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All About Periods
Reviewed by: Krishna Wood White, MD, MPH
en españolTodo sobre la menstruación
A period is when blood comes out through a girl's vagina. It is a sign that she is getting close to the end of puberty. Puberty is when your body goes from looking like a kid's into looking more like a grown-up's.
There is a lot to learn about periods. Here are some common questions that kids have.
When Do Most Girls Get Their Period?
Most girls get their first period when they're around 12. But getting it any time between age 10 and 15 is OK. Every girl's body has its own schedule.
How Will I Know My First Period Is Coming?
There are some signs that a girl's period may start soon. These include:
• She's worn a bra for a few years.
• She has hair under her arms and in her private parts.
• She has some clear, stringy liquid (called discharge) coming from her vagina.
Why Do Girls Get Periods?
A period happens because of changes in hormones in the body. Hormones give messages to the body. These hormones cause the lining of the uterus (or womb) to build up. This gets the uterus ready for an egg (from the mom) and sperm (from the dad) to attach and grow into a baby. If the woman does not get pregnant, the lining breaks down and bleeds. This same process happens every month. That is why most girls and women get their periods around once a month.
Do Periods Happen Regularly When Menstruation Starts?
For the first few years after a girls starts her period, it may not come regularly. This is normal at first. By about 2–3 years after her first period, a girl's periods should be coming around once a month.
How Long Do Periods Last?
Periods usually last about 5 days. But a period can be shorter or last longer.
How Often Does a Period Happen?
Periods usually happen about once a month. But some girls get their periods around every 3 weeks. And others only get a period about once every 6 weeks.
Should I Use a Pad, Tampon, or Menstrual Cup?
There are a few ways to deal with period blood. You may need to experiment a bit to find which works best for you. Some girls use only one method and others switch between different methods.
• Most girls use a pad when they first get their period. Pads are made of cotton and come in lots of different sizes and shapes. They have sticky strips that attach to the underwear.
• Many girls prefer to use tampons instead of pads, especially when playing sports or swimming. A tampon is a cotton plug that a girl puts into her vagina. Most tampons come with an applicator that guides the tampon into place. The tampon absorbs the blood. Don't leave a tampon in for more than 8 hours because this can increase your risk of a serious infection called toxic shock syndrome.
• Some girls prefer a menstrual cup. To use a menstrual cup, a girl inserts it into her vagina. The cup holds the blood until she empties it.
How Much Blood Comes Out?
Although it may look like a lot of blood, a girl usually only loses a few tablespoons of blood for the whole period. Most girls need to change their pad, tampon, or menstrual cup about 3–6 times a day.
Will I Have Periods for the Rest of My Life?
When women are around age 45‒55, they stop having periods (this is called menopause). Women also won't have a period while they are pregnant.
What Is PMS?
PMS (premenstrual syndrome) is when a girl has emotional and physical symptoms right before her period starts or during the early part of her period. A girl with PMS might:
• be in a bad mood
• feel more sad or worried than usual
• feel bloated (swollen)
• gets pimples
Do All Girls Get Cramps?
Lots of girls have cramps with their period, especially in the first few days. If the cramps are very uncomfortable, a warm heating pad on the belly and medicines can help.
Looking Ahead
Periods are a natural, healthy part of a girl's life. They shouldn't get in the way of exercising, having fun, and enjoying life. If you have questions about periods, ask your doctor, a parent, health teacher, school nurse, or older sister.
Reviewed by: Krishna Wood White, MD, MPH
Date reviewed: October 2018

Do Men Have Periods?
A Quarter Of Men Experience 'PMS Symptoms' Due To Daily Hormonal Changes
Nov 20, 2015 03:58 PM By Lizette Borreli @lizcelineb
A quarter of men believe they have monthly “man periods,” with PMS-like symptoms, including stomach cramps, mood swings, and hot flashes. Pixabay, Public Domain
Stomach cramps, mood swings, and hot flashes are all tell-tale signs it’s that time of the month for women — and men. A new survey conducted by VoucherCloud (Think UK version of Groupon) found a quarter of men believe they experience monthly “man periods,” suffering premenstrual (PMS) symptoms from cramps to food cravings.
Jed Diamond, therapist and author of The Irritable Male Syndrome, has done some exploring on the existence of the man period in the past and believes “men have hormonal cycles just as women do.” Contrary to popular belief, men become violent when their testosterone levels go down, where irritability, depression, and withdrawal come with a deficiency of the hormone. Testosterone levels in young men can fluctuate as much as four times daily. However, what is less clear is how these levels vary day by day and week by week.
To explore this man period phenomenon, VoucherCloud asked the male survey respondents of over 2,400 (50 percent men and 50 percent women) if they frequently suffered the same common side effects of PMS that women experience during their menstrual cycle, including tiredness, cramps, and increased sensitivity. The results revealed 26 percent of men experience these feelings on a regular basis, while more shockingly, 58 percent of their female partners believed them. Men identified several PMS-related symptoms as signs of their "man periods," such as constant hunger to general irritability. Males (12 percent) confessed they were "more sensitive about personal weight," while some (5 percent) suffered from "menstrual cramps."
Furthermore, 43 percent of female respondents claimed they offered special support to their partners during this time of the month. When asked how they had done so, some ways included "try and cheer him up" (44 percent) and "walk around on egg shells" (39 percent). Out of those who didn’t believe their partners had man periods, 33 percent told their partner to "man up."
When it comes to spending during man periods, the average male spent an additional $124.62 on food and snacks per month, including takeout, compared to those who didn’t believe in the phenomenon. Men who believed they suffered from menstrual symptoms reportedly spent an extra $97.35 per month to combat their increased food cravings.
A similar 2009 study found a woman’s menstrual cycle does influence her spending habits. In the 10 days before a woman's period begins, she's more likely to go on a shopping spree and overspend about $27. The researchers suggest these women were shopping excessively as a way to deal with negative emotions they experience during their cycle. For example, stress and depression moved some women to shop to cheer themselves up and regulate their emotions.
So, perhaps there is some scientific validity to man periods. A 2004 study suggested men suffer from PMS symptoms as badly as women. The men scored higher than women in depression; lack of arousal; hot flashes and pain, including stomach cramps, back pain, and headaches. The researchers suspected the reason these men complained more than women is because of their difference in pain thresholds. Women could experience more pain, but don’t give it as much attention.
However, ladies should not fear having synchronized periods with men they’re in a relationship with. “In our research only women’s cycles synch with each other, men’s don’t synch with other men’s or women’s — so women in a relationship with each other can often experience that,” Diamond told The Daily Beast.
If you see a man cranky and incredibly hungry, offer him some greasy food and a beer, he may be on his man period.
Sources: Pine KJ. Report on a survey into female economic behavior and the emotion regulatory role of spending. Sheconomics. 2009.
Aubeeluck A. British Psychological Society. 2004.
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From Wikipedia, the free encyclopedia
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This article is about women. For the condition called male menopause, see Andropause. For the medical journal, see Menopause (journal).
Synonyms Climacteric

