Sexual Purpose Research Articles

A Case of Priapism Associated With Rapid Increase in Risperidone Dose

To the Editor: In Greek mythology, a son of Aphrodite and fertility god named Priapos was best noted for his permanently large and erect penis,1 which gave rise to the medical term priapism. Priapism is defined as a genital organ tumescence or rigidity, with or without pain, that persists without any sexual purpose.2 Psychotropic medications can cause this rare side effect by blocking the α1 receptor; among the atypical antipsychotics, risperidone has one of the highest affinities for the α1-adrenergic receptor.3 We report a case of a 21-year-old man who developed priapism after risperidone was restarted and the dose rapidly increased. Early recognition of priapism is emphasized. Case report. Mr A, a 21-year-old Asian-American single man with a 12th-grade education, was admitted to the psychiatric inpatient unit for increasing psychosis and schizophreniform disorder. Initially, the patient reported outpatient compliance on his sole medication of risperidone 2 mg twice daily. On admission day 1, the patient was prescribed risperidone 2 mg orally twice daily. On day 3 of his hospitalization, the risperidone dosage was increased to 3 mg orally twice daily. On the morning of day 4, the patient complained of a persistent and painful erection lasting for 2 hours. Through patient re-interview, it was discovered that the patient was noncompliant with risperidone treatment for approximately 3 days prior to admission. Prior to this event, the patient had no history of priapism, penile trauma, or sexual dysfunction. He had no family history of sickle cell trait or disease. His medical history was significant for cigarette smoking, recreational alcohol and marijuana use, and one instance of smoking methamphetamine months prior to admission; his urine drug screen was negative on admission. He was not taking any other medications. His physical examination was without abnormalities except for penile erection. Laboratory workup results revealed no significant abnormalities. Mr A was given 10 mg of terbutaline orally, and within 1 hour there was complete detumescence and no further treatment was necessary. Risperidone was discontinued, and he was started on asenapine 5 mg twice daily. On follow-up 3 weeks later, no further priapism nor sequelae of sexual dysfunction were reported. Risperidone is an atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It is generally used due to its characteristically fewer extrapyramidal side effects as compared with typical antipsychotics. Initial dosing is generally 2 mg/d with increases of 1 to 2 mg/d every 24 hours.4 Risperidone 4–8 mg/d is the recommended dose range for schizophrenia.4 Risperidone has a high affinity for the dopamine D2, 5-HT2A/2C, α1/α2-adrenergic, and histamine H1 receptors.5 Time to steady state for risperidone ranges from 1 to 7 days with a mean elimination half-life of approximately 19 hours.5 Despite speculation, the most commonly accepted theory for drug-induced priapism is the characteristic α1-adrenergic antagonism leading to decreased sympathetic tone and little to no blood flow in the corpora cavernosa of the penis. Although the mechanism of action of terbutaline is unclear, it is a β2-adrenergic agonist thought to relax the smooth muscles of the corpora cavernosa.6 Approximately 30% of all priapism cases are drug-induced, some of which are from psychotropic medications.7 Without urgent intervention, priapism can lead to fibrosis of tissue leading to permanent impotence. Due to its emergent nature, early patient education is crucial to provide immediate treatment on presentation of symptoms. The uniqueness of this case involves an association of priapism with rapidly restarting risperidone at a medium dose. Physicians should be aware, especially early in the course of therapy, of this rare but potentially serious side effect of risperidone.

Historical books in ethology: sexual purpose used to explain two ancient documentations of infanticide by males

Click to increase image sizeClick to decrease image size ACKNOWLEDGEMENTS M. Delibes-Mateos currently holds a Juan de la Cierva research contract awarded by the Ministerio de Ciencia e Innovación of Spain and the European Social Fund. We are grateful for the comments given by L. Fanini on an earlier draft of this note. An anonymous referee and especially J. Swenson improved a previous version of the manuscript. S. Conradi and A. Cota helped in many ways.

