Consulting “Dr Google” for sexual dysfunction: a contemporary worldwide trend analysis

Global online interest in finasteride sexual side effects

Prior literature has suggested that finasteride may negatively impact men's sexual health. In 2011, the Food and Drug Administration (FDA) provided a warning on finasteride drug labels to incorporate sexual side effects such as reduced libido and erectile dysfunction. We aimed to evaluate global online interest in finasteride sexual side effects, their penetrance and variation, and how they compared overtime. We also aimed to evaluate the influence of the FDA label warnings on web-based searches for finasteride side effects. We utilized Google search engine from January 2004 to December 2020 to include separate trends from web searches of "Propecia," "Propecia side effects," "finasteride", "finasteride side effects", and "post-finasteride syndrome" compared amongst the United States, United Kingdom, and Australia. We performed join-point regression analysis. We compared the annual relative search volume (ARSV) and annual percentage change (APC) to evaluate for loss or gain of interest in the respective key terms. We determined that the average ARSV for "finasteride" was 14.8% in 2004 and increased significantly to 57.3% in 2020 (APC: +9.25%, 95% CI 8 to 10.5, p < 0.001). Likewise, there was significant increased interest in "finasteride side effects" (APC: +20.7, p < 0.001) and "post-finasteride syndrome" (APC: +29.2; p < 0.001) in the United States overtime. Finally, when we compared trends before and after the FDA warnings, the average ASRV of "finasteride", "finasteride side effects", and "post-finasteride syndrome" all increased significantly (p = 0.001, p = 0.014, p < 0.001), respectively. Thus, it is evident that there is a global web-based interest in finasteride and its sexual health side effects, particularly after the FDA warning in 2011. There is boosted public awareness, and thus providers should have more detailed and careful conversations with patients prior to starting a 5α-reductase inhibitor such as finasteride.

A clinical guide to rare male sexual disorders

Conditions referred to as 'male sexual dysfunctions' usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse effects on individuals' sexual health and relationships. Such conditions include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard-flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case-control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defined, and the available options cannot, therefore, adequately address patients' sexual problems and implement appropriate treatment. Thus, larger-scale studies - including prospective trials and comprehensive case registries - are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders.

Assessing ChatGPT's ability to answer questions pertaining to erectile dysfunction: can our patients trust it?

Erectile dysfunction (ED) is a disorder that can cause distress and shame for men suffering from it. Men with ED will often turn to online support and chat groups to ask intimate questions about their health. ChatGPT is an artificial intelligence (AI)-based software that has been trained to engage in conversation with human input. We sought to assess the accuracy, readability, and reproducibility of ChatGPT's responses to frequently asked questions regarding the diagnosis, management, and care of patients with ED. Questions pertaining to ED were derived from clinic encounters with patients as well as online chat forums. These were entered into the free ChatGPT version 3.5 during the month of August 2023. Questions were asked on two separate days from unique accounts and computers to prevent the software from memorizing responses linked to a specific user. A total of 35 questions were asked. Outcomes measured were accuracy using grading from board certified urologists, readability with the Gunning Fog Index, and reproducibility by comparing responses between days. For epidemiology of disease, the percentage of responses that were graded as "comprehensive" or "correct but inadequate" was 100% across both days. There was fair reproducibility and median readability of 15.9 (IQR 2.5). For treatment and prevention, the percentage of responses that were graded as "comprehensive" or "correct but inadequate" was 78.9%. There was poor reproducibility of responses with a median readability of 14.5 (IQR 4.0). Risks of treatment and counseling both had 100% of questions graded as "comprehensive" or "correct but inadequate." The readability score for risks of treatment was median 13.9 (IQR 1.1) and for counseling median 13.8 (IQR 0.5), with good reproducibility for both question domains. ChatGPT provides accurate answers to common patient questions pertaining to ED, although its understanding of treatment options is incomplete and responses are at a reading level too advanced for the average patient.

Brave New Healthcare: A Narrative Review of Digital Healthcare in American Medicine

The digital revolution has had a profound effect on American and global healthcare, which was accelerated by the pandemic and telehealth applications. Digital health also includes popular and more esoteric forms of wearable monitoring systems and interscatter and other wireless technologies that facilitate their telemetry. The rise in artificial intelligence (AI) and machine learning (ML) may serve to improve interpretation from imaging technologies to electrocardiography or electroencephalographic tracings, and new ML techniques may allow these systems to scan data to discern and contextualize patterns that may have evaded human physicians. The necessity of virtual care during the pandemic has morphed into new treatment paradigms, which have gained patient acceptance but still raise issues with respect to privacy laws and credentialing. Augmented and virtual reality tools can facilitate surgical planning and "hands-on" clinical training activities. Patients are working with new frontiers in digital health in the form of "Dr. Google" and patient support websites to learn or share medical information. Patient-facing digital health information is both a blessing and curse, in that it can be a boon to health-literate patients who seek to be more active in their own care. On the other hand, digital health information can lead to false conclusions, catastrophizing, misunderstandings, and "cyberchondria." The role of blockchain, familiar from cryptocurrency, may play a role in future healthcare information and would serve as a disruptive, decentralizing, and potentially beneficial change. These important changes are both exciting and perplexing as clinicians and their patients learn to navigate this new system and how we address the questions it raises, such as medical privacy in a digital age. The goal of this review is to explore the vast range of digital health and how it may impact the healthcare system.

