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Biomedical subjects

S B Levine

Publications and source records attributed to S B Levine.

At least 19 recordsLinked to original sources
PubMed1992

Twelve-month comparison of two treatments for erectile dysfunction: self-injection versus external vacuum devices.

This study directly compared two nonsurgical treatments for erectile dysfunction, self-injection of papaverine/phentolamine and external vacuum devices, in terms of usage rates, effectiveness, side effects, dropout rates, and impact on patient sexual and psychologic functioning. Both alternatives were regularly, successfully, and safely used by patients, though dropout rates were higher for self-injection. Both produced erections of improved quality, and effected sustained improvements in frequency of intercourse, orgasm, and sexual satisfaction. Spontaneous erections also improved with both treatments. General psychiatric symptomatology was decreased, and anxiety was improved. There were no differences between the two treatments in sexual or psychologic impact. Relative contraindications and esthetic considerations are presented.

Coitus↗
PubMed1992

Through the eyes of women: the sexual and psychological responses of women to their partner's treatment with self-injection or external vacuum therapy.

We prospectively delineated and contrasted the sexual, marital and psychological responses of women to their partner's use of 2 treatments for erectile dysfunction: 1) self-injection of papaverine and phentolamine, and 2) vacuum tumescence therapy. The women were assessed at 5 points during a 12-month period with psychometric questionnaires and clinical interviews. Statistical analysis indicated that the women responded equally well to both treatments. They demonstrated significant increases in frequency of intercourse, sexual arousal, coital orgasm and sexual satisfaction. No significant changes were noted on the psychometric questionnaires. The women reported feeling more at ease in their relationships and characterized sex as more leisurely, relaxed and assured. Negative responses focused on the lack of spontaneity and hesitation about initiating sex. Self-injection and vacuum pump therapy restore potency in men and secondarily facilitate improved sexual function in women.

Coitus↗
PubMed1991

Interim report of the DSM-IV Subcommittee on Gender Identity Disorders.

This article summarizes the discussions and recommendations of the DSM-IV Subcommittee on Gender Identity Disorders, a subcommittee of the Child Psychiatry Work Group, regarding diagnostic issues. The issues reviewed include placement in the nomenclature, the concept of a spectrum of gender dysphoria rather than discrete levels of symptomatology, criticisms of current diagnostic criteria, subtyping by sexual orientation, and proposed changes in diagnostic criteria for the current DSM-III-R diagnoses of Gender Identity Disorder of Childhood, Transsexualism, and Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type.

Adolescent↗
PubMed1991

Psychological intimacy.

Psychological intimacy develops between a speaker and a listener. Depending on how individuals fulfill these roles, intimacy may occur or be precluded. Intimacy quickly creates a bond and, if repeated, enhances psychological function. Psychological intimacy is the glue of all important relationships, including professional ones. It also is a powerful motivator of sexual expression and an enhancer of self-esteem. Because its effects are short-lived, psychological intimacy must be frequently reestablished. Mind reading and sexual intimacy, the short-cuts to the benefits of intimacy, are frequently employed to avoid telling about one's private experiences and listening respectfully.

Humans↗
PubMed1991

External vacuum devices in the treatment of erectile dysfunction: a one-year study of sexual and psychosocial impact.

This prospective study assessed the sexual and psychosocial effects of 12 months' use of an external vacuum device in the treatment of erectile dysfunction. Results showed that the external vacuum device produced erections sufficient for intercourse in 87% of the men in our sample. The dropout rate was only 20% over the 12-month period. Use of the external vacuum device was associated with improvements in men's and their partners' sexual functioning. These improvements included erections of better quality, increased partner arousal, and increased frequency of orgasm and sexual satisfaction for men and women. The external vacuum device was also associated with decreases in general psychiatric symptomatology for men. Similar improvements in psychological functioning were not found for partners. Side effects and factors in patient and partner acceptance of the external vacuum device are discussed.

Adaptation, Psychological↗
PubMed1991

Sexual, psychological, and marital impact of self-injection of papaverine and phentolamine: a long-term prospective study.

This prospective study assessed the long-term effects of self-injection of papaverine hydrochloride and phentolamine mesylate along several critical domains for 42 men and 26 partners. Over the course of one year, men were, on average, injecting themselves five times monthly, with 84% of these injections producing satisfactory erections. Treatment resulted in statistically significant improvements in quality of erection, sexual satisfaction, frequency of intercourse, and coital orgasm. The women also demonstrated significant improvement in sexual satisfaction, arousal, frequency of intercourse, and coital orgasm. Decreases in general psychiatric symptomatology were apparent for men but not for partners. The dropout rate was 57%. The common side effects of treatment were development of fibrotic nodules (26%), abnormal liver function values (30%), and bruising (19%). We conclude that self-injection should be considered among the accepted treatments for erectile dysfunction. It does appear to enhance the sexual lives of men and women when the treatment is efficacious and the couple is motivated to utilize it.

Adaptation, Psychological↗
PubMed1991

Informed consent in the electroconvulsive treatment of geriatric patients.

The past 15 years have been marked by an increasingly stringent regulatory atmosphere regarding the administration of ECT, leading to delays in treatment and declines in usage. Regulatory changes requiring judicial intervention in clinical decisions are driven by the notion that only the courts can provide adequate due process protections when legal rights and clinical need conflict. We retrospectively reviewed the documentation of the informed consent process for 62 geriatric patients receiving ECT to assess the degree to which clinicians conformed to the spirit of the informed consent doctrine in a state that allows significant clinical discretion in decisions to administer ECT to patients lacking decisional capacity. In the eight cases in which the patient's decisional capacity was questioned, we found appropriate documentation of the patient's failure to comprehend his condition or the proposed treatment, evidence of a high degree of family involvement in decision making, and extensive use of outside consultants to document decisional incapacity and the need for treatment. Evidence of family participation in decision making was present for a high percentage of cases in which decisional capacity was unquestioned. Our review demonstrated high compliance with the procedural safeguards contained in the state regulation and with the spirit of the informed consent doctrine.

