Female Sexual Arousal Disorder - Sexual Feelings

Emotions are certainly not determined by distinctive stimuli, however by the meaning the spur has aquired some decade. Newly, Damasio introduced in my milieu the call "emotionally competent stimulus," referring to qualify for the complain or incident whose existence, actual or in mental retract, triggers emotion. Whereas there exists biologically pertinent stimuli that are innately pleasurable or aversive, nearly all stimuli shall acquire sense through classical conditioning. Lets consequence, meanings as in stimuli depend over the individual's bygone experience, and as well may vary from one individual with another. Stimuli might possess conveyed many meanings, as well as meanings pertinent for diverse emotions may very well be represent simultaneously. Moreover, this cost as in a spur may disagree over period since it will be influenced by the current inside position of a typical being. Hence, this pleasing respect of a incentive is reliant by the stream internal majesty, and so on prior experience with that incentive.

There is an increasing notion that emotional responses are mandatory or precede feelings. Damasio stresses which all living organisms are intuitive using policy produced to unravel automatically, lacking prim reasoning necessary, this primitive evils of life. He calls my utensils of life governance a "homeostasis robot." At the center set by the organization as in that machinery are plain responses such as style or withdrawal the mortal virtual to some point, and additionally increases or decreases in activity. Advanced up in the organization there exists competitive or cooperative responses. This simpler reactions are incorporated because components of an and yet elaborated together with involved ones. Emotion are high at a organization, using added complexity as in appraisal and even retort. According to Damasio, an emotion is often a dense collection of element and then neural responses forming a distinctive outline. When the intellect detects an emotionally competent incentive, a emotional responses are fashioned automatically. This product because of the responses is often a transient modify of the nation inside of body, and as well of the reason structures which map this body also base thoughts. Damasio and then LeDoux, along with a long period while them James, stress that the conscious experience as in emotion, what we call feelings, will probably be the product within perception of these changes. In my watch, feelings are based at the opinion of a typical emotional physical together with reason responses at the brain; they are the end effect from your complete "machinery of emotion."

Just, functional imaging studies showed that the subjective experience as in countless emotions such as anger, disgust, anxiety, not to mention sexual awakening is associated having activation through the insula plus the orbitofrontal cortex. It has been optional that the insula is involved in this representation of peripheral autonomic combined with somatic awakening which provides effort with conscious awareness as in emotional states. It seems that the advice of autonomic also somatic responses are integrated in a so-called meta-representation within the long run proper fore insula, and this meta-representation appears to provide this base targeted "the subjective icon from your data person for a emotion creature, which is usually emotional awareness".

In men in addition to women alike, meanings as in a sexually competent spur may automatically spawn a genital reply, arranged this genital reply method are intact. This difference between men and as well women in experienced sexual feelings have to do in the virtual contribution as in two sources. Talk about supply is a logically awareness of that automated genital comeback (peripheral comment), which will be a and yet vital basis formen's sexual feelings than targeted women's sexual feelings. Targeted women, a stronger contribution in sexual feelings will come from a trice informer, a meanings generated by the sexual stimulus. In other words, women's sexual feelings will be determined with a superior amount by all kinds as in (certain as well as antagonistic) meanings through the sexual spur than by real genital reply.

Canli et al. found defend for the thought which emotional stimuli activate explicit memory greater promptly in women than in men. They requested 12 women and therefore 12 men, during functional MRI, in time a intensity of their emotional arousal with 96 pictures ranging from neutral in contravening. After 3 weeks, these were given an unexpected recall mission. It found which women rated added pictures because very negatively affecting than did men. A memory brief revealed that women had better recall for the nearly all intensely unhelpful cinema. Exposure for the emotional stimuli resulted in left amygdala activation in both sexes, this inner wits configure for implicit recall. In women only, this left amygdala and as well right hippocampus were activated during the greatest emotionally touching stimuli which were also recognized 3 weeks later. Graphic recall are situated into the neocortex and therefore is mediated by the hippocampus. These findings can evoke that in processing emotional stimuli, exact recall is extra gamely accessible in women. If these findings would organize for sexual stimuli, we can have a neural core targeted our suggestion which sexual stimuli activate plain memory in women, and the this different meanings sexual stimuli can possess, affect sexual feelings.

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Male Enhancement Plastic Surgery firm known as Male Enhancement Group which is dedicated with researching and furthermore comparing male enhancement cream in order to determine which male enhancement goods is safer and so extra potent than other goods about the market. Copyright 2009 David Crawford of Penis Extenders This article might well be freely distributed but if this particular resource box remains attached.

Treatment of Sexual Disorders - Evolution of Current Treatment Approaches

Activation Then Regulation As In Sexual Response

Processing of Sexual Information

In a series of studies we conducted within the long run 1990s, we consistently found that women's genital response and so sexual feelings are not 136 Laan, Everaerd, as well as Both strongly correlated, as affect influences sexual feelings. Other studies had similar findings. In men, correlations between genital response and then sexual feelings are usually significantly positive, suggesting which for men's sexual feelings awareness of their genital response is known as a most important source.

A surprising finding of our studies was the ease with which healthy women become genitally aroused in response to erotic film stimuli. As watching an erotic film depicting explicit sexual activity, best women respond with increased vaginal vasocongestion. That increase occurs within seconds after the onset inside the stimulus, which suggests a relatively automatized response mechanism for which conscious cognitive processes ordinarily are not necessary. Even when these explicit sexual stimuli are negatively evaluated, or induce little or no feelings of sexual arousal, genital responses are elicited. Genital arousal intensity was found to covary consistently with stimulus explicitness, defined given that the extent to which sexual organs and then sexual behaviors are exposed. This particular automatized response occurs not only in young women without sexual problems, unfortunately also in women with a testosterone deficiency, in postmenopausal women, combined with in women with sexual arousal disorder. Such responses are also found during unconsensual sexual activity.

Such a highly automatized mechanism is adaptive of a strictly evolutionary perspective. Whether genital responding in sexual stimuli did not crop up, our species should not survive. For women, a rise in vasocongestion produces vaginal lubrication, which obviously facilitates sexual interaction. One might be tempted in assume which, targeted adaptive reasons, this explicit visual sexual stimuli used in our studies represent a class of unlearned stimuli, in which we are innately prepared to respond. These stimuli seem to override this effects of various attempts at voluntary control.

Emotional stimuli could evoke emotional responses without the involvement as in conscious cognitive processes. For instance, subliminal presentation of slides using phobic objects outcome in fear responses in phobic subjects. While stimuli are consciously recognized not to mention processed, they are evaluated, for instance as being good or bad, attractive or dangereous. According to O'hman, this evolutionary relevance as in stimuli is a logically most salient prerequisite for such a quick, preattentive analysis. Perhaps sexual stimuli fall within this category and can they be unconsciously evaluated not to mention processed. A number of experiments in which sexual stimuli were presented subliminally in male subjects showed that this is indeed possible. Preattentive processing as in sexual stimuli occurs in women as well, nonetheless looks with be dependent upon this type as in prime. Explicit sexual primes do not lead with priming-effects, then again romantic sexual primes do. This particular seems in contradict Ohman's notion that evolutionary relevant primes is generally unconsciously processed. Likely, preattentive processing is not entirely governed by evolution, but yet partly the result of overlearning or conditioning.

