Review of Treating sexual desire disorders.

Reviews the book, Treating sexual desire disorders edited by Sandra R. Leiblum (see record 2010-13144-000). Sandra Leiblum’s Treating sexual desire disorders reviews a broad range of philosophical positions and treatment approaches to sexual desire disorders. This book also contains thoughtful reflections by the chapter authors regarding their personal approaches to treatment and effectiveness. One of the main strengths of this book is the use of case studies to illustrate the diverse approaches to treating sexual desire concerns. One of main weaknesses of the book is the lack of a concluding chapter by Leiblum to distill some of the common and overlapping themes that were present in numerous chapters. Another element that would have strengthened this book would have been more emphasis on outcome studies demonstrating the success of particular approaches. Even with these (minor) weaknesses, the reviewer highly recommends this book for its breadth of treatment approaches. One of the reviewer's take home messages was that sex therapists, relationship therapists, and the medical community need to be working in closer synchrony with each other to address the myriad of issues that underlie sexual desire issues. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sexual dysfunction in the male patients on hemodialysis

Several features of sexual dysfunction, such as infertility, decreased libido and potency, are frequently observed in male patients with uremia, and it usually worsens with time despite of hemodialysis(HD) therapy. Hormonal profile often demonstrates hypergonadotropic hypogonadism, and is suggestive of primary Leydig cell dysfunction. Hypotestosteronemia and hyperprolactinemia may partially participate in the pathogenesis of sexual dysfunction. Uremic toxins, renal anemia, hyperparathyroidism, zinc deficiency, vascular and neurologic abnormalities are also reported to be the causative factors of sexual dysfunction. Correction of anemia with recombinant human erythropoietin sometimes results in the amelioration of sexual potency, probably due to improvement of erectile performance by increased blood viscosity. Psychological derangement should be kept in mind as an another factor of sexual dysfunction.     

Male sexual function and work.

In the context of therapy for many males with sexual dysfunctions, work is considered to interfere with sex. A study of 39 cases of male sexual dysfunction showed that work offers a refuge from awareness of sexual stimuli, an inadequate approach for forcing a return to sexual function, and a focus of attention that allows an avoidance of sexuality. The psychologist treating sexual dysfunctions must set up a series of behavioral steps so that the treatment is directed toward allowing sexual function rather than demanding sexual performance. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Award for Distinguished Scientific Applications of Psychology: David H. Barlow.

David H. Barlow was given the 2000 Award for Distinguished Scientific Applications of Psychology. The award was given for contributions to the understanding of the nature of anxiety and anxiety disorders with the goal of developing reliable and effective psychosocial treatments for anxiety disorders. He has also made notable contributions to the assessment of male sexual arousal and the understanding of the interface of male sexual dysfunction and anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Balloon Therapy.

Describes a humorous approach to psychotherapy in which the patient wears balloons attached to both ears 24 hrs a day for a 1-wk period. Balloon therapy is effective in the treatment of depression, low self-confidence, social isolation and withdrawal, anxiety neuroses, sexual dysfunction, and alcohol abuse and dependence, and is particularly suited for the treatment of autistic and catatonic disorders. Points of therapeutic expertise and contraindications are outlined. (French abstract) (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clonazepam-related sexual dysfunction in male veterans with PTSD

Medication-induced sexual dysfunction can significantly interfere with patients' quality of life and lead to poor compliance. This retrospective study examined the records of 100 male veterans with post-traumatic stress disorder (PTSD) selected in alphabetical order from an active treatment file of 230 patients. Forty-two patients had received clonazepam (mean maximum dose: 3.4 +/- 1.6 mg/day) at some point during their treatment. Of these, 18 (42.9%) complained of significant sexual dysfunction (primarily erectile dysfunction). Eighty-four patients received diazepam (mean maximum dose: 52.1 +/- 29.7 mg/day), nine received alprazolam (mean maximum dose: 5.2 +/- 2.8 mg/day) and eight received lorazepam (mean maximum dose: 3.8 +/- 2.4 mg/day). None of these patients complained of sexual dysfunction during treatment with these three other benzodiazepines. Our findings suggest that benzodiazepines, particularly clonazepam in the current study, can be a cause of sexual dysfunction in many male patients. Prospective studies comparing the overall clinical utility of various benzodiazepines are indicated in this and other clinic populations.     

