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Sexual Attraction

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Hypoactive sexual desireconditioned inhibition

Erences are typically examined on a final test, when the drug is not administered (thus revealing the necessity of opioid reward during paced copulation). However, during this final test without the drug, females previously treated with naloxone display a conditioned disruption of solicitation and lordosis relative to saline-treated females, despite being primed fully with estrogen and progesterone. As a result, males engage in fewer intromissions and achieve fewer ejaculations with those females. A pattern of diminished sexual solicitation and receptivity, which leads to more restricted sexual contact with males, is analogous in many ways to the pattern of sexual behavior displayed by women with hypoactive sexual desire disorder. It is not yet known if this pattern of disrupted appetitive sexual behavior can be restored by pharmacologic or experiential treatments that increase desire in women.

Female Sexual Arousal Disorder

Female sexual arousal disorder (FSAD) is operationalized as the difficulty in reaching and maintaining vaginal lubrication or genital swelling until the completion of the sexual activity (ApA, 2000). Recently, theorists have argued that diagnosis of FSAD should consider not only the physiological dimension of sexual arousal (i.e., lubrication) but the psychological experience as well. Women of all ages may experience difficulty lubricating, although it tends to be more of a problem in later life, typically after menopause. Female sexual arousal disorder is generally assessed and treated in conjunction with female orgasmic disorder or HSDD. To date, there are no validated treatments that focus exclusively on treating female arousal problems, although a number of pharmacological agents for enhancing vaginal engorgement and lubrication are currently under investigation. Techniques are often employed to help the patient become aware of her anxiety or her sexual turn-off thoughts,...

Hypoactive Sexual Desire Disorder

Women with Hypoactive Sexual Desire Disorder (HSDD) complain of a low interest in general sexual activities. There are currently no empirically validated treatments for HSDD. Sex therapy techniques generally consist of 15 to 45 sessions of cognitive therapy aimed at restructuring thoughts or beliefs that may adversely impact sexual desire (e.g., women should not initiate sexual activities, sex is dirty ) and to address negative underlying relationship issues. Behavioral approaches are utilized to teach patients to express intimacy and affection in both nonsexual (e.g., holding hands, hugging) and sexual ways, to incorporate new techniques into their sexual repertoire that may enhance their sexual pleasure, and to increase sexual communication. Testosterone is effective in restoring sexual desire in women with abnormally low testosterone levels (e.g., secondary to removal of the adrenal glands, bilateral removal of the ovaries, menopause).

Sexual Response Sexual Desire

Sexual desire refers to the broad interest in sexual objects or experiences and is generally inferred by self-reported frequency of sexual thoughts, fantasies, dreams, wishes, and interest in initiating and or engaging in sexual experiences. Definition of this construct is complicated by factors such as attitudes, opportunity partner availability, mood, and health. Relationship factors, individual preferences for sexual variety and emotional intimacy are closely linked to sexual desire. Androgens appear to also play a role. In males, about 95 of androgens (e.g., testosterone) are produced by the testes the remainder is produced by the outer adrenal glands. In females, androgens are produced by the ovaries and adrenal glands in quantities much lower than in males (about 20-40 times less Rako, 1996). In both males and females, decreased testosterone levels due to, for example, orchidectomy (removal of testes) or oophorectomy (removal of ovaries) have been linked to impaired sexual...

Hypogonadismagonadism and hypoactive sexual desire

Although there are currently no established models of female sexual dysfunction in rats, there are several reasons to believe that such models could exist. The most obvious would be the consequences of hypogonadism induced by ovariectomy followed by maintenance with different doses of estrogen alone, or estrogen and progesterone. Ovariectomized rats treated with estrogen and progesterone display a complete pattern of procep-tive and receptive behaviors, whereas those treated with estrogen alone display no proceptive behaviors, low levels of lordosis, and high rates of rejection responses. Certain pharmacologic treatments (e.g. apomorphine, oxytocin, PT-141), are able to increase proceptive behaviors and reduce rejection responses in ovariectomized females treated or maintained on estrogen alone. This pattern of data suggests that such drugs may be useful in the treatment of hypoactive sexual desire disorder, with or without accompanying hypogonadism. It will be important to consider...

The Components of Sexual Desire

Sexual desire is not a single phenomenon. Anyone can say he is experiencing sexual desire for several reasons that do not correspond necessarily to the physiology of desire. In this respect Levine has suggested an interesting division according to his view it Table 13.2 Risk factors for low sexual desire in men as reported in the Global Study of Sexual Attitudes and Behaviors 10 . Table 13.2 Risk factors for low sexual desire in men as reported in the Global Study of Sexual Attitudes and Behaviors 10 . is clinically useful to think of desire as consisting of drive (biologic), motive (individual and relationship psychology), and wish (cultural) components 11 . The drive component of desire is what we could expect to be explained (some day) by the neuro-chemical mechanisms in the brain. The motivational component of desire might be a result of the interaction of the couple, for instance I want to have sex with her, otherwise she will leave . And the cultural component of desire can be...

Hypoactive Sexual Desire Disorder HSDD

HSDD is a disorder characterized by absent or low desire for sexual activity that is associated with interpersonal difficulty or distress (ApA, 2000). A distinction is made between receptive and proceptive sexual behaviors, with a lack of proceptive behavior most indicative of true low sexual desire (Pridal & LoPiccolo, 2000). HSDD affects both men and women, and it is the most common primary diagnosis in cases of sexual dysfunction. Segraves and Segraves (1991) conducted a large pharmaceutical study for sexual disorders and found that 19 of clients with a primary diagnosis of HSDD were male. Prevalence estimates for community samples indicate a rate of 15 for males (Rosen & Leiblum, 1995). The three major etiological factors for low sexual desire that have been proposed are hormonal problems, affective-cognitive models, and relationship dynamic theories. Although evidence of hormonal influence on sexual desire in females is inconsistent, research continually shows a relationship...

Etiology of Hypoactive Sexual Desire

Hypoactive sexual desire is a condition that many times is part of another disease or disorder. Other times, the decrease or absence of sexual desire occurs with no other sexual dysfunction or recognizable pathology. In any event, it is critical that the clinician identifies this condition lack of success in treatment of other sexual dysfunctions, like erectile dysfunction, can sometimes be explained by the presence and lack of proper treatment of HSD. The list included in Table 13.4, taken from Meuleman & Van Lankvled (2005) 2 , is a summary of the causes of HSD seen frequently in clinical practice. Hypoactive sexual desire is frequent in men with erectile dysfunction. In a series of 428 men with erectile dysfunction, Corona and co-workers (2004) 5 reported that 43.3 of their participants had the condition. This group found no correlation for patient or partner's age. Men with HSD in this study were not diagnosed as hypogonadic more frequently than men without HSD however ANOVA...

Genital sexual arousal

Upon sexual arousal, the blood supply to the vagina is rapidly increased and at the same time the venous drainage is reduced, thus creating vasocongestion and engorgement with blood. Such an increase in blood flow combined with an enhanced permeability of the capillary tufts induces a neurogenic transu-date, which results in vaginal lubrication. From Reliable and standardized models to study the physiology pharmacology of female vaginal sexual arousal have been described in dogs, rabbits and rats. In these models, vaginal sexual arousal along with clitoral tumescence is induced by peripheral electrical neural stimulation, while direct measurements of various vaginal physiologic variables are performed. These models have been useful to initiate the exploration of the peripheral physiology of female genital sexual response as well as the consequences of various experimental pathophysiologic conditions (e.g. atherosclerosis or hormonal deprivation).

