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PROCEEDINGS OF THE 16TH WORLD MEETING ON SEXUAL MEDICINE, SÃO PAULO, BRAZIL, OCTOBER 8–12, 2014

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ICARISIDE II AMELIORATES ERECTILE FUNCTION IN A RAT MODEL OF BILATERAL CAVERNOUS NERVE INJURY: IMPLICATIONS FOR ACTIVATION OF ENDOGENOUS STEM CELLS Xu, Y1; Guan, R1; Lei, H1; Li, H1; Gao, Z1; Xin, Z1 1: Andrology Center, Peking University First Hospital, Peking University, Beijing, China Objective: Activation of endogenous stem cells (ESCs) might help conservation intrinsic healing capacity of a healthy organism as well as rejuvenation of damaged erectile function. The aim of this study is to investigate the feasibility and mechanism of incariside II (ICA II) in the treatment of ED in a rat model of bilateral cavernous nerves (CN) injury. Methods: sixty newborn male rats were intraperitoneally injected with 5-ethynyl-2-deoxyuridine (EdU; 50 mg/kg) for the purpose of tracking putative ESCs. Eight weeks later, forty-eight rats underwent CN crush injury and were randomized into gavage feeding of solvent (vehicle group), ICA II 0.5, ICA II 1.5 or ICA II 4.5 mg/kg/day. Twelve animals underwent sham surgery, received vehicle treatment and served as sham group. Treatment was continued for 4 weeks followed by a wash-out period of 72 h. Results: Daily gavage feeding of ICA II resulted in a significant improvement of erectile function compared to vehicle group. ICA II treatment partially prevented schwann cell demyelination, SMC loss and collagen deposition in the penis. More EdU-positive cells differentiated into Schwann cells and MSCs in ICA II treated rats than in vehicle controls. In addition, the trend of p38 mitogen activated protein kinase (MAPK) MAPK activaty between groups was similar as that of EdU-positive cells. All these changes were caused by ICA II in a dose-dependent manner. Conclusion: ICA II can ameliorate ED following CN injury by promoting regeneration of nNOS-positive nerves and SMCs in the penis. The underlying mechanism might be due to p38 MAPK activation which could prevent schwann cell demyelination and promote EdUpositive cells (putative ESCs) differentiation. Disclosures: Work supported by industry: no.

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CELL STRETCHING – THE PUTATIVE MECHANISM OF PENILE TRACTION; AN IN-VITRO CELLULAR ANALYSIS De Young, L1; Chung, E2; Brock, G1 1: Canada; 2: Australia Introduction: Penile traction therapy (PTT) has gained considerable popularity as a non-invasive treatment option in Peyronie’s disease (PD), used to improve penile curvature and maintain penile length. The exact mechanism of action of penile traction devices remains unknown. Previously, work on penile plaque cells has shown that stretch induces a decrease in smooth muscle alpha-actin and an increase metalloproteinase 8 (MMP8). The effect of the stretching on extracellular matrix (ECM) components may play an important role on plaque remodeling. Methods: The third passage of primary cell cultures derived from Peyronie’s plaques were sub-cultured on BioFlex-ProNectin plate and the sub-confluent cells were exposed to A Flexecell FX-500 tension

plus system sinusoidal strain of 18% at 1 Hz for 48 hours. Cell culture medium and cellular extracts were analyzed by enzyme-linked immunosorbent assay (ELISA) and Western blot for inflammatory cytokines, collagen, metalloproteinase, and tissue inhibitors of metalloproteinases (TIMPs) expression. Results: The alteration of inflammatory cytokines IL-6, TGF-B, VEGF was measured among the stretched compared to non-stretched cells. Clear evidence of a treatment effect on these cytokines was measured, supporting a cellular basis to its action. Most striking was the alterations in MMP-8 and other MMP levels consistent with tissue remodeling. Conclusion: This unique dynamic study of penile plaque-derived cells cultured in a mechanical environment provides strong evidence for the use of penile traction devices in Peyronie’s disease appearing to facilitate plaque remodeling. Further work to define time course, extent of stretch and other parameters optimizing traction use, is currently ongoing. 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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HEMOLYSIS CONTRIBUTES TO PDE5 DYSREGULATION AND PRIAPISM IN SICKLE CELL BONE MARROW TRANSPLANTED MICE Matsui, H1; Sopko, N1; Hannan, J1; Hsu, L2; Berkowitz, D1; Champion, H3; Burnett, A1; Bivalacqua, T1 1: Johns Hopkins School of Medicine, United States; 2: University of Illinois, United States; 3: University of Pittsburgh Medical Center, United States Objectives: Mechanisms responsible for “nitric oxide (NO) imbalance” in reference to deranged NO signalling, in sickle cell-associated priapism are not fully elucidated. We have hypothesized that reduction in endothelial-derived NO causes phosphodiesterase type 5 (PDE5) dysregulation and thus enhanced corporal smooth muscle relaxation and priapism. Hemolysis that occurs in sickle cell anemia is associated with steady state increases in plasma cell-free haemoglobin, overproduction of reactive oxygen species (ROS) and endothelial dysfunction. Our objective was to determine if acute hemolysis would result in NO/cGMP/PDE5 dysregulation, overproduction of ROS, and thus cause priapism in a sickle cell bone marrow transplanted mice. Material and Methods: Three groups were used: 1) wild type (WT), 2) sickle cell homozygotes (Sickle), and 3) WT mice transplanted with bone marrow (BMT) from Sickle mice which is known to cause direct hemolysis of blood and cause the mice to have a Sickle phenotype. All groups underwent cavernous nerve stimulation (CNS) to assess erectile function. The frequency of erectile responses (erections/hr) pre- and post-stimulation was determined. Penile constitutive nitric oxide synthase (NOS), protein kinase G (PKG) and PDE5 activities as well as ROS (luminol activity) generation were determined. Results: Erectile responses to CNS were significantly enhanced (P < 0.05) in Sickle and BMT Sickle mice when compared to WT. Sickle and BMT Sickle mice demonstrated spontaneous erections preand post-stimulation that were significantly (P < 0.05) increased. Sickle and BMT Sickle mice had significant reductions in penile constitutive NOS, PKG, and PDE5 activities at a time when ROS generation was significantly increased (P < 0.05) compared to values obtained in WT mice penes. Conclusions: The priapic activity in BMT Sickle mice can be attributed to NO/PDE5 dysregulation and is consistent with data obtained

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2 from transgenic Sickle mice. The present data suggest that direct hemolysis of Sickle hemoglobin and thus overproduction of ROS generation may be an etiological causes of endothelial NO imbalance with direct effects on PDE5 regulation in the penis. These molecular findings in a new animal model of BMT Sickle mice suggest that global dysregulation of endothelial-derived NO occurs in sickle-cell disease related priapism, further highlighting the importance of NO in maintaining penile vascular homeostasis. Disclosures: Work supported by industry: no.

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INJECTION OF BDNF TRANSFECTED MSCS IS A POTENTIAL THERAPEUTIC MEASURE FOR NEUROGENIC ERECTILE DYSFUNCTION Wang, X1; Shen, H2 1: Huashan Hospital, Fudan University, China; 2: Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, Shanghai, China Objective: To investigate the effect of intracavernosal injection with brain-derived neurotrophic factor (BDNF) transfected mesenchymal stem cells (MSCs) on the nerve regeneration and recovery of erectile function after cavernous nerve injury (CNI). Material and Method: We established a stable MSC cell line that overexpresses BDNF. The expression levels of BDNF and Vascular endothelial growth factor A (VEGF-A) in the BDNF-MSC and MSC cell lines were detected by western blot. Elisa kits were used to estimate the BDNF and VEGF-A concentration in the cell supernatant. 120 SD rats of 3-month-old were divided randomly into 4 groups. Group1 had a sham operation without cavernous nerve manipulation. The other 3 groups underwent bilateral CNI. Group 2 (Control group) had no further manipulation. Group 3 (MSC group) and Group 4 (BDNFMSC) were treated by intracavernosal injection with MSCs or BDNF transfected MSCs respectively before the abdomen was closed. Erectile function was assessed by cavernosal nerve electrostimulation 12 weeks after operation. The penile tissues were then collected for immunohistochemical staining to detect inducible nitric oxide synthase (iNOS) expression levels. Results: The MSCs demonstrated a spindle-shaped morphology and green fluorescence detection showed that BDNF overexpression MSC cell line was successfully established. Western blot analysis indicated that both BDNF and VEGF-A increased in the BDNF-MSC cell line compared with MSC cell line. Compared with MSC, higher concentration of BDNF and VEGF-A was also detected in BDNF-MSC supernatant by enzyme-linked immunosorbent assay (ELISA). After nerve crushing, the functional evaluation of the control group at 3 months showed a lower mean maximal intracavernous pressure (ICP) with CN stimulation, at 35.47 ± 13.16 cmH2O, than that of the sham group, at 102.20 ± 15.61 cmH2O. Meanwhile, the ICP of BDNF-MSC group was significantly higher than the controls, at 66.04 ± 15.33 cmH2O. Histological analysis with staining of iNOS showed a significant change in the morphology of penile smooth muscle cells. The number of positively stained penile smooth muscle cells tended to increase after treatment with BDNF-MSC. Conclusion: Our study validates that intracavernous injection with BDNF-transfected MSCs can enhance the therapeutic effect of MSCs for the treatment of erectile dysfunction in an animal model. Disclosures: Work supported by industry: no.

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TADALAFIL AMELIORATES METABOLIC SYNDROME-INDUCED ALTERATIONS IN VISCERAL ADIPOSE TISSUE AND LIVER: AN EXPERIMENTAL STUDY IN THE RABBIT Vignozzi, L1; Cellai, I1; Comeglio, P1; Filippi, S2; Mello, T3; Morelli, A4; Galli, A3; Bani, D5; Maggi, M6 1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of NEUROFARBA and of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 3: Gastroenterology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Italy; 5: Department of Experimental and Clinical Medicine, University of Florence, Italy; 6: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Italy Objective: Development of “brown-like” adipocytes within white visceral adipose tissue (VAT) has potential antiobesity effects. Genetic manipulation of cGMP formation suggests a role for this pathway in preadipocytes (PAD) commitment towards a brown phenotype. The aim of this study was to investigate the effect of tadalafil on metabolic syndrome (MetS)-induced VAT dysfunction. Material and Method: We used a non-genomic, high- fat diet (HFD)induced rabbit model of MetS, with or w/o tadalafil Rabbits fed a regular diet were used as controls. Results: In HFD-induced rabbit model of MetS, in-vivo treatment with the PDE5 inhibitor, tadalafil (by increasing cGMP signaling), completely normalized HFD-induced increase of VAT mass and morphological alterations (adipocyte hypertrophy and hypoxia), triglycerides levels. Tadalafil also significantly increased brown adipocyte marker, UCP1, expression in VAT. HFD-induced increase in circulating level and liver expression of TNFα were also decreased by in-vivo tadalafil dosing. We then studied the adipogenic capacity of VAT preadipocytes (rPADs) isolated from rabbits fed a HFD (with or w/o tadalafil). Comparative gene expression analysis in rPADs demonstrated that in vivo tadalafil dosing dramatically increased the expression of genes related to brown-differentiation (UCP1, TMEM26, PGC 1β, BMP4, CIDEA) and mitochondrial biogenesis (TFAM, NRF1) in rPAD, whilst genes related to white adipocytes differentiation (HOXC9) were significantly reduced. Also in-vitro treatment with tadalafil, in HFD-rPAD induced the expression of genes related to brown differentiation (UCP1, TMEM26). By using transmission electron microscopic images analysis in rPAD, we found that HFDinduced mitochondrial morphological abnormalities (reduced size, loss of mitochondrial cristae, an increased matrix density) were all counteracted by in-vitro tadalafil dosing. Conclusions: Tadalafil dosing in a MetS rabbit model ameliorates liver and VAT MetS-induced alterations. This could reflect the ability of tadalafil to restore insulin sensitivity in VAT unable to finalize its storage function, counteracting MetS-induced liver alterations. 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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ANDROGENS POSITIVELY REGULATE NO-MEDIATED RELAXANT PATHWAY IN RAT CLITORIS Vignozzi, L1; Filippi, S2; Cellai, I3; Comeglio, P3; Corno, C3; Corcetto, F3; Maggi, M3 1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences and Department of NEUROFARBA, University of Florence, Florence, Italy; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy Objectives: Female sexual response is the result of a complex interplay between central and peripheral mechanisms . Hormonal regulation of female sexual excitement is poorly understood. To evaluate sex steroid regulation of the NO-dependent relaxant and RhoA/ROCK contractile pathways in clitoris. Material and Methods: Subgroups of ovariectomized rats were or left untreated or supplemented with estradiol, progesterone, testosterone (T) and T plus the aromatase inhibitor, letrozole. mRNA expression (qRTPCR) of genes of the relaxant NO-signaling, and genes of the contractile RhoA/ROCK pathway in clitoris. Results: In- vivo treatment with T increased clitoris eNOS, nNOS, sGC1a3, sGC1b3, PDE5, PKG1 mRNAs, that were all further increased by cotreatment with letrozole. T also increased ROCK2mRNA. E2-supplementation increased RhoA and ROCK2 expression. All NO-signaling genes, and ROCK2 resulted positively associated with T plasma level, while E2 level was positively associated with RhoA, ROCK2 and sGC1a3. When T and E2 (ROCK2 determinants at univariate analysis) were introduced as covariates in a multivariate model, only the association between E2 and ROCK2 was confirmed. To further investigate the effect of T and E2, in isolated rat clitoris smooth muscle cells (clitSMC) we studied migration, as a readout of RhoA/ROCK activity. E2 increased clitSMC migration, and the selective RhoA /ROCK inhibitors. Also T increased clitSMC migration. Letrozole pretreatment abrogated T-induced migration. The non aromatizable androgen, DHT, reduced clitSMC chemotaxis even below untreated cells. Conclusions: Our data demonstrate that T improves the NO-mediated signaling, whilst E2 stimulates the contractile RhoA/ ROCK signaling in clitoris. 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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PERSISTENT GENITAL AROUSAL DISORDER (PGAD): EXPERIENCE WITH MANAGEMENT IN 35 CONSECUTIVE CASES Gagnon, C1; Minton, J1; Goldstein, I2 1: San Diego Sexual Medicine, United States; 2: Alvarado Hospital, United States Objectives: Persistent genital arousal disorder (PGAD) is a rare, unwanted and intrusive sexual dysfunction associated with excessive and unremitting genital arousal and engorgement without sexual interest, with no recognized safe and effective evidence-based treatment. Characteristics of women with PGAD were assessed. Methods: A retrospective clinical chart review was performed on the last 35 women assessed for PGAD. Results: Women (age 46+/−18) had symptoms of PGAD for 17+/−16 years, appearing secondary to increased peripheral sensory afferent input and an under inhibited central sexual arousal reflex center falsely interpreting excess peripheral sensory information as sexual arousal, leading to spontaneous arousal, orgasm and a short refractory period

3 post-orgasm. Conditions resulting in increased peripheral sensory afferent input: altered pre-menopausal hormone integrity, hormonally mediated provoked vestibulodynia; altered menopausal hormone integrity, genitourinary syndrome of menopause; increased nerve fiber density, genetic susceptibility with elevated levels of nerve growth factor substances; injury to or irritation of pudendal nerves transmitting pain and other sensations; abnormal response of tissues to Candida infection, recognized or non-specific allergies; lichen sclerosus or lichen planus; vulvar granuloma fissuratum; peri-urethral glans pathology; clitorodynia; pelvic congestion syndrome; S2 Tarlov cyst; high tone pelvic floor dysfunction. Reducing excess peripheral sensory input with sex therapy/counseling, pelvic floor, pharmacologic, device and surgical treatments, and increasing inhibitory regulation of the uninhibited central sexual reflex center kept the PGAD manageable. Conclusions: PGAD is not so rare: an estimated 20% of healthcare providers at numerous sexual meetings have claimed caring for individuals with PGAD. PGAD can be managed so that afflicted women have normal life quality. Patients diagnosed with PGAD and managed successfully are no longer suicidal or bothered/distressed after treatment(s). PGAD seems to be caused by a combination of excess peripheral afferent stimulation from irritated genital, pudendal nerve, pelvic floor tissues or sacral nerve roots and a central sexual reflex that has limited central inhibition. PGAD may be lifelong, some women do not know any other form of sexual arousal, or acquired after living many years with no hint of PGAD symptoms. The persistent genital arousal usually does not resolve with orgasm. PGAD can also occur and be managed successfully in men. Disclosures: Work supported by industry: no.

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OPEN CROSS-SECTIONAL STUDY OF THE CLINICAL TYPES OF SEXUAL DYSFUNCTION, PERSONALITY TRAITS AND PSYCHOLOGICAL STATUS IN WOMEN WITH INFERTILITY Stenyaeva, N1; Chausov, A1; Chritinin, D2; Sukhikh, G1 1: Federal State Budget Institution “Research Center for Obstetrics, Gynecology and Perinatology” Ministry of Healthcare of the Russian Federation, Russia; 2: I.M.Sechenov First Moscow State Medical University Objective: To assess the clinical types of sexual dysfunction, personality traits and psychological status in infertile women. Material and Methods: A cross-sectional study of mental and sexual health was conducted in women with infertility. The inclusion criteria were primary infertility and the presence of sexual partner. The data of 157 patients within the main treatment group of infertility were assessed according to the ICD-10. Patients completed the Symptom Checklist 90-R (SCL-90-R), the Munich Personality Test (MPT) and the Female Sexual Functioning Index (Russian version) (FSFI). The control group consisted of 53 healthy women. Results: There were revealed significant inverse correlation between association the pairs of domains the FSFI questionnaires and SCL90-R: Desire – Obsessive-Compulsive (r = −0,2, p = 0,04), Desire – Interpersonal Sensitivity (r = −0,2, p = 0,045), Desire – Depression (r = −0,3, p = 0,003), Desire – Psychoticism (r = −0,3, p = 0,004), Arousal – Obsessive-Compulsive (r = −0,2, p = 0,04), Arousal – Depression (r = −0,2, p = 0,015), Arousal – Psychoticism (r = −0,2, p = 0,03), Orgasm – Depression (r = −0,2, p = 0, 04). There were revealed in the clinical group significant inverse correlation between associations of the pairs of domains the FSFI questionnaires and the MPT Desire – Extraversion (r = −0,2, p = 0,049), Desire – Esoteric Tendencies (r = −0,3, p = 0,003), Arousal – Frustration Tolerance (r = 0,4, p = 0), Arousal – Esoteric Tendencies (r = −0,2, p = 0,036), Lubrication – Esoteric Tendencies (r = −0,3, p = 0,003), Orgasm – Esoteric Tendencies (r = −0,3, p = 0,005), Satisfaction – Esoteric Tendencies (r = −0,2, p = 0,03), Pain – Orientation towards Social Norms (r = −0,2, p = 0,045). There were also revealed significant direct corre-

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4 lation between associations of the pairs of domains Desire – Frustration Tolerance (r = 0,4, p = 0), Arousal – Extraversion (r = 0,24, p = 0,01), Lubrication – Frustration Tolerance (r = 0,2, p = 0,03), Satisfaction – Extraversion (r = 0,3, p = 0,03). Conclusions: The study showed that sexual dysfunction in the form of reduced desire, arousal, orgasm disorders in patients with infertility were associated with symptoms of depression, obsessive-compulsive, interpersonal isolation, or sensitivity, as well as with personal characteristics as esoteric tendencies, introversion, reduced tolerance to frustration. Dyspareunia phenomena were more pronounced at low orientation to social norms. Disclosures: Work supported by industry: no.

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SEXUAL FUNCTION IN GENDER MATCH AFTER KIDNEY TRANSPLANTATION Magana, J1; Herrera-Caceres, J2; Gabilondo, B1; Hernandez, M1; Castillejos, R2 1: Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; 2: Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico Objectives: To analyze sexual function among men and women after kidney transplantation by gender match in patients who received grafts from living donors. Materials and Methods: Prospective study from March 2012 to May 2014. Using the Female Sexual Function (FSF) and the International Index of Erectile Function-15 (IIEF-15) questionnaires, sexual function was assessed in patients who received a kidney allograft from a living donor the day before surgery and every month after surgery for 6 months. Results: After a 2 year follow up 54 patients were included. At six months, we saw a significant difference in satisfaction (p = 0.003) and excitation (p = 0.055) in 16 women who received an allograft from men; they seem to have a better score in these areas when compared with other gender match groups. Conclusions: Women who received a kidney allograft from men seem to have better satisfaction and excitation from baseline and compared with other gender match groups six months after surgery. Disclosures: Work supported by industry: no.

