Chronic inflammation has been linked to oncogenesis, including in prostate cancer (PCa). Tumor Necrosis Factor (TNF) has been implicated in many of these chronic inflammatory pathways. We assessed urologic malignancy risk in patients with long-term exposure to TNF inhibitors (TNF-I). Retrospective non-matched cohort study of patients with chronic inflammatory conditions from 1996 to 2023. TNF-I exposure was identified using medications. The unmatched control cohort consisted of TNF-I-unexposed patients with the same chronic inflammatory conditions. Urologic malignancies identified using ICD-10 codes and manual chart review. Inverse Probability of Treatment Weighting was used to balance distributions across exposure groups. Hazard ratios (HR) were estimated using multivariable regression followed by logistic regression for relative risk (RR) on sub-analysis. There were 13,377 patients with TNF-I exposure and 42,832 patients without TNF-I exposure. TNF-I exposure was negatively associated with PCa (HR 0.50, 95

Over the last two decades, tumor necrosis factor-alpha inhibitors (TNF-Is) have become standard therapies for chronic inflammatory disorders, with an ongoing expansion of indications and off-label applications [...]

Background:There is limited research about the prevalence of receptive anal intercourse (RAI), erogeneity and sexual pleasure within the zones of the rectum. Aim:We describe the experience of RAI within a large and diverse population in an online convenience survey, to map zones of erogenous sensation within the rectum, and to assess orgasm function among individuals who practice RAI. Methods:Adult subjects were recruited from an online survey platform and were queried about their history of RAI. Those who endorsed RAI were shown illustrations of the rectum divided into four non-overlapping anatomic regions. Subjects designated regions where they experienced pleasure when touched during RAI. Subjects were also asked about their ability to achieve orgasm from RAI alone or if they required co-stimulation of additional regions. Demographics were collected, and differences were analyzed based on gender, age, and sexual orientation identity. Outcomes:Outcomes include mapped erogeneity of the rectum among men and women and self-reported experiences with RAI, including orgasm function related to RAI among cisgender adults. Results:A total of 466 cisgender men (mean age ± SD, 46.3 ± 17.5 years) and 498 cisgender women (48.1 ± 16.0 years) completed the questionnaire. Women were significantly more likely to endorse prior RAI, as compared to men (34% vs 24%, P < .01). Men were significantly more likely to endorse achieving orgasm from RAI alone, as compared to women (39% vs 19%, P < .05). Gay men and women were more likely to have participated in RAI. The superficial anterior rectum was the most frequently selected region by both men and women as a site of pleasure when touched during RAI. Clinical Implications:The results of this study will highlight preferred zones of erogeneity in the rectum, which could be impacted by surgeries or pathology in these areas. Strengths and Limitations:This study captured a comprehensive assessment of erogenous sensation within the rectum among a large sample. Limitations include the use of a online subjects for data collection, which can result in both response and selection bias. Conclusion:Our findings show that RAI is practiced by many adults across ages, gender, and sexual orientation identities. Both men and women report pleasure from various areas within the rectum, primarily the superficial regions of the rectum. These findings may prove helpful in elucidating practices of RAI. Additionally, understanding erogeneity in the rectum may allow providers to better predict changes due to pathology and treatments of or surrounding these areas.

Introduction:We aim to evaluate the perioperative, oncologic, and survival outcomes of RARP in kidney transplant recipients (KTRs) and compare to propensity-matched controls. Patients and Methods:This was a single-institution retrospective cohort study using the Northwestern Enterprise Data Warehouse. We identified eight KTRs who underwent RARP from January 2018-September 2024 and propensity matched them 1:4 with non-KTR controls using age, body mass index, and pathologic Gleason score. Outcomes were assessed using Wilcoxon rank sum and Fisher's exact tests. Overall survival was analysed using Kaplan-Meier and univariable Cox proportional hazards models. Results:All RARPs in KTRs were completed robotically. Median time from kidney transplant to RARP was 11.1 years (8.9-15.1). KTRs had higher Charlson Comorbidity Index (9.5 vs 4; p < 0.001) but similar operative time (198.5 vs 201; p = 0.8), estimated blood loss (125 vs 90 ml; p = 0.7), and length of hospital stay (1 midnight in both; p = 0.2). KTRs experienced no major complications, graft injuries, episodes of acute kidney injury, or 90-day readmissions. The 30-day urinary tract infection rate was higher in KTRs (25% vs 0%; p = 0.036), who had a median catheterization duration of 11 days (8-12.5). Surgical margin positivity (29% vs 19%, p = 0.6) and biochemical recurrence rates (13% vs 6.3%, p = 0.5) did not differ. Median follow-up time was 3.2 years in KTRs vs 1.7 years in controls (p = 0.13). Allograft function remained stable at 12 months. One KTR died from renal failure 44 months after RARP; none developed metastases or died of PCa. Conclusion:RARP in kidney transplant recipients is feasible and safe for experienced surgeons, with comparable surgical and oncologic outcomes as compared to matched controls. Higher UTI rates suggest modified catheter removal strategies could be considered.

