Orgasmic Function Research Articles

Sexual function after gender affirming phalloplasty

ABSTRACT Introduction Gender-affirming phalloplasty involves the construction of a neophallus using one or more flaps, most often a radial forearm free-flap. Although numerous articles have reported on short-term surgical outcomes of phalloplasty, relatively few studies have followed phalloplasty patient prospectively, starting from before surgery, in order to determine how surgery affects sexual function, including orgasm. Objective As part of a prospective, longitudinal study of barriers to and outcomes of masculinizing gender affirming surgery, researchers assessed patients’ sexual function both prior to and after phalloplasty. This represents a sub-analysis of a larger, ongoing research study addressing psychosocial outcomes of gender affirming surgery, including decision regret. Methods The population included in this analysis includes 7 patients who had been followed for at least 6 months after phalloplasty – at which time post-operative sexual function was initially assessed. Six of those patients were also assessed at one year about other psychosexual outcomes of surgery. Both of these assessments involved custom instruments developed for this study. All patients included in this analysis has been assessed at least once prior to surgery. The most recent assessment was used for all patients. Results Of the included participants, five identified as male and 2 as transgender male. All were White and not Hispanic. All patients who had been assessed for sexual function after phalloplasty reported having been able to experience an orgasm after surgery. Five patients stated that they were satisfied or very satisfied with their sexual sensation during the most recent assessment, and 4 stated they were satisfied with their non-erotic (tactile) sensation. However, only one patients reported being satisfied with being able to urinate as they chose. Despite no patients having undergone penile prosthesis insertion at the time of assessment, one patient reported having been able to engage in sexual penetration with a partner. Of the 6 patients who had completed at least one year of follow-up, all reported their masculine self-image was either slightly or much better. Five reported that their nude appearance was slightly or much better, and all reported an increase in comfort in public locker rooms and showers. Conclusions Overall, preliminary longitudinal data suggests that patients who have undergone gender affirming phalloplasty are satisfied with their sexual function, even when they are unsatisfied with their ability to urinate as they choose. These results support previous research showing that orgasmic function can be maintained after gender affirming phalloplasty. Future data will help determine if phalloplasty can improve orgasmic function in the subset of gender affirmation patients who report no history or orgasm prior to surgery. Disclosure Work supported by industry: no.

PD09-07 HYPERESTROGENISM IS ASSOCIATED WITH SEXUAL FUNCTION IMPAIRMENT IN MEN—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY

You have accessJournal of UrologyCME1 May 2022PD09-07 HYPERESTROGENISM IS ASSOCIATED WITH SEXUAL FUNCTION IMPAIRMENT IN MEN—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY Luca Boeri, Paolo Capogrosso, Giuseppe Fallara, Walter Cazzaniga, Luigi Candela, Federico Belladelli, Edoardo Pozzi, Massimiliano Raffo, Antonio Costa, Christian Corsini, Daniele Cignoli, Nicolò Schifano, Gianmarco Colandrea, Alessia d'Arma, Eugenio Ventimiglia, Rayan Matloob, Federico Dehò, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Antonio CostaAntonio Costa More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Alessia d'ArmaAlessia d'Arma More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002535.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High serum estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality. We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new onset erectile dysfunction (ED) in the real-life setting. METHODS: Data from 547 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF); the IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri’s criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estradiol (E2) levels >42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores. RESULTS: Overall, 96 (17.6%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (35-59) vs. 44 (31-56) years; p <0.001], had more comorbidities [CCI≥1: 26.0% vs. 7.4%; p <0.001] and higher serum testosterone (TT) levels [5.4 (5.2-8.0) vs. 4.3 (4.1-5.7); p=0.01] than those with normal E2 values. A higher rate of severe ED was found in men with elevated E2 levels (49.0% vs. 29.9%; p=0.01). Moreover, the IIEF-orgasmic function (IIEF-OF) domain was lower in ED men with hyperestrogenism than those with normal E2 values [6 (3-10) vs. 9 (5-10), p=0.03]. Serum E2 levels were positively correlated with TT levels (rho 0.26, p <0.001), but negatively correlated with IIEF-OF (rho -0.2, p<0.01) and IIEF-EF scores (rho -0.33, p <0.001). At multivariable logistic regression analysis, hyperestrogenism (OR 2.44, p=0.02) was associated with severe ED after accounting for age, BMI, CCI and serum TT values. CONCLUSIONS: One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with health significant comorbidities, orgasmic function impairment and higher severity of ED. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e179 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Giuseppe Fallara More articles by this author Walter Cazzaniga More articles by this author Luigi Candela More articles by this author Federico Belladelli More articles by this author Edoardo Pozzi More articles by this author Massimiliano Raffo More articles by this author Antonio Costa More articles by this author Christian Corsini More articles by this author Daniele Cignoli More articles by this author Nicolò Schifano More articles by this author Gianmarco Colandrea More articles by this author Alessia d'Arma More articles by this author Eugenio Ventimiglia More articles by this author Rayan Matloob More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...