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A RANDOMIZED, SINGLE CENTER, SINGLE-BLIND, CROSSOVER THERMOGRAPHIC STUDY TO EVALUATE THE EFFECT OF 1000 MCG OF TOPICAL ALPROSTADIL CREAM COMPARED TO AN OVER-THE-COUNTER MARKETED LUBRICANT Goldstein, I1; Gagnon, C2; Minton, J2; Morris, D3; Goldstein, S2 1: Alvarado Hospital, United States; 2: San Diego Sexual Medicine, United States; 3: WebbWrites, United States Objectives: Women have more sexual dysfunction than men, yet there are no FDA-approved drugs for bothersome sexual desire, arousal or orgasm disorders. Study drug efficacy for the treatment of peripheral genital arousal may be assessed by measuring improvement in genital blood inflow using a non-invasive technique such as Forward Looking InfraRed (FLIR) thermography. Alprostadil is a vasoactive compound, increasing intracellular cAMP and activation of protein kinase A, resulting in genital smooth muscle relaxation, vulvovaginal vasodilation and enhanced genital secretion. A prospective, randomized, single center, single-blind, crossover thermographic study was performed to

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evaluate the effect on peripheral genital arousal of 1000 mcg of topical alprostadil cream (Femprox) compared to an over-the-counter (OTC) lubricant. Methods: In this proof-of-concept study, 10 healthy premenopausal women (mean age 32+/−12 years) were topically administered study drug to their clitoris and anterior vaginal wall. Continuous temperature monitoring of the vestibule, clitoris and vulva was conducted for 30 minutes before and 60 minutes post-application in subjects watching a non-sexual (travel) film. After each application subjects completed questionnaires assessing genital sensations and maximum intensity and duration of effect; adverse events were recorded. Results: In all subjects topical alprostadil cream induced a statistically significant increase in temperature of the vestibule, clitoris and vulva relative to the OTC lubricant. Sustained statistically significant treatment differences occurred at 11 minutes post-application for the vestibule, 19 minutes for the clitoris and 9 minutes for the vulva and maintained for the duration of the assessment. Six of the ten women reported being aware/conscious of genital sensations with the topical alprostadil cream and not the OTC lubricant, consistent with concordance of physiological and subjective assessments. Discordence was noted in 30% who reported being aware/conscious of genital sensations with both treatments and 10% who reported not being aware/conscious of genital sensations with either. No adverse events were reported. Conclusion: Topical alprostadil cream administered to healthy premenopausal women induced statistically significant sustained increases in genital temperatures of the vestibule, clitoris and vulva within 20 minutes relative to OTC lubricant. Further studies are planned. Disclosures: Work supported by industry: yes, by Apricus Biosciences (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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FEMALE AROUSAL AND ORGASMIC COMPLAINTS IN A DIVERSE CANCER POPULATION TREATED WITH 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 are as a result of cancer treatments. Presently, 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 10 women who presented with self reported delayed arousal and poor orgasmic response and decreased orgasmic intensity. Results: Patient demographics included median age of 55.4 years. The following malignancies were represented in this small case series: Breast, rectal, uterine, and ovarian and lung. One woman was single and another was divorced whereas 8 were married. All women were sexually active with a functional partner. All patients were diagnosed with vulvar vaginal atrophy and were placed on local moisturizers and lubricants to help mitigate these symptoms. Four patients were on concurrent minimally absorbed local vaginal hormones (3 Estradiol cream, 1 DHEA suppositories). Seven out of 10 women had laboratory blood testing. Most women had normal hormones though the majority had testosterones in the lower one third. All women had estradiol levels in the menopausal 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

The 16th World Meeting on Sexual Medicine 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: Treatment for malignancy affects the genital arousal and orgasmic function. There are several OTC products that purport to improve sexual satisfaction for women. All women treated in this case series reported increased intensity of orgasmic response and decreased latency to orgasm with the use of Zestra®, a mixture of arousal oils and extracts. 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.

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THE VIVEVE SYSTEM IS A NON INVASIVE TREATMENT FOR VAGINAL INTROITAL LAXITY THAT IMPROVE SEXUAL FUNCTION IN ADULT FEMALE SUBJECT Krychman, M1 1: OBGYN, United States Objective/ Introduction: Many women suffer from sexual complaints as a direct result of changes in the integrity of vaginal introitus. The Viveve System is a safe effective treatment of the Vaginal Introital laxity that demonstrates improved sexual function in adult female subjects. Material and Methods: The Viveve System is a monopolar radiofrequency system that uses surface cooling and radiofrequency (RF) energy delivery to provide a non-surgical and minimally invasive approach to create heat within the submucosal layers of vaginal tissue while keeping the surface cool. During the Viveve Procedure™, coolant is delivered to the membrane of the Viveve treatment tip. The RF technology creates a reverse thermal gradient, which heats the deeper tissue at a higher temperature while the coolant protects the surface epithelium. The Viveve System consists of the following components: A Console containing the Radiofrequency Generator, a Cooling Module with Cryogen Canister Port, a Hand piece Assembly with attached cables, Treatment Tip, a Return Pad Electrode and a Cable. Results: To date, over 414 tips have been sold, and over 300 procedures performed in approved areas (Canada, Japan and Hong Kong). In addition the procedure has CE mark and European approval. Eight additional machines are presently on back order. Initial clinical studies have shown safety and efficacy and further randomized sham controlled research is planned for this office based 20–30 minute outpatient procedure which is gaining popularity amongst health care professionals and women. Conclusions: The Viveve Procedure remains a viable treatment for women who have sexual complaints as a result of vaginal introital changes in the genitopelvic matrix. 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 EFFECTS OF FOUR DIFFERENT SUTURE MATERIALS ON PENILE TISSUE OF RATS Tuken, M1; Altinay, S1; Temiz, M1; Cakir, O1; Alkan, S1; Semercioz, A1; Serefoglu, E1 1: Bagcilar Training and Research Hospital, Turkey Introduction: Although several types of suture materials are being used for correction of penile curvatures, to the best of our knowledge, there are no studies in the literature about the effects of these materials on penile tissue. Materials and Methods: A total of 30 male Sprague-Dawley rats were divided into 5 groups. After anesthesia, an abdominal wall incision was made and the proximal side of the right cavernosal body was sutured with 5/0 sutures (group 2: polyethylene terephthalate [ETB], group 3: polypropylene [PRL], group 4: polyglactine [VCR], group 5: polydioxanone [PDS]). An identical needle (3/8–13 mm cutting) without any suture material was passed through cavernosal bodies in the sham group (group 1). After 3 weeks, all rats were sacrificed and penile tissues were examined by the same pathologist to assess the level (0–3) of inflammation, granuloma formation and fibrosis. Results: Kruskal-Wallis test revealed that there was statistically significant difference among five groups regarding inflammation, granuloma formation and fibrosis levels (p < 0.01 for all)(table 1). The groups were further compared with Mann Whitney U test (table 2). The level of inflammation, granulation and fibrosis in the PRL group was not different than the SHAM group. Although the levels of granuloma and fibrosis in the PDS group were also similar to the SHAM group, inflammation level was significantly higher. The inflammation, granuloma formation and fibrosis levels were the highest in the ETB group. VCR caused similar levels of granuloma formation and fibrosis to ETB. Conclusion: PRL suture is associated with the least histopathological changes in the penile tissue. However, non-absorbable nature of this suture may cause discomfort among patients who palpate the knots. PDS, which is a monofilament synthetic absorbable suture, can be a reasonable alternative to PRL as it caused similar levels of granuloma and fibrosis. 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 USE OF TUNICA ALBUGINEA CRURAL GRAFT FOR SEVERE PENILE CURVATURE DUE TO PEYRONIE’S DISEASE: 10 YEARS FOLLOW UP Teloken, C1; Dal’Asta, I1; Coelho, L1; Graziottin, T1 1: UFCSPA – Federal University, Brazil Introduction: Management of severe penile deformity due to Peyronie’s disease is surgically challenging. Various surgical techniques and graft materials have been used; however most of them exhibited suboptimal long-term results, especially with regard to curvature recurrence and erectile dysfunction. We first described the use of autologous tunica albuginea retrieved from the crura as a graft material – TACRUG – and present herein the long-term follow-up results. Methods: We conducted a chart review of patients with preserved erectile function or erectile dysfunction (ED) responding to PDE-5 inhibitors who had undergone plaque incision and graft with crural tunica albuginea for stable penile deformity precluding vaginal intercourse. The TACRUG is obtained through a 3-cm longitudinal perineal incision. A longitudinal segment of tunica in the anterior aspect the corpus cavernosum 2 mm larger than the defect is delimited with methylene blue, preserving the cavernous artery entry point, and carefully removed. A segment of tunica from the contralateral corpus cavernosum may also be retrieved if necessary. The corpus caversonum then is closed with continuous 4-0 polyglactin suture.

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6 Results: One hundred and forty eight patients with a mean follow up of 6 years (range 3 to 11) were included in this analysis. Mean age was 54 years (range 42 to 75). Intraoperative penile straightening was obtained in all cases. Curvature recurrence requiring surgical intervention occurred in 8 % of the patients. Penile shortening was observed in 9%, and 15% patients reported glans numbness. Forteen percent developed postoperative ED, all of which responded to oral PDE-5 inhibitors. Twenty eight percent of individuals who preoperatively responded to PDE-5 inhibitors became unresponsive. Overall, 12.8% patients subsequently underwent penile prosthesis implantation. Eighty nine percent of patients classified the long term postoperative result as excellent or satisfactory. Conclusions: The autologous tunica albuginea crural graft is easily obtained, does not carry the risk of rejection or transmission of infectious diseases and affords satisfactory long-term results, without added costs. Despite the lack of a control group, based on our experience and in comparison to published data, the tunica albuginea crural graft is associated with less curvature recurrence and does not lead to increase risk of ED than other graft material. Disclosures: Work supported by industry: no.

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VENTRAL INTRALESIONAL VERAPAMIL INJECTIONS FOR PEYRONIE’S DISEASE: FEASABILITY AND SAFETY Berookhim, B1; Chevinsky, M1; Jakubowski, C1; Larish, Y1; Nelson, C1; Mulhall, J1 1: Memorial Sloan Kettering Cancer Center, United States Objective: To report our initial experience with ventral intralesional verapamil injections (ILI) for Peyronie’s Disease (PD). Methods: We analyzed prospectively gathered data from an institutional database pertaining to PD patients. For the purposes of this analysis, inclusion criteria included men (i) with uniplanar curvature (ii) who had curvature assessment (CA) with the assistance of intracavernosal injection and developed at least an 80% rigid erection (iii) who underwent 6 ILI (10 mg verapamil in 5 ml saline) and (iv) had an end of treatment CA at least 3 months after treatment completion. Ventrally located plaques were treated similarly to dorsal, with special attention paid to avoid midline injection directly into the urethra. Results: 154 men met all criteria. 144 (93%) had dorsal ILI and 10 (7%) underwent ventral ILI. Mean duration of PD was 8 ± 18 months and 3 ± 2 months (p = 0.46) while mean age was 55 ± 8 and 59 ± 7 years (p = 0.16) respectively. Comorbidity profiles were similar in both groups. Mean baseline curvature was 38 ± 15 degrees and 39 ± 11 degrees (p = 0.96) respectively. No significant difference existed in change in curvature between groups (see Table, p = 0.33). Those who improved in the ventral ILI group had higher mean baseline curvature (51 ± 7 degrees) compared to those who remained stable or worsened (30 ± 7 degrees, p = 0.04). Ventral ILI patients reported rare selflimiting hematuria and occasional blood at the urethral meatus at procedure completion, with a penile ecchymosis rate identical to dorsal ILI patients. There were no reports of urinary clot retention, penile hematoma or delayed urinary symptoms suggestive of urethral stricture. Conclusions: Ventral ILI is a safe procedure. Changes in curvature with ventral injections are similar to those seen with those administered dorsally, with 40% demonstrating clinical improvement. Given our initial data, ILI should be considered in men with ventral plaques.

Dorsal ILI Ventral ILI

Improvement in curvature >10 degrees

Stable curvature

Worsening curvature >10 degrees

25% 40%

44% 50%

31% 10%

Disclosures: Work supported by industry: no.

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016

THE CHRONOLOGY AND SEVERITY OF PENILE SENSORY CHANGES AFTER PLAQUE INCISION AND GRAFTING SURGERY FOR PEYRONIE’S DISEASE Tal, R1; Deveci, S1; Choi, J1; Mulhall, J1 1: Memorial Sloan-Kettering Cancer Center, United States Objective: Besides changes in erectile function, Plaque incision and grafting surgery (PIGS) for PD when performed dorsally, is known to be associated with penile sensory loss. Rates of sensory changes have been cited at 0–12%. This analysis was conducted to define the rate, chronology and predictors of this problem. Material and Methods: The study population consisted of men who (i) had dorsal PIGS (ii) at least 6 months follow-up. Patients are followed up in the office at 1 week, 1 and 6 months and by phone at 12 months and later if continued problems exist. Penile sensation was graded on visual analog 0–10 point scale, where 10 was perfect sensation and 0 total loss of sensation. Sensation loss degree was defined as extensive if circumferential, patchy if diffuse and focal if small and confined to one area of the penile shaft. Using multivariate analysis, predictors of sensation loss were sought including: patient age, diabetes presence, duration of PD, duration of operation. Results: 60 patients were analyzed. Mean age = 52 ± 20 years, mean follow-up of 16 ± 11 months. Mean duration of PD at time of PIG surgery = 18 ± 11 months. 10% had diabetes preop with a mean HBA1C = 7.2 ± 1.8%. Mean duration of self-reported stability = 8 months. 75% of patients had curvature alone, while the remainder had associated indentations or hourglass deformity. Mean baseline primary curvature = 64 ± 28 degrees. All patients were capable of sexual intercourse pre-operatively with or without erectogenic aids. Mean duration of operation = 3.5 ± 1.8 hours. 20% had any sensation loss at 1 week, 20% at 1 month and 7% at 6 months. Severity presented in Table. 2/60 patients had some sensation loss at 1 year and a single patient at 2 years continued to have extensive sensation loss on the glans and distal shaft. Only duration of operation was a predictor, with duration >4 hours being predictive of sensation loss at 6 months, OR 2.1, 95% CI 1.2–3.0 (p < 0.01). Conclusions: Sensation loss is not uncommon after PIG surgery. It decreases in frequency and severity with time with only rare cases occurring beyond 12 months. Longer operations are more likely associated with sensation loss, likely related to difficult neurovascular bundle elevation. Disclosures: Work supported by industry: no.

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SELECTION CRITERIA USED TO GUIDE SURGICAL APPROACH FOR MANAGEMENT OF PEYRONIE’S DISEASE: A SINGLE INSTITUTION EXPERIENCE Papagiannopoulos, D1; Yura, E1; Levine, L1 1: Rush Univeristy Medical Center, United States Objective: Peyronie’s disease (PD) is manifest by a fibrotic plaque within the tunica albuginea of the penis. For select patients, several surgical techniques are available. In an attempt to guide operative selection, we report our series of penile straightening procedures for PD spanning six years, with the following selection criteria. Patients with satisfactory erections and curvature < 60 degrees and no hinge effect were treated with tunica albuginea plication (TAP). Those with satisfactory erections and curvature > 60 degrees and/or hinge effect were treated with partial plaque excision and grafting (PEG). Patients with unsatisfactory erections were treated with placement of inflatable penile prosthesis (IPP). Methods: We retrospectively reviewed all patients who underwent penile straightening procedures for PD between 2007 and 2013.

The 16th World Meeting on Sexual Medicine Work-up involved a history, physical exam, and a duplex ultrasound. When possible, the Peyronie’s Disease Questionnaire (PDQ) was employed to assess bother and distress associated with PD. Objective outcomes and patient satisfaction were assessed post-operatively. Results: A total of 389 patients underwent penile straightening procedures for correction of PD by one surgeon between 2007 and 2013. Of these patients, 29%, (n = 114) received primary TAP, 40% (n = 158) primary PEG, and 30% (N = 114) IPP. Mean follow-up was 17 months. There was a significantly higher incidence of DM within the IPP group (P < 0.01). The PDQ showed no difference in emotional status or bothersome score between groups. Patients with less satisfactory erectile function were more likely to undergo IPP placement (p < 0.01). Those with superior erectile function, a hinge effect or severe curvature were more likely to undergo PEG (p < 0.01). In the presence of a calcified plaque, PEG and IPP placement were significantly more common than TAP (PEG p < 0.01, IPP p = 0.04). Regardless of surgical modality, there were no significant differences in satisfactory rigidity, residual bothersome curve, or ability to engage in intercourse. Conclusion: Patient experience with post-surgical rigidity, ability to engage in intercourse, and residual bothersome curve was not statistically different across the three groups. These results support the use of our selection criteria, even in the face of patient preference. The primary factors that compromised patient adherence to our treatment algorithm were fear of length loss or hesitance to pursue IPP placement. 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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INTRAPLAQUE INJECTION OF TIOCOLCHICINE AND VERAPAMIL IN PEYRONIE’S DISEASE PATIENTS: A PROSPECTIVE RANDOMIZED SINGLE-BLIND COMPARATIVE STUDY Toscano Jr, I1; Rezende, M1; Mello, L1; Pires, L1; Paulillo, D1; Glina, S2 1: Hospital Ipiranga, Brazil; 2: Hospital Ipiranga / Instituto H.Ellis, Brazil Objective: To compare the effects of tiocolchicine or verapamil intraplaque injection on plaque size, sexual function and penile curvature in Peyronie’s Disease (PD) patients. Materials & Methods: A prospective randomized single-blind study involving 25 patients treated with intraplaque tiocolchicine or verapamil injection between June 2008 and September 2012. All patients had been suffering from PD for up to 18 months. Cases with less than 3-month progression, history of trauma or history of surgical PD correction were excluded. Patients were treated weekly in 7 consecutive consultations. The parameters considered were IIEF (International Index of Erectile Function), sonographic measurement of plaque size and photograph-based measurement of penile curvature. Results: Twenty-five patients were randomly assigned to treatment with tiocolchicine (13) or verapamil (12). Mean penile curvature was 46.7° and 36.2° (p = 0.019), and 50.4° and 42.08° (p = 0.012) before and after treatment with tiocolchicine and verapamil, respectively. Penile curvature improved in 69% and remained stable in 23% of tiocolchicine-treated patients, while 66% improvement with 33% stability was documented in patients treated with verapamil. The mean IIEF scores (sexual function) increased from 16.69 to 20.85 (p = 0.23) and decreased from 17.50 to 16.25 (p = 0.58) in tiocolchicine- and verapamil-treated patients, respectively. Plaque size decreased in 61%, increased in 23% and remained unchanged in 15% of tiocolchicinetreated patients. Plaque size decreased in 8% and remained unchanged in 83% of patients in the verapamil group. No adverse effects were observed following tiocolchicine treatment. Conclusions: Tiocolchicine injection improved penile curvature, increased IIEF scores and reduced plaque size in DP patients.

