Gray matter anomalies in pedophiles with and without a history of child sexual offending.

Pedophilia is a psychiatric disorder that is inter-related with but distinct from child sexual offending (CSO). Neural alterations reportedly contribute to both pedophilia and CSO, but until now, no study has distinguished the brain structural anomalies associated with pedophilia from those specifically associated with CSO in pedophilic men. Using high-resolution T1-weighted brain images and voxel-based morphometry, we analyzed the gray matter (GM) volume of the following 219 men recruited at four acquisition sites in Germany: 58 pedophiles with a history of CSO, 60 pedophiles without any history of CSO and 101 non-pedophilic, non-offending controls to control for the effects of age, education level, verbal IQ, sexual orientation and the acquisition site. Although there were no differences in the relative GM volume of the brain specifically associated with pedophilia, statistical parametric maps revealed a highly significant and CSO-related pattern of above vs below the 'normal' GM volume in the right temporal pole, with non-offending pedophiles exhibiting larger volumes than offending pedophiles. Moreover, regression analysis revealed that the lower GM volume of the dorsomedial prefrontal or anterior cingulate cortex was associated with a higher risk of re-offending in pedophilic child molesters. We believe our data provide the first evidence that CSO in pedophilia rather than pedophilia alone is associated with GM anomalies and thus shed new light on the results of previous studies on this topic. These results indicate the need for new neurobehavioral theories on pedophilia and CSO and may be potentially useful for treatment or prevention approaches that aim to reduce the risk of (re)offending in pedophilia.

[Sexual medicine in daily practice : Germany-wide questionnaire of urologists]. / Sexualmedizin im ärztlichen Alltag : Bundesweite Umfrage unter Ärzten in der Urologie.

BACKGROUND: Sexual-related problems are very prevalent. Physicians of different disciplines are frequently contacted by men with those problems. OBJECTIVES: The aim of this study was to investigate the situation of sexual medicine in daily practice and to evaluate German urologists' need for further training in this field with a focus on gender-specific differences. MATERIALS AND METHODS: A five-page questionnaire included questions about sexual medicine in daily practice. A focus was set on physicians dealing with sexual medicine in daily practice and their need for further training in this field. In April/Mai 2015, questionnaires were sent per mail to 5955 urologists, urology residents and andrologists throughout Germany. The questionnaire was developed based on previously published studies and a pretest was performed to evaluate comprehensibility. A χ2 test was performed to determine significant gender-specific differences; for this propose response options were dichotomised. P values ≤0.05 were considered significant. RESULTS: The response rate was 16.0%, representing 955 questionnaires. A total of 50 questionnaires from non-urologists were excluded, so 905 questionnaires were analysed. The mean age was 47.7 ± 10.4 years, 78.9% were male, 97.0% had studied in Germany, 86.7% were specialists and 37.7% had further qualification in andrology. CONCLUSION: Our results emphasize the need for further training in sexual medicine, especially for female physicians. This study underlines the demand for advanced qualification in sexual medicine.

[Dermatological diseases and sexuality. How to proceed?]. / Dermatologische Erkrankungen und Sexualität. Wie geht man vor?

A variety of dermatological diseases is associated with male or female sexual dysfunction. Some sexual disorders are caused organically; erectile dysfunction in men with systemic sclerosis may be due to penile vascular alterations and corporal fibrosis. Other dermatoses such as psoriasis are associated with risk factors (metabolic syndrome) for sexual disorders and may therefore indirectly induce erectile dysfunction. However, the majority of sexual dysfunctions in dermatological patients is caused by reduced self confidence and sexual self esteem leading to affected partnership and sexuality. Dermatologists should be trained in basic sexual medicine and ask their patients for sexual problems. They may not treat sexual disorders, but they should be identified as sympathetic physicians for these problems and should be able to refer the patient to specialists in sexual medicine.

Hebephilia as a sexual disorder.

BACKGROUND: The term "hebephilia" describes the sexual preference for minors at an early pubertal body age. For most clinicians the definition of hebephilia is not obvious and not integrated as a separate category in the DSM-5. METHOD: N = 222 self-motivated applicants from the community for the therapy program of the Prevention Project Dunkelfeld in Berlin were assessed concerning their sexual preference towards minors. RESULTS: Approximately two-thirds (n = 153) showed a sexual interest in early pubertal minors (15 % exclusively; 85 % non-exclusively). Approximately 95 % reported having sexually abused children and/or having used child abusive images at least once in their lifetime. Hebephiles reported a significantly higher level of clinically relevant distress and personality characteristics, as well as more offense-supportive attitudes compared to normative samples. CONCLUSION: Hebephilia can be differentiated from pedophilia in terms of sexual interest for the body age of the minor. Associated personal distress, deviant personality characteristics as well as sexual behavior problems suggest that hebephilia can fulfill the criteria of a sexual disorder which should be considered in classification systems (DSM, ICD).

