Penetrative Sex Research Articles

Does Mistaken Belief in Consent Constitute a Defence in South African Rape Cases?

In the 2020 case of Coko v S 2022 1 SACR 24 (ECG), the Eastern Cape High Court held that a person's mistaken belief in consent to penetrative sex could constitute a valid defence in law. In statutory provisions and jurisprudence, the absence of the victim's consent is fundamental in establishing a case of rape. This paper evaluates the decision, where it was held that when an appellant reasonably believes that the complainant/victim had consented to sex, this alone could be enough to acquit the appellant of the charge of rape.

Sexuality, Disability, and Aging: Queer Temporalities of the Phallus

Sexuality, Disability, and Aging: Queer Temporalities of the Phallus

(077) Physiological Synchrony and Sexual Satisfaction: A Replication and Extension

Abstract Introduction Physiological synchrony (PS) refers to a pattern of psychophysiological covariation in the context of close relationships that is thought to develop as a function of dynamic, reciprocal exchanges across biological systems over time (for a review, see Palumbo et al., 2017). There is strong evidence to suggest that PS is a marker of well-being in romantic relationships, with research illuminating close associations between PS and domains of relational functioning including overall relationship satisfaction and feelings of closeness, connection, and empathy for one’s romantic partner (e.g., Helm et al., 2014; Palumbo et al., 2017; Timmons et al., 2015; Countinho, 2019). More recent research has extended these findings to sexual relationships, finding that PS predicts attraction to a potential sexual partner (Prozachkova et al., 2022) and, in a laboratory setting, global evaluations of sexual satisfaction (Freihart & Meston, 2019). Objective Taken together, there is theoretical and empirical evidence to suggest that psychophysiological attunement between partners may be relevant for their sexual relationship. Building upon these data, the current project seeks to examine PS in a more ecologically valid context: at-home, during sexual activity. The primary aims of the current project include: (1) replicating previous research suggesting that PS observed during non-sexual interactions predicts sexual satisfaction, (2) illuminating whether physiological synchrony manifests between partners during sexual activity, and finally, (3) examining whether the magnitude of the observed synchrony is stronger during sexual activity than during non-sexual interactions. Methods Heterosexual couples in monogamous, romantic relationships were recruited from the community surrounding (University name redacted for review). Participants’ autonomic physiological response were measured in an ambulatory fashion across a baseline task, three non-sexual interpersonal tasks (i.e. looking into each other’s eyes, actively attempting to mirror one another, and holding hands), and sexual activity as measured in three phases (i.e., foreplay, penetrative sex in a prescribed position, and penetrative sex in any position selected by the couple) using chest straps with impedance cardiography technology. Levels of sexual satisfaction were measured via self-report measures that assessed global sexual satisfaction and satisfaction with a specific sexual encounter. Results Data analyses are ongoing with an anticipated completion date of January 2023. Results will be updated with an addendum upon data analysis. Conclusions This is the first dyadic psychophysiological study to examine autonomic linkages between partners during sex. Results may illuminate a candidate mechanism for variation in couple-level sexual satisfaction and, to that end, may provide rationale for future treatment development research utilizing psychophysiological attunement to optimize dyadic sexual outcomes. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: SST

(073) The New, Undescribed, and Lethal Components of The Genitourinary Syndrome of Menopause

Abstract Introduction Genitourinary syndrome of menopause (GSM) has been well described within medical literature and its effects have been well managed by physicians with an extensive understanding of the condition. However, the progression of medicine in each area continues to evolve. We propose new findings that are extremely important to have in consideration of GSM. Objective To describe new findings that are not traditionally associated with GSM, some with lethal consequences: * False abnormal pap smears * Total vulvovaginal obliteration and secondary renal damage * Undiagnosed recurrent urinary tract infections (UTI) in the geriatric population without hormone replacement therapy with secondary sepsis, pneumonia, and death. Methods Large review of recent literature, diagnosis, treatment and follow up of patients within our facility and nursing homes including geriatric females with and without hormone replacement therapy. Results `- Resolution of the abnormal pap smear with the use of local estrogens in more than 1500 cases. - Management of 6 cases of vulvovaginal obliteration with surgery, dilators, increasing penetrative sex, and local estrogens with great results. - Description of some dozens of patients seen and evaluated in home care facilities with undiagnosed UTI by the primary care, showed subsequent findings of sepsis, pneumonia, and even death. Conclusions Emphasize the need to inform and educate healthcare providers, especially primary care, internal medicine, OB/GYN physicians, and urologists the ample growing and potentially lethal spectrum of GSM. Disclosure No

