RESUMO

OBJECTIVE: To apply a new review methodology, called reverse systematic review (RSR), to assess how different classification criteria can influence erectile dysfunction rates in patients undergoing laparoscopic radical prostatectomy (LRP). METHODS: We used RSR from January 1, 2000, until December 31, 2020. The post-prostatectomy erectile dysfunction (PPED) rates were evaluated at 1, 3, 6, 12, and 18 months after surgery in different criteria selected as the most commonly used and divided into four groups: "Erection Sufficient for Intercourse (ESI)", "IIEF-5 > 17", "IIEF-5 > 22" and "Not Available". Temporal distribution of different criteria was analyzed to identify patterns throughout the "natural history" of LRP. RESULTS: 40 systematic reviews on LRP evaluated 81 cohorts and 21,618 patients on PPED. ESI was the predominant form of PPED evaluation (75.3%) followed by IIEF-5 > 22 (11.1%). Despite being a simpler criterion, ESI showed worse PPED rates at 1, 3, 6 and 12 months (8%, 27%, 43% and 51%) than IIEF-5 > 22 (14%, 26%, 45% and 58%). The studies were published between 2005 and 2015, but it was in 2010 that the ESI criterion was established as predominant in the literature, reducing the application of others. CONCLUSION: The RSR has proven effective in demonstrating how the PPED evaluation criteria behaved in the "natural history" of the LRP. It showed how a simple and easy-to-apply criterion, such as the ESI, was preferred by the authors, even showing worse PPED rates than other more complex.

Assuntos

RESUMO

Erectile dysfunction is a condition associated with increasing age. Patient evaluation and management should follow a comprehensive, stepwise approach. The aim of this article was to report our experience with the complete study for erectile dysfunction, including intracavernous injection rigidity test, biothesiometry and colour duplex Doppler ultrasound. Data were collected and analysed prospectively. The primary end point was to determine whether treatment decision-making was eased by the CompED test. Secondary end points were to establish which clinical variables prior to the study could impact the results of the CompED test, to finally improve patient selection for the study. 187 patients were recruited, 31.2% of the patients had an axial rigidity below 50%, 28.5% had a peak systolic velocity <25 cm/s, 13.2% had an end-diastolic velocity >5cm/s and 27.5% had an abnormal biothesiometry. The factors that best predicted an abnormal result in any of the tests were age >70 years, IIEF domain A < 14 points, and previous radical prostatectomy or radiotherapy. The CompED test stands as a new alternative for the evaluation of patients with erectile dysfunction, being less time consuming, aiding in a more accurate determination of the aetiology and guiding treatment decision-making.

Assuntos

RESUMO

O presente artigo visa apresentar a ideia de congelamento como metáfora para a insensibilidade e a anestesia diante de "traumatismos precoces", no contexto da clínica da clivagem, de adoecimentos por "apassivação" e "patologias narcísico-identitárias". Para discutir o tema, é relatado brevemente o caso de uma paciente, aqui chamada Cecília, descrevendo seu adoecimento e defesas ativadas e destacando a "neutralização energética" diante de uma situação de desamparo extremo vivenciado na primeira infância. A aqui denominada clínica da cisão e dos adoecimentos por apassivação tem convocado os analistas a refletir acerca de outras estratégias terapêuticas, de modo que acompanhe não apenas as partes amortecidas, mas também os recursos egoicos de cada paciente.

The present article proposes the presentation of the idea of freezing as a metaphor for insensitivity and anesthesia against early trauma, understanding it within the context of a clinic of cleavage, deterioration due to apassivation and narcissistic pathologies. As an illustration, we present the report of a case of a patient, here called Cecília, describing her illness and activated defenses, highlighting the "energetic neutralization" of Roussillon, facing a situation of extreme helplessness experienced in early childhood. Faced to what we call the scission clinic and the illnesses by apassivation, we are called to reflect on the necessary therapeutic strategies that accompany not only the cushioned parts but also the egoic resources of the patient.

El presente artículo propone la presentación de la idea de congelación como metáfora de la insensibilidad y la anestesia contra el traumatismo temprano, entendiéndola en el contexto de una clínica de escisión, deterioro por apassivación y patologías narcisistas. A modo de ejemplo, presentamos el relato de un caso de una paciente, aquí llamada Cecília, describiendo su enfermedad y las defensas activadas, destacando la "neutralización energética" del Roussillon, frente a una situación de extrema indefensión experimentada en la primera infancia. Frente a lo que llamamos la clínica de la cisión y las enfermedades por apassivación, estamos llamados a reflexionar sobre las estrategias terapéuticas necesarias que acompañan no sólo las partes amortiguadas sino también los recursos egoicos del paciente.

