Manfred E. Beutel

Sexual activity, sexual and partnership satisfaction in ageing men—results from a German representative community study

Summary. Age‐related changes in men have only recently received widespread scientific attention. Although a reduction in sexual interest and satisfaction are common in the ‘ageing male’, little is known about sexual activity and satisfaction in the general population. We therefore investigated age‐related changes in mens sexual activity, and their sexual and partnership satisfaction. We also tried to identify psychosocial determinants of sexual and partnership satisfaction. A representative community‐based sample of 1299 men between 18 and 92 years was interviewed, based on a set of standardised questionnaires, on life satisfaction, physical complaints, personality and interpersonal problems. Comparing the 3 age groups (18–40, 41–60, 61–92 years), we found the proportion of sexually active men to be fairly constant up to the age of 60 (84–85%); while above the age of 60, the proportion declined to 51%. The proportion of men without a partner (32% of the total sample) who were sexually active was lower; in this group sexual activity started to decline between 41 and 60 years (from 74% to 56%), and comparably fewer older men without a partner were sexually active (17%). We also found an age‐related decline in sexual satisfaction, and a slight increase in partnership satisfaction. Sexual activity was a major determinant of sexual satisfaction; sexual and partnership satisfaction were compromised in men who were dissatisfied with their health, and reported somatoform complaints and interpersonal problems. Our results emphasise the contribution of psychosocial factors to declining sexual activity and satisfaction. Future studies in the ageing male should take account of existence and quality of a partnership, and recent sexual activity.

Alexithymic Characteristics and Patient-Therapist Interaction: A Video Analysis of Facial Affect Display

Alexithymia as a disorder of affect regulation entails a patient’s reduced ability to process emotional information. The purpose of this study was to evaluate the impact of alexithymia [as measured by the Toronto Alexithymia Scale (TAS)-26, German version] on affective correlates in a dyadic therapeutic interaction (as recorded by the Emotional Facial Action Coding System). Interviews with 12 in-patients with various psychosomatic disorders (anxiety, depression, somatisation) were videotaped and evaluated for facial affect display. The corresponding emotional reactions of the therapists (split screen) were recorded separately. Patients with high alexithymia scores (TAS-26 total score) tended to display less aggressive affects than those with low scores. The therapists’ predominant emotional reaction to alexithymic patients was contempt. Our findings underscore the deep-rooted nature of alexithymia as a disorder of affect regulation. Since facial affects play a major role in the regulation of emotional interaction, this disorder may evoke negative reactions of potential caregivers.

Prostate-related pain in patients with chronic prostatitis/chronic pelvic pain syndrome.

Symptomatically, this entity is clearly defined [8]. Chronic bacterial prostatitis (NIH II) can develop from acute prostatitis (NIH I) and is characterized as a chronic bacterial infection of the gland. CP/CPPS is classified into inflammatory (NIH IIIA) and the noninflammatory (NIH IIIB) CPPS. In category IIIA, leukocytes can be found in expressed prostatic secretion, in the urine after prostatic massage, and in semen. In NIH IIIB no leukocytes are detectable. patients with NIH IV prostatitis are asymptomatic. The diagnosis may be coincidental, e.g. by detecting leukocytes in prostatic secretion or in the urine after prostatic massage as part of another examination [4]. Frequently, diagnosis can be established morphologically, e.g. after a prostatic biopsy in the management of patients with unclear PSA elevation in serum [9].

Complaints of the Ageing Male Based on a Representative Community Study

OBJECTIVES To determine (a) the relationship between physical and somatoform complaints, distress and life satisfaction and ageing in the male community and (b) their psychosocial determinants. METHODS Two stratified random samples of the German male population (total of 2,182 men) were investigated by standardised questionnaires of complaints (MFI-20, GBB), distress (HADS) and life satisfaction. RESULTS When participants were grouped into six age groups (18-30, 31-40, 41-50, 51-60, 61-70, >70 years), we found a continuous increase of physical, mental and general fatigue, and a reduced activity and motivation associated with age. Exhaustion, cardiovascular and musculoskeletal complaints also increased. This was accompanied by a reduced health satisfaction and increased depression scores. Marked increases of certain complaints occurred in specific age groups. CONCLUSIONS Community data provide important reference points in evaluating the ageing male. Based on regression analyses we could also demonstrate the contribution of psychosocial vulnerability and protective factors to the development of age-related symptoms.

