M E D iC A L
JO lffiN A L
"
'O R I G I N A L
A R T I C L E ~
S e rg io R ic a rd o C a m p a n e lla d e O liv e ira ,
C a rm ita H e le n a N a jja r A b d o
T h e S e x u a lity P ro je c t (P ro -S e x ) o f th e In s titu te o f P s y c h ia try
o f th e H C F M U S P : firs t y e a r o f a c tiv itie s
T h e re s u lts o f o n e y e a r o f a c tiv itie s o f a m u ltid is c ip lin a ry s ta ff c o m p ris e d o f fiv e p s y c h ia tris ts , o n e u ro lo g is t, o n e g y n e c o lo g is t, a n d s e v e n p s y c h o lo g is ts , w h o in te g ra te th e S e x u a lity P ro je c t (P R O -S E X ) o f th e In s titu te o f P s y c h ia tric , H o s p ita l d a s C lfn ic a s , C o lle g e o f
M e d ic in e , U n iv e rs ity o f S a o P a u lo (F M U S P ), a re p re s e n te d , D iffe re n t s e x u a l d is o rd e rs w e re e v a lu a te d a n d tre a te d in 1 4 0 p a tie n ts
(1 1 6 m e n a n d 2 4 w o m e n ). In a d d itio n , a s ta n d a rd p ro to c o l w a s e s ta b lis h e d fo r th e m e d ic a l a s s is ta n c e o f p a tie n ts ; fo u r re s e a rc h
p ro je c ts h a v e b e e n in itia te d ; a n d c o u rs e s w e re o ffe re d to re s id e n ts in p s y c h ia try , u ro lo g y , a n d o b s te tric s -g y n e c o lo g y , a s w e ll a s to u n d e rg ra d u a te a n d p o s tg ra d u a te s tu d e n ts o f F M U S P . T h e P R O S E X s ta ff p re s e n te d th e ir re s e a rc h a t o n e c o n g re s s a n d tw o s y m p o
-s iu m -s , a n d p u b li-s h e d fo u r a rtic le -s . F u rth e rm o re , a n e x te n -s iv e p ro g ra m w a -s e -s ta b li-s h e d fo r 1 9 9 5 in o rd e r to c o n tin u e th e a d v a n c e d m e d ic a l s tu d y o f h u m a n s e x u a lity .
U N IT E R M S : S e x u a lity . S e x u a l d is o rd e rs . M u ltid is c ip lin a ry a s s is ta n c e . M e d ic a l e d u c a tio n . M e d ic a l re s e a rc h .
IN T R O D U C T IO N
T
h em u l t i d i s c i p l i n a r yS e x u a l i t y P r o j e c tp r o j e c t d e v e l o p e d( P R O - S E X )t o e s t a b l i s hi s a p r i o r i t i e s i n t h e t r e a t m e n t o f s e x u a l d i s o r d e r s , a n d a t t e n d t o t h e n e e d s f o r a s s i s t a n c e , e d u c a t i o n a n d r e s e a r c h i n t h i s a r e a . T h i s a p p r o a c h w a s p r o p o s e d b e c a u s e h u m a n s e x u a l i t y a n d i t s d i s o r d e r s , c a n n o t b e p r o p e r l y s t u d i e d w i t h i n a s i n g l e m e d i c a l s p e c i a l t y .T h e s t a f f o f P R O - S E X i s c o m p r i s e d o f p s y ~ h i a t r i s t s , p s y c h o t h e r a p i s t s ( p h y s i c i a n s a n d p s y c h o l o g i s t s ) , u r o l o g i s t s , g y n e c o l o g i s t s a n d a d m i n i s t r a t i v e a s s i s t a n t s . I t b e g a n i t s a c t i v i t i e s i n N o v e m b e r 1 9 9 3 .
A d re s s fo r c o rre s p o n d e n c e :
C a rm ita H e le n a N a jja r A b d o
R u a P a s c a l, 1 8 1 , a p to . 4 1 , C a m p o B e la
S a o P a u lo /S P - B ra s il - C E P 0 4 6 1 6 -0 0 1
F r o m N o v e m b e r 1 9 9 3 t h r o u g h N o v e m b e r 1 9 9 4 , 1 7 6 p a t i e n t s , 1 4 2 m e n a n d 3 4 w o m e n , w e r e a d m i t t e d t o o u r s e r v i c e . M e d i c a l a s s i s t a n c e w a s i n i t i a t e d b y a p e r f o r m i n g p s y c h i a t r i c e x a m i n a t i o n , f o l l o w e d b y a n u r o l o g i c a l o r g y n e c o l o g i c a l e x a m i n a t i o n , a c c o r d i n g t o t h e s e x o f p a t i e n t . P a t i e n t s w e r e o n l y t r e a t e d i f a s e x u a l i t y d i s o r d e r w a s d i a g n o s e d a c c o r d i n g t o t h e I n t e r n a t i o n a l C l a s s i f i c a t i o n o f D i s e a s e s , 1 0th
e d i t i o n . I
P a t i e n t s r e c e i v e d c l i n i c a l s u p p o r t ( p s y c h i a t r i c , u r o l o g i c a l , a n d g y n e c o l o g i c a l ) i f s e x u a l d i s o r d e r s w e r e d u e t o o r g a n i c c a u s e s . B ~ 'i e f p s y c h o t h e r a p y , i n d i v i d u a l o r i n g r o u p , w a s u s e d w h e n e v e r d i s o r d e r s w e r e p s y c h o g e n i c a l l y a s s o c i a t e d o r n o t a s s o c i a t e d t o o r g a n i c d i s t u r b a n c e s . F i g u r e s Ia n d 2 i l l u s t r a t e s o m e c h a r a c t e r i s t i c s o f p a t i e n t s a d m i t t e d t o t h i s s t u d y .