Treatment of Hypoactive Sexual Desire

Treatment of HSD is directed to the putative cause of the condition. There are no effective symptomatic treatments for HSD, as there are for erectile dysfunction (i.e. phosphodiesterase-5 (PDE-5) inhibitors). Bupropion, an antidepressant medication that has an effect in the re-uptake of dopamine and norepinephrine 41 , has been studied, and it has shown a modest effect on women with HSD when compared to placebo (using the slow-release form starting 150 mg day for one week and then 300 mg day) 42,43 . An early report by Crenshaw and co-workers 44 included men and women who were not depressed, but who had some form of psychosexual dysfunction (inhibited sexual desire, inhibited sexual excitement or inhibited orgasm), and indicated some positive effect on patient's rated libido and global improvement, which was statistically significant compared to placebo unfortunately, it is not clear from the report how many men responded. The response rates, though statistically significant when...

Diagnosis of Hypoactive Sexual Desire

The diagnosis of HSD is not difficult if the clinician asks directly about desire or interest for sexual activity. Most patients identify with ease a change in their usual pattern, and this is the way in which the condition is identified most of the time in clinical practice. Sometimes, it is necessary to investigate the indicators of sexual desire, which, although not as direct as the expression of desire, are often good clinical indicators. Table 13.5 shows a list of clinical indicators of sexual desire. Some patients present themselves as having low sexual desire, which in fact is a result of another sexual dysfunction. Erectile dysfunction is sometimes confused by the patient as a sign of diminished desire. Likewise, the avoidance pattern that follows the frustration generated by a persistent dysfunction, like severe premature ejaculation or erectile dysfunction, can also be reported as absence of desire. These clinical situations demand a careful evaluation from the clinician...

Sexual Arousal

Closely connected with desire, sexual arousal is defined in both subjective (e.g., feeling sexually excited) and physiological terms (e.g., genital vasocongestion). The primary markers of sexual arousal in both sexes are increased my-otonia (muscle tension), heart rate, blood pressure, and vasocongestion (blood engorgement), which leads to penile erection in males, and engorgement of the clitoris, labia, and vagina (with lubrication) in females. Physiological sexual arousal in males involves signal input from the brain and spinal cord and peripheral nervous systems, and on a complex interplay between neurotrans-mitters, vasoactive agents, and endocrine factors. Within the penis is a central artery (corpus cavernosum) and veins that exit and drain the erectile bodies. The muscles that Physiological sexual arousal in women begins with vaso-congestion of the vagina, vulva, clitoris, uterus, and possibly the urethra, and can occur within only a few seconds of sexual stimulation. Vaginal...

Sexual Desire

Sexual desire is commonly defined as a wish, need, or drive to seek out and or respond to sexual activities, or the pleasurable anticipation of such activities in the future. It is an appetitive state distinct from genital arousal and sexual activity. The mechanisms underlying sexual desire are not well known, although it is frequently believed to have both biological and psychological components. A number of biological factors are likely to play a role in sexual desire, including testosterone, serotonin, and dopamine. In humans, testosterone is the most widely studied of these to date. It has been shown that testosterone administered to hypogonadal men can restore sexual desire to normal levels. However, testosterone given to nonhypogo-nadal men does not consistently increase desire, and the majority of studies assessing testosterone treatment for The psychological components of sexual desire are believed to stem from both intrapsychic and interpersonal factors. Social influences...

Sexual function assessment in the male

The essential components of sexual function assessment in the male always include erectile response (onset, duration, progression, severity of the problem, nocturnal morning erections, self-stimulatory and visually erotic-induced erections), sexual desire, ejaculation, orgasm, sexually related genital pain disorders and partner sexual function, if available. Often, a dysfunction in one phase may precipitate a dysfunction in another. For instance, men with erectile dysfunction may report a loss of sexual desire or the onset of premature ejaculation.

Interpersonal Dimensions of Sexual Function and Dysfunction

Clinically, it has been frequently observed that sexual problems may be either the cause of, or consequence of, dysfunctional or unsatisfactory relationships. Often, it is difficult to determine which is cause and effect a non-intimate and non-loving relationship, or sexual desire and or performance problems, leading to partner avoidance and antipathy. The research literature is contradictory on this topic, and often difficult to interpret since couples begin therapy with varying degrees of relationship satisfaction.

Sexual Function and Libido

Thyrotoxic men can experience a decreased libido, which seems to be related to increased signs of estrogen effects, including abnormally enlarged breasts (gynecomastia). Some of this may be because thyrotoxicosis increases the amounts of sex hormone binding proteins made by the liver, reducing the amount of male sex hormone (testosterone) available to enter body cells. Men with hyperthyroidism may complain of impotence. Some men may also experience low sperm count and thus impaired fertility. If a young adolescent male develops hyperthyroidism, he may experience a delay in development during normal puberty. Some men do not seem to have any negative effects on their libido during thyrotoxicosis. Of course, the complex effects of thyro-toxicosis on brain function, altering thoughts and behavior, might have additional and differing effects on libido. The effects of thyrotoxicosis on women's sexuality are unclear. Some women may have an increased desire for sex because of the effects of...

Sexuality And The Passions Of The Brain Introductory Remarks

Sexual motivational systems lie at the root of some of the most intense human feelings, ranging from the eroticism and cravings of sexual arousal to the delights and disappointments of orgasm, not to mention social bondings and attachments, not to mention the ongoing dynamics of social relationships and dependencies. Sexual motivation and sexual performance are often dissociated (Everitt, 1990), as are social urges and commitments, especially in the presence of negative mood and emotional states. To better grasp how these relationships may permeate psychiatric concerns, the aim of this brief section is to provide an overview of the neural underpinnings of mammalian sexuality.

Peter A Sargent and Guy M Goodwin Introduction

F52.0 Lack or loss of sexual desire F52.8 Other sexual dysfunction, not caused by organic disorder or disease F52.9 Unspecified sexual dysfunction, not caused by organic disorder or disease The pitfalls of medicalizing sexual dysfunction should be noticed here and have been illuminated in the lampoon by Szaz 2 he has interesting things to say in this area. Accepting the more conventional medical view, nevertheless, epidemiological studies suggest that sexual dysfunction is not uncommon in the general population. An analysis of 22 surveys of psychosexual dysfunction found inhibited sexual desire in 1-15 of men and in 1-35 of women, inhibited sexual excitement in 10-20 of men, premature ejaculation in 35 of men and inhibited orgasm in 5 of men and 5-30 of women.3 The scale and also the variability of these rates provides a potentially confounding background for the interpretation of findings of sexual dysfunction in specific disorders such as depression or as a consequence of treatment...

The Neurobiology of Sexual Function

Sexual desire and arousal have a poorly understood central representation in the brain. Behavioral responses are easier to measure and are known to be determined partly by brain centers directly influencing motor behaviors, and partly by spinal reflexes which can operate

Molecules promoting sexual drive

Table 13.3 presents, in a short format, the various molecules that are thought to participate in the regulation of the biologic component of sexual desire, after a review by Meston 12 . Hypoactive Sexual Desire in Men 151 Table 13.3 Molecules that have been reported to influence sexual desire (modified afterMeston and Frohlich) 12 . Effect on sexual desire T increase Kind of 0 no change population Molecule 4 decrease studied Normal males and hyperactive sexual desire males Fig. 13.2 A conceptual model of the integration of biologic and psychologic factors in sexual desire (after Kaplan, 1995) 35 . The role of testosterone, and perhaps several other androgens, appears to be necessary for the experience of sexual desire in its drive component 32 . It appears that a minimum level of androgen is required for the man to be able to experience sexual desire however the relationship is not completely linear, as the higher level of androgen in blood does not correlate with higher level of...