(478) Patient and Partner Expectations Before Inflatable Penile Implant Surgery: A Qualitative Analysis

Abstract Introduction Patient and partner expectations before inflatable penile prosthesis (IPP) surgery and satisfaction after IPP have not been well studied. Objective The purpose of this study is to qualitatively investigate preoperative expectations of patients and partners. Methods Participants included men undergoing IPP surgery for erectile dysfunction (ED) at our institution. We also included interested partners. Information was collected via preoperative telephone interview. Semantic and latent themes were identified using qualitative inductive thematic analysis. Results Sixteen patients and 6 partners were interviewed prior to IPP surgery. Patients reported penetrative sex as the preferred form of intercourse (100%), orgasm as the desired endpoint for both participants (86.7%), and diminished self-confidence secondary to erectile dysfunction (66.7%). Partners preferred penetrative sex (60%) and the majority denied orgasm as necessary for their satisfaction (80%). Ideally, patients desired intercourse more than three times per week (87.5%), while partners desired intercourse less than 2 times per week (80%). Most patients reported that their partner was unsatisfied with their sexual activity (93.8%), however patients and partners denied communication with their partner regarding sexual desires or satisfaction (86.7%). All patients (100%) and nearly half of partners (40%) hoped to engage in penetrative sex following IPP placement, while most partners desired restored confidence for the patient following surgery (80%). Conclusions Preoperative expectations differ between patients undergoing IPP surgery and their partners. Understanding the impact of these differences on postoperative satisfaction is necessary to identify favorable surgical candidates and provide appropriate preoperative counseling. Disclosure No

(483) Predictors of Hinge Effect in Patients with Peyronie’s Disease

Abstract Introduction Patients with Peyronie’s disease (PD) suffer from a variety of penile deformities including curvature, indentation, hourglass, penile shortening, as well as erectile dysfunction. The presence of a hinge effect can be appreciated at time of penile duplex evaluation as buckling or folding of the shaft when axial pressure is placed on the glans. Patients with hinge effect can experience bothersome buckling of the erection and instability during penetrative sex. The actual characteristics that cause this hinge effect and its clinical implications are not fully understood. Objective We aim to determine the PD factors that cause hinge effect. Furthermore, we seek to assess the role of hinge effect on subsequent surgical intervention. Methods Retrospective chart review was conducted on 1483 patients presenting with PD from 2016 to 2021. 1223 patients who had a complete penile duplex evaluation and hinge assessment were included for analysis. Baseline demographics, penile duplex assessment, and clinical outcomes were recorded. Univariate and multivariate analyses were performed to assess for predictors of hinge effect. Results Hinge effect was observed at the time of penile duplex evaluation in 33% of PD patients. The degree of indentation (1.82 OR, p < 0.001), rigidity of erections (0.82 OR, p=0.002), and degree of primary curvature (1.03 OR, p < 0.001) predicted presence of hinge effect. Furthermore, hinge effect greatly affected the type of surgical intervention required to correct PD deformity. Patients with presence of hinge effect were more likely to require plaque incision/excision and grafting as opposed to tunica albuginea plication in PD patients with good quality erections. When controlling for erectile rigidity, patients who underwent partial plaque excision and grafting were more likely to have hinge when measured girth discrepancy was >1 cm (p < 0.001). In patients requiring penile prosthesis, incision and grafting was more commonly required when hinge effect was present. Conclusions The presence of hinge effect can be extremely bothersome and cause instability of erections during penetrative sex. Multiple factors may predispose to a hinge effect, including quality of erection, severity of curvature. But when controlling for rigidity, a girth discrepancy of >1 cm did appear to pre-dispose to a hinge. Additionally, assessment of hinge effect pre-operatively was important in terms of determining the optimal surgical intervention to correct PD deformities. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

(270) Case Study - Couples Therapy - Impact of Sociocultural Factors in an Unconsummated Marriage

