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Concept: Psychosexual development

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Background Serum testosterone concentrations decrease as men age, but benefits of raising testosterone levels in older men have not been established. Methods We assigned 790 men 65 years of age or older with a serum testosterone concentration of less than 275 ng per deciliter and symptoms suggesting hypoandrogenism to receive either testosterone gel or placebo gel for 1 year. Each man participated in one or more of three trials - the Sexual Function Trial, the Physical Function Trial, and the Vitality Trial. The primary outcome of each of the individual trials was also evaluated in all participants. Results Testosterone treatment increased serum testosterone levels to the mid-normal range for men 19 to 40 years of age. The increase in testosterone levels was associated with significantly increased sexual activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased sexual desire and erectile function. The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003). Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy-Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo. The rates of adverse events were similar in the two groups. Conclusions In symptomatic men 65 years of age or older, raising testosterone concentrations for 1 year from moderately low to the mid-normal range for men 19 to 40 years of age had a moderate benefit with respect to sexual function and some benefit with respect to mood and depressive symptoms but no benefit with respect to vitality or walking distance. The number of participants was too few to draw conclusions about the risks of testosterone treatment. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00799617 .).

Concepts: Clinical trial, Concentration, ClinicalTrials.gov, Testosterone, Human sexual behavior, Erectile dysfunction, Psychosexual development, Libido

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Risk factors for impairment in psychosexual development and satisfaction among adult survivors of childhood cancer are poorly understood. The authors compared psychosexual outcomes between survivors and healthy controls, and tested whether at-risk survivors can be identified by 1) treatment neurotoxicity or 2) diagnosis.

Concepts: Epidemiology, Developmental psychology, Neurotoxicity, Sigmund Freud, Psychosexual development

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In the late nineteenth and early twentieth centuries, the unspoken fear of syphilis played a significant role in the development of beliefs about female sexuality. Many women were afraid of sexual relationships with men because they feared contracting syphilis, which was, at that time, untreatable. Women also feared passing this disease on to their children. Women’s sexual aversion, or repression, became a focus for Freud and his colleagues, whose theory of psychosexual development was based on their treatment of women. This article examines the case of Dora, the memoirs of Mabel Dodge Luhan and other sources to argue that the fear of syphilis was a significant factor in upper- and middle-class women’s avoidance of heterosexual relationships. The fear of syphilis, in turn, became a significant factor in the psychoanalytic construction of female sexuality. The social suppression of the fear of syphilis has had a profound impact on theories of women’s development. The implication for psychiatry is that our models of psychological development occur within a sociocultural milieu and cannot escape suppressed aspects of our culture.

Concepts: Psychology, Gender role, Developmental psychology, Human sexuality, Psychotherapy, Sigmund Freud, Psychosexual development, Hysteria

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Adults who received treatments for childhood cancer that were especially toxic to the nervous system are less likely to have had sexual intercourse, be in a relationship or have children, new research suggests.

Concepts: Central nervous system, Nervous system, Psychology, Brain, Caenorhabditis elegans, Developmental psychology, Human sexuality, Psychosexual development

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Psychosexual development is currently underrepresented in hypospadias outcome research. The aim of this study was to develop and validate a questionnaire addressing psychosexual long-term satisfaction, specifically of adolescent patients, after hypospadias repair.

Concepts: Educational psychology, Developmental psychology, Hypospadias, Psychosexual development

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A comprehensive systematic literature review of reproductive side effects in women 18-55 years old treated with opioids for one month or longer for chronic non cancer pain. A search of seven databases including EMBASE and Medline was undertaken (October 2014 and a limited re-run April 2016). The search contained key words for opioids (generic and specific drug names) and side effects (generic and specific reproductive). Titles were screened using predefined criteria by a single reviewer and abstracts and full texts by two independent reviewers. 10,684 papers were identified and 12 full texts (cohort (one), case-control (four), cross-sectional (four), case series (one) and case report (two) with a maximum of 41 cases in one paper) were included covering three different modes of administration: oral (six), intrathecal (five) and transdermal (one). Amenorrhoea occurred in 23-71% of those receiving oral or intrathecal opioids. Decreased libido was seen in 61-100%. Out of 10 studies which undertook hormonal assays, only two studies showed a statistically significant decrease in hormone levels. This review supports the view that there is a potential relationship between the use of long-term opioids in women and reproductive side effects. The evidence is however weak and the mode of administration, duration, type and dose of opioid might influence associations. Though hormone levels were statistically significant in only two studies, women exhibited clinically important symptoms (decreased libido and altered menstrual cycle). Further investigation is required with larger cohorts and analysis of different delivery methods.

Concepts: Systematic review, Estrogen, Testosterone, Opioid, Menstrual cycle, Morphine, Sigmund Freud, Psychosexual development

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Disruption of psychosexual development and sexual dysfunction are well recognized as profoundly distressing long-term side effects of pediatric cancer treatment. However, little is known about the specific sexual problems facing young adult survivors of childhood cancer (YASCC) and their unmet clinical needs. In this study, we aimed to utilize qualitative methods to characterize sexual dysfunction in YASCC and identify survivor-reported unmet clinical need regarding sexual health information and care.

Concepts: Health care, Psychology, Sexual intercourse, Developmental psychology, Erectile dysfunction, Sexual health, Psychosexual development, Libido

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The virologic characteristics of RAVs developing in patients receiving dual oral therapy with daclatasvir/asunaprevir, including those with previous triple therapy with simeprevir, were evaluated.

Concepts: Developing country, Psychosexual development

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Novice drivers and older drivers are found to have the highest crash risk among all drivers and this has motivated many research studies into various aspects of novice and older drivers. Although age-related declines were expected, studies did not find older drivers to respond slower to hazards. This study examined the hazard detection and response latencies of 14 young novice drivers, 14 young experienced drivers, and 12 older experienced drivers, to abrupt-onset hazards. Older drivers were found to take longer times before fixating on an abrupt-onset road hazard but appeared to have insignificantly faster reaction times after the initial fixation. Hence, the overall response latency did not suggest any age effects. Older drivers also scanned the roadway less as compared to their younger counterparts. No effects of experience were found. The findings provided insight on age-related declines in hazard detection whose effects have been masked by other components of hazard response.

Concepts: Risk, Experience, Road, Hazard, Psychosexual development, Device driver

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The topic of sexuality and infantile sexuality, though less frequently discussed by psychoanalysis in recent decades, has received renewed attention for some years. The intention of this paper is to share some reflections around the role of infantile sexuality in our thinking, how we encounter it in our work with patients and in clinical material. Through reference to questions put forward by Freud (1905) in Three Essays, this paper takes into consideration some areas of the debate that has developed on the subject of infantile sexuality, starting from Freud’s original intuition, including various hypotheses on the genesis of the sexual drive. The author will concentrate on two specific points. Firstly, how infantile sexuality - as a permanent dimension of the subject’s existence - unfolds in the relationship and is deeply influenced by it. And that is how in childhood and adolescence, infantile sexuality ushers in parental sexuality - just as, in the case of our patients, infantile sexuality ushers in the analyst’s sexuality. The second point pertains to the temporal dimension within which infantile sexuality is inscribed. The hypothesis that the author proposes is that infantile sexuality may be understood in the specific time of psychoanalysis [Nachtr√§glichkeit], distinct and different with respect to the linear, evolutionary dimension.

Concepts: Psychology, Concepts in metaphysics, Unconscious mind, Psychoanalysis, Sigmund Freud, Psychosexual development, Carl Jung, Libido