Improving Your Sex Life

Revive Her Drive

Be ready to go through a complete transformation in the way that you think and feel about having sex with your wife or girlfriend! Revive Her Drive is like a Cheat Sheet to woo your woman the way she secretly wants you to, and simply cant express. The solution is based on female-friendly, easy-to-learn strategies that she will love! How nice will that moment be when shes lying in your arms, happy and spent, and she actually Thanks You for helping her to rediscover her sensual self? Shell be grateful that you, Her Man, now that you have the vision and skill to guide her into new, electrifying experiences even if she fights you or resists you now. Women Are sensual creatures. We women want pleasure, intimacy, connection, sensation as much as you do! Ill prove this to you. Once you know how to captivate her, you can turn her into a pleasure-seeking device within 24 hours. Getting that kind of responsiveness is the feedback you need to feel confident this program is working. Discover how Robert rekindled his relationship with Lauren using the tools within Revive Her Drive by watching this short presentation that lays out the whole strategy youll use to transform your intimate life into one of passion, surrender and fantasies-come-true. More here...

Revive Her Drive Summary

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Contents: Ebook
Author: Tim and Susan Bratton
Official Website: reviveherdrive.com
Price: $197.00

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My Revive Her Drive Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the writer was capable of presenting advanced techniques in an extremely easy to understand language.

My opinion on this e-book is, if you do not have this e-book in your collection, your collection is incomplete. I have no regrets for purchasing this.

What Constitutes Capacity to Consent to Sexual Relationships

Precisely what constitutes capacity to consent to sexual activity is unclear in many jurisdictions, even though the definition of capacity is crucial in establishing a balance between a proper empowerment to exercise sexual rights and effective protection from abuse. Clearly, the higher the requirement for knowledge and understanding, the better protection from abuse but the more that people with a 'mental disorder' may be prevented from exercising their sexual rights. In most European countries, there is no requirement that someone engaging in sexual activity should exercise 'informed consent' of the kind required for medical treatment (i.e. to be informed and to choose voluntarily). As a result, there seems to be no need, in law, for a person to demonstrate that he or she understands the nature of sexual activity, its benefits and risks and possible alternatives. If there were such requirements, people would presumably need to understand and differentiate between sexual intercourse,...

The Effects Of Drugs On Womens Orgasmic Ability

A number of psychotherapeutic drugs have been noted to affect the ability of women to attain orgasm. The selective serotonin reuptake inhibitors (SSRIs) frequently affect orgasmic functioning, leading to delayed orgasm or anorg-asmia. There is variability, however, in that some antidepressants have been associated with anorgasmia less frequently than others. For example, the anti-depressant, nefazodone, has been reported to produce fewer sexual side effects in women (34) than many of the earlier-generation SSRIs. Nephazodone increases serotonin activity in general while simultaneously inhibiting serotonin activity at the serotonin2 (5-HT2) receptor. Stimulation of 5-HT2 receptors has been reported to inhibit the release of both norepinephrine and dopamine from several brain areas (35). Because dopamine and norepinephrine have been reported to facilitate sexual behavior, the decrease in serotonergic activity at 5-HT2 receptors (and consequent possible increase in dopamine and...

Models For Treating Sexual Dysfunction Sex Therapy

Sex therapy theory and technique were derived from the pioneering works of both Masters and Johnson (1) and Kaplan (2). Initially Masters, a gynecologist, used an innovative 2 week, mixed-gender, co-therapy team, quasiresidential approach. Sex therapy rapidly morphed into weekly sessions provided within a solo MHP's office based practice. Treatment continued to emphasize sensate focus exercises and the reduction of performance anxiety. By the 1980s, sex therapy reflected a cognitive-behavioral theoretical bias, while typically utilizing Masters and Johnson variations, such as Kaplan's, four phase model of human sexual response desire, excitement, orgasm, and resolution (1,4,5). The models were not necessarily linear and causes could become effects. For instance, an ED might cause diminished desire. However, generally speaking, sex therapy was and is, the diagnosis and treatment of disruptions in any of these four phases and or the sexual pain and muscular disorders. These dysfunctions...

Why Do Women Have Orgasms

It is generally accepted that female orgasms are not essential for reproduction, and any benefit that they may have for female biology is, as yet, unclear. Early theorists believed that orgasm via intercourse activated ovulation and closed off the womb to air, thus facilitating conception (28). When it was later shown that the human female was a spontaneous ovulator at mid-cycle, and that this was unconnected to coitus, the discourse re-focused on the role of uterine suction created by orgasmic contractions in moving ejaculated spermatozoa through the cervix into the uterus and then fallopian tubes. However, there is now good evidence that the fastest transport of spermatozoa into the human uterus is actually in the sexually unstimulated condition (29). the fallopian tubes (29). By dissipating arousal and initiating the resolution of the tenting, orgasm may allow the earlier entry of the spermatozoa into the cervical canal and their subsequent rapid transport to the fallopian tubes....

Definition Of Female Orgasmic Disorder

On the basis of findings from the National Social and Health Life Survey conducted in the early 1990s (60), orgasmic problems are the second most frequently reported sexual problems in US women. Results from this random sample of 1749 US women indicated 24 reported a lack of orgasm in the past year for at least several months or more. This percentage is comparable to the clinic-based data. Orgasmic problems were noted by 29 of 329 healthy women (ages 18 -73) who attended an outpatient gynecological clinic (66) and by 23 of 104 women (18-65+) attending a UK general practice clinic (67). It is difficult to determine the precise incidence of orgasmic difficulties in women, however, because few well-controlled studies have been conducted and definitions of orgasmic disorder vary widely between studies depending on the diagnostic criteria used. The DSM-IV-TR (68) defines female orgasmic disorder (302.73) using the following diagnostic criteria 1. Persistent or recurrent delay in, or...

Combination Therapy for Sexual Dysfunction Integrating Sex Therapy and Sexual Pharmaceuticals

We know, clinically, that many PDE-5 nonresponders will be restored to sexual health through a CT integrating sex therapy and sexual pharmaceuticals. Yet how do we conceptualize such a model so that standard treatment algorithms could be stretched to incorporate this concept The answer is twofold. We need a schema for understanding psychosocial obstacles (PSOs) to successful treatment, integrated into a model that executes that understanding.

Gender Differences In Orgasm

Although some therapists have suggested that different types of orgasm exist for men, it is generally believed that typologies of orgasm intriguingly exist only for women (25). Most of the research in this area is derived from self-reports of women who distinguish orgasmic sensations induced by clitoral stimulation (warm, ticklish, electrical, sharp) from those induced by vaginal stimulation (throbbing, deep, soothing, comfortable). Masters and Johnson (2) claimed that all orgasms in women were physiologically identical regardless of the source of stimulation. However, they did not have the instrumentation to obtain detailed muscular recordings for possible differences between clitoral- and vaginal-induced orgasms. There is now some limited physiological laboratory evidence to suggest that different patterns of uterine (smooth muscle) and striated pelvic muscular activity may occur with vaginal anterior wall stimulation as opposed to clitoral stimulation (15). Several other...

Female orgasmic disorder

Female orgasmic disorder (FOD) is the persistent or m recurrent inability of a woman to have an orgasm (climax or sexual release) after adequate sexual arousal and sex- i ual stimulation. According to the handbook used by men- o tal health professionals to diagnose mental disorders, the e Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (also known as the DSM-IV-TR), this lack of response can be primary (a woman has never had an orgasm) or secondary (acquired after trauma), and can be either general or situation-specific. There are both physiological and psychological causes for a woman's inability to have an orgasm. To receive the diagnosis of FOD, the inability to have an orgasm must not be caused only by physiological problems or be a symptom of another major mental health problem. FOD may be diagnosed when the disorder is caused by a combination of physiological and psychological difficulties. To be considered FOD, the condition must cause personal...

Psychosocial Factors Related To Womens Orgasm

Age, education, social class, religion, personality, and relationship issues are the psychosocial factors most commonly discussed in relation to female orgasmic ability. Laumann et al. (60) found only the youngest group of women (18-24 years) showed rates of orgasm lower than the older groups for both orgasm with a partner and orgasm during masturbation. This is likely to be attributable to age differences in sexual experience. There was no significant relation between education level and orgasmic ability with a partner, but substantial differences between education level and ability to attain orgasm during masturbation. Approximately 87 of women with an advanced degree reported always or usually attaining orgasm during masturbation compared with 42 of women with a high school education. The authors explained this finding as the better educated women having more liberal views on sexuality and being more likely to consider pleasure a major goal of sexual activity. Research based on...

Gender Differences in Sexual Feelings

Our hypothesis is that in women other (stimulus or situational) information beyond stimulus explicitness determines sexual feelings, whereas for men peripheral feedback from genital arousal (and thus stimulus explicitness) is the most important determinant of experience of sexual arousal. This hypothesis fits well with the observed gender difference in response concordance. It coincides with Baumeister's assertion that women evidence greater erotic plasticity than men (90). After reviewing the available evidence on sexual behavior and attitudinal data of men and women, he concluded that women's sexual responses and sexual behaviors are shaped by cultural, social, and situational factors to a greater extent than men's. from orgasm, but may also involve intimacy or bonding. Sexual stimuli, through negative experience, may be associated with aversion and thus turn off any possibility for positive arousal (94). Sustained sexual arousal, which may increase in intensity, must be satisfying...

