Sexsomnia in an Adolescent.

ABSTRACT: Sexsomnia has been reported and is well described in 115 prior cases in the literature. There have been associations with other sleep disorders serving as triggers for confusional arousals, thereby worsening sexsomnia episodes. We present a case of an adolescent boy with a history of resected and treated pineoblastoma who later developed sexsomnia marked by multiple episodes of masturbatory events per night. He had additional suspicions of obstructive sleep apnea. Polysomnography confirmed severe obstructive sleep apnea and captured multiple episodes of sexsomnia from both REM and NREM sleep. The patient also had daytime symptoms of severe anxiety and hypersomnia that required pharmacological intervention, cognitive behavioral techniques, and hypnosis. The patient showed improvement with hypnosis along with a multimodal approach to the treatment of sexsomnia.

Orgasmic Latency and Related Parameters in Women During Partnered and Masturbatory Sex.

INTRODUCTION: Orgasmic latency (OL) during partnered sex (POL) and OL during masturbatory sex (MOL) in women with and without orgasmic difficulty have received minimal attention. AIM: To ascertain POL and MOL both overall and more specifically in women with and without difficulty reaching orgasm and to explore interrelationships between masturbatory and partnered latencies and sexual satisfaction. METHODS: Participants for this study were 2,304 women drawn from community-based samples in the United States and Hungary who completed an investigator-derived questionnaire regarding their sexual history and response, including items related to frequency of masturbation and partnered sex, sexual desire, sexual arousal, orgasmic response, OL, distress, partner distress, and sexual satisfaction. MAIN OUTCOME MEASURE: Self-reported OL and related orgasmic parameters during masturbation and partnered sex in women with and without difficulty reaching orgasm were assessed. RESULTS: POL were longer than those during MOL. Women experiencing difficulty reaching orgasm showed even longer latencies during partnered sex but comparable latencies during masturbation. Covariates related to POL included age, overall relationship quality, masturbation frequency, MOL, and level of distress about not reaching orgasm. CLINICAL IMPLICATIONS: POL in women are substantially longer than men's, suggesting the potential need for an increased repertoire of stimulatory behaviors to increase the woman's arousal. STRENGTH AND LIMITATIONS: The study was well powered and drew from a multi-national population. However, specific types of sexual stimulation during partnered and masturbatory sex were not included in this analysis. CONCLUSION: MOL for women and POL differ significantly, with latencies during partnered sex being substantially longer than masturbation, although women reporting the greatest difficulty reaching orgasm have the longest latencies and are likely to find masturbation more satisfying than women who do not. Rowland DL, Sullivan SL, Hevesi K, et al. Orgasmic Latency and Related Parameters in Women During Partnered and Masturbatory Sex. J Sex Med 2018;15:1463-1471.

Orgasm and women's waist circumference.

OBJECTIVE: Given that adiposity is related to poorer female sexual function, among many other health problems, the present study aimed at testing the hypothesis that larger waist circumference, an index of subcutaneous and abdominal fat mass, is associated with lack of specifically vaginal orgasm. Study design One hundred and twenty Portuguese women of reproductive age had their waist measured and reported their past month frequency of penile-vaginal intercourse (PVI), vaginal orgasm, orgasm from clitoral masturbation during PVI, non-coital partnered sex (in the absence of same-day PVI), non-coital partnered sex orgasm (regardless of same-day PVI), masturbation, and masturbation orgasm. RESULTS: In both simple and partial correlations (controlling for age, social desirability responding, relationship status, and cohabitation status), larger waist circumference was associated with lack of any vaginal orgasm and with having masturbated in the past month. In a multiple regression, larger waist circumference was independently predicted by lesser frequency of vaginal orgasm, greater frequency of masturbation, and older age. CONCLUSION: Abdominal fat mass appears to be adversely associated with lesser capacity for vaginal orgasm, but not for orgasms from other sexual activities. Results are discussed in the context of vaginal orgasm being relatively more contingent on situations of increased fitness in both partners.

Weaker masturbatory erection may be a sign of early cardiovascular risk associated with erectile dysfunction in young men without sexual intercourse.

