Is It All in My Head? Self-reported Psychogenic Erectile Dysfunction and Depression Are Common Among Young Men Seeking Advice on Social Media.

OBJECTIVE: To characterize themes of discussion and specific concerns expressed by users of an internet erectile dysfunction (ED) community using a mixed-methodology approach involving quantitative natural language processing (NLP) and qualitative annotation of content. METHODS: We extracted posts and responses from the Reddit community r/ErectileDysfunction (3100 members) during June 2018 to May 2019. We applied an NLP technique called the meaning extraction method with principal component analysis to computationally identify themes of discussion. We manually annotated a subset (30%) of posts based on NLP-derived themes to evaluate specific content. RESULTS: We analyzed 329 posts and 1702 responses. Meaning extraction method with principal component analysis identified key themes: hypogonadism symptoms, masturbation/sex, evaluation/treatment, alternative therapies, and partner factors (posts); and performance anxiety, hypogonadism evaluation, pornography, and pharmacotherapy (responses). Subset annotation of 100 posts revealed a median author age of 24 years (Interquartile Range (IQR): 20-31). 48% of discussants believed their ED was psychogenic, 38% reported depressive symptoms, and 2% mentioned self-harm/suicidality either attributed to or associated with their ED. 28% of discussants reported seeing a health care professional for ED, and 20% attempted abstinence from pornography/masturbation as a self-prescribed intervention. CONCLUSION: Social media platforms like Reddit empower young men to discuss ED concerns. Fewer than one-third reported seeing a doctor for ED, suggesting that men turn to peers on the internet first, despite risk of misinformation. A majority attributed symptoms to psychological etiologies and excess pornography/masturbation. Depression, self-harm, and suicide emerged as potent concerns. These data underscore the importance of engaging proactively with young men, both in the consultation room and online.

Penile-response profiles of sexual aggressors during phallometric testing.

This study analyzes sexual-preference profiles in a sample of 420 sexual aggressors who exhibited a valid profile during their initial phallometric assessment. The sexual stimuli used in the process were audiotapes describing sexual-offending scenarios. Two types of sexual stimuli sets were used: one developed for sexual aggressors against women and a second developed for sexual aggressors against children. Penile responses were recorded during stimulus presentation using a mercury-in-rubber strain gauge. Classification analyses (hierarchical and K-means clustering combination) were conducted separately for three groups of sexual aggressors: (a) sexual aggressors against children (n = 253), (b) sexual aggressors against women (n = 138), and (c) mixed sexual aggressors (n = 29). The sexual aggressors against children exhibited four penile-response profiles, the sexual aggressors against women two penile-response profiles, and the mixed sexual aggressors only one penile-response profile. In addition, analyses carried out on randomly split subsamples established that the generated profiles for sexual aggressors against children and sexual aggressors against women were stable.

Measurement of risk of sexual violence through phallometric testing.

The use of phallometric testing to determine risk of sexual violence is becoming more widely recognized throughout the world. This technique involves the precise measurement of circumferential change in the penis from flaccidity to erection in response to both 'normal' and deviant sexual stimuli. Phallometric testing is the only pure measure of sexual arousal, and unlike other physiological measures such as heart rate and GSR it is not influenced by arousal states such as fear and anger. The current published research compares the phallometric testing profiles of incarcerated sexual offenders with those of incarcerated nonsexual offenders. Specifically, the sexual arousal of 100 convicted rapists, pedophiles, and nonsexual offenders is examined. This research identifies what differentiates these groups and what best predicts risk of sexual aggression. Implications of these results include the possibility of using phallometric testing as a screening tool for those who work with vulnerable populations (e.g., child care workers, teachers). The principal benefit of phallometric testing, however, lies in the identification of those incarcerated men who are at greatest risk to sexually reoffend and who should thus be denied release from jail.

The effects of false physiological feedback on tumescence and cognitive domains in sexually functional and dysfunctional men.

A false feedback paradigm was used to produce a discrepancy between expected and "actual" tumescence among 57 sexually dysfunctional and 58 sexually functional men randomly assigned to one of four false tumescence feedback conditions: negative (NEG), neutral (NEU), positive (POS), or no (NO) feedback. Participants predicted an erection score before viewing an erotic film and then received false tumescence feedback based on this score. Tumescence and cognitive ratings were obtained before and after the feedback. It was predicted that discrepancies would differ between dysfunctional and functional participants such that functional participants would have the ability to overcome discrepancies, whereas dysfunctional participants would not. As expected, POS decreased tumescence for dysfunctional participants and NO did not influence tumescence for either group. Unexpectedly, NEU decreased tumescence for dysfunctional participants and NEG decreased tumescence for functional participants. Despite tumescence changes, cognitive ratings generally followed the feedback that was given. These results only partially support current models of sexual dysfunction and behavioral regulation. Anxiety, self-focused attention, cognitive interference, and unexpectedness of the feedback could not account for the partial support. However, most feedback that was outside of the realm of the status quo for both functional and dysfunctional participants did decrease tumescence, despite outcome expectancies. These results suggest that both functional and dysfunctional men may be at risk for erectile failure should feedback about their performance be discrepant from what they expect. Prevention and treatment should focus on preparing men for occasional erectile failure and on helping them overcome discrepant feedback.

