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PROCEEDINGS OF THE 2ND BIENNIAL MEETING OF THE MIDDLE EAST SOCIETY FOR SEXUAL MEDICINE, DUBAI, UNITED ARAB EMIRATES, OCTOBER 31–NOVEMBER 2, 2013
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CORRELATION BETWEEN FEMALE SEXUAL BELIEFS AND FEMALE SEXUAL FUNCTION Elkhiat, Y.1; Ghanem, H.1; Osama, N.1 1: Cairo University, Egypt Objective: Assessment of the correlation between sexual beliefs the females got during their past life and the sexual function. Subjects and Methods: This pilot study was carried out on one hundred married Egyptian females recruited from gynecology & obstetrics clinic of Cairo University hospital, employees and medical professionals working in that hospital. Those females had different educational levels and different sociocultural backgrounds. Females with chronic diseases, neurological disorders, psychological disorders, chronic drug use, post menopausal and sexually inactive females were excluded from the study. The study was approved by Cairo University ethical committee. After getting an informed consent to participate in the study each female was interviewed in a structured to get answers for three questionnaires. The first included demographic data as age, occupation, residence, education, financial level . . . etc. The second was a translated Arabic version of the female sexual dysfunctional beliefs questionnaire (FSDBQ) which include six domains namely sexual conservatism, age related beliefs, body image beliefs, motherhood primacy, denying affection primacy and feeling sexual desire and pleasure as a sin. The third was the validated Arabic version of the female sexual function index (FSFI) which include six domains namely desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and coital pain. Results: Studied subjects aged between 21–51years old with the mean age 33.4 years. Age positively correlated with the FSDBQ and negatively correlated with all domains of FSDI (P 0.0001). There was statistically significant difference between manual and intellectual female workers regarding total Sexual Beliefs score and total sexual function score (p 0.0001). There was statistically significant difference between Conservative females and females with moderate religious background regarding total Sexual beliefs score but there was no significant difference between the previously mentioned groups regarding total sexual Function score. Circumcised females showed significant higher FSDBQ score compared to uncircumcised females (P 0.0001). Meanwhile, there was no significant difference between the former groups regarding the total FSFI score. Total FSDBQ score was significantly higher in females grown –up in rural areas as compared to females grown –up in urban areas while total FSFI score was higher in females grown –up in urban areas (P 0.001). There was statistically significant difference between total Sexual beliefs score and total Sexual Function score according to the educational level of studied subjects (P 0.0001). There was statistically significant difference between Total Sexual Beliefs score and total sexual function score between females with different financial level (P 0.001). The Females’ Body mass index (BMI) correlated positively with FSDBQ and negatively with FSFI. Sexual conservatism domain of FSDBQ negatively correlated with all domains of female sexual function index (P 0.0001). There was significant negative correlation between all domains of female sexual functions and denying affection primacy domain of FSDBQ. There was significant negative correlation between all domains of female sexual functions and feeling sexual desire and sexual pleasure as a sin. There was significant negative correlation between domains of female sexual functions and motherhood primacy except for vaginal lubrication. Conclusions: False female sexual beliefs had significant negative effect on female sexual function. Domains of FSDBQ were found to have
negative influence on all female sexual functions. This work revealed the great importance of proper sexuality education to adjust false sexual beliefs, correct misunderstanding, and improve marital relation and quality of life. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
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EXPRESSION OF VASCULAR ENDOTHELIAL GROWTH FACTOR RECEPTORS (VEGFR-1 AND VEGFR-2) IN CORPORA CAVERNOSA (CC) TISSUE IN DIABETIC PATIENTS WITH ERECTILE DYSFUNCTION (ED) Ahmed Mohammed, R.A.1; Mahran, A.M.2; Radwan, M.E.M.3 1: Department of Pathology Faculty of Medicine, Assiut University, Assiut, Egypt; 2: Department of Dermatology, Venereologyand Andrology Faculty of Medicine, Assiut University, Assiut, Egypt; 3: Department of Radiodiagnosis, Faculty of Medicine, Assiut University, Assiut, Egypt Diabetes mellitus (DM) is known to cause vasculogenicimpairment; a major etiological factor underlying DM-associated ED. VEGF plays a major role in maintaining normal function and structure of CC vascular tissue. Itmediates its actions mainly through VEGFR-1 and VEGFR-2. Although several studies examined expression of these receptors in different tissues, their expression on human CC tissues in relation to ED and DM has not beenyet studied. The aim of the following study was to assess expression of VEGFR-1 and -2 at the receptor protein levelin male diabetic patients with ED and to compare it withnon-diabetic patients with ED using immunohistochemicaltechnique. Methods: 40 CC tissue specimens were collected from 16 diabetic and 24 non-diabetic patients with ED during penile implant insertion. Paraffin-embedded Formalin-fixed sections from each specimen were stained with antibodies against VEGFR-1 and VEGFR-2. Level of receptor expression was assesses according to the intensity of the positive staining quality using light microscope. Results: VEGR-1 was detected on both endothelial cells (ECs) and smooth muscles (SM) while VEGFR-2 was restricted to ECs. Weak expression of VEGFR-1 on ECs and SM was detected in 10/24 (42%) and in 12/24 (50%) of diabetic patients respectivelyhowever it was not significantly different from non diabetics P = 0.197 and P = 0.436 respectively. 12/16 (75%) of diabetic patients showed significantly lower expressionof VEGFR-2 comparing with 8/24 (33%) of non diabetics, P = 010. Conclusion: This is a preliminary data reporting effect of DM in reducing expression of VEGFR-2 receptors in CC penile tissues. Because VEGFR-2 is a major mediator for VEGF function, then it would be important to consider such information in using VEGF as a therapeuticagent in treatment of DM-associated ED. Will patients with weak expression of VEGFR-2 get benefit from VEGF therapy? Can intracorporal injection with VEGF restore VEGFR-2 expression? These are all questions to be answered. Disclosure: Work supported by industry: no.
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PREMATURE EJACULATION: A STUDY OF PREVALENCE, RISK FACTORS, AND IMPACT ON SEXUAL RELATIONSHIPS AMONG MARRIED MEN IN SAUDI ARABIA Bukhari, Y.1; Mosli, H.1; Batarfi, A.1; Ashy, J.1; Daghustani, H.1; Eldeek, B.1 1: King Abdulaziz University, Saudi Arabia Introduction: Premature ejaculation (PE) has been extensively researched and discussed in the realm of sexology. The medical fraternity has identified the need for an improved understanding of the global and regional epidemiology of PE. The American Urology Association defines PE as “ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners”. Global Study of Sexual Attitudes and Behaviors (GSSAB), suggested that one-third of men around the world have PE with the lowest prevalence among men in the Middle East (12.4%). However, this modest prevalence reported by (GSSAB), contradicted the general understanding of the scientific community of Saudi Arabia; which strongly believes that PE is highly prevalent among the conservative native male population. Aims: To determine the prevalence of PE among the Saudi male population, to determine its risk factors and to assess the impact of PE on sexual relations. Methods: This study was designed as a non-interventional, observational, comparative cross sectional study which involved 697 community-dwelling native married men living in Jeddah, Saudi Arabia. Results: The prevalence of PE in the study sample was 38.3%. PE was not related to any specific age group but a correlation was noted between PE and a lower level of education, lower socioeconomic status and having only one female sexual partner. PE is strongly related to masturbation and mental stress. Conclusions: PE is a sexual dysfunction commonly noted among the native male population of Saudi Arabia. PE patients need more effort to satisfy their female sexual partners as compared to healthy men. PE leads to sexual dissatisfaction among couples and is a common cause for termination of relationships. Disclosure: Work supported by industry: no.
