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Biomedical subjects

L R Schover

Publications and source records attributed to L R Schover.

At least 19 recordsLinked to original sources
PubMed1992

Psychosexual aspects of the evaluation and management of vulvar vestibulitis.

OBJECTIVE: This article describes the structure and outcome of a collaboration between a gynecologist and a psychologist in evaluating and treating 45 consecutive women with vulvar vestibulitis. STUDY DESIGN: Women were interviewed by the psychologist in a structured format and also filled out questionnaires. Vulvar lesions were defined by clinical examination and colposcopy, and a conservative local excision was performed, without mobilization of the vagina. Postoperatively, women were offered sexual counseling including Kegel exercises, vaginal dilation, and couple therapy. Follow-up data were gathered a mean of 8 months after treatment. RESULTS: Of the 32 women who had both surgical excision of vulvar lesions and contact with the psychologist, 50% were much improved in perceived pain, 41% were somewhate improved, and 9% were unimproved. Factors predictive of an improved outcome included willingness to have psychologic treatment, higher socioeconomic status, and self-report of specific, localized areas of vulvar pain rather than vague, diffuse pain. Parous women were more likely to improve. Those who reported increased pain intensity premenstrually had poorer outcomes. CONCLUSIONS: Vulvar vestibulitis may be a syndrome that results from interacting pathophysiologic and psychologic factors, so that a comprehensive treatment approach is beneficial. Women who have diffuse genital pain or who refuse psychologic intervention may be poor candidates for surgery.

Adult↗
PubMed1992

Psychological aspects of donor insemination: evaluation and follow-up of recipient couples.

OBJECTIVE: To evaluate the utility of psychological screening for couples entering a donor insemination program. DESIGN: Each spouse completed questionnaires. A psychologist reviewed them and rated the psychological fitness of the couple for participation in the program. Follow-up questionnaires were sent to each couple at a mean of 11 months after entry into the program. SETTING: Applicants for donor insemination were studied in an infertility program in a large, tertiary referral center. PATIENTS, PARTICIPANTS: Consecutive applicants to enter the donor insemination program were required to participate in the initial evaluation. INTERVENTIONS: Couples judged by the psychologist to be at risk for a poor psychological outcome had an assessment and counseling interview with the psychologist before proceeding with insemination. MAIN OUTCOME MEASURES: Initially, the Stress and Infertility Questionnaire measured specific anxieties related to donor insemination, marital and sexual impact, and attitudes about confidentiality; the Brief Symptom Inventory measured psychological distress; and the Dyadic Adjustment Inventory assessed marital satisfaction. At follow-up, 48% of couples returned a modified version of the Stress and Infertility Questionnaire and the other two questionnaires. RESULTS: The psychologist's rating was predictive of pregnancy rates (59% for excellent candidates, 41% for acceptable couples, and 14% for couples psychologically at risk). At-risk couples were more likely to drop out of the program (50% versus only 20% of other couples). Sexual problems were reported by 59% of women and 53% of men. Couples believed that a child should not be told of the donor insemination (74% of wives and 80% of husbands). Initially, 64% of wives and 70% of husbands chose total secrecy with families or friends, and these attitudes shifted little over time. CONCLUSION: This screening procedure is cost-effective and suggests that psychological intervention should be attempted with at-risk couples.

Adult↗
PubMed1992

The personality and motivation of semen donors: a comparison with oocyte donors.

Seventeen consecutively recruited candidates for semen donation were evaluated by a psychologist with testing and a structured interview. Most men (71%) were motivated by financial compensation. Only 29% would donate semen if records were open to potential offspring. Fifty-nine per cent of the men were rated as excellent candidates from a psychological perspective and 35% were rated as acceptable with slight reservations. One was excluded as a donor. Psychological testing revealed mildly abnormal subscale scores for 35% of donors. Forty-seven per cent had histories of minor depressive or anxiety episodes and 35% had had periods of heavy alcohol use. Compared to oocyte donors at the same institution, the men were less altruistic, more affluent, and more likely to have abused alcohol. Women had more traumatic family and reproductive histories. Psychological evaluation can be a valuable tool in gamete donor selection.

Confidentiality↗
PubMed1991

Psychological follow-up of women evaluated as oocyte donors.