Dyadic affective interactive patterns in the intake interview as a predictor of outcome.

Abstract Facial affective behavior of patients and therapists is assumed to be closely related to patients’ interpersonal patterns and therapists’ involvement in these patterns. In this study, facial affect displays of patients and therapists during intake interviews were analyzed to determine their impact on the outcome of the subsequent short-term inpatient psychotherapy. Interviews of ten successful and ten unsuccessful patients (15 female, five male) with two therapists were analyzed with Friesen and Ekmans EMFACS procedure. Feeling states of patients and therapists were registered using the Differential Affect Scale. Reciprocal dyadic patterns of facial affect were determined based on the same lead affect of patient and therapist. As expected, reciprocal patterns predicted an unsuccessful treatment outcome and showed a correlation to positive feeling states in the therapist during the interview. Our data suggest that, in unsuccessful cases, therapists became overly involved in patients’ interpersonal patterns.

Psychosomatic aspects in the diagnosis and treatment of erectile dysfunction.

Summary. After a critical review of prevalence data, psychosocial determinants and psychosomatic aspects in the diagnosis and treatment of erectile dysfunction are discussed (with reference to age‐related changes). Widely used laboratory assessments are responsive to psychological factors (e.g. anxiety). Inclusion of the partner in the diagnostic process may change the clinical picture and the treatment recommendations considerably. As illustrated by penile prosthetis treatment and self‐injection of vasoactive substances, acceptance and success of widely used surgical and medical treatments depend largely upon the patients expectations, and the adaptation of the couple to the procedure. Even in cases with a clear organic pathology, fluctuations in erectile functioning may be attributable to psychological influences. As recent psychotherapeutic and psychoeducational approaches underscore, erectile failure is best conceived as a final common pathway of somatic, lifestyle, psychological and partnership determinants. These should be taken into account in comprehensive diagnostic and treatment formulations if the goal of therapy is not only to produce rigid erections, but to increase sexual satisfaction.

Sexuality of the Elderly

Partial androgen deficiency of the aging male is associated with symptoms collectively accepted as the andropause syndrome. The underlying hormonal changes, the definition of age-dependent cofactors for changing sexuality, and the data on decreasing erectile function are the main topics of this critical analysis. Alterations in libido, ejaculation and sperm quality also have to be considered in order to define a change in male sexuality as part of the natural process of aging.

[Symptoms or complaints in the aging male--which questionnaires are available?].

ZusammenfassungBeim alternden Mann werden neben Veränderungen androgener Zielorgane, Störungen der sexuellen Funktion, multiple körperliche vegetative Beschwerden, affektive und kognitive Veränderungen beschrieben. Es besteht Konsens darüber, dass für eine Substitutionstherapie nicht allein der Hormonspiegel maßgeblich ist, sondern auch korrespondierende Symptome und Befindlichkeitsstörungen vorhanden sein müssen. Vorhandene Messverfahren zur Erfassung von Symptomen und Befindlichkeitsstörungen des alternden Mannes werden auf dem Hintergrund von Testgütekriterien diskutiert. Zunehmend gebräuchlich sind Fragebögen. Diese haben den Vorteil, dass sie ökonomisch und unabhängig vom Untersucher sind.Um das breite Spektrum altersassoziierter Veränderungen abzubilden, stehen zahlreiche standardisierte Verfahren zur Verfügung. Diese sind aber in der Regel nicht speziell zur Erfassung androgenabhängiger Veränderungen entwickelt worden. Erste spezielle Aging-male-Fragebögen korrelieren nicht zuverlässig mit Testosteronspiegeln. Hier besteht Forschungs- und Entwicklungsbedarf, um androgenabhängige Befindlichkeitsstörungen zu identifizieren und zu erfassen.AbstractAge associated hypoandrogenism and related changes in sexual function, as well as multiple physical complaints, and affective and cognitive changes have all been described in the aging male. In addition to decreased testosterone levels, clinical symptoms are required in order to perform substitution therapy. The assessment of symptoms and complaints in the aging male is discussed based on scientific test criteria. Commonly used questionnaires have the advantages of economy and independence from the investigator. In order to cover the broad range of age associated changes, numerous standardized and reliable procedures are available. However, these have usually not been developed specifically in order to assess androgen dependent changes. Preliminary, specific “aging male” questionnaires do not correlate reliably with the levels of testosterone. Thus there is a need for research and development in order to identify and assess androgen dependent complaints.