7 Tiocolchicine was more effective than verapamil, with improvement in IIEF scores and reduction in plaque size, despite the lack of statistical significance. Tiocolchicine and verapamil had similar effects on penile curvature. No significant adverse effects were observed in this study. 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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A NEUROCOGNITIVE MODEL FOR PSYCHOGENIC ERECTILE DYSFUNCTION Aponte, R1 1: Unidad de Estudios y Terapia Cognitiva y Sexual, Venezuela Objective: Sexual tipping point model demonstrates both the mental and physical contributors to sexual function and dysfunction. Cognitive factors such as negative sexual automatic thoughts have been identified in patients suffering erectile dysfunction. The aim of this study and review is to propose an integrative model to understand how psychological-cognitive-factors could impact the molecular substratum of erectile dysfunction. Methods: Cognitive rehearsal was applied to fifty patients to identify cognitions in sexual situations. Sexual Health Inventory for Men (SHIM) was applied to evaluate self confidence in obtaining and maintaining an erection. Additionally, urological and hormonal screening was performed. A review of the literature concerning cognitions, central and peripheral neural pathways and neurotransmitters involved in cavernous vasoconstriction leading to psychogenic erectile dysfunction was performed. Results: At the cognitive rehearsal all 50 patients (100%) had erectile failure anticipatory thoughts. At SHIM, sample evidence showed 38 (76%) very low or low and, 12 (22%) moderate self confidence to obtain and maintain erection. None of them showed high self confidence. Urological and hormonal screening was normal. Sexual negative cognitions, located at the prefrontal cortex, impact via corticalstriatumthalamic pathway the amygdale, the hypothalamus, the main modulator of the sympathetic system, and the locus ceruleus, the main norepinephrine nucleus at the central nervous system. Dendrites from the hypothalamus connect to the sympathetic chain and dendrites from the locus ceruleus project to the spinal cord modulating the peripheral response and affecting autonomic activity. The sympathetic system projects to α 1 adrenoreceptors at cavernous vascular smooth muscle through post ganglionar fibers whose neurotransmitter is norepinephrine, increasing intracellular calcium concentration, leading to constriction of the penile vascular system and blocking the erectile response. Discussion: Negative sexual cognitions and low sexual self confidence found in this study is probably associated to central and peripheral neural pathway activation and norepinephrine liberation at the penis, blocking the erectile mechanism. Anxiety and depression neurocognitive models have been well documented. Anticipatory thoughts of threat are idiosyncratic to anxiety. These cognitions located at the prefrontal and cingulate cortex increased amygdale activity associated to anxiety symptoms. Cognitive triad, distortions maladaptive schemas are idiosyncratic to depression. Dysfunctional prefrontal cortex, associated to poor control over stimulus incites aberrant limbic system activity in depressed patients. Functional MRI is needed to confirm this hypothesis. Conclusion: Anticipatory negative thoughts of failure to obtain or maintain erection and low sexual self-confidence almost surely activate central and peripheral neural pathways in psychogenic erectile dysfunction. Disclosures: Work supported by industry: no.

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BRAZILIAN MEN REPORTING THEMSELVES AS BLACK SKINNED COLOR ARE AT RISK FOR GENITAL DYSMORPHIC DISORDER Barboza, R1; Da Silva, E1; Ruellas, T1; Damião, R1 1: Rio de Janeiro State University, Brazil Objective: The vast majority of countries around the world can be considered phallocentric societies as evidenced by the high prevalence of sexual taboos and myths. Anthropologically, the myth of the larger penile size associated to Afro-Americans is a vestige of the African slavery in America. Despite regional differences among human penile size were previously evaluated objectively, we also aimed to assess subjectively their self-perception of penis size and skin color. Material and Method: Five hundred and two volunteers were interviewed. The IMAGE questionnaire was used to evaluate genital selfperception and its implication on quality of life. Subjects were required to self-report as Caucasian, Afro-Brazilian or others. Finally, flaccid penis size was measured with an anthropometric ruler supported on the dorsal penis surface in maximum manual traction, depressing the fat against the pubic bone (RLTmax). When genital dysmorphic disorder was suspected, a mental health team provided additional support. Results: One hundred thirty four (26.9%) men reported themselves as black skinned color, 224 (44.6%) as white skinned color and 143 (28.5%) as uncategorized. Their respective age mean were 54.9 ± 13.9 years old, 55.6 ± 15.6 years old and 54.1 ± 15.7 years old (p = 0.652). While the mean penile length of the self-reported black skinned people was 15.3 ± 4.0 cm and the RLTmax was 16.4 ± 1.7 cm (p = 0.004), the mean reported by the white skinned people was 14.3 ± 3.0 cm and the RLTmax of 15.8 ± 1.6 cm (p < 0.001). Men reported as Afro-Brazilians presented a mean of 6 mm larger penis (RLTmax) than Caucasians in both subjectively (p = 0.007) and objectively (p < 0.001). Men tended to underestimate their penis size. However, Afro-Brazilians presented tendency to overestimate their penis size (32.6% x29.3%, p = 0.045) and this influenced negatively their body image and health related quality of life. Conclusion: Brazilian men reporting themselves as black skinned color are at risk for genital dysmorphic disorder. Disclosures: Work supported by industry: no.

021

THE SEXUAL EDUCATION IN LATIN-AMERICA – A PRELIMINARY EVALUATION Varaschin, R1; Baigorri, G; Rivero, M 1: Centro Integrado de Psicologia, Brazil Introduction: The sexual education has shown the maintenance of negative aspects in the sexual development when this sexual education sustains repression entail in the manifestation of female sexuality. It also reveals the mith of the human male as machine-man. For this reason and in order to identify more suitable instruments of intervention for sex education in developing satisfactory behaviors, attitudes and emotional and sexual response, a Latin America research was conducted, with an initial collaboration between Brazil and Argentina (Chapter of Sexual Medicine – SAU). Materials and Methods: A survey with 17 questions idiomatically adapted to each country, using a structured self-administered questionnaire, non-probability random sample, in a cross-sectional analysis. Results: The research was set up with 537 people (16–73 years old), 59.03% females, 36.41% had a university degree, 87.10% were heterosexual, and 33.40% had no stable relationship. From the analyzed group, 67.94% received sexual education, most of them from an educational institution. The result of the education received was unsatisfactory for 27.34% of the interviewees; and those who rated it as satisfactory, considered it important to prevent STDs/HIV, undesired

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pregnancy, sexual abuse and sexual violence, or according to them, it improved care and their enjoyment of their sexuality. Conclusions: These results underlie the need for an active participation of government authorities and scientific societies in sex education programs aimed to all ages; and especially at parents, educators, health professionals and communicators. They are the instruments for the realization of an adequate lifelong intervention, formal or informal, comprehensive and continuous constitution of a healthy sexuality. They are also the instruments for the development of the quality of life through the exercise of human and sexual rights. Disclosures: Work supported by industry: no.

022

THE IMPACT OF INTERFERON THERAPY ON THE SEXUAL FUNCTION OF HEPATITIS C MALE PATIENTS Abdel Hafez, K1; Kamel, S1; Abdel Aal, A1; Mansour, E1; Mahran, A1 1: Assuit University Hospital, Egypt Objective: To evaluate the impact of interferon therapy on male sexual function. Material and Methods: One hundred patients suffering from hepatitis C infection were included in the study. Fifty two (52%) patients were receiving interferon and forty eight (48%) patients were not receiving interferon. All participants underwent history taking including IIEF-5 score, general and local examination, assessment of hormonal profile and pharmacopenile duplex Doppler ultrasonography. Results: The IIEF-5 score of the non-interferon treated group (18 ± 6.5) was significantly higher than the interferon treated group (12 ± 4.5) (P = 0.022). Moreover, IIEF-5 score showed significant negative correlation with the duration of interferon therapy (r = −0.366, P = 0.01). Forty (76.9%) patients on interferon reported low or absent sexual desire compared to twenty two (45.8%) patients of non-interferon treated group (P = 0.001). Total testosterone among interferon treated patients (188 ± 0.32 ng/ dL) was significantly lower than non-interferon treated patients (270 ± 0.52 ng/dL) (P = 0.001). Similarly, free testosterone level among interferon treated patients (3 ± 0.22 ng/dL) was significantly lower than non-interferon treated group (7 ± 2.3 ng/dL) (P = 0.05). Furthermore, there was statistically significant negative correlation between duration of interferon therapy and serum levels of total and free testosterone (r = −0.326, P = 0.001; r = −0.252, P = 0.01 respectively). Serum estradiol level among interferon treated patients (80 ± 3.3 pg/ ml) were significantly higher than non-interferon treated patients (58 ± 2.3 pg/ml) (P = 0.01). Moreover, serum level of estradiol was significantly correlated to the interferon therapy duration (r = 0.337, P = 0.002). Serum prolactin level showed no significant difference between the interferon treated (13 ± 1.3 ng/ml) and the non-interferon treated groups (12 ± 1.5 ng/ml) (P = : 0.59). However, the serum prolactin level was positively correlated to the interferon therapy duration (r = 0.421, P = 0.03). As regards penile duplex results, thirty eight (73%) patients on interferon showed vasculogenic erectile dysfunction compared to thirty two (66.7%) patients not receiving interferon (P = 0.11). Twenty two (42.2%) patients on interferon showed veno-occlusive dysfunction which was significantly higher than non-interferon group (16.6%) (P = 0.03). On the other hand, eighteen (37.5%) patients of the noninterferon group showed mixed vasculogenic erectile dysfunction which was significantly higher compared to eight (15.4%) patients on interferon therapy (P = 0.05). Conclusion: Interferon had negative impact on male sexual function. Men on interferon showed loss of desire, lower IIEF-5 score, lower total and free testosterone levels and higher estradiol level compared to those not receiving interferon. However, interferon did not affect penile hemodynamics.

The 16th World Meeting on Sexual Medicine Disclosures: Work supported by industry: no.

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FEMALE SEXUAL FUNCTION AND ITS ASSOCIATIONS IN A BRAZILIAN SAMPLE Lucena, B1; Abdo, C2 1: Brazil; 2: University of Sao Paulo, Brazil Objectives: (1) assess female sexual functioning, depression, and anxiety; (2) verify the association between female sexual dysfunction (FSD), depression, and anxiety; and (3) identify the variables associated with the sexual domains: desire, arousal, orgasm, and pain during intercourse. Material and Methods: 110 healthy women (age: 18–61, mean: 38.5 years) among those waiting for gynecological routine consultations was randomly selected for this research. The patients were asked to fill sociodemographic questionnaire, Female Sexual Quotient (FSQ), Beck Depression Inventory (BDI-II), and the Beck Anxiety Inventory (BAI). Results: The analysis of the responses show that 36 (32.7%) women present sexual desire inhibitions; 16 (14.5%) have arousal problems; 35 (31.8%) have orgasm difficulties; 31 (28.2%) report pain during intercourse; and 39 (35.5%) exhibit overall FSD. Depression and anxiety are present in 26 (23.6%) and 37 (33.6%) patients respectively. Low sexual desire is associated to depression, anxiety, education level, body issues, masturbation, and sexual education; arousal is connected to depression, anxiety, age, education level, body issues, sex-related fears, and sexual education; orgasm difficulties is related to depression, anxiety, education level, body issues, sex-related fears, sex-related shame, masturbation, and sexual education; pain during intercourse is associated with depression, monetary income, education level, and sex education. Regression models were used to identify the most significant variables for each domain, resulting in sexual desire being inhibited by the presence of depression; excitation levels being impaired by low education levels and the increase of age; ability to achieve orgasm being hindered by low education levels, anxiety, and sex-related fears; and pain during intercourse increasing with lower education levels and depression. Conclusion: Numerous variables influence female sexual response, depression and anxiety being especially detrimental to sexual functioning. What is more, while depression is more harmful in the early stages of sexual response (desire and arousal), anxiety is the main influence on the orgasm phase. Disclosures: Work supported by industry: no.

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EFFECT OF ISOFLAVONE AND/OR COUNSELING ON SEXUAL FUNCTION DURING THE MENOPAUSAL TRANSITION: A PILOT STUDY Fleury, H1; Abdo, C1 1: ProSex – Program of Studies in Sexuality, University of Sao Paulo Brazil Objective: To compare the effect of isoflavone with or without counseling on sexual function. Material and Method: In a pilot study with 24 women aged 40 to 52 years (mean 44.4 years), the participants were randomized to receive 120 mg isoflavone (Glycine maxima) daily (n = 10) or 120 mg isoflavone daily plus counseling (n = 14). The counseling model consisted of 16 weekly sessions of 90 minutes each. The thematic planning of these sessions was as follows: sexual function, communication and sexual intimacy, sexual self-image, female sexuality, menopausal transition/menopause, the woman’s psychosocial role, and marital relationship. The Female Sexual Function Index (FSFI) was obtained at baseline and 16 weeks later.

9 This project was approved by the Internal Review Board of the University of São Paulo. Each of the patients signed an informed consent form prior to being admitted to the study. The groups were compared using the Kruskal-Wallis test and the chi-square test of homogeneity. Spearman’s rank correlation coefficient was calculated to evaluate whether there was any correlation among sexual function domain scores. Repeated-measures analyses of variance (ANOVA) were used to evaluate whether there was any interaction effect between variables. When statistically significant differences were found, Tukey’s multiple comparisons were performed. Results: There were no statistically significant differences between the groups at baseline. Mean overall FSFI tended to increase with the combination of isoflavone plus counseling (p = 0.036). Statistically significant differences were found in the overall sexual function score and in its domains of desire, orgasm and satisfaction (p < 0.05). Desire improved in both groups (p = 0.038); orgasm decreased in the isoflavone group and increased with the isoflavone plus counseling combination (p = 0.039) and a similar trend was found for satisfaction (p = 0.034). Conclusions: The overall FSFI and its domains improved significantly with the combined therapy. Isoflavone alone did not significantly improve sexual function. The continuity of the study points to a counseling group for women with this profile, aiming to confirm or not the results of the combined therapy. Disclosures: Work supported by industry: no.

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WEAKER MASTURBATORY ERECTION MAY BE A SIGN OF EARLY CARDIOVASCULAR RISK ASSOCIATED WITH ERECTILE DYSFUNCTION IN YOUNG MEN WITHOUT SEXUAL INTERCOURSE Huang, Y1; Chen, B1; Ping, P1; Chen, X1; Wang, H1; Huang, Y1 1: School of Medicine, Shanghai Jiao Tong University, China Objectives: To evaluate the young men presenting weaker masturbatory erection with no sexual intercourse (WME-NS) and verify if this cohort have early cardiovascular risks associated with ED. Material and Methods: Male subjects aged 18–40 years with WME-NS were screened by analyzing detailed sexual intercourse and masturbatory history. The age-matched ED and non-ED population were identified by using International Index of Erectile Function-5 (IIEF-5). All subjects with acute and/or chronic diseases (including diagnosed hypertension and diabetes) and long-term pharmacotherapy were excluded. Nocturnal penile tumescence and rigidity (NPTR), systemic vascular parameters and biochemical indicators related to metabolism were assessed. Comparison analysis and logistic regression analysis were conducted among WME-NS, ED and non-ED population. Results: In total,78 WME-NS cases (mean 28.99 ± 5.92 years), 179 ED cases (mean 30.69 ± 5.21 years) and 43 non-ED cases (mean 28.65 ± 4.30 years) were screened for analysis. Compared with non-ED group, WME-NS group had higher prevalence of early ED risk factors including endothelial dysfunction, insulin resistance, high level of glycosylated serum protein and abnormal NPTR. Multivariable-adjusted logistic regression analysis showed endothelia dysfunction (odds ratio: 8.83 versus 17.11, both P < 0.001) was the independent risk factor for both WME-NS and ED. Conclusions: Weaker masturbatory erection may be a sign of early cardiovascular risk associated with ED in young men without sexual intercourse. More studies are warranted to elucidate the clinical benefits by targeting these formulated strategies. Disclosures: Work supported by industry: no.

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FACTORS CORRELATING WITH SEXUAL INTEREST AND FUNCTION IN LONG-TERM COLORECTAL CANCER SURVIVORS Ayoub, H1; You, Y2; Cao, H1; Hu, C1; Bailey, C3; Chang, G1; Feig, G1; Rodriguez-Bigas, M1; Skibber, J1; Westney, L1 1: MD Anderson Cancer Center, United States; 2: MD Anderson Cancer Center, United States; 3: MD Anderson Cancer Center Purpose: Long-term sexual dysfunction after multimodality treatment of rectal cancer occurs in roughly 40% of patients, irrespective of gender. We sought to evaluate the factors influencing the quality of sexual function as reported on a colorectal cancer specific quality of life instrument. Materials and Methods: Colorectal Cancer (CRC) patients alive > 5 years from their diagnosis were identified from our Tumor Registry. Demographics, tumor characteristics and treatment details were extracted. Patients were mailed a standardized survey – European Organization for Research and Treatment of Cancer (EORTC) CRC disease specific module (CR29). Responses to items in the CR29, generic sexual interest and gender specific sexual function (impotence and dyspareunia), were extracted and analyzed. Univariate and multivariate analysis (logistic and linear) was performed to examine the relationship between clinical treatment factors [extent/location of surgical resection (abdominal, distal rectal or anus), lifetime chemotherapy, lifetime XRT and presence of an ostomy] and sexual interest/ function. A two tailed p < 0.05 was considered statistically significant. Results: Of 830 responders, 671 (81%) completed the sexual items. The mean age was 55.9 (SD, 11.6) years with a mean time from diagnosis of greater than 10 years. In males, decreased sexual interest correlated with younger age (p < 0.001). Impotence was associated with a permanent ostomy (p = 0.0045), radiation (p = 0.0003), current cancer (p = 0.0103) and younger age at cancer diagnosis (p =< 0.001). In female survivors, sexual interest was negatively impacted by permanent ostomy, radiation and younger age of diagnosis but positively related to marriage (0.0001). In univariate analysis, dyspareunia was associated with surgery type (0.0012), permanent ostomy (0.0025), history of radiation therapy (0.0025), prior chemotherapy (0.0061), older age (0.0405) and marital status (10%) to change in sex steroid hormones in men. Methods: One hundred men with complete anthropometry and sex hormone level were included betwen April and July of 2008 from consulting in Uruguay. Free and total testosterone (FT and TT), were assessed at 10:00 AM. Health behaviours and medical history were obtained by structured interview. Body Composition Monitor was used to define the visceral and body fat. It estimates the percentage by the Bioelectrical Impedance method along with the electric resistance, weight, age and gender information. The dual energy x ray absorptiometry method uses two different frequency X rays and rates of absorption of the body to determinate the value based on the difference between the two. Repeated measures regression was used to describe trends in steroid hormones in relation to obesity status, adjusting for age, smoking, alcohol, chronic illness, and physical activity. Results: Visceral fat rather than body fat or BMI was associated with decreased levels of total and free testosterone. Conclusions: Viseral Fat may predict greater decline in testosterone levels with age than central obesity or body mass index. Further studies in this field are recommended to evaluate the clinical impact of nutricional factors in sex hormones. Disclosures: Work supported by industry: no.

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LIGHT-CONTROLLED RELAXATION OF THE PENILE CORPUS CAVERNOSUM USING THE NOVEL NITRIC OXIDE RELEASER NOBL-1

33 Here, we focused on a novel blue light-controllable NO releaser called NOBL-1 and investigated whether we could control relaxation of the corpus cavernosum smooth muscle. Materials and Methods: Male adult Wistar-ST rats were used in this study. The glans, urethra, blood vessels, and tunica albuginea were carefully removed from each penis and placed in chilled Krebs solution, a strip of corpus cavernosum was prepared, and an isometric tension study was performed. After pre-contraction with noradrenaline (10 μM) and the addition of NOBL-1 (1 μM or 10 μM), the response of the corpus cavernosum smooth muscle to irradiation with blue light (470–500 nm) was measured and recorded. Results: The corpus cavernosum smooth muscle that had precontracted with noradrenaline relaxed in response to blue-light irradiation at both doses of NOBL-1. The relaxing response to blue light at 10 μM NOBL-1 was larger than that at 1 μM. In addition, after irradiation was stopped, relaxation at both concentrations of NOBL-1 disappeared and tension returned to that before irradiation. Conclusions: This study demonstrated control of relaxation of the corpus cavernosum smooth muscle using NOBL-1, a novel blue light-controllable NO releaser. Although further in vitro and in vivo studies are needed to prove its potential for ED therapy, our results suggest that NOBL-1 may be a useful tool for penile rehabilitation. Disclosures: Work supported by industry: no.

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PENIS RUPTURE – A TOPIC FOR INTERDISCIPLINARY CONSIDERATION Herwig, R1; Bayerl, M1 1: Vienna International Medical Clinic, Vienna, Austria Objective: The purpose of the interdisciplinary cooperation between urological surgery and physics is the development of a physical simulation tool to be used by surgeons in order to give prognosis of possible penis rupture at a certain degree of deviation of the penis and to take prophylactic action. Materials and Methods: For the physicist it was the first challenge to translate the human organ of the penis into a physical model. Starting and marginal parameters had to be defined, whereby some of them had to be proceeded on the assumption, as physical data of the human living tissue have rarely been measured up to now, such as, f.i. the modulus of elasticity of the tunica, the mass of the penis in erect state and the maximum stress, the tunica can be subdued to. The algorithm and its dependencies had to be developed. Results: This paper is a first step of mathematical-physical simulation with the assumption of a 100 % filled rigid penis. The calculation (see Fig. 1) gives proof of the hypothesis that the fibre-load-angle of the penis is 12 degree (see Fig. 2), much less than 30 degrees, which was the assessment of the authorities of urology up to now. Conclusion: Physical simulation is able to provide the surgeon with a simple instrument to calculate and forecast the risk of the individual patient, based upon dependencies of geometry of the differential geometrical body of the penis.

