Richard A. Carroll

NOCTURNAL PENILE TUMESCENCE AND RIGIDITY IN MEN WITHOUT COMPLAINTS OF ERECTILE DYSFUNCTION USING A NEW QUANTITATIVE ANALYSIS SOFTWARE

Nocturnal penile tumescence and rigidity data were collected during 3 successive nights of home monitoring from 44 men screened for normal sexual functioning. The subjects were well distributed during the interval with an age of 31 to 81 years. Penile brachial indexes, biothesiometry measures and testosterone levels were evaluated. Two new time-intensity measures of tumescence (tumescence activity units) and rigidity (rigidity activity units) were used to summarize erectile activity. A high correlation (r > 0.84, p < 0.001) was found between these summary parameters. It was observed that at least 2 nights of monitoring were required to characterize a subject adequately because some men had single nights with no measurable erectile activity. There were low correlations among penile brachial index, biothesiometry and testosterone outcomes, and nocturnal penile tumescence and rigidity measurements. There was a decrease in measurements of tip rigidity with increasing subject age (r = -0.238, p < 0.05) and an increase in tip rigidity associated with penile girth during erectile events (r = 0.505, p < 0.001). Cumulative distributions of rigidity and tumescence activity units were developed to permit a simple, direct comparison of other nocturnal penile tumescence and rigidity findings to results in the study population.

The Impact of Breast Cancer and Its Treatment on Marital Functioning

This article reviews the research that has examined the impact of breast cancer and its treatment on the patients marital relationship. Breast cancer and its treatment affect not only the patient, but also her intimate partner and their relationship, including their communication, sexual relationship, and role identities. Both positive and negative effects of the experience have been identified. Predictors of marital adjustment following breast cancer are also reviewed, including demographic factors, illness factors, and characteristics of the couple. The strongest predictor of the impact of the cancer experience appears to be the premorbid quality of the relationship. A methodological critique identifies limitations of past research, and suggestions for future research are addressed. Finally, two theoretical paradigms that may account for the impact of breast cancer on relationships are discussed.

Outcomes of Treatment for Gender Dysphoria

This paper reviews the empirical research on the psychosocial outcomes of treatment for gender dysphoria. Recent research has highlighted the heterogeneity of transgendered experiences. There are four possible outcomes for patients who present with the dilemma of gender dysphoria: an unresolved outcome, acceptance of ones given gender, engaging in a cross-gender role on a part-time basis, and making a full-time transition to the other gender role. Clinical work, but not empirical research, suggests that some individuals with gender dysphoria may come to accept their given gender role through psychological treatment. Many individuals find that it is psychologically sufficient to express the transgendered part of themselves through such activities as cross-dressing or gender blending. The large body of research on the outcome of gender reassignment surgery indicates that, for the majority of those who undergo this process, the outcome is positive. Predictors of a good outcome include good pre-reassignment ...

New Women: Sexological Outcomes of Male-to-Female Gender Reassignment Surgery

This research study investigated sexological outcomes of gender reassignment surgery in 17 postoperative male-to-female transsexuals (new women). Study procedures included self-report questionnaires, a structured interview, a medical history and physical examination with gynecological evaluation (the New Womans Gynecological Index), and neovaginal blood flow assessment by photoplethysmography. The results of descriptive analysis, correlational analysis, discriminant analysis, and multiple regression analysis identifying predictors of good sexual functioning are presented. Gender reassignment was rated as successful by 94% of the new women. Two-thirds of the new women were orgasmic. The best predictors of orgasmic potential were genital sensitivity and congruence between gender identity and body. The best predictors of sexual satisfaction were the Stress Inventory total score and the genital neurosensory evaluation. The best predictors of overall success of gender reassignment were vaginal depth and vulva...

Patient characteristics and attendance patterns in outpatient group psychotherapy.

A study of over 700 referrals for group therapy within a large university hospital setting revealed that such services were primarily provided for moderately to severely disturbed patients, mostly ...

Same-Sex Domestic Violence: Prevalence, Unique Aspects, and Clinical Implications.