Cet article est de proposer la présentation de l'idée de gel comme une métaphore de l'insensibilité et l'anesthésie avant au début du traumatisme, le comprendre dans le contexte d'un clivage clinique des maladies par passivation et pathologies narcissiques identité.Comme illustration, nous présentons le rapport de cas d'un patient ici nommé Cecília, décrivant sa maladie et les défenses ont permis, en vedette dans la "neutralisation de l'énergie" du Roussillon, par rapport à une situation extrême d'impuissance vécu dans la première enfance. Transférer à ce que nous nommons que la répartition et les maladies cliniques par passivation, nous sommes appelés à réfléchir sur les stratégies thérapeutiques nécessaires qui accompagnent non seulement les parties, mais aussi les amorties caractéristiques egoic du patient.

Assuntos

RESUMO

Introducción: El cáncer de próstata (CP) presenta una alta prevalencia. La radioterapia con intensidad modulada (IMRT) esuna nueva técnica con impacto poco conocido en la calidad de vida a largo plazo (CDVALP) de estos pacientes. El objetivo fue evaluar CDVALP en este grupo. Materiales y Método: Se incluyeron pacientes tratados entre 2000-2010, con más de 1 año de seguimiento. Se utilizó cuestionario EPIC, que fue completado directamente por el paciente. Se evaluaron dominios objetivos y subjetivos de hábitos urinarios, intestinales, hormonales y sexuales. Estudio aprobado por el comité de ética. Resultados: Se analizaron 45 encuestas. La mediana de edad fue 75 años (rango 55-90), seguimiento 4,4 años (rango 1,5-8,5). Tasa respuesta promedio fue de 96,9 por ciento. La toxicidad moderada-importante objetiva para dominio urinario fue: escape urinario 8,8 por ciento, disuria 4,4 por ciento, incontinencia 4,4 por ciento, uso pañales 2,2 por ciento, hematuria 6,6por ciento. En lo subjetivo, la polaquiuria fue "un problema grande" en 6,7 por ciento. La toxicidad intestinal objetiva moderada-importante fue: frecuencia deposición 8,9 por ciento, diarrea 4,4 por ciento, pujo 6,6 por ciento, incontinencia 4,4 por ciento, hematoquezia 0 por ciento. En el dominio hormonal: bochornos significativos 11,1 por ciento. En dominio sexual: compromiso importante del deseo 57,6 por ciento, erección 66,7 por ciento, orgasmo 55,6 por ciento, en globo 62,4 por ciento, Subjetivamente la disfunción eréctil se consideró "un problema grande" en 31,1 por ciento . En globo, la disfunción sexual subjetiva se consideró importante en 24,4 por ciento y moderada en 17,8 por ciento. Conclusiones: La radioterapia con IMRT se asocia a buena CDVALP en dominios urinario, intestinal, hormonal. La alta toxicidad sexual podría estar asociada a la edad avanzada de los pacientes tratados con radioterapia.(AU)

Background: Prostate cancer has a high prevalence. Intensity modulated radiation therapy (IMRT) is a new technique with little known impact on quality of life (QOL) in the long term of these patients. The objective was to evaluate QOL in this group. Materials and Methods: We included patients from 2000 to 2010, with more than 1 year follow-up. EPIC questionnaire was completed by the patient directly. We evaluated objective and subjective domains urinary and bowel habits, hormonal and sexual symptoms. Study approved by the ethics committee. Results: 45 surveys were analyzed. The median age was 75 years (range 55-90); follow up was 4.4 years (range 1.5-8.5). Average response rate was 96.9 percent. Toxicity moderately important objective for urinary domain was: urinary escape 8,8 percent, dysuria 4,4 percent, incontinence 4.4 percent, use diapers 2,2, hematuria 6,6 percent. In the subjective, polakiuria was "a big problem" in 6,7 percent. Objective Intestinal toxicity moderately important was: deposition rate 8,9. percent, diarrhea 4.4 percent, incontinence 4.4 percent, hematochezia 0 percent. In the hormonal domain clinical significant hot flashes in was 11.1 percent. In sexual domain: significant desire dysfunction in 57.6 percent, erection 66.7, orgasm 55.6 percent, Sexual overall 62.4 percent, subjectively erectile dysfunction was considered "a big problem" in 31.1 percent. Overall, subjective sexual dysfunction was considered important by 24.4 percent and moderate in 17.8 percent. Conclusions: IMRT radiation therapy is associated with good CDVALP in domains urinary, bowel, hormonal. The sexual high toxicity may be associated with older age of patients treated with radiotherapy.(AU)

