A factual study of male potency disorders

Sexual impotence in man

An analysis as to etiology and complaints of 486 cases of male sexual impotence was performed and is presented. Psychological factors are dominant in 68%. Physico-organic or iatrogenic causes accounted for deviations in 26% of the patients examined. Educational factors took an important part mainly in ejaculation disturbances. Primary anejaculation as a consequence of educational flaws occurred in 15% of the patients. Erection disturbances were often the consequence of physico-organic affections. The loss of libido was a real complaint in 19% of the patients.

The neurobiological approach to premature ejaculation

PURPOSE

Data showing the neurobiological background of rapid ejaculation was reviewed. In addition, new hypotheses to integrate clinical symptomatology, psychopharmacotherapy and psychotherapy of rapid ejaculation with brain function are provided.

MATERIALS AND METHODS

A computerized MEDLINE search, and manual bibliographic review of cross-references and neurobiological animal studies were performed. These reports were analyzed, summarized and compared with the studies performed by the author.

RESULTS

The literature on premature ejaculation published between 1887 and 2001 was reviewed. It appeared that the various psychological hypotheses and psychotherapies have not adequately been investigated. In contrast, psychopharmacological treatment studies, animal research data and stopwatch assessments in men with rapid (premature) ejaculation indicate that lifelong rapid ejaculation is a neurobiological phenomenon related to central serotonergic neurotransmission and likely influenced by hereditary factors.

CONCLUSIONS

Basic and clinical psychopharmacological studies suggest that premature ejaculation is a not a psychological disturbance but a neurobiological phenomenon.

An open clinical trial of fluoxetine in the treatment of premature ejaculation

There have been an increased number of recent reports on orgasm-related sexual dysfunction coincident with selective serotonin reuptake inhibitor (SSRI) treatment. In contrast, it has also been reported that SSRIs improve sexual dysfunction. Low doses of clomipramine and paroxetine, potent 5-hydroxytryptamine reuptake blockers, have been found to retard ejaculation time. We hypothesized that the SSRI fluoxetine might be effective in treating premature ejaculation. In an 8-week open-label clinical study, 11 male patients with premature ejaculation were treated with fluoxetine. After a washout period of 2 weeks, each patient was assigned to receive fluoxetine, 20 mg/day for 2 weeks, and then titrated to 60 mg/day, depending on the patient's tolerability and clinical response. A within-subjects comparison of pre- and posttreatment intravaginal ejaculation latency time revealed a significant improvement. Fluoxetine treatment produced significant improvements in self-visual analogue scale scores for sexual desire, anxiety for rapid ejaculation, and partner's satisfaction with ejaculation and overall sexual function. These data suggest that serotonergic antidepressants may be effective in treating rapid ejaculation in men and underline the need to carry out a double-blind, placebo-controlled trial to confirm these results.

Experiences from a marital-sex therapy clinic in Nairobi

Out of 100 first referrals to a newly started family/marital - sex therapy clinic in Nairobi, 52 cases were studied for sociodemographic characteristics, help-seeking pattern for their sexual problems, presentation of the sexual problems, factors that might sustain the sexual problems, types of sexual problems and the treatment approaches. There was a male preponderance. Both married and non-married patients were seen. The problems tended to occur in relatively young people, and for those who were married in relatively early years of their marriage. The patients attributed the causes of the sexual problems to physical rather than psychological factors, although objective assessment found relatively very few possible physical causes. Elementary rather than subtle psychological causes were frequent. These formed fertile grounds for intervention. The findings are discussed in the light of the social-cultural context in which they were obtained.

Cholinergic receptors in corpora cavernosa

In a group of 13 patients who underwent penile surgery, a small amount of cavernosal tissue was removed and examined for content of cholinergic receptors. Three patients did not display any amount of cholinergic receptors. Values in the other 10 patients ranged from 34 to 136 femtomols. In another group of 61 impotent patients with some degree of preserved erectile capacity, cholinergic stimulation was administered to the patients and the response monitored. Preliminary data displayed improved erectile capacity in 41 per cent. Further studies are needed to identify impotent patients who might respond favorably to cholinergic stimulation.

