Search

Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Furthermore, to achieve optimal outcomes in patients with pelvic floor disorders, a consensus is required to identify the best available validated instruments for capturing patient-reported symptoms, such as fecal incontinence, urinary incontinence, constipation, lower urinary tract symptoms, and sexual dysfunction. Other terms included "fecal incontinence", "constipation", obstructed defecation syndrome", "intestinal function", "bowel function", "gastrointestinal symptoms", "sexual function in men", "sexual function in women", "urinary incontinence", "lower urinary tract symptoms", "bladder dysfunction", and "quality of life." Six multidisciplinary workgroups were created, each assigned to investigate a specific symptom: fecal incontinence, constipation, urinary incontinence, lower urinary tract symptoms, male sexual function, and female sexual function. The UDI-6 only contains 6 questions and covers the type of UI, symptoms associated with UI, severity of symptoms and symptom bother. [Extracted from the article]

Introduction: Many transgender and nonbinary (TGNB) individuals seek out puberty blockers (PB) to stop the progression of unwanted changes from endogenous puberty and/or gender affirming hormone therapy (GAHT) to aid in their medical transition. There has been limited research assessing the effect of these hormone therapies on sexual function and desire, especially in comparing GAHT and PB+GAHT. Objective: Our aim was to compare the effect of GAHT and PB+GAHT on sexual function and desire of TGNB individuals during or following hormone therapy. Methods: We performed an IRB approved two institutional study on the effect of GAHT and/or PB on sexual function and desire in adults. The GAHT group (n=12) included individuals who started GAHT (estrogen or testosterone) >18 years old. The PB group (n=10) included subjects with current or past history of GnRH agonist use (>10 years old). Enrolled subjects completed the validated Changes in Sexual Functioning Questionnaire (CSFQ). The CSFQ was validated in adults to assess medication-related changes in sexual functioning. The questionnaire is specific to sex assigned at birth with a male and female version. The answers were scored in total and separated into sexual function and sexual desire subscales. Scores in each group were compared using unpaired t-tests. Results: A total of 22 TGNB (16 assigned male at birth and 6 assigned female at birth: 14 transgender women, 5 transgender men, 3 non-binary) subjects ages 18-25 completed the CSFQ about the effect hormone therapy had on sexual function and desire. There was no difference between groups in total scores (t = 0.8, p = 0.05) or in categories of sexual function (t = 0.3, p = 0.05) and desire (t = 0.8, p = 0.05). There were an equal number of participants in both groups whose results showed sexual dysfunction in total (n=2 per group) and in categories of sexual function (n=7 per group) and desire (n=3 per group). The cause of their dysfunction is unclear at this time and is to be investigated in the future. Interestingly, despite meeting quantitative criteria for sexual dysfunction, 6 participants answered that their sexual life brings them "much" or "great" enjoyment or pleasure. Conclusions: Based on our results, while there were >70% of subjects in each group with impaired sexual function, there were no differences in effect on sexual function and desire between subjects on GAHT vs. PB+GAHT. Additionally, the scores for both groups did not differ substantially from scores of cisgender individuals (Keller, et al 2006). In fact, both the GAHT and PB+GAHT groups scored higher on average in the sexual desire category compared to cisgender individuals. Prospective data collection will help us clarify further whether starting age of pubertal blockers and hormone therapy affects sexual function and desire. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Certain types of masturbation have been shown to affect genital and genitourinary health. However, the full range of health benefits associated with masturbation and its various forms remains inadequately studied. Objective: This study aimed to investigate the literature addressing utilization of masturbation for various health conditions among females. Methods: We conducted a systematic literature review of PubMed, Embase, and Medline from January 1980 to November 2023, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search incorporated keywords such as "masturbation," "sexual pleasure," "benefits of masturbation," "sexual self-stimulation," "solo sex," "onanism," and "self-pleasure." Inclusion criteria for the analysis were clinical trials, cohort studies, and reviews with cisgender women over 18 years old as participants, and masturbation utilized as an intervention. Exclusion criteria were case reports, surveys, studies involving men, or those with a history of gender dysphoria. Results: A total of 176 studies were initially identified. Only five studies met all inclusion and exclusion criteria. Among these, four were clinical trials, and one was a systematic review. All but one study investigated the role of masturbation in the ability to orgasm with or without a partner. Orgasmic function was noted to be improved among participants in these four studies. One study investigated the endocrine changes associated with orgasm and found a significant elevation in post-orgasmic prolactin, similar to men. Participants in all the studies were cisgender women aged 18 to 55, predominantly heterosexual. The intervention duration ranged from 10 minutes per session to multiple sessions over the course of five weeks, with only one study specifying the mode of masturbation (vibrators). Four of the studies used erotica and pornography as augmentation to masturbation, and a partner was involved in the intervention in two of the studies. Only one study employed formal quantitative methods for outcome assessment. Conclusions: Masturbation has primarily been investigated as an intervention for orgasmic dysfunction. There is a significant need for studies examining different types of masturbation and their effects on general and genitourinary health. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Certain types of masturbation have been shown to affect genital and genitourinary health. However, the full range of health benefits associated with masturbation and its various forms remains inadequately studied. Objective: This study aimed to investigate the literature addressing utilization of masturbation for various health conditions among females. Methods: We conducted a systematic literature review of PubMed, Embase, and Medline from January 1980 to November 2023, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search incorporated keywords such as "masturbation," "sexual pleasure," "benefits of masturbation," "sexual self-stimulation," "solo sex," "onanism," and "self-pleasure." Inclusion criteria for the analysis were clinical trials, cohort studies, and reviews with cisgender women over 18 years old as participants, and masturbation utilized as an intervention. Exclusion criteria were case reports, surveys, studies involving men, or those with a history of gender dysphoria. Results: A total of 176 studies were initially identified. Only five studies met all inclusion and exclusion criteria. Among these, four were clinical trials, and one was a systematic review. All but one study investigated the role of masturbation in the ability to orgasm with or without a partner. Orgasmic function was noted to be improved among participants in these four studies. One study investigated the endocrine changes associated with orgasm and found a significant elevation in post-orgasmic prolactin, similar to men. Participants in all the studies were cisgender women aged 18 to 55, predominantly heterosexual. The intervention duration ranged from 10 minutes per session to multiple sessions over the course of five weeks, with only one study specifying the mode of masturbation (vibrators). Four of the studies used erotica and pornography as augmentation to masturbation, and a partner was involved in the intervention in two of the studies. Only one study employed formal quantitative methods for outcome assessment. Conclusions: Masturbation has primarily been investigated as an intervention for orgasmic dysfunction. There is a significant need for studies examining different types of masturbation and their effects on general and genitourinary health. Disclosure: No. [ABSTRACT FROM AUTHOR]