A prerequisite of automatic processing seems to be that sexual meaning resulting of visual sexual stimuli is easily accessible in memory. Regarding basis of a series of priming experiments Janssen et al. presented an information processing model of sexual response. Two information processing pathways are distinguished. The pioneer pathway are about appraisal of sexual stimuli and therefore response generation. That pathway is thought to depend largely on automatic or unconscious processes. The next pathway concerns attention and regulation. In this particular model, sexual arousal are assumed to begin with the activation as in sexual meanings that are stored in explicit memory. Sexual stimuli might elicit other diverse memory traces depending upon the subject's prior experience. This particular in turn activates physiological responses. It directs attention on the stimulus or ensures which attention remains focused along the sexual meaning because of the stimulus. This particular harmonic cooperation between the automatic pathway together with attentional processes eventually results in genital responses and even sexual feelings. Disagreement between sexual response components could befall, according to this model, when the sexual stimulus elicits sexual meanings yet somehow also nonsexual, not to mention more specifically, antagonistic emotional meanings. This sexual meanings activate genital response, nonetheless the balancing of sexual not to mention nonsexual meanings determine to what extent sexual feelings are experienced.

This fact that disagreement between genital combined with subjective sexual arousal happens more often in women might suggest which for women sexual stimuli need, added often than for men, sexual on the other hand also nonsexual or even negative meanings. There is some evidence that sexual stimuli generate negative sexual meanings in women more often than in men. Sexual stimuli evoke mostly positive sexual emotions in men, nevertheless a host as in other nonsexual meanings, both positive and antagonistic, in women.

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David Crawford is the CEO and owner of a Male Enhancement Products company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of Male Enhancement Facts This article may be freely distributed if this resource box stays attached.

Sexual Disfuncombination therapyion Combination Therapy Guidelines Who, How, and When?

Female Sexual Arousal Disorder - Diagnostic Procedures

An ideal protocol for the assessment as in FSAD should be constructed following theoretical and additionally factual knowledge through the physiological, psychophysiological, and in addition psychological mechanisms involved. A protocol then describes the most parsimonious route from presentation as in complaints to efficient therapy. Unfortunately, we are at present far from a consensus on the best probable causes of FSAD. Despite this disagreement, at least two diagnostic procedures should be considered. Firstly, assessment of sexual dysfunction in a biopsychosocial context should start with a verification with all the chief complaints in a clinical interview. The aim of the classic clinical interview will be to gather information concerning current sexual functioning, onset with all the sexual complaint, a context in which a difficulties turn up, or psychological issues that might provide because etiological or maintaining factors for the sexal problems, such as depression, anxiety, personality factors, detrimental self- and therefore body image, plus feelings as in shame or guilt which might result from religious taboos. Sexual problems are common complications of anxiety disorders in addition to impaired sexual desire, arousal together with satisfaction. Laboratory studies suggest potential enhancement of genital arousal by a number of kinds anxiety, yet the precise cognitive, affective, or physiological processes by which anxiety and in addition women's sexual function are related have as yet to be identified. A ongoing works as in Bancroft and also Janssen exploring a dual control model of sexual excitation and then inhibition in men as well as in women, may clarify each role as in anxiety in women's predisposition in sexual inhibition together with to sexual excitement. Essentially the most important but yet hard tasks ?s always to assess whether inadequate sexual stimulation are underlying this sexual problems, which requires detailed probing as in (number bunch lot in) sexual activities, conditions under which sexual activity takes position, before sexual functioning, and also sexual together with emotional feelings for the partner. Several studies have shown which antagonistic sexual combined with emotional feelings for the partner are between the perfect predictors targeted sexual problems. This clinician should always ask in the event the woman has ever experienced sexual abuse, as this particular can seriously affect sexual functioning. Part of women do not feel sufficiently safe during the initial interview to reveal such experiences; nevertheless, it is necessary to inquire about sexual abuse to earn clear that traumatic sexual experiences is often discussed. The initial clinical interview should accommodate a clinician in formulating the situation as well as in deciding what therapy is indicated. An important issue may very well be agreement between therapist and then patient about the formulation of the classic obstical and nature after the therapy. To reach a decision in take therapy, the patient needs to be properly informed about just what diagnosis and also remedy involve.

Ideally, in the case of suspected FSAD, the initial interviews is followed by a psychophysiological assessment. In assessment inside of physical aspects of sexual arousal, the main question to be answered are whether, using adequate stimulation by means of audiovisual, cognitive (fantasy), and/or vibrotactile stimuli, a lubrication-swelling response is possible. Although psychophysiological testing with date are not a routine assessment, we feel that such a make sure it works are crucial in establishing a etiology as in FSAD for two reasons. The learn that was discussed extensively inside your previous paragraph demonstrated how challenging it is to rule out which sexual arousal problems commonly are not caused by a lack of adequate sexual stimulation. Secondly, it showed which impaired genital response cannot be assessed regarding basis of an anamnestic interview. Women using sexual arousal disorder could possibly be less aware of their own genital changes, using which these lack adequate proprioceptive feedback which may further increase their arousal. If a genital response is possible, even for other investigations indicate a existence as in a variable that might compromise physical responses, an organic contribution towards the arousal problem because of the individual women are clinically irrelevant. As was shown before, sexual arousal problems in medically healthy women are greatest likely additional often related to inadequate sexual stimulation due to contextual and therefore relational variables than to somatic causes. For estrogen deplete women, care require to be taken not to simply facilitate painless intercourse up in the nonaroused state with a lubricant yet somehow with consider the possibility which estrogen lack has unmasked long-term lack as in sexual arousal that has been as in contextual etiology. As in note, nonresponse of the psychophysiological assessment doesn t have automatically imply organicity. A woman can possess been too nervous or distracted for the stimuli to be effective, or this stimuli offered would not have matched her sexual preferences. This particular problem of suboptimal sensitivity are not unique with this make sure it works, multiple other well established diagnostic tests of this particular nature have a similar disadvantage.

Two other procedures could be used to corroborate findings that come from the clinical interview along with psychophysiological assessment. Bring in the profits shall be the employ of selfreport measures supplementary on the clinical interview. A Female Sexual Function Index (FSFI) is known as a brief, multidimensional scale targeted assessing sexual function in women, also is currently the most often utilised scheme. Recently, diagnostic cutoff marks were developed by means of sophisticated statistical procedures. Self-report measures may not be very useful targeted clinical purposes for they lack sensitivity not to mention specificity with regard in causes of an individual patient's dysfunction.