Finasteride: a review of its use in male pattern hair loss

The 5alpha-reductase inhibitor finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT), the androgen responsible for male pattern hair loss (androgenetic alopecia) in genetically predisposed men. Results of phase III clinical studies in 1879 men have shown that oral finasteride 1 mg/day promotes hair growth and prevents further hair loss in a significant proportion of men with male pattern hair loss. Evidence suggests that the improvement in hair count reported after 1 year is maintained during 2 years' treatment. In men with vertex hair loss, global photographs showed improvement in hair growth in 48% of finasteride recipients at 1 year and in 66% at 2 years compared with 7% of placebo recipients at each time point. Furthermore, hair counts in these men showed that 83% of finasteride versus 28% of placebo recipients had no further hair loss compared with baseline after 2 years. The clinical efficacy of oral finasteride has not yet been compared with that of topical minoxidil, the only other drug used clinically in patients with male pattern hair loss. Therapeutic dosages of finasteride are generally well tolerated. In phase III studies, 7.7% of patients receiving finasteride 1 mg/day compared with 7.0% of those receiving placebo reported treatment-related adverse events. The overall incidence of sexual function disorders, comprising decreased libido, ejaculation disorder and erectile dysfunction, was significantly greater in finasteride than placebo recipients (3.8 vs 2.1%). All sexual adverse events were reversed on discontinuation of therapy and many resolved in patients who continued therapy. No other drug-related events were reported with an incidence > or =1% in patients receiving finasteride. Most events were of mild to moderate severity. Oral finasteride is contraindicated in pregnant women because of the risk of hypospadias in male fetuses. CONCLUSIONS: Oral finasteride promotes scalp hair growth and prevents further hair loss in a significant proportion of men with male pattern hair loss. With its generally good tolerability profile, finasteride is a new approach to the management of this condition, for which treatment options are few. Its role relative to topical minoxidil has yet to be determined.     

Review of Handbook of treatment for eating disorders.

Reviews the book, Handbook of treatment for eating disorders (2nd ed.) edited by David M. Garner and Paul E. Garfinkel (see record 1997-08478-000). In this book, the editors state that their primary goal is to present treatment approaches in sufficient detail that clinicians can conduct therapy of these disorders. A strong research base undergirds each chapter, filled with extensive case illustration and practical approaches, directed toward the practicing clinician. With new as well as revised chapters, this book consists of five major sections. The first, "The Context for Treatment," describes the history of eating disorders, focusing on Anorexia Nervosa and Bulimia Nervosa. The second, and most coherent, section focuses on cognitive-behavioral and educational approaches. A conglomeration of approaches based on other theoretical perspectives appears in the third section, entitled "Psychodynamic, Feminist, and Family Approaches." In the fourth section, issues around inpatient, partial hospitalization, and drug therapies are reviewed. A final, catch-all section covers special topics, including comorbid histories and conditions (sexual abuse, substance abuse, and medical issues), diagnostic concerns (personality disorders), alternative treatments (group, self-help), treatment dilemmas (treatment refusal in anorexia nervosa), age considerations (prepubertal eating disorders), and binge-eating disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual dysfunction in male schizophrenic patients

BACKGROUND: Neuroleptic treatment in schizophrenic patients is associated with sexual dysfunction. However, it is not clear to what extent the psychiatric disorder and/or the pharmacologic treatment are responsible for the sexual impairment. The aim of the present study was to evaluate the sexual function of untreated and treated male schizophrenic patients in comparison with healthy subjects. METHOD: Participants included 122 male subjects: 20 drug-free schizophrenic patients, 51 neuroleptic-treated (depot form) schizophrenic patients, and 51 normal controls. A detailed structured interview was used to quantitatively and qualitatively assess sexual function. RESULTS: A high frequency of sexual dysfunction was reported by both schizophrenic groups of patients. Impairments in arousal items (erection) and orgasm during sex were reported mainly by the treated patients. Desire parameters were reduced in both schizophrenic groups, but reduction in the frequency of sexual thoughts was confined to the untreated one. The schizophrenic patients were more involved in masturbatory activity in comparison with the control subjects. Treated patients disclosed dissatisfaction with their sexual function. CONCLUSION: Untreated schizophrenic patients exhibit decreased sexual desire. Neuroleptic treatment is associated with restoration of sexual desire yet it entails erectile, orgasmic, and sexual satisfaction problems. Clinicians' awareness and open discussion of sexual problems with patients may improve comprehension and compliance.     