Sexual Feelings

In men and women alike, meanings of a sexually competent stimulus will automatically generate a genital response, granted the genital response system is intact. The difference between men and women in experienced sexual feelings have to do with the relative contribution of two sources. The first source is the awareness of this automatic genital response (peripheral feedback), which will be a more important source for men's sexual feelings than for women's sexual feelings (87). For women, a stronger contribution to sexual feelings will come from a second source, the meanings generated by the sexual stimulus. In other words, women's sexual feelings will be determined to a greater extent by all kinds of (positive and negative) meanings of the sexual stimulus than by actual genital response. hippocampus were activated during the most emotionally arousing stimuli that were also recognized 3 weeks later. Explicit memory is situated in the neocortex and is mediated by the hippocampus (89)....

What Causes Orgasm

Orgasms can be induced via erotic stimulation of a variety of genital and nonge-nital sites. The clitoris and vagina (especially the anterior wall including Halban's fascia and urethra) are the most usual sites of stimulation, but stimulation of the periurethral glands (15), breast nipple or mons (2, pp. 54, 67), mental-imagery or fantasy (2,16), or hypnosis (17) have also been reported to induce orgasm. Orgasms have been noted to occur during sleep (1,18,19), hence consciousness is not an absolute requirement. Cases of spontaneous orgasm have occasionally been described in the psychiatric literature where no obvious sexual stimulus can be ascertained (20). The precise mechanism that triggers orgasm has been a topic of debate for many years but, as of yet, no definitive mechanisms have been identified. Only very recently have investigators examined the brain areas activated during orgasm in women (21). Compared to preorgasm levels of sexual arousal, the brain areas activated during...

What Is Orgasm

Orgasm is a transient peak sensation of intense pleasure that is accompanied by a number of physiological body changes. In men, orgasm is normally accompanied by ejaculation, which makes the event easily identifiable. In women, however, the achievement of orgasm appears to be less facile than for males and recognizing that it has occurred is often difficult for some women. Objective indicators that orgasm has occurred have been sought for many years. Kinsey et al. (1) proposed the abrupt cessation of the ofttimes strenuous movements and extreme tensions of the previous sexual activity and the peace of the resulting state as the most obvious evidence that orgasm had occurred in women. Masters and Johnson (2) described the onset of orgasm as a sensation of suspension or stoppage. In order to serve as a clear marker of orgasm, however, the indicator must involve a bodily change that is unique to orgasm. This necessarily rules out simple measures like peaks of blood pressure, heart and...

Orgasm

There is limited knowledge about the physiological mechanisms and neurobiol-ogy underlying the sensation of orgasm. Orgasm is a complex response involving the whole body. During orgasm, there are changes in the genitalia, in skeletal muscle tone (characteristic spastic contractions of the feet), contractions of facial musculature, vocal reactions (moaning or sighing), semivoluntary movements, general cardiovascular (elevated systolic and diastolic blood pressure) and respiratory changes, somatic sensory experiences, and an altered consciousness. The intense feelings of pleasure and desire accompanying orgasm are mediated by the brain.

Sex Therapy

Like homosexuality, sex problems and their treatment are no longer taboo topics. They are widely discussed in the media, the movies, and by medical experts throughout the world. The importance of good health care, proper nutrition, and appropriate medications to the maintenance of an active sex life are generally recognized. Moderation in the intake of food, coffee, alcohol, and tobacco proper exercise protection against sexually transmitted diseases (STDs) and an awareness that if you do not use it, you will lose it are recommended (Sexuality and Aging, 1997). Perhaps most important of all are love and respect for one's sexual partner and acceptance of sex as normal and desirable at all ages. The rapid but effective treatment of sexual inadequacy was pioneered by Masters and Johnson (1970). Many of the patients seen by them and their students were older adults who had stopped having sexual intercourse because of a misunderstanding about the normal biological changes that accompany...

Sexual intercourse

Unprotected sexual intercourse is the most important transmission route of HIV infection worldwide. Although receptive anal sex is estimated to produce the highest risk of infection, infection after a single insertive contact has also been described. The presence of other sexually transmitted diseases markedly increases the risk of becoming infected with HIV.

Causes and symptoms

The cause of male orgasmic disorders may be organic (related to a condition in the body), but, in most cases, is of psychological origin. It is important for the physician to make every effort to find an underlying cause because the therapy and prognosis depend upon it. A detailed history (including an interview with the sexual partner, if feasible), a general physical examination, the performance of certain laboratory and, in some cases, special tests, are important in the investigation of the underlying cause of the male orgasmic disorder. Organic causes of male orgasmic disorder include the following The most common causes of the male orgasmic syndrome are psychological in nature. The responsible psychological mechanisms may be intrinsic (due to basic internal factors), or extrinsic (due to external or environmental factors). I orgasmic disorder include orgasmic disorder include unsatisfactory relationship with sexual partner Environmental factors may interfere with sexual...

Positive guidelines for success

The better you know yourself, the better you will know your mate. Learn about sex and reproduction. 4. Make love, not war. A good sexual relationship can take years to develop so work at making it better. Explore the techniques of lovemaking without feeling shy or inhibited. This can be helped by books such as The Joy of Sex and videos on lovemaking. Good grooming and a clean body are important.

Combination Therapy The Road To Success

Combining sexual pharmaceuticals and sex therapy is the oral therapy of choice to optimize treatment for all SDs. This is true for men with ED, PE, or retarded ejaculation (RE) and will also be true for FSD. Less medication is required when you modify immediate causes while appreciating other psychological obstacles (20). However, CT is by no means a new idea, and sexual medicine is not the first specialty utilizing a broad-spectrum approach to increase efficacy and satisfaction.

Patient Preference Sexual Scripts and Pharmaceutical Choice

Patients suffering from SD, first express preference when they choose to seek help from a MHP vs. a nonpsychiatric physician. Most MHPs (having ruled out organic etiology) will initially proceed with sex therapy in cases where psy-chogenic etiology is paramount. For many of these patients, sex therapy will be effective in and of itself. For others, the MHP will facilitate incorporating sexual pharmaceuticals into the treatment process, to help bypass or overcome PSOs. The use of sexual pharmaceuticals for these patients may be a temporary recommendation, until a more pro-sexual equilibrium is established for the patient and partner. Reciprocally, pharmacotherapy may be either continuously or intermittently integrated with other attitudinal and behavioral changes necessary for a successful sexual and emotional experience. This will vary based on patient and partner pathologies interacting with the progressive organicity, often secondary to aging. Understanding relapse prevention...

Health Issues Affecting Lgbt Populations

Of those health problems related directly to sexual behavior, HIV is currently the one most closely identified with the gay community, though it was foreshadowed by hepatitis B. The clinical and epidemiological evidence that hepatitis B was prevalent among gay men resulted in landmark hepatitis B vaccine trials in New York City in the late 70's and early 80's (Dienstag, et al., 1982 Stevens and Taylor, 1986 Szmuness, et al., 1980 Szmuness, et al., 1981). Ironically, an epidemiological study tracking the incidence of gay hepatitis B among gay men in three gay urban areas (San Francisco, New York, and Amsterdam) provided some of the earliest evidence about the emergence and progression of HIV (Hessol, et al., 1994 Van Griensven, et al., 1993). HIV has profoundly affected the LGBT community, both in terms of the unprecedented loss of community members and in terms of the community mobilization and institution-building it engendered. Despite advances in treatment and a broad-based change...

Summary And Conclusion

For those individuals where cost is less of a factor in determining decision-making, consultation with a qualified sex therapist offers a potentially more elegant solution, than merely experiencing a trial of sexual pharmaceuticals, when confronted with SD. Yet, it would be unnecessary to subject everyone to a complex evaluation by a sex therapist in advance of a sexual pharmaceutical prescription and brief counseling by a PCP. In part, patients will seek the treatment they want and prefer. Some will seek herbal supplements purchased on the Internet, whereas others will choose a consultation with a MHP specializing in sex therapy. However, if only due to pharmaceutical advertising, most patients will first consult with a physician who will hopefully possess sex counseling expertise, as well as a prescription pad. This physician would adjust treatment according to the individual and couple's history, sexual script, and intra and interpersonal dynamics. All clinicians want to optimize...

Assessment Of Low Desireinterest And The Associated Low Arousability To Identify Therapeutic Options

The DSM-IV-TR definition of hypoactive sexual desire disorder is problematic because its only focus is on initial desire, does not acknowledge the many reasons that motivate the woman towards sexual activity, and ignores the broad range of frequency of fantasies among sexually healthy women. An international group has recently proposed the following definition for women's sexual interest desire disorder Note that it is the additional lack of responsive desire that indicates dysfunction. The word interest was preferred (to desire) given the aforementioned relative infrequency of desire being the reason incentive for engaging in sexual activity. However, for practical purposes of literature review, both words were included in the definition. The current and past context biological, psychosocial, as well as sexual is clarified along with contextual details at the time of onset of the difficulties. The full picture of the woman's sexual response and her partner's response is obtained and...