INTRODUCTION: Although increasing evidences emphasize the importance of early cardiovascular evaluation in men with erectile dysfunction (ED) of unexplained aetiology, impaired masturbation-induced erections in young men are usually overlooked and habitually presumed to be psychological origin. AIMS: To evaluate the young men presenting weaker masturbatory erection with no sexual intercourse (WME-NS) and verify if this cohort have early cardiovascular risks associated with ED. METHODS: Male subjects aged 18-40 years with WME-NS were screened by analyzing detailed sexual intercourse and masturbatory history. The age-matched ED and non-ED population were identified by using International Index of Erectile Function-5 (IIEF-5). All subjects with acute and/or chronic diseases (including diagnosed hypertension and diabetes) and long-term pharmacotherapy were excluded. Nocturnal penile tumescence and rigidity (NPTR), systemic vascular parameters and biochemical indicators related to metabolism were assessed. MAIN OUTCOME MEASURES: Comparison analysis and logistic regression analysis were conducted among WME-NS, ED and non-ED population. RESULTS: In total, 78 WME-NS cases (mean 28.99 ± 5.92 years), 179 ED cases (mean 30.69 ± 5.21 years) and 43 non-ED cases (mean 28.65 ± 4.30 years) were screened for analysis. Compared with non-ED group, WME-NS group had higher prevalence of early ED risk factors including endothelial dysfunction, insulin resistance, high level of glycosylated serum protein and abnormal NPTR. Multivariable-adjusted logistic regression analysis showed endothelia dysfunction (odds ratio: 8.83 vs. 17.11, both P < 0.001) was the independent risk factor for both WME-NS and ED. CONCLUSIONS: Weaker masturbatory erection may be a sign of early cardiovascular risk associated with ED in young men without sexual intercourse. More studies are warranted to elucidate the clinical benefits by targeting these formulated strategies.

Effects of chemical castration on sex offenders in relation to the kinetics of serum testosterone recovery: implications for dosing schedule.

INTRODUCTION: A growing number of countries are adopting chemical castration as treatment and penalty for sex offenders. AIM: The aim of this study is to evaluate the outcome of chemical castration of sexual offenders with a focus on the kinetics of serum testosterone (T) recovery. METHODS: This prospective analysis included 56 sex offenders imprisoned for sexual offenses at the National Forensic Hospital. Thirty-eight and 18 patients who received 3 and 6 months of leuprolide acetate injections were assigned to group A and group B, respectively. MAIN OUTCOME MEASURES: To evaluate treatment efficacy according treatment duration, psychobehavioral assessments and serum T levels were serially measured during the on-cycle and the following observational 12-month off-cycle. RESULTS: Chemical castration and the associated decrease in serum T levels reduced the frequency and intensity of sexual thoughts in 76% and 71% of group A patients and in 78% and 72% of group B patients, respectively. Reductions in masturbation frequency were observed in 74% of group A and 83% of group B patients. The median Wilson's Sex Fantasy Questionnaire (SFQ) scores were also significantly reduced in both groups. In group A, an upsurge of serum T to the flare level was observed during the first 2 months of the off-cycle, accompanied by an intense sexual drive and fantasy. In group B, serum T gradually recovered to the baseline level and continued to upsurge beyond baseline levels during the observational period. SFQ scores of group A returned to pretreatment levels following the observational period; however, SFQ scores of group B remained suppressed. Lack of objective assessments for psychobehavioral outcomes was a limitation. CONCLUSIONS: The efficacy of chemical castration varied according to the treatment duration. Regarding the kinetics of serum T recovery, maintaining at least 6 months of treatment warranted stable control of an excessive sexual drive following treatment cessation.

[Human orgasm from the physiological perspective--part II]. / Orgazm czlowieka z perspektywy fizjologicznej--czesc II.

In contrast to the male orgasm, female orgasm is characterized by high variability and diversity, not only in the general population, but also during the life. Women experience sexual pleasure on many levels: physical, emotional, spiritual and intellectual. Sexual functioning of women and men is determined by many factors. A strong correlation between the state of subjective arousal and genital response (erection) is typical for men. In the case of women important role played: emotions, cognitive interpretation of the situation, age, self-esteem and previous sexual experiences. Among women experience orgasm during intercourse or masturbation is not a goal in itself. Modern approach to the phenomenon of orgasm and sexual education of women, make absence of orgasm as a failure. It becomes a source of low self-esteem, less self-confidence or sense of lack of attractiveness.

Greater resting heart rate variability is associated with orgasms through penile-vaginal intercourse, but not with orgasms from other sources.