Forty-five women were evaluated as candidates to donate oocytes to an infertile couple. Twenty-four women completed a cycle as oocyte donors. Follow-up data on donor satisfaction were obtained for 23 women. Ninety-one per cent were moderately to extremely satisfied with the experience and 74% would donate for another cycle if given the chance. Transient adverse psychological symptoms were reported by two donors but were resolved with medical or psychological treatment. Two women became pregnant soon after donation, one unintentionally. Psychological risk factors predicted donor candidates' decisions to participate and their compliance but were not predictive (within the group that completed a cycle) of donor satisfaction as follow-up or recipient pregnancy.

Adult↗
PubMed1991

Establishment of an oocyte donor program. Donor screening and selection.

IVF with donated oocytes, followed by embryo placement in the uterus of a recipient who has been primed with exogenous steroids, is a successful treatment for special cases of infertility. Preliminary results indicate that the success rate in this situation is even greater than that usually seen with normal IVF (with placement of the embryos back into the uteri of the women from whom the oocytes were recovered). Although different sources for donated oocytes have been identified, the use of "excess" oocytes from IVF cycles and the attempted collection of oocytes at the time of otherwise indicated pelvic surgery have ethical and practical problems associated with their use. We have herein described the establishment of a successful program relying on anonymous volunteers who go through ovarian stimulation, monitoring, and oocyte recovery procedures solely to donate oocytes. The potential donors go through an exhaustive screening and education process before they are accepted in the program. Psychological evaluation of our potential donors indicated a great degree of turmoil in their backgrounds and a wide variety of motivations for actually participating. Despite the extensive educational and screening process, a substantial percentage of the donors did not complete a donation cycle, having either voluntarily withdrawn or been dropped because of lack of compliance. Further investigation of the psychological aspects of participating in such a program is certainly warranted. The use of donated oocytes to alleviate specific types of infertility is quite successful, but the application of this treatment is likely to be limited by the relative unavailability of suitable oocyte donors.

Adult↗
PubMed1990

Intracavernous injection therapy: analysis of results and complications.

Experience with 100 patients who used intracavernous injection therapy with a combination of papaverine with or without phentolamine for 29 months is analyzed in detail. The largest group of patients had vasculogenic erectile failure (56%). At the end of followup 50% of the patients were no longer performing injection. Those who discontinued injection therapy were slightly older and had more vasculogenic erectile failure. The nonfibrotic complications were mild in all instances and did not result in discontinuation of injection therapy. These complications consisted of small hematomas in 20.9% of the patients, mild discomfort in 13.6% and mild liver enzyme abnormalities in 9.8%. No episode of priapism or infection occurred during therapy. Fibrotic complications consisted of nodules or plaques, and correlated significantly with the number of months on injection and the number of injections. At 12 months the fibrotic complication rate was 31 +/- 8.6%. Our study suggests caution regarding the long-term complication rate of intracavernous injection therapy with these compounds and underscores the importance of routine followup examinations. While injection therapy is an effective form of treatment for erectile failure, it is not a satisfactory alternative for many patients and is associated with a significant fibrotic complication rate.

Drug Therapy, Combination↗
PubMed1990

Sexuality, fertility, and renal transplantation: a survey of survivors.

A questionnaire on sexual function and fertility was completed by 54 men and 36 women, at an average of 3 years after successful renal transplant. Sexual desire increased significantly compared to reports of levels 6 months pretransplant. Men also had improved erectile function and ability to reach noncoital orgasms. About a quarter of men and women remained sexually dysfunctional, however. The frequency of sexual activity and overall sexual satisfaction did not improve significantly. Marital status and satisfaction were in the normal range for this group, except that those who became ill before adulthood were less likely to have married or have had children. Infertility was a major concern for 10% of the sample. Regular menstrual cycles were present in 64% of women under age 50, representing a significant improvement after transplantation. Three men fathered a child and two women became pregnant after transplantation. Most patients wanted more information on sexuality, fertility, and renal disease.

Adult↗
PubMed1989

Sexual dysfunction and treatment for early stage cervical cancer.

