Thu, 2005-05-12 15:16

Ok, so I didn’t know there was a difference between Hypersexuality and Persistent Sexual Arousal Syndrome. Actually, while I’d heard of hypersexuality before I’d never heard of PSAS.

The following post will seem to ramble a bit but it follows the path I took through the non-blogging internet to find something new.

In case you’re wondering, part 1

After reading DTG’s post, There’s more to a clitoris than meets the eye (which you should go read) I remembered a fairly low-res MRI of people having intercourse and that made me wonder if there have been any advances in the field (there have but that links only to abstracts so no actual images.)

In case you’re wondering, part 2

One of the abstracts, MRI of female genital and pelvic organs during sexual arousal, Suh DD, Yang CC, Cao Y, Heiman JR, Garland PA, Maravilla KR.

Department of Urology, University of Washington I found suggests good clitoral imaging exists somewhere so I started Googling around and came across…

Persistent Sexual Arousal Syndrome in Women, Sandra Leiblum, PhD; Sharon Nathan, PhD on a site called FemalePatient.com, a peer-reviewed Ob/Gyn journal.

And that’s how I wound up finding out about PSAE in women. I’ll dwell here for a moment before going on to PSAE in men. I will arrive at a conclusion if you’re patient. :-)

Here’s what Leiblum and Nathan have to say in their article:

Whereas hypersexuality refers to excessive desire with or without persistent genital arousal, PSAS refers to physiologic arousal in the absence of conscious desire, which is what makes it so perplexing. While some women can identify a reliable trigger for the feelings of arousal, other women cannot pinpoint a cause for the unrelenting feelings of vaginal vasocongestion and sensitivity. They worry that they might have a pathologic process that requires medical evaluation. It is sometimes for this reason, rather than the subjective distress, that they seek medical consultation and evaluation.

Although the authors have not been able to find any other reference to this condition in the medical or psychiatric literature, Riley described a case of premenstrual hypersexuality that seems similar to PSAS. The case involved a 22-year-old single woman who had lost her job as a result of an intense need to masturbate frequently during the 3 to 4 days prior to menses. She felt the need to masturbate in the lavatory at work up to 12 times daily in addition to sessions at home and even in the car going to work. During these premenstrual days, she reported a continuous state of sexual arousal, with intense tingling in the clitoris and a feeling of vaginal warmth. There was a major increase in genital secretion at this time, which soaked her underclothes and sometimes resulted in a wet patch on her skirt. The genital sensations rose rapidly in intensity, causing her to seek relief through orgasm by self-stimulation; if she did not attain orgasm, the sensations became unbearable. These sensations were not accompanied by sexual fantasies.

In the case reported by Riley, the feelings of continual sexual arousal generally disappeared within 24 hours after the onset of menses, and the patient reported normal sexual needs at other times of the month (ie, she did not actively search for sexual partners, and masturbated only once every 4 to 5 days).

Also

In all the cases reported to date, results of extensive anatomic, hormonal, neurologic, and psychiatric evaluation have been normal. The women seen by the authors are psychologically healthy and functional individuals. While in some instances the symptoms may be attributable to psychological hypotheses, this in no way confirms a psychological cause of the problem; psychosomatic explanations can be postulated for many complaints in the absence of an unambiguous physical etiology.

It is unknown whether PSAS is a new, as opposed to a newly recognized, entity. This is an important distinction in the search for a cause, because if PSAS is truly a new phenomenon, then modern environmental factors (eg, food additives, infectious agents, tight jeans, long-distance bicycling) deserve special attention. More research is needed to determine whether PSAS tends to occur in special populations (eg, long-distance cyclists, women who engage in many hours of spin classes).

The prevalence of PSAS is unknown, though it may be more common than supposed because many women may be too embarrassed to report the complaint to their physicians. As indicated, the authors have spoken with some affected women who are not troubled by the feelings of spontaneous arousal, except when they persist unabated for weeks. Physician inquiry can be helpful in identifying the prevalence of this phenomenon and validating the patient’s experience as genuine, disturbing, and not “all in her head.�? Such complaints must be taken seriously if physicians are to identify the causes, sustaining factors, and therapies for this perplexing problem.

