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Biomedical subjects

S B Levine

Publications and source records attributed to S B Levine.

At least 19 recordsLinked to original sources
PubMed1999

EDITS: development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction.

OBJECTIVES: To develop Patient and Partner versions of a psychometrically sound questionnaire, the EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction), to assess satisfaction with medical treatments for erectile dysfunction. METHODS: Treatment satisfaction differs from treatment efficacy as it focuses on a person's subjective evaluation of treatment received. Twenty-nine items representing the domain of treatment satisfaction for men and 20 representing partner satisfaction were generated. Two independent samples of 28 and 29 couples completed all items at two points in time. Spearman rank-order correlations were derived to assess test-retest reliability and couple coefficients of validity. Internal consistency coefficients were calculated for both Patient and Partner versions and a content validity panel was used to analyze content validity. RESULTS: Only items that met all the following criteria were selected to comprise the final questionnaires: (a) range of response four or more out of five; (b) test-retest reliability greater than 0.70; (c) ratings by at least 70% of the content validity panel as belonging in and being important for the domain; and (d) significant correlation between the subjects' and partners' responses. Eleven patient items met criteria and formed the Patient EDITS; five partner items met criteria and formed the Partner EDITS. Scores on the two inventories were normally distributed with internal consistencies of 0.90 and 0.76, respectively. Test-retest reliability for the Patient EDITS was 0.98; for the Partner EDITS, it was 0.83. CONCLUSIONS: Reliability and validity were well established, enabling the EDITSs to be used to assess satisfaction with treatment modalities for erectile dysfunction and to explore the impact of patient and partner satisfaction on treatment continuation.

Erectile Dysfunction↗
PubMed1996

"Love" and the mental health professions: toward understanding adult love.

This essay explores three aspects of the normal processes of adult-adult love: falling in love, being in love, and staying in love. It describes the emotions, defenses, and challenges inherent in each phase. Love is an ordinary but immensely powerful adult aspiration. As a term it is impossible to define in any singular sense. The attainment of its lofty purposes requires profound intrapsychic adjustments involving creative acts of imagination, the integration of ideals with reality, evolving adaptations to the partner, the maintenance of a positive internal image of the partner, and ongoing struggles to overcome self-interest. These adjustments have not been well characterized by the mental health professions. This is ironic since a large portion of our work involves caring for love's casualties--that is, people whose miseries relate to their inability to successfully negotiate the phases of love or whose happiness is limited by their partners who cannot. Six arguments for ending professional avoidance of the topic are offered, the most compelling of which are love's relevance to both the pathogenesis of mental suffering and to the art of psychotherapeutic healing.

Emotions↗
PubMed1995

On love.

This paper aims to stimulate awareness of the relationship between adult heterosexual love and sexual health. Although rarely discussed in professional circles, adult love is a powerful ideal that strongly influences both individual and relationship psychology. A gap between one's personal ideal of love and the actual experience of it inevitably appears within a long-term relationship. The feelings and behavior that stems from the gap become a crucial management issue for each individual in a relationship. The gap is minimized by an array of defenses and competing life demands, which either enhance or destabilize individual and relationship well-being. Idealization, denial, and rationalization are necessary to preserve the internal sense of loving at all phases of the committed relationship. The limitations of various definitions of sexual health are reviewed. Sixteen suggestions for preserving sexual health in long-term relationships are offered. Most of these involve guidelines for overcoming narcissism. The limitations of modern therapists, even sex therapists, for forthrightly dealing with sexual problems in terms of love are highlighted.

Adult↗
PubMed1995

A double-blind crossover trial of clomipramine for rapid ejaculation in 15 couples.

BACKGROUND: The purpose of this study was to assess the sexual and psychosocial efficacy of clomipramine for rapid ejaculation. METHODS: Fifteen physically healthy, self-selected couples (men had a mean age of 38 years) who met six eligibility criteria and did not meet five exclusion criteria participated in a variable-length, repeated measures, randomized, double-blind, placebo-controlled crossover study with a 2-month follow-up period. Sexual and psychosocial assessments were conducted at baseline, after placebo, after 25 mg/day of clomipramine, after 50 mg/day of clomipramine, and at the 2-month follow-up point. The major outcome measures included stopwatch timing of ejaculation latencies, modified Case Western Reserve University Sexual Function Questionnaire, Symptom Checklist-90-R, Dyadic Adjustment Scale, State-Trait Anxiety Inventory, and the Harder Self-Esteem Inventory. RESULTS: Baseline mean ejaculatory latency was 81 seconds; 25 mg/day of clomipramine increased it to 202 seconds and 50 mg/day of clomipramine to 419 seconds. This resulted in significantly greater sexual satisfaction scores for men and their partners (men, p < .001; women, p < .05), improvements in partner coital orgasmic attainment, and greater relationship and emotional satisfaction for the men. Withdrawal of the drug caused ejaculatory latencies to return to baseline. CONCLUSION: Clomipramine appears to be effective in significantly lengthening ejaculatory latencies and increasing sexual and relationship satisfaction. It can be a cost-effective chronic therapy for selected patients. These impressive results should not be expected in a less carefully screened population of men concerned about the timing of their orgasm during intercourse.