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PREMATURE EJACULATION: PREVALENCE AND PERCEPTION IN QATAR Arafa, M.1; AlSaid, S.2; ElBardisi, H.2 1: Cairo University Hospital, Egypt, Hamad Medical Corporation, Qatar; 2: Hamad Medical Corporation, Qatar Objective(s): To assess the prevalence rate of PE in different age groups in our region and to assess the perception of normal ejaculatory latency by patients. Materials and Method(s): The Arabic Index of Premature Ejaculation (AIPE) was used for diagnoses. A separate questionnaire was also used to assess self-report and perception of premature ejaculation (PE) and perception of patients about the problem. The questionnaires were given to all males attending our hospital whether patients, companions or just visitors from February 2012 till February 2013. Result(s): 3042 subjects were included. 459 were Qatari. According to AIPE the prevalence of PE was 56.48% (1718 patients) with a score ≤30 with an intravaginal ejaculatory latency time (IELT) of 5.2 ± 5.8 seconds. Of these 1718 patients only 991 reported having PE and 727 were satisfied with their IELT. The prevalence of PE in Qatari patients was 66.9% (307 patients) when using AIPE of which only 209 were self-reporting PE. When we used the self-reporting questionnaire the prevalence of PE increased to 69.8% (2123 patients) with IELT 7.1 ± 7.6 seconds. Out of these 2123 patients only 958 patients were diagnosed as having PE by AIPE.
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Erectile dysfunction was self-reported in 731 patients. In this group prevalence of PE was 77.98% (570 patients) with IELT of 4.9 ± 5.3 seconds. Conclusion(s): The prevalence of PE in Qatar is much higher than that reported in other parts of the world. There is significant difference between diagnosed and self-reported prevalence of PE in our region. Disclosure: Work supported by industry: no.
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VAGINISMUS TREATMENT IN LEBANON Sabra, M.1; Eid, T.2 1: Saint-Georges University Hospital. Beirut, Lebanon; 2: Clemenceau Medical Center. Beirut, Lebanon Objective: To our knowledge, no previous studies have been published about vaginismus in Lebanon. Our objective is to report the outcome of a group of 15 patients diagnosed with vaginismus in Lebanon. Materials and Methods: We did a retrospective study on 15 patients presenting for vaginismus between March 2011 and December 2012 to a private clinic in Beirut, Lebanon (Clemenceau Medical Center). We used cognitive-behavioral therapy (CBT) based on education about female sexual anatomy using visual illustrations and a mirror, and desensitization by dressing a list of anxiogenic items, in addition to the use of vaginal dilators. The main outcome was successful penetrative intercourse and the secondary outcome was identifying difficulties in managing vaginismus in this country. Results: The mean age of patients was 28 years. Only 5 patients completed the CBT. Success rate was 100%. In this group, the objective of seeking therapy was desire of pregnancy for 4 patients, and improving sexuality for 1 patient. The mean duration of vaginismus was 19.2 months (6 to 60), the mean number of sessions was 6.4 (5 to 9), and the mean duration of treatment was 5 months (3 to 7), knowing that patients came at their own convenience. 3 out of 5 patients had undergone unsuccessful surgery on the hymen, and two were informed about vaginismus by internet. One patient’s husband refused the use of dilators, but his wife used them secretly. In the second group of ten, patients attended one or two sessions only (education and explanation of the program). One patient reported that vaginismus resolved after the second session. 8 out of 10 patients came to improve their sexuality, and 2 had a desire of pregnancy. The mean duration of vaginismus was 10.8 months (2 to 60). 4 patients in this group lived in another country (Emirates, Saudi Arabia and Egypt). Conclusion: CBT is a successful tool in treating vaginismus in Lebanon. When patients committed to therapy (1/3), success rate was 100%. Desire of pregnancy seems to be more motivating to complete therapy than improving sexuality. Factors that could restrain patients from committing to CBT could be the cost of therapy, not living in the same country, lack of trust in psychological methods and seeking a quick fix like surgery. Disclosure: Work supported by industry: no.
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SEXUAL MEDICINE RESEARCH OUTPUT OF THE MIDDLE EAST: A BIBLIOGRAPHIC STUDY Azarmina, P.1 1: Pfizer Inc., USA Objective: To determine the key topics of scientific investigation in the field of Sexual Medicine in five selected Middle Eastern countries using a bibliographic methodology. Material and Method: Research output of Egypt, Iran, Turkey, Saudi Arabia and Israel in the field of sexual medicine was assessed by counting the number of scientific publications in the field of sexual medicine.
The 2nd Biennial Meeting of the Middle East Society for Sexual Medicine The keywords were initially extracted from ICD-10 and DSM-V and screened by running a number of test searches. Ten high frequency keywords were selected from the list of keywords: erectile, impotence, ejaculation/ ejaculatory, sexual dysfunction, orgasm/orgasmic, dyspareunia, sexual desire, priapism, penile prosthesis and vaginismus, which were subsequently used to estimate the research output of five Middle Eastern countries with highest number of indexed papers in the field of sexual medicine. Results: Out of 3,796 papers identified using this method, Turkish institutions had the first rank with 42% of the papers, followed by Israel (23%), Egypt (20%), Iran (12%) and Saudi Arabia (4%). In terms of topic, Erectile Dysfunctions had the highest number of articles (30%). This was followed by articles on Ejaculatory Dysfunctions (15%), Orgasmic Dysfunctions (5%), Dyspareunia (3%), Sexual Desire Dysfunction (3%), Priapism (2%) and Vaginismus (1%). There was a strong country-by-country variation indicating a concentration of specific topics coming from either a specific country, institution or principle investigator. Conclusion: This bibliographic study highlighted a significant variation in the research output of different countries in the Middle East region. It can be argued that this variation is a reflection of each country’s scientific development, culture, gender roles and incidence of certain sexual dysfunctions. This study can serve as a benchmark for policymakers in the area of research planning and open up opportunities for future collaborations and population-based studies. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
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VAGINAL PENETRATION PHOBIA IN ARAB WOMEN: RETROSPECTIVE COHORT STUDY
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CORPOROTOMY PLUG TECHNIQUE IN THE MANAGEMENT OF PROXIMAL CORPORAL PERFORATION DURING REVISION PENILE PROSTHESIS SURGERY Hakky, T.1; Emtage, J.2; Park, A.1; Martinez, D.1; Rafiei, A.1; Carrion, R.1; Parker, J.1 1: University of South Florida, USA; 2: University of South Florida, United States Objective: Here we discuss the corporotomy plug technique during difficult revision penile prosthesis surgery as a method to place the penile implant as an alternative to the suture sling technique for proximal lateral perforations. Material and Methods: Our patient is a 42 year old man who underwent penile prosthesis surgery and developed erosion. The old implant was subsequently removed. After 6 months, the patient wished to proceed with revision surgery. During the revision surgery the scarred corpora made it difficult to find the correct space. Corporal dilation was performed with Metzenbaum scissors and a posterior lateral corporal perforation was encountered bilaterally. Result: 6 mm Hegar dilators were placed into the os of each perforated track occluding the false passage. We then proceeded in creating a new corporal tunnel using Metzenbaum scissors into the correct track. Brooks dilators and cavertomes were used to dilate these correct spaces. A 9.5 cm meallable implant was then placed. Conclusion: The corportomy plug technique forgoes the need for a suture sling if a viable track can be found in the setting of proximal lateral perforation. It also eliminates the possibility of manipulation of the implant into the false passage, and prevents intubating the lip of the wrong corporotomy. Disclosure: Work supported by industry: no.
Almuammar, T.1 1: King Faisal Specialist Hospital and Research Centre Riyadh, Saudi Arabia Objectives: To evaluate the experience of Arab women in the community presenting with vaginal penetration phobia and to establish the percentage of women who respond to an individualized approach at assessment and treatment including targeting fear and anxiety associated with vaginal penetration. To provide recommendations for the management of vaginal penetration phobia. Materials and Methods: This is a cohort, retrospective study of 100 patients attending a gynaecology clinic for assessment of post-marital vaginal penetration phobia. They were followed up to assess their response to an individualized structured treatment protocol. The patients were given on average 2–3 sessions of sex education and systematic desensitization targeting fear and anxiety associated with vaginal penetration. They were taught relaxation techniques in conjunction with self exploration and insertion of “vaginal trainers”. Psychosexual behavioral therapy involves the active participation of both partners in vaginal dilation. The women were followed up to assess their response to the above interventions. It was possible to get the complete data for 100 patients. Results: More than 95% of the studied group had a completely successful outcome, in that penetrative intercourse is now possible and pregnancy was achieved, when this was the additional desired outcome. Conclusion: An individualised treatment approach was found to be highly successful in the management of vaginal penetration phobia in a community setting. Disclosure: Work supported by industry: no.