Secondly, a careful focused pelvic exam in medically healthy women is possibly in order for lack of arousal are accompanied by complaints as in pain or vaginistic response during sexual activity, or every time a psychophysiological assessment has yielded nonresponse. Within the long run latter case, rare diseases like connective tissue disorder, may well identified. At your former cases a purpose of a typical exam may be additional educational than medical, for instance to observe the consequences of pelvic floor muscle activity. An examination which found no abnormalities can also be as in therapeutic value. Sometimes a general physical examination, not to mention central nervous trading system or hormone levels are necessary, although in most of the cases only genital examination is required. In women using neurological disease affecting pelvic nerves or with a history as in pelvic trauma, a detailed neurological genital exam might well be required, clarifying light touch, pressure, pain, temperature sensation, anal or vaginal tone, voluntary tightening of anus, and furthermore vaginal or bulbocavernosal reflexes. The clinician should be aware of a typical emotional impact of a physical examination and the importance of timing. Because a woman is very anxious about being examined it will be appropriate in wait until she feels over secure. In the case of women who are generally not familiar using self-examination of their genitalia, it is preferable to advice self-examination at residence before a doctor carries out an examination. It is recommended that the procedure is interpreted in detail, what will not to mention what will not take place, as well as the woman's understanding and in addition consent obtained. It is necessary to realize which each medical exam is not capable in examine function, because the genitalia are examined in a nonaroused state. Because such, a medical exam can never replace a psychophysiological assessment.

About The Author

David Crawford is the CEO and owner of a Male Enhancement Pills company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of Male Enhancement Pills This article may be freely distributed if this resource box stays attached.

Sex Therapy

Is Absent or Impaired Genital Responsiveness a Valid Diagnostic Criterion?

In a recent study we investigated whether pre- together with postmenopausal women with sexual arousal disorder are less genitally responsive with visual sexual stimuli than pre- and thus postmenopausal women without sexual problems. Twenty-nine women with sexual arousal disorder, without each somatic or mental comorbidity, diagnosed using strict DSM-IV criteria, and thus 30 age-matched women without sexual problems were shown sexual stimuli depicting cunnilingus combined with intercourse. Genital arousal was assessed as vaginal pulse amplitude (VPA) using vaginal photoplethysmography. We found no significant differences in mean plus maximum genital response between the women using and thus without sexual arousal disorder, nor in latency as in genital response. A women with sexual arousal disorder were no less genitally responsive to visual sexual stimuli than age- and therefore menopausal status-matched women without such problems, even though they had been carefully diagnosed, using strict and furthermore unambiguous criteria of impaired genital responsiveness. These findings are in line with previous studies. A sexual problems these women report were openly not related to their ability in become genitally aroused. In medically healthy women absent or impaired genital responsiveness are not a valid diagnostic criterion.

It is clear that the sexual stimuli used in that laboratory study (perhaps though these stimuli were merely visual) were practical in evoking genital response. In an ecologically extended valid environment (e.g., at home), sexual stimuli cannot always be present or capable. Sexual stimulation must possess been capable at one point at the participants' lives, as primary anorgasmia was an exclusion criterion. Perhaps though a serious attempt was made in rule out lack as in adequate sexual stimulation various skills element explaining the sexual arousal problems, data on sexual responsiveness collected inside your anamnestic interview suggested that the women diagnosed using sexual arousal disorder are unable, in the present circumstances, to provide themselves with adequate sexual stimulation. The exclusion, halfway because of the learn, of a participant who no longer met a criteria targeted sexual arousal disorder after having met a young sexual partner, also illustrates that inadequate sexual stimulation could be about the most important reasons for sexual arousal problems.

In this particular study, genital responses did not differ between a groups with and additionally without sexual arousal disorder, still sexual feelings not to mention affect did. A women with FSAD reported weaker feelings of sexual arousal, weaker genital sensations, weaker sensuous feelings not to mention wonderful affect, together with stronger contravening affect in response with sexual stimulation than a women without sexual problems. Two explanations might account for this. Firstly, women using sexual arousal disorder might differ from women without sexual problems for their appreciation as in sexual stimuli. These stimuli, even though we were holding capable in generating genital response, evoked feelings of anxiety, disgust, also worry. These contravening feelings may possess downplayed reports of sexual feelings, and as well were probably evoked by the sexual stimuli as well as not by the participants becoming aware of their genital response, as reports as in genital response were unrelated in actual genital response. Antagonistic appreciation as in sexual stimuli might extend to, and perhaps perhaps be amplified in, real-life sexual situations, for in such situations, any contravening affect (i.e., towards the partner or the sexual interaction) may well be over salient. Contravening affect can, therefore, be partly responsible for the sexual arousal problems active in the women diagnosed using sexual arousal disorder.

Secondly, women with sexual arousal disorder might be less aware of their own genital changes, with which these lack adequate proprioceptive suggestion that might further increase their arousal. The general absence as in meaningful correlations between VPA and as well sexual feelings in this particular and as well other studies (view next section) supports this particular notion. Perhaps women with sexual arousal disorder possess less intense feedback that come from the genitals within the brain; there exists no data, at present, in substantiate this particular thought. It is impossible to decide which of these explanations are greater likely, for in real-life situations it might never be proven using certainty which sexual stimulation are adequate, combined with awareness of genital response are dependent upon a intensity with all the sexual stimulation. In addition, these explanations are usually not mutually exclusive. We might conclude, however, that the sexual problems of a typical women using sexual arousal disorder will not be related to their ability in become genitally aroused. We propose that in healthy women using sexual arousal disorder, lack as in adequate sexual stimulation, using or without concurrent detrimental affect, underlies this sexual arousal problems.

Organic etiology can underlie sexual disorders in women with a medical condition. There are only a handful as in studies that possess employed VPA measurements in women with a medical condition. A only psychophysiological study in date which found a significant effect of sildenafil on VPA in women with sexual arousal disorder was done in women with SCI, suggesting which in this particular group there was an impaired genital response that can be improved with sildenafil. Another learn compared genital response during visual sexual stimulation of women using diabetes mellitus and then healthy women, showing which VPA was significantly lower covered in the first group. A very recent learn measured VPA in medically healthy women, in women who had undergone a simple hysterectomy, and so in women with a history as in radical hysterectomy targeted cervical cancer. Only given the last group was VPA during visual sexual stimuli impaired, whereas a women using easy hysterectomies reported with experience more sexual problems than the other two groups. Not presence as in sexual arousal problems nonetheless presence as in a medical condition which influences sexual response may therefore be the most important determinant as in impaired genital responsiveness.

Medical conditions which possess been associated using sexual arousal disorder, other than SCI and thus diabetes, are pelvic in addition to breast cancer, multiple sclerosis, brain injury, and so cardiac disease. Mental disorders such as depression can also interfere using sexual function. It can be vital in consider the direct biological influence of disease on sexual pathways and function, and yet equally important s the impact of an experience as in illness. Disease might modify body presentation and body esteem; ideal sexual scenarios is disturbed by constraints that accompany illness. In several patients, sexual arousal and as well desire may decrease in connection using grief about the loss of normal health together with uncertainty about illness outcome. Damage in the autonomic pelvic nerves, which are not always readily identified in surgery to rectum, uterus, or vagina, are associated with sexual dysfunction in women. Medications such as antihypertensives, selective serotonine reuptake inhibitors, and thus benzodiazepines, and chemotherapy, nearly all likely due to chemotherapy-induced ovarian failure, impair sexual response. In addition, the incidence of women complaining of lack of sexual arousal increases at the years around the natural menopausal transition. According to Park et al., postmenopausal women using sexual complaints, who end up not being on estrogen replacement therapy, are particularly vulnerable in is a part call a vasculogenic sexual dysfunction. However, psychophysiological and then preliminary functional magnetic resonance imaging studies as in increases in genital congestion in response with erotic stimulation, fail to identify contrast between pre- and thus postmenopausal women. That can suggest that although urogenital aging results in changes in anatomy in addition to physiology inside genitals, postmenopausal women preserve their genital responsiveness to sufficiently sexually stimulated. This vaginal dryness and furthermore dyspareunia experienced by a few postmenopausal women may result of longstanding lack of sexual arousal/protection from pain previously afforded by estrogen related relatively high blood flow with your unaroused state.