Abstract Introduction The dynamics of marriage are influenced by the social and cultural context. In the East, several unique factors impact the marital relationship. Culturally, sex education, dating and sexual experiences before marriage are uncommon – friends and pornography are the sources of information. Arranged marriages are frequent and families are involved in selecting partners. Couples enter marriage with limited knowledge and experience of sex; therefore, unconsummated marriages are not uncommon. Objective Case study of a couple in therapy to resolve an unconsummated marriage of 1.5 years by addressing relational, psychosocial and cultural factors. Methods History was taken using the Bio-psycho-social paradigm. •An arranged marriage with both partners working in the IT field • Met each other only a few times before marriage • Loss of erection when attempting penetration was the reason for seeking medical help. • No medical aetiology: the couple was referred to a sexologist. • The families of origin were an important part of the lives of both husband and wife. • Both partners hadn’t had any sexual partners before marriage. The husband masturbated a few times a week. • For the husband, erection and ejaculation were both possible with masturbation/partnered masturbation. Both partners would orgasm during foreplay. The wife was initially an unwilling participant in therapy. She felt providing sex was the husband's duty and since he wasn't able to have penetrative sex, he needed to sort his “issue.” She threatened to live separately till then. Her threat was anxiety-provoking, and every occasion of intimacy was one of anxiety and self-doubt about whether he could perform. He had had a long period of unemployment before marriage and that had been an anxious phase too. Therapy began with agreement that both partners would be involved in the therapeutic process and view the situation as a couple to work through together. Their communication was strained – anger outbursts from the husband and days of silence from the wife. The interaction with their respective families was significant and intrusive for the other partner. The first phase addressed patterns of communication and safety to have micro-conflicts. The next phase focused on their developing an identity as a couple and setting boundaries with their families. Intimacy was put on hold till the first 2 phases were worked through. Sex education was provided to both around orgasm, anatomy, penetration and mutual masturbation. The next phase focused on intimacy and experimenting beyond sex; the couple followed the steps of sensate focus. Results The nature of the relationship changed, a couple identity formed and there was comfort to have micro-conflicts. The bonding and psychological safety increased, and overall anxiety reduced. The lens of intimacy and pleasure was widened beyond penetrative sex. After working through four different phases of the therapeutic process, the couple consummated their marriage. Conclusions In marriages that are arranged, various sociocultural factors can impact the quality of the relationship. Establishing psychological safety, creating a boundary for the couple and providing sex education set the stage for the couple to experience physical intimacy in a conducive space. Disclosure No

(276) Sexual Health of Transfeminine Individuals: A Chance to Educate Medical Providers

Abstract Introduction Providers may be unfamiliar with the sexual health needs of transgender patients. This hinders chances to provide comprehensive care, as many patients require prompting to discuss sensitive sexual issues. To increase awareness of these issues, we developed a questionnaire which assessed the sexual health of transfeminine individuals. Objective We sought to describe the sexual experiences and preferences of transfeminine individuals, and to categorize sexual health needs in this population. Methods IRB approval was obtained to develop (with transgender community feedback) a questionnaire assessing urinary and sexual health. Sexual preferences, symptoms, and quality of life (QOL) responses were compared among vaginoplasty (VP) and non-vaginoplasty (NVP) groups. NVP respondents were evaluated based on the International Index of Erectile Function (IIEF) categories: erectile function (EF), orgasmic function (OF), and sexual desire (SD). Results 53 transfeminine individuals (11 vaginoplasty, 10 orchiectomy, 32 no procedure) with mean age of 40 years (range 21-80) participated. Sexual QOL was similar for both groups (Table 1). There was an association between self-reported sexual activity and VP/NVP status, where a higher proportion of NVP respondents reported sexual activity with others and penetrative anal sex (p<0.05). Among NVP respondents, 38 (90.4%) of whom were undergoing hormone therapy, 23 (55%) indicated penile function was important to them. NVP IIEF EF, OF, and SD categories mean scores were 13.3, 5.8, and 5.6, respectively, compared to 25.8, 9.8, and 7.0 from the cis-gender controls in the initial IIEF study. 5 (11.9%) individuals used oral medications for erectile assistance, while 1 (2.3%) had a prosthesis. Conclusions When comparing VP and NVP respondents, we found similarities in sexual QOL while noticing differences in sexual preference, highlighting the diversity of this population. While many NVP respondents reported importance of penile function and presence of erectile dysfunction, only a minority were on treatment. This highlights an opportunity for providers to discuss sexual health with transfeminine patients and offer appropriate treatments. Disclosure No

(424) A Contemporary Assessment of Patients Presenting to a Tertiary Medical Center with Peyronie’s Disease

