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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. More here...

Revive Her Drive Summary


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Orgasmic disorders in women

Orgasm is the reflexive culmination of arousal manifested by rhythmic vaginal wall contractions and the release of muscular tension accompanied by varying degrees of pleasure. Achieving orgasm reliably, usually highly valued by women, is associated with enhanced self-esteem, confidence in one's femininity, and the desire to increase sexual activity.(49) The persistent and recurring difficulty achieving orgasm is labelled anorgasmia. Table 5 lists the diagnostic criteria for anorgasmia set forth in DSM-IV and ICD-10.

Sexual relationships marriage and parenthood

Long-term relationships and parenting children (at some stage) are generally considered to be an integral part of being an adult. In adolescence, emotional and sexual interest and needs develop, and it is at this stage that most young people start to have sexual relationships. However, in spite of a policy of normalization, people with mental retardation are seldom encouraged to develop intimate sexual relationships. Parents tend not to want it to happen, (1.8 and service managers and care staff, though they may not necessarily actively discourage it, often provide little opportunity, or privacy, to enable it to happen. Many people in the general population find it difficult to accept that men and women with mental retardation have ordinary sexual feelings and desires, let alone that they should be allowed to act on them. The argument against allowing people with mental retardation to have sexual partners often involves judgements about whether someone is deemed fit to be a parent....

Male orgasm

Decreasing in intensity and dying away as do the contractions. This is the human orgasm. Orgasm is felt as an intense pleasurable throbbing in the penis and pelvic area and can last from 5 to 60 s. Kinsey et al. (1 ) marshalled the evidence showing that orgasm and ejaculation were separate mechanisms. Briefly, orgasm occurs without ejaculation in preadolescent males, in some adult males orgasm does not occur until a few seconds after ejaculation, a few adult males are anatomically incapable of ejaculation but have orgasms, and males who have been prostatectomized cannot have ejaculations but some can have orgasms. The intensity of orgasm varies with the duration of the sexual arousal (the longer it is maintained the greater the subsequent orgasm), the erotic excitement and novelty of the arousing stimuli, and previous ejaculation, especially the interval from the last one (initial ejaculations have usually better orgasms than subsequent ones). Males have a refractory period after...

Female orgasm

As in the male, the female orgasm creates supreme ecstatic pleasure usually accompanied by throbbing striated muscle contractions, especially of the ischiocavernous and bulbospongiosus muscles, but other pelvic striated muscles can also be involved. (29 The induction of orgasm in women by coital stimulation alone is not as frequent as that in the male, about half not achieving orgasm unless clitoral stimulation is also used. The reason for this difference is ascribed either to the greater inhibitory education about sexual pleasure experienced by women or the lack of correct genital stimulation. A major difference between males and females is that females can be multiorgasmic because they do not have a refractory period after orgasm.(2,39 There is mounting evidence that, unlike the unitary concept of the DEOR model, the erotic stimulation of different genital sites (especially the anterior vaginal wall compared with the clitoris) induces different types of orgasmic response both...

Female Sexual Dysfunction

Female sexual dysfunction is a generalized term for abnormalities in the normal female sexual cycle. It is a highly prevalent problem affecting anywhere from 30 to 50 of women in all age groups. The National Health and Social Life survey of 1749 women found that 43 complained of sexual dysfunction.20 Only recently have the problems involved with female sexuality gained recognition by clinicians. There are risk factors associated with female sexual dysfunction including age, menopause, previous surgery, mental and physical health, and availability of a partner. In 1966, Masters and Johnson21 first described the female sexual response consisting of four successive phases -excitement, plateau, orgasmic, and resolution. This was later modified to the phases of desire, arousal, orgasm, and resolution. It is well recognized today that the female sexual cycle is not just a sequence of events, but a very complex

