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Background Erectile dysfunction (ED) is characterized by a persistent inability to achieve and maintain sufficient penile erection for satisfactory sexual performance persisting for at least six months. Low-intensity pulsed ultrasound (LIPUS), a noninvasive therapy, has shown potential in improving ED by promoting the regeneration of connective tissue, blood vessels, and cavernous nerves, as well as reducing inflammation. This study aims to evaluate the clinical efficacy and histological changes in the corpus cavernosum of patients with ED treated with tadalafil combined with LIPUS through a randomized controlled trial. Methods This study will enroll 114 patients diagnosed with ED who will be randomly assigned to either the treatment group or the control group in a 1:1 ratio using simple random sampling. The treatment group will first receive 5 mg of tadalafil daily combined with twice-weekly LIPUS therapy for 4 weeks. Following a 4-week interval with daily 5 mg tadalafil alone (no LIPUS treatment), the same combined treatment regimen will be repeated. The control group will receive only 5 mg of tadalafil daily. The primary outcome will be assessed using the minimal clinically important difference (MCID) based on the International Index of Erectile Function-5 (IIEF-5) at each follow-up visit. Additional assessments will include the Erection Hardness Score (EHS), penile blood flow parameters, and elasticity values for a comprehensive evaluation. Discussion The study aims to evaluate the efficacy of tadalafil combined with LIPUS for treating ED and to improve the evaluation of treatment response in erectile dysfunction by integrating blood flow parameters and two-dimensional shear wave elastography. Trial registration Trial registration: ClinicalTrials.gov, NCT06543628. Registered 5th August 2024, https://clinicaltrials.gov/study/NCT06543628 .

To evaluate the clinical efficacy, advantages, and disadvantages of the modified Shiraki procedure and the transverse pedicled island flap phalloplasty in treating severe concealed penis in children. This study included seventy children with severe concealed penis treated at Yulin First People’s Hospital from June 2021 to January 2024. They were randomly assigned to either the observation group ( n  = 35), undergoing the modified Shiraki procedure, or the control group ( n  = 35), receiving the transverse pedicled island flap phalloplasty. We assessed average operation time, intraoperative blood loss, penile elongation, time until resolution of penile prepuce edema, flap infection or necrosis, penile erectile pain, prepuce skin redundancy, penile retraction, and overall penile appearance score six months postoperatively. The observation group showed significantly better average operative time and intraoperative blood loss compared to the control group ( p  < 0.05). The time for foreskin edema to regress was longer in the observation group ( p  < 0.05). No significant differences were noted in penile lengthening between groups ( p  > 0.05). The observation group had seven cases of refractory inner prepuce plate swelling and skin redundancy post-operation; two of these cases required secondary surgery, and without skin flap infection or necrosis. The control group reported one case of postoperative hemorrhage and four cases of infection and necrosis of the transferred flap, all resolved after prolonged dressing changes, with one case requiring surgical correction for scar contracture on the side of the penis. Neither group experienced penile erectile pain or retraction. Total complications and reoperations were similar between the groups. No significant difference in the overall penile appearance score was observed between the two groups six months post-surgery ( p  > 0.05). Both the modified Shiraki procedure and the transverse pedicled island flap phalloplasty are effective for treating severe concealed penis in children. The former is characterized by shorter, simpler operations, while the latter offers better cosmetic outcomes despite its complexity.