Transgender females (TF) can experience aggressive forms of prostate cancer, but their uptake of prostate-specific antigen (PSA) screening for prostate cancer is not well-known. Although national guidelines recommend PSA screening based on age, they do not specify recommendations based on gender identity. We evaluate and compare factors associated with recent PSA screening between cisgender men (CM) and TF using Behavioral Risk Factor Surveillance System (BRFSS) survey data. BRFSS 2018-2020 data was queried to identify CM and TF older than 40 who provided responses to BRFSS questions asking time since last PSA test and whether a provider discussed PSA advantages and disadvantages. Rates of recent screening, defined as receiving a PSA test in the last 2 years with no current or past history of prostate cancer, were calculated for CM and TF. Ages were grouped as younger than 55, 55-69, and 70 years and older based on national PSA screening guidelines, and a 1:4 age-matched cohort between CM and TF was created. Weighted multivariable logistic regressions to measure effects of gender identity, sociodemographic variables, and healthcare access on the odds of recent screening and were calculated and presented as odds ratios (ORs) [95% confidence intervals]. The age-matched cohort had 1,252 CM and 313 TF; TF had a lower overall screening rate than CM (24% vs. 42.3%). TF and CM had similar rates of primary care visits within the last year (85% vs. 86%), but TF were less likely to report that a PSA screen was recommended to them by a provider (33% vs. 49%, p<0.001). Even among all patients with this PSA screening recommendation, fewer TF were recently screened than CM (63% vs. 78%, p = 0.002). In a multivariable regression model, TF had lower odds of recent screening (OR = 0.5 [0.32-0.76], p<0.001) when compared to CM. Discussion of PSA advantages with a provider had higher odds (OR = 15 [10.6-21.5], p<0.001) while discussion of PSA disadvantages was not significantly associated with screening (OR = 0.84 [0.6-1.2], p = 0.3). A college education had higher odds of recent screening (OR = 2.66 [1.2-6.3], p = 0.02) than no high school education. In a multivariable regression model of TF patients, TF aged 70 years and older had higher odds of recent screening (OR = 2.8 [1.1-7.1], p = 0.002) than TF aged 55-69, with screening rates of 14%, 21% and 60% for the under 55, 55-69, and 70+ age groups, respectively. Similarly, to the overall cohort, provider-led discussion of PSA advantages had the strongest association with recent screening (OR = 15.4 [6.15-43.1], p < 0.001), followed by being college educated (OR = 5.7 [1.5-24.9], p = 0.01). TF patients were screened with PSA at a lower rate than CM. Discussing PSA screening benefits with a provider had the largest effect on recent screening among TF patients, highlighting the provider's role in screening uptake. Future studies should continue to evaluate the effects of provider perceptions and barriers to healthcare access on PSA screening in TF. [ABSTRACT FROM AUTHOR]

Introduction: Approximately 70% of transgender females express future interest in having children (Auer et al, 2018). However, studies have demonstrated poor semen parameters among this population who undergo sperm cryopreservation (Rodriguez-Wallberg et al, 2021). It remains poorly understood the underlying etiologies which place individuals at increased risk of suboptimal semen parameters. Objective: We sought to identify clinical predictors of lower sperm quality among a cohort of transgender females and to compare this to a cohort of cisgender males. Methods: We retrospectively identified 19 transgender women who underwent sperm cryopreservation at a single andrology lab within an academic institution between November 2021 and April 2023. We identified 16 age-matched cisgender male patients who also underwent sperm cryopreservation prior to oncologic treatment or vasectomy during this period. Data was abstracted from the electronic medical record. Statistical analysis was performed using SPSS version 28. Results: Median age and body mass index of the transgender cohort was 25 years (range: 18-35) and 25.1 kg/m2 (range: 18.0-51.5). Median age and BMI of the cisgender cohort was 29 years (range: 17-37) and 25.2 kg/m2 (range: 18.7-38.0). Cisgender patients underwent sperm cryopreservation for oncologic treatment (81%) and pre-vasectomy planning (19%). 32% of transgender patients were initiated on gender affirming hormonal therapy (estradiol, spironolactone, or both) prior to semen analysis, with mean duration of 25 months (range: 1-108). 37% of transgender and 13% of cisgender patients were on a psychiatric medication with mean duration of 7.6 months (range: 1-19) and 7.5 months (range: 3-12) preceding sperm cryopreservation. 11% of transgender and 6% of cisgender patients endorsed tobacco use. 37% of transgender and 38% of cisgender patients endorsed alcohol use. Mean total motile sperm count (TMSC) was 61 million in the cisgender cohort and 105 million in the transgender cohort (p=0.159). 21% and 38% of the transgender and cisgender cohort had low TMSC (<10 million). Mean post-thaw motility recovery was similar among the two groups (56% vs 57%, p=0.894). Transgender women on hormonal therapy had lower TMSC (p=0.867) and post-thaw motility recovery (p=0.535; Table 1) compared to their hormone-naïve counterparts. Alcohol use was a significant predictor of decreased post-thaw motility recovery among cisgender patients (63% vs 46%; p=0.011; Table 2). Conclusions: Cisgender men had lower TMSC, but this was likely confounded by underlying malignancy. There was a trend toward worse semen parameters among transgender women with a history of hormone use, but larger studies are needed to validate this finding. Psychiatric medications similarly did not appear to be significant predictors of sperm quality among transgender women. Further studies are needed with a larger sample size and cisgender males without malignancy to validate the effect of these modifiable lifestyle factors. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Endo Pharmaceuticals. [ABSTRACT FROM AUTHOR]