An Ukara Ekpe textile from the Igbo culture which is secretly dyed by post-menopausal women.[1]


Symptoms No menstrual periods for a year[2]

Usual onset 49 and 52 years of age[3]

Causes Usually a natural change, surgery that removes both ovaries, some types of chemotherapy[4][5]

Treatment None, lifestyle changes[6]

Medication Menopausal hormone therapy, clonidine, gabapentin, selective serotonin reuptake inhibitors[6][7]

Menopause, also known as the climacteric, is the time in most women's lives when menstrual periods stop permanently, and they are no longer able to bear children.[2][8] Menopause typically occurs between 49 and 52 years of age.[3] Medical professionals often define menopause as having occurred when a woman has not had any vaginal bleeding for a year.[4] It may also be defined by a decrease in hormone production by the ovaries.[9] In those who have had surgery to remove their uterus but still have ovaries, menopause may be viewed to have occurred at the time of the surgery or when their hormone levels fell.[9] Following the removal of the uterus, symptoms typically occur earlier, at an average of 45 years of age.[10]
Before menopause, a woman's periods typically become irregular,[11] which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow.[11] During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, sweating, and reddening of the skin.[11] Hot flashes often stop occurring after a year or two.[8] Other symptoms may include vaginal dryness, trouble sleeping, and mood changes.[11] The severity of symptoms varies between women.[8] While menopause is often thought to be linked to an increase in heart disease, this primarily occurs due to increasing age and does not have a direct relationship with menopause.[8] In some women, problems that were present like endometriosis or painful periods will improve after menopause.[8]
Menopause is usually a natural change.[5] It can occur earlier in those who smoke tobacco.[4][12] Other causes include surgery that removes both ovaries or some types of chemotherapy.[4] At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone.[2] While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine.[13] Menopause is the opposite of menarche, the time when a girl's periods start.[14]
Specific treatment is not usually needed.[6] Some symptoms, however, may be improved with treatment.[6] With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended.[6] Sleeping in a cool room and using a fan may help.[6] The following medications may help: menopausal hormone therapy (MHT), clonidine, gabapentin, or selective serotonin reuptake inhibitors.[6][7] Exercise may help with sleeping problems.[6] While MHT was once routinely prescribed, it is now only recommended in those with significant symptoms, as there are concerns about side effects.[6] High-quality evidence for the effectiveness of alternative medicine has not been found.[8] There is tentative evidence for phytoestrogens.[15]
Signs and symptoms[edit]

Symptoms of menopause
During early menopause transition, the menstrual cycles remain regular but the interval between cycles begins to lengthen. Hormone levels begin to fluctuate. Ovulation may not occur with each cycle.[16]
The date of the final menstrual period is usually taken as the point when menopause has occurred.[16] During the menopausal transition and after menopause, women can experience a wide range of symptoms
Menopause can be induced or occur naturally. Induced menopause occurs as a result of medical treatment such as chemotherapy, radiotherapy, oophorectomy, or complications of tubal ligation, hysterectomy, unilateral salpingo-oophorectomy or leuprorelin usage.[30]

LOOK UP-------Premenopause Perimenopause[e Postmenopause
Male Menopause
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male menopause

DESCRIPTION In this Article

What Is Male Menopause?
How Is Male Menopause Diagnosed?
Can Male Menopause Be Treated?

Women may not be the only ones who suffer the effects of changing hormones. Some doctors are noticing that men are reporting some of the same symptoms that women experience in perimenopause and menopause.

The medical community is debating whether or not men really do go through a well-defined menopause. Doctors say that men receiving hormone therapy with testosterone have reported relief of some of the symptoms associated with so-called male menopause.

What Is Male Menopause?

Because men do not go through a well-defined period referred to as menopause, some doctors refer to this problem as androgen (testosterone) decline in the aging male -- or what some people call low testosterone. Men do experience a decline in the production of the male hormone testosterone with aging, but this also occurs with conditions such as diabetes.

Along with the decline in testosterone, some men experience symptoms that include:
Sexual problems

The relationship of these symptoms to decreased testosterone levels is still controversial.

Unlike menopause in women, when hormone production stops completely, testosterone decline in men is a slower process. The testes, unlike the ovaries, do not run out of the substance it needs to make testosterone. A healthy man may be able to make sperm well into his 80s or later.
Continue Reading Below
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Slideshow: A Visual Guide to Low Testosterone

A dip in a man's sex drive can be a symptom of low testosterone -- or a normal part of aging. See the symptoms and treatments for 'Low T' in this slideshow from WebMD.

However, as a result of disease, subtle changes in the function of the testes may occur as early as age 45 to 50 and more dramatically after the age of 70 in some men.

How Is Male Menopause Diagnosed?

To make the diagnosis of male menopause, the doctor will:
Perform a physical exam
Ask about symptoms
Order tests to rule out medical problems that may be contributing to the condition
Order blood tests, which may include measuring testosterone level

Can Male Menopause Be Treated?

