Relationship between pelvic sensations and lifetime exposure to receptive anal intercourse among people with prostates

BACKGROUND

Despite the negative stigma on receptive anal intercourse (RAI), this behavior has a positive influence on individuals' sexual and relationship health. No large studies have previously looked at specific sensations experienced during RAI and how these sensations may change with experience.

AIM

In this study we aimed to quantify commonly reported pelvic sensations during RAI and determine whether their presentation changes with increasing experience of RAI.

METHODS

An internet survey was conducted on sensations felt during RAI among people with prostates from July 2022-January 2023. The survey content was developed based on a mixed-methods qualitative study and inquired about demographic and sexual histories as well as sensations (pleasure, pain, urinary, and bowel) experienced during RAI. We used descriptive statistics to describe demographic and sexual histories. All data were stratified by lifetime exposure to RAI.

OUTCOMES

The primary outcomes assessed included the quantification of both the primary sensations experienced during RAI and the associated bother.

RESULTS

In total, 975 participants completed the survey. The median age was 32 (range 18-78) years. The average age of first participation in RAI was 21 ± 6.6 years. Most respondents were having sex at least once a week (65%). Nine percent of respondents reported fewer than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences. As the number of experiences with RAI increased (from <10 to >500 exposures), the reported frequency of pleasurable sensation increased from 41% to 92% (P < .0001), whereas severe insertional pain and symptoms of bowel urgency decreased from 39% to 13% and from 21% to 6%, respectively (P < .0001). Urinary urgency sensation did not differ by lifetime RAI experience.

CLINICAL IMPLICATIONS

Lifetime RAI exposure can be readily assessed and correlates not only with pelvic sensation but also many other aspects of sexual health. These results imply that the etiology of dissatisfaction with pleasure or anodyspareunia during RAI may differ by lifetime RAI exposure.

STRENGTHS AND LIMITATIONS

This is the first study to our knowledge to assess pelvic sensations experienced during RAI among a large sample of individuals. This is a cross-sectional study, and we cannot conclude how pelvic sensations change over time among individuals. Internet-based participants may not be representative of clinical populations.

CONCLUSION

Lifetime exposure to RAI is positively associated with pleasure and is negatively associated with pain and bowel urgency. Pelvic sensations experienced during RAI appear to be dependent on lifetime RAI exposure history regardless of age.

Anatomic maps of erogenous sensation and pleasure in the penis: are there difference between circumcised and uncircumcised men?

BACKGROUND

The effects of male circumcision on sexual function remain controversial. Heterogeneity across previous studies and low-quality scientific evidence have resulted in poor understanding of the effects of circumcision on erogenous sensation of the penis and orgasm function.

AIM

In this study we sought to describe and assess differences in erogenous genital sensation and reported orgasm function in circumcised compared with uncircumcised men.

METHODS

Adult male subjects who were recruited on a paid anonymous online survey platform were shown illustrations of 12 anatomic regions of the penis. Subjects were prompted to designate regions as pleasurable when touched during partnered sex and to rate each on a 1-10 scale, with higher erogeneity scores correlating with greater pleasure. Subjects were also asked to characterize their orgasms across 6 experiential domains.

OUTCOMES

Outcomes were differences between circumcised and uncircumcised men in the probabilities that regions would be designated as pleasurable, average pleasure scores, and self-reported orgasm parameters.

RESULTS

In total, 227 circumcised (mean [SD] age 46.6 [17.7] years) and 175 uncircumcised men (47.8 [18.1] years) completed the survey. There were no significant differences in average ratings across all regions between circumcised and uncircumcised men. However, significantly more circumcised men reported preferences for the tip of the penis (38% vs 17%, P = .02) and the middle third of the ventral penile shaft (63% vs 48%, P = .04). Additionally, there were no significant differences in orgasm quality and function across all queried domains between circumcised and uncircumcised cohorts.

CLINICAL IMPLICATIONS

Our findings suggest that circumcision does not change how men describe erogenous genital sensation or how they experience orgasm.

STRENGTHS AND LIMITATIONS

In this study we expanded upon existing literature regarding comparison of sexual function in circumcised and uncircumcised men in its scale and investigation of diverse domains. Limitations include the survey format of data collection.

CONCLUSION

We found no differences in reported erogenous ratings or orgasm function between circumcised and uncircumcised men. These findings suggest that male circumcision does not negatively impact penile erogeneity or orgasm function.

Atlas of the receptive anal sex experience among people with prostates

BACKGROUND

Receptive anal intercourse (RAI) is commonly practiced among individuals of all sexual orientations. However, negative stigmatization by society and health care professionals leads to the underreporting or this practice.

AIM

We sought to assess and describe the subjective role of the prostate as a pleasure center in participants with diverse RAI experiences. The secondary aim was to describe nonprostatic areas within the anorectal region that produce erotic sensation and/or pain.

METHODS

The exploratory sequential multimethod study design included focus groups and semistructured interviews with 30 individuals with prostates who had engaged in RAI. We used graphic elicitation of natal male anatomy to enhance visualization and assess participant perspectives.

OUTCOMES

The main outcome of interest was the identification of anatomic locations of erogenous sensation and pain during RAI.

RESULTS

Among the participants (median age 38, range 24-77 years), most participants (90%) identified as cisgender male. Three major themes emerged within the motivations for RAI, including (1) deriving intrinsic pleasure, (2) providing both pleasure for a partner and a way to improve intimacy/connection, and (3) an inability to be the insertive partner due to physical or mental challenges. The data suggest that the anorectal region produces a variety of erogenous sensations which participants find pleasurable. Overall, 2 major areas of erogenous sensation occur along the anterior rectal wall and within the anus. Within the context of RAI, 2 distinct categories of pain emerged, including pain with insertion and pain at other times.

CLINICAL IMPLICATIONS

Understanding where erogenous sensation originates for each individual may predict sexual functioning after various surgical interventions. Timing and location of pain may aid in further characterizing anodyspareunia.

STRENGTHS AND LIMITATIONS

Our study utilized a sequential design (from focus groups to interviews) with diverse RAI experiences, especially regarding age, geographic location, and prostate pathology. We included individuals of diverse gender identities, but too few to evaluate these groups independently from cisgender men.

CONCLUSION

People with prostates experience pleasure in multiple areas during RAI. Contrary to some lay literature, the prostate region is not the subjective pleasure center for all individuals. Timing and location of pain during RAI may inform areas for intervention. Providing a language for pleasure and pain during RAI may improve communication between not only sexual partners but also clinicians and patients.

Multiple courses of intralesional collagenase injections for Peyronie disease: a retrospective analysis

BACKGROUND

In the original clinical trials evaluating intralesional collagenase Clostridium histolyticum for Peyronie disease (PD), treatment protocols were limited to 8 injections.

AIM

We sought to describe our single-center experience with the use of multiple rounds (>8 injections) of intralesional collagenase in patients with PD.

