Sexuality in perspective.
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Biomedical subjects
Publications and source records attributed to W H Masters.
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Three men have been treated for sexual dysfunction and disorder that developed subsequent to sexual assault by women. Although the men were able to respond effectively sexually during the actual assault experience, they were unable to interact with a female partner of choice in all subsequent sexual opportunities over more than a 2-year period. In treatment, more difficulties were encountered in returning to each man his sense of personal dignity and confidence in his masculinity than in reversal of openly expressed anxieties about sexual performance and neutralization of spectator roles. When possible, parallels were drawn to reactive similarities between male victims of sexual assault and female rape victims.
Certain individuals who want to change their homosexual preference can be helped by a short-term intensive intervention adapted from the Masters and Johnson model for treating heterosexual disorders. Pretreatment counseling aims at improving the patient's dating, sexual, and intimacy skills; creative problem solving; and stress management. Then for 2 weeks the patient and an opposite-sex partner, living in social isolation, meet daily with a therapy team to address fears and anxieties about intimacy as they arise. The directive psychotherapy format alternates between confrontation of maladaptive belief systems and patterns of relating and support for finding new ways of coping that foster a positive self-image.
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The purpose of this paper is to discuss conceptual components of treating paraphilia. Detailed description of the treatment interventions will be published subsequently. The format of the psychotherapy has components similar to the programs for sexual dysfunction and homosexual dissatisfaction therapy. Intensive short-term directive conjoint therapy remains essential. The therapeutic model focuses on the paraphilia as an interpersonal relationship disorder which is manifested as an unproductive and sometimes addictive means of coping with stress, particularly engendered by discomfort with intimacy in adult erotic relationships. The basic model of psychotherapy includes specific intervention directed at potential social skill deficits, changing erotic imagery, attitude and cognitive restructuring, self-esteem difficulties, dating anxiety, sexual dysfunction, intimacy issues and addictive behavior, all of which encourage mastery, self-assertion, self-responsibility and communication skills within the context of a relationship.
The belief that it is impossible for males to respond sexually when subjected to sexual molestation by women is contradicted. Previous research indicating that male sex response can occur in a variety of emotional states, including anger and terror, are corroborated. Eleven cases of male sexual molestation by females are classified and described. A post-trauma reaction occurs in which sexual function and psychological state are affected. The men were all personally interviewed. Recognition of this phenomenon should lead to increased identification of male victims as well as to better medical, psychological, and legal services for them.
One hundred and thirty-six men, who presented at Masters & Johnson Institute for treatment of impotence, ejaculatory incompetence, and inhibited sexual desire, underwent endocrine screening. Eleven men (8.1%) were found to be hyperprolactinemic: three had a mild degree of hyperprolactinemia while eight had markedly elevated serum prolactin levels in conjunction with subnormal serum testosterone levels. The markedly hyperprolactinemic men, all of whom were subsequently found to have prolactin-secreting pituitary adenomas, presented with diverse histories of sexual disorders which were similar to those of men with psychogenic sexual dysfunctions. All eight experienced some degree of improvement of sexual function following a 2-week course of intensive psychotherapy, although full restoration of libido was contingent on reduction of circulating prolactin to normal or near-normal levels. Measurement of prolactin levels should be routinely performed in all men presenting with the above sexual disorders and depressed testosterone levels.
The elderly tend to be victims of "age-ism," a false concept that discourages consideration of sexual activity in old age. Geriatric sexual activity is a vital issue, however, and proper management of attendant problems has great bearing upon mental and physical health. The inevitable processes of aging necessitate adjustments, but these can be accomplished satisfactorily by enlightened understanding between sexual partners.
Plasma testosterone levels in a group of 341 men with sexual dysfunction were compared to those in 199 men with normal sexual function. All subjects were participants in a 2-week intensive conjoint sex therapy program at the Masters & Johnson Institute. Testosterone determinations were made using radioimmunoassay methods after column chromatography; all blood samples were obtained on the second day of therapy between 8:00 and 9:00 a.m. after an overnight fast. Circulating levels of testosterone in men with normal sexual function (mean 635 ng/dl) were not significantly different from testosterone values in sexually dysfunctional men (mean 629 ng/dl). However, men with primary impotence (N = 13) had significantly higher testosterone levels than men with secondary impotence (N = 180), with mean levels of 710 and 574 ng/dl, respectively (p < 0.001). The mean testosterone level for men with ejaculatory imcompetence was 660 ng/dl (N = 15), while for men with premature ejaculation the mean was 622 ng/dl (N = 91). Plasma testosterone concentrations were not related to therapy outcome but were correlated negatively with age of patients.
Sixteen women ages 20 to 41 participated in a project to evaluate the in vivo intravaginal spermicidal effectiveness of nonoxynol-9 foaming suppositories. Testing of each subject was done at 18 different time intervals ranging from 5 seconds to 6 hours following insertion of the vaginal contraceptive. Simulated coitus using a latex dildo was incorporated in the test design to simulate dispersal of the spermicide that occurs during coitus. Semen specimens meeting uniform criteria for sperm count, motility, morphology, and volume were injected intravaginally; three vaginal aspirates were then immediately obtained to evaluate sperm motility microscopically. Maximal spermicidal effectiveness was found between 5 minutes and 1 hour after insertion of the vaginal contraceptive.
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