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SAFETY AND EFFICACY OF TREATING ERECTILE DYSFUNCTION BY LINEAR SHOCKWAVES THERAPY – EXPERIENCE FROM A SECOND GENERATION TECHNOLOGY Reisman, Y.1; Hind, A.2; Varaneckas, A.3; Motil, I.4 1: Amstelland, Netherlands; 2: Urology Center Ramallah, Palestin; 3: Amber Clinic, Lithuania; 4: Uroclinic Brno, Czech Republic Introduction: Vasculogenic erectile dysfunction (ED) which is caused by arteriosclerosis can be treated by a variety of therapies that aim at reducing ED symptoms. Low-intensity shockwaves (LISW) were discovered as an enhancing factor to angiogenesis for treating ischemic heart disease. In addition, LISW therapy demonstrated significantly restoration of erectile function at diabetic rats. The present study evaluates the therapeutic effect of a LISW produced by an innovative device on patients with erectile dysfunction. Objective: The present study was aimed to assess the safety and efficacy of a dedicated shockwave device, ‘Renova’, which was designed to achieve substantially superior organ coverage. Material and Methods: 57 patients with mild to severe ED were treated by Renova as part of a multi-center, open-label, 4-arms prospective pilot study, conducted at 4 sites. The 4 arms differed from each other by the PDE5-I consumption of the patients throughout the study stages. Patients underwent 4 weekly treatment sessions by a novel machine (Renova) that generates line focused shockwaves at 4 treated areas: right and left crus and right and left corpus cavernosum. Each treatment session lasted approximately 15 minutes, did not required anaesthesia and did not cause any pain or adverse effects. Patients’ erectile function was assessed by the IIEF-EF, SEP and GAQ questionnaires at baseline and at 1 and 3 months post treatment. Success
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was defined as an increase of IIEF-EF score from baseline to the second follow up according to the severity of ED symptoms at baseline. Results: The average IIEF-EF score has greatly increased from 14.7 at baseline to 21.6 at 1 month and 3 months post treatment. Out of 57 patients, 47 (82%) had a successful treatment. Among the successful patients, the average IIEF-EF score increase was 8 points. No significant change was seen between the 4 arms. No adverse events were reported during the treatment and the follow-up duration. Conclusions: The results of this study indicate success of the second generation technology for treating ED with linear low-intensity shockwaves. Initial follow up data from almost 60 patients demonstrate a therapeutic improvement in 82% of patients.
QLQ – BR23. Questionnaires were supplemented by questions related to social-economic status and oncology treatment. Results and Conclusions: As of now the research authors will present initial, selected results of how mastectomy, type of treatment (surgery), and the socio-economic and psycho-behavioral factors influence a number of aspects of woman sexuality, as well as the percentage of sexual disorders diagnosed among the patients under scrutiny, all based on analyses of the aforementioned questionnaires and other documentation.
Disclosure: Work supported by industry: yes, by Direx (industry funding only – investigator initiated and executed study). The presenter 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 FUNCTION IN WOMEN AFTER MASTECTOMY: A SURVEY OF POLISH PATIENTS Kowalczyk, R.1; Lew-Starowicz, Z.2; Cedrych, I.3; Białek, A.4; Glogowska, I.5; Krzemieniecki, K.6; Streb, J.6 1: Department of Sexology, Andrzej Frycz Modrzewski Krakow University, Poland; 2: Faculty of Rehabilitation Academy of Physical Education, Warsaw, Poland; 3: Maria Sklodowska- Curie Memorial Cancer Center and Institute of Oncology, Cracow, Poland; 4: Department of Psychiatry and Psychotherapy, Medical University of Silesia, Katowice, Poland; 5: Maria Sklodowska- Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; 6: Department of Clinical Oncology, Cracow University Hospital, Cracow, Poland Objective: As various studies show, women after mastectomy are accompanied by many problems in the sexual sphere; it considerably lowers their quality of life. Goal of the study is to describe the relationship between the illness as well as the treatment of choice and the sexuality of Polish patients. Another goal is a comparison of the study results with results obtained in similar studies in Europe. Design and Method: The target group of 300 women after mastectomy is in the process of assessment. The subjects are recruited among Polish patients diagnosed and treated at the Department of Clinical Oncology, Cracow University Hospital in Cracow, Maria SklodowskaCurie Memorial Cancer Center and Institute of Oncology in Warsaw and its branches in Katowice and Cracow. The following questionnaires are used: Changes in Sexual Functioning Questionnaire (CSFQ – F – C), Body Image Questionnaire (KOCBR), Sexual Interaction Inventory (SII), Quality of Life Questionnaire
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Disclosure: Work supported by industry: no.
A COMPARATIVE 3D MAPPING OF THE CORPUS CAVERNOSUM; THE TITAN AND AMS INFLATABLE PENILE IMPLANTS Hakky, T.1; Parker, J.1; Emtage, J.1; Martinez, D.1; Carrion, R.1 1: University of South Florida, USA Objectives: Intricate anatomical analysis of the distal corpus cavernosum and the tips of the penile implant have yet to be reported. We report our experience using a three dimensional (3D) scanner to reconstruct corporal casts and compare them to the distal ends of two penile implants. Materials & Methods: The silicone tipped Titan Coloplast® inflatable penile prosthesis and the AMS® 700 CX penile prosthesis were analyzed using a 3D scanner. Additionally, we analyzed the exit tubing, and the diameter of the tubing and prosthesis. Four cadaveric phalluses were harvested using Smooth-Cast® 300Q polyurethane molding. The molds were excised and scanned along side the penile prosthesis. 3D scans were completed and analyzed using Leios Mesh software, and GOM Inspect software. Results: The 3D scans demonstrated the mean human corporal radii 1mm from the distal tip to be 5.03 (3.04–6.42) mm, which is an obtuse angle. The silicone tipped Titan penile prosthesis spherical radius at the same level was 3.42 mm while the tip of the AMS prosthesis had a radius of 3.11 mm. It was observed that the trajectory of the cavernosa appeared curvilinear and the distal ends appeared blunt. This analysis was confirmed by 3D mapping. The Titan penile implant exit tubing is at 1.23 degrees while the AMS exit tubing is at 33.51 degrees and the radius of the AMS tubing was 5.21mm while the Titan exit tubing was 3.42. Conclusions: The use of cadaveric cavernosal molds in combination with the 3D scanner allowed us to accurately image the corpus cavernosum. Our findings suggest that anatomically accurate corporal tips appear to be relatively blunt and that the new Titan® silicone tip penile prosthesis and the AMS 700 CX are similar in implant tip shape. The exit tubing diameter and angle from differs considerably, which may affect ease of seating the proximal ends.
The 2nd Biennial Meeting of the Middle East Society for Sexual Medicine Disclosure: Work supported by industry: yes, by coloplast (no industry support in study design or execution).
