Improving Your Sex Life

Revive Her Drive

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

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Psychogenic Factors that Impair Sexual Ability

Through its pervasive influences on a diversity of mind-brain functions, stress can increase or diminish a variety of motivational urges, including sexuality. While mild stress can sometimes increase sexual urges, sustained stress diminishes erotic urges. Indeed, one of the primary stress hormones in the brain, CRH, dramatically reduces all prosocial and sexual activities, as well as all other appetites, when released within the brain (Chapter 21). 1998), consistently promote sexual urges, but many reduce them in ways that are often emotionally troublesome to people. The most widespread problems are associated with the anorgasmia and reductions in sexual motivation that result from the use of antide-pressants, most recently the selective serotonin reuptake inhibitors (SSRIs) (Rosen et al., 1999). However, other agents are not without problems (Gitlin, 1994), and there are some drugs that can facilitate sexual abilities (Crenshaw and Goldberg, 1996). Mammalian sexual energy is...

Male Sex Act Big Picture

The male sex act begins with sexual stimulation. Somatic sensory nerves relay this information to the central nervous system. Parasympathetic impulses from the S2-S4 levels of the spinal cord cause blood to flow into the erectile tissue of the penis, resulting in penile erection. Sympathetic impulses from the T10-L2 spinal cord levels cause seminal fluids to mix with the sperm in the urethra in a process called emission. Ejaculation is the expulsion of the semen from the penis, which is caused by sympathetic innervation as well.

What is anorgasmia and how is it treated

Anorgasmia, the inability to achieve an orgasm, may be congenital or acquired. It is estimated that about 90 of anorgasmia problems are related to psychological issues. Surveys point to performance anxiety as a common psychological problem. There is a relationship between anorgasmia and childhood or adult sexual abuse or rape. Marital strife, boredom with a relationship, coupled with a monotonous sex life are other contributing factors. Some drugs, such as alcohol and the selective serotonin reuptake inhibitors may impair orgasmic response. Certain medical conditions such as spinal cord injury, multiple sclerosis, hormone conditions and diabetes have been implicated. Treatment of anorgasmia

Is there a role for sex therapy in the treatment of ED

Yes, there is often a role for sex therapy in the treatment of ED. You do not have to have psychogenic ED to potentially benefit from sex therapy. Sexual problems do not occur in isolation, nor are their effects limited only to the sexual arena. Sexual problems can be associated with relationship difficulties, decreased self-esteem, anxiety, and depression. Sex therapy is very effective in helping people understand both the physiologic and the psychological aspects of ED. It also helps people identify and deal with unrealistic expectations and negative self-images, understand their partner's sexual needs and requirements, and dispel any myths about sexuality and sexual function that the patient and his partner may have. It also allows for help with relationship issues, such as intimacy conflicts, power and control struggles, and trust issues, which may be just as important as treatment of the ED in the restoration of a healthy sexual relationship.

Female Orgasmic Disorder

Orgasmic dysfunction, the inability to reach orgasm when desired, may be primary, with the patient never having experienced orgasm, or secondary, with the dysfunction manifesting after previous satisfactory orgasmic functioning. Some women may believe they have primary inhibited-orgasm disorder because, unlike many men, they do not reach orgasm solely with vaginal intercourse. Portrayals of female orgasm in novels and films are often overstated or misleading. A basic description of physical orgasm (i.e., pleasurable sensation in genital area and contractions of vagina, followed by a feeling of physical and psychological relaxation) may facilitate discussion of orgasm. Many women prefer simultaneous vaginal and clitoral stimulation, oral-genital sex, or clitoral stimulation alone to have an orgasm and do not have an orgasmic disorder. In both primary and secondary orgasmic dysfunction, it is important to ask about past or current experiences of violence, victimization. and abuse....

Partnered Sexual Activity

In modern Western society, full adulthood is delayed through the adolescent years. As the teenager undergoes sexual physical development, biologic urges for physical intimacy and reproduction may affect sexual behavior. Although many adolescents delay their sexual debut for a variety of reasons, the modern assumption that all teenagers will be willing or able to delay participation in intercourse and other sexual behaviors until age 18, marriage, or some other milestone is at odds with the experience of human history. The Centers for Disease Control and Prevention (CDC) conducts the Youth Risk Behavior Surveillance (YRBS) surveys every 2 years. In 2007, 14,041 questionnaires were completed in 157 high schools nationally, with an overall response rate of 68 . Nationwide, almost half (48 ) of all students reported having experienced sexual intercourse, with the prevalence by state ranging from 36 to 60 . Although 14 of teenagers reported experience with four or more sexual partners,...

Resuming sexual activity

As rehabilitation of stroke patients constantly improves, many new techniques develop but some activities are often neglected because of lack of research, lack or rehabilitation knowledge or because patients themselves do not wish to raise the subject. One such area is a return to their normal sexual activity. Generally, this is not routinely discussed with patients as part of their rehabilitation, although for many, it plays an important role in their life and discussion should be included in the assessment process. There is some information in stroke books, but this is not always readily available to the patient and their partner and the information is not always applicable to their specific needs. The Stroke Association can provide a leaflet, entitled Sex after Stroke Fact sheet 31 which can be downloaded from their website which includes the main points identified by patients and partners. This leaflet should be made available to all stroke patients and their partners both in...

SF Sexual ly t ra ns m ittcd i n fee t ion WSW Women who have sex with women

Don't ask, don't tell Patterns of HIV disclosure among HIV positive men who have sex with men with recent STI practicing high risk behaviour in Los Angeles and Seattle. Sex Transm Infect 2004 80 512-517. 6. Fethers K, Marks C, Mindel A, et al. Sexually Transmitted Infections and risk behaviors in women who have sex with women. Sex Transmit Infect. 2000 76 345-349.

Male Orgasmic Disorder

Men who can sustain a full erection for a reasonable duration of sexual activity will usually be able to reach orgasm. When this is not the case, a more complete evaluation should be undertaken, evaluating the central and peripheral nervous systems, use of medications and substances, and relationship issues. SSRI antidepressants are well known to interfere with orgasm. Alcohol use can cause difficulty with sustaining arousal or with orgasm. Many contextual and partner issues discussed with regard to female patients also apply to men.

Sexual Experiences Following Treatment for Penile Cancer

Studies investigating patients who have undergone a partial or total penectomy for penile cancer have been limited to small retrospective studies. A Norwegian study of 30 men who had been treated for penile cancer assessed sexual function by using a semistructured interview together with a number of self-administered questionnaires.5 The median age of the patients was 57 years and all had undergone treatment at least 11 months previously (median delay 80 months). Unsurprisingly, those patients (n 4) who had undergone the most radical surgery (namely, total penectomy) had the worst sexual function, as evidenced by a reduced sexual interest, severely limited sexual ability, markedly reduced sexual enjoyment, and markedly reduced sexual frequency. Those who had undergone radiotherapy (n 12) or local excision or laser therapy (n 5) had the best sexual function, while those patients who had undergone partial penectomy (n 9) were in an intermediate position. There was a suggestion that the...

Hypoandrogenism of senescence and sexual activity

Aging in men is accompanied by a decrease in libido and sexual activity. Mean coital frequency was reported to be about four times a week at age 20-25 years and decreases to less than twice a month between 75 and 80 years (Masters 1986 Tsitouras-Bulat 1995). Nevertheless, only 15 of men over 60 years old deny any sexual interest (Verwoerdt et al. 1969) and 80 of men over 60 years old remain sexually active (Kaiser 1992). Whereas normal libido requires adequate testosterone levels, as shown by the effect of testosterone withdrawal (Bagatell etal. 1994 Basaria etal. 2002) the testosterone concentration required to sustain sexual activity and maintain libido appears to be rather low (Gooren 1987 Schiavi 1996), and there is good evidence that healthy adults have substantially higher androgen levels than required for normal sexual behavior (Buena etal. 1993 Udry etal. 1985). boredom with, or loss of attractiveness of the (same) sexual partner, as well as monotony of sexual life low level...