[Hebephilia as a sexual disorder]. / Hebephilie als sexuelle Störung.

BACKGROUND: The term "hebephilia" describes the sexual preference for the body scheme of pubescent minors (Tanner stages 2 and 3). For most clinicians the definition of hebephilia as a sexual disorder is not obvious. METHOD: In all assessed males included in the Prevention Project Dunkelfeld at the Institute for Sexual Medicine at the Charité between 2005 and 2011, who met the inclusion criteria and showed no evidence for exclusion criteria (n=222), the existence of a hebephilia was examined. RESULTS: Approximately two thirds of the present sample (n=153) showed responsiveness for the body scheme of pubescent minors. Of these, only 15% were exclusively attracted by the pubescent body scheme and 85% were cases of mixed types. Concerning the clinical aspects of the sexual preference disorder, about 95% reported child sexual abuse and/or having used child abusive images at least once in their lifetime. Additionally, hebephiles reported a higher level of clinical/psychological stress and more distinct personality characteristics in relation to a comparative sample. In terms of risk factors, hebephiles showed more offense-supportive attitudes compared to a male comparative sample. CONCLUSION: Hebephilia is a sexual disorder, but cannot be independently coded in the presently valid classification systems (DSM-IV-TR and ICD-10). Plans to separately include this in future in the DSM-5 represent an important step from a sexological point of view.

[Influence of neurological diseases on partnership and sexuality. Particularly in view of multiple sclerosis and Parkinson's disease]. / Der Einfluss neurologischer Erkrankungen auf Partnerschaft und Sexualität. Unter besonderer Berücksichtigung der Multiplen Sklerose und des Morbus Parkinson.

A great number of neurological diseases exert a direct impact on sexuality, due to lesions in the central and peripheral nervous system and due to different neurological symptoms and their treatment (for example medication). The psychosocial basic needs for acceptance, intimacy, and security, which can be best fulfilled by sexual communication, attain essential importance in the situation of disease-induced helplessness. This implies that not only the experience of sexual pleasure and the functioning of reproduction can be influenced, but the partnership, too. A holistic treatment approach always requires the consideration of partnership aspects.

[Biopsychosocial understanding of human sexuality. Prerequisite for diagnostics and treatment in sexual medicine]. / Biopsychosoziales Verständnis menschlicher Geschlechtlichkeit. Vorausetzung für sexualmedizinische Diagnostik und Therapie.

Sexual medicine is a subdiscipline of clinical medicine that deals with human sexuality and disorders. Sexuality eludes a unilateral definition. As a biologically, psychologically, and socially determined experience dimension of the human being, its individual form depends on biological factors and developments in the person's life. Moreover, sexuality exhibits different dimensions--lust, reproduction, and relationship--that are indeed closely interrelated. For this reason, directing therapy at only one of these dimensions is not adequate. All human beings are programmed toward fulfillment of elementary biopsychosocial needs such as acceptance, closeness, warmth, and security. If these basic needs are shortchanged in terms of fulfillment, all sorts of restrictions in the quality of life ensue, even to the point of resultant disorders of sexual function. Treatment then approaches the roots when it does not center on the sexual dysfunction but rather on the underlying frustrated relationship of the partners. Syndyastic sexual therapy is an important treatment method in sexual medicine.

[Sex therapy for male sexual dysfunction]. / Sexualtherapie bei sexuellen Funktionsstörungen des Mannes.

A high prevalence and incidence of sexual dysfunctions as well as the availability of orally effective medications cause a rising interest in professional help. In diagnosing and treating sexual disorders, a holistic, biopsychosocial understanding of sexuality and a thorough analysis of the specific needs of the couple are of the utmost importance. Furthermore, the typical physician-patient relationship has to be transformed into a physician-couple relationship wherever possible. Sex therapy, then, focuses on the universal psychosocial fundamental needs and their relevance for the complaints of the couple. In this way the main focus of attention is shifted from the sexual dysfunction to the communicative meaning of sexuality within the relationship and to the quality of the partnership as a whole. Thus the sexual problem is put into a new perspective and sexual functions are relieved from the pressure of performance anxiety. Simultaneously intimacy and mutual satisfaction are promoted. The possibility of obtaining an additional qualification in sexual medicine (since 1997 in postgraduate, curricular trainings) is offering new opportunities for urologists to integrate aspects of sexual medicine into their clinical practice and thus to propose a more extensive form of therapy to their patients. This paper reflects the process of this integration, illustrating it with respective case reports; it stresses the necessity of a holistic approach to the treatment of sexual dysfunctions, also in regard to the economic advantages of a biopsychosocially oriented sex therapy.

