The Sexual Inhibition (SIS) and Sexual Excitation (SES) Scales: I. Measuring sexual inhibition and excitation proneness in men

This study involves the development and initial validation of a questionnaire measuring the propensity for sexual inhibition and excitation in men: the Sexual Inhibition Sexual Excitation Scales (SIS/SES). The underlying theoretical model postulates that sexual response and associated behavior depend on dual control mechanisms, involving excitatory and inhibitory neurophysiological systems. The scales and their discriminant and convergent validity and test-retest reliability are described. In a sample of 408 sexually functional men (mean age = 22.8 years), factor analyses identified three higher-level factors: two related to sexual inhibition and one to sexual excitation. Multigroup Confirmatory Factor Analyses revealed that the factor structure provided an acceptable fit to the data obtained in a second (N = 459; mean age = 20.9 years) and third (N = 313; mean age = 46.2 years) sample of men, with similar distributions and relationships with other measures. Theoretical issues and areas for further research, including male sexual dysfunction and risk taking, are discussed.

Sexual behavior in lesbian and heterosexual women: relations with menstrual cycle phase and partner availability

Using a prospective design over three complete menstrual cycles, 147 heterosexual and 89 lesbian women made daily recordings of their basal body temperature (BBT), cervical mucus status, menses, and completed a daily checklist of various sexual behaviors (including sexual self-stimulation and sexual activity with a partner). They also gave their age, height, weight, age at menarche, number of pregnancies, duration of sleep, tobacco, caffeine, and alcohol use, and whether they had a live-in sexual partner. Using BBT, cervical mucus status, and menses information, cycle days were grouped into five discrete phases: menses, follicular, ovulatory, early luteal, and premenstrual. Daily frequencies of sexual behavior with a partner and autosexual behavior were computed for each phase. Mixed ANOVAs on the resultant proportional data revealed similar patterns for autosexual behavior across the phases for both heterosexuals and lesbians who did not have a live-in partner, in which autosexual behavior was highest during the follicular and ovulatory phases. For those with live-in partners, autosexual behavior did not vary across the phases. Lesbians engaged in more autosexual behavior overall. Allosexual behavior peaked during the follicular phase for both heterosexuals and lesbians, and the phasic pattern was unrelated to live-in partner status. Additional analyses suggest that the observed patterns were unrelated to anticipated changes in sexual activity due to menses. Results are discussed in terms of social variables and hormonal fluctuations associated with the menstrual cycle.

Pheromonal influences on sociosexual behavior in young women

A double-blind, placebo-controlled study of a synthesized putative female pheromone was conducted with regularly menstruating, university women (N=36, mean age=27.8). The pheromone formula was derived from earlier work investigating the underarm secretions of fertile, sexually active, heterosexual women. A vial of either synthesized pheromone or placebo was selected blindly and added to a subject's perfume. Subjects recorded seven sociosexual behaviors and reported them weekly across three menstrual cycles. Beginning with Day 8 of each cycle, the first cycle contained a 2-week baseline period followed by an experimental period of as many as 3 weeks each from the next two cycles for a maximum of 6 weeks. The 19 pheromone and 17 placebo subjects did not differ significantly in age, weight, body mass index, dating status or ethnicity nor in reported accuracy, back-filling data, perception of a positive effect or perfume use. Placebo subjects were significantly taller than pheromone subjects. Except for male approaches, subjects did not differ significantly at baseline in average weekly sociosexual behaviors. A significantly greater proportion of pheromone users compared with placebo users increased over baseline in frequency of sexual intercourse, sleeping next to a partner, formal dates and petting/affection/kissing but not in frequency of male approaches, informal dates or masturbation. Three or more sociosexual behaviors increased over baseline for 74% of pheromone users compared with 23% of placebo users. We conclude that this synthesized pheromone formula acted as a sex attractant pheromone and increased the sexual attractiveness of women to men.

Atypical sexual behavior during sleep

OBJECTIVE

This article reports a case series of atypical sexual behavior during sleep, which is often harmful to patients or bed partners.

METHODS

Eleven subjects underwent clinical evaluation of complaints of sleep-related atypical sexual behavior. Complaints included violent masturbation, sexual assaults, and continuous (and loud) sexual vocalizations during sleep. One case was a medical-legal case. Sleep logs, clinical evaluations, sleep questionnaires, structured psychiatric interviews, polysomnography, actigraphy, home electroencephalographic monitoring during sleep, and clinical electroencephalographic monitoring while awake and asleep were used to determine clinical diagnoses.

