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

Psychosexual dysfunction in Indian male patients: revisited after seven years

Short-term (1 year) outcome of 66 male patients with psychosexual dysfunction was studied in the context of patients' sociodemographic and clinical characteristics. A combination of erectile dysfunction and premature ejaculation was the most common diagnosis. Long-term (7 years) outcome of this cohort was evaluated in relation to short-term outcome. Improvement in the short-term indicated favorable long-term outcome. Initial dropout was associated with chronic and continuous sexual dysfunctioning.

Evaluation of I-C papaverine in patients with psychogenic and organic impotence

Forty men with organic or psychogenic impotence, who were highly motivated for treatment, were offered instruction in the intracavernosal (I-C) self-injection of papaverine and regular ongoing supervision by the investigator. Twenty declined immediately, citing a number of reasons, notably qualms about pain of the injection, side-effects and the unnaturalness of the method. Eleven patients discontinued the drug within 11 months; nine used it for at least one year, and all were continuing with it albeit less frequently at the time of assessment. Those who discontinued treatment differed significantly from those who did not; the latter initially used the drug less frequently (less than once per month), did not have a regular sexual partner or had a poor relationship with their sexual partner, and reported a decline in libido during use of the drug. The findings suggest that I-C papaverine, although effective in treating impotence, is not a panacea, and a large percentage of users (55% in our study) are likely to discontinue the drug within a relatively short period of time.

Sex therapy outcome research: a reappraisal of methodology. 1. A treatment study of male sexual dysfunction

In the first section a controlled treatment study of male sexual dysfunction is described. 'Unlucky' randomization of subjects yielded treatment groups which differed with respect to variables of possible prognostic significance. Hence the results are largely uninterpretable. In the second section the predominantly negative or inconsistent findings in sex therapy outcome research are reviewed and methodological problems, such as those described in the first part, are considered as possible reasons for these negative findings. The interrelationships are explored between small treatment groups, prognostic variability, bias, power, and small expected treatment effects. A strategy for future research is proposed, with particular emphasis on the recognition and use of relevant prognostic indices.

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.

Psychological factors involved in impotence. A review of the literature

Recent developments in the treatment of impotence and studies on the results of psychological methods for its treatment seem to indicate that the number of individuals who suffer from impotence of purely psychogenic origin is less than was reported in literature of the last decade. It is undoubtedly true, however, that psychological factors play an important role in the pathogenesis of this disorder. This review looks at psychological factors involved in impotence from three perspectives. Beginning with a historical review, those theoretical bases which formed the premise for psychological therapies are described. Second, diagnostic issues are explored in some detail. Finally, the variety of treatment modalities which have been used, with varying degrees of success, is described. It appears that whatever psychological treatment method is used, the patients who have the best prognosis are those in whom the disorder has lasted for less than two years, who have a strong motivation for psychotherapy, persisting sexual desire, and who are without significant psychopathology.

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.

The directive sex therapies in psychiatric outpatient settings

The treatment techniques and associated outcome studies of the directive sex therapies (DST) are briefly reviewed and data on the treatment of 12 couples are presented. The directive sex therapies have achieved rather impressive results but only with highly selected populations. Studies, such as the present, with a range of patients more typical of psychiatric outpatient settings have consistently achieved lower success rates. The important effect of patient selection on outcome with DST has, to date, received little attention. The present authors discuss selection criteria for DST in the light of the literature and the outcome in their own cases.

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.

Psycho-sexual disorders and their treatment: Part II

In a previously published part of this review the historical and aetiological aspects of sexual inadequacy were considered and an account given of vaginismus. The main problems found in patients with erective and orgasmic dysfunction were also discussed. In this second part, the author considers the conditions of premature ejaculation and ejaculatory incompentance as well as discussing erective and orgasmic incompetence in more detail. Behavioural and other psychotherapeutic measures are considered and a brief review is made of the use and value of drug therapy in patients with sexual dysfunction.

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.