METHODS

We conducted a retrospective analysis of all patients with PD receiving intralesional collagenase injections at our institution from October 2015 through December 2020. Some patients who completed 1 round of treatment elected to undergo additional rounds (16 or 24 injections) based on persistent curvature and presence of penile plaque. Clinical improvement was defined as a 20% reduction in penile curvature from the start of a given round of treatment to the end of that round of treatment. We measured erect penile curvature before and after each round and collected demographics, medical and surgical history, curvature outcomes, and treatment-related adverse events.

OUTCOME

The primary outcome was the reduction in penile curvature after multiple rounds of treatment with intralesional collagenase injections in patients with PD.

RESULTS

A total of 330 patients underwent intralesional collagenase injections for PD, of whom 229 completed at least 8 injections and underwent pre- and posttreatment erect penile goniometry. An overall 42.8% (98/229), 38.6% (22/57), and 12.5% (1/8) of patients achieved clinical improvement after 1 round of therapy (8 injections), 2 rounds (16 injections), and 3 rounds (24 injections), respectively. Mean degree and mean percentage improvement of penile curvature for the start and end of each round of treatment were 8.3° and 16.4% (after 1 round), 7.2° and 16.8% (after 2 rounds), and 3.3° and 8.1% (after 3 rounds). Bruising was the most common complication, with an incidence of at least 50% in each round.

CLINICAL IMPLICATIONS

Knowledge of patient responses to multiple rounds of intralesional collagenase injections may help guide physicians in management and counseling of patients regarding PD treatment options.

STRENGTHS AND LIMITATIONS

This is the first study to evaluate multiple rounds (>8 injections) of intralesional collagenase for PD. Limitations include retrospective analysis and smaller sample size among patients undergoing 3 rounds (24 injections).

CONCLUSION

For patients who did not achieve clinical improvement after 1 round of treatment, an additional round may be beneficial. However, no real improvement was observed for patients undergoing a third round.

Impact of Comprehensive Health Insurance on Quality of Life in Low-Income Hispanic Men with Prostate Cancer

OBJECTIVE

To evaluate the effect of the transition from IMPACT, a disease-focused treatment program, to comprehensive health insurance under Medicaid through the Affordable Care Act (ACA) on general and prostate cancer-specific quality of life (QoL) on a cohort of previously uninsured low-income men. We hypothesize that general QoL would improve and prostate cancer-specific QoL would remain the same after the transition to comprehensive health insurance.

METHODS

We assessed and compared general QoL using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and prostate cancer-specific QoL using the UCLA PCI (Prostate Cancer Index) one year before, at, and one year after the transition between 30 men who transitioned to comprehensive insurance (newly insured/Medicaid group) and 54 men who remained in the prostate cancer program (uninsured/IMPACT group). We assessed the independent effects of Medicaid coverage on QoL outcomes using repeated-measures regression.

RESULTS

Our cohort was composed primarily of Hispanic men (82%). At transition, patient demographics and clinical characteristics were similar between the groups. General and prostate cancer-specific QoL did not differ between the groups and remained stable over time, Radical prostatectomy as primary treatment and shorter time since treatment were associated with worse urinary and sexual function across both groups and over all three time points.

CONCLUSION

Those who transitioned to full-scope insurance and those who remained in the free prostate cancer-focused treatment program had stable general and prostate cancer-specific QoL. High-touch navigation aspects of a disease-focused program may have contributed to stability in outcomes.

Predictive Value of Voiding Efficiency After Active Void Trial in Men Undergoing BPH Surgery

OBJECTIVES

To determine the predictive value of voiding efficiency on acute urinary retention after discharge from BPH surgery.

MATERIALS AND METHODS

We performed a prospective observational cohort study of three surgeons' practices from 2019 to present. All men included underwent trial of void on post-operative day one after transurethral resection of prostate or Holmium enucleation of prostate . Active filling void trials were performed on all patients and voiding efficiency (percent of bladder volume emptied) was calculated. Multivariable logistic regression was performed to determine predictors of developing acute urinary retention.

RESULTS

During the study period, 188 men met inclusion criteria. 110 (59%) men underwent Holmium enucleation of prostate , and 78 (41%) underwent transurethral resection of prostate. The median age of our cohort was 70 (IQR 65-75). The median prostate size was 100g (IQR 61-138g). Nineteen patients (10%) returned after discharge with acute urinary retention requiring catheterization. On post-operative day one, the median voiding efficiency was 75% (IQR 55%-94%). On multivariable analysis, patients with a voiding efficiency less than 50% were 3.8 times more likely (95% confidence interval 1.1-12.8) to develop subsequent retention compared to a voiding efficiency of greater than 75%. Increasing pre-operative prostate size was associated with lower risk of urinary retention after discharge (aOR 0.8, 95%CI 0.6-0.9).

CONCLUSIONS

Voiding efficiency after an active void trial helps stratify risk of urinary retention in patients undergoing benign prostate surgery. High-risk patients include those with voiding efficiencies less than 50% and smaller pre-operative prostate sizes (<80g).

Quality of life in low-income men after surgical castration for metastatic prostate cancer

OBJECTIVE

To compare health-related quality of life in men who underwent surgical vs. medical castration for metastatic prostate cancer.

METHODS

We analyzed data from a prospective cohort of men enrolled in a statewide public health program that provides care for prostate cancer among low-income, uninsured men from 2001 to 2020. Outcome measures included the RAND SF-12 and the UCLA Prostate Cancer Index (PCI) at baseline and every 6 months. We used generalized estimating equations to assess the independent impact of surgical vs. medical castration on health-related quality of life.

RESULTS

Among men with metastatic prostate cancer, 27 underwent orchiectomy, and 274 underwent medical castration. Median cohort age at enrollment was 61.3 years (IQR 56-65); 239 (79%) men had less than a high school education. Average follow-up was 8 months (range 0-45) since study enrollment. Seventy percent of patients within the surgical castration group had their orchiectomy prior to study enrollment (median months since orchiectomy at study enrollment was 9 months, IQR 1-43). Similarly, 59% of patients within the medical castration group had begun ADT prior to study enrollment (median months since ADT initiation at study enrollment was 4 months, IQR 1-12). The majority (66%) had metastatic disease at diagnosis. The 2 groups did not differ in age, race/ethnicity, education, monthly income, baseline PSA, Gleason score, or percent metastatic at diagnosis. SF-12 domains did not differ between those who underwent surgical vs. medical castration (on average throughout follow-up, physical component difference -2.0, 95% CI -8.0-3.9 and mental component difference -1.0, 95% CI -5.4-+3.4). Patients treated with orchiectomy reported better urinary function than those who underwent medical castration (+16 point, 95%CI 5.3-26).

