Automatic Sexual Chemistry

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The Nightingale Method

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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...

Sexuality And The Passions Of The Brain Introductory Remarks

Let us briefly consider these topics in reverse order (1) What are the factors that impair sexual ability (2) What is it about the organization of our brains that creates, at least at a statistical level, the neurophysiology of maleness and femaleness (3) What leads us to have sexual urges and (4) How can we minimize harm in sociosexual activities Since there is not sufficient space to probe such issues in depth, we will restrict our discussion to those issues we feel are pertinent to treatment strategies in biological psychiatry.

Psychogenic Factors that Impair Sexual Ability

Through its pervasive influences on a diversity of mind-brain functions, stress can increase or diminish a variety of motivational urges, including sexuality. While mild stress can sometimes increase sexual urges, sustained stress diminishes erotic urges. Indeed, one of the primary stress hormones in the brain, CRH, dramatically reduces all prosocial and sexual activities, as well as all other appetites, when released within the brain (Chapter 21). 1998), consistently promote sexual urges, but many reduce them in ways that are often emotionally troublesome to people. The most widespread problems are associated with the anorgasmia and reductions in sexual motivation that result from the use of antide-pressants, most recently the selective serotonin reuptake inhibitors (SSRIs) (Rosen et al., 1999). However, other agents are not without problems (Gitlin, 1994), and there are some drugs that can facilitate sexual abilities (Crenshaw and Goldberg, 1996). Mammalian sexual energy is...

Genetic and Epigenetic Creation of Maleness and Femaleness

We have a better understanding of the systems that control sexual urges in the brains of animals than of humans, but there are now abundant reasons to believe the principles, if not the details, will translate well across many mammalian species (Panksepp, 1998 Pfaus, 1996). However, since the variety of sexual strategies among species is so vast (Judson, 2002), the underlying brain details will also vary. Likewise, many complexities arise from the fact that sexual motivation and performance are distinguishable, albeit highly interactive, systems in the brain (Everitt, 1990). Although there has been resistance to the use of animal work to illuminate the human condition, here we will summarize the general principles, while not denying the abundant differences in details across species (Robbins, 1996).

How can bacterial vaginosis be prevented

BV is not completely understood by scientists, and the best ways to prevent it are unknown. However, enough is known to show that BV is associated with having a new sex partner or having multiple sex partners. It is seldom found in women who have never had intercourse. Some basic prevention steps can help reduce the risk of upsetting the natural balance in the vagina and developing BV. These steps include using condoms during sex, limiting the number of sex partners, and refrain from douching.

Sharp Facts Trichomoniasis What is the treatment for trichomoniasis

Trichomoniasis can usually be cured with the prescription drug metronidazole given by mouth in a single dose. The symptoms of trichomoniasis in infected men may disappear within a few weeks without treatment. However, an infected man, even a man who has never had symptoms or whose symptoms have stopped, can continue to infect a female partner until he has been treated. Therefore, both partners should be treated at the same time to eliminate the parasite. Persons being treated for trichomoniasis should avoid sex until they and their sex partners complete treatment and have no symptoms. Metronidazole can be used by pregnant women.

Can I get HIV from kissing

Open-mouth kissing is considered a very low-risk activity for the transmission of HIV. However, prolonged open-mouth kissing could damage the mouth or lips and allow HIV to pass from an infected person to a partner and then enter the body through cuts or sores in the mouth. Because of this possible risk, the Centers for Disease Control and Prevention (CDC) recommends against open-mouth kissing with an infected partner. There is only one case that suggests a woman became infected with HIV from her sex partner through exposure to contaminated blood during open-mouth kissing.

Clinical Presentation

If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an eating disorder hair pulling in the presence of trichotillomania concern with appearance in the presence of body dysmorphic disorder preoccupation with drugs in the presence of a substance use disorder preoccupation with having a serious illness in the presence of hypochondriasis preoccupation with sexual urges or fantasies in the presence of a paraphilia or guilty ruminations in the presence of major depressive disorder.)