Abstract Introduction Peyronie’s disease (PD) is a progressive wound-healing disorder resulting in plaque formation within the tunica albuginea. PD continues to be poorly understood and an area of investigation, with increased awareness by patients and clinicians. Most commonly, PD patients will have a singular plaque and uniplanar curvature in the dorsal or lateral direction. However, previous studies have categorized less common deformities as “atypical”, which includes ventral curvature, multiplanar curvatures, unilateral indentations, hourglass deformity, and severe loss of penile length. Objective We aim to characterize the presenting features of PD within a large cohort of patients presenting to a tertiary referral center. Furthermore, we seek to elucidate the pre-operative factors that correlate with subsequent surgical intervention. Methods 1483 consecutive patients presenting with PD from 2016 to 2021 were retrospectively identified. Patients were excluded if they only had virtual visits, refused penile duplex evaluation, or had PD surgical correction prior to presentation. Baseline demographics, prior treatments, physical exam findings, penile duplex assessment (PDDU), subsequent interventions, and clinical outcomes were documented. Univariate and multivariate analyses were performed to assess pre-operative predictors of subsequent surgical intervention. Results In total, 1263 patients met inclusion criteria. Mean age at presentation was 55.4 ± 11.1 years with a mean duration of PD at presentation of 33.2 ± 42.5 months. Mean primary curvature was 49.8 ± 20.8°. Primary ventral curvature was present in 11.4% and 36.5% of patients had a multiplanar curvature. Mean composite curvature was 60.4 ± 28.2°. Subjective penile shortening was reported by 64.8% of patients with a mean reported loss of 3.8 ± 2.1 cm. During PDDU, indentation/narrowing deformities was appreciated in 73.7%, hourglass deformity in 10.1%, and hinge effect in 33.0% of patients. Calcification was seen in 30.1% of patients. Operative intervention occurred in 35.3% of patients. Hypogonadism (1.56 OR, p=0.04), severity of primary curvature (1.03 OR, p<0.001), hourglass deformity (1.82 OR, p=0.01), decreased tunical elasticity (1.20 OR, p=0.03), and prior intralesional Xiaflex injections (2.94 OR, p <0.001) predicted subsequent surgical correction. Negative predictors of surgical intervention included use of any oral PD treatment (0.43 OR, <0.001) and ability to perform penetrative sex (0.72 OR, p=0.04). 446 (35.3%) patients underwent surgical intervention with 170 (38.1%) plaque incision/excision and grafting, 110 (24.7%) tunical plication, and 166 (37.2%) inflatable penile prosthesis cases. Conclusions Peyronie’s disease remains an incompletely understood disease and presenting features may be changing as a result of more sophisticated evaluation and physician experience. Ventral curvature, multiplanar curvatures, indentation deformity, hourglass deformity, and severe loss of penile length have been described as “atypical”, but these changes are not rare in our cohort of referred patients. Patients with worse erectile function and more severe PD characteristics were predictors of surgical intervention. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Salvage Radical Prostatectomy after Primary Focal Ablative Therapy: A Systematic Review and Meta-Analysis.

Focal therapy (FT) has been gaining popularity as a treatment option for localized intermediate-risk prostate cancer (PCa) due to the associated lower morbidity compared to whole-gland treatment. However, there is an increased risk of local cancer recurrence requiring subsequent treatment in a small proportion of patients. To conduct a systematic review and meta-analysis to better describe and analyze patient postoperative, oncologic, and functional outcomes for those who underwent salvage radical prostatectomy (sRP) to manage their primary FT failure. A systematic review was completed using three databases (PubMed, Embase, and CINAHL) from October to December 2021 to identify data on outcomes in patients who received sRP for cancer recurrence after prior focal treatment. 12 articles (482 patients) were included. Median time to sRP was 24 months. Median follow-up time was 27 months. A meta-analysis revealed a postoperative complication rate of 15% (95% CI: 0.09, 0.24), with 4.6% meeting criteria for a major complication Clavien (CG) grade ≥3. Severe GU toxicity was seen in 3.6% of the patients, and no patients had severe GI toxicity. Positive surgical margins (PSM) were found in 27% (95% CI: 0.19, 0.37). Biochemical recurrence (BCR) after sRP occurred in 23% (95% CI: 0.17, 0.30), indicating a BCR-free probability of 77% at 2 years. Continence (pad-free) and potency (ability to have penetrative sex) were maintained in 67% (95% CI: 0.53, 0.78) and 37% (95% CI: 0.18, 0.62) at 12 months, respectively. Our evidence shows acceptable complication rates and oncologic outcomes; however, with suboptimal functional outcomes for patients undergoing sRP for recurrent PCa after prior FT. Inferior outcomes were observed for salvage treatment compared to primary radical prostatectomy (pRP). More high-quality studies are needed to better characterize outcomes after this sequence of PCa treatments. We looked at treatment outcomes and toxicity for men treated with sRP for prior FT failure. We conclude that these patients will have significant detriment to genitourinary function, with outcomes being worse than those for pRP patients.

An Intervention to Increase Condom Use Among Users of Sexually Transmitted Infection Self-sampling Websites (Wrapped): Protocol for a Randomized Controlled Feasibility Trial.