CONCLUSIONS

Surgical castration did not negatively impact general or disease-specific quality of life. The finding of improved urination after orchiectomy merits further inquiry. This may inform urologists' discussion of surgical vs. medical options for men with castration-sensitive metastatic prostate cancer.

Engagement with HIV and COVID-19 prevention: a national cross-sectional analysis of users on a geosocial networking app (Preprint)

Background

Objective

Methods

Results

Conclusions

Initial Clinical Needs Among Transgender and Non-binary Individuals in a Large, Urban Gender Health Program

BACKGROUND

Transgender and gender-diverse individuals are particularly vulnerable to healthcare discrimination and related health sequelae.

OBJECTIVE

To demonstrate diversity in demographics and explore variance in needs at the time of intake among patients seeking care at a large, urban gender health program.

DESIGN

We present summary statistics of patient demographics, medical histories, and gender-affirming care needs stratified by gender identity and sexual orientation.

PARTICIPANTS

We reviewed all intake interviews with individuals seeking care in our gender health program from 2017 to 2020.

MAIN MEASURES

Clients reported all the types of care in which they were interested at the time of intake as their "reason for call" (i.e., establish primary care, hormone management, surgical services, fertility services, behavioral health, or other health concerns).

KEY RESULTS

Of 836 patients analyzed, 350 identified as trans women, 263 as trans men, and 223 as non-binary. The most prevalent sexual identity was straight among trans women (34%) and trans men (38%), whereas most (69%) non-binary individuals identified as pansexual or queer; only 3% of non-binary individuals identified as straight. Over half of patients reported primary care, hormone management, or surgical services as the primary reason for contacting our program. Straight, transgender women were more likely to report surgical services as their primary reason for contacting our program, whereas gay transgender men were more likely to report primary care as their reason.

CONCLUSIONS

Individuals contacting our gender health program to establish care were diverse in sexual orientation and gender-affirming care needs. Care needs varied with both gender identity and sexual orientation, but primary care, hormone management, and surgical services were high priorities across groups. Providers of gender-affirming care should inquire about sexual orientation and detailed treatment priorities, as trans and gender-diverse populations are not uniform in their treatment needs or goals.

Lubrication Practices and Receptive Anal Sex: Implications for STI Transmission and Prevention

Introduction

Implications of lubricant use in men having sex with men (MSM) are poorly characterized, particularly associations with sexual behavior and rectal sexually transmitted infection (STI) risk.

Aim

We sought to clarify covariates associated with lubrication type including differing sexual preferences and rectal STI prevalence.

Methods

Primary English-speaking individuals ≥18 years old visiting San Francisco City Clinic (SFCC) between April and May of 2018 who endorsed lubricant use during receptive anal sex within the last 3 months were studied. Associations between lubrication type used and collected covariates were assessed using Kruskal-Wallis analysis of variance for continuous variables and Chi-squared test for categorical variables. We used logistic regression to examine the association between lubrication type and rectal STI test result.

Main Outcome Measures

Rectal STI test positivity.

Results

From all enrolled participants, 179 completed the survey and endorsed use of a lubricant during receptive anal sex within the last 3 months. Silicone lubricant users had the most sexual partners in the last 3 months (13 [mean] ± 30 [SD], P= .0003) and were most likely to have a history of gonorrhea. Oil-based lubricant users had the most partners with whom they had receptive anal sex in the last 3 months (7 ± 6, P= .03). Water-based lubricant users most commonly used a condom in their last sexual encounter and had the fewest sexual partners in the last 3 months (4 ± 4, P= .0003). Spit/saliva lubricant use was associated with positive rectal STI result.

Conclusion

Silicone and oil-based lubricant users were more likely to report condomless receptive anal sex and to have a history of gonorrhea while spit/saliva lubricant use associated with positive rectal STI acquisition. Lee A, Gaither TW, Langston ME, et al. Lubrication Practices and Receptive Anal Sex: Implications for STI Transmission and Prevention. Sex Med 2021;9:100341.

Cost-Effectiveness of Screening Ultrasound after a First, Febrile Urinary Tract Infection in Children Age 2-24 Months

OBJECTIVE

To estimate the cost-effectiveness of routine, screening renal bladder ultrasound (RBUS) for children age 2-24 months after a first febrile urinary tract infection (UTI), as recommended by the American Academy of Pediatrics.

STUDY DESIGN

We developed a decision analytic model that simulates a population of children after a first febrile UTI. The model incorporates the diagnostic utility of RBUS to detect vesicoureteral reflux and genitourinary anomalies. We adopted a health-system perspective, 5-year horizon, and included 1-way and 2-way sensitivity analyses. Costs were inflated to 2018 US dollars, and our model incorporated a 3% discounting rate. We compared routine RBUS after first, febrile UTI compared with routine RBUS after second UTI (ie, control arm). Our main outcomes were recurrent UTI rate and incremental cost per quality-adjusted life-year (QALY).

RESULTS

Among children 2-24 months after a first febrile UTI, RBUS had an overall accuracy (true positives + true negatives) of 64.4%. The recurrent UTI rate in the intervention arm was 19.9% compared with 21.0% in the control arm. Thus, 91 patients would need to be screened with RBUS to prevent 1 recurrent UTI. RBUS increases QALYs by +0.0002 per patient screened, corresponding to an incremental cost-effectiveness ratio of $803 000/QALY gained. In the RBUS arm, 20.6% of children would receive unnecessary voiding cystourethrograms compared with 12.2% of children in the control group.

CONCLUSIONS

Screening RBUS after a first, febrile UTI in children age 2-24 months does not meet cost-effectiveness guidelines. Our findings support deferred screening until a second UTI.

Social determinants of self-reported pre-exposure prophylaxis use among a national sample of US men who have sex with men

PURPOSE

Various disparities exist in HIV transmission among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) has been shown to decrease the acquisition of HIV, but there is variation in uptake within the MSM population. We aim to characterise PrEP use and correlates of self-reported PrEP use in a large national sample of urban MSM in the USA.

METHODS

Using data from a geosocial-networking application, a national sample (n=3744) from the largest 50 metropolitan centres in the USA was obtained.

RESULTS

We found 18.1% (95% CI 16.8 to 19.3) of profiles reported using PrEP, with decreased reported PrEP use in younger MSM aged 18-24 years (adjusted OR (aOR)=0.5, 95% CI 0.3 to 0.7), obese MSM (aOR=0.5, 95% CI 0.3 to 0.9), black MSM (aOR=0.6, 95% CI 0.4 to 0.9) and MSM in the South (aOR=0.7, 95% CI 0.5 to 0.9).

CONCLUSION

Significant disparities exist in PrEP reporting by age and among black, Southern US and obese MSM. More research is needed to better understand these disparities.

Antimicrobial prophylaxis for urinary tract infections: implications for adherence assessment

BACKGROUND

Continuous antimicrobial prophylaxis (prophylaxis) is associated with a reduction in recurrent urinary tract infections in children with vesicoureteral reflux. However, adherence to daily medications has been shown to be poor.