O n a w e e k l y b a s i s , t h e m e d i c a l s t a f f s p o n s o r e d m e e t i n g s t o p r e s e n t r e s e a r c h p r o j e c t s i n p r o g r e s s a n d s e m i n a r s o n i m p O l t a n t i s s u e s ; t o d i s c u s s c l i n i c a l c a s e s ; t o e s t a b l i s h p l a n s f o r e x p a n d i n g e d u c a t i o n a l , s c i e n t i f i c a n d a s s i s t a n c e a c t i v i t i e s ; a n d t o r e v i e w t h e m a i n o b j e c t i v e s o f t h i s p r o j e c t .
1 2 0 9
4 4 .8 %
F ig u re 1 - G e n d e r o f P a tie n ts A d m itte d to P ro -S e x (N o v .9 3 / N o v . 9 4 )
H IS T O R Y
T h e n u r s i n g a n d m e d i c a l s t a f f o f t h e I n s t i t u t e o f
P s y c h i a t r y ( I P Q ) o f t h e H o s p i t a l d a s C l f n i c a s ( H C ) ,
C o l l e g e o f M e d i c i n e , U n i v e r s i t y o f S a o P a u l o i n t h e l a s t
f e w y e a r s h a s h a d a n i n c r e a s i n g d e m a n d f o r a s s i s t a n c e b y
p a t i e n t s w h o s e m a i n o r m i n o r c o m p l a i n t s w e r e r e l a t e d t o
s e x u a l d i s o r d e r s .
S i m u l t a n e o u s l y , o t h e r s p e c i a l t i e s o f t h e H C c o m p l e x
h a v e b e e n s u b j e c t t o s i m i l a r d e m a n d s , e s p e c i a l l y t h e
d i s c i p l i n e s o f u r o l o g y , g y n e c o l o g y a n d o b s t e t r i c s . T h e s e
p a t i e n t s w e r e s e n t t o I P Q f o r e x p e r t c o n s u l t a t i o n o r c l i n i c a l
e v a l u a t i o n . T h e i r s e x u a l c o m p l a i n t s i n c l u d e d : p r e m a t u r e
e j a c u l a t i o n , e r e c t i l e d y s f u n c t i o n , a n o r g a s m y , o r
d y s p a r e u n i a . T h i s s y s t e m d i d n o t a l l o w a n a d e q u a t e
i n t e r d i s c i p l i n a r y f o l l o w - u p . T h e w a i t i n g p e r i o d f o r p a t i e n t
a d m i t t e n c e t o I P Q b e c a m e p r o g r e s s i v e l y l o n g e r .
I n a d d i t i o n , t h e a b s e n c e o f a s y s t e m a t i c p r o t o c o l d i d
n o t p e r m i t a s t a n d a r d i z a t i o n o f p r o c e d u r e s t o b e a d o p t e d
a n d s c i e n t i f i c a l l y e v a l u a t e d . I n f a c t , a s t a n d a r d p r o c e d u r e
i s n e c e s s a r y t o e s t a b l i s h t r e a t m e n t f o r d i f f e r e n t g r o u p s o f
p a t i e n t s , a n d t o v a l i d a t e d i f f e r e n t t r e a t m e n t s o r t o i n d i c a t e
n e w d i r e c t i o n s .
F a c e d w i t h t h i s s i t u a t i o n a n d a w a r e o f t h e c o m p l e x i t y
o f t h i s i s s u e a n d i t s i m p l i c a t i o n s o n o t h e r s p h e r e s o f h u m a n
e x i s t e n c e , t h e S e x u a l i t y P r o j e c t w a s o r g a n i z e d i n a
m u l t i d i s c i p l i n a r y m a n n e r .
A C T IV IT IE S
A s s i s t a n c e , e d u c a t i o n a n d r e s e a r c h a r e t h e m a i n o b j e c t i v e s o f t h e S e x u a l i t y P r o j e c t ( P R O - S E X ) , w h i c h h a s
b e e n d e v e l o p e d a c c o r d i n g t o t h e f o l l o w i n g p r e m i s e s :
F ig u re 2 a - P ro p o rtio n o f M a le P a tie n ts A d m itte d to P ro -S e x , A c c o rd in g to A g e A n d A g e G ro u p (N o v . 9 3 / N o v . 9 4 ).
F ig u re 2 b - P ro p o rtio n o f F e m a le P a tie n ts A d m itte d to P ro -S e x , A c c o rd in g to A g e A n d A g e G ro u p (N o v . 9 3 / N o v . 9 4 ).
Assistance
I n i t i a l l y , p a t i e n t s o f b o t h s e x e s a r e s u b m i t t e d t o t r i a g e
a n d e x a m i n e d b y a p s y c h i a t r i s t ; m e n a r e t h e n e v a l u a t e d
b y a u r o l o g i s t a n d w o m e n b y a g y n e c o l o g i s t .
O n c e p a t i e n t s a r e a d m i t t e d t o P R O - S E X , t h e y a r e
s u b m i t t e d t o a p s y c h i a t r i c e v a l u a t i o n a n d t o t h e f o l l o w i n g
s p e c i f i c a n a m n e s i s :
M A S C U L IN E S E X U A L IT Y
U p b r i n g i n g : e d u c a t i o n , p e r c e p t i o n a n d / o r e x p e r i e n c e o f s e x u a l i t y a t h o m e , w i t h f r i e n d s o r r e l a t i v e s .
