Erectile Dysfunction and Prostate Diseases Are the Predominant Google Search Terms Amongst Men’S Health Topics

IJIR: Your Sexual Medicine Journal https://doi.org/10.1038/s41443-021-00448-1

ARTICLE

Erectile dysfunction and prostate diseases are the predominant Google search terms amongst men’s health topics

1 2 2,3 Karim Hanna ● Mark Arthur ● Charles Welliver

Received: 26 December 2020 / Revised: 26 April 2021 / Accepted: 6 May 2021 © The Author(s), under exclusive licence to Springer Nature Limited 2021

Abstract Patients are becoming increasingly active consumers of health information on the internet with urologic concerns being no exception. Our objective was to explore online search trends for topics related to men’s health and identify information- seeking patterns related to news and media coverage of these topics. We used Google Trends (http://google.com/trends)to explore search trends for various search terms related to men’s health in the United States over a 5-year period. Search queries provided graphs depicting search volume as a function of time, geographical data, and related topics and queries. Isolated spikes in search volume were further explored to identify a related event. Erectile dysfunction was the most- searched topic over the last 5 years in the United States. Prostate cancer and benign prostatic hyperplasia were the second

1234567890();,: 1234567890();,: and third most-searched topics, respectively. Other popular topics involved symptoms or pathologies of the testicles and penis. Most topics had relatively stable search volumes, with the exceptions of premature ejaculation and Peyronie’s disease. Several observed spikes in search volume were attributable to singular events, mostly in the form of online article publications or social media posts. We believe it may be helpful for providers to stay informed of cultural events relating to medical conditions to anticipate patient concerns.

Introduction searches for information on surgical options for kidney stones [2]. Interestingly, few studies are looking at search The internet is the general public’s largest and most trends as they relate to men’s health. A recent study by accessible source of information. This is relevant in health Russo et al. used search terms ‘Peyronie’s disease, erectile care as patients have become increasingly active consumers dysfunction (ED), and premature ejaculation’ to assess of health information. Urological information seeking is no public interest regarding penetrance and treatment of these exception to this trend; significant internet use by urology conditions [3]. Another study by Garijo et al. used Google patients has been described since the early 2000s [1]. Trends to assess seasonal variation in ED [4]. While studies Google (Mountain View, CA) is arguably the most fre- using search trends analysis are a growing area in men’s quently used website to search for information. The web- health, we believe there is more information to discover and site’s convenient service Google Trends offers data on characterize. public search interest and search volume that can be Google Trends has the potential to offer important translated into useful insight for providers. This resource glimpses into the information-seeking behaviors for men has already been utilized by individuals in the urological regarding their own health. Topic popularity may be cor- community such as Dreher et al. who analyzed trends of related with disease incidence, as evidenced by Phillips et al. who found a significant correlation between search volume and cancer incidence, including prostate cancer [5]. Not only can topic popularity be assessed, motivations * Mark Arthur [email protected] behind search trends can also be explored. Using Google Trends, Ortiz et al. noted increased search volume about 1 Department of Urology, Boston University Medical Center, suicide following celebrity suicide deaths [6]. This temporal Boston, MA, USA relationship of increased search volume and popular culture 2 Albany Medical College, Albany, NY, USA influence leads us to believe that Google search trends for 3 Albany Stratton VA Medical Center, Albany, NY, USA topics in men’s health are also influenced by cultural events. K. Hanna et al.

Our objective was to explore online search trends for topics related to men’s health and identify information-seeking patterns related to news and media coverage of these topics.