Etiological Background of Sexual Dysfunction from a Psychologic Interpersonal Perspective

Sexual information or stimulation, psychiatric disorders, loss of sexual chemistry, fear of intimacy, impaired self-image or self-esteem, restricted fore-play, poor communication and lack of privacy, may prolong and exacerbate problems, irrespective of the original predisposing or precipitating conditions. Maintaining factors also include contextual factors that can interfere or interrupt sexual activity, such as environmental constraints or anger resentment towards a partner. Each of these four factors adversely contributes to, or diminishes, both the individual's and the couples' ability to sustain an active and satisfying sexual life. Often there is not a clear distinction between predisposing and precipitating and precipitating and maintaining factors. For instance, anxiety can increase an individual's vulnerability to sexual dysfunction as a common predisposing factor it can also serve as a maintaining factor leading to sexual avoidance or arousal inhibition.

History and Epidemiology of Male Sexual Dysfunction

About the same time, research in sex steroid biochemistry led to the development of the birth control pill in the 1960s. The ability for women to control their own reproductive choices played a vital role in the rise of feminism in Western countries and the rise of feminism was a crucial element in producing more liberal social attitudes about human sexuality and the resulting sexual revolution of the late 1960s and early 1970s. Perhaps made possible by this sexual revolution, progress in male sexual medicine accelerated in the 1970s. Prior to this time, sexual dysfunction was considered to be an endocrine or a psychologic problem. The usual treatments were testosterone therapy for men with hypogonadism, and psychotherapy. In the early 1970s, Vaclav Michal, a vascular surgeon from Prague, began to investigate the role of penile revas-cularization techniques for the treatment of vasculo-genic erectile dysfunction 9,10 . Interest in Michal's surgical techniques led Adrian Zorgniotti in...

Models of male sexual dysfunctions

Male rats that do not perform sexually are typically taken out of behavioral studies, so there is very little known about their actual erectile responsiveness. This proportion is generally low, especially if the males are pre-exposed to the test chambers prior to their initial sexual experiences. Some of these males do not display any interest in the female, and do not initiate any kind of sexual activity. However, other males display sexual interest and mount repeatedly, but do not achieve vaginal intromission. The lack of intromission may stem from an inability to achieve erection. Indeed, erectile responses in isolation and intromissions during copulation are both very sensitive to disruption by several classes of drug, including psychomotor stimulants, dopamine and noradren-ergic antagonists, and opioid agonists. Acute or chronic treatment with selective serotonin reuptake inhibitors (SSRIs) does not appear to alter erectile responses or the number of intromissions prior to...

The role of anxiety in sexual dysfunction

More recent studies have suggested that it may not be the subjective role of anxiety, per se, that causes and maintains sexual dysfunction but rather the manner in which anxiety affects an individual's ability to focus on, and process sexual stimuli. Barlow 5 has offered a theoretical model explaining why anxiety may operate differentially in men with and without erectile dysfunction. His model emphasizes the role of cognitive interference in male arousal. In general, what appears to distinguish functional from dysfunctional responding is a difference in selective attention and dis-tractibility. What sex therapists consider performance demand, fear of inadequacy or spectatoring are all forms of situation-specific, task-irrelevant, cognitive activities which distract dysfunctional individuals from task-relevant processing of stimuli in a sexual context 6 .

Hypoactive sexual desire disorder

There are no randomized clinical trials of psychologic intervention with hypoactive sexual desire disorder (HSDD). Clinical wisdom suggests that four dynamics are generally associated with psychologic HSDD. These include depression, anger, sexual arousal patterns that are not available within the present relationship (e.g. sexual arousal to a partner of another gender, sado-masochistic wishes), and relationship discord. By stabilizing mood, diminishing hostility and improving relationship satisfaction, interest in conventional sexual activities often improves. Unfortunately, men with unconventional sexual aspirations typically do not show much improvement in conventional sexual interest.

