Search

Religious beliefs are among the many factors that determine whether sexually dysfunctional persons will seek out a sex therapist. These beliefs may also generate resistance to therapy or influence patients to drop out of treatment before it is complete. Therapists who are sensitive to patients' religious beliefs enhance the likelihood of a successful treatment process. The authors present six case examples from their practice in which religious beliefs played an important role. They urge sex therapists to become more aware of the religious dynamic and to help address the paucity of clinical case material in the literature.

The immediacy of anorexia and bulimia nervosa tends to obscure the adjunct problems of eating-disordered patients. The literature records no data pertaining to the treatment of concomitant psychosexual dysfunctions. The authors report the cases of five young married women referred for psychosexual therapy from eating disorders programs. The therapists found that each of the women was suffering from at least one additional disorder. Basic issues of control, grounded in these patients' early lives, generated intense resistance to treatment. The authors emphasize the need for accelerated research to gather the data from which to develop an effective treatment program for eating-disordered patients with associated sexual dysfunctioning.

Roux-en-Y gastric bypass (RGB) is an accepted operation for the control of body weight in morbidly obese patients. Early technical complications and inadequate weight loss, well-known sequelae of this procedure, necessitated reoperation in 42 patients of 920 who underwent RGB in a 10-year period. Indications for reoperation included dilated gastrojejunal anastomosis (16), inadequate weight loss without demonstrable enlargement of the anastomosis (10), staple line breakdown (6), anastomotic obstruction (4), anastomotic leak (4), and enlarged proximal gastric pouch (2). Reoperation consisted of completely redoing the initial RGB in 20 patients, redoing the anastomosis alone in 17 patients, staple line revision in four patients, and intraoperative dilatation of the anastomosis in one patient. After initial RGB, 26 of the 42 patients (61.9%) experienced major complications. After revision of RGB, there were major complications in 21 patients (50%). In conclusion, major postoperative complications may contribute to RGB failure, RGB revision for early technical failure or inadequate weight loss is associated with a high incidence of major complications and, subsequently, negligible weight loss. Therefore repair of RGB for technical failure or complications is not recommended.

The choice between psychodynamic and symptom-focused treatment tends to polarize clinicians. Unfortunately, practitioners often take sides, universally applying one or the other treatment rather than choosing the approach best suited to each patient's needs. Discussion between the adherents of each treatment may generate more heat than light. To facilitate a more objective discussion of this division, the authors describe some of the major differences between the two viewpoints and discuss their implications. Their purpose is not primarily to choose sides or resolve the dilemmas but rather to clarify the issues involved.