Predictors of altered states of consciousness triggered by sexual activity

ABSTRACT Introduction Altered states of consciousness (ASCs) refer to marked changes in usual waking consciousness. Sexual arousal, orgasm, and resolution, are modulated by neural pathways that are also activated by psychoactive substances that trigger ASCs. Relatedly, self-report studies show that sexual activity may trigger ASCs. However, investigation about sex-related ASCs is scarce. More knowledge in this regard is important, as these states can be pleasant and enriching. Objectives To explore correlates and predictors of ASCs elicited by sexual activity. Method The international sample consisted of 291 participants who responded to an online survey (196 women, 95 men). Sexual functioning was measured with the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF-15). The Modified Tellegen Absorption Scale was used to measure the general propensity to experience ASCs by various triggers (absorption). Alterations of consciousness beginning during or shortly after the last sexual encounter were assessed by four subscales of the Altered States of Consciousness Rating Scale (OAV): 1) Experience of Unity (sense of merging between self and surroundings), 2) Spiritual Experience (sense of connection with a reality outside space and time as ordinarily experienced), 3) Insightfulness (emergence of original thoughts), 4) Blissful State (unusual sense of pleasure, peace, and love). Results Better female sexual function (FSFI total score) correlated significantly with Experience of Unity (r = .24), Blissful State (r = .37), Spiritual Experience (r = .25), and marginally with Insightfulness (r = .15, p = .069). Arousal was the dimension of female sexual function more robustly correlated with ASCs; female arousal correlated with Experience of Unity (r = .27), Blissful State (r = .40), Spiritual Experience (r = .24), and Insightfulness (r = .20). Women's absorption was significantly related to higher desire (r = .15), but not to other dimensions of sexual functioning. In women, sexual arousal and absorption independently predicted Experience of Unity (βSA = .26, βAB = .45), Spiritual Experience (βSA = .23, βAB = .50), Blissful State (βSA = .40, βAB = .29), and Insightfulness (βSA = .19, βAB = .47). All other dimensions of female sexual functioning did not significantly explain additional variance. Men's associations between sexual functioning and ASCs were less consistent: male sexual satisfaction was significantly associated with Experience of Unity (r = .25), Blissful State (r = .34), and Insightfulness (r = .28); male orgasmic function was associated with Blissful State (r =.35). Other IIEF-15 dimensions were unrelated to ASCs. In men, sexual satisfaction and absorption independently predicted Experience of Unity (βSS = .29, βAB = .48), Spiritual Experience (βss = .20, βAB = .52), Blissful State (βSS = .37, βAB = .33), and Insightfulness (βSS = .33, βAB = .51). Conclusions The occurrence of sex-related ASCs appears to be independently related to sexual responsiveness and general propensity to experience ASCs by a variety of triggers, sexual and nonsexual. As noted in previous studies, ASCs and sexual functioning were more strongly related in women than in men. Studies on the importance of ASCs for sexual well-being are warranted. Disclosure Work supported by industry: no.

Hyperestrogenism is associated with sexual function impairment in men – findings from a cross-sectional, real-life study

ABSTRACT Introduction High serum estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality. Objectives We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new onset erectile dysfunction (ED) in the real-life setting. Methods Data from 481 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) and the IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estrogen (E2) levels &amp;gt;42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores. Results Overall, 88 (18.3%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (34-58) vs. 44 (32-55) years; p&amp;lt;0.001], had more comorbidities [CCI≥2: 18 (20.5%) vs. 28 (7.1%); p&amp;lt;0.001] and higher serum testosterone (TT) levels [5.4 (4.2-7.3) vs. 4.3 (3.1-5.7); p=0.02] than those with normal E2 values. A higher rate of severe ED was found in men with elevated E2 levels (48.9% vs. 30%; p=0.02). Moreover, the IIEF-orgasmic function (IIEF-OF) domain was lower in ED men with hyperestrogenism than those with normal E2 values [6 (3-10) vs. 9 (6-10), p=0.03]. Serum E2 levels were positively correlated with TT levels (rho 0.25, p&amp;lt;0.001), but negatively correlated with IIEF-OF scores (rho -0.17, p=0.005) and IIEF-EF scores (rho -0.32, p&amp;lt;0.001) (Figure 1). At multivariable logistic regression analysis, hyperestrogenism (OR 2.37, p=0.03) was associated with severe ED after accounting for age, BMI, CCI and serum T values. Conclusions One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with health significant comorbidities, orgasmic function impairment and higher severity of ED. Disclosure Work supported by industry: no.