Primary Headache Associated with Sexual Activity

This headache disorder includes the subtypes, preorgasmic and orgasmic headaches. The former is associated with sexual excitement, and the second headache occurs at the coup de gras. It is not unusual to see one of these headaches cohabiting in a patient who also has exercise-induced headaches. Table 2.18 Diagnostic criteria for primary headache associated with sexual activity, ICHD-2 Preorgasmic headache B. Occurs during sexual activity and increases with sexual excitement Orgasmic headache B. Occurs at orgasm

Competency to Marry Have Sexual Relations and Divorce

Sexual activity involving minors, the elderly, and the developmentally and intellectually disabled is frequently viewed with concern, distortion, and denial in our culture (Buck v. Bell 1927). Because these groups are subject to abuse, including sexual mistreatment, laws exist to protect impaired persons from sexual exploitation. Sexual activity with a member of these groups can be criminal, even when it is accompanied by actual consent, if a person lacks either legal or mental capacity to consent (i.e., lacks the right or the ability to give legal consent). The meaning of the concept of capable of giving consent for sexual relations is still sharply debated in ethics, law, psychology, and psychiatry. States vary from extremely low criteria, which allow most adults to be found competent (e.g., mere knowledge of the sexual act), to very high criteria, which exclude many (e.g., making a choice based on the person's best interest). One California case defined a high standard as follows...

Sexual Activity

The idea that prostate cancer may be caused by specific forms of sexual activity has a puritanical appeal, especially for people who believe that sex was bestowed on humankind exclusively for procreation, not recreation. Conversely, the idea that prostate cancer is caused by sexual activity may also appeal to men inclined toward hedonism, cancer thus becoming for them a badge of a life well lived, a paean to Priapus. The possibility that certain forms of sexual activity may lead to prostate cancer has been downplayed by many. One expert claimed that ''there is no good reason to believe that having an active sex life could stimulate the prostate to grow, or cause prostate cancer.''23 Another wrote that ''studies attempting to demonstrate a link between prostate cancer and various sexual issues have universally struck out.''24 These conclusions are surprising, given the number of studies that have reported associations between specific sexual activities and the development of prostate...

Theoretical Developments arid the Establishment of a Movement

Agreements with Freud, most notably about Freud's theories on female sexuality. He also played a critical role in later attempting to mediate between Anna Freud and Melanic Klein. Freud also supported Abraham's prominence in the movement and was influenced by his papers on the development of libido

NiCole T Buchanan and Zaje A Harrell

When most women reflect on their lives, they can recall at least one event that could be considered sexual harassment. For many, these events hearken back to high school, or earlier, and include comments made about her body, requests that she perform a sex act, or being groped by a boy, or group of boys, as she walked down the hallway. By college, a young woman may recall an instructor commenting on her body or hinting that she might discover her grade will improve if she will go on a date. By the time she finally enters the workforce, she may have a plethora of harassment experiences that have been so commonplace that few would recognize them as abusive. Once employed, she may be confronted by coworkers, bosses, and even supervisees that repeatedly make comments about her body, what sexual activities they would like to see her perform, or direct demands for sexual compliance that include the promise of a promotion if she does or a demotion if she refuses. Such experiences are not...

Box 23a An example of the benefits of using an advisory group in the planning process

A review of HIV prevention for men who have sex with men (Rees 2004) employed explicit consensus methods to shape the review with the help of practitioners, commissioners and researchers. An advisory group was convened of people from research academic, policy and service organizations and representatives from charities and organizations that have emerged from and speak on behalf of people living with, or affected by, HIV AIDS. The group met three times over the course of the review.

Cross Section Of A Testis

Once puberty has been reached, sperm are manufactured continuously in the testes at a rate of about 125 million each day. The sperm develop around the walls of the seminiferous tubules their tails, which enable them to swim, point towards the centre of the tubules. Mature sperm are stored in a coiled tube called the epididymis, situated behind each testis. The sperm are eventually ejaculated during sexual activity or are reabsorbed Into the body.

Sperm Inside A Seminiferous Tubule

The internal structures of the female reproductive system -the ovaries, fallopian tubes, uterus, and vagina - lie in the lower third of the abdomen. The ovaries contain follicles that store eggs, cells that can fuse with sperm from a man to form offspring. Each month an egg matures and is released from an ovary the fimbriae guide the egg into a fallopian tube, which propels it towards the uterus. The vagina, a passage with muscular walls, connects the uterus to the outside of the body. The external structures, collectively known as the vulva, include the sensitive clitoris and folds of skin called the labia, which protect the entrances to the vagina and the urethra. Just inside the vaginal entrance lie the Bartholin's glands, which secrete a fluid for lubrication during sexual intercourse.

What causes the PSA to rise

Anything that irritates or inflames the prostate can increase the PSA, such as a urinary tract infection, prostatitis, prostate stones, a recent urinary catheter or cystoscopy (a look into the bladder through a specialized telescope-like instrument), recent prostate biopsy, or prostate surgery. Sexual intercourse may increase the PSA up to 10 , and a vigorous rectal examination or prostatic massage before the PSA blood test is drawn may also increase the PSA. Benign enlargement of the prostate (BPH) may also increase the PSA because more prostate cells are present, thus more PSA is produced (see Question 3).

Conflict Between Different Motivational Systems

A prominent example of a conflict between different motivational systems in the psychoanalytic context is one between what Freud (1912) referred to as love and desire which he also referred to as the affectionate and sensual currents ). Freud attributed the conflict between love and desire to the persistence of incestuous wishes so that the person one loves cannot also be the object of sexual desire. As Freud 1912 put it, W herc they love, they cannot desire and where they desire, they cannot love (p. 183). One consequence of this conflict, Freud observed is psychical impotence in men, sexual frigidity in women, and in both a failure to experience pleasure from the sexual act. any case, insofar as in long-term relationships one's attachment figure is generally also one's sexual partner, the conflicting dynamics of the two motivational systems present an integrative challenge that individuals meet with varying degrees of success (see Eagle 2007 for further discussion of these issues .

Effectiveness of Early Detection and Intervention

Two vaccines are designed to protect against the major strains of high-risk HPV. The quadrivalent HPV vaccine (types 6, 11, 16, 18) is currently approved by the U.S. Food and Drug Administration (FDA) for a three-injection series, which is maximally effective if given before the first sexual experience. Pap screening is still necessary even if the woman is fully vaccinated.

LUST Sexual Love and Nurturant CARE Systems of the Brain

Basal forebrain, septal, and anterior hypothalamic preoptic areas of the brain, coursing medially down to the PAG (Pfaff, 1999). The gender specific LUST systems have distinct components as well as many overlapping ones. For instance, female sexuality has been linked more clearly to the dynamics of oxytocinergic brain systems, while male sexuality is more dependent on vasopressinergic components that uniquely energize male sexual eagerness. The orgasmic components for all genders have strong opioid and oxytocinergic aspects.

Burden of Disease

Those at increased risk for HIV infection include men who have had sex with men after 1975 men and women having unprotected sex with multiple partners past or present injection drug users men and women who exchange sex for money or drugs or have sex partners who do individuals whose past or present sex partners were HIV infected, bisexual, or injection drug users persons being treated for STIs and persons with a history of blood transfusion between 1978 and 1985. Persons who request an HIV test despite reporting no individual risk factors may also be considered at increased risk, because this group is likely to include individuals not willing to disclose high-risk behaviors. A higher prevalence is seen in high-risk settings, such as STI clinics, correctional facilities, homeless shelters, tuberculosis clinics, clinics serving men who have sex with men, and adolescent health clinics with a high prevalence of STIs (Chou et al., 2005).

Inhibition of Sperm Maturation

Politics and prudery also stand firmly in the path of progress. Political concerns pose a direct barrier to enlightenment when matters of birth control become an issue to be avoided for fear of offending the large segment of citizens (read voters) who either wish to avoid any discussion of sexual matters or believe that ''just say no'' is the only acceptable policy. Sexual desires, especially among the young, are not amenable to control by social agendas, political positions, or legislative action Our country's history of sexual prudery must bear a significant portion of the blame for the unprecedented high rate of teen pregnancies that politicians love to rail against for political points. Studies indicate no significant difference in sexual activity of American teens and teens in other Western countries. However, there is a dramatically higher pregnancy rate (and higher abortion rate and delivery rate) in the United States. This difference is perhaps attributable to a more open...

