A study using Viagra in a mental health practice.

The clinical responses of 58 men who were given Viagra between April and December 1998 in a psychiatric outpatient setting were tracked through 2 follow-up visits. Four categories of success and 3 categories of failure are defined to describe the outcomes. Although 43% had ideal outcomes--cure or uncomplicated drug-dependent successes--50% again were able to have intercourse and 63% experienced improved erections. Seventeen percent of the original sample did not benefit from the drug; 21% were lost to follow-up. This intent-to-treat study adds more evidence of Viagra's effectiveness and further clarifies the need to focus on psychodynamic considerations when trying to assist the majority of patients who did not have ideal outcomes.

The sexual struggles of 23 clergymen: a follow-up study.

Nineteen clergymen, 17 of whom were Catholic, were followed up 1 to 6 years after their initial evaluation in a program designed to assess the sexual offenses and rehabilitation potential of offending professionals. Methods used included a semistructured interview with a research psychiatrist and a repeat of the MCMI-III. At follow-up, the clergymen were relatively psychologically healthy. The vast majority of the men had returned to previous or higher levels of vocational functioning and felt that they had benefited from their initial evaluation and therapy. None of those who were initially suspected of sexual compulsivity met criteria for excessive sexual expression at follow-up, and none had re-offended. The typical clergyman, whether heterosexual or homosexual, was struggling with loneliness, masturbation conflicts, and the wish to be known beyond their role by others. The confrontative style of the evaluators in pursuing the veracity of the clergy's initial explanations of their behaviors and the use of penile plethysmography were the primary objections to the methods used. Brief psychotherapy seemed to be a cost-effective, well-received intervention for clergy struggling with their sexual conflicts.

A double-blind crossover trial of clomipramine for rapid ejaculation in 15 couples.

BACKGROUND: The purpose of this study was to assess the sexual and psychosocial efficacy of clomipramine for rapid ejaculation. METHODS: Fifteen physically healthy, self-selected couples (men had a mean age of 38 years) who met six eligibility criteria and did not meet five exclusion criteria participated in a variable-length, repeated measures, randomized, double-blind, placebo-controlled crossover study with a 2-month follow-up period. Sexual and psychosocial assessments were conducted at baseline, after placebo, after 25 mg/day of clomipramine, after 50 mg/day of clomipramine, and at the 2-month follow-up point. The major outcome measures included stopwatch timing of ejaculation latencies, modified Case Western Reserve University Sexual Function Questionnaire, Symptom Checklist-90-R, Dyadic Adjustment Scale, State-Trait Anxiety Inventory, and the Harder Self-Esteem Inventory. RESULTS: Baseline mean ejaculatory latency was 81 seconds; 25 mg/day of clomipramine increased it to 202 seconds and 50 mg/day of clomipramine to 419 seconds. This resulted in significantly greater sexual satisfaction scores for men and their partners (men, p < .001; women, p < .05), improvements in partner coital orgasmic attainment, and greater relationship and emotional satisfaction for the men. Withdrawal of the drug caused ejaculatory latencies to return to baseline. CONCLUSION: Clomipramine appears to be effective in significantly lengthening ejaculatory latencies and increasing sexual and relationship satisfaction. It can be a cost-effective chronic therapy for selected patients. These impressive results should not be expected in a less carefully screened population of men concerned about the timing of their orgasm during intercourse.

A guide to taking a sexual history.

Anxiety about discussing sexual issues often leads to an avoidance of the topic. This article encourages and assists clinicians in the task of taking a thorough sexual history. The barriers to accomplishing this task are explored, and a conceptual framework for inquiring about the components of sexual life is provided.

Professionals who sexually offend: evaluation procedures and preliminary findings.