S e c o n d a r y s e x u a l d e v e l o p m e n t : a n 'd r o p a u s e a n d i n c i d e n t s ( s p e c i f i c d i s e a s e s a n d s e x u a l l y t r a n s m i t t e d
d i s e a s e s ) .
S e x u a l i n i t i a t i o n : m a s t u r b a t i o n , c h i l d h o o d s e x u a l p l a y , f i r s t r e l a t i o n s h i p s , f i r s t e x p e r i e n c e s ( f a n t a s i e s ,
f r e q u e n c y a n d p r e f e r e n c e s ) .
S e x u a l i d e n t i t y : ( a p p r o v a l o r d i s a p p r o v a l o f t h e i r b i o l o g i c a l s e x ) .
S e x u a l o r i e n t a t i o n : t h e o p p o s i t e s e x , t h e s a m e s e x , o b j e c t s , m a s t u r b a t i o n ( t y p e ) .
O L IV E IR A , S .R .C . & A S D O , C .H .N . - T h e S e x u a lity P ro je c t (P R O -S E X ) o f th e In s titu te o f P s y c h ia try o f th e H C F M U S P : F irs t y e a r o f a c tiv itie s
Im portance
of sexual
activity
(in the beginning,
currently).
P artners:
num ber,
civil
status,
race,
profession,
physical
appearance,
sex, age.
S exual
intercourse:
perform ance
during lifetim e
(in
the beginning,
evolution
and current
status)
F requency
of sexual intercourse
and favorite caresses
U se of stim ulating
drugs to facilitate
perform ance.
E m otional
life related to sex: need for an em otional
relationship,
and its interference
in sexual pleasure.
C urrent
status
of the
em otional-sexual
life:
the
presence
or absence
of a steady
partner;
num ber
of
partners; frequency
of sexual intercourse;
incidents during
sexual intercourse
(reported
spontaneously
or prom pted).
Im portance
of values:
(cultural,
religious,
fam ily,
related to children,
related to the m asculine
role) and their
interference
on sexual perform ance
and sexuality.
F E M IN IN E
S E X U A L IT Y
U pbringing:
education,
perception
and/or experience
of sexuality
at hom e, w ith friends or relatives.
M enarche,
nlenopause
and pregnancies:
num ber
of
pregnancies
and their acceptance.
A bortions:
spontaneous,
or induced.
S exual
initiation:
m asturbation,
childhood
sexual
play,
first
relationships,
first
experiences
(fantasies,
frequency
and preferences).
S exual
identity:
(approval
or disapproval
of the
biological
sex).
S exual
orientation:
the opposite
sex, the sam e sex,
objects,
m asturbation
(types).
Im portance
of sexual
activity:
(in the beginning,
currently).
P artners:
num ber,
civil
status,
race,
profession,
physical
appearance,
sex.
S exual
intercourse
perform ance:
throughout
life (in
the beginning,
evolution
and current
status);
incidents:
pain, bleeding,
etc;
F req u en cy :
of sexual
intercourse
and
favorite
caresses
E m o tio n al life related to sex : need for a relationship,
and its interference
in sexual pleasure.
U se o f stim u latin g
d ru g s: to facilitate perform ance.
C u rren t
statu s
o f th e
em o tio n al-sex u al
life:
P resence
or absence
of a steady
partner;
num ber
of
partners; frequency
of sexual intercourse;
incidents during
sexual intercourse
(reported
spontaneously
or prom pted).
Im p o rtan ce
o f v alu es: (cultural,
religious,
fam ily,
related to children,
related to fem inine
behavior)
and their
interference
on sexual perform ance
and sexuality.
O nce
patients
are
thus
evaluated
and
properly
diagnosed,
they receive
specific
treatm ent,
i.e.,
clinical
(psychiatric
and/or
urological
or gynecological)
or
psychodynam ic,
or both.
C linical treatm ent
of the underlying
m ental disorder
is based
on
psychiatric
assistance
(if
the
prim ary
disturbance
is prior to the sexual disorder).
If necessary,
psychotherapy
is used for a brief period,
and focuses
on
the current
sexual disorder.
G roups
of "Ii m ited them atic
therapy"
are organized
-
i.e.,
groups
w hich
w ill approach
a specific
subject
based
on
patient
diagnosis
(e.g ..
prem ature
ejaculation)
- for
12-16 w eeks.
T hus,
these
groups
are com prised
of patients
w ith
the sam e
sexual
disorder.
Individual
psychotherapy,
along
different
lines,
is
recom m ended
w henever the psychic structure of the patient
is such that psychotherapy
in group should
not be used.
T he diagnosis
of concom itant
etiologies
determ ines
m ultidisciplinary
assistance.
R E S E A R C H
P R O -S E X
has developed
the follow ing
research
projects:
"L im ited
them atic
therapy
for m ale
patients
w ith
sexual disorders"
(w orking
title). S tag e: analysis
of
data.
A u th o rs:
A lexandre
S aadeh,
F i Ii pe
.Jorge
D .T .S . F erreira,
C arm ita
H .N . A bdo
"E fficacy
of pharm acologic
treatm ent
of anxiety
in
the treatm ent
of prem ature
ejaculation"
(w orking
title).
A u th o rs:
C elso
G rom atzky,
C arm ita
H .N .
A bdo, S ergio R icardo
C . de O liveira.
. •
"S exuality
and C ardiopathy"
(w orking
title).
T his
project
is being
developed
in collaboration
w ith
Instituto
do C orac;ao (IN C O R ),
w ith the objecti ve of
evaluating
the sexual
perform ance
of patients
w ith
coronary
artery disease.