About The Author

David Crawford is the CEO and owner of a Male Enhancement Facts company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of Male Enhancement Facts This article may be freely distributed if this resource box stays attached.

Treatment of Sexual Disorders - Evolution of Current Treatment Approaches

Female Sexual Arousal Disorder - Diagnosing FSAD

FSAD refers to inhibition of the "vasocongestion-lubrication response" to sexual stimulation. 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. The DSM classification of sexual disorders has been derived from phases of the sexual response cycle, on the basis of the work of Masters and Johnson and Kaplan. This model depicts a sexual desire phase and a subsequent sexual arousal phase, characterized by genital vasocongestion, followed by a plateau phase of higher arousal, resulting in orgasm and subsequent resolution. It is assumed in this model that women's sexual response is similar to men's, such that women's sexual dysfunction in DSM-IV mirrors categories of men's sexual dysfunction. In contrast to the third edition of the DSM manual, subjective sexual experience is no longer part of the definition, possibly in a further attempt to match norms and criteria for men's and women's sexual dysfunctions.

There are a number of serious problems with the current DSM-IV classification criteria. Firstly, although the DSM-IV explicitly requires the clinician to assess the adequacy of sexual stimulation only when considering the diagnosis of FOD, adequacy of sexual stimulation is a critical variable in evaluating each of the female sexual dysfunctions, and FSAD in particular. Exactly what is adequate sexual stimulation? Some sort of physical (genital) stimulation is a necessary, but not necessarily sufficient, prerequisite for arousal. For many women, adequate sexual arousal involves physical as well as "psychological" and "situational" stimulation, such as intimacy with a partner, the exchange of confidences, the sharing of hopes and dreams and fears, and not only directly prior to the sexual event. What if certain types of sexual stimulation have been adequate in the past, but not anymore? Is it evidence of FSAD, or could it be explained in terms of habituation or an adaptation to changing life circumstances? And what is meant by "completion of the sexual activity?" Is it masturbation to orgasm, sexual contact with a partner, sexual contact including coitus? These are very different activities that are known to differ in their sexually arousing qualities.

Secondly, the description of the first problem demonstrates that clinical judgements are required about sexual stimulation and the severity of the problem, the validity of which is questionable. The clinician has to evaluate what is normal, based on age, life circumstances, and sexual experience. Research on the basis of which clear criteria can be formulated, is lacking. There is a great variety in the ease with which women can become sexually aroused and which types of stimulation are required.

Thirdly, due to the lack of clear diagnostic criteria, it is often unclear in which cases an FSAD diagnosis or one of the other three main DSM-IV diagnoses is appropriate. The four primary DSM-IV diagnoses pertaining to lack of desire, arousal, orgasm problems or sexual pain, are not independent. Only very infrequently do women present with sexual arousal problems when seeking help for their sexual difficulties, but that does not mean that insufficient sexual arousal is an unimportant factor in the etiology of these difficulties. In actual clinical practice, classification is often done on the basis of the way in which complaints are presented. If the woman is complaining of lack of sexual desire, the diagnosis of hypoactive sexual desire disorder is easily given. If she reports trouble reaching orgasm or cannot climax at all, FOD is the most likely diagnosis. If she reports pain during intercourse, or if penetration is difficult or impossible, the clinician may conclude that dyspareunia or vaginismus is the most accurate diagnostic label. In general, women have difficulty perceiving genital changes associated with sexual arousal. However, women who report little or no desire for sexual activity, lack of orgasm, or sexual pain, may in fact be insufficiently sexually aroused during sexual activity. It is particularly difficult to differentiate between FSAD and FOD. FOD is defined as the persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. In cases where the clinician does not have access to a psychophysiological test in which a woman is presented with (visual and/or tactile) sexual stimuli, while genital responses are being measured, it cannot be established that her deficient orgasmic response occurs despite a normal sexual excitement phase, unless she reports feelings of sexual arousal. Ironically, this subjective criterion has been removed in the DSM-IV.

Studies investigating the efficacy of psychological treatments for sexual dysfunction have demonstrated that directed masturbation training combined with sensate focus techniques is very effective for women with primary anorgasmia to become orgasmic. In fact, this is the only psychological treatment of sexual dysfunctions that deserves the label "well established," and is probably efficacious in secondary orgasmic disorder. The success of this treatment suggests that lack of adequate sexual stimulation is an important etiological factor underlying primary, and probably also secundary, anorgasmia. Consequently, if the clinician would strictly adhere to the DSM-IV criteria, the diagnosis of neither FSAD nor FOD would be appropriate, because the problem can be reversed by adequate sexual stimulation. In any case, primary orgasmic problems may not justify a separate diagnostic category. Perhaps the diagnosis of FOD should be restricted to those women who are strongly sexually aroused but have difficulty surrendering to orgasm. There are no clinical or epidemiological studies that differentiate between women with primary or secondary anorgasmia and other orgasm problems, so we do not know how prevalent this is. Segraves argued that FSAD hardly exists as a distinct entity, whereas we, in contrast, argue that in a classification system based on the etiology of sexual complaints, FSAD should be considered to be the most important female sexual dysfunction, with complaints of lack of desire and orgasm, and pain, frequently being consequences of FSAD.

Finally, there is a good deal of evidence that, especially for women, physiological response does not coincide with subjective experience. Women's subjective experience of sexual arousal appears to be based more on their appraisal of the situation than on their bodily responses. Thus, in the DSM-IV definition of FSAD, probably the most important aspect of women's experience of sexual arousal is neglected, given that absent or impaired genital responsiveness to sexual stimuli is the sole diagnostic criterion for an FSAD diagnosis.

About The Author
David Crawford is the CEO and owner of a male erection size company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of most ejaculations This article may be freely distributed if this resource box stays attached.

Treatment of Sexual Disorders - Evolution of Current Treatment Approaches

Female Sexual Arousal Disorder - Central Nervous System and Spinal Chord Pathways

Neural and spinal components of female sexual arousal anatomy have been analyzed in animals and spinal cord-injured (SCI) women only. There is strong prove for the occurrence of sexual arousal and orgasm in women with SCI who have an intact S5 S5 reflex arc. Not only were genital and extragenital responses to vibrotactile stimulation similar between able-bodied and SCI subjects in a recent study of Sipski et al., subjective descriptions of sensations were indistinguishable between groups. SCI subjects did take longer than ablebodied subjects to reach orgasm. Whipple and Komisaruk indicated that, on the basis of their studies in SCI women in whom cervical stimulant was applied, the vagus nerve conveys a sensory pathway from the cervix to the brain, bypassing the spinal cord, which is responsible for the preservation of sexual arousal and orgasm in these women.