Assuntos

RESUMO

OBJECTIVES: To evaluate the possible effects of Tribulus terrestris herbal medicine in the erectile dysfunction treatment and to quantify its potential impact on serum testosterone levels. DESIGN AND METHODS: Prospective, randomized, double-blind and placebo-controlled study including thirty healthy men selected from 100 patients who presented themselves spontaneously complaining of erectile dysfunction, ≥ 40 years of age, nonsmokers, not undergoing treatment for prostate cancer or erectile dysfunction, no dyslipidemia, no phosphodiesterase inhibitor use, no hormonal manipulation and, if present hypertension and/or diabetes mellitus should be controlled. International Index of Erectile Function (IIEF-5) and serum testosterone were obtained before randomization and after 30 days of study. Patients were randomized into two groups of fifteen subjects each. The study group received 800 mg of Tribulus terrestris, divided into two doses per day for thirty days and the control group received placebo administered in the same way. RESULTS: The groups were statistically equivalent in all aspects evaluated. The mean (SD) age was 60 (9.4) and 62.9 (7.9), P = .36 for intervention and placebo groups, respectively. Before treatment, the intervention group showed mean IIEF-5 of 13.2 (5-21) and mean total testosterone 417.1 ng/dl (270.7-548.4 ng/dl); the placebo group showed mean IIEF-5 of 11.6 (6-21) and mean total testosterone 442.7 ng/dl (301-609.1 ng/dl). After treatment, the intervention group showed mean IIEF-5 of 15.3 (5-21) and mean total testosterone 409.3 ng/dl (216.9-760.8 ng/dl); the placebo group showed mean IIEF-5 of 13.7 (6-21) and mean total testosterone 466.3 ng/dl (264.3-934.3 ng/dl). The time factor caused statistically significant changes in both groups for IIEF-5 only (P = .0004), however, there was no difference between the two groups (P = .7914). CONCLUSIONS: At the dose and interval studied, Tribulus terrestris was not more effective than placebo on improving symptoms of erectile dysfunction or serum total testosterone.

Assuntos

RESUMO

Purpose: The proposal of this study was to determine the prevalence and the associated factors of erectile dysfunction (ED) among hemodialysis (HD) patients. Materials and Methods: This was a cross-sectional study based on data collected from HD male patients. Clinical, demographic and laboratory data of all patients were collected in three HD clinics from December 2010 to June 2011. Patients answered questions of erectile function domain from International Index of Erectile Function. Data were evaluated by descriptive analysis and by univariate (ULRA) and multivariate logistic regression analysis (MLRA). Results: Three hundred and five patients participated of the study. The prevalence of ED was 68.19%. ED was associated with diabetes (DM), benign prostatic hyperplasia, glomerulonephritis as cause of chronic renal failure (CRF), smoking habits, lower creatinine levels (ULRA), use of calcium channel blocker (MLRA), aging, lower education level, alcohol consumption, DM (as cause of CRF) and coronary insufficiency (ULRA and MLRA). Conclusions: ED was highly prevalent in the HD men. It was independently associated with aging, current use of alcohol, long alcohol use (even for those who do not drink more), lower education level, diabetes as cause of CRF, coronary insufficiency and use of channel blockers calcium. .

Assuntos

RESUMO

Este artigo trata do caso de Pierre, um rapaz que apresenta dificuldade nos seus relacionamentos amorosos, angústias de morte e crises desencadeadas por situações fobogênicas: apresentações públicas, viagens, relações sexuais. Além disso, ele se impõe verificações obsessivas. A rememoração revela-se ineficaz por conta de uma clivagem dos afetos. As lembranças permanecem intelectuais. A análise vai ajudálo na organização de uma vida melhor, no desaparecimento das fobias que o debilitavam e dos sintomas obsessivos, à custa de um distanciamento relativo das relações afetivas.

This article presents Pierre’s case, a young man with difficulties in love relations, death anxiety, and crisis triggered by phobia-generating situations: public presentations, trips, sexual relations. Also he imposes himself obsessive verifications. Recalling is inefficient due to affect splitting. Memories remain intellectual. Analysis will help him in the organization of a better life, in the disappearance of phobias that handicapped him, and of the obsessive symptoms, due to a relative distancing from affective relations.

