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PubMed2006

Treatment of paraphilic sexual disorder: the use of topiramate in fetishism.

Topiramate, a newer anticonvulsant, has a modulating effect on voltage-dependent sodium and calcium ion channels, potentiates GABA neurotransmitters and blocks kainite/AMPA glutamate receptors. We describe the use of topiramate in the treatment of fetishism, a paraphilic sexual disorder. A 23-year-old male had developed sexual fantasies and urges towards women's feet and shoes from childhood onwards. The patient would masturbate with women's shoes, which he had bought or stolen from others. He would feel sexually excited by seeing and/or smelling female feet and shoes. He had received individual psychotherapy because of his unusual sexual expressions, marked distress and interpersonal difficulty. However, the psychotherapy was not effective and his symptoms of fetishism did not abate until he had been treated with topiramate (200 mg per day). He has been on the dose of this medication for more than 6 months and his symptoms of fetishism have since diminished. In addition, he has not experienced any significant side-effect with this medication. Experience with our patient suggests that topiramate may be effective in treating paraphilic sexual disorders. Further controlled studies are required to confirm its efficacy in patients of this type.

Adult↗
PubMed2001

Nonoperative treatment of patients with presumed penile fracture.

PURPOSE: Immediate surgical intervention is the basis for treatment of penile fractures due to the high risk of complications associated with conservative management. Unfortunately, patient refusal to undergo surgery has led to conservative treatment of a small group of patients with presumed penile fractures at our institution. We followed these patients in regard to clinical outcome. MATERIALS AND METHODS: Between 1992 and 1999, 5 patients were evaluated after blunt trauma to an erect penis. Patient age at presentation ranged from 19 to 31 years (mean 25). The interval from time of injury to presentation was 24 to 72 hours. Of these patients 4 had been injured during sexual intercourse, while 1 had been injured during masturbation. All 5 patients refused immediate surgical exploration for presumed penile fracture. RESULTS: No patient had any immediate complications. At 6 and 12-month followup all patients reported erections adequate for intercourse without associated pain. One patient reported only mild curvature for which he did not seek treatment. CONCLUSIONS: We report on a subset of young males with presumed penile fracture who refused diagnostic evaluation and therapy, and were able to maintain normal erectile and voiding function. However, longer followup and radiographic evidence will be necessary to corroborate or refute these initial observations.

Adult↗
PubMed2004

Neonatal circumcision: a review of the world's oldest and most controversial operation.

UNLABELLED: Untimely old, circumcision has elicited more controversy and war of words than any surgical procedure in history. Although previous claims of benefits like curing masturbation, gout, epilepsy, and even insanity were no doubt absurd, important research has shed light on real medical benefits of circumcision. In particular, the procedure has consistently shown to result in the decreased risk of debilitating and costly diseases such as HIV, cervical cancer, and infantile urinary tract infection. Because of advances in the understanding of the anatomy of the foreskin and pain conditioning in infants, prevailing attitudes have changed about anesthesia and analgesia during the procedure. This article objectively summarizes the bulk of significant medical literature over the last century to provide an accurate statement about what we know and what we do not know about neonatal circumcision, including its history, epidemiology, medical benefits, complications, contraindications, techniques, management for pain, and current controversies. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the evolution of circumcision, to list the potential benefits of circumcision, to outline the various neonatal circumcision techniques, and to summarize the data on the use of analgesia for circumcision.

Circumcision, Male↗
PubMed2002

Premarital sexual activities among students in a university in Beijing, China.

BACKGROUND: Sexually transmitted diseases are becoming a serious public health problem in China. College students are recognized as one of the age groups most affected. GOAL: The goal was to investigate premarital sexual activities and condom use among college students in Beijing in order to collect the information necessary for research on interventions. STUDY DESIGN: A cross-sectional survey was conducted in June 1999 among students at a university in Beijing. A self-administered, anonymous, structured questionnaire was used. RESULTS: Among those interviewed, 41% reported premarital sexual activities: 28% had kissed partners of the opposite sex, 19% had masturbated, and 12% had engaged in sexual intercourse. Among those who had sexual intercourse, 69% had used condoms. CONCLUSION: Today, more students are engaging in premarital sexual intercourse. Thus, it is necessary to reinforce reproductive health education among college students and provide convenient and optional services that are easily accessed.