[Sexual delinquency and Parkinson's disease]. / Sexuelle Delinquenz und Morbus Parkinson.

The risk of aberrant sexual behaviour such as hypersexuality, exhibitionism, or pederasty may be underestimated in Parkinson's disease and its therapy with high-dosage L-dopa or dopamine agonists. We describe two legal cases which are representative of the forensic assessment of these side effects. The first case brought to court was a 45-year-old man suffering for 20 years from Parkinson's disease who developed hypersexuality and exhibitionism under high-dose therapy with ropinirol. The second patient, a 57-year-old man with an 11-year history of Parkinson's disease, developed increased libido and pederasty under therapy with L-dopa and bromocriptine. We discuss the present literature concerning hypersexuality and sexually deviant behaviour in Parkinson's disease and dopaminergic therapy in the German legal context. Doctors treating Parkinson patients should be aware of increased sexual impulses or reduced behavioural control and ask specifically about them during anamnesis, and counteractive therapeutic strategies should be considered to prevent the occurrence of illegal sexually aberrant behavioural disorders.

Sexual function and testicular perfusion after inguinal hernia repair with mesh.

BACKGROUND: Open tension-free techniques of hernia repair using synthetic meshes revealed an excellent patient comfort with low recurrence rates. The influence of the resulting fibrosis on testicular perfusion and sexual function is still unclear. METHODS: In a prospective observation study testicular volume, perfusion, and sexual function was investigated before plug and patch repair, after 3 months, and every 6 months thereafter. Testicular volume and perfusion was examined by a standardized scrotal ultrasound and duplex sonography. Sexual function was assessed by a validated anonymized questionnaire. RESULTS: Seventy-three patients were included and follow-up examinations by questionnaire and sonography, respectively, were completed in 73 and 68 patients after 3 months, 51 and 43 after 6, and 24 and 14 after 12 months. Preoperative testicular volume and flow volume was comparable between the side of hernia and the contralateral side (average 10.2 +/- 4.8 cm3 versus 9.8 +/- 5.3, respectively) and showed no significant differences during follow-up. In 11 (15%) patients with preexisting disorders sexual function was normalized postoperatively. Ten (14%) other patients (3 of them with neuralgia pain) described limitations of sexual activity due to inguinal pain (n = 4; 6%) or a loss of sensitivity in the inguinal area (n = 6; 8%) after the procedure. Among these, sexual function recovered spontaneously within 12 months postoperatively in 6 patients (2 with inguinal pain, 4 with loss of sensitivity). In all other patients sexual function showed no changes after inguinal hernia repair. CONCLUSIONS: So far there is no evidence for a significant impairment of the cord structures and the sexual function after inguinal hernia repair in the plug and patch technique.

Female analogies to perversion.

Unlike the intrapsychic mechanism for self-esteem regulation in males as a basic component of perversion--extrapsychically (compensationally) culminating in an output of sexual impulses--a functional stabilization of the female self-concept seems more likely if conflict drives were to be focused on reproductional aspects and not on sexuality. It therefore seems more suitable to use a new expression in linguistic analogy to perversion: "reproversion." The case history gives an example of a clinical manifestation of "reproverse" symptom formation. The general survey describes the main points of view in regard to clinically oriented differentiation, i.e., intensity, ego-proximity in the personality structure, and one's own self-acceptance within "reproverse" symptom formation. Underlying personality disturbances are also discussed. The significance of reproversion is relevant to many different specialized medical fields. This is explained in conclusion, using the examples of denied pregnancy and infanticide at birth based on initial empirical results.

[Sexuality and partnership aspects of Parkinson disease. Results of an empirical study of patients and their partners] . / Sexualität und Partnerschaft bei Morbus Parkinson. Ergebnisse einer empirischen Studie bei Betroffenen und ihren Partnern.

In a retrospective, non-randomised cross-sectional study the influence of Parkinson's Disease (PD) on sexuality and partnership in 2099 affected members of the German Parkinson Organization (dPV) were investigated. At an average age of 65, 330 women and 1008 men had been living in partnership for an average of 37 years. Not only sexual dysfunctions occurred both in affected women and men but also an evident reduction of sexual contentment on the whole. The affected patients mentioned specific symptoms of PD and medication as the decisive factors of influence on their sexuality. It was impressive that one single group of substances could influence sexual functions by increasing as well as decreasing them or having no influence at all. Furthermore different sexes in different genders became obvious. The information concerning their partnership situation given by both men and women shows that communication in general, especially caressing and showing feelings, are reduced since diagnosis, whereas a desire for mutual intimacy prevails on the same level as before.

Differential typology and prognosis for dissexual behavior--a follow-up study of previously expert-appraised child molesters.

