Penile Volume Changes Research Articles

AB139. Web promotion of da Vinci robotic prostatectomy exhibits varying sexual health information.

ObjectiveThe surgical robot has been widely adopted in Japan in spite of its high cost and controversy surroundings its benefit. Accordingly, robotic prostatectomy has become the most common treatment options for prostate cancer. The evidence isn’t strong enough to determine whether or not a robot is better than traditional minimally invasive surgery, but the evidence indicates that it is better compared to open surgery. The da Vinci surgical system continues to be the shiny new toy that hospitals boast about on websites. Clinical experience shows that patients are often given unrealistic expectations, especially about the long-term outcomes for erectile function, as well as the time to recovery of erectile function. Sexual dysfunctions other than ED, e.g., orgasmic pain, reduced orgasmic intensity, orgasmic-associated incontinence, penile volume changes with the development of Peyronie’s disease are rarely mentioned to a patient before radical prostatectomy. Hospitals advertise their da Vinci machines in part as a response to perceived consumer demand. The purpose of this analysis was to survey websites for robotic prostatectomy to evaluate the quality of the information found there as it pertains to the outcome for ED.MethodsWe identified 168 centers in Japan that were using robotic prostatectomy. Their websites were reviewed for the following factors: Has information between copied directly from the Intuitive Surgical website? Is ED mentioned as a complication of robotic prostatectomy? Is it suggested that the robotic prostatectomy approach is better than the other technique? Are there references to support the values mentioned? Did the sites give realistic expectations about time to recovery and overall recovery? Are the ED rates cited within the published rates? Are the ED rates cited specific to the individual site? Did the site mention ED treatment options? Did the site mention sexual dysfunction other than ED?ResultsOf the 168 centers websites reviewed, 63 (38%) were academic, while 105 (62%) were community-based. On the websites, 59% of the hospitals only posted robotic prostatectomy as a treatment option for prostate cancer. Almost half (55%) of the centers websites suggested that functional outcome were better for robotic prostatectomy than for the other approach; this compared to rates being 58.7% for academic and 53.3% for community-based (P=0.525). ED was mentioned by only 15%; 28.6% of academic centers mentioned ED compared with 7.6% of community-based centers (P<0.05). Realistic expectations about time to recovery for erectile function and overall recovery were mentioned by only 4%. Only 2% offered the ED rates cited specific to the individual site.ConclusionsTo make informed decisions about their medical care, patients need unbiased, evidence-based information about the benefits and risks of different treatment options. The Internet is a major source of information for prostate cancer patients. However, our study of how hospitals talk about robotic surgery found that many copied directly from Intuitive’s marketing materials. Many centers claimed benefits that were unsupported by evidence and only a minority pointed to potential risks. A balanced presentation of outcomes expected after robotic prostatectomy is necessary to allow patients to make informed treatment decisions and to help them set realistic expectations, which will improve their satisfaction and minimize any regret.

Erotic gender differentiation in pedophilia

Five groups of males were compared on penile volume changes elicited from viewing short movie strips and slides of nude children and adults of both genders. Subject groups were sex offenders against adult females, volunteer controls who erotically preferred adult females, volunteer controls who erotically preferred adult males, heterosexual pedophiles, and homosexual pedophiles. Pedophiles differentiated erotically between females and males less than males who erotically preferred physically mature partners.

Assessment of the sensitivity and specificity of a phallometric test: An update of phallometric diagnosis of pedophilia.

The specificity and sensitivity of the phallometric test of an erotic preference for minors was assessed. The specificity was determined to be 96.9% if using a group of sex offenders against female adults and 80.6% if using a group of paid volunteers. Test results of 27 sex offenders against at least 2 female children each and of 22 offenders against at least 2 male minors each (either against children or against pubescents, but not against both), demonstratedsensitivitiesof 78.2% for heterosexual pedophiles and 88.6% for homosexual pedophiles or hebephiles. From these test sensitivities, the percentage of subjects preferring minors in a group of offenders against only 1 female child each, a group of offenders against at least 1 female child and at least 1 female pubescent each, and a group of offenders against only 1 male minor each (child or pubescent) were determined as being 44.5%, 74.6%, and 86.7%, respectively. The differential diagnosis between the various erotic preferences can be established by means of the phallometric test, which uses continuous recording of penile volume changes while a subject views potentially arousing pictures on screens or listens to such taped narratives (Abel, Becker, Murphy, & Flanagan, 1981). The current study was limited to the phallometric test of pedophilia and homosexual hebephilia as it is used in the differential diagnosis between pedophilia or homosexual hebephilia and gynephilia (Freund, Diamant, & Pinkava, 1958; Quinsey, Steinman, Bergersen, & Holmes, 1975).