Domestic violence is a significant public health issue. Prevalence rates for same-sex domestic violence vary because of methodological issues related to recruitment and definitions of sexual orientation. However, such prevalence rates are currently considered to be similar to slightly greater than other-sex prevalence rates. Research has identified differences between same-sex domestic violence and other-sex domestic violence, including internalized and externalized stressors associated with being a sexual minority that interact with domestic violence to create or exacerbate vulnerabilities, higher risk for complex trauma experiences, and difficulties accessing services. This review provides a critical review of the literature, focusing upon empirical findings regarding same-sex domestic violence.

Couple-based treatment for sexual problems following breast cancer: A review and synthesis of the literature

PurposeAlthough there are many physical and psychological impacts on women’s sexuality following breast cancer diagnosis and treatment, sexual problems often remain unaddressed in these cancer survivors. Given the crucial role of the partner in sexual issues, couple-based sex therapy would appear to be a logical first-line treatment for this population, but there is scant research on the efficacy of couple-based treatments and/or sex therapy in breast cancer survivors.MethodsA review of the literature was conducted using the PMC, PsycINFO, EMBASE, and MEDLINE databases. Articles were included that presented the results of an experimental or quasi-experimental clinical trial evaluating a psychosexual intervention for couples, targeted women diagnosed with breast cancer and their partners, and included outcome measures of sexual function and sexuality. Studies were excluded if the primary intervention was not focused on sexual problems or if they were published in a language other than English.ResultsFrom 2231 records, five articles met criteria for inclusion in the present review. Couple-based sex therapy appears to be an effective and highly accepted treatment for addressing sexual problems in breast cancer patients. These interventions were associated with improvements in sexual physiology, sexual functioning, sexual self-image, and sexual relationships, as well as improved psychological well-being of both breast cancer patients and their partners.ConclusionsBased on this review, the authors address clinical implications, particularly incorporating psychological treatment for sexual problems in comprehensive cancer care, and provide recommendations for further study.

Sexual Function in Female Veterans: A Review.

Women comprise a significant proportion of the veteran population. Much research has been devoted to physical and mental health outcomes in veterans, both of which show significant decreases in quality of life. However, little is known about the effects of female veterans’ unique military experience on sexual function. In particular, military sexual trauma, general military stressors, mental health diagnoses, and other vulnerability factors contribute to sexual dysfunction, dissatisfaction, and decreases in mental health-related quality of life. We propose a model whereby all of these factors interact and contribute to sexual dysfunction in female veterans, and areas for growth in assessment and treatment are discussed.

Should Transvestic Fetishism Be Classified in DSM 5? Recommendations from the WPATH Consensus Process for Revision of the Diagnosis of Transvestic Fetishism

ABSTRACT The World Professional Association for Transgender Health (WPATH) conducted a consensus process in order to develop recommendations for the refinement of diagnoses for Gender Identity Disorders and Transvestic Fetishism for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). This article is the report of the work group on Transvestic Fetishism. It reviews the history of the diagnosis of Transvestic Fetishism in the DSM, the current DSM-IV-TR classification, and the prevalence and characteristics of the phenomenon of transvestic fetishism. The problems with the current diagnostic classification are reviewed. Based on the consensus process, a new diagnostic label and diagnostic criteria are presented. The new diagnosis is Transvestic Disorder, defined by two criteria: (a) recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing and (b) the fantasies, sexual urges, or behaviors are causing clinical distress or impairment in important areas of psychological functioning; that is, the distress is not solely due to external prejudice, stigma, or oppression.

Psychological Aspects of Erectile Dysfunction

Because the brain is intimately involved in the control of erections, a wide variety of psychological factors impact erectile response and may lead to erectile dysfunction (ED). This chapter reviews the assessment of psychological factors in ED, the immediate and underlying psychological conditions involved, and the development of ED over time. Outcome research on psychological treatments for ED is also reviewed. The goal of the chapter is to help health care providers to conduct a comprehensive evaluation of ED that is sensitive to psychological factors.