Hotta, Y1; Ieda, N1; Nakagawa, H1; Kimura, K1 1: Nagoya City University, Japan Objective: Nitric oxide (NO) is very important for the initiation and maintenance of penile erection. NO is typically produced by nerve or endothelial cells; however, NO production requires sexual arousal or shear stress. These conditions may be impaired in some cases such as spinal cord injury or atherosclerosis. Therefore, controlling NO production may be very useful as therapy for erectile dysfunction (ED).

Figure 1

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TRAINING, ATTITUDE AND PRACTICE OF BRAZILIAN RESIDENTS ABOUT SEXUALITY: PRELIMINARY RESULTS Vieira, T1; Souza, E2; Silva, I3; Torloni, M2; Ribeiro, M2; Nakamura, M2 1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil

Figure 2 Disclosures: Work supported by industry: no.

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EFFECT OF NERVE-SPARING DURING RADICAL PROSTATECTOMY ON RECOVERY OF URINARY CONTINENCE IN PATIENTS WITH PREOPERATIVE ERECTILE DYSFUNCTION Park, Y1; Hong, S1; Lee, J2; Kim, S2; Hwang, T2; Kim, C3 1: Seoul St. Mary’s Hospital, The Catholic University of Korea, Korea South; 2: Seoul St. Mary’s Hospital, The Catholic University of Korea, Korea, South; 3: Asan Medical Center, University of Ulsan Objectives: To assess whether nerve-sparing radical prostatectomy (nsRP) is associated with improved recovery of urinary continence compared with non-nerve-sparing procedures (nnsRP) in organconfined prostate cancer patients with preoperative erectile dysfunction. Materials & Methods: A total of 360 patients (International Index of Erectile Function-score 70 yrs, ASA score, and nerve-sparing status were significantly associated with recovery of urinary continence. On multivariate analysis, age > 70 yrs (HR 1.254, 95% CI 1.002–1.478, p = 0.026) and nerve-sparing status (HR 0.713, 95% CI 0.548–0.929, p = 0.012) were independently associated with recovery of urinary continence. Conclusions: Patients with preoperative erectile dysfunction have higher chances of recovering urinary continence after nsRP. Whenever oncologically and technically feasible, a nerve-sparing procedure should be attempted irrespective of preoperative erectile function. Disclosures: Work supported by industry: no.

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Objectives: To assess the training, attitude and practice of Brazilian OB-GYN residents about sexuality. Material and Methods: Cross-sectional study conducted between March/May 2014 with 198 residents enrolled to participate in a free, 20-hours online course about sexuality for medical doctors. Before starting the course, participants were asked to answer an on-line selfresponsive questionnaire to assess their previous sexology training during medical school and residency as well as their attitude and practice up to that moment. Results: The mean age of the participants was 27.9 ± 2.2. Most were female (87.4%), catholic (66.7%), single (78.3%) and had graduated in the last 5 years (91.4%). The participants were from 21 different residency programs, most of which were located in Sao Paulo. Almost half of the participants were in their 2nd (25.8%) or 3rd (23.7%) year of residency, while 22.7% were in their 1st year, 14.0% in their 4th and 13.1% were in their 5th or 6th year of residency. Most (63.1%) of the residents stated that they did not have any classes about sexology in medical school, while 28.3% reported having ≤6 hours of training on this topic. Almost half of the participants (49.0%, n = 97) stated that up to that moment, they had received no formal training about sexology during their residency while 28.8% had received up to 6 hours of training. The main motives to enroll in the online sexology course were to acquire/improve their knowledge about sexology (68.2%) and because of personal interest on the topic (30.0%). Only 5.0% of the respondents routinely asked their patients about their sexual health. Over half of the participants (51.0%) said that they did not feel competent or confident to answer their patients’ questions and 55.1% stated that because they lacked knowledge about sexuality, they would try to minimize the patient’s sexual complaints and change the topic. Conclusions: According to our preliminary results, Brazilian OB-GYN residents enrolling in an online sexuality course have had little previous formal training on sexuality, feel insecure and avoid dealing with these questions in their clinical practice. There is a clear need for additional training in sexuality among Brazilian residents. Disclosures: Work supported by industry: no.

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FEMALE SEXUAL FUNCTION OF OVERWEIGHT WOMEN WITH GESTATIONAL DIABETES MELLITUS Ribeiro, M1; Nakamura, M2; Scanavino, M3; Torloni, M2; Mattar, R.2 1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil Introduction: Obesity and Gestational Diabetes Mellitus (GDM) are increasing worldwide and may alter female sexual function. We hypothesize that among GDM women in the last trimester of pregnancy, those with excess body fat would have worse female sexual function scores than normal weight women. Our aim was to assess the sexual function of overweight compared to normal weight women with GDM, in the same gestational age. Patient and Methods: This was a cross-sectional survey involving 143 Brazilian women with GDM, in the third trimester of pregnancy: 76 were overweight (pre-pregnancy body mass index-BMI ≥ 25.0 Kg/m) and 67 were normal weight (BMI 18.5–24.9 Kg/m). Participants were recruited from March2010 to April2013 at the antenatal clinic of a single public tertiary teaching institution. The Female Sexual Function

The 16th World Meeting on Sexual Medicine 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 variables between the two groups. P < 0.05 was considered significant. Results: The main characteristics of the participants were similar among normal and overweight women. Most were married, catholic, multipara, employed and had at least 9 years of formal education. The mean total FSFI score of the 143 GDM was 23.3 ± 8.6. A total of 46 overweight women scored ≤ 26 on the FSFI compared to 28 of the normal weight women (60.5% versus 41.8%, respectively, P = 0.038). Mean desire domain scores were significantly lower in overweight compared to normal weight patients (3.4 ± 1.2 versus 4.0 ± 1.4, P = 0.007). The proportion of overweight women reporting problems in desire (domain score ≤5) was significantly higher than normal weight women: 48.7% versus 28.3%, respectively (P = 0.021). Overweight women also had significantly lower scores for the lubrication domain, compared to normal weight women (3.8 ± 2.0 versus 4.5 ± 1.6, respectively, P = 0.023). Conclusion: According to our results, being overweight seems to affect the sexual function of women with GDM during the last trimester of pregnancy, as measured by the FSFI questionnaire. Disclosures: 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.

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FEMALE SEXUAL FUNCTION AND QUALITY OF LIFE OF PREGNANT WOMEN – PRELIMINARY RESULTS Ribeiro, M1; Nakamura, M2; Scanavino, M3; Torloni, M2; Forte, B2; Mancini, P2; Mattar, R1 1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil Objectives: Pregnancy is a risk factor for female sexual dysfunction symptoms and may also affect the woman’s quality of life. The aim of this survey was to evaluate the association between sexual function and quality of life among Brazilian pregnant women in the third trimester of pregnancy. Patient and Methods: Cross-sectional study conducted between March 2012 and February 2014 at the antenatal clinic of a public teaching hospital, with 89 healthy pregnant women, between 28 and 40 weeks’ gestation. The Female Sexual Function Index (FSFI) was used to assess sexual function; women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The World Health Organization Quality of Life-Bref (WHOQoL-Bref) questionnaire was used to assess quality of life; the final scores ranges from 0 to 100, with higher scores indicating better quality of life. Student’s t test was used to compare mean WHOQoL-BREF scores between the women with and without sexual dysfunction symptoms. Results: Mean age of the 89 participants was 28.1 ± 5.6 years and mean gestational age was 34.1 ± 3.3 weeks. A total of 56 women (62.9%) had sexual dysfunction symptoms (FSFI ≤ 26). Women in this group had significantly lower scores on the quality of life test than women without sexual dysfunction symptoms (58.8 ± 14.8 versus 66.9 ± 10.7, respectively, p = 0.006). The mean scores of women with sexual dysfunction symptoms were significantly lower than those of women without these symptoms, in all domains of the WHOQoL-BREF including physical health (53.4 ± 15.7 versus 60.7 ± 14.9, p = 0.030), psychological health (63.8 ± 17.8 versus 71.3 ± 11.3, p = 0.028), social relationships (63.5 ± 18.1 versus 72.7 ± 14.7, p = 0.013) and environment (54.4 ± 17.9 versus 62.9 ± 13.1, p = 0.017). Conclusion: There is a high prevalence of sexual dysfunction symptoms in healthy Brazilian women in the third trimester of pregnancy, and these women are significantly more likely to have a worse quality of life than those without sexual dysfunction symptoms.

35 Disclosures: This study was funded by a grant from FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670-4, 12/50225-6 and 12/11787-9.

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EVALUATION OF A WORKSHOP COURSE OF HUMAN SEXUALITY THROUGH A CURRICULUM FOR PROFESSIONAL COMPETENCES IN MEDICAL STUDENTS OF THE UAQ González Ortega, P1; Villaseñor Cuspinera, N1; Sánchez Fernández, L1; Ávila Morales, J1; Leo Amador, G1 1: Universidad Autonoma de Queretaro, Mexico Objective: Evaluate the workshop course of human sexuality with a curriculum for professional competences in medical students of the UAQ. Material and Method: Design of experimental study, by means of an educational intervention of workshop focused on human sexuality based on the theory of the Holon’s. Knowledge, skills, attitudes and satisfaction were evaluated by the workshop course through four instruments ad hoc applied before and after the educational intervention participants. With the respect to cognitive competences used a knowledge exam designed exclusively for the training workshop, evaluating the dimensions: General knowledge of sexuality, reproductivity, gender, eroticism and affection Holon’s. To assess the competency of skills, applied a check list, checking the development of the skills: correct positioning of the condom, application of the eligibility criteria for planning familiar and identification of myths of the sexuality. With regard to the attitudes, to measure these attitudes were items of the validated instrument “Attitudes to sexuality of others” of Alvarez Gayou, 2001.Also developed a satisfaction survey of the workshop on sexuality; to do so, was used the modified instrument of Gil Perez et al., 2010. All designed instruments were validated through three rounds of the six experts from the areas of knowledge: Bioethics, Gynecology, Sexology and Educational Research. He piloted was developed in similar natural group of students from the bachelor of dentistry, with applications test and retest within eight days, calculating a Cronbach alpha ≥ 0.08. Information analysis was carried SPPS ver.19, using simple descriptive statistics and “t student” to measure the effect of the intervention at two times, prior to the workshop and subsequent. Results: The findings for competences, showed significant results: knowledge = 8.562, p = .000; Skills t = −5.913, p = .000 and attitudes t = 7.13, p = .000. The satisfaction of the workshop on sexuality: satisfaction with the course (98%); satisfaction for the teachers (99%); satisfaction with competency-based methodology (98%) and satisfaction with the development of competences (97.4%). Conclusions: Students of medicine, at some point will be counselors or sex educators, and educational intervention shows that it modified an attitude favorably to that is conducive to the respect, openness and tolerance to valid sexual practices that other develop. Finally, is important to incorporate sexuality education for physicians as a subject in their curriculum to strengthen their academic formation. Disclosures: Work supported by industry: no.

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QUALITY OF LIFE AND SEXUAL HEALTH IN MEN WITH PROSTATE CANCER UNDERGOING RADICAL PROSTATECTOMY Naccarato, A1; Souto, S1; Ferreira, U1; Denardi, F1 1: UNICAMP, Brazil Objective: To evaluate the relationship between quality of life(Qol), erectile function and the use of group psychoterapy in pacientes with prostate cancer(PCa) undergoing radical prostatectomy(RP). Material and Methods: Sixty patients undergoing RP between 2002 and 2007, 30 of those had group psychoterapy two weeks before and 12 weeks after surgery. They were evaluated in 2012 for erectile function (IIEF), Qol (SF-36 short form); and ICQI-SF and ICQI-OAB for urinary incontinence. Results: Among the 60 patients 65% accepted the disease and 20% reported concern. The 30 patients who underwent group psychoterapy had better scores in IIEF-5, in satisfaction with life in general, satisfaction with sexual life, satisfaction in the partner relationship; and better results of SF-36, excepting two domains: bodily pain and role emotional. There were significant correlations between IIEF-5 and perception of disconfort (p = 0.030), Physical functioning (p = 0.021), Physical Component (p = 0.005) and Role Emotional (p = 0.009) in patients undergoing group psychoterapy. In patients who did not undergo group psychoterapy there were significant correlations between ICQI-OAB and perception of disconfort (p = 0.025), Social functioning (p = 0.052) and Role Emotional (p = 0.034); between ICQI-SF and perception of disconfort (p = 0.0001). Conclusion: Group psychoterapy has a positive impact on the Qol of patients and the erectile function. Further studies are necessary to identify the impact of self-perception and self-knowledge in the postoperative manegement of RP. Disclosures: Work supported by industry: no.

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RESPONSE PROFILES TO MEN UNDERGOING BLINDED SPERMATIC CORD BLOCKS FOR CHRONIC ORCHALGIA Deveci, S1; Heck, M2; Tal, R3; Mulhall, J3 1: Medical School of Acibadem University, Turkey, Memorial Sloan Kettering Cancer Center, New York; 2: Memorial Sloan Kettering Cancer Center, New York; 3: Memorial Sloan Kettering Cancer Center New York Objective: Chronic orchalgia is a crippling disorder for some men. Spermatic cord denervation (SCD) surgery is effective in carefully selected patients. It is recognized that some men with this condition do not have scrotal pathology and have a large psychological overlay. It is our practice to conduct blinded sperm cord blocks (SCB) to define the etiology of the condition and the potential for success with SCD surgery. Materials: The study population included men who (i) had unilateral orchalgia of ≥6 months (ii) had no scrotal content structural abnormalities on examination or scrotal ultrasound (iii) had no varicocele and (iv) had pain confined solely to the scrotum. Demographic, comorbidity data and physical characteristics were recorded. Two SCB were administered within 1 month of each other. One was local anesthetic (LA, 0.5% bupivacaine) and the other normal saline (NS, 10 mls each). The patient was blinded as to which agent was being administered. Pain was graded on a 0–10 point pain scale. Duration of relief after SCB was measured in minutes. Results: 32 men with mean age = 42 ± 21 years were analyzed. Mean duration of pain = 14 ± 64 (6–120) months. 6 men were postvasectomy, 4 had a history of chronic epididymitis, 4 had scrotal trauma preceding pain onset and 18 had not risk factor identified. Mean baseline pain = 6 ± 3 (3–10); after LA 2.5 ± 3.5 (0–8); after NS 4 ± 5 (2–9) (p < 0.01). In response to LA, 94% had at least a 4 point decrease in pain (mean duration 2.5 hours), but 2/32 (6%) had no significant

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pain reduction. In response to NS, 88% had no significant pain reduction, but 4/32 (12%) had >4 point reduction in pain (duration of relief 1–48 hours). Of the latter 4 patients, three also had a significant response to LA. All vasectomy and chronic epididymitis patients had a positive response to LA and a negative response to NS. All patients with a negative response to LA and positive response to NS belonged to the group with no identifiable risk factors for orchalgia. Conclusions: While SCB with local anesthetic is valuable, the addition of patient blinding using saline injections may select out those patient with a psychological overlay to their orchalgia. This maneuver may, in turn, aid in the selection of those patients most likely to respond to SCD surgery. Disclosures: Work supported by industry: no.

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CHARACTERIZATION OF PATIENTS WITH GENDER DYSPHORIA FOLLOWED AT A TERTIARY HOSPITAL: A REFLECTION ON THEIR EXPERIENCES Lerri, M1; Romão, A1; Nadai, M1; Santos, M2; Rosa-e-Silva, A1; Reis, R1; Lara, L1 1: Faculdade de Medicina de Ribeirão – Universidade de São Paulo (FMRPUSP), Brazil; 2: Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto – Universidade de São Paulo (FFCLRP-USP) Objective: To present the social, emotional and affective aspects of patients with gender dysphoria, assisted in the clinic for Study of Human Sexuality (AESH)-Faculty of Medicine of Ribeirão Preto-University of São Paulo. Methods: We used a semi-structured questionnaire to access sociodemographic and emotional aspects. The risk for anxiety and depression was accessed by using the Hospital Anxiety and Depression Scale (HAD). Results: Forty transsexual with a mean age of 27(18–59) years participated in this study. Of these, 33(82.5%) are male to female (MtF) and 7(17.5%) are female to male (FtM). Twenty-six (6%) are white, and 14(35%) are black. As for origin, 39(97.5%) are from the of São Paulo state, and 1(2.5%) from Minas Gerais state. Thirty-four (85%) had middle school and 6(15%), higher education. Thirty-four (85%) are receiving US$324.74 to 1,620,00/monthly and 6(15%) are unemployed. The use of alcohol, cocaine, marijuana and cigarette is reported by 22(55%) patients. Thirty-six (90%), reported self-medication with hormones. The main reason for searching for AESH was to initiate hormone therapy. The first sexual intercourse occurred between 8 and 15 years for 25(62%) patients. Regarding the affective life of the 23(58%) patients who reported having a partner, 6(26%) are trans-men and 17(74%) are trans-women. Thirty-five (88%) patients reported feeling socially discriminated, 24(68%) felt discrimination at work, 10(28%) at family, and 7(20%) reported discrimination in healthcare units. The prevalence of suicide attempts is high in this sample. Twenty-nine (73%) reported one or more attempts. The motivating factors for suicide attempts were verbalized by patients as: discrimination in 23(48%), non-acceptance of family in 13(28%) and nonacceptance of their body in 12(26%). The attempts occured at age of 10 to 25 years in 24(60%) and at 26 to 31 years old in 5(13%). Thirtyeight (95%) of patients were at risk for depression. Regarding the average, 30(75%) patients were at risk for anxiety. Conclusion: Transgender people live in poor social and emotional conditions and are exposed to social and familial prejudices, as well as prejudices at work, that may impair their quality of life. This may explain the high prevalence of suicide attempts in this population. Expand knowledge to identify variables related to poor quality of life in this population is crucial to outline specific medical and psychological interventions. Also, effective public policies are required to promote health and well-being for transsexuals. Disclosures: Work supported by industry: no.

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BAREBACKING BEHAVIOR AND PERSONALITY AMONG SEXUALLY COMPULSIVE INDIVIDUALS SEEKING TREATMENT IN SÃO PAULO, BRAZIL Amaral, M1; Scanavino, M1 1: Department and Institute of Psychiatry. Clínicas’ Hospital. School of Medicine. University of São Paulo (FMUSP), Brazil Objectives: Investigate the association between barebacking behavior – intentional unprotected anal intercourse among men who have sex with men (MSM), and personality traits in 69 individuals in Sao Paulo, Brazil who sought treatment and met the criteria for compulsive sexual behavior. Material and Methods: Participants underwent psychiatric evaluation, interview for defining the intentional condomless sex, and completed self-report instruments, including the Temperament and Character Inventory of Cloninger and Sexual Compulsivity Scale (SCS) of Kalichman and Rompa. Results: Twenty-five (36%) reported intentional anal intercourse with casual partners, of whom 84% were gay and 16% bisexual (p = 0.03). The mean of sexual compulsivity showed associated with men who engage in barebacking (p = 0.01). Men who reported barebacking scored significantly higher on temperament dimension novelty seeking (p = 0.003) and scored significantly lower on character dimension selfdirectedness (p < 0.001). The variables self-directedness remained significantly associated with the outcome variable barebacking behavior in the multiple logistic regression analysis (p = 0.001). Conclusions: Sexually compulsive individuals who engage in barebacking presented lower self-directedness than the group who not engage in barebacking, which means less autonomy regarding life itself. To the best of our knowledge, it is a first finding considering barebacking behavior in sexually compulsive men. Disclosures: Work supported by industry: no.

