Biomedical subjects

S E Althof

Publications and source records attributed to S E Althof.

At least 19 recordsLinked to original sources

PubMed2002

When an erection alone is not enough: biopsychosocial obstacles to lovemaking.

Giving men firm erections is relatively straightforward these days; getting them to make use of it regularly in lovemaking is more complicated. Discontinuation rates for any of the available medical treatments for erectile dysfunction, including sildenafil, have been found to range from 50% to 60%. Thus, there is a disproportionately high number of individuals who fail to continue using medical interventions compared to those for whom treatment is efficacious. If not efficacy, then what factors contribute to this puzzling dropout phenomenon? This article discusses the psychological resistances of men, women, and couples that contribute to their stopping treatment for erectile dysfunction. Some of the factors that may be responsible include: (1) the length of time the couple was asexual before seeking treatment; (2) the man's approach to resuming a sexual life with his partner; (3) the man's expectations of how sildenafil will change his life; (4) the partner's physical and emotional readiness to resume lovemaking; (5) the meaning for each partner of using a medical intervention to restore lovemaking; (6) the quality of the nonsexual relationship; and (7) unconventional sexual arousal patterns in the man. To be effective, clinicians must go beyond the simple restoration of erectile function to help patients become active lovemakers again.

Combined Modality Therapy↗

PubMed2001

Patient and partner satisfaction with Viagra (sildenafil citrate) treatment as determined by the Erectile Dysfunction Inventory of Treatment Satisfaction Questionnaire.

OBJECTIVES: To assess the efficacy and safety of Viagra (sildenafil citrate) in male outpatients with erectile dysfunction and patient and partner satisfaction with treatment using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). METHODS: A total of 247 patients with erectile dysfunction of broad-spectrum etiology were treated in a randomized, double-blind, parallel-group, multicenter study conducted at outpatient clinics. Patients receiving oral sildenafil (25, 50, and 100 mg) were compared with patients receiving placebo during a 12-week period. The principal efficacy measures were responses to question 3 (ability to achieve an erection) and question 4 (ability to maintain an erection) on the International Index of Erectile Function and three global efficacy questions. Patient and partner satisfaction with treatment were assessed, for the first time, using the EDITS questionnaire. RESULTS: Efficacy scores for the International Index of Erectile Function questions and the global efficacy questions were significantly higher for patients receiving sildenafil than for those receiving placebo (P <0.001). Both patients and partners receiving sildenafil also had significantly higher EDITS scores than those receiving placebo (P <0.001). Adverse events were chiefly mild or moderate. Two patients receiving sildenafil and none receiving placebo discontinued treatment because of adverse events. CONCLUSIONS: Sildenafil was an effective, well-tolerated treatment for erectile dysfunction in an outpatient setting. Partner evaluations corroborated patient assessments. The results from the EDITS questionnaire indicated that after 12 weeks of receiving sildenafil both patients and partners reported higher levels of treatment satisfaction relative to placebo.

Adult↗

PubMed2001

Nocturnal penile tumescence activity unchanged after long-term intracavernous injection therapy.

PURPOSE: Anecdotal evidence suggests that some men have restored erectile function after long-term intracavernous injection therapy for erectile dysfunction. We objectively assessed this phenomenon using nocturnal penile tumescence testing. MATERIALS AND METHODS: In our retrospective study 19 men with a mean age of 53.5 years who had organic erectile dysfunction underwent nocturnal penile tumescence testing before and after prostaglandin E1 based intracavernous injection at least 6 months in duration. The nocturnal penile tumescence parameters measured included the number of erectile episodes, base and tip tumescence, and percent of time with rigidity greater than 70% at the penile base and tip. A 5-item questionnaire was given to all patients after the intracavernous injection period to assess subjective changes in erectile quality. RESULTS: Mean time on intracavernous injection was 2.42 years and mean injection frequency was 3.74 times monthly. Prostaglandin E1 only, and combined prostaglandin E1, phentolamine and papaverine were used in 7 and 9 cases, respectively. Nine patients believed that unaided erection improved after intracavernous injection and 6 achieved intercourse without injection who were unable to do so before injection. No statistically significant changes were noted in any of the 5 objectively measured nocturnal penile tumescence parameters. CONCLUSIONS: Long-term prostaglandin E1 based intracavernous injection may provide subjective improvement in erectile function in some men. However, as measured by nocturnal penile tumescence testing, no objective improvement in spontaneous erectile function occurs.

Alprostadil↗

PubMed2000

Rapid ejaculation.

Rapid ejaculation, or premature ejaculatory dysfunction, is the most frequently encountered sexual complaint of men and couples. It is most common in adolescents, young adults, and other sexually naive males. Increased risk is associated with lack of sexual experience, lack of knowledge regarding normal male and female sexual responses, and with those individuals who highly associate psychological factors (such as fear, guilt, and anxiety) with sexual activity. This article provides a basic review of the pathophysiology of ejaculatory dysfunction and discusses the current treatment options for rapid ejaculation.

Animals↗

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↗

PubMed1998

Evidence based assessment of rapid ejaculation.

This manuscript reviews the clinical and scientific methods utilized to assess treatment outcome in rapid ejaculation. The current methods and measures are critically evaluated and suggestions for future research efforts are included.

Ejaculation↗

PubMed1997

Construction of scales for the Center for Marital and Sexual Health (CMASH) Sexual Functioning Questionnaire.