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GENDER IDENTITY, SEXUAL ORIENATATION AND SEXUAL AROUSAL ASSOCIATED PARAPHILIA AMONG SEX CHAT USERS IN THE MIDDLE EAST Shamndy, M.1 1: Alexandria University Hospital, Egypt Introduction: One of the commonest practices now among all age groups is cyber sex. Sex chat used widely due to ease of reach to internet and availability for all age groups, in our middle east society it is a forbidden religiously to practice sex outside the marriage and with the problem with delayed marriage due to financial problems leads to more and more use of this method for sexual relief and our study focused on this group. Study Aim: To determine the prevalence of paraphlia associated with sexual arousal among cybersex users during sexual fantasies, fantasies accompanying masturbation, and real-life socio-sexual behaviour, also we included gender identity and the sexual orientation of the volunteers in the study. Method: Cross-sectional study, self-reported sexual history data were collected by questionnaire from 1000 volunteers recruited from a sex chat users, from different 21 nationalities. Results: Gender identitity disorders 0.5%, Prevalence of paraphilias 50.5%, Sexual orientations: Homo:4.8% Hetero: 86.9%Bi:8.3% Conclusions: Sexual paraphilias are very common among chat users and this is indicates that it is very prevalent in the middle east societies.Once you found a parahilia please ask in details for others as sometimes many paraphilia come with each other. Hidden sexual preference among of one partner married couples are prevalent lead to disturbance of marital life sexuality. Recommendations do not make shame phyisician from asking every patient about their gender identity, sexual orientation and paraphilias, We need to develop methods for prophylaxis against paraphilias, Consider in management of couple sexual problems to ask about each partners’ preferences, New sexual paraphilias needed to be included in DSM paraphilias are: Incest, Group sex, Sex with more than one at the same time, Practice sex with a wife of friend and friend practice sex with his wife. Disclosure: Work supported by industry: no.
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THE FEMALE SEXUAL FUNCTION INDEX FSFI: TRANSLATION, VALIDATION AND CROSSCULTURAL ADAPTATION OF AN URDU VERSION FOR USE IN PAKISTAN Ur Rehman, K.1; Shabbir Sheikh, S.1; Asif Mahmood, M.1; Sultan, T.1 1: Fatima Memorial College of Medicine and Dentistry, Pakistan
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Finally we selected 66 bilingual females, who had been in a stable sexual relationship over the past 6 months and asked them to fill out the FSFI questionnaire in both languages (Urdu and English) and the responses of the patients were matched. The data were analysed statistically using descriptive statistics, Cronbach’s alpha analysis, Pearson correlation and students t test. Results: In terms of face validity, FSFI was found to be easily understandable and capable of adequately measuring various aspects of female sexual function. A high degree of internal consistency was demonstrated on Cronbach’s alpha analysis. Cronbach α co-efficient for various domains was sufficiently high ranging from 0.97 – 1.00. The clinical assessment of the presence and severity of female sexual dysfunction also matched with the self-report questionnaire. Similarly various domains of FSFI had high degree of correlation between Urdu and English versions (p < 0.001)Conclusion. We can safely conclude that the Urdu version of FSFI is a valid instrument for use in the literate population of Pakistan. Disclosure: Work supported by industry: no.
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PATTERNS OF MALE SEXUAL DYSFUNCTIONS IN UPPER EGYPT: A RETROSPECTIVE ANALYSIS OF 2000 PATIENTS OVER THE LAST 10 YEARS Saleh, R.1; Abu El-Hamd, M.1; Abd El-Hameed , A.1; Abd El-Latif, A.1 1: Sohag Faculty of Medicine, Egypt Objective: To determine the patterns of male sexual dysfunctions in Upper Egypt. Patient and Methods: In this study, we reviewed the medical files of 2000 male patients who attended a private Andrology clinic in Sohag Governorate, Upper Egypt, between 2003 and 2012, with a history of sexual dysfunction. All patients were examined by the same Andrologist (R Saleh). Patient’s data included medical sexual histories. Sexual functions were evaluated by using the IIEF-5 questionnaire. Data were recorded in Excel sheet and analysed by SPSS program. Results: The mean age of the patients was (42.31 ± 12.39). The mean age of the wives was 32.9 ± 12.5. The duration of marriage ranged from 8 years history of BD and resulting paraplegia. He was kept under immunosupressive
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The 2nd Biennial Meeting of the Middle East Society for Sexual Medicine therapy. He had attacks of depression. He noticed loss of his erectile ability for the past 6 years but with normal libido. The International Index of Erectile Functions-5 was 13. No history of tobacco smoking, alcohol intake, diabetes or other concomitant disease. He was 74 kg body weight, 176 cm length & 23.9 body mass index. His blood pressure and cardiac status were normal. Routine blood tests, serum testosterone (6.8 ng/mL) and prolactine (5.9 ng//mL) were all normal. Penile duplex scanning using 0.25 mL PGE1 achieved immediate and excellent erection quality with normal peak systolic and end diastolic velocities; suggesting the possibility of neurologic type of ED (2). Conclusion: BD has a negative impact on male erectile function. We recommend that ED be evaluated while assessing men with BD especially in presence of neurological involvement. The ED in cases of BD is not always vasculogenic type but can be multi-factorial. Thus, multidisciplinary diagnostic approach should be counseled. 1. J Urol 1999; 162: 147 2. J Urol 1986; 135: 714 Disclosure: Work supported by industry: no.
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ANALYSES FOR EGYPT AND THE UNITED ARAB EMIRATES SUBPOPULATIONS FROM THE PROMEED 6-MONTH PROSPECTIVE OBSERVATIONAL STUDY OF PDE5 INHIBITOR TREATMENT PERSISTENCE AND ADHERENCE IN MIDDLE EASTERN AND NORTH AFRICAN MEN WITH ERECTILE DYSFUNCTION Mostafa, T.1; Hussien, T.2; Isterabadi, M.3; El-Meliegy, A.4; Henneges, C.5; Haddad, A.6; Gurbuz, S.7 1: Faculty of Medicine, Cairo University, Egypt; 2: Faculty of Medicine, Alexandria University, Egypt; 3: Al Zahraa Hospital, Sharjah, United Arab Emirates; 4: Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 5: Lilly Deutschland GmbH, Bad Homburg, Germany; 6: Eli Lilly and Company, Lebanese Republic; 7: Eli Lilly and Company, Indianapolis, USA
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Egypt and the United Arab Emirates (UAE) who participated in a prospective, non-interventional, observational study. Materials and Methods: Men were ≥18 years old with ED of any etiology, were PDE5 inhibitor-naïve, and expected to be sexually active in a stable relationship with a female partner. These men were administered PDE5 inhibitors on-demand, selected per routine clinical practice of the physician, with follow-up at baseline and at 1, 3, and 6 months post-enrollment. The patients were defined as persistent at follow-up if they used ≥1 dose of their originally-prescribed PDE5 inhibitor within 4 weeks of the visit. Persistence at 6 months was defined as persistence at all prior follow-up visits. The patients were adherent if they used their most recent PDE5 inhibitor dose as originally prescribed. The transformed Self-Esteem and Relation (SEAR) Questionnaire score and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Total Score were also assessed post-hoc. Results: Patients were from Egypt (n = 99) and the UAE (n = 40); the combined group (n = 139) had a mean (standard deviation) age of 49.8 (11.8) years and mean BMI of 28.9 (4.2). A majority had moderate (52.5%) or severe (30.9%) ED, which was of mixed (25.2%) or organic (38.9%) etiology. More patients were treated with tadalafil (n = 80, 57.6%) than sildenafil (n = 54, 38.9%) or vardenafil (n = 5, 3.6%). At 6 months, 74.8% of all patients were treatment persistent and 75.5% were treatment adherent. All treatments were efficacious in improving ED. The mean International Index of Erectile Function- EF domain scores [95% confidence interval] improved from 15.1 [14.1, 16.1] at baseline to 26.1 [25.4, 26.9] at 6 months. At 6 months, changes from baseline in mean transformed SEAR total scores [95% confidence interval] were statistically significant for both tadalafil (38.4 [32.0, 44.7]) and sildenafil (36.1 [28.8, 43.4]). Mean EDITS total scores were >85 for both Egypt and the UAE at 6 months. Conclusions: At 6 months, approximately 3 out of 4 men were treatment persistent and adherent. Erectile function improved significantly with all treatments, and SEAR scores improved significantly from baseline with both tadalafil and sildenafil. Disclosure: Work supported by industry: yes, by Eli Lilly and Company (industry funding only – investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