Written History of Mr John

Over the past 6 months, the patient has had increasing chest pain with radiation down his left arm despite atenolol, 50 mg daily, and isosorbide dinitrate, 10 mg qid. The patient's chest pain is produced by exercise, emotion, and sexual intercourse. The patient takes nitroglycerin as needed, with relief within 5 minutes. One-block dyspnea on exertion is also present. This has worsened in the past 6 months, before which he could walk two to three blocks. The patient's risk factors for coronary artery disease include a history of untreated hypertension, a 40-pack-year history of smoking (2 packs per day for 20 years), and a brother with a myocardial infarction at the age of 40 years. The patient's brother is now 45 years of age. The patient denies any history of diabetes or hyperlipidemia. At his physician's and wife's request, he has entered the hospital for elective cardiac catheterization. The patient has a significant denial of his illness and a secondary depression. Although...

Impact of Skin Disease on the Patient

Diseases of the skin play a profound role in the way the affected patient interacts socially. If located on visible skin surfaces, long-standing skin diseases may actually interfere with the emotional and psychologic development of the individual. The attitude of a person toward self and others may be markedly affected. Loss of self-esteem is common. The adult with a skin disorder often faces limitation of sexual activity. This disruption of intimacy can foster or increase hostility and anxiety in the patient. Skin is a sensitive marker of an individual's emotions. It is known that blushing can reflect embarrassment, sweating can indicate anxiety, and pallor or ''goose bump'' skin may be associated with fear.

Vulnerabilities To Human Trafficking And Prostitution

The social forces that are assumed to cause human trafficking, such as poverty, human rights violations, gender disparity, and discrimination, are the same as those that channel women, men, and children into prostitution.10,6 Magda, a Mayan Indian woman, described her trafficking experiences during the thirty-six-year armed conflict in Guatemala. Magda narrated how the soldiers kidnapped her from her village after killing her family. She described how they forced her to travel with them over the course of several weeks and used her to have sex with soldiers stationed in remote mountain areas. Reflecting on these traumatic childhood experiences, Magda said, People saw me with them and they didn't do anything to help me. Maybe it's because I was an Indian girl. Maybe they would have helped if they saw a Ladina term used to refer to westernized, biracial, or Sexual violence against women. Violence against women, which increases women's vulnerability to trafficking, is at pandemic levels....

Sexuality And The Passions Of The Brain Introductory Remarks

Sexual motivational systems lie at the root of some of the most intense human feelings, ranging from the eroticism and cravings of sexual arousal to the delights and disappointments of orgasm, not to mention social bondings and attachments, not to mention the ongoing dynamics of social relationships and dependencies. Sexual motivation and sexual performance are often dissociated (Everitt, 1990), as are social urges and commitments, especially in the presence of negative mood and emotional states. To better grasp how these relationships may permeate psychiatric concerns, the aim of this brief section is to provide an overview of the neural underpinnings of mammalian sexuality. Let us briefly consider these topics in reverse order (1) What are the factors that impair sexual ability (2) What is it about the organization of our brains that creates, at least at a statistical level, the neurophysiology of maleness and femaleness (3) What leads us to have...

Influence of testosterone on sexual behaviour in men

Sexual activities with partner Orgasms in sexual activity Besides evidence from nonhuman primates and clinical case reports on effects of castration in human males (Nelson 1995), studies ofhypogonadal men on androgen replacement therapy provide convincing evidence of the essential role of androgens in some aspects of male sexual behaviour (Table 4.1). In patients with induced or spontaneous hypogonadism, pathological withdrawal as well as reintroduction of exogenous androgens affected the frequency of sexual phantasies, sexual arousal and desire, spontanenous erections during sleep and in the morning, ejaculation, sexual activities with and without a partner, and orgasms through coitus or masturbation (Bancroft 1984 1986 Carani etal. 1990a 1992 Davidson etal. 1979 Gooren 1987 Luisi and Franchi 1980 Morales et al. 1997 Salmimies et al. 1982 Schiavi et al. 1988 Skakkebaek etal. 1981). There is only limited evidence on the effects of testosterone administration to eugonadal men with or...

Influence of testosterone on sexual behaviour in women

A variety of models have been used to test the relationship between testosterone and sexuality in women. Because plasma testosterone levels peak around the time of ovulation (Ferin 1996), one investigational strategy involved monitoring changes in several aspects of sexual behaviour at differerent points during the menstrual cycle. As plasma levels of estradiol also reach their highest point at the ovula-tory phase, this research design makes it difficult to prove that testosterone alone induces the increase in sexual behaviour during the midcycle portion of the menstrual cycle observed in some studies (Adams etal. 1978 Harvey 1987 Dennerstein et al. 1994 Matteo and Rissman 1984). But several well-controlled correlational studies measuring circulating testosterone in women found evidence of an androgenic enhancement of sexual behaviour. Higher testosterone levels (midcycle peaks or average levels of plasma testosterone throughout the cycle) were associated with less sexual avoidance...

Epidemiology And Etiology Hepatitis A

Sexual contact with infected persons (e.g., men having sex with other men) Shellfish infected with HAV (e.g., raw oysters) Men having sex with other men Health care providers in contact with infected needles Individuals having multiple sexual partners Perinatal transmission (less than 5 ) Unprofessional body piercing and tattooing

Human Trafficking Issues And Debates

Cussing the torture and abuse used by traffickers, Sarson and MacDonald28 described one young girl's testimony in which she told how her traffickers rented her out to local pedophiles. They also explain how traffickers, like pimps, exploit women and children to meet men's sexual needs. decision that it is reasonable to expect certain women to have sex with up to ten sex buyers a day in order to survive.33 Women who have been trafficked for prostitution tell us that they perform sex acts with as many as twenty to thirty sex buyers a day. Those women most often are poor and most often are racially marginalized. A neocolonial economic perspective is enshrined in a Canadian prostitution tourist's comment about women in Thai prostitution, who stated, These girls gotta eat, don't they I'm putting bread on their plate. I'm making a contribution. They'd starve to death unless they whored. The sex buyer's sympathetic attitude avoids the question Do all women have the right to live without the...

Emission And Ejaculation

Emission and ejaculation are the climax of the male sex act both processes result through sympathetic innervation. Impulses originating in the T10-L2 spinal cord levels travel through the lumbar splanchnic nerves and through the hypogastric plexus to the male reproductive organs and glands (Figure 13-2B).

Monoamine Reuptake Inhibitors

Duloxetine is dosed once daily with a usual initial daily dose of 60 mg. It shows a benign side effect profile, similar to SSRIs, with most patients tolerating the drug extremely well. When side effects occur, the most common include insomnia and asthenia (Goldstein et al., 2002 Detke et al., 2002). There were no significant cardiovascular or genitourinary side effects, no weight gain, and sexual side effects as measured by the Arizona Sexual Experiences Scale did not differ from placebo (Goldstein et al., 2002).

Theoretical Issues

The proximate determinants paradigm provides a second organizing framework. It rests on the observation that the sequential biological process is influenced through only a few mechanisms, specifically, variables that influence sexual activity, the likelihood of conception, and the likelihood that conceptions result in live births (see Davis and Blake 1956). Bongaarts and Potter's (1978) operationalization of the proximate determinants demonstrates that most fertility variability between populations and over time can be accounted for by the following four determinants (1) marriage and marital disruption (as indicators of the segments of the life cycle when women are sexually active), (2) postpartum infecundability (the period after a birth without ovulation its length is determined primarily by the duration and intensity of breastfeeding), (3) use and effectiveness of contraception, and (4) induced abortion. Three other determinants are

Conclusion Perversion and Normality

As noted earlier in this chapter, Freud 119051 began his foundational work on sexuality (The Three Essays) with the topic of perversion. So, as a way of illustrating some continuing central dilemmas, let us conclude an admittedly incomplete entry on a rapidly evolving topic with an overview of this highly contestable category of sexuality. Conventionally, sexual perversion is briefly defined as any deviation from coitus with a person of the opposite sex aimed at achieving orgasm through genital penetration (Laplanche and Pontalis 1967 1973). However, under the bright lights of feminist inquiry, critical object relations theory, and (post-) modern skepticism, the very concept of perversion, and its presumed integrity, become suspect, inviting lively debate. That calling a perversion an illness has functions over and above medical care is suggested by how well psychoanalysts have ignored disclaimers over the course of the past century. Freud j 1905) wrote that perverse practices permit...