Methods

Google Trends (https://trends.google.com/trends/) was used to explore trends of various search terms regarding men’s health in the United States from March 2014 to March 2019. Topics were chosen by a fellowship-trained men’s health practitioner (CW). Topics were selected after reviewing common patient-facing society informational Fig. 1 Most popular men’s health searches. The relative search websites (i.e. Sexual Medicine Society of North America) volumes for the most popular men’s health searches are listed as and commonly handled conditions in a men’s health prac- a function of time and include ED, prostate cancer, BPH, PE, and low tice. Initial search terms were ED, prostate cancer, benign testosterone. prostatic hyperplasia (BPH), premature ejaculation, low testosterone, Peyronie’s disease (PD), testicular cancer, input into Google Trends and compared with the relevant testicular pain, testicular torsion, male infertility, penile men’s health topic. cancer, and azoospermia. Terms were searched as “disease” or “topics”. Alternative terms were also investigated (i.e., impotence vs ED) to ensure the most commonly utilized Results term was assessed. When possible, these terms were searched as “Topics” that cover a group of terms (impotence, ED was the most popularly searched topic in the United ED, erections) that share the same concept in any language, States over the last 5 years, followed by prostate cancer, as defined by Google. BPH, PE, and low testosterone (Fig. 1). Other topics in Search queries returned graphs depicting search volume descending order of search volume were testicular cancer, as a function of time, geographical data, and related topics testicular pain, PD, testicular torsion, male infertility, penile and queries. The program did not supply exact numbers, but cancer, and azoospermia. The search volume for PE saw a instead offered what it called a search volume index (SVI) significant decline in the beginning of 2016 that persisted as a percent of the maximum search volume for the chosen thereafter. PD had large, repeated spikes in its search volume timeframe. Graphs were compared to rank topics based throughout 2018 that tapered in 2019 (Fig. 2). Most other on SVI. topics had relatively stable and much lower search volumes. Discrete or isolated spikes in search volume were further Around June of 2016, ED saw a significant rise in search explored to identify an inciting event. These were arbitrarily volume that returned to baseline in a matter of days. Within defined as sudden increases in search volume by more than the same timeframe, a related query provided by Google 20% within a 1-week period. Once identified, search query Trends is “porn-induced ED,” which produced a spike that dates were limited from the 5-year timeframe to within correlated well with that of ED (Fig. 3). Interestingly, 2 weeks of when the spike occurred. Along with the graph removing the hyphen and searching for “porn-induced ED” and geographical data, the Google Trends results page also produced a different graph that still had correlations with includes a useful section titled “related queries”, which that of ED. A closer look at some topics with interesting appears to be timeframe dependent. Queries listed in these spikes is provided in Fig. 4. These spikes had potentially tables also include percentage values based on relevance by identifiable causes related to news and media. which they are ordered. The trends of related queries were then systematically compared on the website with those of the originally searched topic to explore a possible associa- Discussion tion. If no listed query produced a trend with similarities to that of the topic in question or the spike being explored, a ED affects over 10% of the American male population [7]. regular Google search was performed of the topic itself Given that over 60% of surveyed males view sexual health using the same terminology. Google allows one to filter of high importance to the quality of life [8], it is no surprise results by date, and this was utilized to yield search results that ED is the most popularly searched online disease per- within the same timeframe as the spike. Simplified key- taining to men’s health. The second most common search words related to top results within the first page were then disease “prostate cancer” is the most diagnosed malignancy Erectile dysfunction and prostate diseases are the predominant Google search terms amongst men’s health. . .

Fig. 2 Search trends for Search trends for Peyronie's disease Peyronie’s disease. The relative 100 ’ search volume for Peyronie s 90 disease is listed as a function of time. 80 70 60 50

40 Peyronie's disease 30

Relave search volume 20 10 0 3/23/2014 3/23/2015 3/23/2016 3/23/2017 3/23/2018 Date

Fig. 3 Associations in erectile Associaons in erecle dysfuncon dysfunction. The relative search 100 volumes for associations in erectile dysfunction, porn- 90 induced erectile dysfunction and 80 porn induced erectile 70 dysfunction are listed as a Erecle dysfuncon function of time. 60

50 Porn-induced erecle dysfuncon 40 Porn induced erecle 30 dysfuncon Relave search volume 20

0 3/23/2014 3/23/2015 3/23/2016 3/23/2017 3/23/2018 Date in men [9]. The third most popular term, BPH, affects over increased search volume corresponding to efforts to 15 million men in the United States [10]. The correlation increase awareness for either National Prostate Cancer between disease prevalence and search frequency is Awareness Month or “Movember” during the months of apparent in this analysis. September and November, respectively. This is in stark Both popular search terms and less prevalent topics are contrast to the regularly observed increases in search influenced by contemporary events. On October 4, 2016, volume for breast cancer during its more-publicized actor Ben Stiller published an online blog post [11] detail- awareness month of October, as noted by Phillips et al. ing his fight with prostate cancer and urging the public to [5]. This dichotomy between organic movements brought follow screening guidelines. This triggered a surge of on by celebrities highlighting diseases garnering more Google searches about prostate cancer that would become attention than planned awareness months is interesting and the topic’s peak popularity over the last 5 years. A similar highlights the power of public figures in influencing health trend was also observed on Twitter [12]. The same phe- searches and subsequently disease awareness. Potentially nomenon was observed for the topic of testicular cancer planned awareness months should consider partnering with when Olympian swimmer Nathan Adrian announced over celebrities more frequently to help advance their causes. Instagram that he was diagnosed with the disease on Jan- There were several instances of observed spikes in search uary 24, 2019 [13]. These correlations are apparent when volume topics following increased media coverage of comparing the search volumes for the topics with those of medical findings or accomplishments. One such instance the respective celebrities (Fig. 4). These were perhaps the involved the topic of male infertility. In January 2018, a most striking examples of a direct cause and effect rela- publication linked ibuprofen use to a state of compensated tionship between cultural events and increased health lit- hypogonadism [14]. This was subsequently publicized by eracy among males. Interestingly, there was no trend of online news outlets [15] as a link to decreased male fertility, K. Hanna et al.

