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9, 10 and 11 October 2014

09:00 - 17:00
Unmoderated posters

Location: Foyer

Sexual life in elderly male college students – Federal University of Amapa - Brazil (#204)

R. Campos (Brazil)
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204

Sexual life in elderly male college students – Federal University of Amapa - Brazil

Campos, R1; Sena, I1; Silva, K1; Teles Junior, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa UNIFAP, Brazil

Objective: To evaluate sexual life of elderly male students, mainly their quality of sexual life.

Material and Methods: Cross-sectional, descriptive and quantitative study, with 37 male college students between 60 to 75 years old, who answered the Male Sexual Quotient (MSQ), a questionnaire developed and validated nationally used to assess quality of sexual life. Total maximum score is 50 and to obtain MSQ final score, that total maximum score must be multiplied per 2. MSQ covers a range of physical and emotional aspects of sexual experience, including “desire” (item 1), “confidence” (item 2), “foreplay quality” (item 3), “partner satisfaction” (items 3–4), “erection quality” (items 5–7), “ejaculatory control” (item 8), “ability to achieve orgasm” (item 9) and “intercourse satisfaction” (item 10).  Men who didn´t have sexual intercourse in the last six months were excluded. The data were statistically analyzed by using SPSS 21.0. The study was consented by the institutional ethics committee.

Results: Mean QSM score was 68.3 (partially satisfied). In the population studied, 35.1% was classified as “highly satisfied”, 32.4% “partially satisfied”, 24.3% “average”, 5.4% “dissatisfied” and 2.7% “highly dissatisfied”. In the analysis of sexual domain evaluated by QSM, the mean scores were: desire (7.1), confidence (7.0), foreplay quality (6.9), partner satisfaction (13.4), erection quality (13.5), ejaculatory control (5.4), ability to achieve orgasm (8.1), and intercourse satisfaction (6.8). Premature ejaculation, erectile dysfunction and dissatisfaction with sexual intercourse were suggested sexual problems in 10.4% (n=4) of elderly male students. In 13.5% (n=3), there was inability to achieve orgasm and in 8.1% (n=3), hypoactive sexual desire.

Conclusions: Senescence seems to have negative impact on quality of sexual life, but in this research, the marjority of elderly male college students have a sexual life classified as “satisfied”. The least score in sexual domains was control of ejaculation (suggesting premature ejaculation as a common dysfunction) and the best was ability to achieve orgasm. A few male college students seemed to have sexual problems.

Disclosures:

Work supported by industry: no.

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Integrating sexology education into psychiatry residency training: Perspectives from the USA (#205)

D. Lin (USA)
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205

Integrating sexology education into psychiatry residency training: Perspectives from the USA

Lin, D1; Kleinbart, E

1: Mount Sinai Beth Israel, United States

Objective: The presentation will focus on how psychosexual medicine and sexology education can be integrated into psychiatry residency training.

Material and Method: The Psychosexual Medicine Program currently being implemented at Beth Israel Medical Center, Department of Psychiatry and Behavioral Sciences in New York, NY will be described.

Results: The positive impact on the training program and overwhelming support from faculty and residents of the program will be discussed.

Discussion: An argument will be made why it is important to teach sexual medicine in psychiatry residency training and how psychiatrists are uniquely positioned to be good sexologists. It will be recommended that sexual medicine education become an integrated part of psychiatry residency training everywhere in the USA.

Disclosures:

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

Sperm DNA fragmentation in patients with fertility disorders before and after varicocele procedure (#206)

G. Bastidas (Venezuela)
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206

Sperm DNA fragmentation in patients with fertility disorders before and after varicocele procedure

Bastidas, G1; Escovar, P2; Vieira, M3; Sanoja, A2

1: University of carabobo, Venezuela; 2: University of Carabobo, Venezuela; 3: Instituto H. Ellis

It is shown that varicocele causes increased oxidative stress bringing a testicular abnormal chromatin packaging and / or breaks in the Sperm DNA which is associated with a low rate of fertility in vivo and in Vitro.

General Objective: Analyse DNA fragmentation in patients with sperm fertility disorder before and after varicocelectomy.
Materials and Methods: This is a quasi experimental research of pre and post no control group with a field design, the study population consisted of all patients with a history of infertility of 1 year or more of development with clinical varicocele with no other medical history, no smoking, undergoing varicocelectomy in the “Instituto Docente de urologia” of Valencia during the period January to December 2013, The sample was not random type of volunteers made ​​up of 21 patients. As data collection technique was applied direct observation and TUNEL test to measure sperm DNA fragmentation, the data were normally distributed and were analyzed from the hypothesis test for the difference between means.

Results: The average percentage of sperm DNA fragmentation before and after varicocelectomy was 42% ± 24% ± 1.58 and 1.05, showing a statistically significant decrease (P <0.05). Sperm concentration showed no statistically significant difference from pre to post surgery (P> 0.05); motility before and after varicocelectomy averaged 39% ± 3.53 and 54.1 ± 2.66% , demonstrating a statistically significant increase from pre to post surgery (P <0.05). The morphology before and after the recorded varicocelectomy 12.19% ± 1.10 22.04% ± 1.07 and also demonstrating a statistically significant increase from pre-to post-operative (P <0.05).

Conclusions: Following varicocelectomy patients studied showed a significant decrease in the number of sperm with DNA fragmentation, as well as improvements in the parameters of sperm motility and morphology.

Recommendations: longitudinal cutting studies, assessing issues such as fertility in the medium and long term.

Disclosures:

Work supported by industry: no.

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The role of coenzyme Q10 in the treatment of idiopathic male infertility (#207)

H. Julio Junior (Brazil)
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207

The role of coenzyme Q10 in the treatment of idiopathic male infertility

Julio Junior, H1; Cruz, D1; Leite, R1; Schiavini, J1; Damiao, R1

1: Hospital Universitário Pedro Ernesto, Brazil

Objective: To conduct a systematic review of studies published evaluating the role of coenzyme Q 10 in the improvement of sperm parameters and pregnancy rate in patients with idiopathic oligoasthenozoospermia. 

Material and Method: This study was based on a systematic review in the Medline database demonstrating the effect of the exogenous administration of coenzyme Q10 in the treatment of male infertility. Twenty of the thirty-two articles with significant results in this topic were evaluated.

Results: Coenzyme q10 (2,3-dimethoxy-5-methyl-6-deca-69 prenyl-1,4-benzoquinone, CoQ10) is an isoprenylated  benzoquinone which transports electrons from complexes 1 and 2 to complex 3 in the mitochondrial respiratory chain, presenting a crucial role in cellular metabolism, in reduction of free radicals and in stability of the chain. It is metabolized and reduced in the testis to ubiquinol. The late is a strong lipophilic antioxidant, and can recycle and regenerate other antioxidants such as tocopherol and ascorbate. Decreased serum CoQ10 concentrations as well as a decrease in  seminal fluid have been related to oxidative stress. Studies have demonstrated that daily administration of 200 to 300mg of this medication for at least 6 months can improve semen parameters(such as concentration and motility), but there is disagreement regarding the improvement of the fertility rate.

Conclusion: The studies evaluated demonstrated benefit in improving semen parameters in patients with idiopathic oligoasthenozoospermia treated with coenzyme q10 especially in relation to concentration and motility. However, there is still disagreement regarding the improvement of the pregnancy rate with this treatment.

Disclosures:

Work supported by industry: no.

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A ring constriction of the penis: An emergency presentation of an aged man (#208)

Ahmed El-Sakka (Egypt)
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208

A ring constriction of the penis: An emergency presentation of an aged man

Yousef , I1; Ismail , E1; Gomaa, M1; El-Sakka, A1

1: Suez Canal University, Egypt

Objectives: Strangulation of the penis in the aged population although rarely described in medical literature can lead to a wide range of penile vascular and soft tissue injuries. To address this urological emergency condition that necessitates immediate intervention to remove the constricting object and to expectantly prevent disastrous penile complications.

Materials and Methods: We report a case of penile strangulation that presented to our emergency department (ER). A 75-year-old gentleman presented to ER with severe penile swelling and intractable pain. Patient gave a history of a metallic ring insertion over his penis 3 hours before presentation as a mean for masturbation. Subsequently he was unable to remove it due to progressive swelling. On physical examination the penile shaft was edematous and the metallic ring was thick and embedded in the skin at the base of the penis. After failure of several trials with available tools in the emergency department including orthopedic bone-cutting forceps however, unfortunately this was unsuccessful as the blade cannot be inserted under the ring and the tip of the blade was bent without cutting through the ring. We called "Tinsmith" who has different tools that can cut through metal. We used the metal cutter to cut through the ring. Local and general complications of penile strangulation were assessed.  Penile skin bruises, edema, laceration, strangulation and amputation of the penis, urinary obstruction and general complications should be prevented.

Results: Due to the on time removal of the constricting ring the penile edema was dramatically resolved and penile color regained gradually. Apart from minor bruises, penile skin was intact and patient urinated normally.  The patient made an uneventful recovery.

Conclusions: Penile strangulation, though uncommon, can be challenging to manage. Intervention on an emergency bases is important to prevent local and probably general complications. Patients with long term history of penile strangulation or multiple co-morbidities should be monitored more closely for these general complications.

Disclosures:

Work supported by industry: no.

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Penile cancer in patient with a “Bouglou” penile adornment (#209)

R. Campos (Brazil)
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209

Penile cancer in patient with a “Bouglou” penile adornment

Campos, R1; Souza, G1; Pena, L1; Barros, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa, Brazil

Aim: This case discusses the characteristics of the south-american penile adornment “Bouglou” as well as the risk factors for penile cancer at the region.

Methods: Case reports of one man admitted by the Urological public Service.

Results: A 48-year-old afrodescendant man with a painful penile destructive lesion reported that it began as a condiloma at the penile shaft six months before, which grew towards the glans. He tried to treat first immersing his penis in sulfuric acid and after exfoliating it with “Pedra Pome” (a local stone usually used to exfoliate skin), without any lesion improvement. He implanted 3 nodules under the foreskin penile shaft, which he called “Bouglou” adornments, because his wife requested so. He told that this practice was very common at the region. He confirmed that he continued to be promiscuous even married. He also confirmed that sometimes has sexual intercourses with cows and goats. The diagnosis of penile cancer was confirmed after total penectomy.

 Conclusions: In the region, the practice of penile implantation is known as “Bouglou” and the objects usually used as implants are domino fragments and toothbrush handle, in procedures without any hygienic conditions and that almost always result in complications. The implant incisions are often made with lids of sardine cans and it’s very common local bleeding, swelling and infection that need immediate treatment and result in difficult scarring lesions. Other studies suggests that these penile adornments tries to compensate the subjective little size of their penis, their lack of virility and/or their poor sexual performance. Factors related to Zoophilia may favor chronic inflammatory process and, consequently, dysplasia, such as penile contact with animal external genital mucosae, resulting in microtraumas and exposition to animal anogenital secretion, which can be carcinogenetic to human beings. The present study is the first to suggest a possible association between squamous cell carcinoma and the penile adornments. Possibly, uncorrected implanted penile nodules provoke local and repetitive trauma that can elicit chronic inflammation, which can perform a rule in the pathogenesis of carcinoma.

Disclosures:

Work supported by industry: no.

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Inflatable penile prosthesis implant with triangle shape excision and grafting for surgical therapy of Peyronie's disease: A case report (#210)

A. Miranda (Brazil)
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210

Inflatable penile prosthesis implant with triangle shape excision and grafting for surgical therapy of Peyronie's disease: A case report

Miranda, A1; Machado, B2

1: Ipanema Federal Hospital, Brazil; 2: Federal University of Rio de Janeiro, Brazil

Objective: To describe a new technique of plaque excision and grafting and implantation of an inflatable penile prosthesis to correct penile deviation caused by Peyronie disease in a patient with erectile dysfunction

Methods: We here present a case of a 65-year-old man, without comorbidities, who presented with moderate erectile dysfunction and required a phosphodiesterase type 5 inhibitor to have sexual intercourse. He had a dorsal penile deviation of 60° caused by Peyronie disease. The penile plaque had been stable for 1 year. The patient underwent bi-triangular shape plaque excision, followed by grafting with bovine pericardium and implantation of a 3-piece inflatable penile prosthesis.

Results: Complete penile straightening, without mechanical or geometric abnormalities, was achieved using bi-triangular excision and grafting. This novel technique differs from the commonly used double-Y and H-shape techniques, which may generate mechanical or geometric abnormalities. For this new technique, we used a graft of the same size and shape as that used for the double-Y shape technique. Postoperatively, the patient reported being highly satisfied with the results and could perform sexual intercourse naturally.

Conclusion: To our knowledge, this is the first case in the literature in which the previously reported bi-triangular technique was successfully used for penile prosthesis implantation secondary to Peyronie disease, validating our previous measures and findings. This new technique avoids geometric and mechanical abnormalities and may represent a good solution to correct penile deviation for surgeons who are familiar with the double-Y technique.

Disclosures:

Work supported by industry: no.

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Effectiveness of surgical treatment for Peyronie's Disaese (#211)

K. Nagao (Japan)
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211

Effectiveness of surgical treatment for Peyronie's Disaese

Nagao, K1; Tai, T1; Saigou, R1; Tanaka, N1; Kobayashi, H1; Nakajima, K1

1: Toho University, Japan

Objective: In 1996 the Reproduction Center at Toho University Omori Hospital introduced the option of surgical treatment for patients with penile deformity from Peyronie’s Disease. We examined the effectiveness of this treatment at our center.

Methods: We reviewed the clinical records of 156 men with Peyronie’s Disease who underwent surgery at our center during the 17-year period from 1996 to 2013. Mean age was 51.5 years (range 18–80 years). After receiving 6–12 months of conservative therapy, patients underwent surgery consisting of plication and/or grafting. The grafting process utilized saphenous vein and dermis. The inclusion criteria for grafting included absence of diabetes, penile curvature ≥60°, and an overall penile length of ≤10 cm upon traction.

Results: No patient who underwent plication developed adverse effects such as erectile dysfunction, and all retained the ability for normal intercourse. Most patients who received grafts also underwent plication to correct slightly abnormal curvature. Some patients who received dorsal grafts developed reduced erectile functioning but recovered after beginning treatment with phosphodiesterase type 5 inhibitors. Dermal grafting resulted in temporary constriction, which resolved within 1 year after the operation.

Conclusions: During the period studied, plication and grafting (using saphenous vein and dermis) resulted in no significant adverse effects and improved the condition of patients.

Disclosures:

Work supported by industry: no.

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Assessment of the adequacy of sexual behaviors in intellectually disabled: Construction of scale (#212)

Itor Finotelli Jr. (Brazil)
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212

Assessment of the adequacy of sexual behaviors in intellectually disabled: Construction of scale

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: The present research was developed in exploratory with the objective of investigating the structure of a scale for assessment of the adequacy of sexual behaviors in the individuals with intellectual disabilities (ID).

Methods: Ninety-eight (98) parental, which eighty percent (80%) was women with ages varying between thirty-three (33) and seventy-four (74) years old (M=48.24; SD=10.87), being thirty-five (35%) percent with primary school and sixty-five percent (65%) with secondary school. These parents were responsible for individuals with ID, seventy-five percent (75%) of men with ages varying between eleven (11) and thirty-five (35) years old (M=19.77; SD=5.99) lacking any kind of education in fifty-four percent (54%) of the cases. The instrument denominated as Scale for Assessment of the Adequacy of Sexual Behaviors in Intellectually Disabled has thirty-one (31) items that assess the adequacy of the behaviors, i.e, “One masturbates (self-arousal) in private/protected places”, measured in Likert of four points in the categories “never”, “sometimes”, “moderately”, “always”, “once”.       

Results: The factorial analysis by main components with varimax rotation extracted three dimensions capable of explaining fifty-six percent (56%) of variance; the criteria for the extraction was the scree plot, the eigenvalue>1.5 and the retention of three items with equal weight or higher than .3. The internal consistency by alpha Cronbach estimated the accuracy of the instrument in .62, the dimensions remain between .70 and .80. The dimensions were denominated as Adequacy of Sexual Behavior, Orientation and Autonomy, and Discrimination of Public and Private. Such dimensions fulfill the assumptions of higher vulnerability which the population of ID suffers in regards to sexual abuses, social embarrassment and confinement of individuals as realities lived by population and to the declaration of the Sexual Rights proposed by World Association for Sexual Health. The dimensions were capable yet to discriminate characteristics of the sample in regards to gender and schooling.   

Conclusions: Weigh up limitations in regards to the size of the sample and, despite that, the results were favorable to the search of evidence of validity of the scale, as its improvement. 

Disclosures:

Work supported by industry: no.

The psychoeducational practice in psychological and sexual therapy for treatment of erectile dysfunction (#213)

C. Miranda do Amaral e Silva (Brazil)
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213

The psychoeducational practice in psychological and sexual therapy for treatment of erectile dysfunction

Miranda do Amaral e Silva, C1

1: IBPEX/UNINTER, Brazil

This case study describes the psychological and educational practice in sex therapy for the treatment of erectile dysfunction in a patient with 22 years old without biological difficulty. Thus, believed to in the proposed of a best intervention and the orientation for new studies.

With detailed analysis of the case, through psychotherapeutic technique, it was observed that the patient had low self-esteem, fear and anxiety related to erectile dysfunction, and mild social impairment, in attempts to launch himself a new sexual conquests. The erection difficulty already him have prejudiced since the first sex intercourse, he believed that it had been late, because of low self-esteem. Of course, the first bad sexual experiences brought the fear of failure and the anxiety of performance, enabling schemes incompetence, as the Cognitive-Emotional Model of Male Sexual Dysfunctions, proposed by Noble (2010). About the patient's personality, it was noticed a very demanding and rational standard, facilitator of negative sexual schemas, full of beliefs and myths, brought by him as conservatives.

Given this context, to think of the psychological and sexual therapy approach was emphasized the increased sexual stimulation through masturbation techniques, remembering that the patient does not have a sexual partner. In addition to providing self-knowledge, these techniques helped in reducing the anxiety of performance and fear of failure. It was emphasized also assertiveness training and social skills, influencing directly the process of self-knowledge, and consequently, improved self-esteem. However, the intervention was still incomplete, 'it jumped' the need for a strategy, even these already described, consolidate themselves on the psychoeducation process. Along with cognitive restructuring, the process is defended on cognitive interventions for the deconstruction of myths and erroneous beliefs, overcoming the sexual ignorance. In this case in special with a high standard of self-demand and a very rational personality, success was evident with 8 psychotherapy sessions. So, thinking in clinical practice, where increasingly the number of young men with sexual dysfunction, especially erectile dysfunction without a history of biological problems and without a partner, it is a good strategic of intervention to be used. Further studies, especially quantitatives can show the effectiveness of the approach.

Disclosures:

Work supported by industry: no.

Quality of sexual life and lower urinary tract symptoms in male college students (#214)

K. Silva (Brazil)
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214

Quality of sexual life and lower urinary tract symptoms in male college students

Silva, K1; Campos, R1; Sena, IS1; Soares, V1; Teles Junior, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa UNIFAP, Brazil

Objective: To analyze the relationship between lower urinary tract symptoms (LUTS) and quality of sexual life in elderly male college students. 

Material and Methods: Cross-sectional, descriptive and quantitative study, with 37 male college students, with ages between 60-75 years old, who answered two questionnaires: one to evaluate the quality of sexual life, the Male Sexual Quotient (MSQ), developed and validated nationally, and the International Prostate Symptom Score (I-PSS), used to evaluate the urinary symptoms (7 questions) and their impact on quality of life in general (1 question). The data were statistically analyzed by using SPSS 21.0, with significance levels set at p<0.05. To verify the correlation between the I-PSS and the MSQ, it is used the Pearson test. The study was consented by the institutional ethics committee.  

Results: Mean MSQ was 68.3, classified as “partially satisfied”. Mean I-PSS was 11, classified as “moderate” LUTS. Ninety-five percent of the men had LUTS. According to I-PSS, 14.2% had “severe” symptoms (I-PSS: 20-35), 37.14% had “moderate” symptoms (I-PSS: 8-19) and 48.57% had “mild” symptoms (I-PSS: 1-7). Regarding to urinary symptoms, the students had incomplete emptying (38%), frequency (73%), intermittency (51%), urgency (57%), weak stream (49%), straining (35%). Only 5.4% affirmed to have nocturia. There is a significant correlation between the two ends: MSQ and I-PSS (Pearson Coefficient= -0.435, with p=0.007).

Conclusion: Nearly all men over 60 years old have lower urinary tract symptoms, although almost 50% have them classified as “mild”. Urinary frequency was the most common symptom reported in this group. In old men, the more intense are the lower urinary tract symptoms, the worse would be their quality of sexual life.

Disclosures:

Work supported by industry: no.

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Sexual function and its relation with stress, depression and anxiety (#215)

S. Cedres (Uruguay)
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215

Sexual function and its relation with stress, depression and anxiety

Cedres, S1; Dartayete, G1

1: Uruguay

Introduction: Sexuality is a psychological construction of the personality resulting from the interaction of organic, factors, congenital characteristics, environmental circumstances and social phenomena, in which the individual develops himself. That is why it has to be dealt with through a multidisciplinary, systemic and holistic approach. This paper was made at Centro Plenus in Uruguay, where there is a multidisciplinary group that gives attention to all those patients that think they have some type of sexual dysfunction..

Objectives: To determine the influence of stress, depression and anxiety on sexual dysfunction METHODS: Of the studied cases, 100 predominantly psychogenic subjects with sexual dysfunction were selected. DASS score was used to determine level of stress, depression and anxiety.

Results: There was a relationship between bad sexual performance with high levels of stress, medium levels of depression and anxiety. Among the results, it was observed more stress in man with high educational level, work with people above, erectile dysfunction for more than 3 month. In women, the high stress was observed when they had teenager sons, low sexual desire for more than 3 month, bad relations with their partner for being unable to respond to the partner’s sexual demand.

Disclosures:

Work supported by industry: no.

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Bouglou: a South-American penile adornment (#216)

R. Campos (Brazil)
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216

Bouglou: a South-American penile adornment

Góes, L1; Campos, R1; Silva, K1; Paes, A1; Teixeira, T1

1: Federal University of Amapa, Brazil

Objective: Discussion of three cases reports of “Bouglou" penile adornments during January to May, 2014, establishing the relationship between this eastward trend with the western cultural practices at the region.

Material and Methods: Literature search for MEDLINE-indexed papers followed by a manual bibliographic review of cross-references. We used as search strategies tools the descriptors: penile adornment and penile pearls. The search was extended to non-MEDLINE references using an Internet-based search engine (Google).

Results: The first case involved a 22-year-old patient, prisoner, who inserted the penile Bouglou in May, forced by older prisoners. The second case was a 19-year-old prisoner, who inserted it a month before, willingly, in order to take part of the prisoners group. He had placed the first Bouglou when he was 16, at the Detention Center for Minors. The bearer had suffered from imminent inflammation and pain and then he sought for medical aid. The third case involved 35-year-old patient, boatman, who search medical help because of an epididymis cyst. The penile Bouglou was inserted during his life to improve sexual performance, although he didn’t have a steady partner. The patient showed no interest in removing them. He also denied sexually transmitted diseases (STDs) and confirmed using condoms in all sexual intercourses.

Conclusions: Penile adornments, which are known as fang muk, bullets, chagon balls, goli or bullet, are quite common in Southeast Asian Countries. They’re made of a sort of materials, including stone, plastic pearls or pieces of domino. At the region, it is known as “Bouglou” and it is made of the similar material registered in the literature. The three cases registered showed that this practice is common among men, especially the incarcerated population. Some cases developed local pain and inflammation, pattern not very common in the literature, considering that most cases runs with no complications. The practice of penile Bouglou is associated to the symbol of manhood and potency, demanding from female partner and better sex performance. The incidence of “Bouglou” at the region reveals the intimate relationship between this practice and the Western’s cultural manifestations. It demonstrates that this phenomenon has been travelling from East to West.

Disclosures:

Work supported by industry: no.

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Priapism refractory to primary management methods associated with terazosin therapy (#217)

D. Martinez (USA)
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217

Priapism refractory to primary management methods associated with terazosin therapy

Emtage, J1; Martinez, D1; Hakky, T1; Carrion, R1; Parker, J2; Hall, M1

1: University of South Florida, United States; 2: niversity of South Florida, United States

Objectives: Ischemic priapism is considered a medical emergency, and alpha-adrenergic blockade is a rare cause. This is due to inactivity of the sympathetic input needed for detumescence. Alpha-blockers are commonly used medications for voiding dysfunction. To date, there have been only two reports in the literature of terazosin-induced priapism and both cases were resolved with irrigation/aspiration or phenylephrine injection. We report the case of a terazosin-associated priapism, refractory to the aforementioned primary management methods.

Materials and Methods: Our patient is a 49-year-old male with a 19-year history of T4 incomplete paraplegia. He has had good sexual function without the use of adjuncts. His bladder has been managed with a sphincterotomy and condom catheter but urodynamic studies showed evidence of outlet obstruction despite recent re-do sphincterotomy. He was then started on a terazosin ramp to 10 mg qhs. While on the 6 mg qhs dose the patient presented with an erection persistent for more than four hours. The patient had no other reason for new-onset priapism and had no other recent medication changes.

Results: The patient was subject to irrigation/aspiration and intra-cavernosal injection of phenylephrine, both were unsuccessful. An attempt at Winter’s Shunt was unsuccessful as well. The patient was therefore taken for the standard Al-Ghorab corpoglandular shunt with the Burnett ‘Snake’ manoeuvre. This allowed for complete detumescence. At 3-month follow up, the patient is doing well and is scheduled for penile implant placement.

Conclusions: Priapism is a rare, but important side effect of alpha-blockers. This is especially important given the increasingly frequent and widespread use of these medications for the management of voiding dysfunction. In this medication class, priapism has been most frequently associated with tamsulosin but the association with terazosin is crucial particularly in clinical settings where terazosin is the only medication available for use. Finally, this report highlights that the resultant priapism may be more resistant to primary treatment methods than previously described and may require aggressive surgical intervention for management.

Disclosures:

Work supported by industry: no.

Alternative technique for vasovasostomy in services that do not have microscopy (#218)

A. Filgueiras Pereira Jr. (Brazil)
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218

Alternative technique for vasovasostomy in services that do not have microscopy

Filgueiras Pereira Jr., A1; Julio Jr, H; Cruz, D; Schiavini, J; damiao, R

1: Universidade do estado do Rio de Janeiro, Brazil

Objective: Demonstrate an effective alternative surgery of vasovasostomy without the use of microscopy in services and hospitals that do not have this technology.

Materials & Methods: Surgeries were performed at the Pedro Ernesto University Hospital, Rio de Janeiro, using the spinal anesthetic method. The surgical technique consisted of longitudinal and bilateral scrotal incision, using surgical magnifying glass with 4x. Polypropylene thread (7.0) was used to perform vasovasostomy with 6 stitches in one plane full thickness.

Results: Eight surgical procedures were performed in a period of 12 months. Seven of these patients (87.5%) had sperm in semen examination postoperatively, demonstrating success of the procedure. Only one patient had no surgical reversal. Among patients who had a successful result, one spontaneous pregnancy(14,28%) in this period. The mean operative time was 150min.

Conclusion: Although best results were obtained using the microscopic approach, vasovasostomy performed under loupe magnification has the advantage of reduced costs and reduced operative time. The benefit of this technique is significant especially in countries and hospitals where the microscope is not available.

Disclosures:

Work supported by industry: no.

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Maternal overweight and sexual function of Brazilian women – Preliminary results (#219)

M. Ribeiro (Brazil)
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219

Maternal overweight and sexual function of Brazilian women – Preliminary results

Ribeiro, M1; Nakamura, M2; Scanavino, M3; Torloni, M2; Forte, B.2; Mattar, R2

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

Objectives: Pregnancy and excess adiposity may affect female sexual function. Our aim was to evaluate and compare the sexual function of normal versus overweight pregnant women.

Patient and Methods: Cross-sectional study conducted between March 2012 and February 2014 at the antenatal clinic of a public teaching hospital. Up to the present, 205 healthy women between 14 and 40 weeks´ gestation were recruited:  105 were normal weight and 100 were overweight ((BMI 18.5-24.9 and ≥ 25 Kg/m2, respectively). The Female Sexual Function Index (FSFI) was used to assess sexual function. Women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The Chi-square and Student’s t tests were used to compare variables between the two groups. P < 0.05 was considered significant.

Results: The mean gestational age of 2nd trimester participants was 21.7 ± 4.3 and 22.2 ± 4.0 weeks for normal and overweight women, respectively. The mean gestational age of 3rd trimester participants was 34.8 ± 3.3 and 34.0 ± 3.3 weeks for normal and overweight women, respectively. Socio-demographic characteristics were also similar. Mean final FSFI scores did not differ significantly between the groups: 22.2 ± 10.4 vs 22.0 ± 9.9 (p=0.917) for normal and overweight 2nd trimester participants and 21.9 ± 10.1 vs 19.2 ± 10.4 (p=0.222) for normal and overweight 3rd trimester participants, respectively. A total of 54 normal weight women had symptoms of sexual dysfunction (FSFI score ≤ 26) compared to 79 overweight pregnant women (51.4% x 80.0%, p<0.0001).

