Medical examinations and appeals for NJ public service workers.

The state of New Jersey has more than 200,000 employees in merit system jobs, who are covered by the Department of Personnel's formal hiring mechanism, including a medical examination and appeals process in which physicians play an important role. The State Medical Examiners Panel provides an innovative and practical approach to supply the Merit System Board with independent and objective findings and medical recommendations regarding the appeals. This article summarizes this process and discusses the structure, functions, and outcomes of the medical examiners Panel.

Sexual potency: a pioneer's thirty-five-year overview.

Thirty-five years of interest in human sexual potency are summarized, citing my clinical research and periodic publications during those decades. Emergence of scientific study of human sexuality has been rapid in recent years, leading to improved diagnostic and therapeutic techniques to benefit the impotent male. Although my approach pertained primarily to psychogenic etiology, the interdigitation of emotional and organic factors is emphasized. Currently utilized surgical and pharmacodynamic treatments are noted, as are probable future methodologies.

Sexual potency before and after radical prostatectomy.

A TRIAD OF FACTORS CAN FAVORABLY INFLUENCE THE MAINTENANCE OF SEXUAL POTENCY AFTER RADICAL PROSTATECTOMY: the surgical avoidance of cavernous neurovascular bundles, the preoperative interest of the surgeon in broaching the subject with the patient and the continued encouragement given the patient by his attending physician as to probable preservation of sexual competency following the surgical procedure.

Sexual impotency: counseling of 388 private patients by urologist from 1954 to 1982.

Counseling toward restoration of sexual potency was provided in twenty-eight years to 388 impotent men by one urologist. Most were in the fifty to fifty-nine-year age group. Many had histories of serious trauma, major surgical procedures, vascular diseases, diabetes mellitus, and alcoholism. Clinical judgment rather than elaborate testing was the basic approach to differentiate psychogenic from organic etiology. Strict criteria were used to classify success and failure of response to counseling. The success rate was 75 per cent, generally within three sessions at weekly intervals. Age alone did not preclude restoration of sexual competence. The highest success rate was in the fifty to fifty-nine-year age range for all three groups (white, black, and Asian).

Concurrent bilateral hypernephroma. Successful diagnosis and treatment of one patient.

Clinically unsuspected, bilateral concurrent clear cell cancers of each kidney were identified in a patient during evaluation for acute pancreatitis. A right renal lesion was demonstrated by computerized axial tomography (CAT) scan. Promptly thereafter percutaneous transfemoral aortography was performed, identifying separate, bilateral kidney neoplasms. The surgical outcome at nineteen months postoperatively has been satisfactory.

Urology/sexuality clinic: results of counseling of 67 men.

Of 67 psychogenically impotent men encountered in a new Urology/Sexuality Clinic during its first 36 months of operation at the University of California Medical Center in San Francisco, 52 returned for more than one urologic counseling visit, rendered individually by the senior author in all cases. There was a 79 percent success rate in the form of reinstatement of sexual activity, generally within three sessions, at weekly intervals. Success appeared, for the most part, unrelated to age, to previous treatment elsewhere, or even to major medical or surgical problems among some of these men who ranged in age from 18 to 78 years.

Sexual potency after radical prostatectomy.

Systematically acquired data on preservation or loss of sexual potency after radical prostatectomy have not been reported frequently. Our retrospective study is based on a review of the hospital records of 62 patients who underwent radical prostatectomy between 1968 and 1978. No notation as to preoperative potency was found in the records of 74 per cent of the patients. Of 14 patients who affirmed preoperative potency 6 (43 per cent) reported normal erections and resumption of sexual intercourse postoperatively. The mean of these 6 men was significantly less than the group as a whole (p les than 0.01). It is urged that an adequate sexual history be elicited before any prostatic operation, and certainly in advanced of radical prostatectomy. It is suggested that sexual potency may be retained after radical prostatectomy far more often than has been presumed previously. Thus, urologists should be aware of the sexual interests and competency of their aging male patients, and encourage continuation of sexual activity after radical prostatectomy.

Sexual impotency: current knowledge and treatment I. Urology/sexuality clinic.

Investigative and therapeutic measures for evaluating sexual impotency are rather recent. Psychogenic and organic problems may overlap. Thorough clinical appraisal and objective tests are currently affording better differentiation of etiology and, consequently, appropriate treatment. Causes of and tests for sexual impotency guide the choice of treatment. Surgical intervention can be offered for irreversible organic impotency. However, most instances of acquired impotence are psychogenic. Any nonjudgmental, competent practitioner can aid victims of psychogenic impotence by a "listening and encouragement" method. Urologists, in particular, are commonly confronted with genital/sexual problems and may be best suited as primary therapists by developing interest in urologic counseling. A newly formed Urology/Sexuality Clinic at the University of California in San Francisco provides therapy for patients and offers training for resident physicians.

Psychosexual problems of aging males: urologist's viewpoint.

Sexual impotency is commonly psychogenic. Any therapist who will take the time to hear out his patient's complaints can readily differentiate etiologies that are likely to respond to simple encouragement and support from those that would require more sophisticated psychology. Key points in the patient's medical history are identified to establish the diagnosis of psychogenic impotency. The diagnostic approach is described herein. Most patients with psychogenic impotency have resumed sexual intercourse within three visits.

Genitourinary disorders of old age: therapeutic considerations including counseling for sexual dysfunction.

Genitourinary tissues undergo physical changes with advancing age, due partly to hormonal alterations. However, the greatest influence on continuing sexual function during aging is emotional and is directly related to the psychologic history of the individual patient. The interested professional can help his patient substantially by simply taking time to listen, a process which permits identification of any psychogenic basis for the sexual dysfunction. The entire approach and method of counseling presuppose that psychogenic impotence is the most common form of the problem. This preliminary effort can do no harm. Should it fail, the patient can be referred to other consultants who use more protracted or sophisticated modalities. With the elderly, the clinician can advise patients to share interpersonal warmth and to enjoy the satisfaction of body contact at any age at which this desire and capacity persist. To the aging person, the totality of sexual meaning is more significant than performance or technique. The sympathetic counselor who renders supportive reassurance to the patient usually can expect beneficial results.

Encouraging preservation of sexual function postprostatectomy.

Sexual function after prostatectomy, particularly perirenal, has been reviewed in 128 patients treated in private practice for the past twenty years by one urologist with an avowed bias to encouraging postoperative sexual function. Surgical procedures for benign and neoplastic lesions of the prostate usually do not impair sexual potency when a patient is interested in coitus, has an available partner, and is encouraged by his physician. Review of the literature justifies encouraging preservation of sexual function postprostatectomy.