Sexuality and old age.

Sexuality in older people is a multifaceted field of study. Ageing may offer opportunities for and restrictions on sexuality. Ageing individuals may have increased time for and may wish to explore their sexuality, for example, by considering a same-sex relationship, after a long-term partner dies. However, they may also lack a partner or autonomy. They may develop or have increased symptoms from chronic diseases. Consequent medication may affect their sexual functioning. Their attitudes to sex often change and their capacity for sexual activity may diminish unless they seek help. However, they may lack the confidence to do so and the health professionals consulted may be disinclined or ill-equipped to assist them. They may have concerns regarding how their sexuality or their sexual orientation would be perceived should they require residential care or start to lose their memory. We consider the recent work relating to this broad range of influences on sexuality in old age and conclude that, whilst the challenge for researchers is to accurately clarify the impact of individual factors on sexuality and identify helpful potential interventions, increased academic and educational focus on this area is enhancing the prospects for a sexually enjoyable old age.

An e-mail and telephone helpline for sexual problems - results of a 2-year survey of men's sexual concerns.

INTRODUCTION: Sexual problems are relatively common in the community. The under-reporting of such problems calls for alternative ways of getting a true perspective of the prevalence of sexual dysfunction. AIM: To assess and investigate the concerns, ages and nationality of male users of a electronic helpline using it over 2 years (2009-2010). METHODS: Detailed records were kept of all emails and telephone calls to the helpline which included administrative and clinical queries. The clinical calls and some of the emails were answered by the administrator, while the majority of the emails were answered by a physician. This presentation will deal with the users who emailed for assistance with male sexual dysfunction. (n = 673). RESULTS: The helpline received a total of 6142 calls over the period of investigation, including administrative and press calls. Men accounted for 88% of the callers about sexual dysfunction. Erectile dysfunction accounted for 68% of the complaints by men who used the e-mail service. Premature ejaculation, loss of sex drive, genital problems and masturbation worries were other concerns that were received. A large number of men from the Middle East and the Indian sub-continent used the email service, mostly for premature ejaculation and masturbation worries, related to their arranged marriage. CONCLUSIONS: We found confirmation that the commonest sexual complaints in men were of erectile dysfunction and loss of sex drive. Significant correlations were identified between the types of sexual dysfunction and the age and ethnicity of the men who presented with them.

A comparison between portable ultrasound (MIDUS) and nocturnal RigiScan when confirming the diagnosis of vascular organic erectile disorder.

In recent years, the use of RigiScan and ultrasound to assess erectile dysfunction has fallen from favour. However, in a small minority of specialist cases, where a vascular, neurogenic or psychogenic aetiology requires confirmation, there remains a need for further investigation. To establish if in a preliminary assessment the use of nocturnal RigiScan or male impotence diagnostic ultrasound system (MIDUS) represents best practice as a diagnostic investigation in patients with a history suggestive of vascular organic erectile disorder. Men attending both urological and psychosexual therapy clinics with erectile dysfunction were assessed using a generic assessment schedule. Patients with a history suggestive of vascular erectile disorder were offered the opportunity of dual investigation of their condition. After screening using a provocative RigiScan using visual stimuli that gleaned inconclusive results, patients were offered the chance to enter a study with both nocturnal RigiScan and MIDUS investigation. These were confined for the purposes of this study to RigiScan events, peak systolic flow velocity (PSV) and end-diastolic flow velocity (EDV) from ultrasound examination where an abnormal EDV is defined as in excess of 4.5 cm/s and a normal PSV is variously defined as being greater than 35 cm/s. In all, 38/43 (88%, 95% CI: 76-95%) of men had a nocturnal event exceeding 3 min on the RigiScan investigation. This compares with 17/43 (40%, 95% CI: 26-54%) of men with a normal EDV blood flow of less than 4.5 cm/s (P<0.017) and 32/43 (74%, CI: 60-85%) of men with a normal PSV flow greater than 35 cm/s (NS). Rigiscan and ultrasonography of the cavernosal vessels are of equal usefulness in suspected arterial penile disease although where veno-occlusive disease is suspected, ultrasonography is more specific.

Male erectile disorder: characteristics and treatment choice of a longitudinal cohort study of men.

BACKGROUND: The objective was to collect characteristics of patients with male erectile disorder (MED) attending a male sexual dysfunction clinic and determine the level of psychological morbidity whilst recruiting subjects into a psychotherapy study. METHODS: This was a study of data of 132 patients diagnosed as having male erectile disorder who attended a sexual problems assessment clinic. Men with a psychological component to their condition who accepted couple therapy were compared with those who refused such a treatment as well as with the group of men who were diagnosed as having an organic basis for their condition. All male attendees at the sexual dysfunction clinic over a ten month period were reviewed. The proportion of men with psychogenic factors contributing to the MED and who choose psychological therapy were noted as were demographic factors correlating with accepting therapy. FINDINGS: Psychogenic factors were found to contribute towards the erectile disorder in the majority of cases. 28% of this group accepted couple psychotherapy in preference to a physical treatment. A significant proportion of these couples had returned preliminary questionaries to the clinic and had attended the assessment together. A younger age of onset of the problem for the man; a younger age of his partner; a shorter duration of the relationship together and not being married were all associated with accepting couple psychotherapy in preference to other treatments. CONCLUSIONS: Psychogenic factors are contributory in a majority of cases of erectile dysfunction. Epidemiological factors are identified in a group of men with MED. Where couple psychotherapy is indicated, certain factors are suggestive of patients who will accept such an option. Patient preference for a treatment option may play an important role in the outcome of therapy.