Health Promotion Activities and Information for

Preparation for the birthing process is a key theme around which to discuss care issues and choices such as breastfeeding. Structured educational programs to promote breastfeeding have unclear effectiveness. Pregnant women should be counseled about the risks of possible teratogens, including smoking, alcohol, and drug use, including exposure to medications, prescriptions, OTC drugs, and herbal remedies. Good handwashing is always encouraged because this is one of the best ways to avoid community-acquired infectious diseases. Appropriate immunizations such as influenza and novel influenza A (H1N1) virus should be offered. Common exposures such as workplace conditions and use of hot tubs and saunas should be explored. Exercise should also be encouraged if there is no obstetric contraindication (Box 21-4). Intercourse during pregnancy should be actively addressed because some women are reluctant to discuss this topic even with their physician. Sexual activity can generally...

Specialized circuits for behaviour each jack of one trade together master of all

Just as a hammer bangs in a nail more efficiently than a saw, we need brain circuits that are specialized to solve some specific problems better than others. Evolutionary psychology regards the brain as a set of mini computers, each designed to solve its own problems, such as extracting information from the eyes, processing information from air vibrations arriving at the ear, choosing a sexual partner, selecting what to eat, etc. Having such specialized circuits is an excellent way to deal with the world quickly and well.

Impact of Lung Disease on the Patient

Asthma can affect a person's sexual function both physiologically and psychologically. Asthmatic patients may become more dyspneic as a result of the increased physical demands of sexual intercourse. Bronchospasm may occur, owing to excitement, anxiety, or panic. Anxiety about precipitating an asthmatic attack during sexual intercourse worsens the patient's dyspnea and sexual performance another vicious cycle is set into motion. Patients may then tend to avoid sexual intercourse.

Right to an Unaltered Genome

The right to an unaltered genome is problematic in other ways since, following the ideas of Derek Parfit, we can say that almost everything we do alters our offspring's genome, the most obvious being our choice of sexual partner. When we choose the person we want to be a parent with, we are automatically making decisions about the genome of our offspring. How is germline gene therapy different If it is different, then this difference must lie in the actual process of the therapy, rather than in the fact that the offspring's genomes are different to how they might otherwise be. The problem is, can we even describe this as ''altering'' a person's genome is it not better described as affecting the characteristics that person will have The same description could be applied to germ-line gene therapy, certainly that type which operates on sperm or ova (i.e., before

Human Papillomavirus Vaccine

Although most human papillomavirus (HPV) infections spontaneously resolve, high-risk HPV types are found in 99 of cervical cancers with types 16 and 18, accounting for about 70 of cervical cancers worldwide. HPV is also believed to account for 90 of anal cancers 40 of vulvar, vaginal, or penile cancers and 12 of oral and pharyngeal cancers. Types 6 and 11 HPV account for 90 of genital warts and laryngeal papillomatosis. The bivalent HPV (types 16, 18) vaccine (Cervarix) and the quadrivalent HPV (types 6, 11, 16, 18) vaccine (Gardasil) are licensed for use in U.S. females age 10 to 25 and 9 to 26 years, respectively. Both are recommended for routine vaccination at age 11 or 12 years and are ideally given before onset of sexual intercourse. The bivalent HPV vaccine is given in a 3-dose series at time 0, 1, and 6 months and the quadrivalent HPV vaccine in a 3-dose series at time 0, 2, and 6 months, with the third dose following the first dose by at least 24 weeks (CDC Pink Book, 2009,...

Distal Corporectomy and Split Thickness Skin Grafting

The cosmetic outcome is better than for conventional surgery. However, following excision of larger tumors not all patients will have an adequate penile length to allow voiding while standing or be able to have penetrative sexual intercourse. Therefore, patients need to be well informed prior to surgery and expectations managed accordingly. Case selection is very important, as is close follow-up. The technique can also be used to salvage recurrent disease.54

Cryptic Female Choices

The flagellum is threaded into the female's sper-mathecal duct, and sperm pass along it to gain access to her storage organs. If a male's flagellum is shortened surgically, then the female ejects more of his gametes after mating has occurred. Males with longer flagella are more successful in fertilizing ova and achieve greater reproductive success (Eberhard 1996). The muscles of the female's sperm storage organ play a crucial role in selective ejection of spermatozoa (Rodriguez 1994 Simmons 2001). Mechanisms underlying cryptic female choice have been explored in several insect species (e.g. in the cowpea weevil Wilson et al. 1997 damsel flies Cordoba-Aguilar 1999 and the yellow dungfly Ward, 2000). Although equivalent investigations of mammals are few in number and limited in scope, there are two issues which are worthy of consideration in relation to the origins of human sexuality. Firstly, has cryptic female choice played any role in moulding the evolution of phallic morphology in...

Effects of testosterone therapy on erection in hypogonadal men

A recent large study involving 227 hypogonadal men randomly assigned to therapy with non-scrotal testosterone patches (two testosterone patches per day) or testosterone gel (5-10 g testosterone gel per day) demonstrated significant improvement of erectile function during a treatment period of up to 42 months (Wang et al. 2000 2002). Sexual performance, per-cent full erection and satisfaction with erection were assessed by a simple self-report diary (Lee etal. 2003). Overall, testosterone replacement improved sexual performance, per-cent full erection and erection satisfaction significantly. Maximal increases were observed at the first assessment 30 days after initiation of therapy, and erectile function remained constantly improved thereafter. No significant differences were detected between treatment groups (Fig. 11.1).

How I Made My Decisions

I did not like the threat of impotence at all, but I had had a long and satisfying sex life and was willing to barter it if necessary for a possible cancer cure and additional years of productive life. Given the apparent size and position of my cancer, I was not optimistic about saving both nerves but was hopeful that one could be saved, thereby providing a reasonable chance of continuing to have a sex life. I discussed the possible outcome extensively with my wife, who was extremely supportive and agreed with my decision. Having been happily married for thirty-seven years seemed a great advantage in this situation.

Gambling Sex and Food

Can we be addicted to something besides drugs Maybe we can. Consider the broad definition of addiction, which is a search for, or a preoccupation with something, that ends up being distressing or destructive to you, and you can't easily stop.1 In recent years, there have been more and more studies of various forms of behavioral addiction such as excessive gambling, eating, and sexual activity. The different kinds of addictions have many things in common. First of all, the behavior takes up a lot of time and effort, and it gradually gets out of control such that attempts at stopping or controlling it are unsuccessful. These activities might result in conflicts with teachers, friends, and family members. It might affect the mood and health of the person, and impact the individual's finances, education, or work. Sound familiar

Competencyto StandTrial Evaluation Outcomes

G is a 49-year-old woman whose schizophrenic illness causes her to believe that she has been chosen by God to rid the world of evil. She also has the delusional belief that the local school principal is selling hundreds of innocent children into a slave trade where they are raped, tortured, and eventually killed. Ms. G makes repeated reports to the local police regarding her delusional fears and they reassure her that the school principal is not harming children. They also warn her that if she attempts to go near the principal or threatens to harm him, they will arrest her for stalking and or making a terrorist threat. Even though Ms. G has been told by law enforcement to stay away from the school principal, she continues to fear that more children will be murdered and, therefore, she must keep a close watch on his activities. One morning at 7 55 A.M., Ms. G is slowly driving by the school where she scans the doors seeking warning signs. She sees an 8-year-old girl standing...

Surveillance of testosterone substitution therapy

The presence and frequency of sexual thoughts and fantasies correlate with appropriate testosterone substitution, while loss of libido and sexual desire are a sign of subnormal testosterone values. Spontaneous erections such as those during sleep will not occur if testosterone replacement is inadequate however, erections due to visual erotic stimuli maybe present even with low testosterone levels. The frequency of ejaculations and sexual intercourse correlate with serum testosterone levels in the normal to subnormal range. Therefore, detailed psychological exploration or a diary on sexual activity are useful adjuncts in assessing testosterone substitution. For objective evaluation of psychosexual effects weekly questionnaires on sexual thoughts and fantasies, sexual interest and desire, satisfaction with sexuality,

Impact of Breast Disease on the Patient

The psychosocial problems resulting from breast cancer are far-reaching. Although the loss of an extremity is more disabling in everyday life, the loss of a breast produces intense feelings of loss of the feminine identity. Many women who lose a breast become depressed because they feel their symbol of femininity has been removed. They are afraid that they will no longer be considered ''whole'' women because their bodies have been maimed. They fear that they can no longer be loved normally and that they can no longer experience sexual satisfaction. They fear looking at themselves in a mirror and perceive themselves as ugly. The asymmetry is often described as ''mutilation'' or ''a bomb crater.'' After mastectomy, women often suffer from sexual inhibition and sexual frustration.

