the study showed that sex-related concerns were based within the context of worries about maintaining relationships and re-partnering in mid- and later life, and probing for the normal aspects of aging and the associated changes in sexual health. The online setting of the counseling websites facilitated the posting of both general and personalized queries to get oriented in problems, to triangulate with previous information, and to check the treatability of difficulties when past treatments failed. These findings suggest that online counseling puts a great demand on professionals’ knowledge and understanding of the specifics of later-life sexual health.

Heterosexual-Identified Men’s Endorsement of Masculinity Ideologies Moderates Associations between Pornography Consumption, Body Satisfaction and Sexual Functioning

Social comparison processes during pornography consumption and the pressure to adhere to traditional masculinity ideologies about how a male body should look may influence men’s body satisfaction and in turn explain potential associations between pornography consumption and men’s sexual functioning. The current study analyzed whether pornography consumption was associated with men’s experience of distressing sexual problems through men’s body satisfaction, and whether men’s endorsement of traditional masculinity ideologies moderated those associations. At an Austrian medical university, 261 self-identified heterosexual men (M age = 24.4, SD = 3.5) participated in an online questionnaire study. Results revealed that high frequency of pornography consumption was associated with poor body satisfaction only in men who strongly endorsed the masculinity ideology of men needing to be the dominant. Poor body satisfaction in turn was associated with frequent and/or distressing experiences of erectile difficulty, ejaculating sooner than desired, or diminished intensity of orgasmic sensations. The study’s results suggest that traditional masculinity ideologies and Western ideals about an ideal body should be addressed in clinical practice when treating men with sexual problems. Empowering patients with sexual problems to challenge those norms may be important, especially for men who endorse traditional masculinity ideologies. Keywords: Body satisfaction, Pornography consumption, Sexual problems, Heterosexual men, Masculinity, Austria

Accurately Assessing Gay Men’s Erectile Functioning: A Critique of the International Index of Erectile Function (IIEF) Use with Gay Men

ABSTRACT The International Index of Erectile Functioning (IIEF) has been widely used to measure gay men’s erectile functioning. However, the IIEF was initially developed using a sample of men whose sexual orientation was unspecified. Using scales not validated for specific populations can result in inaccurate assessments. The purpose of the current study was to evaluate the dimensionality, reliability, and validity of the IIEF with a large sample of gay men. One thousand and eighteen men self-identifying as “exclusively gay” completed an online survey consisting of demographics, the IIEF, the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale 4 (PSS4), and the Gay Male Sexual Difficulties (GMSD) erectile difficulties sub-scale. The replicability of the IIEF factor structure with a gay male sample was determined using exploratory and confirmatory factor analyses. Additionally, the HADS, PSS4, and GMSD were used to determine the validity of the IIEF. The current study was unable to replicate the IIEF factor structure. Four items required deletion and the factor solution differed from the original. Thus, reinterpretation of the latent variables was deemed necessary. Although the resultant 12-item IIEF evidenced model fit, validity, and reliability, it is not recommended for use with gay men. The revised IIEF is unable to accurately measure gay men’s erectile functioning as the content of the items fail to capture their sexual behaviors (i.e., insertive and receptive anal sex).

Markers of Sexual Life and Health in Association with Internet Use for Sexual Purposes in Czechs Aged 50 and Older

This study explores the characteristics of people aged 50+ who use the internet for sexual purposes. The markers of sexual expression in association with online sexual activities and their perceived benefits to sexual life were investigated in a sample of 799 internet-recruited Czechs aged 50–96 (54.5% men). The analysis employed multivariate logistic regressions that showed that seeking sexually related information online was higher in men who have erectile difficulties and women who are dissatisfied with sexual frequency. Online pornography use and accessing sex-shop websites were higher for participants who masturbated. Visiting online sex shops was associated with the perceived benefits of Internet use for sexual purposes. The absence of a relationship, the frequency of partnered sex and sexual desire had no predictive effect. The findings suggest that older people use the Internet as a convenient source for sexual stimuli and for enhancing partnered sex, and online sex shops may be beneficial for their sexual lives.

Anxiousness and Distractibility Strengthen Mediated Associations Between Men's Penis Appearance Concerns, Spectatoring, and Sexual Difficulties: A Preregistered Study.

