International Society For Sexual Medicine Research Articles

A comprehensive history of injection therapy for erectile dysfunction, 1982-2023.

Although oral phosphodiesterase 5 inhibitors represent a first choice and long-term option for about half of all patients with erectile dysfunction (ED), self-injection therapy with vasoactive drugs remains a viable alternative for all those who are not reacting or cannot tolerate oral drug therapy. This current injection therapy has an interesting history beginning in 1982. To provide a comprehensive history of self-injection therapy from the very beginnings in 1982 by contemporary witnesses and some members of the International Society for Sexual Medicine's History Committee, a complete history of injection therapy is prepared from eyewitness accounts and review of the published literature on the subject, as well as an update of the current status of self-injection therapy. Published data on injection therapy, as a diagnostic and therapeutic tool for ED, were reviewed thoroughly by PubMed and Medline research from 1982 until June 2023. Early pioneers and witnesses added firsthand details to this historical review. Therapeutic reports of injection therapy were reviewed, and results of side effects and complications were thoroughly reviewed. The pioneers of the first hours were Ronal Virag (1982) for papaverine, Giles Brindley (1983) for cavernosal alpha-blockade (phentolamine and phenoxybenzamine), Adrian Zorgniotti (1985) for papaverine/phentolamine, and Ganesan Adaikan and N. Ishii (1986) for prostaglandin E1. Moxisylyte (thymoxamine) was originally marketed but later withdrawn. The most common side effect is priapism, with the greatest risk of this from papaverine, which has modified its use for therapy. Currently, prostaglandin E1 and trimixes continue to be the agents of choice for diagnostic and therapeutic use in ED. A recent agent is a mixture of a vasoactive intestinal polypeptide (aviptadil) and phentolamine. After 40years, self-injection therapy represents the medication with the highest efficacy and reliability rates and remains a viable option for many couples with ED. The history of this therapy is rich.

Recovery of the hibernating cavernosum by penile revascularization

ABSTRACT Objective Chronic ischemia-related cavernous dysfunction is considered irreversible. However, in certain patients, cavernous function appears to recover with penile revascularization. In this study, we investigated a potential cavernous dysfunction reversibility from a clinical perspective. Patients and Methods We involved 93 young patients in the study with arterial erectile dysfunction (ED) (median age: 30 years). Erectile function tests were performed according to the standard operating procedures of the International Society of Sexual Medicine. Among the participants, 63 and 30 displayed pure arteriogenic and mixed vasculogenic (due to both arterial insufficiency and cavernous dysfunction) ED, respectively. Penile revascularization was performed by anastomosing the inferior epigastric artery to the dorsal artery. The ED treatment success was considered from a score of at least 24 on the International Index of Erectile Function-6. Results Our results proved that penile revascularization cured 92.1% and 73.8% of the patients with pure arteriogenic and mixed vasculogenic ED, respectively (Kaplan-Meier method, log-rank test: no significant difference). The required time for curing 50% of the patients was 10.5 and 10.0 months for pure arteriogenic and mixed vasculogenic ED, respectively, indicating no recovery delay in patients with mixed vascular ED. Furthermore, the cavernous dysfunction degree did not influence cavernous function recovery. Conclusion Penile revascularization cured ED in 73.8% of the patients with mixed vasculogenic ED. Cavernous dysfunction appears to be reversible in certain cases. Furthermore, we observed no delay in functional recovery compared to participants with healthy cavernous function. These two discoveries suggest that cavernous function recovery after penile revascularization is similar to the concept of hibernating myocardium in ischemic myocardium. Although cavernous dysfunction is considered irreversible, it could be reversed in multiple cases with blood flow restoration to the cavernous tissue.

Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective.

The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior." To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

(259) Comparison of Dapoxetine vs Paroxetine vs Clomipramine for Premature Ejaculation Patients