Sigmund Freud and the Psychological View

Freud firmly believed that people are most motivated to be creative when they cannot directly fulfill their sexual needs. Hence he believed that sublimation is the primary cause of creativity. The link between unconscious sexual needs and creativity begins in the early years of life. Although many people do not think of children as having sexual needs, Freud argued that at the age of four, it is typical for children to develop a physical desire for the parent of the opposite sex. Since this need is virtually never met, sublimation sets in, and the first vestiges of a fertile imagination are born. He traced many specific artistic works to the artist's sublimation. For example, he suggested that Leonardo da Vinci's many paintings of the Madonna resulted from a sublimated longing for sexual fulfillment with a mother figure, having lost his own mother early in his life. As he put it

What is erectile dysfunction ED and how common is it

The National Institutes of Health (NIH) definition of erectile dysfunction (ED), previously called impotence, is the consistent inability to achieve and or maintain an erection satisfactory for the completion of sexual performance. The definition is subjective, meaning that the individual (and or his partner) is the person who decides that his erections are not satisfactory. This is in comparison to an objective definition, in which an observer or a test makes the decision that the erection is not satisfactory. The definition is not an all-or-nothing one, meaning that different men may experience different degrees of ED. The most severe form of ED would be the complete absence of erections no nocturnal (nighttime) erections, morning erections, or erections noted with stimulation milder forms may be associated with inadequate degree or duration of rigidity.

Major Complications and Their Treatment

It is vital, however, to place incontinence and impotence in proper perspective. For men whose cancer has grown beyond the prostate or spread to other organs, incontinence and impotence do not loom so large. As Anatole Broyard noted ''In my own case, after a brush with death, I feel that just to be alive is a permanent orgasm.''1 Arguments abound about which is worse, incontinence or impotence. Walsh and Worthington, in their book Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, argue that ''recovery of urine control is far more important and . . . casts a far greater shadow on your life. If something's wrong with your ability to urinate, you'll be reminded of it several times a day or worse, several times an hour not just a few times a week or month.'' On the other hand, many men share the opinion of Charles Williams, who wrote that ''not

Impact of Inflammatory Bowel Disease on the Patient

Interest and participation in sexual activity tend to be at a low level. Many of these individuals prefer to be fondled like a child and largely reject any genital contact. Patients are prone to regard sexual activity in anal terms, such as ''dirty,'' ''unclean,'' or ''soiling.'' They are squeamish about body contact, odors, and secretions. The loss of libido and decreased sexual drive may be related to their fear of bowel action during intercourse, of perineal pain, or that sexual intercourse may in some way further damage the bowel.

Is ED a normal process of aging Is ED preventableIs it curable

It may also take longer to climax. Ejaculation (the release of semen through the penis during orgasm) may not occur, or it may occur with less force. The recovery period after ejaculation increases with age, and many men older than 55 years are not able to have another erection for 12 to 24 hours after ejaculating. These normal changes related to aging should not be confused with sexual dysfunction or ED failure to understand these normal changes and to adapt to them may cause stress and anxiety and may complicate erectile function. In ED, the erections are either inadequate for penetration or do not last long enough for completion of sexual performance. In short, the incidence of ED does increase with age, but it is not an expected process of aging.

What is sexual dysfunction

The term sexual dysfunction broadly encompasses trouble with any component of the sexual response cycle. The sexual response cycle in men consists of sexual desire interest (libido), sexual arousal (erection), orgasm (including emission involuntary discharge of semen from the ejaculatory duct into the urethra and ejaculation), and detumescence (return of the penis to the flaccid, nonerect state). An abnormality in one component of the sexual response cycle may not affect the remainder of the components of the cycle. For example, one may still be able to climax and ejaculate without achieving a rigid erection. Common sexual dysfunctions include problems with libido, ejaculation, and orgasm. Anorgasmia (complete absence of orgasm) occurs in 17 of married men and affects younger men more Orgasm Orgasm is another term used for sexual climax, or the culmination of sexual excitement. Orgasmic dysfunction refers to alterations in orgasmic function or the inability to achieve an orgasm, to...

Behavioral Definitions

Has a history of sexually acting out that is potentially self-damaging (e.g., unprotected sex, hiring prostitutes, cruising the streets for sex, many different sexual partners). 9. Reports a sense of tension or affective arousal before engaging in sexual behavior, and a reduction of tension after completing the sexual act. 10. Engage in illegal sexual acts with a minor.

Antisocial Impulsive And Borderlinenarcissistic Trends

Today both narcissists and normal individuals display a deliberative technique-driven self-structure that demotes the status of sharing relationships. Likewise, both emphasize manipulation and control in order to maximize personal outcomes, simultaneously creating a social veneer designed to mask disinterest. In a paradoxical way, the plague of narcissistic pathology is being cured to some extent by the rapid cultural normalization of narcissism itself. As a product of collective regression, normal narcissism expresses itself in many ways, including enthusiasm for personal achievement, health and fitness, bodily perfection, diet, the ultimate orgasm, spiritual bestowals, and all sorts of self-improvement prescriptions. This is all part of a cultural situation in which radical self-preoccupation is an acceptable, and even admirable, approach to life.

Anneliese A Singh and April Sikes

There has been significant work in developing a comprehensive definition of child sexual abuse, which is any completed or attempted (non-completed) sexual act, sexual contact with, or exploitation (i.e., noncontact sexual interaction) of a child (see3, pp. 14-16, for a full definition). A uniform definition provides researchers, practitioners, and advocates with a consistent manner in which to achieve best practices in understanding the prevalence of child sexual abuse across diverse communities, the context in which child sexual abuse occurs, and strategies for survivor healing.4-5

Copulatory frequencies

There is a popular misconception that human beings are in some way exceptional, as regards frequencies of sexual intercourse after all, our species is sexually active all year round and throughout the menstrual cycle. Many other mammals, by contrast, are seasonal breeders and mating is largely confined to the peri-ovulatory phase of the oestrus cycle. The next chapter will examine the concept of 'loss of oestrus' during human evolution. Here, we are concerned primarily with frequencies of copulation in Homo sapiens, as compared to the non-human primates, and whether sexual selection might have played a role in the evolution of copulatory frequency. frequency of intercourse for 7,602 married men was 4.8 times per month. There was considerable individual variability, however, and rates were slightly higher in village dwellers (5.43 times per month), as compared to married couples living in the city (4.66 times per month). As expected, age was important, so that the highest copulatory...

Recovery of Sexual Potency

The definition of sexual potency varies according to the adopted criteria, such as erection without intercourse (i.e., return of erection) or erection firm enough for intercourse. Moreover, the frequency as well as quality of sexual activity has been recorded (66). Heilbronn technique, our results of erectile response during sexual intercourse with or without using intracavernosal injection in patients who underwent bilateral and unilateral nerve sparing are given in Table 16. Moreover, in contrast to urinary continence, spontaneous sexual potency is difficult to assess objectively (65). Rigiscan studies may provide insight into the organic basis of postradical prostatectomy erectile dysfunction, but are not yet a routine part of evaluation (71).

Changing Relationships

When do teenagers first have sexual intercourse According to the Kinsey Institute, boys are slightly ahead of girls in terms of the average age for first sexual intercourse, with boys doing it for the first time at 16, while girls wait until they reach 17. According to the 2010 Youth Risk Behavior Surveillance, 46 percent of high school seniors had ever had sexual intercourse with similar rates for girls and boys.

The Oestrus That Never

A recurrent theme in discussions about the origins of human sexual behaviour concerns the concept of oestrus, as it applies to female mammals, and to the presumptive loss of oestrus during human evolution. Oestrus, as originally defined by Walter Heape (1900), denotes a period of heightened sexual activity in female mammals, in association with the likelihood that ovulation will occur and that mating will result in conception. Heape noted that 'it is during oestrus, and only at that time, that the female is willing to receive the male.' The term derives from the Greek word for the gadfly, whose bite drives animals into a frenzy the implication being that females are in a state of sexual frenzy or in heat during oestrus. Ovarian hormones (and especially oestrogen and progesterone) control the onset and duration of oestrus, so that ovariectomy is usually associated with loss of the female capacity to display sexual receptivity in many mammals. This is the case, for example, in rodents...

