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The Koro syndrome, a 'special cultural psychiatric syndrome', is encountered in South China, Malaysia and Indonesia, especially among people of Chinese origin. There are only eight case reports of Koro from the Western hemisphere. We present a typical primary Koro patient from Israel. Jewish cultural mores are a contributory factor.
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Six sexual fantasy categories were derived by inductive content analysis, based upon the starting criterion that fantasy is a dynamic and interactional event. Detailed narrative descriptions of sexual fantasy in three conditions, including 'Daydream,' 'masturbatory,' and "During Sex Relations' were obtained from 48 male and 45 female volunteer graduate students. Detailed narrative descriptions of sexual fantasies were collected by administration of sexual fantasy questionnaires. While the intention was to empirically derive sexual fantasy categories which could be used for personality assessment of gender identity, the hypothesis predicted gender-specific variances in fantasy productions according to derived fantasy categories. Results indicated that significantly more females than males fantasized themselves as recipients of sexual activity from fantasized sexual objects, while males fantasized the sexual object as recipients of sexual activity. Marginal tendencies toward reversal of this gender pattern occurred in the 'Mastubatory' condition for males, and in the 'Daydream' sexual fantasy condition for females.
Despite the widespread use of androgen in the treatment of hypogonadal men, its efficacy in restoring sexual behavior to hypogonadal patients has not been established in appropriately controlled behavioral studies. Accordingly, testosterone enanthate or vehicle was injected once every 4 weeks im in a double blind experiment. The subjects were six adult males, aged 32-65 yr, two with gonadal failure and four with secondary hypogonadism. Two doses of testosterone (100 and 400 mg) were administered for approximately 5 months, with the treatments varied at random within and among subjects. Details of sexual activity and experience were followed by the use of daily logs. Frequencies of erections, including nocturnal erections and coitus, showed significant dose-related responses to androgen treatment which closely followed the fluctuations in the circulating testosterone level. As indicated by the Profile of Mood States test, behavioral responses did not appear to be mediated by changes in mood. We concluded that the stimulatory effects of testosterone on sexual activity are rapid, reliable, and not due to a placebo effect. To maintain plasma testosterone and adequate sexual function within normal levels, even high doses of testosterone enanthate should be given no less frequency than once every 3 weeks.
The synthetic steroid 7alpha-methyl-19-nortestosterone (MENT) is a potent androgen that is resistant to 5alpha-reductase. It thus has decreased activity at the prostate and may have advantages over testosterone-based regimens in long term treatment or as part of a male contraceptive. Administration to eugonadal men results in suppression of gonadotropins, but its ability to support androgen-dependent behavior has not been investigated. For sustained release administration, MENT acetate was used, because its diffusion characteristics were more suitable for use in implants. However, upon release the acetate is rapidly hydrolyzed, and MENT is the biologically active moiety in circulation. We studied the effects of MENT on sexual interest and activity, spontaneous erection, and mood states in comparison with testosterone enanthate (TE) in 20 Caucasian and Chinese hypogonadal men recruited in Edinburgh and Hong Kong (n = 10 in each center). Outcomes were measured using a combination of daily diaries, semistructured interviews, and questionnaires. Nocturnal penile tumescence (NPT) was also recorded in the Edinburgh group. After withdrawal of androgen replacement treatment (wash-out phase) for a minimum of 6 weeks, subjects were randomized to two groups in a cross-over design. Drug treatment regimens were of 6-week duration and consisted of two implants, each containing 115 mg MENT acetate, inserted s.c. into the upper arm and removed after 6 weeks and two injections of TE (200 mg, i.m.) 3 weeks apart. MENT treatment resulted in stable plasma MENT concentrations of 1.4 +/- 0.1 nmol/L after 3 weeks and 1.3 +/- 0.1 nmol/L after 6 weeks (mean +/- SEM; all men). Nadir testosterone concentrations were 3.6 +/- 0.6 nmol/L at the end of the wash-out phase and 9.4 +/- 0.6 nmol/L 3 weeks after each injection. There were no differences in hormone concentrations between centers. There were no adverse toxicological effects. There were only minor differences between the two treatments. Both MENT and TE treatment resulted in significant increases in sexual interest and activity, spontaneous erection (both by self-report and NPT measurement), and increases in positive moods, with decreases in negative moods in the Edinburgh group. In the Hong Kong group, both treatments increased waking erection, with a trend toward increased sexual interest and activity. Mood states appeared to be less affected during the wash-out phase than in Edinburgh men and showed no significant response to either treatment. These results demonstrate that MENT has similar effects on sexual activity and mood states as testosterone in hypogonadal men. As NPT is a physiological androgen-dependant outcome, these data provide further evidence for the androgenicity of MENT. The lack of detected effect of either androgen in Hong Kong men other than on waking erection illustrates the importance of the cultural context of symptomatology and its measurement. The appropriate dose of MENT remains to be determined, but these results support its development as a potential androgen replacement therapy.