Immune System Communication with the Nervous System Hormones

Cytokines released after infection produce many effects on behavior, including decreased feeding, sexual activity, and pleasure seeking behaviors. In addition, sleep is increased and cognitive function is impaired (Banks, Farr, and Morley 2002). Several mechanisms have been proposed by which blood-borne cytokines convey information to the CNS (Dinarello 2004). These include cytokine acting at the circumventricular organ (CVO), acting at afferent nerves including the vagal, or altering the permeability of the blood-brain barrier (BBB) to immune cells or another substance. In addition to these indirect mechanisms of effects on cytokines on the brain, cytokine transport across the BBB has also been described. The list of cytokine transporters includes IL-1, IL-6, tumor necrosis factor-a, and the IL-1 receptor antagonist (Banks et al. 2002). The cytokine transporters are usually distinguishable from cytokine receptors and interestingly show differences in regional uptake in the brain...

Urogynecology History

Specific questions will often help clarify the type of incontinence distressing the patient. Women with stress urinary incontinence (SUI), or urine loss associated with exertion, report urine loss with coughing, sneezing, or laughing. Urine loss during physical activity that increases intraabdominal pressure, such as running and sit-ups, also occurs frequently. Women with urge urinary incontinence (UUI), or urine loss associated with uninhibited detrusor muscle contractions,will typically also complain of urinary urgency, nocturia, and symptoms of frequency. These patients often report an urgency to void that occurs with little warning and cannot be repressed, with leakage often occurring on the way to the toilet. They should be asked how many daytime and nocturnal voids they average. More than eight voids per day and two voids per night is considered abnormal. Episodes of enuresis should be specifically elicited. Urge incontinence will often have triggers such as running water,...

Psychosexual development

While sexual activity is often the focus of parental concern when a child reaches adolescence, psychosexual development arises from birth, if not before. In the second half of the first year of life, infants can tell genders apart and by the second year they are aware of their own gender. As noted earlier, they then prefer to play with children of their own gender. In the preschool years, they are increasingly aware of their own bodies. Far from confirming the stereotype of fatness equalling jollity, fat children are more likely than physically disabled children to be rejected by other children and to become depressed. Concern with size and image currently predominate in many Western cultures, and even elementary school children show concerns about being too fat.

Sexuality and repression

Freud discovered that most of these reminiscences were painful or shameful, and not easily accessible to conscious recall. This led him to postulate a mental mechanism which he called repression, which tended to banish unpleasant memories from consciousness. Freud, therefore, was postulating a state of conflict within the mind in which a painful emotion was seeking to be discharged, while another part of the mind was refusing to allow this to happen. According to Freud, nearly all these reminiscences were concerned with sexual experience. Freud remained convinced that sexual satisfaction was the key to happiness, and that what was wrong with the neurotic was failure to achieve a normal sex life. This central conviction had two roots. In his autobiographical study, Freud acknowledges his debt to the ideas of G.T. Fechner, a professor of physics and then philosophy at Leipzig University. During the course of a manic-depressive illness, Fechner introduced the idea of a universal...

Sexually Transmitted Disease Prophylaxis

Normal sexual experimentation involves age-appropriate activities between children of similar age or developmental stage. Motivation for the activity is mutual curiosity and pleasure and involves mutual consent. Sexual abuse involves manipulation, pressure, coercion, threat, or force to involve child in developmentally inappropriate sexual activity and maintain secrecy. Episodes that are very frequent, very intense, or compulsive should also raise concerns.

Biochemistry Hormones

The end result of HYPAC activity is cortisol release in humans, often seen in situations of prolonged stress. Ballenger et al. (1983) found that CSF cortisol correlated negatively with scales in the P-ImpUSS personality factor including the EPQ P scale, the SSS Disinhibition scale, the MMPI Hypomania scale and the number of reported previous and present sexual partners. The low levels of cortisol found in disinhibited antisocial traits in the normal population is consistent with the low levels of urinary cortisol found in habitually psychopathic and violent prisoners (Virkunen, 1985). Low levels of CSF corticotrophin are also typical in alcoholic offenders with psychopathic personality traits (Virkkunen et al., 1994). Cortisol is high in persons with anxiety states and severe depression, but lower in manic states. The low levels of cortisol related to psychopathy may indicate the lack of anxiety and stress reactivity in these personality types. Testosterone from blood is correlated...