Aged↗
PubMed1991

Diagnostic nasal endoscopy and functional endoscopic sinus surgery: an update and review of complications.

Diagnostic nasal endoscopy and functional endoscopic sinus surgery are relatively new techniques that have expanded our understanding of sinus physiology and the etiologies of sinus pathology. Diagnosis at an early stage of chronic sinus disease demonstrates that pathological changes are often limited to the osteomeatal complex and the anterior sinus group. Early disease refractory to aggressive medical management usually responds to surgical treatment. Surgery in this setting is most often performed under local anesthesia, without nasal packing, with an immediate improvement in the patient's symptoms, and with minimal risk of complications.

Chronic Disease↗
PubMed1978

Preservation of erectile function after aortoiliac reconstruction.

Men with aortoiliac atherosclerosis exhibit organic erectile dysfunction caused by inadequate blood flow and/or psychological factors. After aortoiliac reconstruction, organic erectile dysfunction may be due primarily to surgical interruption of autonomic nerve fibers. To avoid this, dissection principles preserving genital autonomic plexi were developed. The results of these dissections were compared with those of conventional bypasses. Thirty nondiabetic men (age range, 43 to 67 years) were studied. A history of erectile capacity was elicited preoperatively and evaluated postoperatively in follow-up interviews every six months. Normal postoperative erectile function was not affected by nerve-sparing dissections. Each of the 11 patients requiring conventional dissections was both preoperatively and postoperatively impotent. Four of the 19 patients who underwent nerve-sparing dissection were preoperatively and postoperatively impotent. Seven of these 19 patients maintained preoperative potency after nerve-sparing dissection. The potency of the remaining eight patients was either completely restored or improved after nerve-sparing dissection. This report emphasizes the importantance of a preoperative determination of a complex interplay of physical and psychological factors in erectile dysfunction.

Adult↗
PubMed1978

The effectiveness of sex therapy for chronic secondary psychological impotence.

This paper describes the treatment results of sexual therapy with 16 couples. The men had chronic secondary psychological impotence. They were evaluated, treated, and followed up by the same sex therapist. Another psychiatrist evaluated each couple after therpay. Pre- and posttherapy Sexual Interaction inventories were administered as numberical measures of therapeutic effectiveness. By the end of treatment 6 men of the 16 were consistently potent and 4 were potent at least half of the time. Of the 11 men who had improved, 10 demonstrated considerable instability in erectile functioning over 1-year follow-up. Sex therapy can improve sexual functioning. However, it does not restore complete sexual health to couples with this complicated disorder.

Adult↗
PubMed1977

Marital sexual dysfunction: female dysfunctions.

The diagnosis, treatment, and referral of married women with sexual dysfunctions require information about the current physiologic deficit, previous sexual capacity, level of sexual desire, masturbatory experience, means of orgasmic attainment, preferred sexual partner, quality of marriage, husband's sexual capacities, and method of contraception. For classification purposes, the three basic physiologic deficits--excitement phase dysfunction, orgasmic phase dysfunction, and vaginismus--are subdivided into primary and secondary types. Primary dysfunctions represent longstanding developmental problems and are usually purely psychological in origin. Secondary dysfunctions occur after a period of normal sexual functioning and may be organic or psychological in origin. The actual determinants of dysfunctions are not well understood, but those factors commonly associated are discussed. The lack of knowledge about the nature of sexual desire, prevalence of dysfunctions, and significance of the inability to attain orgasm with coitus is emphasized. The physician's role in giving advice and treatment is defined.

Adult↗
PubMed1976

Frequency of sexual dysfunction in a general gynecological clinic: an epidemiological approach.

Epidemiological data on female sexual functioning are presented. Fifty-nine 30- to 39-year-old Black women attending a gynecology clinic at University Hospitals of Cleveland for nonsexual complants were interviewed to determine the frequency of sexual dysfunction. Seventeen percent had difficulty achieving orgasm in partner sexual behavior. Most of these women had prior history of adequate sexual functioning; 5% had never been orgasmic. Ten of the 49 women who had no orgasmic difficulty were not satisfied with their sexual relationships. The relative risk of sexual dysfunction was 5 times greater in women who had undergone pelvic surgery.

Adult↗
PubMed1976

Marital sexual dysfunction:introductory concepts.

The concepts presented in this overview of marital sexual dysfunction are derived from increasing clinical experience with couples who seek help for their sexual problems. These couples, in marked contrast to couples with good sexual functioning, usually report a steady state of emotional dissatisfaction and minimal physical pleasure from sex. The affectual and behavioral consequences of persistent dysfunction are reviewed. Sexual therapy is discussed in terms of its two elements, sensate focus and psychotherapy. The various tastks which the sexual therapist may have to accomplish with individual couples are described. Consideration is given to the specific hypothese usually offered as explanation for sexual dysfunction-i.e., organic factors, varying degrees of relationship failure, poor communication, sexual ignorance, performance anxiety, and intrapsychic residua of past experience. A protocol for the screening physician to use in the formulation of a reasonable clinical plan for dysfunctional couples is included.

Anxiety↗