Conclusion: According to our preliminary results, the prevalence of sexual dysfunction symptoms, as measured by the FSFI questionnaire, is higher among overweight than normal weigh pregnant women during the second and third trimesters of pregnancy.

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

Disclosures:

Work supported by industry: no.

show poster

Quality of sexual life of female college student with comorbidities – Amazonia - Brazil (#220)

I. Sena (Brazil)
show abstract

220

Quality of sexual life of female college student with comorbidities – Amazonia - Brazil

Sena, I1; Silva, K1; Campos, R1; Teles Junior, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa UNIFAP, Brazil

Objective: to evaluate the relationship between quality of sexual life with the presence of comorbidities in female college students.

Materials and Methods: Cross-sectional, descriptive and quantitative study, with 123 sexually-active female college students with age range of 34-79 years old, who answered two questionnaires: one to evaluate the sexual quality of life, the Sexual Quotient – Female Version (SQ-F), developed and validated nationally, corresponding a score of 100 points which higher scores indicate better quality standards of sexual life, and the other an epidemiologic questionnaire, where it was asked for the presence of the following diseases: systemic arterial hypertension (SAH), diabetes mellitus (DM), thyroidopathies, osteoporosis, congestive heart failure (CHA) and depression. The data were statistically analyzed by using SPSS 21.0, with significance levels set at P<0.05. One-way ANOVA test was used for statistical evaluation. The study was consented by the institutional ethics committee.

Results: In the population of n=123 female students, 48.8% had at least one comorbidity. There isn´t significant correlation between worse standards of sexual life and the presence of comorbidities in general (p=0.51): the mean SQ-F score of the students with some comorbidity was 64.8, slightly below comparing with those without disease (mean SQ-F score=67.5), both classified as “regular to good”. Among the comorbidities, the most frequent was SAH (26%), followed by DM (13%) and osteoporosis (14%). The only disease that showed statistically relevance in ANOVA test was DM (p=0.02), with mean SQ-F=53.9, therefore classified as “unfavorable to regular”.

Conclusion: Among all comorbidities studied, the most harmful to female quality of sexual life was DM, the second most frequent in the same research. Probably, the pathophysiology of DM is more related to the dysfunction of the mechanisms of the sexual cycle response, differently of the SAH, which showed higher frequency but no statistical correlation with SQ-F.

Disclosures:

Work supported by industry: no.

show poster

Interdisciplinary model for understanding of sexuality (#221)

F. Viola (Argentina)
show abstract

221

Interdisciplinary model for understanding of sexuality

Viola, F1

1: Facultad de Medicina - UNT, Argentina

Sexuality is the most complex human dimension that exists. This is reflected in the difficulty to approach the subject from both research and clinical applications. The resurgence of the concept of sexual health has caused a more operational outlook on the subject. However, difficulties remain, inherent to the object itself and to related perceptions about this object. These difficulties can be associated with the simplification of sexuality to subjects limited to genital and/or reproductive matters. The complexity of sexuality requires expand consideration.

Objectives: Propose a therapeutic model that we call IFE (idea-fact-event). This model is oriented toward an approach to sexual health as it relates potential sexual behaviors, especially in the effect it produces in people.

Material and Methods: Our proposal’s theoretical basis posits three steps that must be considered in assessing sexual cases:

Idea: - What is patient’s– and therapist’s – idea regarding the case, that led to the inquiry?

Fact: - What do we know about the raised sexual fact, and can the consultant know?

Event: - What was the event’s success, as it is presented to us?

Results: We suggest a model based on explicit graphically overlapping circles. This is to define the problem that arises and, accordingly, to help design the proposed therapeutic therapy. Moreover, the same exercise may be helpful to optimize the therapeutic relationship established.

Conclusions: It is important to understand that the event is significant, and that there is always the possibility of allowing the inclusion of the subject’s idea and knowledge. Understanding this would serve to understand that therapeutic adaptation in the field of sexuality is always associated with the prospect of personal construction of meaning. This model is associated with the concept of sexuality as an integral issue and can provide clues necessary to consider treatment and prognosis.

Disclosures:

Work supported by industry: no.

Quality of sexual life and urinary incontinence in female college students in Amapa-Brazil (#222)

R. Campos (Brazil)
show abstract

222

Quality of sexual life and urinary incontinence in female college students in Amapa-Brazil

Campos, R1; Sena, I1; Silva, K1; Soares, V1; Teles Junior, A1; Paes, A1; Teixeira, T1

1: Federal University of Amapa, Brazil

Objective: to evaluate the correlation between the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) and the Sexual Quotient – Female Version (SQ-F) obtained from the college students.

Materials and Methods: Cross-sectional, descriptive and quantitative study, with 57 female college students who answered two questionnaires: one to evaluate the sexual quality of life, the SQ-F, developed and validated in Brazil, and the ICIQ-SF, used to evaluate the urinary incontinence symptoms and their impact on quality of life. The data were statistically analyzed by using SPSS 21.0, with significance levels set at P<0.05. To verify the correlation between the ICQI and the SQ-F, it is used the Pearson´s chi-square tests. The study was approved by the institutional ethics committee. Women who didn´t have sexual intercourse in the last six months were excluded.

Results: The mean age of the participants was 34-59 years old. The mean SQ-F score was 71.57 (standard deviation – SD – 15.15), and was classified as regular to good. 45.6% of women never leak urine, 17.5% leak urine about once a week or less often, 5.3% two or three times a week, 26.3% several times a day. Thirty-one women reported leak of urine, 59.4% usually leak a small amount, 21.9% a moderate amount and 9.4% a large amount of urine. 90.7% of them leak urine when cough or sneeze, or before them can get to the toilet. 9.3% leak when they are physically active/exercising or when they have finished urinating and are dressed. Using a scale of 0 “not at all” to 10 “a great deal”, leaking urine interferes everyday lives of 0 to 5 in 75.2% of women, whereas in 24.8%, it interferes of 6 to 10. In 68.4% of women that leak a small amount of urine, this interference has an intensity of 0 to 3. But in 66.7% who leak a large amount of urine, this interference had an intensity of 8 to 10. Significant correlation is noticed between two extremities (ICQI-SF and SQ-F), with p=0.01 and correlation coefficient = -0.321.

Conclusion: Leak of urine causes major interference in women’s lives and the symptoms of urinary incontinence exert influence on the sexual quality of life. So, the more intense are the urinary incontinence symptoms, the worst will be the female sexual quality of life.

Disclosures:

Work supported by industry: no.

show poster

Educational program in sexual medicine to internal medical students (#223)

Fernando Facio (Brazil)
show abstract

223

Educational program in sexual medicine to internal medical students

Facio, F1; Glina, S2; Torres, L3; Faria, G4; Afif, J5; Abdo, C6

1: FAMERP, Brazil; 2: ABC Medical School, Brazil; 3: Brazil; 4: Inst. Urologia Rio Claro, Brazil; 5: São Paulo, Brazil; 6: USP-SAO PAULO, Brazil

Introduction: We believe that patients expect healthcare providers to be knowledgeable and approachable regarding sexual health. This initial project is a tremendous opportunity to mold the next generation of healthcare providers to view healthy sexuality as a relevant patient concern. The improvement in knowledge on human sexuality of medical students will increase their level and may substantially enhance the capacity of tomorrow’s physicians to provide optimal care for their patients in new possibilities to treatments as new drugs and/or new Procedures.

Methods: The Sexual Society and professional member had the goal of improving academic medical knowledge. They gave a clear demonstration to the students in general, of their limited unfounded notions on the subject of sexual medicine and, at the same time, as sexuality is still a subject full of myths, taboos, bias and misunderstanding, our objective was to provide knowledge about sexuality

Results: Educational Program in Sexual Medicine to internal medical students

Seventy four medical students have participated of this project, they gave back answers about improvement in knowledge, understand and applicable in medical practice. The medical students answered questionnaire before and after about the sexual issue received.   In the evaluation we analyzed a improvement 25% of knowledge and 90% in self trust to discuss sexual behaviors with patients.

Conclusion: As first period of this project we concluded that is very important to  increase professional of the medical students, ED remains underdiagnosed and undertreated because doctor , medical students and professional cannot received information enough in graduate programs in the medical school.

Disclosures:

Work supported by industry: no.

show poster

Review on the role of sexual disorders to increase Iranian divorce rate (#224)

M. Ghorbani (UAE)
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224

Review on the role of sexual disorders to increase Iranian divorce rate

Ghorbani, M1; Foroughi, M2

1: United Arab Emirates; 2: Shahd Baheshti University of Medical Sciences, Iran

Objective: The low rate of divorce has been one of the worthy characteristics of Iranian society in past years. But, rate of official and informal divorces are growing in Iran, so that Iran peoples have forth rank of divorce rate in the world now. Checking of Courts and Health files specifies the main reason of divorces is diagnosed or undiagnosed sexual dysfunction in man or woman or both.

Material and Method: We have studied Sexual Disorders (Including: ED, PE, loss of desire, orgasmic problems, dysparunia, vaginismus)in Iranian divorced couples in the past five years.

In this study, we could check role of general education, sexual health training, aggravating factors (Mental and Physical), age, and duration of marital life in causes of divorce.

Results: This study determined there was no significant difference between educated, literate and illiterate divorced couples about incidence of sexual problems. They have little understanding of their disorders or they don’t know anything about their sexual dysfunction. The most of them can’t specify their problems. More than 50% of them had secondary sexual disorders and they suffered it after marriage.

Conclusions: Cultural and Social subjects, lack of scientific sex education before marital relationship and marriage, absence of continuous sexual health training during marital life, loss of adequate sexual medicine care, increasing opiate users, low knowledge of the medical staff about sexual disorders, social problems and taboos are the main reasons for making sexual crisis in Iranian Society and increasing rate of divorce. Therefore, we need a executive plan to solves mentioned items to reduce divorce rate.

Disclosures:

Work supported by industry: no.

Androgen receptor CAG repeat length polymorphism is associated with risk of metabolic syndrome in a Korean male (#225)

D. Moon (Korea)
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225

Androgen receptor CAG repeat length polymorphism is associated with risk of metabolic syndrome in a Korean male

Bae, Y1; Yoon, C1; Oh, M1; Park, H1; Kim, J1; Moon, D1

1: Korea, South

Objective: The metabolic syndrome (MS) includes a clustering of metabolic derangements and low testosterone levels have been shown to be associated with both components of MS and MS per se. In this study we explored the relationship between androgen receptor (AR) CAG repeat length polymorphism and MS in a Korean male population.

Material and method: The association between AR CAG repeat length polymorphism and metabolic syndrome was analyzed in 144 Korean men (40-80 years old). MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP) criteria (any three or more of thefollowing components were present: abdominal obesity (WC > 102 cm), triglycerides > 150 mg⁄ dL (> 1.7 mmol⁄L), HDL cholesterol < 40 mg ⁄ dL (< 1.04 mmol⁄ L), fasting glucose > 110 mg⁄ dL (> 6.1 mmol ⁄ L), or blood pressure of > 130 ⁄ 85 mmHg). AR CAG repeat length polymorphism was determined by microsatellite fragment sizing and association with clinical factors (MS, age, height, weight, BMI, waist circumference, FBS, total cholesterol, HDL, LDL, triglyceride, HbA1c, sex hormone binding globulin) were analyzed.

Results: Mean age was 56.6±8.4 years. Mean AR CAG repeat length and serum testosterone levels were 20.74±12.5 and 5.5±1.7ng/ml respectively. Twelve men with hypogonadism (serum testosterone level lower than 3.5ng/ml) showed relatively short AR CAG repeat length compared with men with normal serum testosterone level (18.33 vs 20.95, p=0.48). Long AR CAG repeat length is associated with an increase in LDL, triglyceride, and HbAc1 while showing negative correlation with HDL and total cholesterol. Total 113 men had at least 1 component of MS and 27 men were diagnosed with MS (more than 3 components). Men with MS showed relatively longer AR CAG repeat length compared with men without MS (23.3 vs 19.7, p = 0.14). Hypogonadal men showed relatively high risk of MS (OD: 1.656, CI: 0.409-6.709) compared with eugonadal men and in cross-sectional analyses, men with AR CAG repeat length less than 21 combined with hypogonadism showed more increased risk of MS (OR: 2.074, CI: 0.872-4.931).

Conclusion: In conclusion, AR CAG repeat length and hypogonadism seem to be associated with increased risk of MS in Korean male.

Abstract 225

Disclosures:

Supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education(R1304182).

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Perception of patients with vaginismus and strategies in approach (#226)

S. Scalco (Brazil)
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226

Perception of patients with vaginismus and strategies in approach

Scalco, S1

1: UFRGS, Brazil

Introduction: Vaginismus is a sexual dysfunction characterized by contraction of the vaginal muscles, preventing penetration.

Materials and methods: This qualitative and quantitative study reports the perceptions of 29 women with vaginismus, and describes approach strategies. The patients were treated at a private sexology clinic.

Statistical analysis: Continuous variables were expressed as mean and standard deviation or median and interquartile range (25-75 percentiles) and categorical variables by absolute and relative frequencies. Charts and Pareto diagram columns were used for the presentation of some data. The analyses were calculated in Excel 2010 and SPSS software (v. 18.0).

Discussion: When some women narrate partial penetration, they speak of the vagina using distanced, impersonal language, using phrases like "I'm not sure if it entered", in reference to vaginal penetration. After sexual relations – at times up to four years – there is a perception about dysfunction and consequent delay in treatment, which corroborates the lack of an active search for professionals. The patients believe that external factors are an obstacle to the realization of therapeutic exercises, even when those obstacles are not real. The participant-patients improved when therapy became part of therapist-imposed routine, and not a prior motivational drive. Women are recognized as "fragile" in their families of origin, but use authoritarian strategies with their partners. The described "pain" is an irrefutable argument which interrupts intercourse, resulting in a partner who becomes passive and in turn feels disqualified.

Treatment: Therapeutic strategies used with positive results: The word “pain" is not used, substituted with "discomfort“; awareness of a gradual, "step by step“, evolutionary process, using and approach which involves a systematic desensitization; different positioning and relaxation techniques; partner involvement, relieving "responsibility." Therapeutic strategies used with positive results: it not used word “pain" but "discomfort", awareness of gradual process of evolution, the "step by step", systematic desensitization, different possibilities positioning techniques and relaxation, partner involvement, with relief his "responsibility”.

Disclosures:

Work supported by industry: no.

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Evaluation of different sexual domains in adult and elder female college students at Federal University of Amapa-Brazil (#227)

R. Campos (Brazil)
show abstract

227

Evaluation of different sexual domains in adult and elder female college students at Federal University of Amapa-Brazil

Campos, R1; Silva, K1; Sena, I1; Teles Junior, A1; Tongu, M1; Teixeira, T1

1: Federal University of Amapa, Brazil

Objective: To evaluate the different domains of the Sexual Quotient – Female Version (SQ-F) applied to the adults and elder female students.

Materials and Methods: Cross-sectional, descriptive and quantitative study, with 123 female college students who answered a questionnaire to evaluate the sexual quality of life, the SQ-F, developed and nationally validated. Women who didn´t have sexual intercourse in the last six months were excluded. The data were statistically analyzed by using SPSS 21.0, with significance levels set at P<0.05. Analysis of variances (ANOVA) and Pearson´s chi-square tests were used for statistical evaluation, comparing the sexual domains between the two groups of women, adults (34-59 years old) and elder ones (60-79 years old). The study was approved by the institutional ethics committee.

Results: Fifty-seven women have age between 34-59 years old and 66, between 60-79 years old. Domains statistically significant (p<0.05) were: “Foreplay quality” (p=0.001), item 3 of SQ-F, and the “Subjective arousal and harmony with the partner” (p=0.02), items 4 and 5 of SQ-F. In 86% of adult group women, “Foreplay quality” always or almost always stimulate them to continue sexual intercourse, whereas in the elder group, just 51.5% (Pearson´s chi-square test = 0.0001). In domain “Subjective arousal and harmony with the partner”, sixty-five percent of adult group women always or almost always reported being lubricated during sexual intercourse, in contrast to 48.5% of women in elder group (Pearson´s chi-square test = 0.006). In item 5 of SQ-F, forty-three point nine percent of women in the elder group always improve their sexual arousal as their partners´ arousal improve too, whereas it happened just in 35.1% in women of adult group (p=0.01).

Conclusion: Foreplay quality is essential to provide sexual arousal and satisfactory lubrication to sexual relationship. Adult women are strongly stimulated by foreplay quality to keep on having a sexual intercourse. In the elderly women, sexual arousal depends directly from their partners´ arousal and the deficiency of vaginal lubricant is explained mainly by menopause.

Disclosures:

Work supported by industry: no.

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Female arousal and orgasmic complaints in a diverse female population with multiple medical issues treated Zestra®: A topical applied blend of botanical oils (#228)

Michael Krychman (USA)
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228

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

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

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

Objective: Arousal and orgasmic changes occur as a result of chronic medical illness and multiple medication treatments. There is no Food and Drug Administrative approved products presently available for female sexual orgasm dysfunction (FSOD) many troubled women opt for over the counter (OTC) products in an attempt to enhance orgasmic responsivity and improve sexual satisfaction.

Materials/Methods: We present a case series of 13 women who presented with self reported delayed arousal and poor orgasmic response and decreased orgasmic intensity who have a multitude of medical illnesses.

Results: Patient demographics 2 premenopausal women and 11 post-menopausal women (median age 57) Total age range was 36-63. The following illnesses: Lowered libido (6), hypothyroidism (5), hypertension (4), depression (2), ADHD (2), migraines (2), narcolepsy (1), Fibromyalgia (1), hypercholesterolemia (1) were represented in this small case series. Patients on average took 3 prescription medications (range 0-8). Three women were single, 2 were divorced whereas 8 were married. All women were sexually active with a functional and available partner. Ten women had laboratory blood testing; all women had normal free testosterones though two out of the ten were in the lower one third of the normative range. Patients were evaluated and assessed using a standardized protocol (previously described by a sexual medicine gynecologist. All patients reported efficacy with respect to improved intensity of orgasmic response, and decreased latency of time to orgasms after use of the non-prescription product, Zestra®, a proprietary blend of botanical oils and extracts, with subjective improvement in orgasmic intensity and decreased latency to orgasm for select patients. In addition all reported improved sexual satisfaction at the 4-week follow up visit.

Conclusion: As women age into the menopausal years, it is not uncommon to have female sexual complaints in association with medical illnesses and their medications to keep disease stable. Medications and medical illnesses e affects the genital arousal and orgasmic function. This small yet diverse subset of women with a variety of medical conditions reported increased intensity of orgasmic response and decreased latency to orgasm with the use of Zestra ®. Further randomized clinical trial study with standardized screeners and questionnaires with set endpoints is necessary to establish the generalizability of these preliminary case findings

Disclosures:

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

Sexual dysfunction among women receiving maintenance hemodialysis (#229)

M. Menjour (Tunisia)
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229

Sexual dysfunction among women receiving maintenance hemodialysis

Menjour, M1; Khedher, R1; Ben Azzouz, O1; Smaoui, W1; Jbeli, H1; Krid, M1; Ben Fatma, L1; Beji, S1; Zouaghi, K1; Rais, L1; Ben Moussa, F1

1: Rabta Hospital Tunis, Tunisia

Objective: Sexual dysfunction (SD) is common in women hemodialysis. In our country the subject is taboo and its impact remains unknown. The aim of our study is to provide an epidemiological profile of sexual dysfunction in women undergoing hemodialysis.

Methods: We did a cross-sectional study aimed to assess the prevalence and risk factors associated with SD in dialysis women. Eight dialyzed women >18 years old in Rabta hospital were included. SD was assessed using the Female Sexual Function Index.

Results: The mean age of the patients was 61 ± 11 years (42-80 years),   they were all inactive Professional, seven were married and one was widowed, the median dialysis follow-up was 4.5 years. The prevalence SD was 77.8% for all patients. 62.5% of women were postmenopausal and not taking hormone replacement therapy. All patients were hypertensive. The patients with DS were depressed 3 of who had severe anxiety disorders.

Conclusion: The advanced age, menopause, depressive syndrome, sociological and cultural factors seem to be predisposing factors for SD in the dialyzed woman. SD should attract our attention as a clinician so that it is diagnosed and treated to improve the quality of life of patients.

Disclosures:

Work supported by industry: no.

Association between alexithymia and sexual desire in patients with sexual dysfunctions (#230)

Itor Finotelli Jr. (Brazil)
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230

Association between alexithymia and sexual desire in patients with sexual dysfunctions

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Aim: The present study correlated the Sexual Desire Inventory (SDI-2) with the Toronto Alexithymia Scale (TAS-26) in order to estimate the association between alexithymia and sexual desire.

Methods: One hundred and twelve (112) patients, who have been treated in a private clinic in Sao Paulo, Brazil, were assisted and, seventy-eight (78) patients were diagnosed with sexual dysfunction while thirty-four (34) complained about couple issues or a partner with sexual problem. The average age was thirty-three (33) years old for the men and thirty-one (31) for the women. The gender and the type of the complaint did not vary according age. Eighty percent (80%) of the participants had Bachelor degree or equivalent. The instruments were individually applied in the initial assessment observing the ethical compliance demanded in the research.     

Results: Variations were found in the scores for men and women in the total score and dyadic dimension f the SDI-2, further on the total score and one of the dimensions of the TAS-26. This variation indicated that the women had a lower score compared to men concerning desire and higher score concerning negative aspects of focusing on external events and control of emotions. This situation occurred due to the prevalence of complaint about the inhibition of sexual desire. On the other hand, women presented lower desire compared to men in different literature. Moderate negative correlations were estimated between the total score and its dimensions in order to associate the instruments. In this case, the difficulty in fantasizing was negatively associated to sexual desire in dyadic and solitary expressions for both genders. Specifically men, the lack of ability to express thoughts and emotions presented a negative impact in sexual desire in a global way.  

Conclusions: The results provided further evidence of the association of the alexithymia in the sexual behavior, more specifically, in the desire. The difficulty in fantasizing and the lack of ability to express thoughts and emotions, dimensions assessed in the alexithymia, were associated to lower scores in the SDI-2. This evidence supports the importance of considering this capability in humans and complaints related to the sexuality area. 

Disclosures:

Work supported by industry: no.

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lengthening phalloplasty using multi-modality surgical techniques (#231)

A. Helmi (Saudi Arabia)
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231

Lengthening phalloplasty using multi-modality surgical techniques

Helmi, A1; Merdad, T2

1: Prince Sultan Military Medical City; 2: The Man Clinic

Introduction: Lengthening phalloplasty is an operation that aims at increasing the length of the penile shaft. This procedure has been gaining popularity with different surgical techniques  being described to achieve the desired results. We are advocating a unique modified surgical technique with high success rate.

Methods: A retrospective study including consecutive male patients presenting for penile lengthening over the last 9 years. Patients underwent pre-operative andrology and psychological evaluation. The procedure was performed by the same urologist and plastic surgeon simultaneously. A successful surgical outcome is defined as: achieving a lengthening of equal to or more than 3.0 cm.

Results: A total of 45 patients have been included. The age ranged from 27 to 45 years with a median of 33 years. The range of pre-operative penile length in flaccid status was 4.0 to 7.0 cm with an average of 6.5 cm. While the range of pre-operative penile length in erect status was 9.0 to 11.0 cm (average 10.0 cm). The average penile lengthening achieved post-operatively was: 4.35 cm. with a range of 3.8 to 4.9 cm.

There was no major complications or failure of the procedure observed. One patient suffered partial wound dehiscence following return to sexual activity two week after surgery. Patients’ satisfaction with the outcome 6 months following surgery reached 44/45 with one case of dissatisfaction owing to the residual scar.

Discussion: The most popular surgical method used for penile lengthening is release of the suspensory ligament. Our technique differs as it involves urological as well as plastic surgical principles of combining fat reduction, vertical skin lengthening and retro positioning of the skin fold of the root of the penis proximally in order to achieve the maximum length with the safest optimum outcome. The technique will be illustrated by intra-operative edited video and photos.

Conclusion: We have concluded that using our multimodality technique phalloplasty is a safe procedure with 100% surgical success rate in regard to desired length gain and overall patient satisfaction rate of 97% which exceeds the standard procedure.

Disclosures:

Work supported by industry: no.

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Preliminary analysis of the relationship between the degree of penile rigidity and the abscence of nocturnal erection in patients with erectile dysfunction assisted at urology clinic of the Pedro Ernesto University Hospital (#232)

H. Julio Junior (Brazil)
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232

Preliminary analysis of the relationship between the degree of penile rigidity and the abscence of nocturnal erection in patients with erectile dysfunction assisted at urology clinic of the Pedro Ernesto University Hospital

Nunes, J1; Julio Junior, H1; Cruz, D1; Schiavini, J1; Damiao, R1

1: Hospital Universitário Pedro Ernesto, Brazil

Objective: To establish the relationship between the degree of penile rigidity with the absence of nocturnal erections in patients complaining of erectile dysfunction.
Material and Method: This was a cross-sectional study in which 30 patients were analyzed with complaints of erectile dysfunction treated between March 2014 and June 2014 at the Andrology clinic of Pedro Ernesto University Hospital. All patients were evaluated according to the scale of the degree of penile rigidity (Grade 0: flaccid penis; Grade 1: thick penis, but not rigid; Grade 2: penis hard, but not enough to penetrate the vagina; Grade 3: partially rigid, but able to penetrate; Grade 4: completely rigid penis). The absence of nocturnal erections, in this study was based on a subjective analysis.
Results: Of the 30 patients studied, there was a higher prevalence of grade 3 of penile rigidity (36%), followed by grade 2 (33%), grade 1 (28%) and grade 0 (3%). 25% of patients with stiffness Grade 3 reported lack of nocturnal erections. 50% of patients with stiffness grades 1 and 2 reported no nocturnal erection. The patient with grade 0 stiffness showed no nocturnal erection.
Conclusion: In this preliminary evaluation, we observed a direct relationship between the absence of nocturnal erections and a lower degree of penile rigidity during erection. However, this study also presents a reduced number of patients and it will be conducted in order to achieve a total of 200 patients.

Disclosures:

Work supported by industry: no.

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Side effects of the use of transdermal gels and injectable testosterone in the treatment of hypoactive sexual desire disorder in women (#233)

C. Moreira Nis (Uruguay)
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233

Side effects of the use of transdermal gels and injectable testosterone in the treatment of hypoactive sexual desire disorder in women

Moreira Nis, C1; Radesca, D1

1: Clínica Masters, Uruguay

Objective: Testosterone therapy is widely off label prescribed for women with low sexual desire. However, no testosterone product is FDA approved for use in women.

In this study, we briefly share our experience treating hypoactive sexual desire disorder (HSDD) in women using injectable and transdermal gel testosterone. We discuss the adverse reactions, the potential benefits of each therapy and the safety data available on testosterone use in this population.

Material and Method: We designed a descriptive-longitudinal study that takes 52 women ranging in age between 32 and 68 years who received monthly doses of 125 mg of testosterone for a period of up to 4 months. Another homogeneous group of 24 women in the same age range were treated with transdermal testosterone gel, 10 to 15 mg daily, for a period of one month. The results of the adverse effects and the effectiveness of treatment were recorded

Results: The vast majority of women solved their HSDD permanently with each treatment (89% injectable testosterone, 92% testosterone gel). We note that 25% of women who received treatment with injectable testosterone had adverse effects in the first month and that percentage increased as the months passed and it was necessary to stop that treatment. No adverse effects were reported with the use of transdermal testosterone gel.

Conclusion: Transdermal testosterone gel in doses of 10-15 mg per day is the best option for treatment of HSDD.

Disclosures:

Work supported by industry: no.

Transsexualism experienced by adolescents and their families: A literature review (#234)

M. Lerri (Brazil)
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234

Transsexualism experienced by adolescents and their families: A literature review

Lerri, M1; Tiezzi, M1; Romão, A1; Oliveira, M1; Gorayeb, R1; Santos, M2; Lara, L1

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

Objective: To check the literature about the impact of transsexualism in the adolescent´s and their family´s lives Method: The authors conducted a literature review in PubMed, VHL (Virtual Health Library) and Web of Science databases, crossing the terms "transgender", "family", "adolescents", "transexualism", searching for articles related to transsexuals and their families.