A Associaon of prostate cancer and Ben Sller volumes for “penile transplant” also saw a marked increase 100 for the same timeframe (Fig. 4).

80 There were two topics that exhibited trends not clearly

60 linked to popular culture phenomena: PE and PD. PE had significant decreases in its search volume beginning in 2016. 40 Prostate cancer Ben Sller It is unclear why this trend exists, though the fact that many 20 advancements have been made in understanding and treating Relave Search Volume 0 the disease [17] offers a plausible explanation. Unfortunately, 9/1/2016 10/1/2016 11/1/2016 Date it is difficult to determine whether prevalence rates have concurrently decreased. In the case of PD, there were repeated B Associaon of tescular cancer and Nathan Adrian spikes in search volume from January 2018 onward. These 100 spikes subsided by 2019, though smaller fluctuations still 80 occurred. When searching for Google results for PD within 60 that timeframe, one link brought attention to a television

40 Tescular cancer commercial by Endo Pharmaceuticals that began airing during Nathan Adrian 20 that time [18]. This commercial provides a web address to

Relave search volume 0 learn more about the disease. We believe this could explain 12/1/2018 1/1/2019 2/1/2019 the erratic nature of the search trends for PD; Americans may Date be researching this disease in waves that correspond with Endo Pharmaceutical add campaigns. Indeed, the Google C Associaon of male inferlity and ibuprofen inferlity 100 Trends graph for the web address [19]providedbythe ﬂ 80 commercial did have uctuations that coincided with those of the graph for PD. 60 Male inferlity Ibuprofen inferlity While continued internet use has been associated with 40 decreased health literacy decline [20], there is also sub- 20 stantial risk for patients encountering false or misleading Research search volume 0 information. A broad look into available web resources on 12/1/2017 1/1/2018 2/1/2018 the topic of men’s health found that many of the 357 Date websites analyzed were of lower tier and did not meet the D Associaon of penile cancer and penile transplant World Health Organization Health on the Net standards 100 [21]. A recent look into YouTube videos discussing PE 80 found that many of them contained misleading information 60 penile cancer [22]. What is more, misinformation can be propagated via 40 penile transplant social media sharing, as this has been observed regarding

20 genitourinary malignancies [23]. Even Ben Stiller’s post

Relave search volume 0 contained misleading and controversial information 4/1/2016 5/1/2016 6/1/2016 regarding prostate cancer screening [11]. Furthermore, the Date internet serves as an opportunity for drug companies and Fig. 4 Discrete spikes in search volumes for men’s health topics organizations to advertise their products and services [21]. and relevant associations. A Association of prostate cancer and Ben In fact, the web address provided by Endo Pharmaceuticals’ Stiller. B Association of testicular cancer and Nathan Adrian. C Association of male infertility and ibuprofen infertility. D Association commercial directs one directly to a page advertising their of penile cancer and penile transplant. new drug for PD, Xiaflex [19]. This creates a potentially unreliable and biased landscape for patients to obtain health likely resulting in the observed influx in search volume for information. With men being less likely to seek formal male infertility during that timeframe. Searching “ibuprofen medical care overall [24], the astute clinician must adapt infertility” on Google trends produced a graph with a spike and embrace technology to combat misinformation. that correlates to that of male infertility (Fig. 4). This was Fortunately, there is a silver lining to this conundrum. also seen regarding the topic of penile cancer. In May 2016, Just as patients are relying more on the internet to obtain Massachusetts General Hospital announced on its website health information, providers are similarly using it more to that it had completed the first penile transplant within the educate and promote health. This indicates that the internet United States for a patient with penile cancer [16]. This can be harnessed by the medical community to help educate correlated with roughly a threefold increase in searches online consumers and improve health literacy. In the con- about penile cancer during that time. 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