Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic skills
- Part II Common psychiatric problems across the general hospital
- 7 Functional somatic syndromes
- 8 Alcohol problems in the general hospital
- 9 Drug misuse in medical patients
- 10 Sexual problems in medical patients
- 11 Suicide and deliberate self-harm
- 12 Delirium
- 13 Childhood experiences
- Part III Working with specific units
- Part IV Treatment
- Part V Different treatment settings
- Index
- References
10 - Sexual problems in medical patients
from Part II - Common psychiatric problems across the general hospital
Published online by Cambridge University Press: 10 December 2009
By
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic skills
- Part II Common psychiatric problems across the general hospital
- 7 Functional somatic syndromes
- 8 Alcohol problems in the general hospital
- 9 Drug misuse in medical patients
- 10 Sexual problems in medical patients
- 11 Suicide and deliberate self-harm
- 12 Delirium
- 13 Childhood experiences
- Part III Working with specific units
- Part IV Treatment
- Part V Different treatment settings
- Index
- References
Summary
Introduction
Sexual dysfunction is a common consequence of medical illness and should be considered in any medical patient undergoing a psychological assessment. Even though sexual problems can be among the most demoralizing and disabling features of medical disorders, they are frequently overlooked or neglected by clinicians. Furthermore, there is uncertainty about how sexual problems should be defined, particularly in women. In order to make a complete assessment of sexual difficulties the clinician must have a working knowledge of the anatomy, physiology and psychology of sexual function. As in all areas of liaison psychiatry, psychiatrists can only assess the role of psychological factors if they are knowledgeable about the presenting medical problem.
The anatomy and physiology of sex
The penis is composed of two functional compartments, the dorsal, paired corpora cavernosa and the ventral, corpus spongiosum, surrounded by the tunica albuginea. The corpora cavernosa are complex structures composed of smooth muscle fibres, neurones, endothelial-lined vascular spaces, coiled arteries and arterioles. The blood supply arises from the paired cavernosal arteries, which are terminal branches of the internal pudendal artery. Branches of the cavernosal artery, the helicine arteries, open directly into the cavernosal spaces. Blood drains into post-cavernosal venules to reach larger veins that pass through the tunica albuginea and connect with the deep dorsal vein. Blood is retained in the penis during erection by passive compression of the cavernosal venules against the tunica albuginea. Innervation is by somatic and autonomic nervous systems.
Keywords
- Type
- Chapter
- Information
- Handbook of Liaison Psychiatry , pp. 221 - 244Publisher: Cambridge University PressPrint publication year: 2007
References
, , , et al. (2002). Prevalence and correlates of erectile dysfunction in Turkey: a population based study. European Urology, 41, 298–304.Google Scholar
, , , et al. (2003). The impact of cancer on sexual function: a controlled study. Palliative Medicine, 17, 202–5.Google Scholar
Anonymous. (1991). Transsexualism. Lancet, 338, 603–4.
(2001). Female sexual response: the role of drugs in the management of sexual dysfunction. Obstetric and Gynecology, 98, 350–3.Google Scholar
, , , et al. (2000). Report on the international consensus development conference on female sexual dysfunction: definitions and classifications. Journal of Urology, 163, 888–93.Google Scholar
and (1992). Quality of life in treatment of hypertension. A meta-analysis of clinical trials. American Journal of Hypertension, 5, 124–33.Google Scholar
Blanchard, R. and Sheridan, P. M. (1990). Gender reorientation and psychosocial adjustment. In Clinical Management of Gender Identity Disorders in Children and Adults, ed. and . Washington DC: American Psychiatric Press, pp. 159–89.
and , eds. (1990). Clinical Management of Gender Identity Disorders in Children and Adults. Washington DC: American Psychiatric Press.
, , , et al. (1992). Clinical study of the longitudinal deformation of the flaccid penis and its variation with aging. European Urology, 21, 284–6.Google Scholar
, , , et al. (1996). Personality characteristics and sexual functioning of 188 cross-dressing men. Journal of Nervous and Mental Disease, B184, 265–73.Google Scholar
(1999). Feeling Good – The New Mood Therapy. New York: Avon.
(1981). Sexual dysfunction in male diabetics and alcoholics. Sexuality and Disability, 4, 215–19.Google Scholar
and (2000). Sexual dysfunction in gay and bisexual men with HIV infection: evaluation, treatment and implications. AIDS Care, 12, 279–86.Google Scholar
, , , et al. (1997). Psychological functioning of adolescent transsexuals: personality and psychopathology. Journal of Clinical Psychology, 53, 187–96.Google Scholar
, , , et al. (1997). Comorbidity of gender dysphoria and other major psychiatric diagnoses. Archives of Sexual Behaviour, 26, 13–26.Google Scholar
, and (1992). Male cross-gender behaviour in Myanmar (Burma): a description of the acault. Archives of Sexual Behaviour, 21, 313–21.Google Scholar
and (1996). Sexual Pharmacology – Drugs that Affect Sexual Function. New York: Norton.