Results: Sixty articles were selected and their abstracts were analysed. Articles that evaluated quality of life of transgender teens and their families were selected for full article access. Seven articles were selected; all of them designed as exploratory descriptive using semi-structured interviews as instrument. We found that, although mentioning transgender teens and their families in the abstract, all the articles were about other sexual minorities’ population and not about the impact of transsexualism in the adolescent´s and their family´s lives. One article examined victimization at school, but showed no correlation with transsexualism. Another article examined victimization at school and negative psychosocial adjustment when participants reached adulthood. The other five articles were about the importance of social acceptance during adolescence in general, as a protective factor against psychological disorders.

Conclusion: Although this is a current discussion in various professional segments, the theme draws attention to the lack of data on the subject. Therefore, there is a clear need for studies that demonstrate the true impact of transsexualism in the adolescent´s life, a period of development marked by profound psychological changes. It is necessary, above all, to assess the family relationship in order to contextualize the behaviour of these vulnerable adolescents with regard to feelings, emotions, ideas, values and goals during this critical period and to enable effective treatment (medical and psychological) for transsexual adolescents and their families.

Disclosures:

Work supported by industry: no.

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Quality of life of transgender patients: the impact of hormonal therapy and sex reassignment surgery (#235)

E. Da Silva (Brazil)
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235

Quality of life of transgender patients: the impact of hormonal therapy and sex reassignment surgery

Vieira, R1; da Silva, E1; Chalub, M1; Awad, M1; Damião, R1

1: Rio de Janeiro State University, Brazil

Introduction: Transsexualism is defined as the desire to belong to the opposite sex, making the body congruent with the preferred psychological sex through hormonal and surgical treatment. It is characterized by severe psychological suffering and, thus, quality of life (QoL) could be impaired. We aimed to evaluate the impact of sex reassignment surgery on QoL of transgender patients.

Materials and Methods: We analyzed 65 transgender patients, of which 62 were Male-to-Female and 3, Female-to-Male, with a mean age of 35.6 ± 8.6 years and transsexualism was established by a mental health team (psychiatrist and psychologist) in accordance to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) and ICD-10 (International Statistical Classification of Diseases and Related Health Problems) criteria. QoL was assessed by the WHOQoL-Bref (World Health Organization’s Quality of Life) questionnaire. Patients were requested to answer the WHOQoL-Bref questionnaire at the first evaluation, during hormonal therapy, and after sex reassignment surgery were performed.

Results: Body modification due to hormonal therapy only was considered good and the physical domain remained unchanged after sex reassignment surgery (p=0.372). Psychological, social relationship and environment domains improved significantly after sex reassignment surgery (p< 0.001; p=0.021 e p=0.049, respectively).

Conclusions: Body modification due to hormonal therapy causes positive, but moderately impact on the QoL of transgender patients. Sex reassignment surgery has a crucial impact on quality of life of transgender patients.

Disclosures:

Work supported by industry: no.

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Gender non-conforming men and women have higher tendencies for sexual promiscuity (#236)

K. Bártová (Czech Republic)
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236

Gender non-conforming men and women have higher tendencies for sexual promiscuity

Bártová, K1; Binter, J1; Breslerová, K1; Zunová, M1; Varella, M2; Varella Valentova, J3

1: Faculty of Humanities, Charles University in Prague, Czech Republic; 2: University of Brasilia, Institute of Psychology, Brazil; 3: Charles University in Prague and the Academy of Sciences of the Czech Republic, Center for Theoretical Studies, Czech Republic

Objectives: The main aim of this study was to test whether recalled childhood gender-nonconformity (CGN) influences individual sociosexuality, i.e. tendency to uncommitted sexual variability. We hypothesized that increased gender-nonconformity (femininity in men) would decrease sociosexuality in men, but (masculinity in women) increase sociosexuality in women, since sociosexuality is on average higher in men than in women.

Methods: The sample consisted of 248 Czech and Brazilian heterosexual men (mean age = 25.5 years, SD = 4.7), 301 homosexual men (mean age = 26.1 years, SD = 5.4), 475 heterosexual women (mean age = 24.8 years, SD = 4.8) and 118 homosexual women (mean age = 23.9 years, SD = 4.4) under 40 years of age. All participants filled in a standardized questionnaire on CGN and the revised Sociosexual Orientation Inventory (SOI-R with subscales: behavior, attitude and desire). We used partial correlations controlled for age to find associations between participants scores of CGN and SOI-R.

Results: Contrary to our prediction, results showed that the higher gender nonconformity, the higher SOI-behavior (p =.004) and total-SOI-R (p =.019) in heterosexual men, and the higher SOI-behavior (p =.010) and total-SOI-R (p =.016) in homosexual men. In heterosexual women, higher CGN increased SOI-desire (p =.011) and decreased SOI-attitudes (p =.001). Nevertheless, the results applied only to Brazilians, who overall reported lower CGN.

Conclusions: In line with previous research, more masculine heterosexual women reported higher sociosexual desire, which can be explained by androgen effects on sexual libido during early development, together with more masculine socialization and life-style in each culture. On the other hand, more feminine men regardless of their sexual orientation showed higher sociosexuality. We argue that more feminine men, who tend to be higher on social and communicative skills, can use these skills efficiently for flirting and social interactions related to mating, which, in turn, can increase their short-term sexual encounters. Nevertheless, this can be culturally specific, and the feminine-male tactic can work better in contexts where male femininity is relatively rare in the population.

Disclosures:

Work supported by industry: no.

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The importance of an interdisciplinary approach to patients with gender dysphoria and their families: A case report (#237)

M. Lerri (Brazil)
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237

The importance of an interdisciplinary approach to patients with gender dysphoria and their families: A case report

Lerri, M1; Romão , A1; Silva, T1; Santos, M2; Franceschini, S1; Yamaguti, E1; Ferriani, R1; Lara, L1

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

Objectives: To describe the interdisciplinary intervention used in mediate between the transsexual B (MtF) and her family.

Methods: B is currently 21 years old and was born with male genitalia, but regarded herself as a woman trapped in a male body. At age 18 years, B came to the University Hospital for hormone therapy (HT). She wanted to undergo sex reassignment surgery and was suffering from depressive symptoms since her parents did not accept her condition. B regarded herself as being in a foreign body and wanted her body to conform to her self-image. Her parents were hostile. Her father referred to her as an aberration of nature and was unable to understand why his son had chosen to dress as a woman. Her mother reported not understanding the "choice" made by her child. B insisted it was not a choice, that she was a woman born with the wrong body. The treatment process included an open interview, which was recorded and later analyzed. The theoretical framework supported by the literature highlighted the qualitative and exploratory nature of the approach used.

Results: Analysis of the interview revealed situations during which B felt humiliated and excluded, as well as the prevailing heteronormative position of the family. Family members were prejudiced and discriminatory, possibly due to their lack of knowledge about gender dysphoria. After the welcome by the psychologist, a medical gynecologist explained the biological implications of gender dysphoria to B and her parents and informed them of the need for HT to bring B to an adequate female phenotype. The parents cried a lot and asked for time to think. One month later, they returned and were interested in following the treatment of their daughter. A multidisciplinary team consisting of psychologists, gynecologists, physical therapists and psychiatrists began family therapy, based on guidelines and reflections on the role of the family in understanding and accepting B and to improve their quality of life. During these sessions, the parents showed empathy to the suffering of their daughter, accompanying her on all subsequent visits. B currently maintains a female phenotype, is dating men, and says she is very happy. She is waiting for gender reassignment surgery.

Conclusion: This study shows the effectiveness of interdisciplinary work and the value of including the family in addressing these problems and promoting the well-being of these patients.

Disclosures:

Work supported by industry: no.

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Awareness and knowledge of testicular torsion among male students of Babcock University, Ilisan-Remo, Ogun State, Nigeria (#238)

O. Solademi (Nigeria)
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238

Awareness and knowledge of testicular torsion among male students of Babcock University, Ilisan-Remo, Ogun State, Nigeria

Solademi, O1; Oshiname, F2

1: Adeleke University, Nigeria; 2: University of Ibadan, Nigeria

Objective: Testicular Torsion (TT) poses a serious health challenge to young men and it requires immediate medical attention. The rate of testicular loss dramatically increases if treatment is delayed beyond 4 to 6 hours of onset of symptoms. However studies related to the knowledge and awareness of TT among university students are not common in Nigeria. This study therefore assessed the awareness, knowledge and perception of TT among male undergraduates of Babcock University, Ilisan-Remo, Ogun state.

Material & Methods: A three-stage random sampling technique was used to select 500 male respondents across four faculties in the university. A validated questionnaire was used for collecting quantitative data. Descriptive, Chi-square and ANOVA statistics were used for data analysis.

Results: Respondents’ mean age was 21±3.2 years. Only 28.2% had heard about TT. Friends (10.4%), health workers (9.6%), books (6.0%) and magazine (4.8%) were among the sources of information about TT. Respondents’ overall mean knowledge score was 8.5±4.8; while the mean knowledge score by faculty, were Education & Humanities (8.2±4.9), Law & Security Studies (5.9±3.7), Management & Social Sciences (8.4±4.6), Science & Technology (9.1±5.0) (p<0.05). Fifty-eight percent perceived every male to be vulnerable to testicular pain and/or swelling. Majority (62.0%) perceived testicular pain to be a symptom of testicular disorder, while only 67.6% believed that swelling in the testes should be taken seriously. Few (18.2%) knew that testicular pain and/or swelling could lead to loss of testes. While only 0.4% had ever being diagnosed of having TT; 33.0% had ever experienced testicular pain and/or swelling and only 8.4% had ever visited a hospital immediately. Majority (73.0%) of respondents stated that they would visit the hospital immediately if they experience testicular pain and/or swelling in the future, while 11.6% would wait till the next day before visiting a healthcare facility.

Conclusion: Testicular pain and swelling are perceived by the participants to constitute a major reproductive health problem. Participants’ knowledge of testicular torsion was very low. Public enlightenment especially among males is recommended.

Disclosures:

Work supported by industry: no.

An interdisciplinary approach to treat a women with lifelong vaginismus: A case report (#239)

Lucia Lara (Brazil)
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239

An interdisciplinary approach to treat a women with lifelong vaginismus: A case report

Ramos, L1; Lara, L1; Pandochi, H1; Gorayebi, R1; Rosa-e-Silva, A1; Reis, R1; Romão, A1

1: Faculty of Medicine of Ribeirão Preto, Brazil

Introduction: According to diagnostic criteria, vaginismus is described as an involuntary vaginal muscle spasm that occurs with the attempt to introduce in the vagina: the finger, penis, tampon or speculum, interfering with sexual intercourse. Also, this spasm may occur when the woman anticipates vaginal introduction. Objective: The aim of this study was to demonstrate the interdisciplinary approach to a patient with vaginismus that resulted in an improvement of her quality of life.

Methods: A 32-year-old single woman with completed high education, working at a health care hospital, and lived with her parents, participate in this study. She was referred to the Outpatient Clinic of Human Sexuality due to the impossibility of performing a gynecological exam, as well as difficulty to engage in sex due to pain in an attempt to vaginal penetration. An interdisciplinary plan of intervention was structured, focusing on the reduction of the anxiety associated with sexual contact, as well as to diminish muscle contraction. The patient was monitored over a period of five months. The approach consisted of seven sessions of physiotherapy (one/ week), 40 sessions of psychotherapy of 40 minutes each, and weekly psychotherapy with 12 sessions of one hour each. The clinical management of her signs and symptoms involved the use of therapeutic resources such as: a) health education with information about genital anatomy, sexual response, and sexuality in general; b) information and guidance about the practice of erotic self-stimulation and sensory focalization in order to expand body and sensation awareness; c) relaxing training for physical sensations control triggered by anxiety and stress; d) rehabilitation of pelvic floor muscles; e) cognitive-behavioral techniques in order to induce changes in the dysfunctional thought associated with negative emotions; f) erotic reading in order to stimulate sexual fantasies.

Results: The following results were obtained: expansion of the strategies for coping with anxiety, reduction of the discomfort and pain associated with exercises and sexual contact, reduction of defensive behavior in the  gynecological position, expansion of the self-perception with positive consequences regarding self-concept and self-esteem, and expansion of the perception of sexuality transcending the limits of coitus.

Conclusion: Considering the multifactorial nature of human sexuality, the present report shows contributions of interdisciplinary practice to promote integral sexual health. Interdisciplinary approach is an important resource to promote sexual health beyond the pathological aspect, as such intervention includes sexual education so that individual may experience sexuality in a more complete and satisfactory manner.

Disclosures:

Work supported by industry: no.

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Psychological listening to partners of patients with excessive sexual impulse (#240)

M. Scanavino (Brazil)
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240

Psychological listening to partners of patients with excessive sexual impulse

Henckel, M1; Tanganelli, C1; Scanavino, M1

1: Hospital das Clínicas, Brazil

Objective: develop a research instrument of the major difficulties of partners of individuals with compulsive sexual behavior (CSB), through literature review and interviews of 16 partners.

Material and methods: 1) Literature review through query related articles in Lilacs, SciELO, and PubMed. 2) Psychological interviews of 16 partners in individual 60-minute sessions, focusing on psychological difficulties, along two years.

Results: 1) The search for articles resulted in very few sources for consultation. Observed lack of a literature that addressed the relationship between the partner and the individual with CSB. Among those articles relative to our objective, the following points were raised: major patterns of distress, primarily related to ambivalent emotions and the formation of an ambiguous loss are discussed as well as their implications on interpersonal, conjugal, and sexual life. The main difficulty was to make sense of the problem and share with others. 2) Through visits to partners the following difficulties were observed: the manifestation of an avalanche of emotions such as anger, resentment, ambivalence, guilt; the beginning of a process of elaboration of mourning for the mismatch between expected and experienced marital relationship (loss of confidence); the beginning of a process of redeeming himself.

Both methods gave a research protocol with closed questions assessing the following aspects: discovery and reactions; feelings of betrayal, sadness, shame, hatred; elaboration of mourning; separation; attitudes toward the partner (control; care); attitudes of identification, or compassion with the partner; history repeating in previous relationships; family history.

Conclusion: There is a lack of publications about the difficulties faced by a partner of a sexually compulsive individual. The proposed instrument will facilitate the identification of the major psychological difficulties, adopted attitudes and behaviors developed to deal with the crisis.

Disclosures:

Work supported by industry: no.

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When love is gone: A research in psychoanalysis about the pain of love (#241)

M. Baydoun (Brazil)
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241

When love is gone: A research in psychoanalysis about the pain of love

Baydoun, M1; Andrea Vieira de Medeiros, M2

1: Federal University of Rondônia, Brazil; 2: Federal University of Rondônia

Objectives: The research denominated “When Love is Gone: A Study with Young adults from Porto Velho-RO” has been developed since August 2013 by the Center of Studies and Researches of Subjectivity in the Amazons (CEPSAM). It aimed to shed light on the subjective nuances of the pain resulting from the loss of a beloved due to a separation or break-up. Such pain is psychoanalytically known as the pain of mourning, which sometimes seems to be cureless.

Method: The analysis was developed through a reflexive dialogue between the freudolacanian theories on mourning and melancholia and the case-studies of three subjects who were interviewed separately during three meetings each. The content of the interviews was categorized and interpreted following Bardin’s Content Analysis method. 

Results: The analysis stressed different mechanisms through which the subjects attempted to set themselves free from the excruciating psychic pain resulting from an undesired separation, one of which is to substitute the more profound psychic pain by a superficial physical one, made by mutilation. Sublimation is another way through which some subjects tried to deal with the pain of loss, which indirectly remits to a more structural and old pain: the pain of being- a kind of inherent internal emptiness that everyone tries to eradicate. Hence, an unwanted separation can shatter the fantasies and illusions of a perpetual state of content. As such, a certain period of time is necessary for the subject to uninvest the old fantasies and build new ones.

Conclusion: When love is gone, there is nothing much that a health professional can do in order to gather the scattered pieces of memories and fantasies. The haemorrhage is invisible. Only time will tell when the pain would be cured.  

Disclosures:

Work supported by industry: no.

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Sexual function of Brazilian female adolescents managed in a family planning clinic (#242)

M. Negri (Brazil)
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242

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

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

1: Universidade Federal de São Paulo, Brazil

Objectives: There are few studies on the sexual function of female adolescents in developing countries and it is unclear what are the most frequent sexual problems in this population. Our aim was to assess the rate of and identify possible risk factors for sexual dysfunction symptoms among Brazilian female adolescents in a family planning clinic.

Patient and Methods: This cross-sectional analytical study involved 128 sexually active female adolescents (13-19 years) who were using contraceptive methods. Participants were recruited from September 2012 to September 2013 at a public university family planning clinic. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. Women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The Chi-square and Student’s t tests were used to compare the characteristics of girls with and without sexual dysfunction symptoms. P < 0.05 was considered significant.

Results: The mean age of the participants was 17.4 ± 1.52 years and most were single, of mixed race, catholic and had between 8 and 12 years of formal education. Mean age at first sexual intercourse was 14.8±2.0 and 46% of them reported having had intercourse with 2 or more partners. The most popular contraceptive methods were condoms (31.25%) and combined oral contraceptives with condom (21.1%). The mean overall FSFI score was 26.6±5.7 and orgasm was the domain with the lowest mean score (3.9 ± 1.6). 38.3% of the adolescents (N=49) had total FSFI scores ≤ 26. Socio-demographic characteristics were similar among girls with and without sexual dysfunction symptoms. Adolescent who were using only condoms had the lowest mean overall FSFI scores (25.7±6.2).

Conclusion: There is a low prevalence of sexual dysfunction symptoms among Brazilian female adolescents, managed at a public family planning clinic. We could not identify risk factors for sexual dysfunction symptoms in this group of young women.

Disclosures:

Work supported by industry: no.

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Perception in relation to the first sexual intercourse at the center of reference and specialization in sexology of the Pérola Byington Hospital (CRESEX) (#243)

G. Silva (Brazil)
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243

Perception in relation to the first sexual intercourse at the center of reference and specialization in sexology of the Pérola Byington Hospital (CRESEX)

Silva , G1; Santana, T2; Monteiro, Q2; Farias, G3; Rossi, M2

1: Santa Casa de São Paulo Medical School, Brazil; 2: Pérola Byington Hospital ; 3: Pérola Byington Hospital

Object: To evaluated the perception in relation to the first sexual intercourse at the CRESEX in January to October of the year 2013.

Casuistic and Methods: We reviewed 50 files of women attended in the clinic of sexology. The interview is a standard questionnaire of the service and the data is about the feelings related to the first sexual intercourse. The possible answers are Poor, Good, or Do not know.

Results: The age group of the study was 6% for women 15-25 years, 30% 26-35 years 24% 36-45 years 28% 46-55 and 12% aged 56 years or older. Feelings related to first sexual intercourse 62% of women chose bad, 36% chose a good alternative and 2% did not know. Regarding the onset of sexual activity, 40% were between 15 and 18 years, 20% between 18 and 21 years, 14% 25-28 years 10% 22-25 years, and 16% above 25 years. 35% of the women interviewed associated the pain as the main factor to have been a bad perception of the first sexual intercourse.

Discussion: The positive or negative expectations about their first sexual intercourse can bring significant changes in the future sexual health of the women. Adolescents due to lack of knowledge, experience and counseling, may face serious health and social problems such as teenage pregnancy and sexually transmitted diseases (STDs). According to the literature, the age of first intercourse has decreased recently. Unwanted pregnancies often force teenagers to unwanted marriage or limit their opportunities for higher education or employment, predisposing them to dependency and decreased quality of life over the long term. To be most effective, sex education programs are necessary through a collaborative process among families, health professionals, educators, government officials and young people themselves. Early sexual intercourse results in high rates of pregnancy and abortion in adolescence, as well as increased risk of STDs. Countries that have sex education programs in educational institutions can achieve better results, with decreased fees. We noted that the vast majority of women studied had sexual initiation in adolescence and most of them had a bad perception of first sexual intercourse and linked this feeling to pain. The data suggest the importance of the implementation of institutional sex education programs, offering expertise to start healthy and pleasurable sexual activities, ensuring the prevention of unwanted pregnancy and STDs. The sex education programs are important to provide teens the knowledge about a healthy start sexual activity, and the prevention of unwanted pregnancy and STDs.

Disclosures:

Work supported by industry: no.

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Asexuality development among middle aged and older men (#244)

Y. Huang (China)
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244

Asexuality development among middle aged and older men

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

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

Objectives. To assess erectile function in middle-aged and older men with asexuality status and further analyze their specific reasons for this condition.

Material and Methods. Men who had regular sexual intercourse attempts (sex frequency≥1 time per month) were classified into mild erectile dysfunction (ED), moderate to severe ED and non-ED according to International Index of Erectile Function-5, and men having no sexual intercourse attempts for at least 6 months were defined as having an asexuality status. The risk factors associated with ED were collected in a sample of 1,531 Chinese men aged 40 to 80 years, and the self-report reasons for asexuality were recorded in asexual cohort individually. Comparative analyses and multivariate regression models were conducted among these groups.

Results. The prevalence rates of ED and asexuality status were 49.9% and 37.2%. The asexuality status group had higher risk factors than the moderate to severe ED group in terms of old age (age≥65, adjusted odds ratio (OR): 17.69 versus (Vs.) 7.19), diabetes (crude OR: 2.40 Vs. 2.36) and hypertension (crude OR: 1.78 Vs. 1.72). The specific reasons for the asexuality status were “erectile difficulty” (52.9%), “do not care about sexuality” (53.5%)”, “no longer necessary to have sexuality at this age” (47.7%), “severe stress” (44.4%), “severe fatigue” (26.3%) and “masturbation” (26.9%).

Conclusions. Men with an asexual status suffer from higher risk factors for ED than men with moderate to severe ED. The majority of this asexual status could be attributed to a full ED, although the reasons for this transient asexuality also involved sexual attitudes and interests, sexual partners and masturbation.

Disclosures:

Work supported by industry: no.

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Frequency of nocturnal emissions and its psychological consequences among sexually naïve religious teenagers (#245)

Ege Can Serefoglu (Turkey)
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245

Frequency of nocturnal emissions and its psychological consequences among sexually naïve religious teenagers

Yuruk, E1; Gul, A1; Serefoglu, E1

1: Bagcilar Training and Research Hospital, Turkey

Objectives: To assess the frequency of nocturnal emissions among sexually naïve religious teenagers.

Material and Methods: A questionnaire was developed and administered to students staying in a religious dormitory. Data regarding demographic characteristics, masturbation habit and frequency of nocturnal emissions were collected. Moreover, students were asked about their beliefs regarding masturbation and emissions.

Results: A total of 113 male students with the mean age of 15.88±1.47 (range: 13-20) years were included into the study. Of the students 46 (4.4%) reported that they have never masturbated and 19 (17.3%) have never experienced nocturnal emissions. Nocturnal emission frequency was not correlated with age (p=0.092). Having nocturnal emissions was also not related to the duration since last masturbation (p=0.479). Subjects watching TV more than 3 hours/day had nocturnal emissions more than the ones who watch TV less (p=0.006). Of the subjects, 13.6%, 12.6% and 67% believed that masturbation is good, permissible and sin, respectively whereas 59.1%, 20.4% and 7.5% believed that nocturnal emission is good, permissible and sin, respectively.

Conclusion: Although masturbation and nocturnal emissions are frequent among sexlly naïve religious teenagers, a significant amount of them believe that they are sins. Watching TV seems to be associated with the frequency of nocturnal emissions. Further studies are required to elucidate the mechanism of nocturnal emissions.

Disclosures:

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

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Female sexuality: Users’ profile of the family clinic Olímpia Esteves (#246)

J. Rodriques (Brazil)
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246

Female sexuality: Users’ profile of the family clinic Olímpia Esteves

Almeida, M1; Pinto, J1; Ribero, J1; Rodriques, J1; Santos, M1; Schetter, P1

1: Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Brazil

Objective: The Program of Tutorial Education: Women’s Health and Female Sexuality (PET), as the IFRJ’s Research Project, which is linked with the Ministry of Education, has been working with researches and sexual education groups for women. The objective of this work was identify the female population profile that frequents the Family clinic Olímpia Esteves, as the development of their sexuality and create a data bank for researches and activities of extension for the PET group.

Material and Method: It's about quantitative qualitative research, and as a research tool, was used a structured interview. We investigated groups of women by age group, dividing them into four groups (adolescents, adults, pregnant women and post climacteric). The interviews were realized in the Family clinic. For the analysis was used the Collective discourse and as an analysis instrument we used the system QualyQuantiSoft version 1.6c build(2).

Result: It is known that the passage of adolescence and youth for adulthood is, yet, marked by significant and combined changes of personal, social, psychological and physiological order, not always harmonious and peaceful. It’s observed that the majority of the women didn't have the perception of the changes in their bodies in the puberty period that reflects in their low self-esteem as adults. The Women, even feeling a little sexual desire for their partner, make sex for satisfy the partner. Most Women don't follow the Cycle of sexual answer of Master & Johnson.

Conclusion: It was found that among the various data analyzed to find the profile of women's sexuality, they still seek to be loved much more than physical sexual satisfaction seeking greater intimacy and emotional involvement. We verified the need for sex education for these women, in view of that they have no sense of their own sexuality independent of age.

Disclosures:

Work supported by industry: no.

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Workshops on sexuality for elderly women: Sharing experiences and knowledge (#247)

M. Almeida (Brazil)
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247

Workshops on sexuality for elderly women: Sharing experiences and knowledge

Almeida, M1; Pinto, J1; Ribeiro, J1; Rodriques, J1; Santos, M1; Schetter, P1

1: Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Brazil

Objectives: We aim to promote sex education in elderly women participating in our extension project, recognizing the consequences of their relations in the family, employment and society, listening and granting them the word, building spaces for dialogue, both individually as well as group, so that there is a deepening in experience, greater understanding of the issue and a collective exchange of experiences among women themselves, facilitate the acquisition of new concepts, changes in behavior and lifestyle.

Material and Methods: We made a questionary for survey data in order to draw  the profile of the women participants of the workshops, the fellows conducted home visits to the application of research document. Five meetings of two hours each were performed weekly. With an average of twenty participants. The methodology was used with dynamic, video presentations and a space of reflection for women. For the workshops registration we used a Field diary and as evaluation, a qualitative questionary.

Results: It was observed in each workshop, moments of great emotion, sharing experiences of private life. Many women associate happiness with the importance of family, others the beauty, faith, religion, and physical activity. Women showed satisfaction with self-image and declare themselves happy with life. Some admitted that they never used condoms. Those without a steady partner admit the importance of using it, but they said that while they were married, they also didn't use it. As we teach the importance of exercises for the pelvic floor, some declared that they know, but they didn't know their efficacy, perhaps because they had never realize it.

Conclusion: Socializing with other women of the same age was reported as positive thing, as well the exchange of experiences and discussions are relevant to the daily lives of these women. The subjects were seen in a mature and responsible manner, with a look of interest. We realized that the best way to bring knowledge to those women was raising questions and generating discussion among them about the various topics covered.

Disclosures:

Work supported by industry: no.

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Proposal for a psychoeducational intervention on difficulties in romantic relationships, sexual risk behavior and sexual dysfunctions in patients with Severe Mental Illness Rehabilitation Center and Hospital Day (CRHD) IPq-HCFMUSP. (#248)

M. Scanavino (Brazil)
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248

Proposal for a psychoeducational intervention on difficulties in romantic relationships, sexual risk behavior and sexual dysfunctions in patients with Severe Mental Illness Rehabilitation Center and Hospital Day (CRHD) IPq-HCFMUSP.

Vieira, J1; Scanavino, M1

1: Hospital das Clinicas - FMUSP, Brazil

Objective(s): Individuals with Severe Mental Illness (SMI) present difficulty to maintain a main partner, sexual dysfunctions, and to HIV risk behaviors. We aim to develop a specific intervention on sexual health for people with SMI.

Material and Method(s): a literature review was conducted in the following databases: PubMed, SciELO, Google Scholar. For the construction of the proposed psychoeducational intervention 31 articles and 2 books,, 5 manuals and 3 websites (on STD / HIV / AIDS, family planning and prevention strategies) were consulted. Main results of searches:1) a few articles involving specific sexual health interventions for individuals with SMI were found; 2) Those studies described interventions ranging between three and 15 sessions, in mixed or separated by gender groups, which main themes involved sexual anatomy, development of behavior strategies toward romantic encounters, sexually transmitted diseases (STDs), HIV transmission, safer sex practices, negotiation of condom use, sexual response, and contraception. The main methods used were lectures, tests, games, videos, group discussion, strategy training, safer sex workshops and role play.