Quality and benefits of the erectile dysfunction information on websites, social-media, and applications

Erectile Dysfunction (ED) is defined as the persistent inability to obtain and maintain an erection that enables satisfactory sexual intercourse. ED prevalence vary across age groups, affecting approximately 1-9% of men under 40, 2-9% of those aged 40-59, and increasing to 20-40% for those aged 60-69. However, it remains a frequently untreated or insufficiently treated condition. Especially due to the feeling of discomfort and guilt, patients often avoid consulting their physicians; in this context, digital innovation could potentially play a pivotal role in the diagnosis and management of ED. This narrative review depicts the ongoing status of digital innovations in ED focusing on websites, social media platforms and mobile health applications (MHA). We examined Google, social media platforms (Facebook, Twitter, YouTube, and TikTok), and the recently developed MHA apps on Google Play Store and Apple App Store. Websites provide readily available but sometimes difficult to understand information, while social media is easy to understand and act on. MHA apps are the most complete and trustworthy tool for self-care management. In conclusion, digital innovations are a continuously growing source of information and therapeutic tools.

Web based research in sexual medicine: a position statement of the European Society for Sexual Medicine

Background

Although the use of the Web has brought major advances in every step of the research process, this also comes with several methodological challenges.

Aim

The article presents the European Society for Sexual Medicine's position statements on key methodological concerns relative to Web-based research in sexual medicine.

Methods

The authors conducted a systematic scoping review of articles using Web-based research methods in sexual medicine. For the creation of the statements, the authors processed the data from the methodology of the studies and formulated the final statements reaching 100% agreement in the group.

Outcomes

European Society for Sexual Medicine statements were provided on the following domains: definition of the population of interest, selection of the population of interest, data collection quality, response rate, self-reported questionnaire, consent, and legal obligations.

Results

Researchers should justify the relevance of the Internet population to the population of interest; should clearly describe how they identified study participants; should select and employ specific measures to avoid hoax; should explicitly describe the process of calculation of response and completion rates as well as the relative implications; should validate traditional sexual health questionnaires for online and, if possible, multilingual use; should not ignore consent in Web-based research; and need to be knowledgeable of the technical measures and legal obligations to protect anonymity.

Implications

Researchers are advised to include trained computer scientists in their group, have a good understanding of their legal obligations as to collecting, storing and disseminating personal data, and design their studies by taking into account the challenges of Web-based research.

Strengths and limitations

The heterogeneity of the included studies and methodological low quality of most of them was a limitation, which also shows the importance of this study and the need for guidelines regarding Web-based research.

Conclusion

Large uncontrolled samples could be a threat to the quality of the studies and increase bias if researchers are not mindful of the methodological challenges they would need to account for.

Voice Assistants as Consultants for Male Patients with Sexual Dysfunction: A Reliable Option?

The aim of this study was to evaluate the ability of Google Assistant, Alexa, and Siri to recognize and answer questions about male sexual health. Each VA was tested on a smart speaker: Alexa on Amazon Echo Dot 4th Gen., Google Assistant on Google Home Mini, and Siri on Apple HomePod. A pool of patients' frequently asked questions regarding erectile dysfunction (ED), premature ejaculation (PE), Peyronie's disease (PD), male infertility, and other aspects of male sexual health were identified by authors. The recognition of question was evaluated ("yes" or "not"). For each recognized question, the response characteristics (domains) were rated on a scale from 0 to 10 (according to the quality). We chose the recognition rate of the questions as the primary outcome and the quality of the answers as the secondary outcome. Overall, the best VA in recognizing questions was Siri, with a total of 83.3% questions compared with 64.0% for Alexa (p = 0.024) and 74.0% for Google Assistant (p = 0.061). Siri was associated with a significantly higher recognition rate than Alexa for PE (80% vs. 40%; p = 0.002) and PD (66.7% vs. 33.3%; p = 0.010). The quality of the responses was classified as low in 57 out of 105 cases (54.3%), intermediate in 46 cases (43.8%), and high in only 2 cases (1.9%), highlighting an overall intermediate-low quality of the answers. Male infertility was the condition associated with the highest mean scores in "Targeted response to the problem" (7.32 ± 2.57), "Scientific correctness of the answer", (5.9 ± 2.76) "Completeness of the answer" (5.14 ± 2.56), and "Understandability of the response for a patient" (5.3 ± 2.51) domains. Siri was associated with significantly higher scores than Alexa (p < 0.05) in several domains of all conditions evaluated. The question recognition rate of VAs is quite high; however, the quality of the answers is still intermediate-low. Siri seems superior to Alexa in both question recognition and response quality. Male infertility appears to be the sexual dysfunction best addressed by VAs.

Worldwide Evolution of Vaccinable and Nonvaccinable Viral Skin Infections: Google Trends Analysis

BACKGROUND

Most common viral skin infections are not reportable conditions. Studying the population dynamics of these viral epidemics using traditional field methods is costly and time-consuming, especially over wide geographical areas.

OBJECTIVE

This study aimed to explore the evolution, seasonality, and distribution of vaccinable and nonvaccinable viral skin infections through an analysis of Google Trends.

METHODS

Worldwide search trends from January 2004 through May 2021 for viral skin infections were extracted from Google Trends, quantified, and analyzed.

