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

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 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

The internet is the general public’s largest and most accessible source of information. This is relevant in health care as patients have become increasingly active consumers of health information. Urological information seeking is no exception to this trend; significant internet use by urology patients has been described since the early 2000s [1].

Google (Mountain View, CA) is arguably the most frequently used website to search for information. The website’s convenient service Google Trends offers data on public search interest and search volume that can be translated into useful insight for providers. This resource has already been utilized by individuals in the urological community such as Dreher et al. who analyzed trends of searches for information on surgical options for kidney stones [2]. Interestingly, few studies are looking at search trends as they relate to men’s health. A recent study by Russo et al. used search terms ‘Peyronie’s disease, erectile dysfunction (ED), and premature ejaculation’ to assess public interest regarding penetrance and treatment of these conditions [3]. Another study by Garijo et al. used Google Trends to assess seasonal variation in ED [4]. While studies using search trends analysis are a growing area in men’s health, we believe there is more information to discover and characterize.

Google Trends has the potential to offer important glimpses into the information-seeking behaviors for men regarding their own health. Topic popularity may be correlated 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 behind search trends can also be explored. Using Google Trends, Ortiz et al. noted increased search volume about suicide following celebrity suicide deaths [6]. This temporal relationship of increased search volume and popular culture influence leads us to believe that Google search trends for topics in men’s health are also influenced by cultural events. 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 websites (i.e. Sexual Medicine Society of North America) and commonly handled conditions in a men’s health practice. Initial search terms were ED, prostate cancer, benign prostatic hyperplasia (BPH), premature ejaculation, low testosterone, Peyronie’s disease (PD), testicular cancer, testicular pain, testicular torsion, male infertility, penile 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 term was assessed. When possible, these terms were searched as “Topics” that cover a group of terms (impotence, ED, erections) that share the same concept in any language, as defined by Google.

Search queries returned graphs depicting search volume as a function of time, geographical data, and related topics and queries. The program did not supply exact numbers, but instead offered what it called a search volume index (SVI) as a percent of the maximum search volume for the chosen timeframe. Graphs were compared to rank topics based on SVI.

Discrete or isolated spikes in search volume were further explored to identify an inciting event. These were arbitrarily defined as sudden increases in search volume by more than 20% within a 1-week period. Once identified, search query dates were limited from the 5-year timeframe to within 2 weeks of when the spike occurred. Along with the graph and geographical data, the Google Trends results page also includes a useful section titled “related queries”, which appears to be timeframe dependent. Queries listed in these tables also include percentage values based on relevance by 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 association. If no listed query produced a trend with similarities to that of the topic in question or the spike being explored, a regular Google search was performed of the topic itself using the same terminology. Google allows one to filter results by date, and this was utilized to yield search results within the same timeframe as the spike. Simplified keywords related to top results within the first page were then input into Google Trends and compared with the relevant men’s health topic.

Results

ED was the most popularly searched topic in the United States over the last 5 years, followed by prostate cancer, BPH, PE, and low testosterone (Fig. 1). Other topics in descending order of search volume were testicular cancer, testicular pain, PD, testicular torsion, male infertility, penile cancer, and azoospermia. The search volume for PE saw a significant decline in the beginning of 2016 that persisted thereafter. PD had large, repeated spikes in its search volume throughout 2018 that tapered in 2019 (Fig. 2). Most other topics had relatively stable and much lower search volumes.

Fig. 1: Most popular men’s health searches.
figure1

The relative search volumes for the most popular men’s health searches are listed as a function of time and include ED, prostate cancer, BPH, PE, and low testosterone.

Fig. 2: Search trends for Peyronie’s disease.
figure2

The relative search volume for Peyronie’s disease is listed as a function of time.

Around June of 2016, ED saw a significant rise in search volume that returned to baseline in a matter of days. Within the same timeframe, a related query provided by Google Trends is “porn-induced ED,” which produced a spike that correlated well with that of ED (Fig. 3). Interestingly, removing the hyphen and searching for “porn-induced ED” produced a different graph that still had correlations with that of ED. A closer look at some topics with interesting spikes is provided in Fig. 4. These spikes had potentially identifiable causes related to news and media.

Fig. 3: Associations in erectile dysfunction.
figure3

The relative search volumes for associations in erectile dysfunction, porn-induced erectile dysfunction and porn induced erectile dysfunction are listed as a function of time.

Fig. 4: Discrete spikes in search volumes for men’s health topics and relevant associations.
figure4

A Association of prostate cancer and Ben Stiller. B Association of testicular cancer and Nathan Adrian. C Association of male infertility and ibuprofen infertility. D Association of penile cancer and penile transplant.

Discussion

ED affects over 10% of the American male population [7]. Given that over 60% of surveyed males view sexual health of high importance to the quality of life [8], it is no surprise that ED is the most popularly searched online disease pertaining to men’s health. The second most common search disease “prostate cancer” is the most diagnosed malignancy in men [9]. The third most popular term, BPH, affects over 15 million men in the United States [10]. The correlation between disease prevalence and search frequency is apparent in this analysis.