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PATIENT REPORTED OUTCOMES AFTER METOIDIOPLASTY Kuehhas, FE1; De Luca, F2; Spilotros, M2; Richardson, S2; Garaffa, G2; Ralph, D2; Christopher, N2 1: Medical University of Vienna, Austria; 2: St. Peter’s Andrology Centre and Institute of Urology, University College London, London, United Kingdom Objective: To analyze patient reported outcomes after metoidioplasty in female-to-male gender reassignment surgery. Metoidioplasty is requested by patients because it is perceived to preserve sexual sensation, allow them to void standing and have minimal scarring with the appearance of a small but cosmetically acceptable penis. Material and Methods: All patients who underwent metoidioplasty, between 1999 and 2014, were retrospectively analyzed and patient reported outcomes were evaluated through a non-validated questionnaire, which was designed in cooperation with trans-gender patients. Results: 48 patients were identified of which 3 were lost to follow-up and 1 underwent gender reversal to female. The response rate to the questionnaire was (21/48) 44% of which 17/48 (35%) still had just a metoidioplasty. Mean age at the time of surgery was 37.8 years. Mean follow-up was 49.3 months. The complication rate was 59% (55% urethral fistulae or strictures, 25% infected testicular prosthesis, 20% other). Most patients (29/48, 60%) were content with the metoidioplasty but 12 (25%) went on to have a full size phalloplasty with a further 3 (6%) requesting a phalloplasty. Of the phalloplasties, 5 were radial forearm flap, 6 were abdominal flap and 1 was a Gillies phalloplasty. The mean length of the metoidioplasty was 3.8 cm (range 2–5 cm). Looking at just the 17 metoidioplasty patients, sexual function was very good with patients being satisfied or partially satisfied with erection quality (94%), masturbation (100%) and orgasm (100%).

37 Desire for sexual intercourse was high (88%) but ability to penetrate was low (24%). Voiding function was much poorer in contrast, with patients being satisfied or partially satisfied with ability to void standing (47%), confidence using a public urinal (12%) and satisfaction voiding standing (71%). Spraying of urine was a feature in 59%. Cosmesis was moderate with patients being satisfied or partially satisfied with cosmetic appearance (77%) and penis length (71%). 94% were happy with the pre-operative information given but only 82% would recommend this operation to a friend and only 71% would do the operation again given current knowledge. Conclusion: Metoidioplasty results in good patient reported outcomes with respect to sexual function and cosmesis but much poorer voiding outcomes than perceived. Comprehensive preoperative information on the procedure and expected result is critical to patient satisfaction. Disclosures: Work supported by industry: no.

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PROFILE OF WOMEN WITH ANORGASMIA: A RESTROSPECTIVE ANALYSIS Lordello, M1; Ambrogini, C1; Fanganiello, AL1; Araújo, T1; Zaneti, M1; Veloso, L1; Piccirillo, L1; Crude, B1; Silva, I1 1: Unifesp, Brazil Aim: Describe the profile of women who sought for outpatient treatment, complaining about anorgasmia, from June 2012 to June 2014. Material and Methods: The sample included 32 women, aged between 22 and 62 years old, sexually active, who performed medical, psychological and physiotherapy assessment at Aphrodite Project. Were assessed the following aspects at their medical record: age, scholarity, relationship status, religion, psychiatric history, sexual violence, sexual response cycle and masturbation. Results: Most of women with anorgasmia have between 20 and 30 years (34,5%), with a reduction of this percentage over the years. From 31 to 40 years (28,1%), from 41 to 50 years (25%), from 51 to 60 years (9,3%) and over 61 years (3,1%). They have primary anorgasmia (59,4%) most of all, situational (28,1%) and secondary (12,5%). The majority of them have at least, complete high school (81,2%) and are married or in a consensual marriage (43,9%), followed by those who date (34,3%). The catholic religion is the most present among these women (43,9%). Most of them don’t have psychiatric disorders (47%), followed by those who had at least one depressive episode (28,1%). Regarding to sexual violence, 75% mentioned never having gone through such experience. Regarding to sexual response cycle, 46,8% present desire always or occasionally; sexual arousal always 56,3% and occasionally 31,2%. Most of women don’t practice masturbation or rarely practices it (56,3%) and 25% often practice, although don’t achieve orgasm with the partner. Conclusions: According with this profile, we can conclude that age is a significant parameter in anorgasmia, because the dysfunction decreases with increasing age, it shows the importance of experience and learning in capacity of achieve orgasm. Psychiatric disorders and sexual violence are not among the main factors that predispose women to anorgasmia. These women present, most of time, a sexual response cycle preserved, with normal desire and arousal, lacking only orgasm. Finally, the absence of masturbation is directly linked to the inability to achieve orgasm. Disclosures: Work supported by industry: no.

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SEXUAL FUNCTION OF BRAZILIAN FEMALE ADOLESCENTS AND YOUNG ADULTS 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: The sexual function of female adolescents and young adults is still under investigation. Our aim was to assess the sexual function of Brazilian female adolescents compared to young adults. Patient and Methods: This cross-sectional study involved 199 sexually active Brazilian females: 128 adolescents (13–19 years) and 71 young adults (20–25 years). 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 variables between the two groups. P < 0.05 was considered significant. Results: Most participants were single, catholic and had between 8 and 12 years of formal education. The mean age of the girls was 17.4 ± 1.5 vs 22.1 ± 1.8 years (P < 0.0001), for adolescents and young adults, respectively. Mean age at first sexual intercourse was 14.8 ± 2.0 vs 16.3 ± 2.2 years (P < 0.0001) for adolescents and young adults, respectively. Most of them reported having had intercourse with 2 or more partners (46% adolescents versus 71.8% young adults, P = 0.001). The mean total FSFI scores of the 199 participants was 26.5 ± 5.9 and 39.7% of them were at risk for sexual dysfunction symptoms. A total of 49 adolescents scored ≤ 26 on the FSFI compared to 30 young adults (38.3% versus 42.3%, respectively, P = 0.651). Young adults had significantly lower mean total scores, compared to adolescents female (23.6 ± 6.2 versus 26.6 ± 5.7, P = 0.001). The young adults group also had significantly lower scores for the sexual satisfaction domain, compared to the adolescents group (4.6 ± 1.5 versus 5.1 ± 1.1, P = 0.008, respectively). Conclusion: There is a high prevalence of sexual dysfunction symptoms among Brazilian female adolescents and young adults and they are significantly more likely to be at risk for sexual dysfunction than the female adolescents. However, adolescents have significantly higher overall and sexual satisfaction domain FSFI scores than young adults. Disclosures: Work supported by industry: no.

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MILITARY SEXUAL TRAUMA IN MALE MILITARY PERSONNEL Wilcox, S1; Schuyler, A1; Campbell, S1; Redmond, S1 1: University of Southern California, United States Objective: To assess the rate of military sexual trauma (MST) in a nation-wide sample of male military personnel and evaluate the impact of MST on psychosocial functioning and quality of life (QOL). Research on sexual trauma and victimization has historically focused on women, who have been more likely to report such experiences. While rates of sexual trauma and victimization are lower in men, it still exists and the subsequent impact on psychological and physical functioning can be severe. Military personnel often under report psychological problems and the sensitive nature of MST in men is predicted to further reduce reported rates in military personnel, in addition to the complexities of assessing MST. Further, men with MST are more likely to report comorbid mental health diagnoses and are nearly three times more likely to report PTSD than men without MST. Material and Methods: This exploratory study used data from a larger study on sexual functioning problems in military populations age 40 and younger. This sample consisted of 367 male military personnel aged 18–40 years. Process modeling was performed to examine the psychosocial processes by which MST can influence QOL. We pre-

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dicted that MST would be associated with reduced mental health outcomes, which would be associated with lower QOL. Results: Results show high rates of MST in male military personnel and indicate the negative association MST can have on mental health outcomes and QOL. Conclusions: This study underscores the importance of assessing MST in men (in addition to women). While men are less likely to report MST, there may be many unreported cases that are significantly impacting psychosocial functioning and QOL. Strategies aimed at reducing MST in both men and women can significantly improve the readiness of military populations. Disclosures: Work supported by industry: yes, by California Community Foundation – Iraq Afghanistan Deployment Impact Fund (industry funding only – investigator initiated and executed study).

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SEXUALITY AND DEPRESSION AMONG PREGNANT WOMEN WITH RECURRENT SPONTANEOUS ABORTION Francisco, M1; Mattar, R1; Nakamura, M1 1: UNIFESP, Brazil Objective: To analyze, among pregnant women with a history of recurrent spontaneous abortion (RSA), symptoms of depression, sexual behavior, emotional support from the partners and the interrelationships between these factors. Methods: This was a prospective case-control study, being the first group of RSA and the second by primigravidae. It has been used the Beck Depression Inventory (BDI), the Female Sexual Function Index (FSFI) and two more questionnaires, one about emotional aspects resulting from sexual intercourse during pregnancy and another about the emotional and social support offered by the partner. To compare quantitative variables with normal distribution, it has been used the Student t test, and categorical variables were compared using the chisquare test or Fisher’s exact test. The statistical significance was set at p < 0.05. Results: The BDI showed approximately twice the incidence of depression in the group RSA. Regarding sexual function, the average scores of the FSFI were lower for the group RSA, and only under the desire (average 3.4 ± 1.3 for the RSA group and 3.7 ± 1.1) was not statistically significant (p = 0.003). We have realized that, regardless of the pregnant woman having or not having RSA history, the higher the depression score, the lower the sexuality score. Conclusions: RSA pregnant group often experience depression twice and more impaired sexual function. There is an inverse association between depression and sexual function / emotional support from the partner and direct association between emotional support and sexual function. Disclosures: Work supported by industry: no.

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COMPARISON OF TRADITIONAL FEMALE SEXUAL FUNCTION INDEX SCORE VERSUS ADAPTED SCORE FOR POSTMENOPAUSAL LATIN-AMERICAN WOMEN Silva, G1; Lima, S1; Reis, BF2; Bernardo, B2; Macruz, C2 1: Santa Casa de São Paulo Medical School, Brazil; 2: São Paulo Medical School, Brazil Introduction: When using the FSFI, the currently acceptable cutoff value for diagnosing Sexual Dysfunction (SD) in women between 18 and 74 years of age is ≤26.5. Nevertheless, this index can yield SD rates

The 16th World Meeting on Sexual Medicine varying from 22 to 50% in fertile women, which would then lead to the inappropriate conclusion that the majority of fertile and healthy women in their fourth decade of life have SD. For this reason, there has been some debate about considering the ideal total score as ≤23. In fact, in a study with pre-menopausal women of Latin origin not using oral contraceptives, an FSFI score ≤ 23 was considered as the cutoff value for diagnosing them as having SD. Therefore, considering studies and the fact that we have also been evaluating a post-menopausal female cohort of Latin origin, we used as a cutoff value FSFI ≤ 23 and we also calculated the SD rates in our study considering the traditional cutoff value of FSFI ≤ 26.5. Objective: To compare the traditional Female Sexual Function Index versus adapted score for postmenopausal Latin-American women. Methods: This is a case-control study. The group consisted of postmenopausal women that usually seek treatment at the Endocrine Gynecology Clinic at the Santa Casa de São Paulo Medical School at and at the Basic Health Units (Vila Barbosa, Vila Dionísia and Vila Santa Maria) participating in the Family Health Program promoted by the local municipal health authorities in São Paulo, in the period between February 2011 and February 2013. The study was conducted in accordance with the Declaration of Helsinki. All patients signed a voluntary informed consent form that was approved by the Medical Ethics Committees at the Faculty of Medical Sciences at Santa Casa de São Paulo .The women considered as being post-menopausal were those with amenorrhea ≥1 year and FSH ≥30 mUI/mL. The MetS diagnosis was determined by the ATP III. The sexual function was performed by using the FSFI. These are indicative of SD risk when their values are less than or equal to 26.5 points – in post-menopausal women, the cutoff value FSFI 21, 16–21, 11–16, 7–11, and ≤7, respectively. We investigated the relationship between carotid artery plaque with ED using the Spearman correlation test, the Mantel-Haenszel Extension test, and logistic regression analyses. Results: The median age was 57 years, and the median IIEF were 15. The IIEF showed a significant negative linear correlation with maximum intima-media thickness (max IMT) (correlation coefficient = −0.132, P < 0.001). Additionally, there was a significant increase in the severity of ED with increased the severity of plaque size (P trend < 0.001). There was a greater likelihood of having moderate ED in the moderate and severe plaque size groups when compared to the absence of plaque group, after adjusting for age and components of metabolic syndrome (odds ratio [OR] = 1.672, P = 0.021). Conclusions: In this study, the IIEF were significantly correlated with increased plaque size. Our data indicates the potential role of ED as predictors of carotid artery plaque.

Hatem, A1; Eid, A2; Swidan, A2; Salama, N3 1: Faculty of medicine, university of alexandria, Egypt; 2: Faculty of medicine, University of Alexandria, Egypt; 3: Faculty of Medicine, University of Alexandria, Egypt

Disclosures: Work supported by industry: no.

Objectives: Determination of the potential effect of metabolic syndrome (MetS) on erectile function in Egyptian men and description of the sociodemographic characteristics of these men. Material and Methods: A cohort of 220 patients presenting to Alexandria urology department ages between 30 and 75 years were prospectively assessed and divided into two groups. Group I (n = 110) diagnosed with MetS and mean age of 55.4 years. Group II controls (n = 110) subjects with no MetS and mean age 53.5 years. Patients filled the International Index for Erectile Function (IIEF) questionnaire, Medical, personal history and BMI data were tabulated. Presence of metabolic syndrome was determined when three or more of the five risk factors were present according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP)-III. Results: In the study groupI 82(74.5%) of the patients had ED. Of these, 19 (17.3 %) had mild, 25 (22.7%) had moderate and 38 (34.5 %) had severe ED. and 38(34.5%) of patients without metabolic syndrome had ED. Of these, 22 (20 %) had mild, 10 (9.1 %) had moderate and 6(5.5 %) had severe ED. (P < 0.001; odds ratio 5.549; 95% CI 3.101 –9.928). Patients with metabolic syndrome had lower IIEF-EF domain scores than controls. Logistic regression analysis for the study group revealed that abnormal FBG was the most important criteria for ED (OR 1.013, 95% CI 1.004–1.022; P = 0.007) while on T Ed positively correlated to FBG, HDL, triglycerides and blood pressure (p < 0.001). Conclusions: Metabolic syndrome is a potential risk factor for ED in Egyptian men. Patients with metabolic syndrome should be questioned about ED. The diabetic patients are the most risky for ED.

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Disclosures: Work supported by industry: no.

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THE RELATIONSHIP OF CAROTID ARTERY PLAQUE WITH ERECTILE DYSFUNCTION Lee, J1 1: National Police Hospital, Korea, South Objective: Erectile dysfunction (ED) and carotid artery disease are known predictors of cardiovascular disease. However, little is known regarding the relationship of carotid artery disease with ED. Elucidation of the relationship of ED with carotid plaque would be helpful in comprehensive and detailed management in ED patients. Therefore, we evaluated the relationship of carotid artery disease with and ED. Material and Methods: We enrolled 799 men who had participated in a health examination. During this examination, they received an international index of erectile function-5 (IIEF), a carotid duplex ultrasound, and a full metabolic work-up. The plaques were classified into three groups according to the severity of plaque size (absence: ≤1 mm, mild: 1.1–2.0 mm, and moderate to severe: ≥2.1 mm). Additionally, we

DETECTION OF A TADALAFIL ANALOGUE AS AN ADULTERANT IN A DIETARY SUPPLEMENT FOR ERECTILE DYSFUNCTION Ulloa, J1; Sambrotta, L1; Redko, F1; Mazza, O1; Garrido, G1; Becher, E1; Muschietti, L1 1: University of Buenos Aires, Argentina Introduction: Cases of adulteration of dietary supplements with tadalafil, sildenafil and vardenafil, or their unapproved analogues have been reported worldwide. Mainly, the presence of the latter represents a serious health risk to consumers as their efficacy and toxic effects have not been assessed and may result in unpredictable adverse effects. Aim: To investigate the suspected adulteration with synthetic PDE-5 inhibitors in a dietary supplement marketed in Argentina for the treatment of erectile dysfunction (ED). Methods: The content of the capsules of the dietary supplement (Sample A) was analysed by Thin Layer Chromatography (TLC) and High Performance Liquid Chromatography (HPLC-DAD). From the organic extract of sample A, a major compound was purified by column chromatography (CC). The isolated compound was identified by proton nuclear magnetic resonance (1H NMR) and carbon NMR (13C NMR), heteronuclear single quantum correlation (HSQC), distortionless enhancement by polarization transfer (DEPT 135), Electrospray ionization-Mass Spectrometry (ESI-MS); and Ultraviolet (UV) and Infrared (FT-IR) spectroscopy. Main Outcome Measure: Proof of adulteration of herbal products with synthetic PDE-5 inhibitors. Results: By TLC and HPLC analysis, a major compound was detected in sample A organic extract. The purification of this extract by CC led to the isolation of a pure compound which was identified according to its spectral data as (6R,12aR)-2-amino-6-(1,3-benzodioxol-5-yl)2,3,6,7,12,12a-hexahydropyrazino [1’,2’:1,6] pyrido [3,4-b] indole-1,4dione or aminotadalafil. Conclusions: An unapproved PDE-5 inhibitor analogue, which was identified as aminotadalafil, has been detected in a dietary supplement. This study represents the first report in Latin America and one of the few independent studies of an adulteration with an unapproved PDE-5 inhibitor of an herbal product for ED treatment. Disclosures: Work supported by industry: no.

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PERCEPTIONS AND ATTITUDE TOWARDS THE TREATMENT OF PE WITH TRADITIONAL MEDICATION VS WESTERN MEDICATION: THE RESULT OF SCOPE (SEXUAL CONCERNS ON PREMATURE EJACULATIONS) Lam, M1; Loh, J2; Siaw, M3; Lim, L3; Razack, A4; Ong, T4; Lee, E3 1: University of Leicester, United Kingdom; 2: University of Southampton, United Kingdom; 3: Monash University, Malaysia; 4: Department of Surgery, University of Malaya, Kuala Lumpur Objective: Premature Ejaculation (PE) is a commonplace medical condition affecting both men and their sexual partners in approximately 30% of the general population. The objective of this study aims to identify the perceptions and attitudes of treatment seeking preference between traditional and western medications in a rapidly developing and diverse socio-economic Asian country. Methods: The study population was obtained primarily from both urological and non urological clinics in an urban tertiary hospital. Convenience sampling was employed and the participants completed a non-validated questionnaire which recorded their perception towards PE and the different treatment modalities. Demographical details of age, gender, income brackets and education backgrounds were also identified. Results: A total sample population of 1541 subjects (792 males and 749 females) were enrolled into this study. Of which, 80.1% of the sample population agreed that PE is a condition treatable with medications. A huge majority of participants (95.5%) would readily accept any treatment interventions offered to them as they view it as necessary (92.2%). Despite such perception, only 79.5% of subjects would accept western medicine as their first line choice of therapy with only 88% believing it to be effective. It is noteworthy that 63.4% of the respondents would also readily accept traditional medications as an alternative remedy for PE. Conclusion: This study has identified that majority of the respondents are keen and accepting in seeking medical treatment for PE. The general consensus agrees that western medication would yield promising results and is viewed as the first choice in PE management. As with most Asian communities, most of the participants are also open to the idea of using traditional medications as an alternative or adjunct in the treatment of PE. As such, further studies should be done to examine the different compounds that have been used traditionally and clinicians should address the risk of drug interactions and adverse effects through focused patient education. Disclosures: Work supported by industry: no.

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EFFECT OF CHRONIC SKIN DISEASES ON FEMALE SEXUAL FUNCTION IN UPPER EGYPT Abdel hafez, H1; Abdel Motalab, A1; Ismail, S1 1: Assiut University Hospital, Egypt Objectives: Female sexual dysfunction in chronic diseases has become a popular and important health concern in recent years. Dermatological diseases can have a significant impact upon sexual function. The aim of this study was to investigate sexual function in females with chronic dermatologic diseases in upper Egypt, for the first time to the best of our Knowledge. Material and Methods: A total of 100 female patients with chronic dermatological problems and 100 healthy volunteers as age-matched control group were enrolled in the study. The validated Arabic version of Female Sexual Function Index (FSFI) was used to assess female sexual function. The cut-off score to define sexual dysfunction on the

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total FSFI score was obtained from a validation study that determined a total score below 26.55 to denote sexual dysfunction. Results: This study included 100 patients (71 with vitiligo and 29 with psoriasis), their age ranged from 18 to 50 years with mean ± SD 36.11 ± 9.12 and 100 healthy control their age ranged from 18 to 50 years with mean ± SD 33.79 ± 8.17. Mean duration of the disease was 6.21 ± 6.50. Percentage of involvement ranged from 3–90% with mean ± SD 39.51 ± 28.11. Fifty two percent of the patients proved to have sexual dysfunction. Total FSFI score was not significantly decreased in patients versus control. However, there was statistically significant difference in some of its domains as lubrication, satisfaction and pain (p < 0.05). Age of the patients showed negative correlation with desire, arousal, lubrication, orgasm, satisfaction and the total FSFI. Also, the duration of the disease showed negative correlation with arousal, orgasm, satisfaction and total FSFI. However, the percentage of involvement of the disease showed no correlation with total FSFI or individual domains. Conclusion: Sexual health is affected in female patients with chronic dermatological diseases. These patients need for physicians to implement attention on the impact of their diseases on sexual health in order to provide a better quality of life. Disclosures: Work supported by industry: no.