Encephalopathy Syndrome

About 8 days before admission he developed a sore throat and fever. Two days before hospitalization he noted dark urine almost the color of reddish ale. He had been previously well and had been on university sports teams. He now worked as a journalist. He had had no serious past illnesses. He had many girlfriends and had been sexually active with a number of partners, some of whom he picked up in bars. He never had taken cocaine or other drugs and did not drink excessively. His mother had systemic lupus erythematosis. His father had hypertension, well controlled with medications.

Bladder Infections Say Goodbye to UTI

Bladder infections, also known as cystitis, are one of the most common conditions among women of all ages. According to a new study at the University of Washington School of Medicine, an estimated 7 million episodes of acute cystitis occur annually in the United States with an annual cost of 1 billion. The study further showed the term honeymoon cystitis is still accurate in that having sexual intercourse increases the risk of developing the condition. Escherichia coli (E. coli) bacteria found in fecal material is responsible for up to 90 percent of all urinary tract infections (UTI). Fecal-contaminated bacteria gains access to the bladder through the urethra.

Listing Pleasurable Activities

(Examples taking a walk, going to a church or synagogue group, playing a musical instrument, walking the dog, watching a TV program, going to the library, talking on the phone to a friend, talking to a therapist, playing a sport, watching a comedy movie, having sex, riding a bicycle, visiting the Humane Society, listening to music, practicing a hobby, sitting in a cafe, cooking, driving, sewing, dancing, working at a homeless shelter, writing in a journal, taking photographs, taking a class, painting or drawing, soaking in the bathtub, eating at a restaurant, listening to a relaxation tape, shopping, hiking, gardening, praying, meditating, going for a swim, eating lunch outside, attending a lecture, washing your face or hair, lying out in the sun, playing with a pet)

The human menstrual cycle and sexual behaviour

Given such factors and the extreme complexity of situation-dependent variables in the lives of modern humans, it should not surprise the reader that scores of studies have failed to reveal simple relationships between the menstrual cycle and sexual behaviour. Failure to measure hormonal changes, to record behaviour with precision, and to control for the effects of mood has limited the scope of many studies. Almost 30 years ago, Schreiner-Engel (1980 1981) reviewed the results of thirty-two studies which reported peaks of sexual activity at mid-cycle (N 8), pre-menstrually (N 17), during menses (N 4), and post-menstru-ally (N 18). Pawlowski's (1999a) review contains a majority of publications reporting increases in female sexual interest and proceptivity in the fol-licular and peri-ovulatory phases of the menstrual cycle (with pre-menstrual increases also in five out of sixteen reports). The results of a more recent study, by Wilcox et al. (2004), are shown in Figure 6.10. This focused...

Who is a candidate for MUSE

Men who have undergone prior radical prostatectomy appear to have an increased risk of penile or urethral burning with MUSE, and they should be warned about this possibility. The exact cause of this side effect is not known, but it may be caused by a postsurgical supersensitivity of the corpora or increased retention of the MUSE in the penis because the dorsal vein may have been tied off at the time of radical prostatectomy. In particular, patients who have experienced pain with alprostadil in the past are likely to experience discomfort with MUSE. Hypotension (low blood pressure) and syncope (fainting) have been noted with MUSE as well and can be associated with serious cardiovascular consequences. For this reason, MUSE should be used with caution in men who have significant cardiovascular risks and in older men. In addition, the use of MUSE requires test dosing in the office to ensure that there is no hypotensive or syncopal event with use. Men who are at increased risk for...

Clinical Features

After these acute episodes the blood pressure may remain elevated, return to normal, or even fall to hypotensive levels. Sustained hypertension is present in approximately 50 of patients with pheochromocytoma, mimicking the more common essential hypertension. A number of factors, some simply causing mechanical pressure on the tumor, have been identified as causative of the paroxysms urination (with tumors of the urinary bladder), vigorous physical exercise, defecation, sexual intercourse, and ingestion of alcohol. In unprepared patients, severe and even lethal paroxysms have been associated with invasive procedures such as angiography, labor and delivery, diagnostic needle biopsy,13 general anesthesia, and surgical procedures. Less stereotypical are symptoms such as nausea, lassitude, heat intolerance, anxiety,

Historical Considerations

Phallic reconstruction poses a difficult challenge for the penile cancer surgeon. The main goals of surgery are the creation of a cosmetically acceptable sensate neophal-lus with the incorporation of a neourethra to allow voiding standing up and with enough bulk to allow the insertion of a penile prosthesis in order to allow sexual intercourse.1

Erectile Disorders Erectile Dysfunction

Erectile dysfunction (ED) refers to the inability to attain and or maintain penile erection sufficient for satisfactory sexual performance (NIH Consensus Development Panel on Impotence, 1993). Sexual function declines with age, and normal erectile function depends on a number of body systems cardiovascular, endocrine, muscular, nervous, psychological (Lue, 2000). Disorders in any of these can lead to ED, although many factors often are involved.

Tightfitting and nona bsor bent clothing

A small percentage of male partners have penile or oral colonisation of identical strains VVC is often associated with the onset of sexual activity ' ransfcr of organism from rectum to vagina irritation of the vulvovagina I area during sexual intercourse may enhance invasion of organisms

Possible benefits of androgen replacement in women

Multiple studies demonstrate clear evidence that testosterone replacement enhances sexual function in hypogonadal men. In women, there is also strong data in this regard. The best-known study demonstrating a beneficial effect of androgen replacement on sexual function in women was published in 1987 (Sherwin and Gelfand 1987). This trial, although non-randomized and unblinded, did demonstrate increased arousal, fantasy, coitus and orgasm in postmenopausal women given monthly intra-muscular testosterone enanthate (150 mg) and 10 mg of E2 valerate. However, mean serum testosterone levels noted in this study were well over 200 ng dl, at least five times the physiological range seen in naturally post-menopausal women. Accordingly, a later study reported that prolonged use of this preparation resulted in virulizing effects in a number of women (Urman et al. 1991). More sexuality data exists with testosterone replacement via subcutaneous (SQ) testosterone pellets, with or without concomitant...

What are the success and satisfaction rates for the vacuum device

The initial report on the vacuum device, which was published in 1985, reported a 90 success rate for this device in achieving an erection that was adequate for sexual performance. Since then, published success rates with the vacuum device have ranged from 84-95 , and overall satisfaction rates reported for this device have ranged from 72-94 . Notably, the vacuum device has been shown to be effective in treating men with erectile dysfunction of many different causes. In patients with spinal cord injuries, the success rate is reported to be 92 . In those with psychogenic erectile dysfunction, this device also yields good results. In men who have erectile dysfunction caused by arterial disease or after radical prostatectomy, the success rate ranges from 90-100 . Furthermore, the vacuum device is successful in some men who were impotent after the removal of a penile prosthesis.

Cosleeping Children Sleeping in the Parents

I have long advised not having children sleep with the parents. However, I realize now that 50 percent of some cultures in the United States practice co-sleeping in fact, it is the preferred pattern of sleeping in most families throughout the world. There are advantages and disadvantages. I think that children are disturbed if they watch their parents during a sexual act. Child psychologists and psychiatrists agree that this can be disturbing and misunderstood by even the youngest child. Parents who choose to co-sleep with their children tell me that they find it easy to place the baby in another room during sexual activities. Another potential disadvantage to co-sleeping is that it may be more difficult to move a child to a separate bed or room when the child is older.

How Does Epilepsy Affect Womens Sexuality

Hyposexuality is seen more often in epileptic women than in the general population 25-65 of women with TLE are estimated to be affected.44 As with epileptic men, hyposexuality in epileptic women is seen much more often in those with TLE than with primarily generalized epilepsy. Hyposexuality is characterized by lack of libido and difficulty in achieving orgasm. The disorder may be a result of a number of factors, including psychosocial disability, medications (see text that

Complications Associated with Radiotherapy

Limited data are available concerning functional and psychosexual outcomes of organ-preservation by radiotherapy. Opsjordsmoen et al. reported on post-therapy sexuality in 30 men.34 Patients underwent a semistructured interview and completed three self-administered questionnaires (psychosocial adjustment to severe illness (PAIS), mental symptoms (GHQ), and quality of life (EORTC QLQ C-30)). A global score of overall sexual functioning was constructed consisting of sexual interest, sexual ability, sexual satisfaction, sexual identity, partner relationship, and frequency of coitus. In 10 of 12 patients treated with radiotherapy the sexual global score was not or only slightly reduced. Eleven out of fourteen patients treated with local surgery, laser beam treatment, or partial penectomy had moderate to severe reduction of global sexual score. All four patients who had undergone total penec-tomy recorded a severely reduced sexual global score. It was remarkable that in the patients...