Este artículo trata del caso de Pierre, un muchacho que presenta dificultad en sus relaciones amorosas, angustias de muerte y crisis desencadenadas por situaciones fobogénicas: presentaciones públicas, viajes, relaciones sexuales. Además, él se impone verificaciones obsesivas. La rememoración se revela ineficaz debido a un clivaje de los afectos. Los recuerdos permanecen intelectuales. El análisis lo ayudará a una mejor organización de la vida, al desaparecimiento de las fobias que lo debilitaban y de los síntomas obsesivos, a costo de un distanciamiento relativo de las relaciones afectivas.

Assuntos

RESUMO

Tomando como base um caso clínico, abordo o surgimento de impotência em um rapaz como forma de proteção (defesa) diante de um pai invasivo. Tomo como referência as hipóteses teóricas propostas por D. W. Winnicott sobre o amadurecimento e a importância do pai nesse trajeto. O caso apresentado aponta como a distorção da função paterna teve um efeito traumático sobre o paciente, não fornecendo a necessária segurança para as vicissitudes da adolescência. Essa situação provocou uma regressão importante, a qual precisou ser revivida no processo analítico.(AU)

Based on a clinical case I approach the emergence of impotence in a young man as a protection mechanism (defense) facing an invasive father. This work is based on the theoretical hypotheses, posed by D. W. Winnicott, on the role of the father in the development process. The case presented shows how distortions in the parental function had a traumatic effect on the patient, who was left without the required confidence to face adolescence. This situation led to a substantial regression, which had to be relived in the analytical process.(AU)

RESUMO

PURPOSE: We performed a retrospective study to analyze the effectiveness of implantable penile prostheses in the treatment of erectile dysfunction. MATERIALS AND METHODS: This study included 249 patients who received implants between 2001 and 2008. A total of 139 patients who underwent penile prosthesis implantation were interviewed. RESULTS: Approximately half of patients had previously used oral drugs before implantation of the prosthesis. About 45 percent had diabetes, 25.9 percent had previously undergone radical prostatectomy (RP), and 64 percent had hypertension. Exchange was performed in 5.7 percent for fracture, inadequate size, or extrusion. A total of 24.5 percent of men had immediate postoperative pain, 7.9 percent had local infection, and 8.6 percent had other complications. Patients who had previously undergone RP were 3.2 times more likely to experience a postoperative complication than patients who had not (p = 0.061). Eighty-nine (64 percent) patients returned to having sex as they had before being diagnosed with ED. Ninety-two of the men (66.2 percent) had sexual intercourse one to two times per week. One hundred twenty patients (86.3 percent) rated their level of satisfaction as good, excellent or very good, which was similar to the percentage of partners. The mean follow-up was 40 months. CONCLUSION: Higher rates of postoperative infections and mechanical problems with the implant were found in this study as compared to other studies, which was probably associated with the relative lack of experience of the trainees who were performing the surgeries. Patients with a history of RP or diabetes mellitus prior to implantation were at higher risk of postoperative complications.

Assuntos

RESUMO

A disfunção erétil tem fatores de risco similares aos das doenças cardiovasculares, mas também pode ser um fator de risco independente para tais doenças. As evidências atuais consideram a disfunção erétil como uma desordem primordialmente de origem vascular e, mais do que isso, como um marcador precoce das doenças cardiovasculares. Apesar disso, o potencial da disfunção erétil como um sinal para alertar os médicos para uma possível manifestação precoce de doenças cardiovasculares mais graves tem sido pouco explorado na prática clínica diária.

Assuntos

RESUMO

A disfunção erétil ou "incapacidade de obter e manter ereção peniana" é condição antiga na história da humanidade. No entanto, ainda é uma entidade muito frequente nos consultórios médicos que merece atenção, abordagem e tratamento específico.Apesar do grande avanço da medicina, a história clínica e exame físico são partes fundamentais no diagnóstico e conduta desses pacientes. Durante anamnese detalhada, as causas etiológicas podem ser facilmente identificadas e direcionar a forma de tratamento mais adequada.Nos últimos anos vários novos métodos terapêuticos foram desenvolvidos e outros, utilizados no passado, foram aperfeiçoados. Dentre esses, os principais são: os inibidores da 5-fosfodiesterase (5FDE), avaliação psicológica, injeções intracavernosas e próteses penianas.Com certeza, a medicação via oral utilizada sob demanda mudou a história da disfunção erétil e se tornou o tratamento mais utilizado e efetivo para esse grupo de pacientes. Por esse motivo, especialistas no assunto se referem à história da disfunção erétil como "era pré e pós-inibidores da 5FDE".