Recommendations For Clinical Practice

The first question is whether the client wants to be sexual at all. This question may refer to people that were excluded from Masters and Johnson's studies. These may be people so deeply involved in relational conflict, that they, as Masters and Johnson put it, need legal advice instead of sex and relationship therapy (101). The prognosis for a rewarding sexual relationship, even if all the relational discord was to be resolved, seems to be poor (121). Learning to stop arguing or learning to do that more effectively does not necessarily improve the sexual relationship. For that, as we have argued, situations with positive sexual meanings are a first prerequisite.

Chlamydia trachomatis

Routine screening of asymptomatic, sexually active adolescent females undergoing pelvic examination is recommended. Annual screening should be done for women age 20-24 years who are either inconsistent users of barrier contraceptives or who acquired a new sex partner or had more than one sexual partner in the past 3 months. II. Gonorrhea. Gonorrhea has an incidence of 800,000 cases annually. Routine screening for gonorrhea is recommended among women at high risk of infection, including prostitutes, women with a history of repeated episodes of gonorrhea, women under age 25 years with two or more sex partners in the past year, and women with mucopurulent cervicitis.

Mendel Begins Plant Experiments

In his research, Mendel used a discovery that had been made not long before Plants have sex. It had long been assumed that plant flowering and reproduction simply happened. The first and most important step toward reversing that view came when an 18th-century scientist, Carolus Linnaeus, devised a new system of plant species classification that made plant sex the basis of species determination. Linnaeus also described hybrids. (When Mendel told his students about plant reproduction, often using plain street terms, some of the students would titter. Don't be stupid These are natural things, Mendel would say.)

Neoplastic Complications of Hivaids

KS is a malignant vascular neoplasm usually arising in cutaneous tissues and lymph nodes. The incidence is higher in men who have sex with men historically, it was one of the first features of the newly described syndrome in 1981, which was later termed AIDS. KS usually is seen with CD4 counts of less than 50 cells mm3. Lesions are typically red or purple macules coalescing to plaques, papules or nodules, but can be bluish or

Empirical Support Of Relationalcultural Theory

Data from empirical research increasingly supports the power of connection to protect and to heal. The literature on resilience shows that a connection with one adult (parent or teacher) is the single best protection against high-risk behaviors of drinking, violence, depression, and suicide in adolescents (Resnick et al., 1997). Students who felt connected were less likely to use cigarettes, alcohol, or drugs less likely to engage in early sexual activity, violence, or become pregnant and less likely to experience emotional distress. These studies do not point to personality traits or diagnostic categories as the best predictors of outcome they clearly and strongly point to the centrality of connection.

Cost Effectiveness Analysis

Cost effectiveness analysis typically expresses the tradeoff between the costs of an intervention to the non-financial outcomes as a ratio. Cost effectiveness analysis is concerned with what is happening at the margins - that is, an accounting of the additional, or incremental, costs and effects of an intervention. Cost effectiveness analysis can inform health care decision making by indicating which of several alternative demands for health care spending can improve health the most. For example, consider a city public health official who must decide between expanding one of three programs - smoking cessation, safe sex counseling, or food inspection -within a fixed budget. CEA can indicate which of the three programs will be associated with the greatest improvement in health effects. These health effects could be measured as life years gained, hospitalizations averted, improvements in quality of life scores, or many other metrics. Real world decision making can highlight the...

Condylomata acuminata

Condylomata acuminata are caused by human papillomaviruses (HPV). They are usually present as genital warts, but other locations (oral) are known to be involved. HIV-infected patients have a higher risk of acquiring genital warts. The typical pathogens, human papillomavirus type 6 or type 11, are not normally considered to be cancerogenic. Although, in both male and female HIV-infected patients, epithelial atypia is seen more often than in uninfected persons. Besides sexual intercourse, transmission of papillomavirus may be possible via smear infection and perhaps through contaminated objects. But the primary risk factor remains the number of sexual partners.

Strategies Directed at Communities with Greatest Need

These residential patterns result in the geographic clustering of vulnerable populations. Health disparities, which occur strikingly by race-ethnic group and income level, also occur among neighborhoods (Karpati, et al., 2004). In 2003, in an effort to reduce excess morbidity and mortality in neighborhoods where poor health outcomes aggregate, the DOHMH established three District Public Health Offices (DPHOs) in Harlem, the South Bronx and North-Central Brooklyn. If mortality rates in these targeted areas were the same as in New York's wealthiest neighborhoods, more that 4,000 deaths would be averted each year. Disparities in mortality are complemented by marked differences in individual risk factors reported by residents. New York City is able to document such variation at the neighborhood level with data available from the Community Health Survey. High rates of smoking, HIV infection, sexually transmitted disease, obesity and physical inactivity also cluster in these three...

Cardiovascular Disease in the Medico Legal Era An Introduction

Other types of litigation such as personal injury (e.g. automobile accident), or product liability (e.g. adverse drug affects, or claims that cars or tires were defective leading to an accident) often also require knowledge of cardiovascular disease. For instance, an automobile accident may apparently lead to the death of the driver as a result of trauma however, if the driver actually had an arrhythmic cardiac arrest prior to the accident (e.g. coronary artery ischemia or cardiomyopathy) and then crashed, this would mitigate if not eliminate the liability of insurers or the automobile manufacturer. In another instance, a so-called drug adverse effect may represent the natural consequences of the underlying disease for which the drug was prescribed, rather than a complication of the drug. An example of this phenomenon is sudden cardiac death during sexual activity of an individual with diabetic cardiomyopathy, who is taking Viagra for erectile dysfunction secondary to diabetic...

Unusual Characteristics Of Sex Chromosomes And Mitochondria

If they do, this would explain why one sex must contribute all of the mitochondria. It can be used as an argument that there should only be two sexes. In fact, however, cases are known where organisms have more than two sexes. The slime mold, Physarum polycephalum, has 13 sexes. However, these turn out to be hierarchical. When two sexes mate, the higher one on the hierarchy donates its mitochondria to the offspring. This ensures that only one parental set of mitochondria survive. So one important thing about sex is who you get your mitochondria from.

Maternal effects on HPG function and mating behavior

These findings reveal evidence for the maternal programming of sexual behavior in the female rat. Moreover, maternal care is associated not only with alterations in sexual behavior in the adult rat but also in the timing of the onset of sexual behavior. The female offspring of Low LG mothers show vaginal opening (an unambiguous indication of pubertal development in the rat) significantly earlier in life than do the offspring of High LG dams. These findings provide a stunning parallel to the human literature (see below) in which the onset of reproductive function as well as sexual activity were influenced by parental care in early life.

Presentation of Germ Cell Tumors

The swelling within the testis may be noticed by the patient or his sexual partner. The presence of tes-ticular atrophy, which is a predisposing factor for GCT, may make the swelling more readily apparent. Atrophy of the testis can occur as a result of cryp-torchidism (especially when it has not been corrected until late childhood), infection (particularly mumps orchitis), or torsion or local trauma. Some men with testicular tumors and atrophic testes may present to an infertility clinic and be diagnosed on examination in that setting.2

Voyeurism Exhibitionism and Frotteurism

The paraphilic focus in voyeurism is sexual fantasies, urges, or behaviors involving observing unsuspecting persons, usually unclothed and or engaged in sexual activity. Federoff has described the requirement aspect of voyeurism and the other paraphilias as the central feature distinguishing them from nonpar-aphilic equivalents (34). It is not simply the act of watching a women naked, undressing, or engaging in sex that arouses the paraphilic voyeur the victim's lack of suspicion that she is being observed and the risk of being discovered are central to the voyeur's arousal. Like the exhibitionist, the voyeur rarely makes contact with his victim. His ritual often is accompanied by masturbation during or after the voyeuristic episode. Money has described variants of voyeurism (33). They include pictophilia, or dependence on viewing pornography for arousal, and troilism, or dependence for arousal on observing one's partner on hire or loan to a third party while engaged in sexual...

The Behavioristic View

Brinkman, for instance, gave an explanation model (27). He assumed that vaginismus is the end result of a classic conditioning process in which painful sexual intercourse took place. As a consequence of this process, the penis is conditioned into an aversion stimulus that when an approach is made, gives rise to tension and avoidance behavior, which once again leads to painful spasm of, in particular, the vaginal and anal sphincter muscles. Brinkman assumed that conditioning of the vaginistic reaction can occur in various ways. Sometimes one negative experience is enough, particularly in the case of incest or rape. Often, conditioning takes place over several experiences and such influences are far more difficult to establish.

Demography Of Lgbt People

Varying widely in sociodemographic characteristics, like racial and cultural background, income, age and place of residence. They also vary in their self-definition and level of affinity with other LGBT people. Furthermore, identity can change over time and is neither static nor independent, but the result of a complex interplay between place, community and politics (Kenney, 2001). Public health has often turned to behavioral definitions (e.g., men who have sex men or MSM) to overcome the problems with defining groups by sexual orientation, but behavioral definitions mute the importance of identity and of LGBT cultures that thrive among a wide array of ethnic and racial groups (Meyer, 2001). Despite their differences and these definitional difficulties, LGBT people share experiences of living in a society that stigmatizes and discriminates against same-sex identity and behavior and transgressive gender expression. The social and institutional forces that sustain such stigma and...