Finally, a telling quote from the introductory paragraphs

In the majority of cases in which the woman presents in the physician’s office, the feeling of unremitting arousal is experienced as intrusive and unwanted. In some instances, however, the feelings of more or less constant arousal are experienced as pleasurable, if mysterious. In these cases, the woman may not want evaluation or treatment. It is for this reason that the phenomenon may be underreported, even though it is a significant aspect of female sexual response that deserves wider recognition and evaluation.

Ok, so I’m definitely qualified either by training nor by gender to comment on this report, beyond the observation that contemporary sex-positive philosophy boils down to consent and therefore, by extension, if your body feels fiercely horny and you don’t want it to then that’s a problem worth exploring, and the case histories do suggest it was problematic at least for the women who reported it.

Disclaimer: I’m never comfortable with the term syndrome for stuff like this unless there’s a lot more supporting evidence and a clear definition of where the line between ordinary and abnormal should be drawn. That said I Googled further to see if there’s a comparable “syndrome” in men.

There’s not much to speak of. The Boston Medical School’s Institute for Sexual Medicine says

In men, the condition of persistent arousal may be considered as the condition of priapism. Consensed definitions and management strategies exist for men with priapism. There is no parallel consensed definition for women with persistent sexual arousal.

This is more familiar ground for me, and at least judging from Leiblum and Nathan’s original article I’d say it’s not comparable at all. For one thing Priapism is pretty well documented. For another it generally hurts and if not treated pretty quickly it can cause scarring, impotence, and possibly gangrene if not treated quickly. (It’s an involuntary persistant erection, frequently caused by nerve damage, medication, chemotherapy, and Sickle-cell anemia, and if untreated results in pooling and partial coagulation of blood in the penis.)

A better comparison (where “better” is defined loosely) might be Satyriasis which something called MedFriendly.com defines as

Satyriasis is excessive, abnormal, or uncontrollable sexual/romantic behavior, desire, and excitement in the male.

WHAT CAUSES SATYRIASIS?

Satyriasis is believed to be caused by extreme narcissism, which is a state in which one interprets and relates everything to oneself and not to other people or things. Any feelings of inferiority (feeling one is not as good as someone else in something) is controlled by conquering females in a sexual way. Some believe that the cause of satyriasis is biological as opposed to psychological, or even a combination of the two.

After that the searches peter out pretty quickly. A high level of chaff in most of the Google results it irritatingly difficult to find much more to say (except golly, there are a lot of “potency enhancers�? being advertised out there.)

At least (at least so far) medical journals aren’t suggesting that women with PSAS are narcissists attempting to overcome inadequacy through sexual conquest!

On an optimistic note, the authors of Columbia University’s Go Ask Alice information site have a promising reply to a student’s question Am I a nymphomaniac – Is it possible to have too much sex?

A magic number doesn’t answer the question, “How much sex is too much?”, nor does a national average. Religion, culture, family values, and personal feelings and choice help define what each individual considers “enough” or “too much” sex. The question to consider then is: what makes you think your stats are off the charts? You mentioned that you’re beginning to consider too much sex a bad thing. What is bad about it? Is it bad because it’s unhealthy? Because your skin is tender? Because you’re neglecting your school/work? Are you still eating and sleeping? Are you answering the mail and phone? Seeing your friends? Having fun? You need to begin this process by answering these questions, defining what you might consider to be “too much,” and also identifying what’s bad about it.

Unless your sexual behavior is interfering with your daily routine, it is likely that you and your partner have high sex drives and enjoy having sex together during this time period. Once you figure out or feel more comfortable with the frequency of your sex sessions, you and your partner won’t need to take a mini vacation from them…

Thus endeth my ramble through the outside world. At some point I’d still like to find some high-resolution imagery of genital anatomy for DTG. I learned a ton of stuff I didn’t know, and maybe unlearned a few things I thought I understood. Next time I go on a Google escapade I’ll try to keep it a little more focused though. :-)