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Background

Sexual health is often negatively impacted by cancer therapies. National Comprehensive Cancer Network (NCCN) survivorship guidelines for sexual health broadly recommend sexual aids, without detail about quality or availability. Using a consumer-oriented approach to identify and evaluate the "Internet of Things (IoT)", our aim was to evaluate availability and quality of non-pharmacologic sexual aids to increase knowledge of sexual health resources.

Methods

NCCN Survivorship 1.2022 guidelines were used to identify 13 non-pharmacologic categories of sexual aids related to recommendations about sexual health (e.g., vaginal dilator, vacuum erection device). For each of the item categories, an initial internet search evaluated the top 25 links for the "Best of." Links were categorized by publication and author type, and candidate sexual health items were recorded. A separate search, using "best adult toy website" and "best sexual health website", identified three mainstream consumer sites, four sexual health sites, and manufacturer websites selling candidate items. Websites were then used to record each item's customer ratings on a 5-star scale. Before evaluating ratings, unavailable items were excluded. For dilators, dildos, and vibrators, items larger than estimated median penile dimensions (6.5" length, 4.6" circumference, 1.6" diameter) were also excluded due to likely being uncomfortable and non-therapeutic for most patients. Customer ratings search was conducted in May 2023. Potential therapeutic value was defined as a minimum of 50 ratings and a 4-star average. Descriptive statistics included prevalence, median, and range.

Results

The initial search for "best XXX" on 350 total hyperlinks yielded 874 potential items in the 13 categories from a diverse range of sources; 17.3% of links were connected to medical or health periodicals, but most (60.3%) were from magazines, newspapers, and blog posts. Content was rarely from NCCN (2.7%) or non-NCCN (1.9%) medical sources. Content authors were mostly journalists, bloggers, or unknown author type (17.3%, 18.1%, and 33.2% respectively). For the 874 candidate items, 537 met criteria for potential therapeutic value. Among the 537 items evaluated, 292 items met our customer-reported quality threshold, with a median of 631 reviews (range 51-128,481) and a median rating of 4.4 stars (4.0-5.0). We identified useful items in each NCCN category with a median of 7 (1-107).

Conclusions

Non-medical sources publish most sexual health items. Medical content rarely ranks highly on internet search. To address gaps between general recommendations and practical application, we identified many highly rated, potentially useful products in NCCN-designated categories that may be valuable for patients as well as clinicians. We will publish the full list to lessen access and knowledge gaps and to stimulate further research.

Read an interview about the study here.