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A 55-year-old man presented with the acute onset of seizures occurring during the post orgasmic phase of sexual intercourse. Evaluation for brain neoplasm was negative. During the hospital stay, the patient developed status epilepticus during which electrocardiogram documented complete heart block. The seizure disorder was corrected with the insertion of a permanent epicardial pacemaker.
With the current oncological emphasis on radical treatment allied to minimal invasiveness, choice of treatment relies on precise clinical staging. The corpora cavernosa of the penis represent a well defined anatomical structure distinct from the corpus spongiosum and the glans which are tightly connected to one another. In case of primary penile tumour the T.N.M. classification of the American Joint Committee on Cancer includes in the T2 stage both infiltration of the corpus spongiosum and of corpora cavernosa. Jackson's classification seems to be more pertinent as it limits to stage 1 cases involving the glans and corona and classifies as stage 2 cases limited to the corpora cavernosa. Partial penectomy can prove overly invasive, yet insufficiently radical, if the anatomical continuity of the spongious tissue is not considered. Carcinoma of the glandular corpus spongiosum without cavernosal involvement indicates glandulectomy with partial uretrectomy and apical cavernous-urethrostomy. Preserving the corpora cavernosa is an option of great relevance to the quality of life of the patient: erectile ability and stand-up micturition are not affected and the patient keeps complete sexual ability and orgasmic sensation. In case of scrotal or public involvement, emasculation with hemipelvectomy must be attempted; if indicated, it can be followed by radiotherapy. Perineo/abdominal reconstruction can be followed by urinary diversion with adjuvant chemotherapy. In selective cases neophallic reconstruction can be later attempted using the inferior abdominal rectum muscle.
Testosterone andecanoate (andriol) was used for treatment of copulative dysfunction in 18 young and middle-aged males in a dose 160 mg/day (a 10-12-day treatment course) or 40-80 mg/day (up to 6 week maintenance course). Clinical responses concerning such sexual symptoms as libido, erection, ejaculation and orgasm were achieved in most of the patients. Pretreatment blood levels of testosterone were not decreased. The treatment aroused these levels which persisted higher that pretreatment ones for 3 months. Estradiol was slightly higher after the treatment. Andriol is recommended for treatment of copulative dysfunction in young and middle-aged males.
OBJECTIVES: A case of traumatic avulsion of penile skin with amputation of the penis and sectioning of the urethra is described. METHODS/RESULTS: Surgical management included embedding the penis without scrotal skin and subsequent reconstruction utilizing scrotal skin. The patient has recovered sexual activity, although sensitivity has been reduced as a consequence of penile amputation. Six months postoperatively, the patient has reported orgasm during intercourse. CONCLUSIONS: The surgical technique of embedding the penis is safe and preserves elasticity for subsequent reconstruction of the urethral meatus.
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.
The authors examined by questionnaire the prevalence and the possible relationship of childhood sexual abuse and dysfunctional family background to the later sexual dysfunctions in a nonclinical male and female student sample. Of the 202 females, 44 (21.8%) reported a narrowly defined childhood sexual abuse, of the 301 men who completed the questionnaires 29 (9.6%) reported any kind of a sexually abusive experience, and 17 (5.6%) were victims of a marked childhood sexual victimization. 66 (32.6%) females and 79 (26%) males reported an adverse family background. Long-lasting adverse familial relationship to attachment figures were significant to later sexual dysfunctions in both sexes. Women, who reported repeated childhood sexual abuse, reported significantly more frequently sexual desire disorder and orgasm disorder. However, males who experienced-in most cases single-childhood sexual abuse, showed not more frequently sexual dysfunctions than nonvictims.