OBJECTIVE

To determine patient/caregiver factors associated with non-adherence and to determine whether adherence alters the effect of prophylaxis on recurrent UTIs and renal scarring.

STUDY DESIGN

We conducted a secondary analysis of the Randomized Intervention for Children with Vesicoureteral Reflux trial. We stratified adherence scores into quartiles to assess trends within the data. We assessed predictors of non-adherence using ordinal logistic regression. We then examined the efficacy of prophylaxis stratified by adherence quartiles.

RESULTS

Six hundred patients were included in the analysis. The quartiles of adherence were as follows: 1st quartile-0-70% adherence; 2nd quartile-71-91% adherence; 3rd quartile-92-96% adherence; and 4th quartile->96% adherence. Neither demographic factors nor disease severity was associated with non-adherence. In the subanalysis of patients who were toilet trained at baseline, increasing bladder and bowel dysfunction (BBD) symptom score was associated with non-adherence (adjusted odds ratio, aOR = 1.1, 95% confidence interval [CI] 1.0-1.2). Patients least adherent were 2.5 times more likely (95%CI 1.1-5.6) to have a recurrent UTI compared with patients most adherent. After controlling for treatment arm, age, sex, degree of reflux, BBD, and number of UTIs, patients least adherent (taking the study medication less than <70% of the time) were at highest risk for renal scarring (aOR = 24.2, 95%CI 3.0-197). In contrast, among the most adherent quartile, the probability of renal scarring was highest in those assigned prophylaxis (16.2% compared with 1.7% in those most adherent to placebo).

CONCLUSIONS

Adherence is distinctly related to clinical outcomes in children with VUR. Non-adherence is common and represents a distinct clinical entity that is associated with renal scarring. Adherence should be assessed in prophylaxis management algorithms.

Minority Recruitment Trends in Phase III Prostate Cancer Clinical Trials (2003 to 2014): Progress and Critical Areas for Improvement

PURPOSE

American minority groups have been historically underrepresented in phase III prostate cancer clinical trials despite often having higher risk disease. We analyzed enrollment trends of major racial/ethnic groups in the United States in phase III prostate cancer trials between 2003 and 2014 compared to SEER (Surveillance, Epidemiology and End Results) incidence data.

MATERIALS AND METHODS

Phase III prostate cancer trials primarily enrolling patients from the United States were identified in the ClinicalTrials.gov database. Enrollment trends were analyzed for major racial/ethnic groups. Prostate cancer incidence data from the SEER registry were used to identify enrollment targets. The enrollment difference was determined by calculating the absolute difference between the percent of a racial/ethnic subgroup in the SEER registry population and the percent of that subgroup in the phase III prostate cancer trial population.

RESULTS

Among 39 studies identified African American enrollment in therapeutic trials increased across the study period (p <0.001). The enrollment difference for African Americans was -9.0% (95% CI -7.6- -10.5, p <0.001) in 2003 to 2005 and 1.4% (95% CI 0.2-2.6, p = 0.020) in 2012 to 2014. However, African American men were under enrolled in metastatic disease trials (enrollment difference -5.8%, 95% CI -4.8- -6.8, p <0.001). Latino and Asian American men were consistently under enrolled in all trial types.

CONCLUSIONS

Minority groups in the United States were largely under enrolled in phase III prostate cancer trials between 2003 and 2014. While recruitment efforts may have had an impact, as demonstrated by increased enrollment of African American men, there remains a need to expand recruitment efforts to achieve diversity in trials.

Clinical significance of cystoscopic urethral stricture recurrence after anterior urethroplasty: a multi-institution analysis from Trauma and Urologic Reconstructive Network of Surgeons (TURNS)

PURPOSE

To assess the functional Queryoutcome of patients with cystoscopic recurrence of stricture post-urethroplasty and to evaluate the role of cystoscopy as initial screening tool to predict future failure.

METHODS

Cases with cystoscopy data after anterior urethroplasty in a multi-institutional database were retrospectively studied. Based on cystoscopic evaluation, performed within 3-months post-urethroplasty, patients were categorized as small-caliber (SC) stricture recurrence: stricture unable to be passed by standard cystoscope, large-caliber (LC) stricture accommodating a cystoscope, and no recurrence. We assessed the cumulative probability of intervention and the quality of life scores in association with cystoscopic recurrence 1-year post-urethroplasty. Patients with history of hypospadias, perineal urethrostomy, urethral fistula, and meatal pathology were excluded.

RESULTS

From a total of 2630 men in our cohort, 1054 patients met the inclusion criteria: normal (n = 740), LC recurrence (n = 178), and SC recurrence (n = 136) based on the first cystoscopic evaluation performed at median 111 days postoperatively. Median follow-up was 350 days (IQR 121-617) after urethroplasty. Cystoscopic recurrence was significantly associated with secondary interventions (2.7%, 6.2%, 33.8% in normal, LC, and SC groups, respectively). Quality of life variables were not statistically significantly different among the three study groups.

CONCLUSIONS

Many patients with cystoscopic recurrence do not need an intervention after initial urethroplasty. Despite good negative predictive value, cystoscopy alone may be a poor screening test for stricture recurrence defined by patient symptoms and need for secondary interventions.

Predictors of becoming overweight among pediatric patients at risk for urinary tract infections

BACKGROUND

The association between obesity and urinary dysfunction in childhood has been described, albeit through retrospective analysis, making temporal relationships difficult to establish.

OBJECTIVE

The objective of this study was to determine risk factors for significant weight gain in children at risk for recurrent urinary tract infections.

STUDY DESIGN

A secondary analysis of the Randomized Intervention for Children with Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation trials was conducted. The outcome of interest in these children was significant increase in body mass index (BMI) percentile (>85th BMI percentile for sex and age) in previously normal-weight children. Multivariable logistic regression was used to determine the independent effects of predetermined risk factors.

RESULTS

In total, 446 patients were included in the study. Most patients aged less than 1 year at study entry (229, 51%), and 399 (89%) of patients were female. Eighty-four patients (17%) became clinically overweight. Patients assigned to prophylactic antibiotics were not more likely to gain significant BMI percentiles (adjusted odds ratio [aOR] = 1.1, 95% confidence interval [CI]=0.6-1.8). Significant BMI percentiles were gained in Hispanic/Latino patients compared with whites (aOR = 3.3, 95% CI=1.7-6.4), in children who were infants at study enrollment compared with non-infants (aOR = 2.1, 95% CI=1.2-3.8), and in those with persistent reflux during the study period (aOR = 2.1, 95% CI=1.0-4.3). Neither patients assigned to prophylactic antibiotics (aOR = 1.1, 95% CI=0.6-1.8) nor patients with bladder and bowel dysfunction (BBD) (aOR = 1.2, 95% CI=0.6-2.3) were more likely to gain significant BMI percentiles.