Objectives: To assess treatment persistence and adherence over 6 months to on-demand PDE5 inhibitors among men with ED from
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PROCEEDINGS OF THE 2ND BIENNIAL MEETING OF THE MIDDLE EAST SOCIETY FOR SEXUAL MEDICINE, DUBAI, UNITED ARAB EMIRATES, OCTOBER 31–NOVEMBER 2, 2013
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CORRELATION BETWEEN FEMALE SEXUAL BELIEFS AND FEMALE SEXUAL FUNCTION Elkhiat, Y.1; Ghanem, H.1; Osama, N.1 1: Cairo University, Egypt Objective: Assessment of the correlation between sexual beliefs the females got during their past life and the sexual function. Subjects and Methods: This pilot study was carried out on one hundred married Egyptian females recruited from gynecology & obstetrics clinic of Cairo University hospital, employees and medical professionals working in that hospital. Those females had different educational levels and different sociocultural backgrounds. Females with chronic diseases, neurological disorders, psychological disorders, chronic drug use, post menopausal and sexually inactive females were excluded from the study. The study was approved by Cairo University ethical committee. After getting an informed consent to participate in the study each female was interviewed in a structured to get answers for three questionnaires. The first included demographic data as age, occupation, residence, education, financial level . . . etc. The second was a translated Arabic version of the female sexual dysfunctional beliefs questionnaire (FSDBQ) which include six domains namely sexual conservatism, age related beliefs, body image beliefs, motherhood primacy, denying affection primacy and feeling sexual desire and pleasure as a sin. The third was the validated Arabic version of the female sexual function index (FSFI) which include six domains namely desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and coital pain. Results: Studied subjects aged between 21–51years old with the mean age 33.4 years. Age positively correlated with the FSDBQ and negatively correlated with all domains of FSDI (P 0.0001). There was statistically significant difference between manual and intellectual female workers regarding total Sexual Beliefs score and total sexual function score (p 0.0001). There was statistically significant difference between Conservative females and females with moderate religious background regarding total Sexual beliefs score but there was no significant difference between the previously mentioned groups regarding total sexual Function score. Circumcised females showed significant higher FSDBQ score compared to uncircumcised females (P 0.0001). Meanwhile, there was no significant difference between the former groups regarding the total FSFI score. Total FSDBQ score was significantly higher in females grown –up in rural areas as compared to females grown –up in urban areas while total FSFI score was higher in females grown –up in urban areas (P 0.001). There was statistically significant difference between total Sexual beliefs score and total Sexual Function score according to the educational level of studied subjects (P 0.0001). There was statistically significant difference between Total Sexual Beliefs score and total sexual function score between females with different financial level (P 0.001). The Females’ Body mass index (BMI) correlated positively with FSDBQ and negatively with FSFI. Sexual conservatism domain of FSDBQ negatively correlated with all domains of female sexual function index (P 0.0001). There was significant negative correlation between all domains of female sexual functions and denying affection primacy domain of FSDBQ. There was significant negative correlation between all domains of female sexual functions and feeling sexual desire and sexual pleasure as a sin. There was significant negative correlation between domains of female sexual functions and motherhood primacy except for vaginal lubrication. Conclusions: False female sexual beliefs had significant negative effect on female sexual function. Domains of FSDBQ were found to have
negative influence on all female sexual functions. This work revealed the great importance of proper sexuality education to adjust false sexual beliefs, correct misunderstanding, and improve marital relation and quality of life. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
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EXPRESSION OF VASCULAR ENDOTHELIAL GROWTH FACTOR RECEPTORS (VEGFR-1 AND VEGFR-2) IN CORPORA CAVERNOSA (CC) TISSUE IN DIABETIC PATIENTS WITH ERECTILE DYSFUNCTION (ED) Ahmed Mohammed, R.A.1; Mahran, A.M.2; Radwan, M.E.M.3 1: Department of Pathology Faculty of Medicine, Assiut University, Assiut, Egypt; 2: Department of Dermatology, Venereologyand Andrology Faculty of Medicine, Assiut University, Assiut, Egypt; 3: Department of Radiodiagnosis, Faculty of Medicine, Assiut University, Assiut, Egypt Diabetes mellitus (DM) is known to cause vasculogenicimpairment; a major etiological factor underlying DM-associated ED. VEGF plays a major role in maintaining normal function and structure of CC vascular tissue. Itmediates its actions mainly through VEGFR-1 and VEGFR-2. Although several studies examined expression of these receptors in different tissues, their expression on human CC tissues in relation to ED and DM has not beenyet studied. The aim of the following study was to assess expression of VEGFR-1 and -2 at the receptor protein levelin male diabetic patients with ED and to compare it withnon-diabetic patients with ED using immunohistochemicaltechnique. Methods: 40 CC tissue specimens were collected from 16 diabetic and 24 non-diabetic patients with ED during penile implant insertion. Paraffin-embedded Formalin-fixed sections from each specimen were stained with antibodies against VEGFR-1 and VEGFR-2. Level of receptor expression was assesses according to the intensity of the positive staining quality using light microscope. Results: VEGR-1 was detected on both endothelial cells (ECs) and smooth muscles (SM) while VEGFR-2 was restricted to ECs. Weak expression of VEGFR-1 on ECs and SM was detected in 10/24 (42%) and in 12/24 (50%) of diabetic patients respectivelyhowever it was not significantly different from non diabetics P = 0.197 and P = 0.436 respectively. 12/16 (75%) of diabetic patients showed significantly lower expressionof VEGFR-2 comparing with 8/24 (33%) of non diabetics, P = 010. Conclusion: This is a preliminary data reporting effect of DM in reducing expression of VEGFR-2 receptors in CC penile tissues. Because VEGFR-2 is a major mediator for VEGF function, then it would be important to consider such information in using VEGF as a therapeuticagent in treatment of DM-associated ED. Will patients with weak expression of VEGFR-2 get benefit from VEGF therapy? Can intracorporal injection with VEGF restore VEGFR-2 expression? These are all questions to be answered. Disclosure: Work supported by industry: no.
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PREMATURE EJACULATION: A STUDY OF PREVALENCE, RISK FACTORS, AND IMPACT ON SEXUAL RELATIONSHIPS AMONG MARRIED MEN IN SAUDI ARABIA Bukhari, Y.1; Mosli, H.1; Batarfi, A.1; Ashy, J.1; Daghustani, H.1; Eldeek, B.1 1: King Abdulaziz University, Saudi Arabia Introduction: Premature ejaculation (PE) has been extensively researched and discussed in the realm of sexology. The medical fraternity has identified the need for an improved understanding of the global and regional epidemiology of PE. The American Urology Association defines PE as “ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners”. Global Study of Sexual Attitudes and Behaviors (GSSAB), suggested that one-third of men around the world have PE with the lowest prevalence among men in the Middle East (12.4%). However, this modest prevalence reported by (GSSAB), contradicted the general understanding of the scientific community of Saudi Arabia; which strongly believes that PE is highly prevalent among the conservative native male population. Aims: To determine the prevalence of PE among the Saudi male population, to determine its risk factors and to assess the impact of PE on sexual relations. Methods: This study was designed as a non-interventional, observational, comparative cross sectional study which involved 697 community-dwelling native married men living in Jeddah, Saudi Arabia. Results: The prevalence of PE in the study sample was 38.3%. PE was not related to any specific age group but a correlation was noted between PE and a lower level of education, lower socioeconomic status and having only one female sexual partner. PE is strongly related to masturbation and mental stress. Conclusions: PE is a sexual dysfunction commonly noted among the native male population of Saudi Arabia. PE patients need more effort to satisfy their female sexual partners as compared to healthy men. PE leads to sexual dissatisfaction among couples and is a common cause for termination of relationships. Disclosure: Work supported by industry: no.
