Relationships between disease and sex were investigated in the outpatients of our psychosomatic clinic. 1) Problems concerning sex were observed in 35 (20.3%) out of 172 outpatients excluding depression at our psychosomatic clinic. 2) Female patients amounted to 85.7%(30) of all the patients who had sexual problems. There were 26 patients (74%) whose ages ranged from 20 to 40. 3) Details of sexual problems were as follows : Sexual frustration, frigidity, premature ejaculation, abnormal acceleration of sexual desire, impotence, neurotic masturbation, sexual delusion, fear of venereal disease, fear of sexual intercourse, fear of loss of virginity, pregnancy outside of marriage, incest, sexual perversion, living together of feme and concubine, manic-depressive psychosis and sexual problems, sexual relations between patients and nurses, chronic disease and sexual problems, sexual relations between father and his adopted daughter. 4) In the clinical site, sexual problems were projected or hidden behind the disease in the following forms : Defense mechanisms (conversion reaction, escape, denial), positive transference, troubles between husband and wife (separation, divorce), abnormal mental state of the patient (neurosis), refusal of sexual intercourse, symptoms concerning sex (delusion, sexual frustration, impotence, incomplete sexual feeling, masturbation and onanism, inadaptability to sexual development and aging, and abnormal sexuality.) 5) Psycho-sociological backgrounds creating sexual problems were analysed. 6) When the Kyushu University Medical Index (KMI) was executed on 85 depressive patients, only 17 (20.9 %) gave affirmative answers regarding sexual difficulties. Sexual problems were latent in 6 patients (9.3 %) out of 64 excluding the above-mentioned 17 depressive patients. 7) The following 4 cases of sexual problems were presented : Anorexia nervosa, ulcerative colitis, depression and Shay-Drager syndrome.

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The relation between personality characteristics and therapeutic effects was studied in 38 patients with psychogenic impotence, who consisted of 17 cases of honeymoon impotence, 17 of neurotic impotence and four other cases. As for the personality, Yatabe Guilford Personality Inventory (YG test) and Minesota Multiphasic Personality Inventory (MMPI) were investigated. The therapeutic effect was determined mainly by the results of brief psychotherapy. According to test, psychogenic impotence cases contained markedly less E types than the neurotic controls and markedly less D types than college students. The A type was found to be significantly more numerous than the above two control groups. The average score of individual parameters in the impotence cases gave the values in between the two control groups. Such a tendency was especially marked in the cases of honeymoon impotence. According to MMPI, the average T score and the profile of individual parameters in psychogenic impotence cases resembled very closely to those of the control neurotic cases. Honeymoon impotence group tended to show a lower T score than that of neurotic impotence cases. The cases having abnormal parameters of over 70 T scores were found in l/3 of honeymoon impotence case., and in 2/3 of neurotic impotence group. The abnormal score was found mostly in D parameter. No significant correlation was observed between YG test and MMPI. The therapeutic results showed 28.9% of cure, 28.9% of alleviation and 42.4% of unchanged cases. No Significant correlation was observed between the findings of personality tests and therapeutic results. However, more alleviation cases were in seen the E type of YG, showing more abnormal scores in MMPI. Those showing favorable therapeutic results were the ones whose routine communication with the marital partner was good and also who were able to receive the wife's cooperation.