Impact of urinary incontinence on sexual function in patients presenting for lower urinary tract symptoms

ABSTRACT Introduction Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). Objective We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. Methods In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged &amp;gt;18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Result Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p&amp;lt;0.001), IIEF-EF (rho= -0.15; p&amp;lt;0.001), IIEF-IS (rho = -0.1; p=0.004) and IIEF-OS (rho = -0.12; p&amp;lt;0.001). Sexual desire and orgasmic function domains were not correlated with ICIQ-UI-SF. Finally, higher BMI (Coeff 0.12; 95% CI 0.03-0.32; p=0.011), diabetes (Coeff 1.76; 0.35-3.18; p=0.015) and presence of comorbidities (Coeff: 0.9; 0.06-0.1.74; p=0.035) were associated with higher ICIQ-UI-SF scores. Main limitations of the study were that ICIQ-UI-SF does not discriminate between urge or stress UI. Conclusion In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). Disclosure Work supported by industry: no.

Sexual and Functional Outcomes after Penile cancer treatment-perspective from a tertiary cancer care hospital in Nepal

Background: The mainstay of treatment for penile cancer is Penectomy with inguinal lymph node dissection following risk stratification followed by chemo-radiotherapy. Despite satisfactory oncological result, penile surgery has significant impact on patient’s functional and sexual quality of life. This retrospective analysis is to evaluate sexual and functional outcome of patient after curative treatment and its possible associations with clinic-pathological characteristics. Methods: This is a retrospective study conducted at Bhaktapur Cancer Hospital from January 2011 to December 2015 of histologically confirmed cases of carcinoma penis. Clinical and pathological characteristic data included age, history of smoking, clinical presentation, anatomical site, presence of lymph nodes or distant metastasis, primary tumor size (pT ) and TNM staging, surgery involved, length of remaining penile shaft, histopathological type, chemotherapy and radiotherapy patient received and follow ups time. International Index of Erectile Function (IIEF-5) questionnaire was used to assess sexual function which encompasses five questions and addresses the relevant domains of male sexual function respectively erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction and Urinary function were noted during follow up . Result: Among the cases, 64 cases were pathologically proven for penile cancer. The age of patient entering the study group included from 22 years to 88 years with mean age of 58.75±12.30 years. All patients except one were married and sexually active prior to treatment. Vast majority of the patients 63 (98.4%) were not circumcised and majority of cases 42 (65.64%) were smoker. The mean size of the tumor was 3.25±1.208 cm. Majority of patients 54(84.4%) underwent partialam putation of penis while 2(3.1%) patients had undergone total amputation of penis. The multivariate analysis of different factors showed that T staging ≥ T2 and penile shaft(cm) &lt;3cm were independent risk factors for sexual dysfunctions (odds ratio = 13.64; 95% confidence interval = 1.02-181.005), and (odds ratio = 0.03; 95% confidence interval = 00-0.05) respectively. Out of 56 cases, 33(58.9%) had different grades of sexual dysfunction where 15(26.8%) cases were severe, 5(8.9%) cases were moderate, 8(14.3%) cases were mild to moderate and 5(8.9%) cases were mild. 23 (41.1%) cases who did not have any form of sexual dysfunction. One (1.8%) case had urethral stricture, 3(5.4%) cases had meatal stenosis, 2(3.6%) cases had penile edema and 4 (7.1%) cases had penile discoloration. Conclusions: Amputation of penis with inguinal lymph node dissection which is necessary for curative intent of the disease is disfiguring and has a profound and lasting sexual dysfunction, voiding problems, penile appearance and cosmetic problems, all of which may adversely affect the patient’s quality of life. Emphasis on preventive aspects and early detection should be emphasized to get rid of this disease.