Reducing the rates of sexually transmitted infections (STIs) among young people is a public health priority. The best way to avoid STIs from penetrative sex is to use a condom, but young people report inconsistent use. A missed opportunity to intervene to increase condom use is when young people access self-sampling kits for STIs through the internet. The potential of this opportunity is enhanced by the increasing numbers of young people being tested through this route every year in England. Hence, in a cocreation by young people, stakeholders, and researchers, Wrapped was developed--a fully automated, multicomponent, and interactive digital behavior change intervention developed for users of STI self-sampling websites, who are aged 16-24 years. This paper is a protocol for a feasibility randomized controlled trial (fRCT). The fRCT seeks to establish whether it is feasible to run a randomized controlled trial to test the effectiveness and cost-effectiveness of Wrapped. Wrapped aims to reduce the incidence of STIs through increasing correct and consistent use of condoms among users of STI self-sampling websites, who are aged 16-24 years. A 2-arm parallel-group randomized fRCT of Wrapped plus usual care, compared to usual care only (basic information on STIs and condom use), with a nested qualitative study. A minimum of 230 participants (aged 16-24 years) are recruited from an existing chlamydia self-sampling website. Participants are randomized into 1 of 2 parallel groups (1:1 allocation). Primary outcomes are the percentage of users recruited to the fRCT and the percentage of randomized participants who return a chlamydia self-sampling kit at month 12. Additionally, besides chlamydia positivity based on biological samples, surveys at baseline, month 3, month 6, and month 12, are used to assess condom use attitude, behavioral capability, self-efficacy, and intention, along with details of any partnered sexual activity and condom use, and health economic data. Nested qualitative interviews with trial participants are used to gain insight into the factors affecting recruitment and attrition. Recruitment to the fRCT began in March 2021 and was completed in October 2021. Data collection was completed in December 2022. This feasibility study will provide data to inform the design of a future-definitive trial. This work is timely given a rapid rise in the use of internet testing for STIs and the sustained high levels of STIs among young people. ISRCTN Registry ISRCTN17478654; http://www.isrctn.com/ISRCTN17478654. DERR1-10.2196/43645.

Men, Sides, and Homosexism: A Small-Scale Empirical Study of the Lived Experiences of Men Who Identify as Sides

ABSTRACT The present study contributes to recent scholarship on homosexism and side sexualities by providing empirical evidence that supports stigmatizing societal responses to non-penetrative sexual practices among men who have sex with men as well as to those engaging in such practices. The study provides a close reading of two scenes of the series Cucumber (2015) which depict marginalizing attitudes toward a man who prefers non-penetrative to penetrative anal sex with other men as well as findings from interviews with men who identify as sides on a permanent or occasional basis. The findings confirm that the lived experiences of men who identify as sides are not different to the Henry’s in Cucumber (2015), and participants of this study challenge the absence of positive representations of men who identify as sides in popular culture.

Online partner seeking and high-risk behaviour in men who have sex with men and male-to-female transgendered people in Mumbai, India: Implications for prevention strategies.

It is important to understand the current internet-related sexual behaviours of high-risk groups such as men who have sex with men (MSM). We designed the present study to understand the types of online/mobile apps used by MSM and male-to-female transgendered people/hijras [TGH] in Mumbai, India. We also compared the internet-related 'partner seeking' and 'sexual behaviours' in MSM and TGH in Mumbai, India. This is a cross-sectional analysis of secondary data collected (April to June 2020) from 8582 MSM and 4163 TGH from five targeted intervention programmes each in Mumbai, Maharashtra, India. Data on demographics, years of association with the intervention, number and type of online/mobile apps used, sexual behaviours including partners from virtual space and non-virtual (physical) space, group sex, attending parties, mobility for sexual partners, and HIV status were collected. MSM were more likely to have mobile phone (88% vs 51%, p < 0.001) and internet access over the phone (78% vs 27%; p < 0.001) compared with TGH. The common apps used by MSM were Grindr (48%), Facebook (42%), and Blued (36%). MSM were more likely to have partners from virtual space (91% vs 67%; p < 0.001). A higher proportion of MSM had attended parties (28% vs 2%; p < 0.001), had group sex (16% vs 6%; p < 0.001), and were mobile for sex (25% vs 4%). MSM and TGH who had partners from virtual space were significantly more likely to report 'missed a condom at least once during penetrative sex in the past one week' (17% vs 12%; p<0.001). In HIV positive MSM, group sex, parties, and mobility for sex, were only in those who reported partners from the virtual space. Internet-based interventions for MSM should be incorporated in the existing targeted intervention programme and outreach workers should be trained in virtual outreach services. Among TGH, given the low reach and use of smartphones and apps, internet-based interventions may not be such a useful option, and the existing physical targeted intervention programmes should be strengthened.