DISCUSSION

Significant BMI percentile gain is common in patients at risk for UTIs. Hispanic/Latino ethnicity, persistent reflux, and younger age, specifically infants than non-infants, were identified as independent risk factors for becoming overweight in this population. Exposure to prophylactic antibiotics and BBD were not associated with becoming overweight.

CONCLUSION

Risk for becoming overweight should be discussed when managing patients at risk for UTIs, especially in the subpopulations identified.

Racial distribution of urology workforce in United States in comparison to general population

Background

To compare the current racial/ethnic characteristics of practicing urologists to the U.S. population by American Urological Association (AUA) census geographic region.

Methods

We compared urologist demographics from the 2014 AUA census to U.S. census data. Underrepresented in medicine (URM) status was defined as African-American (AA) or Hispanic race/ethnicity. Percent differences by AUA section were calculated by subtracting weighted frequencies of race/ethnicity for urologists from the general population. A negative percent difference denotes underrepresentation of urologists relative to the general population; positive percent difference denotes overrepresentation.

Results

URM urologists (n=728, 6.5%) were younger and more often female than non-URM counterparts. Overall, AA and Hispanic urologists were underrepresented in most sections while Caucasian and Asian urologists were overrepresented. AA urologists were most underrepresented in the East South-Central section (−34.4%). Hispanic urologists (−38%) were most underrepresented in the Pacific section (−38%). Overall, the percentage of URM urologists, compared to non-URM urologists, were highest in the South Atlantic [37.9% (276/728) vs. 19.2% (1,984/10,319), P<0.01] and West South-Central [15.9% (116/728) vs. 11.1% (1,143/10,319), P<0.01].

Conclusions

URM urologists tend to be younger with a higher proportion of female providers, indicating a shift in race and gender. URM urologists were most underrepresented in the East South-Central and Pacific sections.

Genital burns in the United States: Disproportionate prevalence in the pediatric population

INTRODUCTION AND OBJECTIVES

To describe the epidemiology of genital burns in the U.S. and investigate the underlying etiology.

METHODS

The National Electronic Injury Surveillance System database was queried for individuals who sustained genital burns from 2000 to 2016. We collected data on age, gender, injury diagnosis, disposition, and causative agents. Multivariate analysis was performed to determine predictors of hospitalization.

RESULTS

We estimate 17,026 (95% CI 16,649-17,404) cases of genital burns presented to emergency departments nationally. Genital burns occurred more in males than females (12,295 vs 4,731). Scalding (57.9%) was the most common mechanism of injury and hot water (35.7%) the most common causative agent. Significant predictors of hospitalization on multivariate analysis were multi-surface (OR 4.4), scalding (OR 11.5) and thermal burns (OR 27.9). Children ages 0-2 had the highest prevalence of genital burns, and children ages 0-12 comprised 37.1% of the study. For children <5years of age, majority of the burns were caused by hot water in the bathroom. In age group 6-12, the most common causes of genital burns were cooking-related scalds due to hot foods and water.

CONCLUSIONS

Children sustain genital burns at a higher rate than adults and many appear to have a preventable mechanism. Improved product design for safety and educating caregivers about potential hazardous situations are needed.

Risk Factors for the Development of Bladder and Bowel Dysfunction

BACKGROUND

Patients with vesicoureteral reflux and concomitant bladder and bowel dysfunction (BBD) are at high risk for febrile urinary tract infections. Risk factors for BBD have been identified in retrospective studies without validated measures.

METHODS

We conducted a secondary analysis of the Randomized Intervention for Children with Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation trials. The outcome of interest in the analysis of these children was the development of BBD, defined by using the dysfunctional voiding questionnaire, during any time point in the studies. We used multivariable logistic regression to determine the independent effects of sex, baseline percentile BMI, cohort status (Randomized Intervention for Children with Vesicoureteral Reflux versus Careful Urinary Tract Infection Evaluation), continuous antibiotic prophylaxis (yes or no), and reflux status (dilating versus nondilating) on the development of BBD.

RESULTS

Three hundred and eighteen patients met inclusion criteria. The majority of patients (244 patients, 77%) were not toilet trained at baseline visit. The median baseline age (interquartile range) was 21 months (11-35 months), and 299 (94%) patients were girls. During the study period, 111 (35%) developed BBD. Baseline BMI percentile was not associated with BBD development (adjusted odds ratio [aOR] = 1.0; 95% confidence interval [CI]: 0.9-1.1), whereas female sex was highly associated with BBD development (aOR = 12.7; 95% CI: 1.6-98). Patients with dilating reflux at baseline were 2.1 times more likely to develop BBD (95% CI: 1.2-3.7). Antibiotic prophylaxis was not associated with BBD development (aOR = 0.8; 95% CI: 0.4-1.4).

CONCLUSIONS

Dilating reflux and female sex were identified as risk factors for development of BBD, but neither BMI nor prophylactic antibiotics was associated with the development of BBD.

Prevalence of Pubic Hair Grooming-Related Injuries and Identification of High-Risk Individuals in the United States

Importance

Pubic hair grooming is a common practice that can lead to injury and morbidity.

Objective

To identify demographic and behavioral risk factors associated with pubic hair grooming-related injuries to characterize individuals with high risk of injury and develop recommendations for safe grooming practices.

Design, Setting, and Participants

This cross-sectional study conducted a national survey of noninstitutionalized US adults (aged 18-65 years). The web-based survey was conducted through a probability-based web panel designed to be representative of the US population. Data were collected in January 2014 and analyzed from August 1, 2016, through February 1, 2017.

Main Outcomes and Measures

Grooming-related injury history (yes or no), high-frequency injuries (>5 lifetime injuries), and injury requiring medical attention.

Results

Among the 7570 participants who completed the survey (4198 men [55.5%] and 3372 women [44.5%]; mean (SD) age, 41.9 [18.9] years), 5674 of 7456 (76.1%) reported a history of grooming (66.5% of men and 85.3% of women [weighted percentages]). Grooming-related injury was reported by 1430 groomers (weighted prevalence, 25.6%), with more women sustaining an injury than men (868 [27.1%] vs 562 [23.7%]; P = .01). Laceration was the most common injury sustained (818 [61.2%]), followed by burn (307 [23.0%]) and rashes (163 [12.2%]). Common areas for grooming-related injury for men were the scrotum (378 [67.2%]), penis (196 [34.8%]), and pubis (162 [28.9%]); for women, the pubis (445 [51.3%]), inner thigh (340 [44.9%]), vagina (369 [42.5%]), and perineum (115 [13.2%]). After adjustment for age, duration of grooming, hairiness, instrument used, and grooming frequency, men who removed all their pubic hair 11 times or more during their lifespan had an increased risk for grooming injury (adjusted odds ratio [AOR], 1.97; 95% CI, 1.28-3.01; P = .002) and were prone to repeated high-frequency injuries (AOR, 3.89; 95% CI, 2.01-7.52; P < .001) compared with groomers who did not remove all their pubic hair. Women who removed all their pubic hair 11 times or more had increased odds of injury (AOR, 2.21; 95% CI, 1.53-3.19; P < .001) and high-frequency injuries (AOR, 2.98; 95% CI, 1.78-5.01; P < .001) compared with groomers who do not remove all their pubic hair. In women, waxing decreased the odds of high-frequency injuries (AOR, 0.11; 95% CI, 0.03-0.43; P = .001) compared with nonelectric blades. In total, 79 injuries among 5674 groomers (1.4%) required medical attention.