Victims of Child Maltreatment

Studies show boys, most whom are sexually victimized between the ages of 6 and 10, are just as traumatized by the experience as are girls. By nature of their physiology, older boys might experience erection, ejaculation, and orgasm. It should be understood that these responses are automatic and are not indicative of any reduction in trauma caused by their sexual violation by an adult. The experience of feelings of confusion, guilt, fear, betrayal, shame, and anger are gender neutral in sexual abuse.

Who Prescribes Analyst or Psychopharmacologist

Example Reaction to Separation from the Therapist. Dr. B, a single college professor, was treated with lithium for a childhood onset bipolar illness. Repeated attempts to stop the lithium led to episodes of hypomania and depression, so he and his psychiatrist agreed to continue it indefinitely. Traumatized by a sadistic, explosively angry father and furious with the loving but ineffective mother who could not defend him against his father's rage, Mr. B could not tolerate exploration into feelings about his past and demanded that the psychiatrist allow him to control the topics addressed in sessions. Though quite impaired in interpersonal relationships, Dr. B managed fairly well professionally as long as he had a session with his psychiatrist every month, where he discussed current issues concerning his sexual performance with women and anger with his department chair. When the psychiatrist left for a 3-month maternity leave,

General Considerations

Any woman in the reproductive age group who is sexually active and misses her menstrual period should be considered pregnant until proven otherwise. Even if she presents with symptoms not directly related to the abdomen, she should be evaluated for pregnancy. A sexually active woman in the reproductive age group may have a history of 2 years of amenorrhea (loss of menstrual periods) but can be pregnant nonetheless. Whatever the cause of the amenorrhea was 2 years ago, it may be different now. ''Think pregnancy'' should be your motto in the evaluation of such patients. This is extremely important because the diagnosis or treatment of a woman's medical or surgical problem may be deleterious to the developing fetus if she is pregnant. As discussed later in this chapter, many of the symptoms of pregnancy are nonspecific and can be interpreted erroneously if the pregnancy is not recognized. For example, the urinary frequency that is common in early pregnancy might easily be mistaken for...

Subcortical structures

The form of hypersexuality noted in the Kluver-Bucy syndrome in man probably represents a failure to discriminate and effectively channel otherwise intact basic drives in the external world (Horn & Zasler, 1990 Mesulam, 1985, 2000a, 2000b). Throughout phylogeny eating, sexual, and aggressive behaviours have been consistently linked to limbic structures (Horn & Zasler, 1990), and direct stimulation of the amygdala often results in aggressive behaviours in primates and other animals (Horn & Zasler, 1990). In humans, complex partial seizures of temporal lobe origin (i.e., temporal lobe epilepsy TLE) have been associated with disturbances in sexual functioning and demonstrates the clinical effects of recurrent amygdalar stimulation (Horn & Zasler, 1990). TLE may display itself as a sexual seizure with sexual genital sensations and autonomic changes associated with arousal (Boller & Frank, 1982 Freemon & Nevis, 1969). In certain cases, sexual activity may precipitate a seizure. Remmilard,...

Patients with impaired mood and wellbeing

Consistent with the effects of DHEA on mood andwellbeing in patients with adrenal insufficiency beneficial effects were also observed in randomizeddouble-blind studies in patients with major depression (Wolkowitz etal. 1999) and midlife dysthymia (Bloch et al. 1999). DHEA also improved scores on an ADL scale in patients with myotonic dystrophy (Sugino et al. 1998). Reiter et al. (1999) have reported an improvement in erectile function, sexual satisfaction and orgasmic function in 4060 year old men suffering from erectile dysfunction and receiving 50 mg DHEA day for six months in a randomized double-blind fashion. To compare the efficacy of DHEA vs. placebo in Alzheimer disease 58 patients were randomized to six months of treatment with DHEA (100 mg day) or placebo. A transient effect on cognitive performance narrowly missed significance (Wolkowitz et al. 2003), possibly because of the small patient sample. Recently Strous et al. (2003) have studied the efficacy of DHEA (100 mg day) in...

Effects on the central nervous system

Libido and sexual satisfaction are influenced by DHEA in women with AI (Arlt etal. 1999a) and in elderly women with age-related low DHEAS (Baulieu etal. 2000). Also in men, only impaired sexuality benefits from DHEA administration (Reiter et al. 1999) while normal baseline performance cannot be enhanced (Arlt et al. 2001). The effect of DHEA on libido and sexuality is most likely a consequence of increased androgenic activity derived from DHEA by peripheral bioconversion. In recent years it has become increasingly clear that androgens play a keyrole for female sexuality (Arlt 2003 Shifren et al. 2000). In fact, the adrenals are a major source of female androgens (Labrie et al. 2003) and their fundamental role for female sexuality (Waxenberg et al. 1959) has been rediscovered by studies on the therapeutic potential of DHEA. The available evidence and the superior pharmacokinetic properties make DHEA a highly attractive tool for treatment of impaired sexuality in women. However, firm...

Methodological issues

As alluded to in the discussion of methodology in chapter 2, assessment of sexual changes consequent to closed head injury requires a differentiation between the source of the behavioural changes (Aloni & Katz, 1999). Primary sexual dysfunction refers to a dysfunction that is organic in origin and directly caused by the injury. This stands in contrast to secondary sexual dysfunction, which refers to the delayed aftereffect caused by the primary injury (Kaplan, 1983) that emerges as a consequence of the loss of function associated with the primary injury. Thus, an individual with TBI may not necessarily sustain damage to any of the complex matrix of neuroanatomi-cal regions discussed above, but may develop a secondary depressive state associated with the loss of employment, quality of life, recreational pursuits, or intimate relationships with spouse, family, or friends and still have sexual dysfunction as a secondary effect of the injury mediated by the depression. For example, in...

Multidimensional Scale for Assessment ofErectile Dysfunction

These questions ask about the effects your erection problems have had on your sex life over the past 4 weeks. Please answer the following questions as honestly and clearly as possible. In answering these questions, the following definitions apply Sexual activity includes intercourse, caressing, foreplay, and masturbation. Sexual intercourse is defined as vaginal penetration of the partner (you entered your partner). Sexual stimulation includes situations like foreplay with a partner, looking at erotic pictures, etc.

Female Sexual Arousal Disorder

The DSM-IV-TR defines female sexual arousal disorder as the inability to attain or maintain a genital lubrication-swelling response during sexual activity. The American Foundation for Urologic Disease recommended division of this diagnosis into subjective, genital, and combined subtypes. It also urged recognition of persistent sexual arousal disorder characterized by spontaneous, intrusive, and unwanted genital arousal . . . unrelieved by one or more orgasms (Basson et al., 2003).

Sexual Pain Disorders Vaginismus

Uncontrolled reports suggest that sex therapy may be helpful (McGuire and Hawton, 2005). Vaginismus is not under the patient's conscious control. Therapy must be directed at restoring conscious control under conditions that respect the patient's autonomy and maintain the patient's safety from further trauma. If the patient expresses fear or anxiety, pelvic examination may be deferred, and in severe cases, sedation may be necessary. Any physical abnormalities detected on pelvic examination, such as infections, should first be treated. After this, the patient may begin self-treatment with size-graded plastic or silicone vaginal dilators, gradually teaching her vagina to remain relaxed and receive nonpainful, self-controlled penetration (see Web Resources). Specialized physical therapists teach patients to use biofeedback to relax the pelvic floor musculature this can be more effective than treatment with dilators and is often preferred by patients....

Rule 3 Define the nature of your relationship with the person you want to help

Obviously, the nature of your relationship will influence how your efforts are received. If you're the parent of someone who is eating disordered, the ordinary stress, strain, and intensity of that parent-child relationship will color and magnify any reactions to your help. Even if you're 100 right, you might be met with more resistance and denial than a non-relative would. If your relationship with the person is more formal than personal, your efforts may be perceived as coercive or bullying. If you're confidantes, you risk jeopardizing the closeness of the relationship if the person isn't yet ready for help. A more casual acquaintance is apt to be seen as pushy or nosy. If you're the romantic or sexual partner, tact, delicacy, and a heightened degree of understanding are crucial for your helping efforts to be acceptable.

