Orgasm in the postoperative transsexual.

The dearth of information regarding organism in postoperative transsexuals prompted the authors to study its prevalence. The sample consisted of 14 male-to-female (M-F) and 9 female-to-male (F-M) postoperative transsexuals. The relationship of orgasm to sexual and general satisfaction was explored via a specially designed questionnaire. Orgastic capacity declined in the M-F group and increased in the (F-M) group. Despite the decrease in orgasm in the M-F group, satisfaction with sex and general satisfaction with the results of surgery were high in both groups. General satisfaction of 86% replicates other studies. Frequency of sex increased by 75% in the M-F group and by 100% in the F-M group. A phalloplasty does not appear to be a critical factor in orgasm or in sexual satisfaction. The general conclusion is reached that it is possible to change one's body image and sexual identity and be sexually satisfied despite inadequate sexual functioning.

Ego-dystonic homosexuality.

The patient coming in with a dysphoria over his or her homosexual feelings, fantasies or behavior must be given the choice of working through the homophobia or the heterophobia. With the first choice, treatment is directed toward decreasing shame over the homosexual orientation and integrating the patient's social role and personal identity. If a move toward greater heterosexuality is chosen, techniques range from psychoanalysis to time-limited psychodynamic psychotherapy to behavioral techniques. Behavioral techniques may involve in vitro or in vivo desensitization. Issues in selecting the appropriate form of therapy are sometimes subtle and complex, and ethical issues frequently beset the therapist. The patient must be kept fully informed of his or her options, and the choice and the goals of therapy must be arrived at by both patient and therapist.

The relation of plasma androgen levels to sexual behaviors and attitudes of women.

Four androgens: dehydroepiandrosterone (DHEA), androstenedione (A), testosterone (T), and dihydrotestosterone (DHT), a variety of sexual behaviors and attitudes, and several moods were determined regularly in two groups of healthy, married women who differed by three decades in age. The younger women exhibited significantly higher levels of each androgen, the differences being almost entirely attributable to ovarian failure in the older group. Although the older women reported the same levels of sexual desire and sexual arousal as the younger women, their intercourse frequencies and self-rated sexual gratification scores were significantly lower than the values obtained for the younger wives. One or more of the androgen levels related significantly and in the expected direction to each stage of the four-stage sexual response process. Global measures of so-called "sexual adjustment" and estimates of anxiety, depression, and hostility feelings experienced by these women did not relate significantly to any of the four androgen levels.

The Sex Knowledge and Attitude Test (SKAT).

The Sex Knowledge and Attitude Test (SKAT) was designed to measure knowledge, attitudes and degree of experience in a variety of sexual behaviors, and to be used as a teaching and research instrument. The SKAT has been administered to over 35,000 students, approximately two-thirds of whom have been medical students. SKAT has served two major objectives: to measure changes in knowledge and attitudes after a course or program in human sexuality and to demonstrate the deficiencies of medical and nursing education in preparing health professionals to aid patients with sexual problems. Additional types of research using the SKAT are suggested.

PIP: Designed to measure knowledge, attitudes and degree of experience in a variety of sexual behaviors, the Sex Knowledge and Attitude Test (SKAT) has been administered to 35,000 students, two-thirds of which were medical. The test was originally designed in 1967 by Harold I. Lief, MD and David Reed, PhD, at the Center for the Study of Sex Education in Medicine, Marriage Council of Philadelphia. A pool of questionnaire items was drawn from a survey of literature, clinical experience, and socially controversial sex topics. Items were either multiple-choice or true-false. A number of variables are measured through scales. The SKAT yields 5 scores: 4 attitude and 1 knowledge score. The attitude section consists of 35 5-alternative, Likert-type items; responses to the items result in scores on 4 attitude scales: heterosexual relations (HR); sexual myths (SM); abortion (A); and Autoeroticism or Masturbation (M). Biographical information and sexual experience sections of the SKAT are not scored. SKAT has been used most often in educational settings where it is used to evlauate courses in human sexuality, not as part of controlled research. SKAT results are useful in demonstrating deficiencies of sexual health education.

Plasma testosterone level and sexual behavior of couples.

Eleven couples, ages 21-31 years and married for at least 1 year, were studied intensively over a three menstrual cycle period from both an endocrine and a sexual behavioral standpoint. Each subject was interviewed individually and had a blood sample drawn twice weekly. Interviews were rated independently by two psychiatrists for degree of sexual initiation, responsivity, avoidance, couple interaction, and mood. Wives rated themselves also for degree of sexual gratification (responsivity). Plasma levels of testosterone and cortisol were determined for both husbands and wives while progesterone and estradiol levels were determined additionally for wives. Husband's initiation scores were significantly correlated with their wives responsivity (clinically rated) scores for 10 of the 11 couples; wives' initiation scores were significantly related to their husband's responsivity scores for 8 of the 11 couples. When either set of correlation coefficients was treated as a new variable and intercorrelated with the husband's average testosterone levels, a significant relationship was obtained. Intercourse frequency, while not related to either partner's average testosterone levels, was related to wives' testosterone levels at their ovulatory peaks. The wivess' self-rated gratification scores correlated significantly with their own plasma testosterone levels. Inspection of each wife's plasma testosterone profile across the three cycles indicated that a dichotomy coccurred, with some women showing a high baseline level and others showing a low baseline level. When wives were dichotomized on this basis, it was found that high baseline testosterone level was significantly related to high self-rated gratification score and to ability to form good interpersonal relationships.

Marital therapy from a psychiatric perspective: an overview.

The authors describe various methods of marital therapy in use today. Although absence of a unifying conceptual scheme in the past has hampered developments in this field, the increasing acknowledgment by psychiatrists of the important effect of the environmental system on thoughts, feelings, and behavior has facilitated a therapeutic approach stressing not only a person's intrapsychic conflicts but current environmental, family, and spouse-related phenomena. The authors discuss three dimensions of marital psychodynamics--power, intimacy, and marital boundary setting--and relate them to the marital life cycle and to four classifications of the marital relationship: 1) rules for defining power, 2) parental stage, 3) level of intimacy, and 4) personality style and psychiatric terminology. The paper includes a brief discussion of therapy techniques, sex counseling, the use of cotherapists, the future of marriage, and alternative lifestyles.