Browsing by Author "Bernie, Helen"

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    Defining the impact of Peyronie's disease on the psychosocial status of gay men
    (Wiley, 2021-01) Salter, Carolyn A.; Nascimento, Bruno; Terrier, Jean-Etienne; Taniguchi, Hisanori; Bernie, Helen; Miranda, Eduardo; Jenkins, Lawrence; Schofield, Elizabeth; Mulhall, John P.; Urology, School of Medicine
    Background Little sexual health research has been conducted in gay men. Anecdotally, this population seems to experience more bother related to Peyronie's disease (PD). Objectives To examine the impact of PD on psychosocial factors in gay vs straight men. Materials and Methods All PD patients who were seen in the sexual medicine clinic were included. They completed three instruments: the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire, and a depression questionnaire (CES-D). We described demographics and sexual variables by sexual orientation. We then compared PDQ items and summary scores by sexual orientation, using a series of independent samples t tests. Results 34 consecutive gay and 464 straight men were included. Age and baseline characteristics were similar between the two cohorts, with the exception that fewer gay men were partnered (56% vs 87%, P < .01), and those with a partner had a shorter relationship duration: 109 ± 9 months vs 262 ± 175 months, P < .01. For the SEAR questionnaire, gay men demonstrated a more significant psychosocial impact of PD overall with lower SEAR sums (41 vs 57, P = .01) and a lower sexual relationship subdomain score (28 vs 47, P < .01). 41% of gay men vs 26% of straight men had CES-D scores consistent with depression as defined by a score of ≥16 (P = .09). In the PDQ domains, gay men scored less favorably with regard to bother scores (7 vs 5, P = .03) and pain scores (8 vs 4, P = .04). Discussion Gay men with PD experience significantly more psychosocial impact as evidenced by less favorable SEAR sum and sexual relationship scores, CES-D scores, and PDQ pain and bother domain scores. Conclusion The psychosocial impact of PD is significant in all men, but it appears to be greater in gay men.
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    Incidence of Venous Thromboembolism and Hematoma Following Placement of Inflatable Penile Prosthetic: Safety of Perioperative Subcutaneous Heparin
    (2023-07-28) Good, Jacob; Bernie, Helen
    BACKGROUND/OBJECTIVE: Patients undergoing inflatable penile prosthetic (IPP) surgery are at an increased risk for cardiovascular complications such as venous thromboembolism (VTE) following surgery due to pre-existing comorbidities associated with erectile dysfunction. The use of perioperative subcutaneous heparin (SqH) along with a surgical drain has been shown to be effective in preventing VTE in IPP patients, without increasing hematoma formation. Not all prosthetic surgeons utilize surgical drains postoperatively. In this study we aim to assess the safety and efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain. METHODS: This was a retrospective review from January 2021-July 2023 of patients who underwent IPP placement or explant and replacement at a single institution. Patient demographics, comorbidities, Caprini risk factor scores, VTE risk factors, and 90-day post-operative complications, including hematoma formation, were reviewed. Statistical analyses were performed comparing these variables in men who received SqH and those who did not. RESULTS: We reviewed data for 240 patients; 53% (n=127) received perioperative SqH. The incidence of VTE was 0.9% (1/113) in the non-SqH group, and no VTE was recorded in the group receiving SqH. There was no statistical significance in hematoma formation between groups (SqH 5.5% vs. non-SqH 6.2% p=.898). Beyond hypertension prevalence (SqH 74.8% vs. non-SqH 62.8% p=.045), there was no difference between comorbidities or Caprini risk factor scores (SqH 6.79 vs. non-SqH 6.82 p=.474) between groups (Table 1). 94% of the patients in this study were considered high risk for VTE. CONCLUSIONS: Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no increased risk of hematoma formation or post-operative complications between the groups. Perioperative SqH should be considered in all patients undergoing IPP surgery.
