Book Review

Sexual Dysfunction: A Neuro-Medical Approach

N Engl J Med 1994; 331:1664December 15, 1994

Article

Sexual Dysfunction: A Neuro-Medical Approach
Edited by Carlos Singer and William J. Weiner. 375 pp. Armonk, N.Y., Futura, 1994. $55. ISBN: 0-87993-582-0

The study of sexual dysfunction has for years suffered from a lack of well-controlled, scientific studies and objective data. In the past few years, insightful physicians and scientists have entered the field and added a tremendous amount to our knowledge. With this increase in knowledge comes a responsibility for the clinician to take an active role in assessing and treating his or her patients' sexual dysfunction. This book is not intended specifically for urologists or neurologists but for any physician wishing to understand better the causes, workup, and treatment of sexual dysfunction.

The book has four parts, covering the normal anatomy and physiology of sexual function and diagnostic techniques, sexual dysfunction in specific neurologic disease states, sexual dysfunction due to non-neurologic causes, and nonspecific therapeutic options. Not surprisingly, since the editors are both neurologists, the book is weighted toward sexual dysfunction in neurologic disease. However, the contributors represent the fields of urology, psychiatry, gerontology, and endocrinology, as well as neurology.

Part 1 has several highlights. Chapter 3 on female sexual dysfunction gives a complete overview of a frequently overlooked topic. Chapter 4 thoroughly discusses the monitoring of nocturnal penile tumescence, although the photographs are not of the highest quality.

Part 2 begins with the editors' own chapter on sexual dysfunction in Parkinson's disease and includes discussion of female patients with this disorder; it is an excellent contribution to the book. Chapters 7 and 9, on sexual dysfunction in patients with spinal cord injury and diabetes, respectively, are exceptionally thorough and well written, and both include sections on female sexual dysfunction in these disorders.

Part 3 focuses on sexual dysfunction due to non-neurologic disorders -- psychogenic, endocrinologic, vascular, and iatrogenic. The chapter by Donatucci and Lue on vascular disease is particularly good. In it they discuss all aspects of vascular dysfunction; the illustrations here are the best in the book.

Part 4, on therapy for sexual dysfunction, is the shortest section. However, its two chapters should prove useful for physicians who are not frequently called on to treat sexual dysfunction. A segment on therapeutic approaches for women with sexual dysfunction would have been beneficial, but is missing.

Overall, the book is a good reference, easily readable, with short chapters. The reference lists are exhaustive and up to date. The chapters overlap considerably, but this does not detract from the overall substance of the book. Sexual Dysfunction should prove most useful to nonurologists, since practicing urologists will probably be familiar with most of the data relevant to sexual dysfunction in men.

Daniel L. Watson, M.D.
Brigham and Women's Hospital, Boston, MA 02115

Brian Saltzman, M.D.
Beth Israel Hospital, Boston, MA 02215