Abstract Introduction Premature ejaculation (PE) is a common male sexual dysfunction. The International Society for Sexual Medicine (ISSM) defines PE as the inability to delay ejaculation during all or nearly all vaginal penetrations with latency time before or within 1 minute of penetration for lifelong PE and within 3 minutes for acquired PE and negative personal consequences such as distress, bother, frustration. The introduction of Selective Serotonin reuptake inhibitors (SSRIs) and Tricyclic antidepressants (TCA) revolutionized the treatment of PE. However not many studies have compared the efficacy and safety of these drugs in a single study. Objective To compare the clinical efficacy and safety of Dapoxetine, Paroxetine, and Clomipramine for the oral pharmacotherapy of PE. Methods Men presenting with self-reported PE were evaluated with full medical/sexual history, comorbidities, focused physical examination, assessment for Erectile function, any investigations suggested by these findings. IELT was determined by stopwatch method for every intercourse attempt. IELT were recorded before and after using the above medications in each group. ISSM definition of PE formed basis of diagnosis. All patients were married potent men in a stable relationship for at least 6 months and possible sexual intercourse equal or greater than one per week. None of the patients had received other treatment for PE for at least 4 weeks before the start of the study. All subjects gave their written informed consent before entering the study. Standardized assessment measures such as validated questionnaires & Patient Reported Outcomes (PRO) used as adjunct for assessment. Results 48 Patients with PE were recruited in this study. Patients were randomly assigned to receive 60 mg Dapoxetine ‘on-demand’(group 1, n = 24), or 20 mg Paroxetine daily (group 2, n = 12) or 50 mg Clomipramine (group 3, n = 12) orally daily during a 12-week period for each agent. After 12 weeks of treatment with Dapoxetine, Paroxetine and Clomipramine, the IELT was increased from the pretreatment mean of 35 seconds to 184 seconds, from 32 seconds to 178 seconds and from 34 seconds to 169 seconds, respectively (P = 0.01 in group 1 and 2,P = 0.02 in group 3). Baseline and 12-week mean intercourse satisfaction domain values of the IIEF were 10, 11, 10 and 14, 15, 13 in groups 1, 2, and 3 respectively. The mean number of coitus per week pretreatment and at 12-week treatment were 1.4, 1.3 and 1.3/week which rose to 2.4, 2.3 and 2.2 for Dapoxetine, Paroxetine and Clomipramine, respectively. The most common adverse effects of each drug were nausea, diarrhea, headache and perspiration. Conclusions Oral SSRIs & TCA are safe and effective treatments for PE. Dapoxetine, although approved, does Not appear to be widely used; cost could be an issue. Its use can result in better QoL for the patient and their sexual partner. Paroxetine has the advantage of improving IELT with well-tolerated side effects. It has good efficacy in the treatment of PE. Higher dose of Clomipramine results in a longer IELT without higher risk of adverse events. Larger studies with different dosages and treatment regimens are required to yield more credible outcomes. Disclosure No.

(016) A Global Survey of Sexual Dysfunction Management among Urologists and Sexual Medicine Experts

Abstract Introduction Understanding and addressing sexual dysfunction is of paramount importance to enhance the overall well-being and quality of life of individuals worldwide. While significant progress has been made in the field of sexual medicine, variability in practice patterns among healthcare professionals remains a potential barrier to optimal patient care. To bridge this knowledge gap and identify the prevailing trends in sexual dysfunction management, we conducted an international survey targeting urologists specializing in Andrology, Sexual Medicine, and related fields. Objective This international survey aimed to assess male and female sexual dysfunction management practices among sexual medicine physicians across to globe to identify variability in practice patterns. Methods A survey was distributed globally to urologists specializing in Andrology, Sexual Medicine, and related fields who are members of International Society for Sexual Medicine (ISSM) or affiliated regional societies (SMSNA, ESSM, MESSM, APSSM, SASSM, SLAMS, ISSWSH, SIU). Demographic information (age, gender, specialty, and practice setting) and treatment approaches for male and female sexual dysfunction were collected. Respondents also reported the percentage of their practice dedicated to sexual dysfunction and whether treatments were covered by health insurance. Results A total of 200/3000 practitioners participated, with 101 (50.7%) identifying as urologists. The majority were male (72.9%) and worked in private practice or community hospitals (32.7%) or a mixture of both (34.2%). Male sexual dysfunction was treated by 71.4% of respondents, with 25.7% dedicating 75–100% of their practice to it. Female sexual dysfunction was treated by 36.9% of respondents, with 64% dedicating 0–25% of their practice to it. Health insurance covered 25–49% of their care for 41.2% of respondents, predominantly provided by private companies (45.9%). The most common treatments for erectile dysfunction were oral medications (86.5%), injections (61.7%), and inflatable penile prostheses (45.1). For Peyronie's disease, oral therapies (59.1%) and penile traction therapy (34.4%) were most frequently offered, while surgical treatment for Peyronie's disease was offered by 58.2% of respondents, with penile prostheses being the primary choice (79.7%). Regarding female sexual dysfunction, 58.4% of respondents offered treatments for genitourinary syndrome of menopause/atrophic vaginitis, with vaginal estrogen being the most common choice (50%). For dyspareunia due to vaginismus/hypertonic pelvic floor dysfunction, 50.3% of respondents offered treatment, with pelvic floor exercise/physiotherapy being the most recommended (66%). Conclusions This study provides valuable insights for healthcare professionals, policymakers, and researchers regarding the current landscape of sexual dysfunction management. The results underscore the importance of continuous efforts to develop comprehensive and individualized approaches, ensuring that both male and female patients receive effective and accessible care for their sexual health concerns. By addressing issues related to insurance coverage and fostering interdisciplinary collaboration, the medical community can collectively work towards improving sexual well-being and quality of life for patients worldwide. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(215) Investigating if Hormonal Dysfunctions are Risk Factors in Men Complaining of Premature Ejaculation

Abstract 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. Objective 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 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). Conclusions 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 Disclosure No.