There persist large gaps in our understanding of the central nervous control of female sexual function. Most of the animal work refers to receptive behavior in female rats and very little to the control of genital responses. According to McKenna, the autonomic and somatic innervation of the genitals is based upon spinal mechanisms, regulated by supraspinal sites. Sensory information from the genitals project to interneurons in the lower spinal cord, which possibly generate the coordinated activity of sexual responses. The spinal reflex mechanisms are under inhibitory (through serotonergic activity) and excitatory (through adrenergic activity) control from supraspinal nuclei. These nuclei are highly interconnected. Many of them also receive genital sensory information. It is likely that during sexual activity, sensory activation of supraspinal sites causes a reduction in the inhibition, and an increase in the excitation of the spinal reflexive mechanisms by the supraspinal sites. Higher order sensory and cognitive processes may modulate the activity of supraspinal nuclei controlling sexual function.

About The Author
David Crawford is the CEO and owner of a male eyaculation company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of paralyzed penis This article may be freely distributed if this resource box stays attached.

Sexual Dysfunction - Partner Issues

Female Sexual Arousal Disorder - The Anterior Vaginal Wall

When Masters and Johnson published their account of the physiology of the sexual reaction, they fought Freud's theory of the transition of erogeneous zones in women. According to these famous sexologists, nerve endings in the vagina are highly spread. Hence, during coital stimulus the clitoris is stimulated indirectly, possibly through the movement or friction of the labia. Hite's data sustained this point of view. Almost all women who reached orgasm through stimulation from coitus alone had experienced orgasm through masturbation. Many women needed supplemental manual stimulant to orgasm during coitus, and an even larger number was unable to orgasm during coitus at all.

Apparently, coitus alone is not a very impelling stimulus for orgasm in women. In 1950, Grafenberg rendered an alternative to Masters and Johnson's explanation for the relative ineffectuality of coitus to cause orgasm. He identified an area of erectile tissue on the anterior wall of the vagina along the course of the urethra, about a third of the way in from the introitus and below the base of the bladder. Strong digital stimulant of this zone would trigger a rapid and high level of sexual arousal which, if kept, evoked orgasm. This paper was ignored until 1982, at which time this area was renamed as the G-spot. According to Levin, still, there is no credible scientific prove for the presence of either a unique G-spot with its own plexus of nerve fibers or for the fluid that is frequently released when orgasm is reached from stimulus of this area being anything other than urine. Because it is hard to see how strong stimulation of this G-spot would not also stimulate other erogeneous structures such as the urethra and clitoral tissue, Levin argues that the whole area should be viewed as the anterior wall erogeneous complex. Grafenberg pointed out that coitus in the so-called missionary position (ventral ventral) prevents stimulus of the anterior vaginal wall and would therefore not be optimally sexually stimulating for women. Instead, contact with the anterior wall is very close, when the intercourse is performed more bestiarum or a la vache that is, a posteriori . Thence, Grafenberg's suggestion was not that coitus itself is an inefficient sexual stimulus for women, but only coitus in the missionary position.

Sensitiveness of the entire vaginal wall has been explored in several studies. Weijmar Schultz et al. used an electrical stimulus for exploration under nonerotic conditions. This study sustains sensitiveness of the anterior vaginal wall, even though sensitivity of this area was much lower than that of the clitoris.

About The Author
David Crawford is the CEO and owner of a male enhancer company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of before and after penis enlargement This article may be freely distributed if this resource box stays attached.

Epidemiology of Sexual Disfunction

Female Sexual Arousal Disorder - Anatomy and Physiology

Clitoris and Surrounding Erectile Tissue

There is a significant density of tactile receptors in the clitoris. The anterior vaginal wall is also rich in tactile receptors. Freud encouraged a developmental idea about volatility to explain how a little girl turns into a woman. He indicated 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 limited period of anasthesia, Freud thought, was needed to enable successful transferrence of a girl's erotogenic susceptibility to stimulant from the clitoris to the vaginal orifice. Even though his suggestion that there are also tactile receptors in the anterior vaginal wall is correct, there is no evidence that the anterior wall becomes excitable at the expense of clitoral sensitivity. Contrary to Freud's belief, there is ample evidence that women who learned to know their own sexuality through masturbation are able to transfer this knowledge (or skill) to coital stimulation with a partner. For a long time, ideas similar to those of Freud have been used to suppress masturbation in girls and women. Even today there are many women with a partner, who feel guilty when masturbating.

The clitoris contains two stripes of erectile tissue (corpora cavernosum) that diverge into the crura inside the labia majora. On the foundation of recent anatomical studies, O Connell et al. advised to rename these structures as bulbs of the clitoris. They found that there is erectile tissue linked to the clitoris and extending backwards, surrounding the perineal part of the urethra. Nevertheless, most anatomical facts have been known for a long time. The clitoris parasympathethic innervation comes from lumbosacral segments L2 S2, while its sympathetic supply is from the hypogastric superior plexus. The pudendal and hypogastric nerves serve its sensory innervation. It responds with increased blood flow and tumescence on being stimulated through sexual arousal. Nitric oxide synthase (NOS), among many other neuropeptides, has been identified in the complex network of nerves in the clitoral tissue.

About The Author

David Crawford is the CEO and owner of a Male Enhancement Products company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2009 David Crawford of Male Enhancement Facts This article may be freely distributed if this resource box stays attached.

Sex Therapy

Female Sexual Arousal Disorder

"The Maiden Must Be Kissed Into A Woman"

Most pharmacological treatments that are currently being developed for women with sexual arousal disorder are directed at remedying a vasculogenic deficit. In a study we did in the late 1990s we compared pre- and postmenopausal women with and without sexual arousal disorder, diagnosed according to strict DSM-IV criteria. Women with any somatic or mental comorbidity were excluded. This study investigated whether pre- and postmenopausal women with sexual arousal disorder were less genitally responsive to visual sexual stimuli than pre- and postmenopausal women without sexual problems. From the findings of this study we concluded that in such women, sexual arousal disorder is unconnected to organic etiology. In other words, we are certain, from this and other studies to be reviewed, that in women without any somatic or mental comorbidity, impaired genital responsiveness is not a valid diagnostic criterion. The sexual problems of women with sexual arousal disorder are not related to their potential to become genitally aroused. We propose that in healthy women with sexual arousal disorder, lack of sufficient sexual stimulation, with or without concurrent negative effect, underlies sexual arousal problems. This view is at odds with the dominant view on male sexual arousal problems.

In the history of sexological science, the study of women's sexuality has been omitted, or has been obscured by comparisons with sexuality of men. In textbooks, descriptions of women and men's sexuality were frequently aimed at increasing awareness of similarities in physiological and psychological mechanisms. Even today, clear conceptualities of women's sexual problems and dysfunctions seem impeded by dominance of the male model.