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    Perceptions and attitudes toward sexual norms: key insights from the International Society of Sexual Medicine Young Researchers Committee survey
    (Oxford University Press, 2025-05-18) Nascimento, Bruno; Pozzi, Edoardo; Boeri, Luca; Capogrosso, Paolo; Bernie, Helen; Bajic, Petar; Fisher, Alessandra; Garcia-Gomez, Borja; Milekovic, Uros; Salter, Carolyn; Modgil, Vaibhav; Taniguchi, Hisanori; Tenorio, Filipe; Sokolakis, Ioannis; Salonia, Andrea; Urology, School of Medicine
    Background: Sexuality is a complex aspect of human life, and the perception of sexual normality may vary across genders, religious beliefs, and other aspects. Aim: To report preliminary findings of a pilot survey on sexual attitudes, behaviors, and individual perception of sexual normality in a contemporary cross-cultural scenario. Methods: A 48-item survey was developed by the Young Researchers Committee (YRC) on behalf of the International Society for Sexual Medicine (ISSM) to collect data on cross-cultural perceptions and attitudes toward sexual norms. The survey consisted of questions related to sexual attraction, behavior, identity, orientation, and subjective perception of sexual normality. Data were collected via five translated versions across five countries (Italy, United States, Brazil, Spain, and Japan) and analyzed to investigate how cultural norms, personal experiences, and social expectations shape individuals' views on sexual normality. Outcomes: The primary outcome was to assess gender-based differences in sexual behaviors, satisfaction, religious beliefs' impact, pornography use, and anatomical perceptions. Results: This pilot study included 3423 respondents [63.5% female, 36.2% male; median (IQR) age 39 (30.00, 50.00) years]. Of all, active sexual life was reported by 83.3% participants, with 58.8% expressing satisfaction with their sex life. Heterosexual orientation was predominant (90%), with significant differences in distribution between genders in terms of sexual orientation (P < .001). Religious influence on sexual activity was reported by 18.6% of respondents, more commonly among females (20.2% vs 15.8%, P < .001). Median ages of first sexual intercourse and pornography exposure were 18 (16.00, 19.00) and 14 (12.00, 16.00) years, respectively, with females reporting older ages for both experiences (P < .001). Regarding perceptions of normality, most respondents (55.6%) believed first sexual intercourse typically occurs between 16 and 19 years. The perception of normal erect penile length differed between genders, with men more likely to report greater values (>16.1 cm: 13.1% vs 6.2%, P < .01). Gender differences were also observed in orgasm frequency, with fewer females reporting orgasm during >80% of sexual encounters (38.2% vs 66.5%, P < .001). Clinical implications: Our findings shape the development of sexual education, fostering inclusivity, equity, and sexual health for overall satisfaction. Strengths and limitations: Possible biases associated with different modalities throughout data collections and with different linguistic and cultural weights given the cross-sectional nature of the pilot survey. Conclusion: Current preliminary findings from the pilot survey developed by the ISSM YRC start shedding lights on perceptions and attitudes toward sexual norms, and gender differences in sexual behaviors and satisfaction.
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    The Utilization and Impact of Aromatase Inhibitor Therapy in Men With Elevated Estradiol Levels on Testosterone Therapy
    (Oxford University Press, 2021) Punjani, Nahid; Bernie, Helen; Salter, Carolyn; Flores, Jose; Benfante, Nicole; Mulhall, John P.; Urology, School of Medicine
    Introduction: Testosterone therapy (TTH) for testosterone deficiency (TD) may lead to elevated estradiol (E2) levels requiring management to avoid unnecessary adverse effects. Aim: To examine the impact of aromatase inhibitors, specifically anastrozole (AZ), in men with elevated E2 on TTH. Methods: All patients on TTH at a high volume sexual medicine practice between 2005 and 2019 were reviewed. Men with E2 levels >60 pg/mL regardless of symptoms or 40–60 pg/mL with subjective symptoms were started on AZ 0.5 mg 3x/week. Routine hormone profile and symptom assessment were completed to ensure symptom resolution, reduction of E2 levels and maintenance of testosterone levels. Multivariable logistic regression was completed to determine predictors of men more likely to respond to therapy. Main Outcome Measure: Demographic and hormonal profiles of men on AZ and predictors of response to therapy. Results: 1708 men with TD were placed on TTH. Of these, 51 (3%) were treated with AZ (AZ+). After exclusions, 44 (2.6%) had elevated estradiol levels >60 pg/mL or >40 pg/mL with symptoms. Demographics were similar between groups. TTH distribution between groups was different with greater rates of topical TTH in the AZ- groups (AZ+:34.1% vs AZ-:53.5%) and greater rates of intramuscular TTH in the AZ+ group (AZ+:38.6% vs AZ-:18.5%) (P = .017 overall). Of the 44 men treated with AZ, 68.0% had pre-AZ E2 levels ≥60 pg/mL and 32.0% had levels between 40 and 60 pg/mL. Median pre-AZ E2 levels were 65 (interquartile range [IQR], 55–94) pg/mL in comparison to 22 (IQR 15–38) pg/mL post-AZ E2 levels (P < .001). Total testosterone levels were similar before and after AZ use (616 (IQR 548–846) ng/dL and 596 (IQR 419–798) ng/dL, respectively, P = .926). No statistically significant predictive factors of E2 reduction using AZ were found. Conclusion: While no statistically significant predictors for E2 recovery in men on AZ were found, AZ remains a reasonable option for E2 reduction in men with elevated levels on TTH.