If testosterone levels are low, testosterone replacement therapy may help relieve symptoms such as:
Loss of interest in sex (decreased libido)

Just as with hormone replacement therapy in women, testosterone replacement therapy has potential risks and side effects. Replacing testosterone may worsen prostate cancer, for example.
If you are considering androgen replacement therapy, talk to a doctor to learn more. Your doctor may also recommend certain lifestyle or other changes to help with some symptoms of male menopause. These include:
Exercise program
Medications, such as an antidepressant
WebMD Medical Reference Reviewed by William Blahd, MD on January 14, 2017
MSNBC: "Male Menopause Out of the Closet."
WebMD Feature: "Menopause: Not Just For Women."
Mayo Foundation for Medical Education and Research: "Male menopause: Myth or reality?" "Aging Male Syndrome."
Mayo Foundation for Medical Education and Research: "Testosterone therapy: Can it help older men feel young again."
MedlinePlus Medical Encyclopedia: "Aging changes in the male reproductive system."
© 2017 WebMD, LLC. All rights reserved.
Next ArticleUrinary Incontinence and Men: Tips for Coping Day to Day

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The Mechanics of ED

An erection occurs when blood fills two chambers known as the corpora cavernosa. This causes the penis to expand and stiffen, much like a balloon as it is filled with air. The process is triggered by impulses from the brain and genital nerves. Anything that blocks these impulses or restricts blood flow to the penis can result in ED.
Yet evidence shows that good blood sugar control can minimize this risk. Other conditions that may cause ED include cardiovascular disease, atherosclerosis (hardening of the arteries), kidney disease, and multiple sclerosis. These illnesses can impair blood flow or nerve impulses throughout the body.

Causes of ED: Chronic Disease
The link between chronic disease and ED is most striking for diabetes. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Yet evidence shows that good blood sugar control can minimize this risk. Other conditions that may cause ED include cardiovascular disease, atherosclerosis (hardening of the arteries), kidney disease, and multiple sclerosis. These illnesses can impair blood flow or nerve impulses throughout the body.
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Causes of ED: Lifestyle
Lifestyle choices that impair blood circulation can contribute to ED. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis particularly vulnerable to ED. Being overweight and getting too little exercise also contribute to ED. Studies indicate that men who exercise regularly have a lower risk of ED.

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Causes of ED: Surgery
Surgery, including treatments for prostate cancer, bladder cancer, or BPH can sometimes damage nerves and blood vessels near the penis. In some cases, the nerve damage is permanent, and the patient will require treatment to achieve an erection. In others, surgery causes temporary ED that improves on its own after 6 to 18 months.
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Causes of ED: Medication
ED may be a side effect of medication, including certain blood pressure drugs, antidepressants, and tranquilizers. Men should talk with their doctor if they suspect a prescription or over-the-counter drug may be causing erectile problems. Never stop any medicine without first consulting your doctor.
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Causes of ED: Psychological
ED usually has something physical behind it, particularly in older men. But psychological factors can be a factor in many cases of ED. Experts say stress, depression, poor self-esteem, and performance anxiety can short-circuit the process that leads to an erection. These factors can also make the problem worse in men whose ED stems from something physical.

ED and Bicycling
Research suggests avid cyclists suffer more ED than other athletes. The trouble lies in the shape of some bicycle seats that put pressure on the perineum. This area between the anus and scrotum contains arteries and nerves vital to sexual arousal. Cyclists who ride for many hours each week may benefit from seats designed to protect the perineum.
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Diagnosing ED: Physical Exam
To diagnose ED, your doctor will ask you questions about your symptoms and medical history. The doctor will conduct a complete physical exam to uncover signs such as poor circulation or nerve trouble. And your physician will look for abnormalities of the genital area that could cause problems with erections.
Diagnosing ED: Lab Tests
Several lab tests can help diagnose male sexual problems. Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire. Blood cell counts, blood sugar levels, cholesterol levels, and liver function tests can reveal medical conditions that may account for ED.
Diagnosing ED: Lab Tests
Several lab tests can help diagnose male sexual problems. Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire. Blood cell counts, blood sugar levels, cholesterol levels, and liver function tests can reveal medical conditions that may account for ED.
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ED: A Sign of Heart Disease?
In some cases, ED can be a warning sign of more serious disease. One study suggests ED is a strong predictor of heart attack, stroke, and death from cardiovascular disease. The researchers say all men diagnosed with ED should be evaluated for cardiovascular disease. This does not mean every man with ED will develop heart disease, or that every man with heart disease has ED, but patients should be aware of the link.
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Treating ED: Lifestyle Changes
Many men with ED are able to improve sexual function by making a few lifestyle changes. Giving up smoking, losing weight, and exercising more often can help by improving blood flow. If you suspect a medication could be contributing to ED, talk to your doctor about adjusting the dosage or switching to another drug.
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Treating ED: Oral Medications
You’ve probably heard of Viagra, but it’s not the only pill for ED. This class of drugs also includes Cialis, Levitra, Staxyn, and Stendra. All work by improving blood flow to the penis during arousal. They're generally taken 30-60 minutes before sexual activity and should not be used more than once a day. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. Staxyn dissolves in the mouth. All require an OK from your doctor first for safety.
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Treating ED: Injections
While pills for ED are convenient, some men sustain stronger erections by injecting medication directly into the penis. Drugs approved for this purpose work by widening the blood vessels, causing the penis to become engorged with blood. Another option is inserting a medicated pellet into the urethra. The pellet can trigger an erection within 10 minutes.
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Treating ED: Vacuum Devices (Pumps)
Vacuum devices for ED, also called pumps, offer an alternative to medication. The penis is placed inside a cylinder. A pump draws air out of the cylinder, creating a partial vacuum around the penis. This causes it to fill with blood, leading to an erection. An elastic band worn around the base of the penis maintains the erection during intercourse.
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Treating ED: Surgery
If ED is caused by a blockage in an artery leading to the penis, surgery can often restore blood flow. Good candidates are typically younger men whose blockage stems from an injury to the crotch or pelvis. The procedure is not recommended for older men with widespread narrowing of the arteries.
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Treating ED: Implants
In men with persistent ED, a penile implant can restore sexual function. An inflatable implant uses two cylinders that are surgically placed inside the penis. When an erection is desired, the man uses a pump to fill the cylinders with pressurized fluid. Another option is a malleable implant, which bolsters erections with surgically implanted rods.
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Treating ED: Psychotherapy
Even when ED has a known physical cause, psychotherapy can be beneficial. A therapist can teach the man and his partner techniques to reduce performance anxiety and improve intimacy. Therapy can also help couples adjust to the use of vacuum devices and implants.
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Treating ED: Alternative Therapies
Talk with your doctor before trying supplements for ED. They can contain 10 or more ingredients and may complicate other health conditions. Asian ginseng and ginkgo biloba (seen here) are popular, but there isn't a lot of good research on their effectiveness. Some men find that taking a DHEA supplement improves their ability to have an erection. Unfortunately, the long-term safety of DHEA supplements is unknown. Most doctors do not recommend using it.
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Treating ED: Buyer Beware
A quick web search will reveal dozens of "dietary supplements" that claim to treat ED. But the FDA warns that many of these are not what they seem. An investigation discovered the pills often contain prescription drugs not listed on the label, including the active ingredient in Viagra. This puts the man at risk for dangerous drug interactions.
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ED: Reducing the Risk
Some tips to reduce the risk of ED include:
Exercise and maintain a healthy weight.
Stop smoking.
Avoid alcohol and substance abuse.
Keep diabetes under control.
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Discussing ED With Your Partner
It's natural to feel angry or embarrassed when dealing with ED. But don't forget that your partner is also affected. Talking openly about ED will help your partner understand the diagnosis and treatment options. This can reassure a partner that you haven't lost interest.