MP36-11 PREDICTORS OF HINGE EFFECT IN PATIENTS WITH PEYRONIE'S DISEASE

You have accessJournal of UrologyCME1 Apr 2023MP36-11 PREDICTORS OF HINGE EFFECT IN PATIENTS WITH PEYRONIE'S DISEASE Daniel Roadman, Vinson Wang, William Langbo, David Paddock, and Laurence Levine Daniel RoadmanDaniel Roadman More articles by this author , Vinson WangVinson Wang More articles by this author , William LangboWilliam Langbo More articles by this author , David PaddockDavid Paddock More articles by this author , and Laurence LevineLaurence Levine More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with Peyronie’s disease (PD) suffer from a variety of penile deformities including curvature, indentation, hourglass, shortening, and erectile dysfunction (ED). The presence of a hinge effect can be appreciated during penile duplex assessment (PDDU) as buckling or folding of the shaft when axial pressure is placed on the glans. Patients with hinge effect can experience bothersome buckling of the erection and instability during penetrative sex. The characteristics that cause hinge effect and its clinical implications are not fully understood. We aim to determine the PD factors that cause hinge effect and to assess the role of hinge effect on subsequent surgical intervention. METHODS: Retrospective review was conducted on 1,483 patients presenting with PD from 2016-2021. Complete PDDU and hinge assessment were obtained in 1,223 included for analysis. Baseline demographics, PDDU findings, and clinical outcomes were obtained. Univariate and multivariate analyses were performed to assess for predictors of hinge effect. RESULTS: Hinge effect was observed at the time of PDDU in 33% of PD patients. The degree of indentation (1.82 OR, p<0.001), rigidity of erections (0.82 OR, p=0.002), and degree of primary curvature (1.03 OR, p<0.001) predicted presence of hinge effect. Furthermore, hinge effect greatly affected the type of surgical intervention required to correct PD deformity. Patients with hinge effect were more likely to require plaque incision/excision and grafting as opposed to tunica albuginea plication in PD patients with good quality erections. When controlling for erectile rigidity, patients who underwent partial plaque excision and grafting were more likely to have hinge when measured girth discrepancy was >1 cm (p<0.001). In those requiring penile prosthesis, incision and grafting was more commonly required when hinge effect was present. CONCLUSIONS: The presence of hinge effect can be extremely bothersome and cause instability of erections during penetrative sex. Multiple factors may predispose to a hinge effect, including quality of erection and severity of curvature. When controlling for rigidity, a girth discrepancy of >1 cm did appear to pre-dispose to a hinge. Additionally, assessment of hinge effect pre-operatively was important in determining the optimal surgical intervention to correct PD deformities. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e483 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Roadman More articles by this author Vinson Wang More articles by this author William Langbo More articles by this author David Paddock More articles by this author Laurence Levine More articles by this author Expand All Advertisement PDF downloadLoading ...

Sexuality and Religious Ethics: Analysis in a Multicultural University Context.

Sexuality is still perceived by some cultures as a taboo subject. Although there is now a more open attitude towards sexuality, the maintenance of virginity is one of the most concerning issues in some religions. The aim of this research is to investigate the sexual behavior of university students and analyze how culture and religion influence the beliefs and maintenance of virginity in women and men. A mixed methodology was used, involving 355 students in the quantitative design and 18 informants for the qualitative study who took part in two focus groups. The results indicate that religion and the degree of religious practice are predictor variables for the decision to have penetrative sex, with Muslim women and men giving more importance to the maintenance of a woman's virginity. However, this hymen-centric view does not prevent other sexual practices, such as oral and/or anal sex, among young people who wish to maintain their virginity until marriage. Religious ethics continue to influence the sexual behavior of young people today. Therefore, nursing education must address these issues to improve the affective sexual health of the population.