RESULTS

Atypical sexual behaviors during sleep were associated with feelings of guilt, shame, and depression. Because of these feelings, patients and bed partners often tolerated the abnormal behavior for long periods of time without seeking medical attention. The following pathologic sleep disorders were demonstrated on polysomnography: partial complex seizures, sleep-disordered breathing, stage 3 to 4 non-rapid eye movement (REM) sleep parasomnias, and REM sleep behavior disorder. These findings were concurrent with morning amnesia.

CONCLUSIONS

The atypical behaviors were related to different syndromes despite the similarity of complaints from bed partners. In most cases the disturbing and often harmful symptoms were controlled when counseling was instituted and sleep disorders were treated. In some cases treatment of seizures or psychiatric disorders was also needed. Clonazepam with simultaneous psychotherapy was the most common successful treatment combination. The addition of antidepressant or antiepileptic medications was required in specific cases.

Addressing semen loss concerns: towards culturally appropriate HIV/AIDS interventions in Gujarat, India

A situation analysis of sexual networking and sexual health in an industrial area of Gujarat, India, identified anxiety about masturbation and other semen loss concerns as major preoccupations among young men. This paper describes how the Deepak Charitable Trust addressed these concerns in their HIV prevention programme for young men aged 15 to 30. Flowcharts were used as participatory learning tools and to obtain data on the perceived consequences of masturbation, both before and after intervention activities. Research was also done on the relation between semen-related anxieties and sexual risk behaviour by DCT and two other NGOs among young men engaging in unsafe sexual behaviour. DCT advocates addressing masturbation and other semen loss concerns in all sexual health campaigns in South Asia, based on the magnitude of these concerns, their potential to confound syndromic management of STIs and their significance as an idiom of psychosocial distress. Masturbation and associated anxieties about sexual performance are seen as health issues and discussed as such by the programme. There is immediate identification among young men, whether or not they are already sexually active, and it provides an excellent entry point for sexual health and safer sex education. The community response to these efforts has been entirely positive.

Sexual dysfunction: a neglected complication of panic disorder and social phobia

Little is known about sexual dysfunctions comorbid with anxiety disorder. The aim of this study is to evaluate retrospectively the sexual function of social phobic patients in comparison with a panic disorder sample. Using a semistructured interview (SCID-I), 30 patients with social phobia and 28 patients with panic disorder were examined. The DSM-IV criteria were employed to diagnose sexual dysfunctions in this sample; however, the "C" criterion, which states that "the sexual dysfunction cannot be related to other Axis I disorders," was excluded. Panic disorder patients reported a significantly greater proportion of sexual disorders compared with social phobics: 75% (21/28) vs. 33.3% (10/30) (p = .0034). Sexual aversion disorder was the most common sexual dysfunction in both male (35.7%; 5/14) and female (50%; 7/14) panic disorder patients, and premature ejaculation was the most common sexual dysfunction in male social phobic patients: 47.4% (9/19). These results suggest that sexual dysfunctions are frequent and neglected complications of social phobia and panic disorder.

The clinical outcome of childhood masturbation

This study was performed to investigate the clinical outcome of childhood masturbation. For this purpose 50 children (mean age = 48.7 +/- 24.5 months, 34 girls females and 16 boys males) with masturbation symptoms were examined at first visit to the Department of Child Psychiatry and two years thereafter with psychiatric interviews. The mean masturbation frequency at the initial interview was significantly decreased after two years. It was noted that 39 children (78%) were completely recovered and 11 children (22%) continued to masturbate after two years. Children who did not recover were significantly younger, began to masturbate earlier and masturbated more frequently than others at the time of initial evaluation. It was concluded that the findings about the beneficial effect of sedative drugs in combination with parental guidance, education and means for behavior modification were promising.

Ejaculatory latency and control in men with premature ejaculation: an analysis across sexual activities using multiple sources of information

OBJECTIVE

Men with premature ejaculation (PE) exhibit diminished control over and short latency to ejaculation. The present study attempted to delineate further characteristics of men with PE and to address a number of presumed hypotheses regarding the etiology of this disorder.

METHODS

Twenty-six men with PE were compared with an age-matched group of 13 sexually functional men on multiple indices of erectile and ejaculatory response during coital and masturbatory activities. These data were collected through retrospective, prospective, and laboratory methods.

RESULTS

Psychophysiological testing indicated greater ejaculatory vulnerability to penile stimulation, although not visual erotic stimulation, in PE men than functional controls. PE men also showed subtle anomalies in the way they perceived their somatic response. The correlation between measures of ejaculatory latency and control was positive and high for intercourse, but low or even negative for masturbation. Whereas functional men showed consistency in ejaculatory latency over coital and masturbatory activities, PE men exhibited much shorter latencies during coitus than masturbation. Data collected under various methodologies (retrospective, prospective, and laboratory) showed greater consistency among sexually functional subjects; and preliminary analysis of laboratory data suggests psychophysiological methodology is as effective in differentiating dysfunctional from functional men as prospective and retrospective methodologies.

