Altered Sexuality Syndromes

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Altered sexuality may take many forms. The loss of libido is the most common form and can present as inhibited excitement or orgasm. Hypoactive sexual desire may be due to a number of psychiatric, medical, and neurological disorders. Typically, the cause is functional and the condition occurs in the presence of anxiety or depression. Hyposexuality associated with hypergraphia, hyper-religiosity, irritability, and elation comprise the main features of the Gastaut-Geschwind syndrome. This syndrome has been described as an interictal syndrome in patients with epilepsy of temporal lobe origin. These patients may also demonstrate "viscosity," which refers to a stickiness of thought processes and an interpersonal adhesiveness, and circumstantiality, which is manifest as a difficulty in terminating conversations.

A vigorous sexual drive can be a normal variant of human sexuality, but when it interferes with normal activities of living or is pursued at inappropriate times and with unwilling partners, it is considered pathological. Historically, hypersexuality was described as part of the Kluver-Bucy syndrome in association with loss of anxiety, diminished aggression, hypermetamorphosis, visual agnosia, and hyperorality. This syndrome is rare in humans but has occurred as a result of encephalitis. [21] Lesions of the hypothalamus are the most likely to create sexual disinterest, but medial temporal lobe damage may produce the same result. Frontal lobe lesions often create disinhibited behavior that may or may not be associated with a change in libido. Hypersexuality may also occur in individuals with Parkinson's disease or other parkinsonian patients treated with dopaminergic agents including levodopa, dopamine agonists, and amantadine.

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