Short stature and failure of pubertal development in thalassaemia major: evidence for hypothalamic neurosecretory dysfunction of growth hormone secretion and defective pituitary gonadotropin secretion

In patients with beta-thalassaemia major, frequent blood transfusions combined with desferrioxamine chelation therapy lead to an improved rate of survival. Endocrine disorders related to secondary haemosiderosis such as short stature, delayed puberty and hypogonadism are major problems in both adolescent and adult patients. A total of 32 patients with beta-thalassaemia major undergoing treatment at the Children's Hospital, University of G?ttingen were examined. Fourteen of these were short in stature. Growth hormone (GH) secretion was investigated in 13 patients exhibiting either a short stature or reduced growth rate. The stimulated GH secretion of 10 patients in this subgroup lay within the normal range. Studies of their spontaneous GH secretion during the night revealed that these patients had a markedly reduced mean GH and reduced amplitudes in their GH peaks. Low insulin-like growth factor (IGF)-I levels were seen in the growth-retarded thalassaemic patients. Eight were subjected to an IGF generation test and showed a strong increase in both IGF-I and insulin-like growth factor binding protein (IGFBP)-3 levels indicating intact IGF-I generation by the liver. Hypogonadotropic hypogonadism was found to be present in both the male and female patients with impaired sexual development. After priming with LH-releasing hormone (GnRH) per pump in 2 female and 5 male patients, no change in either their serum oestradiol or testosterone levels or in LH/FSH response to GnRH was observed suggesting that they were suffering from a severe pituitary gonadotropin insufficiency. Three male patients at the age of puberty but exhibiting short stature. low GH, low IGF-I and hypogonadism received low dose long-acting testosterone. After 3 12 months of therapy there was a marked growth spurt, higher nocturnal GH levels and an increase in both IGF-I and IGFBP-3. CONCLUSION: Reduced GH secretion and low IGF-I in thalassaemic patients are related to a neurosecretory dysfunction due to iron overload rather than to liver damage. Hypogonadotropic hypogonadism is caused by the selective loss of pituitary gonadotropin function. In patients with both GH deficiency and hypogonadism, low dose sexual steroid treatment should be considered either as an alternative or an additional treatment before starting GH therapy.     

Empirically supported couple and family interventions for marital distress and adult mental health problems.

This article evaluates the efficacy, effectiveness, and clinical significance of empirically supported couple and family interventions for treating marital distress and individual adult disorders, including anxiety disorders, depression, sexual dysfunctions, alcoholism and problem drinking, and schizophrenia. In addition to consideration of different theoretical approaches to treating these disorders, different ways of including a partner or family in treatment are highlighted: (a) partner–family-assisted interventions, (b) disorder-specific partner–family interventions, and (c) more general couple–family therapy. Findings across diagnostic groups and issues involved in applying efficacy criteria to these populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating disorders in males: a report on 135 patients

OBJECTIVE: The goal of this study was to better understand the etiology, clinical characteristics, and prognosis of eating disorders in males. METHOD: All males with eating disorders who had been treated at Massachusetts General Hospital from Jan. 1, 1980, to Dec. 31, 1994, were identified. Hospital charts and psychiatric departmental records were reviewed to verify that the eating disorders met DSM-IV criteria and to abstract demographic and clinical data. RESULTS: One hundred thirty-five males with eating disorders were identified, of whom 62 (46%) were bulimic, 30 (22%) were anorexic, and 43 (32%) met criteria for an eating disorder not otherwise specified. There were marked differences in sexual orientation by diagnostic group; 42% of the male bulimic patients were identified as either homosexual or bisexual, and 58% of the anorexic patients were identified as asexual. Comorbid psychiatric disorders were common, particularly major depressive disorder (54% of all patients), substance abuse (37%), and personality disorder (26%). Many patients had a family history of affective disorder (29%) or alcoholism (37%). CONCLUSIONS: While most characteristics of males and females with eating disorders are similar, homosexuality/bisexuality appears to be a specific risk factor for males, especially for those who develop bulimia nervosa. Future research on the link between sexual orientation and eating disorders would help guide prevention and treatment strategies.     