For a long time, the general idea in western civilization has been that although women may have a disposition for sexual feelings, in decent and healthy women these feelings will only be aroused by a loving husband. In women, particularly in those who live a natural and healthy life, sexual excitement also tends to occur spontaneously, but by no means so often as in men. In a very large number of women the sexual impulse remains latent until aroused by a lover's caresses. The youth spontaneously becomes a man; but the maiden as it has been said must be kissed into a woman . Stekel conceived that it was a man's task to awaken sexual feelings in a woman, a responsibility that should not be taken lightly. As a matter of fact it is the duty of every man whose wife is unfortunately anaesthetic to investigate for himself his marital partner's sensitive zones, adroitly, carefully until he discovers the areas or positions which are effective of rousing his wife's libido and of bringing on her orgasm during intercourse . He disapprovingly remarked: There are men so brutally blunt and so selfish that they take no trouble to study their wives so as to become acquainted with their erogenous zones and learn to meet their particular desires . About half a century earlier, a book entitled The Functions and Disorder of the Reproductive Organs by W. Acton, a surgeon, passed through many editions and was popularly viewed as a standard authority on the subjects with which it dealt. The book was almost solely concerned with men; the author evidently regarded the function of reproduction as exclusively appertaining to men. He claimed that women, if well brought up, are, and should be, absolutely ignorant of all matters concerning it. I should say, this author remarked, that the majority of women (happily for society) are not very much troubled with sexual feeling of any kind. The speculation that women do possess sexual feelings he considered a vile aspersion.

It was not until the late 18th century, nevertheless, that the above view had become the superior one. For thousands of years prior to this, scholars had assumed that concept could not take place without the woman becoming sexually aroused and having an orgasm. Therefore, sexual pleasure for women was not only accepted, but also substantial. However, although sexual feelings in women were acknowledged, they were not always considered to be unproblematic. Shorter summarized the prevalent view of women's sexuality in the Middle Ages as follows: Women are furnaces of carnality, who time and again will lead men to perdition, if given a chance. Because the flame of female sexuality could snuff out a man's spirit, women had sexually to be broken and controlled .

Ellis had distinctive opinions about differences between women and men relating the physiological mechanisms involved in sexuality. In men, the process of tumescence and detumescence was regarded to be simple. In women we have in the clitoris a corresponding apparatus on a small scale, but behind this has developed a much more extensive mechanism, which also demands satisfaction, and requires for that satisfaction the presence of different conditions that are almost antagonistic. . . . It is the difference, roughly speaking, between a lock and a key. . . .We have to imagine a lock that not only requires a key to fit it, but should only be entered at the right moment, and, under the best conditions, may only become adjusted to the key by considerable use . It seems that phrases such as an extensive mechanism behind the clitoris served to conceal ignorance about physiological facts. Even today, scholars recognize that it is glaringly obvious that we know so little about sexual arousal that we cannot answer some of the most elementary questions about the human genital function .

Laqueur demonstrated that conceptions about human sexuality were not the result of scientific progress. Rather, he argued, they were part of social and political changes, explicable only within the context of battles over gender and power . Feminists have long criticized the notion that the behavior and abilities of women are uniquely determined by their biology. This criticism led to an almost total rejection of the role of biology in the construction of gender. It also contributed to an image of female sexuality devoid of the body. Masters and Johnson were the first to cautiously study and describe the genital and extragenital shifts that occurred in sexually aroused women. Tiefer critiqued the suggestion of the human sexual response cycle as a universal model for sexual response, not in the least because the concept of sexual desire was not embedded in the model, therewith eliminating an element which is notoriously variable within populations . She argued that the human sexual response cycle, with its genital focus, neglects women's sexual priorities and experiences. Indeed, Masters and Johnson did not assess the subjective sexual experience of the 694 men and women who were studied. Their emphasis on peripheral physiology, particularly the genital vasocongestive processes linked with sexual response, may reflect the influence of primarily male-dominated theorizing and research in sexology, with its inevitable emphasis on penile vaginal sexual contact. Tiefer wondered why problems such as too little tenderness or partner has no sense of romance were excluded. These problems have been oftentimes reported by women. The sexual response cycle model assumes men and women have and like the same kind of sexuality. Still, different studies show that women care more about affection and intimacy, and men care more about sexual gratification in sexual relationships. There seems to be support for the cliche Men give love to get sex, and women give sex to get love. Men and women are raised with different sets of sexual values. Tiefer concludes that focusing on the physical aspects of sexuality and ignoring other aspects of the sexual response cycle favors men's value training over women's.

About The Author

David Crawford is the CEO and owner of a Male Enhancement Reviews company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2009 David Crawford of Natural Male Enhancement This article may be freely distributed if this resource box stays attached.

Sexual Disfuncombination therapyion Combination Therapy Guidelines Who, How, and When?

Sexual Aversion Disorder - Diagnostic Criteria

DSM-IV-TR includes sexual aversion disorder in its Sexual and Gender Identity Disorders classification (Table 1.1).

Table 1.1 DSM-IV-TR Criteria for Sexual Aversion Disorder

A. Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner
B. The disturbance causes marked distress or interpersonal difficulty
C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another sexual dysfunction)

In reply to these criteria, The Sexual Function Health Council of the American Foundation for Urologic Disease convened the Consensus Development Panel on Female Sexual Dysfunction. Their expressed impression was that DSM-IV is limited to mental disorders and thus too narrow to offer a useful, broad diagnostic classification for female sexual dysfunction.

Two of the panel's advised amendments to the DSM-IV criteria are relevant to sexual aversion. While the DSM-IV criteria underline interpersonal distress, the panel preferred to emphasize personal distress as important to the diagnosis. Second, the panel specifically distinguished between psychogenic and organically based disorders. This revised classification system includes sexual aversion under the category of sexual desire disorders along with hypoactive sexual desire disorders (Table 1.2).

Table 1.2 1999 Consensus Classification of Female Sexual Dysfunction

I. Sexual desire disorders
A. Hypoactive sexual desire disorder
B. Sexual aversion disorder
II. Sexual arousal disorder
III. Orgasmic disorder
IV. Sexual pain disorders
A. Dyspareunia
B. Vaginismus
C. Other sexual pain disorders

The consensus panel acquired a very detailed document to identify and justify their new classification system. Sexual aversion disorder, yet, was given little attention and by virtue of being placed in the category of sexual desire disorders, is likely to be overlooked.

DSM-IV-TR distinguishes between lifelong (primary) and incurred (secondary) sexual aversion. This is a distinction that, in light of Mowrer's two-factor theory, is tough to defend. From the view of learning theory, aversion must, by definition, be acquired. Lifelong sexual aversion must still have been acquired at some point along the way. Crenshaw specifies lifelong aversion as a negative or unenthusiastic response to sexual interactions from earliest memories to present. Nevertheless, no matter how absent the memory of life before the aversion, the aversion was certainly learned, either directly or vicariously. Crenshaw observes that patients presenting with primary aversion often were raised in strict religious and moral environments, which supports our contention that the aversion was learned, albeit vicariously. She also indicates that there may have been some history of psychosexual trauma, which again would have been learned and not lifelong.