Gnrh Enters Blood Vessels In

Round And Ovarian Ligaments

Conveys urine and semen to outside of body inserted into the vagina during sexual intercourse the glans penis is richly supplied with sensory nerve endings associated with feelings of pleasure during sexual stimulation Testosterone also increases the rate of cellular metabolism and production of red blood cells by stimulating release of erythropoietin. For this reason, the average number of red blood cells in a cubic millimeter of blood is usually greater in males than in females. Testosterone stimulates sexual activity by affecting certain portions of the brain.

Vacuum constriction devices and constriction rings for men with

ED A vacuum constriction device (VCD) (93) is simply a rigid tube that is placed over the penis. A vacuum is then created inside the tube either manually or by a battery-powered motor. The penis becomes erect when such a negative pressure surrounds it. This principle is not new, and was being used as a treatment for ED as far back as 1874. For some men, this vacuum is sufficient, but others need a constriction ring which when applied to the base of the erect penis, preventing venous leakage once the tube is removed for sexual activity to commence. of users, and 25 report petechiae. Other effects that can put some men off the idea include cold numb penis, lack of ejaculation, pivoting of the penis and altered sensation at orgasm, which may be uncomfortable.

Etiologysexual Disorder

In this chapter, I omitted all sorts of methodologically weak publications in the field of psychotherapy that have been published during the last 30 years. Unfortunately, in last decade hardly any or even no progress has been made in the development of evidence-based research into the psychology and psychotherapy of ejaculatory disturbances. Instead, I have tried to provide you with up-to-date knowledge about the neurobiology and pharmacological treatment of ejaculatory disorders. Most of it, however, pertains to premature ejaculation. I hope and am also convinced that in the near future, with the development of new animal models of ejaculatory disturbances, the use of brain-imaging techniques in humans, and interest of pharmaceutical companies, also the other ejaculatory and orgasm disturbances, will become amenable for effective drug treatment. Nevertheless, one should always talk with patients, inform them about the most recent knowledge of their ejacu-latory problem, and most of...

Model Of Sexual Response Showing Various Incentives And Motivations To Be Sexual And Arousal Triggering And

Figure 3.1 Sex response cycle showing many motivations to be sexual, and responsive triggered desire. A positive outcome emotionally and physically allows sexual satisfaction (goal set enroute) plus other rewards that motivated initially. Reprinted from Obstet Gynecol 2001 98 350-353. Basson, with permission from the American College of Obstetricians and Gynecologists. Figure 3.1 Sex response cycle showing many motivations to be sexual, and responsive triggered desire. A positive outcome emotionally and physically allows sexual satisfaction (goal set enroute) plus other rewards that motivated initially. Reprinted from Obstet Gynecol 2001 98 350-353. Basson, with permission from the American College of Obstetricians and Gynecologists.

Common Name Of Polystoma Integerrimum

Ati Patho Tree

Adult parasite accumulates reserves, but assembles no eggs while frog is living on land during most of year. When frogs enter water to spawn in spring, the parasite assembles and lays its eggs. Hormonal changes in the host may control parasite reproduction parasites feed on blood and would have access to hormones circulating in the blood. Ciliated oncomiracidia invade frog tadpole gills. If attached to young tadpole, parasites become precociously sexually mature and lay a few eggs. On-comiracidia infecting older tadpoles remain immature when the host undergoes metamorphosis, they migrate via the digestive tract and possibly the skin to the host's bladder where they mature. Single egg retained in uterus of adult develops and hatches larva remains in host of its parent, increasing the host's parasite burden by autoinfection. In Polystoma nearcticum, which infests North American tree frogs, the parasite's egg assembly switches on and off abruptly as sexual activity of host switches on...

Lifelong Delayed Ejaculation

With every man presenting with delayed ejaculation, it is essential to obtain a full sexual and medical history and clinical examination of the patient. It is important to find out the situations in which ejaculation is impaired (location, sexual activity, specific partner), the frequency with which ejaculation is inhibited, the degree of delay of orgasm, whether the complaint existed from the first sexual encounters (lifelong) or occurred later in life (acquired), and whether orgasm and ejaculation are both lacking. By vibratory stimulation (93) of the penis an ejaculation can be induced. The percentage of success to cure lifelong delayed ejaculation, however, is unknown. Electrical stimulation (94) of the internal ejaculatory organs by a transrectal electrical probe (electro-ejaculation) is mainly used to obtain semen in paraplegic men. This intervention is extremely painful in men with normal sensation and is not an option to treat lifelong delayed ejaculation. Masturbation...

Introduction The False Dichotomy

The 20th century marked huge strides in our knowledge of sexual disorders and their treatments, however, advancements were followed by periods of reductio-nistic thinking. Etiology was conceptualized dichotomously, first as psychogenic and then organic. Early in the 20th century, Freud highlighted deep-seated anxiety and internal conflict as the root of sexual problems experienced by both men and women. By mid-century, Masters and Johnson (1) and then Kaplan (2) designated performance anxiety as the primary culprit, while providing a nod to organic factors. Together, they catalyzed the emergence of sex therapy, which relied on cognitive and behavioral prescriptions to improve patient functioning. For the next two decades, a psychological sensibility dominated discussions of the causes and cures of sexual dysfunctions (SDs). However, during the late 1980s, there was a progressive shift toward surgical and predominantly pharmaceutical treatments for male erectile dysfunction (ED). By...

Sexual aversion disorder

To understand sexual aversion disorder, one should first understand that there are circumstances in which it is normal for people to lose interest in sexual activity. The reader can then compare these situations to the loss of desire associated with serious sexual disorders, including sexual aversion disorder. There are a number of reasons that people lose interest in sexual intercourse. It is normal to experience a loss of desire during menopause directly after the birth of a child before or during menstruation during recovery from an illness or surgery and during such major or stressful life changes as death of a loved one, job loss, retirement, or divorce. These are considered normal causes for fluctuations in sexual desire and are generally temporary. Changing roles, such as becoming a parent for the Sexual aversion disorder represents a much stronger dislike of and active avoidance of sexual activity than the normal ups and downs in desire described above. Sexual aversion...

Vulvar Vestibulitis Syndrome

Cognitive-behavioral interventions for vulvar vestibulitis syndrome include cognitive-behavioral pain management, sex therapy, and pelvic floor biofeedback to target both pain reduction and sexual functioning. Success rates ranging from 43 to 86 have been reported in two uncontrolled studies in which sex therapy and pain management were combined (93,94). In 1996, Weijmar Schultz et al. (95) published a prospective and partially randomized treatment outcome study investigating the effectiveness of behavioral intervention with or without surgery. Results from this study indicated that women in both groups benefited in terms of pain reduction, with no significant differences between women who had undergone the behavioral intervention alone vs. those who underwent the combined treatment of behavioral intervention and surgery. The authors suggest that the behavioral approach should be the first line of treatment for ves-tibulitis sufferers, with the surgery acting as an additional form of...

The Sexual Response Cycle

There are four phases in the sexual response cycle I. excitation, II. plateau, III. orgasm, and IV. resolution (Masters, Johnson, & Kolodny, 1994). In men, phase I (excitation) is characterized by erection of the penis. Phase I takes place more slowly in women and is characterized by the production of lubricating fluid in the vagina, an increase in the diameter of the clitoris, and increased congestion of the labia with blood. For both sexes, phase II (plateau) is marked by a rise in the blood congestion of the pelvis and a strong feeling of sexual tension. A sex flush colors the forehead, neck, and chest, sometimes extending to the abdominal area. Phase III (orgasm) occurs in two stages in men a preejaculatory contraction of the muscles involved in ejaculation, and actual ejaculation. The same muscles are involved in the orgasms of women as those of men. During phase IV (resolution), which is usually completed more quickly in men than in women, the congestion of the blood vessels...

Cognitive Behavioral Approaches

Cognitive-behavioral therapy for female orgasmic disorder aims at promoting changes in attitudes and sexually relevant thoughts, decreasing anxiety, and increasing orgasmic ability and satisfaction. Traditionally, the behavioral exercises used to induce these changes include directed masturbation, sensate focus, and systematic desensitization. Sex education, communication skills training, and Kegel exercises are also often included in cognitive-behavioral treatment programs for anorgasmia. Masturbation exercises are believed to benefit women with orgasm difficulties for a number of reasons. To the extent that focusing on nonsexual cues can impede sexual performance (70), masturbation exercises can help the woman to direct her attention to sexually pleasurable physical sensations. Because masturbation can be performed alone, any anxiety that may be associated with partner evaluation is necessarily eliminated. Relatedly, the amount and intensity of sexual stimulation is directly under...

Ginseng And Aphrodisiac Activity

The effect of ginseng on sexual activity has intrigued the general public and many research workers. Bao et al. (1984b) observed that there was no disturbance of the ovarian cycle in stressed female mice if ginseng was administered. Bao et al. (1984c) also reported that ginseng extracts given to male mice prevented stress-induced decrease of sexual activity. Similarly Lian and Zhang (1998) also noted that repeated daily hanging stress reduced sexual activity in male mice as assessed by licking, mounting and mating activity. The plasma testosterone level was reduced but treatment with ginsenoside Rb1 (2.5, 5 or 10 mg kg, i p) before each stress event countered the repeated stress-induced sexual deficiency and raised the plasma testosterone level. It was concluded that ginsenoside Rb1 was capable of maintaining the normal plasma testosterone level. compounds. Therefore the reputed sex hormone-like activity of ginseng has not, as yet, been adequately explained. It could be argued that...

