A Combined- Constructionist Therapeutic Approach To Couples Experiencing Erectile Dysfunction: Part I

Marked changes have occurred in the conceptualization and treatment of Erectile Dysfunction (ED) in the past two decades. Emphasis has shifted to the role of biomedical and organic factors using medical and surgical interventions in the etiology of sexual dysfunction, deemphasizing the quality of the overall couple relationship. However, by using only a medical approach, the couple is left with balancing the positive and negative facets of a considerably different relationship with sex now in their lives and their relationship. This paper is Part I of a two part article on erectile dysfunction. Part I presents information on the bio-medical factors that may be related to ED and the medical model treatment approaches. Part II presents information on the psychological and systemic issues that may be related to erectile dysfunction, encouraging the use of a combined-constructionist framework.     

Pharmacologic management of sexual dysfunction: benefits and limitations

What is the current knowledge concerning the pharmacologic treatment of human sexual dysfunction? A number of interventions, including oral phophodiesterase inhibitors and intracorporeal agents with vasodilatory effects, are available to treat male erectile disorder. Serotonergic drugs have been shown to be effective in the treatment of rapid ejaculation. Various lines of research suggest that high dosages of androgenic agents may eventually have a role in the treatment of decreased libido in females. There may be a role for phophodiesterase inhibitors in the treatment of a subgroup of women with arousal disorders. Normal sexual function involves successful integration of biological, psychological, and interpersonal influences. Clinical psychiatry with its biopsychosocial model should incorporate the treatment of human sexual dysfunction within its purview.     

Cognitive-Behavioral Erectile Dysfunction Treatment for Gay Men

The purpose of the present paper is to assist cognitive-behavioral therapists who are treating erectile dysfunction among gay men. Little information is available to cognitive-behavioral therapists about the psychological and social effects of erectile dysfunction in this population, or how to incorporate the concerns of gay men with erectile dysfunction into a case conceptualization and treatment plan. The present paper provides an overview of the extant research on erectile dysfunction and of its treatment among gay men. The application of clinical research on erectile dysfunction to treatment for gay men will be illustrated using two case examples.     

Use of Erectile Prostheses in Patients with Free Forearm Flap Phalloplasty

ABSTRACT

Today, the free radial forearm flap phalloplasty is the method of choice for most surgeons engaged in female to male sex reassignment surgery. However, one of the main disadvantages of this procedure is the patients' inability to have sexual intercourse, due to their missing ability to have an erection. In this paper, we present our experiences with more than 100 patients that we provided with erectile prostheses that were originally designed for the use in biological males suffering from erectile dysfunction. We will show that the complication rate in transsexual patients is not significantly higher than in biological males. We therefore recommend the use of erectile prostheses in transsexual patients as a safe, reliable and successful way of obtaining the ability to have sexual intercourse.     

Long-term outcome of sex therapy

In a prospective investigation of the long-term outcome of 140 couples who had entered sex therapy 1–6 yrs earlier for a variety of sexual dysfunctions, successful follow-up, mostly by interview, was possible with at least one partner in 75% of cases. While recurrence of sexual difficulties was common, coping strategies were identified which often helped overcome relapses. Improvements in couples' general relationships resulting from treatment were usually sustained. Long-term outcome was excellent for vaginismus, good for erectile dysfunction, but often poor for premature ejaculation, and especially, for female impaired sexual interest. While the results of this study support the continued use of sex therapy for sexual dysfunction, they also emphasize the need for new therapeutic approaches for problems with poor outcome, especially female loss of sexual interest.     

Management Strategies of Sexual Dysfunctions

The purpose of this essay is to discuss on the possible impact on a couple's sexual relationships when the male partner's erectile problems contribute to a sexual dysfunction on the part of the female. The complex reciprocal nature of sexual interactions emphasizes the importance of the relationship for sexual function and dysfunction. The treatment of sexual dysfunction then takes into account the contribution of factors from the couple and the system. An integrated behavioural-systems approach is applied to address both sexual and non-sexual aspects of the interaction in the marital unit. This approach outlines a range of methods that may be used during the treatment of sexual dysfunctions in order to bring about relevant changes in sexual functioning and general relationships.     