There are limited data on the effects of gender affirming hormone therapy on prostate specific antigen (PSA) values in transgender or non-binary individuals (TGNB) born with prostate glands. Additionally, the relative incidence of prostate cancer in TGNB individuals compared to cisgender men is poorly characterized. This study hypothesized that various gender affirming hormone therapies would significantly reduce PSA, and possibly result in lower incidence of prostate cancer either due to biological effect or from reduced detection with PSA suppression. This was a multicenter, nationwide cohort study of individuals receiving care in the VA Healthcare system. For analyses comparing TGNB individuals to cisgender men, TGNB patients were matched to cisgender controls by year of birth. To account for repeated testing of PSA within patients as well as matching between cohorts, linear mixed effects modeling was employed. We studied separately the effects of gender affirming hormone therapies using gonadotropin-releasing hormone agonist/antagonists (GnRH containing regimens) and non-GnRH containing regimens. We quantified incidence of prostate cancer as new cases per 1000 patient-years, measuring exposure from time of age 50 to last follow up or death. Our cohort included 1,024 self-identified TGNB individuals assigned male at birth who received PSA testing in the VA Healthcare System. Use of non-GnRH hormone therapy was associated with a 1.30 ng/mL lower PSA (95% confidence interval (CI) = 1.14-1.46, P < 0.001) and GnRH hormone therapy was associated with a 1.08 ng/mL lower PSA (95% CI = 0.60-1.55, P < 0.001) in matched analysis with cisgender men. Within the TGNB cohort, there were 450 individuals who had undergone PSA testing both before and after initiation of hormone therapy. For these individuals, initiation of non-GnRH therapy resulted in a 0.49 ng/mL decrease (95% CI = 0.35-0.62, P < 0.001) and initiation of GnRH hormone therapy resulted in a 0.73 ng/mL decrease (95% CI = 0.43-1.02, P < 0.001) from a pre-hormone therapy median PSA baseline of 0.70 ng/mL. TGNB individuals developed prostate cancer at a rate of 1.79 per 1,000 patient-years compared to 4.02 per 1,000 patient-years in cisgender individuals. TGNB individuals undergoing gender affirming hormone therapies experience decreases in PSA and are less likely to be diagnosed with prostate cancer than matched cisgender individuals. It is not clear if the lower incidence of prostate cancer is the result of hormonal chemoprevention or ascertainment bias from suppression of PSA. Future work should establish if a lower PSA threshold for biopsy should be used for TGNB individuals receiving gender affirming hormone therapy who elect to undergo prostate cancer screening. [ABSTRACT FROM AUTHOR]

As it is well known, the power loss of transformer core steel depends on a series of parameters which vary in the final core in complex ways. The aim of the present study was to investigate the corresponding dependencies for the second key characteristic, i.e., magnetostriction (MS), as the most significant source of no-load noise. The MS-performance of core material was investigated by means of a rotational single sheet tester (RSST). Compared to loss, the peak-to-peak MS in rolling direction (RD; as the direction of strongest strain) shows similar increases with increases of both induction and axis ratio a. On the other hand, the shape of induction pattern B (t) proves to be rather insignificant, MS being similar for elliptic and rhombic magnetization. While increased dynamics of the pattern yields rising eddy current loss, MS remains unaffected. However, the harmonics show increases as being of relevance for audible noise. While mechanical tension in RD yields slight decreases of MS for alternating magnetization, MS for rotational magnetization increases for both tension and compression. As in the case of loss, MS shows significant increases for DC-bias which correlates with reports of increased noise. The study also included local measurements on a 2-limb, 1-phase model core and on a 3-limb, 3-phase core. MS remains in the order of 0.5 ppm for the 1-phase core, except from its corners. On the other hand, T-joint regions of the 3-phase core show values up to the order of 6 ppm, in accordance to RSST-results. Moderate DC magnetization, as being possible in practice as a long term phenomenon, yields distinct increase of MS intensity and MS harmonics with strong regional differences. [ABSTRACT FROM PUBLISHER]