We indicate that these early authors may have intended that primary refers to aversion developed so early in life that the individual did not have the chance to have normal partnered sexual behavior before acquiring the aversion. Cases in the literature described as examples of primary aversion [e.g., case history of Bridgitte and Ms. C and case histories 1 and 2] typically involve early, presexual negative conditioning of sex in childhood, mediated by environmental learning but specifically not by sexual abuse. Secondary aversion, in contrast, would be diagnosed in cases of specific recollection of childhood abuse or later negative sexual experience that is the proximate cause of current sexual aversion.

It is further possible that this secondary descriptor has been maintained in the taxonomies because sexual aversion has been confounded with hypoactive sexual desire. Hypoactive sexual desire may legitimately be either a biologic or a learned condition. The biologic contribution could well have been present since birth or early in life and thereby present a primary or lifelong condition. Moreover, a patient with hypoactive sexual desire may become avoidant of sexual activity. Sexual disinterest in the context of the demands of a relationship could evolve into irritation or anger and appear clinically very much like aversion. This demonstration, yet, would be absent in the fear and anxiety reply to sexual behavior, which is critical for the aversion diagnosis.

About The Author

David Crawford is the CEO and owner of a Natural Male Enhancement company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2009 David Crawford of Male Enhancement Pills This article may be freely distributed if this resource box stays attached.

Diabetes and The Importance of Following a Physician's Advice

Sexual Aversion Disorder - Introduction

Crenshaw has been credited for first reporting the sexual aversion syndrome. Her description, published in 1985, remains one of two comprehensive manuscripts describing this disorder, joined only by Kaplan s 1987 book, Sexual Aversion, Sexual Phobias and Panic Disorder. Kaplan suggested that sexual aversion is best conceptualized as handling a dual diagnosis, sexual anxiety and panic disorder. Kaplan believed that one must treat the underlying organic panic disorder with medication before addressing the sexual aversion. Her model served to de-emphasize the aversion factors of the diagnosis in favor of the panic component. Seen in historical context, still, she had identified the biological underpinnings of the sexual disorders in ways that current conceptual formulations take for granted. Recently, others have again underscored the relationship between sexual aversion and panic disorder.

Contempt this early work, sexual aversion disorder is often overlooked in the spectrum of sexual disorders. Although it was first acknowledged as a diagnosis in 1984, with the publication of DSM-III-R, relatively little has been published about the etiology and treatment of sexual aversion. Often regarded a variant of an anxiety disorder, sexual aversion was not included in any of the earlier DSM editions. Although it finally achieved diagnostic status as a sexual disorder in 1984, it is often ignored or pushed to a secondary status within the field of sex therapy. A review of the most widely used sex therapy handbooks rarely finds any text that devote a chapter solely to sexual aversion. Most take on some explanation of aversion in the context of understanding hypoactive desire, the impact of sexual abuse, or vaginismus and dyspareunia.

Sexual aversion disorder is sometimes referred to as sexual phobia. Gold and Gold argued against the latter descriptor, noting that aversion implies an element of abhorrence and disgust, while phobia does not. In our experience, sexual aversion routinely is clinically characterized by revulsion and disgust in ways that phobias only rarely are. However, according to DSM-IV-TR measures, sexual aversion does not involve the physiologic responses that we often associate with aversion. While sexual aversion typically addresses these responses (e.g., nausea, revulsion, shortness of breath), aversion by these criteria can also be shown as simple avoidance of partnered sexual behavior and a panic response to engaging in partnered sexual activity.

Aversion is a conditioned response that applies to many behaviors. Aversion may be best recognized as the conditioned response that develops in response to cancer chemotherapeutic agents. In this circumstance, aversion implies more than phobic avoidance; aversion is characterized by nausea and vomiting. In contrast, nevertheless, others writing on sexual aversion keep that sexual aversion is equivalent to sexual phobia the essential diagnostic feature is persistent fear and avoidance.

From our perspective, conditioned aversion is perhaps best understood using Mowrer's two-factor theory. Mowrer theorized that two separate learning processes contribute to avoidance conditioning. A conditioned emotional response results from pairing a previously neutral or positive stimulus (sexual behavior) with a painful or traumatic event (and thus is classically conditioned). Having been paired with discomfort, the sexual stimuli now produce aversive emotional reactions (e.g., anxiety, revulsion, disgust) in the absence of the original painful stimulation. The later conditioned avoidance response is operantly conditioned (negatively reinforced) in that avoidance of sexual stimulus obviates or reduces the aversive response. Sexual aversion, from the two-factor avoidance perspective, can be conceptualized as maintained by this avoidance response.

Sexual aversions can be general or quite specific. Aversions can originate in response to any sexual stimulus, overt or covert, such that a patient may present with a limited aversion to a highly specific sexual thought or behavior, or may expose more global revulsion to sexuality in any form.

Incidence and prevalence of sexual aversion disorder are not known, despite being regarded widespread by several overviews. In addition, diagnostic criteria do not address gender differences in prevalence. Gold and Gold describe the typical etiological model for the development of aversion in women to be sexual abuse, while the etiologic model for men in their view is performance anxiety. Our clinical experience is that significantly more women than men meet the criteria for sexual aversion disorder. Ponticas hypothesizes that this gender distinction may be an artifact. Men with sexual aversion disorder are likely to resist entering relationships and thereby avoid the resulting relationship conflict that might lead them into therapy. Moreover, more women with sexual aversion disorder may present clinically due to the overlap in etiology and diagnostic criteria with hypoactive sexual desire disorder which has a much greater prevalence in women than in men.

Since the criteria for sexual aversion disorder overlap with symptoms of both panic disorder and hypoactive sexual desire disorder, even experts in treating sexual disorders persist somewhat unclear regarding how and when to diagnose sexual aversion.

About The Author

David Crawford is the CEO and owner of a sex enhancement products company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of products for premature ejaculation This article may be freely distributed if this resource box stays attached.

Patient Preference, Sexual Scripts, and Pharmaceutical Choice

Male Hypoactive Sexual Desire Disorder - Summary And Conclusions

Many may see it as a truism that men and women are sexually different, but in the latter half of the 20th century there has been a strong attempt to view the two as functionally balanced. In spite of this endeavor at equation, evidence about just how men and women differ, especially in the crucial area of sexual desire, is quickly accumulating. Although doubtlessly unintentional, investigations of sexual desire in women have shed light on the same in men. These notices have insinuated that the pattern of sexual desire leading in arousal is more true of men than women (where desire might follow arousal), and that sexual desire tends to be quantitatively greater in men.