Result(s): Based on the literature consulted, we drafted an an intervention consisting of 10 sessions of 60 minutes each involving 12 themes, which were organized as: 1st meeting:  (1) the Brazilian Sexual Behavior.. (2) Physiology and Anatomy 2nd meeting: (3) male (Masters and Johnson) and female sexual response (Basson). (4) Sexual dysfunctions; 3rd meeting: (5) STDs / HIV / AIDS transmission and prevention; 4th meeting: (6) Sexual Risk Behavior (7) Contraceptive Methods (8) Working assertiveness in negotiating the use of condoms; 5th meeting: (9) Stigmas: Mental Illness and Sexuality: (10) How to find a romantic partner? ; 6th meeting: (11) Effects of Mental Illness on sexuality (12) Effects of the use of medication on sexuality; 7th meeting: dynamic about relationships; 8th meeting: Review on the previous sessions; 9th meeting: dynamics involving negotiation of condom use; 10th meeting: Revision. The methods are lecture, videos, group discussions, dynamic, and workshop including materials such as rubber penis, etc.. All sessions will be directed by a nurse familiar with Sexual Health.

Conclusion(s): The intervention includes the difficulties on romantic relationships, sexual dysfunctions and sexual risk behaviors for individuals with SMI.

Disclosures:

Work supported by industry: no.

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Sex addiction: Fact or fiction (#249)

D. Lin (USA)
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249

Sex addiction: Fact or fiction

Lin, D1; Bergel, A; Gerz, E

1: Mount Sinai Beth Israel, United States

Objective: To determine whether hypersexual behavior can appropriately be characterized as an addiction, or rather, a symptom or manifestation of a co-existing Axis I or Axis II Disorder.

Material and Method: A literature review is being conducted to explore these opposing viewpoints. Articles published from the year 2000 to present relating to the topic of sex addiction/ hypersexuality/ sexual compulsivity/ impulsivity are reviewed.

Results: The concept of sexual addiction was introduced in the 1970‘s. Two schools of thought have. Proponents of sex "addiction" argue that the neurochemical changes associated with hypersexual behavior are quite similar to that of drug addiction. They argued that sex "addicts" can experience a psychological withdrawal as experienced by those addicted to drugs of abuse. Some proponents of sex addiction even advise a 12-step treatment program. Critics of sex addiction argue that increased sexual activity is a way of alleviating affective symptoms, or is reflective of the impulsivity, associated with concomitant Axis I or Axis II pathology. They postulate that treating the underlying psychiatric disorder would ameliorate hypersexual behavior.

Discussion: Despite standard, and even increasing use of the term "sex addiction" in media and popular culture, mental health professionals remain divided in regards to this subject. The proposed inclusion and subsequent rejection of hypersexual disorder in DSM-V highlights this existing debate. The notion of hypersexual behavior as an addiction warrants further exploration, especially since how it is defined may dictate treatment modality.

Disclosures:

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

Implementation of a multidisciplinary sexual counseling service (#250)

Monica Santos Lopes (Brazil)
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250

Implementation of a multidisciplinary sexual counseling service

Pinto, J1; Santos, M1; Ribeiro, J1; Almeida, M1; Rodrigues, J1; Schettert, P1

1: Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Brazil

Objectives: The "Multidisciplinary Sexual Counseling Service" project aims to guide customers to see themselves as individuals with a focus on developing their sexuality, with sex education actions, emphasizing health promotion through disease prevention and sexuality development. In addition, the project aims to identify partners and resources in the community that can be leveraged by the team of the Clinical School of the Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro (IFRJ) (Federal Institute of Education, Science and Technology) – Realengo Campus.

Material and Methods: The service will be available twice a week. A specific sexuality case history will be held for each user. We will hold a weekly staff meeting in which we will define the best approach strategies and plan the activities to be performed on the day. At first, eight weekly consultations, each of them 40-minute-long, will be available for users originating from established referral and counter referral flows with education and healthcare units.

Results: Since this is a pioneering project, the results will be obtained over the development of the activities, but we already have a set manual, and established Reference and Counter Reference flows with education and healthcare units from the extension activities in sex education for groups of women.

Conclusion: This pioneering proposal goes beyond classes or groups of sex education; it is characterized as a scheduled offer, under the perspective of integral health, to one of the most weakened matters in society, thus taking care of individuals in an equanimous manner.

Disclosures:

Work supported by industry: no.

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Sexual psychotherapy and actual mismatchs (#251)

V. Menezes (Brazil)
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251

Sexual psychotherapy and actual mismatchs

Menezes, V1

1: Consultório de Psicologia Vitória Menezes, Brazil

Objective: To argue the challenges imposed to sexual psychotherapy by the evolution of the social mismatchs. Material and Methods: This is a qualitative etnographic research, based on appointments of the pschotherapist understandings about client’s environment, aggregated during systemic attendance, recorded from 1990 to 2014, at sexual psychotherapy setting, after each consultation.

Results: It is consensual to admit the human sexuality as a biossocial cultural psychological phenomenon. As to biologic point of view, the human being was never been analyzed as nowadays. On the counterpart, the body is suffering as we have never view, because they do not sleep, they have no leisure, they lack training. The investment on his/her and on the other is denied. The exercise of fantasy, obviously, is decreasing. Social network represents the great change in interpersonal communication at present. It moves away who is near, and approaches who is distant. Sons are third rated. Fusion is confounded with intimacy. The World Health Organization alerts that depression in the fifth major public health problem. Sexuality is composed of rubbing and fantasy. Sons as “I want it all now” probably will experience difficulty to discover pleasure, simply due to lack of training. The absence of family may be the item that causes the major prejudice to sexuality. Clients are lost and they look for solutions. These solutions are always searched with the same hurry already familiar to them, with no reflection. And professionals experience also frustration because the apparent (or not) inefficiency on their work and not only derived of a mere repetition of the famous technics of distant 60’s. Sex is much more than performance. Who has lived positive experiences, probably will take profits, finding more easily sexual maturity, because we can not forget that sex is an expression of life. 

Conclusion: Sexual psychotherapy has solid bases, from Sexual Therapy proposed by Master & Johnson, but nowadays it claims to a new, deeper and systemic approach, which must respect the personal “difficulties”  of each couple, as a result of the actual biosocial cultural and psychological context, which requires of professionals an incessant training and qualification to rethink that sex is, today, probably the unique and last opportunity for “no outsourcing” the human being. To live his/her sexuality, the humans need to be fully present, to negotiate, to concede, to fantasy, to gain and to loose, to respond personally to the results. 

Disclosures:

Work supported by industry: no.

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Biological and social profile of victims of sexual violence assisted by the HMIPV (#252)

S. Scalco (Brazil)
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252

Biological and social profile of victims of sexual violence assisted by the HMIPV

Scalco, S1; Grecco, C2; Daniela, K3

1: UFRGS, Brazil; 2: HMIPV, Brazil; 3: UFRGS

Context: sexual violence is a cruel and persistent worldwide epidemic. It occurs in a number of social contexts and its main victims are women and children. SV has a severe impact on quality of life and may have a series of physical, psychological and ethical consequences, so that health services are often involved in the treatment and counseling of its victims. Furthermore, SV perpetuates a violent and patriarchal social culture and is therefore a serious concern at societal level.

Purpose: the goal of the present study was to assess the biological and social profile of victims of SV assisted by a multidisciplinary health team in a public hospital in Porto Alegre, in a service targeted specifically at this population.

Material and Methods: this was a cross-sectional retrospective study. Data were collected using a specially designed questionnaire, based on an instrument used to collect patient data in the hospital’s Gynecology and Obstetrics emergency service, the Pediatric Emergency service and the STD/SV Outpatient Clinic. All women admitted to the hospital between 01/01/2011 and 01/01/2012 were eligible for study participation. Male patients, children below 12 years of age and individuals who were not victims of SV were excluded from participation.

Conclusion: the present study found significant differences between the characteristics of victims of chronic and acute SV which suggested relationships between the age and education of victims and type and duration of the abuse to which they were more vulnerable.

Disclosures:

Work supported by industry: no.

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Impact of sexual activity on HbA1c levels in patients with type 2 diabetes mellitus after penile prosthesis implantation (#253)

R. Talib (Qatar)
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253

Impact of sexual activity on HbA1c levels in patients with type 2 diabetes mellitus after penile prosthesis implantation

Talib, R1; Canguven, O1; Al Ansari, A1

1: Hamad Medical Corporation, Qatar

Objective: According to previous studies, average sexual activity ranks as mild to moderate in terms of exercise intensity. Regular exercise that consists of different types including aerobic and resistance training was found as associated with haemoglobin A1c (HbA1c) reduction in patients with type 2 DM. The objective of this study was to examine the benefits of sexual activity on HbA1c in penile prosthesis implanted patients with type 2 DM.

Material and Methods: Sixty-seven male subjects who had HbA1c levels of  ≥6.5% before and could perform regular sexual activity after the implantations were enrolled. The contribution of sexual activity on glycemic control assessed by HbA1c level as well as age, duration of DM and frequency of sexual activity were evaluated.

Results: Mean age and mean time from the surgery of the study patients was 59.9 years (range: 30-82) and 22.6 months (range: 10-63), respectively. The average of penile prosthesis usage for sexual activity was 9.9 times per month (range: 2-28). Compared with the pre-implantation, the absolute mean change in HbA1c after penile prosthesis implantation was found as -0.2% (p>0.05). This study also revealed that more sexual activity was associated with more reduction in HbA1c.

Conclusion: The present study demonstrated that sexual activity was associated with HbA1c reduction, which is clinically important in patients with type 2 DM after penile prosthesis implantation.

Disclosures:

Work supported by industry: yes, by Hamad Medical Corporation Research Center (industry funding only - investigator initiated and executed study).

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Diagnostic manual for sexology DMS III (#254)

Fernando Bianco (Venezuela)
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254

Diagnostic manual for sexology DMS III

Bianco, F1

1: CIPPSV/IIP, Venezuela

Objectives: To present a Classification of Sex and Sexual Disorders.  THE MDS III 

Methods: Sexology have become an independent field (WAS 1989). One of his areas is Clinical Sexology. We develop from FLASSES (1991) and lately from WAMS (2009) and AISM (2010) a Classification of Sex and Sexual Disorders –MDS III- which started as a work of few and now a large group of clinician are involved. Each disorders was clinically described and tested using an objective Medical History apply in the field of Medical Sexology

Results: A Classification with 18 Codes for the Disorders of the Sex Development Process, 64 Codes for the Disorders of Sexual Function Process and 24 Codes for Others suggested Disorders.

Conclusions: The MDS III so far has proven to open an operative communication between clinicians and will help to do more homogenous research.

Disclosures:

Work supported by industry: no.

Semantic conceptualization related to sexual medicine, sexual therapy, clinical sexology and sexual health. A study in health sciences students of the Universidad de Guadalajara, México (#255)

O. Matsui-Santana (Mexico)
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255

Semantic conceptualization related to sexual medicine, sexual therapy, clinical sexology and sexual health. A study in health sciences students of the Universidad de Guadalajara, México

Matsui-Santana, O1; Villaseñor-Farías, M1; Flores-González, L1; Lomelí-Garza, J1; Cortés-Campos, G1; Guillén-Rico, L1

1: Universidad de Guadalajara, Mexico

The Universidad de Guadalajara, in the state of Jalisco, is the second largest university of Mexico. It has five campuses with an undergraduate medical education program, which comprise a total of 5,587 medical students; plus 1,585 other medical students from a private university which is incorporated to the University of Guadalajara system with the same study program. An obligatory Human sexuality course has been included in this Medical program since 1996, which is shared with other students in health sciences careers. An academic reform of this medical program, starting for the fall semester 2014, has included an additional required course on sexual medicine, exclusively for medical students at the 7th semester.

Objective: The aim of this study is to explore meanings and conceptual conflicts related to sexual medicine among health sciences university students at the campus Guadalajara.

Material & Methods: Application of a questionnaire, which includes stimuli words such as sexual medicine, sexual therapy, clinical sexology and sexual health, was applied to medical students and from other health sciences careers. Stimulus definitions were analyzed using a technique known as semantic networks.

Results: Differences were found by sex, careers and the condition of having taken the introductory course of human sexuality prior to the application of the instrument. As expected, the analysis showed several conflicts for the meanings or concepts for the stimuli words; also they do not have clear which type of professional should attend different sexual health problems.

Conclusion: Concepts related to sexual medicine, sexual therapy, clinical sexology and sexual health, seem to be unclear among medicine students, which stands for needed more specific knowledge, attitudes and skills in sexual medicine for general physicians training in order to be more prepared to meet society demands for their sexual health. These results are needed to elaborate the Sexual Medicine course program for medical students at the Universidad de Guadalajara, Mexico.

Disclosures:

Work supported by industry: no.

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Improvement of metabolic syndrome (MetS) parameters in 362 obese hypogonadal men upon long-term treatment with testosterone undecanoate (TU) injections: Observational data from two registry studies (#256)

F. Saad (Germany)
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256

Improvement of metabolic syndrome (MetS) parameters in 362 obese hypogonadal men upon long-term treatment with testosterone undecanoate (TU) injections: Observational data from two registry studies

Saad, F1; Haider, A2; Yassin, A3; Doros, G4; Traish, A5

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: Institute for Urology and Andrology, Germany; 4: BU School of Public Health, USA; 5: BU School of Medicine, USA

Objective: To assess changes in metabolic syndrome parameters in hypogonadal men under long-term treatment with testosterone undecanoate (TU) injections.

Material and Methods: From two cumulative registry studies, 362 men with obesity grade I (BMI 30-34.9), grade II (BMI 35-39.9) and grade III (BMI ≥ 40 kg/m2) were selected. All men received TU for up to 6 years. 

Results: Grade I (n=185, mean age: 58.4±8.0 years): Glucose (mg/dl) decreased from 107.22±30.2 to 97.87 ±14.42 (p<0.0001), change from baseline -8.37±1.83 mg/dl, HbA1c (%) from 6.58±1.24 to 5.6±0.76, change from baseline -1.05±0.06%. Total cholesterol (TC; mg/dl) decreased from 268.43±44.24 to 191.47±16.8, LDL (mg/dl) from 158.75±32.82 to 116.26±34.65, triglycerides (TG; mg/dl) from 257.49±62.1 to 193.23±29.01. HDL (mg/dl) increased from 46.53±15.93 to 56.09±15.71. The TC:HDL ratio declined from 6.39±2.41 to 3.64±0.87 (p<0.0001 for all). Systolic blood pressure (SBP; mmHg) decreased from 143.96±15.09 to 130.11 ±8.95, diastolic blood pressure (DBP) from 85.54±10.84 to 78.23±5.82. Grade II (n=131, 60.6±5.6 years): Glucose (mg/dl) decreased from 114.17±27.04 to 99.3±11.49 (p<0.0001), change from baseline -14.83 ±2.19 mg/dl, HbA1c (%) from 7.63±1.31 to 5.9±0.73, change from baseline -1.69±0.07%. TC (mg/dl) decreased from 292.23±41.07 to 196.78±19.85, LDL (mg/dl) from 174.5±28.46 to 125.86±35.8, TG (mg/dl) from 292.12 ±61.15 to 194.19±20.66. HDL (mg/dl) increased from 57.35±19.17 to 67.41±18.82. The TC:HDL ratio declined from 5.86±2.76 to 3.2±1.12 (p<0.0001 for all). SBP (mmHg) decreased from 159.15±14.71 to 135.26±10.97, DBP from 95.02±11.86 to 79.66±4.96. Grade III (n=46, 60.3±5.4 years): Glucose (mg/dl) decreased from 115.48 ±23.85 to 96.54±2.9 (p<0.0001), change from baseline -18.48±2.96 mg/dl, HbA1c (%) from 7.57±1.38 to 6.08±0.5, change from baseline -1.61±0.13%. TC (mg/dl) decreased from 306.76±43.03 to 192.23±9.17, LDL (mg/dl) from 190.57±36.6 to 136.24±28.07, TG (mg/dl) from 326.87±60.21 to 194.4±12.59. HDL (mg/dl) increased from 62.76±18.7 to 72.55±13.34. The TC:HDL ratio declined from 5.47±2.57 to 2.75±0.59 (p<0.0001 for all). SBP (mmHg) decreased from 161.04±14.3 to 142.05±9.57, DBP from 97.07±10.91 to 80.89±6.76.

Conclusions: All changes were meaningful and sustained for the full observation time. TRT seems to be effective to improve MetS and cardiovascular risk profile in obese hypogonadal men.

Disclosures:

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

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A rare case of prolactinoma causing erectile disfunction in a young man (#257)

E. Andrade Dias Coutinho de Souza (Brazil)
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257

A rare case of prolactinoma causing erectile disfunction in a young man

Andrade Dias Coutinho de Souza, E1; Julio Junior, H1; Schiavini, J1; Damião, R1; Cruz, D1

1: UERJ, Brazil

Objective: To report an atypical case of erectile dysfunction secondary to prolactinoma in a young patient. 

Materials and Methods: Retrospective analysis of a patient with erectile dysfunction secondary to a prolactinoma treated at uro-andrology service of Pedro Ernesto University Hospital (RJ), in January 2014. This 43 year old male patient was complaining of erectile dysfunction for seven years, worsening in the last year (IIEF-5: 9). He showed no decrease in libido or other complaints. Physical examination showed galactorrhea in the left breast, without any genital abnormality. An initial evaluation with plasma glucose, lipid profile and total testosterone was started.

Results: Laboratory initial exams showed a decreased level of total testosterone (43ng/mL), therefore others hormonal exams were requested, that revealed an increased level in serum prolactin (1329ng/mL). After that, the patient performed a sella magnetic resonance imaging (MRI) that identified a prominent expansive mass capturing contrast, measuring about 3,2 x 2,7 x 2, 2 cm, with its epicentre in the sella turcica. After diagnosis of prolactinoma, the patient was also referred to endocrinology and neurosurgery for evaluation, beginning clinical treatment with cabergoline 4 times per week. Currently, the patient is still using cabergoline, with improvement of serum prolactin level (200,4ng/mL). However, there has been no improvement in the overall level of testosterone (40ng/mL) and IIEF-5.

Conclusion: In this case the patient received cabergoline with improvement of prolactin, without benefits in the overall level of testosterone and IIEF-5. It is imperative to follow a protocol in the erectile dysfunction complaint, even in young patients, so that atypical cases are not neglected. Clinical treatment is accomplished through the use of dopamine agonists and, if not successful, the treatment can be surgical. If even after treatment hypogonadism persists, the use of testosterone may be necessary.

Disclosures:

Work supported by industry: no.

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Erectile dysfunction and HIV infection (#258)

S. Cedres (Uruguay)
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258

Erectile dysfunction and HIV infection

Cedres, S1; Puppo, D1

1: Uruguay

A high proportion of male patients with HIV infection suffer from sexual dysfunction (erectile dysfunction or low sexual desire) that decrees their quality of life (1).

Objective: To evaluate the degree of sexual dysfunction in a population of men with HIV, and make the correlation with demographic, immunological and treatment characteristics.

Methods: The analyses include 47 men with HIV infection assisted in ambulatory service of the Infection Institute, using an anonymous questionnaire, the International Index of Erectile Function-5 (IIEF-5), and Test of Sexual Desire of Masters & Johnson. Regression analysis was used to determine the correlation among the variables.

Results: The mean age of the patients was 42.13 years; there were 31 cases of erectile dysfunction and 39 cases of low sexual desire.  36 were treated with active antiretroviral treatment (HAART). There was statistically significant correlation between sexual dysfunction and : age, homosexual contact as HIV transmission mode,  symptomatic infection, use of tranquillizers, low cultural level, no stable couple, smokers, CD4 cell count < 200 cells/mm, viral load >30.000 and treatment containing protease inhibitors (PI). (p< 0.05).

Conclusion: The etiology of SD is often multifactorial, and may be caused by endocrinological, psychogenic, neurogenic arteriogenic or iatrogenic abnormalities. Results of this study suggest that erectile dysfunction and low sexual desire are also found in patients who are on HAART, specially if their regimens contain PI. Physicians need to talk about sexual issues with their patients, in order to improve the sexual well being.

Disclosures:

Work supported by industry: no.

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Clinical study of erectile dysfunction using color-flow doppler with intracavernous prostaglandin E1 injection (#259)

T. Yun (Korea)
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259

Clinical study of erectile dysfunction using color-flow doppler with intracavernous prostaglandin E1 injection

Yun, T1; Jeon, H1; Sohn, D2

1: Manomedi urologic Clinic, Korea, South; 2: The Catholic University of Korea

Objective: Doppler evaluation in erectile dysfunction(ED) has a significant role in determining the cause of ED. We evaluate the contributing factors and etiology of ED using penile duplex Doppler ultrasonography

Materials and Methods: We examined 42 patients with ED. All patients were assessed by history, laboratory studies and Doppler sonography after intracavernosal injection of 10 µg PG E1. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were measured. Then ultrasonographic diagnosis of ED were classified as arteriogenic ED and veno-occlusive ED.

Results: The mean age of patient was 47±9.9 years and 41% of the patients had contributing factors (Hypertension 16%; Diabetes 10%).  35% of the patients had vasculogenic impotence (arteriogenic 16%; venogenic 19%).

The mean PSV was 19±3.3cm/sec in arteriogenic, 32±4.3cm/sec in venogenic and 34±2.7cm/sec in normal vascular findings. The mean EDV was 0.9±1.3cm/sec in arteriogenci, 6.0±1.3cm/sec in venogenic and 1.3±1.4cm/sec in normal vascular findings. The mean RI was 0.9±0.06 in arteriogenic, 0.78±0.02 in venogenic and 0.94±0.04 in normal vascular findings.

Conclusion: Penile duplex Doppler ultrasonography may be useful in screening for vasculogenic impotence and establishing appropriate treatment plan.

Disclosures:

Work supported by industry: no.

Prevalence of erectile dysfunction in hemodialysis patients (#260)

M. Menjour (Tunisia)
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260

Prevalence of erectile dysfunction in hemodialysis patients

Menjour, M1; Ben Azouz, O1; Khedher, R1; Smaoui, W1; Ben Fatma, L1; Krid, M1; Zouaghi, K1; Beji, S1; Rais, L1; Ben Moussa, F1

1: Rabta Hospital Tunis, Tunisia

Objective: ED is difficult to diagnose and its prevalence in dialysis patients is unknown. The aim of this study is to determine the prevalence of sexual dysfunction among hemodialysis patients.

Material and Methods: We did a cross-sectional study aimed to assess the prevalence and risk factors associated with ED in dialysis patients. Eighteen dialyzed men >18 years old in Rabta hospital were included. ED was assessed using the abridged version of International Index of Erectile Function already validated in dialysis patients. A descriptive study was performed to identify the factors associated with ED in patients.

Results: The mean age of the patients was 46 ± 13 years (19-68 years) and the median dialysis follow-up was 5.1 years.  All ED was severe. The prevalence ED was 77.8% for all patients. The prevalence of ED was 62.5% in patients younger than 50 years and 90% in those 50 years or older. Three patients had ED before dialysis; they all had a urological disease. All patients with diabetic nephropathy have an ED. 64.2% of patients with ED has a depressive syndrome. Marital status, comorbidity, hemoglobin level, and use of antihypertensive drugs were not significantly different between patients with and without ED. Only 1 patient received treatment for ED and sought a consultation with an urologist.

Conclusion: ED should be screened in all chronic dialyzed because of its negative impact on the lives of patients. Its treatment requires a multidisciplinary approach and adequate psychological support.

Disclosures:

Work supported by industry: no.

The prevalence of erectile dysfunction at a primary healthcare clinic in Kwa Zulu Natal (#261)

Prithy Ramlachan (South Africa)
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261

The prevalence of erectile dysfunction at a primary healthcare clinic in Kwa Zulu Natal

Ramlachan, P1; Lockat, Y; Ross, A; Rungiah, C

1: Newkwa Medical Centre, South Africa

Objectives: The objectives of this study were to determine the prevalence of erectile dysfunction (ED) in men attending a primary healthcare (PHC) clinic in Durban, KwaZulu-Natal, and to document any relationship between ED and age, smoking, economic status and co-morbid conditions.

Design: An observational, descriptive, cross-sectional study.

Setting and subjects: More than 50% of men aged 40-70 years experience some degree of erectile dysfunction. However, no data is available on the prevalence of ED in a primary healthcare (PHC) setting in KwaZulu-Natal. Between February and March 2008, 1 300 questionnaires were distributed to men aged 18 years and older with no exclusion criteria, attending a general PHC clinic.

Outcome measures: Responses were captured using a validated structured questionnaire (International Index of Erectile Function-15).

Results: Eight hundred and three questionnaires were eligible for analysis. The overall prevalence rate of ED was 64.9% (521), of whom 22,5% (117) had mild ED, 30,7% (160) moderate ED, and 46,8% (244) severe ED. Erectile dysfunction increased with age, and there was a strong association between ED and economic status and co-morbid conditions.

Conclusion: The prevalence of ED at this urban PHC clinic was high. Increased awareness by doctors working in the clinic may result in improved assessment and appropriate treatment that will enhance patients’ quality of life.

Disclosures:

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

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Clinical analysis of the characterization of magnetic resonance imaging and endoscopic therapy in refractory hematospermia (#262)

Y. Li (China)
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262

Clinical analysis of the characterization of magnetic resonance imaging and endoscopic therapy in refractory hematospermia

Li, Y1

1: Daping Hospital, Third Military Medical University, China

ObjectivesTo assess the etiological diagnostic value of magnetic resonance imaging (MRI) by analysis of the pelvic MRI manifestations or characteristic changes around the ejaculatory duct area and to evaluate the therapeutic effect of transurethral minimally invasive endoscopic treatment in the persistent and refractory hematospermia patients who are ineffective to the conservative treatment.

Methods:The morphological features and characteristic changes around the area of the bilateral seminal vesicles (SVs) and ejaculatory duct (ED) in 76 patients with persistent and refractory hematospermia were retrospectively analyzed. All the 76 patients followed by undergoing transurethral minimally invasive endoscopic examination and treatment. The therapeutic effect was followed up, analyzed and summarized.

ResultsIt was found that 88.2% (67/76) patients with persistent and refractory hematospermia showed typical and characteristic changes in the ED and SVs area including 61.8% (47/76) patients showed the signal intensity changes in seminal vesicle;34.2% (26/76) patients showed significant cystic dilatation(the width of SV is bigger than 1.7cm or the diameter of the inner tubular structure is bigger than 5mm)in unilateral or bilateral SVs, with or without the internal signal intensity changes; 36.8%(28/76) patients showed the formation of cysts in the ejaculatory area such as prostatic utricular cysts in 27.6% (21/76) patients, Müllerian duct cysts in 3.9% (3/76) patients, Ejaculatory duct cysts in 3.9% (3/76) patients, and Seminal vesicle cyst in 1.3% (1/76) patient.11.8% (9/76) patients did not show any obvious abnormal changes in MRI. All the patients were successfully performed transurethral minimally invasive endoscopic. No obvious complications or carcinoma were found during and after the surgeries.The all patients were followed-up for 3-36 months. The hematospermia and related symptoms were disappeared after surgery, except for two patients experienced recurrence of hematospermia after 5 and 11 months, underwent the same treatment and recovered during the followed-up period. The urination and ejaculation are usually as well as before surgery. 97.4% (74/76) patients have normal orgasm and pleasant sensation after surgery, except two old patients complained that slightly decreased.

ConclusionThe three-dimensional MRI has significant etiological diagnostic value and provides reliable information for the subsequent treatment. The transurethral endoscopic technique is a simple, safe, reliable and effective treatment method for the patients with persistent and refractory hematospermia.

Disclosures:

Work supported by industry: no.

Clinical review of patient perceptions in switching from on demand to daily dose Tadalafil for erectile dysfunction (#263)

V. Bhatia (UAE)
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263

Clinical review of patient perceptions in switching from on demand to daily dose Tadalafil for erectile dysfunction

Bhatia, V1

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

Objective: Phosphodiesterase 5 inhibitors (PDE5i) are the established first line therapy for most cases of erectile dysfunction(ED).It is estimated that 20-30% of ED patients may drop out and discontinue the usage of these drugs. This study aims to evaluate the patient perspective of discontinuation of on demand Tadalafil 20 mgm and switching to daily Tadalafil 5mgm for ED.

Material & Methods: The study comprises 72 men with median age 56 years suffering from ED of average 1.6 years duration. Co-morbidities included-Hypertension(46%),Diabetes(38%),Dyslipidemia(32%) and Smoking(28%)The primary indication for usage of on demand Tadalafil 20 mgm was ED. All the patients had used 20mgm Tadalafil on demand on more than 8 occassions over the last 3 months.

Results: Thirty eight out of 72 men opted to discontinue on demand 20mgm Tadalafil and switch to daily dose 5mgm Tadalafil.A detailed interview was conducted to identify the reasons for this switch over. The salient factors were-1) Unsatisfactory clinical response to on demand dose (42%), 2)Adverse effects with on demand dose(22%), 3)Concomitant improvement in LUTS (44%), 4)Economic factors-daily dose therapy is cheaper than on demand (14%), 5) Freedom of spontaneous sexual activity with daily dose(36%),6) Patient perception of daily dose as a long term cure for ED (26%), 7)Combination of above factors (78%). Overall 76% of patients planned to continue daily dose Tadalafil 5 mgm.

