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Sexual Emergencies: A Psychiatrist's Perspective
Published in R. Thara, Lakshmi Vijayakumar, Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
T.S. Sathyanarayana Rao, Gurvinder Kalra
It is not uncommon for patients to present to the ED with rectal foreign bodies. The nature of the rectal foreign body is said to be limited only by the imagination of the patient concerned (Manimaran, Shorafa and Eccersley 2009; Koornstra and Weersma 2008; Clarke et al. 2005; Wigle 1988). A person may insert a foreign body into the rectum to stimulate himself/herself sexually, may slip it in accidentally, or may even do so deliberately with the intention of concealing some substance (Clarke et al. 2005; Wigle 1988; Griffin and McGwin 2009; Yacobi, Tsivian and Sidi 2007). Patients may present with abdominal pain, pelvic, or anal discomfort and constipation. The presence of foreign bodies in the rectum can lead to various types of colorectal traumatic injuries, including rectal perforations and sphincter injuries; hence, it should be considered a serious condition and treated on an emergency basis (Ruiz et al. 2001; Rodriguez–Hermosa et al. 2007).
Chronic Perineal Pain
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Giuseppe Chiarioni, William E. Whitehead
Clinical neurophysiology has improved our knowledge of this disorder, but a definitive diagnostic test is still not available. As in many neuropathic pain syndromes, the diagnosis of pudendal neuralgia is primarily clinical and should be reviewed in the light of the course of the disease. In 2006, a multidisciplinary working party on pudendal neuralgia was held in Nantes (France) to conclude that only the operative finding of nerve entrapment and post-operative pain relief can formally confirm the diagnosis, and then only provided the placebo effect of surgery is excluded.9 However, four domains to diagnose pudendal neuralgia have been defined, namely: a) essential criteria, b) complementary diagnostic criteria, c) exclusion criteria and d) associated signs not excluding the diagnosis. Essential criteria are particularly relevant and worth detailed discussion: 1) Pain should be limited to the innervation territory of the pudendal nerve. This excludes any pain that is limited to the coccygeal, pelvic or gluteal areas. 2) Pain is predominantly experienced whilst sitting in accordance with the nerve compression aetiology hypothesis. In longstanding pudendal neuralgia, pain may become continuous, but it is still worsened by the sitting position. 3) The pain rarely awakens the patient at night and only transiently. 4) On clinical exam, no objective sensory impairment can be found, even in the presence of paraesthesia. The presence of a sensory defect should prompt investigations to exclude diseases of the sacral nerve roots and the cauda equina. Reasons to explain this feature are unclear, but anatomic variance of the peripheral nerves is likely. 5) Pain should be relieved by anaesthetic infiltration of the pudendal nerve. This is an essential criterion but poorly specific. As a matter of fact, pain related to any perineal disease may be relieved by pudendal nerve block for anatomical reasons.1 However, a negative block does not exclude the diagnosis if performed too distally. In the complementary diagnostic criteria are included the sensation of a rectal foreign body and the worsening of pain during defaecation. Exclusion criteria of pudendal neuralgia are pain in territory unrelated to pudendal nerve, symptomatic pruritus instead of paraesthesia, exclusively paroxysmal pain and relevant imaging abnormalities that may explain the symptom.9
Clinical effect of computed guided pudendal nerve block for patients with premature ejaculation: a pilot study
Published in Scandinavian Journal of Urology, 2020
Fouad Aoun, Georges Mjaess, Joseph Assaf, Anthony Kallas Chemaly, Tonine Younan, Simone Albisinni, Fabienne Absil, Thierry Roumeguère, Renaud Bollens
Patients were included if they (i) were men aged 18–45 years, (ii) had a score >16 in the 5-item version of the International Index of Erectile Function (IIEF-5) [11], (iii) were sexually active more than once per week with stable female partners in the last 3 months, (iv) had a score ≥11 in the Premature Ejaculation Diagnostic Tool (PEDT) [12], (v) had minimal or no response to recommended conventional pharmacologic treatment (selective serotonin reuptake inhibitors, topical anesthetic agents) and psychological/behavioral management, and were off treatment for the last 3 months, and (vi) agreed to participate in our study. We should note that patients had had some symptoms or clinical features of pudendal nerve entrapment (e.g. allodynia or hyperpathia, rectal foreign body sensation, urinary frequency and/or pain on a full bladder, etc.) but did not have all the essential criteria of the Nantes criteria [13]. These symptoms will not be discussed in the present study. Patients with thyroid problem, diabetes mellitus, neurological disease, extensive alcohol use, or the use of any medication known to cause sexual dysfunction were excluded from the study. Patients with iodine contrast allergy were also excluded. The study was conducted in accordance with the Declaration of Helsinki and all patients gave their written informed consent after approval of the study by the local Medical Ethical Committee.