Methods and results of the psychiatric evaluations of 31 professionals who have been accused of sexually inappropriate behaviors within their work context are presented. Eight types of professionals were evaluated; the majority were clergy, physicians, and teachers. Paraphilia was diagnosed in 26%, a nonparaphilic sexual compulsive syndrome in another 29%, and some form of character disorder in 58%. Seven professionals had offended six or more times. The ethical failures of the professionals were diverse and could not simply be explained by psychiatric diagnoses. Approximately half of the professionals were thought to be safe to return to work, often with a recommendation for psychotherapy and monitoring of their professional activities. A recommendation to no longer practice their professional roles was given for 47% of those evaluated, and the referring agency followed through with the recommendation. Outpatient psychotherapy was recommended for 84% of the sample. Psychotropic medications were occasionally recommended.

Sexual, psychological, and marital impact of self-injection of papaverine and phentolamine: a long-term prospective study.

This prospective study assessed the long-term effects of self-injection of papaverine hydrochloride and phentolamine mesylate along several critical domains for 42 men and 26 partners. Over the course of one year, men were, on average, injecting themselves five times monthly, with 84% of these injections producing satisfactory erections. Treatment resulted in statistically significant improvements in quality of erection, sexual satisfaction, frequency of intercourse, and coital orgasm. The women also demonstrated significant improvement in sexual satisfaction, arousal, frequency of intercourse, and coital orgasm. Decreases in general psychiatric symptomatology were apparent for men but not for partners. The dropout rate was 57%. The common side effects of treatment were development of fibrotic nodules (26%), abnormal liver function values (30%), and bruising (19%). We conclude that self-injection should be considered among the accepted treatments for erectile dysfunction. It does appear to enhance the sexual lives of men and women when the treatment is efficacious and the couple is motivated to utilize it.

Essay on the diagnosis and nature of paraphilia.

Increasing clinical experience has allowed the formulation of three psychodynamic viewpoints about the nature of the paraphilic disorder. Paraphilia is a disorder of sexual identity development, often solely of the intention component, that has three characteristics: a long-standing, highly arousing, unusual erotic preoccupation; a pressure to act upon the erotic fantasy; sexual dysfunction with a partner during conventional sexual behavior. Paraphilia is also a disorder of self-regulation characterized by a considerable gap between personal aspirations and behaviors. Finally, paraphilia is a dramatic impairment in the capacity to love. Two rarely recognized issues complicate the nosology of paraphilia: Many related sexual problems are often confused with paraphilia, and some paraphilias manifest themselves as variations in gender identity and object choice. The defensive functions of paraphilia are discussed and common terms used in conjunction with paraphilia are redefined.

Self-injection of papaverine and phentolamine in the treatment of psychogenic impotence.

This study prospectively assessed the use, effectiveness, and sexual and psychosocial impact of self-injection treatment in 15 men with psychogenic impotence. Sixty percent dropped out of self-injection treatment by 6 months. Those who remained used self-injections about four times monthly with a 94% success rate. Frequency of intercourse and sexual satisfaction increased. Anxiety decreased, and trends toward improvement in depression and self-esteem were evident. Qualitative data indicated that performance anxiety was not alleviated, dependence upon injections for intercourse remained, symptom substitution did not occur, and capacity for intimacy was not improved.

Side effects of self-administration of intracavernous papaverine and phentolamine for the treatment of impotence.

Beginning October 1985, 111 men agreed to enter a prospective study of the side effects of low dose papaverine/phentolamine therapy. A total of 46 men dropped out, 30 during the initial phase. The percentage of men with painless nodules almost consistently doubled from one followup examination to the next: 8 per cent at 1 month, 17 per cent at 3 months, 32 per cent at 6 months and 57 per cent at 12 months. The average injection frequency of those with nodules was 2 1/2 times higher than those without nodules. Of the men 41 per cent required an increased dose of medications during followup, and 40 per cent of 50 men had at least 1 abnormality of liver function, most of these involving mild to moderate elevations of alkaline phosphatase and lactic dehydrogenase. Priapism was not encountered during self-injection but it did occur twice in 329 physician-administered injections. Careful regular monitoring of patients should continue as some patients enter the second year of treatment.