PubMed Health⌕ Search

Biomedical subjects

M E Metz

Publications and source records attributed to M E Metz.

13 recordsLinked to original sources
PubMed1997

Premature ejaculation: a psychophysiological review.

This review examines the most common male sexual dysfunction, premature ejaculation (PE). The prevalence, classification, neurophysiology, neuropharmacology, and psychological studies that offer evidence useful for understanding and clinically evaluating PE are reviewed. It is proposed that there are two basic kinds of PE: biogenic and psychogenic. Studies reporting pharmacological aspects of ejaculation offer some suggestions regarding the mechanisms of ejaculation as well as possible pharmacologic aid for some premature ejaculators. The traditional assumption among sex therapists that PE is almost universally caused by psychological features, and easily treated with sex therapy behavioral techniques, is drawn into question. Based on the limited available results from systematic investigations, behavioral treatments for PE remain beneficial to only a minority of men three years after treatment ends, suggesting that this male dysfunction is difficult to treat effectively. The mediocre results reported in treatment outcome studies may be due, in part, to reports on heterogeneous groups of premature ejaculators, for whom treatment has been generalized rather than targeted to the specific type of PE. We propose a biological and psychological etiology. With more discriminating assessment and more specific diagnosis of PE, and with treatment designed to address the particular type of PE, long-term outcome should improve for this common sexual dysfunction.

Antidepressive Agents↗
PubMed1997

Sexual difficulties, concerns, and satisfaction in homosexual men: an empirical study with implications for HIV prevention.

Minimal research has investigated the prevalence of sexual disorders in homosexual men. We examined sexual performance concerns, problems, and satisfaction in a convenience sample of 197 homosexual men who attended a health seminar. Sexual dysfunction and sexual concerns were found to be common problems. Almost all men reported some sexual difficulty over their lifetime, and more than half reported a current sexual difficulty. A further 25% of the sampled men identified other sexual concerns as well. Despite these figures, most participants-whether single, dating, or in a relationship-reported average to above-average sexual satisfaction. Correlates of sexual satisfaction included more liberal attitudes toward human sexuality, greater comfort with men's sexual attractions to other men, lower levels of internalized homophobia, and greater satisfaction with one's relationship status. Painful receptive anal intercourse appeared to be a common, yet previously underacknowledged, difficulty. Almost half of the respondents described HIV/AIDS as having a negative impact on their sexual functioning, with most reporting an increase in fear of sex as the major negative outcome.

Adult↗
PubMed1993

Relationship conflict management patterns among sex dysfunction, sex offender, and satisfied couples.

A substantial amount of research has distinguished specific behaviors of distressed from nondistressed couples. Among this evidence are differences in relationship conflict management styles. This investigation examined differences in relationship satisfaction and conflict management styles among 30 sex dysfunction, 25 sex offender, and 26 satisfied couples assessed by the Dyadic Adjustment Scale (DAS) and the Styles of Conflict Inventory (SCI). Results indicate significantly different levels of marital adjustment and distinctive conflict management patterns among the three couples groups. The two sex problem groups were significantly more distressed than the satisfied couples, and sex offender couples appeared more conflicted than sex dysfunction couples. Compared to satisfied couples, sex dysfunction couples address relationship conflict with somewhat polarized roles with an "avoid vs. engage" pattern, while sex offender couples employ a more chaotic "engage-avoid vs. engage-avoid" style. These different patterns of reactivity to conflict suggest that individualized treatment approaches to this dimension of the clinical picture is warranted.

Adaptation, Psychological↗
PubMed1992

A group therapy format for the simultaneous treatment of marital and sexual dysfunctions: a case illustration.

This report describes a brief, 15-session couples group therapy format developed by a university-affiliated human sexuality clinic for the simultaneous treatment of marital and sexual dysfunctions. The major marital and sexual themes addressed in this group treatment design, an overview and description of the structure of the cognitive-behavioral approach, and a case illustration are presented.

Cognitive Behavioral Therapy↗
PubMed1990

Men's expectations of physicians in sexual health concerns.

This study assessed 62 men for their expectations of primary care physicians in attending to sexual health concerns. The physician was the professional most preferred for consultation regarding sexual concerns, and men look for qualities of professionalism, empathy, trust, and comfort in their physician. While 97% of the men reported prior sexual concerns, only 19% had discussed these issues with their doctor. Most were hesitant, but wanted to deal with sex problems. They preferred that the physician initiate the discussion. These findings suggest an under-utilization of sexual health care by men and support the role of the primary care physician as an important sexual health provider.

Adolescent↗
PubMed1990

Napping and sleep disturbances in the elderly.

Elderly patients often describe sleep problems that present diagnostic dilemmas. This study sought to clarify the relationship between patients' reports of daytime napping and nocturnal sleep disturbances by surveying 132 older adults (ages 58-95). Prevalence, frequency, and duration of napping were analyzed with respect to (a) age and sex, and (b) indicators of nocturnal sleep disturbance, including awakenings, latency to sleep onset, and subjective estimates of sleep quality. Age had the greatest effect on napping, with older subjects taking more frequent and longer naps. Although a non-significant trend suggested that the duration of naps may be associated with increased difficulty initiating nocturnal sleep, no significant relationship was observed between any reported napping dimension and indicators of nocturnal sleep difficulty except for a small subgroup who used pharmacologic sleep aids.

Aged↗
PubMed1988

Women's expectations of physicians in sexual health concerns.

This study surveyed 56 women to assess their expectations for the primary care physician to inquire about sexual concerns and to diagnose and treat sexual problems. The study indicates that the physician is the professional most frequently consulted about sexual concerns and that patients expect even more leadership from the physician in raising the issue of sexual health. Women look for empathy, warmth, confidentiality, and professional competence in discussions with their doctor about sexual matters; and they are open to referrals for treatment of sexual problems and physician-sponsored sex education programs.

