Book Review

Sexual Dysfunction: Neurologic, urologic, and gynecologic aspects

N Engl J Med 1995; 332:1312May 11, 1995

Article

Sexual Dysfunction: Neurologic, urologic, and gynecologic aspects
By Richard Lechtenberg and Dana A. Ohl. 410 pp., illustrated. Philadelphia, Lea & Febiger, 1994. $69.50. ISBN: 0-8121-1496-5

The definition of normal sexual function continues to defy medical professionals and talk-show hosts alike, but recent investigation into the pathophysiology of sex has brought a wealth of scientific and clinical information to this emotionally charged topic. The prevailing attitude has changed from a psychodynamic perspective to a more biologic point of view that sees behavior as occurring within a range of healthy variation. Cultural, ethical, and moral hurdles have impeded scientific inquiry into human sexual physiology, yet great progress has been made in the evaluation and treatment of sexual dysfunction. This concise, balanced, and well-organized book reviews the basic scientific and clinical topics relevant for a wide range of clinicians. It focuses on sexual problems encountered in neurologic disorders and on the evaluation and treatment of impotence.

The first of the book's five sections, on epidemiology, impresses the reader with how widespread are complaints about sexual function and satisfaction, particularly among older patients and those with common illnesses. This introductory chapter reminds the clinician that sexual impairments may be among the most distressing aspects of diabetes, neurologic or vascular disease, and other ailments.

Clear illustrations of central and peripheral nerve pathways and pelvic anatomy help the reader understand the neurologic and anatomical basis of normal sexual function, the topic of the second section. The complex hemodynamic and neurologic responses to sexual stimuli are the basis for understanding the specific effects of medications, neurologic diseases, and anatomical derangements on sexual function. The third section, the largest and richest, details specific dysfunctions. Many useful illustrations show the variety of conditions that are due to medication, intracranial and other neuropathologic disorders, vascular disease, age, and derangements of genital anatomy. The most provocative chapters contain detailed discussions of mechanisms of sexual dysfunction in patients with intracranial, spinal cord, or peripheral neuropathologic diseases. Because disorders of sexual function may detract substantially from quality of life, physicians who care for such patients should be familiar with the common difficulties and their treatments.

The remaining two sections, on the evaluation of patients and therapeutics, provide extensive information on techniques of evaluating impotence and the variety of corrective options. Noninvasive diagnostic tests are described with many helpful illustrations. Numerous photographs of the nonsurgical devices used to treat impotence illustrate the considerations involved in prescribing such therapy. Also illustrated are surgical revascularization and the treatment of venous incompetence, with detailed photographs of various penile prostheses and their implantation. Though sufficiently comprehensive for urologists, the discussion can also give readers from every field a comfortable familiarity with these interventions.

An excellent feature of this book is the inclusion of chapters devoted to the psychological components of all sexual dysfunctions and to the multitude of disorders that cannot be ascribed to organic disease. One chapter is devoted to strategies in sex therapy, and there are very thoughtful chapters on the physical and emotional effects of gynecologic and urologic surgery.

This well-written, concise book provides enough detail and sufficient references for the specialist, and an organization and style that will make it useful to any practitioner.

Douglas Dahl, M.D.
Brian Saltzman, M.D.
Harvard Medical School, Boston, MA 02115