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Female autoerotic deaths are less common than male ones and usually present in a less obvious way. Thus, such deaths can be easily overlooked, even by senior investigators, if the latter are not fully aware of the particularities of female autoerotic cases. We present the case of a 34-year-old woman, found dead in her apartment, with several foreign body insertions and a dog leash around the neck. Despite the great experience of the investigative team, autoerotic death was not considered at first. This case illustrates the importance of forensic teams having knowledge of the particularities of female autoerotic deaths.
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Some of the changes in sexual behavior and relationships with spouses and other females following the commencement of bisexual activity by women after the age of 30 were studied by conducting in-depth personal interviews with 50 women. Each participant, at the time of her first sexual activity with another female: (a) was married; (b) was at least 30; (c) was, with her spouse, engaging in consensual swinging activities; (d) was enjoying sex with males; and (e) had no history, prior to age 30, of sexual attraction to females. Generally, the subjects revealed high levels of participation in, and enjoyment of, sexual activity with other females, in addition to high levels of enjoyable heterosexual activity. Their generally happy and stable marriages tended somewhat to improve, as did their overall sex lives, and they saw their relationships with other females as significantly improved. Significant changes in sexual fantasies occurred. In all cases, sexual orientation became bisexual, but overall preference for male sex partners did not change.
Anal manipulation and penetration produce stimulation enjoyed as sexual by some people. Although this type of sexual activity is not new, the current social climate of sexual freedom and experimentation has brought it out into the open. This paper reviews some of the anatomical, physiological, and behavioral aspects of this variation of human sexual gratification, and provides the practicing professional, who has to deal with questions on anal sexuality, with information on the subject and suitable background material and literature references for further study.
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Kleine-Levin syndrome is characterized by periodic hypersomnia, hyperphagia, sexual disinhibitions and behavioral disturbances. The prognosis is generally benign, with normal cognitive and social functions after the episodes. We describe a typical case of Kleine-Levin syndrome associated with apparent academic decline, neuropsychological sequelae and personality alterations after the second episode of the illness. Further research in the natural history of Kleine-Levin syndrome is needed, for example, to determine whether early intervention would improve long-term prognosis.
This article examines the sexual practices of young Brazilians based on data from the GRAVAD Research Project, a household survey targeting males and females from 18 to 24 years of age (n = 4,634) in three Brazilian State capitals: Porto Alegre, Rio de Janeiro, and Salvador. The set of practices experienced over the course of their sexual careers is characterized by traits of social belonging, elements from individual life histories, and prescribed rules of conduct for men and women. The authors compared the young people's range of lifetime practices and those from last sexual relations in order to discuss the spread and incorporation of practices into life histories. The data point to the hegemony of vaginal sex in both the lifetime repertoire of sexual practices and the last sexual encounters, such that vaginal sex provides the prime definition of heterosexuality.
OBJECTIVE: To report on the sociodemographic characteristics and work experiences of 31 male sex workers (MSWs) in the city of Córdoba, Argentina. METHODS: Information on each of the MSWs was collected using a questionnaire that covered his personal characteristics and his work background, self-assessed general health status, and use of health and social services. Scales were included in order to assess attitudes towards condom use, knowledge about safe sex, perceptions about the risk of getting HIV, individual self-efficacy, and locus of control. The questionnaire also asked each respondent to rank his level of agreement with interactive strategies for gaining client compliance with safe sex practices. RESULTS: In terms of their self-identity, out of the 30 MSWs who answered the question, 10 of them (33.3%) self-identified as heterosexual and 9 (30%) as bisexual. Alcohol and drug consumption and unsafe sexual practices were relatively low among the MSWs. Of the 31 MSWs responding, 21 of them (67.7%) reported that they had been tested for HIV, but only 13 of them (41.9%) said they had been vaccinated for either hepatitis A or hepatitis B. A variety of differences were found between the study's 17 street sex workers (sex workers who offer their services in public places such as streets and parks) and the 14 independent sex workers (sex workers who are self-employed, advertise and manage their own business, and have an exclusive location for their commercial sex work). The street MSWs were younger and had less formal education. Independent MSWs were economically more settled, had been working longer in the sex industry, and were more comfortable about having sex with men. Independent MSWs were also more likely to report a gay sexual orientation and less likely to report using alcohol, marijuana, or other substances. CONCLUSIONS: The differences between street MSWs and independent MSWs are important since they could influence the negotiating of safer sex practices with clients. Programs aimed at preventing the spread of HIV and other sexually transmitted infections and promoting responsible self-care among MSWs in Córdoba should be introduced. Such programs could increase the proportion of MSWs who know their HIV serostatus and could make MSWs more aware of the risk of different sex acts performed in commercial sex encounters. Given the differences that we found between street MSWs and independent MSWs, specific strategies and educational materials should be developed for those two subgroups within the MSW population.
Numerous accounts documenting the introduction of foreign bodies into the urinary bladder have been reported. These foreign bodies are typically self-inserted via urethral but migration from adjacent organs by an ulcerative process and penetrating injuries are also reported. However, ''contrary'' migration of a self-inflicted vesical foreign body to the retroperitoneum was not previously reported in literature. We report here a case of a ballpoint pen self-inserted via urethral by a female patient, which was identified in retroperitoneal position years later.
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