https://www.sjsu.edu/people/jennifer.gregg/courses/c4/s1/sex.pdf

Psychological and interpersonal dimensions of sexual function and dysfunction.

The Neurobiological Approach to Premature Ejaculation

Reciprocity counseling: A rapid learning-based procedure for marital counseling.

Treatment outcome with sex offenders

Objectives. The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment and management of paraphilia, with a focus on the treatment of adults males. Because such treatments are not delivered in isolation, the role of specific psychosocial and psychotherapeutic interventions was also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients with paraphilia. The aim of these guidelines is to improve the quality of care and to aid physicians in clinical decisions. Methods. The aim of these guidelines was to bring together different views on the appropriate treatment of paraphilias from experts representing different continents. To achieve this aim, an extensive literature search was conducted using the English language literature indexed on MEDLINE/PubMed (1990–2009 for SSRIs) (1969–2009 for antiandrogen treatments), supplemented by other sources, including published reviews. Results. Each trea...

/pdf/the-world-federation-of-societies-of-biological-psychiatry-48pzecae5s.pdf

The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias.

1. A psychopathic male with uncontrollable and deviant sexual behaviour (homosexuality, attempted incest, fetishism, transvestism) was treated with the antiandrogen using cyproterone acetate 100 mg per day—for three weeks. After four days plasma testosterone levels (basal 9 a.m. and 6 p.m. and during masturbation—pre, immediate post, and 30 mins. post) had dropped by approximately 50 per cent; clinically both erectile and ejaculatory capacity and `libido' (sexual feelings, tension, fantasies, etc.) were reduced, the former to a much greater extent than the latter. Both clinical and endocrine effects were completely reversible eight weeks after discontinuing the drug.

2. Two other cases (a homosexual and a \` hypersexual') studied clinically showed complete suppression of sexual responsiveness (\`physiological' and `libido') on doses ranging from 50 mg/day–150 mg/day; the effects were reversible on stopping the drug.

3. In addition to the action on sexual feelings and functioning, all patients noted a general tranquillizing effect.

Antiandrogen (cyproterone acetate) therapy in deviant hypersexuality

(1) Fifty-four subjects who presented with a primary complaint of disordered potency were studied prospectively to provide factual data.

(2) Three main types of potency disorder were recognized, viz. persistent difficulty in obtaining or sustaining an erection (impotence), failure to ejaculate (impotentia ejaculandi), and premature ejaculation. Impotence was further divided into acute onset and insidious onset types.

(3) Treatment was designed and applied (for a minimum of one year) according to the findings in the individual case. It aimed at removing or modifying psychological factors which the therapist judged might be inhibiting the male's sexual capacity. Treatment consisted of a combination of muscular relaxation, provision (as far as possible) from the partner of optimum sexual stimulation, sex education, and "psychotherapy".

(4) The response to therapy was poor; only 37 per cent. were cured or improved, whilst 63 per cent. were unchanged or worse. The "acute onset" cases had a significantly better treatment response than the other groups.

(5) The evidence suggested that "limiting" constitutional factors might be responsible for the generally poor results.

(6) Although the present series does not purport to be representative of all potency disorders, the findings indicate that essentially psychogenic conditions may represent only a small fraction of all cases likely to be encountered in a general psychiatric clinic.

A Factual Study of Male Potency Disorders

(1) Out of 67 male subjects who presented in a psychiatric out-patient department with a primary disorder of potency and who provided social, clinical and psychological data, 49 (73 per cent.) satisfied the "treated criterion" of attending for a minimum of 20 fortnightly interviews during one year. Forty-three female partners provided complementary data and co-operated to a greater or lesser degree in treatment.

(2) The response to therapy was comparatively poor; 39 per cent. of the series were recovered or improved, whilst 61 per cent. were unchanged or worse.

(3) A statistical analysis to determine factors which might influence the response to therapy was carried out.

