Bulbocavernosus reflex testing in 100 consecutive cases of erectile dysfunction.

Electrophysiologic testing of the bulbocavernosus reflex is often part of the routine workup of erectile dysfunction. To assess how often prolonged or absent reflexes occur 100 consecutive males with erectile dysfunction, who had been referred to a hospital-based medial sexology program, were tested. Four per cent had prolonged latency times (greater than 43 msec), and an additional 5 per cent had an absent reflex. Bulbocavernosus reflex testing needs to be done in males where penile revascularization, or sex therapy, or both, are being considered as therapeutic options. An abnormal latency would contraindicate revascularization and should limit outcome expectations of sex therapy. It does not need to be a routine part of the diagnostic workup.

Sexual and psychological implications of gynecologic malignancy.

The sexual implications of gynecologic malignancy are best understood by asking, and answering, the following three questions. What is the psychological effect on the woman? What is the physiological effect on the woman? What is the psychological effect on the partner? The psychological effect of the cancer on the woman is primarily determined by whether the malignancy is primary, recurrent, or terminal; the primary physiological determinants are whether the treatment is with surgery, radiation, or chemotherapy. The partner can be affected psychologically by all six of the variables. Preoperative knowledge of the woman's sexual history may influence subsequent treatments.

Noninvasive penile arterial evaluation in 120 males with erectile dysfunction.

One hundred twenty males referred to a hospital-based Medical Sexology Program for evaluation of erectile dysfunction had, as part of that workup, a noninvasive penile arterial assessment which included determination of (1) blood pressure in each of the six penile arteries, (2) patency of each cavernosal artery, and (3) brachial blood pressure. The systolic pressures in each of the six penile arteries were averaged and divided by the brachial systolic pressure to determine the penile brachial index (PBI). When a PBI of 0.75 or less was correlated with a history of myocardial infarction, coronary artery bypass, or cerebral vascular accident, a P value of 0.069 resulted, certainly suggesting that each is a manifestation of arterial disease.

Male sexual dysfunction associated with coronary heart disease.

A pilot study of 18 males (age range 38-68) hospitalized for an acute myocardial infarction (MI) revealed that 44% were impotent and 28% had had premature ejaculation prior to the MI. A subsequent research project is the basis of this article. During a 10-month period, 131 male patients (age range 31-86), while hospitalized for an acute MI, were interviewed about their pre-MI sexual functioning. Two-thirds of the males had--by their own definition--a significant sexual problem. Among the sexually dysfunctional group, 64% were impotent, 28% had a significant (greater than 50%) decrease in sexual frequency, and 8% had premature ejaculation. No adverse side effects occurred from a detailed sexual history being taken while the male was recovering from an acute MI. One implication for cardiac rehabilitation is that returning to the pre-MI level of sexual functioning is not enough.

Sexual dysfunction associated with diabetes mellitus.

Sexual dysfunction associated with diabetes mellitis has been reviewed. The prevalence of impotence among diabetic males ranges between 50 and 60 percent. Duration of diabetes does not correlate with the increasing incidence of impotence, but increasing age of the male is associated. The etiology of impotence is generally assumed to be autonomic neuropathy; the role of vascular pathology is moot. Retrograde ejaculation is present in one to two percent of the cases. Nocturnal penile tumescence monitoring during periods of rapid eye movement (REM) sleep will aid in the differential diagnosis of organic vs psychogenic etiology. Penile prostheses should be considered in the treatment of organic impotence, while sex counseling is indicated for psychogenic cases. The effect of diabetes on female sexual response is conflicting. Further research in needed.

History-taking in sex counseling.

A formula for obtaining a sexual history that has both diagnostic and therapeutic significance has been presented. By utilizing the relationship between effective stimulation of a sufficient quantity in a nuturing environment, the physician will be able to clarify what has either caused or is maintaining the sexual difficulty. It will be most beneficial if the physician explains the history-taking approach to the woman. In this way she can see how her answers relate to the problem and to the direction of treatment. A history-taking approach structured in this manner is most helpful to the physician and the woman.

Postpartum and Postabortal Ovarian Vein Thrombophlebitis.

Six cases of ovarian vein thrombophlebitis are reported including one resulting in operative death, a case diagnosed by phlebography, a postabortal case, and a case followed by habitual abortion. An historic review of this disease is presented. It is suggested that the ovarian vein may be the most commonly involved vein in puerperal pelvic thrombophlebitis.

Dyspareunia.

Dyspareunia--painful intercourse--is a common cause of sexual difficulty. The following paper discusses, for both males and females, the common causes of dyspareunia and in many instances the appropriate treatment. Painful intercourse for the male is related either to the prepuce, glans penis, penile shaft, testicles, or urethra and prostate gland, whereas painful intercourse for the female is related to the vaginal opening, clitoris, vagina, or uterus, tubes, and/or ovaries. Each of the above is discussed.

PIP: Dyspareunia, a common cause of sexual difficulties, is discussed and a logical approach to diagnosis of the causes is presented. Male dyspar eunia is related to the following anatomical structures: 1) prepuce, 2) glans penis, 3) penile shaft, 4) testicles, and 5) urethra and prostate gland. Female dyspareunia is related anatomically to: 1) vaginal opening; 2) clitoris; 3) vagina; and 4) uterus, tubes, and/or ovaries.