CONCLUSION

Although ejaculatory latency and control tend to be related, these measures are not always stable over different kinds of sexual activity or using different methods of data collection. Psychophysiological methodology is effective in differentiating group membership (PE vs. control), but does not predict individual ejaculatory responses measured prospectively.

Sex offending as a psychosocial sequela of traumatic brain injury

OBJECTIVE

To describe the nature and extent of sexual offending after traumatic brain injury (TBI).

DESIGN

Retrospective file review.

SETTING

A brain injury unit providing inpatient and outpatient rehabilitation services.

PARTICIPANTS

A review of five years of admissions to the Brain Injury Rehabilitation Unit (N = 477) identified a sample of 29 males who committed 128 incidents of sex offending.

MAIN OUTCOME MEASURES

A protocol to record data on demographic, injury, radiological, and psychosocial variables and offending behaviors.

RESULTS

Of the total population of 445 clients with TBI, 6.5% (n = 29) were identified as having committed some form of sexual offense. Alcohol was a factor in only three (2.3%) of the incidents, and only two clients had a preinjury history of sexual offending. The most common offenses were the "touching" offenses, followed by exhibitionism and overt sexual aggression. Staff members were the most common targets of the offenses, followed by members of the general public, other people with TBI, and family members.

CONCLUSIONS

Sex offending is a significant clinical problem among a small minority of men after TBI. The absence of alcohol and preinjury histories of sexual offending suggest that the brain injury and contingent sequelae were a significant etiological factor underlying the offenses. A number of implications for the clinical management of clients with sexually aberrant behaviors is identified and discussed.

Classifying serial killers

We attempted to match the appearance and demeanor of 27 serial killers to the postmortem 'signatures' found on their victims' bodies. Our results suggest that a link may exist between postmortem signatures and two complementary appearance-demeanor types.

Posttraumatic erectile potential of spinal cord injured men: how physiologic recordings supplement subjective reports

OBJECTIVE

To investigate by means of a neurophysiologic model the remaining erectile function in spinal cord injured men.

DESIGN

A nonrandomized control trial.

SETTING

A Referred Care Center.

SUBJECTS

Forty-seven spinal cord injured men and 7 noninjured controls.

INTERVENTION

The subject penile responses were recorded by a penile strain gauge during two sessions--one to obtain baseline responses, and one with reflexogenic stimulation (masturbation) and psychogenic stimulation (film).

MEASURES

Average tumescence, maximal tumescence, percentage rigidity, and duration of tumescence and rigidity.

RESULTS

Significant results were found for subjects with lower lesions using psychogenic stimulation as their optimal mode compared with reflexogenic stimulation as an alternate mode, and for subjects with higher lesions using reflexogenic stimulation as their optimal mode, compared with psychogenic stimulation as an alternate mode. The responses with optimal stimulation modes were comparable to those achieved by controls.

CONCLUSION

The findings validate the neurophysiologic model of posttraumatic erectile potential as a function of the lesion type and stimulation source. The results were comparable to those of noninjured subjects; the potential for normal function is present and may be amenable to sexual rehabilitation or use in conjunction with new oral drug treatments for impotence.

Sexual knowledge and practice in Pakistani young men

BACKGROUND

There is a shortage of scientific data on the subject of sexuality from Pakistan. We decided to document misconceptions among Pakistani young men, regarding masturbation and nocturnal emissions and to make a case for sex education in the country.

OBJECTIVE

To study the knowledge, attitude and practice of Pakistani young men as regards masturbation and nocturnal emissions and to see any associations with demographic factors like age, marital status, occupation, level of education and socio economic status.

METHOD

A questionnaire was developed, based on the objectives of the study. It was administered to 188 men between the age's 18-30 years, who presented to the outpatient department of the Aga Khan University Hospital. There was double entry of the data from questionnaires and the demographic form into the computer program, using the Fox Pro for windows and the SPSS for windows.

RESULTS

We found a high prevalence of misconceptions and guilt associated with both these acts. Eighty percent of the respondents had masturbated while a 94% had experienced nocturnal emissions. 31.4% and 62.8% of the respondents reported association of physical illness and weakness with masturbation. Responses were 14.9% and 42.6% for nocturnal emissions. Association of guilt with masturbation and nocturnal emissions was 68.6% and 32% respectively. We also studied the association of demographic variables with these prevalence figures, in order to point out areas for future studies and interventions.