PURPOSE: To assess the physical, psychological, social, and organ-specific long-term treatment sequelae occurring in women with muscle-invading bladder carcinoma treated with combined modality therapy that allowed for bladder conservation in 67% of patients. PATIENTS AND METHODS: Patients with muscle-invading (T2-4a,Nx,M0) bladder cancer were treated with maximal transurethral resection followed by induction chemoradiotherapy (cisplatin x 2 plus 40 Gy pelvic irradiation or the same preceded by 2 cycles of methotrexate, cisplatin, and vinblastine) between the years 1986 and 1994. Women who had a complete response and all those who were not candidates for cystectomy received consolidation therapy of additional cisplatin and tumor boost to 64.8 Gy. Women who were incomplete responders and those who developed recurrent invasive tumor underwent immediate radical cystectomy. Forty-two women were treated with this approach, 21 of whom (median age, 69 years; median follow-up time, 56 months) were available for and underwent a structured interview of treatment and health-related issues using a quantitative symptom score. RESULTS: All 21 patients have full urinary continence and no dysuria. Nineteen report unchanged or improved bladder capacity and function. No patient reported loss of bowel continence. Of the five women who were sexually active, two report an increase in intercourse frequency and one noted a decrease. There is no decrease in intercourse satisfaction or orgasm, and no dyspareunia or vaginal bleeding was noted. Eleven patients reported high levels of anxiety related to their bladder cancer before treatment. This was significantly reduced or absent in 9 of 11 after treatment. Actuarial overall survival for all 42 women was 58% at 5 years. Actuarial overall survival with an intact bladder was 47% at 5 years. DISCUSSION: This study shows that overall survival is high when chemoradiation and transurethral resection are used in potential bladder-sparing protocols for muscle-invading transitional cell carcinoma of the bladder in women. Furthermore, 67% of the women, including most long-term survivors, retain their bladders. The functional quality of the conserved organ, the rectum, and the vagina, as reported by the patients, was excellent.
Within the context of Freud's theory of instinctual drives, analytic data from three female patients are presented which refute his concept that penis envy is the basis for female object choice. Contrary to Freud's theory, these patients did not feel their genitalia or genital arousal were inadequate. Rather, they believed their genital sexuality and fantasies were powerful and gratifying, but dangerous and bad. Their subsequent guilt and fears led secondarily to their defensive wish to have a penis to avoid their core conflicts; their penis envy was pathological. The data unequivocally demonstrate that the clitoris is not an inferior organ, but is the locus for the initiation of intense pleasure and occasional orgasm as early as ages four to six, when vaginal awareness also is present. In addition the material provides evidence that girls choose fathers to feel loved and valued, and that their wish for a baby is not a substitute for a relinquished wish for a penis. Observational studies and a vignette suggest that the instinctual drives of the genital phase coalesce with a change in object relations, forming an important motivation for a girl to switch her primary love object from her mother to her father.
Recent research suggesting that a high proportion of men and women remain sexually active well into later life refutes the prevailing myth that aging and sexual dysfunction are inexorably linked. Age-related physiological changes do not render a meaningful sexual relationship impossible or even necessarily difficult. In men, greater physical stimulation is required to attain and maintain erections, and orgasms are less intense. In women, menopause terminates fertility and produces changes stemming from estrogen deficiency. The extent to which aging affects sexual function depends largely on psychological, pharmacological, and illness-related factors. In this article I review the physiological sex-related changes that occur as part of the normal aging process in men and women. I also summarize the effects on sexual function of age-related psychological issues, illness factors, and medication use. An understanding of the sexual changes that accompany normal aging may help physicians give patients realistic and encouraging advice on sexuality. Although it is important that older men and women not fall into the psychosocial trap of expecting (or worse, trying to force) the kind and degree of sexual response characteristic of their youth, it is equally as important that they not fall prey to the negative folklore according to which decreased physical intimacy is an inevitable consequence of the passage of time.
There are patients who complaint the loss of sexual desire, loss of erection, absence of emission, absence of orgasm, and premature ejaculation. When the primary disturbance is in the producing or releasing process of testosterone in the testis, it increases the gonadotropic stimulation and results in the hypergonadotropic hypogonadism. Hypogonadotropic hypogonadism, in contrast, suggests that the disturbance in the hypophysis or hypothalamus. Patients who have the primary disturbance in the hypothalamus sometimes do not respond to LHRH, but repeated pulsatile LHRH stimulation induces the response. LH-testosterone is known to be the main axis of sexual function. However, growth hormone (GH) also has an important role. GH is necessary for adults, not only for children. Its deficiency arises easy fatiguability, loss of sexual desire, loss of erection, and oligo- or azoospermia. Erectile dysfunction is frequently caused by vascular, neurological and psychosomatic disorders. A variety of drugs are known to cause male sexual insufficiency. Many environmental factors and stress may affect the release of LH and GH, and therefore disturb the male sexual function.