While it is becoming increasingly common for people to identify as transgender or gender-non-binary, our understanding of the influence of gender identity on disease severity of hormone-sensitive malignancies, including prostate cancer (PC) is limited. The goal of this study is to compare the aggressiveness of disease and survival outcomes between transgender or gender non-binary (TG) and cis-gender (CG) patients with PC. The cohort included patients diagnosed with PC between 1999 and 2022 within the Veterans Health Administration (VHA) Database. TG patients were identified with an ICD 9 or 10 diagnosis code that occurred prior to PC diagnosis. Treatment information and baseline disease characteristics were ascertained through the VHA electronic health records. Multivariable logistic regressions were performed to estimate the association between TG status and presenting with Gleason > = 8, PSA > 20 ng/mL, and metastatic disease at diagnosis. Covariates in these models included age at diagnosis, race, ethnicity, marital status, and smoking status. Metastases were identified through natural language processing from cancer or radiology documents. Time to metastases was defined as the time from PC diagnosis to metastases, with other causes of death considered as competing risks. The association between TG identity status and metastatic disease was calculated with a Cox regression model. The difference in overall survival was assessed with the Kaplan-Meier method and log-rank test. The final cohort was composed of 282,264 individuals, 219 (0.08%) of which were identified as TG. TG patients have similar odds of presenting with presenting with Gleason Score ≥8 (Odds Ratio (OR) 1.18, p = 0.31), PSA >20 ng/mL (OR 0.78, p = 0.59), and metastasis at diagnosis (OR 0.47, p = 0.29). There were 34,918 patients who develop metastatic disease at any time, 24 of which were TG. The 10-year cumulative incidence of metastases for TG and CG individuals was 11.5% (95% Confidence Interval (CI): 6.6-16.1%) and 13.9% (CI: 13.7-14.0%), respectively. There was no significant difference between TG status and risk of developing metastases (Hazard Ratio (HR) 0.93, p = 0.71). The 10-year overall survival for TG and CG was 73.4% (CI: 66.5-80.9%) and 65.0% (CI: 64.8-65.2%), respectively. There was no significant difference between TG status and overall survival (Hazard Ratio (HR) 0.83, p = 0.13). TG individuals do not appear to have a difference in disease characteristics at diagnosis or survival compared to CG individuals. Future research should be done to determine the effect of gender affirming treatment on these outcomes. Furthermore, it is unclear if diagnosis codes are accurately identifying TG individuals. [ABSTRACT FROM AUTHOR]