(2002). Reliable and valid self-report outcome measures in sexual dysfunction: a systematic review. Archives of Sexual Behaviour, 31, 197–209.Google Scholar
(1998). Changes in the sexual orientation of six heterosexual male-to-female transsexuals. Archives of Sexual Behaviour, 27, 605–14.Google Scholar
, and (2000). Sex and relationships following childbirth: a first report from general practice of 131 couples. British Journal of General Practice, 50, 223–4.Google Scholar
, , , et al., on behalf of the steering group of the National Prostatectomy Audit. (1996). There is significant sexual dissatisfaction following TURP. British Journal of Urology, 77, 161A.Google Scholar
, and (1997). Long-term follow up after sex reassignment surgery. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 31, 39–45.Google Scholar
(2002). Sexual dysfunction in neurologic disease. Clinical Neuropharmacology, 25, 126–32.Google Scholar
, , , et al., for the sildenafil study group. (1998). Oral sildenafil in the treatment of erectile dysfunction. New England Journal of Medicine, 338, 1397–404.Google Scholar
, and (2000). The male menopause – does it exist?British Medical Journal, 320, 858–61.Google Scholar
, and (2001). Medical management of sexual difficulties in HIV-positive individuals. International Journal of STD AIDS, 12, 587–92.Google Scholar
(2000). Intimacy and sexuality for the woman with breast cancer. Cancer Nursing, 23, 230–6.Google Scholar
and (1995). Sexual function in women with advanced multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry, 59, 83–6.Google Scholar
, , , et al. (1999). A systematic approach to erectile dysfunction in the cardiovascular patient: a consensus statement. International Journal of Clinical Practice, 53, 445–51.Google Scholar
, , , et al. (2001). Sexual functioning after treatment for testicular cancer – review and meta-analysis of 36 empirical studies between 1975–2000. Archives of Sexual Behaviour, 30, 55–74.Google Scholar
, and (2001). Male sexual function and its disorders: physiology, pathophysiology, clinical investigation and treatment. Endocrine Reviews, 22, 342–88.Google Scholar
(1974). The New Sex Therapy. New York: Brunner/Mazel.
, , , et al. (1997). The provision of psychosexual services by genitourinary medicine physicians in the United Kingdom. International Journal of STD AIDS, 8, 402–4.Google Scholar
, , , et al. (2001). Sexual dysfunction following stroke. Comprehensive Psychiatry, 42, 217–22.Google Scholar
, , , et al. (2002). Sexual dysfunction in 156 ambulatory HIV-infected men receiving highly active antiretroviral therapy combinations with and without protease inhibitors. Journal of Acquired Immune Deficiency Syndrome, 30, 187–90.Google Scholar
, , , et al. (1998). Factors predictive of regret in sex reassignment. Acta Psychiatrica Scandinavica, 97, 284–9.Google Scholar
and (1970). Human Sexual Inadequacy. Boston: Little Brown.
McCoy, N. L. and Matyas, J. R. (1998). McCoy Female Sexuality Questionnaire. In Handbook of Sexuality-related Measures, ed. , , , et al. London: Sage pp. 249–51.