Complex Relationships Between Behavior and Motivation

One cannot infer the existence of a motivation merely by the presence of certain behaviors. For example, aggressive behavior does not presuppose a motivation or drive for aggression. Behavior is due to many factors. This complexity is illustrated by eating disorders such as obesity or bulimia, as well as in everyday life when people who are not food deprived nevertheless crave food when bored or anxious. Likewise, individuals can find food aversive and abstain from eating even when there is a strong tissue need for nourishment (Capaldi, 1996). People may eat when feeling unloved, and individuals may refrain from eating when motivated to seek social approval, obtain a job, or participate in a political hunger strike. Similarly, sexual behavior may occur when individuals seek power, prestige, or social approval rather than sexual gratification related to sexual arousal (McClelland, 1973). Although physiological needs may be powerful sources of motivation, they are neither necessary nor...

Reproductive Behavior

Thalamus involved in the regulation of sexual behavior. Oxytocin injections into the hypothalamus of estrogen-primed female rats facilitate female sexual behavior, while oxytocin antagonists block this behavior. Oxytocin may also play a role in sexual performance in males. For example, oxytocin levels in the cerebrospinal fluid are elevated after ejaculation in male rats and oxytocin injections decrease the latency to ejaculation. Oxytocin also stimulates the occurrence of spontaneous, noncontact penile erections in male rats. The role of oxytocin in human sexuality is unclear however, plasma oxytocin levels increase during sexual arousal and peak at orgasm in both men and women.

Benefits of androgen therapy

T therapy may have more significant effects on libido than on erectile function 170 . In one study, normalization of serum T levels in hypogonadal men with ED resulted in only short-term improvement (one month) in erectile function and sexual satisfaction, while improvement of sexual desire was statistically significant for the six months of the study, making the use of T therapy alone questionable in this population 74 . However, T monotherapy did improve sexual performance, desire, and motivation in men with hypogonadism, in clinical trials with transdermal T-gel formulation. Maximal improvement occurred on day 30 and continued for the six-month duration of the study 30 .

Complications of penile prosthetic surgery and their management

Erectile Radiology

Only a few authors have reported long-term results of semi-rigid prostheses. Salama 52 reported that 70 of patients and 57 of partners were satisfied with their semi-rigid AMS 650 or Mentor Accu-Form prostheses. There was an increase in the frequency of intercourse, sexual desire and ability to achieve orgasm. Of note, dislike for the device was the most common cause for dissatisfaction among patients, while a sense of unnaturalness was the most common cause for dissatisfaction for partners.

Copulatory behavior and measures of female sexual motivation or desire

Females to allow mounting by a male, with the lordosis reflex being the best known and most studied response. Unfortunately, there is no counterpart for lordosis in women. In contrast, psychologic arousal or desire in women is likely to be very close to proceptivity. For this reason, the study of proceptive behaviors is also relevant to any preclinical investigation of potential of compounds for the treatment of female sexual disorders or dysfunctions (FSD). Indeed, recently it has been reported that the melanocortin agonist, PT-141, increased rates of sexual solicitation and hops and darts in female rats selectively. This same drug increased female-initiated sexual activity in early Phase IIa clinical trials. These two observations were critically important to begin to establish solicitation as a valid model of female sexual desire.

Mehrabians PAD Pleasure ArousabilityDominance Temperamen t Model

The emotion-centered theory of temperament is based on assumptions that allow a search for a variety of links between temperament and other behaviors and behavior disorders in a diversity of situations and environments. A series of studies has been conducted by Mehrabian (1980) and his associates to illustrate the links between temperament and such phenomena as eating characteristics and disorders (Mehrabian, 1987 Mehrabian & Riccioni, 1986 Mehrabian, Nahum, & Duke, 1985-1986), chronic stimulant use (Mehrabian, 1986 1995b), sexual desire and dysfunction (Mehrabian & Stanton-Mohr, 1985), illness (Mehrabian, 1995b Mehrabian & Bernath, 1991 Mehrabian & Ross, 1977), emotional empathy (Mehrabian, Young, & Sato, 1988), and environmental preferences (Hines & Mehrabian, 1979 Mehrabian, 1978a). It is impossible to refer to all these studies however, two lines of research mentioned in the following paragraphs illustrate Mehrabian's approach to the study of temperament characteristics as related...

Rectification of terms

In humans, sexual dysfunctions form around the categories of sexual arousal, desire, orgasm, and pain. Arousal may be separated into physiologic genital arousal (sometimes referred to as potency ) and subjective or psychologic arousal that denotes a conscious awareness of the genital sensations. However, this psychologic arousal may be an important component of sexual desire (sometimes referred to as libido or motivation ). Sexual arousal and desire sum into behavioral responses of copulation Sexual arousal Sexual desire Females and males

Routine laboratory tests

Free testosterone, testosterone, prolactin and dehydroepiandrosterone sulfate (DHEAS) are the specific hormones that may be part of the ED evaluation. These hormones have been associated with sexual desire. Luteinizing hormone (LH), follicle-stimulating hormone (FSH) and sex hormone-binding globulin (SHBG) are determined for further differential diagnosis in the case of low testosterone values, to ascertain primary or secondary hypo-gonadism. Estradiol, growth hormone or, better, insulin-like growth factor 1 (IGF-1) and thyroid parameters are determined in individual cases to diagnose further hormonal deficits.

Treatment of men with sexual dysfunction and hyperprolactinemia

Noma, or at least prevent its growth 18,230 . In addition, unlike PDE5-I, PRL-lowering agents allow return of sexual desire, and in the case of ED spontaneous erections, and avoid the necessity to plan sexual intercourse. Therefore dopamine-agonists should be the first choice treatment. This therapy may not be definitive. If PRL returns within the normal range, while there is no macro-adenoma, it may be stopped every year, or every other year, for several weeks before determining the PRL level. In 20 of the cases, HPRL does not return after a number of years 255 .

Side Effects of Antidepressants

Most likely to cause these side effects but TCAs, MAOIs, venlafaxine, lithium, and carbamazepine can also cause them. SSRIs, MAOIs, and venlafaxine are more prone to causing anorgasmia and decreased libido while TCAs are the most likely to cause difficulty maintaining erection.

Sexual motivation and desire

Desire has always been difficult to define objectively. In the DSM-IV-TR, the diagnosis of hypoactive sexual desire disorder is given when desire for and fantasy about sexual activity are chronically or recurrently deficient or absent. By converse logic, then sexual desire is the presence of desire for, and fantasy about, sexual activity. This definition appears coherent but is circular. How does desire manifest itself Like people, animals manifest sexual excitement behaviorally. They increase their motor output in anticipation of copulation and work for the opportunity to copulate or to obtain primary or secondary (conditioned) sexual rewards associated with copulation. Animals will also choose between two or more sexual incentives based on the strength of the incentive cues and the animal's own internal drive state. What characterizes these behaviors is that they occur before copulation Courtship, operant responses, conditioned locomotion in anticipation of sex, time spent near a...

Clinical picture of hypogonadism

After puberty, the clinical picture may vary considerably according to the time elapsed since puberty and the degree of the androgen deficiency. Body proportions, size of penis, and pitch of voice do not change. Body and facial hair may decrease. The main clinical signs are reduced sexual desire and potency, and infertility. Size and consistency of testes vary from normal to significantly reduced. Long-term androgen deficiency usually causes atrophy of muscle mass, osteoporosis, loss of strength and energy, normochromic and normocytic anemia, fatigue, and mood disturbances.

Acceptance Longterm Use and Dropout Rates of VCD

Although VCD therapy is able to produce erections sufficient for sexual intercourse in more than 75 of users 29 , the main reasons for discontinuation of VCD therapy were ineffectiveness, side effects, the time-consuming nature of the procedure, lack of acceptance by patient and partner, and the relatively high costs of the devices 28 . Once VCD turned out to be effective, significant increase in frequency of intercourse, sexual arousal, coital orgasm and sexual satisfaction was reported by patients' partners 30 .