Anatomy and Physiology

When Masters and Johnson (10) published their account of the physiology of the sexual response, they opposed Freud's theory of the transition of erogeneous zones in women. According to these famous sexologists, nerve endings in the vagina are extremely sparse. Therefore, during coital stimulation the clitoris is stimulated indirectly, possibly through the movement or friction of the labia. Hite's data supported this point of view. Almost all women who reached orgasm through stimulation from coitus alone had experienced orgasm through masturbation. Many women needed additional manual stimulation to orgasm during coitus, and an even larger number was unable to orgasm during coitus at all (12). Apparently, coitus alone is not a very effective stimulus for orgasm in women. In 1950, Grafenberg (25) provided an alternative to Masters and Johnson's explanation for the relative ineffectiveness of coitus to induce orgasm. He described an area of erectile tissue on the anterior wall of the...

Is Absent or Impaired Genital Responsiveness a Valid Diagnostic Criterion

It is clear that the sexual stimuli used in this laboratory study (even though these stimuli were merely visual) were effective in evoking genital response. In an ecologically more valid environment (e.g., at home), sexual stimuli may not always be present or effective. Sexual stimulation must have been effective at one point in the participants' lives, because primary anorgasmia was an exclusion criterion. Even though a serious attempt was made to rule out lack of adequate sexual stimulation as a factor explaining the sexual arousal problems, data on sexual responsiveness collected in the anamnestic interview suggested that the women diagnosed with sexual arousal disorder are unable, in their present situation, to provide themselves with adequate sexual stimulation. The exclusion, halfway through the study, of a participant who no longer met the criteria for sexual arousal disorder after having met a new sexual partner, also illustrates that inadequate sexual stimulation may be one...

Anatomy And Physiology Of Erection

In its flaccid state, the penis acts as a tube through which urine is passed directly from the bladder via the urethra (13,14). The urethra is also a conduit for the ejaculate, which can be expelled by the penis in both its flaccid and erect state. The penile urethra is encased by a sleeve of erectile tissue called the corpus spongio-sum, which expands at the tip of the penis forming the glans and at the base forming the bulb. The function of the spongiosum is to maintain the patency of the urethra during sexual activity so that the ejaculate is not prevented from being expelled by a collapsed structure. The main erectile components of the penis are the left and right corpora cavernosa that communicate via perforations to affect a single erectile chamber. These two connecting bodies attach to the rami of the pelvis after turning through a surprisingly sharp angle to become the deep erectile crura. and becomes fully erect. Further reflex contraction of the ischiocavernous muscles...

Psychoanalytic Models of Etiology

Stoller described sexual masochism as the neurotic eroticization of maternal hatred, a narcissistic solution to early life trauma (74), although in later writings, after observing many higher functioning individuals and couples who engaged in recreational S& M practices, he questioned his earlier assumptions (77,78). Kernberg suggested that masochists experience narcissistic gratification in the grandiose view of the self associated with high tolerance for pain (79). Waska described the masochist as alternating between compulsion toward servitude and rage at the internalized possessive, rejecting, or neglectful maternal object (80). The masochist suffers a core incapacity to self-soothe and, therefore, deep cravings to be soothed by others. The cravings, and accompanying rage, explain the masochist's inherently ambivalent position, in which self-suffering disguises feelings of anger and yearning for maternal soothing. Ultimately, his compensatory style is one of the expecting to be...

Premature ejaculation

Premature ejaculation (PE) refers to the persistent or recurrent discharge of semen with minimal sexual stimulation before, on, or shortly after penetration, before the person wishes it, and earlier than he expects it. In making the diagnosis of PE, the clinician must take into account factors that affect the length of time that the man feels sexually excited. These factors include the age of the patient and his partner, the newness of the sexual partner, and the location and recent frequency of sexual activity. Abstinence Refraining from sexual intercourse for a period of time. Orgasm Another word for sexual climax. In the male, orgasm is usually accompanied by ejaculation but may be experienced as distinct from ejaculation. Premature ejaculation is common in adolescents where it may be made worse by feelings of sinfulness concerning sexual activity, fear of discovery, fear of making the partner pregnant, or fear of contracting a sexually transmitted disease (STD). All of these may...

Domains Of Inquiry And Action In Applied Developmental Science

Medicine Wheel Template

Grafting its roots and branches in community psychology and prevention science (e.g., Weissberg & Greenberg, 1998). Although developmental psychopathology may focus more often on outcomes reflecting health and behavior problems or mental disorders or illness, the developmental assets framework emphasizes outcomes (or even processes) such as competence or thriving, as captured in the emerging line of inquiry and practice commonly called positive youth development (Benson et al., 1998, p. 141 see also Pittman & Irby, 1996). ADS emphasizes the importance of simultaneous consideration of both orientations. In addition, whereas developmental psychopathology is explicitly life-span oriented as noted in the definitions stated earlier, the developmental assets framework, at least to date, is more focused (in derivation though not implication) on the processes boldest in the second decade of life. The empirical and theoretical foundations for the framework emphasize three types of health...

Athome methods of overcoming dysfunction

If, after completing the above steps, an orgasm has not been reached, the patient may find that the use of a vibrator on or around the clitoris is effective. c. Once masturbation has resulted in orgasm, the patient should masturbate with her partner present and demonstrate pleasurable stimulation techniques.

Biological Theories of the Paraphilias

Understanding of the neurobiology of sexual functioning, both normal and deviant, is incomplete. Nevertheless, it is clear that sexual interest and function derive from both the central nervous system and endocrine factors. In normal sexual arousal, central nervous system involvement includes a cascade of connections from the neocortex to the limbic system and the hypothalamus, particularly the preoptic area and the brainstem (113). Sexual arousal begins via either sensory input, such as tactile, visual or olfactory stimulation, or via fantasy in the neocortex. This cortical arousal propagates through the limbic system and hypothalamus to enable a progression of physiologic events that promote sexual behaviors and orgasm. Subcortical brain areas are important for sexual functioning and include the limbic system and the preoptic nuclei in the hypothalamus. Both peptides, such as beta endorphin and oxytocin, and LHRH modulate sexual behavior in animals.

Uniform Crime Reports

We boys had normal libidos and a great curiosity about sex, and we were very interested in the carnival girlie shows that came to town every year. We were also aware that uncontrolled passion can cause trouble and even lead to violence. There were reports of men beating their wives (rarely vice versa), but murders were more likely to occur once every 10 years rather than 10 times a year. We knew from Warner Bros. movies that big cities were full of juvenile delinquents and gangsters, but thank goodness they weren't in our town. About our only

Treatment For Vaginismus

The above-described views and treatment models show that there is wide variation in the causal attributes of vaginismus and that this diagnostic variety leads to an even wider variety of therapeutic interventions. In itself this is not particularly surprising when we consider that in order to have sexual intercourse in a satisfactory manner, obviously apart from the physical conditions that have to be met, there must also be special knowledge, expertise, attitudes and, last but not least, emotional moods. All this is overruled by motivation Do I really want to These rates suggest that all treatment forms achieve results and as far as this aspect is concerned, they vary very little. This indicates a nonspecific treatment effect. In terms of attention, validation of her complaint, and the patient's feeling of control and competence, the active constituents seem to be effective on a meta level than on a content level. Cost effectiveness ratios of the diverse treatment forms then become...

Medical Letter In Reference To Erical Dysfunction

Carmichael MS, Warburton VL, Dixen J, Davidson JM. Relationship among cardiovascular, muscular, and oxytocin responses during human sexual activity. Arch Sex Behav 1994 23 59-79. 9. Bohlen G, Held JP, Sanderson MO, Ahlgren A. The female orgasm pelvic contractions. Arch Sex Behav 1982 11 367-386. 10. Davidson JM. The psychobiology of sexual experience. In Davidson JM, Davidson RJ, eds. The Psychobiology of Consciousness. New York Plenum Press, 1980 271-332. 14. Kruger THC, Haake P, Hartman U, Schedlowski M, Exton MS. Orgasm-induced prolactin secretion Feedback control of sexual drive Neurosci Biobehav Rev 2002 26 31-44. 16. Whipple B, Ogden G, Komisaruk BR. Physiological correlates of imagery-induced orgasm in women. Arch Sex Behav 1992 21 121-133. 19. Wells BL. Nocturnal orgasms Females' perception of a normal sexual experience. J Sex Res 1983 22 412-437. 20. Polatin P, Douglas DE. Spontaneous orgasm in a case of schizophrenia. Psychoanal Rev 1953 40 17-26. 25. Fisher S. The Female...

Evidence Based Medicine

But this is also true for behavioural therapy. Masters and Johnson (21) deliberately refuted a definition of premature ejaculation in terms of a man's ejaculation time duration. Instead, they insisted on defining premature ejaculation in terms of the female partner response, for example, as a male's inability to inhibit ejaculation long enough for the partner to reach orgasm in 50 of intercourses. It is obvious that their definition is inadequate because it implies that any male partner of females who have difficulty in reaching orgasm on 50 of intercourses suffers from premature ejaculation.