RESULTS

Time series decomposition showed that the total search term volume for warts; zoster; roseola; measles; hand, foot, and mouth disease (HFMD); varicella; and rubella increased worldwide over the study period, whereas the interest for Pityriasis rosea and herpes simplex decreased. Internet searches for HFMD, varicella, and measles exhibited the highest seasonal patterns. The interest for measles and rubella was more pronounced in African countries, whereas the interest for HFMD and roseola was more pronounced in East Asia.

CONCLUSIONS

Harnessing data generated by web searches may increase the efficacy of traditional surveillance systems and strengthens the suspicion that the incidence of some vaccinable viral skin infections such as varicella, measles, and rubella may be globally increasing, whereas the incidence of common nonvaccinable skin infections remains stable.

Online Symptom Checkers are Poor Tools for Diagnosing Men's Health Conditions

OBJECTIVE

To analyze the accuracy of the four most commonly used online symptom checkers (OSCs) in diagnosing erectile dysfunction (ED), scrotal pain (SP), Peyronie's disease (PD), and low testosterone (LT).

METHODS AND OUTCOMES

One-hundred and sixty artificial vignettes were created by de-identifying recent initial outpatient consults presenting to discuss ED (40), SP (40), PD (40), and LT (40). The vignettes were entered into the 4 most frequently used OSCs (WebMD, MedicineNet, EverydayHealth, and SutterHealth) as determined by web traffic analysis tools. The top 5 conditions listed in the OSC differential diagnosis were recorded and scored.

RESULTS

WebMD's accuracy for ED, SP, PD, and LT vignettes was 0%, 22.5%, 0%, and 95%, respectively. EverydayHealth was only able to diagnose SP 20% of the time, and failed to diagnose ED, PD, or LT on all occasions. MedicineNet diagnosed ED, PD, SP, and LT in 100%, 98%, 27.5%, and 0% of vignettes, respectively. SutterHealth correctly diagnosed ED, SP, and LT in 100%, 20%, and 80% of patients, respectively. Cumulatively, the OSCs were most accurate in diagnosing ED and least accurate in diagnosing SP when using the Top 1 (37.5% vs. 6.9%) and Top 5 (50% vs. 24.5%) of the suggested conditions.

CONCLUSIONS

No OSC could accurately diagnose all the conditions tested. The OSCs, on average, were poor at suggesting precise diagnoses for ED, PD, LT, SP. Patients and practitioners should be cautioned regarding the accuracy of OSCs.

Internet- and mobile-based psychological interventions for sexual dysfunctions: a systematic review and meta-analysis

Sexual dysfunctions are highly prevalent and undertreated. Internet- and mobile-based psychological interventions (IMIs) could be a promising addition to close this treatment gap, given their accessibility, anonymity, and scalability. This systematic review and meta-analysis investigated the efficacy of IMIs for sexual dysfunctions. A comprehensive literature search was conducted in August 2021 on randomized controlled trials investigating the effects of IMIs on sexual functioning and satisfaction compared to a control condition. Twelve RCTs with 14 comparisons were reviewed with six IMIs targeting female and six IMIs targeting male sexual dysfunctions and n = 952 participants were evaluated in the meta-analysis. IMIs were significantly more effective than control conditions (k = 11 waitlist control group, k = 3 online discussion board) at post-treatment for female sexual functioning (g = 0.59, CI: 0.28–0.90, I²= 0%) and satisfaction (g = 0.90, CI: 0.02–1.79, I²= 82%), and male sexual functioning (g = 0.18, CI: 0.02–0.34, I²= 0%). No significant effect was found for male sexual satisfaction (g = 0.69, CI: −0.13–1.51, I²= 88%) with substantial heterogeneity in studies. Most studies showed high dropout, with ten studies indicating some concern of risk of bias, and two studies showing high risk of bias. The results suggest that IMIs can be an effective treatment for sexual dysfunctions, although additional high-quality research is needed. Given the limited availability of specialized treatment for sexual dysfunctions and individual preferences for discrete treatment options, IMIs seem to be a valuable addition to routine care, empowering individuals to promote their sexual health on a guided self-help basis.

Impact of Breast Cancer Awareness Month on Public Interest in the United States between 2012 and 2021: A Google Trends Analysis

Breast Cancer Awareness Month (BCAM) has a long history of over 30 years, established in 1985 to occur every October, and the National Breast Cancer Foundation now leads the operation. There have been no studies to evaluate the impact of the BCAM on public awareness of breast cancer. We analyzed the impact of BCAM on public awareness of breast cancer in the U.S. from 2012 to 2021 using the relative search volume (RSV) of Google Trends as a surrogate. We also analyzed the impact of Lung Cancer Awareness Month (LCAM) and Prostate Cancer Awareness Month (PCAM) on public awareness of lung and prostate cancer, respectively, to see differences in their effectiveness among the health observances for the top three most common cancers in the U.S. We performed a joinpoint regression analysis to identify statistically significant time points of a change in trend. There were joinpoints around BCAM for “Breast cancer” every year from 2012 to 2021, with a significant increase in the weekly RSVs from 21.9% to 46.7%. Except for 2013 and 2015 for “Lung cancer,” when significant increases in the RSV at 1.8% and 1.2% per week were observed around LCAM, no joinpoints were noted around LCAM or PCAM. These results imply that BCAM has successfully improved the public awareness of breast cancer in the U.S. compared to other representative health observances, likely due to the effective involvement of non-medical industries, influencers affected by breast cancer, and an awareness symbol.