Pathophysiology of DHEA deficiency

More recently, a DHEA deficiency state has been reported in young, healthy, regularly menstruating premenopausal women presenting with decreased libido 297 . The regular menstrual periods support normal cyclical ovarian function and ovarian testosterone production. However, since adrenal DHEA contributes to almost half of a premenopausal woman's circulating androgens, such a deficiency

Etiological Background of Sexual Dysfunction from a Psychologic Interpersonal Perspective

Precipitating factors are those that initiate or trigger sexual problems. For any one individual it is impossible to predict which factors, under what circumstances, will impair sexual desire or performance. Nonetheless, an individual's vulnerability to a particular set of circumstances can precipitate sexual dysfunction. For instance, traumatic events such as the discovery of a spouse's infidelity may cause one man to lose his sexual desire while another man's desire may increase. While initially a precipitating event may be problematic and distressing, it need not necessarily lead to a diagnosable dysfunction in the long term. Over time however, repetition of such events, especially those that damage self-confidence and self-esteem result in sexual dysfunction, even in reasonably resilient individuals. Examples of such precipitating events include con-flictual separation or divorce, a sudden brush with death through an accident or disease process, or unsatisfying sexual experiences.

Role of sexual satisfaction of the female partner of sexually dysfunctional men

The role of the female partner in both treatment seeking behavior and treatment success has been recently highlighted. The female partner is an important agent in motivating the man to seek treatment for his ED 15 . ED also has an impact on female sexual response. Sexual desire, arousal, orgasm and

History and Epidemiology of Male Sexual Dysfunction

It seems paradoxical that among the physiologic functions of the human body, sexual function has generated the greatest popular awareness and curiosity, but the least scientific inquiry. Despite the considerable human behavior, both virtuous and evil, that has been motivated by human sexuality, restrictive social attitudes and taboos have severely inhibited scientific investigation of human sexual function. Working within a restrictive social environment, a few irrepressible investigators and observers of human behavior have changed the course of modern social science and philosophy through their interests in sexual medicine and sexual psychology. Sigmund Freud brought new concepts of the importance of sexuality to the forefront of Western creative thinking at the end of the 19 th century and beginning of the 20th century 1 . As early as 1896, the aphrodisiac effects of yohimbine were reported by Leopold Spiegel, who extracted this substance from the bark of the West African yohimbe...

Sexual Urges Regrets and Remedies

The different gender identities of the brain, engraved during fetal development, are activated by maturing gonadal steroid secretions during puberty. To have a male brain means many things. The enlarged SDN-POA nuclei of males promotes male-typical sexual urges via the activational effects of T, and experimental damage to those brain areas diminishes male sexual behavior more than that of females. In contrast, female receptivity is dependent much more on circuits within the ventromedial hypothalamus, which are sensitized by E and progesterone (Pfaff, 1999), which are not essential for male sexuality. Of course, there are many other brain areas, including prominently the bed nucleus of the stria terminalis (BNST) and corticomedial amygdala, along with many neurochemistries, that contribute to the flow of sexual arousal. To some degree both males and females contain circuitry that is more typical of the other gender. For instance, administration of T into adult females can rapidly...

Adolescent Sex Offenders

An increasing number of rehabilitation programs are now available for the specific treatment of the adolescent sex offender. A National Adolescent Perpetrator Network has been established with guidelines for treatment components and goals. These include confronting denial, accepting responsibility, understanding the pattern or cycle of sexually offensive behaviors, developing empathy for victims, controlling deviant sexual arousal, combating cognitive distortions that trigger offending, expressing emotions and the self, developing trust, remediating social skills deficits, and preventing relapse. In addition, these intensive treatment programs focus on didactic instruction on normal human sexuality, training in interpersonal and dating skills, and the teaching of anger control techniques. Psychodynamic-oriented therapy has shown disappointing results, whereas various behavioral, cognitive-behavioral, and prescriptive approaches have proved to be most efficacious. Many programs use a...

Screening for hypogonadism in sexual dysfunctions

Several authors question the recommendation of routine T determination in ED because of the cost of hormone determinations, the low prevalence of hy-pogonadism in this population, and the limited success rate of T therapy in the hypogonadal ED patient 18,54 . They recommend screening only patients with low sexual desire or abnormal physical examination (small and soft testes, reduced body hair, and so on). However, in a study of routine determinations of TT in over 1000 ED patients, the specificity, sensitivity, and efficiency of low sexual desire in the detection of low T (

Models of male sexual dysfunctions

Hypoactive sexual desire Another way to study hypoactive desire in male rats is to examine their sexual responsiveness following multiple ejaculations, a phenomenon known as sexual exhaustion . Male rats are able to ejaculate several times before becoming unresponsive. During this period of sexual activity, there is a progressive increase in the post-ejaculatory refractory period consonant, with a decrease in the number of intromissions before each ejaculation and a lengthening of the interintromission interval (a state that suggests a progressive loss of erectile function as the number of ejaculations increases). After males become sexually exhausted, they remain unresponsive to female solicitations for up to 72hrs. Rodriguez-Manzo and colleagues have examined the ability of several classes of drug to increase the responsiveness of these males, including the opioid antagonist naloxone, 8-OH-DPAT, and the a2 presynaptic au-toreceptor antagonist yohimbine. Only yohimbine increased the...

Available preparations

Usually observed 10 to 14 days after injection. A regimen of T enanthate or cypionate results in highs and lows in serum T levels that are attended by similar changes in the patient's mood, sexual desire and activity, and energy level. The advantages of this form of therapy include low cost and high peak serum levels of T. The disadvantages include the pain of injection and the need for frequent medical visits for administration of the injections.

Female Sexual Function

It is important to emphasize that compared to human males, in whom ability to achieve and maintain erections sufficient for sexual activity is also good for self-esteem related to competent sexual performance, in women there is no clear relationship between physiologic performance and sexual desire. The subjective feeling of sexual arousal results more from cognitive processing of stimulus, meaning and content than from peripheral vasocon-gestive feedback. Indeed, there are well-identified discrepancies between physiologic and subjective measures of sexual arousal in women, and often no correlation between them (e.g. following treatment with PDE-5 inhibitors). It is not yet known how vaginal responses are integrated with behavioral responses. It remains questionable that increased vaginal blood flow could be perceived by females and participates in the stimulation of behavioral measures of sexual arousal. Accordingly, a more integra-tive approach is necessary to investigate female...

Routine or selective serum PRL determination

According to many authors, the very low prevalence of significant HPRL can hardly justify routine determination of PRL in ED patients, due to the frequency of this condition and the cost of the determination 234 . Most recommend determination of serum PRL only in case of low T level, or low sexual desire. However many ED patients with normal serum T despite marked HPRL have been reported, including some with pituitary tumors, therefore unlikely to be macroprolactinemias 230 . In one study, determining serum PRL only in case of low T would have led to neglect of six of 12 marked HPRL and three of seven pituitary tumors 18 . Likewise sexual desire may be normal, or seem normal to the patient, in ED patients with HPRL 241 . Buvat etal. 249 found that by restricting the determination to those men with low sexual desire, gynecomastia, or serum T

Altered Sexuality Syndromes

Altered sexuality may take many forms. The loss of libido is the most common form and can present as inhibited excitement or orgasm. Hypoactive sexual desire may be due to a number of psychiatric, medical, and neurological disorders. Typically, the cause is functional and the condition occurs in the presence of anxiety or depression. Hyposexuality associated with hypergraphia, hyper-religiosity, irritability, and elation comprise the main features of the Gastaut-Geschwind syndrome. This syndrome has been described as an interictal syndrome in patients with epilepsy of temporal lobe origin. These patients may also demonstrate viscosity, which refers to a stickiness of thought processes and an interpersonal adhesiveness, and circumstantiality, which is manifest as a difficulty in terminating conversations.