Both popular search terms and less prevalent topics are influenced by contemporary events. On October 4, 2016, actor Ben Stiller published an online blog post [11] detailing his fight with prostate cancer and urging the public to follow screening guidelines. This triggered a surge of Google searches about prostate cancer that would become the topic’s peak popularity over the last 5 years. A similar trend was also observed on Twitter [12]. The same phenomenon was observed for the topic of testicular cancer when Olympian swimmer Nathan Adrian announced over Instagram that he was diagnosed with the disease on January 24, 2019 [13]. These correlations are apparent when comparing the search volumes for the topics with those of the respective celebrities (Fig. 4). These were perhaps the most striking examples of a direct cause and effect relationship between cultural events and increased health literacy among males. Interestingly, there was no trend of increased search volume corresponding to efforts to increase awareness for either National Prostate Cancer Awareness Month or “Movember” during the months of September and November, respectively. This is in stark contrast to the regularly observed increases in search volume for breast cancer during its more-publicized awareness month of October, as noted by Phillips et al. [5]. This dichotomy between organic movements brought on by celebrities highlighting diseases garnering more attention than planned awareness months is interesting and highlights the power of public figures in influencing health searches and subsequently disease awareness. Potentially planned awareness months should consider partnering with celebrities more frequently to help advance their causes.

There were several instances of observed spikes in search volume topics following increased media coverage of medical findings or accomplishments. One such instance involved the topic of male infertility. In January 2018, a publication linked ibuprofen use to a state of compensated hypogonadism [14]. This was subsequently publicized by online news outlets [15] as a link to decreased male fertility, likely resulting in the observed influx in search volume for male infertility during that timeframe. Searching “ibuprofen infertility” on Google trends produced a graph with a spike that correlates to that of male infertility (Fig. 4). This was also seen regarding the topic of penile cancer. In May 2016, Massachusetts General Hospital announced on its website that it had completed the first penile transplant within the United States for a patient with penile cancer [16]. This correlated with roughly a threefold increase in searches about penile cancer during that time. Indeed, search volumes for “penile transplant” also saw a marked increase for the same timeframe (Fig. 4).

There were two topics that exhibited trends not clearly linked to popular culture phenomena: PE and PD. PE had significant decreases in its search volume beginning in 2016. It is unclear why this trend exists, though the fact that many advancements have been made in understanding and treating the disease [17] offers a plausible explanation. Unfortunately, it is difficult to determine whether prevalence rates have concurrently decreased. In the case of PD, there were repeated spikes in search volume from January 2018 onward. These spikes subsided by 2019, though smaller fluctuations still occurred. When searching for Google results for PD within that timeframe, one link brought attention to a television commercial by Endo Pharmaceuticals that began airing during that time [18]. This commercial provides a web address to learn more about the disease. We believe this could explain the erratic nature of the search trends for PD; Americans may be researching this disease in waves that correspond with Endo Pharmaceutical add campaigns. Indeed, the Google Trends graph for the web address [19] provided by the commercial did have fluctuations that coincided with those of the graph for PD.

While continued internet use has been associated with decreased health literacy decline [20], there is also substantial risk for patients encountering false or misleading information. A broad look into available web resources on the topic of men’s health found that many of the 357 websites analyzed were of lower tier and did not meet the World Health Organization Health on the Net standards [21]. A recent look into YouTube videos discussing PE found that many of them contained misleading information [22]. What is more, misinformation can be propagated via social media sharing, as this has been observed regarding genitourinary malignancies [23]. Even Ben Stiller’s post contained misleading and controversial information regarding prostate cancer screening [11]. Furthermore, the internet serves as an opportunity for drug companies and organizations to advertise their products and services [21]. In fact, the web address provided by Endo Pharmaceuticals’ commercial directs one directly to a page advertising their new drug for PD, Xiaflex [19]. This creates a potentially unreliable and biased landscape for patients to obtain health information. With men being less likely to seek formal medical care overall [24], the astute clinician must adapt and embrace technology to combat misinformation.

Fortunately, there is a silver lining to this conundrum. Just as patients are relying more on the internet to obtain health information, providers are similarly using it more to educate and promote health. This indicates that the internet can be harnessed by the medical community to help educate online consumers and improve health literacy. In the context of men’s health, there are already websites that are sponsored by government and private organizations that serve as reliable sources of information [21]. Furthermore, urologists specifically have been using social media at dramatically increasing rates [25, 26]. Given that the general population will only become more connected to the internet and social media, it would be beneficial for medical providers to follow the same trend.

There are several limitations to this study that should be noted. For one, only trends specific to the Google search engine are used. Those of other search engines such as Bing and Yahoo are not explored in this paper. The most significant limitation is inherent to Google Trends in that it does not provide true values for search volumes but instead provides the SVI. The SVI reports relative values based on the maximum search volume, making detailed and meaningful statistical analysis difficult. Another limitation is that there was no set protocol by which the studied men’s health topics were chosen. There is an underlying selection bias in using topics that have interesting trends and observable associations with people or events. Another issue is that searching for an association in observed trends is limited to the program’s suggestions and blind searches, which do not always provide meaningful answers. Furthermore, it is impossible to determine if these proposed associations are more correlation or causation. It should be noted that there is no way of determining what percentage of the total search volume was made by patients seeking information. It is possible that some of the topics are popular because they are also searched and researched by health care professionals.

Searches for men’s health topics online appear to be related to cultural events including celebrity announcements with planned health awareness months having less of an effect. The most popular topics are those relating to sexual dysfunction and commonly occurring diseases of the prostate. In the future, it may be helpful for providers to stay informed of cultural events relating to medical conditions to anticipate patient concerns and questions and for awareness months to look to celebrity advocates to help deliver their message.

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Correspondence to Mark Arthur.

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KH and MA—no conflicts of interest. CW—Compensated Reviewer for Oakstone Publishing, Medscape.

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Hanna, K., Arthur, M. & Welliver, C. Erectile dysfunction and prostate diseases are the predominant Google search terms amongst men’s health topics. Int J Impot Res (2021). https://doi.org/10.1038/s41443-021-00448-1

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