Heterosexuality, homosexuality, and erotic age preference

Heterosexual and homosexual males who erotically preferred physically mature partners were compared with respect to the erotic impact of the nonpreferred age groups (of the preferred gender) and the nonpreferred gender. Erotic impact was assessed by phallometric test of erotic gender and age preferences. This measures penile volume changes during the presentation of potentially erotic stimuli. Homosexual males who preferred physically mature partners responded no more to male children than heterosexual males who preferred physically mature partners responded to female children. Although heterosexual males showed a (slight) erotic aversion to the male stimuli, and homosexual males did not show an aversion to the female stimuli, this difference was minimal.

Identifying Sexual Preferences in Intrafamilial and Extrafamilial Child Sexual Abusers

Twenty-seven erotic and sexually neutral movie clips were shown to 191 men, consisting of 62 heterosexual intrafamilial child sexual abusers, 57 heterosexual and 25 homosexual extrafamilial child sexual abusers and 47 community controls. The stimuli depicted males and females from ages 6 to 25 years. Maximum penile volume changes were recorded during the 30 second stimulus presentations. Analyses showed that the phallometric test had high internal consistency (alpha=0.93) and revealed the expected erotic preference profiles for controls and extrafamilial offender groups. The homosexual group reacted most to 13–15 year old boys which made them more easily discriminated from the other groups. The intrafamilial offenders, however, overlapped considerably with controls and only 10% showed a pattern of penile responses expected for the ‘classical pedophile’, i.e., largest responses to female children. The pattern of results supported the accumulating evidence that child sexual abusers are heterogeneous in terms of their sexual preference profiles.

The courtship disorders.

This study tested parts of the hypothesis that voyeurism, exhibitionism, toucheurism and frotteurism, obscene telephone calling, and at least some cases of the preferential rape pattern are all based on the same disturbance. In Part One, a frequency count of patients referred for one of these activities who subsequently reported having engaged in others of this same class was in accord with the clinical impression that there is a high degree of concomitance among at least some of these activities. In Parts Two and Three, relative preference for anomalous vs. normal erotic interactions was assessed by monitoring penile volume changes during verbally presented descriptions of corresponding situations. Part Two demonstrated that patients who suffered from one of the disorders in question other than voyeurism and who denied voyeuristic activity or tendencies, nonetheless responded more to narratives describing voyeuristic situations than did controls. Part Three showed that exhibitionists who denied toucheuristic activity or tendencies responded more to toucheuristic stimuli than did controls.

Experimental analysis of pedophilia

It was hypothesized that the population of pedophiles differs from that of males who prefer physically mature partners, in respect of the proportion of bisexual members in each group. Bisexuality was assessed by means of a verbal scale and by recording penile volume changes during the presentation of movie clips of nude males and females. Results supported the hypothesis. An earlier finding of a difference between pedophiles and males who prefer physically mature partners, in respect to feminine gender identity, was retested using the Feminine Gender Identity Scale (for males). It could be confirmed only for homosexual males and therefore cannot be accepted as a general difference between pedophiles and persons who prefer physically mature partners.

The discrete syndromes of transvestism and transsexualism

The literature concerning the relationship between transvestism and transsexualism is briefly reviewed. Some workers consider the two conditions to be on a continuum, whereas others feel that they are independent clinical entities. To clarify the relationship between the two syndromes, biographical data were collected and penile volume changes recorded in 29 subjects who identified themselves as transsexuals and 35 who identified themselves as transvestites. In comparison to the transvestite subjects, significantly more transsexuals were younger, were single, cross-dressed fully, and reported homosexual interest, a feminine gender identity, and a desire for a sex-change surgery. In comparison to the transsexual subjects, significantly more transvestites reported heterosexual interest, cross-dressed partially, and had shown fetishistic arousal. It is concluded that transvestism and transsexualism are separate clinical entities.