Sexual dysfunctions of hyperprolactinemic men

A literature review encompassing more than 300 men with HPRL 229 found sexual dysfunctions in 88 , including ED in almost every case. The most typical pattern associates ED with a reduced sexual desire. Delayed or absent orgasm are also associated in some cases, but virtually never isolated. Several cases of retrograde ejaculation, sometimes cured by dopamine-agonist therapy, were also reported 230 . Other clinical symptoms of HPRL are uncommon reduced body hair in 40 of the cases, gynecomastia in 21 , galactorrhea in 13 .

Methodology of Diagnostic Research

Subjects should be involved in a stable, monogamous heterosexual relationship, prepared to attempt intercourse on a regular basis, and provide written informed consent. The presence of comorbid erectile dysfunction (ED) should be evaluated using a validated instrument such as the international index of erectile function (IIEF), and patients with any degree of ED should be either excluded from the study or treated as a separate subgroup. Patients with hypoactive sexual desire or other sexual disorders, urogenital infection, major psychiatric disorders, a history of drug and alcohol abuse or contraindications to the study drug should be excluded from the study.

Epidemiology and Risk Factors

Data from a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults, known as the National Health and Social Life Survey, and that included 1749 women and 1410 men aged 18 to 59 years at the time of the survey, was analyzed by Laumann and colleagues 7 . A latent class analysis (LCA) was used to evaluate the syndromal clustering of individual sexual symptoms. Latent class analysis is a statistical method well suited for grouping categoric data into latent classes 8 . Latent class analysis tests, whether a latent variable, or specified as a set of mutually exclusive classes, accounts for observed covariation among manifest, categoric variables 9 . This study reports a 5 prevalence of low sexual desire, which should be compared to the 5 prevalence reported for erectile dysfunction. Table 13.1 presents the risk factors reported for this population. In a more recent report, named the Global Study of Sexual Attitudes and Behaviors (GSSAB) an...

During Ejaculation Thesperm Passesto What

Thinking sexual thoughts can lead to female sexual desire, and this aids greatly in the performance of the female sexual act. Such desire is based largely on a woman's background training as well as on her physiological drive, although sexual desire does increase in proportion to the level of sex hormones secreted. Desire also changes during the monthly sexual cycle, reaching a peak near the time of ovulation, probably because of the high levels of estrogen secretion during the preovulatory period.

Recommendations for screening and therapy

Testosterone levels needed for normal sexual function may vary between individuals. Some men may have normal sexual function even if their T levels fall into the age-adjusted lower normal range 221 . However, in patients with ED and or hypoactive sexual desire, T testing is recommended to screen for hypogonadism. T therapy is appropriate when clinical indications and biochemical evidence of hypogonadism exist 168,222 . In men with ED, determining T levels only in case of either low sexual desire or abnormal physical examination overlooks many patients with

Responsibility of hypogonadism

Data accumulated in such men show that T is required for pubertal acquisition of gender characteristics as well as adult sexual behavior and functional capacity, including libido, ejaculation, and spontaneous erections. Administration of T during placebo-controlled studies demonstrated that sexual desire and arousal are T-dependent 13,29,30 and represent the main impact of T on sexual function of men. The frequency of sexual activity 13,30,31 and spontaneous erections (especially sleep related, i.e. morning and nocturnal) 13,29,32 are also clearly T-dependent. The psychic erections (i.e. in response to erotic stimuli) were initially thought to be androgen-independent 33 , but are in fact partly T-dependent 34 . Ejaculations 31 and orgasm 35 are also partly androgen-dependent. Providing T therapy is the only possibility of restoring sexual desire 13,74 , which is often low in such patients, especially since low sexual desire is a frequent cause of drop-out from PDE5i therapy.

Vulnerability and Risk

Than vulnerability to victimization, as victims will exist as long as perpetrators keep offending. Many single-factor theories exist to explain rape perpetration, but rape appears to be complex. A combination of societal, relational, and individual factors including biological and psychological characteristics may be necessary to explain perpetration. The confluence model attempts to do that, proposing that male sexual aggression results from an impersonal-promiscuous orientation to sex, hostile attitudes toward and mistrust of women, and sexual arousal from the domination of women, all of which are shaped by adverse childhood experiences. Many researchers have recognized the important role of societal factors such as patriarchy (the political, economic, and social domination of women by men) in understanding rape perpetration. Research has pointed to factors such as media images (e.g., pornography), sexist attitudes toward women, and male peer support for violence, which, combined...

Psychiatric Misdiagnosis

Unipolar depression can manifest with irritability and sadness, poor appetite, weight loss, sleeplessness, no energy, a lack of sex drive, anxiety, and panic. Thyrotoxic symptoms unfortunately mimic these same manifestations. Finally, thyrotoxicosis can sometimes cause euphoric mood swings, a characteristic of a mania, which is present in bipolar disorder (formerly known as manic depression). These issues are discussed more in Chapter 24, which covers depression.

Prevalence of hyperprolactinemia in other sexual dysfunctions

Routine determination of serum PRL in men consecutively seen for hypoactive sexual desire without ED (n 53), anorgasmia retarded ejaculation (n 74), and premature ejaculation (n 124) 210,249 found no HPRL in the two former sexual dysfunctions. However Schwartz etal. 250 reported on some male HPRLs revealed by isolated hypoac-tive sexual desire or anorgasmia. In contrast, serum PRL was mildly elevated (20-35ng mL) in 13 men with premature ejaculation (10 ). This was not the cause of sexual dysfunction since bromocriptine failed in every case to prolong the time to ejaculation. In addition serum T was normal in every case and no pituitary adenoma was detected in any patient.

Development of sexuality and sexual identity

These stages have been used, contested and developed mainly within the field of adult psychotherapy (Bateman, Brown and Pedder 2000), but have been less used to aid understanding of children's sexual feelings, thoughts and behaviours. Freud's pronouncement that sexuality is 'latent' in the middle childhood years has led, in many cultures, to a lack of recognition of childhood sexuality (Ryan 2000). However, as Ryan points out, research across cultures has found evidence of considerable sexual activity and interest amongst pre-pubescent children. Her own American survey of adult child abuse professionals found that almost 20 per cent of respondents remembered experiencing sexual arousal by the age of six years (Ryan, Miyoshi and Krugman 1988).

Diagnosis and Evaluation

Terminating intercourse due to pain), and reviewing the conditions under which the man is able to ejaculate, (e.g. during sleep, with masturbation, with partner's hand or mouth stimulation, or infrequently, with varying coital positions). Domains related to the psychologic and relationship issues commonly associated with IE (identified in the previous section) require investigation. Thus, the developmental course of the problem, including predisposing issues of religiosity, and variables that improve or worsen performance, particularly those related to psycho-sexual arousal, should be noted. Coital and mastur-batory patterns, perceived partner attractiveness, the use of fantasy during sex, and anxiety surrounding performance, require exploration. If orgasmic attainment had been possible previously, the clinician should review the life events circumstances temporally related to orgasmic cessation events in question, which may be pharmaceuticals, illness, or a variety of life stressors...

Pedophilia and Child Molestation

Various theories have been proffered to explain why adults might become sexually involved with children. Finkelhor and Araji (1986) have classified the various theories that have been developed to explain pedophilia into four categories (1) those that explain why an individual might engage in or fantasize about sexual relations with a child (emotional congruence) (2) theories that focus on how individuals could become sexually aroused by a child (sexual arousal to children) (3) theories that focus on why individuals are unable to obtain sexual and emotional satisfaction from other sources (blockage) and (4) explanations of why individuals are not deterred by social conventions from their behavior (disinhibition). It has been postulated that inappropriate sexual arousal may underlie adults' sexual interest in children. However, research indicates that in a large proportion of cases, sexual activity with a child occurs only once and appears to be opportunistic rather than indicative of...

