Male sexual dysfunctions in neurological diseases : from pathophysiology to rehabilitation

196 Pages·2011·3.46 MB·English

by  Rocco Salvatore Calabrò

NEUROLOGY - LABORATORY AND CLINICAL RESEARCH DEVELOPMENTS

M S D
ALE EXUAL YSFUNCTIONS
N D :
IN EUROLOGICAL ISEASES
F P
ROM ATHOPHYSIOLOGY
TO REHABILITATION

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NEUROLOGY – LABORATORY AND CLINICAL
RESEARCH DEVELOPMENTS

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SEXOLOGY RESEARCH AND ISSUES

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NEUROLOGY - LABORATORY AND CLINICAL RESEARCH DEVELOPMENTS

M S D
ALE EXUAL YSFUNCTIONS
N D :
IN EUROLOGICAL ISEASES
F P
ROM ATHOPHYSIOLOGY
TO REHABILITATION

CALABRÒ ROCCO SALVATORE
EDITOR

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Library of Congress Cataloging-in-Publication Data

Male sexual dysfunctions in neurological diseases : from pathophysiology to
rehabilitation / editor, Rocco Salvatore Calabrr.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-61122-189-3 (eBook)
1. Sexual disorders. 2. Impotence. 3. Men--Diseases. 4. Nervous
system--Diseases--Complications. 5. Genitourinary manifestations of general
diseases. I. Calabrr, Rocco Salvatore.
[DNLM: 1. Sexual Dysfunction, Physiological--physiopathology. 2.
Men--psychology. 3. Nervous System Diseases--complications. 4. Sexual
Dysfunction, Physiological--therapy. WJ 709]
RC877.M353 2010
616.6'922--dc22
2010034036

Published by Nova Science Publishers, Inc. † New York
Contents

Preface ix
Chapter 1 Neuroanatomy and Physiology of Human Sexuality 1
Rocco Salvatore Calabrò and Placido Bramanti
Chapter 2 Psychological Aspects of Human Sexuality 25
Jacopo Grisolaghi, Fabrizio Quattrini
and Rocco Salvatore Calabrò
Chapter 3 Clinical and Instrumental Diagnosis of Sexual Disorders 37
Giuseppe Gervasi, Placido Bramanti, Paolo Di Bella,
Nunzio Muscarà, Silvia Marino and Rocco Salvatore Calabrò
Chapter 4 Sexual Dysfunction and Epilepsy 67
Rocco Salvatore Calabrò and Adriana Magaudda
Chapter 5 Sexuality after Stroke 81
Rocco Salvatore Calabrò and Giuseppe Gervasi
Chapter 6 Sexual Dysfunction in Multiple Sclerosis 93
Lorenzo De Santi, Edoardo Sessa and Rocco Salvatore Calabrò
Chapter 7 Sexuality in Neurodegenerative Disorders 105
Silvia Marino, Francesco Cordici, Annalisa Baglieri,
Giuseppe Gervasi, Placido Bramanti and Rocco Salvatore Calabrò
Chapter 8 Sexual Dysfunction in Spinal Cord Injury 121
Concetta Pastura, Gianni D’Aleo, Antonino Levita,
and Rocco Salvatore Calabrò
Chapter 9 Sexuality in Other Neuropsychiatric Disorders 133
Giuseppe Gervasi, Domenico Italiano, Carmela Rifici,
Giuseppina Digangi, Placido Bramanti,
and Rocco Salvatore Calabrò
Chapter 10 Treatment and Rehabilitation of Sexual Dysfunctions in
Neurological Diseases 155
Rocco Salvatore Calabrò, Anna Furnari and Placido Bramanti
vi Contents
Authors' Affiliations 171
Index 173
To my son Mario

“There are only two tragedies in life: one is not getting what one wants, the other is
getting it”. Oscar Wilde

Preface

All individuals, regardless of disability, are sexual beings.
Sexual function in patients with physical or neurological disabilities is often disregarded
by healthcare professionals, though it is a topic of great importance to patients and to those
with whom they share significant relationships. Too often, physicians believe that sexuality is
not as important as the injury or illness that brought the patient to the rehabilitation team. The
quality of personal relationships, sexual ones in particular, exerts great impact on a patient's
self-esteem and support network. The multiple physical, psychological, and emotional
changes that may occur after a catastrophic injury, or as a result of a congenital disability or
chronic illness, must be addressed not only in the context of the patient, but also of the
patient's support system. The issue of sexuality must be addressed during the acute and long-
term rehabilitation processes. Sexual function recovery is no less important than any other
aspect of functional rehabilitation from a disabling disease or injury. Indeed, people with
disabilities are sexual individuals with sexual desires; their concerns require the attention of
health care providers. The most popular myth surrounding people with disabilities is that they
are less sexual than persons without disabilities. Entrenched socio-cultural beliefs have
created significant barriers that prevent individuals with disabilities from exploring their
sexuality; these false beliefs may be more disabling than physical impairment itself. The
mention of a 'disabled' person engaging in sexual intercourse is guaranteed to raise a lot of
eyebrows. An individual in a wheelchair is regarded as an object of pity, not of desire: being
'ugly' or overweight does not render a person asexual, but having a physical disability does.
The worst part of this prejudice is that many people with disabilities believe this myth. People
with a disability or a permanent illness may wonder whether they can have children, if their
partners will stay with them, if anyone will find them sexually desirable, or if they will ever
enjoy sex again. Many assume, incorrectly, that sexual intimacy is no longer possible due to
sensation loss in the genitals since ―sex means only sexual intercourse‖ and ―sex is just
genital pleasure and should necessarily end with orgasms‖. Moreover, sex is often associated
with youth and physical attractiveness and, when it is not, it is often seen as "unseemly". As a
result, some may decide to ignore sexuality issues because they believe that they no longer
apply to them; others will seek any opportunity to restore sexual-esteem. Questions, concerns,
and feelings of anger regarding sexuality are natural in cases of disability or illness.
Neurological disorders frequently alter sexual response by changing the process of sexual
stimuli to preclude arousal, decreasing or increasing desire, and curtailing genital
engorgement. Patients with a neurological disease may challenge the physical ability to