(203) Awareness of Monkeypox Virus Among International Urology Faculty and Trainees is Low: Implications for Early Recognition and Diagnosis

Abstract Introduction The recent international outbreak of Monkeypox virus (Mpox), has raised concerns regarding the recognition and management of this disease among healthcare professionals. The genitourinary presentation of Mpox as variable cutaneous lesions poses a unique challenge for Urologists in its prevention, diagnosis, and management. Objective To assess the understanding and recognition of Mpox among international urologists and urology trainees. Methods A survey relating to the presentation, transmission, and management of Mpox was distributed to urologists and urology trainees during the joint 23rd Sexual Medicine Society of North America (SMSNA)/ 23rd International Society for Sexual Medicine (ISSM) conference. Results Out of 960 attendees, 97 (10.1%) responded to the survey. The rate of respondents who correctly identified a Mpox lesion from a series of cutaneous lesions was 25.8%. A similarly low number of respondents were able to identify the likelihood of having anogenital lesions and oral bleeding on presentation with Mpox at 15.5% and 19.6% respectively. A higher number of respondents accurately noted that diagnosis of Mpox may be made with PCR (79.4%) and that men with multiple male sexual partners are at the highest risk of transmission (72.2%) (Table 1). Conclusions When surveyed regarding the presentation, transmission, and management of Mpox, urologists and urology trainees were generally unable to accurately identify Mpox from a series of cutaneous lesions or the rate at which Mpox may present with anogenital lesions. The limited recognition of its presentation, appropriate diagnostic methods, and distinguishing features from sexually transmitted lesions raises concerns about potential missed diagnoses and delayed treatment. Continued education within the urology community may be necessary for the appropriate detection of and intervention against Mpox. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Antares Pharma, Clarus Therapeutics.

(363) A Global Survey of Sexual Dysfunction Management Among Urologists and Sexual Medicine Experts

Abstract Introduction Understanding and addressing sexual dysfunction is of paramount importance to enhance the overall well-being and quality of life of individuals worldwide. While significant progress has been made in the field of sexual medicine, variability in practice patterns among healthcare professionals remains a potential barrier to optimal patient care. To bridge this knowledge gap and identify the prevailing trends in sexual dysfunction management, we conducted an international survey targeting urologists specializing in Andrology, Sexual Medicine, and related fields. Objective This international survey aimed to assess male and female sexual dysfunction management practices among sexual medicine physicians across to globe to identify variability in practice patterns. Methods A survey was distributed globally to urologists specializing in Andrology, Sexual Medicine, and related fields who are members of International Society for Sexual Medicine (ISSM) or affiliated regional societies (SMSNA, ESSM, MESSM, APSSM, SASSM, SLAMS, ISSWSH, SIU). Demographic information (age, gender, specialty, and practice setting) and treatment approaches for male and female sexual dysfunction were collected. Respondents also reported the percentage of their practice dedicated to sexual dysfunction and whether treatments were covered by health insurance. Results A total of 200/3000 practitioners participated, with 101 (50.7%) identifying as urologists. The majority were male (72.9%) and worked in private practice or community hospitals (32.7%) or a mixture of both (34.2%). Male sexual dysfunction was treated by 71.4% of respondents, with 25.7% dedicating 75-100% of their practice to it. Female sexual dysfunction was treated by 36.9% of respondents, with 64% dedicating 0-25% of their practice to it. Health insurance covered 25-49% of their care for 41.2% of respondents, predominantly provided by private companies (45.9%). The most common treatments for erectile dysfunction were oral medications (86.5%), injections (61.7%), and inflatable penile prostheses (45.1). For Peyronie's disease, oral therapies (59.1%) and penile traction therapy (34.4%) were most frequently offered, while surgical treatment for Peyronie's disease was offered by 58.2% of respondents, with penile prostheses being the primary choice (79.7%). Regarding female sexual dysfunction, 58.4% of respondents offered treatments for genitourinary syndrome of menopause/atrophic vaginitis, with vaginal estrogen being the most common choice (50%). For dyspareunia due to vaginismus/hypertonic pelvic floor dysfunction, 50.3% of respondents offered treatment, with pelvic floor exercise/physiotherapy being the most recommended (66%). Conclusions This study provides valuable insights for healthcare professionals, policymakers, and researchers regarding the current landscape of sexual dysfunction management. The results underscore the importance of continuous efforts to develop comprehensive and individualized approaches, ensuring that both male and female patients receive effective and accessible care for their sexual health concerns. By addressing issues related to insurance coverage and fostering interdisciplinary collaboration, the medical community can collectively work towards improving sexual well-being and quality of life for patients worldwide. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

The association of reproductive hormones, thyroid function, and vitamin levels with premature ejaculation: A prospective case-control study.