Special Issues for a Romantic Partner to Consider

Let's look at the special issues inherent in helping a romantic partner take the road to recovery. A romantic sexual relationship is an intense, emotional connection between people who are physically attracted to each other and who discover, over time, that they can trust each other in a special way. That trust makes it possible for them to share their innermost thoughts without fear of ridicule or exposure, and allows the physical aspects of the attraction to blossom and find expression in a romantic context. physical intimacy can be very difficult to achieve and maintain. In fact, it can be frightening. Many young women who have eating disorders will say they feel fat and ugly even when they're not. The tendency is to perceive the self as body parts, scrutinizing their breasts, stomach, hips, thighs, and buttocks instead of being able to look in a mirror and see the whole person. When a particular woman literally cannot see what her lover sees, humor evaporates, joking is...

Premature Rapid Ejaculation

Premature ejaculation refers to the occurrence of male ejaculation, usually with orgasm, before desired by the individual, his partner, or both. Premature ejaculation is also referred to as rapid ejaculation or difficulty with ejaculatory control. Evaluation of premature ejaculation is by history. Onset, circumstances, and meaning (personal and relationship) of the dysfunction should be explored, as well as pertinent past sexual experiences. For example, young men whose first sexual experiences were rushed may later have difficulty establishing ejaculatory control in more relaxed contexts. Men having intercourse infrequently are more likely to ejaculate rapidly. The clinician should determine whether a patient can delay his ejaculation while masturbating. In addition, information regarding the patient's level of sexual knowledge and his partner's expectations may be significant. Behavioral techniques, such as the squeeze technique, stop and start, masturbation training, and...

Prevalence and incidence of disturbances of sexual functioning

Walker and Jablon (1961) report that in a large sample of World War II veterans with head injury (739 men) the vast majority (87 ) had no complaint about their sexual functioning subsequent to the injury. Eight percent complained of impotence or reduced libido, four reported an increase in sexual desire, and 14 reported other problems regarding their sexual appetites. The frontally injured subjects tended to have more sexual complaints than individuals injured in other brain regions. At the 25-year follow-up (Walker, 1972), an unspecified number of wives complained of diminution of sexual functioning in their spouses and wondered whether anything might be done to enhance his sexual interest (p. 8). posttraumatic amnesia of at least seven days. Bond observed no association between the duration of posttraumatic amnesia, the level of physical disability or cognitive impairment, and the level of sexual activity. Oddy, Humphrey, and Utley (1978) studied 50 adults, six months subsequent to...

Clinical Considerations in the Care of Lesbian Gay and Bisexual Patients

Gay men sometimes report difficulty in obtaining adequate health care caused by providers' bias and fear of discrimination. Any male patient who presents for treatment of urethri-tis should be asked about participation in oral-genital sex or receptive anal intercourse, because some treatment regimens for urethral gonorrhea and chlamydia are not effective against pharyngeal and anal infections. A careful exposure history should be taken, even if the patient self-identifies as heterosexual, because some heterosexual-identified men may have same-gender sexual experiences.

The Internets Impact on Clinical Psychiatry

As Internet technology makes more medical information available to the public, relationships between patients and physicians are changing. Patients often do not tell their physicians about what they learned or did online (Hart et al. 2004). Today, patients go online to research their symptoms and their illnesses, often arriving at the doctor's office with printouts or information they learned online. Pharmaceutical manufacturers have also been using the Internet for direct-to-consumer advertising of prescription medications. When a RealAge quiz became a popular link among users of social networking sites, a journalist found that the quiz was a clearinghouse for several large drug companies allowing them to use almost any combination of answers from the test to find people to market to, including whether someone is taking antidepressants, how sexually active they are and even if their marriage is happy (Clifford 2009). Social networking sites for health, such as PatientsLikeMe (http...

Over the Past 6 Months

During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner 4. During sexual intercourse, how difficult was it to maintain your erection after you had penetrated (entered) your partner 5. When you attempted sexual intercourse, how often was it satisfactory for you

LUSTSexuality Systems

The most prominent additional neuropeptide systems implicated in sociosexual feelings and desires are the brain systems that utilize the posterior-pituitary nona-peptides oxytocin (OXY) and arginine-vasopressin (AVP). Oxytocinergic activity within the brain is substantially facilitated by the more female-specific adult sex hormones, estrogen and progesterone, while AVP systems are promoted by the more male-specific adult sex hormone testosterone. In animal models, OXY promotes female sexual behavior, but it is also compatible with male sexual urges, perhaps because the molecule is not only a general social hormone within the brain (Insel, 1997) but is released markedly by pleasurable somatosensory stimulation and at orgasm (Carter, 1998 Uvnas-Moberg, 1998). Thus, it would be anticipated that under the right contextual conditions (i.e., those that support eroticism), oxytocinergics that get to the right regions of the brain, perhaps even via intranasal routes, would tend to increase...

The female reproductive tract 1041 Overview

The female reproductive tract contains smooth muscle in its walls, and has a secretory epithelium lining it. As one would expect, it is innervated throughout by the autonomic nervous system. Nevertheless, it is intriguing that - apart from a few obvious exceptions - the functions of the innervation are largely unknown. It has been demonstrated in the rat, for instance, that complete autonomic denervation does not preclude normal intercourse, conception, pregnancy, delivery of live pups, and their suckling. Obvious functions of the innervation pertain largely to the behavioural aspects of sexual activity - erection of the clitoris, mucous secretion in the cervix providing lubrication of the vagina and orgasm probably all have reflex components in which the autonomic innervation provides the efferent limb.

Psychosexual Disorders

Psychosexual dysfunction evolves in up to 50 of patients after TBI. Infrequent intercourse is the most common problem.225 Neuroendocrine dysfunction, pain, neurologic impairments, cognitive and behavioral dysfunction, alterations in libido, bowel and bladder incontinence, and psychosocial issues can often be managed.226 Hypersexuality and disinhibition of sexual activity sometimes follow a medial basalfrontal or diencephalic injury. The Kluver-Bucy syndrome is associated with bitemporal injuries. Change in sexual preference has been related to limbic lesions.227

Diagnostic Evaluation

Stern, there appear to be several important diagnoses. Inflammatory bowel disease (IBD), irritable bowel syndrome, traveler's diarrhea, pseudomembranous colitis, celiac disease, and giardiasis are certainly in the differential diagnosis. The history of iritis and low back pain makes the diagnosis of IBD a strong possibility. IBD, consisting of Crohn's disease and ulcerative colitis, is very common, with an annual incidence in the United States of approximately 3 to 10 new cases per 100,000 people. Extraintestinal inflammatory manifestations are common. Ocular manifestations occur in 5 of patients with IBD, and ankylosing spondylitis, in 5 to 10 . The most common extraintestinal manifestation is a peripheral, large-joint, asymmetric, nondeforming arthritis this occurs in 20 of patients with IBD. Mr. Stern does not have a history of this type of arthritis. Genetic disorders seem unlikely, inasmuch as the appearance of this patient's problem started at age 27 or 28....

Clinical Manifestations and Pathology Trachoma

Gonococcal conjunctivitis, due to Neisseria gonorrhea, infects newborns as well as children and adults. Whereas newborns acquire the eye disease in the birth canal from their mother's vaginal secretions, others may contract the disease by direct or indirect contact. Although there may be nonvene-real transmission - especially in the tropics - the disease is now transmitted mainly by sexual intercourse. In infants the eyelids may be very swollen, and ulceration of the cornea often follows. Ocular gonorrhea infection used to be one of the principal causes of blindness in Europe until the 1880s, when a silver nitrate solution came into use in newborns. Since then, the dramatic decrease in blindness that has resulted is one of great victories of scientific medicine (Thygeson 1971 Insler 1987).

Obstructive Sleep Apnea

Tiredness, sleepiness, and a sense that sleep is not refreshing are characteristic symptoms of sleep apnea, often accompanied by impaired memory and concentration. The sleepiness often increases gradually over several years as patients gain weight. Some patients feel mentally dull or disoriented each morning. Daytime sleepiness is usually most apparent after lunch, while driving or reading, or in other boring sedentary situations. Patients often minimize difficulties with sleepiness and describe it as no worse than in colleagues or peers. With more severe apnea, patients may fall asleep on the telephone or during sexual intercourse and may have episodes of automatic behavior during which complex activities are performed such as driving for miles with no recollection. Although daytime

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