Adolescent↗
PubMed2003

A study of sexuality education performance and associated factors among elementary school nurses in Taipei.

The purpose of this study was to investigate the performance and associated factors of sexuality education by elementary school nurses in Taipei. A structured questionnaire was utilized to collect data from a convenience sample of 145 elementary school nurses. The Kuder-Richarson reliability for sex knowledge scale was.73, and Cronbach's agr; for sex attitude scale was.93. The findings of the study were as followed: (1) Sex knowledge was high among study samples. The average scores for sex knowledge regarding " masturbation ", " sexual harassment and sexual abuse " were among the highest; those regarding " secondary sexual characteristics ", " ovulation ", " menstruation health care ", and " sexually transmitted diseases " were among the lowest. (2) Sex attitude was positive. Eighty percent of the study subjects agreed that school nurses were responsible for the promotion of sexual health in schools. More than 90% of the study subjects were willing to participate actively in sexuality education program in school, providing health consultation and guidance. (3) Twenty percent of the study subjects were not involved in sex education because they were not invited or due to busy working schedule.(4) Marital status, highest level of education, job title, job seniority, continuing education or training experience were the factors associated with the implementation of sexuality education among school nurses.

Adult↗
PubMed2004

Sexual behavior and sexual function of adults after hypospadias surgery: a comparative study.

PURPOSE: We assessed sexual behavior and sexual function in adults operated on for hypospadias. MATERIALS AND METHODS: Long-term psychosexual adjustment was assessed with a standardized questionnaire which was mailed to 57 patients with hypospadias older than 18 years and 60 age matched normal control subjects. RESULTS: A total of 37 patients with hypospadias and 39 controls participated. Self-reported strength of libido on a scale of 1 to 5 was shown to be similar in the 2 groups. Patients with hypospadias did not have problems in achieving erection and average self-rated quality of erection ranging from 1 to 5 was the same as that of controls (mean value 4.5). Patients with hypospadias noted curvature in a downward direction in a significantly higher proportion compared to controls (40% vs 18%, respectively). There were 13 patients with hypospadias who had ejaculation difficulties, of whom 6 had spraying and 7 had only dribbling of ejaculate. Patients with hypospadias masturbated significantly less often, were significantly less sexually active and had a smaller total number of sexual partners compared to control subjects. Control subjects were significantly more completely satisfied with their sexual life compared to patients with hypospadias (76.92% vs 51.35%, respectively). CONCLUSIONS: Sexual function of patients who underwent surgery for hypospadias in general is not affected. However, there is clearly a difference in certain aspects of sexual behavior between patients with hypospadias and controls. Followup and adequate counselling of patients who underwent surgery for hypospadias in adult life is necessary.

Adult↗
PubMed2003

Glans, urethra, and corporeal body reconstruction by free osteocutaneous forearm flap transfer.

A 30-year-old man presented with short penile corporeal bodies hosting a 3-cm fibular graft, absence of glans, and proximal penile hypospadias. The patient underwent a forearm flap transfer with an "umbrella-like" skin flap for glans and urethra reconstruction and a radial bone strut to allow for rigidity. The postoperative course was uneventful and the patient was followed-up with fluximetry tests at 2 weeks, 4 weeks, 2 months, and 6 months, showing no stenoses and normal stable values. Masturbation started at month 3 postoperatively and intercourse began at month 4, with both resulting in orgasm. At 6 months postoperatively, touch sensation, pain, and sensibility to heat were present, but sensibility to cold was absent. Light touch pressure was detected with 4.74 Semmes-Weinstein monofilament, and static two-point discrimination was 20 mm at the neoglans. One year postoperatively, a stable increased length up to 9 cm at rest and 13 cm at erection with a satisfactory anatomic definition could still be proved.

Adult↗
PubMed2005

The impotent couple: low desire.