Adult↗
PubMedDate not supplied

Premature ejaculation: a psychophysiological approach for assessment and management.

This article distinguishes several subtypes of biogenic and psychogenic premature ejaculation (PE) according to their etiologic features: the physiological PE types of (a) neurologic constitution, (b) acute physical illness, (c) physical injury, and (d) pharmacologic side effect; and the psychological PE types of (a) psychological constitution, (b) acute psychological distress, (c) relationship distress, and (d) psychosexual skills deficit. Attention is given to assessment and differential diagnosis, and to specific treatment of the types of PE, such as the pharmacologic management of difficult neurologic cases. Effective psychosexual treatment combines multiple strategies such as physiological relaxation, pubococcygeal muscle training, cognitive and behavioral pacing strategies, and the involvement of the partner in the therapy. Treatment should determine the specific type of PE and comprehensively address its particular features in order to improve long-term treatment effectiveness.

Combined Modality Therapy↗
PubMedDate not supplied

A new non-pharmacological vacuum therapy for female sexual dysfunction.

Although Female Sexual Dysfunction (FSD) affects 40% of American women, there is no FDA-approved pharmaceutical therapy. The EROS-CTD (Clitoral Therapy Device, UroMetrics, Inc., St. Paul, MN) treatment is the first FDA cleared-to-market therapy for FSD. Clitoral engorgement is believed to play an important role in female sexual arousal and overall sexual satisfaction. The EROS-CTD is a small, battery-powered device designed to enhance clitoral engorgement, increase blood flow to the clitoris, and ultimately improve arousal in women with FSD. The objective of this study was to assess the effectiveness of the EROS-CTD on sexual arousal (genital sensation, vaginal lubrication, ability to reach orgasm, and sexual satisfaction) in normal volunteers and women with FSD.

Adult↗
PubMedDate not supplied

Sexual dysfunction, Part I: Classification, etiology, and pathogenesis.

BACKGROUND: The sexual dysfunctions are extremely common but are rarely recognized by primary care physicians. They represent inhibitions in the appetitive or psychophysiologic changes that characterize the complete adult sexual response and are classified into four major categories: (1) sexual desire disorders (hypoactive sexual desire, sexual aversion disorder), (2) sexual arousal disorders (female sexual arousal disorder, male erectile dysfunction), (3) orgasmic disorders (inhibited male or female orgasm, premature ejaculation), and (4) sexual pain disorders (dyspareunia, vaginismus). METHODS: Articles about the sexual dysfunctions were obtained from a search of MEDLINE files from 1966 to the present using the categories as key words, along with the general key word "sexual dysfunction." Additional articles came from the reference lists of dysfunction-specific reviews. RESULTS AND CONCLUSIONS: Cause and pathogenesis span a continuum from organic to psychogenic and most often include a mosaic of factors. Organic factors include chronic illness, pregnancy, pharmacologic agents, endocrine alterations, and a host of other medical, surgical, and traumatic factors. Psychogenic factors include an array of individual factors (e.g., depression, anxiety, fear, frustration, guilt hypochondria, intrapsychic conflict), interpersonal and relationship factors (e.g., poor communication, relationship conflict, diminished trust, fear of intimacy, poor relationship models, family system conflict), psychosexual factors (e.g., negative learning and attitudes, performance anxiety, prior sexual trauma, restrictive religiosity, intellectual defenses), and sexual enactment factors (e.g., skill and knowledge deficits, unrealistic performance expectations). Understanding the cause and pathophysiology of sexual disorders will help primary care physicians diagnose these problems accurately and manage them effectively.

Humans↗
PubMedDate not supplied

Sexual dysfunction, Part II: Diagnosis, management, and prognosis.

BACKGROUND: Sexual problems are common but infrequently diagnosed. They are classified into four major categories: (1) sexual desire disorders, (2) sexual arousal disorders, (3) orgasmic disorders, and (4) sexual pain disorders. METHODS: MEDLINE files from 1966 to the present were searched using the specific sexual dysfunctions as key words along with the general key word "sexual dysfunction" to review the published literature. Additional articles came from the reference lists of dysfunction-specific reviews. RESULTS AND CONCLUSIONS: The key to diagnosis often rests on the physician's willingness to raise the issue with patients. A rational protocol can be followed to identify causative organic and psychogenic factors using the psychosexual and medical history, a comprehensive physical examination, psychological assessment instruments, laboratory tests, and special procedures. Current psychological treatment includes one or more of the following components: sensate focus exercises, cognitive-behavioral therapy, relaxation training, hypnosis and guided imagery, and group therapies. Specific techniques, such as directed self-stimulation, the stop-start and squeeze techniques, the sexological examination, systematic desensitization, and Kegel exercises, are added therapy when appropriate. Marital therapy to improve communication and resolve conflict is also part of standard therapy. Medical management can include pharmacologic agents to correct endocrine dysfunctions or to alter the progression of the sexual response. Surgical management can involve arterial revascularization, venous ligation, and penile implants. A noninvasive vacuum constriction device is also used to treat erectile disorders. The long-term prognosis of the sexual dysfunctions varies with the type of disorder and its causes. Generally good results (80 to 95 percent satisfaction) are obtained when treating vaginismus, dyspareunia, male erectile disorders, and female orgasmic dysfunctions. Long-term results are modestly successful (40 to 80 percent) when treating inhibited male orgasm and premature ejaculation. Long-term success is poorest at present for treating sexual desire disorders.

Clinical Protocols↗