Peyronie's Disease: Identification of Patients Requiring Additional Therapy

ABSTRACT Introduction Peyronie's disease (PD) is a connective tissue disorder of the penile tunica albuginea, that can often cause penile deformity, pain, sexual dysfunction, and shortening. Therapies available include penile traction, oral medications, intralesional therapy, and surgical management. Many patients undergo multiple therapies for this disease due to poor satisfaction or lack of subjective improvement. Objective We thus sought out to delineate which patients were more likely to undergo a second therapy. Methods A cohort of 385 men who underwent therapy for Peyronie's disease from 2014-2018 were analyzed. A univariate analysis of patient demographics, subjective complaints, IIEF score parameters, primary treatments, and secondary treatment approaches was conducted. Results Of the 385 men identified, 29 patients ultimately decided to undergo a secondary treatment approach with 14 patients undergoing penile traction therapy, 7 intralesional therapy (Xiaflex) and 9 surgical therapy (5 penile plication, 2 insertion of inflatable penile prosthesis, and 2 grafting). 17 patients initially underwent surgery for PD with 23.53% of these patients undergoing a second line therapy (p&amp;lt;0.0469). 148 patients initially underwent Xiaflex injections with 12.16% of these patients undergoing a second line therapy (p&amp;lt;0.0227). Patients with poor orgasmic function as determined by IIEF questionnaire (median scores 8 vs 2, p&amp;lt;0.0420), men with greater objective curvature (median curvature 45 vs 35, p&amp;lt;0.0220), and men with greater stretched penile length (13.5 cm vs 12 cm, p=0.0284) were also more likely to undergo secondary therapy. Table 1 shows all factors associated with increased likelihood for secondary therapy. Conclusions Peyronie's disease is often a complex condition to treat due to the mental, emotional, and physical toll this disease takes on patients. It is helpful to determine which patients could likely require secondary therapy as this may help guide patient counseling and further management. Disclosure No

Masturbation Frequency and Sexual Function in Individuals with and without Sexual Partners

The aim of this study was to investigate the association between masturbation frequency and sexual dysfunction among men and women, focusing on individuals with and without regular sexual partners, and to determine whether sexual compatibility (e.g., similar sexual desire levels and a match between desired behaviors and behaviors one’s partner is willing to engage in) in the relationship affects masturbation frequency. Here, 12,271 Finnish men and women completed an online survey about masturbation frequency, sexual function, and sexual compatibility with their partner for those who were in a relationship. The results indicated that masturbation frequency was positively associated with overall sexual function for women. This was moderated by relationship status, meaning that more frequent masturbation was associated with better orgasmic function and sexual satisfaction in single women, whereas the opposite was true for women who were in a relationship. For men, more frequent masturbation was associated with better erectile function for single men, and better ejaculatory latency but worse orgasmic function, intercourse satisfaction, and more symptoms of delayed ejaculation for men who were in a relationship. Lower sexual compatibility and sexual dysfunctions in the partner were associated with more frequent masturbation in both sexes. The associations between masturbation frequency and sexual function vary for single and partnered individuals, and are, for the latter group, further affected by sexual compatibility.

Coming Soon: Ability to Orgasm After Gender Affirming Vaginoplasty

Many patients have goals related to sexual health when seeking gender-affirming vaginoplasty, and previous investigations have only studied the ability to orgasm at cross-sectional timepoints. Our aim is to quantify the time to orgasm postoperative gender-affirming vaginoplasty and describe potential correlative factors, including preoperative orgasm, to improve preoperative counseling. A retrospective chart review was utilized to extract factors thought to influence pre and postoperative orgasm in patients undergoing robotic peritoneal flap vaginoplasty. Mean days to orgasm plus one standard deviation above that mean was used to define the time at which patients would be considered anorgasmic. Orgasm was documented as a categorical variable on the basis of surgeon interviews during pre and postoperative appointments while time to orgasm was measured as days from surgery to first date documented as orgasmic in the medical record. A total of 199 patients underwent surgery from September 2017 to August 2020. The median time to orgasm was 180 days. 178 patients had completed 1 year or greater of follow-up, and of these patients, 153 (86%) were orgasmic and 25 patients (14%) were not. Difficulty in preoperative orgasm was correlated only with older age (median age 45.9 years vs 31.7, P=.03). Postoperative orgasm was not significantly correlated with preoperative orgasm. The only factor related to postoperative orgasm was smoking history: 12 of 55 patients (21.8%) who had a positive smoking history and sufficient follow-up reported anorgasmia (P-value .046). Interventions for anorgasmic patients include testosterone replacement, pelvic floor physical therapy, and psychotherapy. Preoperative difficulty with orgasm improves with gender-affirming robotic peritoneal flap vaginoplasty, while smoking had a negative impact on postoperative orgasm recovery despite negative cotinine test prior to surgery. This investigation is the first effort to determine a timeline for the return of orgasmic function after gender-affirming vaginoplasty. It is limited by retrospective review methodology and lack of long-term follow-up. The association of smoking with postoperative orgasm despite universal nicotine cessation prior to surgery may indicate prolonged smoking cessation improves orgasmic outcomes or that underlying, unmeasured exposures correlated with smoking may be the factor inhibiting recovery of orgasm. The majority of patients were orgasmic at their 6-month follow-up appointments, however, patients continued to become newly orgasmic in appreciable numbers more than 1 year after surgery. Blasdel G, Kloer C, Parker A, et al. Coming Soon: Ability to Orgasm After Gender Affirming Vaginoplasty. J Sex Med 2022;19:781-788.