INTRODUCTION: Resting heart rate variability (HRV), a marker of parasympathetic activity, is a predictor of health and longevity. Better erectile function is associated with greater resting HRV (assessed by high frequency power [HF]), and in both sexes, penile-vaginal intercourse (PVI) is the only sexual behavior consistently associated with indices of better physical and mental health, including greater resting HRV (assessed by standard deviation [SD] of heart rate [HR]). AIMS: To examine the hypotheses that greater frequency of orgasms attained through PVI (for women, without additional simultaneous clitoral stimulation; vaginal orgasm) are associated with greater resting HRV. A differential hypothesis is that HRV measures will be unrelated to orgasmic frequency from noncoital sexual activities. METHODS: Coitally experienced men and women (N = 143) had their heart rate measured for 5 minutes and reported the frequency of various sexual behaviors and corresponding orgasms in a recent representative month. MAIN OUTCOME MEASURES: Partial correlations and analyses of covariance controlling for social desirability responding were used to examine the associations of sexual activities with time and frequency domains of HRV. RESULTS: For men, greater resting SD of HR was associated with greater PVI orgasm frequency. For women, greater resting SD of HR was associated with any vaginal orgasm. These findings remained after controlling for cohabitation. Sexual activities were unrelated to HF. Lifetime number of PVI partners was unrelated to SD of HR and HF. CONCLUSIONS: Findings are discussed in the context of orgasms through PVI enhancing HRV, and greater parasympathetic tone favoring the capacity to engage in PVI, and in the case of women, to reach vaginal orgasm. The possibility of healthier people having greater resting HRV and more frequent orgasms through specifically PVI is also considered.

Sexual functioning in transsexuals following hormone therapy and genital surgery: a review.

INTRODUCTION: Sexual function following genital sexual reassignment surgery (SRS) is an important outcome for many transsexuals, affecting the choice of surgical technique, satisfaction with surgery, and quality of life. However, compared to other outcome measures, little clinical and research attention has been given to sexual functioning following SRS. AIM: To discuss the potential impact of cross-sex hormone therapy and SRS on sexual function and to summarize the published empirical research on postsurgical sexual functioning in male-to-female (MtF) and female-to-male (FtM) transsexuals. METHODS: Cross-sex hormone therapy and SRS techniques are outlined, the potential roles of cross-sex hormone therapy and SRS on sexual function are discussed, and peer-reviewed literature published in English on postoperative sexual functioning in MtF and FtM transsexuals is reviewed. MAIN OUTCOME MEASURES: Sexual desire, sexual arousal, and ability to achieve orgasm following SRS. RESULTS: Contrary to early views, transsexualism does not appear to be associated with a hyposexual condition. In MtF transsexuals, rates of hypoactive sexual desire disorder (HSDD) are similar to those found in the general female population. In FtM transsexuals, sexual desire appears unequivocally to increase following SRS. Studies with MtF transsexuals have revealed not only vasocongestion, but also the secretion of fluid during sexual arousal. Research on sexual arousal in FtM transsexuals is sorely lacking, but at least one study indicates increased arousal following SRS. The most substantial literature on sexual functioning in postoperative transsexuals pertains to orgasm, with most reports indicating moderate to high rates of orgasmic functioning in both MtF and FtM transsexuals. CONCLUSIONS: Based on the available literature, transsexuals appear to have adequate sexual functioning and/or high rates of sexual satisfaction following SRS. Further research is required to understand fully the effects of varying types and dosages of cross-sex hormone therapies and particular SRS techniques on sexual functioning.

Hand activities in infantile masturbation: a video analysis of 13 cases.

BACKGROUND: Infantile masturbation is considered a variant of normal behaviour. The abrupt and spontaneous onset, altered sensorium and autonomic phenomena during episodes may suggest an epileptic fit. Therefore, children with infantile masturbation are often admitted to hospital and undergo unnecessary tests. The purpose of the present study was to provide a detailed description of hand activities in infantile masturbation. METHODS: The authors reviewed video recordings of 2 boys and 11 girls with infantile masturbation. Position, movements and activities of hands and fingers during episodes were registered. RESULTS: Five patterns of hand activities were registered: Fisting (four infants), grasping of toys, furniture or clothing (ten infants), chorea-like "piano playing" hand movements (two infants), pressure over the diaper/genital region (one infant) and bimanual manipulation of items (four infants). Fisting was primarily observed in the younger infants, and bimanual manipulation was primarily seen in the older infants. CONCLUSIONS: Recognizing one or more of the five distinct patterns of hand activities in infantile masturbation may help establishing the diagnosis.

Cerebral vasospasm and headache during sexual intercourse and masturbatory orgasms.