A u th o rs:
A ntonio
M ansur,
C arm ita
H .N . A bdo, A lexandre
S aadeh.
PRO-SEX published the following articles in 1994
O liveira S R C , A bdo C H N . "A lgum as
reflexoes
sobre
a im portancia
do casal
na genese
de
patologia
sexuais".
"S om e
reflections
on the im portance
of
S a o P a u lo M e d ic a l J o u r n a l/R P M 1 1 4 ( 4 ) : 1 2 0 8 - 1 2 1 5 , 1 9 9 6 O L IV E IR A , S .R .C . & A B D O , C .H .N . - T h e S e x u a lity P r o je c t ( P R O - S E X ) o f th e In s titu te o f
1211
couples
in the genesis
of sexual
disorders."
Rev
Psiquiat
Clfn 1994;21 (I): 15-8.
2Abdo
CRN,
Gromatzky
C,
Oliveira
SRC.
"Concomitancia
de Depressao,
Disfunc;ao
Eretil
Peniana e Ripotestosteronemia:
Relato de tres casos".
"Concomitance
of depression,
erectile
dysfunction,
and
hypotestosteronemia:
report
of three
cases."
Congresso
Brasileiro
de Psquiatria.
Pousada
do Rio
Quente,
Anais,
1994.
3Abdo CRN. "A mulher no contexto
s6cio-psfquico:
Sexo
e
Dominac;ao"/"W omen
in
a
social-psychological
perspective:
sex and domination"
(Round
Table Topic). XIII Congresso
Brasileiro
de
Psiquiatria.
Pousada
do Rio Quente,
Anais,
1994.
4Postgraduation
In 1994, a comparative
study of anxiety
disorders
and premature
ejaculation
was started
and is currently
being
carried
out
by Sergio
Ricardo
Campanella
de
Oliveira
under the supervision
of Prof Dr. Carmite
R.N.
Aldo, for a M asters
degree.
Education
In 1994, PRO-SEX
was responsible
for the following
educational
activities
for:
1. Postgraduate students
Course:
"Aspectos
da
Sexualidade
Humana"/
"Aspects
of
Ruman
Sexuality"
(M PS-726).
Responsibility:
Prof. Dr. Carmita
H.N. Abdo from
the Department
of Psychiatry,
College of M edicine,
University
of Sao Paulo.
Course:
"Psicoterapi
a
Fami liar" /
"Fami
Iy
Psychotherapy"
(M PS-726).
Responsibility:
Prof. Dr.
Carmita
R.N.
Abdo
from
the
Department
of
Psychiatry,
College
of M edicine,
University
of Sao
Paulo.
2. Medical residents
Course:
"Disturbios
Sexuais"/
"Sexual
Disorders,"
for
first-year
residents
of
the
Department
of
Psychiatry,
FM USP.
Responsibility:
Prof.
Dr.
Carmita
R.N. Abdo.
Lecture:
"Aspectos
Psfquicos
da Disfunc;ao Eretil"/
"Psychical
Aspects
Of Erectile
Dysfunction,"
for
first-,
second-,
and
third-year
residents
of the
Department
of Urology,
FM USP.
Lecture:
"Sexualidade
Feminina"/
"Female
Sexuality," for first-, second-, and third-year
residents
of the Department
of Gynecology
and Obstetrics,
FM USP
Optional
training
for third-year
psychiatry
residents
of the Department
of Psychiatry,
FM USP.
Trainees:
Filipe
D.T.S.
Ferreira,
Fabio
Salzano
e M iriam
Regina
M oretti.
3. Undergraduate students
Lecture: "Aspectos
psicol6gicos
do desenvolvimento
da Sexualidade"/
"Psychological
aspects
of sexual
development"
for the Course of M edical
Psychology
for the third-year
students ofFM USP.
Lecturer:
Prof.
Dr. Carmita
R.N.Abdo.
Lecture:
"A famnia
como mantenedora
da doenc;a"/
"The family as a maintainer of disease" for the Course
of M edical
Psychology
for third-year
students
of
FM USP. Lecturer:
Prof. Dr. Carmita
R.N.Abdo.
I N T E R N S H I P S
For physicians:
Dr. Celso Gromatzky,
urologist,
and
Dr. Joserita
Serrano
de Assis,
gynecologist,
are
responsible
for the clinical
assistance
of patients
in
the PRO-SEX.
They
take
part
in weekly
clinical
meetings,
and
participate
in
research
of
a
multidisciplinary
approach.
For psychologists:
Andrea
Newmann,
Alina
D.D.
Barone, Aurea R. Giaquinto,
Beatriz Kalman, Cecflia
Brasiliense
Carneiro,
Ymara
L.C.
Victolo,
M arco
Antonio
P. Amato,
Rita
Di Giacomo
Domingues
collaborate
in psychotherapeutic
assistance,
and take
part in clinical
meetings
and research
projects.
P A R T I C I P A T I O N I N S Y M P O S I U M S A N D
C O N G R E S S E S
Symposium
of the Interassistance
Section
of the
Institute
of Psychiatry,
RCFM USP:
"Psiquiatria
e
Psicologia
no
Rospital
Geral:
integrando
as
especialidades
-
Sexualidade"/
"Psychiatry
and
Psychology
ina
General
Rospi tal:
integrati
ng
specialties
-
Sexuality",
held in April
1994.