To investigate whether serum hormone (testosterone, prolactin, gonadotropins, and thyroid hormones) and vitamin (vitamin B12, folic acid, and vitamin D) levels are associated with premature ejaculation (PE). This prospective case-control study included 126 patients with PE (lifelong PE [LPE] in 94 and acquired PE [APE] in 32) who presented to the urology outpatient clinic between April 2016 and January 2023 and 92 healthy men as a control group. The diagnosis of PE was based on the criteria defined by the International Society for Sexual Medicine. Serum total testosterone (TT), free and bioavailable testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, thyroid-stimulating hormone, free triiodothyronine, thyroxine (fT4), vitamin B12, folic acid, and vitamin D levels were measured. Serum TT, fT4, and vitamin D levels were significantly higher in patients with PE than in the control group (p=0.022, p=0.002, and p=0.044, respectively). However, the serum vitamin B12 level was significantly lower in the PE group (p=0.021). In the multivariate logistic regression analysis, only vitamin B12 was found to be an independent risk factor for PE, with an estimated odds ratio of 0.997 (95% confidence interval 0.994-0.999, p=0.036). This study demonstrated that lower vitamin B12 levels are associated with the presence of PE. Therefore, we believe that it would be beneficial to consider vitamin B12 levels in the evaluation of patients with PE.

MP79-18 QUALITY OF ONLINE MEDICAL INFORMATION ABOUT PENILE AUGMENTATION TREATMENT

You have accessJournal of UrologyCME1 Apr 2023MP79-18 QUALITY OF ONLINE MEDICAL INFORMATION ABOUT PENILE AUGMENTATION TREATMENT Jeffrey Lee, Chiya Abramowitz, Dhaval jivanji, Elie Kaplan-Marans, and Jacob Khurgin Jeffrey LeeJeffrey Lee More articles by this author , Chiya AbramowitzChiya Abramowitz More articles by this author , Dhaval jivanjiDhaval jivanji More articles by this author , Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , and Jacob KhurginJacob Khurgin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is estimated that more than half of adult men in the United States express concerns about their penis size. With lack in available scientific data, the American Urological Association (AUA) and International Society for Sexual Medicine (ISSM) currently do not recommend any treatment options for penile augmentation. Nonetheless, many online resources speak on this topic and may be providing patients with inaccurate information. Therefore, we aimed to assess the quality of online educational information regarding treatment options for penile augmentation. METHODS: A Google search was performed using the terms “penile augmentation”, “penile enlargement”, and “penile enhancement”. The first 100 webpages were assessed. Duplicate websites, scientific publications, sub-pages of identical websites, or websites with pay walls were excluded from analysis. The quality of the website was assessed by presence of Health on the net (HON) code certification and by the DISCERN instrument. Two independent reviewers scored each webpage and inter-rater reliability calculated. Websites were categorized by the type of resource. RESULTS: After applying the exclusion criteria, a total of 69 websites were included in the data analysis. There were 9 (12.7%) websites with HON code certification. The mean DISCERN score was 38.2 out of 80, which is considered “poor” quality. Inter-rater reliability of the DISCERN score was 0.76. Webpages with HON code certification had a higher mean DISCERN score (52.7 versus 36.1, p<0.0001). Of the 45 commercial webpages, cosmetic and plastic surgeons (48.9%) comprised the larger proportion whereas urologists (42.2%). There was no significant difference in the DISCERN scores of commercial websites by urologists (n=19) compared to commercial websites by all other medical specialties (n=26) (34.9 versus 34.4, p=0.80). CONCLUSIONS: Overall, the quality of online patient education regarding penile augmentation is poor. Websites with HON certification were seen to have better quality of health information. Although regulation of online material is difficult, promotion of accurate information from the AUA or ISSM can help improve online content for patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1148 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Lee More articles by this author Chiya Abramowitz More articles by this author Dhaval jivanji More articles by this author Elie Kaplan-Marans More articles by this author Jacob Khurgin More articles by this author Expand All Advertisement PDF downloadLoading ...

