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Download PDF Psychogenic movement disorders : neurology and neuropsychiatry

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They'll want the reassurance of knowing that others have similar problems and that treatments may help improve their problems. Among patients with MS, the most common SD problems for men are erectile dysfunction and ejaculation issues.

Psychogenic Movement Disorders

A study 3 also reported that "a significant positive relationship was found between sexual dysfunction and lower-limb and bladder disability. The good news is that many problems with sexual dysfunction that may arise in MS or other neurologic conditions are treatable, and a wide range of products are available. Oral medications: ED medications help achieve and maintain erections and are effective in about 50 percent of males with MS.

Injectable medications: Injected using a small gauge needle at the base of the penis into the corpora cavernosa just before sexual activity, these agents take about five to 10 minutes to activate—even with no stimulation.

Results of a single treatment can last anywhere from one to two hours. Injection therapy can be administered as monotherapy with prostaglandin E-1 or a multiagent mixture such as a trimixture of phentolamine, papaverine, and prostaglandin E1; a quadmixture of phentolamine, papaverine, prostaglandin E1 and atropine; or a bimixture of phentolamine and papaverine.

Penile treatments: A few treatments are available including two and three-piece inflatable implants as well as semi-rigid malleable rods. Muscle relaxants and pain medication: Various medications can help spasms and pain that often interfere with sex.

Functional neurologic disorders/conversion disorder - Symptoms and causes - Mayo Clinic

An interesting note is that sildenafil Viagra, Pfizer may also have a beneficial therapeutic effect in the treatment of stroke, subarachnoid hemorrhage, dementia, learning, and neurodegenerative disorders by enhancing angiogenesis and neurogenesis. Although sildenafil shows some promise as a therapeutic agent in selected neurological disorders, well-designed clinical trials are needed before the agent can be recommended for use in any neurological disorder.

Bottom line: Regardless of the primary diagnosis, Dr. Morley sums up, "For neurologists, they should be paying attention to premature ejaculation and failure to ejaculate because they are commonly associated with neurologic disorders," he says. Morley says. Lack of orgasm and sexual enthusiasm are treatable and not uncommon within the neurological realm, he adds. At the minimum the question should be, 'Do you have any sexual problems you want to talk about?

Vaginal estrogen therapy: Treating vaginal dryness is typically more effective with topical estrogen rather than oral estrogen. Estrogen applied to the vagina can still result in estrogen reaching bloodstream, but the amount is minimal. Timing of other medications: Stachowiak writes that certain medications can impair sexual functioning and recommends taking sexual activity into consideration with timing of medications, if problematic. Make a map of the body: Because MS affects the processing of nerve signals, things that formerly stimulated someone with MS may no longer do so. Patients can make a sensory "body map," in which they systematically touch themselves and see what parts respond, and how.

An open line of communication with their partner is paramount and this information should be shared. Kegel exercises: Also known as "pelvic floor exercises," these might be best explained to patients as tightening and releasing the muscle that controls the stream of urine. Bottom Line: Regardless of gender, a wealth of tips will be highly individualized to the patients and the dynamic of the relationship with their partner.

While medications and therapies are important, issues like communication and reassurance need to be in place in any relationship. Unfortunately, sexual activity is often overlooked. In order to effectively manage the whole person, neurologists must open the door to discussion of sexual dysfunction. Morley says the expertise of urologists, endocrinologists, gynecologists, and geriatricians can come into play, but he cautions against directing patients to a provider without the proper sexual health background. You're looking for someone in the area who's got a reputation in your community for effectively handling sexual dysfunction.

Morley says web sites like webmd. Morley assists with questions are valuable tools for patients seeking information.

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So why aren't patients—and neurologists—talking more about it? To deal with these problems, patients can explore several options: Vaginal estrogen therapy: Treating vaginal dryness is typically more effective with topical estrogen rather than oral estrogen. Vaginal estrogen therapy comes in several forms: Vaginal estrogen cream Estrace, Premarin, others. Patients insert this cream directly into the vagina with an applicator, usually at bedtime.

This is usually a daily regimen for the first few weeks and then application two or three times a week thereafter is adequate. Vaginal estrogen ring Estring. A soft, flexible ring is inserted into the upper part of the vagina by patients or their physician. The ring releases a consistent dose of estrogen while in place and should be changed about every three months.

When are psychological therapies best for Functional Neurological Disorder treatment?

Vaginal estrogen tablet Vagifem. Patients use a disposable applicator to place a vaginal estrogen tablet in the vagina. Otherwise it is hidden from view.


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Home Books Movement Disorders, 3e. Previous Chapter. Next Chapter. Sa, Daniel S. Chapter Psychogenic Movement Disorders. Watts R. Ray L. Watts, et al. Accessed September 22,