BACKGROUND: The pathophysiology of the explosive type of headache associated with sexual activity is not completely understood. Five reported cases of patients with thunderclap headache, precipitated by sexual activity, in association with concomitant cerebral arterial narrowing, were found in the literature. METHODS: A 44-year-old woman with both coital and masturbatory headaches during orgasm associated with segmental reversible cerebral artery vasospasm was investigated. Cerebral anatomy and eventual spasm was documented by magnetic resonance imaging or digital angiography before, during, and after resolution of the orgasmic headache-vasospasm clinical manifestation. CONCLUSION: Findings of cerebral arterial narrowing, presented by some patients shortly after orgasmic headache attacks, support the hypothesis that segmental vasospasm may exert a role in the pathogenesis of this uncommon type of headache. The literature is reviewed, and possible mechanisms underlying the development of orgasmic headache are discussed.

Disorders of orgasm in women.

INTRODUCTION: Orgasm is a sensation of intense pleasure creating an altered consciousness state accompanied by pelvic striated circumvaginal musculature and uterine/anal contractions and myotonia that resolves sexually-induced vasocongestion and induces well-being/contentment. In 1,749 randomly-sampled U.S. women, 24% reported an orgasmic dysfunction. AIM: To provide recommendations/guidelines concerning state-of-the-art knowledge for management of orgasmic disorders in women. METHODS: An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Disorders of Orgasm in Women Committee, there were four experts from two countries. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. RESULTS: Female Orgasmic Disorder, the second most frequently reported women's sexual problem is considered to be the persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase that causes marked distress or interpersonal difficulty (DSM-IV). Empirical treatment outcome research is available for cognitive behavioral and pharmacological approaches. Cognitive-behavioral therapy for anorgasmia promotes attitude and sexually-relevant thought changes and anxiety reduction using behavioral exercises such as directed masturbation, sensate focus, and systematic desensitization treatments as well as sex education, communication skills training, and Kegel exercises. To date there are no pharmacological agents trials (i.e., bupropion, granisetron, and sildenafil) proven to be beneficial beyond placebo in enhancing orgasmic function in women diagnosed with Female Orgasmic Disorder. CONCLUSIONS: More research is needed in understanding management of women with orgasmic dysfunction.

Do all orgasms feel alike? Evaluating a two-dimensional model of the orgasm experience across gender and sexual context.

The characteristics common to all human orgasm experiences and potential gender and contextual factors affecting these experiences were investigated in two studies. A two-dimensional descriptive model of the orgasm experience was evaluated by testing hypotheses concerning (a) fit of the model to adjective-ratings data describing male and female orgasm experiences, and (b) sexual context effects on the importance of model components. In the first model-evaluation study, 888 university students (523 women) provided adjective ratings to convey orgasm experiences attained through both solitary masturbation and sex with a partner. In a cross-validation study, 798 university students (503 women) provided similar ratings to convey orgasm experiences attained either through solitary masturbation or through sex with a partner. Overall, findings supported the utility of a two-dimensional model of the orgasm experience, an adjective-rating approach in comparing male and female orgasm, and the importance of examining sexual context effects on the orgasm experience.

Masturbation mimicking seizure in an infant.

A 3.5-month-old boy was referred to our hospital with the diagnosis of infantile spasm. His developmental milestones and physical examination were normal. During the follow-up we recorded about six to nine attacks a day and the duration of attacks was changed between 15 seconds-1.5 minutes. During the episodic attacks he was flushed and had tonic posturing associated with crossing of thighs, without loss of consciousness and his eye movements were normal. Routine and long-term electroencephalogram (EEG) were normal during attack. The patient was diagnosed as masturbation according to the clinical and EEG findings. In conclusion, we would like to stress that masturbation should also be considered in infants who were admitted with complaint of seizure, and aside from EEG monitoring a detailed history and careful observation are very important factors in differential diagnosis of these two different conditions.

Posttraumatic erectile potential of spinal cord injured men: how physiologic recordings supplement subjective reports.