Responsibility of hypogonadism

Individual 10,36 , but markedly variable between individuals 10,31,36 , and may be specific to each parameter of sexual function 37 . For example, in a study by Kelleher, the average T level from which hy-pogonadal males on testosterone pellet implants began to perceive androgen deficiency symptoms leading them to request a new implantation was 2.6 ng mL (or 10nmol L), but the individual levels varied from less than 1 to 4.5 ng mL. In another series of hypogonadal males on injectable T esters, the individual threshold level varied from 1.1 to 3.6 ng mL 10,36 . Overall, levels below 2ng mL are in most cases associated with impairment of sexual function 10,31,36 , and levels below 1.4-2ng mL with diminished nocturnal erections 38 . Conversely, from a ceiling level of 4.5-6 ng mL, according to the studies 10,31,36,37 , the effect of T is maximum and is not enhanced with additional T supplementation. In eugonadal males, a significant increase in sexual interest and arousal 27,39,40 ,...

Hypogonadismagonadism

In male rats, castration or the administration of androgen synthesis inhibitors, like cyproterone acetate, disrupt and ultimately eliminate copulatory behaviors and penile reflexes progressively over time. They also shrink androgen sensitive peripheral tissues (e.g. penis and prostate). Although the degree of disruption depends on the amount of androgen synthesis inhibition that is induced (e.g. moderate following low doses of cyproterone acetate to total disruption following castration), the amount of time it takes to reach an asymptotic level of behavioral or reflexive performance depends on the level of sexual experience male rats have prior to treatment. In each case, subsequent exogenous administration of androgens or estrogens can restore sexual interest and copulatory behavior, with nonaromatizable androgens (such as dihydrotes-tosterone) restoring peripheral tissues, and aro-matizable androgens (e.g. testosterone) restoring behavioural measures. As with hypogonadal men,...

Risk Assessment and Risk Reduction Counseling Guidance and Training for Health Care Providers

You can't tell if potential partners are high risk just by looking at them. People who may be at higher risk of having a sexually transmitted infection including those who trade sex for money or sex for drugs, because they may have sex with many other people. Other people who may be at higher risk are people who share needles, because this activity can result in HIV, Hepatitis B and C infections, which can then be spread sexually. Non-monogamous men who have sex with men are also at higher risk of being infected with HIV and Hepatitis B because the risk of transmitting these viruses is greater with anal intercourse than with vaginal or oral intercourse and because these men may have many sex partners. Well Doc, I'm really not ready to have just one sex partner I guess I need to think about using a condom more often.

Pedophilia and Child Molestation

Significant confusion surrounds the use of the term pedophilia. First, the term pedophilia is often used to refer to incest, in addition to nonfamilial adult-child sexual relations (e.g., McConaghy, 2001). In addition, the term pedophilia has been used by a number of researchers to encompass a much broader population. Finkelhor and Araji (1986), for example, have used the term to refer to all individuals who have any sexual interest or contact with a child, regardless of the transient nature of that interest Specifically, we define pedophilia as occurring when an adult has a conscious sexual interest in prepubertal children. We infer that sexual interest from one of two behaviors either (a) the adult has had some sexual contact with a child (meaning that he touched the child or had the child touch him with the purpose of becoming sexually aroused), or (b) the adult has masturbated to sexual fantasies involving children (Finkelhor and Araji, 1986 146-147). These uses of the term...

Origins of Multibonding

A study of the Ngwa Igbo in Nigeria identified five principal reasons for men to maintain more than one wife because having more than one wife allows the Ngwa husband to (1) have the many children that he desires (2) heighten his prestige and boost his ego among his peers (3) enhance his status within his community (4) ensure a sufficient availability of labor to perform the necessary farm work and the processing of commercial oil-palm produce and (5) satisfy his sexual urges (Uchendu, 1965). Indian Muslim men have offered various reasons for having taken additional wives to have a better life-partner, to be able to have a child because the first wife is barren, to ameliorate the lack of homeness in their homes resulting from the primary wife's long-term illness, to restore light and laughter to their lives, to increase the household income through the additional wife's wages from employment, and to reduce their level of frustration with the first wife that resulted from her lack of...