Adult↗
PubMed1995

What is clinical sexuality?

A collage of eight overlapping themes for the definition of sexuality is presented prior to undertaking a historical overview of the rapid development of the field that began in 1970 as "sex therapy." The limitations of theory, behavioral science, and the art of medicine as they apply to helping people with their sexual concerns are highlighted.

Gender Identity↗
PubMed1994

Professionals who sexually offend: evaluation procedures and preliminary findings.

Methods and results of the psychiatric evaluations of 31 professionals who have been accused of sexually inappropriate behaviors within their work context are presented. Eight types of professionals were evaluated; the majority were clergy, physicians, and teachers. Paraphilia was diagnosed in 26%, a nonparaphilic sexual compulsive syndrome in another 29%, and some form of character disorder in 58%. Seven professionals had offended six or more times. The ethical failures of the professionals were diverse and could not simply be explained by psychiatric diagnoses. Approximately half of the professionals were thought to be safe to return to work, often with a recommendation for psychotherapy and monitoring of their professional activities. A recommendation to no longer practice their professional roles was given for 47% of those evaluated, and the referring agency followed through with the recommendation. Outpatient psychotherapy was recommended for 84% of the sample. Psychotropic medications were occasionally recommended.

Adult↗
PubMed1994

The impact of systemic lupus erythematosus on women's sexual functioning.

OBJECTIVE: We investigated the impact of systemic lupus erythematosus (SLE) and the mediating effects of psychosocial factors on women's sexual adjustment. METHODS: Data were obtained through structured interviews and psychometric scales administered to 100 female subjects with SLE and 71 disease-free controls. RESULTS: Compared with controls, patients with SLE had a significantly higher rate of abstention (26 vs 4%, p < 0.01), a lower frequency of sexual activity among the sexually active (p < 0.05), diminished vaginal lubrication (p < 0.01), and poorer general sexual adjustment (p < 0.01). Greater disease severity was associated with more impairment in sexual function (p < 0.01). Variables mediating the relationship between diagnostic status and sexual outcome included age (delta R2 = 0.04, p < 0.01), relationship status (delta R2 = 0.03, p < 0.05), weight concerns (delta R2 = 0.05, p < 0.01), premorbid sexual adjustment (delta R2 = 0.04, p < 0.01), and depression (delta R2 = 0.03, p < 0.05). Seventy-two percent of patients with SLE were receptive to physician inquiry about sexual functioning and 82% desired further education about the sexual impact of the disease. CONCLUSION: Our results suggest that sexual impairment is not inevitable among women with SLE. The role that providers can play in helping to prevent sexual difficulties is discussed.

Adult↗
PubMed1993

Medical and psychosocial predictors of sexual outcome among women with systemic lupus erythematosus.

The influence of medical and psychosocial variables on sexual outcome in 100 women with systemic lupus erythematosus was examined. Subjects were administered a sexual adjustment interview and scales assessing depression, body image, and relationship quality. Medical data were obtained from patients and physicians. Key predictors of sexual outcome were disease severity (P < 0.001), premorbid sexual adjustment (P < 0.05), and relationship quality (P < 0.05). Results suggest that the impact of systemic lupus erythematosus on sexual response may best be understood by considering a combination of interpersonal, psychological, and medical conditions in a patient's life.

Adult↗
PubMed1993

Gender-disturbed males.

Adolescent and adult cross-dressing or "transvestism" is the most common antecedent behavioral pattern among those who request sex reassignment surgery. Transvestites are actually a diverse group of men who differ in their gender identities, orientation, and intention. They do, however, have in common a soothing image of themselves as women. Because of this, whether cross-dressing occurs among masculine or feminine males or heterosexuals, homosexuals, bisexuals, or asexuals, or among those with paraphilia, the behavior should be considered the expression of their consciously felt femininity. The confusing differences among cross-dressing males may be explained by their diversity along three dimensions: 1) the ambition for heterosexual intercourse; 2) the natural history of their sexual arousal to female clothing; 3) their current capacity to integrate their masculine and feminine strivings into separate compartments. When cross-dressers give up all vestiges of male gender role behaviors and successfully live and work full time as women, the appropriate descriptive term for them becomes "transsexual."

Adaptation, Psychological↗
PubMed1993

Clinical approach to the sexuality of patients with spinal cord injury.

This article discusses four complex clinical perspectives on the sexual impact of spinal cord injury: the sexual equilibrium between two people, the sexual psychology of one individual, the general biology of the organically impaired person, and the sexual pathophysiology of the spinal cord deficit. These topics affect the re-establishment and maintenance of a sexual life after irreversible spinal cord trauma.