Psychophysiological assessment of change in erotic preferences

The difficulties involved in validating effectiveness of the various therapies of anomalous erotic preferences are often underestimated. Basically, methods of physiological assessment of erotic preferences would appear to be promising. However they still pose considerable problems. There are two kinds of such methods, those where measurement of general arousal is employed, and those which are based on assessment of sexual arousal proper. The former are only weak indicators of erotic preferences; the latter are to date represented only by assessment of penile volume changes to various kinds of potentially erotic stimuli (the phallometric test). The usefulness of the latter method in assessment of (therapeutic) changes in erotic preferences is basically limited to one particular situation only. Directions are pointed out in which this test is to be further developed to make it more generally useful as an indicator of (therapeutic) change in erotic preferences.

Comparison of two penile measures of erotic arousal

The phallometric test, which makes possible measurement of penile responses to various stimulus configurations, was originally devised as a volumetric method (description of details: Freund. 1965: Freund et al., 1965). However. Bancroft et al. (1966) replaced volume measurement by circumference measurement, using basically a Whitney (1949) type strain gauge. A similar device for circumference measurement had already been used by Fisher et al. (1965) for the assessment of erectile activity cycles during sleep. Other strain gauges for penile circumference measurement have been designed by Jovanovic (1967a, b). Johnson and Kitching (1968) and Barlow et al. (1970) and with the exception of McConaghy (1967) and Barr (1973), apparently all the authors who currently work with the phallometric test of erotic preference use circumference measurement instead of volume measurement. This substitution seems to imply that penile volume changes are closely parallelled by circumference changes, an assumption which may be warranted for gross penile responses but which may not hold at all for responses in the range of mild sexual arousal. Under these circumstances direct comparison of both kinds of measurement appeared to be necessary.

The phobic theory of male homosexuality.

A particular version of the phobic theory of male homosexuality was tested, namely that homosexuality is based on an aversion against heterosexual intercourse. In androphilic men, penile volume changes to verbal and written descriptions of the subjects' involvement in the various phases of heterosexual interaction were measured. Prior to each exposition of a verbal representation of such a phase, the subjects were prearoused by pictures of male nudes. Descriptions of involvement in the situation of locating a prospective female partner and of involvement in heterosexual pretactile interaction were responded to with penile detumescence that did not differ significantly from that to descriptions of involvement in sexually neutral situations. There was a further increase in penile volume of the prearoused subjects on descriptions of their involvement in heterosexual tactile interaction and intercourse. These results contradict the hypothesis tested, whereas the subjects' verbal ratings of the various stimulus configurations on a disgust scale were in agreement with the phobic theory.

The female child as a surrogate object.

Because most heterosexual pedophilic offenses are committed by males who in fact erotically prefer adult females, the hypothesis was tested that males with nondeviant erotic preferences are generally prone to react in a sexual way to female children. With nondeviant subjects, penile volume changes (PVCs) were measured to stimulus slides and movie pictures of males and females, varying in age. There were significant differerences in PVCs to each of the female age groups shown, and responses were greater to all female age groups than to the male ones. PVCs to the youngest female age group (6 to 8 years) were clearly different not only from those to pictures of males but also from those to neutral slides. Reactions to certain parts of the female and male bodies at various stages of development were also assessed. Of female children, only the pubic region, and to some degree the buttocks, elicited clearly distinctive reactions.

Penile response conditioning and its relationship to aversion therapy in homosexuals

Penile volume responses to moving pictures of female and male nudes were investigated in 11 heterosexual and 40 homosexual subjects. Responses to visual stimuli of a red circle which regularly preceded the female nude and a green triangle which regularly preceded the male were also measured. Ten of the 11 heterosexual and 15 of the 40 homosexual subjects showed statistically significant differences in response to the nudes of the two sexes. In addition to the penile volume increase occurring to the pictures of the sex to which they were attracted, these subjects showed a penile volume decrease to pictures of the other sex. It was suggested that this volume decrease indicated the presence of an inhibitory process preventing generalisation of the sexual response to the sex opposite to that to which the subject is attracted. Penile volume changes similar to those produced by the pictures of the nudes occurred as conditioned responses to the visual stimuli preceding the nudes. The strength of positive (volume increase) conditioned responses correlated highly with the strength of the corresponding unconditioned responses in both the heterosexual and homosexual groups. The negative (volume decrease) conditioned responses were of the same order of magnitude as the corresponding unconditioned responses, in the case of the heterosexual subjects, and significantly stronger in the case of the homosexuals. This unusual finding suggests that the negative conditioned response may have special features compared with the positive response. The magnitude of the negative response in the homosexual subjects correlated significantly with the degree of their reported response 2 weeks after 5 days of aversion therapy.