The factors associated significantly (p<0.05) with a poor outcome were: premature ejaculation; insidious onset impotence; a disorder of long duration; personality disorder in the male; absence of motivation for therapy; a sex drive other than heterosexual; absence of desire in the coital situation; unwillingness or inability of the female to co-operate in treatment; personality disorder in the female.

A better outcome (p<0.05) was associated with: acute onset impotence; a disorder of short duration; a heterosexual sex drive; presence of desire in the coital situation; absence of personality disorder in the male; marital happiness in the male; a male rating of loving his spouse; motivation for treatment; marital happiness in the female; willingness and ability of the female to co-operate fully in treatment; absence of personality disorder in the female.

(4) It is suggested that these findings might be of some help in predicting success or failure in out-patient treatment of males suffering from disordered potency.

Disorders of Sexual Potency in the Male: A Clinical and Statistical Study of Some Factors Related to Short-term Prognosis

The majority of “behaviourally oriented” treatments for non-consummation due to vaginismus combine (a) teaching the patient how to relax the perineal muscles, (b) simultaneous vaginal exploration and dilatation, preferably performed by the patient herself, and (c) some form of psychotherapy (Lazarus, 1963; Malleson, 1942; Friedman, 1962; Brady, 1966). Surprisingly perhaps, active participation by the male spouse is considered unnecessary by some experts (Malleson, 1942; Friedman, 1962). Friedman has shown there was no statistical relationship between actively involving the male in therapy and the outcome of treatment.

An Innovation in the "Behavioural" Treatment of a Case of Non-consummation due to Vaginismus

Hormone treatment for impotence and impotentia ejaculandi (delayed or absent ejaculation in the presence of normal erections and desire) (Johnson, 1965) is based on two assumptions: namely—that (1) potency in the male is androgen dependent and (2) impotency is due to relative androgen deficiency (Miller, 1968; Margolis et al., 1967; Sobotka, 1969). The synthetic preparations most frequently used are methyl testosterone, various esters, including the propionate, deconate, enanthate, etc. (Tuthill, 1955; Kupperman, 1967) and more recently a number of testosterone- ‘aphrodisiac’ combinations (Margolis et al., 1967; Cooper et al., 1971, etc.). Despite some claims of therapeutic success for the various regimes, the administration of exogenous hormones has several pharmacologic disadvantages. For instance methyl testosterone, which has to be taken sublingually or bucally, may be associated with severe toxic effects such as cholestatic jaundice, etc. (Goodman and Gilman, 1965). Parenterally administered testosterone esters, although less toxic and more certainly absorbed than methyl testosterone, have all the drawbacks of the intramuscular route; also their rate(s) of tissue release may not be optimal for metabolism. Additionally, all these synthetic compounds may inhibit endogenous testosterone formation and spermatogenesis by suppressing pituitary gonadotrophins. Long term administration may result in Leydig cell inactivity and even disuse atrophy. Recently Harkness et al. (1964, 1968) have observed that clomiphene (Fig. 1), a non-steroid triethylene derivative which in females stimulates the anovulatory ovary to secrete oestrogens (Bishop, 1970), significantly raised the levels of urinary steroid metabolites, including testosterone, in a proportion of ‘normal’ and corticosteroid deficient males. This unexpected testosterone elevating effect suggested its possible ‘experimental’ use as an alternative drug treatment in impotence. Accordingly a limited pilot study on five ‘primary’ (non-organic) impotent males was conducted: its main aims were (a) to assess the potential clinical utility of the drug and (b) to study its effects on the ‘pituitary-testes-axis' as reflected by plasma testosterone levels.

Alan J. Cooper

Papers

Antiandrogen (cyproterone acetate) therapy in deviant hypersexuality

A Factual Study of Male Potency Disorders

Disorders of Sexual Potency in the Male: A Clinical and Statistical Study of Some Factors Related to Short-term Prognosis

An Innovation in the "Behavioural" Treatment of a Case of Non-consummation due to Vaginismus

The effects of clomiphene in impotence. A clinical and endocrine study.