Female↗
PubMed1992

Twelve-month comparison of two treatments for erectile dysfunction: self-injection versus external vacuum devices.

This study directly compared two nonsurgical treatments for erectile dysfunction, self-injection of papaverine/phentolamine and external vacuum devices, in terms of usage rates, effectiveness, side effects, dropout rates, and impact on patient sexual and psychologic functioning. Both alternatives were regularly, successfully, and safely used by patients, though dropout rates were higher for self-injection. Both produced erections of improved quality, and effected sustained improvements in frequency of intercourse, orgasm, and sexual satisfaction. Spontaneous erections also improved with both treatments. General psychiatric symptomatology was decreased, and anxiety was improved. There were no differences between the two treatments in sexual or psychologic impact. Relative contraindications and esthetic considerations are presented.

Coitus↗
PubMed1992

Through the eyes of women: the sexual and psychological responses of women to their partner's treatment with self-injection or external vacuum therapy.

We prospectively delineated and contrasted the sexual, marital and psychological responses of women to their partner's use of 2 treatments for erectile dysfunction: 1) self-injection of papaverine and phentolamine, and 2) vacuum tumescence therapy. The women were assessed at 5 points during a 12-month period with psychometric questionnaires and clinical interviews. Statistical analysis indicated that the women responded equally well to both treatments. They demonstrated significant increases in frequency of intercourse, sexual arousal, coital orgasm and sexual satisfaction. No significant changes were noted on the psychometric questionnaires. The women reported feeling more at ease in their relationships and characterized sex as more leisurely, relaxed and assured. Negative responses focused on the lack of spontaneity and hesitation about initiating sex. Self-injection and vacuum pump therapy restore potency in men and secondarily facilitate improved sexual function in women.

Coitus↗
PubMed1991

Interim report of the DSM-IV Subcommittee on Gender Identity Disorders.

This article summarizes the discussions and recommendations of the DSM-IV Subcommittee on Gender Identity Disorders, a subcommittee of the Child Psychiatry Work Group, regarding diagnostic issues. The issues reviewed include placement in the nomenclature, the concept of a spectrum of gender dysphoria rather than discrete levels of symptomatology, criticisms of current diagnostic criteria, subtyping by sexual orientation, and proposed changes in diagnostic criteria for the current DSM-III-R diagnoses of Gender Identity Disorder of Childhood, Transsexualism, and Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type.

Adolescent↗
PubMed1991

Psychological intimacy.

Psychological intimacy develops between a speaker and a listener. Depending on how individuals fulfill these roles, intimacy may occur or be precluded. Intimacy quickly creates a bond and, if repeated, enhances psychological function. Psychological intimacy is the glue of all important relationships, including professional ones. It also is a powerful motivator of sexual expression and an enhancer of self-esteem. Because its effects are short-lived, psychological intimacy must be frequently reestablished. Mind reading and sexual intimacy, the short-cuts to the benefits of intimacy, are frequently employed to avoid telling about one's private experiences and listening respectfully.

Humans↗
PubMed1991

External vacuum devices in the treatment of erectile dysfunction: a one-year study of sexual and psychosocial impact.

This prospective study assessed the sexual and psychosocial effects of 12 months' use of an external vacuum device in the treatment of erectile dysfunction. Results showed that the external vacuum device produced erections sufficient for intercourse in 87% of the men in our sample. The dropout rate was only 20% over the 12-month period. Use of the external vacuum device was associated with improvements in men's and their partners' sexual functioning. These improvements included erections of better quality, increased partner arousal, and increased frequency of orgasm and sexual satisfaction for men and women. The external vacuum device was also associated with decreases in general psychiatric symptomatology for men. Similar improvements in psychological functioning were not found for partners. Side effects and factors in patient and partner acceptance of the external vacuum device are discussed.

Adaptation, Psychological↗
PubMed1991

Sexual, psychological, and marital impact of self-injection of papaverine and phentolamine: a long-term prospective study.

This prospective study assessed the long-term effects of self-injection of papaverine hydrochloride and phentolamine mesylate along several critical domains for 42 men and 26 partners. Over the course of one year, men were, on average, injecting themselves five times monthly, with 84% of these injections producing satisfactory erections. Treatment resulted in statistically significant improvements in quality of erection, sexual satisfaction, frequency of intercourse, and coital orgasm. The women also demonstrated significant improvement in sexual satisfaction, arousal, frequency of intercourse, and coital orgasm. Decreases in general psychiatric symptomatology were apparent for men but not for partners. The dropout rate was 57%. The common side effects of treatment were development of fibrotic nodules (26%), abnormal liver function values (30%), and bruising (19%). We conclude that self-injection should be considered among the accepted treatments for erectile dysfunction. It does appear to enhance the sexual lives of men and women when the treatment is efficacious and the couple is motivated to utilize it.

Adaptation, Psychological↗