Conclusions and Relevance

Grooming frequency and degree of grooming (ie, removing all pubic hair) are independent risk factors for injury. The present data may help identify injury-prone groomers and lead to safer grooming practices.

Understanding patients' preferences for surgical management of urethral stricture disease

OBJECTIVES

To understand how prioritization of treatment attributes and treatment choice varies by patient characteristics, we sought to specifically determine how demographic variables affect patient treatment preference.

PATIENTS AND METHODS

Male patients with urethral stricture disease participated in a choice-based conjoint (CBC) analysis exercise evaluating six treatment attributes associated with internal urethrotomy and urethroplasty. Demographic and past symptom data were collected. Stratified analysis of demographic variables, including age, education, income, was conducted using a mixed effect logistic regression model to evaluate the coefficient size and confidence intervals between the treatments attribute preferences of each strata.

RESULTS

169 patients completed the CBC exercise and were included in our analysis. Overall success of the procedure is the most important treatment attribute to patients and this persists across strata. Older patients (≥65) express preferences for better success rates and fewer future procedures, whereas younger patients prefer a less invasive approach and are more willing to accept additional procedures if needed. Patients with lower levels of education preferred open reconstruction and had a stronger preference against multiple future procedures, whereas those with higher levels of education preferred endoscopic treatment and had a less strong preference against multiple future procedures. Low-income individuals express statistically significant stronger negative preferences against high copay costs compared to high-income individuals.

CONCLUSION

These results can help to inform physicians' counseling about surgical management of urethral stricture disease to better align patient preferences with treatment selection and encourage shared decision making.

Characterization of Genital Dissatisfaction in a National Sample of U.S. Men

Male genital satisfaction is an important aspect of psychosocial and sexual health. The Index of Male Genital Image (IMGI) is a new scale that measures perceptions of male genitalia. We aim to characterize genital satisfaction using the IMGI and correlate dissatisfaction with sexual activity. We conducted a nationally representative survey of non-institutionalized adults aged 18-65 years residing in the U.S. In total, 4198 men completed the survey and 3996 (95.2 %) completed the IMGI. Men reported highest satisfaction with the shape of their glans (64 %), lowest satisfaction with the length of their flaccid penis size (27 %), and neutrality with the scent of their genitals (44 %). No demographic characteristics (age, race, sexual orientation, education, location, and income) were significantly associated with genital dissatisfaction. Men who were dissatisfied with their genitals were less likely to report being sexually active (73.5 %) than those who were satisfied (86.3 %). Penetrative vaginal sex (85.2 vs. 89.5 %) and receptive oral intercourse (61.0 vs. 66.2 %) were reported less by dissatisfied men. Overall, most U.S. men were satisfied with their genitals; however, a subset (14 %) report low genital satisfaction, which included men of all ages, races, and socioeconomic groups. Low genital satisfaction is associated with a decrease in sexual activity. These results provide clinicians and health educators a baseline of genital satisfaction to provide education and reassurance.

Gender differences in promotions and scholarly productivity in academic urology

INTRODUCTION

The gender demographics within urology are changing as more women are entering the workforce. Since research productivity strongly influence career advancement, we aim to characterize gender differences in scholarly productivity and promotions in a cohort of graduated academic urologists.

MATERIALS AND METHODS

Urologists who graduated between 2002 and 2008 from 34 residency programs affiliated with the top 50 urology hospitals as ranked in 2009 by U.S. News & World Report were followed longitudinally. Only urologists affiliated with an academic teaching hospital were included for analysis.

RESULTS

A total of 543 residents graduated, 459 (84.5%) males and 84 (15.5%) females. Of these, 173 entered academia, 137 (79.2%) males and 36 (20.8%) females. Women had fewer publications compared to men (mean 19.3 versus 61.7, p = 0.001). Fewer women compared to men were promoted from assistant professor 11 (30.6%) versus 83 (60.6%), p = 0.005. Fewer women achieved associate professor 10 (27.8%) versus 67 (48.9%), p = 0.005 or professor ranks 1 (2.8%) versus 16 (11.7%), p = 0.005 respectively compared to men. In a multivariate logistic regression analysis, after controlling for the number of total publications and number of years since graduation, gender was not predictive of achieving promotion, OR = 0.81 (95% CI 0.31-2.13), p = 0.673.

CONCLUSIONS

Women are underrepresented in senior faculty roles in urology. Scholarly productivity seems to play a major role in academic promotion within urology. With increasing women in academic urology, further studies are needed to explore predictors of promotion and how women can achieve higher leadership roles in the field.

The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis

BACKGROUND

Erectile dysfunction (ED) after treatment for prostate cancer with radiotherapy (RT) is well known, and pooled estimates of ED after RT will provide more accurate patient education.

AIM

To systematically evaluate the natural history of ED in men with previous erectile function after prostate RT and to determine clinical factors associated with ED.

METHODS

We performed a review of the PubMed and Medline, Embase, Cochrane Library, and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports included a measurement of ED before and after prostate RT. Two hundred seventy-eight abstracts were screened and 105 publications met the criteria for inclusion. Only men with known erectile function before RT were included in the analysis.

OUTCOME

ED after RT of the prostate.

RESULTS

In total, 17,057 men underwent brachytherapy (65%), 8,166 men underwent external-beam RT (31%), and 1,046 men underwent both (4%). Seven common instruments were used to measure ED, including 23 different cutoffs for ED. The Sexual Health Inventory for Men (SHIM) was used in 31 studies (30%). Pooled estimates of SHIM-confirmed ED (score <10-17) suggested the prevalence of ED after RT is 34% of men (95% CI = 0.29-0.39) at 1 year and 57% (95% CI = 0.53-0.61) at 5.5 years. Compared with brachytherapy, studies of the two types of radiation increased the proportion of new-onset ED found by 12.3% of studies (95% CI = 2.3-22.4). For every 10% who were lost to follow-up, the proportion of ED reported increased by 2.3% (95% CI = 0.03-4.7).

CLINICAL IMPLICATIONS

ED is common regardless of RT modality and increases during each year of follow-up. Using the SHIM, ED is found in approximately 50% patients at 5 years.

