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A recent case in my office has prompted me to tackle a complex subject: neural therapy's place in treating sexual dysfunction. A short newsletter does not allow for discussion in depth, but a few observations and a case history may be helpful nevertheless. Sexual dysfunction receives only cursory coverage in the Dosch neural therapy textbook. Perhaps that reflects the era in which it was written. Sexual function has become a preoccupation of our time, (for better or for worse) and physicians are now expected to have at least some knowledge of it. Sexual dysfunction (in its broadest sense) may be classified in three categories, although there is often considerable overlap. The first group has an emotional basis, e.g. relationship difficulties, unresolved emotional conflicts, a history of sexual abuse, anxiety, or simply preoccupation with other life matters. The research literature provides abundant evidence of the psychosomatic basis of much sexual dysfunction. The evidence can be summarized by concluding that nature has a way of suppressing sexual interest (and function) when there are more important issues at hand, such as survival. The second category of sexual dysfunction is related to hormonal deficiency, especially (but not exclusively) the sex hormones. Here overlap with the previous category is possible, as a high stress lifestyle may provoke the so‐called "cortisol steal", where the adrenal glands produce more cortisol at the expense of the sex hormones. Treatment of sexual dysfunction involving hormonal issues nearly always requires concurrent attention to lifestyle and nutritional status. The third category of sexual dysfunction is that involving neurophysiological problems. It goes without saying that brain and spinal cord injury, adverse drug reactions, diabetic neuropathy and other neurological conditions can cause sexual dysfunction, usually difficult to treat. However there is a subgroup of patients whose sexual dysfunction is related to autonomic nervous system disturbance, who are candidates for neural therapy. These patients often have suffered trauma to the reproductive organs or pelvis. Childbirth and gynecological surgery is the most common in women, prostate surgery the most common in men. Both sexes can also be affected by external trauma, such as motor vehicle accidents. The most common interference field affecting sexual dysfunction is the pelvic plexus (or "Frankenhauser plexus"). It is not unusual for patients to report improved sexual function after treatment of the pelvic plexus, even when the goal is to treat some other problem, such as chronic pain or mennorhagia. A rare (in my experience) interference field affecting sexual function is a vasectomy scar. Here is a recent case from my practice: A healthy 59-year-old man presented with bilateral anterior knee pain of gradual onset and of 5 years' duration. He had had x-rays, physiotherapy and an exercise program with minimal improvement. While giving his history, he volunteered that he had suffered from intermittent erectile dysfunction for about 30 years. He had been investigated at a Men's Clinic and was told that his ED was "age and stress-related". He was otherwise in excellent health, was happily married, took no other medications and did not smoke. Cialis® (tadalafil) was effective and helpful. His surgical history was limited to wisdom teeth extractions in his youth, a vasectomy at age 29 and nasal septoplasty at age 39. Physical examination revealed tight hamstrings and depressed craniosacral rhythm throughout the body. However the pelvis was symmetric and there was no imbalance of the hip ad-/abductors. Somatic dysfunction was found at C2, the nose, thoracic diaphragm and the right sacroiliac joint. These were treated with osteopathic unwinding techniques and considerable relaxation of the tight muscles resulted. Autonomic response testing found an interference field in the right proximal scrotum, corresponding to a vasectomy scar. This was treated with a Tenscam device. 5 weeks later the patient returned with almost complete resolution of this knee pain, but what pleased him (and his wife) most was that the erectile dysfunction had disappeared. In fact he was experiencing morning erections for the first time in over 30 years. The relationship between vasectomy, sexual function, post-surgical pain and prostate problems including cancer has been studied for over 30 years. Post‐vasectomy pain syndrome is not rare and is a recognized entity. Erectile dysfunction may occur after vasectomy but when this occurs psychosocial factors are considered to be the most likely cause. In fact after many years of research, prevailing opinion now appears to be that the surgical procedure itself offers no significant risk of sexual dysfunction. Erectile dysfunction caused by vasectomy scar interference fields must therefore be rare, or at least uncommon enough that the incidence is masked by the more readily identified psychological factors. I would be interested to hear from readers if any others have come across vasectomy scar interference fields causing sexual dysfunction. Sincerely, Robert F. Kidd, MD, CM |