Berufsbezogene Einstellungen, Ressourcen und Risikomerkmale im Therapieverlauf:

Zusammenfassung. Hintergrund. Das Fehlen standardisierter Messverfahren ist hinderlich fur die psychotherapeutische Diagnostik und Bearbeitung berufsbezogener Belastungen und Konflikte. Der AVEM (Arbeitsbezogenes Verhaltens- und Erlebensmuster) erfasst Selbstbeschreibungen berufsbezogener Einstellungen, Bewaltigungsressourcen und Risikomerkmale differenziert und okonomisch, wurde allerdings an nicht- klinischen Stichproben (Lehrerinnen, Fuhrungskrafte) entwickelt. Fragestellung: Uberprufung der Eignung des AVEM fur psychisch und psychosomatisch Kranke. Methode: 644 Patientinnen und Patienten wurden bei Aufnahme zur stationaren psychosomatischen Rehabilitation, Entlassung und 3-Monatskatamnese (N = 329) untersucht. Ergebnisse: Faktorenstruktur und Reliabilitat wurden repliziert. Korrelationen mit weiteren Selbstbeschreibungsverfahren ergaben Validitatshinweise. Selbsteinschatzungen berufsbezogener Ressourcen veranderten sich wahrend der Therapie in Richtung auf die Normstichprobe. Schlussfolgerungen: Es ha...

Symptomatik oder Befindlichkeitsstörungen des alternden Mannes—Welche Fragebögen stehen zur Verfügung?

ZusammenfassungBeim alternden Mann werden neben Veränderungen androgener Zielorgane, Störungen der sexuellen Funktion, multiple körperliche vegetative Beschwerden, affektive und kognitive Veränderungen beschrieben. Es besteht Konsens darüber, dass für eine Substitutionstherapie nicht allein der Hormonspiegel maßgeblich ist, sondern auch korrespondierende Symptome und Befindlichkeitsstörungen vorhanden sein müssen. Vorhandene Messverfahren zur Erfassung von Symptomen und Befindlichkeitsstörungen des alternden Mannes werden auf dem Hintergrund von Testgütekriterien diskutiert. Zunehmend gebräuchlich sind Fragebögen. Diese haben den Vorteil, dass sie ökonomisch und unabhängig vom Untersucher sind.Um das breite Spektrum altersassoziierter Veränderungen abzubilden, stehen zahlreiche standardisierte Verfahren zur Verfügung. Diese sind aber in der Regel nicht speziell zur Erfassung androgenabhängiger Veränderungen entwickelt worden. Erste spezielle Aging-male-Fragebögen korrelieren nicht zuverlässig mit Testosteronspiegeln. Hier besteht Forschungs- und Entwicklungsbedarf, um androgenabhängige Befindlichkeitsstörungen zu identifizieren und zu erfassen.AbstractAge associated hypoandrogenism and related changes in sexual function, as well as multiple physical complaints, and affective and cognitive changes have all been described in the aging male. In addition to decreased testosterone levels, clinical symptoms are required in order to perform substitution therapy. The assessment of symptoms and complaints in the aging male is discussed based on scientific test criteria. Commonly used questionnaires have the advantages of economy and independence from the investigator. In order to cover the broad range of age associated changes, numerous standardized and reliable procedures are available. However, these have usually not been developed specifically in order to assess androgen dependent changes. Preliminary, specific “aging male” questionnaires do not correlate reliably with the levels of testosterone. Thus there is a need for research and development in order to identify and assess androgen dependent complaints.