Eusebio Rubio Aurioles

The DSM IV, in its current edition, defines HSD disorder as persistently or recurrently deficient (or absent) sexual fantasy and desire for sexual activity, leading to marked distress or interpersonal difficulty 6 . However, since the DSM IV is a psychiatric classification, its definition excludes HSD when it is caused by another medical disorder, or even another sexual dysfunction. There is some discussion in the literature as to this requirement, as the clinical practice illustrates, that the co-existence of HSD disorder with other sexual dysfunctions such as erectile dysfunction is rather common 5 , and the management of the combined conditions often requires specific clinical decisions and actions.

Sex Work

Locales within the U.K. indicate that they may have a regular boy-or girlfriend and or casual sexual partners of either sex (Davies and Feldman, 1999). Distinctions are often made between regular and casual customers relationships with regular customers may involve caring as well as a financial transaction (Davies and Feldman, Relatively little research has been conducted relating to the individuals who purchase sexual favors. It has been argued that the client of a prostitute or sex worker does not want only an orgasm, because there are other means of achieving orgasm. It has further been argued that he does not want sex, because sex can be obtained from willing partners who do not wish to be paid. One man explained his underlying motivation for utilizing the services of a sex worker

Defining Fetish

Level 1 Individuals experience a slight preference for certain kinds of sex partners, sexual stimuli or sexual activity. The term fetish should not be applied at this level. Level 2 This represents the lowest level of fetishism, where a strong preference exists for certain kinds of sex partners, sexual stimuli or sexual activity. Level 4 This level represents the highest level of fetishism, where specific stimuli take the place of a sex partner. Fetishism is also conceived of as a mental disorder. The current reference work for the diagnosis of mental disorders, the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR, 2000) classifies fetishism as a paraphilia and sets forth diagnostic criteria for what is considered to be a disorder recurrent, intense sexually arousing sexual fantasies, sexual urges, or behaviors involving the use of nonliving objects for a period of at least six months clinically significant distress or impairment in social, occupational, or...

Sexual Desire

Although very little research has been done on disorders of desire in general, the vast majority of research has focused on HSDD rather than SAD. HSDD, however, is the subject of much disagreement among researchers, including issues of prevalence, diagnostic criteria, etiology, and treatment methods. Indeed, some argue that the diagnosis itself merely pathologizes normal human variation in desire levels (i.e., low desire becomes a problem only when one's partner has a higher level of desire). Such areas of disagreement are exacerbated by the difficulty in accurately measuring levels of sexual desire. In the absence of a consensus regarding what constitutes the most salient aspects of sexual desire (e.g., frequency of sexual behavior, frequency of sexual fantasy, intensity of sexual urges, etc.), researchers frequently are in disagreement even as to how to measure sexual desire.

Fetish and Health

Almost no research has been conducted on the short-term or long-term health effects of engaging in fetish or related behaviors with sexual partners. One researcher has noted the possibility that casual sex may lead to feelings of ego bruising rejection (Lee, 1983). However, sex may be casual regardless of the nature of the sexual activity. Henkin and Holiday (1996), recognizing the difference between the therapeutic potential of any event or experience, regardless of its nature, and the therapeutic process, have advised their readers to avoid doing psychotherapy in the dungeon in an attempt to resolve past issues.

Defining Monogamy

The inclusion of the term polyamory lends yet another dimension to this discussion and serves to underscore further the inadequacy of our language to describe simultaneously the multiple dimensions of relationships. Polyamory includes many different styles of multiple intimate involvements, such as polyfidelity or group marriage primary relationships open to secondary affairs and casual sexual involvement with two or more people (Munson and Stelboum, Multilateral marriage Wife swapping Group marriage Intimate living Swinging Casual sex Secondary partner Recreational sex Fuck buddy Boy girl toy Friends with benefits

Psychogenic

Apfelbaum labels this as a desire disorder specific to partnered sex 89 . Consistent with this idea, recent data indicate that, unlike sexually-functional men, or men with other sexual dysfunctions, men with IE report better erections during masturbation than during foreplay or intercourse 75 . Disparity between the reality of sex with the partner and the sexual fantasy (whether or not unconventional) used during masturbation, is another potential cause of IE 90 . This disparity takes many forms, such as partner attractiveness and body type, sexual orientation, and the specific sex activity performed. In summary, high-frequency, idiosyncratic masturbation, combined with fantasy partner disparity, may well predispose men to experiencing problems with arousal and ejaculation 76 .