Medical Definition of Impotence

Impotence: A common problem among men characterized by the consistent inability to sustain an erection sufficient for sexual intercourse or the inability to achieve ejaculation, or both. Impotence can vary. It can involve a total inability to achieve an erection or ejaculation, an inconsistent ability to do so, or a tendency to sustain only very brief erections.
The risk of impotence increases with age. It is four-fold higher in men in their 60s compared with those in their 40s according to a study published in the Journal of Urology (2000;163:460-463). Men with less education are also more likely to experience impotence, perhaps because they tend to have less healthy lifestyles, eat a less healthy diet, drink more and exercise less. Physical exercise tends to lessen the risk of impotence.
Impotence can have emotional causes but most often it is due to a physical problem. The physical causes of impotence include diseases (such as diabetes and hypertension), injuries (such as from prostate surgery), side-effects of drugs (such as the protease inhibitors used in HIV therapy), and disorders (such as atherosclerosis) that impair blood flow in the penis. Impotence is treatable in all age groups. Treatments include psychotherapy, vacuum devices, surgery and, most often today, drug therapy.
Advertising for drugs for the treatment of impotence has greatly popularized the problem better known in the ads by its other name, erectile dysfunction.
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Penile plethysmograph
From Wikipedia, the free encyclopedia
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Penile plethysmograph
[edit on Wikidata]
Penile plethysmography (PPG) or phallometry is measurement of bloodflow to the penis, typically used as a proxy for measurement of sexual arousal. The most commonly reported methods of conducting penile plethysmography involve the measurement of the circumference of the penis with a mercury-in-rubber or electromechanical strain gauge, or the volume of the penis with an airtight cylinder and inflatable cuff at the base of the penis. Corpora cavernosa nerve penile plethysmographs measure changes in response to inter-operative electric stimulation during surgery. The volumetric procedure was invented by Kurt Freund and is considered to be particularly sensitive at low arousal levels. The easier to use circumferential measures are more widely used, however, and more common in studies using erotic film stimuli. A corresponding device in women is the vaginal photoplethysmograph.[1]
For sexual offenders it is typically used to determine the level of sexual arousal as the subject is exposed to sexually suggestive content, such as pictures, movies or audio, although some have argued that phallometry is not always appropriate for the evaluation of sexual preferences or treatment effects.[2] A 1998 large-scale meta-analytic review of the scientific reports demonstrated that phallometric response to stimuli depicting children, though only 32% accurate, had the highest accuracy among methods of identifying which sexual offenders will go on to commit new sexual crimes.[3]
For prostatectomy nerve-sparing surgery, the surgeon applies a mild electrical stimulation near the cavernous nerves of penis to verify their locations and avoid operative trauma. Damage to these difficult-to-see nerves can cause erectile dysfunction outcomes. At the surgery's conclusion, the electrical stimulation penile plethysmograph result is a prognosis which helps to manage the erectile function outcomes earlier than the many months required for recovery.[4]
Reliability and validity
Critique of methodological problems
Erectile dysfunction
Male homosexuality
Pedophilia, hebephilia, pedohebephilia, and ephebophilia
Volumetric penile plethysmography
Circumferential penile plethysmography
Legal admissibility
United States
Use as trial evidence
Post-conviction use
Ethics and legality of use
See also
External links

There are two types of penile plethysmograph:
Volumetric air chamber
When this is placed over the subject's penis, as tumescence increases, the air displaced is measured.
Circumferential transducer

This uses a mercury-in-rubber or indium/gallium-in-rubber ring or electromechanical strain gauge and is placed around the shaft of the subject's penis to measure changes in circumference.
The circumferential type is more common,[5] but the volumetric method is believed to be more accurate at low arousal levels.[6]
Significant suppliers of PPG machines include Behavioral Technology Inc. and Medical Monitoring Systems. The device is known to be used in Brazil, Britain, Canada, China, Czech Republic, Hong Kong, New Zealand, Norway, Slovak Republic, Spain, and the United States.
The surgical machine is supplied as CaverMap by Blue Torch Medical Technology, Inc.

A roughly equivalent procedure for women, vaginal photoplethysmography, measures blood through the walls of the vagina, which researchers claim increases during sexual arousal.