Assuntos

RESUMO

Objective: The objective of the present study was to verify if there is any relation between diabetes mellitus and male infertility. Methods: the spermograms of 43 non-diabetic subjects and 12 diabetic patients (type 1 and 2) aged 20-60 years were compared. Spermiological findings in diabetic patients were compared with those of normal individuals of the same age. Serum testosterone, prolactin, follicle-stimulant hormone, luteinizing hormone, glucose and glycosilated hemoglobin were assayed in diabetic patients. Results: Six diabetic patients (four type 1 and two type 2) presented chronic complications attributed to neuropathy and vascular insufficiency. No difference was observed in the semen characteristics (odor, color, viscosity and pH) between the control group and the diabetic patients. There were no differences between seminal concentrations and percentage of motile spermatozoa during the first hour of observation in the two groups (p < 0.05). Impotence was reported by four diabetic patients (33.3%). Erectile failure was associated with diabetic microangiopathy and neuropathy. There were no controls with impotence. No significant hormonal changes were found in the diabetic patients. Conclusions: The present results suggest that neuropathy and vascular insufficiency may be implicated in sexual dysfunction in type 1 and 2 diabetic patients, without significantly affecting the hypothalamic-pituitary-gonadal axis.

Objetivo: O objetivo do presente estudo foi verificar se há relação entre diabetes mellitus e infertilidade masculina. Métodos: Foi estudado espermograma de 43 indivíduos não-diabéticos e 12 diabéticos (tipo I e tipo II) com idade variando entre 20 e 60 anos. Os diabéticos também foram submetidos à dosagem hormonal de testosterona, prolactina, hormônio folículo-estimulante e hormônio luteinizante, além da e glicemia de jejum e hemoglobina glicosilada. Resultados: Foram encontrados seis pacientes diabéticos (quatro tipo I e dois pacientes tipo II) com complicações crônicas decorrentes da vásculo- e neuropatia diabéticas. A análise do líquido seminal dos voluntários, não-diabéticos e diabéticos, não mostrou diferenças entre as características dos sêmens: odor, cor, viscosidade e pH. Também não houve diferença entre as concentrações seminais e a porcentagem de espermatozoides móveis durante a primeira hora de observação entre os dois grupos (p > 0,05). Foi relatada impotência por quatro diabéticos (33,3%) com complicações crônicas do diabetes, secundárias à neuropatia e à angiopatia diabética. Não foi encontrada impotência em nenhum paciente do grupo não-diabético. Não foram encontradas alterações hormonais significativas nos diabéticos. Conclusões: Os resultados sugerem que a neuropatia e insuficiência vascular podem estar relacionadas à disfunção sexual em pacientes diabéticos tipo I e II, sem, entretanto, comprometimento do eixo hipotálamo-hifofisário-gonadal.

RESUMO

A psicologia entende-se perfeitamente com a história, uma vez que o presente e o passado unem-se no método científico psicanalítico. No divã do psicanalista ou no ambiente social, o presente é invadido pelo passado por intermédio do cotidiano, da literatura, da moral, do direito, da linguagem, das ciências, das técnicas, das artes. Com o objetivo de ilustrar a interdisciplinaridade na história e na psicologia, são discutidas duas visões sobre a sexualidade: a primeira refere-se à exteriorização extrema da impotência, a partir do julgamento de impotentes; a segunda seleciona a interiorização da culpa por meio da transformação de procedimentos legais de inculpação do impotente em conflitos internos. Destaca-se, assim, a visita à história, à procura de vítimas de tribunais a serviço da repressão dos incapacitados, e a visita aos porões da história de pacientes, à procura de formas para a supressão da repressão mental que os incapacitou.

Psychology and history are perfect bedfellows, since the present and the past come together in the psychoanalytical scientific method. On the psychoanalyst's couch or in the social setting, the present is invaded by the past through the daily routine, literature, morals, law, language, science, technology, the arts. With the purpose of illustrating the inter-disciplinarity of history and psychology, two views of sexuality are discussed: the first refers to an extreme externalization of impotence, based on the judgment of those who are impotent; the second view selects the internalization of guilt, by means of the transformation of the legal procedures incriminating the impotent subject in internal conflicts. Thus, the visit to history stands out, in the search for victims of the courts, in the service of the repression of the disabled, and the visit to the fundaments of the patients' history in the search for ways to suppress the mental repression that disabled them.