Sexual transmission of HIV requires exposure to the virus and infection of activated mucosal immune cells, specifically CD4 + T cells or dendritic cells. The foreskin is a major site of viral entry in heterosexual transmission of HIV. Although the probability of acquiring HIV from a sexual encounter is low, the risk varies even after adjusting for known HIV risk factors. The genital microbiome may account for some of the variability in risk by interacting with the host immune system to trigger inflammatory responses that mediate the infection of mucosal immune cells. We conducted a case-control study of uncircumcised participants nested within a randomized-controlled trial of male circumcision in Rakai, Uganda. Using penile (coronal sulcus) swabs collected by study personnel at trial enrollment, we characterized the penile microbiome by sequencing and real-time PCR and cytokine levels by electrochemiluminescence assays. The absolute abundances of penile anaerobes at enrollment were associated with later risk of HIV seroconversion, with a 10-fold increase in Prevotella , Dialister , Finegoldia , and Peptoniphilus increasing the odds of HIV acquisition by 54 to 63%, after controlling for other known HIV risk factors. Increased abundances of anaerobic bacteria were also correlated with increased cytokines, including interleukin-8, which can trigger an inflammatory response that recruits susceptible immune cells, suggesting a mechanism underlying the increased risk. These same anaerobic genera can be shared between heterosexual partners and are associated with increased HIV acquisition in women, pointing to anaerobic dysbiosis in the genital microbiome and an accompanying inflammatory response as a novel, independent, and transmissible risk factor for HIV infection. IMPORTANCE We found that uncircumcised men who became infected by HIV during a 2-year clinical trial had higher levels of penile anaerobes than uncircumcised men who remained HIV negative. We also found that having higher levels of penile anaerobes was also associated with higher production of immune factors that recruit HIV target cells to the foreskin, suggesting that anaerobes may modify HIV risk by triggering inflammation. These anaerobes are known to be shared by heterosexual partners and are associated with HIV risk in women. Therefore, penile anaerobes may be a sexually transmissible risk factor for HIV, and modifying the penile microbiome could potentially reduce HIV acquisition in both men and women. We found that uncircumcised men who became infected by HIV during a 2-year clinical trial had higher levels of penile anaerobes than uncircumcised men who remained HIV negative. We also found that having higher levels of penile anaerobes was also associated with higher production of immune factors that recruit HIV target cells to the foreskin, suggesting that anaerobes may modify HIV risk by triggering inflammation. These anaerobes are known to be shared by heterosexual partners and are associated with HIV risk in women. Therefore, penile anaerobes may be a sexually transmissible risk factor for HIV, and modifying the penile microbiome could potentially reduce HIV acquisition in both men and women.

Während sich Humor zumeist darin erschöpft, Abweichungen von der Norm zu verspotten, können Komödien oder auch Witze auf sehr viel abgründigere Art widersprüchliche Verhältnisse reflektieren. Wenn „Enthusiasmus\" dabei die subjektive Voraussetzung benennt und „Peinlichkeit\" das (negative) Objekt, dann wird schon deutlich, dass es um Ambivalenzen geht, die quer zu Personen und sozialen Rollen liegen. Kaum überraschend steht bei der überwiegenden Mehrzahl der Exponate Sex im Fokus. Sie bringt damit feministischen Widerstand auf lustige Art zur Geltung: Die Aneignung des sakrosankten Symbols erscheint so unproblematisch wie die Unverletzbarkeit von Comicfiguren selbstverständlich. Judith Bernstein wird in Bezug auf eine andere Front allerdings maximal explizit, wenn sie neben die mit den Fingern gemalte Form eines Atompilzes, in dem sich eine Vagina dentata abzeichnet, groß die Worte „Trump Horror\" schreibt und an der Wurzel einen vor Schreck geschrumpften Penis einfügt.

Während die Vagina als genaues Pendant zur männlich aneignenden Lust und dem Primat der Fortpflanzung dienendes Organ verstanden werden kann, ist es nach ihrer Auffassung die Klitoris, die sich dieser Logik widersetzt, indem sie unabhängig vom eindimensionalen Triebziel lustvolle Empfindungen ermöglicht. Allerdings wird auch hier neuerdings ein Zweifel laut: ob nicht die Benennung .Verstümmelung\" ihrerseits eine Form der Stigmatisierung und Herabsetzung, sowohl der Betroffenen als auch von deren Kulturen sei. Ist also womöglich die Sprache der Emanzipation eine weitere Form kolonialistischer Missachtung?

Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionApplication for ESRA Abstract PrizesBackground and AimsIn paediatric male circumcision, caudal block (CB) is considered as a reliable, effective technique. Despite increasing interest, the dorsal penile nerve block (DPNB) provided less intra- and postoperative analgesia than CB. Intravenous (iv) dexamethasone, an increasingly used adjunct in regional anaesthesia, has been associated with prolonged block duration. However, its role in increased DPNB efficacy remains unclear. The aim of this study is to investigate whether intravenous dexamethasone increases the analgesic efficacy of the DPNB, measured by the Face, Legs, Activity, Cry, Consolability (FLACC) scale scores during the first 24 postoperative hours.MethodsFifty-four patients, aged 1 to 6 years old, scheduled for circumcision were randomized into 3 groups: group 1 (CB 0.5 ml/kg levobupivacaine 0,25% with iv dexamethasone (CB + DXM, n = 18)), group 2 (DPNB 0.2 ml/kg levobupivacaine 0,5% with iv dexamethasone (DPNB + DXM, n = 21)) and group 3 (DPNB 0.2 ml/kg levobupivacaine 0,5% without dexamethasone (DPNB, n = 15)). The primary outcome is the FLACC score at predefined timepoints (30 minutes, 1, 2, 6, 12 and 24 hours after surgery) during the first 24 postoperative hours.ResultsUsing a cumulative link mixed model, the odds for lower FLACC scores were not significantly different between the 3 groups using group 1 as reference (group 2: 0.636 [- 0.285 – 1.558; p = 0.176] & group 3: 0.641 [-0.344 – 1.625; p = 0.202]).Abstract P306 Figure 1CONSORT flow diagram[Image Omitted. See PDF.]Abstract P306 Table 1Demographics by treatment group[Image Omitted. See PDF.]Abstract P306 Figure 2Predicted FLACC score probabilities per treatment allocation. CB + DXM: caudal block with iv dexamethasone; DPNB: dorsal penile nerve block without iv dexamethasone; DPNB + DXM: dorsal penile nerve block with iv dexamethasone[Image Omitted. See PDF.]ConclusionsUsing intravenous dexamethasone as an adjunct in a DPNB does not increase the odds for lower FLACC scores during the first 24 postoperative hours after paediatric circumcision.

Background Phthalates are endocrine-disrupting chemicals with anti-androgenic qualities and studies reported associations between prenatal phthalate exposure and infant genitalia. This study investigated whether increased prenatal phthalate exposure is associated with decreased fetal penile measures. Methods Data was from the New York University Children’s Health and Environment Study (2016–2019). Maternal urinary concentrations of 16 phthalate metabolites were quantified at <18 weeks gestation as a proxy for fetal exposure ( n  = 334 male pregnancies). We retrospectively measured penile length and width using ultrasounds conducted 18–24 weeks gestation ( n  = 173 fetuses). Associations of maternal urinary levels of phthalates with fetal penile length and width were determined using linear regression models. Results 57.2% of women were Hispanic, 31.8% Non-Hispanic White, 6.4% Asian, 2.3% Non-Hispanic Black, and 2.3% multiple races. Mean maternal age was 32 years (standard deviation [SD] = 5.7). Mean penile length was 7.13 mm (SD = 1.47) and width was 6.16 mm (SD = 0.87). An inverse relationship was observed between maternal levels of mono-ethyl phthalate and fetal penile length, and mono-(7-carboxy-n-heptyl) phthalate and penile width, though estimates were small and not significant when considering correction for multiple comparisons. Conclusions In our cohort we found no clinically meaningful associations between early pregnancy phthalate exposure and fetal penile length or width. Impact First-trimester phthalate metabolites were assessed in pregnant women in New York City. Penile length and width were retrospectively measured on clinically assessed ultrasounds conducted ≥18 weeks and <24 weeks of gestation. In this cohort, no clinically meaningful associations were observed between first-trimester prenatal phthalate exposure and fetal penile length. This study contributes to the limited but growing research on the impact of prenatal phthalate exposure on male fetal genital development. The results emphasize that there may not be a clear association between prenatal phthalate exposure and fetal penile length and width, and further research on this topic may be required.

Der Beckenboden (BB) ist eine komplexe Struktur. Er erfüllt multiple Funktionen, von denen die Lagesicherung der Beckenorgane und der damit verbundene Einfluss auf die Harn- und Stuhlkontinenz bereits gut erforscht sind. Das BB-Gewebe wird durch die physiologischen Alterungsprozesse wesentlich geschwächt. Zusätzlich belasten Lebensevents wie Schwangerschaft und Geburt, operative Eingriffe, aber auch typische Alterserkrankungen wie Diabetes, Lungen- und Stoffwechselerkrankungen diesen Körperbereich. Die Wirksamkeit des Trainings der BB-Muskulatur auf die Kontinenz und Organsenkung ist wissenschaftlich auch in der älteren Bevölkerung bewiesen. Therapeutische Konzepte, die auf die Behandlung des Fasziengewebes im BB fokussieren, werden aktuell nicht standardisiert eingesetzt. Da Alterungsprozesse zu Bindegewebeveränderungen führen, erscheint der Einsatz von Faszientechniken jedoch überlegenswert.

We present a case of a 64-year-old uncircumcised male who initially presented to the provider with a 1 year history of a solitary lesion on the glans penis that was clinically diagnosed as porokeratosis of Mabelli. A biopsy on a follow-up visit confirmed providers clinical suspicion. This article highlights the progression and treatment options for porokeratosis on the male genitalia.