O L I V E I R A , S . R . C . & A B D O , C . H . N . - T h e S e x u a l i t y P r o j e c t ( P R O - S E X ) o f t h e I n s t i t u t e o f
P s y c h i a t r y o f t h e H C F M U S P : F i r s t y e a r o f a c t i v i t i e s
S IN G LE M A R R IE D W ID O W E D D IV O R C E D T O T A L
M en 54 (46.6% ) 49 (42.2% ) 4 (3.4% ) 9 (7.8% ) 116 (100.0% )
W om en 9 (37.4% ) 13 (54.2% ) 1 (4.2% ) 1 (4.2% ) 24 (100.0% )
S y m p o s iu m o f th e In te ra s s is ta n c e S e c tio n o f th e
In s titu te o f P s y c h ia try , H C F M U S P : " P s iq u ia tria e
P s ic o lo g ia n o H o s p ita l G e ra l:
Mulher" /
" P s y c h ia try a n d P s y c h o lo g y in a G e n e ra l H o s p ita l:Women,"
h e ld in O c to b e r 1 9 9 4 .X III C O N G R E S S O B R A S IL E IR O D E
P S IQ U IA T R IA h e ld in S e p te m b e r 1 9 9 4 : th e
p a rtic ip a tio n o f th e p ro fe s s io n a ls o f P R O -S E X w a s
p re v io u s ly m e n tio n e d u n d e r th e h e a d in g
R E S E A R C H .
D E M O G R A P H IC D A T A A N D D IA G N O S E S
O F P A T IE N T S A D M IT T E D T O P R O -S E X ,
D U R IN G T H E F IR S T Y E A R O F A C T IV IT IE S
T h e p a tie n ts a s s is te d b y th e c lin ic a l s ta ff o f P R O
-S E X w e re e v a lu a te d in o p e n in te rv ie w s b y p s y c h ia tris ts ,
g y n e c o lo g is ts , a n d u ro lo g is ts . T h e p a tie n ts s u s p e c te d o f
p rim a ry s e x u a l d is o rd e rs w e re e x a m in e d b y a u ro lo g is t
(m a le p a tie n ts ) o r a g y n e c o lo g is t (fe m a le p a tie n ts ) to
e x c lu d e th e p o s s ib ility o f p a th o lo g ie s o f th is ty p e .
T h e p s y c h ia tric d ia g n o s is fo r e a c h p a tie n t w a s
re c o rd e d in th e ir m e d ic a l file s , a n d s ta n d a rd iz e d a c c o rd in g
to th e In te rn a tio n a l C la s s ific a tio n o f D is e a s e s , 1 0 th e d itio n ,
IC D 1 0 (1 9 9 3 ). D e m o g ra p h ic d a ta w e re o b ta in e d b y
c o n s u ltin g IP Q file s .
D E M O G R A P H IC
D A T A
GENDER
O n e h u n d re d fo rty p a tie n ts w e re s e le c te d fro m a to ta l
o f 1 7 6 c a s e s a s s is te d d u rin g th e p e rio d o f th is s tu d y : 1 1 6
w e re m a le (8 2 .9 p e rc e n t), a n d 2 4 w e re fe m a le (1 7 .1
p e rc e n t), a s d e p ic te d in F ig u re 1 .
AGE
P a tie n ts w e re c a te g o riz e d in to th re e d is tin c t g ro u p s
b a s e d o n a g e , re g a rd le s s o f s e x : 1 8 to 3 5 , 3 6 to 6 0 , a n d
o ld e r th a n 6 0 y e a rs . T h e m e n 's a g e s ra n g e d fro m 1 8 to 7 6
y e a rs , a n d th e w o m e n 's fro m 1 9 to 6 7 . T h e d is trib u tio n o f
p a tie n ts a c c o rd in g to a g e is s h o w n in F ig u re 2 a a n d 2 b .
T h e m e a n a g e o f m e n (3 7 .8 y e a rs ) is h ig h e r th a n o f
w o m e n (3 5 .2 y e a rs ). M o s t o f th e p a tie n ts w e re b e tw e e n
1 8 a n d 3 5 y e a rs (4 7 .4 p e rc e n t m a le a n d 5 8 .3 p e rc e n t
fe m a le ). T h e y o u n g e r g ro u p s s o u g h t m e d ic a l a s s is ta n c e
m o re o fte n (1 8 to 3 5 , a n d 3 6 to 6 0 y e a rs ), c o rre s p o n d in g
to 9 2 .2 p e rc e n t o f m a le a n d 9 1 .6 p e rc e n t o f fe m a le c a s e s .
ORIGIN
A ll p a tie n ts a d m itte d c a m e fro m th e c ity o f S a o P a u lo .
CIVIL STA TUS
A s s h o w n in T a b le I, m o s t o f th e fe m a le p a tie n ts
w e re m a rrie d (5 4 .2 p e rc e n t); s in g le w o m e n a c c o u n te d fo r
3 7 .4 p e rc e n t o f th e c a s e s . O n th e o th e r h a n d , m o s t o f th e
m a le p a tie n ts w e re s in g le (4 6 .6 p e rc e n t), a n d m a rrie d m e n
a c c o u n te d fo r 4 2 .2 p e rc e n t.
D IA G N O S IS S U R V E Y B Y (IC D -10)
GENERAL CONSIDERA TIONS
A s s h o w n in T a b le 2 , fro m a to ta l o f 1 4 0 p a tie n ts
w ith 4 .3 p e rc e n t (6 c a s e s ) n o t b e in g p ro p e rly c la s s ifie d ,
2 .9 p e rc e n t (4 m a le c a s e s ) h a d a s e x u a l d is o rd e r o f o rg a n ic
o rig in .