Assuntos

RESUMO

A disfunção erétil (DE), outrora denominada erroneamente de impotência sexual, é um problema bastante comum e angustiante que acomete o homem. Considerada quase que exclusivamente de origem psicogênica até a década de 80, o melhor entendimento da fisiologia da ereção, bem como de sua fisiopatologia possibilitaram identificar causas orgânicas responsáveis por essa condição, que hoje sabemos serem muito mais freqüentes do que imaginávamos. Apesar de ser uma desordem benigna, esta disfunção pode interferir com a saúde física e psicossocial do paciente e/ou sua (seu) parceira (o), impactando de forma significativa na sua qualidade de vida. No Brasil, um estudo revelou que a DE acomete 45,1% dos homens adultos, em algum grau. Estima-se que, atualmente, cerca de 25 milhões de homens brasileiros com mais de 18 anos de idade sofram de algum grau de disfunção erétil e que 45% destes tenham disfunção moderada ou grave, mostrando que essa condição deve ser considerada um problema de saúde pública importante em nosso meio. Nesta revisão de literatura, pretendemos rever e expor os principais conceitos que envolvem o tema disfunção erétil, possibilitando ao médico generalista uma forma prática de abordagem diagnóstica e terapêutica dos que sofrem dessa doença.

RESUMO

As autoras descrevem o trabalho com um grupo de residentes de urologia com o objetivo de promover um campo de reflexão da prática médica a partir do enfoque psicanalítico. O grupo teve como um de seus objetivos ampliar a captação da subjetividade na relação médico-paciente, sensibilizando o olhar clínico, para além da objetividade da consulta médica. Foi possível trabalhar sobre as escolhas feitas no cotidiano dos atendimentos valorizando a relação interpessoal, desenvolvendo a capacidade de diagnosticar o paciente e não somente a doença. Os estudantes familiarizaram-se com conceitos psicanalíticos, a partir de situações clínicas, apresentadas por eles ao grupo. Observamos na escolha da profissão de médico, a fantasia do poder, da imunização à dor, à doença e à morte, o que leva o estudante, no período da residência, a sofrer vários golpes narcísicos. O médico é treinado para salvar, curar, servir e, na maioria das vezes, se sente demasiadamente responsável pelo paciente. Diante do naufrágio de tais ideais, os limites são experienciados como extremos, eclodindo sentimentos de inadequação e culpa. Colaborar com a estrutura egóica do residente para enfrentar as situações traumáticas a que estará exposto ao longo da vida profissional poderia ser de grande valia na formação do médico

The authors describe the work with a group of residentes in Urology with the aim of thinking about medical practice, according to a psychoanalytic point of view. One of the goup ambitions was the enlargement of the subjectivity perception in doctor-patient relationship. Adding a touch of sensibility to the clinic eye, beyond the objectivity of medical consultation. Working on chioices made from everyday assistances improved the interpersonal relationship, developing the ability of diagnosing the the patient and not only the disease. The studentd learned psychoanalytical concepts, from clinical situations presented to the group. We observe, in the choice for medical activity, a fantasy of power, of immunity to pain, to illnes and to death, what leads the residente to go though several narcissistic woundes. A doctoe is traindes to save, to heal and to serve and in most cases they feel excessively reponsable for their patients. Before the sinking of such ideals, limits are experienced as being extreme, causing feeling of unfitness and blame. Collaborating with the residents´egoistical structure in facing the traumatic situations they shall be exposed to along their professional lives might be of great value in the doctor´s formation

RESUMO

A masculinidade, como sintoma, utiliza a atividade do pênis ereto como estandarte de sustentação imaginária da potência fálica. A instalação da disfunção erétil (que afeta o órgão) coloca em questão a masculinidade (que afeta o ser), confirmando a sensação subjetiva de "impotência" sexual - sujeito e sintoma se fundem no fracasso eretivo.

Masculinity, as a symptom, uses the erect penis activity as an imaginary maintenance banner of the phallic potency. The installation of the erectile dysfunction (which affects the organ) raises the issue of masculinity (which affects the being itself), thus confirming the subjective sensation of sexual "impotence" - subject and symptom fall in the erective failure.

Assuntos