Wikipedia provides better quality medical information on male sexual dysfunctions than Baidu Encyclopedia (Preprint)

Background

Sexual dysfunction is a private set of disorders that may cause stigma for patients when discussing their private problems with doctors. They might also feel reluctant to initiate a face-to-face consultation. Internet searches are gradually becoming the first choice for people with sexual dysfunction to obtain health information. Globally, Wikipedia is the most popular and consulted validated encyclopedia website in the English-speaking world. Baidu Encyclopedia is becoming the dominant source in Chinese-speaking regions; however, the objectivity and readability of the content are yet to be evaluated.

Objective

Hence, we aimed to evaluate the reliability, readability, and objectivity of male sexual dysfunction content on Wikipedia and Baidu Encyclopedia.

Methods

The Chinese Baidu Encyclopedia and English Wikipedia were investigated. All possible synonymous and derivative keywords for the most common male sexual dysfunction, erectile dysfunction, premature ejaculation, and their most common complication, chronic prostatitis/chronic pelvic pain syndrome, were screened. Two doctors evaluated the articles on Chinese Baidu Encyclopedia and English Wikipedia. The Journal of the American Medical Association (JAMA) scoring system, DISCERN instrument, and Global Quality Score (GQS) were used to assess the quality of disease-related articles.

Results

The total DISCERN scores (P=.002) and JAMA scores (P=.001) for Wikipedia were significantly higher than those of Baidu Encyclopedia; there was no statistical difference between the GQS scores (P=.31) for these websites. Specifically, the DISCERN Section 1 score (P<.001) for Wikipedia was significantly higher than that of Baidu Encyclopedia, while the differences between the DISCERN Section 2 and 3 scores (P=.14 and P=.17, respectively) were minor. Furthermore, Wikipedia had a higher proportion of high total DISCERN scores (P<.001) and DISCERN Section 1 scores (P<.001) than Baidu Encyclopedia. Baidu Encyclopedia and Wikipedia both had low DISCERN Section 2 and 3 scores (P=.49 and P=.99, respectively), and most of these scores were low quality.

Conclusions

Wikipedia provides more reliable, higher quality, and more objective information than Baidu Encyclopedia. Yet, there are opportunities for both platforms to vastly improve their content quality. Moreover, both sites had similar poor quality content on treatment options. Joint efforts of physicians, physician associations, medical institutions, and internet platforms are needed to provide reliable, readable, and objective knowledge about diseases.

Impact of the world hand hygiene and global handwashing days on public awareness between 2016 and 2020: Google trends analysis

BACKGROUND

Scientific evidence suggest that hand hygiene as one of the most effective measures to control infection. To promote good hand hygiene practices, the World Health Organization introduced May 5 as World Hand Hygiene Day (WHHD), and international stakeholders established Global Handwashing Day (GHD) on October 15. However, its contributions to raising public awareness of hand hygiene is unclear.

METHODS

This study evaluates the impact of the WHHD and GHD on the public awareness of hand hygiene in Japan, the United Kingdom, the United States, and worldwide from 2016 to 2020, using the relative search volume of "Hand hygiene" in Google Trends as a surrogate. To identify a statistically significant timepoint of a trend change, we performed Joinpoint regression analysis.

RESULTS

Upticks of the relative search volumes as well as joinpoints were noted worldwide around the WHHD and GHD from 2016 to 2019, but no joinpoints were identified around the WHHD and GHD in 2020. No such changes were observed in Japan, the United Kingdom, and the United States during these periods.

CONCLUSIONS

While the WHHD was originally established to raise awareness of hand hygiene in healthcare facilities, our result suggests that the WHHD and GHD may not have effectively disseminated the importance of hand hygiene to the general public at a country level. Additional policy measures to advocate hand hygiene to the public are necessary to communicate its benefits.

Malaysian Public Interest in Common Medical Problems: A 10-Year Google Trends Analysis

Background

An analysis of internet search has been performed to evaluate the public interest in health problems. Google Trends (GT) serves as a free platform to analyse the search traffic for specific terms in the Google search engine. This observational study aims to investigate the trend of Malaysian population in using the Google search engine on common medical problems and explore the geographical influence on the language used.

Material and method

Fifteen pairs of keywords, in Malay and English language, were chosen after going through forward and backward translation and vetting by a panel of experts. GT data for the selected keywords from 1st of January 2011 to 31st of December 2020 was extracted. Trend analysis was performed using paired t-test between the first half of the decade and the second half of the decade. The different languages used were analysed based on geographical variation using paired t-test.

Results

The public interest on those keywords was markedly increased in the second half of the decade with 29 out of 30 keywords showing statistically significant difference. Majority of the states preferred to use Malay keywords, especially those residing at the East Coast of Peninsular Malaysia.

Conclusion

This observational study illustrates the ability of GT to track healthcare interest among Malaysian population. GT provides a good platform to analyse specific healthcare interest in Malaysian population, but investigators have to bear in mind the geographical influence on the language used.