Does vibration offer any advantage over visual stimulation studies (VSS) in the assessment of erectile capacity?

The purpose of this work was to determine whether vibration stimulation or erotic videotape material can provide an acceptable diagnostic yield for patients with erectile dysfunction (ED) without the patient needing to endure more explicit erotic films, which may be distasteful to some patients, or intracavernous injections, to which there may be a high inhibitory response. Ninety-five subjects were randomly exposed to either vibration or videotape alone and erectile response monitored by the RigiScan. Where no clinical response was recorded by the RigiScan or by self-report by the patient, both stimuli were presented to the subject. Forty-nine subjects received vibration first and 46 received videotape first. Use of clinically based standardised measures revealed neither group achieving above threshold responses to the first stimulation and there were no differences between the two groups. Eight subjects (8%) between both groups exceeded the tip threshold during combination stimulation. Single stimulation with vibration or erotic videotape with provocative RigiScan monitoring is unhelpful in the assessment of ED in any of the diagnostic subgroups of ED. In comparison to previous provocative studies, combination of stimuli sets, whilst increasing penile response (circumferential change and rigidity) did not lead to significant evidence of clinically relevant responses using current RigiScan measures or patient self-report of change. Further studies are necessary to determine the most useful set of stimuli for provocation studies with the RigiScan.

Does psychological testing help to predict the response to acupuncture or massage/relaxation therapy in patients presenting to a general neurology clinic with headache?

Patients with chronic headache were offered treatment by acupuncture or massage with relaxation instead of a change in their prescribed medication. They were randomly allocated to either treatment. There was a significant improvement in pain ratings with both treatment types. Specifically a greater effect was seen in migraine patients treated by massage with relaxation when compared to acupuncture. No psychological factors were found to predict response to either treatment. At the end of the study, 13% of patients were significantly more worried that there may be a more serious cause underlying their headache despite reassurance and an improvement in their headache scores.

Treatment outcome of brief couple therapy in psychogenic male erectile disorder.

Treatment outcome was studied in 37 couples who entered brief combined sex and relationship therapy for male erectile disorder in a specialized clinic. Treatment was completed by nearly two thirds of the couples. Significant improvements in target symptoms, questionnaire scores, including the Golombok Rust Inventory of Sexual Satisfaction, and frequency of attempts at sexual activity were recorded. Results suggest that behavioral-systems couple therapy and modified modern sex therapy offer a brief, flexible, and reproducible treatment option for men with psychogenic factors associated with erectile disorder.

Suction to the breasts of a transsexual male.

Patients attending gender dysphoria clinics may report attempts to hasten the transition to the preferred gender. This may involve ingestion of higher quantities of hormones than prescribed or acts of self-mutilation to the genitals. A case is reported of an attempt to encourage breast-tissue development using a sink plunger.

Returning a referral for erectile dysfunction to the referrer by two different routes.

OBJECTIVE: To compare the prescribing pattern and attitude of general practitioners (GPs) in response to a clinic returning a patient referred for erectile dysfunction (ED) to the referrer by two different methods. METHODS: Referrals on a waiting list for an assessment of ED were reviewed and a subgroup of patients with criteria enabling them to be eligible for a prescription under the National Health Service (NHS) identified. The GP was informed either in writing or by telephone that the clinic had written to the patient, suggesting he make direct contact with his GP. A follow-up questionnaire was sent to each GP one month after the initial letter to the patient and contact with the GP. RESULTS: Of 91 questionnaires sent to GPs, 66 (73%) were completed; an additional five GPs corresponded by letter rather than completing the questionnaire. The long waiting time for assessment had led to 35% of patients having already tried sildenafil, and by the time the questionnaire was completed, 57% of patients had tried sildenafil. Ten times as many referrers indicated that they were happy to initiate a prescription for sildenafil than not to do so, for those men eligible for an NHS prescription. More GPs who had received a letter returned the completed questionnaire (80%) than those who had received a courtesy telephone call (64%). There were no differences between the groups of GPs in their attitude to our contact with their patient and no difference in prescribing pattern. Conclusion The provision of guidelines and advice to GPs either by telephone or letter is acceptable practice in reducing long waiting-list times for ED. Safe, simple and effective treatments are available for GPs to use under NHS guidelines.

Effects of depot neuroleptics on driving performance in chronic schizophrenic patients.

Patients who are prescribed psychotropic medication may be expected to have some impairment in general attention and concentration and in measures of psychological and motor performance. These impairments may be due to the illness itself, the medication or the combination of both. Twenty two patients who were receiving depot neuroleptics for chronic schizophrenia were compared with sixteen control subjects in their performance on simulated driving tests. There was a significant decrement in driving performance in the index group compared with a normal control group.

Sexology as a profession in the United Kingdom.

To identify clinicians working within the field of sexual and psychosexual medicine and to identify and quantify the diversity of problems seen by specialist physicians, nurses and therapists working in the UK and compare these with French clinicians, a prospective 89 item questionnaire was sent to 2352 practitioners in the UK. Eight hundred and fourteen completed questionnaires were returned detailing clinician practice and training and the presenting problems of patients in their clinical practice. The commonest presenting problem amongst men was erectile dysfunction (562/814) followed by emotional and relational problems. The commonest problem for women was loss or absence of sexual desire and was of a similar magnitude to that of erectile dysfunction in men. The substantial majority of clinicians working with patients and clients with sexual problems are non-physicians from a diverse professional training background which contrasts with a high number of physicians in France. The high incidence of emotional and relational problems in both men and women would suggest that clinical services require considerable psychotherapeutic consultation space within the service provision.