Postmenopausal Dyspareunia

Attempts to lessen the pain through the use of water-based lubricants and topical estradiol cream had not been successful, and she did not wish to try systemic hormone replacement therapy for fear of developing breast cancer. A detailed sexual history revealed that Brenda had suffered from intermittent pain during intercourse for at least 15 years but had never complained about it, and that Alexander had always had difficulties with ejaculatory control. Over the past 4 years, Brenda reported difficulty getting sexually aroused, diminished lubrication, postcoital bleeding, and less interest in sex. Their current sexual frequency was less than once every 3 months, a frustrating situation for Alexander, who had hoped that their youngest child leaving home in the previous year would result in more frequent sexual activity. In the previous 5 years, the couple had also experienced significant life stressors including the sudden death of Brenda's mother and major financial problems....

Neuropsychiatric complications

Alcoholic paranoia is the development of paranoid delusions in the absence of hallucinations. Morbid jealousy (see Chapter 8) of the sexual partner is a frequent theme, in which case dangerousness (see Chapter 21) must be assessed because of the risk of assault or even homicide.

Models of Differentiation

She hypothesised that for those sexual serial murderers where the role of victim was as an object, the crime scene behaviours would reflect few emotional elements with little interpersonal interaction. The offender would be unlikely to be influenced by the victims' responses, acting out a personal ritualised script, in which the victim plays no part as a human being. She also hypothesised that post-mortem injuries and sexual acts as well as excessive violence and dismemberment would co-occur with these other indicators of the 'victim as object'. Where the role of the victim is as a person, Hodge (in press) hypothesised that the crime scene behaviour will reflect the importance of the victim as a particular person. She proposes that this will be shown in the co-occurrence of variables that indicate the degree and style of interaction between the two. Excessive violence would be rare, sexual activity would be more likely to be 'normal' ones such as full sexual intercourse prior to death...

Minority Groups Urban Life And Health

The overall benefit of community resources to all their residents is what Rose (1985) has called a preventive paradox, that is everybody benefits by being exposed to multiple sources of information and services (Rose, 1985). A good example of this paradox is the case of health promotion leading to positive health behaviors, such as physical activity, anti-smoking campaigns, and sexual education among adolescents. People living in urban areas are more likely to be active than those living in rural settings, regardless of their race ethnicity, and as a result less likely to be overweight (Eberhardt, et al., 2001). Cigarette smoking and birth rates among adolescents are lower in urban setting than in rural areas (Eberhardt, et al., 2001). In fact, there is evidence that black adolescents in urban cities have lower rates of smoking than whites and are more likely to initiate later in life (Bachman, et al., 1991 Mcintosh, 1995 Nelson, et al., 1995 Siegfried, 1991). However, not all...

Identifying Psychosocial Barriers to Success

Only recently, have physicians begun incorporating sex therapy concepts, and recognized that resistance to lovemaking is often emotional. Clearly, medical treatments alone are often insufficient, in helping couples resume a satisfying sexual life. There are a variety of bio-psychosocial obstacles to be recovered that contribute to treatment complexity. All of these variables impact compliance and sex lives substantially, in addition to the role of organic etiology (20). There are multiple sources of patient and partner psychological resistance, which may converge to sabotage treatment (i) What is the mental status of both the patient and the partner and how will this impact treatment, regardless of the approach utilized What is the nature and degree of patient and partner psychopathology (such as depression) What are the attitudinal distortions causing unrealistic expectations, as well as endpoint performance anxiety (ii) What is the nature of patient and partner readiness for...

Epidemiology Of Sexual Dysfunction

A population study of US females aged 18-65 (25) found that -33 of US females reported low libido, trouble with orgasm, or difficulty with lubrication for at least 1 month in the previous year. Other surveys have reported similar findings. Hawton (38) studied sexual activity in a community sample in Oxford, United Kingdom and found that 17 reported never experiencing an orgasm and only 29 reported experiencing orgasm at least 50 of the time. Marital satisfaction was the major predictor of sexual activity and satisfaction. Dunn (39,40) also reported several population studies in the United Kingdom. Approximately 40 of the women reported a sexual problem, the most common being difficulty reaching orgasm. A recent population survey in Sweden (41) of sexual behavior in women aged 18-74 found that the most common problems were low desire followed by orgasm and arousal difficulties. They also reported considerable co-morbidity between sexual disorders. Some (42) questioned the methodology...

Case Study Jon and Linda

Jon and Linda enjoyed high frequency successful coital activity with mutually enjoyable coital orgasms, despite their intermittent marital disharmony over a 15-year period. Three years ago, Jon started SSRI treatment for depression, secondary to work stress. His depression exacerbated his insecurity about his intelligence and abilities. He developed ED and could not erect, but his sexual desire was still strong. Medication helped his moodiness and reduced his depression. They both wanted Jon on the antidepressant medications, yet their marital conflict increased. His psychopharmacologist tried reducing the SSRI and augmenting with bupropion. This did not help If anything, it uncharacteristically, worsened his sex life. They tried switching him from paroxetine to bupropion to escitalopram. During this time, he lost his job, and money problems became worse. He needed to move to a different city in order to find work, uprooting Linda and the kids. He also used a low dose,...

Brain Evolution And Behavior A Role For Genomic Imprinting

These important anatomical changes in the evolutionary development of the mammalian brain have been crucial in the reorganization of reproductive strategies involving sex differences in the brain and behavior. Especially important has been the pseudogenization of vomeronasal and olfactory receptor genes and the downregulation of gonadal and placental hormones in determining sexual and maternal care together with the upregulation of social determinants of behavior. Castrate male primates continue to show a sexual interest in females years after gonadectomy (Michael and Wilson, 1973) but lose sexual interest within days of losing dominance and social status (Keverne, 1992). Reproductive strategies are therefore very complex and embedded in social learning and social structure of the group in which primates live. Moreover, delaying the onset of puberty and extending the period of postnatal care has permitted extensive growth and enlargement of the neocortex. In Old World female primates,...

Environmental adversity and sexual maturation

Suggested that environmental adversity is associated with a decreased quality of parental care that directly leads to early menarche and earlier onset of sexual activity in human females. There is strong evidence that insecure attachment is more prevalent in populations living under conditions of risk and uncertainty (i.e., poverty and inequality Belsky, 1997a McLoyd, 1990 Repetti, et al., 2002 and see above). The age of menarche is influenced by the quality of family function (Ellis et al., 1999), number of major life events (Coall and Chisholm, 2003 Surbey, 1990) family conflict (Graber et al., 1995 Moffitt et al., 1992), marital conflict (Kim and Smith, 1998a,b Wierson et al., 1993), and negative family relationships (Ellis and Garber, 2000 Kim et al., 1997). Despite some exceptions (Campbell and Udry, 1995 Graber et al., 1995), the majority of studies show that childhood psychosocial stress predicts earlier menarche. There is strong evidence for familial influences on sexual...

Relevance for vertebrate systems

To link sexual karyotype to the development of sex-specific characteristics. Arnold has proposed that regulatory genes on the X (that escape dosage compensation) and Y chromosomes may directly organize sex-specific CNS characteristics (Arnold, 2004). Indeed, there is some evidence that the Y-chromosome sex-determining gene Sry has such a role in the nervous system (Dewing et al., 2006). However, such a model may capture only one aspect of this process. It is also quite possible that sexual karyotype controls much more complex regulatory networks, such as those characteristic of C. elegans and Drosophila sex determination, that read the sex-determining signal and set into motion a cascade of interactions that only very indirectly lead to sex-specific gene expression. The potential existence of such a pathway in the mammalian nervous system has intriguing implications for the mechanisms that bring about sex differences in neuroanatomy and neural function moreover, genes in such a...

Nondietary Prostate Cancer Risk Factors

Of an androgenic profile associated with prostate cancer development.27 Smokers have higher circulating testosterone levels than nonsmokers.28 While there is no direct link between androgen levels and sexually transmitted diseases, androgen levels may be modestly correlated with indices of sexual activity.29 Among the various parameters of sexual activity indices and prostate cancer risk that have been evaluated (e.g., age at first intercourse, frequency of intercourse, marital status), the only one that has been consistently linked to prostate cancer risk is a history of a sexually transmitted disease.31 While this has suggested to some a possible infectious etiology, the epidemiology does not strongly support this premise. For example, Ross and colleagues32 showed that celibate priests do not have a low risk of prostate cancer and unlike cervical cancer (known to be caused by a sexually transmitted infectious agent), prostate cancer is not inversely related to socioeconomic status,...

General Multicultural Issues

Among other problems with the compatibility approach (see Paniagua, 1998, pp. 6-7), the compatibility approach fails to distinguish between race and ethnicity concepts (Paniagua, 1998 Waytt, 1991 Wilkinson, 1993). In general, race is a category of persons who are related by a common heredity or ancestry and who are perceived and responded to in terms of external features or traits (Wilkinson, 1993, p. 19). Ethnicity, however, often refers to a shared culture and lifestyles (Wilkinson, 1993, p. 19). In terms of this distinction, the client and the therapist may share the same racial group (e.g., both Hispanics), but they may not share the same ethnicity (e.g., they have different values and lifestyles). Failure to appreciate this distinction when providing mental health services to culturally diverse groups may have a profound negative impact in such services. For example, highly acculturated Hispanic clinicians working with less acculturated Hispanic clients with HIV AIDS may not...