Conclusion: Daily dose Tadalafil 5mgm appears to be preferred by patients over on demand 20 mgm Tadalafil for ED treatment.

Disclosures:

Work supported by industry: no.

Incidence of erectile dysfunction (ED) and ED medication use in a large screening population (#264)

W. Poage (USA)
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264

Incidence of erectile dysfunction (ED) and ED medication use in a large screening population

Poage, W1; Crawford, E1; Stone, N2

1: Prostate Conditions Education Council / University of Colorado HSC, United States; 2: Prostate Conditions Education Council / Mount Sinai, United States

Objectives:  To investigate the factors that influencing erectile function (EF) and ED medication use in men who had health assessment during the nationwide prostate cancer awareness weeks (PCAW) in 2011 and 2012.

Materials and Methods: 9288 men who attended PCAW in 2011-2012 filled out a health assessment which included the 25 point sexual health inventory (SHIM) and ED medication use. Associations between total SHIM score, age, race, exercise frequency, body mass index (BMI), low testosterone (T<300 ng/dL), heart disease (HD) and diabetes (AODM) were tested by ANOVA. The effect of multiple variables on SHIM score was determined by logistic regression. Differences between ED medication use and attendee characteristics was determined by chi-square analysis (Pearson).

Results: The mean age was 62 years (median 61.7, range 19-99), BMI 28.1 kg/m2 (median 27.3, range 12.9-88.4), T 361.1 ng/dL (median 329, range 21-2411) and SHIM score 17.9 (median 20, range 1-25). SHIM score < 17 was present in 3274 (35.2%). SHIM was highest in Blacks (p<0.001), with more frequent exercise (p=0.001), lower BMI (p<0.001), high T (p=0.024), lower age (p<0.001) and absence of HD and AODM (p<0.001).  Linear regression demonstrated only age, HD and AODM (all p<0.001) as significant predictors of higher SHIM. Of the 9288 men, 1817 (18.7%) reported use of ED medication. ED medication use was Viagra 46.8%, Cialis 18.9%, Levitra 6.2%, herbs 7.8%, other 12.6% and combination 7.7%. ED medication was most frequently used by Blacks (22.2% vs 17.9% for White, p<0.001), with increasing age (p<0.001) and in men with AODM (23.2% vs. 18.2%, p<0.001). Men with high BMI or HD did not report higher ED medication use. Of the ED medications Viagra was used more by Whites than Blacks (50.3% vs 33.9%, p<0.001) while the use of herbs was highest in Asians (29.6% vs 10.9% in Whites, p<0.001).

Conclusions: ED medications were used by about 50% of men indicating ED by SHIM score (<17). Viagra was the most frequent medication used and of the ED medications was most often used by Whites. Blacks reported use of ED medication more frequently than other races. Overweight men and those with HD, who have higher frequency of ED, did not report more medication use than men with lower BMI or those without HD.

Disclosures:

Work supported by industry: no.

Minimal clinically important differences (MCIDs) improvement of the IIEF-Erectile Function domain is a proxy of patient weaning from Tadalafil OaD in men with psychogenic erectile dysfunction - Realistic picture from the everiday clinical practice (#265)

P. Capogrosso (Italy)
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265

Minimal clinically important differences (MCIDs) improvement of the IIEF-Erectile Function domain is a proxy of patient weaning from Tadalafil OaD in men with psychogenic erectile dysfunction - Realistic picture from the everiday clinical practice

Capogrosso, P1; Boeri, L1; Colicchia, M1; Ventimiglia, E2; Serino, A1; La Croce, G2; Castagna, G1; Russo, A1; Damiano, R3; Montorsi, F1; Salonia, A1

1: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; 2: Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; 3: Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy

Objectives: Assess efficacy, treatment satisfaction and erectile function (EF) confidence in a cohort of patients with pure psychogenic erectile dysfunction (ED) treated with tadalafil 5mg once daily (Tad OaD).

Methods: Data from 100 consecutive patients seeking first medical help for pure psychogenic ED throughout the last 24 months were analysed. Tadalafil 5mg OaD was prescribed to all patients for not less than 6 months. Patients completed a baseline IIEF before therapy and at survey. Patients were requested to complete a non-validated questionnaire assessing compliance to and subjective satisfaction over the prescribed therapy. Descriptive statistics and logistic regression models tested patients compliance to and efficacy of long-term treatment with Tad OaD [also considering MCIDs criteria].

Results: Overall, 30 (30%) patients refused to answer at the survey. Of the remaining 70 patients, 57 (57%) did use the treatment as prescribed, while 13(13%) patients did not even start the therapy. Thirty (52.6%) of the total amount of patients taking Tad OaD discontinued the therapy at the end of the first 6 months course; conversely, 27 (47.4% )kept taking the drug over the prescribed course. Mean IIEF-EF significantly improved for both groups at FU evaluation (p<0.001). Overall, 32 (60.4%) patients showed a significant improvement also according to MCIDs criteria. Of those patients who tooktadalafilOaD34 (63%) thought to be able to get successful erections dismissing Tad OaD at some point throughout the course of therapy, even with 15 (45.5%)who considered that option after 1 month since therapy began. Younger (≤40 yrs) and healthier patients (CCI<1) thought more often to may dismiss the therapy during treatment (chi2 4.0; p<0.05; chi2 4.191;p=0.04). Conversely baseline IIEF-EF did not influence patient behaviour over treatment drop-off. At multivariate analysis, EF improvement according to MCIDs criteria was significantly associated with patient’s subjective feeling of independence from Tad OaD (OR 6.7; p=0.01).

Conclusions: Our findings showed that Tad OaD significantly improved EF of patients with psychogenic ED. Of all, 63% of patients were confident of having full erections after drug discontinuation. Conversely, almost half of them did not discontinue the therapy after the first prescription of 6 months. MCIDs improvement of IIEF-EF was a proxy of patient weaning from Tad OaD continuous treatment.

Disclosures:

Work supported by industry: no.

show poster

Penile rehabilitation following radical prostatectomy is not common among Japanese Urological Association members (#266)

K. Matsushita (Japan)
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266

Penile rehabilitation following radical prostatectomy is not common among Japanese Urological Association members

Matsushita, K1; Tai , T2; Nagao , K2; Mulhall , J3

1: St. Lukes International Hp / Juntendo University School of Medicine, Japan; 2: Toho University School of Medicine, Japan; 3: Memorial Sloan-Kettering Cancer Center, USA

Objective: Despite the fact that the benefits are still unclear, penile rehabilitation after radical prostatectomy (RP) has become the standard of care for many urologists. Given the lack of definitive proof regarding the benefits, however, a standard program or optimal algorithm does not exist. Furthermore, financial, insurance, and cultural considerations might cause regional differences in the practice of penile rehabilitation. We sought to explore contemporary trends in penile rehabilitation practice patterns of Japanese Urological Association (JUA) members.

Material & Methods: The proprietary questionnaire was comprised of 35 questions that addressed practitioner demographic factors and current practice status regarding rehabilitation. The questionnaire was mailed to all the representatives of urology departments authorized by the JUA.

Results: 376 physicians completed the questionnaire, representing a response rate of 31%. Twenty percent of the responders were members of the Japanese Society for Sexual Medicine (JSSM), 10% had formal sexual medicine specialty training, 68% were urologic oncology specialists, and 91% performed RP. Of the responders, 47% were not aware of the concept of penile rehabilitation and 29% performed some form of rehabilitation. As part of the primary rehabilitation strategy, 97% used phosphodiesterase type 5 inhibitors (PDE5i), 8% used a vacuum device, 13% used intracavernosal injections (ICI), and 2% used intra-urethral prostaglandin. Twenty percent commenced rehabilitation immediately after urethral catheter removal, and 36% within the first three months after RP. 37%, 21%, and 18% ceased rehabilitation at ≤12, 13-18, and 19-24 months, respectively. Six percent rehabilitate all RP patients, 94% only do it with selected patients. For 76%, selection for rehabilitation was dependent upon patient age, 72% upon nerve-sparing status, 70% upon preoperative erectile function, and 39% upon comorbidity. With regard to the primary reason for not performing rehabilitation: 52% said they were not familiar with the concept; 22% said patients could not afford it, and 22% gave another reason. Performing rehabilitation was positively associated with being a member of JSSM (P < 0.001), seeing post-RP patients (P < 0.001), sexual medicine specialty training (P < 0.001), being a urologic oncologist (P = 0.01), performing RP (P = 0.034), and surgeons using the laparoscopic or robotic-assisted approach (P < 0.001).

Conclusion: Among the respondents, penile rehabilitation is not common. The most commonly employed strategy is PDE5i use and ICI were not in common use. Clinicians who are engaged in the field of sexual medicine and see a lot of such patients are more likely to use rehabilitation practice.

Disclosures:

Work supported by industry: no.

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Efficacy study of Iodenafila carbonate in patients with erectile dysfunction carriers of chronic renal failure undergoing hemodialysis (#267)

I. Moreira (Brazil)
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267

Efficacy study of Iodenafila carbonate in patients with erectile dysfunction carriers of chronic renal failure undergoing hemodialysis

Moreira, I1; Cardoso, R1; Silva, B1

1: UFAL, Brazil

Objective: This study aims to evaluate the effectiveness of iodenafila carbonate in patients with erectile dysfunction, heterossexual, with a fixed partner in the last six months, patients with chronic renal failure submitted to hemodialysis.

Material and Methods: 76 patients on hemodialysis for more than six months, older than 18 and who have erectile dysfunction were evaluated in three hemodialysis centers in the State of Alagoas, by applying the International Index of Erectile Function (IIEF-5). Patients included in the study were randomized to receive active medication, lodenafil carbonate (80mg) or placebo and instructed to keep sexual relations twice a week. The revaluation occurred with 7, 14 and 30 days, by IIEF-05 and checked for the presence of side effects. Were available for each patient four boxes, identified by a number corresponding to the patient. In each consultation was given a box containing one blister, consisting of 2 tablets. The patient was instructed to use 1 tablet 1 hour before each intercourse, totaling two sexual relationships during each week. The chi-square test was used to compare the comorbidities, characteristics of the population studied, as well as the relationship between the use of active medication or placebo with the IIEF-05. Values of p <0.05 was considered significant.

Result: The prevalence of effectiveness of iodenafila carbonate in patients with chronic renal failure submitted to hemodialysis was significant (62%). The population studied showed, in general, low side effects. Being 11% of those who partook of the lodenafil carbonate (80mg) have nausea.

Conclusion: The evaluation after the specified period showed that the use of lodenafil at a dose of 80 mg presented a statistically significant improvement in erectile function compared to placebo-treated group.

Disclosures:

Work supported by industry: yes, by Laboratório Cristália (industry funding only - investigator initiated and executed study).

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Role of nocturnal penile tumescence and rigidity in response to daily sildenafil in patients with erectile dysfunction due to pelvic fracture urethral disruption: a single-center experience (#268)

Bing Gao (China)
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268

Role of nocturnal penile tumescence and rigidity in response to daily sildenafil in patients with erectile dysfunction due to pelvic fracture urethral disruption: a single-center experience

Peng, J1; Zhang, Z1; Gao, B1; Cui, W1; Yuan, Y1

1: Peking University First Hospital, China

Introduction: Erectile dysfunction (ED) is common in patients with pelvic fracture urethral disruption (PFUD). ED in these patients is almost organic and in some patients, the disease is refractory to phosphodiesterase type 5 (PDE-5) inhibitors. The selection of optimal therapy is important. The causes of ED have been used as a referred parameter to select therapy; however, the cause may be indefinite. In this retrospective study, we aimed to find an optimal variable to guide therapy choice.

Materials and methods: We included 38 patients with ED due to PFUD who were evaluated subjectively and objectively by the International Index of Erectile Function 5 (IIEF-5), Nocturnal Penile Tumescence and Rigidity (NPTR) test and penile Doppler ultrasonography. 31 patients received daily sildenafil 50mg for 3 months and were followed up. Patients reported successful vaginal penetration and intercourse were considered to respond to daily sildenafil treatment.

Results: In total, 54.8% of patients showed response to sildenafil defined as reporting successful vaginal penetration and intercourse. Patients with neurogenic, arterial and venous ED did not differ in efficiency rates (P=0.587). However, the penile erectile rigidity recorded by NPTR test affected efficiency significantly (P=0.046). Patients with tip rigidity >40% had the highest response rate (76.9%), but the response rate for patients with tip rigidity <20% was only 22.2%.

Conclusion: NPTR recording can reveal resident erectile function in patients with ED due to trauma and is significant for selecting pharmacological treatment as optimal therapy.

Disclosures:

Work supported by industry: no.

Data on the utilization of treatment modalities for erectile dysfunction in Taiwan in the era of phosphodiesterase type 5 inhibitors (#269)

W. Tsai (Taiwan)
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269

Data on the utilization of treatment modalities for erectile dysfunction in Taiwan in the era of phosphodiesterase type 5 inhibitors

Tsai, W1; Jiann, B2

1: Mackay Memorial Hospital, Taiwan; 2: Kaohsiung Veterans General Hospital, Taiwan

Objectives: Oral phosphodiesterase type 5 (PDE5) inhibitors, intracavernosal injection, and penile implants are mainstay treatments for erectile dysfunction (ED). We report utilization data and user characteristics for these modalities in Taiwan between 1999 and 2011. Usage data are important to guide health care expenditure and may help clinicians understand the market and consumer behavior and to identify influencing factors.

Materials and Methods:We collected sales data on the PDE5 inhibitors and medications of intracavernosal injection from Intercontinental Marketing Services Health. The data of penile implants was collected from the local importing company. Demographic and clinical data of patients were obtained retrospectively through medical chart review. The χ2-test was used to compare categorical parameters and analysis of variance (ANOVA) was used to compare numeric parameters.

Results: Between 1999 and 2011, sales of PDE5 inhibitors increased 5.9-fold, whereas those of alprostadil and penile implants remained stable. Discontinuation of treatment with PDE5 inhibitors or intracavernosal injection reached 90% within 3 years of treatment initiation. The age of patients who first received PDE5 inhibitors for ED showed a tendency to decrease over consecutive years, with a mean age of 65.1 years in 1999 and 53.7 years in 2011.

Conclusions:The increasing market for PDE5 inhibitors reflects both their global acceptance as the primary treatment for ED and the growing burden of ED. The mean age of patients who first receive treatment with PDE5 inhibitors has decreased over consecutive years, reflecting increased public awareness and recognition of the advantages of PDE5 inhibitors.

Disclosures:

Work supported by industry: no.

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The NPT in the diagnosis of male erectile dysfunction (#270)

Z. Bing (China)
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270

The NPT in the diagnosis of male erectile dysfunction

Manbo, J1; Liuhong, C1; Bing, Z1; Jun, C1; Tao, Q1; Bo, W1; Xiaoming, L1

1: The Third Affiliated Hospital of Sun Yat-Sen University, China

Objective: To evaluate the application and limitation of nocturnal penile tumescence ( NPT ) in forensic identification for male erectile dysfunction.

Methods: This was a retrospected analysis. From 2006 to 2013, totally 137 men complaining erectile dysfunction came to our department for forensic identification .The relationship between the injured area,the result of NPT and the clinic diagnosis were analyzed.

Results: 75% of pelvic fractures with urethral injury lead to organic ED. results of NPT with organic ED is significant correlation (r = 0.665), the positive rate can reach 100%. There are 8 cases with normal NPT results were diagnosed with organic ED, 1 case of paraplegic, 2 cases of brain injury result in cognitive dysfunction, 5 cases have limitation of length and the angle of erection.

Conclusion: (1) Pelvic fractures with urethral injury are prone to having organic ED. (2) NPT could reflect the penile hardness and is an important tool for forensic identification for male erectile dysfunction, but no help for diagnosis of the length and angle during erection,to improve the level of forensic clinical identification, we need to take comprehensive examination according to the actual condition of patient. (3) ED is a comprehensive diagnosis, basing on penile hardness, erectile angle and penile length.

Disclosures:

Work supported by industry: no.

The sexy singer and dancing sex: relationships between sexuality and musicality in women (#271)

J. Varella Valentova (Czech Republic)
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271

The sexy singer and dancing sex: relationships between sexuality and musicality in women

Varella , M1; Varella Valentova, J2

1: University of Brasilia, Brazil; 2: Charles University in Prague, Czech Republic

Objectives: We aimed to explore whether self-promotion through musicality is related to sexuality in young adult women. We predicted that women more prone to masturbation and intercourse would be more prone to singing and dancing.

Material and Methods: Participants were 40 Czech university students with mean age 22.43 years (SD= 2.42). They answered an anonymous questionnaire about their sexual activities, in particular number of sexual partners, age of first intercourse, masturbation, and vaginal orgasm, actual frequency of masturbation and of sexual activities. They also reported their motivation, frequency and experience of singing and dancing in public, and also the quality of their display. 

Results: Several sexuality measures correlated in the predicted direction with both dancing and singing measures. In particular, women with higher experience with both singing and dancing in public reported higher number of sexual partners, higher frequency of masturbations and lower age of first masturbation and of vaginal orgasm. Lower age of the first vaginal orgasm also negatively correlated with the self-rated quality of singing, and singing creativity. Dancing frequency further correlated with masturbation frequency. Quality of singing correlated with frequency of actual sexual activities, and women with more formal education of singing and dancing reported higher frequency of masturbations and lower age of first masturbation.

Conclusions: Higher sexual libido in women seems to be positively related with singing and dancing proficiency.

Our results indicate that the sexual libido can increase tendency towards self-promoting ornamented activities, as well as self-promoting activities can increase sexual opportunities, desires, and self-esteem. Although more research is needed, encouragement of singing and dancing in women can promote more active sexual life, which might be of interest to counseling professions dealing with frequent low sexual desire and activity in women.

Disclosures:

Work supported by industry: no.

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Improvement of erectile function by testosterone treatment in hypogonadal men are independent of age and sustained for up to 6 years (#272)

F. Saad (Germany)
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272

Improvement of erectile function by testosterone treatment in hypogonadal men are independent of age and sustained for up to 6 years

Saad, F1; Haider, A2; Yassin, A3; Doros, G4; Traish, A5

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: Institute for Urology and Andrology, Germany; 4: BU School of Publica Health, USA; 5: BU School of Medicine, USA

Objective: To assess whether effects of long-term treatment with testosterone undecanoate (TU) injections on erectile function in hypogonadal men are dependent on age.

Material and Methods: 561 hypogonadal men from two urology offices in Germany were enrolled into independent observational registry studies following the same protocol. We performed a pooled analysis of men ≤65 years of age (Group Y) and men >65 years (Group O) of age from both registries. All men received TU injections for up to 6 years. IIEF-EF (maximum score: 30, according to Cappelleri et al., Urol 1999) was assessed at baseline and every 3 months. Our calculations were based on annual averages.

Results: Group Y (n= 450, mean age: 56.10±6.29 years; minimum: 32, maximum: 65): IIEF-EF improved from 14.94±7.34 at baseline to 19.23±5.94 after 1 year, 21.58±5.72 at 2 years, 22.57±5.53 at 3 years, 22.98±5 at 4 years, 23.39±4.96 at 5 years, and 24.21±4.39 at 6 years. Changes were statistically significant vs baseline at each year (p<0.0001) and at 2 years vs. 1 year (p<0.0001), 3 years vs. 2 years (p<0.0001), 4 years vs. 3 years (p=0.0071) and sustained thereafter. The model-adjusted mean change from baseline was 8.53±0.26.

Group O (n=111, mean age: 68.45±2.91 years; min.: 66, max.: 84): IIEF-EF improved from 11.87±7.58 at baseline to 16.79±6.35 after 1 year, 18.71±6.75 at 2 years, 19.46±6.62 at 3 years, 19.95±7.19 at 4 years, 20.16±7.11 at 5 years, and 22.12±6.41 at 6 years. Changes were statistically significant vs baseline at each year (p<0.0001) and at 2 years vs. 1 year (p<0.0001) and sustained thereafter. The model-adjusted mean change from baseline was 8.12±0.59. - A limitation of our study was that we did not record any changes in use of PDE5 inhibitors. At baseline, 55 patients (10%) were on a PDE5 inhibitor.

Conclusions: As expected, erectile function was slightly better in younger hypogonadal men compared to older hypogonadal men. Improvement under long-term testosterone treatment was in the same magnitude in both groups. In younger men, changes occurred over a period of 4 years. In contrast, changes in older men were most pronounced during the first 2 years of treatment. Most importantly, once improvements were achieved, they were sustained for the full observation period. T therapy seems to be effective to improve and maintain erectile function in hypogonadal men, independent of age.

Disclosures:

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

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Improvement of erectile function in hypogonadal men with obesity grades I to III upon long-term treatment with testosterone undecanoate (TU) injections (#273)

F. Saad (Germany)
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273

Improvement of erectile function in hypogonadal men with obesity grades I to III upon long-term treatment with testosterone undecanoate (TU) injections

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

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

Objective: To assess erectile function in obese hypogonadal men under long-term testosterone (T) therapy.

Material and Methods: Single-center, prospective, cumulative registry study of 340 hypogonadal men. 237 men with obesity grade I-III were selected. All men received TU injections for up to 7 years. IIEF-EF domain (6 items, maximum score: 30, according to Cappelleri et al., Urol 1999) was filled in at each three-monthly visit.

Results: Grade I (n=103, mean age: 58 years): Mean IIEF-EF improved from 19.76±5 to 25.76±3.43, mean change from baseline: 5.02. The increase was statistically significant vs. baseline each year (p<0.0001) and vs. previous year for the first two years after which it was sustained. In 48% of men, IIEF-EF improved by 1 category, in 21% by 2 and in 4% by 3 categories. 27 men remained within the same category, 3 men’s scores of whom 2 had discontinued T therapy due to a diagnosis of prostate cancer dropped by 1 category. 50% achieved normal erectile function. Grade II (n=98, mean age: 60 years): Mean IIEF-EF improved from 19.98±4.52 to 26.38±1.3, mean change from baseline: 5.1. The increase was statistically significant vs. baseline each year (p<0.0001) and vs. previous year for the first two years after which it was sustained. In 48% of men, IIEF-EF improved by 1 category, in 20% by 2, in 6% by 3 and in 1 man by 4 categories. 22 men remained within the same category despite slight improvements in score, 2 men’s scores of whom 1 had discontinued T therapy due to a diagnosis of prostate cancer dropped by 1 category. 57% achieved normal erectile function. Grade III (n=36, mean age: 60 years): Mean IIEF-EF improved from 20.78±4.3 to 26.88±1.36, mean change from baseline: 5.1. The increase was statistically significant vs. baseline each year (p<0.0001) and vs. previous year for the first three years after which it was sustained. In 56% of men, IIEF-EF improved by 1 category, in 22% by 2 and in 6% by 3 categories. 5 men remained within the same category despite slight improvements in score, 1 man’s score dropped from 26 to 25 changing from “no ED” to “mild ED”. 56% men achieved normal erectile function.

Conclusions: Improvements in erectile function were clinically meaningful and significant during the first 2 to 3 years of T therapy and sustained during the full treatment duration. They were independent of obesity grade. It may be necessary to continue T therapy for 2 to 3 years before an optimal response is achieved.

Disclosures:

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

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Longitudinal changes of free testosterone levels with aging in Japanese men from a community-based longitudinal study (#274)

A. Takayanagi (Japan)
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274

Longitudinal changes of free testosterone levels with aging in Japanese men from a community-based longitudinal study

Takayanagi, A1; Kobayashi, K1; Fukuta, F1; Matsuki, M1; Matsuda, Y1; Masumori, N1

1: Sapporo Medical University School of Medicine, Japan

Objective: It is well known that the male testosterone level is reduced with aging. Although there was a report that evaluated normal free testosterone levels in healthy Japanese men, there has been no report about their longitudinal changes of free testosterone levels. We previously reported the longitudinal changes of sexual function of Japanese men. We concluded that their sexual function declined with aging and erectile rigidity was most correlated with aging. In this study, we evaluated the longitudinal changes of the free testosterone level and its relationship with sexual function in Japanese men.

Material and Method: From 1992 to 1993, we conducted a cross-sectional community-based study on sexual function as well as lower urinary tract symptoms in Japanese men aged 40-79 years. After 15 years, a follow-up study was conducted to determine longitudinal changes of their sexual function. Of the 319 participants in the initial study, 135 participated again in the follow-up study. Sexual function was assessed in the two studies using the same questionnaire and serum free testosterone levels were also measured in both studies.

Result: Of the 135 participants, 127 were eligible for evaluation. The median ages of the participants in the initial and follow-up studies were 57 and 71 years old, respectively. The median free testosterone levels in the initial and follow-up studies were 12.1 pg/ml and 4.1pg/ml, respectively. The free testosterone level decreased in men of each age decade (40s, 50s, 60s and 70s) of the initial study, and the median decreases of free testosterone were 9.0 pg/ml, 7.9 pg/ml, 7.8 pg/ml and 7.9 pg/ml for those in their 40s, 50s, 60s and 70s, respectively. These decreases of free testosterone levels were not significantly different among the age decades (p=0.71). When we evaluated the relationship between decreases of free testosterone levels and decline of sexual function by aging, we could not find a significant relationship between these changes.

Conclusion: We found steadily decreased serum free testosterone levels of Japanese men in all age decades in a community-based longitudinal study.

Disclosures:

Work supported by industry: no.

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Factors affecting adherence to testosterone replacement therapy (#275)

Ege Can Serefoglu (Turkey)
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275

Factors affecting adherence to testosterone replacement therapy

Gul, A1; Berktas, M2; Yuruk, E1; Muslumanoglu, A1; Serefoglu, E1

1: Bagcilar Training and Research Hospital, Turkey; 2: Yeditepe University Pharmacoeconomics and Pharmacoepidemiology Research Center, Turkey

Objectives: In spite of the wide-spread use of testosterone replacement therapy (TRT), there is limited data regarding the patients’ satisfaction and adherence to the treatment. The purpose of this study is to evaluate the factors which may have an impact on patients’ adherence to TRT prescribed for hypogonadism.

Materials and Methods: In this retrospective study, patients who had been prescribed testosterone gel therapy between January and September 2013 were retrospectively evaluated and their demographics were recorded along with their testosterone levels. Afterwards, those patients were reached via telephone and asked whether they still continue TRT and their reasons for quitting treatment were noted.

Results: Of the screened patients, 60 men with a mean age of 40.9±9.9 (range: 21-59) years were prescribed daily transdermal testosterone gel 50 mg during the given period. Baseline total testosterone levels of 50 men (83.3%) were below 2.5 ng/ml. Of the patients, 31 (51.7%) could be reached via telephone and accepted to participate to the study and only 7 (11.7%) were still using TRT. The reasons for quitting TRT were no efficacy (18.3%), physicians’ recommendation (6.7%), deciding to stop after beneficial effect (5.0%) and other reasons (10%). Kaplan Meier estimation revealed that mean time to TRT withdrawal was 5.9±0.9 months. Parametric survival model using Frechet distribution revealed that neither being older than 45 years nor having lower testosterone level has an effect on adherence (P=0.528 and P=0.641, respectively).

Conclusion: Although testosterone gels are frequently prescribed by the physicians, patient adherence is low and being older or having low testosterone level does not affect patients’ satisfaction. Sexual medicine specialists are suggested to evaluate their patients carefully in terms of benefits and risk of TRT before prescribing these gels.

Disclosures:

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

show poster

Testosterone deficiency in Argentina (#276)

Edgardo Becher (Argentina)
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276

Testosterone deficiency in Argentina

Lopez Silva, M1; Becher , E1; Nolazco, C1; Alvarez Albero, A1; Calabia, P1; Fabre, B1; Grosman, H1; Mazza, O1

1: Hospital de Clinicas Jose de San Martin, Argentina

Objectives: Testosterone Deficiency (TD) is a syndrome that presents with symptoms of hypogonadism and low blood testosterone levels. The primary objective was to establish the incidence of TD in a group of individuals during a prostate awareness week campaign. Secondarily, the predictive potential of the Morley´s questionnaire, the relationship between the severity of prostate symptoms and hormonal values, and the relationship between metabolic syndrome (MS), Body Mass Index (BMI) and lipids with testosterone levels.

Methods: Cross sectional analysis in a group of 474 individuals among 2,906 who attended a prostate awareness week campaign in Buenos Aires, Argentina answered the Morley’s and International Prostate Symptom Score (IPSS) questionnaires, underwent a physical examination and blood levels of sex hormones, lipid profile and Prostatic Specific Antigen (PSA) were measured. The presence of MS was assessed according to the criteria of the ATP III.

Results: Age: 59,26 (31-85)  Incidence of TD was 9.51% . Morley´s Question 1 had greater statistical power to TD (p 0.01). There was no difference in the severity of IPSS (p> 0.05) between groups with normal or low testosterone. The presence of MS was significantly higher (p <0.0001, p <0.01) in the group of patients with lowered testosterone.