Prolonging the lifespan of transplanted organs is critical to combat the shortage of this life‐saving resource. Chronic rejection, with irreversible demise of the allograft, is often caused by the development of donor‐specific HLA antibodies. Currently, enumerating molecular (amino acid) mismatches between recipient and donor is promoted to identify patients at higher risk of developing HLA antibodies, for use in organ allocation, and immunosuppression‐minimization strategies. We have counseled against the incorporation of such approaches into clinical use and hypothesized that not all molecular mismatches equally contribute to generation of donor‐specific immune responses. Herein, we document statistical shortcomings in previous study design: for example, use of individuals who lack the ability to generate donor‐specific‐antibodies (HLA identical) as part of the negative cohort. We provide experimental evidence, using CRISPR‐Cas9‐edited cells, to rebut the claim that the HLAMatchmaker eplets represent “functional epitopes.” We further used unique sub‐cohorts of patients, those receiving an allograft with two HLA‐DQ mismatches yet developing antibodies only to one mismatch (2MM1DSA), to interrogate differential immunogenicity. Our results demonstrate that mismatches of DQα05‐heterodimers exhibit the highest immunogenicity. Additionally, we demonstrate that the DQα chain critically contributes to the overall qualities of DQ molecules. Lastly, our data proposes that an augmented risk to develop donor‐specific HLA‐DQ antibodies is dependent on qualitative (evolutionary and functional) divergence between recipient and donor, rather than the mere number of molecular mismatches. Overall, we propose an immunological mechanistic rationale to explain differential HLA‐DQ immunogenicity, with potential ramifications for other pathological processes such as autoimmunity and infections.

Abstract Introduction Sexual satisfaction is an important contributor to quality of life. While it has been documented that cisgender men tend to experience greater sexual satisfaction than cisgender women, there is limited research into the nuanced factors that contribute to sexual satisfaction, such as self- versus partner-centered focuses, and differences that exist between sexual orientation groups. Objective The aim of this study is to assess for differences in sexual satisfaction that exist between cisgender men (CM) versus cisgender women (CW) and between sexual orientation subgroups using a validated sexual satisfaction survey. Methods An anonymous, online questionnaire was administered via Qualtrics as part of a larger study on sexual function and pleasure sensation. In addition to providing demographic information, respondents completed the New Sexual Satisfaction Scale (NSSS)- a validated 20-item psychometric scale that assesses sexual satisfaction in the past 6-months across two 10-item subscales: the ego-centered subscale and the partner/sexual activity-centered subscale. Each respondent’s 5-point Likert scale for their NSSS was summated across all 20-items (range: 20-100), with higher sum totals indicating greater reported sexual satisfaction. Statistical analyses were completed via Qualtrics Stats iQ software utilizing ANOVA and chi-square tests, with p<0.05 indicating statistical significance. Results A total of 305 CM and 288 CW were recruited through Qualtrics and completed the NSSS. (Table 1) CM were significantly more likely to report greater total sexual satisfaction than CW, with mean ± SD NSSS scores (out of 100) of 74.5 ± 16.7 and 68.5 ± 19.7, respectively (p<0.0001). With respect to individual measures of the NSSS, CM were significantly more likely to report satisfaction across 14/20 measures (all p<0.05): “My focus/concentration during sexual activity;” “My emotional opening up during sex;” “The frequency of my orgasms;” “The quality of my orgasms;” “My ability to let go and focus on my own pleasure during sex;” “The balance between what I give and receive in sex;” “ “My mood after sexual activity;” “The intensity of my sexual arousal;” “My body’s ability to perform sexually in a satisfactory way;” “The variety of my sexual activities;” “The way I sexually react to my partner;” “My partner’s emotional availability during sex;” “The pleasure I provide my partner;” and “My partner’s ability to satisfy my sexual needs”. There was no statistically significant difference in total NSSS score between sexual orientation groups of CM and CW (p>0.05). (Figure 1). Conclusions CM reported significantly greater sexual satisfaction than CW. Notably, CM reported greater satisfaction in 10/10 ego-centered subscale measures relating to their personal pleasure and 4/10 partner/activity-centered subscale measures relating to their perception of their partner during sex. On the otherhand, there was no significant difference in sexual satisfaction between sexual orientation groups. These findings highlight the nuanced differences that exist within the spheres of personal sexual pleasure, with CM experiencing greater ego-centered pleasure. These findings highlight how a variety of self- and partner-centered nuances ultimately contribute to differences in overall sexual pleasure between CM and CW. Disclosure No.