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PREMATURE EJACULATION: PREVALENCE AND PERCEPTION IN QATAR Arafa, M.1; AlSaid, S.2; ElBardisi, H.2 1: Cairo University Hospital, Egypt, Hamad Medical Corporation, Qatar; 2: Hamad Medical Corporation, Qatar Objective(s): To assess the prevalence rate of PE in different age groups in our region and to assess the perception of normal ejaculatory latency by patients. Materials and Method(s): The Arabic Index of Premature Ejaculation (AIPE) was used for diagnoses. A separate questionnaire was also used to assess self-report and perception of premature ejaculation (PE) and perception of patients about the problem. The questionnaires were given to all males attending our hospital whether patients, companions or just visitors from February 2012 till February 2013. Result(s): 3042 subjects were included. 459 were Qatari. According to AIPE the prevalence of PE was 56.48% (1718 patients) with a score ≤30 with an intravaginal ejaculatory latency time (IELT) of 5.2 ± 5.8 seconds. Of these 1718 patients only 991 reported having PE and 727 were satisfied with their IELT. The prevalence of PE in Qatari patients was 66.9% (307 patients) when using AIPE of which only 209 were self-reporting PE. When we used the self-reporting questionnaire the prevalence of PE increased to 69.8% (2123 patients) with IELT 7.1 ± 7.6 seconds. Out of these 2123 patients only 958 patients were diagnosed as having PE by AIPE.
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Erectile dysfunction was self-reported in 731 patients. In this group prevalence of PE was 77.98% (570 patients) with IELT of 4.9 ± 5.3 seconds. Conclusion(s): The prevalence of PE in Qatar is much higher than that reported in other parts of the world. There is significant difference between diagnosed and self-reported prevalence of PE in our region. Disclosure: Work supported by industry: no.
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VAGINISMUS TREATMENT IN LEBANON Sabra, M.1; Eid, T.2 1: Saint-Georges University Hospital. Beirut, Lebanon; 2: Clemenceau Medical Center. Beirut, Lebanon Objective: To our knowledge, no previous studies have been published about vaginismus in Lebanon. Our objective is to report the outcome of a group of 15 patients diagnosed with vaginismus in Lebanon. Materials and Methods: We did a retrospective study on 15 patients presenting for vaginismus between March 2011 and December 2012 to a private clinic in Beirut, Lebanon (Clemenceau Medical Center). We used cognitive-behavioral therapy (CBT) based on education about female sexual anatomy using visual illustrations and a mirror, and desensitization by dressing a list of anxiogenic items, in addition to the use of vaginal dilators. The main outcome was successful penetrative intercourse and the secondary outcome was identifying difficulties in managing vaginismus in this country. Results: The mean age of patients was 28 years. Only 5 patients completed the CBT. Success rate was 100%. In this group, the objective of seeking therapy was desire of pregnancy for 4 patients, and improving sexuality for 1 patient. The mean duration of vaginismus was 19.2 months (6 to 60), the mean number of sessions was 6.4 (5 to 9), and the mean duration of treatment was 5 months (3 to 7), knowing that patients came at their own convenience. 3 out of 5 patients had undergone unsuccessful surgery on the hymen, and two were informed about vaginismus by internet. One patient’s husband refused the use of dilators, but his wife used them secretly. In the second group of ten, patients attended one or two sessions only (education and explanation of the program). One patient reported that vaginismus resolved after the second session. 8 out of 10 patients came to improve their sexuality, and 2 had a desire of pregnancy. The mean duration of vaginismus was 10.8 months (2 to 60). 4 patients in this group lived in another country (Emirates, Saudi Arabia and Egypt). Conclusion: CBT is a successful tool in treating vaginismus in Lebanon. When patients committed to therapy (1/3), success rate was 100%. Desire of pregnancy seems to be more motivating to complete therapy than improving sexuality. Factors that could restrain patients from committing to CBT could be the cost of therapy, not living in the same country, lack of trust in psychological methods and seeking a quick fix like surgery. Disclosure: Work supported by industry: no.
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SEXUAL MEDICINE RESEARCH OUTPUT OF THE MIDDLE EAST: A BIBLIOGRAPHIC STUDY Azarmina, P.1 1: Pfizer Inc., USA Objective: To determine the key topics of scientific investigation in the field of Sexual Medicine in five selected Middle Eastern countries using a bibliographic methodology. Material and Method: Research output of Egypt, Iran, Turkey, Saudi Arabia and Israel in the field of sexual medicine was assessed by counting the number of scientific publications in the field of sexual medicine.
The 2nd Biennial Meeting of the Middle East Society for Sexual Medicine The keywords were initially extracted from ICD-10 and DSM-V and screened by running a number of test searches. Ten high frequency keywords were selected from the list of keywords: erectile, impotence, ejaculation/ ejaculatory, sexual dysfunction, orgasm/orgasmic, dyspareunia, sexual desire, priapism, penile prosthesis and vaginismus, which were subsequently used to estimate the research output of five Middle Eastern countries with highest number of indexed papers in the field of sexual medicine. Results: Out of 3,796 papers identified using this method, Turkish institutions had the first rank with 42% of the papers, followed by Israel (23%), Egypt (20%), Iran (12%) and Saudi Arabia (4%). In terms of topic, Erectile Dysfunctions had the highest number of articles (30%). This was followed by articles on Ejaculatory Dysfunctions (15%), Orgasmic Dysfunctions (5%), Dyspareunia (3%), Sexual Desire Dysfunction (3%), Priapism (2%) and Vaginismus (1%). There was a strong country-by-country variation indicating a concentration of specific topics coming from either a specific country, institution or principle investigator. Conclusion: This bibliographic study highlighted a significant variation in the research output of different countries in the Middle East region. It can be argued that this variation is a reflection of each country’s scientific development, culture, gender roles and incidence of certain sexual dysfunctions. This study can serve as a benchmark for policymakers in the area of research planning and open up opportunities for future collaborations and population-based studies. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
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VAGINAL PENETRATION PHOBIA IN ARAB WOMEN: RETROSPECTIVE COHORT STUDY
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CORPOROTOMY PLUG TECHNIQUE IN THE MANAGEMENT OF PROXIMAL CORPORAL PERFORATION DURING REVISION PENILE PROSTHESIS SURGERY Hakky, T.1; Emtage, J.2; Park, A.1; Martinez, D.1; Rafiei, A.1; Carrion, R.1; Parker, J.1 1: University of South Florida, USA; 2: University of South Florida, United States Objective: Here we discuss the corporotomy plug technique during difficult revision penile prosthesis surgery as a method to place the penile implant as an alternative to the suture sling technique for proximal lateral perforations. Material and Methods: Our patient is a 42 year old man who underwent penile prosthesis surgery and developed erosion. The old implant was subsequently removed. After 6 months, the patient wished to proceed with revision surgery. During the revision surgery the scarred corpora made it difficult to find the correct space. Corporal dilation was performed with Metzenbaum scissors and a posterior lateral corporal perforation was encountered bilaterally. Result: 6 mm Hegar dilators were placed into the os of each perforated track occluding the false passage. We then proceeded in creating a new corporal tunnel using Metzenbaum scissors into the correct track. Brooks dilators and cavertomes were used to dilate these correct spaces. A 9.5 cm meallable implant was then placed. Conclusion: The corportomy plug technique forgoes the need for a suture sling if a viable track can be found in the setting of proximal lateral perforation. It also eliminates the possibility of manipulation of the implant into the false passage, and prevents intubating the lip of the wrong corporotomy. Disclosure: Work supported by industry: no.
Almuammar, T.1 1: King Faisal Specialist Hospital and Research Centre Riyadh, Saudi Arabia Objectives: To evaluate the experience of Arab women in the community presenting with vaginal penetration phobia and to establish the percentage of women who respond to an individualized approach at assessment and treatment including targeting fear and anxiety associated with vaginal penetration. To provide recommendations for the management of vaginal penetration phobia. Materials and Methods: This is a cohort, retrospective study of 100 patients attending a gynaecology clinic for assessment of post-marital vaginal penetration phobia. They were followed up to assess their response to an individualized structured treatment protocol. The patients were given on average 2–3 sessions of sex education and systematic desensitization targeting fear and anxiety associated with vaginal penetration. They were taught relaxation techniques in conjunction with self exploration and insertion of “vaginal trainers”. Psychosexual behavioral therapy involves the active participation of both partners in vaginal dilation. The women were followed up to assess their response to the above interventions. It was possible to get the complete data for 100 patients. Results: More than 95% of the studied group had a completely successful outcome, in that penetrative intercourse is now possible and pregnancy was achieved, when this was the additional desired outcome. Conclusion: An individualised treatment approach was found to be highly successful in the management of vaginal penetration phobia in a community setting. Disclosure: Work supported by industry: no.