Exploring the motivations and fantasies of strip club customers in relation to legal regulations.

Strip clubs are a popular form of adult entertainment in the contemporary United States. Strip clubs are also highly embattled entertainment venues, based on assumptions about their associations with prostitution, drug use, and "negative secondary effects" in surrounding areas, such as increased crime rates and decreased property values. Based on participant observation in five strip clubs in one city and on qualitative interviews with 30 regular male customers of those clubs, this essay seeks to challenge assumptions about the kinds of encounters sought in and purchased in such venues. Instead of visiting strip clubs out of a desire to purchase sexual release with the dancers, I found that the regular male customers were seeking an atmosphere different from both work and home, personal and sexual acceptance from women and the pleasure of a sexualized encounter without the pressures of physical performance, and a form of leisure that offered a relative degree of "safety" as well as "excitement." Further, the men's own fantasies of identity, their understandings of marriage, and their commitment to a particular kind of monogamy influenced their choice of entertainment and the pleasure that they took in their encounters with the dancers. The essay discusses these motivations and their relational aspects and assesses strip club regulation in light of these observations and findings.

Comparison of health-related quality of life and prostate-associated symptoms after primary and salvage cryotherapy for prostate cancer.

PURPOSE: Recent advances in cryosurgery of the prostate have led to the ability to treat tumors successfully with decreased morbidity. The patients' perspectives of this relatively new technique, however, have not yet been addressed. The purpose of this study was to compare health related quality of life (QoL) as well as prostate-associated symptoms in patients after primary and salvage cryoablation for clinically localized prostate cancer using a self-administered questionnaire. METHODS: A total of 131 consecutive patients who underwent cryoablation of the prostate between 1997 and 2001 were included in this confidential mailing study. The patients were either (a) patients with localized prostate cancer with contraindications for radical surgery, including patients refusing other forms of therapy, or (b) had locally recurrent prostate cancer after failure of radiation therapy. All patients received 3 months of neoadjuvant androgen deprivation therapy prior to cryosurgery and were surgically treated by the same surgeon using an argon-based system. We used the EORTC QLQ-C30, a commonly used, multidimensional instrument together with a supplementing, prostate-cancer-specific module. RESULTS: Eighty-one of the 131 patients (response rate 62%) returned the questionnaires. The two groups were comparable regarding age (mean age 72.8 vs 70.1 for the primary and the salvage group, respectively; p=0.22). The overall QoL scores were high in both groups. Primary cryotherapy patients fared significantly better regarding physical (p=0.005) and social (p=0.024) functioning compared with salvage cryotherapy patients. The most prominent prostate-related symptom in both patient groups was sexual dysfunction, followed by urinary symptoms, which were significantly more severe in the salvage group (p=0.001). Incontinence rates were 5.9 and 10% in the primary and the salvage group, respectively. Severe erectile dysfunction was reported in 86 and 90% of the primary and the salvage group, respectively. CONCLUSIONS: The present study demonstrates that, in selected patients, cryotherapy is a treatment option which has a functional outcome comparable to traditionally used prostate cancer treatments. More information regarding QoL is necessary for appropriate patient counseling and individual decision-making in the presence of various treatment alternatives.

Reproducibility and clinical and concurrent validity of the MSF-4: a four-item male sexual function questionnaire for patients with benign prostatic hyperplasia.

INTRODUCTION: The MSF-4 (Male Sexual Function 4-item) questionnaire is a condition-specific four-item scale of men's sexuality. We describe two studies that were conducted to assess the reproducibility and validity of the MSF-4 questionnaire. METHODS: Study 1 was a Phase III, multicenter study with a double-blind, parallel group design which was conducted in five countries. The objectives were to check the construct validity and factorial structure of the MSF-4 along with internal consistency reliability and clinical validity. Study 2 was a longitudinal, noncomparative, observational multicenter study to assess the reproducibility and the clinical and concurrent validity of the MSF-4. RESULTS: When exploratory factor analysis was performed with a free number of factors, the variability of the global MSF-4 score was based on a single factor across all countries in Study 1 except Spain. There was a high level of internal consistency reliability (Cronbach's alphas 0.68-0.90) and the MSF-4 was able to significantly discriminate different health states as assessed by the International Prostate Symptom Score (I-PSS) or Quality of Life (QoL) questionnaire. In study 2, there was a significant correlation between the MSF-4 and the International Index of Erectile Function (IIEF) scores (p = .0001 for all items) especially erectile function (correlation coefficient -0.77). The MSF-4 was able to distinguish among patients with differing degrees of benign prostatic hyperplasia (BPH) symptoms as measured by the I-PSS (p = .0001) and between those with and without sexual disorders (p = .0001). CONCLUSION: The MSF-4 is a psychometrically validated questionnaire with good reproducibility and clinical validity, which allows easy and appropriate assessment of male sexual function in the clinical setting.