Erektil disfonksiyon 2.basamak tedavide intrakavernozal alprostadil kullanımının cinsel fonksiyonlar üzerine etkisi

Objective: In patients treated through the application of intracavernosal alprostadil in second-line treatment due to erectile dysfunction, the effect of the treatment on sexual functions measured with a 15-question International Index of Erectile Function (IIEF-15) questionnaire was investigated in this study. Material and Methods: Twenty-one patients treated due to erectile dysfunction between June 2018-October 2019, taking inadequate response from first-line treatment modalities, were applied intracavernosal alprostadil in second-line treatment and continued it for more than 12 weeks were included in the study, retrospectively. Ages, comorbid diseases, drug usage duration, drug-related side effects, penile Doppler ultrasonography (USG) parameters before application and the erection functions before and 12 weeks after drug use were evaluated with IIEF-15 form for the patients. Intracavernosal alprostadil was started with a dose of 5 μg and was continued with a dose of 10 μg as the result of dose titration. Results: The mean peak systolic blood flow velocity (PS) value of the patients was 24.4 ±15.1 cm/sec, and the mean end-diastolic flow velocity (ED) value was measured as 4.3±4.5 cm/sec based on the pre-treatment penile Doppler USG.Although the IIEF scores were measured in the 12th week, mean drug usage durations were measured as 21.9±16.6 weeks. Erectile Function Score was 9.2±5.3 before application; it was detected as 20.33±6.2 after the application. Orgasmic Function Score was 3.2±2.5 before application; it was detected as 7.5±2.4 after the application. Sexual Desire Score was 3.72±1.48 before application; it was detected as 8.9±1.4 after the application. Intercourse Satisfaction Score was 3.7±2.8 before application; it was detected as 9.1±2.7 after the application. Overall Satisfaction Score was 4±1.7 before application; it was detected as 8.1±1.7 after the application (All parameters p&lt;0.001). Conclusion: Intracavernosal alprostadil treatment used in erectile dysfunction second-line treatment is a cost-effective and efficient treatment method with a tolerable side effect profile and provides recovery in sexual parameters that can be measured with IIEF-15 parameters. Keywords: Alprostadil, erectile dysfunction, intracavernosal treatment.

Comparison of sexual function between women with iatrogenic and natural menopause

IntroductionMenopause refers to the permanent cessation of menstruation resulting from the loss of ovarian activity. Studies have shown that menopause has an impact on the life quality of women as well as their sexual function. In this study, we sought to characterise the differences in the sexual function of women with iatrogenic menopause and those with natural menopause. MethodsData were collected from 300 women in this study. The Symptom Check List and the Female Sexual Function Index were the main data collection instruments. Forty-eight patients with a Symptom Check List score ≥0.5 were not included in the study. Therefore, we enrolled a cohort of 252 menopausal women at a tertiary care setting in Turkey. The independent sample t-test, one-way analysis of variance, Pearson correlation and logistic regression analysis were used in this study and p value of <0.05 was considered statistically significant. ResultsIn our study, menopause women were divided into two equal groups based on the type of menopause (natural vs. iatrogenic). The iatrogenic group was further divided into 3 sub-groups; drug-induced 30 (12%), radiotherapy-induced 18 (7%) and surgical 78 (31%). No significant difference in sexual function between groups were observed with respect to mean scores for desire, arousal, lubrication, orgasm, satisfaction, pain and sexual function (p>0.05). ConclusionsOur results suggest that sexuality-specific problems during menopause are multifactorial and not solely attributable to biological or psychological factors. Our findings call for comprehensive interventions to address the psychological and biological effects of menopause in order to improve the life quality of women.