Hypoactive sexual desire (HSD) is the deficiency of sexual fantasies and desire that should be considered as a disorder if it causes distress to the couple. In the general population, it is the most widespread sexuality-related problem. It is generally accepted that testosterone and prolactin regulate sexual desire. We recently reported that other psychobiological factors associate with HSD in a sample of almost 500 male patients attending our Outpatient Clinic for sexual dysfunction, by using SIEDY structured interview. We now originally extend investigation to a threefold broader patient sample. Considering marital parameters, perceived partner's libido and climax, patient's partner diseases, conflictual or even prolonged couple relationship were all significantly associated with an impairment of patients' sexual desire. Moreover, other lifestyle factors as satisfaction at work and/or domestic inhabitant relationship were significantly correlated to hypoactive sexual desire disorder (HSDD). Among hormonal parameters, severe hyperprolactinaemia (>700 mU/L), although rarely diagnosed (<2.0%), seems to play a greater role than the more common (23%) endocrine disease hypogonadism (testosterone < 12 nm) to the pathogenesis of HSD (RR = 7.5 [2.5-22.4] vs. 1.5 [1.1-1.9], respectively). Both mental disorders and use of medication interfering with sexual function were also significantly associated with HSDD, as well as depressive and anxiety symptoms. Finally, HSD was inversely correlated to sexual and masturbation frequency attempts. In conclusion, HSD is associated with several biological, psychological, and relational factors that can be simultaneously identified and quantified using the SIEDY structured interview.

Climacteric↗
PubMed1988

Parents' perception of social and sexual functions in adolescents with Down's syndrome.

The authors investigated parental perceptions of social interactions, interest in the opposite sex, sexual functions and issues concerning sex education in young persons with Down's syndrome. The evaluation of the data revealed that more than half of the study population showed interest in the opposite sex and are attending social gatherings. Many of the youngsters had expressed a desire to get married, however, only a few had an interest in sexual relationships. Masturbation was observed in 40% of the young men and in 22% of the young women. About half of the parents feel that their children should be sterilized or should have other forms of birth control if they would be able to reproduce. Only a limited number of adolescents had sex education. More parents who have girls with Down's syndrome than those who have boys are worried that their child may be taken advantage of sexually.

Adolescent↗
PubMed1992

Increases in knowledge following a course of sex education for people with intellectual disabilities.

Although sex education programmes are thought to be useful in teaching people with intellectual disabilities, there is very little evidence that the material taught is retained by clients. This paper reports data which has been collected routinely on a sex education programme. Forty-six subjects were assessed on their level of sexual knowledge in seven areas: parts of the body, masturbation, male puberty, female puberty, intercourse, pregnancy and childbirth, and birth control and venereal disease. They were retested after a 9-month sex education programme and tested again at a 3-month follow-up. A control group of 14 subjects were tested on two occasions, 4 months apart. There were significant and substantial increases in sexual knowledge on all areas for the experimental group. The control group showed no corresponding increases in knowledge.

Adolescent↗
PubMed1977

Research in human sexuality education.

Since human sexuality courses are relatively recent additions to most U.S. medical school curricula, there are no established procedures for evaluating the courses. The purpose of this study was to test medical students' attitudes toward concepts in sexuality before and after a 5-day sexuality course using the semantic differential. The concepts students rated were "my sexuality", "masturbation", "homosexuality", and "my role in understanding sexual problems". Post-test scores were subtracted from pre-test scores and analysed by multivariate analysis of variance testing for significant difference from zero. Ninety-six second-year medical students completed the pre- and post-semantic differential tests. The changes between the pre- and post-tests were significant at the 0-001 level for all four concepts with the concept "homosexuality" showing the greatest change. The study suggests the semantic differential may be an effective instrument in assessing attitude changes. It also suggests the teaching techniques used in human sexuality courses may be successfully applied to other areas of medical education.

Adult↗
PubMedDate not supplied

Semen quality and sex hormone pattern of 29 middle aged men.