The original volumetric was developed during the 1950s by Kurt Freund in then-Czechoslovakia. Freund later wrote, "In the early fifties homosexual interaction was still an indictable offense in Czechoslovakia. I was of course opposed to this measure, but I still thought, as did my colleagues at the psychiatric university hospital in Prague where I was working, that homosexuality was an experientially acquired neurosis". He then developed phallometry to replace psychoanalytic methods of assessment because "[P]sychoanalysis had turned out to be a failure, virtually unusable as an instrument for individual diagnosis or research....When phallometry began to look promising as a test of erotic sex and age preferences, we started using it mainly as a test of pedophilia, that is determining who has an erotic preference for children over adults".[7]

In post–World War II Czechoslovakia, Freund was assigned by the communist government the task of identifying among military conscripts men who were falsely declaring themselves to be gay to avoid the draft.[8][9] "Freund (1957) developed the first device, which measured penile volume changes... to distinguish heterosexual and homosexual males for the Czechoslovakian army."[10] When he escaped Europe for Canada, Freund was able to pursue his research using phallometry for the assessment of sexual offenders.[8] At that time, attempts to develop methods of changing homosexual men into heterosexual men were being made by many sexologists, including John Bancroft,[11] Albert Ellis,[12] and William Masters of the Masters and Johnson Institute.[13] Because phallometry showed that such methods were failures, Freund was among the first sexologists to declare that such attempts were unethical.[8][14] Based primarily on Freund's studies, decriminalization of homosexuality took place in Czechoslovakia in 1961. (See also LGBT rights in the Czech Republic.)
Reliability and validity[edit]

In 1994, the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) of the American Psychiatric Association stated that penile plethysmography has been used in research settings to assess various paraphilias by measuring an individual's sexual arousal in response to visual and auditory stimuli. The reliability and validity of this procedure in clinical assessment have not been well established, and clinical experience suggests that subjects can simulate response by manipulating mental images."[15] In contrast, a recent meta-analysis provides support for the validity of phallometric testing as a measure of sexual interests in children across 37 samples and 6,785 individuals.[16]

In 1998, Hanson and Bussière published a comprehensive meta-analysis of 61 scientific reports on the prediction of sexual offenses spanning more than 40,000 individual cases. They ascertained that of all the methods attempted and reported, penile phethysmographic responses to imagery depicting children was the single most accurate predictor of sexual re-offense across 7 studies reporting data from phallometric testing.[3] Another meta-analysis in 2005 of 13 studies and 2,180 individual cases repeated the finding that phallometric responses to children was a strong predictor of sexual re-offense.[17]
A more recent meta-analysis that included 16 samples and 2,709 sexual offenders replicated and extended the previous findings that phallometric responding to children is a predictor of sexual re-offence.[16] This meta-analysis extended previous meta-analytic research by showing phallometric responding to both male and female pedophilic and hebephilic stimuli predict sexual re-offence. Further, this meta-analysis showed that phallometric testing predicts sexual re-offence in distinct subgroups of sexual offenders against children.
Critique of methodological problems[edit]
There are criticisms of the methodology used to determine the reliability and specificity of penile plethysmography. One such criticism is that while penile plethysmography is said to be important for being more objective than a test subject’s subjective reports on sexual arousal, the argument for penile plethysmography being a more reliable gauge of sexual arousal than vaginal plethysmography is still that there is a higher correspondence on average between what the test subjects report and what the instruments observe in male subjects than in female subjects. There is a criticism of this discrepancy for lacking consistency in the standards of whether or not subjective reports are useful. There is also criticism regarding the possibility of sampling bias being greater in male subjects of penile plethysmography than in female subjects of vaginal plethysmography, males being generally more aware of their physical sexual responses than females in most cultures may cause the male volunteers to be almost exclusively individuals who have category specific erections due to those with nonspecific erections fearing erection in taboo contexts and therefore not signing up for the studies. This effect may explain apparent male specificity as a result of methodological bias. The difference between tests of volunteers and tests of convicted or suspected sex offenders in penile plethysmography results may be caused by the sex offender group often effectively lacking the choice not to volunteer, without difference in erection patterns from the average population. One criticism of reoffending studies is that cultural attitudes that assume that men are sexually attracted to what they phallometrically respond to may cause men with no actual sexual interest in children to identify as pedophiles due to knowing that they phallometrically respond to them, making them more likely to be convicted again.[18][19]

Erectile dysfunction[edit]
The penile plethysmograph has value in screening organic versus psychogenic erectile dysfunction in urological polysomnography centres.[20] Lack of sexual response during REM sleep may indicate that further evaluation by a urologist is required.[21]
When applied during nerve-sparing surgery, electrical stimulation penile plethysmograph is an erectile dysfunction prognostic. The patient is provided with objective information on his specific outcome which aids in planning for further erectile function therapies.[22]
Male homosexuality[edit]
Phallometry may be able to distinguish gay men from heterosexual men.[23][24][25] A phallometric study indicated that men who are more homophobic show greater penile arousal to stimuli depicting gay sex than do less homophobic men.[26]
Pedophilia, hebephilia, pedohebephilia, and ephebophilia[edit]
Studies examining the efficiency of using penile plethysmograph to distinguish pedophilic men from non-pedophilic men, including hebephiles, show that a majority can be correctly assigned to the proper category.[27][28][29] Sensitivity of a phallometric test is defined as the accuracy of the test to identify pedophilic (or hebephilic) individuals as having these sexual interests. Specificity of these tests is defined as the accuracy of the test to identify non-pedophilic (or non-hebephilic) individuals as such. Meta-analytic research has shown that sexual offenders against children show greater responding on phallomtric tests for pedophilia and hebephilia than controls.[16]

Volumetric penile plethysmography[edit]
In one study, 21% of the subjects were excluded for various reasons, including "the subject's erotic age-preference was uncertain and his phallometrically diagnosed sex-preference was the same as his verbal claim" and attempts to influence the outcome of the test.[28] This study found the sensitivity for identifying pedohebephilia in sexual offenders against children admitting to this interest to be 100%. In addition, the sensitivity for this phallometric test in partially admitting sexual offenders against children was found to be 77% and for denying sexual offenders against children to be 58%. The specificity of this volumetric phallometric test for pedohebephilia was estimated to be 95%.