2061. High Rates of Viremic HIV, Risky Sexual Behaviors, and Interest in Gender Affirming Hormone Therapy among Transgender Individuals Who Engage in Transactional Sex

Abstract Background In the U.S., HIV transmission persists largely through sexual transmission in gender and sexual minorities. Transactional sex (TS) is a known risk factor for HIV transmission, yet risk behaviors and engagement in HIV treatment and other medical services among transgender (TG) individuals who have TS are poorly understood. Methods PATCH is a natural history study of TG individuals in Washington, DC. Participants complete laboratory testing and surveys, including assessment of TS – defined as previous year sex in exchange for drugs, money or shelter. Fisher’s exact test was used for statistical analysis. Results Of 54 participants assigned male at birth (AMAB), 21(39%) endorsed TS, the majority of whom were female (81%), Black (95%), median age 35, and HIV+ (76%; Table 1). Of those with HIV, 12 (75%) were prescribed ART, though only 8 (50%) had HIV VL &amp;lt; 200. The majority of TG people with TS had sex weekly or more (75%), with &amp;gt; 5 partners/year (62%) and used their penis (80%) and anus (90%) during TS. A minority consistently used condoms in receptive anal sex (29%), penetrative anal sex (25%), penetrative vaginal sex (17%), and chem sex (8%). While 95% had ever taken gender affirming hormone therapy (GAHT), 62% were not prescribed GAHT at screening, of whom, 54% were interested in seeing a provider for GAHT. When compared to non-TS participants, TG individuals with TS were more likely to have chem sex (p&amp;lt; 0.01), use drugs daily or more (p=0.04), use amphetamines (p&amp;lt; 0.01) and cocaine (p&amp;lt; 0.01), and less likely to have GAHT prescribed by a provider (p=0.03). HIV+ patients with TS were less likely to have HIV VL&amp;lt; 200 (p=0.02). Table 1:Participant Characteristics and Associations with Transactional Sex Conclusion This cohort of AMAB TG individuals with TS had high rates of viremic HIV, and multiple risk factors for HIV transmission, including frequent condomless sex with multiple partners. Additionally, those with TS were more likely to have high risk drug use, indicating that novel strategies to decrease risk associated with chem sex, particularly stimulant use, should be prioritized. Further, nearly all TG participants with TS had taken GAHT, yet were less likely to get GAHT from a provider. As many had interest in seeing a provider for GAHT, co-locating GAHT with HIV treatment and prevention services could help providers engage this population and address HIV-related risks. Disclosures Shyam Kottilil, MD, PhD, Arbutus Pharmaceuticals: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support|Regeneron Pharmaceuticals: Advisor/Consultant|Silverback Therapeutics: Advisor/Consultant|The Liver Company: Advisor/Consultant|Yufan Biotechnologies: Advisor/Consultant Sarah Kattakuzhy, MD, Gilead: Grant/Research Support Elana S. Rosenthal, MD, Gilead: Grant/Research Support|Merck: Grant/Research Support.

Health and service utilization among a sample of gender-diverse youth of color: the TRUTH study.

While there is growing research considering the experiences of transgender youth whose identities align with the gender binary, especially among young trans women, there are significantly fewer studies that accurately capture data about nonbinary youth, and even fewer studies capturing the experiences of transgender and gender diverse (TGD) youth of color. The purpose of this research was to assess the prevalence of sexual health behaviors, mental health challenges, substance use, and healthcare utilization among Black/African American, Latinx, Asian/Pacific Islander, indigenous and multi-racial/ethnic TGD youth, who have been largely underrepresented in research. A total of 108 TGD youth ages 16-24 were recruited into the Trans Youth of Color Study (TRUTH). Each participant completed a 90-min survey administered by a research assistant with more sensitive information collected using ACASI. In addition to a completing a survey administered by research staff, participants also participated in specimen collection, which included urine sampling to assess recent substance use without a prescription, self-collected rectal/frontal and throat swabs to test for gonorrhea and chlamydia, and a blood draw to test for recent use of drugs, gonorrhea and chlamydia, and syphilis. The sample was recruited at public venues, community outreach and referral, through social media outreach, and via participant referral. Cross-sectional analyses were from a single study visit. Compared to rates among their cisgender peers, participants reported experiencing adverse social and structural determinants of health-e.g. food insecurity (61%), housing instability (30%), and limited access to healthcare (26% had no place to go for healthcare)-and elevated rates of illicit drug use (19-85%), mental health problems (e.g. 60% self-reported depression), and involvement in sexual risk-related behaviors (e.g. among those reporting penetrative sex 57-67% reported sex without a condom). This study adds descriptions of both mental and sexual health outcomes of a non-clinical sample of TGD youth to the literature, particularly among young transgender men and gender nonbinary youth, who have frequently been excluded from previous studies of sexual health. The findings document experiences and behaviors among TGD youth that contribute to mental and sexual health concerns, including rates of substance use, and healthcare utilization.