New Insights into the Pathophysiology of Sickle Cell Disease‐Associated Priapism

Priapism is defined as an erectile disorder, in which erection persists uncontrollably without sexual purpose. The precise mechanisms involved in the development of sickle cell disease-associated priapism are ill defined. To summarize the recent developments that increase our understanding of the molecular mechanisms of priapism. This article reviews the literature (Medline search 2000-2010) that relates the key molecular signaling pathways that contribute to the development of priapism associated with sickle-cell disease. It focuses on basic science investigations using multiple animal models. The reader will be informed of the most current research regarding the role of endothelial nitric oxide synthase, phosphodiesterase type 5 (PDE5), adenosine, RhoA/Rho-kinase (ROCK), and opiorphins in the pathophysiology of priapism. New concepts in the field of priapism research suggest that priapism often results from altered vascular homeostatic actions in the penis and is associated with deficient erection control mechanisms on a molecular level. A leading proposal in this regard is the notion of aberrant signaling of the endothelium-derived nitric oxide and PDE5 signal transduction pathway in the penis. Additionally, dysfunctional regulatory control of signal transduction systems which interact with this pathway such as adenosine and RhoA/Rho-kinase may contribute to the development of priapism. Recent investigations of opiorphins also demonstrate a role in regulating corporal smooth muscle tone and thereby dysregulation of erection physiology in priapism. These advances have paved the way for understanding this disorder as having a molecular pathogenesis. As the science underlying priapism further emerges, increasingly effective therapeutics for sickle cell disease-associated priapism is certain to follow.

Gender, Sexual Affect, and Motivations for Internet Pornography Use

ABSTRACT The Internet has substantially changed the way society consumes pornographic material and as become the most popular venue for this sexual purpose. However, researchers have paid little attention to why people use pornographic material online. Arguing that the use of Internet pornography is a motivated behavior meant to obtain what one wants to see, this study attempts to identify specific motivations for Internet pornography use. In addition, this study analyzes how gender and sexual affect—positive or negative—are associated with motivations for Internet pornography use. Overall, 321 undergraduate students including males and females responded to an online questionnaire. Findings show that motivations behind Internet pornography use can be broken down into four factors—relationship, mood management, habitual use, and fantasy. Males revealed far stronger motivations than females; and those with more erotophilic tendencies were more likely than those with more erotophobic tendencies to be motivated to use Internet pornography for all four motivational factors. The implications of the findings are discussed.

Got milk? Not in public!

The American focus on the sexual purpose of breasts, rather than the physiological function of breasts, has serious public health consequences. Discomfort with breastfeeding in public lowers breastfeeding rates, which in turn negatively affects women's and children's short- and long-term health.

Therapy insight: priapism associated with hematologic dyscrasias

Priapism is defined as a genuine erectile disorder, in which erection persists uncontrollably without sexual purpose. This disorder is often overlooked in comparison to other male sexual dysfunctions, principally because of its seeming rarity. Priapism, however, occurs frequently in certain patient populations, including those with hematologic dyscrasias. Most commonly, priapism affects patients with sickle cell disease. The reported prevalence rate in this group ranges between 29% and 42% of males. The significance of priapism is further emphasized by the fact that this disorder commonly causes erectile tissue damage and leads to the loss of functional erections. These observations highlight the need for proper clinical recognition of priapism in order to enable appropriate management. Here, the current knowledge of priapism as it relates to hematologic and coagulative diseases is discussed, with a focus on the diagnosis and treatment of the disorder.

Making a Bad Law Worse

IN ITS FINAL DAYS IN OFFICE, Jean Chretien government had some good--or at least provocatively interesting--ideas about justice. It proposed to legalise same-sex marriage, and it offered plan to partially decriminalise use of marijuana. It also had one very bad idea: Bill C-20, proposal to amend and strengthen existing law (See. 163.1 of Criminal Code). The centrepiece of Bill C-20 is disturbing move to eliminate defence of artistic or an educational, scientific or medical purpose against charge of pornography, and replace it with defence of serving public good. Then, having abolished artistic merit drafters of bill further proposed that written material dominant characteristic of which is description, for sexual purpose, of sexual activity with person under age of eighteen that would be an offence under Criminal Code should also be made clime. (1) Though passage of Bill C-20 was interrupted by prorogation of Parliament in November 2003, new government of Prime Minister Paul Martin has option of resuming consideration of this legislative scheme. To understand how and why Parliament of Canada arrived at startling idea of partially striking down longstanding right of artists to freedom of speech and expression requires bit of history. (2) Ever since its legislative passage in summer 1993, more than decade ago, Sec. 163.1 of Criminal Code (a supplement to Sec. 163, law against obscenity) was conceptually inchoate. Yet, original notion for law, as drafted by Ministry of Justice, was reasonably coherent. Tee core idea was that any sexual representation of actual children that was produced through commission of sexual crime against those children should be prohibited. For example, it is illegal for an adult to engage in sexual touching of children under age of fourteen or to counsel or induce sexual touching of such children. It's also illegal for adults to engage in sex with persons under age of eighteen with whom they are in relation of authority or trust (such as relationships between teachers and students under eighteen), or to provide an inducement for young people under eighteen to engage in sex with adults (as in prostitutional circumstances). Since such acts are crimes against children and young people, reasoning went, representations of those acts perpetuated and extended harm caused by original violation. The new law also contained one novel feature: while obscenity law criminalised making, distribution and sale of obscene materials, law also criminalised mere possession of pornography, first law in Canadian jurisprudence to Criminalise simple possession of expressive materials. Unfortunately, law passed by Parliament in 1993 was far different from one envisaged by its drafters. Once bill reached Commons, it was drastically expanded by legislators, and law that was hastily passed in June 1993 was, in our view, constitutionally overbroad. The term means, in legal circles, that law captures activities and materials that are protected by Constitution and that should not be criminalised. The overbreadth of law is found in law's definition of pornography. In Section 163.1, child pornography means a photographic, film, video or other visual representation ... that shows person who is or is depicted as being under age of 18 and is engaged in or is depicted as engaged in explicit sexual activity. As well, includes representations the dominant characteristic of which is depiction, for sexual purpose, of sexual organ or anal region of person under age of 18 years. Finally, also includes written material or visual representation that advocates or counsels sexual activity with person under age of 18 years that would be crime under Criminal Code. …