OBJECTIVE: To investigate by means of a neurophysiologic model the remaining erectile function in spinal cord injured men. DESIGN: A nonrandomized control trial. SETTING: A Referred Care Center. SUBJECTS: Forty-seven spinal cord injured men and 7 noninjured controls. INTERVENTION: The subject penile responses were recorded by a penile strain gauge during two sessions--one to obtain baseline responses, and one with reflexogenic stimulation (masturbation) and psychogenic stimulation (film). MEASURES: Average tumescence, maximal tumescence, percentage rigidity, and duration of tumescence and rigidity. RESULTS: Significant results were found for subjects with lower lesions using psychogenic stimulation as their optimal mode compared with reflexogenic stimulation as an alternate mode, and for subjects with higher lesions using reflexogenic stimulation as their optimal mode, compared with psychogenic stimulation as an alternate mode. The responses with optimal stimulation modes were comparable to those achieved by controls. CONCLUSION: The findings validate the neurophysiologic model of posttraumatic erectile potential as a function of the lesion type and stimulation source. The results were comparable to those of noninjured subjects; the potential for normal function is present and may be amenable to sexual rehabilitation or use in conjunction with new oral drug treatments for impotence.

Prostatodynia in United Nations peacekeeping forces in Haiti.

Prostatodynia is a clinical entity associated with voiding symptoms and pelvic pain suggestive of prostatitis but with a normal prostate examination and without evidence of inflammation or infection in expressed prostatic secretions. The problem tends to be chronic and is vexing in its management. Although thought to be a common condition, prevalence data are generally lacking. From June to October 1995, the U.S. Army's 86th Combat Support Hospital provided medical support to a multinational United Nations peacekeeping force in Haiti. Patients diagnosed with prostatodynia were more common (13 cases) than men with other urologic problems (urolithiasis, 6 cases; urinary tract infection, 6 cases; scrotal abscess/mass, 2 cases; epididymitis, 1 case). Patients tended to be young (mean age 29.8), had multiple visits, failed to respond to multiple courses of antibiotics for presumed "prostatitis," and denied recent sexual relations. Some patients reported having had similar symptoms on prolonged separation from their spouses in the past that resolved with resumption of normal intercourse. Masturbation, however, had no impact on symptoms and was painful in some individuals. Terazosin, an alpha-antagonist, and stress-reduction therapy led to improvement in some patients' symptoms. A discussion of these retrospective findings in light of what is known about the possible etiologies and treatment of prostatodynia is presented. Prostatodynia appears to be a common problem in deployed troops and can lead to frequent use of medical services. Physicians supporting long deployments need to be aware of this entity.

Physiological parameters associated with the performance of a distracting task and genital self-stimulation in women with complete spinal cord injuries.

OBJECTIVE: To compare the physiological sexual responses of women with complete spinal cord injuries (SCI) with those of able-bodied women. DESIGN: Controlled laboratory-based analysis of responses to a distracting task coupled with manual genital stimulation versus masturbation. SETTING: The sexual physiology laboratory at our free-standing rehabilitation hospital. PARTICIPANTS: A volunteer sample of 10 women with complete SCI along with 10 able-bodied women, matched for age and educational status. INTERVENTIONS: A 78-minute protocol using 6-minute baselines alternating with 12-minute testing conditions. DEPENDENT-VARIABLES: Vaginal pulse amplitude, subjective arousal, heart rate, respiratory rate, and blood pressure. RESULTS: Subjective sexual arousal increased in able-bodied women with manual genital stimulation in conjunction with performance of a distracting task and was further augmented by removal of the distracting task and continuing with masturbation. In contrast, complete SCI subjects did not demonstrate increased subjective arousal with performance of the distracting task in conjunction with manual genital stimulation; however, they did evidence significant increases in arousal when the distracting task was eliminated. CONCLUSIONS: Genital responses tended to parallel subjective responses in able-bodied women; however, women with SCI revealed nonsignificant changes in genital responses throughout the treatment protocol. It is hypothesized that the genital and subjective responses of able-bodied subjects reflect the additive components of reflex and then psychogenic sexual arousal. Furthermore, the lack of responsivity in the SCI subjects was thought to be related to compromised upper extremity function in the majority of our subjects. Further work is necessary to validate these hypotheses.

De virginibus puerisque: the function of the human foreskin considered from an evolutionary perspective.

The functional significance of the human male foreskin is considered in evolutionary terms. It is postulated that there is a lifetime's reproductive advantage in delaying the age of first coitus, and hence of first childbirth, for some years after puberty, until the parents are better established as providers. Phimosis and preputial adhesions are common in human males because they have selective advantage, tending to impede and therefore delay the onset of sexual activity. The physical signs of female virginity have an analogous function, and have been selected for in the same way. This hypothesis also provides a consistent explanation for the worldwide tradition of circumcision and for the common practice of masturbation by human males.