Complete androgen insensitivity syndrome: long-term medical, surgical, and psychosexual outcome.

Controversy concerning the most appropriate treatment guidelines for intersex children currently exists. This is due to a lack of long-term information regarding medical, surgical, and psychosexual outcome in affected adults. We have assessed by questionnaire and medical examination the physical and psychosexual status of 14 women with documented complete androgen insensitivity syndrome (CAIS). We have also determined participant knowledge of CAIS as well as opinion of medical and surgical treatment. As a whole, secondary sexual development of these women was satisfactory, as judged by both participants and physicians. In general, most women were satisfied with their psychosexual development and sexual function. Factors reported to contribute to dissatisfaction were sexual abuse in one case and marked obesity in another. All of the women who participated were satisfied with having been raised as females, and none desired a gender reassignment. Although not perfect, the medical, surgical, and psychosexual outcomes for women with CAIS were satisfactory; however, specific ways for improving long-term treatment of this population were identified.

The genealogical descent of sexual psychoneuroendocrinology from sex and health theory: the eighteenth to the twentieth centuries.

In the aftermath of the inquisition, secular health theory became separate from sacred health theory. Both assimilated vital spirits or sympathies as explanatory concepts. Sympathies were progressively transformed into internal secretions and the hormones of endocrinology. The sexual genealogy of psychoneuroendocrinology traces back to the sexual transplantation experiments of John Hunger (1728 - 93). Sexology, the science, has the same genealogy, whereas sexosophy, the philosophy, does not. In sexosophy, the theory that vital spirits or sympathies lost by masturbation caused debility or degeneracy became, along with health-food and exercise theories, popular in 19th-century health doctrine. Graham crackers and kellogg's cornflakes were by-products of the diet/abstinence doctrine. With police power under the Comstock Law (1873), 19th-century sexosophy negated sexuality so effectively that human sexual psychoneuroendocrine research remains muffled and deprived of funds in 1983.

Growth of intelligence: failure and catch-up associated respectively with abuse and rescue in the syndrome of abuse dwarfism.

IQ change in association with change of environment occurred in a sample of 34 patients with a diagnosis of abuse dwarfism. Low and persistent impairment of IQ was associated with abuse. By contrast, IQ elevation was associated with rescue. Multiple regression analysis revealed that duration of rescue was the primary variable associated with IQ elevation; age and IQ level at rescue were secondary. IQ elevation was gradual and progressive over the years, as rescue was maintained. In abuse, the mean IQ was 66 (range, 36-101), and after rescue it was 90 (range 48-133). The greatest magnitude of change, from IQ 36 to 120, was in a girl between the ages of 3 yr 8 months and 13 yr 11 months.

Adult erotosexual status and fetal hormonal masculinization and demasculinization: 46,XX congenital virilizing adrenal hyperplasia and 46,XY androgen-insensitivity syndrome compared.

Among 30 young women with a history of the treated adrenogenital syndrome (CVAH), 11 (37%) rated themselves as bisexual or homosexual. Among a control group consisting of 15 women with the 46,XY androgen-insensitivity syndrome (AIS) plus 12 with the Rokitansky syndrome (MRKS), the corresponding figure was 2 (7%), both bisexual. Chi-square was significant beyond the 0.01 level. In Kinsey's 1953 sample 15% of women experienced homoerotic arousal imagery by age 20, and 10% had had homoerotic partner contact. The most likely hypothesis to explain the CVAH findings is that of a prenatal and/or neonatal masculinizing effect on sexual dimorphism of the brain in interaction with other developmental variables.

Pituitary function in adult males receiving medroxyprogesterone acetate.

The pituitary, adrenal, and gonadal functions of nine males (six XY, two XYY, and one XY/XYY) were studied after at least 6 months of medroxyprogesterone acetate (MPA) therapy for antisocial or sex-offending behavior. Five were studied both before and during therapy, four only during therapy. MPA was effective in decreasing serum gonadotropin and plasma testosterone concentrations. MPA caused no change in the 24-hour rhythm or total integrated concentration of growth hormone. The plasma cortisol circadian rhythm was suppressed but not obliterated by MPA therapy. Although a significant decrease (P less than 0.001) in 24-hour integrated concentrations of plasma cortisol was also found, the rise in the plasma cortisol level after insulin-induced hypoglycemia was unchanged.

Effects of standard and eccentric overload strength training in young women.

PURPOSE: According to the force-velocity relationship of human skeletal muscle, the maximal load one can lift is limited by the concentric movement phase, and the eccentric phase is always underloaded. In the present study, we hypothesized that acute exercise training using an eccentric overload compared with standard loading would lead to greater neuromuscular and strength adaptations. METHODS: Sedentary women (age 20.9 yr) were tested for concentric and eccentric three-repetition maximum (3RM), maximal isokinetic eccentric and concentric and isometric force and associated EMG activity of selected thigh muscles before and after 7 consecutive days of exercise training of the left quadriceps. The exercise program was designed so that the total weight lifted was similar between the eccentric overload (EO, N = 10) and standard group (ST, N = 10), but EO exercised with about 50% greater eccentric load whereas the controls did not exercise (N = 10). RESULTS: There was a 22% increase in the total weight lifted over 7 d. On the average, EOs compared with STs strength gains were approximately twofold greater. Changes in EMG paralleled the changes in muscle strength without changes in biceps femoris coactivity during knee extension. CONCLUSION: Because the strength gains were achieved by exercising at low intensities and over a short time period, exercise prescription of eccentric overloading appears especially suitable for elders, individuals deconditioned due to an injury, and the chronically diseased.