Antipsychotika und sexuelle Dysfunktion

Antipsychotic drugs are used in the treatment of psychotic symptoms in schizophrenia and affective disorders. A direct correlation between increased dopaminergic activity and increased sexual desire and sexual activity is well documented in animal experiments and from observations in humans. Comparatively little researched and recognized is pharmacologically induced sexual dysfunction. In contrast to the antipsychotic effect and extrapyramidal motor side effects, no dose–response relationships are known for sexual side effects. This may be due to the fact that antipsychotics act at different levels in the sexual experience. Sexual dysfunction may be present on social, psychological, central nervous system and peripheral–organic levels, respectively. These levels are closely associated with each other and influence each other. Therefore, sexual dysfunction is generally a combination of dysfunctions at several of these levels. For a variety of reasons, there are no generally accepted standards for a healthy and fulfilling sex life. As a treating physician, the fact that sexual disorders are also not a rare phenomenon in mentally and physically healthy people should be kept in mind and that patients with schizophrenia regardless of the etiology of the sexual dysfunction may also benefit from sexual medicine or specific psychotherapeutic treatment.     

What's in a Disorder

Abstract

This paper analyzes the emergence of two FDA-approved products to treat “sexual disorders”: Viagra, a drug prescribed for the treatment of erectile dysfunction, and the Eros, a device prescribed for the treatment of female sexual dysfunction. Through an analysis of advertising and promotional materials for Viagra and the Eros, we argue that these pharmaceutical devices and the discourses they circulate reinforce normative gender ideals by enacting dominant cultural narratives of masculinity, femininity, and male and female sexuality. These cultural narratives of normative gender structure sexuality in such a way that reinforces certain kinds of masculinity, femininity, and (hetero)sexuality, thereby rendering “atypical” gender and sexual expressions, desires, and appearances invisible and marginal. We argue that these constructions reify cultural ideologies about “what counts” as legitimate and appropriate sexuality and that these constructions have profound implication for social actors, sexologists, and therapists.     

Religion and Coping with Sexual Impotence in Later Life

ABSTRACT

Eighty-three elderly men with sexual impotence attending a university-affiliated urology clinic underwent psychological evaluations. Religious conservatives and frequent church attenders showed a greater prevalence of help-seeking behaviors; they were also more likely to perceive their partners as supportive of their attempts to get help for impotence problems. There was no evidence that either religious affiliation or activity buffered against the psycho-logical stresses conferred by sexual dysfunction. Moreover, religious conservatives and frequent attenders were more restricted in the range of sexual behaviors they used to facilitate arousal and maximize partner satisfaction. These Findings may help guide clinicians and counselors called on to address male sexual dysfunction among the religious elderly.     

Remaking the real man: Erectile dysfunction palliatives and the social re-construction of the male Heterosexual life cycle

The popularity of impotence or erectile dysfunction (ED) drugs and the powerful imagery of their promotional campaigns may be a significant contributor to the social reconstruction of male sexuality and aging in general, and popular understandings of the male heterosexual in particular. This is note-worthy given that the heterosexual male is a demographic that has, historically, been quite resistant to the whims of the psycho-medical establishment. Given men’s psychological and physiological makeup, the emerging social expectations of male sexuality may be wholly unrealistic, with its matter-overmind rhetoric. Examining the language and imagery of several ED drug campaigns, and considering some popular therapeutic, and academic discourse on the subject, the paper considers some of the expectations facing men in our society today that have recently been generated by the sexual pharmacology industry. The analysis suggests how these new expectations potentially liberate and constrain men in various ways, solidifies a male ethos that focuses almost exclusively on the physical component, and thereby displaces men from the context of the romantic relationship.     

Psychosexual Dysfunction Among Gynecological Cancer Survivors

The purpose of this paper is to summarize the empirical findings related to the assessment and treatment of sexual difficulties commonly experienced by gynecological cancer survivors and to make suggestions for future research and practice in this area. First, we describe the sexual problems that are most frequently reported by gynecological cancer patients and some of their common medical and psychological correlates. These include pain, premature ovarian failure, changes in vaginal anatomy, emotional distress, body image, and sexual self-concept. The complex interaction of physiological and psychological variables plays an important role in the development of sexual dysfunction in this patient population. Furthermore, we review the empirical studies that have examined the effects of sexual rehabilitation therapy on the sexual functioning of gynecological cancer survivors and provide relevant research and clinical recommendations. We also discuss reasons to involve patients' sexual partners in psychosocial oncology research, given the complex interplay between patients' and partners' psychosexual issues.     