The objective of this study was to identify a set of scales for summarizing the results of the Center for Marital and Sexual Health Sexual Functioning Questionnaire (CMASH SFQ). Scales for this instrument were constructed using patients' responses to the CMASH SFQ in a recent clinical trial of prostaglandin E1 (PGE1, alprostadil), an injectable vasodilator used to treat erectile dysfunction. A set of items was identified as a scale if they met predetermined standards of internal consistency, discriminant validity, and convergent validity. The reproducibility of the scales was then evaluated, and the extent to which the scales reliably measured change in treatment-related quality of life was assessed. Reliable and responsive scales for four domains related to sexual functioning were identified. Items in these scales were generally internally consistent; items in the scales and the scores for the scales generally satisfied criteria of discriminant validity; and the scales generally satisfied the standard for convergent validity. Evaluating patients' responses to the CMASH SFQ with scores for four reliable and responsive scales allows easier summarization of patients' sexual functioning and increases the statistical power of evaluations of the effects of interventions designed to improve sexual functioning.

Adult↗

PubMed1997

Quality of life effects of alprostadil therapy for erectile dysfunction.

PURPOSE: We evaluated the quality of life effects of self-administered intracavernosal injection of alprostadil sterile powder for erectile dysfunction when used by patients for up to 18 months. MATERIALS AND METHODS: Clinical and self-reported measurements were used to assess physiological and psychological status at baseline, and at 3, 6, 12 and 18 months for 579 patients who entered the self-injection phase of an open label, flexible dose clinical trial. Quality of life was measured using the Center for Marital and Sexual Health Sexual Functioning Questionnaire, which focuses on the psychosocial and physical dimensions of erectile dysfunction; the Brief Symptom Inventory, which measures mental health, and the Duke Health Profile, which measures general quality of life. The primary evaluations were quality of life changes from baseline to post-initiation periods and reasons for treatment discontinuation. RESULTS: The Center for Marital and Sexual Health Sexual Functioning Questionnaire displayed improvements at all post-initiation periods in 10 questions (p < 0.001, Student's paired t-tests) grouped into scales representing frequency of sexual activity, erection, orgasm and satisfaction domains. On the Brief Symptom Inventory interpersonal sensitivity, anxiety and depression as well as global scores improved (p < 0.001). Overall mental health as measured by the Duke Health Profile also improved (p < 0.01) between baseline and 6 months. The reasons most frequently cited for treatment discontinuation were nonfirm erections and injection site pain. CONCLUSIONS: Clinical improvements in erectile function due to alprostadil therapy were associated with improvements in sexual activity, sexual satisfaction and overall mental health.

Adult↗

PubMed1996

The reliability and validity of a sexual functioning questionnaire.

The present study assessed the reliability and validity of a measure of sexual functioning, the CMSH-SFQ, for male patients and their partners. The CMSH-SFQ measures erectile and orgasmic functioning, sexual drive, frequency of sexual behavior, and sexual satisfaction. Test-retest reliability was assessed with 19 males and 19 females for the baseline CMSH-SFQ. Criterion validity was measured by comparing the answers of 25 male patients to those of their partners at baseline and follow-up. The majority of items had acceptable levels of reliability and validity. The CMSH-SFQ provides a reliable and valid device that can be used to measure global sexual functioning in men and their partners and may be used to evaluate the efficacy of treatments for sexual dysfunctions. Limitations and suggestions for use of the CMSH-SFQ are addressed.

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

The evaluation and management of erectile dysfunction.

Significant progress has been realized in the evaluation and treatment of erectile disorders during the past 15 years. The establishment of interdisciplinary teams and evolution of treatment centers have led to comprehensive, state-of-the-art evaluation and multiple innovative treatment options. Limitations in our knowledge, however, remain because age-related standards for diagnostic tests are not available. In some cases, we remain humble and uncertain about the validity of our diagnostic methods and our ability to offer proper treatments. The field is not standing still, however, and we expect that further refinements in evaluation techniques based on new findings in physiology and fresh psychological and medical approaches will make erectile dysfunction more efficiently and effectively treatable.

Adult↗

PubMed1995

Pharmacologic treatment of rapid ejaculation.

There appears to be a great deal of excitement regarding the potential of clomipramine and serotonin reuptake inhibitor drugs to treat rapid ejaculation. I worry that pharmacologic intervention will be recommended indiscriminately by busy physicians unaware of the complexities of men's/couples' sexual equilibrium. Interdisciplinary teams need to develop thoughtful guidelines that address the thorny issues surrounding the evolution of this new treatment alternative.

1-Naphthylamine↗

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↗

PubMed1993

Proverb familiarity and the mental status examination.

Asking patients to interpret proverbs is a traditional method of assessing abstract thinking ability. Familiarity with a proverb increases the likelihood of interpreting it correctly. Differences in proverb familiarity among patients could lead clinicians to incorrectly conclude that a patient is thinking concretely, and thus to underestimate the patient's cognitive ability. Clinicians should be aware of this possibility when assessing patients from different racial and gender groups. The authors surveyed 229 Afro-American and 104 Caucasian high school students to determine their familiarity with 25 proverbs. Thirty-seven clinicians were also asked to rate their patients' familiarity with the same proverbs. The authors found no differences in proverb familiarity between the black and white students or the male and female students. Clinicians' beliefs about proverb familiarity in their patients were found to be inaccurate.

Adolescent↗

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↗

PubMed1992

Books helpful to patients with sexual and marital problems: a bibliography.

The aim of this project was to develop a current, problem-focused list of books helpful to patients with sexual and/or marital problems. Survey forms requesting respondents to list books helpful to patients with specific marital/sexual problems were sent to all members of the Society for Sex Therapy and Research (SSTAR) and the clinical members of the Society for the Scientific Study of Sex (SSSS). Of 933 forms, 170 (18%) were returned. Responses were verified for accuracy and a full citation was developed for each. Tabulations of responses were calculated and a bibliography developed.

Humans↗