Further studies by Freund have estimated the sensitivity of a volumetric test for pedohebephilia to be 35% for sexual offenders against children with a single female victim, 70% for those with two or more female victims, 77% for those offenders with one male victim, and 84% for those with two or more male victims.[30] In this study, the specificity of the test was estimated to be 81% in community males and 97% in sexual offenders against adults. In a similar study, the sensitivity of a volumetric test for pedophilia to be 62% for sexual offenders against children with a single female victim, 90% for those with two or more female victims, 76% for those offenders with one male victim, and 95% for those with two or more male victims.[31]
In a separate study, sensitivity of the method to distinguish between pedohebephilic men from non-pedohebephilic men was estimated between 29% and 61% depending on subgroup.[27] Specifically, sensitivity was estimated to be 61% for sexual offenders against children with 3 or more victims and 34% in incest offenders. The specificity of the test using a sample of sexual offenders against adults was 96% and the area under the curve for the test was estimated to be .86. Further research by this group found the specificity of this test to be 83% in a sample of non-offenders.[32] More recent research has found volumetric phallometry to have a sensitivity of 72% for pedophilia, 70% for hebephilia, and 75% for pedohebephilia and a specificity of 95%, 91%, and 91% for these paraphilias, respectively.[33]
Circumferential penile plethysmography[edit]

Other studies have examined the sensitivity and specificity of circumferential phallometry to identify different sexual interests in children. Sensitivity for a circumferential phallometric test for pedophilia has been estimated to be 63% in sexual offenders against children,[34] 65% in extrafamilial offenders against children and 68.4% in incest offenders.[35] Additional research has found different circumferential phallometric tests to have a sensitivity of 93%,[36] 96%,[37] 35%,[38] 78%,[39] and 50%[40] in sexual offenders against children. In incest offenders, the sensitivity of circumferential phallometric tests has been estimated as 19% and 60% in extrafamilial offenders against children.[41] In terms of specificity of these tests for pedophilia, research has estimated the specificity as 92%,[37] 82%,[41] 76%,[39] and 92%[40] in samples of community males and 80%[38] and 92%[40] in sexual offenders against adults.
A single study has examined the accuracy of a circumferential phallometric test for hebephilia.[41] This study found the sensitivity of the hebephilia test to be 70% in extrafamilial offenders against children and 52% in incest offenders. In addition, the specificity for this phallometric test was 68% in a sample of community males.
Other studies have found different phallometric tests for pedohebephilia to have a sensitivity of 75% in incest offenders, 67% in extrafamilial offenders against children,[42] and 64%,[43] 64%,[44] 44%,[38] and 53%,[45] in sexual offenders against children.
In addition, Abel and colleagues found ephebophilic stimuli to have a sensitivity of 50%.[34]

Another study examined the possibility that juvenile sex offenders might be able to suppress arousal deemed deviant. Of the juveniles who exhibited sexual arousal, categorization was made into two age appropriate categories—Adult and Peer responders—and three age inappropriate categories—Child, Child/Adult, and Nondiscriminating responders—based on whether they had the greatest sexual arousal in response to adult female, peer female, or younger child female stimuli. Sexual arousal in response to older adult women or peers was deemed age appropriate; sexual arousal in response to significantly younger females was deemed inappropriate. Many of the juveniles who denied responsibility for their offenses showed no sexual arousal at all—however about one-third still showed age inappropriate arousal despite denying responsibility for their offenses.[46]
Phallometry might distinguish men with erotic interests in cross-dressing from non-cross-dressers.[47][48]
There is some evidence that phallometry can distinguish groups of men with biastophilia (a paraphilia involving rape) from groups of men without it.[49]

Legal admissibility[edit]
In general, phallometric test results are employed as part of the sentencing and rehabilitation phase of forensic systems, but not for determining whether a specific defendant is guilty of any specific offense against any specific person.
United States[edit]
Use as trial evidence[edit]

In the United States, a scientific technique could not be used as evidence in court unless the technique was "generally accepted" as reliable in the relevant scientific community. This was known as the Frye standard, adopted in 1923. In 1993, the doctrine was rejected by the Supreme Court of the United States in favor of a more comprehensive "reliable foundation" test in Daubert v. Merrell Dow Pharmaceuticals. In the Daubert standard, the "generally accepted" test was no longer determinative. Several other factors could now be considered, including whether the technique had been published and peer reviewed. Myers notes, "Courts that have considered penile plethysmography generally rule that the technique is not sufficiently reliable for use in court."[50]
In United States v. Powers the court excluded the penile plethysmograph test because it failed to qualify under Daubert's scientific validity prong for two reasons: the scientific literature does not regard the test as a valid diagnostic tool, and "a vast majority of incest offenders who do not admit their guilt, such as Powers, show a normal reaction to the test. The Government argues that such false negatives render the test unreliable."[51]
According to Barker and Howell, penile plethysmography (PPG) does not meet the legal threshold for the guilt phase for the following reasons:[52]
No standardization
Test results are not sufficiently accurate
Results are subject to faking and voluntary control by test subjects
High incidence of false negatives and false positives
Results are open to interpretation
They concluded, "Until a way can be devised to detect and/or control false negatives and false positives, the validity of the test data will be questionable."[52] Responding to Barker and Howell, Simon and Schouten noted, "Our own analysis suggests that the standardization and faking issues, as well as other problems not addressed in the Barker and Howell paper, warrant much more guarded conclusions about the use of the plethysmograph in legal and clinical settings."[2] Prentky noted "the increased likelihood in forensic settings that dissimulation may compromise the validity of the assessment."[53] Hall and Crowther noted penile plethysmography "may be even more problematic than other [methods] in assessing susceptibility of the test to faking."[54]
In State of North Carolina v. Spencer,[55] the court reviewed the literature and case law and concluded that penile plethysmography was scientifically unreliable: "Despite the sophistication of the current equipment technology, a question remains whether the information emitted is a valid and reliable means of assessing sexual preference."
More recently, a substantial amount of research data has been gathered and reviewed, and significant steps have been taken toward standardization.[citation needed] According to Launay (1999), "[T]he validity of the technique for research and clinical assessment is now established;"[56] it is only the use in guilt-determination proceedings that is inappropriate.[citation needed] Fedoroff and Moran called it an "experimental procedure" and noted, "Virtually every expert who has written about phallometry has cautioned that it is insufficiently sensitive or specific to be used to determine the guilt or innocence of a person accused of a sex crime."[57]
Post-conviction use[edit]
Phallometry is widely considered appropriate for treatment and supervision of convicted sex offenders: "Courts have permitted plethysmographic testing for monitoring compliance by convicted sex offenders with the conditions of their community placement as part of crime-related treatment for sexual deviancy."[58] Its use for the treatment and management of sexual offenders is recommended by the Association for the Treatment of Sexual Abusers.[59] Becker notes it "should never be used exclusively in forensic decision making."[60] The sexual assault trial of basketball player Kobe Bryant in Colorado brought this device and its use to public attention before the case was dropped in 2004, because Colorado law would have required evaluation with this device following conviction.[61] The United States Court of Appeals for the Ninth Circuit recently addressed the procedures required before a federal supervised release program could include penile plethysmograph testing.[62] The device is routinely used at civil commitment facilities, but "some clinicians and offenders say it is easy, particularly in a laboratory, to stifle arousal and thus cheat on a plethysmograph test."[63] This has been reported to occur in 16% of cases.[27]
During the Catholic sex abuse cases, the reliability of the test was questioned by some officials in the Roman Catholic Archdiocese of Philadelphia. Later, these officials chose to seek therapy at an institution where the plethysmograph was not used.[64]