Assessment of sexual frequency, function, and behavior, as well as martial happiness and psychological distress was performed for 61 women with early stage, invasive cervical cancer at the time of diagnosis. Cancer treatment was radical hysterectomy alone for 26 women and radiotherapy with or without surgery for 37. Followups took place at 6 and 12 months after cancer therapy. Women's sexual satisfaction, capacity for orgasm, and frequency of masturbation remained stable, whereas frequency of sexual activity with a partner and range of sexual practices decreased significantly by one year. Women who received irradiation with or without surgery resembled women who underwent radical hysterectomy alone at 6 months. By one year, however, the radiotherapy group had developed dyspareunia, which was reflected in gynecologist ratings at pelvic examination. The women receiving radiotherapy also had more problems with sexual desire and arousal, and were less likely to resume several daily life activities. Cancer treatment modality was not related to marital happiness or stability, however.

Activities of Daily Living↗
PubMed1989

A program for matched, anonymous oocyte donation.

The authors' program for matched, anonymous oocyte donation has resulted in two successful pregnancies among the first eight oocyte recipients. All oocyte recipients to date have had ovarian failure or absence with premature ovarian failure the most common cause. All recipients were cycled on a program of incremental oral micronized estradiol and intramuscular progesterone-in-oil. Thirteen candidates for oocyte donation were screened to obtain 8 donors. One donor candidate was excluded because of her medical history. The psychological screening of 2 of the other donor candidates (who subsequently did not complete the donation cycle) revealed a primary motive of financial gain. In general, the psychological profiles of donor candidates revealed a high incidence of troubled families and either reproductive loss or loss of a parent. Ovarian stimulation of the donors followed our standard in vitro fertilization protocol. The recipients' exogenous steroid replacement continued until days 97 and 101, respectively, of the two gestations. Both pregnancies resulted in the delivery of normal singleton males--the first at 40 weeks, the second at 35 weeks.

Adult↗
PubMed1989

Sex therapy for the penile prosthesis recipient.

In conclusion, the evidence for technical success of the penile prosthesis is clear, but more detailed follow-up studies suggest that a large minority of patients and partners fail to achieve sexual satisfaction. If the goal of surgery is to restore sexual frequency, variety, and pleasure to optimal levels, an integrated treatment program that incorporates sex therapy may be more successful than implantation alone. The type of sex therapy required depends on the risk factors present for postsurgery sexual dissatisfaction. A majority of patients can benefit from several sessions of brief sexual counseling preoperatively, with routine follow-up at 3 and 6 months after surgery to identify problems in resuming sex successfully. I also would point out that an integrated treatment approach is just as applicable to home intracavernosal injection programs. Including sex therapy in the package might reduce the large drop-out rates currently being seen and might decrease the risk of misuse of these medications.

Consumer Behavior↗
PubMed1988

Brief sexual counseling for medical patients: a workshop for training professionals.

Most sexual concerns and dysfunctions in medical patients are unrecognized because neither patient nor health care team addresses the issue. A 5-day workshop is presented in detail so that clinicians specializing in treating sexual problems can educate primary care professionals in assessing sexual problems and providing brief sexual counseling. Suggestions for truncating the workshop or tailoring it to specific audiences are also included.

Curriculum↗
PubMed1987

Sexuality and fertility in urologic cancer patients.

With the advent of effective treatment for urologic cancer, the preservation of sexual function and fertility has become an important goal. Some cancer treatments damage the physiological systems involved in reproduction. All have a psychological impact on sexuality. For men with prostate cancer, current issues in sexual rehabilitation include the debate on nerve-sparing radical prostatectomy, the role of vascular damage in causing erectile dysfunction after radiotherapy, and the need for a better understanding of hormonal effects on central and peripheral mechanisms of sexual function. In the treatment of men and women with bladder cancer, the sexual function morbidity of radical cystectomy is described in data from prospective interview studies. Sexual desire and orgasm remain normal after surgery despite disruption of the genital vasocongestion accompanying sexual arousal. Long-term follow-up studies of testicular cancer patients suggest that some increase in sexual dysfunction does occur. Infertility remains a concern for a subgroup of younger, childless men. Attempts to modify or eliminate retroperitoneal lymphadenectomy are discussed, as is recovery of spermatogenesis after chemotherapy and radiotherapy. Sexual function in patients with penile, urethral, or renal cell carcinoma is briefly reviewed.