Apart from other factors the sexual behaviour of man and woman depends also on age. Like other physiological conditions the sexual function underlies changes according to age, representing themselves in slowed down sexual reaction, diminished intensity of orgasm and ejaculation as well as decreased libido. In general the sexual activity of both sexes is diminishing after the 50th year of life, simultaneously showing that the sexual function in man more easily becomes disturbed--not so in woman.
In male infants, traumatic ablation of the penis, with or without loss of the testicles may occur as a sequel to mutilatory violence, accidental injury, or circumcision error. Post-traumatically, one program of case management is surgical sex reassignment to live as a girl, with female hormonal therapy at the age of puberty. The other program is genital reconstructive surgery to live as a boy, with male hormonal therapy at puberty if the testicles are missing. In both programs, the long term outcome is less than perfect and is contingent on intervening variables that include societal ideology; surgical technology; juvenile and adolescent timing and frequency of hospital admissions construed by the child as nosocomial abuse; development of body image; health and sex education; fertility versus sterility; coitus and orgasm; possible lesbian orientation if living as a girl; and long-term cost accounting, including the psychic cost of being a pawn in possible malpractice litigation on whose disability a very large fortune in compensation may devolve. There is, as yet, no unanimously endorsed set of guidelines for the treatment of genital trauma and mutilation in infancy, and no provision for a statistical depository for outcome data.
Impaired sexual function has been noted to occur in various psychiatric illnesses. In affective disorders, disturbances of libido, erection and orgasm have been reported. Disordered sexual behavior has also been noted in patients with schizophrenia and anorexia nervosa. Clinical speculation suggests that anxiety disorders may also be associated with a higher prevalence of sexual problems.
BACKGROUND: Sexuality has an individual connotation, is influenced by biological, environmental and cultural factors and is present throughout all life. AM: To assess the sexual behavior of a group of Chilean women. SUBJECTS AND METHODS: A specially devised inquiry was applied to 301 women, aged 20 to 70 years old, that consulted in a medical service. RESULTS: Seventy seven percent of women were sexually active. These figures ranged from 80% of women aged 40-44 years old to 40% of women over 60. Sixty percent of women living together, 53.7% of single women, 65.6% of divorced women, 94.2% of married women and 100% of widows were sexually active. Women aged 25 to 29 years old had a mean of 8.4 relations per month compared with 3.3 relations among women older than 55. The frequency of sexual intercourse was higher in women living together and lower in widows. The mean age at the first intercourse was 20.6 +/- 4.5 years. Ninety three percent had experienced sexual desire and the percentage of satisfactory sexual relations does not change with age. Less educated women had a lower frequency of orgasms. CONCLUSIONS: Age and legal status of women are related to their sexual behavior and less educated women have a less satisfactory sexual life.
The cognitive system is structured from sets of schema, patterns of neural activity that allow the assimilation or accommodation of new experiences and so, by a process of consolidation, the gradual development of knowledge and understanding. As well as schema for purely cognitive processes, there are similar structures that enable individuals to deal with sexual behaviour and affectual relationships (e.g. hedonia, self-esteem, personal preferences and body image). In depression, there is a well established disruption of cognitive function that results in anhedonia and a loss of pleasure, including that from sexual activities. Many antidepressants also have a direct pharmacological action on the central nervous system and disrupt cognitive function, so increasing anhedonia and impairing sexual function. Drug actions on cognitive structures, which in turn increase anhedonia and reduce sexual libido, are over and above any direct pharmacological effects on the more overt behavioural activities associated with sex, including orgasm, erectile function, potency and ejaculation. The tricyclic antidepressants, for example, destroy the cognitive structures that are vital to maintain normal libido as well as disturbing overt sexual behaviours. Some selective serotonin reuptake inhibitors (SSRIs; paroxetine and sertraline) are associated with behavioural activation that is also responsible for an impairment of sexual function. However, there are clear differences between the SSRIs, and fluvoxamine (relative to the other SSRIs) has little effect on objective measures of cognition or on cerebral and behavioural components of sexual function.