Abstract Introduction Menopause has been associated with a myriad of genitourinary and sexual function symptoms that revolve around changes to the vulva and vagina. The medical literature at present primarily assesses genitourinary syndromes of menopause, with limited focus on how these physiological changes to the vulva and vagina may impact sexual function and satisfaction. Objective To describe differences that exist between pre- versus postmenopausal women in erogenous sensation zone (ESZ) maps of the vulva and measured satisfaction with partnered sex. Methods Sexually active cisgender women were recruited via Qualtrics and completed an anonymous, online questionnaire. Respondents viewed anatomic illustrations of the vulva with nine predefined areas and were instructed to select structures that bring them pleasure when touched during sex with a partner. A map of erogenous sensation of the vulva was then created based on the number of respondents selecting each structure. Respondents also completed the New Sexual Satisfaction Scale (NSSS), a 20-item psychometric survey that assesses sexual satisfaction with partnered sex on a 5-point Likert scale, with potential scores ranging from 20 (minimal sexual satisfaction) to 100 (maximum sexual satisfaction). Results Pre- and postmenopausal women were equally as likely to select at least one ESZ of the vulva (77% premenopausal women vs 81% postmenopausal women, p=0.4). The vaginal introitus, peri urethra, and clitoris were the three most frequently selected structures out of the nine ESZs of the vulva out of all respondents (Figure 1). Assessment for differences in selection between pre- and postmenopausal women for each structure revealed that significantly more premenopausal women selected the clitoris as erogenous (43% vs 32%, p<0.03). There was no statistically significant difference in the other vulvar ESZs. With respect to partnered sexual satisfaction (as measured by the NSSS), there was no statistically significant difference between groups. Premenopausal women reported an average NSSS score of 69 out of 100 and postmenopausal women 67 out of 100 (p=0.3). Conclusions While premenopausal women were significantly more likely to report the clitoris as erogenous as compared to postmenopausal women, there was no significant difference between groups in erogenous mapping of the eight other vulvar structures. This finding of reduced clitoral erogeneity is supported by the phenomenon of vulvovaginal atrophy, which is associated with the reduction in estrogen and other sex steroids that occurs during menopause. While menopause has been associated with sexual dysfunction, we found no statistically significant difference in self-reported satisfaction with partnered sexual activities. Disclosure No.

Abstract Introduction Erogenous zones (EZ) of the body elicit feelings of sexual arousal in response to tactile stimulation. While previous studies have defined general whole-body maps and detailed maps of the genitalia, there is limited data that defines extragenital structures and compares findings between cisgender men (CM) and cisgender women (CW). Objective This study aims to describe EZs of the head and neck, and to describe differences in EZs that exist between CM and CW. Methods A total of 403 CM and 451 CW (mean age 47.2 ± 16.8 and 48.9 ± 15.5y respectively, p>0.05) were recruited and administered an anonymous, online questionnaire via Qualtrics. Standardized anatomic illustrations with 11 predefined areas of the head and neck were presented to respondents, who were instructed to select which structure(s) bring them pleasure when touched during sex. For each EZ selected, the respondent was asked to rate its importance to their sexual pleasure on a 10-point Likert scale, from “1-not at all important” to “10-extremely important.” Differences in frequency of selection and importance ratings were analyzed via Qualtrics Stats iQ software using Fisher’s exact test and t-tests, with p>0.05 indicating statistical significance. Results Of the 11 head and neck EZs, the tongue, neck, ear, and lips were the most frequently selected structures (Figure 1). A comparison between CM and CW revealed that CM were significantly more likely to indicate erogeneity of the tongue (51.4% vs 41.3%, p<0.05) and nose (5.2% vs 2.0%, p<0.02). CW were more likely to indicate the posterior neck as erogenous (40.1% vs 30.3%, p<0.01). Statistically significant differences in ratings revealed that CM were more likely to indicate higher levels of importance to sexual pleasure of the cheek (6.3 ± x vs. 5.1 ±, p<0.03) and forehead (5.3 vs. 2.8, p<0.001). Conclusions EZs of the head and neck were centralized around the mouth, neck, and ears. CM were more likely to select structures around the mouth while CW selected the anterior and posterior neck. While some statistically significant differences were found in EZs between CM and CW, the majority of similarly selected and rated EZs indicate a pattern of comparable overall distributions of extragenital EZs. Findings from this study highlight the presence of extragenital erogeneity, and the importance of prioritizing the preservation of tactile sensation in head and neck surgeries (or communicating these risks to patients during preop consultations). These EZ maps may furthermore be used in future studies to compare pre- versus postoperative changes in erogenous sensation amongst patients who undergo head and neck surgery. Disclosure No.

Abstract Introduction Despite the prevalence, relevance, and impact of menopause on people with ovaries, there is a paucity of research on its impact on sexual function and satisfaction. While an association between menopause and sexual dysfunction has been found, no studies assessed objective parameters of orgasm function and many utilized sexual satisfaction surveys that did not include participants’ perceptions of their sexual partner(s). Objective This study aimed to assess differences between pre- versus postmenopausal cisgender women using a six-parameter inventory of orgasm function and a validated sexual satisfaction psychometric scale, using both ego-centered and partner-centered measures. Methods Respondents were recruited and administered an anonymous, online questionnaire via Qualtrics as part of a larger study on sexual function and erogenous sensation. The questionnaire queried demographic information, menopause status, and six parameters of orgasm function under the controlled scenario of solo masturbation. Satisfaction with sexual activity with a partner was measured by the validated New Sexual Satisfaction Scale (NSSS), a 20-item psychometric survey that measures sexual satisfaction in the past six months across two subscales: the ego-centered and partner-/activity-centered subscale. The 5-point Likert scales for all 20 questions were summated, for a total possible score of 20 (minimum sexual satisfaction) to 100 (maximum sexual satisfaction). Statistical analyses were completed using Qualtrics Stats iQ, utilizing ANOVA and chi-square tests. Results A total of 283 cisgender women completed the study questionnaire. Premenopausal women were significantly more likely to report a higher average frequency of engaging in sexual activities with a partner and solo masturbation (Table 1). Of the six orgasm parameters (Table 2), the only statistically significant difference existed in the experience of orgasm as peaks, with more postmenopausal women reporting a multi-peaked orgasm versus a single-peak orgasm. The average NSSS score amongst all cisgender women in our sample was 68±20, and there was no statistically significant difference (p<0.8) between pre- versus postmenopausal cisgender women. Of the 20 questions within the NSSS, there was no statistically significant difference in 10/10 and 9/10 of the partner-centered NSSS subscale questions between the two groups. The only statistically significant difference between groups was premenopausal women reported higher satisfaction with the partner-centered measure of “The way I sexually react to my partner” (p<0.05). Conclusions Contrary to the medical literature, we found no significant difference in total sexual satisfaction between pre- versus postmenopausal cisgender women, as measured by the validated NSSS. Moreover, there was no significant difference in 5/6 of the orgasm parameter measurements. While sexual satisfaction is intrinsically linked to sexual function, it is important to note that self-perception of partner and activities may also play an important role in shaping an individual’s pleasure during sex. These findings highlight the importance of considering these nuances when assessing sexual satisfaction and may help to better inform the sexual function/satisfaction expectations of cisgender women as they approach menopause. Disclosure No.