Men with penis appearance concerns are more likely to experience sexual difficulties because they engage in spectatoring (i.e., negative self-critical attentional focus during sex). This preregistered study investigated whether anxious and distractible personality traits make men with penis appearance concerns more likely to engage in spectatoring and, in turn, experience sexual difficulties. In a sample of 858 sexually active men in predominantly mixed-gender relationships, we replicated previous findings that penis appearance concerns were associated with greater spectatoring, and in turn greater problems with erection and orgasm. Additionally, our novel hypotheses that anxiousness and distractibility would strengthen these associations were partially supported. Anxiousness strengthened associations between penis appearance concerns and sexual embarrassment, and in turn was associated with greater reports of erectile and orgasmic difficulties. However, anxiousness did not strengthen the mediated associations between penis appearance concerns, self-focus, and erectile and orgasmic difficulties. Distractibility strengthened associations between sexual embarrassment and erectile difficulties, and in turn strengthened the mediated associations between penis appearance concerns, sexual embarrassment, and erectile difficulties. However, distractibility did not strengthen associations between sexual embarrassment and orgasmic difficulties, between sexual self-focus and erectile difficulties, nor between sexual self-focus and orgasmic difficulties. Implications for therapeutic treatments are discussed.

P-02-75 EFFECTS ON SEXUAL RESPONSE AND MOTIVATIONS IN ENGAGING IN CHEMSEX ACTIVITIES IN A GROUP OF MEN WHO HAVE SEX WITH MEN (MSM)

Chemsex is referred to illicit drugs use (GHB/GBL, methamphetamine, and mephedrone) to enhance the sexual activity in Men who have Sex with Men (MSM). Most studies focused on the health risks associated to chemsex, while less attention was paid on the effects on sexual response and motivations to engage in this behavior. The current study aims to investigate how drugs used in chemsex might affect the sexual activity and which are the motivations encouraging men to use them. 20 MSM involved in chemsex activities (mean age = 38.6±12.4) were assessed with an ad hoc semi-structured interview between February and July 2019 exploring sexuality in chemsex. Interviews transcripts were thematically analyzed. Inclusion criteria were being cisgender MSM and having at least a chemsex experience in the last year. Participants showed significant individual differences in the effects of chemsex drugs on sexuality. The most common effects were an increase in sexual desire and subjective arousal, usually associated with a higher disinhibition and the presence of erectile difficulties. Some men reported a significant extension of the sexual experience (till 24-48 hours), with consequent delais and difficulties in reaching orgasms. Many participants highlighted an intensified perception of intimacy during chemsex. Regarding feelings and motivations, the increase in arousal and pleasure are the most frequent factors reported, followed by the possibility to lose controls and being considered as part of an intimate group/community. Some men reported to be motivated by their partners and friends and to use chemsex drugs as palliative for negative mental states and sexual/identity problems.

On the Relationship Between Erectile Function and Sexual Distress in Men with Prostate Cancer.

Erectile difficulties are common after prostate cancer (PCa) treatment and are associated with sexual distress. However, the relationship between erectile function and sexual distress has yet to be carefully examined. This study had three goals: (1) examine the relationship between erectile function and sexual distress; (2) determine groups of men based on erectile function and sexual distress; and (3) examine the psychosexual characteristics of these groups. A cross section of 233 sexually active men after PCa treatment (age M = 64.90 years, SD = 7.50) completed an online survey containing demographic, health, and sexuality and relationship questionnaires. The relationship between erectile function and sexual distress was curvilinear. Four groups of men were found: good erectile function and low sexual distress, poor erectile function and high sexual distress, but also good erectile function yet high sexual distress, and poor erectile function and low sexual distress. Regardless of erectile function, men with greater sexual distress were more depressed, reported additional sexual concerns, placed less value on sex, were less sexually satisfied, and used protective buffering communication more frequently. They were also less likely to be satisfied with their adaptation to sexual changes and less likely to have found a solution to those changes. The relationship between erectile function and sexual distress is complex, characterized by a wide array of responses to erectile function (high and low distress) and multiple correlates of sexual distress. These results broaden the concept of sexual recovery after PCa treatment, which may assist clinicians and researchers to better address sexual problems after PCa treatment.

Management of transient ejaculation failure due to erectile difficulties encountered on the oocyte retrieval day

IntroductionTransient ejaculation failure can be seen on the oocyte retrieval day which might cause the cancelation of oocyte retrieval procedure. The aim of this study was to evaluate the management of these patients and to assess the clinical outcome of intracytoplasmic sperm injection (ICSI) using spermatozoa obtained from them. MethodsThe records of the oocyte pick-up (OPU) procedures between November 2014 and January 2017 were reviewed, the management and ICSI outcomes of 26 patients with transient ejaculation failure due to erectile difficulties on the oocyte retrieval day were evaluated. ResultsIntracavernosal injection (ICI), percutaneous sperm aspiration (PESA) and microdissection testicular sperm extraction (micro-TESE) were performed to 15, 6 and 5 patients, respectively. The sperm retrieval rate (SRR) and live birth rate (LBR) of ICI, PESA and micro-TESE were 26%, 63.6% and 100% and 40%, 16.7%, 38.4% respectively. ConclusionsAlthough a limited number of cases were evaluated in this study, micro-TESE appears to be the preferable approach when assessed both in terms of sperm retrieval method success and ICSI results.