Evaluation of the female sexual function after vaginal surgery using the FSFI (Female Sexual Function Index).

Urinary Incontinence (UI) and Pelvic Organ Prolapse (POP) have a detrimental effect on Female Sexual Function (FSF). We decided to focus on the effect of vaginal surgery for UI and/or POP on FSF. MATERIALS AND METHODS. 72 women (aged 42-80, mean age: 62) were given the FSFI questionnaire after undergoing the following operations: 54 Tension-Free Vaginal Slings (TFVS), 12 Kelly plications, 3 hysterectomies+Kelly, 2 Tension-Free Vaginal Slings+Kelly, 1 hysterectomy+ Kelly+posterior IVS. RESULTS. 35 women did not answer the questionnaire, 6 women were sexually inactive and answered only partially; 31 patients answered completely. Mean pre- and postoperative scores were, respectively, 25.26 and 25.22 (normal >26.55). 9 patients had a normal preoperative score, whereas 22 a pathological score. The FSFI score did not change postoperatively in 26 women; it worsened in 3 and improved in 2 women treated because of coital incontinence. CONCLUSIONS. Vaginal surgery for UI and/or POP does not seem to affect FSF in the great majority of cases; conditions may worsen or improve, the latter definitely resulting from the treatment of Coital Incontinence. The high number of patients not answering the questionnaire deserves further studies and it could be - at least partially - explained on the basis of psychological and/or cultural problems regarding the highly emotional issues of sex, incontinence and prolapse.

The VEPSY UPDATED Project: clinical rationale and technical approach.

More than 10 years ago, Tart (1990) described virtual reality (VR) as a technological model of consciousness offering intriguing possibilities for developing diagnostic, inductive, psychotherapeutic, and training techniques that can extend and supplement current ones. To exploit and understand this potential is the overall goal of the "Telemedicine and Portable Virtual Environment in Clinical Psychology"--VEPSY UPDATED--a European Community-funded research project (IST-2000-25323, www.cybertherapy.info). Particularly, its specific goal is the development of different PC-based virtual reality modules to be used in clinical assessment and treatment of social phobia, panic disorders, male sexual disorders, obesity, and eating disorders. The paper describes the clinical and technical rationale behind the clinical applications developed by the project. Moreover, the paper focuses its analysis on the possible role of VR in clinical psychology and how it can be used for therapeutic change.

The VEPSY UPDATED project: technical and clinical rationale.

The emergence of new shared media, such as the Internet and virtual reality are changing the ways in which people relate, communicate, and live. Health care, and in particular clinical psychology, is one of the areas that could be most dramatically reshaped by these new technologies. To exploit and understand this potential is the overall goal of the "Telemedicine and Portable Virtual Environment in Clinical Psychology"--VEPSY UPDATED--an European Community funded research project (IST-2000-25323, http://www.vepsy.com) whose specific goal is the development of different PC based virtual reality modules to be used in clinical assessment and treatment. In particular the developed modules have been using to address the following pathologies: anxiety disorders; male impotence and premature ejaculation; obesity, bulimia and binge-eating disorders. The chapter details the general technical and clinical characteristics of the developed modules.

The VEPSY updated project: virtual reality in clinical psychology.

Many of us grew up with the naive assumption that couches are the best used therapeutic tools in psychotherapy. But tools for psychotherapy are evolving in a much more complex environment than a designer's chaise lounge. In particular, virtual reality (VR) devices have the potential for appearing soon in many consulting rooms. The use of VR in medicine is not a novelty. Applications of virtual environments for health care have been developed in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); preventive medicine and patient education; medical education and training; visualization of massive medical databases; and architectural design for health care facilities. However, there is a growing recognition that VR can play an important role in clinical psychology, too. To exploit and understand this potential is the main goal of the Telemedicine and Portable Virtual Environment in Clinical Psychology--VEPSY Updated--a European Community-funded research project (IST-2000-25323, http://www.vepsy.com). The project will provide innovative tools-telemedicine and portable-for the treatment of patients, clinical trials to verify their viability, and action plans for dissemination of its results to an extended audience-potential users and influential groups. The project will also develop different personal computer (PC)-based virtual reality modules to be used in clinical assessment and treatment. In particular, the developed modules will address the following pathologies: anxiety disorders; male impotence and premature ejaculation; and obesity, bulimia, and binge-eating disorders.

PET supports the hypothesized existence of a male sexual brain algorithm that may respond to treatment combining psychotherapy with virtual reality.

Could a brain circuit exist, verifiable using positron emission tomography (PET), that links coitus and its dysfunctions, such as impotence? Could re-establishing normal sexual functioning be linked with the normalization of some sort of altered brain metabolism utilizing a therapeutic project that uses psychodynamic psychotherapy integrating virtual reality (VR)? A Brain PET Scan and a self-administered sexual activity questionnaire were given to 11 heterosexual patients affected by impotence due to psychological causes, both before and approximately 6 months after a cycle of psychodynamic psychotherapy. Seven randomly-selected patients received psychotherapy with VR technology using the Optale Method. PET data, used to indicate glucose consumption in various brain areas, were compared with data from normal patients, and a statistical analysis was run. Alterations in cerebral metabolic functioning were displayed in the following areas: frontal cortex, nucleus caudatus, and thalamus. The seven patients who received psychotherapy with VR technology "normalized" in these same areas and attained satisfactory sexual performance. The existence of a male sex algorithm may be hypothesized that links the frontal cortex, nucleus caudatus, and thalamus, and explains its action on cortical motor areas and/or on the medial preoptic area of the hypothalamus, which may respond to treatment combining psychotherapy with VR.

A VR based therapy for the treatment of impotence and premature ejaculation.

The use of psycho-dynamic psychotherapy integrating virtual reality (VR) dealt with in this study on the treatment of erection dysfunctions and premature ejaculation started several years ago, after having seen the scarce results we obtained using exclusively a psycho-dynamic approach (accompanied by pre-recorded sound and music). Considering the particular way that full-immersion VR involves the subject who experiences it, we hypothesized that better results could be obtained during therapy for these sexual disorders and in particular regarding the nature of erection dysfunction, commonly referred to as impotence "a persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection." The plan for therapy consisted of 12 hour-long sessions over a 25-week period, and the methods involved the use of a VR helmet, joystick and miniature television screens that projected specially-designed CD-ROM programs on psychological development.

Multimedia and virtual reality techniques in the treatment of male erectile disorders.

The present study is based on the observation that computer-simulated reality applied by virtual reality (VR) methods may offer a new means of treating male erectile disorders. The experimental design was based on the theory of psychological development, supported by multimedia acoustic experience and clinical tests. The method involved the use of virtual reality equipment and specially designed CD-ROM programmes. Excluding 15% drop-outs, the success rate was 82% for male erectile disorders due to psychological factors and 84%, excluding 17% drop-outs, for combined factor disorders. Psychotherapy with VR seems to hasten the healing process and reduce drop-outs, suggesting that this method opens or consolidates new or rarely used brain pathways, facilitating the flow of new mnemonic associations that promote the satisfaction of natural drives.