Comparison of subperiosteal vs subgaleal elevation techniques used in forehead lifts

OBJECTIVE: To describe the occurrence and management of sexual dysfunction induced by selective serotonin-reuptake inhibitors (SSRIs), to provide an overview of sexual dysfunction, reports of SSRI-induced sexual dysfunction, and management strategies. DATA SOURCES: Information was retrieved from a MEDLINE English-literature search from January 1986 to July 1998 and by review of references. Indexing terms included sexual dysfunction, antidepressants, selective serotonergic reuptake inhibitors, fluoxetine, sertraline, paroxetine, fluvoxamine, clomipramine, buspirone, nefazodone, bupropion, cyproheptadine, amantadine, yohimbine, and central nervous system stimulants. STUDY SELECTION: There are no controlled studies describing SSRI-induced sexual dysfunction or its management. Twenty-one studies are presented, including 2 open-label studies, 12 case series, and 7 case reports. SSRI-induced sexual dysfunction is described with fluoxetine, paroxetine, sertraline, and fluvoxamine for 3-24 weeks of therapy. DATA SYNTHESIS: Data were organized according to the pharmacologic agent used in the management of SSRI dysfunction, target population, SSRI implicated, type of sexual dysfunction, experimental design, and treatment response. Data were extracted from methodology and results sections of reports. Methodologic flaws included failure to account for gender differences, omission of SSRI dose and duration, and use of concomitant drugs. CONCLUSIONS: The frequency of reports suggests that SSRI-induced dysfunction is a common adverse effect; controlled studies are necessary to determine prevalence. Most reports have occurred with fluoxetine, but this phenomenon may be related to its widespread use. Further study is needed to evaluate baseline sexual function, to define target populations, and to compare SSRIs in inducing sexual dysfunction. Serotonin antagonists and dopamine agonists have been used most often to treat SSRI-induced dysfunction and have generally been effective, but controlled studies are also needed.     

Multivariate assessment of sexual dysfunction.

Reviews assessment techniques used by clinicians and researchers to evaluate male, female, and couple sexual dysfunction. Assessment by self-report includes evaluation by interview, questionnaire, and behavioral records. Various methods for the physiological assessment of male impotence and female arousal deficiency are also reviewed. Relations among measures derived from the psychological, behavioral, and physiological domains showed considerable disagreement. However, because sexual dysfunctioning derives its meaning from all 3 contexts, measures from one should not be considered theoretically more or less valid than those from another. Conceptual issues involved in assessment using measures and techniques from all 3 domains are discussed. The differentiation of psychogenic and organic sexual dysfunction and the use of assessment outcomes to plan treatment are discussed. (72 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress urinary incontinence and genito-sexual conditions. Study of 35 cases

OBJECTIVES: To determine frequency and type of sexual disorders in stress urinary incontinence. To determine their physiopathologic mechanisms and psychologic impact. METHODS: 35 patients with stress urinary incontinence were prospectively investigated with special attention for sexuals disorders. Clinical examination, visual analogic scores testing psychologic impact, urodynamic investigation and electrophysiologic testing (electromyography, sacral latency and terminal pudendal nerve latency measurements) were performed. RESULTS: Sexual dysfunction was noted in 86% of the cases. Urinary incontinence during sexual intercourse was seen in 28%, anorgasmia noted in 60%. No correlation was demonstrated between different parameters (age, anorectal disorders, prolapsus, weight, pregnancy, visual analogic scales testing disturbance of the quality of life induced by urinary incontinence) and the presence of sexual dysfunction. CONCLUSION: This fact suggest that perineal stretch neuropathy, with progressive denervation of striated pelvic sphincter musculature due to repeated stretch injury of the innervation when the pelvic floor is weak, is not probably the most important factor to determine sexuals disorders. Psychogenic factors may be always considered in diagnosis and treatment.     

Behavioral marriage therapy: Current status.