Introduction: Sexual health is a fundamental dimension of overall human well-being, deeply intertwined with physical health, interpersonal relationships, and the overall quality of life. However, sexual dysfunction is prevalent among both men and women. Despite it's common occurrence, it often remains underdiagnosed and undertreated. In an attempt to improve the treatment landscape and offer new hope for those suffering from sexual dysfunction, researchers have turned to explore unconventional therapies, examining substances beyond the traditional medicinal spectrum. Compounds typically associated with recreational use, like cannabis and LSD, have been subjects of recent studies, exploring their potential therapeutic value. Notably, 3,4-Methylenedioxymethamphetamine (MDMA), colloquially known as 'Ecstasy,' has been attracting significant scientific interest. This synthetic amphetamine is known for its psychostimulant and entactogenic properties, and anecdotally noted for its potential effects on the sexual response cycle. Objective: To examine the existing literature on the effects of MDMA on male and female sexual responsiveness and the potential role of MDMA in treating sexual dysfunction of various etiologies. Methods: We conducted a systematic review on the effects of MDMA on each domain of the female and male sexual response cycles. PubMed, MEDLINE, and EMBASE were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms utilized were "MDMA" or "Ecstasy" in combination with "desire," "arousal", "lubrication", "orgasm", "pleasure", "libido", "erection" and "ejaculation". Inclusion criteria for this review were MDMA use by study subjects, sexual outcomes in at least one domain of the female and/or male sexual response cycles were described and measured. Randomized control trials (RCT), cohort studies (both prospective and retrospective), surveys, and literature reviews published between January 2000 and June 2022 were included. Results: We identified 181 studies, of which six met criteria for assessment of the female sexual response cycle and eight met criteria for assessment of the male sexual response cycle. Four of six studies reported increased sexual desire with MDMA use among women. Arousal and lubrication were improved with MDMA use in three of four studies, but they were not affected in one randomized control study. In men, seven studies evaluated the effects of MDMA on desire and/or arousal, five studies measured impact on erection, three on orgasm, and two on ejaculation. Sixty percent of interview-based studies reported increased sexual desire in men, while 40% reported mixed or no effect. Two studies reported impairment of erection, two reported mixed effects, and one reported "fear of erection impairment." In both men and women, all studies evaluating orgasm reported delay in achieving orgasm, but increased intensity and pleasure if achieved. Primary outcome measures were variable and largely qualitative. Conclusions: Our findings suggest that MDMA generally increases sexual desire and intensifies orgasm when achieved. While producing conflicting evidence on sexual arousal in both sexes, MDMA may impair erectile and ejaculatory function in men. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Sexual health is a fundamental dimension of overall human well-being, deeply intertwined with physical health, interpersonal relationships, and the overall quality of life. However, sexual dysfunction is prevalent among both men and women. Despite it's common occurrence, it often remains underdiagnosed and undertreated. In an attempt to improve the treatment landscape and offer new hope for those suffering from sexual dysfunction, researchers have turned to explore unconventional therapies, examining substances beyond the traditional medicinal spectrum. Compounds typically associated with recreational use, like cannabis and LSD, have been subjects of recent studies, exploring their potential therapeutic value. Notably, 3,4-Methylenedioxymethamphetamine (MDMA), colloquially known as 'Ecstasy,' has been attracting significant scientific interest. This synthetic amphetamine is known for its psychostimulant and entactogenic properties, and anecdotally noted for its potential effects on the sexual response cycle. Objective: To examine the existing literature on the effects of MDMA on male and female sexual responsiveness and the potential role of MDMA in treating sexual dysfunction of various etiologies. Methods: We conducted a systematic review on the effects of MDMA on each domain of the female and male sexual response cycles. PubMed, MEDLINE, and EMBASE were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms utilized were "MDMA" or "Ecstasy" in combination with "desire," "arousal", "lubrication", "orgasm", "pleasure", "libido", "erection" and "ejaculation". Inclusion criteria for this review were MDMA use by study subjects, sexual outcomes in at least one domain of the female and/or male sexual response cycles were described and measured. Randomized control trials (RCT), cohort studies (both prospective and retrospective), surveys, and literature reviews published between January 2000 and June 2022 were included. Results: We identified 181 studies, of which six met criteria for assessment of the female sexual response cycle and eight met criteria for assessment of the male sexual response cycle. Four of six studies reported increased sexual desire with MDMA use among women. Arousal and lubrication were improved with MDMA use in three of four studies, but they were not affected in one randomized control study. In men, seven studies evaluated the effects of MDMA on desire and/or arousal, five studies measured impact on erection, three on orgasm, and two on ejaculation. Sixty percent of interview-based studies reported increased sexual desire in men, while 40% reported mixed or no effect. Two studies reported impairment of erection, two reported mixed effects, and one reported "fear of erection impairment." In both men and women, all studies evaluating orgasm reported delay in achieving orgasm, but increased intensity and pleasure if achieved. Primary outcome measures were variable and largely qualitative. Conclusions: Our findings suggest that MDMA generally increases sexual desire and intensifies orgasm when achieved. While producing conflicting evidence on sexual arousal in both sexes, MDMA may impair erectile and ejaculatory function in men. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have evaluated surgical outcomes and aesthetic results of Genital Gender Affirming Surgery (GGAS) while few studies have examined sexual outcomes after GGAS. Objective: We sought to systematically review the literature on sexual health outcomes of metoidioplasty in the transmasculine population. Methods: PubMed, Embase, and Web of Science was used to identify studies through April 29, 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Figure 1 shows search terms, inclusion, and exclusion criteria. Results: Fourteen papers were included. Findings on arousal/desire ranged from 86% (n=48) reporting desire for sex to 100% (n=1455) reporting no difficulty in arousal. Preserved erogenous sensation and no issues with masturbation was reported in 100% of people across studies (n=1164;1455). Orgasm ability ranged from 66-70% (n=115) who were able to orgasm during sexual activity or masturbation to 100% (n=1455) who had no problems with orgasm. Orgasm satisfaction was found to be 100% (n=48). A study found that 80% (n=15) had challenges with erections, with 83% (n=18) of Erection Hardness Scores were 'larger but not hard' or 'hard but not hard enough for penetration.' Earlier studies reported 100% of people had an erection (n=1599), and ratings of 'satisfied' or 'partially satisfied' in 94% (n=145). Across studies, 87-100% were unable to have penetrative sex (87% unable, n=15; 100% unable, n=737). For some, the inability to penetrate was the most dissatisfactory aspect of the metoidioplasty for 39% of patients (n=28). Conclusions: Current literature on transmasculine people undergoing GGAS shows high ratings of arousal/desire, preservation of erogenous sensation, masturbation, and ability to orgasm following metoidioplasty. Data on the ability and adequacy of erection is less definitive. Overall ratings of sexual health appear high, but inability to have penetrative sex remains a source of persistent dissatisfaction for some. Further studies using surveys validated in transmasculine populations are needed to definitively describe sexual function after GGAS. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Various validated questionnaires have been designed to evaluate sexual dysfunction as it relates to specific phases of the sexual response cycle, which include desire, arousal, orgasm, and resolution. Although there is a breadth of data on the surgical and aesthetic outcomes of patients who have undergone gender-affirming pelvic surgery (GAPS), there are limited data on sexual outcomes as they relate to the sexual response cycle after GAPS. Questionnaires are a crucial tool for research and clinical assessment of sexual dysfunction. However, many of the validated questionnaires for sexual dysfunction were not created for use in transgender patients after GAPS. To date, there is not a validated questionnaire specifically for patients who have undergone GAPS. Objective: We sought to review the most commonly used sexual function questionnaires and assess their inclusivity as it relates to transgender patients who have undergone GAPS. Methods: A PubMed and PsycINFO search was carried out using the keywords: "Validated questionnaires" AND "sexual dysfunction" OR "arousal" OR "desire" OR "libido" OR "satisfaction" OR "quality of life". We then reviewed the most commonly used validated sexual dysfunction questionnaires and graded them on the metrics of medical applicability of patients who had undergone vaginoplasty, metoidioplasty, or phalloplasty, affirming language, and inclusion of identities beyond fully binary transgender people. The validated questionaries were reviewed by a comprehensive sexual health expert and a gender-affirming surgeon. Results: Of the 13 questionnaires reviewed, only 5 met all metrics for inclusiveness. 4/13 of the validated questionnaires used exclusionary gendered language (female vs male), 6/13 were not physiologically applicable to patients who had undergone GAS (vaginal lubrication, ejaculation etc) and 2/13 assumed heterosexual orientation. Conclusions: The current clinical and research tools used to define sexual dysfunction are not inclusive of people who have undergone gender-affirming surgery. Validated questionnaires are needed to optimally assess the sexual outcomes of patients who have undergone GAS. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Gender affirming hormone therapy (GAHT) is part of the transition for many transgender and nonbinary (TGNB) individuals. Additionally, it has become increasingly more common for TGNB youth to receive puberty blockers (GnRH agonist) to halt the pubertal progression. There have been few studies investigating sexual function and desire either during or after puberty blockers (PB) and/or GAHT. Objective: Our aim was to qualitatively evaluate the sexual experience of TGNB individuals during or following PB and/or GAHT, and outline any potential differences between the two groups. Methods: We performed an IRB approved two institutional study on the effect of PB and/or GAHT on sexual function and desire. The GAHT group (n=16): individuals who started GAHT (estrogen or testosterone) >18 years. The PB+GAHT group (n=10): subjects with current or past GnRH agonist use +GAHT. All 26 enrolled subjects were interviewed using an open-ended topical guide. Qualitative analysis was performed by hand coding the interview transcripts using Constructivist Grounded Theory qualitative methods. Results: A total of 26 TGNB (20 assigned male at birth, 6 assigned female at birth: 18 transgender women, 5 transgender men, 3 non-binary) subjects ages 18-25y were interviewed about the effect of PB and/or GAHT on their sexual function and desire. Our analysis uncovered several themes that were consistent between groups (Table 1). Conclusions: Themes were similar for both groups. Half the participants in each group reported feeling no regrets regarding hormone therapy, and the other half reported that they wished they had started hormones sooner. Two notable differences were identified between groups: those on PB+GAHT reported "less dysphoria" as a positive change in sexual desire, and the GAHT group reported more enjoyable sexual experiences since being on hormones. Interestingly, results did not reveal any significant differences between groups. The most prominent theme that arose in both groups was that the positive changes in sexual function and desire outweighed any negative changes that arose. Disclosure: No. [ABSTRACT FROM AUTHOR]

