Interim report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic: Chairman's recommendations--Part I.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
T L Crenshaw
Publications and source records attributed to T L Crenshaw.
Pharmacologic modification of psychosexual dysfunction.
Sixty female and male outpatients with psychosexual dysfunction (sexual aversion/inhibited sexual desire, inhibited sexual excitement, and/or inhibited orgasm) participated in a comparison of the efficacy of bupropion hydrochloride vs placebo. Eight weeks of single-blind treatment with placebo was given at the outset to establish a baseline of sexual ratings/behavior and to eliminate placebo responders. Patients were then assigned randomly to 12 weeks of double-blind treatment with bupropion, 225-450 mg/day, or matching placebo. The onset of therapeutic sexual effects was gradual, but by the end of 12 weeks of treatment, significantly greater improvements were noted on the libido and global assessments of sexual functioning in the bupropion group. Sixty-three percent of the bupropion-treated patients reported themselves much or very much improved, compared with 3% for placebo. Changes in the frequency of sexual behavior, however, were much less dramatic and consisted largely of trends toward more sexual activity. To our knowledge, these results represent the first demonstration in a well-controlled clinical trial of an improvement in the psychological aspects of sexual dysfunction due to pharmacologic treatment.
Adult↗
The sexual aversion syndrome.
Sexual aversion is a widespread, poorly recognized syndrome occurring in both males and females. Once diagnosed, it is relatively resistant to conventional forms of therapy. Aversion is characterized by an unwillingness to get involved in sexual activity, with avoidance of any touching or communication that might lead to sexual involvement. This syndrome usually presents as a lack of libido, low sex drive, inhibited sexual desire or arousal dysfunction. Aversion may be seen along with other sexual dysfunctions, as a precipitating cause or as a consequence. However, aversion can also be the only dysfunction present. Once aversion is correctly diagnosed, identifying the type of aversion present is a prerequisite to appropriate therapy. Primary and secondary aversion are treated differently and have a different prognosis. This article describes the Sexual Aversion Syndrome, and distinguishes between primary and secondary aversion for the purpose of treatment and prognosis.
Adolescent↗
Initiation of erection and semen release by rectal probe electrostimulation (RPE).
Instrumentation and methodology are described for rectal probe electrostimulation (RPE) in human males to elicit erection and allow semen collection. This system virtually eliminates shock hazard; the simultaneous monitoring of current, voltage and impedance ensures reliability and repeatability. It was tested with 8 neurologically intact subjects, and 12 paraplegic patients with lesions between T4 and L2. Platinum electrodes delivered current (density never exceeding 0.37 mA per mm. at the electrode) at frequencies of 60 Hz, 20 Hz, and 0.25 Hz. Erection was elicited repeatably in only 1 of the intact subjects, and no seminal emissions or ejaculations occurred. Discomfort prevented current delivery beyond levels even 50 per cent of those safely acceptable. Six of 10 paraplegic patients (2 others had penile implants) developed erections with 20 Hz; the other 2 frequencies were much less effective. The extent of RPE-induced penile tumescence varied directly with electrode surface area and applied current intensity. Discomfort was minimal. Retrograde seminal emission in 5 of the 12 paraplegics was verified by post-stimulation recovery of sperm via voiding or bladder irrigation via catheter. Although motility was very low, 4 of 8 recovered bladder-urine/seminal fluid specimens indicated sperm counts and morphology consonant with use in artificial insemination. Thus, RPE, if combined with techniques to allow antegrade semen collection, may be a useful technique for spinal cord-injured men who, as part of their sexual rehabilitation, are interested in siring children.
Adult↗