Courts in Canada came to a similar conclusion as those in the United States. The Supreme Court of Canada adopted the Daubert doctrine in R. v . J.-L.J. [2000] 2 S.C.R. 600, which upheld a lower court's decision to exclude testimony by a psychiatrist who had administered several tests on the accused, including a penile plethysmograph:
A level of reliability that is quite useful in therapy because it yields some information about a course of treatment is not necessarily sufficiently reliable to be used in a court of law to identify or exclude the accused as a potential perpetrator of an offence. In fact, penile plethysmography has received a mixed reception in Quebec courts: Protection de la jeunesse – 539, [1992] R.J.Q. 1144; R. c. Blondin, [1996] Q.J. No. 3605 (QL) (S.C.); L. Morin and C. Boisclair in "La preuve d'abus sexuel: allégations, déclarations et l'évaluation d'expert" (1992), 23 R.D.U.S. 27. Efforts to use penile plethysmography in the United States as proof of disposition have largely been rejected: People v. John W., 185 Cal.App.3d 801 (1986); Gentry v. State, 443 S.E.2d 667 (Ga. Ct. App. 1994); United States v. Powers, 59 F.3d 1460 (4th Cir. 1995); State v. Spencer, 459 S.E.2d 812 (N.C. App. 1995); J. E. B. Myers et al., "Expert Testimony in Child Sexual Abuse Litigation" (1989), 68 Neb. L. Rev. 1, at pp. 134-35; J. G. Barker and R. J. Howell, "The Plethysmograph: A Review of Recent Literature" (1992), 20 Bull. Am. Acad. of Psychiatry & L. 13.
— [65]

As of 2010, all youth in sex offender treatment programs administered by the Youth Forensic Psychiatric Service of British Columbia were offered a voluntary penile plethysmograph test to predict whether they can properly control their deviant arousal, or whether they will require medication or other forms of treatment. According to sceptics, however, the test does not reliably predict recurrent violations.[66]
Ethics and legality of use[edit]

Robert Todd Carroll writes, "More objectionable than the questionable scientific validity of the device, however, are the moral and legal questions its use raises."[67] Carroll and others cite the legality of the depictions of minors, as well as the constitutionality of requiring PPG for admission to jobs or the military, or in custody cases. In Harrington v. Almy the United States Court of Appeals for the First Circuit found that a PPG ordered to be administered by William O'Donohue as a precondition of employment was a violation of plaintiff's rights under the Fourteenth Amendment to the United States Constitution.[68][69] In a 2009 report led by Robert Clift on use of the device on adolescent offenders,[70] the authors acknowledge in their conclusions that PPG tests "are problematic ethically and should be used only after therapists have carefully weighed the benefits versus the negatives."[71] The Minister of Children and Family Development closed the program examined in Clift's report in 2010 following complaints by civil rights groups.[72][73] The principal manufacturer of the device stopped making them in the 1990s.[74]
The EU's leading human rights agency, the Fundamental Rights Agency, has criticised the use of phallometric tests by the Czech Republic to determine whether asylum seekers presenting themselves as homosexual were in fact gay. According to the Agency, the Czech Republic was in 2010 the only EU country to employ a sexual arousal test, which the Agency said could violate the European Convention on Human Rights.[75] In 2011 the EU commission issued a statement calling the Czech practice illegal, saying "The practice of phallometric tests constitutes a strong interference with the person's private life and human dignity. This kind of degrading treatment should not be accepted in the European Union, nor elsewhere."[76] The Czech Interior Ministry replied that the testing was conducted only after written consent has been obtained, and when it was not possible to use a different method of verification. According to the Ministry, all those who had passed the test had been granted asylum.[77]
See also[edit]