Growth Hormone Hypersecretion Museuloskeletal Increas

Other Arthralgias, slight kyphosis, visceromegaly, reproductive problems (women amenorrhea, galactorrhea, anovulatory problems men decreased libido, hypogonadism), hyperprolactinemia, adenomatous polyps and colon cancer, esophageal and gastric cancer, parathyroid and pancreatic islet cell adenomas (MEN-I syndrome)

Female Sexual Dysfunction

Sexual dysfunctions in females, as in males, may stem from anxiety. Helen S. Kaplan described the causes as either current or remote. Current or ongoing causes occur during the sexual experience and create distraction, fear, anger, or other unpleasant emotional states these interfere with the ability to relax and allow sexual arousal to build. such immediate causes might include fear of failure, performance anxiety, lack of effective sexual technique, failure to communicate desires, or spectatoring a term coined by William Masters and Virginia Johnson to describe conscious monitoring and judging of sexual behavior. Remote causes are derived from previous childhood experiences, in-trapsychic conflict, and or serious problems within the relationship between sexual partners. Guilt about past sexual experiences, extremely restrictive family and religious backgrounds, a history of traumatic sexual experiences such as incest or sexual assault, or unconscious conflicts that evoke anxiety at...

Neuroimaging of Happiness and Reward

The most consistent activation across several studies involving happiness induction is in the basal ganglia (ventral striate and putamen) (Phan et al., 2002). These include recognition of happy faces, pleasant pictures (including attractive faces), recall of happy memories, pleasant sexual arousal and competitive arousal of a successful nature (reviewed in Phan et al., 2002). In one study, transient happiness had no areas of significantly increased activity but was associated with significant and widespread reductions in cortical rCBF, especially in the right prefrontal and bilateral temporal-parietal regions (George et al., 1995).

Method Of Preparation And Composition Of Recipes

Methi (Fenugreek) Paratha with Curd Wheat flour (20 g) and suji (35 g) were sieved together. To this, chopped fenugreek leaves (100 g), green chilli (2.5 g), ginger (2.5 g), cumin seeds powder (2.5 g), salt, and Spirulina powder were added. Mixture was made into soft dough. The dough was divided into small balls and rolled into triangular-shaped chapatis. The chapatis were placed on a hot tava and after a minute, they were turned on to the other side. Little oil (10 g used for all parathas) was applied, and it was fried on both the sides until they turn golden brown in color and served with 50 g curd. Potato Methi with Chapati Methi (fenugreek leaves, 100 g) was chopped finely. Onion (30 g) was cut into slices. Potato (20 g) was peeled and cut into equal pieces. Oil (5 g) was heated onion and cumin seeds (2.5 g) were added and fried until they turn light brown in color. Potato, methi, salt, and red chilli were added. When half cooked, dried green mango powder (2.5 g) and Spirulina...

Reciprocity Of Human Corticolimbic Activity

A third line comes from recent studies looking at voluntary suppression of emotion. Male sexual arousal has been found to produce a significant activation of the right amygdala, right anterior temporal pole (BA38), and hypothalamus, but when subjects voluntarily inhibited their sexual arousal, no significant loci of activation were noted in these structures. Instead, significant activations were present in the right medial DLPFC (BA10) and the right ACC BA32 (Beauregard et al., 2001). Similarly, healthy females induced into a sad state while watching sad film clips showed activation of subgenual cingulate, insula, amygdala, and midbrain. When instructed to suppress their sad feelings, subjects showed significant loci of activation in the right DLPFC (BA9) and the right orbitofrontal cortex (OFC) (BA11). This is consistent with the role of right DLPFC in negative mood, as pinpointed by Liotti and Mayberg (2001) as well as TMS methodologies in treating depression (see Chapter 19).

Sensory Evaluation Of Spirulina Incorporated Recipes

Rice is another cereal, which is widely consumed in India. In view of this, it was thought worthwhile to see if Spirulina could be incorporated in various rice preparations. There were four different types of rice that were prepared, for example, coriander rice, fenugreek rice, spinach rice, and vegetable pulao. All the different types of rice were served with 50 g of curd. As evident from Table 3.2, no significant difference was observed in the scores between the control and Spirulina-supplemented recipes in all rice preparations. It was heartening to know that spinach rice with raita supplemented with Spirulina at 1 g and 2.5 g levels was more acceptable than the control sample. With regard to coriander rice, fenugreek rice, and vegetable pulao, the overall acceptability though nonsignificant showed a decreasing trend with increasing level of Spirulina supplementation (Table 3.2). In addition to this, it was observed that the color and appearance of Spirulina-supplemented rice at 1...

Eusebio Rubio Aurioles

Hypoactive sexual desire (HSD) is a condition that is characterized by the absence or notable decrease in the frequency in which the man experiences desire for sexual activity. In contrast with other conditions related to the sexual life, the key clinical determinants of this diagnosis are not as concrete and readily identified as erection or ejaculation for instance, in the case of HSD these clinical features refer to a variety of expressions of sexual desire, since the occurrence of sexual desire is an internal and subjective experience. Because of this, HSD has been historically either not identified 1 , or erroneously diagnosed and presented (and treated) as other sexual dysfunctions like erectile dysfunction 2 . Hypoactive sexual desire was first defined as a clinical entity in 1977 3 , and recognized as a valid clinical diagnosis with the publication of the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM III) in 1980 4 . In recent publications, the...

Premature Ejaculation

Sociobiologists have theorized that it offers an evolutionary advantage and has been built into the human organism (Hong, 1984). However, this theory does not effectively deal with the large variability in duration of intercourse that has been observed both across and within species. Another theory proposed by Kaplan (1974) postulates that men with premature ejaculation are not able to accurately perceive their own level of sexual arousal and thus do not engage in any self-control procedures to avoid rapid ejaculation. One laboratory analogue indicates, however, that men with premature ejaculation were better able to perceive their own levels of sexual arousal when compared to controls (Spiess, Geer, & O'Donohue, 1984). More recently, psychopharmacological treatment of PE has been the subject of research. According to Rosen et al. (1999), several uncontrolled studies of SSRI treatment of PE have indicated that pharmacological treatment may be efficacious....

Disorders of Desire

Disorders of desire were identified later than were other dysfunctions, when the scope of sexual performance was expanded to include the preliminary emotional and physical reactions of arousal and desire. Kaplan states that inhibited or hypoactive sexual desire may be the most common, sexual dysfunction. Inhibited sexual desire (ISD) is referred to in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) as a persistent and pervasive inhibition of sexual desire (i.e., the woman experiences low libido, lack of sexual response to genital stimulation, and lack of or very limited interest in and satisfaction with sexual activities). Women may react to this dysfunction with any of a wide range of emotions, from nonchalant acceptance to worry and acute distress. sexual dysfunction is diagnosed when the individual experiences distress with the symptom. Absolute or primary inhibited desire is rare situa-tional ISD is more common.

Dyspareunia

Dyspareunia is similar to vaginismus in that there is pain associated with sexual intercourse however, the involuntary vaginal muscle spasm is absent. Dyspareunia may be caused by insufficient vaginal lubrication due to lack of sexual arousal, senile vaginitis, or reactions to medication. It may also result from gynecological disorders such as herpes, vaginal infection, endometriosis, rigid hymen, or hymeneal tags. When pain accompanies intercourse, anxiety results, arousal diminishes, and there is avoidance of sexual encounter. Complete physical and pelvic examinations are required in the assessment and treatment of dys-pareunia because of the many physical factors that could contribute to the pain.