O n e h u n d re d th i rty p a tie n ts h a d p s y c h ia tric
d ia g n o s e s (9 2 .9 p e rc e n t o f to ta l c a s e s ): 1 0 7 w e re m a le
(8 2 .3 p e rc e n t) a n d 2 3 w e re fe m a le (1 7 .7 p e rc e n t). F o r
c o m p a rin g d a ta , a n a ly s e s o f d iffe re n t d ia g n o s e s w e re
p e rfo rm e d fo r e a c h s e x .
T A B L E 2
F re q u e n c y o f M a le P a tie n ts w ith o u t P s y c h ia tric D ia g n o s is B a s e d o n Ic d -1 0 (N o v . 9 3 /N o v . 9 4 ) E re c tile D y s fu n c tio n o f O rg a n ic O rig in
D ia g n o s is
D ia b e te 's M e llitu s w ith P e rip h e ric a l C irc u la to ry D is o rd e r
A th e ro s c le ro s is L im b s A te rie s
T o ta l
IC D -1 0
2 5 0 6 /2
4 4 0 2 /4
N u m b e r o f C a s e s
2 2
4
T his survey also revealed that 32 patients (24.6 percent) show ed m ore than one psychiatric diagnosis; m ainly erectile dysfunction and prem ature ejaculation in 10 cases (31.3 percent of the diagnostic associations and 7.7 percent of total diagnoses).
O ther associations w ill be show n separately for m asculine and fem inine disorders.
T hree patients (tw o m en and one w om an) (2.3 percent of the total cases) w ere hom osexual. H ow ever, only the fem ale case could be classified by the adopted
diagnostic criterion, due to the ego-dystonic character of her sexual orientation (F 66.1).
DIAGNOSTIC DATA FOR MALE PATIENTS
A ccording to the data show n in T able 3, the m ost frequent diagnosis is prem ature ejaculation (47 cases, 36.7 percent of total cases and 43.9 percent of m ale cases), follow ed by erectile dysfunction (44 cases, 34.0 percent of total cases and 41.1 percent of m ale cases).
T A B L E 3
F re q u e n c y o f D ia g n o s e s A m o n g M a le P a tie n ts
D ia g n o s is
P re m a tu re E ja c u la tio n
E re c tile D y s fu n c tio n
L a c k o f P le a s u re
T ra n s s e x u a lis m
O th e r D is o rd e r O f S e x u a l P re fe re n c e
P s y c h . B e h a v . D is . A s s o c . S e x . D e v . O rie n t****
P e rs o n a lity D is o rd e r**
E p is o d e s o f D e p re s s io n **
N o n s p e c ifie d E p is o d e s o f A n x ie ty **
T ra n q u iliz e r A b u s e *
M ild O lig o p h re n ia *
R e s id u a l S c h iz o p h re n ia *
B ip o la r D is o rd e r*
S o c ia l P h o b ia *
G e n e ra liz e d A n x ie ty D is o rd e r*
T o ta l
IC D -1 0 (re f)
F 5 2 -4
F 5 2 -2
F 5 2 .1 .1
F 6 4 .0
F 6 5 .8
F 6 6 ***
F 6 0 ***
F 3 2 ***
F 4 1 .9
F 1 3 .1
F 7 0 .8
F 2 0 .5
F 3 1 .7
F 4 0 .1
F 4 1 .1
N u m b e r
4 7
44
2
2
3 2
3
2
5
1
1
1
1
1
1 # 1 1 6
P e rc e n ta g e
4 3 .9 %
4 4 .1 %
1 .9 %
1 .9 %
2 .8 %
1 .9 %
2 .8 %
1 .9 %
4 .7 %
0 .9 %
0 .9 %
0 .9 %
0 .9 %
0 .9 %
0 .9 %
1 0 7 .3 %
'No Associated Sexual Diagnoses
"Secondary Diagnosis of Sexual Dysfunction
"'Specific Diagnosis Only for the Group
•••• Psychic Disorder And Abnormal Behavior Associated with Sexual Development and Orientation
#Some Patients Presented more than One Psychiatric Diagnosis
O L IV E IR A , S .R .C . & A B D O , C .H .N . - T h e S e x u a lity P ro je c t (P R O -S E X ) o f th e In s titu te o f P s y c h ia try o f th e H C F M U S P : F irs t y e a r o f a c tiv itie s
O r g a s m i c D y s f u n c t i o n
L a c k o f P l e a s u r e
D y s p a r e u n i a
E g o - D y s t . H o m o s . * * *
V a g i n i s m u s
N o n s p e c i f i e d D i s o r d . P e r s o n . * * * *
T o t a l
F 5 2 . 3 1 7 7 3 . 9 %
0 2 8 . 7 %
F 5 2 . 6 2 8 . 7 %
F 6 6 . 1 1 4 . 3 %
F 5 2 . 5 1 4 . 3 %
F 6 0 . 9 * 1 4 . 3 %
2 4 * * 1 0 4 . 2 %
• No Associated Sexual Diagnoses
•• One Patient has Two Psychiatric Diagnosis
••• Ego-Dystonic Homosexualism
•••• Nonspecified Personality Disorder
T h e s e t w o d i s o r d e r s a c c o u n t f o r 8 5 . 0 p e r c e n t o f
d i a g n o s e s i n m a l e p a t i e n t s .
T h e m o s t f r e q u e n t p s y c h i c d i s o r d e r s a s s o c i a t e d w i t h
m a l e s e x u a l d y s f u n c t i o n a r e : p e r s o n a l i t y d i s o r d e r s ( 3 c a s e s ,
2 . 8 p e r c e n t m a l e c a s e s ) ; e p i s o d e s o f d e p r e s s i o n ( 2 c a s e s ,
1 . 9 p e r c e n t m a l e c a s e s ) a n d e p i s o d e s o f a n x i e t y ( 5 c a s e s ,
4 . 7 p e r c e n t m a l e c a s e s ) .