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SAFETY AND EFFICACY OF TREATING ERECTILE DYSFUNCTION BY LINEAR SHOCKWAVES THERAPY – EXPERIENCE FROM A SECOND GENERATION TECHNOLOGY Reisman, Y.1; Hind, A.2; Varaneckas, A.3; Motil, I.4 1: Amstelland, Netherlands; 2: Urology Center Ramallah, Palestin; 3: Amber Clinic, Lithuania; 4: Uroclinic Brno, Czech Republic Introduction: Vasculogenic erectile dysfunction (ED) which is caused by arteriosclerosis can be treated by a variety of therapies that aim at reducing ED symptoms. Low-intensity shockwaves (LISW) were discovered as an enhancing factor to angiogenesis for treating ischemic heart disease. In addition, LISW therapy demonstrated significantly restoration of erectile function at diabetic rats. The present study evaluates the therapeutic effect of a LISW produced by an innovative device on patients with erectile dysfunction. Objective: The present study was aimed to assess the safety and efficacy of a dedicated shockwave device, ‘Renova’, which was designed to achieve substantially superior organ coverage. Material and Methods: 57 patients with mild to severe ED were treated by Renova as part of a multi-center, open-label, 4-arms prospective pilot study, conducted at 4 sites. The 4 arms differed from each other by the PDE5-I consumption of the patients throughout the study stages. Patients underwent 4 weekly treatment sessions by a novel machine (Renova) that generates line focused shockwaves at 4 treated areas: right and left crus and right and left corpus cavernosum. Each treatment session lasted approximately 15 minutes, did not required anaesthesia and did not cause any pain or adverse effects. Patients’ erectile function was assessed by the IIEF-EF, SEP and GAQ questionnaires at baseline and at 1 and 3 months post treatment. Success
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was defined as an increase of IIEF-EF score from baseline to the second follow up according to the severity of ED symptoms at baseline. Results: The average IIEF-EF score has greatly increased from 14.7 at baseline to 21.6 at 1 month and 3 months post treatment. Out of 57 patients, 47 (82%) had a successful treatment. Among the successful patients, the average IIEF-EF score increase was 8 points. No significant change was seen between the 4 arms. No adverse events were reported during the treatment and the follow-up duration. Conclusions: The results of this study indicate success of the second generation technology for treating ED with linear low-intensity shockwaves. Initial follow up data from almost 60 patients demonstrate a therapeutic improvement in 82% of patients.
QLQ – BR23. Questionnaires were supplemented by questions related to social-economic status and oncology treatment. Results and Conclusions: As of now the research authors will present initial, selected results of how mastectomy, type of treatment (surgery), and the socio-economic and psycho-behavioral factors influence a number of aspects of woman sexuality, as well as the percentage of sexual disorders diagnosed among the patients under scrutiny, all based on analyses of the aforementioned questionnaires and other documentation.
Disclosure: Work supported by industry: yes, by Direx (industry funding only – investigator initiated and executed study). The presenter 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 FUNCTION IN WOMEN AFTER MASTECTOMY: A SURVEY OF POLISH PATIENTS Kowalczyk, R.1; Lew-Starowicz, Z.2; Cedrych, I.3; Białek, A.4; Glogowska, I.5; Krzemieniecki, K.6; Streb, J.6 1: Department of Sexology, Andrzej Frycz Modrzewski Krakow University, Poland; 2: Faculty of Rehabilitation Academy of Physical Education, Warsaw, Poland; 3: Maria Sklodowska- Curie Memorial Cancer Center and Institute of Oncology, Cracow, Poland; 4: Department of Psychiatry and Psychotherapy, Medical University of Silesia, Katowice, Poland; 5: Maria Sklodowska- Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; 6: Department of Clinical Oncology, Cracow University Hospital, Cracow, Poland Objective: As various studies show, women after mastectomy are accompanied by many problems in the sexual sphere; it considerably lowers their quality of life. Goal of the study is to describe the relationship between the illness as well as the treatment of choice and the sexuality of Polish patients. Another goal is a comparison of the study results with results obtained in similar studies in Europe. Design and Method: The target group of 300 women after mastectomy is in the process of assessment. The subjects are recruited among Polish patients diagnosed and treated at the Department of Clinical Oncology, Cracow University Hospital in Cracow, Maria SklodowskaCurie Memorial Cancer Center and Institute of Oncology in Warsaw and its branches in Katowice and Cracow. The following questionnaires are used: Changes in Sexual Functioning Questionnaire (CSFQ – F – C), Body Image Questionnaire (KOCBR), Sexual Interaction Inventory (SII), Quality of Life Questionnaire
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Disclosure: Work supported by industry: no.
A COMPARATIVE 3D MAPPING OF THE CORPUS CAVERNOSUM; THE TITAN AND AMS INFLATABLE PENILE IMPLANTS Hakky, T.1; Parker, J.1; Emtage, J.1; Martinez, D.1; Carrion, R.1 1: University of South Florida, USA Objectives: Intricate anatomical analysis of the distal corpus cavernosum and the tips of the penile implant have yet to be reported. We report our experience using a three dimensional (3D) scanner to reconstruct corporal casts and compare them to the distal ends of two penile implants. Materials & Methods: The silicone tipped Titan Coloplast® inflatable penile prosthesis and the AMS® 700 CX penile prosthesis were analyzed using a 3D scanner. Additionally, we analyzed the exit tubing, and the diameter of the tubing and prosthesis. Four cadaveric phalluses were harvested using Smooth-Cast® 300Q polyurethane molding. The molds were excised and scanned along side the penile prosthesis. 3D scans were completed and analyzed using Leios Mesh software, and GOM Inspect software. Results: The 3D scans demonstrated the mean human corporal radii 1mm from the distal tip to be 5.03 (3.04–6.42) mm, which is an obtuse angle. The silicone tipped Titan penile prosthesis spherical radius at the same level was 3.42 mm while the tip of the AMS prosthesis had a radius of 3.11 mm. It was observed that the trajectory of the cavernosa appeared curvilinear and the distal ends appeared blunt. This analysis was confirmed by 3D mapping. The Titan penile implant exit tubing is at 1.23 degrees while the AMS exit tubing is at 33.51 degrees and the radius of the AMS tubing was 5.21mm while the Titan exit tubing was 3.42. Conclusions: The use of cadaveric cavernosal molds in combination with the 3D scanner allowed us to accurately image the corpus cavernosum. Our findings suggest that anatomically accurate corporal tips appear to be relatively blunt and that the new Titan® silicone tip penile prosthesis and the AMS 700 CX are similar in implant tip shape. The exit tubing diameter and angle from differs considerably, which may affect ease of seating the proximal ends.
The 2nd Biennial Meeting of the Middle East Society for Sexual Medicine Disclosure: Work supported by industry: yes, by coloplast (no industry support in study design or execution).