Thirty-nine men with sexual disturbances in middle-age (52-68 years) were included in this study. Semen samples were obtained by masturbation and were analysed for its composition Serum was prepared and analysed for FSH, LH, prolactin and testosterone. Results were compared with the values obtained in a recent study by the authors on a young fertile group (Homonnai et al. - 1980). Hormonal evaluation revealed a significant increase in FSH, LH, and prolactin concentrations, Testosterone levels were not different in the two groups (old v:s young). Nevertheless, accessory gland functions were depressed, semen volume decreased by 30% and fructose secretion by the seminal vesicle was diminished significantly. The average sperm concentration and morphology were not different than in young group but their quality in terms of motility and vitality was depressed. Sperm production by the tests was decreased by 30% compared to the young control group. Increased serum prolactin levels and elevated estrogen activity may be responsible for the sexual disturbances known in older men.

Aged↗
PubMedDate not supplied

Seminal parameters of ejaculates collected successively with sixty minute interval in infertile men: effect of combination of prazosin and terbutaline on these parameters.

Out of 37 infertile men, 33 who were able to give two ejaculates by masturbation successively with a sixty minute interval, were studied. There was no significant change in sperm density in the second ejaculation whereas seminal volume decreased (P less than 0.01) and sperm motility increased (P less than 0.05) significantly. After a seven-day treatment with combination of prazosin (alpha 1-blocker) and terbutaline (beta 2-stimulator), the same successive ejaculates were obtained from only 27 of these patients. In this case sperm density and motility changed insignificantly, whereas seminal volume again decreased (P less than 0.01) significantly. The changes in seminal parameters were not significant between the pre- and post-treatment second ones. In a short-term study there are not any alterations to observe. The favourable results with a long-term treatment, published by Japanese authors, require a confirmation by further studies.

Adult↗
PubMed2007

Tadalafil as an in vitro sperm motility stimulant.

Tadalafil (Cialis) is a known oral selective phosphodiesterase-5 inhibitor used widely in the management of erectile dysfunction. To assess its ability on human sperm motility in vitro, 70 asthenozoospermic semen specimens delivered by masturbation were investigated. Semen samples were divided equally into four tubes, one as a control and to the others tadalafil dissolved solution was added in vitro in three different concentrations (4.0, 1.0, 0.5 mg ml(-1) respectively). The tubes were incubated and were followed up for sperm motility per cent changes for 0.5, 1, 2, 3 h. It was found that the concentration used played an important role in the degree of sperm enhancement. Specimens treated with 4 mg ml(-1) tadalafil solution demonstrated a significant decrease in sperm motility compared with the controls. Specimens treated with 1.0 mg ml(-1) solution demonstrated significant increase in sperm progressive forward motility. Specimens treated with 0.5 mg ml(-1) solution demonstrated significant increases in sperm motility but lower than that of 1 mg ml(-1) concentration. It is concluded that in vitro use of tadalafil solution in special concentration has a significant stimulatory effect on asthenozoospermic sperm motility.

Adolescent↗
PubMed2006

A three-step statistical procedure to identify sperm kinematic subpopulations in canine ejaculates: changes after cryopreservation.

Strong evidences suggest that many different sperm subpopulations co-exist within the mammalian ejaculate. These subpopulations have been identified in a number of species; however, to the best of our knowledge, no data exist regarding the existence of sperm subpopulations within the canine ejaculate. Ejaculates were obtained by masturbation from four mongrels and processed using a standard freezing protocol. Motility data were analysed before and after cryopreservation using a computer assisted sperm analysis (CASA) system ISAS. On raw data, a principal component analysis (PCA) was performed to reduce the number of motility descriptors to a few informative variables, and then a K-means cluster procedure was performed and then a regression analysis to validate the clusters obtained in the second analysis. ANOVAs and chi-squared analyses were used to compare clusters and males. PCA revealed that two principal components represented more that the 88% of the variance with eigenvalues of 3.25 and 3.02, respectively. The clustering and discriminant analysis using curvilinear velocity and linear velocity as variables revealed the existence of 11 sperm subpopulations--four of them characterized by high velocities, two by medium values and five by low velocities. After freezing-thawing, nine subpopulations were found--four of high velocities, two of medium and three of low velocities. It is concluded that freezing-thawing not only impairs sperm motility but also produces changes in the sperm subpopulation structure in the canine ejaculate, that the evaluation of the sperm structure subpopulations is a better indicator of semen quality and freezeability than the use of mean values, and that two sperm motility quality indexes can be used to resume of the variables obtained from the CASA analysis.