STRENGTHS AND LIMITATIONS

The strengths of this systematic review include strict inclusion criteria of studies that measured baseline erectile function, no evidence for large effect size bias, and a large number of studies, which allow for modeling techniques. However, all data included in this analysis were observational, which leaves the possibility that residual confounding factors increase the rates of ED.

CONCLUSION

Definitions and measurements of ED after RT vary considerably in published series and could account for variability in the prevalence of reported ED. Loss to follow-up in studies could bias the results to overestimate ED. Gaither TW, Awad MA, Osterberg EC, et al. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017;14:1071-1078.

Web-Based Physician Ratings for California Physicians on Probation

Background

 Web-based physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours, and disciplinary records along with ratings and reviews. Whether higher patient ratings are associated with higher quality of care is unclear.

Objective

 The aim of this study was to characterize the impact of physician probation on consumer ratings by comparing website ratings between doctors on probation against matched controls.

Methods

 A retrospective review of data from the Medical Board of California for physicians placed on probation from December 1989 to September 2015 was performed. Violations were categorized into nine types. Nonprobation controls were matched by zip code and specialty with probation cases in a 2:1 ratio using the California Department of Consumer Affairs website. Web-based reviews were recorded from vitals.com, healthgrades.com, and ratemds.com (ratings range from 1-5).

Results

 A total of 410 physicians were placed on probation for 866 violations. The mean (standard deviation [SD]) number of ratings per doctor was 5.2 (7.8) for cases and 4 (6.3) for controls (P=.003). The mean rating for physicians on probation was 3.7 (1.6) compared with 4.0 (1.0) for controls when all three rating websites were pooled (P<.001). Violations for medical documentation, incompetence, prescription negligence, and fraud were found to have statistically significant lower rating scores. Conversely, scores for professionalism, drugs or alcohol, crime, sexual misconduct, and personal illness were similar between cases and controls. In a univariate analysis, probation was found to be associated with lower rating, odds ratio=1.5 (95% CI 1.0-2.2). This association was not significant in a multivariate model when we included age and gender.

Conclusions

 Web-based physician ratings were lower for doctors on probation indicating that patients may perceive a difference. Despite these statistical findings, the absolute difference was quite small. Physician rating websites have utility but are imperfect proxies for competence. Further research on physician Web-based ratings is warranted to understand what they measure and how they are associated with quality.

Pubic Hair Grooming Prevalence and Motivation Among Women in the United States

Importance

Pubic hair grooming is an increasingly prevalent trend. Several studies have sought to characterize its prevalence, associated demographics, and motivations.

Objective

To characterize current pubic hair grooming practices in the United States.

Design, Setting, and Participants

In this cross-sectional study, a nationally representative survey was conducted in January 2013 of noninstitutionalized adults aged 18 to 65 years residing in the United States via the GfK Group (formerly Knowledge Networks) panel members. Data analysis was performed from November to December 2015.

Interventions

A questionnaire examining pubic hair grooming habits.

Main Outcomes and Measures

Demographic characteristics and motivations associated with pubic hair grooming.

Results

A total of 3372 women were surveyed. Fifty-six women did not answer the grooming question; consequently, 3316 women were included in the analysis. Of these women, 2778 (83.8%) reported pubic hair grooming and 538 (16.2%) reported never grooming. On multivariate regression, several factors associated with grooming were found. When compared with younger women (aged 18-24 years), women aged 45 through 55 years (odds ratio [OR], 0.05; 95% CI, 0.01-0.49; P = .01) and those older than 55 years (OR, 0.04; 95% CI, 0.00-0.34; P = .003) were significantly less likely to groom. Women with some college (OR, 3.36; 95% CI, 1.65-6.84; P = .001) or a bachelor's degree (OR, 2.39; 95% CI, 1.17-4.88; P = .02) were more likely to have groomed. Race was also significantly associated with grooming, with all groups reporting less grooming when compared with white women. No association was found between grooming and income, relationship status, or geographic location.

Conclusions and Relevance

This study provides a nationally representative assessment of contemporary female pubic hair grooming habits. Demographic differences in grooming were found, which may reflect cultural variations in preference related to pubic hair. Health care professionals and those who provide grooming services can use this information to better counsel patients and understand grooming practices.

Estimated total costs from non-fatal and fatal bicycle crashes in the USA: 1997–2013

Introduction

Emergency department visits and hospital admissions resulting from adult bicycle trauma have increased dramatically. Annual medical costs and work losses of these incidents last were estimated for 2005 and quality-of-life losses for 2000.

Methods

We estimated costs associated with adult bicycle injuries in the USA using 1997–2013 non-fatal incidence data from the National Electronic Injury Surveillance System with cost estimates from the Consumer Product Safety Commission's Injury Cost Model, and 1999–2013 fatal incidence data from the National Vital Statistics System costed by similar methods.

Results

Approximately 3.8 million non-fatal adult bicycle injuries were reported during the study period and 9839 deaths. In 2010 dollars, estimated adult bicycle injury costs totalled $24.4 billion in 2013. Estimated injury costs per mile bicycled fell from $2.85 in 2001 to $2.35 in 2009. From 1999 to 2013, total estimated costs were $209 billion due to non-fatal bicycle injuries and $28 billion due to fatal injuries. Inflation-free annual costs in the study period increased by 137% for non-fatal injuries and 23% for fatal injuries. The share of non-fatal costs associated with injuries to riders age 45 and older increased by 1.6% (95% CI 1.4% to 1.9%) annually. The proportion of costs due to incidents that occurred on a street or highway steadily increased by 0.8% (95% CI 0.4% to 1.3%) annually.

Conclusions

Inflation-free costs per case associated with non-fatal bicycle injuries are increasing. The growth in costs is especially associated with rising ridership, riders 45 and older, and street/highway crashes.

Management of Pediatric Grade IV Renal Trauma

PURPOSE OF REVIEW

Review the current literature regarding the management of grade IV renal injuries in children.

RECENT FINDINGS

Children are at increased risk for renal trauma compared to adults due to differences in anatomy. Newer grading systems have been proposed and are reviewed. Observation of most grade IV renal injuries is safe. Operative intervention is necessary for the unstable patient to control life-threatening bleeding with either angioembolization or open exploration. Symptomatic urinomas may require percutaneous drainage and/or endoscopic stent placement. Ureteropelvic junction (UPJ) disruption, seen more often in children, requires immediate surgical repair. Grade IV renal injuries in children are increasingly managed in a conservative manner.