Publishing industry–sponsored studies

The debate around the role of pharmaceutical industries (hereinafter “pharma”) in the field of sexual medicine over the course of my (A.S.) nearly 30 years of clinical and translational research on this amazing topic has been harsh and sometimes unproductive. This is a welcome opportunity to exchange some observations and thoughts and open an interesting debate for younger colleagues who, for chronologic reasons, missed a flourishing moment of initiatives and studies in this beloved field. Indeed, on one hand, long-term experience helps; on the other, fresh ideas corroborate the experience and open extraordinary new horizons. Historically, pharma have provided valuable support to medical research in terms of funding and intellectual contributions, resulting in several advancements and developments in patient care. That’s all folks: pharma have supported great scientifically rigorous research in the field. Or perhaps it may be better to say—this could be all, dear folks. In the specific and relatively narrow context of sexual medicine, pharma have played a primary role throughout the last 50 years, with an incredible peak in the late 1990s and early 21st century in (1) the discovery, development, and implementation of drugs for the treatment of erectile dysfunction (ED) that have drastically revolutionized the field; (2) the way that we treat patients; (3) our way of approaching medicine; and (4) the way in which research, at least clinical research, has been conducted from 1998 onward. Here, whatever the mythologic origin of sildenafil was—the iconic progenitor of all phosphodiesterase type 5 inhibitors (PDE5is)1,2—and whatever the intention with which sildenafil was initially under investigation,3 it is clear that the quality of life of patients struggling with ED would not have been as dramatically improved as it is now without the financial and managing support of pharma. Second, it is also very clear that, as the physicians and research experts in the field of sexual medicine, we would have never had the opportunity to conduct so many well-designed studies or get to know one another and exchange ideas and projects without the existence of sildenafil and, thereafter, all other PDE5Is that were conceived,4 produced, and launched on the market in the following years. This has been the case not only regarding ED but also surrounding other male sexual dysfunctions (eg, premature ejaculation5) and women’s sexual health.6-8 Last but not least, pharma have played a major role in supporting national and international scientific societies in the area of sexual medicine. This aspect is certainly no less relevant. In fact, the financial support of pharma has been paramount to the execution of research studies and the public presentation of results in the contexts of dedicated experts—opportunities that otherwise would have been difficult to come by. A striking example is the “birth” of the European Society for Sexual Medicine (formally ESIR) in 1995, with the first congress being held in Porto Carras, Greece. This has been the case for many other affiliated societies of the International Society for Sexual Medicine. Likewise, funds from pharma have provided seeds and starting grants to many research centers, by means of which they were able to develop independent lines of research and have the subsequent opportunity to apply for more competitive grants. Again, what an incredible cultural exchange it has been to meet and discuss—sometimes even to vigorously clash on—some of the many themes that the field of sexual medicine proposes. All of this has been thanks to the sponsorship of pharma, who have been able to promote their belief and support in the development of a healthy and correct scientific culture while supporting their own business objectives.

Evaluation of the quality of life of patients with premature ejaculation (lifelong and acquired).

SUMMARYOBJECTIVE:The aim of this study was to evaluate the quality of life of patients with lifelong and acquired premature ejaculation and to examine its relationship with depression and anxiety.METHODS:Between February 2017 and January 2018, a total of 175 patients with premature ejaculation and 132 control men who applied to the urology department of the training and research hospital with the complaint of Premature Ejaculation were included. Patients were divided into three groups according to International Society for Sexual Medicine (ISSM) criteria as follows: Group 1, lifelong premature ejaculation; Group 2, acquired premature ejaculation, and Group 3, control group without premature ejaculation. A detailed medical history of patients was obtained and physical examinations were performed. Intravaginal ejaculation latency time (IELT) was recorded and patients were administered International Erectile Function Index-5 (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Sexual Health Inventory for Men (SHIM), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI)-1 and STAI-2, and Short Form-36 (SF-36).RESULTS:The mean mental component score (MCS) of the SF-36 was 51.65±6.57 in the lifelong premature ejaculation group, 49.33±8.65 in the acquired premature ejaculation group, and 61.12±11.09 in the control group (p<0.0001). The mean physical component score (PCS) was 50.99±7.43 in the lifelong premature ejaculation group, 48.32±11.58 in the acquired premature ejaculation group, and 55.17±8.10 in the control group (p<0.0001). Quality of life of premature ejaculation patients as assessed by SF-36 was lower in the subscales of physical functioning, general health perception, vitality, and role limitations due to emotional functioning, compared to the control group.CONCLUSIONS:Lifelong and acquired premature ejaculation patients deteriorate their quality of life: the deterioration in these patients’ quality of life also negatively affects their depression and anxiety states.

