Urethral Masturbation and Sexual Disinhibition in Dementia: A Case Report

Article excerpt

Abstract: Urethral masturbation and sexual disinhibition asmanifestations of behavioral and psychological symptoms of dementia (BPSD) are described in a 90-year-old patient who repeatedly self-inserted foreign bodies into his urethra. A diagnosis was made of late onset sexual disinhibition and hypersexuality in a patient with Dementia of the Alzheimer Type. Significant reduction of his sexual behavior was achieved with low doses of haloperidol. Similar symptoms are noted in Pick's disease, other fronto-temporal lesions, mania and following a seizure or treatment of Parkinson's disease, and have been described as Kluver-Busy-type. Clinicians should consider this diagnosis when investigating dysuria, cystitis, haematuria and urinary tract infections even in the very old.

The following article deals with urethral masturbation and sexual disinhibition as manifestations of behavioral and psychological symptoms of dementia (BPSD). The case reported herein describes a 90-year-old patient who repeatedly self-inserted foreign bodies into his urethra. It is a case of late onset sexual disinhibition and hypersexuality in a patient diagnosed as having Dementia of the Alzheimer Type. Significant reduction of this sexual behavior was achieved with low doses of haloperidol treatment. Causes and differential diagnosis of such behavior are discussed along with possible pharmacological and environmental treatment options.

Introduction

Sexual disinhibition is known to be one of the behavioral and psychological symptoms of dementia (BPSD) (1), with a known frequency of 6.7% in Dementia of the Alzheimer Type (DAT) (2).

Urethral masturbation in which a foreign object is inserted into the urethra for erotic stimulation is a variant of masturbation which is rarely reported in the elderly (3).

The following case study describes a 90-year-old demented patient who manifested sexual disinhibition and hypersexuality by repetitive self-insertion of foreign bodies into the urethra (SIFBU) and the bladder. Causes and differential diagnosis for understanding this phenomenon are discussed along with possible pharmacological and environmental treatment options.

Case Report

Mr. P, a 90-year-old widowed man, was admitted in September 1998 to an internal medicine department in a geriatric hospital because of urinary retention, after he had been found in his bathroom with a lipstick smear around his urethral meatus and a few drops of blood that stained the floor. During the four years prior to the present hospitalization he had had three other admissions to the same department.

His first admission in 1994 occurred because of urosepsis and overflow incontinence. At that time his relevant medical history revealed that he had suffered from recurrent urinary tract infections in the last five years. The urologist's examinations revealed prostate hyperplasia and the presence of two strictures in the urethra. A supra-pubic cystostomy was performed as an emergency procedure. Subsequently, after urethral dilations, the patient was able to void satisfactorily.

The patient's second admission in May 1997 occurred because of micturition difficulties. Catheterization attempts had failed. Urological examinations revealed the presence of a foreign body stuck at the penoscrotal part of the urethra. The object was removed through the cystoscope and spontaneous micturition resumed. The foreign body proved to be a fragment of a chocolate bar wrapping rolled up to form a cylinder measuring 3.0cm x 0.5cm. No additional foreign bodies were found in the urine bladder at that time. The patient admitted that he had inserted the foreign bodies into the urethra, but he did not remember when he had done it and he gave no explanation for this behavior. In view of the patient's medical history of recurrent urinary tract infections (UTI) and urethral strictures, an explanation about the risks of self-insertion of foreign bodies into the urethra was given to him. …