Abstract Introduction Erogenous sensation zones (ESZs) of the body elicit sexual arousal in response to touch. Prior studies have established general maps of external ESZs, but they did not assess internal surfaces or focus on individual structures of the genitalia. Objective To develop a topographic map of the ESZs of the vulva and vagina. Methods A sample of n=451 sexually active cisgender women (mean age 48.9 ± 15.5 years) were administered an anonymous, online questionnaire via Qualtrics. Respondents selected predefined areas from anatomic illustrations of the vulva and vagina that bring them pleasure when touched during sex. Respondents then rated the importance of each zone to their sexual pleasure on a 10-point Likert scale. Results More respondents selected at least one area of the vulva as an ESZ (82%), as compared to the vagina (59.4%). Of the vulva (Figure 1), the clitoris, peri urethra, and vaginal introitus were the three most frequently selected and highest rated structures. The five ESZs of the vagina (Figure 2) revealed a preference for the superficial anterior region of the vaginal canal. The cervix and posterior areas were selected and rated lower than the superficial aspects. Conclusions The vulva and vagina were associated with enhanced erogenous sensation not only at (but also in regions immediately peripheral to) the clitoris. These ESZs were also rated as "highly important" to sexual pleasure. Notwithstanding these trends, the wide range of selection-frequency and pleasure-importance ratings emphasizes the subjective and varying experience of sexual arousal between individuals. These ESZ maps may enhance patient education, particularly among individuals who suffer from sexual dysfunction or other factors that lend to diminished sexual arousal. Disclosure No.

Abstract Introduction Masturbation has been associated with a number of health and quality of life benefits, including improved self-esteem, sexual agency, and stress relief. While prior studies have asserted an association between solo masturbation and satisfaction with partnered sex, there is a paucity of literature that assesses specific parameters of masturbatory orgasm function and their potential association with sexual satisfaction. Objective This study aims to explore the association between satisfaction with partnered sex and six parameters of masturbatory orgasm function/satisfaction. Methods Respondents were recruited via Qualtrics and completed an anonymous, online questionnaire that assessed sexual satisfaction, based on the New Sexual Satisfaction Scale (NSSS)–a validated, 20-item survey. NSSS scores were calculated by summing the possible 5-point Likert scale ratings across all 20 questions, with a higher NSSS score indicating greater satisfaction with partnered sex. Respondents also completed questions that queried frequency of masturbation and partnered-sexual activity, as well as six parameters of orgasm function measured under the condition of solo-masturbation: lead time to orgasm, duration of orgasm, refractory period between orgasms, location of orgasm experience, experience of orgasm, and satisfaction with orgasm. Statistical analyses were completed using Qualtrics Stats iQ software to assess for an association between NSSS score and the aforementioned variables. Results A sample of n=178 sexually active cisgender women (mean age = 43.6±14.9 years) completed the study survey. Cisgender women who reported higher NSSS scores were significantly more likely to endorse engaging in partnered sexual activities on a more frequent basis (p<0.05), but there was no statistically significant relationship between NSSS score and frequency of solo-masturbation (p=0.2). A statistically significant relationship existed between NSSS score and 2/6 of the masturbatory orgasm parameters assessed (Figure 1). Cisgender women with higher partnered sexual satisfaction scores reported significantly longer duration of masturbatory orgasm and higher satisfaction with orgasm during masturbation (both p<0.01). There were otherwise no significant associations between NSSS score and lead-time to orgasm, refractory period between orgasms, experience of orgasm as single vs. multiple peaks, or bodily location of orgasm experience under the condition of masturbation. Conclusions Cisgender women who reported more frequent partnered sexual activity, as well as a longer duration of masturbatory orgasm time and higher satisfaction with orgasm from masturbation, reported significantly greater partnered sexual satisfaction. This association between satisfaction with solo masturbation and satisfaction with partnered sexual activity supports leading theories of masturbation improving body knowledge, self-confidence, and sexual agency. Findings also highlight how variability in orgasm function does not always result in differences in sexual satisfaction, which is more so associated with self-perceived orgasm satisfaction. Disclosure No.