In terms of identifying socially-dysfunctional forms of sexuality--regardless of the legal valuation--dissexuality is defined as "an expression of social failure in sexual behavior." This failure was the subject of a longitudinal analysis of 186 expert-appraised pedophile sexual delinquents at the University of Kiel from 1945 through 1981. Of the child molesters 121 were followed up between September 1990 and September 1992 and 100 were personally contacted. The goal was to empirically develop prognosis criteria, given knowledge of the former delinquents' social development as well as sexual/dissexual practices, which could be of both forensic and interdisciplinary use. Among the bi- and homosexually-orientated pedophiles, the number of offenders for which the act is one of "compensation" was half of the initial collective. In contrast, this number was three-quarters for the heterosexually-orientated perpetrators. Correspondingly, the other half of the bi- and homosexually-orientated pedophiles were either exclusive-type or non-exclusive-type pedophiles (the so-called "true" pedophiles). Among the heterosexually-orientated offenders, the number was only one-quarter. According to the empirical data, we may expect a biographically continuing potential of dissexual behavior for only the exclusive and the non-exclusive type of pedophilia. Most of the relapsed dissexual activities showed up a long time after the expert's report. This is true for both the heterosexually- and the bi- and homosexually orientated groups. The present evaluation of the results allows assignment of behavior for certain delinquent typologies restricted to life phases or lifelong dissexual behavior.

[Aurorism: clinical manifestation of a 'female analogy' of perversion]. / Aurorismus: Klinische Erscheinungsform einer 'weiblichen Analogie' zur Perversion.

UNLABELLED: There have been no convincing ideas to date explaining the far less frequent occurrence of perverse symptom formation in females compared to males. HYPOTHESIS: Unlike the intrapsychic mechanisms for self-esteem regulation in males as a basic component of perversion--extraphysically (compensatory) culminating in an output of sexual impulses--a functional stabilisation of the female self-concept seems more likely if conflict drives were to be focussed on reproductional aspects and not on sexuality. Hence, it seems--in linguistic analogy to perversion--more suitable to use a new expression: "reproversion". A case history of "aurorism" gives an example of a clinical manifestation in terms of "reprovese" symptom formation. A general survey describes the main points of view in regard to a clinically orientated subdivision, namely intensity, the ego-proximity in the personality structure and the own self-acceptance within the "reproverse" symptom formation as well as a view of the underlying personality disturbances.

[Is there a 'female version' of perversion?]. / Gibt es eine 'weibliche Analogie' zur Perversion?

UNLABELLED: There have been no convincing ideas to date explaining the far less frequent occurrence of perverse symptom formation in females compared to males. HYPOTHESIS: Unlike the intrapsychic mechanisms for self-esteem regulation in males as a basic component of perversion--extraphysical (compensational) culminating in an output of sexual impulses--a functional stabilisation of the female self concept seems more likely, if conflict drives were to be focussed on reproductive aspects and not on sexuality. It therefore seems--in linguistic analogy to perversion--more suitable to use a new expression: "reproversion". In addition to a theoretical explanation of the "reproversion" concept and one case history, a general survey describes the various clinical manifestations covering intensity, the egoproximity within the personality structure, the expressed form and meaning of the "reproverse" symptom formation as well as giving a view of the underlying personality disturbances. Finally, some theoretical reflections on ideological aspects point out the diverse judgement of perversion and "reproversion" in society today.

[Cortical distribution of 2 delta frequencies in slow wave sleep]. / Kortikale Verteilung zweier delta-Frequenzen im langsamen Schlaf.

Many persons show two different types of delta-activity during synchronized sleep; these can already be differentiated visually as follows: one is located over the anterior brain areas, has a high frequency and is monomorph, the other one is located over the posterior brain areas, has a low frequency and is polymorph. However, both rhythms overlap considerably regarding their cortical distribution. The high high frequency delta-activity usually ranges from 1.5-2.9 Hz with a maximum at 2Hz; the one with low frequency ranges from 0.1-1.4 Hz with a maximum at 0.9 Hz. The interhemispheric coherence of the delta-activities is high with 0.7-0.9; for the anterior regions it is slightly higher than for the posterior ones. The intrahemispheric coherence is low, as was to be expected, and it is less than 0.3.

Occurrence of malignant peritoneal mesothelioma after surgery and irradiation for cervical cancer.

Mesothelioma of the peritoneal cavity after irradiation is rare, and the diagnosis is sometimes difficult to establish. The following case is a report of a mesothelioma occurring 9 years after radiation therapy for carcinoma of the cervix. In this patient, who had a hysterectomy and bilateral oophorectomy 7 years prior to the mesothelioma diagnosis, the histologic, histochemical, and ultrastructural findings were all consistent with a diagnosis of malignant peritoneal mesothelioma. It is believed that this case is one of the first well-documented cases of peritoneal mesothelioma in a female who was treated by pelvic irradiation for another neoplasm.