#Menopause: The Menopause Ontology Project

ABSTRACT Introduction Medical professionals and patients increasingly utilize social media to connect and share healthcare information. Twitter is a popular social media platform with 186 million users in 2020 alone. Twitter users employ hashtags-terms or phrases proceeded by the “#” symbol-to aggregate data about related subjects. Hashtag ontologies are groups of hashtags used to standardize terminology and facilitate easier communication. Objective To create a hashtag ontology specific to menopause. Methods This study analyzed tweets including the hashtag #menopause between November 2019 and November 2021 to identify co-occurring hashtags related to menopause. Tweets performed by the International Society for the Study of Women's Sexual Health, North American Menopause Society, International Menopause Society, and International Society of Sexual Medicine amongst others were included in analysis. To analyze hashtag utilization amongst all Twitter users, hashtags from the “Top” tweets Twitter search function from October 2021 were also analyzed. Co-occurring hashtags were recorded as well as the type of user who performed the tweet during the “Top” tweets analysis. The Society of Gynecologic Surgeons hashtag ontology was also reviewed as a cross reference and for completeness. Social media influencers and experts reviewed and edited the hashtag list. The hashtags were then grouped by subject and the ontology was finalized. Results We analyzed three-hundred eighty-two tweets with #menopause. Major societies produced 231 tweets and expert influencers produced 53 tweets. Using the “Top” tweets search function from October 2021, we identified 98 additional tweets. Of the users included in the “Top” tweets, 40% were patient advocates or advocacy groups; 38% were medical professionals, academics, societies, or journals; and 22% were general users. In total, 123 unique hashtags were identified. After social media influencer and expert review, 32 hashtags were included in the final ontology. The ontology was then grouped into the following categories based on subject matter: general, premature menopause, hormones, sexual function, and genital disorders. The finalized ontology appears in Table 1. Conclusions Social media is an important tool for medical professionals and patients. Our study is the first to develop a hashtag ontology specific to menopause. Adoption of a hashtag ontology with standardized terminology by medical professionals may facilitate easier communication with peers and patients. Disclosure No

Involvement of histamine H3 receptor agonism in premature ejaculation revealed by a novel evaluation system

ABSTRACT Introduction Premature ejaculation (PE) has been defined by the International Society for Sexual Medicine (ISSM) as follows: men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Although local anesthetics and serotonin selective reuptake inhibitors (SSRIs) have been mainly used for the treatment of PE, there are several safety concerns and weak efficacy. To date, there have been no pharmacological treatments for PE approved by the Food and Drug Administration (FDA) in the United States. Therefore, there is still a need for the development of novel therapeutics that have sufficient efficacy and fewer side effects. We identified Histamine H3 receptor (H3R) as a potential target for treatment of PE. It is well known that H3R is mainly expressed by neuronal cells of the central nervous system, but its expression on peripheral nerves, especially Aβ sensory nerves, has also been reported. Activation of H3R in peripheral sensory neurons has been reported to inhibit mechanical stimulation-induced pain. This suggests that H3R stimulation can suppress neural activity induced by mechanical stimulation in the penis, but there have been no reports on the role of H3R in ejaculation function, and its mechanism of action is unknown. Objective In order to characterize the role of H3R in ejaculation prolongation, electrophysiological and behavioral studies were performed with imetit (H3R agonist) and ciproxifan (H3R antagonist) in male rats. Methods We developed a novel electrophysiological evaluation system for analyzing the spinal-penile neurotransmission mechanism, investigated the effects of imetit on penile neurotransmission. Also, we evaluated the effect of imetit on mechanical stimuli induced neuronal firing at genitofemoral nerve. For evaluating the effects of imetit for ejaculation, we used the copulatory behavior test in order to directly measure ejaculation latency (EL), which is a primary endpoint in clinical trial. Results In vivo electrophysiological study, imeit significantly attenuated the mechanical stimuli induced firing at spinal dorsal horn in a novel evaluation system. This inhibitory effect of imetit was also observed at genitofemoral nerve. Inhibition on firing was significantly inhibited by ciproxifan, but not inhibited by H4R antagonist. In the copulatory behavior test, imetit showed a strong prolongation effect on EL. This effect was significantly inhibited by ciproxifan. Conclusions These results suggest that stimulation of H3R suppresses the mechanical stimuli induced neuronal firing on spinal-penile neurotransmission system, resulting in prolongation of ejaculation latency. H3R agonist is expected as a new treatment for PE. Disclosure Work supported by industry: yes, by Mitsubishi Tanabe Pharma Corporation. A consultant, employee (part time or full time) or shareholder is among the authors (Mitsubishi Tanabe Pharma Corporation).

Effect of a tadalafil 5-mg single daily dose on lifelong premature ejaculation: A single-blinded placebo-controlled study