Conclusions: In our population we found an incidence of TD 9.51%, a positive relationship between low testosterone and increase in metabolic risk factors. Not all questions which generated a positive Morley´s questionnaire have the same value in predicting low Testosterone.

Disclosures:

Work supported by industry: no.

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A possible relationship between serum sex hormones and lower urinary tract symptoms in men that underwent transurethral resection of prostate (#277)

J. Qi (China)
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277

A possible relationship between serum sex hormones and lower urinary tract symptoms in men that underwent transurethral resection of prostate

Wu, Y1; Wang, W1; Xu, D1; Bai, Q1; Zhang, L1; Gu, Z1; QI, J1

1: Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China

Objective: In this study we searched for a possible relationship between sex hormone levels and the lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) that underwent transurethral surgery.

Material and Methods: The study was conducted in 158 patients who were coming to our hospital for surgery. Clinical conditions were assessed by body mass index (BMI), digital rectal examination, International Prostate Symptom Score (IPSS) and transrectal ultrasonography (TRUS). Sex hormones (including total testosterone (TT), estradiol (E2), progesterone (P), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin (PRL)) and prostate-specific antigen (PSA) were measured before the operation. Correlations were determined using univariate and multivariate regression analysis.

Results: The mean age was 72 ± 9 years. The total IPSS was significantly associated with the TT level (r=-0.206, P=0.01). Other sex hormone levels were not correlated with total IPSS. However, some interesting ratios such as E2/T (r=0.227, P=0.004) and FSH/LH (r=-0.166, P=0.038) were associated with total IPSS. Further analysis showed that the subscore (nocturia) was associated with age (r=0.161, P=0.044), BMI (r=0.210, P=0.008), TT (r=-0.192, P=0.016). Moreover we divided all the patients into two subgroups on the basis of IPSS severity (<20 or >=20). The mean TT level was in the normal range but that it was significantly related to the presence of severe LUTS.

Conclusions: In our study, the severity of LUTS was not associated with serum levels of sex hormones in men that underwent transurethral surgery, except for TT. Endogenous testosterone may play a beneficial role on lower urinary tract function. The potential mechanisms need more additional large studies.

Disclosures:

Work supported by industry: no.

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Luteinizing hormone level predicts the efficacy of testosterone replacement for late-onset hypogonadism (#278)

A. Abdelhamed (Japan)
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278

Luteinizing hormone level predicts the efficacy of testosterone replacement for late-onset hypogonadism

Abdelhamed, A1; Hisasue, S1; Shirai, M1; Matsushita, K1; Kimura, M2; Ide, H2; Muto, S2; Yamaguchi, R2; Tsujimura, A1; Horie, S1

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

Objective: Several predictors were proposed as the predictors for the efficacy of testosterone replacement (TRT) for late-onset hypogonadism (LOH); however, it is still unclear. In the current study, we evaluated the predictors for the TRT efficacy for LOH.

Materials and Methods: We evaluated the patients who presented at our men’s health clinic between July 2010 and March 2012. Of these patients, 212 with the data available before and after TRT were enrolled into this study. We evaluated free testosterone (fT) level and luteinizing hormone (LH) level in the morning, questionnaires of aging males symptoms scale (AMS), sexual health inventory for men (SHIM), and international prostate symptom score (IPSS). We defined AMS <26 as normalization after TRT, and carried out multivariate analysis using logistic regression for the efficacy of TRT with the parameters of age, fT, LH, IPSS, SHIM, and AMS.

Results: Median age of the patients was 55 years (range: 28 to 81). Mean fT level was 6.14±0.265 pg/ml (mean±SEM) and mean LH level was 6.57±0.477mIU/ml. IPSS, AMS total and each domain score of sexual, somatic, and psychological were significantly improved after TRT.(p<0.001, Student’s t-test) Logistic regression analysis revealed that baseline LH was the significant predictor.

Conclusions: Our study suggested that low LH level seemed to relate to the severity of LOH. The low LH level might predict the low response to TRT for LOH. We should give an attention to the LH level of the patients with LOH symptoms as well as testosterone level.

Disclosures:

Work supported by industry: no.

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Changes of sexual activity, hormones and epileptic seizures in a woman with adrenal adenoma (#279)

V. Matulevicius (Lithuania)
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279

Changes of sexual activity, hormones and epileptic seizures in a woman with adrenal adenoma

Matulevicius, V1; Ostrauskas, R1; Ciaplinskiene, L1

1: Lithuanian University of Health Sciences, Lithuania

Objective: To report a case of androgen secreting adrenal adenoma with clinical manifestations of suddenly appeared amenorrhea, hirsutism, seizures, weight gain and decreased sexual activity before with complete recovery and even increase of sexual activity at 12 months after surgical removal of the tumor.

Material and Methods: Presentation of clinical case with comments. Clinical and laboratory, hormonal and imagine investigations were run as performed usually at Kaunas Clinics. Sexual function was evaluated using The Female Sexual Function Index (FSFI).

Results: Seizures, amenorrhea, weight gain and hirsutism suddenly appeared in 38-year-old fertile woman, followed by decrease of sexual activity. Right adrenal tumor was detected. Plasma concetrations of dehidroepiandrosterone-sulfate (DHEA-S) and testosterone (T) were strongly elevated. Surgical removal of the adenoma was performed what conditioned decrease of DHEA-S, T and other hormones in 2-24 hours for the level of adrenal insufficiency. After 1 month all the hormones returned to normal level and were maintained at this level for 12 months after operation. Menses reappeared in 6 weeks. Seizures has not been presented. Sexual function investigation indicate that woman was at sexual dysfunction risk (FSFI total score26.55) 1 month before the operation (score-19.0) and 1 month after the surgical removal (score-25.0). Women reported the best sexual function 12 months after the operation (score-33.3). Desire, arousal and orgasm scores appears to be increased 6 months after the operation if compared to the situation before the manifestation of the disease, 1 month before the operation and 1 month after the surgical removal. Following the surgery, arousal, lubrication, orgasm and satisfaction scores did not differ during the period from 6 to 12 months. On the long term follow-up after the operation desire score was equal to desire score before the manifestation of the disease.

Conclusions: We discuss the complete recovery of a 38-year-old woman after removal of DHEA-S and testosterone secreting adrenal adenoma. Decreased sexual activity at high endogenous concentrations of DHEA-S, T and increased to higher than predisease level at 12 months after removal of adrenal androgen secreting tumor is suggestive for androgen receptor mediated down and up – regulation of sexual activity in middle-aged women.

Disclosures:

Work supported by industry: no.

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Testosterone therapy and improvement of sexual function in men with parcial androgen decline (#280)

S. Cedres (Uruguay)
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280

Testosterone therapy and improvement of sexual function in men with parcial androgen decline

Cedres, S1; Arroyo, C1

1: Uruguay

Introduction: The decrease of plasma testosterone (T) in old age may be inherent to the aging process or secondary to environmental factors. This is called “PADAM” (Partial Androgen decline in the aging male), defined as bioavailable testosterone (BT) < 0,75 ng/ml(1). The Androgen replacement therapy has demonstrated great improvement of quality of life and sexual function (2).

Methods: We determined plasma T, luteinizing hormone (LH) and calculated the BT of patients that consulted for sexual dysfunction without severe prostatic disease, and not using potentially interfering medications. The aims were to determine the presence of PADAM, to find a relation with chronic illness, to study the changes in sexual function and to determine the presence of adverse effects (benign prostate hyperplasia, polycythaemia, changes liver function tests or in lipids test) after 6 injections of Testosterone enanthate (250 mg) in oil vehicle deep intramuscular. Sexual function was assessed with the International Index of Erectile Function and the Sexual Desire Test at baseline and after treatment.

Results: 92 patients consulted for sexual dysfunction, and 72 had PADAM (mean age 58 years). There were considerable comorbidities: 54/72 (FR=0.75) stress, 51/72 (FR=0.70) type 2 diabetes, 50/72 (FR=0.69) smokers, 48/72 (FR=0.67) social alcohol ingestion, 28/72 (FR=0.39) cardiac failure, 10/72 (FR=0.14) renal insufficiency and 49/72 (FR=0.68) overweight. The duration of sexual complains was on average 2.5 years. 70/72 were hipergonadotropic hipogonadism (high LH). In all patients serum testosterone levels were restored to normal within 4 weeks. All of them reported a significant improvement in all domains of erectile function and sexual desire after treatment (p<0.005 – Wilcoxon pairs range test).

After treatment, no significant changes were noticed in serum PSA, liver function, lipids tests, haemoglobin or haematocrit.

Conclusions: All patients with sexual dysfunction need to be screened for hipogonadism. Testosterone supplementation improves sexual function in all of them.

Disclosures:

Work supported by industry: no.

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Full biochemical diagnosis of hypogonadism at the first visit including LH – Experience of an andropause clinic (#281)

J. Drouin (Canada)
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281

Full biochemical diagnosis of hypogonadism at the first visit including LH – Experience of an andropause clinic

Drouin, J1

1: Laval University Hospital Center, Canada

Introduction: Recommendations have been published on hypogonadism.  However, no international consensus on diagnosis and follow up exist. The andropause clinic in Quebec has decided to establish its own consensus based on Quebec expert opinion from different specialties.  

Current recommendations suggest that a biochemical diagnosis be conducted during the first visit (Total testosterone; TT) and the second visit if TT is moderately low or borderline (TT, Sex Hormone Binding Globulin, calculated Free Testosterone, Luteinizing Hormone [LH] and prolactin in some Bioavailable Testosterone). Serum LH is recommended to distinguish between primary (testicular) and secondary (pituitary-hypothalamic) hypogonadism.  However, clinical observation suggests that the rate of attending a second visit is low and the opportunity to obtain these measures may be missed.

The purpose is to provide physicians with recommendations on procedures for diagnosing hypogonadism using biochemical measurements including LH as soon as the first visit.

Methodology: Ongoing expert meetings from different specialties in Quebec, Canada (family medicine, urologists, endocrinologists, psychiatrists, sexologists, cardiologists and nutritionists) were conducted. The first recommendations were proposed in 2005 and subsequent changes added on a yearly basis.

Result: Expert opinion suggests that biochemical measures traditionally taken during the first and second visits now be combined into the first visit.

Conclusion: To assess biochemical measurements including LH as soon as the first visit ensures that the patient is correctly investigated and will be managed accordingly.

Disclosures:

Work supported by industry: no.

Male patients with hypogonadism at the general hospital (#282)

C. Arroyo (Uruguay)
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282

Male patients with hypogonadism at the general hospital

Arroyo, C1; Cedres, S1

1: Uruguay

Introduction: Hypogonadism is defined as deficient or absent male gonadal function that results in insufficient testosterone secretion ( Free testosterone (FT) ≤7,2  ng/dL between 55-60 years old and  ≤ 5,6 ng/dL in patients > 60 years old,). It can exert diverse effects on the well-being.This condition is fairly common in certain populations (1). Once diagnosed, Hypogonadism is usually easily treated by testosterone replacement therapy. The contraindication are: prostate cancer, severe benign prostate hyperplasia, severe dyslipemia and polycythaemia (2).

Aims: To estimate the prevalence of Hypogonadism in men aged ≥55 years assisted (for any reason) in the Internal Medicine and Urology rooms of the Hospital. A second objective was to correlate the presence of Hypogonadism with select comorbid conditions and symptoms, study the impact on sexual function and verify how many of them could be included in androgen therapy.

Methods: A blood sample was obtained between 8 am and noon and assayed for FT, haematocrit, lipids and liver function test and PSA. Sexual dysfunction, quality of life and comorbid conditions were recorded. All the patients had digital rectal examination by urologist.

Results: Of 52 patients: 27 (RF=0,52) had significantly low FT  levels and another 11 (RF=0,21) had low-normal levels. Only 14 (RF=0,27) had normal level. Odds ratios for having Hypogonadism were significantly higher in men with anemia (1.64), hyperlipidaemia (1.29), diabetes (1.99), chronic renal failure (1.45) and smokers(2.38).  All patients with Hypogonadism had erectile dysfunction, and half of them had quite sexual activity for over a year. The testosterone replacement therapy was contraindicated in 10 patients because of severe urinary symptoms and prostate exam with grade 3 enlarged prostate (in 5 of them prostate cancer was confirmed). No one had hematology contraindications.
Conclusion: We found high prevalence of hypogonadism in hospitalized patient and studied its impact on quality of sex life. We should screen this groups of patients to offer specific treatment.

Disclosures:

Work supported by industry: no.

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Influences of testosterone deficiency for oxidative stress and inflammation markers in castrated rats (#283)

T. Katoka (Japan)
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283

Influences of testosterone deficiency for oxidative stress and inflammation markers in castrated rats

Katoka, T1; Hotta, Y2; Maeda, Y2; Kimura, K1

1: Graduate School of Medical Sciences, Nagoya City University, Japan; 2: Graduate School of Pharmaceutical Sciences, Nagoya City University, Japan

Objective(s): Testosterone deficiency is thought to cause erectile dysfunction by decreasing NO bioavailability. However, the mechanism by which testosterone deficiency affects erectile function is not fully clear. We investigated the effects of testosterone deficiency on oxidative stress and inflammation in the erectile tissues of castrated rats.

Material and Method(s): Male rats were categorized into the following groups: castrated (Cast), castrated with testosterone (3 mg/kg/day) (Cast+T), and sham (Sham). At 4 weeks after the operation, erectile function was evaluated by measurement of ICP/MAP on cavernous nerve stimulation. The relaxation and contractile responses of the corpus cavernosum were measured using an isometric tension study. Measurement of serum sex hormones and asymmetric dimethyl arginine (ADMA), an endogenous nitric oxide synthase (NOS) inhibitor, were performed with UPLC-MS/MS. For structural analyses, rat penises were harvested. Masson's trichrome staining was used to calculate the smooth muscle (SM)/collagen ratio using computer image analysis. Real time PCR was used to determine the expression levels of catalase (CAT), super oxide dismutase (SOD), glutathione peroxidase (GPx), NADPH oxidase-1 (NOX-1), NOX-4, p22phox, inducible NOS (iNOS), interleukin (IL-6), and NF-κB mRNAs.

Result(s): The ICP/MAP ratio was 0.61 ± 0.03 in Sham, 0.26 ± 0.04 in Cast (p < 0.01 vs. Sham) and 0.56 ± 0.06 in Cast+T (p < 0.01 vs. Cast). Relaxation responses induced by acetylcholine were decreased in Cast compared to Sham and Cast+T (p < 0.05). Serum ADMA levels in Cast were significantly higher than in Sham and Cast+T (p < 0.05). The SM/collagen ratio in Cast was significantly lower than in Sham and Cast+T (p < 0.05). CAT, SOD and GPx mRNA expression levels were not significantly different between the three groups (p > 0.05). However NOX-1, NOX-4, p22phox, iNOS, IL-6 and NF-κB mRNA expression levels in Cast were significantly higher than in Sham and Cast+T (p < 0.05).

Conclusion(s): Testosterone deficiency increased oxidative stress and inflammation markers in castrated rats. It caused oxidative stress by up-regulating NOX and p22phox, and it also caused inflammation in the corpus cavernosum.

Disclosures:

Work supported by industry: no.

Effect of putatives inhibitors of phosphodiesterases in corpora cavernosa isolated from rabbit and human (#284)

R. Campos (Brazil)
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284

Effect of putatives inhibitors of phosphodiesterases in corpora cavernosa isolated from rabbit and human

Campos, R1; Lescano, C1; Zaminelli, T1; Rodrigues, R1; Mónica, F1; De Nucci, G1

1: State University of Campinas, Brazil

Objective: Phosphodiesterases inhibitors are the first line medications indicated to treat erectile dysfunction. The aim of this study was evaluate the effects of tadalafil analogues 3-(benzo[d][1,3]dioxol-5-yl)-1-(1H-indol-3-yl)-7-methyl-6,7-dihydro-3H-oxazolo[3,4-a]pyrazine-5,8-dione ( BL 106), 1-(1H-indol-3-yl)-3-(4-methoxyphenyl)-7-methyl-6,7-dihydro-3H-oxazolo[3,4 a]pyrazine-5,8-dione (BL 106-1), 1-(1H-indol-3-yl)-7-methyl-3-phenyl-6,7-dihydro-3H-oxazolo[3,4-a]pyrazine-5,8-dione (BL 106-2), 3-(4-chlorophenyl)-1-(1H-indol-3-yl)-7-methyl-6,7-dihydro-3H-oxazolo[3,4-a]pyrazine-5,8-dione (BL 106-3). On corpora cavernosa tissues and measure the contents of cycle nucleotides in cells lineages.

Material and Methods: Curves concentration response to BL 106 were constructed in isolated rabbit (Rcc) and human corpora cavernosa (Hcc) respectively pre- contracted with phenylephrine (10uM), noradrenaline (3uM). Curves concentration response to BL 106-1, BL 106-2, BL 106-3 were design in Rcc pre contracted with phenylephrine (10uM). Levels of guanosine monophosphate cycle (cGMP) and adenosine monophosphate cycle (cAMP) were measured in T84 cells and Jurkat cells, respectively, after treatment with these analogues (50uM).

Results: The compound BL 106 produced concentration dependent relaxation in Hcc (pEC50: 7.14 ± 0.27; Emax 81±7 n=3) and Rcc (pEC50:6.58 ; Emax 90.2% n=3). The compounds BL 106-01; BL 106-02 and BL 106-03 (0.001-10 μM) produced relaxations in Rcc with pEC50 of 6.07 (n=3), pEC50 of 6.89 (n=2) and pEC50 of 6.54 (n=3), respectively; and Emax values of 83.3% , 86.2%  and 80.1% , respectively. The compound BL 106 (50uM) increased the levels of cGMP in T84 cells in 40% after stimulation with Escherichia coli toxin (STa) (827.22 ± 91.34 cGMP pmol/10min/mg and 587.97 ± 60.86 cGMPpmol /10min/mg; p<0.05; Anova followed by Turkey test). Compounds BL 106-1, 106-2, 106-3 (50uM) did not increase the cGMP contents prior STa stimulation or it absence. BL 106(50uM) increased the levels of cAMP in Jurkat cells in 225% after stimulation with foskolin (50uM) (68.08 ± 9.53, pmol/10min/mg and 21.04 ± 6.28 cAMP, pmol/10min/mg). On the other hand, BL 106-1, BL 106-2 and BL 106-3 did not increased the contents of cAMP.

Conclusion: The four new compounds promoted smooth muscle relaxation in concentration dependent manner and only the compound BL 106 interfered in the levels of cycles nucleotides.

Disclosures:

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

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Serum free testosterone and its relation with erectile function in aging men (#285)

C. Arroyo (Uruguay)
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285

Serum free testosterone and its relation with erectile function in aging men

Arroyo, C1; Cedres, S1; Decia, R1

1: Uruguay

Background: People with low serum testosterona often comlain of erectile dysfunction. (1)

Objectives: To evaluate the relationship between serum free testosterone (FT) and erectile function in aging men at the General Hospital.

Materials and Methods: FT was measured between 8:00 and 10:00 a.m. in all men aged older than 55 assisted (for any reason) in the Internal Medicine and Urology rooms of the Hospital. Low FT was defined as FT lower than 7,2  ng/dL between 55-60 years old and  lower than 5,6 ng/dL in patients older than 60 years old. All the patients included completed the IIEF-5 questionary, which score ranges from 1 to 25 and the ED was classified into five groups according to the scores: severe (1-7), moderate (8-11), mild-moderate (12-16), mild (17-21) and no ED (22-25).

Results: 52 patients were included. The prevalence of all degrees of erectile dysfunction was 43/52 (RF= 0,83). The degree of erectile dysfunction was mild in 7/43, mild to moderate in 10/43, moderate in 14/43  and severe in 12/43.

27/52 (RF=0,52) had significantly low FT  levels and 11/52 (RF=0,21) had low-normal levels.

It was a statistical significance between the presence of low FT and moderate and severe ED (p<0.05, chi-squared test – alpha of 0,05).

Conclusions: We found high prevalence of DE in hospitalized patient. It showed a clear correlation with low FT. We should screen these groups of patients to offer specific treatment.

Disclosures:

Work supported by industry: no.

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The use of erection enhancer drugs in men who seeks an urological private consultation (#286)

F. Glina (Brazil)
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286

The use of erection enhancer drugs in men who seeks an urological private consultation

Rosalino, R1; Glina, F1; Glina, S1

1: Instituto H. Ellis, Brazil

Objective: Evaluate the use of erection enhancer drugs in men who seeked an urological private consultation.

Material and Methods: This research was approved by the Ethical Committee o f our institution. The charts of 438 men (15 to 90 years old, mean age: 50.9 years) who seeked a urological consultation were evaluated retrospectively. Initially was identified if the reason of the initial visit was any sexual dysfunction or any other urological condition. In patients who did not consult because a sexual dysfunction was identified how they considered their sexual function (normal or abnormal) and in every men (sexual complain or urological complain) if they had used any erection enhancer drug (phosphodiesterase type 5 inhibitors – PDE5i or intracavernous injections - ICI).

Results: 269 men ( 15 to 90 years old, mean age 50.9 years) seeked urological consultation because a urological complain (non-sexual complain). 170 of them considered their sexual function as normal, 69 had erectile dysfunction, 5 reported no sexual activity and in 25 charts there were no reference to patient´s sexual function.  Of 170 men with normal sexual function, 31 reported the use of PDE5i, 3 of ICI and 2 of both drugs; of 69 patients with erectile dysfunction, 28 used PDE5e  and 2 ICI.  Of 163 men who attende because of a sexual dysfunction (17 to 86 years old; mean age 50.7 years); 92 used PDE5i, 4 used ICI and 2 used both drugs.

Conclusions: Twenty and one percent of men who seeked a urological consultation and did not complain of erectile dysfunction use some drug to enhance their erectile function.  Forty five percent of men who seeked  a urological consultation and complained of erectile dysfunction use some drug to enhance their erectile function. Among the men who seeked a urological consultation because a sexual dysfunction, 60% already used  some drug to enhance their erectile function .

Disclosures:

Work supported by industry: no.

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Erectile dysfunction in Qatar: Prevalence and risk factors in 1,052 participants—A pilot study (#287)

A. Majzoub (Qatar)
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287

Erectile dysfunction in Qatar: Prevalence and risk factors in 1,052 participants—A pilot study

Majzoub, A1; Al Naimi, A 1; Talib, R 1; Canguven, O1

1: Hamad Medical Corporation, Qatar

Objective(s): The aim of this study is to investigate the prevalence of erectile dysfunction (ED) in Qatar and to determine the risk factors associated with it.

Materials and method(s): This is a cross-sectional survey study of men attending the outpatient department at Hamad Medical Corporation in Qatar between February 2012 and February 2013. The International Index of Erectile Function (IIEF)-5 questionnaire was used for data collection. In addition to the IIEF-5 score, each participant's medical history was taken, with special emphasis on risk factors for ED, including diabetes mellitus (DM), hypertension (HTN), dyslipidemia, coronary artery disease (CAD), and smoking habits, and on their body mass index.

Result(s): One thousand fifty-two participants were randomly selected to fill out the IIEF-5 questionnaire. The participants' mean age (±SD) was 41.87 ± 13.24 years. Analysis of replies to the IIEF-5 showed that ED was present in 573 out of 1,052 participants (54.5%). Fifty-six (5%) participants had severe ED, 61 (6%) had moderate ED, 173 (16%) had mild to moderate ED, and 283 (27%) had mild ED. Risk factors for ED that held statistical significance were age (odds ratio [OR] = 2.9, 95% confidence interval [CI] 2.1–4.1, P < 0.001), DM (OR = 2.6, 95% CI 1.7–3.9, P < 0.001), HTN (OR = 1.6, 95% CI 1.1–2.5, P = 0.012), dyslipidemia (OR = 1.5, 95% CI 1.1–2.4, P = 0.024), and CAD (OR = 3.2, 95% CI 1.3–7.5, P = 0.009).

Conclusion(s): We found that the prevalence rate of ED in Qatar is quite similar to the regional reported rates. Overall, we demonstrated that nearly more than half of our participants suffered from ED. Besides age, DM, HTN, CAD, and dyslipidemia were found to be the most important risk factors for ED.

Disclosures:

Work supported by industry: no.

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Sexually transmitted disease and sexual orientation among a sample of men who seek for treatment to compulsive sexual behavior in Sao Paulo, Brazil (#288)

M. Scanavino (Brazil)
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288

Sexually transmitted disease and sexual orientation among a sample of men who seek for treatment to compulsive sexual behavior in Sao Paulo, Brazil

Scanavino, M1; Nisida, I1; Vieira, JC1; Amaral, M1; Parsons, J2

1: USP, Brazil; 2: CUNY, US

Objective: To identify connections among sexually transmitted disease (STD) and sexual orientation among a sample of men seeking for treatment of compulsive sexual behavior (CSB) in São Paulo, Brazil.

Material and Method: One hundred and four men (28% gay and bisexual, 72% heterosexual) who met diagnostic criteria for excessive sexual drive and sexual addiction, underwent  blood exam for assessing STD. The blood samples were tested for antibodies against C hepatitis, HIV and Treponema pallidum by ELISA using standard techniques. All antibody positive specimens were further tested by confirmatory assays. The participants also answered the Sexual Compulsivity Scale.

Results: The mean age was 39.0 (SD=9.9) years, and the mean of years of education was 14.9 (SD=4.6). Individuals who identify themselves as gay or bisexual presented more HIV infection, treponema, and any STD, than those who identify themselves as heterosexual, respectively, 28% vs. 3% (p = 0.001), 23% vs. 4% (p=0.006), and 41% vs. 7%. The mean score of SCS was 30.9 (SD=6.4), and we didn’t find differences on SCS scores according sexual orientation, and presenting HIV, C hepatitis, treponema, or any STD.

Conclusion: STD were more frequent among individuals who identify themselves as gay or bisexual among this CSB seeking treatment sample.

Disclosures:

Work supported by industry: no.

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Levels of knowledge, attitudes and practices in relation to reproductive health among underage pregnant and post-partum women of the Hospital Gustavo Fricke and Hospital Carlos Van Buren between may and june 2013 (#289)

M. Zavala Mena (Chile)
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289

Levels of knowledge, attitudes and practices in relation to reproductive health among underage pregnant and post-partum women of the Hospital Gustavo Fricke and Hospital Carlos Van Buren between may and june 2013

Zavala Mena, M1; Avilés Torres, J1; Vicencio Macaya, S1

1: Universidad de Valparaíso, Chile

Objective: Describe the levels of information about sexual health of underage pregnant and post-partum women.

Material and Methods: Transversal descriptive study, we surveyed all in-patients under the age of 18 admitted to the gynecology and obstetrics ward of both hospitals Gustavo Fricke and hospital Van Buren Between May and June 2013.

Results: A total of 43 patients were surveyed. The mean age of the mother was 16.1 ± 0.8 years while the patient’s mother first pregnancy age was 19 ± 6.1 years (p<0.05). In the other hand the mean age of the progenitor was 20.1 ± 5.5 years, this difference was also significant (p<0.001). The mean of total sexual partners of the patients was 1.92 ± 1.6, No difference in total completed school years was found.  The mean age at first intercourse was 14.3 ± 1.5. 66% of the surveyed patients stated love as the main reason of first intercourse. 85.7% had a stable couple, however only 78.6% of them were the progenitor. The 73% of the surveyed refer as their pregnancy as unplanned. Only 14% state never having any form of sexual education and 38% never used a contraception method. 85% of the patients don’t know what to do in conditions that void their contraception method. 46% does not know any form of emergency contraception. 90.4% consider the preservative as an effective contraception method mean while 64% consider it effective preventing sexually transmitted diseases, 35.7% states that coitus interruptus is an effective contraception method. 37.6% answers there are no probabilities of the transmission of AIDS during fellatio. 40.5% states that penetration is the most important part of sexual relations.

Conclusions: This sample contextualizes under age pregnancy younger than the age of the patient’s mother, with an older progenitor with same level of education. There is a clear lack of knowledge in the use of contraception, especially regarding what to do in conditions that void the efficacy of the used method; in despite of that most of the patients received at least some form of sexual education. It’s imperative to take a more significant, practical and clear approach to sexual heath at younger ages to give adolescents a responsible way of living their sexuality.    

Disclosures:

Work supported by industry: no.

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Sexual function in patients with prostatic hyperplasia (#290)

C. Arroyo (Uruguay)
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290

Sexual function in patients with prostatic hyperplasia

Arroyo, C1; Cedres, S1; Decia, R1

1: Uruguay

Multiple studies have demonstrated a true relationship between benign prostatatic hyperplasia (BPH) and erectile dysfunction (ED) (1)

Objecitve: To evaluate the degree of sexual dysfunction in a population of men with benign prostatic hyperplasia (BPH) accompanied by lower urinary tract symptoms (LUTS), and to assess the correlation between sexual dysfunction and urinary symptoms and age.