High School Girls’ Experience of Victimization by Boys: Where Sexual Harassment Meets Aggression

School-based research into sexual harassment, on the one hand, and aggression (including bullying) on the other, originate from different disciplinary traditions, but are beginning to connect. We examined whether the sexual harassment of high school girls by boys can be regarded as a form of aggression. Year 8 to 10 girls from 5 coeducational high schools (N = 679) responded to a 24-item version of the Direct and Indirect Aggression Scale, including 6 new sexually toned items; participants indicated how often they experienced each behavior. Principal components analysis identified 4 components: direct aggression, psychological aggression, cyberbullying, and sexual harassment. The latter included the more intrusive sexually toned behaviors, whereas verbal sexualized insults were a component of psychological aggression—the component that most strongly undermined girls’ sense of safety at school. Research and policies on school peer victimization need to explicitly include sexual aspects, in recognition of the harmfulness of such “everyday” psychological aggression.     

Intercorrelations among general arousability, emerging and current sexual desire, and severity of sexual dysfunction in women

Intercorrelations among general trait arousability, emerging sexual desire, current sexual desire, lack of sexual desire perceived as a problem, and sexual dysfunction were assessed in 65 women currently involved in marital or de facto heterosexual relationships. The Stimulus Screening Test was used to measure general arousability and the Assessment of Sexual Function and Dysfunction Questionnaire was used to measure emerging sexual desire, current sexual desire lack of sexual desire, and sexual dysfunction. Analysis showed that arousability was positively associated with current levels of sexual desire which was negatively associated with sexual dysfunction. There was a curvilinear relationship between arousability and sexual dysfunction, with women experiencing both high and low levels of arousability being more likely to score higher on measures of sexual dysfunction than those experiencing medium levels of arousal. The possible implications of these results are discussed.     

Roman Catholic Gay Priests: Internalized Homophobia, Sexual Identity, and Psychological Well-Being

Using convenience sampling, a national sample of 156 actively ministering or retired Roman Catholic priests was obtained. One hundred and five (105) of these priests identified as gay/homosexual (67.3 %), 42 identified as heterosexual (26.9 %), and 9 identified as bisexual (5.8 %). Due to the small number of bisexual participants, the bisexual priests’ responses were excluded, and the whole sample was divided into a gay/homosexual group and a heterosexual comparison group. This confidential study yielded a response rate of 78 %. The priests were mailed self-report survey instruments, including the Scales of Psychological Well-Being, the Internalized Homonegativity Inventory, the Gay Identity Questionnaire, the Depression-Happiness Scale, and the Marlowe-Crowne Social Desirability Scale, as well as a demographics questionnaire. Results demonstrated that internalized homophobia was negatively correlated with psychological well-being and associated with depression. Internalized homophobia was also found to be related to less integration of sexual identity. There was no significant difference between the gay/homosexual and the heterosexual group in their psychological well-being and depression scores, and both groups emerged as high scorers on the measures of psychological well-being and depression-happiness (high scores on this bipolar instrument indicate happiness). Implications and limitations of the study are reviewed and discussed.     

Associations between assertiveness,psychological well‐being,and self‐esteem in adolescents

This study explored the associations between adolescents’ assertive behavior, psychological well‐being, and self‐esteem. The sample consisted of 1,023 students (14.9 ± .51; 47.6% boys). Two dimensions of the Scale for Interpersonal Behavior (distress and performance), 2 factors of the General Health Questionnaire‐12 (depression/anxiety and social dysfunction), and 2 factors of the Rosenberg Self‐Esteem Scale (positive self‐esteem and negative self‐esteem) were used; data were analyzed using hierarchical linear regression. It was found that (a) the more anxious respondents felt in assertive situations, the less frequently they engaged in these situations; and that (b) both dimensions of assertiveness were associated with psychological well‐being and self‐esteem.     