Online Public Attention of COVID-19 Vaccination in Mainland China

With the approval of the vaccine in mainland China, concerns over its safety and efficacy emerged. Since the Chinese vaccine has been promoted by the Chinese government for months and got emergency approval from the World Health Organization. The Chinese vaccination program is yet to be identified from the perspective of local populations. The COVID-19 vaccine-related keywords for the period from January 2019 to April 2021 were examined and queried from the Baidu search index. The searching popularity, searching trend, demographic distributions and users’ demand were analyzed. The first vaccine enquiry emerged on 25th January 2020, and 17 vaccination keywords were retrieved and with a total BSI value of 13,708,853. The average monthly searching trend growth is 21.05% (p < 0.05) and was led by people aged 20–29 (39.22%) years old. Over 54.93% of the demand term search were pandemic relevant, and the summed vaccine demand ratio was 44.79%. With the rising search population in COVID-19 vaccination, education programs and materials should be designed for teens and people above the 40 s. Also, vaccine-related birth safety should be alerted and further investigated.

Relationship between Dietary Patterns with Benign Prostatic Hyperplasia and Erectile Dysfunction: A Collaborative Review

Interest in the role of dietary patterns has been consistently emerging in recent years due to much research that has documented the impact of metabolism on erectile dysfunction (ED) and/or benign prostatic hyperplasia (BPH). We conducted a non-systematic review of English articles published from 1964 to September 2021. The search terms were: (“dietary patterns” OR “diet”) AND/OR (“erectile dysfunction”) AND/OR (“benign prostatic hyperplasia”). In the present review, we have highlighted how the association between dietary patterns and two of the most frequent pathologies in urology, namely erectile dysfunction and benign prostatic hyperplasia, is present in the literature. The data suggested that a diet that is more adherent to the Mediterranean diet or that emphasizes the presence of vegetables, fruits, nuts, legumes, and fish or other sources of long-chain (n-3) fats, in addition to reduced content of red meat, may have a beneficial role on erectile function. At the same time, the same beneficial effects can be transferred to BPH as a result of the indirect regulatory effects on prostatic growth and smooth muscle tone, thus determining an improvement in symptoms. Certainly, in-depth studies and translational medicine are needed to confirm these encouraging data.

Facing Counterfeit Medications in Sexual Medicine. A Systematic Scoping Review on Social Strategies and Technological Solutions

Introduction

The counterfeit phenomenon is a largely under-reported issue, with potentially large burden for healthcare. The market for counterfeit drugs used in sexual medicine, most notably type 5 phosphodiesterase inhibitors (PDE5i), is rapidly growing.

Aims

To report the health risks associated with the use of counterfeit medications, the reasons driving their use, and the strategies enacted to contain this phenomenon.

Methods

A systematic scoping review of the literature regarding counterfeit PDE5i was carried between January and June 2021, then updated in August 2021.

Main Outcome Measure

We primarily aimed to clarify the main drivers for counterfeit PDE5i use, the health risks associated, and the currently available strategies to fight counterfeiters.

Results

One hundred thirty-one records were considered for the present scoping review. Production of fake PDE5i is highly lucrative and the lacking awareness of the potential health risks makes it a largely exploitable market by counterfeiters. Adulteration with other drugs, microbial contamination and unreliable dosages make counterfeit medications a cause of worry also outside of the sexual medicine scope. Several laboratory techniques have been devised to identify and quantify the presence of other compounds in counterfeit medications. Strategies aimed at improving awareness, providing antitampering packaging and producing non-falsifiable products, such as the orodispersible formulations, are also described.

Clinical implications

Improving our understanding of the PDE5i counterfeit phenomenon can be helpful to promote awareness of this issue and to improve patient care.

Strengths & Limitations

Despite the systematic approach, few clinical studies were retrieved, and data concerning the prevalence of counterfeit PDE5i use is not available on a global scale.

Conclusion

The counterfeit phenomenon is a steadily growing issue, with PDE5i being the most counterfeited medication with potentially large harmful effects on unaware consumers.

Sansone A, Cuzin B, and Jannini EA. Facing Counterfeit Medications in Sexual Medicine. A Systematic Scoping Review on Social Strategies and Technological Solutions. Sex Med 2021;9:100437.

Epidemiologic evolution of common cutaneous infestations and arthropod bites: A Google Trends analysis

Background

Common cutaneous infestations and arthropod bites are not reportable conditions in most countries. Their worldwide epidemiologic evolution and distribution are mostly unknown.

Objective

To explore the evolution and geographic distribution of common cutaneous infestations and arthropod bites through an analysis of Google Trends.

Methods

Search trends from 2004 through March 2021 for common cutaneous infestations and arthropod bites were extracted from Google Trends, quantified, and analyzed.

Results

Time series decomposition showed that total search term volume for pubic lice decreased worldwide over the study period, while the interest for ticks, pediculosis, insect bites, scabies, lice, and bed bugs increased (in increasing order). The interest for bed bugs was more pronounced in the former Union of Soviet Socialist Republics countries, interest for lice in Near East and Middle East countries, and interest for pubic lice in South American countries. Internet searches for bed bugs, insect bites, and ticks exhibited the highest seasonal patterns.

Limitations

Retrospective analysis limits interpretation.

Conclusion

Surveillance systems based on Google Trends may enhance the timeliness of traditional surveillance systems and suggest that, while most cutaneous infestations increase worldwide, pubic lice may be globally declining.

Online Public Attention Toward Premature Ejaculation in Mainland China: Infodemiology Study Using the Baidu Index

BACKGROUND

Premature ejaculation (PE) is one of the most described psychosocial stress and sexual complaints worldwide. Previous investigations have focused predominantly on the prospective identification of cases that meet researchers' specific criteria. The genuine demand from patients with regard to information on PE and related issues may thus be neglected.