Abstract Introduction Erogenous sensation zones (ESZs) elicit feelings of sexual arousal in response to touch. Prior research has generated whole-body erogenous sensation maps, but they do not differentiate between individual anatomical structures or assess for erogenous sensation of internal surfaces of the body, such as the vagina and anal canal. There is an even greater paucity of literature on the ability to orgasm from vaginal and anal receptive intercourse. Objective To describe detailed maps of erogenous sensation of the vagina and anal canal amongst cisgender women, and assess for ability to orgasm from receptive intercourse. Methods Respondents were recruited via Qualtrics and completed an anonymous, online questionnaire. They were instructed to indicate ESZs by selecting from predefined areas that bring them pleasure when touched during sex with a partner from anatomic illustrations of the vagina and anal canal. Respondents were also queried on their ability to orgasm from receptive vaginal and anal intercourse. All statistical analyses were completed using Qualtrics Stats iQ software, with p<0.05 indicating statistical significance. ESZ maps were generated based on the proportion of respondents selecting each anatomical structure as erogenous. Results A sample of 441 sexually active cisgender women completed the study survey (mean age 48.9±15.6y). Of the five ESZs of the vagina (Figure 1), the superficial anterior (selected by 48% respondents) and superficial posterior (33%) regions were the most frequently selected areas. The four ESZs of the anal canal further revealed greater erogeneity at the superficial anterior (18%) and superficial posterior (11%) walls (Figure 2). With respect to ability to orgasm from receptive intercourse, 35% of cisgender women reported being able to orgasm from vaginal penetration alone while 45% required simultaneous costimulation of another body part and 10% reported an inability to orgasm during receptive vaginal intercourse, regardless of costimulation (Figure 3a). Additionally, 19% of cisgender women reported an ability to orgasm from receptive anal intercourse alone, while 50% required costimulation and 31% reported an inability to orgasm during receptive anal intercourse, regardless of costimulation (Figure 3b). Conclusions Erogenous sensation of the vagina and anal canal is primarily localized to the superficial walls of both structures, with a greater preference for the superficial anterior zones. These findings support the proposed location of the “G-spot” existing proximal to Skene’s glands in the anterior portion of the vaginal canal. Results from this study further highlight the importance of costimulation in achieving orgasm during receptive vaginal and anal intercourse, with only a minority of respondents reporting an ability to orgasm from vaginal or anal penetration alone. Disclosure No.

Abstract Introduction As the average life expectancy increases, so does the need to improve older adults’ quality of life. Sexual function and satisfaction have been intimately tied to well-being, and older age has been associated with a decline in sexual activity, sexual function, and desire. However, there is limited research that focuses on the association between age and specific measurements of sexual function, such as orgasm parameters, frequency of sexual activity, and sexual satisfaction. Objective To describe and compare measures of sexual activity, orgasm quality, and satisfaction between women of different ages. Methods Respondents were recruited via Qualtrics and administered an anonymous online survey. Respondents were separated into groups based on age ranges: younger adults (<40 years old), middle-aged adults (40 to 59 years old), and older adults (≥60 years old). Additional demographic characteristics and sexuality measures were documented, including sexual orientation, partnership status at the time of survey, ability to orgasm, frequency of masturbation and sexual activity, and sexual satisfaction (as measured by the validated New Sexual Satisfaction Scale (NSSS)). An orgasm quality inventory queried the following six variables, under the control condition of masturbation: (1) time to orgasm; (2) duration of orgasm; (3) refractory period between orgasms; (4) experience of orgasm as a single or multi-peak event; (5) bodily location of orgasm experience; and (6) satisfaction with orgasm quality. Results A total of 423 sexually active cisgender women (average age ± standard deviation: 48.9 ± 15.6 years old) completed our survey. Older women were significantly more likely to identify as heterosexual and deny dating or being in a current relationship (both p<0.001). Additionally, older women were significantly more likely to deny masturbation and sexual activity with a partner (p<0.001). There was no statistically significant difference in ability to achieve orgasm between age groups (p=0.5). With respect to orgasm parameters (Table 1), younger women reported a significantly lower refractory period between orgasms, as compared to middle-aged and older women. Compared to other age groups, significantly more older women reported their orgasm as a multi-peak event (p<0.04) and were more likely to report the location of orgasm sensation as occurring in their genitals, as opposed to extragenital areas (e.g., arms, thighs, face, back) or whole body (p<0.01). There were no statistically significant differences between age and lead time to orgasm, duration of orgasm, or satisfaction with orgasm. Differences in sexual satisfaction (as measured by the NSSS, with higher scores indicating greater sexual satisfaction) were found to be statistically insignificant as well. Conclusions While older women reported a significant decrease in frequency of masturbation and sexual activity, they only differed in three out of six measures in our orgasm inventory. While these measures indicate a difference in older women’s experience of orgasm, it is important to note that there were no significant differences across multiple measures of sexual satisfaction between women of different ages. Disclosure No.

