Fear of Vaginal Penetration in the Absence of Pain as a Separate Category of Female Sexual Dysfunction: A Conceptual Overview.

Functional sexual pain disorders in women are a particular challenge to the gynecologist, inasmuch as phobic avoidance and guarding on the part of the patient lead to difficulties in the gynecological examination and diagnosis. In some such cases examination may even be impossible. Vaginismus is the commonly diagnosed etiology of such cases. This article offers an overview of vaginismus and approaches to its treatment but also examines a subset of penetration-avoidant patients who do not appear to have a pain component. We have reviewed this separate category conceptually and clinically, and propose that this case subset be separated from the diagnosis of vaginismus and designated as vaginal penetration phobia (VPP).We further propose that this category be diagnosed as one of several possible presentations of phobic disorder, under the rubric of mental health disorder, and thus be separated from gynecology. The nosological implications are raised.

Association between tobacco smoking and bipolar affective disorder: clinical, epidemiological, cross-sectional, retrospective study in outpatients.

PURPOSE: Although high rates of smoking have been reported among psychiatric patients, only a few studies examined the prevalence of smoking in bipolar disorder, and findings are inconsistent. We investigated smoking among bipolar patients. METHODS: We examined the prevalence of smoking in of 102 patients that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for bipolar I disorder in Israel and evaluated the relationship between smoking and demographic and clinical data. RESULTS: Fifty-five of the bipolar patients (53.9%) smoked, with a rate that is 2.36 times higher than among the general population in Israel (22.8%). Significant relationships were revealed between smoking and lifetime history of alcohol dependence/abuse (P = .02), between smoking and history of drug use (P ≤ .01), and between smoking and age of illness onset (P = .04). LIMITATIONS: The cross-sectional nature of the study and the relatively small sample size preclude generalization of the findings. Nicotine levels were not measured; thus, the information regarding smoking was subjective. CONCLUSIONS: Bipolar patients smoke more than the general population. Bipolar patients that are moderate or heavy smokers are more likely than nonsmokers to consume alcohol and abuse psychoactive substances. Contrary to findings of previous studies, no association was found between clinical variables of bipolar patients and smoking.

Medication phobia: a new cause of drug noncompliance in Parkinson disease.

OBJECTIVE: To describe a new form of anxiety in patients with Parkinson disease (PD). METHODS: We retrospectively reviewed 100 consecutive charts of patients with PD to identify those who did not adhere to their medication schedule owing to irrational fear of taking their medication. Information pertaining to their PD and comorbid medical conditions was collected. RESULTS: We identified 6 patients with PD who had severe disability, yet anxiety from taking the medication caused avoidance of taking appropriate oral medication. This avoidance persisted in the face of reassurance that the medication is not dangerous and that taking the medication would improve their disability. CONCLUSION: This study describes a new form of anxiety in patients with PD. We propose the term ``medication phobia'' to describe these patients.

Ectopic glandular breast tissue in a lactating young woman.

BACKGROUND: Ectopic breast tissue is a rare occurrence in pregnant women and should not be confused with abscess or other causes. Ectopic breast tissue is present at birth but often only diagnosed after puberty, pregnancy, or lactation. OBJECTIVE: Misdiagnosis is of concern due to the fact that ectopic breast tissue may undergo pathological changes with increased risk of malignancy. Therefore, it is vital for emergency physicians to be able to recognize this process and ensure proper follow-up care. CASE REPORT: We present a case of ectopic breast tissue in a 19-year-old primigravida. CONCLUSION: Surgical removal for the purpose of prophylaxis of malignant changes is not currently recommended. Definitive diagnosis is established by fine-needle aspiration and excisional biopsy.

Are premature ejaculation symptoms curable?

INTRODUCTION: While premature ejaculation (PE) is the most common sexual dysfunction in men under 40, there is currently no government-approved therapy for its treatment. Is a cure possible? METHODS: Four experts in the area of PE and its treatment were asked to contribute their opinions. MAIN OUTCOME MEASURE: To provide food for thought, discussion, and possible further research in a poorly understood area of sexual medicine. RESULTS: Differences among the different types of PE, and the ability to cure them are discussed. One expert examines the possible differences in lifelong and acquired PE as an explanation as to why treatment for the former does not carry over after termination of treatment whereas the latter can be treated successfully. The second and third experts break PE into four categories, explaining that those forms that are curable at present are not true PE or are based on anxiety. The last expert discusses the potential of a combined clinical and research platform to better understand the relative contributions of biological, behavioral, and couple factors to the disorder for potential curability. CONCLUSION: Improved understanding of the types of PE and their various etiologies and pathophysiologies would improve the potential for cure.

Development of a physician attributes database as a resource for medical education, professionalism and student evaluation.

In the light of the growing interest in professionalism and non-cognitive attributes in medical education, a focus group (FG) methodology was used to achieve a database of desired physician attributes. Ten FGs, consisting of medical faculty, service heads, residents, general practitioners, students and patients, took place, producing 169 desired attributes; further attributes were derived from a literature search, and the Mission and Vision Statement (MVS) of the authors' medical faculty. A total of 254 separate attributes finally emerged, after a process of combining and collapsing similar items. Attributes appearing with the highest frequency were: honest, empathic, patient, capacity to be an attentive listener, understanding, able to work in a team, intellectual curiosity, egalitarian. The high number of attributes generated in this study provides an indication of what the profession is wanting of itself. This database is multipotential and preliminary in nature and requires further processing before achieving full relevance.

Teaching the cultural dimensions of the patient-physician relationship: a novel approach using didactic trigger films.

The use of trigger films (TFs) for undergraduate teaching is well established in the Technion School of Medicine and elsewhere. These are typically based on a written script highlighting diverse issues within the patient-physician relationship (PPR). We report here on the staging of a filmed script-free encounter between a physician and an actress-patient as a further development of the TF approach. This involved the creation of a clinical interaction in which the patient's revealed cultural background demanded an adaptive response from the physician in order to achieve a stable PPR and to institute effective treatment. Considerable improvisation was thus required. Prior directorial manipulation of the conditions of the interview enhanced the didactic power and goals of the TF. After completion of the filming, the physician and the actress studied the video and then repeated the interview within the same situation free of directorial input. The two sequential videotaped interviews constitute the final product. These TFs appear to carry a wide spectrum of didactic messages at many levels including the need to relate effectively to the cultural aspects in the PPR, and the importance of self-observation as a tool for change and learning.

Gonadal tumor with granulosa cell tumor features in an adult testis.

Granulosa cell tumor is almost exclusively an ovarian tumor. Rare cases of granulosa cell tumor have been reported involving the testes. We report a testicular gonadal stromal tumor with granulosa cell differentiation in a 54-year-old white man. The tumor was discovered by an ultrasound evaluation for left hydrocele. The patient was clinically asymptomatic. On frozen section, the initial impression was a malignant lymphoma. Final histology on the orchiectomy specimen showed a gonadal stromal tumor with granulosa cell features. Immunohistochemical studies excluded malignant lymphoma and germ cell tumors, consistent with a stromal tumor. This case report illustrates the challenges for the pathologist in making an accurate diagnosis in unusual testicular tumors.