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ASSOCIATION BETWEEN ALEXITHYMIA AND SEXUAL SELF-EFFICACY IN PATIENTS WITH ERECTILE DYSFUNCTION AND PREMATURE EJACULATION Finotelli Jr., I1 1: Paulista Institute of Sexuality (InPaSex), Brazil Introduction: Alexithymia is characterized by the difficulty in identify and describe emotions, lack of fantasies and cognitive style externally oriented. Researches associate negative influences of this condition in the sexual function. The objective for this study was to investigate such influences in the men sexual self-efficacy. Methods: Fifty-six (56) patients, who have been treated in a private clinic in Sao Paulo, Brazil, were assisted and, thirty-one (31) patients were diagnosed with premature ejaculation (PE) and twenty-five (25) with erectile dysfunction (ED). The ages vary between twenty (20) and fifty-eight (58) years old (M = 32.61; SD = 9.87), fifty-seven percent (57%) were single, thirty-six percent (36%) married and seven percent (7%) divorced. The majority of seventy-five percent (75%) of the participants had a Bachelor degree or equivalent. For this measurement, the Toronto Alexithymia Scale (TAS-26) and Sexual SelfEfficacy – Erectile Function (SSES-E) that evaluate the sexual function and dimensions denominated as obtaining and maintaining an erection, were used. Results: No differences in the score for TAS-26 were found among subjects with PE and ED. For the SSES-S, the subjects with PE had higher scores compared to the subjects with ED in the total score and in the obtaining dimension. No differences were found in the maintaining dimension, which was expected because none of the dysfunctions is capable of providing favorable states for the erectile maintenance. For association between the instruments, moderate negative correlations were found only in the dimensions. In this case, the ability of sexual self-efficacy in behaviors on the erectile maintenance was compromised due to the high scores in the TAS-26 dimensions related to the difficulty in identify/describe feeling and distinguish bodily sensations, and the inability of expressing and understand emotions. This situation can compromise behaviors for the continuity of the erection, i.e. the communication about the way to stimulate; the capability of sexual attraction; the diversity of stimuli, besides penetration; the non-anxiety or fear during sexual activity; among others. Conclusions: Related to alexithymia, the inability to identify feelings and the lack of ability to express emotions keep the negative association in the self-efficacy connected to erectile maintenance behaviors. This

The 16th World Meeting on Sexual Medicine association can implicate in the clinical management of male sexual dysfunctions. Disclosures: Work supported by industry: no.

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THE INFLUENCE OF MARITAL MYTHS WHEN COMPARING CLINICAL AND NON-CLINICAL SUBJECTS Finotelli Jr., I1 1: Paulista Institute of Sexuality (InPaSex), Brazil Introduction: Different social instances estipulate to a subject how one should act socially. These expectations are described by beliefs and attitudes connected to different social practices. Such beliefs may influence the way an individual behaves. The objective was to compare influences of marital beliefs in individuals with and without relationship complaints. Methods: The sample was composed by sixty (60) participants, who have been treated in a private clinic and sixty (60) participants from a private university, both in Sao Paulo, Brazil. The clinical sample was composed by patients with marital complaints. The ages vary between twenty-one (21) and sixty-two (62), (M = 30.30; SD = 10.11), gender and type of sample do not vary according age. In order for the data to be collected, a questionnaire based in the book Marital Myths, from Arnold A. Lazarus, which contains twenty-four (24) myths related to marital practices. These myths were transformed in items and the score of the questionnaire was designated the greater the amount of claims, the higher one’s belief. Results: Differences were found in the score of the samples, in this case, the clinical participants confirm more myths compared to the university ones. Comparing items, two (2) had significant differences. In the search for dimensions, factorial analysis for main components and varimax rotation extracted three (3) dimensions which were denominated as Crisis Situation, Relationship Maintenance and Trust. Only the Relationship Maintenance dimension presented significant differences in the score of the sample, presenting higher score for the clinical participants. Conclusions: To assess the beliefs of an individual regarding marital relationship may represent an aspect to be intervened in people who seek processes of marital psychotherapy. In the research, the clinical sample presented higher frequency of the myths compared to the sample of individual without any marital complaints. These myths were connected to aspects of relationship maintenance. The results also presented the feasibility of using and the construction of scales to assess the beliefs of the individual regarding marital relationship. Disclosures: Work supported by industry: no.

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COMPREHENSIVE CARE FOR RAPE VICTIMS: ADHERENCE TO HIV/STD PROPHYLAXIS AND TO LABORATORY FOLLOW UP AT THE RAPE VICTIM CARE CENTER, SCHOOL OF MEDICINE, UNIVERSITY OF SÃO PAULO, BRAZIL Nisida, I1; Boulos, M2; Atui, F3; Diegoli, C4; Segurado, A5 1: Rape Victim Care Center, Division of Infectious diseases, Hospital das Clínicas da FMUSP, Brazil; 2: Rape Victim Care Center, Division of Infectious Diseases,Hospital das Clínicas da FMUSP, Brazil; 3: Colorectal Surgery, Hospital das Clínicas da FMUSP, Brazil; 4: Gynecology, Hospital das Clínicas da FMUSP, Brazil; 5: Division of Infectious Diseases, Hospital das Clínicas da FMUSP, Brazil Objective: To identify factors associated with completion of prophylactic interventions for rape victims in a tertiary university care setting.

45 Methods: We conducted a retrospective medical chart review of patients who attended NAVIS (Rape Victim Care Center, School of Medicine, University of São Paulo) from 2001 to 2009. All patients were referred to NAVIS after having showed up at the emergency room of a tertiary university hospital in São Paulo, up to 72 hours after SA. All eligible patients were prescribed HIV/STD chemoprophylaxis (anti-retroviral drugs, ceftriaxone, metronidazole, azithromycin), hepatitis B immunization and submitted to a laboratory screening and follow-up (lab FU) that consisted of detection of anti-HIV, hepatitis B and C and syphilis antibodies. The study outcome – adherence to chemoprophylaxis and lab FU was classified as: incomplete (G1); complete chemoprophylaxis (G2) (patients treated as recommended for more than 30 days); and complete prophylaxis and lab FU (G3) (patients who completed chemoprophylaxis and hepatitis B immunization, and underwent 2 lab screenings on days 60 and 180 after SA. Using the Chi-square test patients from G2 and G3 were compared to those in G1 in regard to independent variables of interest that included: age, gender and SA characteristics [(known or unknown perpetrator), anatomical site (vaginal, oral or anal penetration)]. Results: 136 of 274 patients were eligible for HIV/STD prophylaxis: 109 (80.2%) female and 27 (19.8%) male; 103 (75.7%) over 14 years old. As far as the study outcome is concerned, 42 patients (30.9%) were classified in G2 and 59 patients (43.4%) in G3. Oral penetration was associated with complete chemoprophylaxis (p < 0.001), whereas anal and oral penetration (p < 0.001) and report of ejaculation (p < 0.001) with completion of both chemoprophylaxis and lab FU. No patient tested positive for HIV infection on day 180. Conclusion: Our results highlight factors associated with complete adherence to chemoprophylaxis, hepatitis B immunization and lab FU in rape victims assisted in a university care center in São Paulo. Special attention in future studies is warranted to the assessment of multidimensional barriers to completion of these prophylactic interventions, in order to enhance their effectiveness. Disclosures: Work supported by industry: no.

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LONG-TERM ERECTILE FUNCTION OUTCOMES IN APTIENTS SUBMITTED TO EITHER TRANS-URETHRAL RESECTION (TURP) OR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Capogrosso, P1; Boeri, L1; Serino, A1; Colicchia, M2; Ventimiglia, E1; 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 long-term predictive factors of erectile function (EF) outcomes in patients treated with HoLEP vs TURP for bladder outlet obstruction associated with benign prostate hyperplasia (BPH). Methods: Data from 99 patients submitted to HoLEP and 102 patients submitted to TURP with a minimum 5-yr follow-up (FU) were analyzed. All patients completed a remembered (= targeting EF related to a date preceding surgery) and a real-time (= targeting EF over the 4 weeks prior to survey)IIEF-EF domain. Both a remembered and a real-time IPSS were also completed. Logistic regression models tested the association among potential clinical predictors and postoperative IIEF-EF scores [also considering Minimal Clinically Important Differences (MCIDs) criteria] in both groups. Results: HoLEP patients showed higher preop prostate volumes than TURP patients [65.7 (34.3) vs 56.6 (23.3) ml; p = 0.03). At long-term FU, post IPSS significantly improved after HoLEP [23.1 (7.5) vs 6.3 (5.4)] and after TURP [22.1 (6.2) vs 7.39 (5.5)], respectively (all p = 0.001). A significant improvement was observed for irritative and obstructive symptoms in both groups (all p < 0.001), without intergroups differences. IIEF-EF values were significantly lower after

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46 surgery, without inter-groups differences [HoLEP: 24.27 (7.4) vs 17.1 (10.7); p = 0.001; and, TURP: 22.6 (8.9) vs 13.6 (10.7); p = 0.001]. Conversely, as a whole only 14 (7%) patients improved their EF after surgery, irrespective of type of surgery [7 (7.1%) vs 7 (7.0%)]. A significant improvement according to MCIDs criteria was observed in 12 (5.9%) patients. At MVA, preop IIEF-EF emerged as an independent predictor for either a postop improvement or a decrease of IIEF-EF for TURP patients (OR:0.83; p = 0.02; OR:1.1; p = 0.01, respectively). Conversely, age at FU (OR:1.19; p < 0.01) and preop IIEF-EF (OR:1.14; p = 0.01) were associated with a decrease of postop IIEF-EF in HoLEP patients. TURP patients showed higher rates of overall postop complications than HoLEP patients [23.2% vs 6.1%; p = 0.001]. Conclusions: Long-term FU data showed no differences between HoLEP vs TURP in terms of EF and urinary symptoms improvements after surgery. Preoperative EF emerged as an independent predictor of EF maintenance after both types of procedures. Disclosures: Work supported by industry: no.

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AUTOIMMUNE DISEASES ARE HIGHLY COMORBID IN PATIENTS WITH PEYRONIE’S DISEASE – RESULTS OF A CROSS-SECTIONAL REAL LIFE STUDY AMONG CAUCASIAN-EUROPEAN EM Ventimiglia, E1; Colicchia, M2; Capogrosso, P2; Serino, A2; Boeri, L2; Castagna, G2; La Croce, G2; Russo, A1; Castiglione, F2; Montorsi, F1; Salonia, A2 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 Objectives: We sought to investigate autoimmune diseases’ prevalence in a cohort of patients seeking medical help for sexual dysfunction, focusing on those complaining of Peyronie’s disease (PD). Methods: Complete sociodemographic and clinical data from 1140 consecutive patients presenting for new-onset sexual dysfunction (Jan 2010 – June 2013) were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI) as a continuous or a categorized variable (0 vs 1 vs ≥2). Categorized measured body mass index (BMI) cut-offs were used as proposed by the NIH. All patients completed the International Index of Erectile Function (IIEF) domains. Autoimmune diseases were assessed through a comprehensive history examination and stratified according to ICD-9 classification. Results: Of 1140, ED and PD were diagnosed in 665 (58.3%) and in 148 (13%) men, respectively. Of all, 34 (3%) patients had a confirmed diagnosis of autoimmune disease. Among PD patients, 14 (9.5%) presented with an autoimmune disorder; conversely, non-PD patients did present an autoimmune disease in a significantly lesser amount of cases [20/992 (2%); χ2: 24.7; p < 0.001]. Patients with PD were older (mean (SD) age: 57.2 (13.1) vs 47.5 (15.6) years; p < 0.001) as compared with non-PD individuals. Conversely, the two groups did not differ in terms of CCI, continuous or categorized BMI. At univariable analysis, cigarette smoking (OR: 1.54; p = 0.04) was significantly correlated with PD. At multivariable analysis, age and a history of autoimmune disease achieved independent predictor status for PD (OR: 1.05; p < 0.01, and OR: 5.74; p < 0.001), after accounting for patient age, CCI, BMI and autoimmune diseases. Conclusions: Autoimmune diseases emerge as highly comorbid with PD in a large cohort of individuals seeking medical help for sexual dysfunction in the real life setting. Disclosures: Work supported by industry: no.

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A GEOMETRIC MODEL OF PLAQUE INCISION AND GRAFT FOR PEYRONIE’S DISEASE WITH GEOMETIC ANALYSES OF DIFFERENT TECHNIQUES Miranda, A1; Sampaio, F2 1: Ipanema Federal Hospital, Brazil; 2: Urogenital Research Unit, State University of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil Objective: To analyze the geometric and mechanical consequences of plaque incision and graft (PIG) on penile rectification surgery. Material & Methods: A tridimensional penile simile model with a curvature of 85o was created to test all of the most common PIG techniques. PIG with double-Y, H-shape and Egydio techniques were used to rectify the curved penile model. The results that differed from a rectified cylinder shape were highlighted. Results: All of the analyzed techniques created a geometric distortion that could be linked to poor surgical results. We suggest a new technique to resolve these abnormalities. Conclusions: Current techniques designed to correct penile deviation using PIG present geometric and mechanical imperfections with potential consequences to the postoperative success rate. The new technique proposed in this report could be a possible solution to solve the geometric distortion caused by PIG. Disclosures: Work supported by industry: no.

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EFFICACY OF EXTENDED INTRALESIONAL VERAPAMIL THERAPY FOR PEYRONIE’S DISEASE IN EARLY RESPONDERS Berookhim, B1; Larish, Y1; Chevinsky, M1; Jakubowski, C1; Jamzadeh, A1; Nelson, C1; Mulhall, J1 1: Memorial Sloan Kettering Cancer Center, United States Objective: To report our experience using a total of 12 intralesional verapamil injections (ILVi), among men with a good response following the initial 6 ILVi for treatment of Peyronie’s disease. Methods: The study population consists of men (i) with palpable penile plaque (ii) uniplanar penile curvature and (iii) who underwent 6 ILVi (10 mg verapamil in 5 ml saline) every 2 weeks. All patients were evaluated with a penile injection assisted deformity assessment (DA) at baseline. Those reporting improvement after 6 ILVi had a repeat DA within 2 weeks, and when clinical improvement was documented were offered an additional course of 6 ILVi. ILVi 7–12 were administered identically to the first 6 ILVi. A final end of treatment DA was conducted 3 months after last ILVi (number 12). Results: 123 men had 6 ILVi. Mean duration of PD was 4 ± 3 months. There was a non-significant mean 2.1 degree increase in curvature from baseline (35.0 ± 18.3) to 6 injections (37.2 ± 20.1, p = 0.19). 30 (24%) had a >10 degree decrease, 53 (43%) were unchanged (10 degree increase. 17 patients (10%) had documentable improvement after 6 injections and proceeded to 12 ILVi. Mean age = 51 ± 12 years and the mean number of months with PD at the time ILVi was commenced = 4 ± 4 (range 2–14) months. Following 6 ILVi, there was a significant reduction in mean degree curvature (41 to 30.0, p = 0.05). 9 (53%) had a >10 degree decrease, 5 (29%) were unchanged (10 degree increase. There was a mean reduction in curvature between 6 and 12 treatments of 3.8 degrees (30 to 26.2, p = 0.28). 6 (35%) had a >10 degrees decrease, 7 (41%) were unchanged (10 degree increase. Overall, among those patients who opted for 12 ILVi, there was a significant reduction in curvature from baseline to 12 injections (41 to 26.2, p = 0.01, mean reduction = 14.7). 9 (53%) had a >10 degree decrease, 4 (24%) were unchanged (10 degree increase.

The 16th World Meeting on Sexual Medicine Conclusions: Among patients with demonstrated improvement following an initial course of 6 ILVi, one third will appear to experience further improvement with an additional 6 ILVi. Consideration should be given to a longer course of treatment for those men considered early responders to ILVi. Disclosures: Work supported by industry: no.

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INTERNATIONAL MULTICENTER PSYCHOMETRIC EVALUATION OF PATIENT REPORTED OUTCOME DATA FOR THE TREATMENT OF PEYRONIE’S DISEASE Kueronya, V1; Miernik, A2; Kojovic, V3; Hatzichristodoulou, G4; Egydio, P5; Tosev, G6; Falcone, M7; Djordjevic, M3; Schoenthaler, M2; Fahr, C2; De Luca, F8; Kuehhas, F9 1: Medical University of Vienna, Department of Obstetrics and Gynecology 2 Medical University of Freiburg, Department of Urology; 2: Medical University of Freiburg, Department of Urology; 3: School of Medicine, University of Belgrade; 4: Technical University of Munich, Rechts der Isar Medical Center, Department of Urology; 5: Centre for Peyronie’s Disease Reconstruction, Sao Paulo; 6: Medical University of Heidelberg, Department of Urology; 7: Medical University of Turin, Department of Urology ; 8: Institute of Urology, University College London; 9: Medical University of Vienna, Department of Urology Objective: To compare patient reported outcomes for the Nesbit procedure, plaque incision and grafting, and the insertion of a malleable penile implant following surgical correction of the penile curvature. Material and Methods: A retrospective review was performed regarding men who underwent surgical correction of PD between January 2010 and December 2012 at six international centres. Patient functional outcomes and satisfaction were evaluated with a non-validated questionnaire. Furthermore, clinical data were retrospectively analyzed. Results: The average response rate to the questionnaire was 70,9%, resulting in a study cohort of 206 patients. The Nesbit procedure, plaque incision with grafting, or implantation of a malleable penile prosthesis was performed in 50, 48, and 108 individuals, respectively. Overall, 79.1% reported a subjective loss of penile length due to PD (range 2.1–3.2 cm), preoperatively. Those patients treated with a malleable penile implant reported the greatest subjective penile length loss, due to PD. A subjective loss of penile length of >2.5 cm resulted in reduced preoperative sex ability. Postoperatively, 78.0%, 29.2% and 24.1% patients in the Nesbit, grafting, and implant groups reported a postoperative, subjective loss of penile length (range, 0.4–1.2 cm), with 86.3%, 78.6%, and 82.1% of the patients in each group, respectively, being bothered by loss of length. Conclusion: Penile length loss due to PD affects the majority of patients. Further penile length loss due to the surgical correction leads to bother among the affected patients, irrespective of the magnitude of the loss. The Nesbit procedure was associated with the highest losses in penile length. In patients with PD and severe erectile dysfunction, a concomitant lengthening procedure may be offered to patients to help overcome the psychological burden caused by the loss of penile length. Disclosures: Work supported by industry: no.

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THE NESBIT PROCEDURE FOR PEYRONIE’S DISEASE: SIX YEAR FOLLOW UP Yap, T1; Raheem, A1; Spilotros, M1; De Luca, F1; Handalage, C1; Lucky, M1; Imbeault, A1; Muneer, A1; Christopher, N1; Garaffa, G1; Ralph, D1 1: University College Hospital, United Kingdom Objective: When treating Peyronie’s disease by plaque incision and grafting, the initial results are favourable, but at 5 years up to 67% of patients have deteriorated, usually due to erectile dysfunction (ED). Is this due to the type of operation or the disease itself? To answer this question we have therefore evaluated the six year outcome of the Nesbit procedure for Peyronie’s Disease. Material & Methods: Between 2006 and 2008, 116 patients underwent the Nesbit procedure (90 patients with Peyronie’s disease and 26 controls with congenital curvature). Data was collected for risk factors of ED including diabetes, hypertension & hypercholestrolemia and the presence of residual curvature, penile shortening and sexual function (using the IIEF-5 questionnaire and objective use of PDE5 inhibitors). The congenital group was used as controls as they had no pre-operative ED or risk factors. Fisher’s exact test and unpaired t-tests were used to compare scores between groups as appropriate. Results: Median follow-up was 78 months for all patients. Mean age of the Peyronie’s group was 57 (range 29–75), and 24 (range 16–36) in the congenital group. Penile shortening > 1 cm and residual curvature (>30 degrees) was reported in 61% and 6% of Peyronie’s patients (no significant difference with control group, p = 1.0). Pre-operative ED was present in 16% of Peyronie’s patients and new-onset ED requiring PDE5 inhibitors occurred in a further 7% at 3 months and 16 % at 6 years post op. At 6 years, 14% of men with pre-op and new onset ED had progressed from medication to injectables. The most significant risk factor in Peyronie’s patients for developing pre & post-op ED was hypertension (p < 0.05 compared to non ED patients). At 6 years, the mean IIEF-5 in the Peyronie’s patients was 16 and significantly lower than the controls at 25 (p < 0.05). Conclusion: The Nesbit operation may cause penile shortening and result in a residual curvature, but this occurs equally in both Peyronie’s Disease and controls. However, erectile dysfunction is common in Peyronie’s disease and deteriorates with time. As the control patients did not develop ED, the disease and not the type of operation is the likely cause. This difference is likely due to associated co-morbidities especially hypertension in the older Peyronie’s group. This long term data will help with counselling and decision-making in men requiring surgical intervention. Disclosures: Work supported by industry: no.