A m o n g t h e m e n , 5 . 7 p e r c e n t ( 6 c a s e s ) d i d n o t p r e s e n t
a n y d i a g n o s i s r e l a t e d t o a s e x u a l i t y d i s o r d e r . T h e r e w e r e
o n l y s e c o n d a r y c o m p l a i n t s r e l a t e d t o t h e i r p r i m a r y
d i s o r d e r s , ' a n d t h u s c o u l d n o t b e c l a s s i f i e d i n t h e g r o u p o f
s e x u a l d i s o r d e r s ( I c a s e f o r e a c h d i s o r d e r ) . T h e s e d i s o r d e r s
w e r e : s o c i a l p h o b i a ( F 4 0 . 1 ) , t r a n q u i l i z e r a b u s e ( F 1 3 . 1 ) ,
m i l d o l i g o p h r e n i a ( F 7 0 . 8 ) , r e s i d u a l s c h i z o p h r e n i a ( F 2 0 . 5 ) ,
b i p o l a r d i s o r d e r ( F 3 1 . 7 ) , a n d g e n e r a l i z e d a n x i e t y d i s o r d e r
( F 4 1 . 1 ) .
T w o c a s e s ( 1 . 9 p e r c e n t m a l e p a t i e n t s ) o f
t r a n s s e x u a l i s m , 3 c a s e s ( 2 . 8 p e r c e n t ) o f s e x u a l p r e f e r e n c e
d i s o r d e r s ( t h e w e l l - k n o w n p a r a p h i l i a ) , a n d t w o c a s e s ( 1 . 9
p e r c e n t ) o f p s y c h o l o g i c a l d i s o r d e r a n d a b n o r m a l b e h a v i o r
a s s o c i a t e d w i t h s e x u a l d e v e l o p m e n t a n d o r i e n t a t i o n ( F 6 6 )
w e r e a l s o o b s e r v e d .
T h u s , m o s t m a l e p a t i e n t s ( 8 6 . 7 p e r c e n t ) p r e s e n t e d
d i a g n o s e s o f t h e g r o u p F 5 0 - F 5 9 ( B e h a v i o r a l s y n d r o m e s
a s s o c i a t e d w i t h p h y s i o l o g i c a l d i s t u r b a n c e s a n d p h y s i c a l
f a c t o r s ) , a n d o n l y 7 . 4 p e r c e n t c a s e s p r e s e n t e d d i a g n o s e s
o f t h e g r o u p F 6 0 - F 6 9 p e r s o n a l i t y ( P e r s o n a l i t y a n d b e h a v i o r
d i s o r d e r s i n a d u l t s ) . T h e o t h e r s ( 5 . 6 p e r c e n t ) d i d n o t p r e s e n t
a n y s e x u a l d i s o r d e r .
DIAGNOSTIC DATA FOR FEMALE PATIENTS
I n r e g a r d t o t h e f e m a l e s e x , a c c o r d i n g t o T a b l e 4 ,
t h e m o s t f r e q u e n t d i s o r d e r w a s o r g a s m i c d y s f u n c t i o n
( 7 3 . 9 p e r c e n t f e m a l e p a t i e n t s ) ; t w o c a s e s ( 8 . 7 p e r c e n t )
o f a n o r g a s m y , 2 c a s e s ( 8 . 7 p e r c e n t ) o f d y s p a r e u n i a , I
c a s e ( 4 . 3 p e r c e n t ) o f v a g i n i s m u s , a n d I c a s e ( 4 . 3
p e r c e n t ) o f e g o - d y s t o n i c h o m o s e x u a l i t y w e r e a l s o
o b s e r v e d . T h e r e w a s a l s o o n e c a s e ( 4 . 3 p e r c e n t ) o f
o r g a s m i c d y s f u n c t i o n a s s o c i a t e d w i t h d y s p a r e u n i a , a n d
I c a s e t h a t c o u l d n o t b e c l a s s i f i e d a s a s e x u a l d i s o r d e r
( F 6 0 . 9 - n o n s p e c i f i e d p e r s o n a l i t y d i s o r d e r s ) .
A m o n g a l l f e m a l e p a t i e n t s , 4 c a s e s ( 1 7 . 4 p e r c e n t )
p r e s e n t e d a p s y c h i a t r i c d i a g n o s i s a s s o c i a t e d w i t h a n
i d e n t i f i e d s e x u a l d i s o r d e r , a n d a l l o f t h e s e p a t i e n t s
p r e s e n t e d a n x i e t y d i s o r d e r s ( 3 c a s e s o f g e n e r a l i z e d a n x i e t y
d i s o r d e r , a n d I c a s e o f n o n s p e c i f i e d a n x i e t y ) .
N o c a s e s o f p a r a p h i l i a w e r e o b s e r v e d , c o n f i r m i n g
t h e r e s u l t s o f l i t e r a t u r e a b o u t t h e i r a b s o l u t e p r e d o m i n a n c e
i n m e n .
M o s t o f t h e f e m a l e p a t i e n t s ( 9 5 . 6 p e r c e n t ) w e r e
c l a s s i f i e d i n t h e g r o u p F 5 0 - F 5 9 , a n d o n l y 4 . 4 p e r c e n t i n
t h e g r o u p F 6 0 - F 6 9 . S i m i l a r l y t o t h e m a l e p o p u l a t i o n , t h e s e
f i n d i n g s d e m o n s t r a t e t h e p r e v a l e n c e o f s e x u a l d y s f u n c t i o n s
a s s o c i a t e d w i t h s e x u a l i t y d i s o r d e r s .
