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Erotism and chaos.

There is a continuum from primitive, undifferentiated feelings that are simply the manifestations of homeostatic balance and imbalance to highly differentiated, pleasurable erotic feelings that characterize mature, intimate love relationships. Sensory reactions are elevated from simple reflex levels to highly complex, sophisticated affects that involve wide areas of the psyche. Thus, affects are associated with integration and organized psychic structure. Consequently they may function in various ways. Freud developed a continuum for anxiety as initially functioning as a conversion reaction enabling sexual feelings that cannot reach mentational levels or be consummated in erotic activity to be discharged. It reaches a final level of organization where it serves as a signal calling various defenses into play as emerging instinctual impulses threaten to upset psychodynamic equilibrium. I have focused on how affects, erotic feelings in particular, have an organizing function that binds a primitive inner agitation that occurs during what is called a prementational stage of the neonatal period. This is a stage that precedes psychological processes. Sexual feelings are generated as an attempt to bind inner chaos that stems from an amorphous, inchoate psychic state. Erotic feelings are experienced in order to smoothe inner tension. The patient tries but seldom achieves calm because the affective binding and structuralizing process, in itself, becomes painful and disruptive. I present several clinical incidents and also refer to so-called treatment relationships where the therapist absorbs the patient's chaos and then acts out sexually which leads to a total breakdown of the therapeutic setting.

Anxiety Disorders↗

Androgens and sexual behavior.

Sexual behavior in humans may be classified according to gender role, gender identity, and gender orientation. Sexually dimorphic behavior in humans is generally felt to be determined by postnatal socialization. Recent work in laboratory animals shows that sexual behavior is a function of circulating steroid hormones, particularly androgens. Testosterone given during a critical period in prenatal or immediate postnatal life causes permanent organizational effects on brain structure and function in laboratory animals. Studies in human patients with testicular feminization, 5-alpha-reductase deficiency, congenital adrenal hyperplasia, or prenatal steroid hormone exposure, provide clinical examples of possible effects of prenatal hormone action in the brain as opposed to postnatal socialization. However, these studies do not permit a clear assessment of the role played by either prenatal steroid hormones or postnatal socialization factors in the ultimate expression of sexual behavior in humans.

Androgens↗

Construction of neophallus in male pseudohermaphroditism.

Eight patients with male pseudohermaphroditism were treated between the years 1988-1994. They showed various physical-sexual anomalies. In 4 patients the existing penis was lengthened, the urethra was created and the split scrotum was fused. In the 4 remaining patients a new penis was created from lateral groin or abdominal tubed or skin-gracilis flaps, and made rigid by means of a silicon implant. The scrotum was reconstructed. The results were satisfying. On the basis of our own experience it may be said that the reconstruction of genitals must be planned individually, depending on the abnormalities in the physical-sexual development and the psycho-sexual orientation of the patient.

Adolescent↗