Sexological testing
Labial thermistor clip
Clitoral photoplethysmograph
Vaginal photoplethysmograph
Jump up
^ Prause, Nicole, and Erick Janssen. "Blood flow: Vaginal photoplethysmography." Women’s sexual function and dysfunction: Study, diagnosis, and treatment (2006): 359-367.
Jump up to:
a b Simon W. T.; Schouten P. G. (1992). "The plethysmograph reconsidered: Comments on Barker and Howell". Bulletin of the American Academy of Psychiatry and the Law. 20: 13–25.
Jump up to:
a b Hanson R. K.; Bussière M. T. (1998). "Predicting relapse: A meta-analysis of sexual offender recidivism studies". Journal of Consulting and Clinical Psychology. 66: 348–362. doi:10.1037/0022-006x.66.2.348.
Jump up
^ Klotz L, Heaton J, Jewett M, et al. (November 2000). "A randomized phase 3 study of intraoperative cavernosa nerve stimulation with penile tumescence monitoring to improve nerve sparing during radical prostatectomy". J. Urol. 164 (5): 1573–8. doi:10.1016/S0022-5347(05)67031-0. PMID 11025707.
Jump up
^ Howes R. J. (1995). "A survey of plethysmographic assessment in North America". Sexual Abuse: A Journal of Research and Treatment. 7: 9–24. doi:10.1007/bf02254871.
Jump up
^ Kuban M, Barbaree HE, Blanchard R (August 1999). "A comparison of volume and circumference phallometry: response magnitude and method agreement" (PDF). Arch Sex Behav. 28 (4): 345–59. doi:10.1023/A:1018700813140. PMID 10553495.
Jump up
^ Freund K (1991). "Reflections on the development of the phallometric method of assessing sexual preference". Annals of Sex Research. 4: 221–228. doi:10.1007/BF00850054.
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a b c Wilson, R. J., & Mathon, H. F. (2006, fall). Remembering Kurt Freund (1914-1996). ATSA Forum. Beaverton, OR: Association for the Treatment of Sexual Abusers.
Jump up
^ penile plethysmograph (PPG) (Sceptic's dictionary)
Jump up
^ W O'Donohue, E Letourneau. The psychometric properties of the penile tumescence assessment of child molesters. Journal of Psychopathology and Behavioral Assessment, 1992
Jump up
^ Bancroft J (December 1969). "Aversion therapy of homosexuality. A pilot study of 10 cases". Br J Psychiatry. 115 (529): 1417–31. doi:10.1192/bjp.115.529.1417. PMID 5358532.
Jump up
^ Ellis A (1956). "The effectiveness of psychotherapy with individuals who have severe homosexual problems". Journal of Consulting Psychology. 20: 191–195. doi:10.1037/h0044762.
Jump up
^ Schwartz MF, Masters WH (February 1984). "The Masters and Johnson treatment program for dissatisfied homosexual men". Am J Psychiatry. 141 (2): 173–81. doi:10.1176/ajp.141.2.173. PMID 6691475.
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^ (link is external) (link is external)
Jump up
^ DSM-IV, p. 524.
Jump up
^ Fedoroff, JP; Moran, B (1997). "Myths and Misconceptions about Sex Offenders". The Canadian Journal of Human Sexuality. 6: 1997.
Jump up
^ Clift, JRW; Rajlic, G; Gretton, H (2009). "Discriminative and Predictive Validity of the Penile Plethysmograph in Adolescent Sex Offenders". Sexual Abuse. 21 (3): 335–362. doi:10.1177/1079063209338491. PMID 19587382.
Jump up
^ Bula, Frances (July 27, 2010). B.C. rights group complains about testing of young sex offenders. The Globe and Mail
Jump up
^ Staff report (August 8, 2010). B.C. used penile teen sex test for decades. CBC News
Jump up
^ Wintonyk, Darcy (July 29, 2010). B.C. permanently halts sexual arousal testing. CTV News
Jump up
^ Hyde, Alan (1997). The legal penis. Bodies of Law, pp. 173 ff. Princeton University Press, ISBN 978-0-691-01228-5
Jump up
^ Czech gay asylum 'phallometric test' criticised by EU (BBC, December 8, 2010)
Jump up
^ Czech sexuality tests not legal, EU commission says (EUobserver, 17.05.2011)
Jump up
^ Czech Republic defends test of gay asylum seekers despite EU criticism (, Dec 08 2010)
External links[edit]
Legal Definition of Penile Plethysmograph
Online version of penile plethysmography entry in Skeptic's Dictionary via Robert Todd Carroll
British Psychological Society's Guidelines for PPG
Phallometry in Research and Clinical Diagnosis by Dr. Ray Blanchard
Male genital surgical and other procedures: reproductive system (ICD-9-CM V3 60–64, ICD-10-PCS 0V)
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seminal vesicles:
Vas deferens
VasectomyVasectomy reversal VasovasostomyVasoepididymostomy
Orchiectomy CastrationOrchiopexy
CircumcisionPenectomyPenile prosthesisPreputioplasty
Penile plethysmographPostage stamp testFrenuloplasty of prepuce of penis
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from katrineelizabethsackett 32463 whitelady 5'2 1/2 5'3
7101 n ih 35 austin tx by burger king
note female also have a test done
this article and a article under wikipedia also
today is oct 8 2018

Penile Plethysmography Testing for Convicted Sex Offenders
Michael C. Harlow and Charles L. Scott
Journal of the American Academy of Psychiatry and the Law Online December 2007, 35 (4) 536-537;
Plethysmography Testing Requirements for Supervised Release of Sex Offenders Deemed an Undue Deprivation of Liberty When Less Invasive Testing Methods Are Available

Penile plethysmography tests a man's level of sexual arousal and “involves placing a pressure-sensitive device around a man's penis, presenting him with an array of sexually stimulating images, in determining his level of sexual attraction by measuring minute changes in his erectile responses” (Odeshoo JR: Of penology and perversity: the use of penile plethysmography on convicted child sex offenders. Temp Pol Civ Rights Law Rev 14:1, 2004). American sex offender treatment programs utilize this test widely, and U.S. courts mandate plethysmography frequently as a term of supervised release. Penile plethysmography, polygraph, and Abel tests are utilized to monitor whether a supervised-release sex offender is at increased risk of reoffending.

In U.S. v. Weber, 451 F.3d 552 (9th Cir. 2006), Matthew Henry Weber filed an appeal for relief from his terms of supervised release mandated by the U.S. Central District of California. The court required that on release from prison, Mr. Weber could be compelled to submit to penile plethysmography evaluation if his probation officer deemed such testing warranted. The defendant petitioned the Ninth Circuit Court of Appeals to remove this supervised-release condition, arguing that penile plethysmography was not “reasonably related to deterrence, rehabilitation, or public safety, and even if one of these interests was met, penile plethysmography was an unreasonable and unnecessary deprivation of liberty.”
from katrinesackett32463 whitelady 5'2 1/2 5'3 7101 n ih 35 austi ntx by burger king
oct 2018
find article also under google under Wikipedia for male and females

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