Other Changes

Estrogen loss can affect other parts of your sex life as well. Your libido may actually increase because testosterone levels can rise when estrogen levels drop. (The general rule is that your levels of testosterone will either stay the same or increase.) However, women who do experience an increase in sexual desire will also be frustrated that their vaginas are not accommodating their needs. First, there is the lubrication problem more stimulation is required to lubricate the vagina naturally. Second, a decrease in estrogen means that less blood flows to the vagina and clitoris, which means that orgasm may be more difficult to achieve or may not last as long as it normally has in the past. Other changes involve the breasts. Normally, estrogen causes blood to flow into the breasts during arousal, which makes the nipples more erect, sensitive, and responsive. Estrogen loss causes less blood to flow to the breasts, which makes them less sensitive. And finally, since the vagina shrinks as...

Nymphomania

Broadly speaking, nymphomania refers to the condition of a woman whose sexual desire and or behavior is referred to by terms like insatiable, abnormally intense, unquenchable, unrestrained, or uncontrollable. In practice, the term is poorly defined and often loosely applied. It is usually distinguished from sexual promiscuity, but many proposed definitions use the two expressions interchangeably.

Pornography

A distinction is often made between pornography and erotica. Erotica has been defined as sexually explicit material that depicts adult men and women consensually involved in pleasurable, nonviolent, nondegrading sexual interactions (Seto, Maric, and Barbaree, 2001 37). In contrast, pornography involves depictions of sexual interactions in which one or more of the participants is objectified and rendered powerless or nonconsenting (Marshall and Barrett, 1990). Degrading pornography may portray people, usually women, as submissive or hypersexual individuals who derive pleasure from the sex act despite, or because of, the degradation and humiliation (Fisher and Barak, 1991). In its most extreme forms, pornography depicts acts of violence, torture, degradation, and mutilation of victims, who are most frequently females (MacKinnon, 1987). It has been argued that the goal of pornography is to produce sexual arousal in response to the sexual abuse of women (MacKinnon, 1987).

History And Overview

Individual cases of lead poisoning were reported as early as 200 bc. However, it was not until the twentieth century that industrialization and modernization resulted in a need for medical evaluation and treatment of health effects caused by exposure to harmful chemicals. To meet this need, a new medical specialty was developed called occupational and environmental medicine. Unfortunately, the number of physicians in this specialty is too few to treat the number of patients requiring evaluation and treatment. Even in academic and workplace settings that offer this expertise, neurological input is paramount because many of the health effects due to chemical exposure are related to the central and peripheral nervous systems. Whereas some health effects such as pulmonary distress and gastrointestinal symptoms are noticed easily by the affected individual, some nervous system effects may be unrecognized. Acute, high-level exposure to a toxicant often results in clearly identifiable signs...

Defining Fetish

Fetishism occurred when the fetich itself (rather than the person associated with it) becomes the exclusive object of sexual desire so that, rather than sexual intercourse, strange manipulations of the fetich became the sexual aim (Krafft-Ebing, 1886 spelling as in original text). Empirical research, however, suggests that intimacy and fetishism are able to coexist, either within a specific relationship, or through the maintenance of a primary relationship while engaging in fetish behavior with outside partners (Weinberg, Williams, and Calhan, 1994). Level 3 At this level, fetishism is moderately intense and individuals require specific stimuli in order to experience sexual arousal and perform sexually. beyond the use of female clothing used in cross-dressing or devices designed for the purpose of genital stimulation. Transvestic fetishism is delineated as a separate category of paraphilia to refer to biological males who wear clothing of the opposite sex and, at least on some...

Fetishism

Fetishism is essentially characterized by the use of nonliving objects or, less frequently, parts of the human body as the preferred or exclusive method of producing sexual excitement. These objects or body parts (called fetishes) are essential for sexual satisfaction in the fetishist and constitute the focal point of sexual arousal. Fetishists are almost always males. The objects involved in fetishism can be quite varied and commonly include women's underpants, shoes, stockings, and gloves parts of the body that typically become fetishes include breasts, hair, ears, hands, and feet.

Defining Monogamy

Yet other researchers have distinguished between social monogamy and sexual monogamy, arguing that, although U.S. culture assumes that social monogamy and sexual monogamy are synonymous, they aren't (Barash and Lipton, 2001 Hrdy, quoted in Morell, 1998). In contrast to sexual monogamy, social monogamy refers to the pairing up of individuals to live together, share resources, copulate, and produce and raise children. It has been asserted that there is simply no question whether sexual desire for multiple partners is 'natural'. It is. Similarly, there is no question of monogamy being 'natural'. It isn't (Barash and Lipton, 2001 2). A similar dichotomy has been suggested by the distinction made between sexual exclusivity and possession and the creation of a long-term or life-long project with another person (Francis and Gontier, 1987). Accordingly, it has been argued, aspiring monogamists are going against some of the deepest-seated evolutionary inclinations with which biology has...

Psychogenic

The above patterns suggest that IE men, rather than withholding ejaculation as suggested by earlier psychoanalytic interpretations, may lack sufficient psychosexual arousal during coitus to achieve orgasm. That is, their arousal response to their partner cannot match their response to self-stimulation and self-generated fantasy. In this respect, IE is thought to be due to difficulties in psychosexual arousal. This is supported by psychophysiologic research demonstrating that although men with IE attain erections comparable to sexually-functional controls, or men with PE during visual and penile psychosexual stimulation, they report far lower levels of subjective sexual arousal 75,76 . Apfelbaum has suggested that the couple interprets the man's strong erectile response as erroneous evidence that he is ready for sex and capable of achieving orgasm 89 .

Thyroid hormones

330 found ED in 64 and 15 , respectively (associated with hypoactive sexual desire and retarded ejaculation in most of the hypothyroid patients), and premature ejaculation in 7 and 50 , respectively. After return to normal levels of serum thyroid hormones for eight to 12 weeks, the prevalence of premature ejaculation fell from 50 to 15 in the hyperthyroid patients, while that of retarded ejaculation was reduced by half in those with hypothy-roidism. The mean ejaculation latency time doubled in the former and significantly decreased in the latter, suggesting the possibility of a direct involvement of thyroid hormones in the physiology of ejaculation. In 38 patients referred for ED and found to be hypothyroid, Baskin 331 reported that erectile function returned in the majority following thyroid hormone substitution. Conversely Wortsman et al. 332 did not observe any sexual improvement following thy-roxin treatment in a short series of ED patients with primary hypothyroidism. In...

Partner evaluation

Involvement of the partner in the diagnosis and treatment of ED has been shown to better delineate the nature of the female sexual dysfunction as well as the extent of the couples' problem. Partner involvement may enhance the outcome 22 . These authors used the Index of Sexual Life (ISL) questionnaire, specifically designed to measure the impact of ED on female partners' sexuality. They demonstrated that ED has a negative impact on the sexual life of female partners, specifically on their sexual satisfaction and sexual drive. Further analyses showed lower sexual satisfaction and sex drive for women reporting a disturbance or change in their own sex lives, than for women who did not. Older women had lower scores

Psychologic

The man with situational inhibited ejaculation who is able to ejaculate on his own but not with a partner undergoes a desensitizing programme. First, he masturbates on his own imagining that his partner is present. He continues stimulation, by whatever means he usually uses, to high levels of sexual arousal. He is told to try not to ejaculate (to reduce goal-focused anxiety), but rather to prolong stimulation so that he can enjoy long periods of heightened arousal. After a few sessions he finds he is unable not to ejaculate. He repeats this exercise on three or four subsequent occasions. He then repeats the process in the following sequence of situations

General Conclusion

Real progress has been made in understanding the neuroanatomical and neurochemical mechanisms of erection, ejaculation, solicitation, and other sexual responses, and in the design of rational pharmacologic treatments for certain sexual dysfunctions. We have begun to examine the mechanisms that underlie desire, and how sexual stimulation and reward impact on endpoints like sexual arousal, desire, attractiveness, and even mate choice. Progress in these areas could not have been made without the help of animal models. The evolution of sexual physiology and behaviour have been highly conserved, therefore animal models of human sexual response can be used successfully as preclinical tools so long as the functional endpoints are homologous or analogous, and carry predictive validity. When setting up testing paradigms to study preclinical models of human sexual function in laboratory animals, it is essential to ask the animals human questions that they can answer in their own...

