Case study

Bob is a 55-year-old man who had been married for 27 years to Marie (not their real names). He works as a sales manager. They have two children, the youngest of whom moved out 1 year ago. She has had no major health problems. He has had diabetes for 5 years and the main treatment was diet, exercise (because he was greatly overweight), and an oral medication.

He described erection problems and waning sexual desire over the previous 2 years. He could not say which developed first. He reported thinking little about sexual matters in the present and only occasionally trying to engage in sexual activity with his wife—usually on her initiative. He also reported no inclination to masturbate and added that since he married, he "didn't need to", given that sexual activity with his wife was sufficient for his sexual needs. In the present, he said that pictures of women undressed did not "do anything" for him. His erections with his wife were 5/10 (on a scale of 0-10 where 0 meant no erection whatsoever, and 10 was full and stiff. He was not aware of morning erections although would sometimes wake up with some swelling of his penis (about 2-3/10). The last time he recalled a full erection under any circumstance was about 4 years prior. He did not report ejaculation difficulties now or in the past but did say that the intensity of his orgasm had lessened.

Bob was all the more distressed because his current sexual status was markedly different than in the past. Until recent years, he would have sexual thoughts regularly, took the initiative in inviting his wife to bed (several times each week), enjoyed looking at women's bodies especially in the summertime when they were less covered, and had no erection problems prior to about 4 years ago.

He wondered if the sexual changes were a result of his age. He had read an article in a newspaper about "andropause" and thought that this might be the explanation of his difficulties. He asked his family doctor about oral medications for "ED" (he had seen advertisements on television), and testosterone, and received both. Neither oral medications nor three injections of testosterone resulted in any sexual change. When he was seen in consultation by a "sex specialist" who asked about his knowledge of the connection between diabetes and sexual difficulties, he recalled hearing something in a diabetic clinic he had attended but confessed that his knowledge was only fragmentary.

Unfortunately, most of the empirical research on HSDD in men has either not subtyped the syndrome, or the report is unclear and results are embedded in a difficult-to-interpret melange of information. For example, one study separated three groups of college-age men: those with "Inhibited Sexual Desire" (ISD—a term that was used in earlier versions of the DSM for HSDD), erectile dysfunction, and controls (14). Not surprisingly, the men with ISD fantasized less about sexual matters than the other two groups. However, the ISD group masturbated more than the other two. Evidently, there were many men with a situational desire disorder in the ISD group. To illustrate the lack of clarity about what constituted a diagnosis of ISD as well as the absence of subtyping, two men who described no fantasy at intake were excluded from the study!

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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