ABSTRACT Objective To investigate the effectiveness and safety of a tadalafil 5-mg single daily dose in the treatment of lifelong premature ejaculation (PE). Patients and Methods A total of 55 men with lifelong PE were enrolled in this study. The intravaginal ejaculatory latency time (IELT) and Premature Ejaculation Diagnostic Tool (PEDT) were used to assess the efficacy of tadalafil. Baseline recording of the IELT (using a stopwatch) and PEDT was done. Patients were randomised to take a single daily dose of tadalafil 5 mg or placebo. Re-assessment was done by IELT and PEDT after 1 and 3 months. Results As regard, age, number of children, frequency of intercourse and duration of PE there are no statically significant differences between both groups. In both the tadalafil 5-mg and placebo groups the IELT statically significantly increased after 1 month by a mean (SD) of 4.8 (4.7) and 5 (4.9) s, and after 3 months by a mean (SD) of 6.6 (7) and 4.5 (9) s; and the PEDT scores significantly improved after 1 month by a mean (SD) of 2.1 (1.9) and 2 (1.5), and after 3 months by a mean (SD) of 3.5 (2.5) and 3.3 (2.2). However, there is was no statically significant difference between the tadalafil 5-mg and placebo groups for the IELT and PEDT at baseline or after 1 and 3 months of treatment. Conclusions Despite 5-mg tadalafil once daily being safe and it showed only a slight improvement in IELT and PEDT in the treatment of lifelong PE, failing to show any statistically significant difference from the placebo drug. Abbreviations: ED: erectile dysfunction; 5-HT: 5-hydroxytryptamine (serotonin); IELT: the intravaginal ejaculation latency time; ISSM: International Society of Sexual Medicine; PE: premature ejaculation; PEDT: Premature Ejaculation Diagnostic Tool; PDE5i: phosphodiesterase-5 inhibitor; SSRI: selective serotonin reuptake inhibitor

Advances and Missteps in Diagnosing Premature Ejaculation: Analysis and Future Directions

There are several problems with diagnostic criteria for premature ejaculation (PE) that lack objectivity, clarity and precision. They hamper accurate determination of PE prevalence estimates, investigations into the etiology of the dysfunction, impact on partners, development of validated Patient Reported Outcomes, regulatory authority oversight, and which men might benefit from specific treatment interventions. We sought to review, analyze and comment on the evolution of the definitions of PE and offer suggestions for future directions for PE definitions. Our goal is to propose strategies whereby the criterion sets are useful to researchers, clinicians and governmental oversight agencies alike and bring harmony and scientific rigor among the conflicting and confusing definitions. There are several premature ejaculation definitions published in the peer reviewed medical literature. The PUBMED electronic database from 1970 to 2021 was searched for published definitions. Search terms included the medical subject headings of premature ejaculation, definition and diagnosis. In chronological order, Table 1 lists the various diagnosis and criteria sets for PE. We discuss the process by which constructs, which make up diagnostic criteria sets, are operationalized and validated. We review definitions of PE beginning with Masters and Johnson's focus on partner orgasmic attainment and move through the nebulous and subjective criterion sets found in the early Diagnostic and Statistical Manuals and International Classification of Disease series, to the more evidenced-based definitions found in International Society of Sexual Medicine, Diagnostic and Statistical Manuals-5 and the American Urological Association (AUA) definitions. Additionally, we discuss how constructs and criteria sets have been adopted to minimize errors of inclusion and exclusion in defining disease/dysfunction. This manuscript offers a careful chronological analysis of the published definitions of PE. This historical lens allows the reader to perceive the shifting science underlying the development of PE definitions. The manuscript is limited regarding our comments on acquired PE as evidenced-based research is incomplete. Over the past 50 years there has been considerable forward momentum in defining PE based on well conducted scientific studies. We support the American Urological Association's modification in Intravaginal ejaculatory latency time to 2-minutes for lifelong PE, concur with the 11th revision of the International Classification of Diseases recommendation for changing the terminology from premature ejaculation to early ejaculation. We also recommend ongoing validation of definitions, moving away from the current heterosexist definition of PE based on penile-vaginal sex and urge further population based research into acquired PE to develop stronger evidenced-based criterion sets for this subtype. Althof SE, McMahon CG, Rowland DL. Advances and Missteps in Diagnosing Premature Ejaculation: Analysis and Future Directions. J Sex Med 2022;19:64-73.

Comprehensive History of the International Society for Sexual Medicine-Journals and Communication.

This is a comprehensive history of the International Society for Sexual Medicine (ISSM) and its founding organizations regarding the publications, including the journals and the publication committee, and the communication tools of the organization since its inception. The object of this review is to provide a detailed and comprehensive history of the publication and communication tools of the ISSM and the people who have participated in production of these efforts. Recorded Publication Committee minutes, filed letters, the various journals themselves, printed News bulletins, and Publishers reports to the society served as source documents to produce this history. The author has participated in many of the journal establishments and has kept an extensive personnel file of the events related in this history. All written history has not only relied on personal memories of these events but have been verified from the stored personal files. Printed and website stored journal and News bulletin have served as source material for this history. Also, Power Point presentations by the editors of the journals at the Publication Committee meetings have served as source material. Finally, annual, and semi-annual reports of the Publishers presented at Publication Committee meetings of the ISSM are source material. After extensive review of the historical material listed in the Methods section of this abstract, this comprehensive history of the communication efforts of this society has provided a rich and dynamic historical document for this society. This extensive, detailed, and comprehensive history of the communication tools of this society help us to record and remember the events and the people involved in this process. Sharing scientific information and information regarding the life of the International Society for Sexual Medicine have been an important function of this society from early. Lewis RW. Comprehensive History of the International Society for Sexual Medicine-Journals and Communication. Sex Med Rev 2021;9:542-567.