Only recently, the stigma of women using vibrators for sexual pleasure has started to fade. However, for many it still remains a taboo and surrounded with anxiety despite a variety of potential health benefits from its use. Due to the sensitive nature of the conditions Female Pelvic Medicine and Reconstructive Surgery (FPMRS) specialists treat, they are best suited to review and recommend vibrators to women as a health maintenance intervention. The aim of this review is to evaluate the current utilization and recommendations of vibrator use. We performed a systematic review of PubMed, clinicaltrials.gov, Ovid and the Cochrane databases from inception to January 2021. The search was based on the keywords: "sex toy woman", "pelvic vibrator", "sexual stimulation vibrator", "vaginal vibrator" "vibrator pelvic floor", "vibrator incontinence". Five hundred forty-nine relevant articles were identified. Studies that met inclusion criteria (original research, female subjects, vibrators studied for health benefit) were reviewed. Exclusion criteria included expert opinion or content was not related to our aims. A total of 17 original studies met the criteria and were reviewed in depth. The studies naturally fell into four topics: sexual function (8), pelvic floor muscles (2), incontinence (6), and vulvodynia (1). Among the identified studies, vibrators were considered as an accepted modality to enhance a woman's sexual experience, positively correlated with increased sexual desire, satisfaction, and overall sexual function. Vibratory stimulation can improve pelvic floor muscles strength, vulvodynia, and incontinence. Vibrators are not well studied and given the promising benefits demonstrated in the articles identified, more research efforts should be directed towards investigating their utility. Considering the potential pelvic health benefits of vibrators, their recommendation to women should be included in our pelvic floor disorder treatment armamentarium. No [ABSTRACT FROM AUTHOR]

Purpose: Synthetic mesh for herniorrhaphy has been placed under critical observation regarding the potential association of mesh placement and the subsequent development of autoimmune diseases. We sought to evaluate whether there is a link between synthetic polypropylene mesh repairs and the subsequent development of systemic/autoimmune disorders (SAID).Study Design: Adult men undergoing hernia repair with mesh between January 2008 and December 2009 in New York State were identified using International Classification of Diseases, Ninth Revision, Modification procedure codes and Current Procedural Terminology Coding System, Fourth Edition codes. A control cohort of men undergoing colonoscopy was created with whom to compare outcomes.Results: A total of 29,712 patients underwent hernia repair between January 2008 and December 2009. In the control cohort, 79,265 patients underwent colonoscopy. During the entire follow-up, 475 patients undergoing hernia repair and 1305 patients in the control cohort were diagnosed with autoimmune disease. When patients were matched based on demographics, comorbidities and procedure date, hernia repair was not associated with an increased risk of developing autoimmune disease over the entire follow-up time period. 1.6% of those in the hernia group vs. 1.7% of those in the colonoscopy group developed SAID [risk ratio (95% CI): hernia vs. colonoscopy 0.93(0.79-1.09)]. No association between mesh surgery and increased risks of SAID was found at any of the specified time points (6 months, 1 year, and 2-year follow-up).Conclusions: Mesh-based hernia repair was not associated with the development of autoimmune diseases compared to those undergoing routine screening colonoscopy. [ABSTRACT FROM AUTHOR]

Female sexual wellness is a highly complex condition that builds not only on biological factors, but also on social norms, background, religion, education, and social media. One source where both women and men learn about sexual behavior, interactions, and expectations is pornography. This resource has become widely available to anyone with access to the internet. While pornography is a way of expanding sexual horizons, like any media it may misrepresent more common behaviors and expectations for both genders. The impact of pornography on male attitudes towards sex and women in general has previously been described. This not only harming males, but it also potentially has negative effects on female sexual wellness as well. The purpose of this review is to evaluate how women's sexuality is portrayed in the most commonly viewed pornography videos in order to understand its role in female sexual health. Videos from the category "most viewed videos" based on internet ratings were viewed. We analyzed the content and female and male sexual behaviors. We reviewed the 25 most viewed videos by the general public from the five most popular free pornography websites. The two most commonly viewed contexts were sexual encounters between step relatives (16%) and during casting sessions (16%). With the majority of videos having two participants (92%), two videos included three and five participants. Overall, only 9 (36%) videos demonstrated at least one female orgasm with 5 (20 %) videos showing clitoral stimulation before reaching orgasm. Only 4 (16%) videos did not demonstrate male orgasm. Similarly, only 8 (32%) videos pictured a female as the recipient of oral sex, whereas all but 3 (12%) videos showed the male as the recipient. Only in one (4%) video did a woman have more than one orgasm. Anal sex was represented in 4 (16%) of videos, with novelty toy uses in one (4%) video. The most viewed videos on popular pornography sites did not represent the most common sexual scenarios as these were between step relatives and during casting sessions. Pornography demonstrates preference for male-centered pleasure. Although the majority of women climax with clitoral stimulation, this was not represented by popular pornography sites. Inaccurate portrayal of female sexuality can contribute to sexual performance anxiety, unfulfilled expectations among both partners, and sexual dysfunction. More research is needed to determine the best referral websites representing more realistic female sexual behavior. No [ABSTRACT FROM AUTHOR]

