James W. Maddock

Assessment and evaluation protocol for surgical treatment of impotence

In the past ten years, significant advances have been made in the treatment of male sexual impotence, both psychotherapeutically and surgically. Awareness of these advances has produced conomitant demands for effective application of these methods to a growing number of candidates. A valuable contribution to this effort is the use of an appropriate package of psychological assessment instruments. The rationales for such a package are diagnostic, prognostic, rehabilitative, and evalauative. In addition, it can help to generate some valuable research data on the nature of male sexual function and dysfunction. Psychological assessment is an established part of psychotherapeutic and behavioral approaches to the treatment of erectile failure.1,2 Recently, it has also been acknowledged as an important factor in surgical intervention3,4 and an important adjunct to physiological measurement of erectile capacity.5,4

Incest and Other Sexual Contacts between Adults and Children

A sizable minority of children—perhaps 25–30% of girls and 15–20% of boys—have inappropriate sexual contact with an adult prior to adolescence (Kinsey et al., 1953; Rossman, 1976). “Inappropriate” here refers to an explicit, genitally focused contact whose major purpose is erotic gratification of the adult regardless of the child’s feelings. These contacts are exploitive of children, because they largely ignore the feelings of the child in favor of adult gratification and because they reflect (overtly or covertly) the dynamics of coercion (i.e., “big” overpowering “little”). This contrasts with the natural, sexually tinged touching, which is a normal part of growing up—being bathed by a parent, being examined by a physician, being discovered during masturbation or sex play, even the hugging, kissing, and stroking that are part of the sensual and erotic fabric of everyday family life.

Sexual Concerns of Childhood

Children enter the world as sexed beings. Prenatal processes have established the basis for a gender identity (in most cases) as well as the capacity for erotically stimulating interaction with the environment. From the moment of birth, significant persons in the infant’s environment respond to the individual as a male or female. An elaborate psychosocial network forms that supports the perceived biological sex of the child. This network will provide more or less flexible choices of role-related behaviors as the child grows and struggles to develop a coherent, socially acceptable, but personally unique, sexual identity (Money and Erhardt, 1972). Numerous complexities and challenges lie along the road toward adult sexual identity. This chapter will focus primarily on erotic aspects of childhood socialization, whereas later chapters (4 and 6) will examine the pitfalls and problems of gender identity formation and sex-role socialization.

Developmental human sexuality: the introduction of a new curriculum in child psychiatry training.

The training objectives, content and course evaluation results of a new curriculum offering, Developmental Human Sexuality, for child and adult psychiatric residents are described and discussed.

The evaluation of sexual health services in a medical setting.

An interdisciplinary Sexual Health Services unit has been established at the University of Minnesota Medical School that offers counseling and treatment programs for a wide variety of sex-related concerns and problems. The programs are based on the principles of responsibility for self, permission to be sexual, the use of reeducation, the facilitation of increased awareness in clients, and structured behavior change. The programs have been evaluated according to client satisfaction with the extent to which they have met pretreatment goals and according to results of pre/posttesting with objective instruments. One year follow-up results from 131 clients and immediate posttreatment results from 411 clients show positive change in a large majority of cases.