Background Erogenous sensation zones (ESZs) elicit sexual pleasure upon stimulation. General ESZ maps exist, but they do not assess internal areas of the body, differentiate between individual structures, or quantify the importance of individual ESZs to sexual pleasure. Maps of aversive sensation zones (ASZs), or bodily areas individuals dislike having touched during sex, have not been described. Aim To create detailed erogenous and aversive sensory maps of the vulva, vagina, and breasts, and assess the importance of each erogenous structure to sexual pleasure. Methods An anonymous online questionnaire was administered to 441 sexually active cisgender women (mean age 48.9 +/- 15.5 years) from March to June 2020 via Qualtrics. Respondents selected ESZs and ASZs from anatomic illustrations and rated each ESZ's importance to their sexual pleasure. Respondents' reasoning for choosing each ASZ was queried. Outcomes Heat maps of ESZ and ASZ selection frequency, ESZ importance ratings, and ASZ reasoning. Results More respondents selected >= 1 areas of the vulva as erogenous (82.0%), in comparison to the breasts (77.4%) and vagina (59.4%). The two most erogenous areas of the breast were also the most aversive: breast tissue (57.8% ESZ selection; 5.4% ASZ) and nipples (42.7%; 6.5%). Respondents most commonly reported these areas as aversive due to: "It's overly sensitive" and "It hurts." The most frequently selected ESZs of the vulva were the vaginal introitus (50.8%), periurethra (42.6%), and glans clitoris (41.3%). The top ASZs were the anus (34.0%) and perineum (7.9%), with primary reasons being: "It's gross," "It hurts," and "I'm ashamed/embarrassed." Of the five ESZs of the vagina, the superficial anterior (48.1%) and superficial posterior (32.9%) regions were the most selected. The cervix (6.8%), superficial posterior (5%), and deep posterior (3.4%) regions were the top ASZs due to "It hurts" and/or "It's overly sensitive." Clinical Implications Erogenous and aversive sensory maps could help identify sexual concerns, inform preoperative counseling, and track sensory changes. Strengths and Limitations This study captured detailed maps of internal and external ESZs and ASZs of the breasts, vulva, and vagina. Limitations include recall bias and inclusion of only cisgender women, rather than all people who share the same anatomy, irrespective of gender identity. Conclusions Erogenous sensation was most prominent in the vulvar structures, including the vaginal introitus and glans clitoris, followed by the superficial surface of the vaginal canal. Aversive sensation associated with the anus primarily came from feelings of judgment and shame, while other ASZs were reportedly due to pain and sensitivity.

Abstract Introduction Erogenous zones (EZs) of the body elicit sexual arousal in response to touch. While previous studies have attempted to map erogeneity throughout the body, they did not assess internal surfaces or individual genital structures/sub-areas. Furthermore, previous work did not query how important specific EZs were to subjects’ sexual pleasure, nor did it assess what body areas people specifically dislike having touched during sex. Objective To develop detailed, topographic maps of erogenous and aversive sensation throughout the vulva, vagina, and breasts. Methods A sample of 441 sexually active cisgender women (mean age 48.9 ± 15.6 years) completed our anonymous, online questionnaire via Qualtrics®. Respondents selected predefined areas from anatomic illustrations that bring them pleasure when touched during sex, and areas that they dislike having touched during sex. For each EZ, respondents rated its importance to their sexual pleasure on a 10-point Likert scale, and/or indicated why they dislike having a specific area touched. Maps of erogeneity and aversion were generated based on the percent of respondents that selected each zone. Results More respondents selected at least one area of the vulva as erogenous (82.0%), as compared to the breasts (77.4%) and vagina (59.4%). Of the EZs of the vulva (Figure 1a), the vaginal introitus (50.8%), peri urethra (42.6%), and clitoris (41.3%) were the three most frequently selected and highest rated structures for pleasure. Conversely, the anus (34.0%) and perineum (7.9%) were the most disliked areas (Figure 1b) for the primary reason of respondents finding “It’s gross,” followed by “It hurts” and “I’m ashamed/embarrassed.” The five EZs of the vagina (Figure 2a) revealed enhanced erogeneity in the superficial anterior (48.1%) and posterior (32.9%) regions. The cervix (6.8%) and posterior zones (3.4%, 5.0%) of the vagina were the most disliked areas (Figure 2b) due to respondents reporting that “It hurts” and “It’s overly sensitive.” Interestingly, two of the most erogenous zones of the breasts (Figure 3a) were also the most disliked (Figure 3b): fatty breast tissue (57.8% erogenous, 5.4% aversive) and the nipples (42.7%, 6.5%). Respondent reasoning for disliking these areas included “It’s overly sensitive,” “It hurts,” and “It reminds me of a bad experience.” Conclusions The vulva and vagina were associated with enhanced erogenous sensation not only at (but also in regions immediately peripheral to) the clitoris. These EZs were also rated as “highly important” to sexual pleasure. The anus was overwhelmingly associated with aversive sensation due to feelings of judgment/shame. Other aversive zones were primarily disliked for objective reasons of pain and sensitivity. Disclosure No