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The role of the psychiatrist who deals with the patients with functional impotence was discussed, especially from the standpoint of the doctor-patient relationship in medical treatment. According to our statistics, 31 patients suffering from functional impotence consulted the Neuro-psychiatric Clinic of Hiroshima University School of Medicine, during the period from January 1976 to December 1978. 1) Almost all of these patients, except 4,made their first contact with other clinical departments ; Urology 16,Gynaecology & Tocology 7,Orthopaedic Surgery 2 and Internal Medicine 2.Subsequently they were referred to the Neuro-psychiatric Clinic. This indicates that the urologist and the gynaecologist play a more important role in the primary examination of functionally important patients than the psychiatrist. Therefore the urologist and the gynaecologist have a duty to give the patients proper advice and promptly refer them to the best possible therapists. This is because there are a limited number of experienced psychiatrists who can offer psycho-therapy to impotent patients in Japan. 2) The psychiatrist, in treating impotence, must realize that he should be experienced in differential diagnosis which requires accurate and detailed knowledge of specialization. This was revealed in our data : 31 functionally impotent patients included some non-psychogenic patients. Eighteen cases were finally found to be non-psychogenic despite their apparent "psychogenic" outlook at first glance. They were not psychogenic but rather psychotic including schizophrenic 8,depressive 6,epileptic l, mentally retarded I and so on. They should undergo an appropriate drug therapy under the supervision of a specialist. Our data showed that only 13 were "psychogenic" impotent patients. 3) The psychiatrist as a psychotherapist can possibly classify the "psychogenic impotent patients" into two groups according to the level of their psychological problems. One group is that of actual psychogenesis and the other is of subconscious psychogenesis. Patients with actual psychogenesis have a therapeutic indication to behavior therapy, suggestive psychotherapy and supportive psychotherapy, etc. Patients with subconscious psychogenesis, on the other hand, have an indication to psycho-analytical psychotherapy. Our 13 psychogenic impotent patients included 7 in the first group and 6 in the latter, With regard to the treatment of psychogenic impotence, the role of psychiatrist as a psycho-analyst seems to be lesser than it has been generally expected.

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Social and psychologic problems were neglected in the treatment of sexual disturbance in the past. In this paper, we reported on our treatment for psychosomatic sexual disturbances which were caused by physical sexual disorders. (1) Disorders on sexual development. Patients with Klinefelter syndrome and male hermaphroditism were suffering from psychological sexual troubles in spite of successful hormonal therapy. When treated psychosomatically, however, good results were obtained. (2) Hypogonadism. Patients with eunuchism and eunuchoidism who had anxiety about marriage in spite of satisfactory hormonal therapy were treated psychosomatically. Consequently, they became able to lead a happy life with their spouse. (3) Impotence. Take honey-moon impotence, for instance. Favorable results were obtained when the couple restored their tender feelings and the wife became co-operative in the treatment. It is important to establish a good working relationship in a couple when we treat a patient with functional impotence. (4) Surgical stress and testosterone. Plasma and urinary testosterone levels tended to decrease under surgical stress. We would emphasize that the treatment of male sexual disturbance should be approached not only from the physical standpoint but also from the psychosocial standpoint.

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In our Urology Department, a total of 132 patients of impotence were seen in the past one year and three months. These patients represented 4.2% of all one male patients treated at our outpatient clinic during this period. When classified according to primary afflictions, mental impotence was seen as high as 72.4% of the patients aged 20-30,whereas it was gradually superseded by organic impotence from the ages around 40,finally holding 70% of the patients over 60. In discriminating organic impotence from functional ones, a high-sensitive thermometer is used ; temperatures of the penile skin are recorded. In addition, changes with visual sexual stimulation or in REM sleep period are checked to distinguish the two categories of impotence. According to our discrimination criteria, 88.3% of the patients proved functional impotence. In treating these impotence patients, we do not necessarily insist on managing the impotent penis to force its way into the vagina, but rather help the couple enjoy their sexual life by using appropriate drugs as occasion calls besides employing a silicone prosthetic supplement for an erection effect, which would help the patient feel confident that even the impotent could physically perform sexual activity with help of sophysticated techniques. Consequently, 84.6% of the patients reached complete cure when treated with our synthetic approach.

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Obstetrics and gynecology deals with the symbolic organs as well as the healthy maintenance of womanhood and motherhood. Diseases in this field, therefore, not only cause physical disturbances, but may also develop into factors obstructing their role of womanhood. Lying in the background of these diseases are often found problems surrounding the sex, without solution to which treatment would not at times proceed favorably. In this paper, a review is made by the author on 192 cases treated by him for psychosomatic syndrome in the field of gynecology which involved sexual problems. By classification, patients with direct sexual complaints were found in 83 cases (43.2%) and those with somatic and mental complaints in 109 cases (56.8%).But even in these latter cases, the author found that the patients were seeking at the same time solution to their sexual problems that lay behind their gynecological syndrome. Direct sexual complaints included frigidity, impotence, frustration, abnormal sex and paraphilia. Complaints of gynecological syndrome, on the other hand, included leukorrhea, itching of vulva, pain (vulva, vagina, lower abdomen, loins), metrorrhagia, irregular menstruation, fever, vegetative syndrome (stiff-shoulder, headache, dullness, chilly constitution, flushing, vertigo, etc.), abnormality of sensation and desire for babies. Complaints that lay behind these were mental immaturity of sex, shamefulness of onanism, terror, self-accusation, masochism, guiltiness of extra-marital intercourse, hystericism, sexual trauma, sexual apprehension, sense of loss of woman-hood, sense of menopausal termination.