Comprehensive History of the International Society for Sexual Medicine.

This is a detailed comprehensive history of the International Society for Sexual Medicine (ISSM) since its beginning in 1978. This was constructed after interest was shown following an oral presentation to the Executive Committee of this organization during their 2020 virtual (Zoom) business meeting. To provide for the membership of ISSM a detailed history of their society since its inception until 2020 and have this serve as a repository document for review of the long history as needed by the society. Written documents were used as source material for this history. Some documents from my personal files included letters, minutes of meetings, program booklets. Other data published in our ISSM printed and online website served as sources. Finally, documents supplied to me by our business office regarding written files were used to provide valid documentation for the construction of this history. There were very few anecdotes from my memory that were included. The comprehensive nature of this history provides a repository of our rich history of events and people involved in the ISSM. This is the first comprehensive history of the ISSM that is collected from actual historical documents. Lewis RW. Comprehensive History of the International Society for Sexual Medicine. Sex Med Rev 2021;9:517-541.

Increased attentional network activity in premature ejaculation patients with anxiety revealed by resting-state functional magnetic resonance imaging.

Psychological account hypothesizes that premature ejaculation (PE) is a learned pattern of rapid ejaculation maintained by anxiety about sexual failure, whereas neuropsychological accounts hypothesizes that PE is the result of dysfunction of central nervous system regulating ejaculatory. However, the central neural mechanism underlying PE patients with anxiety remains unclear. Resting-state functional magnetic resonance imaging (fMRI) data were collected in 20 PE (diagnoses based on PE Guidelines drafted by the International Society for Sexual Medicine [ISSM]) patients with anxiety and 25 matched healthy controls (HCs) from January 2019 to December 2020. The values of fractional amplitude of low-frequency fluctuation (fALFF) were compared between groups. Moreover, the correlations between fALFF and the severity of PE and anxiety of patients were examined. PE patients with anxiety had increased fALFF values in the right inferior frontal gyrus (opercular part) and middle frontal gyrus. In addition, significant positive correlations were found between the scores of PE diagnostic tool (PEDT) and fALFF values of the right inferior frontal gyrus (opercular part), as well as the right middle frontal gyrus. Moreover, fALFF values of the right inferior frontal gyrus (opercular part) and middle frontal gyrus were positively correlated with the scores of self-rating anxiety scale (SAS). Our results suggested that increased attentional network activity might play a critical role in the neural basis of PE patients with anxiety.

Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation

BackgroundPeyronie’s disease (PD) is a challenging clinical entity. To assist clinicians with diagnosis and management, four separate organizations have published PD guidelines over the past five years, but there remains a lack of consensus and data-driven recommendations for many aspects of diagnosis and treatment. AimTo compare and contrast PD guidelines, highlighting key similarities and differences among the guideline panel recommendations and identify areas for further research. MethodsWe performed an extensive review to compare and contrast diagnosis and treatment recommendations from publically available published PD guidelines from four different organizations: American Urological Association, European Association of Urology, Canadian Urologic Association, and the International Society of Sexual Medicine. OutcomesKey similarities and differences with regards to definition, evaluation, nonsurgical and surgical treatments were compared. ResultsPoints of general consensus among the guideline panels included: History is adequate for diagnosis of PD, and intracavernosal injection is a gold standard to evaluate penile deformity prior to invasive intervention. Careful counseling with shared decision-making is required prior to treatment. In general, plication and incision and/or grafting surgery is reserved for patients with preserved erectile function whereas penile prosthesis implantation is the only surgical option for PD patients with erectile dysfunction. Overall, nonsurgical treatments have inferior evidence of efficacy with these being the main area of controversy; however, all societies recognize that intralesional injections may be used. 0Further research into the pathophysiology of PD may direct novel treatments targeted towards early intervention and rigorous outcomes research may direct best practices for the surgical treatment of PD in the future. Clinical ImplicationsPD is a challenging clinical entity. Direct comparison of the published PD guidelines highlights clear standards of care as well as areas where more research is needed to promote higher levels of evidence-based practice. Strengths & LimitationsTo our knowledge this is the first report to directly compare and contrast published guidelines pertaining to the diagnosis and management of PD. Limitations include the lack of evidence-quality review pertaining to individual guideline recommendations, although this was not the aim of this review. ConclusionWe highlight consensus of major urologic societies on many aspects of work up and management of PD with notable exceptions which may guide further research.Manka MG, White LA, Yafi FA, et al. Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. J Sex Med 2021;18:363–375.