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GENDER IDENTITY, SEXUAL ORIENATATION AND SEXUAL AROUSAL ASSOCIATED PARAPHILIA AMONG SEX CHAT USERS IN THE MIDDLE EAST Shamndy, M.1 1: Alexandria University Hospital, Egypt Introduction: One of the commonest practices now among all age groups is cyber sex. Sex chat used widely due to ease of reach to internet and availability for all age groups, in our middle east society it is a forbidden religiously to practice sex outside the marriage and with the problem with delayed marriage due to financial problems leads to more and more use of this method for sexual relief and our study focused on this group. Study Aim: To determine the prevalence of paraphlia associated with sexual arousal among cybersex users during sexual fantasies, fantasies accompanying masturbation, and real-life socio-sexual behaviour, also we included gender identity and the sexual orientation of the volunteers in the study. Method: Cross-sectional study, self-reported sexual history data were collected by questionnaire from 1000 volunteers recruited from a sex chat users, from different 21 nationalities. Results: Gender identitity disorders 0.5%, Prevalence of paraphilias 50.5%, Sexual orientations: Homo:4.8% Hetero: 86.9%Bi:8.3% Conclusions: Sexual paraphilias are very common among chat users and this is indicates that it is very prevalent in the middle east societies.Once you found a parahilia please ask in details for others as sometimes many paraphilia come with each other. Hidden sexual preference among of one partner married couples are prevalent lead to disturbance of marital life sexuality. Recommendations do not make shame phyisician from asking every patient about their gender identity, sexual orientation and paraphilias, We need to develop methods for prophylaxis against paraphilias, Consider in management of couple sexual problems to ask about each partners’ preferences, New sexual paraphilias needed to be included in DSM paraphilias are: Incest, Group sex, Sex with more than one at the same time, Practice sex with a wife of friend and friend practice sex with his wife. Disclosure: Work supported by industry: no.
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THE FEMALE SEXUAL FUNCTION INDEX FSFI: TRANSLATION, VALIDATION AND CROSSCULTURAL ADAPTATION OF AN URDU VERSION FOR USE IN PAKISTAN Ur Rehman, K.1; Shabbir Sheikh, S.1; Asif Mahmood, M.1; Sultan, T.1 1: Fatima Memorial College of Medicine and Dentistry, Pakistan
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Finally we selected 66 bilingual females, who had been in a stable sexual relationship over the past 6 months and asked them to fill out the FSFI questionnaire in both languages (Urdu and English) and the responses of the patients were matched. The data were analysed statistically using descriptive statistics, Cronbach’s alpha analysis, Pearson correlation and students t test. Results: In terms of face validity, FSFI was found to be easily understandable and capable of adequately measuring various aspects of female sexual function. A high degree of internal consistency was demonstrated on Cronbach’s alpha analysis. Cronbach α co-efficient for various domains was sufficiently high ranging from 0.97 – 1.00. The clinical assessment of the presence and severity of female sexual dysfunction also matched with the self-report questionnaire. Similarly various domains of FSFI had high degree of correlation between Urdu and English versions (p < 0.001)Conclusion. We can safely conclude that the Urdu version of FSFI is a valid instrument for use in the literate population of Pakistan. Disclosure: Work supported by industry: no.
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PATTERNS OF MALE SEXUAL DYSFUNCTIONS IN UPPER EGYPT: A RETROSPECTIVE ANALYSIS OF 2000 PATIENTS OVER THE LAST 10 YEARS Saleh, R.1; Abu El-Hamd, M.1; Abd El-Hameed , A.1; Abd El-Latif, A.1 1: Sohag Faculty of Medicine, Egypt Objective: To determine the patterns of male sexual dysfunctions in Upper Egypt. Patient and Methods: In this study, we reviewed the medical files of 2000 male patients who attended a private Andrology clinic in Sohag Governorate, Upper Egypt, between 2003 and 2012, with a history of sexual dysfunction. All patients were examined by the same Andrologist (R Saleh). Patient’s data included medical sexual histories. Sexual functions were evaluated by using the IIEF-5 questionnaire. Data were recorded in Excel sheet and analysed by SPSS program. Results: The mean age of the patients was (42.31 ± 12.39). The mean age of the wives was 32.9 ± 12.5. The duration of marriage ranged from 8 years history of BD and resulting paraplegia. He was kept under immunosupressive
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The 2nd Biennial Meeting of the Middle East Society for Sexual Medicine therapy. He had attacks of depression. He noticed loss of his erectile ability for the past 6 years but with normal libido. The International Index of Erectile Functions-5 was 13. No history of tobacco smoking, alcohol intake, diabetes or other concomitant disease. He was 74 kg body weight, 176 cm length & 23.9 body mass index. His blood pressure and cardiac status were normal. Routine blood tests, serum testosterone (6.8 ng/mL) and prolactine (5.9 ng//mL) were all normal. Penile duplex scanning using 0.25 mL PGE1 achieved immediate and excellent erection quality with normal peak systolic and end diastolic velocities; suggesting the possibility of neurologic type of ED (2). Conclusion: BD has a negative impact on male erectile function. We recommend that ED be evaluated while assessing men with BD especially in presence of neurological involvement. The ED in cases of BD is not always vasculogenic type but can be multi-factorial. Thus, multidisciplinary diagnostic approach should be counseled. 1. J Urol 1999; 162: 147 2. J Urol 1986; 135: 714 Disclosure: Work supported by industry: no.
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ANALYSES FOR EGYPT AND THE UNITED ARAB EMIRATES SUBPOPULATIONS FROM THE PROMEED 6-MONTH PROSPECTIVE OBSERVATIONAL STUDY OF PDE5 INHIBITOR TREATMENT PERSISTENCE AND ADHERENCE IN MIDDLE EASTERN AND NORTH AFRICAN MEN WITH ERECTILE DYSFUNCTION Mostafa, T.1; Hussien, T.2; Isterabadi, M.3; El-Meliegy, A.4; Henneges, C.5; Haddad, A.6; Gurbuz, S.7 1: Faculty of Medicine, Cairo University, Egypt; 2: Faculty of Medicine, Alexandria University, Egypt; 3: Al Zahraa Hospital, Sharjah, United Arab Emirates; 4: Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 5: Lilly Deutschland GmbH, Bad Homburg, Germany; 6: Eli Lilly and Company, Lebanese Republic; 7: Eli Lilly and Company, Indianapolis, USA
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Egypt and the United Arab Emirates (UAE) who participated in a prospective, non-interventional, observational study. Materials and Methods: Men were ≥18 years old with ED of any etiology, were PDE5 inhibitor-naïve, and expected to be sexually active in a stable relationship with a female partner. These men were administered PDE5 inhibitors on-demand, selected per routine clinical practice of the physician, with follow-up at baseline and at 1, 3, and 6 months post-enrollment. The patients were defined as persistent at follow-up if they used ≥1 dose of their originally-prescribed PDE5 inhibitor within 4 weeks of the visit. Persistence at 6 months was defined as persistence at all prior follow-up visits. The patients were adherent if they used their most recent PDE5 inhibitor dose as originally prescribed. The transformed Self-Esteem and Relation (SEAR) Questionnaire score and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Total Score were also assessed post-hoc. Results: Patients were from Egypt (n = 99) and the UAE (n = 40); the combined group (n = 139) had a mean (standard deviation) age of 49.8 (11.8) years and mean BMI of 28.9 (4.2). A majority had moderate (52.5%) or severe (30.9%) ED, which was of mixed (25.2%) or organic (38.9%) etiology. More patients were treated with tadalafil (n = 80, 57.6%) than sildenafil (n = 54, 38.9%) or vardenafil (n = 5, 3.6%). At 6 months, 74.8% of all patients were treatment persistent and 75.5% were treatment adherent. All treatments were efficacious in improving ED. The mean International Index of Erectile Function- EF domain scores [95% confidence interval] improved from 15.1 [14.1, 16.1] at baseline to 26.1 [25.4, 26.9] at 6 months. At 6 months, changes from baseline in mean transformed SEAR total scores [95% confidence interval] were statistically significant for both tadalafil (38.4 [32.0, 44.7]) and sildenafil (36.1 [28.8, 43.4]). Mean EDITS total scores were >85 for both Egypt and the UAE at 6 months. Conclusions: At 6 months, approximately 3 out of 4 men were treatment persistent and adherent. Erectile function improved significantly with all treatments, and SEAR scores improved significantly from baseline with both tadalafil and sildenafil. Disclosure: Work supported by industry: yes, by Eli Lilly and Company (industry funding only – investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
Objectives: To assess treatment persistence and adherence over 6 months to on-demand PDE5 inhibitors among men with ED from
J Sex Med 2013;10(suppl 6):423–429