Gait adaptations before and after anterior cruciate ligament reconstruction surgery.

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics, during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.

Longitudinal studies in clinical psychoendocrinology: methodology.

There are five universal exigencies of being human, against which a person's existence can be evaluated: pairbondage, troopbondage, abidance, ycleptance, and foredoomance. They constitute a template from which a standardized agenda or schedule of inquiry is generated, as needed, for a particular research investigation. The schedule of inquiry is painstakingly designed ahead of time so as to ensure coverage of all the variables relevant to a particular study. For economy of expense and effort, subjects conclude their own prior interviews by summarizing it on tape, with the interviewer making a written record, verbatim, of what will become subheadings in the transcript. Inquiry progresses from an open-ended to a forced choice interrogatory. Topics in the public domain open the way to inquiry on personally sensitive issues. So also do parables drawn from actual cases and used as personalized narrative projective tests. A cumulative record, covering as many as 25 years, is indexed so that relevant material can be located, abstracted, and classified for any particular study. A jury of two or more then uses the abstracted data to fill out a prepared data schedule, using its own standardized scoring or rating criteria. By contrast, an ordinary questionnaire uses standardized questions, and each subject applies his or her own unstandardized scoring or rating criteria in answering them. In the final step, the jury's ratings are tabulated on a master chart that consolidates the scores of a group of subjects and controls, ready for statistical analysis.

Evolutionary sexology: the hypothesis of song and sex.

In subhuman mammalian species, lovemaps are homogeneous and are more or less biorobotically fixed, whereas in the human species they are emancipated from biorobotism and are personalized, idiosyncratic, and heterogenous-as, for example, in the paraphilias. The evolutionary sexological hypothesis described herein proposes that emancipation of all of the biorobotic mindbrain maps, the mating map included, was essential for, and coincident with the evolution of the human speechmap from the songmap. Accordingly the first human language was a love song rather than a howl of warning. The bare essentials of sexuoerotic arousal and response are in three categories: haptoerotic (cutaneous), morphoerotic (visual), and gnomoerotic (narrative).

New phylism theory and autism: pathognomonic impairment of troopbonding.

A phylism is a unit of existence, part of an individual's species heritage. It is neither nature nor nurture, but a phyletically dictated product of the interaction of both at a crucial developmental period which may be either prenatal, postnatal, or both. In the syndrome of autism, the phylism of troopbonding is specifically impaired, and other phylisms may be hypertrophic. The phylism of limerent (lover-lover) pairbonding is not impaired, and it may be the source of discordance with other members of the troop. Shyness is an attenuated manifestation of autism. The etiology of impaired troopbonding may be heritable, and almost certainly will prove to be neurochemical also, probably as an analogue of the Lesch-Nyhan syndrome. The lives of autistic children are subject to secondary shaping by the environment of living.

New phylism theory and the homosexualization of the visualization of lust.

Nature needs nurture is the paradigm that replaces nature versus nurture. Nature's determinants are phylismic, i.e. they belong to the person phylogenetically as a member of the species and are not individually fortuitous. Phylismically, in the human species, vision and contrectation supplant pheromones as procreative attractants. The primary visual attractant, the sexual body morphology of a potential partner, is in all likelihood hormonally encoded into the sexual brain in fetal and/or neonatal life. Should the prenatal or neonatal encoding of the visual attractant become transposed from the visual image of the body morphology of the other sex to that of the same sex, then the brain would be biased in subsequent development toward some degree or variation of homosexual or bisexual attraction.

Matched pair of siblings concordant for 46,XY hermaphroditism with female sex assignment, and discordant for erotosexual outcome.

The two siblings in this comparison constitute a matched pair on the basis of concordance not only for prenatal history and diagnosis but also for assigned sex as girls, and for spontaneous hormonal puberty that was not feminizing, but masculinizing. They were further concordant in being surgically and hormonally feminized, with their own informed consent, early in adolescence. Subsequently, they became discordant, for the younger one has lived continuously as a woman, with a feminine gender-identity/role (G-I/R) socially and erotosexually, whereas the older one became self-reassigned to live as a man with a masculine G-I/R socially and erotosexually, hormonally supported on testosterone replacement therapy. Flattening of the chest was readily accomplished by plastic surgery, but phalloplasty was not attempted, primarily because of the technical obstacles and, to a lesser extent, the cost.

Bisexually concordant, heterosexually and homosexually discordant: a matched-pair comparison of male and female adrenogenital syndrome.