OBJECTIVE

This study aims to examine the online search trend and user demand related to PE on a national and regional scale using the dominant major search engine in mainland China.

METHODS

The Baidu Index was queried using the PE-related terms for the period of January 2011 to December 2020. The search volume for each term was recorded to analyze the search trend and demographic distributions. For user interest, the demand and trend data were collected and analyzed.

RESULTS

Of the 36 available PE search keywords, 4 PE searching topics were identified. The Baidu Search Index for each PE topic varied from 46.30% (86,840,487/187,558,154) to 6.40% (12,009,307/187,558,154). The annual percent change (APC) for the complaint topic was 48.80% (P<.001) for 2011 to 2014 and -16.82% (P<.001) for 2014 to 2020. The APC for the inquiry topic was 16.21% (P=.41) for 2011 to 2014 and -11.00% (P<.001) for 2014 to 2020. For the prognosis topic, the annual APC was 11.18% (P<.001) for 2011 to 2017 and -19.86% (P<.001) for 2017 to 2020. For the treatment topic, the annual APC was 14.04% (P<.001) for 2011 to 2016 and -38.83% (P<.001) for 2016 to 2020. The age distribution of those searching for topics related to PE showed that the population aged 20 to 40 years comprised nearly 70% of the total search inquiries (second was 17.95% in the age group younger than 19 years). People from East China made over 50% of the total search queries.

CONCLUSIONS

The fluctuating online popularity of PE searches reflects the real-time population demands. It may help medical professionals better understand population interest, population concerns, regional variations, and gender differences on a nationwide scale and make disease-specific health care policies. The internet search data could be more reliable when the insufficient and lagging registry data are completed.

Impact of the World Antimicrobial Awareness Week on public interest between 2015 and 2020: A Google Trends analysis

OBJECTIVES

To evaluate the impact of the World Antimicrobial Awareness Week (WAAW) on public awareness of antimicrobial resistance using Google Trends analysis.

METHODS

The impact of WAAW on public awareness of 'antimicrobial resistance' (AMR), 'antibacterial', and 'antibiotics' in Japan, the UK, the United States, and worldwide from 2015 to 2020 was analyzed, using the relative search volume (RSV) of Google Trends as a surrogate. A joinpoint regression analysis was performed to identify a statistically significant time point of a change in trend.

RESULTS

No joinpoints around WAAW were identified in Japan, the United Kingdom, or the United States from 2015 to 2020 with RSVs of 'AMR', whereas increasing RSVs were noted worldwide in 2017 and 2020. Further, there were decreasing RSVs of 'antibiotics' in the first half of 2020, which could be due to the COVID-19 pandemic. The study results suggest that WAAW did little to improve public awareness of AMR in the selected countries despite its contribution worldwide.

CONCLUSIONS

This study implies that we need to develop a more effective method to improve public awareness to fight against AMR.

Correlation between Twitter mentions and academic citations in sexual medicine journals

Social media services, especially Twitter, are used as a commonly sharing tool in the scientific world. This widespread use of Twitter would be an effective method in spreading academic publications. So, we aimed to investigate the relationship between Twitter mentions and traditional citations of articles in sexual medicine journals in this study. We reviewed the articles published in seven journals of sexual medicine (2 years after the publication of the articles) between January 2018 and June 2018. In the first half of 2018, 410 articles were extracted. Of these, 352 (85.9%) were original articles, while 58 (14.1%) were review articles. The median number of citations of the articles mentioned at least once on Twitter was 7 (interquartile range: 0-111) for Google Scholar, whereas it was 0 (interquartile range: 0-63) for Scopus, respectively. It was 4 (interquartile range: 0-25) for Google Scholar and 0 (interquartile range: 0-7) for Scopus. The publications mentioned on Twitter were cited more than the non-mentioned publications in the traditional-based citation system (p < 0.001). A significant relationship between the citation numbers and tweet numbers was also observed (p < 0.001). Also, in the linear regression model, the tweet numbers (p < 0.001) and article types (p < 0.001) were found to be related to the Google Scholar citation numbers. In conclusion, using Twitter as a professional tool in academic life would allow information to be propagated and responded quickly, especially for sexual medicine journals.

The impact of asexual trait and porn addiction in a young men healthy cohort

In the present study, we aimed to evaluate the association between asexual trait, erectile dysfunction (ED) and porn addiction in a community sample of young men. Between August 2019 and October 2019, a total of 559 young male adults were subjected to an online survey sponsored by social networks with the aim of assessing their sexual habits. The following questionnaires were administered: The International Index of Erectile Function (IIEF-5), Masturbation Erection index (MEI), Pornography Craving Questionnaire (PCQ) and Asexuality Identification Scale (AIS). The overall rate of ED according to IIEF-5 was 26.0% (165/478), the rate of ED according to MEI was 16.9% (81/478) and the rate ED in patients with AIS ≥23 indicating asexual trait was 10.0% (48/478). We found that IIEF-5 was positively associated with MEI (b = 0.32; p < .01) and negatively with AIS (b = -0.36; p < .01) and MEI was negatively associated with AIS (b = -0.36; p < .01). We found that MEI (odds ratio [OR]: 0.86; p < .01) and IIEF-5 (OR: 0.89; p < .01) were inversely associated with asexual trait. The presence of asexual trait can hide a greater risk of finding ED both in intercourse or masturbation. These results should be taken into consideration during the general assessment of the patient with sexual problems.

