Candace B. Risen

Side Effects of Self-Administration of Intracavernous Papaverine and Phentolamine for the Treatment of Impotence

Beginning October 1985, 111 men agreed to enter a prospective study of the side effects of low dose papaverine/phentolamine therapy. A total of 46 men dropped out, 30 during the initial phase. The percentage of men with painless nodules almost consistently doubled from one followup examination to the next: 8 per cent at 1 month, 17 per cent at 3 months, 32 per cent at 6 months and 57 per cent at 12 months. The average injection frequency of those with nodules was 2 1/2 times higher than those without nodules. Of the men 41 per cent required an increased dose of medications during followup, and 40 per cent of 50 men had at least 1 abnormality of liver function, most of these involving mild to moderate elevations of alkaline phosphatase and lactic dehydrogenase. Priapism was not encountered during self-injection but it did occur twice in 329 physician-administered injections. Careful regular monitoring of patients should continue as some patients enter the second year of treatment.

Handbook of clinical sexuality for mental health professionals

Review(s) of: Handbook of Clinical Sexuality for Mental Health Professionals - 2nd Edition, by Stephen B. Levine (Ed.), Candace B. Risen and Stanley E. Althof (Associate Eds.) Routledge, 2010. HB. RRP

Why do so many people drop out from auto-injection therapy for impotence?

164.95.

Intracavernosal injection in the treatment of impotence: A prospective study of sexual, psychological, and marital functioning

Although intracavernous injection of vasoactive substances has been shown to be a reasonable and reliable method of reversing impotence, studies assessing patient acceptance of this new technology are lacking. By prospectively following patients and willing partners over a 2-year period, this study sought to document patient utilization rates and the reasons why patients decline or discontinue injection therapy. The cumulative dropout rate was 46%, with patients being most at risk for leaving the program after evaluation or during the trial dose phase. Patients decline treatment because they are unable to accept the idea of injecting themselves or because of potential side effects. Patients discontinue treatment because of perceived lack of efficacy. Patient and programatic obstacles to utilization of self-injection therapy are analyzed.

Sexual, Psychological, and Marital Impact of Self-Injection of Papaverine and Phentolamine: A Long-Term Prospective Study

This study assessed the sexual, psychosocial, and medical impact of intracavernosal injection of papaverine hydrochloride and phentolamine mesylate in the treatment of impotence. Ninety-six percent of patients initially achieved satisfactory erections with injections. Common side effects of self-injections included bruising (26%), nodule development (21%), abnormal liver function tests (7%), and pain (5%). No nodules resulted in penile bending or pain, and no patient discontinued treatment due to nodule development. Dropout rate to date was 35%. Self-injection treatment was associated with increases in erection quality, intercourse frequency, and sexual satisfaction, and decreases in masturbation frequency for patients. Partners also reported increases in intercourse frequency, coital arousal, and satisfaction. Decreases in general psychiatric symptomatology and increases in relationship satisfaction and self-esteem were apparent for patients, but not for partners.

Self-injection of papaverine and phentolamine in the treatment of psychogenic impotence

This prospective study assessed the long-term effects of self-injection of papaverine hydrochloride and phentolamine mesylate along several critical domains for 42 men and 26 partners. Over the course of one year, men were, on average, injecting themselves five times monthly, with 84% of these injections producing satisfactory erections. Treatment resulted in statistically significant improvements in quality of erection, sexual satisfaction, frequency of intercourse, and coital orgasm. The women also demonstrated significant improvement in sexual satisfaction, arousal, frequency of intercourse, and coital orgasm. Decreases in general psychiatric symptomatology were apparent for men but not for partners. The dropout rate was 57%. The common side effects of treatment were development of fibrotic nodules (26%), abnormal liver function values (30%), and bruising (19%). We conclude that self-injection should be considered among the accepted treatments for erectile dysfunction. It does appear to enhance the sexual lives of men and women when the treatment is efficacious and the couple is motivated to utilize it.

A Study Using Viagra in a Mental Health Practice

This study prospectively assessed the use, effectiveness, and sexual and psychosocial impact of self-injection treatment in 15 men with psychogenic impotence. Sixty percent dropped out of self-injection treatment by 6 months. Those who remained used self-injections about four times monthly with a 94% success rate. Frequency of intercourse and sexual satisfaction increased. Anxiety decreased, and trends toward improvement in depression and self-esteem were evident. Qualitative data indicated that performance anxiety was not alleviated, dependence upon injections for intercourse remained, symptom substitution did not occur, and capacity for intimacy was not improved.

The sexual struggles of 23 clergymen: a follow-up study.

The clinical responses of 58 men who were given Viagra between April and December 1998 in a psychiatric outpatient setting were tracked through 2 follow-up visits. Four categories of success and 3 categories offailure are defined to describe the outcomes. Although 43% had ideal outcomes-cure or uncomplicated drug-dependent successes-50% again were able to have intercourse and 63% experienced improved erections. Seventeen percent of the original sample did not benefit from the drug; 21% were lost to follow-up. This intent-to-treat study adds more evidence of Viagras effectiveness and further clarifies the need to focus on psychodynamic considerations when trying to assist the majority of patients who did not have ideal outcomes.The clinical responses of 58 men who were given Viagra between April and December 1998 in a psychiatric outpatient setting were tracked through 2 follow-up visits. Four categories of success and 3 categories of failure are defined to describe the outcomes. Although 43% had ideal outcomes--cure or uncomplicated drug-dependent successes--50% again were able to have intercourse and 63% experienced improved erections. Seventeen percent of the original sample did not benefit from the drug; 21% were lost to follow-up. This intent-to-treat study adds more evidence of Viagras effectiveness and further clarifies the need to focus on psychodynamic considerations when trying to assist the majority of patients who did not have ideal outcomes.

Professionals who sexually offend: evaluation procedures and preliminary findings.

Nineteen clergymen, 17 of whom were Catholic, were followed up 1 to 6 years after their initial evaluation in a program designed to assess the sexual offenses and rehabilitation potential of offending professionals. Methods used included a semistructured interview with a research psychiatrist and a repeat of the MCMI-III. At follow-up, the clergymen were relatively psychologically healthy. The vast majority of the men had returned to previous or higher levels of vocational functioning and felt that they had benefited from their initial evaluation and therapy. None of those who were initially suspected of sexual compulsivity met criteria for excessive sexual expression at follow-up, and none had re-offended. The typical clergyman, whether heterosexual or homosexual, was struggling with loneliness, masturbation conflicts, and the wish to be known beyond their role by others. The confrontative style of the evaluators in pursuing the veracity of the clergys initial explanations of their behaviors and the use of penile plethysmography were the primary objections to the methods used. Brief psychotherapy seemed to be a cost-effective, well-received intervention for clergy struggling with their sexual conflicts.

A guide to taking a sexual history.

Methods and results of the psychiatric evaluations of 31 professionals who have been accused of sexually inappropriate behaviors within their work context are presented. Eight types of professionals were evaluated; the majority were clergy, physicians, and teachers. Paraphilia was diagnosed in 26%, a nonparaphilic sexual compulsive syndrome in another 29%, and some form of character disorder in 58%. Seven professionals had offended six or more times. The ethical failures of the professionals were diverse and could not simply be explained by psychiatric diagnoses. Approximately half of the professionals were thought to be safe to return to work, often with a recommendation for psychotherapy and monitoring of their professional activities. A recommendation to no longer practice their professional roles was given for 47% of those evaluated, and the referring agency followed through with the recommendation. Outpatient psychotherapy was recommended for 84% of the sample. Psychotropic medications were occasionally recommended.