Physiology of Female Sexual Function

Normal sensation is also critical in allowing sexual arousal, and the ability to achieve orgasm requires an intact sympathetic outflow tract. In women with diabetes or spinal cord injuries, the neuropathy may result in diminished levels of sexual functioning and orgasmic disorders. Similarly, after pelvic floor surgery, orgasmic function can be potentially affected by changes in the pelvic floor muscles because they modulate vaginal receptivity as well as the motor responses during orgasm.

Assessing and diagnosing drug use disorders

A thorough assessment of a drug use disorder spans personal demographic features, health status, health symptoms, and social functioning considerations together with an appraisal of the specific psychological and social functions which drug use serves the individual. (14) Specific drug-related harms range from minor adverse physical or psychological morbidities which are directly induced by an illicit substance, to acute and chronic health disorders (e.g. circulatory problems) or overdose and death. In addition to assessing the harm arising from drug use itself, the potential of contagion and transmission of HIV infection and other blood-borne diseases has made it important to assess specific risk behaviours (e.g. sharing of drug injection equipment non-condom penetrative sexual intercourse). The assessment of psychiatric comorbidity should also be considered when conducting assessment. The improvement in psychiatric symptoms is an important treatment goal, but their nature, sequelae,...

Adjusting to Changes in Sexual Function in MS

Normal sexual function changes throughout one's lifetime, but having multiple sclerosis (MS) can profoundly affect an individual's sexual experience in a variety of ways. The most frequently reported change in men is diminished capacity to obtain or maintain an erection (impotence), while the most frequent change reported by women is partial or total loss of libido (sexual desire). Symptoms that can affect sexual activity include Difficulties in meeting expectations about sexual expression, which can particularly affect those who live with a disability

Differential Diagnosis

Predominantly an infection of sexually active individuals, usually observed in boys. Signs and symptoms include painful or burning urination and discharge from the urethral meatus. Causes may be gonococcal (Neisseria gonorrhea) and nongonococcal urethritis (NGU), which is now more frequent in the United States. NGU may be due to Chlamydia trachomatis, Ureaplasma urealyticum, and, less commonly, Trichomonas vaginalis or herpesvirus infection.

Physical Exam Key Points

Inspect skin and perineum for evidence of rashes, redness, or irritation. Look for evidence of discharge. Perform pelvic exam in sexually active adolescent girls who present with dysuria and discharge to rule out vaginitis, cervicitis, and pelvic inflammatory disease.

Coping With Msrelated Changes In Sexual Response

You need to discuss changes in your sexual feelings and ask what treatments are available to enhance your sexuality. Communicate your concerns to your healthcare provider, including your current medications. Make a date for a sensual evening. Partners can enjoy each other physically and engage in sensual exploration of each other's bodies, without the pressure of having to have sexual intercourse. approved several medicines called phos-phodiesterase-type-5 (PDE-5) inhibitors. PDE-5 inhibitors work by blocking a chemical in the erectile tissues that causes erections to become flaccid. These medicines include sildenafil (Viagra ), vardenafil (Levitra ), and tadalafil (Cialis ). To date, only sildenafil has been completed in clinical trials with men who have MS, although the other medicines are highly similar and can be prescribed for persons with MS. These medicines do not improve libido, but are helpful in maintaining erections when they occur. They are typically taken an hour before...