Adult↗
PubMed1987

Sexual rehabilitation in a cancer center: diagnosis and outcome in 384 consultations.

A program of sexual rehabilitation in a cancer center evaluated 308 men and 76 women, using a structured interview. The site of the malignancy was pelvic or genital in 79% of men and 58% of women. Most patients (73%) had one or two sessions of sexual counseling, but therapy was more intensive for about a quarter of patients. Partners were included in counseling by 28% of women and 56% of men. Although cancer patients and spouses of patients reported similar rates of sexual dysfunction before cancer diagnosis, after cancer treatment husbands and wives of patients maintained stable sexual function, while dysfunctions increased dramatically in all categories except premature ejaculation for patients. Patients who were older or had pelvic/genital tumors were more likely to develop arousal-phase sexual dysfunctions. Psychological distress was correlated with rates of low sexual desire and dyspareunia in both men and women. The success of treatment in reversing sexual dysfunction was rated by the therapist in 118 cases. Patients who were younger, who were not clinically depressed, and who had less conflicted marriages had more positive outcomes. Good outcome was also associated with a longer duration of treatment.

Adult↗
PubMed1986

Sexual and marital relationships after radiotherapy for seminoma.

Questionnaires on sexual function, marital status, and fertility were returned by 84 men who received radiotherapy for seminoma (Stage I, II, or III). The mean length of follow-up was ten years. Although 93 per cent were married, 19 per cent had low rates of sexual activity, 12 per cent reported low sexual desire, 15 per cent had erectile dysfunction, 10 per cent had difficulty reaching orgasm, and 14 per cent had premature ejaculation. The most common problems were reduced intensity of orgasm (33%) and reduced semen volume (49%). Twenty-one men remained childless, and 30 per cent of men worried at least occasionally about infertility. Thirteen children were conceived after cancer therapy. The data suggest that sexual dysfunction and infertility are important concerns for a subgroup of men treated for seminoma.

Adult↗
PubMed1986

Sexual rehabilitation and male radical cystectomy.

Sexual function was assessed before radical cystectomy in 112 men: 20 per cent were sexually inactive and 35 per cent had erectile dysfunction. Sexual function before cystectomy was an index of general health status and correlated significantly with survival free of disease. Followup data on sexual function were provided by 73 men at an average of 13 months postoperatively. After cystectomy, which was performed via standard operative techniques, 91 per cent of the men experienced some degree of erectile dysfunction but 50 per cent remained sexually active, at least using noncoital stimulation. Thirteen men chose to have a penile prosthesis implanted. Sexual counseling was rated as satisfactory by 80 per cent of the men.

Adult↗
PubMed1985

Sexual and marital relationships after treatment for nonseminomatous testicular cancer.

Data from 121 patient questionnaires suggest that treatment for nonseminomatous testicular cancer not only causes sterility but also disrupts marital and sexual happiness in 10 to 20 per cent of patients. Treatment included unilateral orchiectomy and retroperitoneal lymphadenectomy alone in 47 men; 30 had additional chemotherapy, 8 had additional radiotherapy, and 26 were treated with all three modalities. Erectile and orgasmic problems were more prevalent when radiotherapy was included. Compared with healthy men, patients reported less sexual activity, lower sexual desire, more erectile dysfunction, more difficulty achieving orgasm, reduced orgasmic intensity, and, for 82 per cent, a greatly reduced semen volume. The longer the time since treatment, the more likely the patient was to have antegrade ejaculation. Although the patients' 12.8 per cent divorce and/or separation rate is not unusually high, those whose marriages ended cited sexual dysfunction and cancer treatment as significant sources of stress. Sterility was a frequent source of anxiety for one quarter of the patients.

Adolescent↗
PubMed1985

Sexual function and female radical cystectomy: a case series.

We interviewed 9 sexually active women about sexual function before and after radical cystectomy. Of the women 6 also had received preoperative irradiation. Seven women resumed sexual activity. All subjects experienced dyspareunia on initial attempts but 6 had overcome the pain at followup 6 to 37 months postoperatively. These women were coitally orgasmic and reported no decrease in pleasure or change in the type of sexual stimulation required to produce orgasm. The results provide knowledge about the physiology of female orgasm and a basis for counseling patients.

Adult↗