For patients with non-obstructive azoospermia, the outcome of testicular sperm extraction correlates with self-esteem, sexual health and the quality of the couple\u2019s relationship

BackgroundA very small number of studies have indicated that azoospermia or negative testicular sperm extraction (TESE) outcomes are linked to depression or erectile dysfunction. However, the data are often weak, conflicting and gathered with non-validated questionnaires. Hence, we performed a cross-sectional study of 44 men with non-obstructive azoospermia. Levels of self-esteem and the quality of the couple’s sex life and overall relationship were assessed with validated questionnaires before and after the TESE procedure as a function of the TESE outcome.ResultsA positive TESE outcome (n = 24) was associated with a statistically significant increase in self-esteem (particularly with regard to family aspects), sexual health and couples’ adjustment quality. In contrast, a negative TESE outcome (n = 20) was associated with statistically significant decreases in self-esteem, erectile function, intercourse satisfaction, orgasmic function, couples’ adjustment quality and all aspects of the couple’s relationship (consensus, cohesion, satisfaction and affection).ConclusionFor men with non-obstructive azoospermia (NOA), negative TESE outcomes may have a negative impact on self-esteem and the quality of the couple’s sex life and overall relationship. This should be borne in mind when counselling men with NOA and their partners to (ideally) help them to cope with and decrease the harmful impacts of azoospermia and negative TESE.

A0543 - Risk of orgasmic function impairment after HoLEP – findings of a prospective real-life trial (ExpHo)

A0543 - Risk of orgasmic function impairment after HoLEP – findings of a prospective real-life trial (ExpHo)

THE EFFECT OF BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS ON PARTNER SEXUAL FUNCTIONS

Objective: Bladder pain syndrome/Interstitial cystitis (BPS/IC) negatively affects both women’s social life and sexual functions. The study researched if this situation can negatively affect the sexual functions of the male partners of these women. Material and Method: The husbands of fifty female patients, who were treated for BPS/IC in our clinic, were contacted by telephone. The international index of erectile function-5 (IIEF-5), premature ejaculation diagnostic tool (PEDT), orgasmic function, sexual desire, sexual intercourse satisfaction and total satisfaction scores were used for the survey (Group 1). The same questionnaire was also used with fifty men whose wives did not have IC/BPS but who had applied to the urology outpatient clinic (Group 2). The scores of the participants were recorded and then the groups were compared. Results: The median IIEF-5 score was 23 (22-24) in both groups (p=0.899). Both groups had a median orgasmic score of 8 (7-9) (p=0.980). While the Median PEDT score was 7.00 (4.00-12.25) in Group 1, it was 4.50 (3.00-6.00) in Group 2 (p=0.002). The men in Group 2 were significantly more advantageous than Group 1 in terms of sexual desire, sexual intercourse satisfaction and total satisfaction scores, (p=0.003, p=0.0001 and p=0.003, respectively). Conclusion: Although BPS/IC does not have a significant effect on the IIEF-5 score of the husbands of women, it negatively affects the scores of sexual desire, sexual intercourse satisfaction, total satisfaction and premature ejaculation.

THE EFFECT OF BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS ON PARTNER SEXUAL FUNCTIONS

Objective: Bladder pain syndrome/Interstitial cystitis (BPS/IC) negatively affects both women’s social life and sexual functions. The study researched if this situation can negatively affect the sexual functions of the male partners of these women. Material and Method: The husbands of fifty female patients, who were treated for BPS/IC in our clinic, were contacted by telephone. The international index of erectile function-5 (IIEF-5), premature ejaculation diagnostic tool (PEDT), orgasmic function, sexual desire, sexual intercourse satisfaction and total satisfaction scores were used for the survey (Group 1). The same questionnaire was also used with fifty men whose wives did not have IC/BPS but who had applied to the urology outpatient clinic (Group 2). The scores of the participants were recorded and then the groups were compared. Results: The median IIEF-5 score was 23 (22-24) in both groups (p=0.899). Both groups had a median orgasmic score of 8 (7-9) (p=0.980). While the Median PEDT score was 7.00 (4.00-12.25) in Group 1, it was 4.50 (3.00-6.00) in Group 2 (p=0.002). The men in Group 2 were significantly more advantageous than Group 1 in terms of sexual desire, sexual intercourse satisfaction and total satisfaction scores, (p=0.003, p=0.0001 and p=0.003, respectively). Conclusion: Although BPS/IC does not have a significant effect on the IIEF-5 score of the husbands of women, it negatively affects the scores of sexual desire, sexual intercourse satisfaction, total satisfaction and premature ejaculation.

Efficacy of Adjusted Dose Tadalafil for Treating Erectile Dysfunction in Patients on Chronic Hemodialysis.