Trends in appearance of female genitalia has been influenced by social media, entertainment industry, and even politics. Cosmetic labiaplasty has increased by 39% over the last decade. Wide availability and accessibility of pornography is another source where women and men learn about the anticipated normal appearance of the genitals. The purpose of this review is to evaluate the current trends in appearance of female genitalia based on the most viewed pornography videos. We hypothesized that pornography may influence such trends in labiaplasty. After panel of experts agreed on definitions and classifications of the different genital parts and beautification trends, we reviewed videos from the category "most viewed videos" on the most popular free pornography websites. We analyzed common representations of female genital appearance, including hair grooming (completely shaved, trimmed, natural), hyperpigmentation (natural with hyperpigmented perianal and labial skin vs. bleached with equal hyperpigmentation throughout), appearance of labia majora (thickness, length), appearance of labia minora (presence and length compared to the labia majora), clitoral hood appearance (status post clitoral hood reduction), and width of the genital hiatus. We reviewed the 25 most viewed videos from the five most popular free pornography websites. Among females and males, complete shaving of the pubic hair was the most common pattern, 56% (14) and 52% (13) respectively, followed by the trimmed pubic hair equally among both genders 40% (10). Only 8% of videos demonstrated labia majora resembling pre-pubertal (surgically enhanced) appearance. 44% of women had labia minora larger than labia majora, 36% had them at equal length, and 16% showed no labia minora and were consistent with labiaplasty. 92% of videos demonstrated a normal appearing clitoral hood with no signs of surgical reduction. Bleaching or removal of natural hyperpigmentation was noted in 20% of videos. Wide genital hiatus consistent with vaginal delivery was identified in 16% of videos. No signs of pelvic organ prolapse, piercings, or other abnormalities were noted. We found that the most popular pornography videos had a range of genital appearances, disproving our hypothesis that labiaplasty and bleaching are commonly seen in pornography. However, pornography likely has influenced trends in hair removal. The most viewed videos on the most popular pornography sites may nonetheless create expectations for both genders on the genital appearance of a partner. No [ABSTRACT FROM AUTHOR]

Female sexual wellness is a highly complex condition that builds not only on biological factors, but also on social norms, background, religion, education, and social media. One source where both women and men learn about sexual behavior, interactions, and expectations is pornography. This resource has become widely available to anyone with access to the internet. While pornography is a way of expanding sexual horizons, like any media it may misrepresent more common behaviors and expectations for both genders. The purpose of this review is to evaluate how women's sexuality is portrayed in the most commonly viewed pornography videos in order to understand its role in female sexual health. Videos from the category "most viewed videos" based on internet ratings were viewed. We analyzed the content and female and male sexual behaviors portrayed. We reviewed the 25 most viewed videos by the general public from the five most popular free pornography websites. The two most commonly viewed contexts were sexual encounters between step relatives (16%) and during casting sessions (16%). With the majority of videos having two participants (92%), two videos included three and five participants. Overall, only 9 (36%) videos demonstrated at least one female orgasm with 5 (20 %) videos showing clitoral stimulation before reaching orgasm. Only 4 (16%) videos did not demonstrate male orgasm. Similarly, only 8 (32%) videos pictured a female as the recipient of oral sex, whereas all but 3 (12%) videos showed the male as the recipient. Only in one (4%) video did a woman have more than one orgasm. Anal sex was represented in 4 (16%) of videos, with novelty toy uses in one (4%) video. We found that he most viewed videos on popular pornography sites did not represent the most common real life sexual scenarios and were predominantly male-pleasure centered.Inaccurate portrayal of female sexuality can contribute to sexual performance anxiety, unfulfilled expectations among both partners, and sexual dysfunction. More research is needed to determine the best referral websites and categories for women and their partners, representing more realistic female sexual behavior. No [ABSTRACT FROM AUTHOR]

A woman's sexual activity is a challenging topic to discuss for both provider and patient. Common questions about sexual activity imply that a woman is having partnered sexual activity with vaginal penetration. Discussion about masturbation or solo sexual experiences tend to be even more uncomfortable and considered a societal taboo. Nevertheless, solo sexual activity is an important part of physical and emotional health. The aim of this pilot study is to examine the differences in sexual health, pelvic floor health and overall wellness among women with predominantly partnered sexual activity (PSA) compared to solo sexual activity (SSA). This is a prospective pilot study of sexually active women with PSA and SSA age 18 to 99 years who presented for consultation to our Female Pelvic Medicine and Reconstructive Surgery clinic with a pelvic floor complain between May 2021 and August 2021. Participants were given validated questionnaires for 1) sexual health: Female Sexual Function Index (FSFI) and The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire International Urogynecological Association (IUGA) Revised (PISQ-IR); 2) pelvic floor function: The Pelvic Floor Distress Inventory Questionnaire (PFDI), Genitourinary Pain Index (GUPI), Interstitial cystitis/Painful bladder syndrome (IC/PBS), and 3) overall health: (Self-reported quality of life (SF-12), Patient Health Questionnaire (PHQ-9)). Physical exam and interview on sexual practices were performed. Demographics and health information were recorded. All data were analyzed with descriptive statistics, comparisons were made using Fisher Exact Test and Wilcoxson Rank Sum Tests. Among 23 women recruited in the pilot study, 13 had PSA and ten women had SSA. Among PSA, six women were also masturbating. Those who were sexually active with a partner were younger (p=0.021), and less likely to have neurologic disorders (p=0.022). No significant differences in demographics, comorbidities, hormonal therapies, pelvic floor disorders, or overall well-being were found between two groups. Women involved in PSA had significantly higher total FSFI score (p=0.035), sexual satisfaction (p=0.012). Interestingly, women with PSA had higher scores on ICSI (p=0.046) and less likely used a vibrator or sex toy ever in their lives (p=0.02). No significant differences in pelvic health and overall wellness were noted between women with PSA and SSA. Satisfaction from sexual activity is higher among younger women involved in partnered sex, in spite of no significant differences present in desire and orgasm domains. Sexual activity is more than just vaginal penetrative intercourse thus solo sexual practices should be assessed by medical providers especially in older women who might not have available partners. No [ABSTRACT FROM AUTHOR]