Development and Change

This is the essentially biological process of change in a person's physiology with age. Knowledge of what is typical of people at certain ages, such as sexual activity, can thus be used to form a view as to the maturity of the person committing the crimes and to the basis for longer-term variations in an individual's criminal activity.

Outbreak Characterization

A cohort study is technically easier to conduct than is a case-control study. It is typically used for those outbreaks in which there is a small well-defined population available for interview. Examples of suitable cohorts are everyone who attended a wedding, a school, a camp, or a business conference or who ate at a specific restaurant on a given day. An investigator designs a form with three main types of questions (1) contact and demographic information, (2) presence and onset of illness, and (3) specific exposures. For example, for a wedding at which gastrointestinal illness occurred, the questionnaire would include questions about sex, age, vomiting and diarrhea, every food item served or available (identified from menu's and the party coordinator), drinks, ice, and edible party favors. If the biological agent norovirus was suspected, exposure to public vomiting, other events such as the rehearsal dinner, and or individuals known to be ill might also be asked. (An example of a...

Activation And Regulation Of Sexual Response Processing of Sexual Information

In a series of studies we conducted in the 1990s see Ref. (14) for a review , we consistently found that women's genital response and sexual feelings are not strongly correlated, and that affect influences sexual feelings. Other studies had similar findings (43 -45,47-49,65). In men, correlations between genital response and sexual feelings are usually significantly positive, suggesting that for men's sexual feelings awareness of their genital response is the most important source. A surprising finding from our studies was the ease with which healthy women become genitally aroused in response to erotic film stimuli. When watching an erotic film depicting explicit sexual activity, most women respond with increased vaginal vasocongestion. This increase occurs within seconds after the onset of the stimulus, which suggests a relatively automatized response mechanism for which conscious cognitive processes are not necessary. Even when these explicit sexual stimuli are negatively evaluated,...

Specific Multicultural Issues

As noted by Paniagua (1998), the revelation of family secrets among African American clients in mental health services is a matter of timing (i.e., do not pressure these clients to discuss their secrets rather, wait until the client is ready to reveal that secret). An overall approach to handle family secrets among African American families in the present context, including three elements (Paniagua, 1998, p. 31) (a) listen carefully to what the client and or the family is saying (e.g., are they interested in talking about the etiology of the disease or about ways to help the client to deal with a current episode of depression after knowing about the HIV status) (b) attend to the amount of silence when the client is questioned about an issue that appears to be sensitive (e.g., questions regarding sexual activities, substance use), and (c) do not ask questions leading to the revelation of family secrets. For example, the question Do you know that HIV can be transmitted through sexual...

Erectile dysfunction

Erectile dysfunction (ED) may be defined as the consistent inability to achieve or maintain an erection sufficient to permit satisfactory sexual intercourse. The word consistent is included in the definition because most men experience transient episodes of ED that are temporary and usually associated with fatigue, anger, depression or other stressful emotions. The use of the formerly used term impotence has been virtually abandoned because of its inherent stigma of weakness and lack of power. Different men experience varying patterns of ED. Men with ED may report the inability to experience any erection from the beginning of a sexual experience, while others experience an erection that is not maintained at penetration. Other men may lose the erection during sexual intercourse, and others can only experience erection upon awakening or during self-masturbation.

Treatment Psychological Treatments

Prior to publication of Masters and Johnson's seminal book on sex therapy (101), sexual problems were seen as consequences of (nonsexual) psychological conflicts, immaturity, and relational conflicts. Masters and Johnson proposed to directly attempt to reverse the sexual dysfunction by a kind of graded practice and focus on sexual feelings (sensate focus). If sexual arousal depends directly on sexual stimulation, that very stimulation should be the topic of discussion (masturbation training). A sexual dysfunction was no longer something pertaining to the individual, rather, it was regarded as a dysfunction of the couple. It was assumed that the couple did not communicate in a way that allowed sexual arousal to occur when they intended to produce it. Treatment goals were associated with the couple concept the treatment goal was for orgasm through coital stimulation. This connection between treatment format and goals was lost once Masters and Johnson's concept was used in common...

Diagnostic Procedures

Which anxiety and women's sexual function are related have as yet to be identified (50). The ongoing work of Bancroft and Janssen (59) exploring a dual control model of sexual excitation and inhibition in men as well as in women, may clarify any role of anxiety in women's predisposition to sexual inhibition and to sexual excitement. One of the most important but difficult tasks is to assess whether inadequate sexual stimulation is underlying the sexual problems, which requires detailed probing of (variety in) sexual activities, conditions under which sexual activity takes place, prior sexual functioning, and sexual and emotional feelings for the partner. Several studies have shown that negative sexual and emotional feelings for the partner are among the best predictors for sexual problems (16,60). The clinician should always ask if the woman has ever experienced sexual abuse, as this may seriously affect sexual functioning (61). Some women do not feel sufficiently safe during the...

Acquired Delayed Ejaculation

Of ejaculation is usually irreversible and the patient should be counseled to optimize his and his partner's enjoyment from the residual sexual functioning. Androgen deficiency requires appropriate testosterone replacement therapy. In the case of inadequate stimulation, pelvic floor exercises may be helpful. Most patients require general advice on reducing precipitating factors, reduction in alcohol use, finding more time for sexual activity when not fatigued.

Traditional Markers Of Sexual Desire

Fantasies, which are a marker of sexual desire in DSM-IV-TR may, in fact, serve as a deliberate means of creating arousal and reinforcing desire. Data confirm the clinical experience that women fantasize to deliberately focus on their sexual feelings and avoid the distractions that are interfering with their sexual response (47). Awareness of sexual desire is not the most frequent reason women accept or initiate sexual activity (1 -6).

The Psychoanalytical View

More recent research revealed that women with vaginismus have significantly increased comorbid anxiety disorders, whereas depression rates are not found to be increased (4,19,20). The role of childhood sexual trauma is unclear, since different frequency rates are found (3,4), and the presence of increased rates of posttraumatic stress disorder has not been investigated as yet. Psychological characteristics, measured with self-report instruments, do not unequivocally corroborate the presence of anxiety disorders. Personality traits found to be more often present in this group suggest the presence of self-focused attention and negative self-evaluation in the etiology or maintenance of vaginismus (3,20). Sexual functioning may be impaired with regard to sexual desire and arousal response during sexual activity. Psychopathology and impaired psychological functioning may be caused as well as effect of vaginismus. Experimental evidence thus far documented the role of experienced threat in...

Placental Regulation Of Maternal Endocrine Function And Behavior

The placenta, developed from the cell lineage of fetal trophectoderm, exerts considerable influence on maternal endocrine function. Progesterone is the steroid hormone that dominates pregnancy and is necessary to sustain pregnancy. High levels of progesterone during pregnancy are a function of the fetal placenta either directly (primates) or indirectly (rodents) by production of placental hormones that sustain the ovarian corpus luteum. Progesterone has a broad spectrum of effects by acting on many maternal tissues (Keverne, 2006). Notable among these is the brain, particularly the hypothalamus (Fig. 8.1). In the hypothalamic region of the brain, high levels of progesterone exert a negative feedback on the pulsatile release of gonadotropin-releasing hormone (GnRH) preventing ovulatory cycles and curtailing female sexual behavior. The GnRH neurons are not themselves steroid receptive cells but it is thought that negative feedback inhibition occurs via the action of steroids on...

Classification General Sexual Issues

Sexual disorders in general are classified in the Text Revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).* One of the sections in DSM-IV-TR is titled Sexual and Gender Disorders. Sexual disorders classified in the DSM system follow the thinking of Masters and Johnson (1), and Kaplan (10). The former described a Sex Response Cycle (SRC) that consisted of four phases, each of which they named excitement, plateau, orgasm, and resolution. Kaplan then added another element that had previously been missing, namely, desire. In addition, she reconceptualized the SRC into three parts desire, response, and orgasm, each of which was associated with a different disorder. The DSM system is similarly organized.

History And Clinical Examination The History

Start with general information about the man's life and work. Employment related stress and relationship difficulties are often involved in the etiology. Ask about the problem, its duration, frequency, and specifics such as whether the erection can be elicited but not maintained (suggestive of a veno-occlusive disorder). Ask about his past medical history and current treatments. As we have already seen, an elderly diabetic is in the highest risk group for ED. What is the patient's motivation for seeking help, and why now There is sometimes a mismatch of expectation between the patient and his sexual partner. ED is often situational, occurring only in the presence of a partner, but the man may enjoy satisfactory masturbation and have spontaneous nocturnal erections. Note that loss of nocturnal erections is a strong indicator of a physical problem, but can also be as a result of a major depressive disorder. Ask specific questions about other cardiovascular, neurological, and...