Sexual and emotional variables influencing sexual response to erotica: a psychophysiological investigation.

The relative contribution of attentional and emotional factors to the physiological and subjective sexual arousal elicited by erotic film was evaluated. Sexual arousal, attentional, and emotional responses were measured while 30 men were presented with a series of erotic film segments. Levels of physiological and subjective sexual arousal were higher when subjects became absorbed in the activities portrayed in the film and when they experienced the depicted erotic encounters as appetitive, than when they were distracted and perceived the encounters as aversive. The erotic film elicited a diminished startle response to a sudden burst of white noise presented during stimulation relative to the nature film, suggesting that at a physiological level the erotic segments of film were processed as more appetitive in valence. The level of sexual arousal elicited by the erotic segments was related to the extent to which subjects were entertained by the film, even though there was considerable anxiety generated by the portrayed sexual scenarios. Sexual response was not significantly correlated with trait measures of absorption (as indexed by the Tellegen Absorption Scale) nor with vividness of imagery (as assessed by the Betts Questionnaire upon Mental Imagery). Arousal was related to state-assessed attentional and emotional variables, and physiological measures of emotional response, demonstrating the multidimensional nature of the sexual response. Future directions for comparing male sexual response patterns with female response patterns are suggested.

Sexual preference for child and aggressive stimuli: comparison of rapists and child molesters using auditory and visual stimuli.

154 Ss were tested using penile plethysmography as part of intake into a voluntary inpatient sex offender treatment program. The testing protocol included slide stimuli of nude males and females in four age categories ranging from age 1 to adult; audiotaped descriptions of sexual activity with children of both genders which included fondling, sexual contact with no resistance, coercive sexual contact, sexual assault, nonsexual assault, and consensual sexual contact with an adult; videotaped depictions of rape of an adult woman, nonsexual assault of an adult woman and consensual sexual involvement with an adult woman, and audiotaped descriptions that paralleled the videotapes. The results indicated that child molesters (male victim) show a decidedly more offense related arousal profile than either child molesters (female victim) or rapists, and that the profiles of child molesters (female victim) and rapists are remarkably similar, although statistically significantly different from each other. Rapists respond significantly more to rape and nonsexual assault than either of the two child molester groups, with child molesters with female victims responding more than those with male victims. In all three groups, the highest level of noncoercive adult responding was to women, with differences among offense groups present for visual stimuli, but not in response to auditory stimuli. Overall, the patterns of results are similar whether they are based on composites across stimulus modality or on the individual stimuli.

Male sexual fantasy: multidimensionality in content.

Sixty-six men provided ratings of the extent to which they regarded fantasies depicting nominated sexual activities as sexually arousing. A Male Sexual Fantasy Questionnaire (MSFQ) with five subscales was constructed following factor analysis of these ratings. The subscales yield separate scores for fantasies representing sensual, genital, public sex, sexual dominance-submission, and sexual aggression themes. Levels of penile tumescence recorded while men engaged in fantasies depicting content represented in the MSFQ correlated with the extent to which these men earlier had rated these same fantasies as sexually arousing. Since ratings on the MSFQ did not correlate substantially or consistently with scores on the Betts Questionnaire Upon Mental Imagery, the Imaginal Processes Inventory, and the Gordon Test of Visual Imagery Control, sexual fantasy may be mediated by processes different from those involved in non-sexual imagery and daydreaming. The need to validate use of the MSFQ in several clinical contexts is noted.

Enhancement of fantasy-induced sexual arousal in men through training in sexual imagery.

Men who in earlier experiments in the same laboratory had been unable to enhance penile tumescence to any substantial degree by engaging in erotic fantasy were given two sessions of either sexual imagery training or general imagery training. Participants in the sexual imagery training program subsequently demonstrated increased physiological and subjective sexual arousal during unstructured as well as structured sexual fantasy. The gains were undiminished at follow-up, 1 month after the end of training. In contrast, general imagery training did not enhance fantasy-induced sexual arousal. Both training programs improved vividness of imagery, as assessed by the Betts QMI Scale, but only sexual imagery training led subjects to report that they were able to form sexual images with higher clarity when engaging in fantasy. Sexual arousal was thus enhanced through context-specific imagery training, a strategy commonly used in the clinical practice of sex therapy.