CONCLUSION

We have documented the misconceptions regarding masturbation and nocturnal emissions among Pakistani young men and have made a case for sex education of our youth.

Fracture of the penis--a rare injury on the Jos Plateau, Nigeria

A case of a 37 years old veterinary surgeon who sustained right sided fracture of the base of the penis during masturbation is presented. He was seen more than 48 hours after his injury with the typical painful swelling, angulation and tenderness at the fracture site. The tear was promptly repaired using the Laubscher's subcoronal sleeve technique. He regained his ability to achieve erection on the third post operative day. This is a rare injury on the Jos Plateau--being the only documented case in 11 years in this tertiary health facility and so we consider it necessary to highlight salient points in the diagnosis and treatment. Psychotherapy was found very useful in this patient in order to wean his off masturbation especially during the immediate post operative period. His short term follow up has been uneventful; he is now able to achieve normal and straight erection and sexual intercourse without pain--a view corroborated by his wife.

Short-term psychoanalytic psychotherapy with obsessive preadolescents

The phenomenological and psychodynamic differences between obsessive preadolescents and obsessive adults are pointed out. Case material shows how an effective therapeutic alliance on psychoanalytic lines can be established quite early with preadolescents. The therapy can be shortened mainly by opening up sexual subjects connected with the onset of puberty, and by working through the guilt engendered by the ambivalent relations this age group has with its parents.

Traumatic masturbatory syndrome

This article describes a previously unreported pattern of atypical masturbatory behavior, which presents as either an erectile or orgasmic disorder in men. Four case histories are described of men who masturbated in an idiosyncratic manner. The distinguishing features of the masturbatory style include a prone position and daily masturbation over a period of years. It is suggested that the primary care physician or specialist (urologist or neurologist) screen for this problematic style when presented with male sexual dysfunction. Further, and more controversially, it is suggested that a primary prevention model would argue for masturbatory instruction in the home, classroom, or pediatric clinical setting.

A case of auto-erotic asphyxia in a long-term psychiatric setting

The syndrome of auto-erotic asphyxia (AEA) involves the deliberate induction of cerebral hypoxia to produce or enhance sexual excitement. This sexual practice is normally only discovered when death results from the act because these individuals rarely seek professional advice. The practice of AEA in the living case presented here was initially misinterpreted as parasuicidal behaviour. This type of sexual behaviour should always be considered a differential for parasuicidal activity involving asphyxia. Aetiology, treatment and the need for health professionals to be aware of this syndrome are discussed.

Efficacy of lithium carbonate on public and compulsive masturbation: a female case with mild mental disability

The efficacy of lithium carbonate in the first reported case of a female with mild mental disability who engaged in public and compulsive masturbation is described. The patient was born in 1975, and was 19 years old at first admission. A diagnosis of schizophrenia was initially suspected, therefore the patient was given medication including pimozide, haloperidol, carbamazepine, diazepam and levomepromazine. These medications, however, did not control the symptoms, and the patient showed several side effects, such as incontinence. Only lithium carbonate was efficacious among the medications administered; the patient's abnormal sexual behavior was significantly reduced and no conspicuous side effects were recognized. The mechanisms of lithium carbonate in controlling abnormal sexual behavior are discussed.

High schoolers masturbatory practices: their relationship to sexual intercourse and personal characteristics

This study examined the self-reported masturbatory experiences of high schooler and the relationships between masturbation and sexual intercourse and personal characteristics of these young people. A total of 436 suburban Australian adolescents between 15 and 18 years of age participated. Boys were more likely to report ever having masturbated (58.5%, versus 42.7%) and to have done so more frequently than girls (38.2% versus 8.7% reporting masturbating three or more times a week). While there was no significant sex difference in the age of initiation of masturbation there was some evidence that girls began masturbation earlier than boys. Whether sexual intercourse replaced or supplemented masturbation as a sexual practice could not be resolved, but there was evidence that masturbation was positively correlated with sexual self esteem. Young people whose parents provided a more open environment for the discussion of sexuality were more likely to report having masturbated, although the environment had a complex relationship with masturbatory practices as did young people's self rated physical maturity compared to their peers. A range of social and contextual factors must be explored to understand more fully this important component of young people's sexual experience.

Masturbation in prepubescent children: a case report and review of the literature

A 10-year-old girl observed to have episodes of flushing, pallor and weakness, was referred for investigation of possible carcinoid syndrome. The cause of these episodes was masturbation. Masturbation occurs at all ages and in most cases is considered normal behaviour. Lack of recognition of this phenomenon in children may lead to unnecessary investigations and treatment.