BACKGROUND: Sexual behaviour is often altered in chronic illness. AIM: To evaluate sexual behaviour in coeliac patients before and after treatment with a gluten-free diet. PATIENTS: Fifty-five adults with coeliac disease and 51 age- and sex-matched healthy controls. METHODS: Routine clinical and laboratory work-up was used for diagnosis of coeliac disease. Age of first sexual intercourse, prevalence of individuals who were sexually active, frequency of intercourse, reduction in sexual desire, difficulty in attaining orgasm, pain during intercourse, and prevalence of individuals defining themselves as satisfied with their sexual life were investigated by an anonymous, self-administered questionnaire administered before and after one year's treatment with a gluten-free diet in coeliac patients, and only once in controls. Analyses included clinical conditions, demographic and socio-economic data. RESULTS: Compared with controls, untreated coeliac patients had a significantly lower frequency of intercourse and a lower prevalence of individuals satisfied with their sexual life. Patients with overt and subclinical coeliac disease did not show significant differences for any indices of sexual behaviour. Compared with untreated conditions, coeliac patients after one year of treatment had improved values for all indices of sexual behaviour: differences were significant for frequency of intercourse and prevalence of individuals satisfied with their sexual life. CONCLUSION: Untreated coeliac disease, even in its subclinical presentation, is associated with disorders in sexual behaviour which are improved by the dietary treatment.
OBJECTIVE: To study the changes in normal sexual behavior that accompany the vulvar vestibulitis syndrome and to gauge an appropriate classification for the resulting sexual dysfunction. STUDY DESIGN: Following full medical screening, questionnaires were administered to assess sexual history, illness behavior and vulvar discomfort. Forty patients who met the criteria of vestibulitis syndrome composed the study cohort. RESULTS: The average duration of reported vulvar pain was 33 months (range, 3-240). The cohort showed no significant differences when compared with normative data on the sexual history form in their level of sexual desire, duration of intercourse or chance of female orgasm with intercourse or masturbation. Patients were: (1) highly likely to experience vulvar pain with intercourse (P < .001), (2) highly likely to have significantly reduced arousal potential (P < .001), (3) highly likely to complain of vulvar symptoms preventing intercourse from occurring (P < .001), (4) highly likely to have a reduced interest in intercourse and to have negative feelings toward it (P < .001); and (5) highly likely to refuse a partner's sexual advances (P < .001). CONCLUSION: In the case of vulvar vestibulitis, the most appropriate Diagnostic and Statistical Manual of Mental Disorders, fourth edition, classification appears to be sexual dysfunction due to a general medical condition.
Ejaculatory disorders include premature ejaculation (p. e.), deficient ejaculation (d. e.) and retrograde ejaculation (r. e.). On the basis of the history and simple investigations, the various disorders are relatively easy to differentiate. History taking should include information about the ability to ejaculate, including nocturnal emission and the ability to experience orgasm. Investigations mainly include the demonstration of sperm in the postmasturbation urine, analysis of the ejaculate, determination of the secretion markers of the adnexa and ultrasonographic examination of the genital organs. The treatment of choice in premature ejaculation is sexual therapeutic behavioral training, where necessary in combination with medication to delay ejaculation, e. g. diazepam or chlorodizepoxid. In the absence of underlying organic disease deficient ejaculation is treated with behavioral therapy or vibrator stimulation of the glans. Postoperative or post-traumatic disorders, however, often require transrectal electrojaculatory stimulation or sperm aspiration from vas deferens. There are three principles of management of retrograde ejaculation: 1. conversion of retrograde into antegrade ejaculation by drug therapy, 2. harvesting of sperm from postorgasm urine and 3. surgical treatment. Our own observations have shown that drug treatment of ejaculatory dysfunction is ineffective in patients with anorgasm or when postmasturbation urine contained no spermatozoa. Currently male infertility due to ejaculatory problems can be effectively treated, where necessary in combination with the new methods of assisted fertilisation, for which purpose, however, accurate identification of the ejaculation disorder presenting is required.