Positive to sweet

Allesthesia is a more physiological term that has been used (Cabanac, 1971, 1979) to depict the regulatory role of hedonics in behavior. Like the example above with regard to sodium hunger, shifts in everything from temperature to sexual attraction underlie hedonic judgments. In fact, one of the more interesting examples is the motivational behaviors that are revealed with regard to cooling the brain Rats will press a bar to alter their brain temperature (Corbit, 1973 Stellar and Corbit, 1973). Key features of central states are the appetitive behaviors and their diverse expression and consummatory behaviors.

Sadism

The origin of the term sadism is associated with the Marquis de Sade, a French writer (1740-1815). He wrote novels in which he describes scenes of torture and killing in a sexual context (Hucker, 1997). In the DSM-IV (American Psychiatric Association ApA , 1994), sadism is defined as a paraphilia and is included in the section on sexual and gender identity disorders. A diagnosis of sadism requires the following criteria over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person and the fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational or other important areas of functioning (ApA, 1994, p. 530). According to Dietz, Hazelwood, and Warren (1990), the essence of sadism is not the suffering of the victim but the...

Olfactory Cortex

One of the most evocative of senses, olfaction produces powerful responses in humans and is used as a primitive but potent form of communication among animals. It is important to sexual attraction and may provide an early alarm signal of potential danger, while disgusting smells may signal the presence of toxins or other contaminants. Brain areas subserving various olfactory abilities, such as olfactory acuity, olfactory identification ability, and olfactory memory, may be differentially affected in various disease states.

Orgasm

In males and females, orgasm is characterized by a peak in sexual pleasure that is accompanied by rhythmic contractions of the genital and reproductive organs, cardiovascular and respiratory changes, and a release of sexual tension. In males, orgasm generally occurs in two stages emission, which refers to rhythmic muscular contractions that force semen into the ejaculatory ducts, and expulsion, which is the release of semen through the urethra (ejaculation). Unlike males, some females (approximately 15 ) are able to experience multiple orgasms, and some women experience orgasm and perhaps ejaculation when the Grafenberg spot, an area along the anterior wall of the vagina, is stimulated. Contrary to Freud's assertion of two distinct types of orgasm in females, clitoral (the infantile orgasm) and vaginal (the mature orgasm), Masters and Johnson (1966) found no physiological differences in orgasm produced by vaginal versus clitoral stimulation. Other researchers note that intensity of...

Sexual Dysfunction

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 sexual contact with a sexual partner. Arousal difficulties include female sexual arousal disorder inhibition of the vasocongestive lubrication response and male erectile disorder. Women of all ages may experience difficulty with lubrication, although it tends to be a problem more associated with menopause. Erectile problems may be of organic (e.g., circulatory problems, neurological disorders, hormone imbalances) or psycho-genic (e.g., performance anxiety) origin. The ability to have erections during REM sleep suggests that the problem is psychological. Approximately 7 of men ages 18-29 years, and...

Notes and References

Wolf, A.P., Childhood association, sexual attraction and the incest taboo A Chinese case. American Anthropologist 68 883-898 (1966). 19. Spitz, R.A., Hospitalism an inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child 1 53-74 (1945). Spitz, R.A., Hospitalism. A follow-up report on investigation described in Vol 1, 1945. Psychoanalytic Study of the Child 2 113-117 (1946). Spitz, R.A. and K.M. Wolf, Anaclitic depression An inquiry into the genesis of psychiatric conditions in early childhood, II. Psychoanalytic Study of the Child 2 313-342 (1946). Wolf, A.P., Childhood association, sexual attraction and the incest taboo A Chinese case. American Anthropologist 68 883-898 (1966).

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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