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The author had the opportunities to consult with 145 women having sexual disorders for the past 8 years. In this paper, the author reported his clinical observations of these cases which_ were summarized as follows : 1) The author introduced a clinical classification of sexual disorders in order to establish a. diagnostic standard and a treatment approach on the basis of the patients' main complaints. at the initial visit to the hospital. According to this classification, out of the 145 cases, 24.l % Complained of abnormal sexual desire, 45.5% abnormal sexual sensations and 30.3% problems in sexual intercourse. When sexual disorders were subdivided, lack of orgasm, loss; of sexual desire, difficulty in performing sexual intercourse were found very frequently. 2) With regard to diagnosis, it was found very useful to use a self-rating sexual satisfaction curve of the author's origin and a sexual personality test which was a modification of the TAT. 3) In many cases, causative factors in sexual disorders were manifold and intricately interrelated including physical factors based on the female life cycle, reactions to and attitudes towards sex, and ability to relate to the opposite sex. No single cause was identified in the disorders. 4) The author has been conducting sexual counselling for female patients with sexual dysfunctions. The results were : improvement in 65.5%, no improvement in 25.5% and follow-up studies impossible in 9%' The results were also evaluated according to the length of time spent prior to the consultation. The counselling was effective in 81.5% of those who started treatment within one year of the onset, 80.5% within I to 2 years, 69.3% within 3 to 4 years. However, the counselling was effective only in 34.2% when it was started after 5 years from the onset. Thus, the longer was the time spent prior to the onset, the less effective was the counselling. Among the important factors which made the treatment effective were early consultation, early diagnosis and early treatment from the standpoint of comprehensive, psychosomatic medicine.

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Sexual response in reciprocal inhibition theory by Wolpe has successfully cured the patients suffering from sexual impotence. In the clinical practice, Masters and Johnson's therapeutic approaches to sexual impotence are often combined with Wolpe's behavior therapy. Sexual impotence in male can be divided into (1) erectile impotence (2) premature ejaculation and (3) delayed ejaculation or ejaculatory incompetence. The author treated a patient who complained of erectile impotence and ejaculatory incompetence even after the operation of hypopysen tumor. His wife cooperated with him in the therapeutic sessions and tried the so-called squeeze technique with him. As a result his sexual arousal became heightened enough to ejaculate after several trials. About one year's follow up it proved that he and his wife were still living their happy marriage life and got a child.

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This study was undertaken in order to analyze hospitalized patients with headache in our department during the past 10 years on the basis of case histories. The results were summarized as follows ; l) Of all the patients, 118 cases with headache (8.9% in total) were detected who consisted predominantly of males. Patients in their 40's consisted mostly of both sexes. 2) Seventy-four cases (62.7%) of muscle contraction headache, 4 cases (3.4%) of vascular headache and 10 cases (8.5%) of combined headache were classified according to pathogenesis. Forty-one cases (34.7%) of depressive state, 22 cases (18.6%) of anxiety neurosis and 21 cases (17.8%) of conversion hysteria were found. 3) The results of CMI, which was given to 98 cases, indicated that many had a neurotic tendency (77.6%). The YG test was administered to 105 cases but revealed no particular tendencies. Psychological problems consisted mainly of family and occupational conflicts. 4) Our approach was comprised of combined psychosomatic therapy including drugs and psycho-therapy, mainly fasting therapy. Thirty-four cases were cured and 77 had improved at discharge. Prognostic evaluation noted that 64 cases (77.2%) had returned to their usual life, with cure in 32 cases and improvement in 32 cases. 5) The influence of fasting therapy was beneficial on headache in some cases.

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A 13-year-old girl presented the psychogenic visual disturbance and color blindness. Psychotherapy was very effective. The author discussed some problems of ocular hysteria.

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