Although erectile dysfunction is frequently seen in hemodialysis patients, little information is documented about the efficacy of phosphodiesterase type 5 (PDE5) inhibitors and almost all the articles evaluate sildenafil. We aimed to evaluate the efficacy of chronic low dose tadalafil in this group of patients. The International Index of Erectile Function (IIEF) questionairre was administered to patients under hemodialysis program. A total of 58 patients with ED (International Index of Erectile Function (IIEF) score < 26), each having a stable partner, between 18-60 years, receiving routine outpatient HD matched the inclusion criteria and divided into two equal groups; placebo and tadalafil 5 mg/3 days. Changes of the IIEF score was recorded after one month of treatment. The mean age of the patients was 50.0±9.93 years. Duration of dialysis was 57.5(12-108) months. Hemoglobin (g/dl) and creatinin clearence (ml/Min) values of placebo and tadalafil groups were not significantly different; 10.9(8.8-14) vs 10.7(8.9-13) and 5.7±1.3 vs 6.0±1.4 respectively. There was a statistically significant increase for all subgroups related erectile dysfunction 9.28±4.17 vs 21.07±5.99 (p=0.037), intercourse satisfaction 8(3-9) vs 10(5-15) (p<0.001), orgasmic function 4(1-10) vs 8(4-10) (p<0.001), sexual desire 4(2-10) vs 7(3-9) (p<0.001) and general satisfaction 5(2-9) vs 6(2-9) (p<0.001) with low dose of tadalafil at the end of four weeks without any major side effects. There was only a significant increase in sexual desire 4(3-9) vs 6(4-10) (p<0.001),in placebo group with an insignificant change in all other IIEF domains. Total IIEF score of the placebo group was insignificantly increased from 21.13±7.73 to 21.99±7.04 (p=0.771) while there was a statistically significant increase in tadalafil group; from 20.87±8.84 to 30.75±7.04 (p<0.001). Tadalafil 5 mg once in three days is appear to be efficacious and well tolerated for the treatment of ED in hemodialysis patients.

Tadalafil improves erectile dysfunction and quality of life in men with cirrhosis: a randomized double blind placebo controlled trial.

Patients with cirrhosis have high prevalence of erectile dysfunction (ED). The aim of this study was to study the efficacy and safety of tadalafil for ED in patients with cirrhosis. 140 cirrhotic males with ED were randomized into tadalafil 10mg daily (n = 70) or placebo (n = 70) for 12weeks. ED was diagnosed if erectile function (EF) domain score was < 25 in International Index of Erectile Function (IIEF) questionnaire. The erectile function domain consists of six questions concerning erection frequency, erection firmness, frequency of partner penetration, frequency of maintaining erection after penetration, ability to maintain erection to completion of intercourse and confidence in achieving and maintaining erection. Primary outcome was proportion of patients having an increase in > 5 points in EF domain of the IIEF. Generalized Anxiety Disorder 7(GAD-7) questionnaire was used for screening and severity measuring of GAD. The presence of depression was screened using the Patient Health Questionnaire (PHQ-9) and the assessment of health related quality of life was done using the Short Form (36) Health Survey. At the end of 12weeks, more patients in tadalafil group achieved > 5 points increase in the EF domain of the IIEF when compared with the placebo group [44(62.9%) vs. 21(30%), p < 0.001]. At the end of 12weeks, patients receiving tadalafil had significantly more change in scores on the erectile function domain, orgasmic function domain, intercourse satisfaction domain, overall satisfaction domain, erection vaginal penetration rates and successful intercourse; significantly more decline in the GAD-7 and PHQ-9 scores; significantly more improvement in scores of five of the eight domains of SF-36 (general health perception, vitality score, social functioning, role emotional and mental health) and the mental component summary rates when compared with placebo. The development of side effects and the changes in HVPG were not significantly different between the two groups. Tadalafil therapy may enhance erectile function, improve anxiety, depression and quality of life; and is well tolerated by men with cirrhosis (CTP score < 10) and ED. However, further larger and long-term studies are needed to confirm these results and look for rarer side effects of using tadalafil in patients with cirrhosis. ClinicalTrials.gov identifier number NCT03566914; first posted date: June 25, 2018.

It's The "Why": Links between (Non)autonomous Sexual Motives, Sexual Assertiveness, and Women's Orgasm in Casual Sex.