Female sexual dysfunction (FSD) is an orphaned field due to numerous barriers faced by both providers and patients. Internet platforms, such as mobile applications, are potential tools to overcome these barriers and improve patient access to education and management options for FSD. The purpose of this review is to identify existing applications addressing female sexual health and evaluate their educational content and services. We searched the internet and Apple App Store for key words including: "sexual wellness app for women", "female sexual health app", "best sex apps for women", "sexual health for women", "sexual health", "sexual wellness". A panel of female pelvic medicine and reconstructive surgery experts reviewed the apps for quality of content, scientific basis of provided information, interactivity, usability and whether they would recommend it as a reference tool for patients. Of the 204 apps identified, 182 were excluded based on unrelated content (sex frequency trackers, ovulation trackers, sex games for couples, etc.). Two applications did not work and three were meant to be used with a vibrator. Total of 17 apps were analyzed and divided into five categories: educational (6), emotions and communication (2), relaxation and meditation (4), general sexual health (2), and social and fun (3). Among these 17 apps, eight required either a one-time payment ($4.99- 9.99) or annual subscription ($23-120) and two apps were advertisement driven. The apps from the educational category were reviewed in further details. All of the educational apps provided scientific information in collaboration with health experts, however only three offered interactive features. When assessed for usability, one app received good (70) and five received excellent (97.5) scores based on the System Usability Scale (SUS). The majority of the apps (5) provided information on pathology and treatments of orgasmic dysfunction, but only one app, created by a physician, provided information on all categories of female sexual dysfunctions. The reviewers identified only one app that they would recommend as a credible resource for patients to use. Internet apps provide an ideal platform for women to learn about sexual health and female sexual dysfunction, which is rarely addressed by their healthcare providers. Apps may also serve as a valuable reference for providers. Our review of relevant apps available on the Apple App Store revealed only six with evidence-based information, and only one that would be recommended to patients by experts in the field. Clearly, there is a need for more accessible, educational resources addressing female sexual dysfunction for patients and providers. No [ABSTRACT FROM AUTHOR]

Trends in appearance of female genitalia has been influenced by social media, entertainment industry, and even politics. Cosmetic labiaplasty has increased by 56% over the last decade. Wide availability and accessibility of pornography is another source where women and men learn about the anticipated normal appearance of the genitals. The purpose of this review is to evaluate the current trends in appearance of female genitalia based on the most viewed pornography videos. We hypothesized that pornography may influence such trends in labiaplasty. After panel of experts agreed on definitions and classifications of the different genital parts and beautification trends, we reviewed videos from the category "most viewed videos" on the most popular free pornography websites. We analyzed common representations of female genital appearance, including hair grooming (completely shaved, trimmed, natural), hyperpigmentation (natural with hyperpigmented perianal and labial skin vs. bleached with equal hyperpigmentation throughout), appearance of labia majora (thickness, length), appearance of labia minora (presence and length compared to the labia majora), clitoral hood appearance (status post clitoral hood reduction), and width of the genital hiatus. We reviewed the 25 most viewed videos from the five most popular free pornography websites. Among females and males, complete shaving of the pubic hair was the most common pattern, 56% (14) and 52% (13) respectively, followed by the trimmed pubic hair equally among both genders 40% (10). Only 8% of videos demonstrated labia majora resembling pre-pubertal (surgically enhanced) appearance. 44% of women had labia minora larger than labia majora, 36% had them at equal length, and 16% showed no labia minora. We did not see any dangling labia. 92% of videos demonstrated a normal appearing clitoral hood with no signs of surgical reduction. Bleaching or removal of natural hyperpigmentation was noted in 20% of videos. Wide genital hiatus consistent with vaginal delivery was identified in 16% of videos. No signs of pelvic organ prolapse, piercings, or other abnormalities were noted. We found that the most popular pornography videos had a range of genital appearances. Pornogaphy definitely influenced hair grooming pattern. The most viewed videos on the most popular pornography sites may create expectations for both genders on the genital appearance of a partner. No [ABSTRACT FROM AUTHOR]

A recently developed calculation scheme for the computer modelling of the load-controlled noise of oil-insulated three-phase power transformers is presented. This modelling scheme allows the precise and efficient computation of the coupled electromagnetic, mechanical and acoustic fields. The equations are solved using the finite element method (FEM) as well as the boundary element method (BEM), resulting in a separation of the calculation of the winding and tank surface vibrations (using FEM) and the computation of the acoustic free-field radiation (using BEM). The complex dynamic behaviour of the loaded transformer can then be studied and, furthermore, an appropriate computer-aided design including an investigation and optimization of design parameters can be established.The validity of the computer simulations has been verified by means of appropriate measurements. Simulated and measured values for winding and tank surface vibrations as well as sound power levels of the loaded transformer are found to be in good agreement. The applicability of the calculation scheme with respect to the computer-aided design of power transformers is demonstrated by reporting two practical applications: the influence of the stiffness of winding supports and the influence of the tap changer positions. [Copyright &y& Elsevier]