Erectile dysfunction and prostate diseases are the predominant Google search terms amongst men's health topics

Patients are becoming increasingly active consumers of health information on the internet with urologic concerns being no exception. Our objective was to explore online search trends for topics related to men's health and identify information-seeking patterns related to news and media coverage of these topics. We used Google Trends ( http://google.com/trends ) to explore search trends for various search terms related to men's health in the United States over a 5-year period. Search queries provided graphs depicting search volume as a function of time, geographical data, and related topics and queries. Isolated spikes in search volume were further explored to identify a related event. Erectile dysfunction was the most-searched topic over the last 5 years in the United States. Prostate cancer and benign prostatic hyperplasia were the second and third most-searched topics, respectively. Other popular topics involved symptoms or pathologies of the testicles and penis. Most topics had relatively stable search volumes, with the exceptions of premature ejaculation and Peyronie's disease. Several observed spikes in search volume were attributable to singular events, mostly in the form of online article publications or social media posts. We believe it may be helpful for providers to stay informed of cultural events relating to medical conditions to anticipate patient concerns.

Penile length and circumference dimensions: A large study in young Italian men

The aim of the present study was to evaluate the size of the penis in flaccidity and in erection of Italian men. A total of 4,685 men living in Italy and who have been visited at the Italian urology operating units were involved in the study between January 2019 and January 2020. Each patient was given details on how to measure their penis (erect length and circumference) in flaccidity and in erection, from the lower base to the distal penile tip. Mean (standard deviation [SD]) flaccid penis length was 9.47 (2.69), mean (SD) flaccid penis circumference was 9.59 (3.08), mean (SD) erect penis length was 16.78 (2.55) and mean (SD) erect penis circumference was 12.03 (3.82). At the linear regression analysis, height was associated with flaccid penis length (β = 0.04; p-value = .01), and erect penis length was (β = 0.05; p-value < .01) and erect penis circumference was (β = 0.06; p-value < .01). Height is proportional to the length of the penis in flaccidity and in erection, and to the circumference in erection. The increase in BMI leads to a reduction in the length of the erect penis, as well as weight gain reduces the length of the flaccid penis.

Impact of the World Inflammatory Bowel Disease Day and Crohn's and Colitis Awareness Week on Population Interest Between 2016 and 2020: Google Trends Analysis

Background

More than 6 million people are affected by inflammatory bowel disease (IBD) globally. The World IBD Day (WID, May 19) and Crohn's and Colitis Awareness Week (CCAW, December 1-7) occur yearly as national health observances to raise public awareness of IBD, but their effects are unclear.

Objective

The aim of this study was to analyze the relationship between WID or CCAW and the public health awareness on IBD represented by the Google search engine query data.

Methods

This study evaluates the impact of WID and CCAW on the public awareness of IBD in the United States and worldwide from 2016 to 2020 by using the relative search volume of "IBD," "ulcerative colitis," and "Crohn's disease" in Google Trends. To identify significant time points of trend changes (joinpoints), we performed joinpoint regression analysis.

Results

No joinpoints were noted around the time of WID or CCAW during the study period in the search results of the United States. Worldwide, joinpoints were noted around WID in 2020 with the search for "IBD" and around CCAW in 2017 and 2019 with the search for "ulcerative colitis." However, the extents of trend changes were modest without statistically significant increases.

Conclusions

These results posed a question that WID and CCAW might not have worked as expected to raise public awareness of IBD. Additional studies are needed to precisely estimate the impact of health observances to raise the awareness of IBD.

The impact of COVID-19 pandemic on pornography habits: a global analysis of Google Trends

As the COVID-19 spread globally, social distancing, self-isolation/quarantine, and national lockdowns have become crucial to control the pandemic. However, these measures may also lead to increases in social isolation, loneliness, and stress, which can alter the consumption of pornography habits. The aim of the study was thus to explore the interest pattern in pornography and coronavirus-themed pornography during the COVID-19 outbreak. Google Trends® was employed to determine the most popular porn websites (Porn, XNXX, PornHub, xVideos, and xHamster), and coronavirus-themed pornography worldwide and in six nations with different COVID-19 outbreak and self-isolation recommendations. We analyzed every search trend on Google® from January 9, 2020 to May 25, 2020 using “joint point regression analysis”. Comparisons of week relative search volume (WRSV) and temporal patterns were analyzed to assess the change of interest in search terms during nations lockdowns. Paired t-test was used to compare WRSV values among the porn websites during the national lockdowns and the equivalent timespan of the weeks in the previous 4 years. The research trend of almost every keyword increased with significant inflection points for those nations with a straight “stay at home orders” (China, Italy, Spain, and France). “PornHub” and “Porn” showed the highest increase of interest worldwide with an average weekend percentage change (AWPC) of 4.9 and 3.8, respectively. The mean WRSV for keywords in USA and Sweden did not show a similar increase as the other nations. The WRSV percentage change with the historical data had a peak during the straight nations’ lockdowns (p < 0.01). All the nations had a significant increase in WRSV coronavirus-themed pornography for each keyword (p < 0.01) with an AWPC, ranging worldwide between 18.5 and 61.8 (p < 0.01), after the beginning of self-quarantine. As strengths this study uses a big data technology to collect worldwide trend of interest, however, data are anonymous and do not allow analysis of subpopulation groups. In conclusion, we demonstrated an increased interest in pornography and coronavirus-themed pornography after the outbreak of COVID-19 in nations with a straight “stay at home orders”.