The intoxication defense in Canada: why women should care

This paper explains the impact on women--as victims/witnesses and as accused persons--of the Supreme Court of Canada's decision in R. v. Daviault' regarding the defense of intoxication. Prior to the decision in Daviault, the defense of intoxication was available for only one class of criminal offenses: those described as offenses (defined below). The defense was therefore absolutely barred for all other offenses, including sexual assault, manslaughter, and common assault. The effect of Daviault is to make a new defense, that of intoxication, available for all of these offenses. If successful, the defense means that men accused of sexual assault, wife assault, and femicide will be acquitted and not subject to any sanctions. This paper is divided into three sections. Section I gives an overview of the law of the intoxication defense and the impact of the Canadian Charter of Rights and Freedoms2 on the law and on the resulting Daviault decision. Section II analyzes the implications of Daviault for women who have been victimized by violent offenders and for women charged with criminal offenses. Section III provides a description and an assessment of options for reform of the law after Daviault, including those canvassed by the Department of Justice in its recodification project. I. The law of the intoxication defense A. Pre-Charter The early response of the criminal law in England to an accused's allegations that he should not be held responsible for a crime committed while intoxicated was unequivocally negative.3 In 1920 the English case of D.P.P. v. Beard4 established the intent/general classification that still survives in Canadian law today. This classification is anomalous in that it is applicable only to the law governing intoxication; it has no relevance to any other criminal law issue. The effect of this classification was to make voluntary intoxication available as a defense for certain crimes, those characterized as offenses, while still precluding intoxication as a defense for offenses. The Supreme Court of Canada has adopted, as part of Canadian common law, this understanding of the intoxication defense and the classification scheme, most notably in R. v. George,5 R. v. Leary,b and R. v Swietlinski.7 The law governing the intoxication defense applies whether the accused has abused alcohol, drugs, or some combination of the two.8 Specific intent offenses are, with some exceptions,9 those offenses where either the Criminal Code of Canada10 or the common law defines the mental element of the offense as one that is specifically focused on producing a particular consequence. The idea is that for such offenses, extreme intoxication could impair the accused's capacity to deliberately pursue a course of action intended to result in a particular outcome. For example, the following offenses have been put in the specific intent category by the judiciary: murder (requires proof of intention to cause the death of the victim),11 theft (requires proof of intent to deprive another permanently of his property),12 touching a child for a sexual purpose,13 uttering a threat to cause death,14 and using violence to overcome a victim's resistance.15 General intent offenses are those that have as their mental element an intent to commit the immediate act, without reference to producing any specific consequences. For these offenses, it is thought that the mental element is so minimal as to require only basic voluntariness, and that no amount of alcohol or drug consumption, short of insanity, could obliterate one's capacity to intend one's immediate physical movements. Alternatively, it has been stated by judges that the mental element involved in voluntarily incapacitating oneself is sufficiently blameworthy to allow it to be substituted for the mental element for general intent offenses. …

Relationship between sex drive and sexual frustration and purpose in life.

Forty-eight college students (18 males, M age = 24.3, 30 females, M age = 23.5) participated in a study that investigated the relationship between one's sense of purpose in life and sexual attitudes and behavior. The test instruments included the Purpose in Life Test (PIL), a Sex Drive and Interest Scale, and a Sexual Frustration and Maladjustment Scale. Correlations were computed between the students' PIL scores and scores on each of the sex scales. The results indicated no relationship between PIL scores and the scores on the sex drive scale, whereas significant negative correlations were found between PIL scores and the sexual frustration scores for males and for the combined group of males and females. The scores on the PIL and the sexual frustration scale were not related to the students' sex. These results support Frankl's theory that sexual frustration may be a manifestation of a more general existential frustration.