Methods: Hospitalized men > 55 years were evaluated.They all received digital rectal examination by urologist and were evaluated through the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and serum testosterone. ED was classified into five groups according to the scores: severe (1-7), moderate (8-11), mild-moderate (12-16), mild (17-21) and no ED (22-25). Regression analysis was used to determine the correlation among the variables.

Results: 52 patients were included. The prevalence of benign prostatic hyperplasia was 41/52 (RF= 0,92). The mean age of the patients was 68.23 years, the mean IPSS score was 19,2, and the mean IIEF-5 was 8.45. There were 45 cases of erectile dysfunction. There was statistically significant correlation between IIEF-5 scores and : age, serum testosterone, IPSS scores, BPH (p< 0.05). Serum testosterone did not correlate to IPSS score.

Conclusion: Results of this study suggest that age, serum testosterone, BPH and LUTS are risk factors of sexual function, and sexual dysfunction is closely related to the severity of LUTS. This makes a direct association between male ED and BPH, supports the theory that the association between the two pathologies could be due instead to the common link of ageing.We recommend further studies, preferably of a longitudinal and/or qualitative character, to gain a more profound understanding of the interaction, probably multifactorial, between them.

Disclosures:

Work supported by industry: no.

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Testicular prosthesis: A need for electronic registry (#291)

R. El Hassan (United Kingdom)
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291

Testicular prosthesis: A need for electronic registry

El Hassan, R1

1: City Hospitals Sunderland, United Kingdom

Background and Purpose: Testicular prosthesis (implants) has been inserted for over 40 years. Surgical complications are well known, however the long term effects are not defined. The aim of this study was to contact our patients, update the records and govern a patient satisfaction questionnaire.

Methods: Since January 2002, 48 testicular prosthesis were inserted after orchidectomy for cancer and non cancer testicles. 5 were removed due to complications. 43 patients were entered in the study. Invitation to outpatient clinic and/or telephone contact was considered. Previously developed questionnaire (2001) was used.

Results: Mean age at insertion was 25 (range 7 to 54). Despite repeated attempts only 7 patients (16%) were contactable of which one declined the invitation. The six who responded reported good to excellent overall satisfaction. Of the remaining 36 patients (84%), 5 had moved away, 8 patients were at addresses supplied by family practitioners but were not contactable and 23 patients had received the invitation but did not respond.

Conclusion: Patients who have had testicular prosthesis insertion are young, busy and in gainful employment. They are more likely to move away. A longer series of testicular cancer patients with or without prosthesis also had just 55% responders and presumably it was not possible to determine who had the prosthesis. Our study shows the daunting task of contacting patients with testicular prosthesis if required for a manufacturing problem as seen in some breast implants. Perhaps it is time to consider a platform in the form of an electronic registry to facilitate traceability.

Disclosures:

Work supported by industry: no.

Taking a sexual history - Checklist for medical students (#292)

D. Elder (Australia)
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292

Taking a sexual history - Checklist for medical students

Elder, D1

1: Southern Specialist Centre, Adelaide, Australia

Introduction: Medical Students worldwide lack exposure to teaching in Sexual Medicine.

Taking a Sexual History is a basic skill that enhances the diagnostic process and improves communication.

Method: Three phases of history taking allow a gradation from familiar to more sensitive areas of questioning.

Results: Checklist will assist in the evaluation of sexual dysfunctions that are reported in up to 43% of women and 31% of men in the 18 to 59 year age group.

Conclusion: Checklist provides students with a framework for current learning and future reference.

Disclosures:

Work supported by industry: no.

show poster

Treatment and epidemiological profile of male infertility in the Pedro Ernesto University Hospital (RJ) (#293)

E. Andrade Dias Coutinho de Souza (Brazil)
show abstract

293

Treatment and epidemiological profile of male infertility in the Pedro Ernesto University Hospital (RJ)

Andrade Dias Coutinho de Souza, E1; Julio Junior, H1; Schiavini, J1; Damião, R1; Cruz, D1

1: UERJ, Brazil

Objective: Evaluate the results of patients with infertility undergoing clinical or surgical treatment at a University Hospital. 

Materials and Methods: From August 2013 to June 2014, fifty two patients with infertility have been followed on andrology medical attendant of Pedro Ernesto University Hospital (RJ), divided into primary infertility (36 cases) and secondary (16 cases), 12 of these after vasectomy. The median age of the patients was 38,2 years (20-56 years). In the sperm analysis, 24 (46%) patients had azoospermia (14 obstructive and 10 non-obstructive) and 28 (54%) had oligoasthenoteratozoospermia, and 13 of these patients had clinical varicocele. The clinical treatment was administered to patients with non-obstructive azoospermia and those who had oligoasthenoteratozoospermia without clinical varicocele (total of 25 patients). The clinical treatment consisted on the administration of coenzyme Q10 at a dose of 200mg/day for 6 months, associated with Tribulus Terrestris 250mg three times a day for 2 months and clomiphene citrate 50mg/day for 2 months. Patients with clinical varicocele underwent surgical subinguinal correction with magnification. Finally, patients with secondary infertility due to vasectomy (12), 7 underwent reversal by vasovasoanastomosis technique. Monitoring was done with sperm analysis after 1 and 6 months of treatment.

Results: In this period, 11 patients showed improvement of sperm count due to clinical or surgical treatment, 6 of them after vasectomy reversal (one became pregnant), 2 after varicocelectomy, and 3 after clinical approach. Thirty five patients have not returned for reassessment.

Conclusion: Infertility is a common condition in urological clinic and this work aims to show the epidemiological data of a university hospital in Rio de Janeiro and the treatment proposed for the same in this hospital.

Disclosures:

Work supported by industry: no.

show poster

Sexual complaints in postmenopausal women (#294)

T. Embiruçu (Brazil)
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294

Sexual complaints in postmenopausal women

Embiruçu, T1; Ambrogini, C2; Lordello, M2; Zaneti, M2; Veloso, L2; Bentes, L2; Fanganiello, A2; Laviola, B2; Haidar, M2

1: São Paulo Federal University, Brazil; 2: São Paulo Federal University, UNIFESP

Aim: Avaluate sexual complaints in postmenopausal women from February 2010 to March 2012.

Methods: 84 women had been asked about her sexual lifes. There were questions for libido, orgasm, dyspareunia, vaginal dryness and vaginal bleeding during the coitus. The woman could indicate one or more sexual problem. Hormonal therapy was exclusion criteria. All women have been with sexual partners, age between 40 and 65 years and minimun one year and maximun 10 years of menopause.

Results:  Vaginal dryness was observed in 67 women (79,7%); lack of libido 70,2%; sexual pain 65,47%; fail of orgasm 29,7% and bleeding during the coitus 8,3%.

Conclusions: In postmenopausal women the mean sexual complain was vaginal dryness folowed by lack of libido and sexual pain. However, the anorgasmia was not observed in the same proportion. It can be a question why in postmenopausal women vaginal dryness, hypoactive sexual desire and dyspareunia don’t cause more anorgasmia.

Disclosures:

Work supported by industry: no.

show poster

Chronic pancreatitis, malabsortion and sexual dysfunction (#295)

J. Herrera-Caceres (Mexico)
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295

Chronic pancreatitis, malabsortion and sexual dysfunction

Herrera-Cáceres, J1; Flores-Rodríguez, J1; Nava-Sanchez, J1; Magaña-Rodríguez, J1; Pelaez, M1; Hernández-Calleros, J1; Castillejos-Molina, R1

1: INCMNSZ, Mexico

Objectives: To evaluate if the sexual health in patients with chronic pancreatitis is affected by their nutritional status.

Material & Methods: We did a prospective evaluation including patients from the "Pancreas Clinic" from our institution. Evaluation included demographics, a sexual function assessment (IIEF and IFSF), depression questionnaire (Beck Questionnaire) and a quality of life assessment (SF-36). We did an analysis of prevalence and associated risk factors.

Results: We included 26 patients (57.7% female), mean age was 45 (SD 15.6) years old. Mean IIEF score was 38.7 (9.1% had No-ED, 18.2% had mild ED, 36.2% had mild-moderate ED, 9.1% had moderate ED and 27.3% had severe ED), IFSF 53.0 (14.3% had sexual dysfunction), 65.3% were married or in a stable relationship and 50.0% had a Beck score negative for depression. In female, a waist circumference <80cm was associated with better IFSF scores, including full score, and individual domains such as lubrication and orgasm. No patients had a triglyceride count >150 mg/dl. Total cholesterol of 200 mmol/L was not associated with sexual dysfunction. BMI was not associated to sexual dysfunction in either gender. Several other variables including marital status, chronic pain albumin, bilirubin levels, creatinine, etc. showed no statistical association with sexual dysfunction in either men of female patients.

Conclusions: We could not find any statistically significant association with total IIEF scores. For female patients, waist circumference <80 cm was associated with a better sexual outcomes. Neither nutritional status nor depression scores cause a significant sexual health diminishment in the present group. Perhaps this can be explained due to adequate control of the chronic pancreatitis reaching "normal" conditions despite the baseline malabsortion and chronic pain.

Disclosures:

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

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Efficacy of Tamoxifen and L- carnitine on sperm ultrastructure and seminal oxidative stress in patients with idiopathic oligoasthenoteratozoospermia (#297)

E. Nada (Egypt)
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297

Efficacy of Tamoxifen and L- carnitine on sperm ultrastructure and seminal oxidative stress in patients with idiopathic oligoasthenoteratozoospermia

Nada, E1; El Taieb, M2; Ibrahim , H2; Al Saied, A2

1: Department of Dermatology, Venereology and Andrology, Sohag University, Egypt; 2: Department of Dermatology, Venereology and Andrology, South Valley University, Egypt

Objective: Idiopathic oligoathenoteratozoospermia (iOAT) is a common finding in male infertility evaluation. Oxidative stress (OS) may underlie its pathology. Tamoxifen and L-carnitine are used to treat idiopathic male infertility. Aim of this work is to detect the efficacy of tamoxifen and L-carnitine on sperm parameters, sperm ultrastructure and seminal OS in iOAT patients.

Material and Methods: 60 patients were recruited in this study and divided into three groups, the 1stwas treated with tamoxifen, 2nd with l-carnitine, 3rd with both drugs. Semen analysis, malondialdehye (MDA) level and transmission electron microscopy (TEM) have been performed before and after three months treatment.

Results: The first group showed significant improvement in MDA levels, sperm concentration, sperm morphology, ultrastructural head, acrosomal and mitochondrial anomalies (P<0.01). Other parameters were not significantly improved. In the 2nd group, significant improvement in MDA, sperm motility, sperm

morphology, ultrastructural mitochondrial and tail anomalies were detected (P<0.01). No significant improvement in the other parameters. 3rd group showed improvement in MDA, all semen parameters and all ultastructural anomalies (P<0.01).

Conclusion: Tamoxifenand L-carnitine are effective in improving seminal OS, semen parameters and sperm ultrastructure. Combination of both drugs is superior to monotherapy.

Disclosures:

Work supported by industry: no.

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Investigation for the current state of education of sexual medicine in Japanese medical schools (#298)

M. Shirai (Japan)
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298

Investigation for the current state of education of sexual medicine in Japanese medical schools

Shirai, M1; Hisasue, S2; Abdelhamed, A2; Tsujimura, A2; Limura, K1; Koyasu, H1; Yanada, S1; Arai, T1; Mizuno, T1; Nagao, K1; Horie, S2

1: Juntendo University Urayasu Hospital, Japan; 2: Juntendo University, Japan

Objectives: The purpose of the present study was to investigate the current state of education of sexual medicine in Japanese medical schools.

Material and Methods: We surveyed the number of lecture components according to Parish SJ (Journal of Sexual Medicine 2013; 10:3-18), the time of curriculum hours, the degree of sufficiency level of the components, and the degree of sufficiency level of the curriculum hours in the medical schools in Japan.

Results: Of the 80 medical schools, the faculties of the urological department of 69 medical schools (86%) responded. The mean number of lecture components was 7.8. The most common components of the lectures were: sexually transmitted infections (85.5%), cause and correlates of sexual dysfunction (81.2%), and impact of medical illness and their treatment on sexual function (71%). The least common components of the lectures were: sexual abuse (1.4%), sexual minority and sexual health (5.8%), and skills for comfort with sexual language and terminology (5.8%).  The mean total curriculum hour was 113minutes. The degree of sufficiency level of the components was sufficient (28%), and insufficient (72%) for the faculties. The degree of sufficiency level of the curriculum hours was sufficient (50%), and insufficient (50%) for the faculties.

Conclusions: While curriculum hour is insufficient for the faculties in half of medical schools, over 70% medical schools answered that the lecture components is insufficient, too. Now we should make every effort to achieve sufficient hours and sufficient components for sexual medicine education. We need the standardized syllabus and materials for sexual medicine in medical schools in Japan.

Disclosures:

Work supported by industry: no.

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Minimal incisional phalloplasty using Acellular Dermal Matrix Allograft (#299)

T. Yun (Korea)
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299

Minimal incisional phalloplasty using Acellular Dermal Matrix Allograft

Yun, T1; Jeon, H1; Sohn, D2

1: Manomedi urologic Clinic, Korea, South; 2: The Catholic University of Korea

Objective: Many penile augmentation has been performed with various materials and methods. Fat injection for penile augmentation has complications like contour irregularities, fat migration and absorption. Recently, Allograft implant has been used and the safety has been improved with surgical technique development. The aim of this study is to report clinical safety and surgical techniques in complex phalloplasty using Acellular Dermal Matrix Allograft.

Materials and Methods: Acellular Dermal Matrix Allograft (MegaDerm) was used for phalloplasty. It has micro porous fibrous structure for rapid and regular ingrowth of autologous connective tissue. We operated penile augmentation in 183 patients with MegaDerm. In the penile dorsal area, 1~2cm from the subglans was incised at a length of 3 to 5 cm and was dissected from glans to the prepubic junction.  Then, a fundiform ligament was incised for lengthening. Implant was designed according to the size of the penis and we incised multiple horizontal and vertical slits in collagen tissue using knife for improving of graft survival. Thereafter, enhancement tissue was placed between the dartos fascia and Buck’s fascia. The dartos fascis and skin were closed by 2 layers and whole body of penis except glans was wrapped up by elasctic bandage evenly. To reduce nocturnal erectile pain and discomfort, we prescribed oral ketoconazole which can reduce nocturnal erection.

Results:  The mean operation time was about 40 minutes and most patients had sexual intercourse successfully after 1 month. The average augmented effect in circumference was 34% and mean penile length gain (flaccid penis) was 2.3cm.  Complications like graft failure was occurred in 2 patients (1%) and the graft was removed partially or entirely. Other complications like inflammation or wound dehiscence were treated through conservative treatment.

Conclusion: This complex phalloplasty using Allograft MegaDerm implant with minimal incision showed positive results in safety and effectiveness. In our experience, these technique may be a good choice in penile augmentation surgery in the future.

Disclosures:

Work supported by industry: no.

Attention and risky sexual behavior among a sample of men seeking for treatment of compulsive sexual behavior (CSB) in São Paulo, Brazil (#300)

M. Scanavino (Brazil)
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300

Attention and risky sexual behavior among a sample of men seeking for treatment of compulsive sexual behavior (CSB) in São Paulo, Brazil

Scanavino, M1; Messina, B1; Fuentes, D1; Parsons, J2

1: USP, Brazil; 2: NYC, US

Objective: We aim to examine connections among attention neurocognitive variables and risky sexual behavior among a sample of sexually compulsive men seeking for treatment of compulsive sexual behavior (CSB) in São Paulo, Brazil.

Material and Methods: One hundred eleven men (43% gay and bisexual, 57 % heterosexual) who met diagnostic criteria for excessive sexual drive and sexual addiction, answered questions about risky sexual behavior (use of condom when engaging in anal sex with casual partners, use of condom when engaging in vaginal sex with casual partners, number of casual partners, casual sex, casual sex with multiple partners) and underwent to neurocognitive assessment consisting of the Continuous Performance Task (CPT) which investigates the following attention variables: omission, commission, reaction time, and perseveration.

Results: The mean age was 38.7 (SD=7.9) years, and the mean of years of education was 15.2 (SD=4.6). Individuals reporting engaging in excessive casual sex presented higher Omission errors, and a tendency to more Perseveration errors, than those who do not engage, respectively, M=4.6; SD=8.3 vs. 2.4; SD=3.1; p=0.05; and M=0.7; SD=1.3 vs. M=0.3; SD=0.7; p=0.07.  Individuals reporting engaging in casual sex with multiple partners presented a tendency to present more Omission errors than those who do not engage (M=4.9; SD=7.8 vs. M=2.7; SD=5.4; p=0.07). Individuals reporting frequent use of condom when engaging in vaginal sex presented higher Reaction Time than those who do not report (M=459.4; SD=346.4 vs. M=413.5; SD=288.1; p=0.04).

Conclusion: Difficulties with attention were associated with some of the variables related with risky sexual behavior.

Disclosures:

Work supported by industry: no.

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Clinical prevalence and associated factors of erectile dysfunction in uremia patients in Singapore (#301)

L. Lau (Singapore)
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301

Clinical prevalence and associated factors of erectile dysfunction in uremia patients in Singapore

Lau, L1; Adaikan, P2; Vathsala, A2; Srilatha, B2; Wong, M2; Koh, L3; Ma, V3

1: YLL SOM, NUS, Singapore; 2: YLL SoM, NUS, Singapore; 3: National University Hospital, Singapore

Objective: Erectile dysfunction (ED) is a well-known clinical concern with strong negative impact on the couple’s quality of life. It is also widely prevalent among uremia patients. In Singapore, where there is considerable number of patients undergoing chronic dialysis therapy, limited epidemiologic and community data exists on the prevalence, severity and clinical correlates of ED. This clinical study is aimed at assessing the prevalence of sexual dysfunction and the associated risk factors among male uremia patients.

Material and Methods: Two validated screening tools – IIEF and PHQ9 - were utilized to assess the level of ED and depression respectively. General and specific history covered the clinical correlates predisposing to derangement. The study subjects comprised 150 men aged 21 - 65 years in long standing relationship who are undergoing dialysis and clinical management at the National University Hospital, Singapore. 

Results: The uremia subjects were of mean age, 53.9±8.9 years and have been on hemodialysis for 1 to 312 months. The major underlying etiologies of renal failure were diabetic nephropathy (58%), chronic glomerulonephritis (28%) hypertension (4%) and adult polycystic kidney disease (3.3%).  Observational findings revealed that up to 65% of the cohort was not sexually active for the past 4 weeks. Severe ED (IIEF score: 0-6) was reported in 66.7% of the uremia patients in contrast to only 6% reporting normal erectile function (IIEF score: 25-30). While 30% of the uremia patients had low desire for sexual activity (IIEF score 0-2), a dismally high 68.7% and 67.3% had impaired orgasmic function and severe dissatisfaction score respectively. Co-morbidities for ED that are highly prevalent in these uremia patients include hypertension (82%), diabetes (54.7%) and dyslipidemia (49.3%). Based on PHQ-9 score analysis, severe depressive symptoms prevail in 3.4% which correlated with self-reported frequency of 3.3%. The incidence of minimal, mild, moderate and moderately severe depression was noted in 45.2%, 30.8%, 14.4% and 6.2% of study subjects respectively.

Conclusions: This study highlighted a high prevalence of ED (94% of any degree) in uremia patients undergoing dialysis therapy. All domains of sexual function (erectile, orgasmic, desire and satisfaction) were severely affected.  The sexual well-being as a quality of life issue in these uremia patients warrants further evaluation and intervention in view of extended life expectancy of patients as a result of improvements in dialysis therapy.

Disclosures:

Work supported by industry: no.

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Physical therapy as an alternative in erectile rehabilitation after radical prostatectomy: The vacuum erection device role (#302)

M. Barbosa Jr (Brazil)
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302

Physical therapy as an alternative in erectile rehabilitation after radical prostatectomy: The vacuum erection device role

Barbosa Jr, M1; Julio Jr, H2; Carrerette, F2

1: Brazil; 2: Hospital Universitário Pedro Ernesto/UERJ, Brazil

Objective: To evaluate the quality of penile erection of a patient after radical retropubic prostatectomy, performed for about a year and six months, before and after being subjected to the protocol of physical therapy.

Materials and Methods: Patient, 56 years old, BMI of 18, denying diabetes mellitus, cardiovascular diseases and smoking, normotensive. Sexually active before surgery and denying ED preview. Made use of vasoactive drugs, starting with sildenafil 50mg daily, increasing to tadalafil 10 mg on alternate days from surgery until after the last contact made with the same 15 months after completion of physiotherapy. And the treatment consists of therapy with ultrasound, vacuum erector device and the pelvic and perineal muscles kinesiotherapy performed in 20 sessions, 2 times per week. The questionnaire on male sexual health SHIM (Sexual Health Inventory for Man) was applied before, immediately after being subjected to twenty sessions of physiotherapy, and around fifteen months after treatment.

Results and discussion: Progressive improvement by mechanical stimulation by and vacuum and ultrasound therapy has been observed in the erectile response, from the fifth session. Increasing the SHIM score of 6, severe ED, for 12, moderate at the end of the 20 sessions. Reached the score of 23 to 15 months after the end of treatment, which means absence of ED. There are few randomized controlled studies on physical therapy intervention in the treatment of ED, especially after radical prostatectomy being Sommer (2002) and Dorey et al (2004) are responsible for some of these studies, both use the pelvic floor muscles kinesiotherapy as a treatment, but in different etiologies. Had significant improvement in the quality of erection in 80% of patients after 3 months and 40% after 6 months of treatment, respectively. This case study originated in a research project on Post-Graduate Medical Sciences, Universidade do Estado do Rio de Janeiro, aiming to introduce the physical therapy using vacuum erector device for the treatment of post-prostatectomy ED. Therefore, a statistically significant, randomized, controlled trial.

Disclosures:

Work supported by industry: no.

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High patient satisfaction after implantation of a 3-piece inflatable penile prosthesis: correlation of the IIEF and EDITS questionnaire (#303)

G. Hatzichristodoulou (Germany)
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303

High patient satisfaction after implantation of a 3-piece inflatable penile prosthesis: correlation of the IIEF and EDITS questionnaire

Hatzichristodoulou, G1; Klorek, T; Gschwend, J

1: Technische Universität München, Klinikum rechts der Isar, Germany

Objectives: Penile prosthesis implantation (PPI) is indicated in patients with erectile dysfunction (ED) who have failed conservative treatment. Satisfaction rates after PPI is high. However, several instruments exist for assessment of treatment and outcome satisfaction. The aim of this study was to assess long-term results and satisfaction rates after PPI by comparing the International Index of Erectile Function (IIEF-5) and the Erectile Dysfunction Inventory for Treatment and Satisfaction (EDITS) questionnaire.

Materials und Methods: Patients undergoing PPI were included in this prospective study at a single academic centre. Erectile function was assessed pre- and postoperatively by the IIEF-5 questionnaire. Patient satisfaction after PPI was assessed with the EDITS questionnaire. Both tools were compared and correlated to each other postoperatively in the long-term. Additional, quality of life before and after PPI was assessed by a 4-point scale (poor to high).

Results: From March 2010 to April 2014, n=31 patients underwent PPI. In all patients a 3-piece inflatable penile prosthesis (Coloplast Titan OTR, Coloplast, Minneapolis, MN, USA) was implanted. The average stay in hospital was 3.4 days (range: 3-5 days). After a mean follow-up of 25.8 months (range: 3-48 months) all patients were able to use the device and to achieve a sufficient erection. 29/31 (93.5%) patients were very satisfied with the implant. Mean IIEF-5 score before and after PPI was 8.3 points (range: 5-13 points) and 23.4 points (range: 21-25 points), respectively. Treatment satisfaction assessed by the EDITS questionnaire was mean 90.9 points (range: 77.5-100). Results of the IIEF-5 and EDITS questionnaire correlated well in terms of erectile function and treatment satisfaction. Additional, quality of life in those 29 patients increased significantly after PPI.

Conclusions: PPI is highly effective in restoring erectile function in patients with ED not responding to conservative treatment. PPI is associated with high satisfaction rates in affected patients. The IIEF-5 and EDITS questionnaire correlate in terms of erectile function and treatment satisfaction. Both tools can be implemented in the regular follow-up.

Disclosures:

Work supported by industry: no.

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Modeling with Coloplast implant reduces up to 70 degrees of curvature (#304)

Andrew Kramer (USA)
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304

Modeling with Coloplast implant reduces up to 70 degrees of curvature

Kramer, A1; Narang, G2

1: University of Maryland School of Medicine, United States; 2: University of Maryland School of Medicine

Objective: The goal is to understand how placing a penile implant and performing a modeling procedure can repair penile curvature, and what are the limits of what is achievable.

Materials and Methods: A protractor was used in surgery to measure before and after recordings in penile implant patients undergoing a modeling procedure.  Pre-operative measures were recorded either with in office injection or pre-operative photographs.  Then implants were placed, modeling performed if appropriate, and a final post-operative measurement performed. 65 patients had some curvature noted either before surgery, or detected during the course of the procedure, and they were included in the study.

Results: In 60 of the patients, the curvature was at or below 70 degrees, and their postoperative curvature measured on the OR table was completely eliminated or repaired to 0 degrees.  Five of the 65 patients had severe curves of over 70 degrees.  These were not completed fixed with implant plus modeling, but the total amount of repair was still 70 degrees, so 90 degree curvatures were straightened to 20 degrees.

Conclusion: Penile implant with modeling is extremely effective for repairing penile curvature.  Most men will be straight with implant plus modeling, some with severe curves can expect 70 degrees of repair.

Disclosures:

Work supported by industry: no.

Radiation related inflatable penile prosthesis complex erosions: A case report (#305)

Run Wang (USA)
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305

Radiation related inflatable penile prosthesis complex erosions: A case report

Wagenheim , G1; Niti , N1; Lin, H1; Wang, R2

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

Objective: We present a case of both reservoir erosion into the bladder and distal urethral cylinder erosion related to radiation therapy for prostate cancer.

Material and Methods: The 71 year-old male patient with a history of Gleason 4+3 = 7 prostate cancer treated by robotic assisted radical prostatectomy with bilateral non-nerve sparing. He developed post-prostatectomy ED that was treated with implantation of Coloplast Titan IPP at outside hospital. The penile implant worked very well for two years. Unfortunately, biochemical recurrence of the prostate cancer was discovered 2 years after the IPP placement. This was treated with intensity modulated radiation therapy (IMRT), 70 GY. Three months after radiation therapy, the patient presented to our clinic with complaints of urinary frequency, urgency and nocturia. He also reported distal urethral pain, discomfort, and occasional discharge. Exam identified IPP cylinder erosion into the distal urethral lumen. The patient was then scheduled for surgical removal of the IPP. A median raphe scrotal incision was used, in the site of the previous procedure’s incision. After the tubes between the IPP pump and the IPP cylinders were identified and exposed, purulent fluid was encountered. Therefore, the decision was made to remove the entire device, including the reservoir in the space of Retzius. Dissection was carried down to the bilateral cylinders proximally. The cylinders were removed and a modified Mulcahy antibiotic irrigation was performed. During this irrigation, it was confirmed that the distal left cylinder was the implant responsible for the distal urethral erosion.  However, after removal of the scrotal and corporal components, the dissection of the reservoir was noted to be especially challenging. Deeper dissection along the tube to reservoir encountered a small channel with clear fluid, thought to be urine. The dissection was then discontinued at this point, and flexible cystoscopy was performed. This identified a previously undiagnosed erosion of the entire reservoir into the bladder through the anterior lateral bladder wall. The dissection was then continued, the reservoir removed, and the cystotomy repaired. A 20 F Foley catheter was placed.

Results: The IPP cylinders, pump and reservoir were removed and the injury bladder was repaired.

Conclusions: Our case represents the rare combination of both erosion of the reservoir into the bladder as well as distal urethral cylinder erosion approximately three years from implantation of an IPP. We recommend avoiding the placement of reservoirs into the space of Retzius for all patients undergoing IPP implantation.

Disclosures:

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

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The feasibility of three-piece inflatable penile prosthesis implantation in patients who underwent radical pelvic surgery (#306)

M. Usta (Turkey)
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306

The feasibility of three-piece inflatable penile prosthesis implantation in patients who underwent radical pelvic surgery

Usta, M1

1: Akdeniz University School of Medicine Department of Urology

Introduction and Objectives: Inflatable 3-piece penile prosthesis (IPP) is usually performed in patients with ED, who previously underwent radical pelvic surgery (RPS) due to malignant diseases. We evaluated the results of IPP implantation in men with previous radical pelvic surgery history.

Methods: Between 2000 and 2013, 302 patients  were evaluated retrospectively. Patients divided into two groups according to radical pelvic surgery situation (group-1 with previous RPS vs. group-2 without previous RPS history). Age, additional surgeries, co-morbid diseases, prosthetic materials, the type of incision, intraoperative and postoperative complications, patient-partner satisfaction were recorded. Statistical significance was considered if p<0.005.