Online interest in surgical treatment for benign prostatic hyperplasia using Google trends

PURPOSE

Online health information-seeking behavior has increased over the past 15 years; however, little is known about the online interest for surgical treatment of men with benign prostatic hyperplasia. We used Google Trends to evaluate online interest for various surgical procedures for benign prostatic hyperplasia in the US and worldwide.

METHODS

Transurethral resection of the prostate, photoselective vaporization of the prostate, Holmium laser enucleation of the prostate, Urolift, and Rezum were selected as search terms of interest within Google Trends. Google Trends normalizes the popularity of search terms on a 0-100 scale. ANOVA and the average rate of change in popularity scores were conducted from July 2015 to February 2019.

RESULTS

From 2004 to 2019, online interest in transurethral resection of the prostate and photoselective vaporization of the prostate remained stable in the US and worldwide; meanwhile, there was an upward trend for Urolift and Rezum. There was a statistically significant increase in the online interest for Holmium laser enucleation of the prostate in the US and worldwide; however, the mean popularity score was significantly higher worldwide.

CONCLUSIONS

A shift in online interest towards minimally invasive surgical therapies for benign prostatic hyperplasia was demonstrated in the US and worldwide and parallels clinical practice patterns, such as HoLEP and Urolift surgical volumes in Indiana and Australia, respectively. Google Trends can be used in real-time to gauge online interest for surgical procedures and help guide physician-patient counseling.

Low-intensity extracorporeal shockwave therapy among urologist practitioners: how the opinion of urologists changed between 2016 and 2019

Over the past few years, an increase use of low-intensity shockwave therapy (LISWT) for the treatment of erectile dysfunction (ED) has been observed. However, many controversies in the scientific literature about its efficacy still exist. We aimed to investigate changes in the pattern of usage and attitudes toward LISWT for ED among experts over the last years. A dedicated online survey was sent to delegates at the Congress for the EAU Section of Andrological Urology (ESAU) in Prague from 31st October to 1st November 2019. The survey captured demographic data, professional background, and the experience and personal knowledge about LISWT. The results were compared with a previous survey conducted in 2016 and investigating the same topics in order to assess changes in the knowledge and opinion on LISWT over time. Overall, 172 and 192 questionnaires were available from 2019 and 2016, respectively. Participants in the 2019 survey were 80 (45.7%) urologists, 52 (29.7%) uro-andrologists, and 34 (19.4%) residents in urology, from 30 different countries. Compared to the past, we observed an increase of respondents who were familiar with LISWT (75 vs. 95%; p < 0.0001) and who performed LISWT in their routine practice (38% in 2019 vs. 14% in 2016; p < 0.0001). Conversely, no changes in terms of overall perception of treatment efficacy were registered over time (68% in 2019 vs. 72% in 2016 considered LISWT as an effective treatment, respectively (p = 0.5)). An increased proportion of physicians had suggested a wider application of LISWT, and some even advocated its use in nonvasculogenic ED (33% in 2019 vs. 5.9% in 2016; p < 0.0001). The awareness and clinical application of LISWT for ED have increased over time, despite the lack of robust evidence in terms of effectiveness. Further research on the benefit of LISWT is needed to guide physicians in the therapeutic management of ED patients.

Trends in reported male sexual dysfunction over the past decade: an evolving landscape

We investigated changes in patterns of reported male SDs at a single academic centre over a 10-year time frame. Comprehensive data of 2013 patients consecutively assessed for the first time by a single Sexual Medicine expert between 2006 and 2019 has been analysed. All patients were assessed with a thorough sexual and medical history. Primary reason for seeking medical help at first assessment was recorded for all patients and categorized as: erectile dysfunction (ED), premature ejaculation (PE), low/reduced sexual desire/interest (LSD/I), Peyronie's disease (PD), and other SDs. Linear and logistic regression models tested the association between different reasons for seeking medical help and the time at first evaluation. Local polynomial regression model explored the probability of reporting different SDs over the analysed time frame. Median (IQR) age at first clinical assessment was 50 (38-61) years. Overall, most patients were assessed for ED (824; 41%), followed by PD (369; 18%), PE (322; 16%), LSD/I (204; 10%) and other SDs (294; 15%). Significant changes in terms of reported SD over the analysed time frame were observed. The likelihood of assessing patients for ED significantly increased up to 2013, with a decrease in the past 5 years (p < 0.001). PE assessment at presentation linearly decreased over time (OR: 0.94; 95% CI: 0.91-0.96; p < 0.001). Patients assessed during the past few years were more likely to report PD (OR: 1.20; 95% CI: 1.15-1.25; p < 0.001) and LSD/I (OR: 1.21; 95% CI: 1.16-1.26; p < 0.001), with a linear increase over the evaluated time frame. Likewise, patients were also more likely to report other SDs (Coeff: 1.06; 95% CI: 1.02-1.10; p = 0.004), with a linear increase over time. These results may reflect real changes in SD incidence, increased public awareness towards different SDs and the possible impact of novel treatments available on the market throughout the same time frame.