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MEDICAL SEX THERAPY: A NOVEL CERTIFICATION PROGRAM THAT INCORPORATES BOTH SEXUAL MEDICINE AND SEX THERAPY TRAINING AND DIDACTIC LEARNING Krychman, M1; Lee, S2 1: OBGYN, United States; 2: Sex Therapist, USA Objective: Sexual Medicine is considered a multidisciplinary field of study. Many organizations focus on either the psychological training or medical expertise yet the integration of both facets to adequately train sexual health care specialists is often lacking. Materials/Methods: The Florida Postgraduate Sex Therapy Training Institute of has developed an integrated program entitled, “Medical Sex Therapy.” The course consists of two 60 -hour courses which include didactic and interactive learning from an experienced sex therapist and a sexual medicine physician. The core curriculum is comprehensive and covers both male and female sexual function and dysfunction as well as paraphilia, sexual compulsivity, gender and orientation and unconventional sexual practices. Case presentation and

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48 hands on study is an integral part of the course work. The participant is required to review current sexual medicine and sex therapy research literature and preform detailed case study supervision with an expert accredited supervisor. Once completion of the program, the participant may be certified in the state of Florida as a certified Sex Therapist. Medical Sex Therapy credits and supervision hours are fully accredited towards certification by the American Association of Sex Educators, Counsellors and Therapists (AASECT). Results: To date, fifty-three health care professionals, from the following specialties: Ob/GYN, nurse practitioners, psychiatry, psychology, psychotherapy, marital counselling have attended the program, twenty have completed certification and ten are completing additional hours to fulfil AASECT certification. Conclusion: In order to best serve the client with sexual problems a multifaceted approach is often warranted. Didactic learning, case training, education and supervision in sexuality are necessary for comprehensive care of these complex patients. 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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RISK FACTORS FOR DISEASES SEXUALLY TRANSMITTED INFECTIONS (STIS) AND ITS ASSOCIATION WITH SEXUAL BEHAVIORS IN STUDENTS OF THE FACULTY OF MEDICINE OF THE UNIVERSIDAD AUTONOMA DE QUERETARO (UAQ) González Ortega, P1; Villaseñor Cuspinera, N1; García Gutiérrez, M1; Ávila Morales, J1; Leo Amador, G1 1: Universidad Autonoma de Queretaro, Mexico Objective: To determine risk factors for diseases sexually transmitted infections (STIs) and its association with sexual behaviors in students of the Faculty of Medicine of the Universidad Autonoma de Queretaro(UAQ). Material and Method: Observational study, involving students of medicine and Dentistry of the UAQ on a voluntary basis and with informed consent. The determination of the risk factor for STDs was made with the application of a questionnaire which evaluates sexual risk factors, consists of 9 items: homosexuality, multiple partners of the participant and his/her respective partner, sex with sex workers, exercising prostitution, bisexuality, use of the sharps, injecting drug user and the frequency of the use of the condom, and their theoretical basis is the standard official Mexican 003-SSA2-1993 criteria of opt-out for blood and organ donation. In addition, Hidalgo-San Martin et al. 2003 validated instrument is used to measure social and personal sexual behaviors. The dimensions evaluated for social sexual behaviors: fantasy, search, image, casual dating and formal courtship. For social sexual behaviors were analyzed: external contact, Self-eroticism sensations, not genital intimate contact and intimate genital contact. The data processing was performed using SPPS, presenting the information in descriptive statistics and contingency tables. The association between variables was analyzed with Chi-square test and logistic regression was done. Results: 648 students, of whom 445(68.6%) of medicine and 203 (31.4%) of dentistry. The average age was 20.6 years. Women represented by 374(57.7%) and the male 274(42.3%). Risk factors were assessed by gender, by determining Odds Ratio (OR) and Chi square. The significant results were: multiple couples OR 2.92, CL (1.84–4.63) p = .000; Prostitution OR 8.35, CL (1–185.12), p = .019 and bisexuality OR. 2.90, CL (1.36–6.27), p = .002. The significant social sexual behaviors were: Fantasy OR 2.53, CL (1.20–3.46), p = .004; Image OR 6.47, CL (3.57–11.93), p = 0.000; Dating casual OR 1.75, CL (1.05– 2.92), p = .022. Significant body sexual behaviors: Contact external OR 1.6, CL (1.02–2.77), p = .030; Auto sexual sensations OR 4.5, CL (2.58–8.23), p = .000 and intimate genital contact OR 1.56, CL (1.11– 2.20), p = .007.

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X2 test (Statistically significance p value < 0.05) and 95% CL. The risk factors for STDs were associated with: fantasy, image, casual dating, external contact, and genital contact. Conclusions: There are differences in sexual behaviors between men and women, which should be considered for the design and implementation of educational strategies in sexual health focus to STD prevention. Disclosures: Work supported by industry: no.

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PROPOSAL FOR AN INSTRUMENT FOR CHARACTERIZATION OF SEXUAL EXPERIENCES IN CHILDHOOD AND / OR ADOLESCENCE (ICSECA) OF INDIVIDUALS WITH COMPULSIVE SEXUAL BEHAVIOR Dos Reis, S1; Scanavino, M1 1: Institute of Psychiatry (IPq) of the Clínicas’ Hospital of the University of São Paulo Medical School (FMUSP), Brazil Objectives: One of the etiological factors of Compulsive Sexual Behavior (CSB) is Child Sexual Abuse (CSA). The consequences on mental health are directly related to the type of violence, the victim’s reaction, characteristics of the abuse (duration, frequency, time, age, onset of abuse, type of kinship, type of sexual experiences, number of abusers), but there is a lack of measures to specific evaluation of individuals with CSB who suffered CSA in childhood. We aim to develop an instruments for the characterization of sexual experiences suffered in childhood and / or adolescence to specific evaluation in adults with CSB. Method: A literature search was performed in the following databases: Pubmed, Lilacs and Scielo, with keywords: compulsive sexual behavior, sexual addiction, child sexual abuse, measures, scale and instruments, all of 1985/2014, in English and Portuguese. After deleting those papers unrelated to the topic, 25 articles were analyzed for the development of the instrument. Results: The following aspects were considered most relevant: quantitative aspects (number of episodes, number of abusers, period in childhood and / or adolescence); qualitative aspects (age of victim, age of the abuser, bond, type of abuse (without contact or penetration)); experiential aspects (past sexual experiences, past and present feelings about the episode; if it was revealed; if it was the host family, if it was a traumatic experience; or involving seduction). All these aspects were investigated if the participant reported has had sexual experience before age 13 with someone at least 5 years older; and / or has had between 13 and 18 years with someone at least 10 years older. Based upon those aspects we drafted o the Instrument consisting of 25 closed questions for self-fulfillment. Conclusion: There is a diversity of qualitative, quantitative and experiential aspects that should be investigated in order to characterize the experience of CSA in a sample of individuals with CSB. The characterization of CSA may facilitate investigations on the connections between sexual experiences in childhood and adolescence and mental and sexual health in adulthood of individuals with CSB. Disclosures: Work supported by industry: no.

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NEUROPSYCHOLOGICAL ASPECTS ABOUT DECISION-MAKING AND COGNITIVE FLEXIBILITY OF 25 PATIENTS WITH COMPULSIVE SEXUAL BEHAVIOR (CSB) AND 25 CONTROLS Messina, B1; Scanavino, M1 1: IPQ-HCFMUSP, Brazil Objectives: There are few studies on Neuropsychological aspects of patients with compulsive sexual behavior (CSB), and the results are controversial. We aim to investigate through the Iowa Tests Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST), respectively, the Decision Making and Cognitive Flexibility, of 25 patients with CSB and 25 controls. Methods: 25 men with CSB, after being diagnosed to 52.7 F Excessive sexual appetite (ICD-10), and sexual addiction (Goodman), underwent to neurocognitive assessment by neuropsychologist who applied the IGT and the WCST. They also answered the Sexual Compulsivity Scale (SCS). Results: The patients presented higher scores (M = 28.4, SD = 7.07) than controls (M = 15.8, SD = 5.8) (P < 0.001) in the SCS. Regarding Decision Making (IGT), patients had lower scores (M = 13.2, SD = 25.81) than controls (M = 25. 12, SD = 24.0) (P = 0.04) in the variable Trend General (TG), as well as the first block of the analysis by segments (5 blocks), patients presented a tendency to scoring lower (M = −5.28; SD = 5.4) than controls (M = −1.12, SD = 5.8) (P = 0.006); suggesting an initial process of taking more impulsive decision. Conclusions: The results suggest more impulsive decision making in patients with CSB when comparing with controls. 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 PIOGLITAZONE ON ERECTILE FUNCTION RECOVERY IN A RAT MODEL OF POST-PROSTATECTOMY ERECTILE DYSFUNCTION Aliperti, L1; Tan, R1; Lasker, G1; Hagan, S2; Hellstrom, JA1; Gokce, A1; Trost, L3; Kadowitz, P1; Sikka, S1; Hellstrom, W1 1: Tulane University School of Medicine, United States; 2: Tulane University School of Medicine, United States School of Medicine; 3: Mayo Clinic, United States

49 Conclusion: Pioglitazone improves EF in rats undergoing BNCI via a nitric-oxide mediated pathway. Disclosures: Work supported by industry: no.

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PERIPHERAL EFFECTS OF OPIATES AGONIST IN ISOLATED CORPUS CAVERNOSUM Rodrigues, R1; de Oliveira, M2; Antunes, E1; De Nucci, G1; Mónica, F1 1: UNICAMP, Brazil; 2: UNIVAP, Brazil Objective: The peripheral effects of opiates in the corpus cavernosum (CC) are controversial, since both detumesce and priaprism were observed. To date, there are no studies that evaluated the role of opiate system in isolated CC. The aim of this work was to assess the peripheral effects of opiates in isolated CC from rats (RCC). Material and Methods: Concentration-response curves to fentanyl, loperamide and endomorphin-1 were carried out in the absence and presence of the non-selective opiate antagonist (naloxone 10 μM), selective μ-opiate antagonist (ciprodime 100 nM), soluble guanylyl cyclase inhibitor (ODQ 10 μM), nitric oxide synthase inhibitor (L-NAME, 100 μM) or potassium channel blockers (glibenclamide 10 μM, tetraetylammonium 1 uM, apamine 100 nM and charybdotoxin 100 nM) in tissues pre-contracted with phenylephrine (PE, 10 μM). In vivo assay was realized by determining basal and stimulated intracavernous pressure (ICP) before and after intracavernosal infusion of fentanyl (4 μg/kg, 5 min). Immunohistochemical analysis for μ and δ- opioid receptors was also carried out. Results: Immunohistochemical analysis revealed the expression of μ and δ- opioid receptors in nerve fibers of RCC. The μ-opiate agonists (n = 5) fentanyl, loperamide and endomorphin-1 produced concentration-dependent relaxation with values of Emax of 110 ± 3%; 105 ± 3%; 57 ± 2% and pEC50 of 5.81 ± 0.06; 4,94 ± 0.04; 5,57 ± 0.07 (n = 5), respectively. Naloxone did not alter the relaxation induced by μ-opiate agonists, while the selective μ-opiate antagonist ciprodime caused a 1.7-fold and 1.5-fold (P < 0.05) on the relaxation induced by fentanyl and loperamide. The potassium channel blockers significantly reduced the values of pEC50 relaxation of fentanyl 5.57 ± 0.03 and loperamide (4.39 ± 0.04). Neither L-NAME nor ODQ altered the relaxation induced by opioids agonists. Intracavernosal infusion of fentanyl increased the basal ICP on 3.8 ± 0.5 mmHg and stimulated ICP (from 36,5 ± 2,8 to 48,6 ± 4,5, P < 0.05). Conclusions: Opioids receptors are expressed on RCC and their agonists induced relaxation. However, further studies should be carried out in order to verify whether these receptors have any role on the neurotransmitters release and thus on erectile function. Disclosures: Work supported by industry: no.

Objectives: To examine the effect of pioglitazone on erectile function (EF) in a rat model of post-prostatectomy erectile dysfunction (ED). Methods: Twenty adult rats were divided into four groups: a) sham, b) control – bilateral cavernosal nerve crush injury (BNCI), c) BNCI + low-dose pioglitazone (PioL) and d) BNCI + high-dose pioglitazone (PioH). Sham and control rats were administered phosphate buffered saline, while PioL and PioH rats received 0.65 and 6.5 mg/kg of pioglitazone, respectively. All treatments were administered by oral gavage for 14 days. Following treatment, animals underwent surgery for endpoint cavernosal response to define hemodynamic parameters of erectile function reported as the ratio of intracavernosal pressure to mean arterial pressure (ICP/MAP). Corporal tissue was retrieved for histologic and molecular analysis. Results: Animals treated with pioglitazone experienced dosedependent improvements in ICP/MAP, with PioH achieving results similar to sham: sham 0.774; BCNI 0.421; PioL 0.616; PioH 0.758 (p = 0.0006). PioH animals demonstrated increased expression of eNOS and nNOS, while both PioL and PioH had increased staining for anti-smooth muscle actin antibody and non-significant increases in cGMP.

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NONALCOHOLIC STEATOHEPATITIS AS A NOVEL PLAYER IN METABOLIC SYNDROME-INDUCED ERECTILE DYSFUNCTION: AN EXPERIMENTAL STUDY IN THE RABBIT

METFORMIN IN VITRO AND IN VIVO INCREASES ADENOSINE SIGNALLING IN RABBIT CORPORA CAVERNOSA

Vignozzi, L1; Filippi, S2; Comeglio, P1; Cellai, I3; Sarchielli, E4; Morelli, A4; Rastrelli, G1; Maneschi, E3; Galli, A5; Vannelli, G4; Saad, F6; Mannucci, E7; Adorini, L8; Maggi, M1 1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences and Department of NEUROFARBA, University of Forence, Italy; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Italy; 5: Gastroenterology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 6: Global Medical Affairs Men’s Healthcare, Bayer Pharma AG, Berlin, Germany; 7: Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Italy; 8: Intercept Pharmaceuticals, New York, USA Objectives: A pathogenic link between erectile dysfunction (ED) and metabolic syndrome (MetS) is now well established. Nonalcoholic steatohepatitis (NASH), the hepatic hallmark of MetS, is regarded as an active player in the pathogenesis of MetS-associated cardiovascular disease. The aim of this study was aimed at evaluating the relationship between MetS-induced NASH and penile dysfunction. Material and Methods: We used a non-genomic, high- fat diet (HFD)-induced rabbit model of MetS, and treated HFD rabbits with testosterone (T), with the farnesoid X receptor agonist obeticholic acid (OCA), or with the anti-TNFa mAb infliximab. Rabbits fed a regular diet were used as controls. Results: Liver histomorphological and gene expression analysis demonstrated NASH in HFD rabbits. Several genes related to inflammation (including TNFa), activation of stellate cells, fibrosis, lipid metabolism parameters were negatively associated to maximal acetylcholine (Ach)-induced–penile relaxation. When all these putative liver determinants of penile Ach responsiveness were tested as covariates in a multivariate model, only the association between hepatic TNFa expression and Ach response was confirmed. Accordingly, circulating levels of TNFa were increased in HFD rabbits. T and OCA in HFD rabbits both reduced TNFa liver expression and plasma levels, with a parallel increase of penile eNOS expression and Ach-responsiveness. Also neutralization of TNFa with infliximab treatment normalized HFD-induced hypo-responsiveness to Ach, as well as responsiveness to vardenafil, a PDE5 inhibitor. Conclusions: MetS-induced NASH in HFD rabbits plays an active role in the pathogenesis of ED, through TNFa, as indicated by treatments reducing liver and circulating TNFa levels, or neutralizing TNFa action, which improve Ach-penile responsiveness in HFD rabbits. 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.

Vignozzi, L1; Filippi, S2; Comeglio, P1; Cellai, I3; Morelli, A4; Rastrelli, G5; Maneschi, E1; Mannucci, E6; Maggi, M3 1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences and Department of NEUROFARBA, University of Forence, Italy; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Italy; 5: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence,Italy; 6: Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Italy Objective: In subjects with erectile dysfunction responding poorly to sildenafil, metformin was reported to improve erections. The aim of this study was to investigate metformin’s mechanism of action on erectile function, focusing on adenosine (ADO) and nitric oxide (NO) signaling in an animal model of high fat diet (HFD)-induced metabolic syndrome. Material and Methods: In vitro contractility studies were used to investigate the effect of in vivo and ex vivo metformin administration on ADO-or acetylcholine (Ach)-induced relaxation of penile strips from HFD, as compared to animals fed a regular diet (RD). We evaluate also the expression of genes related to penile smooth muscle relaxation and contractility. Results: Expression of ADO receptor type 3 (A3R), ADO deaminase (ADA), AMP deaminase type 1 (AMPD1) and 2 (AMPD2) was decreased in HFD, as compared to RD. Accordingly, in HFD the ADO relaxant effect was potentiated as compared to RD. In vivo metformin treatment in both RD and HFD significantly increased the ADO relaxing effect, although to a different extent. In penile strips from HFD, in vivo metformin normalized A3R, ADA and AMPD1, further decreased AMPD2, increased dimethylarginine-dimethylaminohydrolase and restored impaired Ach-induced relaxation. Ex vivo metformin time-and dose-dependently increased the relaxant effect of ADO in RD. The potentiating effect of metformin on ADO-induced relaxation was significantly reduced by pre-incubation with NOS inhibitor L-NAME. Interestingly, in vivo testosterone supplementation in HFD rabbits increased penile expression of eNOS, AMPD2 and restored metformin’s potentiating effect on ADO induced relaxation, up to RD level. Conclusions: In conclusion, metformin in vivo and ex vivo increases ADO signalling in CC, most probably interfering with NO formation and ADO breakdown. 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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EXCESSIVE FRUCTOSE ADMINISTRATION FROM CHILDHOOD MAY INDUCE OXIDATIVE STRESS VIA THE AGE-NADPH OXIDASE PATHWAY, RESULTING IN ERECTILE DYSFUNCTION IN ADULT RATS Hotta, Y1; Nakamura, D1; Yahagi, R1; Kataoka, T1; Maeda, Y1; Kimura, K1 1: Nagoya City University, Japan Objective: Fructose is widely used in many sweets and beverages. Excessive fructose administration induces oxidative stress via the activation of NADPH oxidase by advanced glycation end products (AGE).

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The 16th World Meeting on Sexual Medicine However, it is unknown how excessive fructose administration from childhood affects erectile function in adulthood. In this study, we investigated the relationship between excessive fructose administration and erectile dysfunction in rats. Materials and Methods: Four-week-old male Wistar-ST rats were divided into three groups: control, 5% fructose, and 10% fructose. Control rats were given normal water, while those in the treatment groups were given 5% or 10% fructose water to drink at libitum for eight weeks. After eight weeks, the levels of blood glucose (BG) and serum bioavailable testosterone (bio-T) were measured, and erectile function was assessed. Serum bio-T levels were measured by UPLC/ MS/MS. Erectile function was evaluated by gauging changes in the intracavernous pressure (ICP)/mean arterial pressure (MAP) ratio under stimulation of the cavernous nerve. mRNA expression of receptor for AGE (RAGE) and NADPH oxidase 1, 2, and 4 in the corpus cavernosum (CC) of the animals was measured by real-time PCR analysis. ANOVA and Bonferroni’s multiple t-test were used for statistical analysis. Results: No intergroup difference was observed in the body weight of the animals. BG levels in the 5% and 10% fructose groups were higher than those in the control group. ICP/MAP ratios of the fructosetreated animals were significantly lower (p < 0.05) than those of the control animals. Bio-T levels in the fructose-treated animals were lower (in a dose-dependent manner) than those in the control animals (p < 0.05; 10% fructose group). Moreover, mRNA expression of RAGE and NADPH oxidase 1, 2, and 4 in the CC of the fructosetreated animals was dose-dependently higher than that in the control animals. Conclusions: Excessive administration of fructose from childhood may induce erectile dysfunction in adult rats because of the production of oxidative stress via the AGE-NADPH oxidase pathway. Disclosures: Work supported by industry: no.