Women Living with Men who Use Viagra

ABSTRACT

Since the launch of Viagra, there have been few studies on the perspective of the female partner. Through a multiple case study approach drawing from phenomenology and the constant comparative method of analysis, this qualitative exploratory study examines the stories of four women living with a spouse who is currently taking Viagra. Findings highlight the need for a more holistic approach to treating erectile dysfunction that supports both partners within the couple relationship. It is also suggested that greater attention should be given to the relationship and to the sexual needs of women.     

Sexuelle Funktionsstörungen und ambulante Psychotherapie

Based on a literature review the following questions are discussed: how prevalent are sexual dysfunctions in the community and in treatment samples (particularly in psychotherapy patients)? How many patients with sexual dysfunctions seek help in outpatient psychotherapy and for how many patients would this kind of treatment be indicated? Data show that only relatively few patients with sexual dysfunctions are being treated in outpatient psychotherapy. Deficits concerning detection and monitoring of sexual dysfunctions and in terms of interdisciplinary treatment are obvious. To find possible reasons for these deficits the multifactorial etiology of sexual dysfunctions, the segmentation of care and also psychological variables characterizing the patient (denial of dysfunction) and the therapist (subjective need for specific training) are discussed. It is proposed that routine use of screening questionnaires for sexual dysfunctions should be introduced and it is described how the diagnostics and treatment implementation for sexual dysfunctions can be effectively integrated into clinical practice. Finally, arguments for a broader representation of research on sexual dysfunction in the field of clinical psychology are presented.     

The psychological conditions that predict work engagement among tertiary education employees

This study investigated the extent to which the psychological conditions and job characteristics predicted work engagement amongst higher education employees (n?=?149, females?=?60%) from a South African University. The participants completed a variety of instruments on psychological conditions of work, job characteristics and work engagement viz; the Work Engagement Scale (WES), Psychological Meaningfulness Scale (PMS), Job Enrichment Scale (JES), Work-Role Fit Scale (W-RFS), Co-Worker Relations Scale (C-WRS), Psychological Availability Scale (PAS), Self-Consciousness Scale (SCS), Job Resources Scale (JRS), Outside Activities Scale (OAS), Psychological Safety Scale (PSS), Supervisory Relations Scale (SRS) and the Co-Worker Norms Scale (CWNS). Data analysis applied multiple regression to predict work engagement from psychological meaningfulness, psychological availability and job characteristics and also to determine the mediation effect of psychological condition of availability on the relationship between work engagement and job characteristics (resources). Findings suggest psychological meaningfulness to predict work engagement and to mediate the relationship between job characteristics and work engagement. Psychological resources for work engagement should emphasise a sense of meaningfulness as a resource for work participation.     

“I don’t want to be an artificial man”: Narrative reconstruction of sexuality among prostate cancer survivors

After interviewing prostate cancer support group members, I use narrative analysis to examine survivors’ post-illness stories of changes in sexual activity and identity. The main events in the narratives were the choice of a treatment option and the post-treatment changes in survivors’ sex lives, whether described as the end of the sex life or the beginning of a modified one. Survivors characterized their wives as uninterested in sex and seldom described support group peers as helpful sources of sex-related information. The value of health took precedence over the desire for sex among men who experienced erectile dysfunction. My observations suggest implications related to (a) masculine identity, (b) sex among the elderly, (c) the social construction of sexuality, (d) defining and redefining sexuality, (e) physician-patient interaction, (f) sex talk among social support group members, and (g) the apparent clash between the values of sex and health.     

大学生心理传统性及现代性、人格特质与双元孝道的关系

为了考察心理传统性及现代性、特质移情、权威主义人格与双元孝道之间的关系,426名大学生完成了心理传统性与现代性量表、特质移情量表、权威主义人格量表、孝道信念量表。结果显示：1）心理现代性、特质移情对互惠性孝道直接效应和间接效应显著,特质移情在心理现代性与互惠性孝道之间起部分中介的作用;2）心理传统性、权威主义人格对权威性孝道直接的效应及间接效应显著,权威主义人格在心理传统性与权威性孝道之间起部分中介的作用。