Existing literature shows conflicting and inconclusive evidence regarding women's sexual experiences in casual sex. Some studies have found negative sexual outcomes (e.g., fewer orgasms), while others have found positive sexual outcomes (e.g., more orgasms, higher sexual satisfaction) when women had casual sex. According to self-determination theory (Deci & Ryan, 1985), people's needs are fulfilled when their choice and behavior are self-motivated and reflect their intrinsic values. We hypothesized that women's autonomous motivation to have casual sex would be associated with higher orgasmic function, whereas nonautonomous motivation would be associated with lower orgasmic function in casual sex. We also hypothesized that sexual assertiveness would mediate the relationship between sexual motives and orgasmic function in casual sex. Participants in this study were women (N = 401) aged 18-59years who reported having had casual sex in the past 12months. Participants completed an online survey reporting their motives to have casual sex, sexual assertiveness, and orgasmic function (e.g., orgasm frequency, satisfaction with orgasm) in casual sex. We focused on two motives: (a) pleasure motive and (b) insecurity (i.e., self-esteem boost and pressure) motive. Results showed that greater pleasure (autonomous) motives related to higher sexual assertiveness, which in turn related to higher orgasmic function in casual sex. In contrast, greater insecurity (nonautonomous) motives related to lower sexual assertiveness, which in turn related to lower orgasmic function in casual sex. The findings support self-determination theory, suggesting that autonomous motives are important for women's sexual experience in casual sex.

Effect of Foot Reflexology on Sexual Function of Patients under Hemodialysis: A Randomized Parallel Controlled Clinical Trial.

Introduction Hemodialysis patients experience sexual dysfunction due to the nature of their disease and its complications. Dialysis patients have reported sexual dysfunction as one of the most important stressors, which leads to many psychological and physiological problems. Sexual function in hemodialysis patients has been improved with pharmaceutical and nonpharmacological therapies. Foot reflexology is a complementary and alternative treatment that can be used in conjunction with contemporary care. By activating the chemical nerve system, reflexology may balance enzymes and regulate endocrine function. Objectives To determine the effect of foot reflexology on the sexual function of hemodialysis patients. Methods This randomized controlled trial was conducted on 47 patients on chronic hemodialysis referred to Imam Reza Hospital in Sirjan, Iran, who were divided into two groups of reflexology (n = 24; male = 19 and female = 5) and sham (n = 23; male = 18, and female = 5). The intervention group received foot reflexology during dialysis for four weeks, three times a week, 30 minutes each time (15 minutes per foot). The sham group received nonspecific foot massage without applying pressure on standard reflex points with the same condition and duration as the intervention group. The international index of erectile function and female sexual function index was assessed before, immediately, and one month after the intervention. Results The results showed that immediately after the intervention, male orgasm function, sexual desire, and intercourse satisfaction in the reflexology group was significantly higher than those of the sham group. There was no significant difference between the two groups regarding erectile function and overall satisfaction. Furthermore, there was no significant difference between the two groups in terms of different aspects of female sexual function. Conclusions Foot reflexology, as an effective intervention treatment, can reduce some aspects of sexual dysfunction of male patients under hemodialysis.

The Relationship Between Pelvic Floor Function and Sexual Function in Perimenopausal Women.

IntroductionPerimenopausal women with pelvic floor dysfunction have worse sexual function than women with functional pelvic floor muscle (PFM), especially in terms of libido, orgasm, sexual satisfaction, and total Female Sexual Function Index (FSFI) scores.AimTo explore the relationship between pelvic floor muscle function, hormone levels and sexual function in perimenopausal women.MethodsAn analytical cross-sectional study was conducted in 252 women aged 40–55 without pelvic floor disease with FSFI, pelvic floor muscle strength and the hormone levels.Main Outcome MeasureThe principle aim was to determine the relationships between sexual dysfunction, PFM strength, and hormone levels.ResultsIn the functional PFM group, the proportion of menopausal hormone therapy was higher. The proportion of overweight in the dysfunctional PFM group was higher, and had more sexual desire disorder, more orgasm disorder, lower sexual satisfaction, and poor FSFI scores. The correlation between PFM strength, sexual function and female sex hormones suggested that PFM strength and libido, sexual satisfaction and FSFI score are significantly positively correlated, while PFM strength and sexual arousal disorder and vaginal lubricity had a positive correlation. In the multivariate analysis of the risk of sexual dysfunction among perimenopausal women, the higher the PFM strength, the lower the risk of sexual dysfunction.ConclusionsPerimenopausal women with pelvic floor dysfunction have worse sexual function than women with functional PFM, especially in obese women, those with central adiposity, and not using hormone replacement therapy. The PFM strength was weakly positively correlated with sexual arousal, orgasm, sexual satisfaction, and FSFI score.Zhuo Z, Wang C, Yu H, et al. The Relationship Between Pelvic Floor Function and Sexual Function in Perimenopausal Women. Sex Med 2021;9:100441.