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DECREASED BASAL LEVELS OF NEUROTROPHIC FACTORS AND IMPAIRED NEURITE OUTGROWTH IN MAJOR PELVIC GANGLIA FROM TYPE 2 DIABETIC RATS WITH ERECTILE DYSFUNCTION Hannan, J1; Musicki, B1; Liu, X1; Burnett, A1; Bivalacqua, T1 1: Johns Hopkins School of Medicine, United States Objectives: Type 2 diabetes is a common disorder that causes progressive damage to the autonomic nervous system leading to erectile dysfunction (ED). Furthermore, obese diabetic men have significantly worse ED outcomes following radical prostatectomy (RP) than men without diabetes. This study aimed to characterize the basal levels of neurotrophic factors and neurite outgrowth in the major pelvic ganglia (MPG) of a high fat diet/low dose streptozotocin (STZ)-induced type 2 diabetic rat model. Material and Methods: Male Sprague-Dawley rats were fed a high-fat diet (60% Kcal) for two weeks followed by 2 low dose injections of STZ (20 mg/kg) to induce diabetes. Rats were continuously fed the high fat diet and assessed at 3 and 5 weeks after diabetes induction. Control rats were fed a normal chow diet. Blood glucose was recorded and erectile function was assessed by measuring the ratio of intracavernosal pressure to mean arterial pressure (ICP/MAP) after cavernous nerve stimulation. MPGs were collected and gene expression analysis by qPCR was performed for neurotrophic factor 3 (NT3), nerve growth factor (NGF), glial-derived neurotrophic factor (GDNF) and brain derived neurotrophic factor (BDNF). Additional MPGs (n = 4/group) were cultured in reduced growth factor matrigel for 48 h and neurite growth was measured. Results: Blood glucose was elevated 3 and 5 weeks following diabetes induction compared to controls (215 ± 13, 223 ± 12, 76 ± 1.8 mg/dl, respectively; p < 0.05). Erectile function was significantly decreased in all diabetic rats compared to controls (6V, ICP/MAP: 3 wk

51 0.55 ± 0.093; 5 wk 0.51 ± 0.088; Con 0.84 ± 0.027; p < 0.05). There was a slight decrease in the gene expression of NT3, NGF, GDNF and BDNF after 3 weeks of diabetes. After 5 weeks of diabetes, NT3, NGF and BDNF was significantly lower than controls (p < 0.05). MPG neurite outgrowth was significantly decreased in type 2 diabetic rats after 3 and 5 wks compared to controls in sham (3 wk: 224 ± 19 μm; 5 wk: 190 ± 24 μm; Con: 315 ± 8 μm, p < 0.05). Conclusions: Neurotrophic factors are significantly decreased in MPGs from early type 2 diabetic rats and may contribute to decreased neuronal outgrowth. These deficits in neurotrophic factors may help explain why diabetic men have less erectile function recovery following RP and increasing neurotrophic growth factors may have therapeutic benefit in the treatment of diabetic peripheral neuropathy. Disclosures: Work supported by industry: no.

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LOWER GAP BETWEEN IDEAL AND ACTUAL PARTNERS (GIAP) IN RELATIONSHIP AND SEXUAL HIERARCHY PREDICTS RELATIONSHIP SATISFACTION IN HETEROSEXUALS, BUT IN HOMOSEXALS ONLY SEXUAL GIAP MATTERS Varella Valentova, J1; Varella, M2 1: Charles University in Prague, Czech Republic; 2: University of Brasilia, Brazil Objectives: Sexual and romantic relationships are usually initiated through mutual attraction, which is, at least to some point, set by individual partner preferences. Nevertheless, ideal partner preferences and actual mate choices can differ to some degree. In general, it is expected that higher Gap between Ideal and Actual Partner (GIAP) can negatively influence relationship satisfaction, regardless of gender and sexual orientation. We tested whether the level of dominance in actual relationship and sexual activity, and also whether the GIAP in dominance influences the current relationship quality. Material and Methods: Coupled Czech and Brazilian 514 women (459 heterosexual), and 297 men (168 heterosexual) between 18 and 40 years filled in online questionnaires, where they reported their age, length of the current relationship, sexual orientation, Dyadic Adjustment Scale (DAS), their ideal preferences for dominance in relationship and sex, and their actual dominance in relationship and in sex with the current partner. We computed absolute differences between preferred and actual dominance and regressed them on DAS. Results: In heterosexual men, lower GIAP in relationship and sex and also lower actual dominance predicted increased relationship satisfaction. In heterosexual women, controlled for age, lower GIAP in both relationship and sex, and also lower relationship duration predicted increased DAS. In both homosexual men and women, only lower GIAP in sexual dominance predicted increased DAS. Conclusions: As predicted, smaller GIAP in relationship and sexual dominance increased perceived overall relationship quality in heterosexual men and women. However, in homosexuals only GIAP in sexual dominance did so, which suggests that how they resolve the same-sex intercourse is more decisive for them than relationship hierarchy. Thus, sexual orientation matters when it comes to sexual dominance and relationship satisfaction. Furthermore, more submissive heterosexual men but heterosexual women in shorter relationships reported greater relationship satisfaction. These results held across the ethnically distinct populations, which adds support to a more universal pattern in romantic relationship dynamics. Disclosures: Work supported by industry: no.

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SPIDER VENOM TOXIN TX2-6 FROM PHONEUTRIA NIGRIVENTER INDUCES PRIAPISM EVEN AFTER CAVERNOUSAL DENERVATION IN MICE Ravelli, K1; Ramos, A1; Gonçalves, L1; Magnoli, F1; Troncone, L1 1: Instituto Butantan, Brazil The Phoneutria nigriventer spider toxin Tx2-6 causes priapism in humans and mice. NO-Synthase inhibitors abolish toxin-induced priapism as well as all the other symptoms of intoxication. Objectives: to investigate if cavernousal denervation abolishes the toxin-induced priapism, the role of NO signaling in this process using the NO-sensitive fluorescent dye DAF-FM, and nitrite assay method of Griess. Methods: mice penis samples were incubated in the presence of the NO-sensitive fluorophore DAF-FM and observed with a confocal fluorescence microscope before and after the addition of Tx2-6 toxin as well as L-NAME and Sodium Nitropruside (SNP) controls; total nitrites were assayed by the Griess method in control and toxinexposed penile sections and controls; cavernosal nerve excision/ denervation performed in mice was confirmed by histological assessment of fibrosis (Mason’s trichromic staining) immunohistochemical staining for synaptophysin, and failure in fertilizing female mice; toluidine blue staining was also performed. Results: normal tissues controls treated with L-NAME, SNP and saline showed a steady increase in fluorescence and tissue incubated with toxin showed the same trend as well; production of nitrites assayed by the Griess method also failed to detect toxin-induced increases while NPS caused a dose-dependent increase and L-NAME a small decrease. Denervated mice showed intense fibrosis of the cavernousal tissue as well as absence of synaptophysin IHC staining; surprisingly mice showed toxin-induced priapism when tested 30 or 60 days after denervation; while sham-operated mice presented full priapism denervated animals showed partial priapism possibly due to the fibrosis. Discussion: confocal DAF-FM imaging showed remarkable NO-related staining of mastocytes (confirmed by toluidine blue staining) but failed to show NO-related fluorescence in cavernousal tissue (possibly given to the high auto-fluorescence of this tissue) but the absence of nitrite accumulation after toxin cast doubts on the involvement of NO signaling; most importantly, these results reveal that erection caused by Tx2-6 toxin might not be depend on penile nerves integrity and opens a new perspective for the treatment of erectile dysfunction. Disclosures: Work supported by industry: no.

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OPEN COMPARATIVE CROSS-SECTIONAL STUDY OF FREQUENCY AND STRUCTURE OF SEXUAL DYSFUNCTION IN PATIENTS OF THE GYNECOLOGICAL CLINIC AND WOMEN WITH INFERTILITY Stenyaeva, N1; Chausov, A1; Chritinin, D2; Sukhikh, G1 1: Federal State Budget Institution “Research Center for Obstetrics, Gynecology and Perinatology” Ministry of Healthcare of the Russian Federation, Russia; 2: I.M.Sechenov First Moscow State Medical University Objective: To assess the features of sexual function in fertile women routinely visiting gynecological clinic, and women suffering from infertility. Material and Method: In this open-label, cross-sectional study in 2 cohorts we compared the features of sexual function in patients in the gynecological clinic and women with infertility. The inclusion criteria were the reproductive age and the presence of sexual partner. The group 1 included 829 fertile women at the age of 31.42 ± 6.37. The

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group 2 included 157 patients with infertility at the age of 33.38 ± 4.96 years. They were assessed with the Female Sexual Functioning Index (Russian version) (FSFI). P values of less than 0.05 were significantly considered. Additionally, women answered the questions: Do you think that you have a sexual problem? Are you ready to consult a doctor to solve sexual problems? Results: There was no significant difference between two groups in desire, lubrication, pain and the sum domains scores of the FSFI. We found significant difference between the two groups of FSFI arousal component score (4,34 ± 1,19 vs 4,71 ± 0,85), orgasm (4,38 ± 1,31 vs 4,80 ± 1,49), and satisfaction (4,48 ± 1,73 vs 4,72 ± 1,30). 17.78% in the group 1 vs. 11.46% in the group 2 believed that they had sexual dysfunction, 26.78% in the group 1 vs. 22.93% in the group 2 were not sure with their answers. 25.75% vs. 12.10% were ready to consult a sexologist, 26.54% vs. 22.93% doubted with their answers. Conclusion: It is known that the notion of normal sexual function varies widely. Personal satisfaction of sexual needs and sexual function are not always comparable with the results of its assessment with the questionnaires. The infertility in marriage creates a long stressful situation for the spouses, causes severe mental trauma resulting in personal, family, social maladjustment and promotes the formation of borderline mental disorders and sexual dysfunction. However, our study showed that women, who are actively struggling with infertility, are better adapted to the sexual life in comparison with another patients of gynecological clinic. The study allowed to reveal latent sexual dysfunction, which manifests with disturbances of sexual function components, but a woman does not fully realize the problem and is not ready to actively attempt to solve it. Interestingly, infertile women showed normal sexual function which seems a compensatory answer to reproductive disorders. Disclosures: Work supported by industry: no.

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EFFECT OF SOLUBLE GUANYLATE CYCLASE MODULATORS, BAY 60-2770 AND BAY 41-2272 IN ISOLATED CORPUS CAVERNOSUM FROM NORMOTENSIVE AND SPONTANEOUSLY HYPERTENSIVE RATS Estancial, C1; Antunes, E1; Rodrigues, R1; Barbosa, A1; Mónica, F1 1: UNICAMP, Brazil Objective: This study is aimed to verify the effect of soluble guanylate cyclase (sGC) modulators, BAY 60-2770 (activator) and BAY 41-2272 (stimulator) in isolated corpus cavernosum (CC) from normotensive (WKY) and spontaneously hypertensive rats (SHR). Material and Methods: Concentration-response curves to BAY 60-2770 (0.01–10 μM) and BAY 41-2272 (0.01–10 μM) were carried out in the absence and in the presence of sGC inhibitor (ODQ, 10 μM) in tissues pre-contracted with phenylephrine (PE, 10 μM). Potency (pEC50) and maximal response (Emax) values were calculated. In vivo assay was realized by determining basal and stimulated intracavernous pressure (ICP) before and after intracavernosal injection of BAY 60-2770 (350 ng/Kg) or BAY 41-2272 (350 ng/Kg). Protein expression for α1 (Anti-sGC α1 – subunit, 1:500 and beta-1 Anti-sGC β1-subunit, 1:1000) subunits were also assessed. The experimental protocols were approved by the Animal Ethical Committee of UNICAMP (2721-1). Results: BAY 60-2770 and BAY 41-2272 produced concentrationdependent relaxation in isolated CC from WKY (pEC50: 7.01 ± 0.45 and 6.05 ± 0.10; Emax: 99 ± 13 and 76 ± 4 %, n = 5–7, respectively) and SHR (pEC50: 6.99 ± 0.15 and 6.11 ± 0.16; Emax: 95 ± 5 and 87 ± 6%, n = 5–7, respectively). Whereas the addition of ODQ produced a 7-fold rightward shift (P < 0.05) in BAY 41-227-induced relaxation, the pEC50 values of BAY 60-2770 was shift by 5-fold to the left. Protein levels for α1 and β1 subunits of sGC did not differ between WKY and SHR. BAY 60-2770 augmented ICP by 25,9% at 16 Hz only in CC from WKY. BAY 41-2272 did not alter ICP in CC from WKY or SHR.

The 16th World Meeting on Sexual Medicine Conclusion: BAY 41-2272 and BAY 60-2770 relaxed corpus cavernosum from hypertensive rats and may constitute a therapeutic option for the treatment of erectile dysfunction. Soluble guanylate cyclase modulators have been proposed as pharmacological tools to differentiate the oxidative state of sGC. In the present study we may speculate that sGC is not oxidized in CC from SHR, as the relaxing response induced by BAY 41-2272 or BAY 60-2770 in CC from SHR did not differ from that of WKY. Disclosures: Work supported by industry: no.

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ASSOCIATION OF VITAMIN D STATUS, DIABETES TYPE 2 AND HYPOGONADISM IN MEN WITH ERECTILE DIYSFUNCTION: A CROSS-SECTIONAL STUDY Alvarenga, C1; Guglielmetti, G1; Cezarino, B1; Regina dos Santos, A1; Cury, J1; Srougi, M1 1: HCFMUSP, Brazil Objective: Increasing numbers of men are being diagnosed with low levels of testosterone, associated with erectile dysfunction, loss of sexual desire and decrease of morning erections. The Interrelationships between hormones of the hypothalamic-pituitary-testicular (HPT) axis, hypogonadism, vitamin D, erectile dysfunction and low libido remain unclear. We investigated in this study whether HPT axis hormones, diabetes type 2 and hypogonadism are associated with serum levels of 25-hydroxyvitamin D (25(OH)D) in men with erectile dysfunction. Design and Methods: A total of 352 men aged 38–84 years are followed at the urological division of the Hospital das Clínicas da USP, from 2012 to 2013, complaining of erectile dysfunction and/or low libido. Of these 352 men, 52 men presented with hypogonadism (Testosterone (T) levels 10 P Value

1.6 ± 1.4 7.1 ± 2 12 ± 1.7 –

6.4 ± 2.1 8.2 ± 3.2 12.3 ± 3.4 150 mg/ dL (>1.7 mmol/L), HDL cholesterol < 40 mg / dL ( 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 ± 1.7 ng/ml respectively. Twelve men with hypogonadism (serum testosterone level

Figure 1 Association between AR CAG repeat length and risk of MS 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 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

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68 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 participantpatients 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 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 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 postmenopausal 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.

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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

The 16th World Meeting on Sexual Medicine 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.

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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 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 preoperative 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 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.

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70 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 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.

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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 (FMRPUSP), 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

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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 semistructured 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 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 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 totalSOI-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 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 (FMRPUSP), 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

71 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 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). Fiftyeight 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

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72 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.

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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 selfperception with positive consequences regarding self-concept and selfesteem, 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 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 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

The 16th World Meeting on Sexual Medicine 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 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) 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.

73 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 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 selfreport 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%).

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74 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 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 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).

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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 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 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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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

75 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 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 Scalco, S1; Grecco, C2; Daniela, K3 1: UFRGS, Brazil; 2: HMIPV, Brazil; 3: UFRGS

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

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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.

DIAGNOSTIC MANUAL FOR SEXOLOGY DMS III

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

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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 preimplantation, 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.

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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.

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Matsui-Santana, O1; Villaseñor-Farías, M1; Flores-González, Lomelí-Garza, J1; Cortés-Campos, G1; Guillén-Rico, L1 1: Universidad de Guadalajara, Mexico

L1;

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

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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.

senter and/or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Disclosures: Work supported by industry: no.

A RARE CASE OF PROLACTINOMA CAUSING ERECTILE DISFUNCTION IN A YOUNG MAN

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Andrade Dias Coutinho de Souza, E1; Julio Junior, H1; Schiavini, J1; Damião, R1; Cruz, D1 1: UERJ, Brazil

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 pre-

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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 (43 ng/mL), therefore others hormonal exams were requested, that revealed an increased level in serum prolactin (1329 ng/ 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 (200,4 ng/mL). However, there has been no improvement in the overall level of testosterone (40 ng/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 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

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78 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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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.

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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)

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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 Li, Y1 1: Daping Hospital, Third Military Medical University, China Objectives: To 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. Results: It 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 1.7 cm or the diameter of the inner tubular structure is bigger than 5 mm)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. Conclusion: The three-dimensional MRI has significant etiological diagnostic value and provides reliable information for the subsequent treatment. The transurethral endoscopic technique is a simple, safe,

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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 5 mgm 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 20 mgm 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 20 mgm Tadalafil and switch to daily dose 5 mgm 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 5 mgm appears to be preferred by patients over on demand 20 mgm Tadalafil for ED treatment. Disclosures: Work supported by industry: no.

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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).

79 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 (40% had the highest response rate (76.9%), but the response rate for patients with tip rigidity 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 modeladjusted 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.

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82 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 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 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 crosssectional 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 4.1 pg/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 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 16th World Meeting on Sexual Medicine 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.

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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 Wu, Y1; Wang, W1; Xu, D1; Bai, Q1; Zhang, L1; Gu, Z1; QI, J1 1: Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China

83 (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), folliclestimulating 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). 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 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 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 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.

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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]pyrazine5,8-dione (BL 106), 1-(1H-indol-3-yl)-3-(4-methoxyphenyl)-7methyl-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[3,4a]pyrazine-5,8-dione (BL 106-2), 3-(4-chlorophenyl)-1-(1H-indol-3yl)-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.

85 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 (10 uM), noradrenaline (3 uM). Curves concentration response to BL 106-1, BL 106-2, BL 106-3 were design in Rcc pre contracted with phenylephrine (10 uM). 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 (50 uM). 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 (50 uM) increased the levels of cGMP in T84 cells in 40% after stimulation with Escherichia coli toxin (STa) (827.22 ± 91.34 cGMP pmol/10 min/mg and 587.97 ± 60.86 cGMPpmol /10 min/mg; p < 0.05; Anova followed by Turkey test). Compounds BL 106-1, 106-2, 106-3 (50 uM) did not increase the cGMP contents prior STa stimulation or it absence. BL 106(50 uM) increased the levels of cAMP in Jurkat cells in 225% after stimulation with foskolin (50 uM) (68.08 ± 9.53, pmol/ 10 min/mg and 21.04 ± 6.28 cAMP, pmol/10 min/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 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 Rosalino, M1; 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 Majzoub, A1; Al Naimi, A1; Talib, R1; 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),

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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 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 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

The 16th World Meeting on Sexual Medicine 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

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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.

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.

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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.

Disclosures: Work supported by industry: no.

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TREATMENT AND EPIDEMIOLOGICAL PROFILE OF MALE INFERTILITY IN THE PEDRO ERNESTO UNIVERSITY HOSPITAL (RJ)

CHRONIC PANCREATITIS, MALABSORTION AND SEXUAL DYSFUNCTION

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 200 mg/day for 6 months, associated with Tribulus Terrestris 250 mg three times a day for 2 months and clomiphene citrate 50 mg/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.

Herrera-Cáceres, J1; Flores-Rodríguez, Magaña-Rodríguez, J1; Pelaez, M1; Castillejos-Molina, R1 1: INCMNSZ, Mexico

J1; Nava-Sanchez, Hernández-Calleros,

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 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 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 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 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

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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.

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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-20deoxyguanosine (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.

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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 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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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.

EARLY CERVICAL CANCER: IMPACT OF PERITONEAL VAGINOPLASTY COMBINED WITH LAPAROSCOPIC RADICAL HYSTERECTOMY IMPROVED SEXUAL FUNCTION 1

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.

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Shu-Qin, C ; Ling-Zhi, K ; Hong-Ye, J ; Li, F ; Jun, C ; Shu-Zhong, Y 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.

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

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96 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.

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The 16th World Meeting on Sexual Medicine 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.