NEUROLOGY - LABORATORY AND CLINICAL RESEARCH DEVELOPMENTS MALE SEXUAL DYSFUNCTIONS IN NEUROLOGICAL DISEASES: FROM PATHOPHYSIOLOGY TO REHABILITATION No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services. NEUROLOGY – LABORATORY AND CLINICAL RESEARCH DEVELOPMENTS Additional books in this series can be found on Nova‘s website under the Series tab. Additional E-books in this series can be found on Nova‘s website under the E-book tab. SEXOLOGY RESEARCH AND ISSUES Additional books in this series can be found on Nova‘s website under the Series tab. Additional E-books in this series can be found on Nova‘s website under the E-book tab. NEUROLOGY - LABORATORY AND CLINICAL RESEARCH DEVELOPMENTS MALE SEXUAL DYSFUNCTIONS IN NEUROLOGICAL DISEASES: FROM PATHOPHYSIOLOGY TO REHABILITATION CALABRÒ ROCCO SALVATORE EDITOR Nova Science Publishers, Inc. New York Copyright © 2011 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers‘ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. Additional color graphics may be available in the e-book version of this book. 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 x Calabrò Rocco Salvatore communicate, embrace, stimulate, engage in intercourse, and maintain urinary and bowel continence during sexual activity. Thus, these patients, especially if male and young, may regard their sexual loss to be its most devastating aspect. Subjects, in particular those affected by neurological disorders, should be questioned about their sexuality in order to address possible sexual dysfunction. Epilepsy, demyelinating disorders, brain and spinal cord injuries, and the treatment used in these diseases, may often cause erectile and/ or ejaculation dysfunctions; it may also affect sexual desire in young men. Furthermore, alterations in the sexual area of patients with cerebrovascular diseases and neurodegenerative disorders may exacerbate their quality of life. When sex and disability are discussed while counseling a neurological