Surgical excision of perineal nodular induration: A cyclist's third testicle

Perineal nodular induration (PNI), or biker's nodule, is a rare, bothersome, pseudotumour. Herein, we describe the surgical technique used to treat a healthy cyclist who developed an enlarging PNI for five years that grew into a perineal mass. The mass prevented him from cycling due to worsening discomfort and heaviness. The PNI-associated mass was successfully removed by wide surgical excision and a local advancement flap. Subsequently, the patient resumed cycling. Histopathology report demonstrated a benign lesion with abundant ropy collagen with native smooth muscle, vessels, and rare fibroblast-like spindle cells. With the increasing popularity of cycling, PNI may become more common, and health providers should be aware of this rare entity and how it can be safely removed.

Guidelines of guidelines: a review of urethral stricture evaluation, management, and follow-up

BACKGROUND

Our objective is to report a comparative review of recently released guidelines for the evaluation, management, and follow-up of urethral stricture disease.

METHODS

This is an analysis of the American Urologic Association (AUA) and Société Internationale d'Urologie (SIU) guidelines on urethral stricture. Strength of recommendations is stratified according to letter grade that corresponds to the level of evidence provided by the literature.

RESULTS

Although few, the discrepancies between the recommendations offered by the two guidelines can be best explained by varying interpretations of the literature and available evidence on urethral strictures. When comparing the AUA guidelines and the SIU guidelines on urethral stricture, there are very few discrepancies. Perhaps the most notable difference is in the use of repeat DVIU or urethral dilation after an initial failed attempt. SIU guidelines state that there are instances where repeat DVIU or urethral dilation can be indicated, and they give a range of time at which stricture recurrence post procedure mandates an urethroplasty (less than 3 to 6 months). The AUA guidelines definitively state that repeat endoscopic procedures should not be offered as an alternative to urethroplasty, and they do not mention time of stricture recurrence as a factor. SIU guidelines allow for management of urethral stricture with indwelling urethral stenting.

CONCLUSIONS

Overall there is a need for more high quality research in the work up, management, and follow up care of urethral stricture.

Patient-centered Treatment Decisions for Urethral Stricture: Conjoint Analysis Improves Surgical Decision-making

OBJECTIVE

To determine whether the use of a choice-based conjoint analysis (CA) exercise decreased patients' decisional conflict about treatment preferences for surgical management of urethral stricture disease. Understanding patient preferences for treatment decisions assists in shared decision-making and emphasizes patient-centered outcomes. CA offers a method to understand what risks patients are willing to take for what gains.

METHODS

The CA methodology was used by providing participants with case-based choices to elucidate the relative importance that individuals place on various treatment aspects. Patients' decisional conflict regarding surgery for urethral stricture was assessed before and after the CA exercise to assess the impact the exercise had on their decisional conflict.

RESULTS

Completion of the CA exercise resulted in a significant decrease in decisional conflict (P < .001). The majority (59.5%) of participants with decisional conflict before the CA exercise experienced a decrease in decisional conflict afterwards, with only a minority (16.5%) experiencing new decisional conflict after the exercise. Participants felt the choice-based CA exercise was helpful in deciding what was important in making treatment decisions (70%) and in expressing their priorities and treatment preferences (82%). The number needed to counsel to achieve a decrease in decisional conflict was 1.69 and to achieve no decisional conflict was 3.65.

CONCLUSION

Choice-based CA improves patients' ability to express their treatment preferences and decreases decisional conflict. CA may be a new tool that physicians and patients can use to aid in shared decision-making with a focus on patient-centered outcomes.

Impact of Sexual Orientation Identity on Medical Morbidities in Male-to-Female Transgender Patients

PURPOSE

We aim to describe the relationship between sexual orientation identity and medical morbidities in a large sample of male-to-female (MTF) transgender patients.

METHODS

We reviewed medical records of patients presenting for MTF sex reassignment surgery (SRS) by a single, high-volume surgeon from 2011 to 2015. Sexual attraction to men (heterosexual), women (lesbian), or both (bisexual) was asked of each patient. We examined 16 medical morbidities for this analysis.

RESULTS

During the study period, 330 MTF transgender patients presented for SRS. The average age at the time of surgery was 38.9 (range 18-76). One hundred and one patients (32%) reported being heterosexual, 110 patients (34%) reported being lesbian, and 108 patients (34%) reported being bisexual. Lesbian patients presented for SRS at older ages (mean = 43 years old) compared with heterosexual patients (mean = 36 years old) and bisexual patients (mean = 37), P < 0.01. No differences were found in the majority of coexisting medical morbidities by sexual orientation identity. Lesbian patients had greater odds of having a history of depression, age-adjusted odds ratio (aOR) = 2.36, 95% confidence interval (CI) 1.26-4.40, compared with heterosexual patients. Lesbian patients had higher odds of being married or partnered, aOR = 2.31, 95% CI (1.27-4.19), compared with heterosexual patients. Heterosexual patients had higher odds of having human immunodeficiency virus (HIV), aOR = 9.07, 95% CI (1.08-76.5) compared with lesbian patients.

CONCLUSIONS

Sexual orientation identity in MTF transgender patients is variable. The majority of medical morbidities are not associated with sexual orientation identity. Although HIV and depression are common morbidities among MTF patients seeking SRS, the prevalence of these morbidities differs by sexual orientation identity, but these findings need replication. Counseling and future research initiatives in transgender care should incorporate sexual orientation identity and associated risk behavior.

Correlation between pubic hair grooming and STIs: results from a nationally representative probability sample

OBJECTIVE

STIs are the most common infections among adults. Concurrently, pubic hair grooming is prevalent. Small-scale studies have demonstrated a relationship between pubic hair grooming and STIs. We aim to examine this relationship in a large sample of men and women.

DESIGN

We conducted a probability survey of US residents aged 18-65 years. The survey ascertained self-reported pubic hair grooming practices, sexual behaviours and STI history. We defined extreme grooming as removal of all pubic hair more than 11 times per year and high-frequency grooming as daily/weekly trimming. Cutaneous STIs included herpes, human papillomavirus, syphilis and molluscum. Secretory STIs included gonorrhoea, chlamydia and HIV. We analysed lice separately.

RESULTS

Of 7580 respondents who completed the survey, 74% reported grooming their pubic hair, 66% of men and 84% of women. After adjusting for age and lifetime sexual partners, ever having groomed was positively associated with a history of self-reported STIs (OR 1.8; 95% CI 1.4 to 2.2), including cutaneous STIs (OR 2.6; CI 1.8 to 3.7), secretory STIs (OR 1.7; CI 1.3 to 2.2) and lice (OR 1.9; CI 1.3 to 2.9). These positive associations were stronger for extreme groomers (OR 4.4; CI 2.9 to 6.8) and high-frequency groomers (OR 3.5; CI 2.3 to 5.4) with cutaneous STIs, and for non-extreme groomers (OR 2.0; CI 1.3 to 3.0) and low-frequency groomers (OR 2.0; CI 1.3 to 3.1) with lice.

CONCLUSIONS

Among a representative sample of US residents, pubic hair grooming was positively related to self-reported STI history. Further research is warranted to gain insight into STI risk-reduction strategies.