E X P A N S IO N O F P R O - S E X
IN 1 9 9 5
T h e I s t S y m p o s i u m o n S e x u a l i t y , " D i a g n o s i s a n d
t r e a t m e n t o f s e x u a l d i s o r d e r s , " i s i n i t s f i n a l s t a g e o f
o r g a n i z a t i o n , a n d w i l l b e d i r e c t e d a t p r o f e s s i o n a l s i n t h e
m e n t a l h e a l t h a r e a .
T h i s e v e n t w i l l b e h e l d a t t h e I n s t i t u t e o f P s y c h i a t r y
o f H C F M U S P i n O c t o b e r 1 9 9 5 .
S a o P a u lo M e d ic a l J o u r n a l/R P M 1 1 4 ( 4 ) : 1 2 0 8 - 1 2 1 5 , 1 9 9 6 O L IV E IR A , S .R .C . & A B D O , C .H .N . - T h e S e x u a lity P r o je c t ( P R O - S E X ) o f th e In s titu te o f
1 2 1 5
T h e E d u c a tio n a l C lin ic o f S e x u a l D is o rd e rs , w a s
s ta rte d in F e b ru a ry 1 9 9 5 , a n d is h e ld w e e k ly , m a in ly fo r
s e c o n d -y e a r p s y c h ia try re s id e n ts o f th e In s titu te o f
P s y c h ia try o f H C F M U S P .
T h e fo llo w in g a re in th e p la n n in g a n d o rg a n iz a tio n a l
s ta g e : th e C lin ic o f S e x u a lity in P re g n a n c y (to b e
e s ta b lis h e d w ith th e O b s te tric s C o u rs e o f th e H C F M U S P );
th e C lin ic o f S e x u a lity in M e n o p a u s e (w ith th e G y n e c o lo g y
C o u rs e o f th e H C F M U S P ); a n d th e C lin ic o f S e x u a lity in
p h y s ic a lly -re h a b ilita te d p e rs o n s (w ith th e R e h a b ilita tio n
H o s p ita l o f H C F M U S P ).
T w o n e w p ro je c ts w ill b e in itia te d b y P R O -S E X fo r
M a s te r's d e g re e s in 1 9 9 5 :
" F e m a le o rg a s m ic d y s fu n c tio n : n o rm a l v a ria tio n o f
s e x u a lity , a u to n o m o u s n o s o lo g ic a l s y m p to m o r
e n tity ," b y F a b io S c h im id t G o ffi J r.
" L im ite d g ro u p p s y c h o th e ra p y fo r tre a tm e n t o f
e re c tile d y s fu n c tio n ," b y F ilip e J o rg e D o n te l T e ix e ira
S o a re s F e rre ira .
T h e S e x u a lity P ro je c t w ill b e re s tru c tu re d in 1 9 9 5 ,
a n d w ill h a v e th re e a re a s : a s s is ta n c e , e d u c a tio n a n d
re s e a rc h . T h u s , P R O -S E X in te n d s to ta k e a n e w s te p in
th e a d v a n c e d s tu d y o f h u m a n s e x u a lity , fro m a c lin ic a l"
p o in t o f v ie w .
R E S U M O
O s a u to re s a p re s e n ta m 0 re s u lta d o d e u m a n a d e a tiv id a d e d e c in c o p s iq u ia tra s , u m u ro lo g is ta , u m a g in e c o lo g is ta e s e te p s ic o lo g o s q u e fa z e m p a rte d o P ro je to S e x u a lid a d e (P R O -S E X ) d o In s titu to d e P s iq u ia tria d o H o s p ita l d a s C lfn ic a s d a F a c u ld a d e d e M e d ic in a d a U n iv e rs id a d e d e S a o P a u lo (F M U S P ). N e s te p e rfo d o , 1 4 0 p a c ie n te s (1 1 6 h o m e n s e 2 4 m u lh e re s ) in ic ia ra m tra ta m e n to m u ltid is c ip lin a r p a ra tra n s to rn o s s e x u a is d iv e rs o s . N e s te p e rio d o , ta m b e m , fo i e s ta b e le c id o u m p ro to c o lo d e a te n d im e n to , m in is tra d o s c u rs o s p a ra m e d ic o s re s id e n te s d e P s iq u ia tria , U ro lo g ia e O b s te trfc ia , b e m c o m o p a ra a lu n o s d a g ra d u a c ;a o e d a p o s -g ra d u a c ;a o d a F M U S P e fo ra m in ic ia d o s q u a tro p ro je to s d e p e s q u is a . O s in te g ra n te s d o P R O -S E X s e a p re s e n ta m e m u m C o n g re s s o e d o is S im p o s io s e o b tiv e ra m q u a tro p u b lic a c ;6 e s . A le m d is to d e fin ira m a m p la p ro g ra m a c ;a o p a ra 1 9 9 5 , n o in tu ito d e d a r s e q u e n c ia a o e s tu d o m e d ic o a v a n c ;a d o d a S e x u a lid a d e H u m a n a .
REFERENCES
I. W o rld H e a lth O rg a n iz a tio n . C la s s ific a < ;a o d e T ra n s to rn o s
M e n ta is e d e C o m p o rta m e n to d a C la s s ific a < ;a o In te rn a c io n a l
d a s D o e n < ;a s , Io n e d i< ;a o (IC D -IO ). P o rto A le g re : A rte s
M 6 d ic a s , 1 9 9 3 .
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