Analysis of Variance↗
PubMed1989

Stage-related behavioural problems in the 1-4 year old child: parental expectations in a child development unit referral group compared with a control group.

Behavioural problems in preschool (1-4 years) children are a common cause of referral to health services. Parents of children presenting to the child development unit with behavioural problems (n = 18) were compared with a control group (n = 45). A questionnaire was utilized to examine the parents' expectations of the children's behaviours. As might be expected, the parents of children presenting to the Unit rated their children as having more difficult behaviours. These parents had unrealistic expectations, particularly for the 'negative' behaviours (disobedience, temper tantrums, defiance and whinging). However, they were able to anticipate normal age-related difficulties in some problem areas (dawdling during mealtimes, masturbating, not sharing toys and being jealous of one's siblings). Counselling should address the issue of matching the expectations of parents with the individual rates of development of their children.

Adult↗
PubMed1990

Luteinizing hormone-releasing hormone analogue (Buserelin) treatment for central precocious puberty: a multi-centre trial.

A multi-centre open trial of Buserelin, a luteinizing hormone-releasing hormone (LHRH) analogue, was conducted in 13 children with central precocious puberty. Eleven children (eight girls and three boys), aged 3.4-10.2 years at commencement, completed the required 12 month period of treatment. Initially all patients received the drug by intranasal spray in a dose of 1200 micrograms/day, but by the end of the 12 month period two were having daily subcutaneous injections and three were receiving an increased dose intranasally. The first month of treatment was associated in one boy with increased aggression and masturbation, and in the girls with an increase in the prevalence of vaginal bleeding. Thereafter, however, both behavioural abnormalities and menstruation were suppressed. Median bone age increased significantly during the study, but without any significant change in the ratio of height age to bone age. The median predicted adult height for the group therefore did not alter significantly over the twelve months of the study. Buserelin treatment caused a reduction in the peak luteinizing hormone and follicle-stimulating hormone (FSH) responses to LHRH, mostly to prepubertal levels, and also suppressed basal FSH. In the first weeks of treatment, the girls' serum oestradiol levels rose significantly and then fell to prepubertal or early pubertal levels. A similar pattern was seen for serum testosterone levels. Serum somatomedin-C levels, however, showed little fluctuation over the course of the study. Buserelin treatment was safe and well accepted, and offers the promise of improved linear growth potential in precocious puberty.

Administration, Inhalation↗
PubMed2006

Serial neurochemical measurement of cerebrospinal fluid during the human sexual response cycle.

Recent studies examining the neuroendocrine response pattern underlying the human sexual response cycle revealed transient activation of the sympathoadrenal system and a substantial, long-lasting increase in plasma prolactin concentrations following orgasm in men and women. Prolactin has been discussed as being part of a feedback mechanism that signals centers in the central nervous system, such as the dopaminergic system controlling sexual arousal. To further elucidate the central role of neuropeptides, biogenic monoamines and neurotransmitters in human sexual behavior, a serial cerebrospinal fluid (CSF)-sampling technique was implemented using a previously established experimental paradigm for sexual activity in a laboratory setting. In parallel with peripheral endocrine measures, lumbar CSF was drawn via an indwelling spinal catheter during the sexual response cycle in 10 healthy males and 10 age-matched controls, and analysed for prolactin, oxytocin, biogenic monoamines and/or their metabolites as well as inhibitory and excitatory neurotransmitter concentrations. Parallel to raised peripheral sympathetic activity, norepinephrine also increased in CSF during audiovisual, masturbation-induced sexual arousal and orgasm, and remained elevated for the remainder of the session (F(4,72) = 8.79, P = 0.000). In contrast, none of the other measures, in particular prolactin and dopamine or its metabolites, reflected significant alteration. In conclusion, the human sexual response cycle is characterized by an increase in sympathetic activity in plasma and CSF, and by pronounced secretion of plasma prolactin after orgasm. However, alterations in dopaminergic or peptidergic activity are not found in lumbar CSF, possibly due to local and restricted release in diencephalic and mesencephalic brain regions.

Adult↗