Results: 88 (23%) of patients (Group-1) had a history of previous RPS and 6 of them undervent radical cysoprostatectomy+ileal loop/ileal neobladder. The remaining 82 patients underwent radical prostatectomy due to localized prostate cancer. While in 37 patients IPP were implanted by penoscrotal incsion, in 51 patients the infrapubic approach was preferred. On the other hand, in group-2 (n=214; without previous RPS); 50 and 164 IPP’s were implanted using the penoscrotal and infrapubic incision, respectively. Statistical analysis showed no significant differences between the two groups for intraoperative and postoperative complications.

Conclusions: The 3-piece IPP implantation can be safely performed in men with ED who previously underwent radical pelvic surgery.

Disclosures:

Work supported by industry: no.

Ejaculatory disorders during 20 years of revision (#307)

Juan Uribe (Colombia)
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307

Ejaculatory disorders during 20 years of revision

Uribe, J1; Montoya, L2

1: Medicina Sexual, Colombia; 2: Universidad CES

Introduction/Aim: Ejaculatory disorders (EjD) are a male sexual dysfunction with high prevalence and multiple diagnoses that transcend beyond premature ejaculation (PE). Aim of this study was to compare premature ejaculation subgroup (PE) with other ejaculatory disorders, grouped as "Diminished ejaculatory disorders" or (DED).

Materials and Methods: A descriptive study of 814 patients, with ejaculatory disorders (EjD) for 20 years (June 1994 to June 2014), in a sexual medicine consultation in Medellin-Colombia. Premature Ejaculation subgroup (PE), was divided in lifelong (primary) and acquired (secondary); DED subgroup included: Decrease volume or force, delayed ejaculation or anejaculation, anorgasmia and painful ejaculation. Study was conducted in compliance with ethical principles and exploratory analysis was chi square, Fischer and t student tests.

Results: 814 patients, mean age 41.4 years; subgroup with premature ejaculation PE was the largest with 632 (77.64%) patients, of which 374 (45.94%) were PE lifelong, (mean age 37,8 years) and 249 (33%) were PE acquired (mean age 44,4 yerars); age difference between them was significant (p=<0.001). DED subgroup were 182 patients (19.2%)  of which had delayed ejaculation/anejaculation 69 (8.4%), decrease volume or force 65 (7,98%), painful ejaculation 19 (2.3%) and anorgasmia 29 (3,56%). The age difference between PE subgroup (39.8 years) vs DED subgroup (47.96 years) was also significant (p = <0.001).

Conclusions: Ejaculatory disorders (EjD) are headed by premature ejaculation; PE lifelong (primary) was the most frequent diagnosis and patients were younger (mean age 36,8 y). Other ejaculatory disorders DED, "diminished ejaculatory disorders" were  22 %, with a higher mean age and a predominance of low-volume group (8%).

 

Abstract 307

Disclosures:

Work supported by industry: no.

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Effects of tamsulosin on premature ejaculation in men with LUTS/BPH (#308)

J. Hyun (Korea)
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308

Effects of tamsulosin on premature ejaculation in men with LUTS/BPH

Hyun, J1; Choi, SM1; Choi, J1; Kam, S1

1: Gyeongsang National University Hospital, Korea, South

Purpose: Previous studies have revealed that tamsulosin is not only effective on improving Lower Urinary Tract Symptoms (LUTS), but also effective on erectile functions. However, from the evaluation of its effect on ejaculatory function, there were some negative effects including decreased amount of ejaculation. But the effects of tamsulosin on premature ejaculation (PE) are hard to find. Therefore, this study was conducted to understand the effect of tamsulosin on PE of benign prostatic hyperplasia.

Material and methods: 29 patients who visited with LUTS were categorized into 2 groups of LUTS-only patients group (n=12) and LUTS combined with PE patients group (n=17), and 0.4mg of tamsulosin was administered for 12 weeks. And comparative analyses of before and after the treatment were conducted for IPSS (International Prostate Symptom Score), IIEF (International Index of Erectile Function), IELT (Intravaginal Ejaculation Latency Time), PEDT (Premature Ejaculation Diagnostic Tool) and PEP (Premature Ejaculation Profile). The patients with IPSS score at or higher than 8 were determined as LUTS patients, and the patients with less than 2 minutes of IELT and at or higher than 9 of PEDT score were determined as PE patients.

Result: IPSS of LUTS group after tamsulosin treatment showed a significant decrease (from 19.6±10.03 to 15.4±7.76, p=0.044), and IPSS of the group of patients with LUTS combined with PE also showed a significant decrease (from 25.4±8.94 to 20.4±10.34, p=0.03). There was no statistically significant change of PEDT for LUTS group, but there was a significant decrease of PEDT (from 12.1±3.31 to 8.4±4.49, p=0.012) in the group of patient with LUTS combined with PE.

Conclusion: Tamsulosin has not only treatment effect for LUTS but also it improves PE of LUTS/BPH patients combined with premature ejaculation. Further large scale studies are needed in LUTS/BPH with PE to fully elaborate the effects of tamsulosin on premature ejaculation

Disclosures:

Work supported by industry: no.

Comparison between men with and without sexual dysfunctions according to the index of premature ejaculation: Evidences of validity (#309)

Itor Finotelli Jr. (Brazil)
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309

Comparison between men with and without sexual dysfunctions according to the index of premature ejaculation: Evidences of validity

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: To contribute for the development of the instruments that assess sexual aspects, the present research investigated evidences of validity based in the relation with other variables for the Brazilian adaptation of the Index of Premature Ejaculation (IPE). The IPE is a questionnaire that contains ten (10) items that assess the premature ejaculation in the dimensions of sexual satisfaction, ejaculatory control and distress.  

Methods: The sample was composed by ninety (90) participants, who have been treated in a private clinic and one hundred and fifty (150) participants from a private university, both in Sao Paulo, Brazil. The clinical patients was composed of patients diagnosed with sexual dysfunction, being thirty (30) with erectile dysfunction (ED), thirty (30) with premature ejaculation (PE), and thirty (30) with both dysfunction (ED+PE). The ages vary between eighteen (18) and sixty-one (61) years old (M=26.46; SD=8.47), and the type of sample did not differ according age. Eighty percent (80%) of the participants had Bachelor degree or equivalent. The application occurred collectively in the university e individually in the clinic, in appropriate places, observing the ethical compliance demanded in the research.

Results: Differences were found in the score of the samples, in this case, the participants non clinical had higher scores and dimensions in the total score compared with clinical ones. The results demonstrated yet differences between the participants by analysis of variance (ANOVA), according the type of sample and diagnostic. In a classification of the scores this represented that non clinical men had higher score in comparison to men with ED, who in turn, scored higher than men with PE and, consequently, the participants with ED+PE had lower scores. These differences were both for score and for the dimensions.

Conclusions: These data corresponded to expectations of sexual functioning, according to the instrument differing the groups according to sexual dysfunctions. The set of analysis provided the Brazilian adaptation of the IPE evidence of validity based in the relations with other variables and the possibility of creation of cutting points for the instrument.   

Disclosures:

Work supported by industry: no.

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Premature ejaculation: Prevalence and perception in Qatar (#310)

M. Arafa (Qatar)
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310

Premature ejaculation: Prevalence and perception in Qatar

Majzoub, A1; Arafa, M1; Elbardisi, H 1; Al Said, S1

1: Hamad Medical Corporation, Qatar

Objective(s): To assess the prevalence rate of PE in different age groups in our region and to assess the perception of normal ejaculatory latency by patients.

Materials and method(s): The Arabic Index of Premature Ejaculation (AIPE) was used for diagnoses. A separate questionnaire was also used to assess self-report and perception of premature ejaculation (PE) and perception of patients about the problem. The questionnaires were given to all males attending our hospital whether patients, companions or just visitors from February 2012 till February 2013.

Result(s): 3042 subjects were included. 459 were Qatari. According to AIPE the prevalence of PE was 56.48% (1718patients) with a score ≤ 30 with an intravaginal ejaculatory latency time (IELT) of 5.2±5.8 seconds. Of these 1718 patients only 991 reported having PE and 727 were satisfied with their IELT. The prevalence of PE in Qatari patients was 66.9% (307 patients) when using AIPE of which only 209 were self-reporting PE.

When we used the self-reporting questionnaire the prevalence of PE increased to 69.8% (2123 patients) with IELT 7.1±7.6 seconds. Out of these 2123 patients only 958 patients were diagnosed as having PE by AIPE.

Erectile dysfunction was self-reported in 731 patients. In this group prevalence of PE was 77.98% (570 patients) with IELT of 4.9±5.3 seconds.

Conclusion(s): The prevalence of PE in Qatar is much higher than that reported in other parts of the world. There is significant difference between diagnosed and self-reported prevalence of PE in our region.

Disclosures:

Work supported by industry: no.

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The report of HIV seroconversion in three individuals under treatment for sexual compulsivity and proposition for a comprehensive follow up (#311)

I. Nisida (Brazil)
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311

The report of HIV seroconversion in three individuals under treatment for sexual compulsivity and proposition for a comprehensive follow up

Nisida, I1; Amaral, M2; Vieira, J2; Scanavino, M2

1: Hospital das Clínicas da FMUSP, Brazil; 2: Department and Institute of Psychiatry, Hospital das Clínicas da FMUSP, Brazil

Objectives: We aim to report the HIV seroconversion of three men with compulsive sexual behavior (CSB) under treatment in São Paulo, Brazil; and the proposition for a comprehensive follow up including infectious assessment, sexual health directions, beyond of the CSB treatment.

Material and Method(s): 1) Report of three men with CSB under treatment in São Paulo, Brazil who seroconverted to HIV; 2) Brief search in literature for previous proposition of follow up of men with CSB regarding HIV risk acquisition; 3) Proposition for a comprehensive follow up including infectious assessment, sexual health directions, with a multidisciplinary team, updated to the current guidelines on people at higher risk for acquisition of HIV.

Result(s): 1) The reporting involve three men who have sex with men (MSM), aged from 27 to 31 years, presenting high severity of psychopathologic issues such as depression, anxiety, sexual compulsivity, suicidal risk and higher number of casual partners and reporting frequently unprotected sexual behavior. One presented syphilis during the follow up period. They were under psychological and psychiatric (taking serotonin reuptake inhibitors and/or mood stabilizer), from Mars 2010 until May 2014; 2) The search on PubMed resulted in very few papers and none specific to follow up of individuals with CSB. 3) The comprehensive follow up proposed to take care of CSB individuals is:  Psychiatric and concomitant Infectious disease follow up to promote sexual health (condom use; discuss number of casual partners, offering HIV test every three months, drug medication for sexual transmitted diseases (STD) if needed or HIV post exposure prophylaxis with zidovudine/lamivudine/lopinavir/ritonavir). Sexual health interview with a member of the team every 3 months addressing motivations toward adhere safer sex practices.

Conclusion(s): CSB individuals are a special group of high risky sexual behavior who needs special psychiatric and infectious disease support to reduce HIV risk transmission.

Disclosures:

Work supported by industry: no.

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Demystifying the difficulties to ask about sexuality (#312)

J. Venegas Vera (Chile)
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312

Demystifying the difficulties to ask about sexuality

Venegas Vera, J1; Novick, V2; Pizarro, P2; Wenger, D2

1: Hospital Van Buren/Universidad de Valparaiso, Chile; 2: Universidad Valparaiso

Introduction: The prevalence of male and female sexual dysfunction is high but the query with the involvement of patients or the investigation of dysfunction on the part of doctors is much lower prevalence is described. Difficulties in the physician and / or patient to initiate a conversation about sexual health have been proposed as explanations for the discrepancy. Analysis of a study by our group to confirm erectile dysfunction as a marker of endothelial health has allowed us to rethink notion of the difficulty in questioning about sexual life as a limitation of caregiver staff that as a condition of the patient.

Material and Methods:  The sample consisted of 100 men admitted to the medical service or hospital emergency unit Fricke, Viña del Mar. 50 admitted with acute coronary syndrome and 50 for any other reason, were interviewed about their erectile function prior to this current hospitalization. These men were between 40 and 70, and the interviewers, female students of the last degree of medical school, 24 years. The oral interview was done using a validated standard assessment of erectile function.

Results: Of the 100 men selected to answer the interview, eight were discarded because of health problems. For the remaining 92, only two refused to answer directly the sexual function interview, giving a rate of access to an interview answers to sexual, 97%. About 50% (n = 44) were patients hospitalized for acute coronary syndrome.

Conclusions: Notably, the high rate of responders to a questionnaire of sexual life, even in extreme conditions of health. And equally, the absence of limitations to answer questions about sexual function despite differences of gender and age between interviewer/interviewee. This report confirms that a high percentage of patients find appropriate discussion of sexual issues in a medical context. It presents the health care provider as primarily responsible for not initiating conversation about sexual health consultant. This encourages us to continue our line of work academic education and training of the young doctor of sexology topics to adequately address this area as directed health of their patients.

Disclosures:

Work supported by industry: no.

A community-based analysis of the prevalence of and genotype distribution of high-risk HPV in asymptomatic female college students (#313)

H. Imai (Japan)
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313

A community-based analysis of the prevalence of and genotype distribution of high-risk HPV in asymptomatic female college students

Imai, H1; Nakao, N2

1: National Institute of Public Health, Japan; 2: National Institute of Public Health

Objective: Epidemiological information on risk factors for infection and the distribution of HPV genotypes in young women, who are at higher risk for HPV infection-induced cervical cancer, is essential for promoting cervical cancer prevention. We undertook a community-based analysis of the prevalence of, risk factors for, and genotype distribution of high-risk HPV in young, asymptomatic, female college students.

Material and Methods: This community-based, cross-sectional study investigated potentially carcinogenic high-risk HPV infection among young, asymptomatic, female students. Self-administered surveys and self-collected vaginal swabs were distributed. The samples were screened for HPV infection with the Digene Hybrid Capture 2 assay, which includes probes for high-risk HPV (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68).

Results: The subjects were 1183 female student volunteers who provided valid specimens and tested positive for beta globin. 770 of these women were sexually active, and 125 (16.2%) of them had high-risk HPV infections. Logistic regression analysis revealed that HR-HPV infection was related to smoking history (odds ratio (OR) 2.13; 95% confidence interval (95%CI) 1.98 to 5.05; p < 0.01), total number of partners (OR 4.72; 95% CI 1.97 to 11.32 if partners > 5; p < 0.001), number of partners in the past 6 months (OR 3.12; 95% CI 1.42 to 6.87; p < 0.01), improper use of condoms (OR 2.21; 95% CI 1.25 to 3.90; p < 0.01), and Chlamydia infection (OR 2.61; 95% CI 1.28 to 5.34; p < 0.01) . The most common HR-HPV genotype was HPV 52 (6.4%), followed by HPV 16 (3.1%), HPV 56 (3.0%) and HPV58 (2.6%).

Conclusion: The prevalence of HR-HPV infection among young, asymptomatic, female students in East Asian countries was in the intermediate range. Before the widespread use of vaccination, the most common HR-HPV genotypes were HPV 52, 16, 56, and 58.

Disclosures:

Work supported by industry: no.

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Quality of sexual life of women with urinary complaints attended at women's hospital in a state of Amazonia - Brazil (#314)

J. Cardoso (Brazil)
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314

Quality of sexual life of women with urinary complaints attended at women's hospital in a state of Amazonia - Brazil

Filho, C1; Rego, A1; Cardoso, J1; Araújo, D1; Góes, L1; Nunes, LM1; Teixeira, R1; Teixeira, T1

1: Federal University of Amapa, Brazil

Objectives: The number of women with sexual dysfunctions has raised and requires strategies on specific approach to prevent and treat these dysfunctions. This study proposes an evaluation about how urinary complaints and age affect the quality of sexual life of women attended at Female Urology Ambulatory, in different phases of their lives.

Materials & Methods: Descriptive study with quantitative approach (with 108 patients during the period of february to july, 2011). Inclusion criteria: women with urinary complaints not confirmed by urodynamics and not submitted to surgical treatment to this complaint. Patients unable to complete the questionnaire, pregnant, postpartum, breastfeeding and under 18 years old were excluded. They answered the Inventory of Sexual Satisfaction (Female GRISS Questionnaire). Sociodemographic and gynecological data were collected too. Data were analyzed by chi-square test. All statistic processing was performed in BIOESTAT 5.3.

Results: Sociodemographic factors shown 45 as medium age, married (44.4%), High School degree (46.3%) and living in urban areas (98.1%). Urinary complaint were: stress urinary incontinence (89.8%), urgency (78%), urge-incontinence (78.2%) and nocturia (55.6%). 9.3% suffered Sexual Abuse. Gynecological and obstetrical antecedents evaluated Age of Menarche (media 13 years old), Menopause (31.5%), Multiparity (83.3%), Natural Labor (79.6%) and First Sexual Intercourse before 20 years old (70.4%). The GRISS questionnaire evaluation showed lowest scores in women aged 60 or more, especially at the dominions: Frequency of Sexual Intercourse (media: < 39- 5.8; 40 to 59- 4.7 e older than 60- 3.5), Sexual Communication (media: 3; 3.5; 4,3), Sexual Satisfaction (media: 5.8; 4.7; 3.5), Female Sensuality Expression (media: 5.5; 4.7; 4.6) and highest scores at  Female Sexual Avoid (media: 4.4; 4.2; 4.6), Absence of Orgasm (media: 4.5; 4.6; 4.8), what confirm a significant decrease in sexual activity in menopausal women associated with female urological dysfunctions. The dominion Vaginism/Dyspareunia did not show difference according to age (media: 6.2; 5.5; 5.7). This study shows the impact of advanced age (> 60) at frequency and satisfaction with sexual intercourse, although these patients seem to communicate better about sexual issues. Most of women declared that urinary symptoms disrupt their sexual life.

Conclusion: There was a strong relationship between urinary complaints and disruptions on female quality of sexual life and decreasing sexual intercourses, especially in menopause. Among urinary symptoms, Urinary Incontinence seems to imply more significantly in the quality of sexual activity, developing strong influence on their quality of life.

Disclosures:

Work supported by industry: no.

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Association between instruments that evaluates the psychopathological constructs in patients with sexual dysfunction (#315)

Itor Finotelli Jr. (Brazil)
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315

Association between instruments that evaluates the psychopathological constructs in patients with sexual dysfunction

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: Researched that evaluate the same construct by different measuring instruments demonstrated strong positive associations and/or moderated ones between these instruments in different types of population. The objective of the study was to investigate these associations in a sample of people with sexual dysfunctions, according instruments that assess psychopathological constructs.

Methods: One hundred and seven (107) patients (70% men and 30% women) diagnosed with sexual dysfunctions, who have been treated in a private clinic in Sao Paulo, Brazil. The average age was thirty-three (33) years old for men and thirty-one (31) years old for women, being eighty percent (80%) of the participants with Bachelor degree or equivalent. The applied instruments were Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Symptom Checklist (SCL-40R), which assesses, in the Brazilian version, the dimensions Psychoticism, Obsessiveness-Compulsiveness, Somatization and Anxiety; and the Neuroticism and Emotional Adjustment Scale Factor (EFN), instrument of the Brazilian origin that assesses the dimensions Vulnerability, Psychosocial Maladjustment, Anxiety and Depression.

Results: Positive moderate association were found among all the instruments, except or the dimension Psychosocial Maladjustment of the EFN. The magnitudes of these associations remained between r=.27 a r=.66. The bigger magnitudes were those that evaluated the same construct, i.e. the BAI with the dimension Anxiety of EFN and SCL-90r, followed by magnitudes with related constructs such as Depression, the Psychoticism, the Obsessiveness-Compulsiveness and the Vulnerability. The dimension Somatization of the EFN was the one that presented the smallest magnitudes in regards to the constructs.

Conclusions: Both in clinical and as in research, every measuring process needs the decision-making in choosing the measurement instrument. The results presented moderate positive associations between the instruments in the evaluation process of a same construct. However, these instruments evaluated differently the same phenomenon in, at least, thirty-six percent (36%). According to the need of each process, clinical and researchers should be aware of these differences in people with sexual dysfunction concerning instruments that evaluate psychopathological constructs.  

Disclosures:

Work supported by industry: no.

Effects of KH-204 on the expression of heat shock protein 70 and germ cell apoptosis in infertility rat models (#316)

W. Bae (Korea)
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316

Effects of KH-204 on the expression of heat shock protein 70 and germ cell apoptosis in infertility rat models

Bae, W1; Ha, U1; Kim, K1; Kim, S1; Cho, H1; Hong, S1; Lee, J1; Hwang, T1; Kim, S1

1: Department of Urology, College of Medicine, The Catholic University of Korea, Korea, South

Objective(s): Idiopathic infertility is a significant number of causes of male infertility. Empirical treatments are used for idiopathic male infertility, and antioxidant supplementation is a kind of management of oxidative stress related infertility. We investigated the antioxidant effects of the modified Ojayeonjonghwan (KH-204) in a rat model of cryptorchidism.

Material and Method(s): Male rats were divided into four groups (n=8 in each): a normal control group, a cryptorchidism-induced control group and two cryptorchidism-induced groups treated p.o. with either 200 or 400 mg/kg, KH-204 for 4 weeks. The testes and epididymides from rats in all groups were removed, weighed and subjected to histological examination and semen analysis after surgery. Oxidative stress was assessed by measuring 8-hydroxy-20-deoxyguanosine (8-OHdG), superoxide dismutase (SOD) and heat shock protein (HSP) levels. Apoptosis was determined using a terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labeling assay.

Result(s): Treatment with the multi-herbal medicine KH-204 (1) increased the mean weight of the cryptorchid testes; (2) restored sperm counts, motility and germinal cell layer thickness; (3) decreased levels of 8-OHdG and increased levels of SOD; and (4) decreased HSP70 levels and apoptosis.

Conclusion(s): It suggests that KH-204 may be beneficial for regaining testicular function via the reduction of HSP70 expression and apoptosis.

Disclosures:

Work supported by industry: no.

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Influence of the materials for the intravesical device on the changes of macrophage migratory inhibitory factor and urinary inflammatory cytokines (#317)

W. Bae (Korea)
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317

Influence of the materials for the intravesical device on the changes of macrophage migratory inhibitory factor and urinary inflammatory cytokines

Bae, W1; Kim, K1; Kim, S1; Cho, H1; Hong, S1; Lee, J1; Hwang, T1; Kim, S1

1: College of Medicine, The Catholic University of Korea, Korea, South

Objective(s): The implantable medical devices have been widely used in the various medical fields as well as urology. Although the present urologic implantable devices are made of the biocompatible materials, some patients can experience urinary tract infection associated with the devices. Therefore, we evaluated the influence of the polymers on the macrophage migratory inhibitory factor (MIF) and urinary inflammatory cytokines of the bladder to find the better materials for the implantable devices.

Material and Method(s): The 2 kinds of polymer, polydimethylsiloxane (PDMS) and polymethyl methacrylate (PMMA) were chose for the implanted materials in the bladder. A 2 mm-sized, coin-shaped lead was made and coated with PDMS or PMMA. Rats were divided into 4 groups: control (n=15), rats implanted with lead in the bladder (n=15), rats implanted with PDMS-coated lead (n=21) or PMMA-coated lead (n=21) groups. After 1, 2, 4 weeks, urinary inflammatory cytokine levels were checked. And the expression degree of macrophage and MIF were compared in the bladder tissue at 1, 2, 4 weeks after implantation.

Result(s): After 4 weeks, the level of urinary inflammatory cytokines of the rats implanted with PDMS- or PMMA-coated lead were significantly lower than that of the rats implanted with leads. At 1 week, the increased expression of macrophage were observed except control group, however the significantly decrease expression of macrophage of the rats implanted with PDMS- or PMMA-coated lead were noted at 2 and 4 weeks. Moreover, the significantly decreased expression of MIF was observed in the rats implanted with PDMS- or PMMA-coated lead. In addition, the lower expression of macrophage and MIF expression was noticed in the rats implanted with PMMA-coated lead than PDMS-coated lead.

Conclusion(s): PDMS or PMMA are suggested for the biocompatible polymers in the bladder. Moreover, PMMA may be more appropriate materials for the intravesical implantable device.

Disclosures:

Work supported by industry: no.

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Early cervical cancer: Impact of peritoneal vaginoplasty combined with laparoscopic radical hysterectomy improved sexual function (#318)

C. Shu-Qin (China)
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318

Early cervical cancer: Impact of peritoneal vaginoplasty combined with laparoscopic radical hysterectomy improved sexual function

Shu-Qin, C1; Ling-Zhi, K1; Hong-Ye, J1; Li, F1; Jun, C2; Shu-Zhong, Y1

1: The First Affiliated Hospital of Sun Yat-sen University, China; 2: The Third Affiliated Hospital of Sun Yat-sen University, China

Objective: We investigated the impact of laparoscopic radical hysterectomy (LRH) in combination with peritoneal vaginoplasty (PV) in improving sexual function following radical hysterectomy (RH), in patients with early cervical cancer.

Methods: A total of 79 patients with early-stage cervical cancer younger than 45 years were assigned to receive LRH in combination with PV (the LRH-PV group) (n=31) or LRH alone (the LRH group) (n=48). Other 40 healthy females were selected as controls (the control group). The sexual function was assessed with female sexual functioning index (FSFI). FSFI scores and sexual function in the postoperative 1 year were compared between the LRH-PV and LRH groups, LRH-PV and control groups, LRH and control groups, respectively.

Results: Patients with LRH-PV showed significantly higher scores in sexual satisfaction, lubrication, pain, and total score than those with LRH alone (P < 0.05) but were not statistically different in scores regarding sexual desire, arousal and orgasm (P > 0.05). Healthy controls showed the highest in total scores and six domains among all subjects. Additionally, the FSFI total scores in the LRH-PV group, LRH group and (LRH-PV+LRH) group were significantly decreased compared to the control (P < 0.05).

Conclusion: PV to lengthen the vagina improves sexual function of patients with early cervical cancer receiving LRH in sexual satisfaction, lubrication, pain.

Disclosures:

Work supported by industry: no.

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Bilateral rod fracture: A rare malleable prosthesis mechanical complication (#319)

S. Ahmed (Brazil)
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319

Bilateral rod fracture: A rare malleable prosthesis mechanical complication

Von Laer, R1; Julio Junior, H1; Ahmed, S1; Oliveira, R1; Sabaneeff, J1

1: Hospital Federal Cradoso Fontes, Brazil

Objective: to report a rare case of bilateral rod fracture of a malleable prosthesis and its management.

Material and methods: A 69 year old man submitted to malleable prosthesis implantation due to erectile dysfunction secondary to radical prostatectomy  with no recover with drug therapy. Two months after the implantation procedure, during a sexual intercourse, the patient heard a loud “crack”, followed by instantaneous shortening of the prosthesis bilaterally. No urinary and algic complaints were noticed. On examination: perineal region and scrotum without evidence of hematoma nor edema.

Results: A Magnetic Resonance Imaging of the pelvic region was requested and showed a discontinuity of the two components of the penile prosthesis, one in corpus cavernosum, in their proximal segments, with right angled proximal component superiorly relative to the rest of the prosthesis, and other, the left, with the angled inferiorly discontinuous component relative to the proximal the remainder of the prosthesis. There is a small bulging of the lower surface of the base of the penis right there, determined by printing the prosthesis. There is no evidence of penile or surrounding tissue collections. Pacient underwent a prosthesis change.

Conclusion: Despite the effectiveness and safety of the malleable prosthesis, there is one complication that depends only of the prosthesis and that doctors have to know that exists and how to diagnose it.

Disclosures:

Work supported by industry: no.

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Validated questionnaires to assess sexual function of survivors of the uterine cervical neoplasm (#320)

L. Farinha Silva (Brazil)
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320

Validated questionnaires to assess sexual function of survivors of the uterine cervical neoplasm

Farinha Silva, L1

1: Instituto Nacional de Câncer José Alencar Gomes da Silva , Brazil

Uterine cervical neoplasm is the third most prevalent cancer in Brazil and the fourth most common type of cancer among women worldwide. Therapeutic modalities consist of surgery, radiation and chemotherapy which are associated with female sexual dysfunction, either by surgical approach, by irradiation of the pelvic region or by adverse accustomed to chemotherapy. The questionnaires for the assessment of sexual dysfunction are facilitators in understanding this disorder, enable your graduation thus enabling the comparison between groups of patients and assist in addressing this issue by health professionals.

Objective: After extensive literature review, to identify questionnaires validated for assessment of sexual function of women survivors of the uterine cervical neoplasm.

Material and Method: analyzed studies released between January 1984 and December 2013 were rated on their internal validity.

Results: twenty seven studies were included, the majority has analyzed the internal validity by Cronbach's alpha.

Conclusion: Only three questionnaires are validated for assessment of sexual function of survivors of cancer of the cervix.

Disclosures:

Work supported by industry: no.

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