The impact of pathological jealousy

Delusional jealousy is anguishing to the sufferer and even more so to the sexual partner who is accused of infidelity. The latter is subjected to escalating emotional abuse, and indignation, protest, and proof of innocence are unavailing. Physical violence, especially by males, is common (Z3) and in a proportion of cases finally ends in homicide, sometimes followed by the suicide of the perpetrator. (Z4 Subjected to prolonged threat, many victims are too terrified to speak up, and some become housebound in a vain attempt to prevent accusations of philandering. From time to time the situation reveals itself when the desperate partner attempts suicide and talks to a helping professional when recovering.

Respiratory rate may be respiratory compensation for metabolic

Perform a GU exam to evaluate for pelvic inflammatory disease in a sexually active febrile adolescent. Consider UTI in a febrile girl without other evidence of an infectious focus. Physical findings (eg, CVA tenderness) are less reliable in younger children. Male adolescents must be assessed for testicular tenderness of epididymitis.

Actions and Site of Actions

Most of the serotonin in the brain is in the brainstem, specifically in the raphe nuclei considerable amounts also are present in areas of the hypothalamus, the lim-bic system, and the pituitary gland. Current evidence indicates that serotonin is involved in the regulation of several aspects of behavior, including sleep, pain perception, depression, sexual activity, and aggressiveness. Some of the most important antidepressant agents are believed to prevent the reuptake of serotonin (see Chapter 33). Serotonin also may be involved in temperature regulation and in the hypothalamic control of the release of pituitary hormones.

Biological Effects

Furthermore, it has been demonstrated that ACTH plays a role in sexual behavior and the determination of sexual dimorphism. Prenatal administration of ACTH elicits changes in the serotoninergic system, (e.g. by increasing 5-HT uptake) and induces changes in the dopaminergic innervation of the brain which persists until adulthood. These anatomical changes are coupled to severe dysfunctions of sexual activity in males, while sexual activity is not significantly altered in females.

Psychotherapy and counselling

Treatment of AD initially focuses on psychotherapeutic and counselling interventions to reduce the stressor, enhance the capacity to cope with a stressor that cannot be reduced or removed, and establish a system of support to maximize adaptation. The patient needs to be made aware of the significant dysfunction that the stressor has caused and consider strategies to manage the disability. Some stressors, for example taking on more responsibility than can be managed by the individual, or putting oneself at risk (e.g. unprotected sex with an unknown partner), can be avoided or minimized. Other stressors may elicit an over-reaction on the part of the patient (e.g. abandonment by a lover). The patient may attempt suicide or become reclusive, damaging his or her source of income. In this situation, the therapist would assist the patient to verbalize his or her disappointed feelings and rage rather than behaving destructively. The role of verbalization in minimizing the discomfort of the...

Rates Of Hpvdna Detection And Abnormal Cytology

Younger women have HPV rates up to six to eightfold than that of older women. Prevalence rates range from 12 to 56 in women under 21 years compared with 2-7 in women more than 35 years of age (4,5,16,17). Although, some countries have prevalence rates that begin to rise again after the age of 50 years, the rates do not reach to those of young women (18). Approximately, 50 of adolescents and young women acquire a cervical HPV infection within 5-7 years after initiating sexual intercourse with the highest risk factor being a recent new sexual partner (19). As previously discussed LSIL is the morphological manifestation of cervical HPV infections and high rates of LSIL would therefore be expected in this group. Rates of LSIL range from 2 to 14 (20-22) in adolescents whereas in older women ( 30 years) the rates range from 0.6 to 1 . However, it is important to emphasize that HPV detection in adolescents is most commonly associated with normal cytology. More than three-quarters of infected...