Which groups are most affected by sexual violence? A disaggregated analysis by sex, age, and HIV-status of adolescents living in South Africa

BackgroundEstimates on sexual violence (SV) among adolescents are rarely disaggregated by key indicators. ObjectiveWe examine the independent effects of sex, age, HIV status and mode of HIV acquisition on the exposure to SV using generalised estimating equations models and proportional hazard model. Participant and settingData from a 4-year prospective cohort study of 1447 adolescents (ages 10–19, 57% girls, 76% living with HIV) in South Africa. MethodsWe describe the lifetime prevalence of three forms of SV: non-contact (unwanted showing of private parts), contact (coerced sexual debut, attempted and completed forced penetrative or oral sex,) and exploitative (sex in exchange for goods/money). ResultsOverall, 23.9% (95%CI = 21.7%–26.1%) reported exposure to SV at some point in their lives: non-contact = 5.7%, contact = 9.0% and exploitative = 15.8%. While girls reported higher rates of exploitative (18.4% vs 12.3%; p < 0.001) and contact SV (12.3% vs 4.6%; p < 0.001), there were no differences in levels of non-contact SV by sex (6.5% vs 4.6%; p = 0.086). Exposure to any SV doubled in late adolescence (10–14 years = 7.0% vs ≥15 years = 31.7%; aIRR = 2.07; 95%CI = 1.82–2.37). Though level of SV were comparable between those living with HIV and those HIV-uninfected (22.9% vs 26.2%; p = 0.182), adolescents who recently acquired HIV were twice as likely to experience SV compared to adolescents who perinatally acquired HIV (42.3% vs 15.7%; aIRR = 2.03; 95%CI = 1.73–2.39). This association persisted when analysis was restricted to incidence SV during follow-up (aIRR = 1.53; 95%CI = 1.23–2.10). ConclusionExposure to SV was high for both sexes, increased with age and more prevalent among adolescents who recently acquired HIV. SV prevention and response services must also be offered to boys and strengthened in HIV care services.

Safer Sex Practices (Portrayals of Sexuality in Pornography)

Safer Sex Practices (Portrayals of Sexuality in Pornography)

Sexual Development in Perinatally HIV-Infected Young People: A Systematic Review and Explorative Study.

Similar to other young people with a chronic health condition, perinatally HIV-infected (PHIV) adolescents may have an impacted sexual development. This paper aims to compare sexual milestones of PHIV to HIV uninfected peers, through a systematic review (SR) and explorative study. We performed a systematic search in 4 electronic databases (Medline, Embase, Web of Science, and Scopus), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Last search in all databases was performed in May 2021. We included studies that reported on quantitative data of any of the main outcomes and compared PHIV to HIV uninfected control groups. Main outcomes were defined as the occurrence and/or debut age of sexual milestones (falling in love, having been in a romantic relationship, masturbation, kissing, non-genital caressing (feeling or petting, touching), genital caressing (fingering, handjob), giving or receiving oral sex, and penetrative sex (vaginal or anal). We excluded case reports, audits, guidelines, editorials, abstracts, studies that reported on behaviorally infected HIV patients, studies that did not include an HIV uninfected control group and studies that could not be translated to English or Dutch. We used the Agency for Health Care Research and Quality (AHRQ) Checklist for quality assessment. We performed qualitative synthesis of the data. In the explorative study, we compared sexual milestones of PHIV and HIV uninfected controls matched for age, sex, ethnicity and educational level, using a subset of questions of a validated questionnaire. We included eighteen studies in the SR, describing outcomes of an estimated 1,963 participants. Seventeen studies compared the occurrence and/or debut age of intercourse in PHIV and HIV uninfected controls and 4 studies reported on any of the other sexual milestones. The majority of studies found no difference in occurrence (12 of 16 studies) or debut age (6 of 8 studies) of intercourse in PHIV compared to controls. Two of 4 studies reporting on any of the other milestones found no significant differences between PHIV and HIV uninfected controls. In the explorative study, we included ten PHIV participants and 16 HIV uninfected, matched controls. PHIV tended to report a later debut age of sexual milestones than controls (not significant). The SR includes only a small number of studies and few studies report on non-penetrative milestones. The explorative study adds to this review by including non-penetrative milestones and comparing PHIV to HIV-uninfected, well-matched controls. However, the sample size was small. PHIV seem to engage in sexual activities and achieve sexual milestones at a similar rate as their HIV uninfected peers, with a tendency of a later start in well treated PHIV. The review was registered in the PROSPERO database (CRD42021252103) and funded by AIDSfonds. AIDSfonds had no role in the study design or interpretations of this study. ter Haar AM, Fieten A, Van den Hof M, et al. Sexual Development in Perinatally HIV-Infected Young People: A Systematic Review and Explorative Study. Sex Med 2022;10:100578.