Psychoanalytic Models of Etiology

Psychoanalytic writers posit that early life experiences are fundamentally related to the development of the paraphilias. Stoller asserted that vengeful hostility, in response to the young child's ambivalent struggle to separate from his mother, is the core of all perversion (67). Many variations of this theme have been proposed. Psychoanalytic theory suggests that fetishism is due to unconscious fears and a sense of inadequacy related to early childhood experience (68,69). Freud proposed that...

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...

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...

Is Absent or Impaired Genital Responsiveness a Valid Diagnostic Criterion

In a recent study we investigated whether pre- and postmenopausal women with sexual arousal disorder are less genitally responsive to visual sexual stimuli than pre- and postmenopausal women without sexual problems (42). Twenty-nine women with sexual arousal disorder (15 premenopausal and 14 postmenopausal), without any somatic or mental comorbidity, diagnosed using strict DSM-IV criteria, and 30 age-matched women without sexual problems (16 premenopausal and 14 postmenopausal) were shown...

William L Maurice

Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada Sexual Desire Differences in Men and Women 69 Normal Sexual Desire for Men 72 Components and Measurement (21) 83 Normal Aging Changes in the Quantity 84 Origin, Production, and Control 85 Theoretical Perspectives Biological, Psychological, and Social 88 Endocrine Abnormalities 89 Presence of Another Sexual or Gender Disorder in a Patient or Partner 89 Sexual Difficulties in a Partner 90 Paraphilias...

References

Sexual desire, orgasm, and sexual fantasies a study of 625 Danish women born in 1910, 1936 and 1958. J Sex Educ Ther 1991 17 111-115. 2. Hill CA, Preston LK. Individual differences in the experience of sexual motivation theory and measurement of dispositional sexual motives. J Sex Res 1996 33(1) 27-45. 3. Galyer KT, Conaglen HM, Hare A, Conaglen JV. The effect of gynecological surgery on sexual desire. J Sex Marital Ther 1999 25 81-88. 4. Schultz WCM, van de...

Anatomy and Physiology

Clitoris and Surrounding Erectile Tissue There is a considerable density of tactile receptors in the clitoris. The anterior vaginal wall is also rich in tactile receptors. Freud (23) entertained a developmental idea about excitability to explain how a little girl turns into a woman. He argued that from the onset of puberty, libido increases in boys at the same time, in girls, a fresh wave of repression occurs that affects clitoridal sexuality. This finite period of anasthesia, Freud thought,...

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....

Blood Investigations

Order blood investigations depending on your findings. In our clinic, men are offered tests for fasting glucose prolactin levels high density lipoprotein ratio and triglycerides a 9 am testosterone, SHBG and free androgen index. Other specific tests may be appropriate (e.g., LH and free testosterone TSH). Some centers are able to offer further investigations. To assess erectile function, nocturnal penile tumescence (NPT) can be assessed using strain gauges. However, rigidity is seen as an...

Subtypes of HSDD

Clinicians are directed to subtype the diagnosis of HSDD, that is, to say if the pattern has been (A) lifelong or acquired (i.e., always existed since puberty or followed a period of normal sexual desire), (B) situational or generalized (i.e., has existed only in some sexual circumstances or all) and (C) due to psychological or combined factors. Maurice (12 pp. 54-55) considers diagnostic subtyping to be clinically useful in helping to point towards the etiology and thus assessment and...

Treatment Protocol

Treatment according to protocol comprises an, at the start, unknown number of sessions. The first session takes 45-60 min. Subsequent sessions take 20 min. Sessions are held once every 2-4 weeks. Major components of the treatment include information about vaginismus, a physical examination, explanation of the treatment, behavioral therapy, sensation focus exercises, pelvic floor muscle exercises, systematic desensitization, and cognitive therapy. These components do not have a fixed order they...

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...

Vulvar Vestibulitis Syndrome

Treatment for vestibulitis is typically guided by the medical model. This model follows a traditional strategy of starting with conservative, non-invasive treatments and progressing to more invasive ones (89). Palliative interventions (e.g., sitz baths) to reduce the pain are the first-line treatment choice for dyspa-reunia. If these are not effective, treatment progresses to topical interventions (e.g., lidocaine, corticosteriods), systemic medications (e.g., oral corticosteriods,...

Definition

In DSM-IV (American Psychiatric Association, 1994), retarded ejaculation is termed Male Orgasmic Disorder and defined as a persistent or recurrent delay in, or absence of, orgasm in a male following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration. In more simple terms, retarded ejaculation means that a man finds it difficult or impossible to ejaculate, despite the presence...

Diagnosing FSAD

FSAD refers to inhibition of the vasocongestion-lubrication response to sexual stimulation (1). In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), FSAD (302.72) is defined as the pervasive or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement, coupled with marked distress or interpersonal difficulty (1). The DSM classification of sexual disorders...

Sexual Desire Disorders

The DSM-IV-TR (6) category of Sexual and Gender Disorders is divided into three parts, one of which is Sexual Dysfunctions. One of the group of sexual dysfunctions is Sexual Desire Disorders (SDD) of which there are two kinds (A) hypoactive sexual desire disorder (HSDD) and (B) sexual aversion disorder (SAD). No distinction is made between SDDs that affect men and those affecting women. The assumption is evidently made that sexual desire and desire problems are the same in both gender groups a...