Corresponding to several different studies, at any one time about 16% of men experience HSDD. Still, sexual desire evidences in different ways (both psychologically and behaviorally), and it is far from clear just who is included in this 16%. Does it represent, for example, men who have sexual thoughts but do not act on them? Men who act on some occasions but not others (acquired and situational)? Men who had sexual thoughts and feelings in the past but not nowadays (acquired and generalized)? Men who do not have those feelings now and never have thought much about sexual issues (lifelong and generalized)? The trend of sexual desire in men to decline as they become older has been repeatedly shown. But does this observation mean that an elderly man who experiences reduced sexual desire has HSDD and is part of the 16% (men who are sometimes referred to as having andropause, ADAM or PADAM ? Or, conversely, should we look at the age-related decline not as pathological, but rather as a normal part of the process of becoming older? And who decides the answer? Is this a medical determination made by health professionals or one which is social? Lots of questions and few answers. The bottom line is that the definition of HSDD in men in most studies is quite vague, so one might fairly ask (at least rhetorically): just what are the boundaries surrounding the diagnosis?

Apart from the issue of diagnostic borders, the assessment of HSDD in men is not complex and involves a few questions in the history about sexual thoughts, fantasies, activities with a partner or oneself, a consideration of health status, and conducting a few laboratory tests. Those routines will assist in the process of subtyping, which, in turn, is necessary for finding etiology and treatment.

Each of the subtypes of HSDD has many possible origins. For example, if a man discovers that he is completely absorbed sexually at the beginning of a new relationship and not otherwise, or only when watching a computer screen displaying engaging women without clothes, then evidently his sexual desire is quite intact but is highly focussed. In this instance, biomedical hypothesis about the aetiology will not (with the possibly exception of hyperprolactinemia) be fruitful and does not make clinical sense. Thinking in psychosocial ways about etiology and treatment in such an instance will be more prosperous and, on the basis of clinical experience, intrapersonal issues involving the capacity for intimacy loom large.

If, on the other hand, the man has desire difficulties of comparatively recent origin which extend to all conditions when he would be expected to react with sexual feelings, then a clinician might indeed think about biomedical issues. Medical and psychiatric disorders, or medications utilised in treatment, appear to be a frequent cause of acquired HSDD. If the man is seemingly healthy, considering subtle problems like hormone aberrations might establish helpful. Two hormones in particular greatly influence sexual desire, namely, testosterone and prolactin, and both must be scrutinized if the problem is generalized.

Released information on the treatment of HSDD in men who do not have any apparent explanation for their difficulties, leaves clinicians with little direction. First, diagnostic subtyping is virtually nonexistent. Second, there are no controlled studies on a homogeneous sample of men in which psychotherapy was the keystone of treatment. As well, a review of the use of couple therapy led in pessimistic conclusions. Third, only one placebo-controlled drug study (bupropion in a nondepressed mixed population of men and women) has taken place but fortunately suggested improvement. Fourth, only one study of the use of a hormone (testosterone) alone has taken place but involved a mere 10 patients, a fact which even one of the authors decried.

HSDD in men can be an sensitive condition, especially when sexual desire is actually present but is not shown in a way that involves the patient's partner. The reproductive consequences can be severe. To suggest that more research is needed into this disorder would be an understatement. All aspects of HSDD in men need to be carefully analysed, starting with as basic an issue as trying to clarify what is encompassed within the definition.

About The Author

David Crawford is the CEO and owner of a male sex facts company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of male enlargement surgery This article may be freely distributed if this resource box stays attached.

Treatment of Sexual Disorders - Evolution of Current Treatment Approaches

Age-Related Hypogonadal Syndrome - Psychotherapy

O'Carroll reviewed the psychological and medical literature from 1970 to 1989, searching for controlled treatment studies of HSDD. He discovered eight such studies, two of which regarded only men. (Of the other six, two included both men and women as the identified patient and four concerned women as the patients together with their partners). His commentary was critical and contemplated essential discouragement in that he found no controlled studies with a homogeneous sample in which psychotherapy was the keystone of treatment and none which involved both drug/hormone treatment and psychotherapy.

Yet, some of what does exist in the literature on the psychotherapy of HSDD in men will be reviewed. Heiman et al. considered studies on the treatment of sexual desire disorders in couples. None of the studies involved only men; most related to the treatment of HSDD in women only, or involved reports that referred to both men and women as the identified patient. Of the three studies that involved men with sexual desire difficultness, only one involved information concerning diagnostic subtyping. The latter investigation reported on a 3-month follow-up of 152 couples in which at least one person had a desire difficulty as part of the delivering complaint. Fifty-eight (58%) of the men had a diagnosis of low sexual desire. Seventeen percent were lifelong and 40% were global. Numbers of patients were not given in the report. In comparing couples in which either the man or the woman showed with a desire difficultness, the authors concluded that initially there was a lower rate of sexual activity when the man was the identified patient, that men tended to initiate sexual activity more often, and that men were more likely to have a situational and produced form of desire difficulty. With a behavioural form of treatment, the authors found at follow-up that significant treatment gains had been made and maintained. In addition, they also claimed that the lifetime/acquired and global/situational differentiation did not predict therapeutic result. This latter statement failed to distinguish between couples in which the man or the woman was the identified patient, unfortunate because it is quite conceivable that the distinction has more meaning for one gender than the other.

The review by Heiman et al. described another study involving a 3-year follow-up of 38 couples treated for sexual dysfunction. The group included six men identified as having HSDD with or without another sexual dysfunction diagnosis. Thirty-three percent of all the men had a notable health problem (it was unclear how many of the six men with HSDD were in this group). In spite of the fact that a diagnostic subtyping system was adopted, it was inexplicably not involved in the report. A behavioural form of treatment was utilized and the outcomes were reported on an individual basis for men and women. The authors concluded that the diagnostically relevant items (that were measured), that is, desire for sexual contact and oftenness of sexual contact, clearly establish a lack of supported success for both men and women.

The Heiman et al. report also included a study by McCarthy of (i) 20 couples in which the outcomes for the men and women were not separately stated and (ii) eight men without partners of whom many reported advance but the original problems were rather unclear (the example of HSDD given in the report was evidently a result of another sexual dysfunction).

O'Donohue et al. surveyed the sex-related literature on the psychological treatment of male sexual dysfunctions. They explicitly omitted studies that relied only on medical treatment. In a clear statement concerning the treatment of sexual desire problems, the authors concluded that no controlled treatment-outcome studies were found for the treatment of . . . sexual aversion disorder and hypoactive sexual desire disorder . . . in men.

Several studies in the O'Donohue review had a mixture of diagnoses and some included men with HSDD. In one such group the outcomes were not reported separately for men and women. Another looked at 40 couples in which the men had erectile dysfunction and/or loss of sexual interest, and compared the potency of three treatments: weekly couple counseling, monthly couple counseling, and T. Subjects were broken into two groups, with high or low levels of sexual interest. Each group was randomly allocated to (i) testosterone or placebo therapy and (ii) weekly or monthly counseling. Results showed no statistically large group deviations in initial clinical ratings and essential relapse between the first and second follow-up in the erections ratings and sexual interest ratings. In addition the oftenness of sexual thoughts at the second follow-up were (statistically) significantly higher in the placebo group.

About The Author

David Crawford is the CEO and owner of a male erection enhancement company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of best male enhancement pill This article may be freely distributed if this resource box stays attached.

Sexual Dysfunction - Partner Issues