Reviews the literature on behavioral approaches to marriage therapy. First, theories regarding the nature, etiology, and maintenance of marital problems are presented; second, behavioral approaches to treatment are described; and third, attempts to assess the efficacy of these treatments are evaluated. Although there is some highly suggestive evidence that behavioral interventions are effective, conclusive demonstrations have not been forthcoming. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of SSRIs on sexual function: a critical review

Sexual problems are highly prevalent in both men and women and are affected by, among other factors, mood state, interpersonal functioning, and psychotropic medications. The incidence of antidepressant-induced sexual dysfunction is difficult to estimate because of the potentially confounding effects of the illness itself, social and interpersonal comorbidities, medication effects, and design and assessment problems in most studies. Estimates of sexual dysfunction vary from a small percentage to more than 80%. This article reviews current evidence regarding sexual side effects of selective serotonin reuptake inhibitors (SSRIs). Among the sexual side effects most commonly associated with SSRIs are delayed ejaculation and absent or delayed orgasm. Sexual desire (libido) and arousal difficulties are also frequently reported, although the specific association of these disorders to SSRI use has not been consistently shown. The effects of SSRIs on sexual functioning seem strongly dose-related and may vary among the group according to serotonin and dopamine reuptake mechanisms, induction of prolactin release, anticholinergic effects, inhibition of nitric oxide synthetase, and propensity for accumulation over time. A variety of strategies have been reported in the management of SSRI-induced sexual dysfunction, including waiting for tolerance to develop, dosage reduction, drug holidays, substitution of another antidepressant drug, and various augmentation strategies with 5-hydroxytryptamine-2 (5-HT2), 5-HT3, and alpha2 adrenergic receptor antagonists, 5-HT1A and dopamine receptor agonists, and phosphodiesterase (PDE5) enzyme inhibitors. Sexual side effects of SSRIs should not be viewed as entirely negative; some studies have shown improved control of premature ejaculation in men. The impacts of sexual side effects of SSRIs on treatment compliance and on patients' quality of life are important clinical considerations.     

Introduction to the special section on contemporary issues in human sexuality: research and practice

Critical issues in human sexuality have changed markedly during the past decade and so have the contributions of psychology to the evaluation and treatment of sexual behavior problems. Some of the greatest challenges facing psychologists today include the increasing emphasis on medical interventions for the male sexual disorders and the relative decline of traditional behavioral sex therapies, the recalcitrance of sexual desire disorders, the prevention of "unsafe" sexual behavior, and the limited understanding of female sexuality. This overview introduces a series of 5 articles that examine these selected critical issues in human sexuality. Guidelines for clinical practice and directions for future research are highlighted.     

Treatments of psychogenic female sexual dysfunctions.

Evaluates research evidence on the effectiveness of the treatments of psychogenic female sexual dysfunctions. Included are analyses of design, methodology, and outcome criteria. The studies are reviewed within 7 categories: individual verbal psychotherapy, couple reeducation, systematic desensitization, extensive retraining programs, combination approaches, group therapy, and vaginal exercise. Over half of the studies were case reports. The studies reflected various methodological weaknesses, including the confounding of treatment procedures, the failure to control for the differential treatment effects on the types of disorders, and the failure to use valid and reliable methods of data collection. Treatment successes were usually defined differently across the studies, a characteristic that inhibits the generalizability of the findings. Various methods of systematic desensitization have been successful in treating vaginismus, dyspareunia, orgasmic dysfunctions, and feelings of aversion toward sexual stimulation. Retraining programs seem to be effective in treating orgasmic dysfunctions. Recommendations for future research include the suggestion that controlled investigations should determine the most effective treatment methods for each of the dysfunctions. (71 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender issues and eating disorders

Sexual problems are not specific for eating disorders. The etiology is complex and no one single causal facter has been identified. However, clinical as well as epidemiological studies have shown that eating disorders occur more commonly in females than males. The evidence that eating disorders are more common in females has resulted in the postulation that socio-cultural factors may be important. An important aspect of the socio-cultural position of women which may contribute to eating disorders is the conflict in roles. Clinical experience and research have shown the important role of sexual problems and traumas in the development of anorexia nervosa and bulimia. When compared to anorexics, bulimics reported greater sexual interest and activity.