Does He have a Vascular Basis to His ED

Diabetes, smoking, hypertension, hyperlipidaemia, and so on, are all underlying causative factors for vascular impairment. Since the erectile response is a hemo-dynamic event, it is hardly surprising that damage to the vessels will result in partial or complete loss of the ability to not only achieve but also maintain an erection long enough for it to be useful to its owner and his partner. A standard vascular examination can reveal important clues that may not only indicate a vascular reason...

Pharmacological Treatment of the Paraphilias

There is no data to suggest that pharmacological intervention cans specifically target or ameliorate underlying paraphilic mechanisms. Rather, pharmacological interventions are either symptom focused or directed toward ameliorating or managing comorbid conditions. For example, where hypersexuality is a factor, pharmacological treatments are commonly implemented to lower libidinal drive where concurrent mania fosters hypersexuality, mood stabilizing agents are indicated where comorbid depression...

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...

Other Unlicensed Treatment Therapies for Men with ED

Several new formulations are being developed, such as topical alprostadil and intranasal apomorphine. New agents are being developed, including selective PDE3 4 5 inhibitors MS-223131 (Bristol-Myers Squibb), T-1032 (Tanabe Seiyaku), TA-1790 (Vivus), sildenafil nitrate (NCX-911) (NicOx) nonselective inhibitors of postsynaptic alpha-adrenoceptors within the corpus cavernosum phentolamine (Vasomax Schering Plough), melanocortin receptor agonists such as melatonan II (Palatin) (s.c. and intranasal)...

Lifelong Delayed Ejaculation

According to the classical psychological view, lifelong delayed ejaculation is attributed to fear, anxiety, hostility, and relationship difficulties (85-87). Many different manifestations of anxiety and fear have been hypothesized, including fears of death and castration, fear of loss of self resulting from loss of semen, fear of castration by the female genitals, fear that ejaculation would hurt the female, fear of being hurt by the female, performance anxiety, unwillingness to give of oneself...

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

For one or more of the earlier mentioned reasons, a woman choosing to be receptive to sexual stimuli (or to provide them) can subsequently become sexually aroused. The degree of emotional intimacy with her partner that may have even been the major motivating force, is also a very important influence on her arousability to the sexual stimuli. Various other psychological and biological factors will influence this arousability such that the processing of the sexual information in her mind may or...

Etiologysexual Disorder

The syndrome is probably very rare. Treatment No treatment is available yet. CONCLUSIONS 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...

Marcel D Waldinger

Leyenburg Hospital, The Hague, The Netherlands Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute for Neurosciences, Utrecht University, Utrecht, The Netherlands Neurobiology of Ejaculation 219 Serotonin, 5-Hydroxytryptamine Neurotransmission and Positron Emission Tomography-Scan Studies in Humans 222 The First Period (1887-1917) Early Ejaculation 223 The Second Period (1917-1950) Neurosis and Psychosomatic Disorder 223 The Third Period (1950-1990) Learned Behavior 224...

Psychological Treatment of the Paraphilias

As earlier research has demonstrated, medication may modify target symptoms such as anxiety, depression, obsessionality, or hypersexual drive, but cannot cure the paraphilia or interpersonal problems (166). Psychotherapy is essential to foster compliance with medication, ameliorate attitudinal problems, and to develop cognitive skills in resisting and managing paraphilic fantasies and urges. Because concurrent treatment modalities may demand the involvement of multiple clincians, issues of...

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...

The Behavioristic View

Another view on the origination of vaginistic reaction comes from the behavior-istic angle. Although the majority of authors with this point of view agree that vaginismus is a conditioned anxiety reaction that results in spasm of the entrance to the vagina 23-26 , only a small minority give an explanation for the origination of this behavior. Brinkman, for instance, gave an explanation model 27 . He assumed that vaginismus is the end result of a classic conditioning process in which painful...

Surgical Interventions for Men with ED

Penile arterial revascularization is only appropriate in young patients with demonstrable arteriogenic ED due to congenital vascular anomalies or traumatic injuries to the pudendal or penile arteries e.g., after road traffic accidents . There are three forms of penile prostheses available semi-rigid, malleable, and inflatable. Typical candidates for a penile implant are patients with chronic disease states such as long-term diabetes and end-organ failure or severe arterio-genic impotence...

Case Study

Jim, 32 years old, and Rebecca not their real names , 31 years old, were referred to a psychiatrist because of lack of sexual desire on Jim's part. They had been married for 5 years and did not have children. Actually, Rebecca initiated the referral through their family doctor. In tears, she told the doctor of her longing to have children and hearing the ticking of the biological clock. In the course of asking detailed fertility-related questions, the doctor discovered that intercourse was...

The Ejaculation Distribution Theory of Premature Ejaculation

Waldinger 5,49 formulated a new theory on the etiology and genesis of lifelong premature ejaculation. He postulated that lifelong premature ejaculation is not an Figure 9.2 The IELT 29 measured by stopwatch in a sample of 110 Dutch males with lifelong premature ejaculation. Ninety percent ejaculates within 1 min and 80 ejaculates within 30 s 48 . Figure 9.2 The IELT 29 measured by stopwatch in a sample of 110 Dutch males with lifelong premature ejaculation. Ninety percent ejaculates within 1...