Theoretical Perspectives Biological Psychological and Social

One might look first at differing points of view about sexuality in general. Some view sexual difficulties from primarily a biomedical perspective and regard sex as natural. Kolodny et al. wrote to define sex as natural means just as an individual cannot be taught to sweat or how to digest food, a man cannot be taught to have an erection, nor can a woman be taught to lubricate vaginally. Because the reflex pathways of sexual functioning are inborn does not mean that they are immune from disruption due to impaired health, cultural conditioning, or interpersonal stress (30 p. 479) Some have reworded 'naturally' to mean 'automatically, without purpose or without effort' (31). Others look at sexuality and see the absence of intimacy as being crucial to understanding the psychological origins of many sexual difficulties (11,32). One can particularly appreciate (and learn from) the implications of the absence of intimacy for sexual relationships generally, and sexual desire in particular,...

Reproductive biology

Each of the great apes has a distinct mating system that is directly associated with their social organization and behavior. Sexual activity is not seasonal, all female great apes have a predictable reproductive cycle that is usually about a month in duration. Offspring are most often singletons, although twins have been reported on rare occasions. A female makes an enormous investment in each of her young, who will remain dependent on her for years. Males do not take a direct role in the care of their offspring, although they do provide indirect care in the form of group protection and usually demonstrate amazing levels of tolerance and good will towards infants and juveniles. Neither of these generalizations specifically apply to wild orangutans, since males rarely encounter, or interact with, youngsters. ual dimorphism is the result of female preference for larger males, as well as male-male competition. Larger males are able to provide better protection for the females and...

Attachment and detachment in family development and autonomy and life cycle

The parent child attachment changes over time to allow for the developing independence in the child. The degree of detachment increases until the child reaches the stage of an autonomous adult. The attachment and detachment process is a dynamic involving the child moving away from the parent and the parent letting go the child. Through out this period the child develops other attachments outside the family and in adulthood finds a sexual partner to establish another family. These changes in the family are part of the family life cycle which has particular transition points of change - birth, infancy, childhood, adolescence, adulthood, middle age, retirement and aging and death. These transition points are times of stress for the family as the change is negotiated.

The United States constitutional right of privacy

172 In particular, Justice White made it clear that the policy behind the statute - namely, an attempt to ban 'illicit sexual relationships' (and by this was meant all forms of 'promiscuity' and sexual relations between non-married couples) - was perfectly permissible as a legislative goal. 181 As Rubenfeld has noted, 'The great peculiarity of the privacy cases is their predominant, though not exclusive, focus on sexuality - not sex as such, of course, but sexuality in the broad sense of that term the network of decisions and conduct relating to the conditions under which sex is permissible, the social institutions surrounding sexual relationships, and the procreative consequences of sex. Nothing in the privacy cases says that the doctrine must gravitate around sexuality. Nevertheless, it has', 'The Right of Privacy', 744. justification for upholding the Georgia statute was advanced. Rather, it poses the question, why is privacy - which is clearly concerned with sexual conduct and...

The One Gene One Enzyme Hypothesis

Following the Second World War, the face of genetics was transformed as biochemists and geneticists teamed up to explore what genes do in the cell, and what they are. What was new was not the concept that genes function by way of enzymes, but the use of microorganisms. Single-celled microbes allowed geneticists to avoid the complexity of tissue differentiation and cellular integration when searching for a bridge between gene and character. The geneticist isolated mutants that were found to be unable to grow, or that grew poorly on a well-defined growth medium, and the biochemist sought the reason for this inability. Thus, a suitable organism for biochemical genetics was one whose sex life and growth could be brought under meticulous control. The model organisms of classical genetics, Drosophila, corn, and mice, so useful for establishing the chromosome theory of inheritance, were quickly outcompeted by rapidly reproducing microorganisms fungi, yeast, algae, protists, and bacteria.

Racial Groups and Hivaids

Table II shows a summary of exposure category in male adults adolescents across racial groups. In general, a greater number of African American and Hispanic males have been reported with AIDS through 1997, compared with Asian and American Indian males. In the case of men who have sex with men as a risk factor for HIV infection, whites have taken the lead since 1981 (first year when AIDS symptoms were reported to the CDC). It should be noted, however, that African Americans and Hispanics have historically constituted a small number in the United States compared to whites. Therefore, 32 and 44 of AIDS cases among African Americans and Hispanics, respectively (Table II), reported through 1997 is in disproportion to the number of persons from these two racial groups in the U.S. population (Ward & Duchin, 1998). Another significant finding is that the number of AIDS cases resulting from heterosexual contacts (Table II) have been higher among African American and Hispanic males relative...

Medicalization Of Sexuality

Bancroft (42) among others cautions just about a few important issues connected to medicalization of human sexuality. He points out that male sexuality has been medicalized for most of the 20th century, and that medical profession has paid more attention to female sexuality lately (interestingly, this increased interest seems to parallel with the increased interest of the pharmaceutical industry in female sexuality). Bancroft points out that the interface between psychological processes and physiological response, especially in women, is not well understood. He discusses the numerous male-female differences in sexuality. He also asks, when is a sexual problem a sexual dysfunction, as many times impaired sexual interest or response in women is psychologically understandable and thus rather an adaptive response to a problem in the sexual relationship rather than sexual dysfunction.

Sexual dimorphism in the C elegans nervous system

Interestingly, the existence of these two forms of sexual dimorphism is also characteristic of more complex organisms. As in C. elegans, vertebrate species have sex-specific neural structures, such as those that innervate the genitalia. In contrast, sex differences in the C. elegans core nervous system may be more analogous to subtler sexual dimorphisms in the vertebrate CNS, such as the difference in size of the hypothalamic medial preoptic area in mammals (Raisman and Field, 1971) and the high-vocal center in songbirds (Nottebohm and Arnold, 1976). Though, unlike C. elegans core nervous system differences, these structures likely have sex differences in cell number, in both cases these can be seen as modulations in the properties of neural structures common to both sexes.

An Example HIV Screening in Pregnant Women

Throughout this chapter, the following health care program will serve to illustrate some of the advantages and limitations of cost effectiveness analysis, which will be referred to as the pregnant women example. Screening pregnant women for HIV infection offers opportunities to initiate prenatal antiretroviral therapy, a medical intervention proven to decrease the rates of HIV transmission from mothers to infants. Additionally, identifying women early in their infection provides opportunities for counseling about breast feeding and safe sex. The newborn baby also benefits from early identification and appropriate therapy for HIV infection. However, recent studies estimate about 25 of HIV-seropositive individuals are unaware of their status (Fleming, et al., 2000). Furthermore, a significant proportion of women are still not tested during pregnancy or in labor (Bulterys, et al., 2004 Lansky, et al., 2001 Aynalem, et al., 2004). As an alternative to testing women (with consent), some...

Operational Definition of Premature Ejaculation

DSM-IV (47) defines premature ejaculation as persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before the person wishes it. Until recently, any scientific basis for the DSM-IV definition was lacking. For instance, the meaning of persistent, recurrent, minimal, and shortly after is vague and certainly needs further qualification. In order to get an empirically operationalized definition, Waldinger and co-workers investigated 110 consecutively enrolled men with lifelong premature ejaculation (48). In this study, men and their female partners were instructed to use a stopwatch at home during each coitus for a period of 4 weeks (Fig. 9.2). It was found that 10 of these men ejaculated between 1 and 2 min but that the majority (90 ) of them ejaculated within 1 min of intromission, and even 80 actually ejaculating within 30 s whereas 60 ejaculated within 15 s (48). The age of the men and duration of their relationship were not...

Age Changes in Sexual Behavior

Today, sex appears to be more popular than ever. Both the frequency of sexual intercourse and the variety of techniques used are appreciably greater than they were prior to the 1960s (Rosen & Hall, 1984). In one study, it was found that three-fourths of all 19-year-olds reported having sexual intercourse. Apparently, a sizable number of this group was quite busy in college. An estimated 28 of males and 29 of females in their freshman year of college reported having had premarital intercourse, but these figures had risen to 82 and 86 , respectively, by their senior year (Centers for Disease Control, 1992). Statistics such as these provide support for the description of late adolescence and early adulthood as a time of raging hormones, a characterization that seems truer for males than for females. In males, the sexual urge reaches a peak during the late teens or early twenties, but not until a decade or so later has it reached its peak in females. This observation provides support...

A core concern for privacy personal information or beyond

Information concerning how an individual voted at the last general election, how frequently she has sexual intercourse, her divergent sexual habits, her mental health, suicide attempts, misuse of drugs or alcohol and genetic predispositions to illness or congenital handicaps are classified as 'highly sensitive'. In comparison, information relating to an individual's previous address, the fact that she is adopted, her NHS number, her absences from work or her credit rating are examples of information of'moderate sensitivity'. Finally, information of 'low sensitivity' includes sporting activities, membership of clubs, employer details, home address and the fact that an individual wears glasses. Wacks identifies six factors which assist in the categorisation of personal information.128 These are

Environmental Sex Determination

Environmental factors are also important in determining sex in many reptiles. Although most snakes and lizards have sex chromosomes, in many turtles, crocodiles, and alligators, temperature during embryonic development determines sexual phenotype. In turtles, for example, warm temperatures produce females during certain times of the year, whereas cool temperatures produce males. In alligators, the reverse is true.

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