The role of anxiety in sexual dysfunctions: a review

Studies are reviewed which (a) compare anxiety and other measures of psychopathology between normals and dysfunctionals ; (b) evaluate the effectiveness of anxiety reduction procedures for treating sexual dysfunctions; and (c) try to identify anxiety-related stimuli that alter sexual arousal. The studies, in general, suggest that (a) anxiety is common among people with sexual dysfunctions, but that the level and nature of the anxiety may vary greatly between individuals; (b) anxiety reduction procedures improve some, but probably not all, aspects of sexual dysfunctions; and (c) recent research has begun to identify some anxiety-related factors that can disrupt sexual arousal.

Men and women who do not have orgasms

In the well-known condition of primary complete anorgasmia in women, the glandipudendal ('bulbocavernosus') reflex is often absent, and this is strongly correlated with failure of treatment. From these facts, and from properties of the glandipudendal reflex, we argue that organic abnormalities in the spinal cord contribute to causing the condition in some cases. We report nine cases of complete primary anorgasmia in men, two of whom lacked glandipudendal reflexes. The condition need not imply sterility; in all these nine (as also in three incomplete cases) we were able to obtain semen by electroejaculation or vibratory stimulation, and the wife of one patient is now pregnant.

Symptomatology and psychological aspects of male sexual inadequacy: results of an experimental study

Forty-two male patients and their sexual partners were studied. Sixteen of the patients had psychogenic erectile failure (eight each with the primary and secondary forms), 16 were premature ejaculators, and 10 had diabetes-related impotence. Because of the higher mean age of the diabetics, two control groups were used, an age-matched older group (eight healthy males and their partners) and an age-matched younger group (16 healthy males and their partners). The results for the various groups on a semi-standardized interview about sexual behavior and on five psychological assessment scales were compared. Of the 88 questions on the semi-standardized interview, 11 permitted assignment of the patients to the correct group. The diabetics suffered from "prevailing erectile impotence." They viewed themselves as being less disturbed sexually than the other patients did, although on the basis of their symptoms their impotence was actually more severe. The patients with psychogenic erectile impotence had a "situational" sexual disorder in which sexual anxiety played an important role. They viewed themselves as more insecure than the diabetics and the controls and they overidealized their partners and mothers. There appear to be two subgroups of premature ejaculators: The E1 group of patients seemed to be less "neurotic" than the E2 group. On the psychological measures the latter was quite similar to the group of patients with psychogenic erectile impotence. All patient groups except E1 were significantly more depressed than the control groups.

Psychophysiological aspects of male sexual inadequacy: results of an experimental study

Forty-two male patients and their sexual partners were studied: 16 patients with "psychogenic" erectile failure (eight each with the primary and secondary forms), 16 premature ejaculators, and 10 patients with diabetes-related impotence. Due to the higher mean age of the diabetics, an age-matched older control group (eight healthy males and their sexual partners) and an age-matched younger control group (16 healthy males and their sexual partners) were also studied. In an experimental situation various psychophysiological parameters were evaluated. The viewing of films depicting sexual behavior produced psychophysiological reactions in all subjects. The patient groups and the controls differed on the following five parameters: amount of increase in systolic blood pressure, amount of increase in number of spontaneous fluctuations in skin resistance, erection amplitude, latency of erection, and duration of erection. In the diabetic group the three erection parameters were very depressed. In the group with primary psychogenic erectile impotence all five parameters were lower than in the controls, with the greatest difference in spontaneous fluctuations in skin resistance. The psychophysiological profile of the group of patients with secondary psychogenic erectile impotence was surprisingly similar to the profile of the diabetics, with a sharp increase in systolic blood pressure and in spontaneous fluctuations in skin resistance, but very depressed erection parameters. There were no marked differences between the controls and the premature ejaculators. There were only a few correlations between self-rated sexual arousal and psychophysiological measures of sexual stimulation and these were not very high. They were found mainly in the patient groups.

Psychogenic impotence: a critical review

A critical review of the literature on psychogenic impotence is undertaken with special reference to recent advances in objective evaluation of erectile function and radiographic visualization of the penile arteries. Standardization of nomenclature, subclassification of acute versus insidious erectile dysfunction, insistence on objective criteria for declaring erectile dysfunction or a cure of the same, and the reestablishment of psychogenic impotence as a diagnosis of exclusion are to be encouraged.