Abstract Introduction For thousands of years male circumcision (MC) has been performed for cultural, religious, aesthetic, and public health reasons, and it continues to be among the most common surgical procedure performed worldwide. The effects of MC on sexual function remains controversial, despite recent systematic reviews demonstrating no adverse effects. A key area of debate regarding MC has been the impact of MC on penile sensation. Existing literature evaluating changes in penile sensitivity and pleasure following MC have primarily focused on the penis glans and the frenulum-area of the shaft. Additionally, studies describing the effects of MC on orgasm have focused on the changes in ease of reaching orgasm/ejaculatory latency. In truth, although patients rely on providers to counsel them about what results they might expect to occur with MC, the effects of MC on erogenous sensation and other orgasm-related domains of sexual function are still not well understood. Objective We sought to expand on the existing literature by assessing erogenous sensation throughout the entire penis surface area, and to evaluate differences in reported orgasm function among circumcised and uncircumcised men. Methods Adult male subjects recruited from a paid anonymous online survey platform (QualtricsTM, USA) were shown anatomic illustrations of a penis whose entire surface area was divided into 12 different regions. Subjects were instructed to identify regions they found pleasurable when touched during sex, and to rate each on a 1-10 scale. Subjects were also asked to characterize their typical orgasm across the following six domains: 1. Lead-time, 2. Orgasm duration, 3. Perceived body-location(s) of orgasm-sensation, 4. Classification of orgasm experience as a single or multiple-peak event, 5. Refractory period duration, and 6. Overall satisfaction. Comparisons between circumcised and uncircumcised men were performed with a 2-tailed T-test. The Benjamini-Hochberg Procedure with FDR=0.05 was applied to control for multiple comparisons. Results The survey was completed by 227 circumcised (mean age ± SD, 46.6 ± 17.7y) and 175 uncircumcised men (47.8 ± 18.1y). There were no significant differences in ratings across all twelve regions among circumcised and uncircumcised cohorts. However, when subjects were asked to identify which regions gave pleasure when touched during sex, significantly more circumcised (vs. uncircumcised) men reported a preference for the penis-tip (38% vs 17%, p=0.024) and the middle third of their ventral shaft (63% vs 48%, p=0.036). There were no significant differences in reported experience with orgasm quality and function across all six queried domains among circumcised and uncircumcised cohorts. Conclusions Our findings suggest that both circumcised and uncircumcised men experience pleasure in their penis and experiences with orgasm function similarly. Although we often think of the tip of the penis as being the “most erogenous” location for men, we found that scored erogeneity was generally similar across the entire length of the penis. Although overall erogeneity ratings did not differ, we found that circumcised men reported more areas of their penis as “pleasurable when touched during sex”, as compared to their uncircumcised counterparts. These findings will be important to share with patients and their families considering MC. Disclosure No