, , , et al. (1997). Dyspareunia: sexual dysfunction or pain syndrome?Journal of Nervous and Mental Disease, 185, 561–9.Google Scholar
, , , et al. (2002). Cigarette smoking as a risk factor for erectile dysfunction: results from an Italian epidemiological study. European Urology, 41, 294–7.Google Scholar
and (2003). Female sexual dysfunction in postmenopausal women: systematic review of placebo-controlled trials. American Journal of Obstetrics and Gynecology, 188, 286–93.Google Scholar
(1955). An examination of some basic sexual concepts: the evidence of human hermaphroditism. Bulletin of Johns Hopkins Hospital, 97, 301–19.Google Scholar
(1994). The concept of gender identity disorder in childhood and adolescence after 39 years. Journal of Sex and Marital Therapy, 20, 163–77.Google Scholar
, and (2002). Antidepressant medications: a review of the evidence for drug-induced sexual dysfunction. Journal of Affective Disorders, 69, 19–40.Google Scholar
(2003). The making of a disease: female sexual dysfunction. British Medical Journal, 236, 45–7.Google Scholar
, and (2001). Sexual dysfunction after treatment for testicular cancer. A systematic review. Journal of Psychosomatic Research, 51, 735–43.Google Scholar
, and (2003). Problems with sexual function in people attending London general practitioners. British Medical Journal, 327, 423.Google Scholar
, and (1998). Sexual adjustment of male alcoholics: changes from before to after receiving alcoholism counselling with and without marital therapy. Addictive Behaviours, 23, 419–25.Google Scholar
, and (1999). Three cases of macroprolactinaemia. Journal of the Royal Society of Medicine, 92, 342–4.Google Scholar
, , , et al. (1999). Sexual behaviour during pregnancy. Australian and New Zealand Journal of Obstetrics and Gynecology, 39, 48–50.Google Scholar
and (1996). Semen analysis in young men with varicocele: a preliminary study. Journal of Urology, 156 (2S), 788–90.Google Scholar
and (2001). Alcohol, drugs and sexual function. Journal of Psychoactive Drugs, 33, 223–32.Google Scholar
, , , et al. (2001). Spinal cord injury and sexuality in married or partnered men: activities, function, needs and predictors of sexual adjustment. Archives of Sexual Behaviour, 30, 591–602.Google Scholar
(1997). Transurethral alprostadil with MUSE (medication urethral system for erection) vs. intracavernosal alprostadil – a comparative study in 103 patients with erectile dysfunction. International Journal of Impotence Research, 9, 187–92.Google Scholar
(1999). Sexual problems associated with infertility, pregnancy, and ageing. British Medical Journal, 318, 587–9.Google Scholar
, , , et al. (1988). Assessment of sexual function in depressed, impotent, and healthy men: factor analysis of a brief sexual function questionnaire for men. Psychiatry Research, 24, 231–50.Google Scholar
, , , et al. (1997). The International Index of Erectile Dysfunction (ILEF). A multidimensional scale for assessment of erectile dysfunction. Urology, 49, 822–30.Google Scholar
and (1996). What Works for Whom? A Critical Review of Psychotherapy Research. London: Guildford.
and (1995). Harry Benjamin's first ten cases (1938–1953): a clinical historical note. Archives of Sexual Behaviour, 24, 73–93.Google Scholar
(1990). Chronic alcoholism and male sexual dysfunction. Journal of Sexual and Marital Therapy, 16, 23–33.Google Scholar
, , , et al. (1995a). Diabetes, psychological function and male sexuality. Journal of Psychosomatic Research, 39, 305–14.Google Scholar
, , , et al. (1995b). Chronic alcoholism and male sexual function. American Journal of Psychiatry, 152, 1045–51.Google Scholar
, , , et al. (2000). Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. New England Journal of Medicine, 343, 682–8.Google Scholar
, , , et al. (2001). Prevalence of chronic prostatitis in men with premature ejaculation. Urology, 58, 198–202.Google Scholar
and (2000). The relationship between depression and erectile dysfunction. Current Psychiatric Reports, 2, 201–5.Google Scholar
and (2001). Prevalence of sexual dysfunctions: results from a decade of research. Archives of Sexual Behaviour, 30, 177–219.Google Scholar
and (1994). Transsexualism and gender reassignment. British Journal of Psychiatry, 165, 417–19.Google Scholar
, and (1993). Sex reassignment surgery. A study of 141 Dutch transsexuals. British Journal of Psychiatry, 162, 681–5.Google Scholar
, , , et al. (1993). Discrimination between psychogenic and organic erectile disorder. Journal of Psychosomatic Research, 37, 135–45.Google Scholar
, , , et al. (2000). Sexual function measurement and outcomes in cancer survivors and matched controls. Journal of Sex Research, 37, 213–25.Google Scholar
, and (1994). Self report assessment of female sexual function. Archives of Sexual Behaviour, 23, 627–43.Google Scholar
(2000). Sexology and the pharmaceutical industry: the threat of co-optation. The Journal of Sex Research, 37, 273–83.Google Scholar
and (2002). Identification of a potential ejaculation generator in the spinal cord. Science, 297, 1566–9.Google Scholar
(1992). Male and female transsexuals: a comparison. Singapore Medical Journal, 33, 182–5.Google Scholar
, , , et al. (2000). Time course of effects of testosterone administration on sexual arousal in women. Archives of General Psychiatry, 57, 149–53.Google Scholar
(1892). Psychopathia Sexualis. London.
, and (1998). Classification sexual dysfunctions: towards DSM-V and ICD-11. Comprehensive Psychiatry, 39, 333–7.Google Scholar
, and (1996). Penile length in the flaccid and erect state guidelines for penile augmentation. Journal of Urology, 156, 995–7.Google Scholar
, , , et al. (2001). Sexual dysfunction in multiple sclerosis: a 2-year follow-up study. Journal of Neurological Sciences, 187, 1–5.Google Scholar