Retarded ejaculation reconceptualization and implications for treatment

Retarded ejaculation, RE, has received little attention in the past; however with greater sexual awareness, therapists may find a significant increase in requests for help with this dysfunction. A major concern of this paper is that RE has been too narrowly defined. Additional problems in previous literature include conceptual confusion, poorly defined criteria, vague descriptors, and methodological problems. Incidence, definitions and categorizations are followed by a look at etiology, assessment, and treatment results. The present article broadens the definition of RE, presents psychophysiological stimulation deprivation as a generally overlooked cause, and offers a thorough bibliography for reference purposes.

Family constellation and psychosexual disturbances

In patients with psychosexual disturbances (impotence and ejaculatio praecox) the family constellation during childhood and the patients' occupations were compared with the Swedish population census. The parents of the patients were older, and the patients were more often the only son or the only child. A greater percentage of the patients had technical or office administrative professions than the inhabitants in Stockholm. The findings are discussed with references to a supposed focus on achievement in the upbringing of the oldest or only son. Focus on achievement may cause emotional restraint and subsequently psychosexual disturbances.

Impotence: prognosis (a controlled study)

Sixty-five patients primarily referred for erectile impotence were investigated and treated in a psychiatric out-patient department. Information was obtained from patients and wherever possible from their partners. Subjects were treated either with chemotherapy or with a modified form of Masters and Johnson's technique. A controlled group were not given any specific treatment. Results indicated that neither chemotherapy or behaviour modification (modified Masters and Johnson's technique) were in any way superior to no treatment. The prognosis was related to the clinical features of the subjects rather than to the form of treatment. Subjects in whom impotence was caused by a specific psychological or physical trauma showed a much better prognosis than those who had an insidious decline in sexual potency without any discernible psychological or physical factors. The decline in these latter subjects with a very poor prognosis was possibly due to inherent physiological factors.

A study of 65 impotent males

Sixty-five patients primarily referred for erectile impotence were investigated. Information was obtained from patients and their partners. The demographic data are compared with those from a non-impotent psychiatric out-patient group, matched for age. Results indicate that impotent cases do not form a homogeneous population and can be classified into three fairly distinct groups. These groups differ in age, marital status, sex drive, pre-marital and post-marital relationships, duration of illness, etc. Group 1 develop impotence because of anxiety in sexual situations. Group 2 react to the sexual response and personality of their partners, while Group 3 decline, perhaps from inherent constitutional causes. Factors such as religious restrictions, sexual taboos, alcoholism and homosexuality do not appear to be of any aetiological importance.

Behavioural changes after treatment with testosterone: case report

A male patient is described whose loss of sexual interest and activity was due to gonadal failure, presumably the result partly of Klinefelter's syndrome and partly of orchitis, though the latter was unilateral. He showed no change during a placebo control period, but within a few days of starting replacement treatment with testosterone he reported a return of sexual interest and showed a response to sexually arousing stimuli; sexual attitudes also improved. This case is of interest because of the specific and rapid psychological response to the correction of an androgen deficiency.

Androgen function in "psychogenic" and "constitutional" types of impotence

Androgen function was studied in twenty-five physically healthy "primarily" impotent males classified on clinical criteria into "psychogenic" or "constitutional" groups. The mean urinary testosterone level in the former was significantly higher than in the latter group (P<0.005). Important variables associated significantly with higher urinary testosterone levels (P<0.05) were (a) "late onset" impotence, (b) shorter duration than two years, (c) stronger "sex drive," and (d) an alternative sexual outlet to orgasm and ejaculation in the three months preceding referral; the last-mentioned appeared to be the single most important discriminatory feature.It is suggested that testosterone excretion patterns-namely, high, average, and low-may be one method of classifying impotence.

Disorders of sexual potency in the male: a clinical and statistical study of some factors related to short-term prognosis

Although the literature relating to the prognosis of male potency disorders and the factors that influence this is vast, there is a dearth of factual data on the subject. Most of the opinions expressed, without supporting figures, are clinical impressions, and the majority indicate that the outcome of therapy in these disorders is generally favourable (Ellis, 1948; Jones, 1919; Rees 1935; Allen, 1962; Stafford-Clark, 1954; Gutheil, 1959). However, Johnson's (1965b) recent important contribution has challenged this consensus; he suggests that; with or without treatment, the prognosis in disordered potency is much worse than has hitherto been believed.