Complications

Penile bruising, or petechiae, are the most common complications of VCD. Painful ejaculation, due to the constriction ring, has been commonly reported 11,13 . As mentioned, although VCD are able to give sufficient penile rigidity in the majority of patients, vaginal penetration can be impaired because of the instability of the phallus at the penis base, and ejaculation is achieved in less than two-thirds of men due to the fact that passage through the urethra is blocked by the constriction ring 11 . In addition, satisfaction with sexual intercourse may be impaired because the whole situation may not be accompanied by a subjective state of physical or mental sexual arousal. Thus, the mere physical presence of an erection does not seem to evoke bodily or mental feelings of sexual arousal, especially in the partners 24 .

Adrenal Disorders

Clinical Features and Associated Disorders. The clinical features of adrenal insufficiency are influenced by the site of dysfunction, because PAI affects all of the adrenocortical hormones, whereas SAI only affects glucocorticoids. Thus, hyperpigmentation, salt craving, and hyperkalemia are unique to patients with PAI. Patients with adrenal insufficiency may present acutely or as a chronic condition. Acute adrenal insufficiency is a medical emergency (so-called addisonian crisis) characterized by mental status changes, fever, hypotension, volume depletion, arthralgias, myalgias, and abdominal pain that may mimic an acute abdomen. 101. Chronic adrenal insufficiency may present more insidiously with fatigue, weakness, GI symptoms, amenorrhea, decreased libido, salt craving, arthralgias, and hypoglycemic symptoms. Neurological manifestations can include confusion, apathy, depression, psychosis, paranoia, and myalgias, as well as hypoglycemic symptoms. 102 In addition, a past medical...

Transvestism

In the psychosexual disorder of transvestism, there is recurrent and persistent cross-dressing by a heterosexual male for the purposes of his own sexual arousal. That is, the man achieves sexual satisfaction simply by putting on women's clothing, although masturbation (and heterosexual intercourse) is often engaged in once the individual is attired in female garb. Although anxiety, depression, guilt, and shame are often associated with the desire to cross-dress, the transvestite continues to do so because of the considerable satisfaction derived from the practice. Finally, transvestism needs to be distinguished from transsexualism, fetishism, and homosexuality because each of these is sometimes confused with this disorder. In transsexualism there is a chronic sense of discomfort and inap-propriateness about one's anatomic sex, a persistent wish to be rid of one's own genitals, a desire to live as a member of the opposite sex, and never any sexual arousal associated with cross-dressing...

Sexual Deviations

Sexual deviations, or paraphilias, are psychosexual disorders characterized by sexual arousal in response to objects or situations that are not part of normative sexual arousal-activity patterns and that in varying degrees may interfere with the capacity for reciprocal affectionate sexual activity. This term simply emphasizes that the deviation (para) is in that to which the individual is attracted (philia). It encompasses a number and variety of sexual behaviors that, at this time, are sufficiently discrepant from society's norms and standards concerning sexually acceptable behavior as to be judged deviant. In the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the American Psychiatric Association paraphilias are classified as of several types (1) preference for use of a nonhuman object for sexual arousal (2) repetitive sexual activity with persons involving real or simulated suffering or humiliation and (3) repetitive sexual activity with nonconsenting partners.

Pharmacotherapy

SRIs (clomipramine, fluoxetine, sertraline, paroxetine, flu-voxamine, and citalopram) are the most effective pharmacological treatment for OCD. These medications block the reuptake of serotonin, which is suspected to be related to OCD symptoms. On average, rates of improvement with adequate trials of SRIs (at least 12 weeks) range from 20 to 40 . However, response varies widely from patient to patient and side effects such as nausea, sleep disturbances, or decreased sex drive are common. Importantly, once phar-macotherapy is stopped OCD symptoms return in 85 of patients.

Epidemiology

IE can be classified as either lifelong or acquired. It may be global, occurring with every sexual encounter and all sexual partners, or it may be intermittent and situational. Some men with acquired IE can masturbate to orgasm, whereas others will or cannot. Approximately 75 of a recent clinical sample could reach orgasm through masturbation 74 . As is the case with other types of sexual dysfunction, men with IE may report significantly higher levels of personal and relationship distress, sexual dissatisfaction, sexual performance anxiety and general health issues compared to sexually-functional controls 10,75 . A distinguishing characteristic of these men is that they typically have no difficulty attaining or keeping their erections, yet report lower levels of subjective sexual arousal compared with sexually-functional controls 76 .

Clinical History

In one eye or in the optic nerve should be considered. Painful monocular visual loss is characteristic of an inflammatory or demyelinating optic neuropathy. With binocular visual loss, a lesion of both eyes or optic nerves, or of the chiasm, tract, radiations, or occipital lobe should be investigated. Associated neurological deficits, such as motor or sensory abnormalities, also assist in localization and often indicate a hemispheric abnormality. Medical conditions should always be investigated in the review of systems. Hypertension and diabetes, for instance, predispose the patient to vascular disease, and a history of coronary artery disease should alert the examiner to the possibility of carotid artery insufficiency as well. Visual loss accompanied by endocrine symptoms, such as those consistent with hypopituitarism (e.g., amenorrhea, decreased libido, impotence) or pituitary hypersecretion (e.g., galactorrhea, acromegaly), suggests a chiasmal disorder.

Sexual Dysfunction

Diseases of the neurological, vascular, and endocrine systems (e.g., diabetes, cancer, multiple sclerosis) can impair virtually any stage of the sexual response. Medications used to treat depression, high blood pressure, psychiatric disorders, and cancer, as well as numerous recreational drugs (e.g., barbiturates, narcotics, alcohol abuse, tobacco smoking) can interfere with sexual desire, arousal, and orgasm. Psychological factors contributing to impaired sexual function most commonly include anxiety, relationship concerns, negative attitudes about sex, religious inhibition, and fears of pregnancy. Low or absent sexual desire (hypoactive sexual desire) is the most common problem of couples going into sex therapy. Approximately 33 of women and 15 of men ages 18-59 report a lack of sexual interest (Laumann, Gagnon, Michael, & Michaels, 1994). Sexual aversion disorder is an extreme, irrational fear or dislike of sexual activity that leads to the avoidance of all or nearly all genital...

Libido

SSRIs, tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) have all been reported to be associated with a reduction in sexual interest in some patients. Jacobsen78 reported reduced libido in 21 of 160 patients treated with fluoxetine. Ten percent of his series reported decrease in libido alone, and a further 11 reported decrease in libido and decreased sexual response. A recent analysis of pooled data from several placebo-controlled trials involving nefazodone, imipramine and fluoxetine provides a useful guide for all aspects of sexual dysfunction to be described here and in the following paragraphs.79 Decreased libido was found in 0.5 of placebo-treated patients, 0.7 of nefazodone-treated patients, 1.6 of imipramine-treated patients and 2.2 of fluoxetine treated patients. The rate of decreased libido for fluoxetine treatment was significantly greater than for placebo. The differences observed between nefazodone and fluoxetine may depend upon the 5-HT2C receptor...

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