You have accessJournal of UrologyCME1 Apr 2023PD08-03 LONG-TERM TUMOR NECROSIS FACTOR-ALPHA INHIBITOR USE INCREASES THE RISK OF RENAL CELL CARCINOMA Conor Driscoll, Jordan Rich, Dylan Isaacson, Joseph Nicolas, Yu Jiang, Xinlei Mi, Christopher Yang, Victoria Kocsuta, Regine Goh, Niti Patel, Eric Li, Rashid Siddiqui, Travis Meyers, John Witte, Linda Kachuri, Hui Zhang, Molly Beestrum, Edward Schaeffer, and Shilajit Kundu Conor DriscollConor Driscoll More articles by this author , Jordan RichJordan Rich More articles by this author , Dylan IsaacsonDylan Isaacson More articles by this author , Joseph NicolasJoseph Nicolas More articles by this author , Yu JiangYu Jiang More articles by this author , Xinlei MiXinlei Mi More articles by this author , Christopher YangChristopher Yang More articles by this author , Victoria KocsutaVictoria Kocsuta More articles by this author , Regine GohRegine Goh More articles by this author , Niti PatelNiti Patel More articles by this author , Eric LiEric Li More articles by this author , Rashid SiddiquiRashid Siddiqui More articles by this author , Travis MeyersTravis Meyers More articles by this author , John WitteJohn Witte More articles by this author , Linda KachuriLinda Kachuri More articles by this author , Hui ZhangHui Zhang More articles by this author , Molly BeestrumMolly Beestrum More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Shilajit KunduShilajit Kundu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003239.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Tumor necrosis factor-alpha inhibitors (TNF-I) are widely prescribed for chronic inflammatory conditions. Renal cell carcinoma (RCC) is known to be immune-responsive with the immune upregulation the mainstay of therapy for advanced disease. Prior studies of TNF-I use and malignancy risk with short follow-up have not demonstrated consistent associations outside non-melanoma skin cancers. We performed a broader, contemporary study of this potential relationship incorporating a large institutional cohort analysis. METHODS: This was a retrospective, unmatched-cohort study involving a single academic medical center and conducted from 1998 to 2022. 11,086 patients with TNF-I exposure for inflammatory conditions and 32,665 patients with inflammatory conditions without TNF-I exposure were identified. Cox proportional hazards regression analysis, adjusting for age, race, gender, smoking status and underlying inflammatory disease type, was performed. TNF-I exposure was considered a time-varying factor, as TNF-I induction date was not fixed for patients in the TNF-I-exposed group. Models were fit incorporating all patients who developed any malignancy during the study period and individually for each type of cancer. Results of regression models were presented as forest plots with hazard ratios and 95% confidence intervals. RESULTS: TNF-I exposure was associated with increased risk of any malignancy (HR=1.19, 95% CI 1.09-1.29, p<0.001). TNF-I exposure was positively associated with risk of RCC (HR 1.47, 95% CI 1.00-2.15, p=0.05). CONCLUSIONS: This increased risk of RCC in patients exposed to TNF-I suggests that this tumor microenvironment is potentially subject to TNF-mediated immune regulation and that patients on TNF-I may benefit from screening. Source of Funding: Polsky Urologic Cancer Institute, Northwestern University Feinberg School of Medicine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e233 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Conor Driscoll More articles by this author Jordan Rich More articles by this author Dylan Isaacson More articles by this author Joseph Nicolas More articles by this author Yu Jiang More articles by this author Xinlei Mi More articles by this author Christopher Yang More articles by this author Victoria Kocsuta More articles by this author Regine Goh More articles by this author Niti Patel More articles by this author Eric Li More articles by this author Rashid Siddiqui More articles by this author Travis Meyers More articles by this author John Witte More articles by this author Linda Kachuri More articles by this author Hui Zhang More articles by this author Molly Beestrum More articles by this author Edward Schaeffer More articles by this author Shilajit Kundu More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP40-04 LONG-TERM TUMOR NECROSIS FACTOR-ALPHA INHIBITOR USE DECREASES THE RISK OF PROSTATE CANCER Conor Driscoll, Jordan Rich, Dylan Isaacson, Joseph Nicolas, Yu Jiang, Xinlei Mi, Christopher Yang, Victoria Kocsuta, Regine Goh, Niti Patel, Eric Li, Rashid Siddiqui, Travis Meyers, John Witte, Linda Kachuri, Hui Zhang, Molly Beestrum, Edward Schaeffer, and Shilajit Kundu Conor DriscollConor Driscoll More articles by this author , Jordan RichJordan Rich More articles by this author , Dylan IsaacsonDylan Isaacson More articles by this author , Joseph NicolasJoseph Nicolas More articles by this author , Yu JiangYu Jiang More articles by this author , Xinlei MiXinlei Mi More articles by this author , Christopher YangChristopher Yang More articles by this author , Victoria KocsutaVictoria Kocsuta More articles by this author , Regine GohRegine Goh More articles by this author , Niti PatelNiti Patel More articles by this author , Eric LiEric Li More articles by this author , Rashid SiddiquiRashid Siddiqui More articles by this author , Travis MeyersTravis Meyers More articles by this author , John WitteJohn Witte More articles by this author , Linda KachuriLinda Kachuri More articles by this author , Hui ZhangHui Zhang More articles by this author , Molly BeestrumMolly Beestrum More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Shilajit KunduShilajit Kundu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is estimated that inflammation accounts for 20% of all cancers. Tumor necrosis factor-alpha inhibitors (TNF-I) are widely prescribed for chronic inflammatory conditions yet modulatory effect on prostate cancer risk is not known. We hypothesize that affecting systemic TNF-alpha modifies risk of prostate cancer and performed a contemporary study in a large regional medical system. METHODS: This was a retrospective, unmatched-cohort study involving a regional hospital system between 1998 and 2022. 4,209 men with TNF-I exposure for inflammatory conditions and 10,981 men with inflammatory conditions without TNF-I exposure were identified. Cox proportional hazards regression analysis, adjusting for age, race, gender, smoking status and underlying inflammatory disease type, was performed. TNF-I exposure was considered a time-varying factor, as TNF-I induction date was not fixed for patients in the TNF-I-exposed group. Models were fit incorporating all patients who developed any malignancy during the study period and individually for each type of cancer. Results of regression models were presented as forest plots with hazard ratios and 95% confidence intervals. RESULTS: While TNF-I exposure was associated with increased risk of any malignancy (HR=1.19, 95% CI 1.09-1.29, p<0.001), exposure to TNF-I had a strongly protective effect against a diagnosis of prostate cancer (HR=0.58, 95% CI 0.42-0.80, p=0.001). CONCLUSIONS: Decreased risk of prostate cancer in men exposed to TNF-I suggests that the inflammatory milieu of prostate cancer development is potentially modulated by the anti-inflammatory effects of TNF-I and should be studied further. Source of Funding: Polsky Urologic Cancer Institute, Northwestern University Feinberg School of Medicine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e546 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Conor Driscoll More articles by this author Jordan Rich More articles by this author Dylan Isaacson More articles by this author Joseph Nicolas More articles by this author Yu Jiang More articles by this author Xinlei Mi More articles by this author Christopher Yang More articles by this author Victoria Kocsuta More articles by this author Regine Goh More articles by this author Niti Patel More articles by this author Eric Li More articles by this author Rashid Siddiqui More articles by this author Travis Meyers More articles by this author John Witte More articles by this author Linda Kachuri More articles by this author Hui Zhang More articles by this author Molly Beestrum More articles by this author Edward Schaeffer More articles by this author Shilajit Kundu More articles by this author Expand All Advertisement PDF downloadLoading ...

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.