Prenatal hormonal experiments in subprimate species demonstrate conclusively that the pattern of adult mating behavior is masculinized or feminized as a function of prenatal hormonalization of the brain. In primates, especially human beings, postnatal socialization is superimposed on prenatal hormonalization. The syndrome of congenital virilizing adrenal hyperplasia [CVAH] is an experiment of nature in which the fetal brain is prenatally hormonalized by a masculinizing excess of androgen from abnormally functioning adrenal cortices. The syndrome was diagnosed in two children, one a chromosomal, 46,XX female, and one a 46,XY male, who amongst many others were psychoendocrinologically followed into adulthood. Each was able to fall in love exclusively with a female as a partner in sexuoerotic activity, though each experienced also, on an investigative basis, at least one genitosexual encounter with a male. On a behavioral technicality, therefore, each had a history of bisexual practices, whereas subjectively the woman identified herself as a lesbian, and the man as a Kinsey-one heterosexual. Hormonally, it may be inferred that in prenatal life both were ultramasculinized to such a degree that it was impossible for any postnatal interventions to permit the man to become a bona fide homosexual, or the woman a bona fide heterosexual. The full implication of these findings and those of similar cases for homosexual/heterosexual theory remains to be ascertained.

Forensic sexology: paraphilic serial rape (biastophilia) and lust murder (erotophonophilia).

Forensic sexology is not synonymous with either forensic psychiatry or forensic psychology. It is a specialty in its own right, and is needed in the courtroom. Paraphilic sex offenders on trial are misrepresented as being, by their own choice, psychopathic or sociopathic deviates. They are unable to explain their paraphilic criminality to either themselves or society. In a case of serial rape and serial lust murder here presented, the contributory causes are examined and differentiated as hereditary predisposition, hormonal functioning; pathological relationships, sexual abuse; and syndrome overlap with bipolar disorder, schizoid disorder, antisocial personality disorder, epilepsy, and multiple personality. The precipitating causes were differentiated as childhood head injuries, and adult head injury at age 20. Left impact trauma and sexological trauma were sequelae of the adult injury. The full range of diagnostic resources was not available for a prisoner on death row. Capital punishment has not prevented the reemergence in each new generation of serial rape and serial lust murder as an epidemiological, public health problem. Punishment is an ineffectual substitute for epidemiological research into cause, effect, and prevention.

Paleodigms and paleodigmatics: a new theoretical construct applicable to Munchausen's syndrome by proxy, child-abuse dwarfism, paraphilias, anorexia nervosa, and other syndromes.

A paleodigm is a formulation of ancient folk wisdom that encodes a causal explanation in a saying or story that penetrates the idiom of everyday language and influences behavior. Although paleodigms are not, per se, causative, they have diagnostic, prognostic, and therapeutic significance in syndromes like Munchausen's syndrome by proxy.

Paraphilias: phenomenology and classification.

DSM-III incorrectly designates the majority of paraphilias as atypical. Only eight are named, and those because of their forensic history, rather than their pathology and therapeutic need. In this paper, thirty-odd paraphilias are subdivided into six categories on the basis of their phenomenological dynamics. The new concept of the developmental lovemap is introduced for the first time. A new treatment originated by the author in 1966 combines an androgen agonist with counseling therapy.

Pedagogical handicap associated with micropenis and other CHARGE syndrome anomalies of embryogenesis: four 46, XY cases reared as girls.

Genital hypoplasia (micropenis) and CNS impairments are among multiple anomalies of embryogenesis that are found in association in a syndrome for which the acronym CHARGE has recently been coined. The CNS anomalies are either peripheral or central or both. Their various manifestations are impaired hearing and vision; impaired motor performance and visual-motor coordination; IQ deficit either overall or specific to verbal reasoning or praxic reasoning; and social ineptitude consequent on impaired social maturation. These various impairments constitute a pedagogical handicap which, even though of major severity, is not refractory to clinical treatment and educational therapy.

Behavior cytogenetics and Turner's syndrome: a new principle in counseling and psychotherapy.

In the orthodox theory and practice of psychotherapy and counseling, each case is considered to be unique or idiodynamic in terms of psychodynamic history. According to a new and still unorthodox principle, a syndrome may have a common psychodynamic denominator, shared by all or most carriers of the syndrome. As illustrated with reference to Turner's (45,X) syndrome, application of this new principle expedites the psychodiagnostic and psychotherapeutic procedures.

Semen-conservation doctrine from ancient Ayurvedic to modern sexological theory.

The ancient doctrine of semen conservation has a long philosophical history in Europe and Asia. In Sanskrit, semen is equated with sukra, the life force. As early as 600 B.C., the Caraka Samhita taught the importance of sukra, and gave prescriptions to augment it. In the 18th century, semen conservation theory reentered Western medicine through Tissot's Treatise on the Diseases Produced by Onanism. It became the basis of the degeneracy theory of all disease, and of the masturbation hysteria of the 19th and 20th centuries.