Histrionic Personality Disorder

Criterion 2 (interaction with others is often characterized by inappropriate sexually seductive or provocative behavior) may be a poor fit for many in later life because of the reduced number of potential sexual partners, especially among older women who greatly outnumber older men. Nonetheless, older adults may still meet this criterion if they are inappropriately provocative and seductive despite any real intention of creating a sexual relationship. Criterion 7 (is suggestible, that is, easily influenced by others or circumstances) may be problematic especially when cognitive impairments are present (e.g., poor planning and impaired judgment) and in cases where very frail older adults do not have much actual control over their environments. Being easily influenced ( going with the flow and not causing any problems ) may, in fact, be encouraged and

Cervical Cancer Screening

As discussed earlier, the high rates of HPV and abnormal cytology in adolescents began the movement to screen all sexually active women including young adolescents in the United States (9-11). The guidelines also proposed that once screening was initiated, if three consecutive annual Pap smears were normal, screening intervals could be extended to every 3 years except for high risk women who should be screened annually. All adolescent women who are sexually active are often considered high risk (9) because adolescents have the highest rates of STIs including Neisseria gonorrhoeae and C. trachomatis (3,47,48). The low sensitivity of a single smear fueled the recommendations for early and frequent screening (49). However, new data suggest that even if adolescents are not screened within 3 years after the onset of sexual activity the chances of any HPV progressing to carcinoma-in situ are extremely rare. Whereas, screening and discovering abnormal cytological smears create unnecessary...

Using Simulation to Infer Motives

A third reason to consider the simulation account is that certain aspects of the process may operate spontaneously. The discovery of mirror neurons in monkeys suggests a possible neural basis for the process of entering into another's mental state. When people observe the goal-directed actions of others, such as grasping an object, it is possible that related neurons and hand muscles are activated within the observer (Decety, Chapter 9, this volume Fadiga, Fogassi, Pavesi, & Rizzolatti, 1995 Gallese & Goldman, 1998). Other research suggests that feelings of empathy may be spontaneously activated in an observer. When people are exposed to someone who is in an emotionally arousing situation, they often spontaneously experience feelings of empathy (Hodges & Wegner, 1997). In turn, empathic feelings, or a feeling of general similarity with the other, may prompt attempts at simulation. For example, a study by Ames (2004) illustrates how feelings of similarity can prompt people to project...

Models of psychotherapy

The model is a useful one even within a more limited outpatient psychotherapeutic setting. Some patients will readily identify their distress when overwhelmed by powerful sexual feelings or when confronted with personal and social responsibilities perceived as the result of growing up. The aims of the psychotherapy are to support the patient while she is beginning to abandon the psychobiological regression of anorexia nervosa. In addition she is encouraged to broaden her perception of herself in ways that are no longer wholly dependent on her physical appearance but include an improved sense of competence and self-esteem. She is helped to tackle personal and social problems from which she had previously escaped so that she can address her own and her parents' concerns about sexuality.

Sexuality as a social construct and the concept of sexual scripting

Laqueur(5) suggests that while the sexual biology remained unchanged, its expression has been influenced over the centuries by culture, social class, ethnic group, and religion. This concept, that human sexuality is a social construct, has been strongly argued by Foucault (6) and promoted by other social constructionist authors.(7) Gagnon and Simon(8) introduced the concept of 'sexual scripting'. Scripts organize and determine the circumstances under which sexual activity occurs, they are involved in 'learning the meaning of internal states, organizing the sequences of specific sexual acts, decoding novel situations, setting limits on sexual responses and linking meanings from non-sexual aspects of life to specifically sexual experience'. Money (9) employed a similar construction in his development of 'love maps' for the individual. While patterns of behaviour are influenced by society and social forces, there is a dearth of evidence to show that sexual identity, orientation, or...

Courtship mating behaviouractivity initiating normal sexual behaviour

With the exception of rape, humans initiate sexual activity with courtship behaviour. Sometimes courtship activity precedes the desire phase, sometimes it occurs during the desire phase, and sometimes in the excitation phase (Fig (d)). Evolutionary psychology attempts to explain the strategies of mating. (24 Its message is not always palatable to modern sensitivities about sexual equality. It is argued that women invest more in their offspring than men,(25) that this investment is a scarce resource that men compete for, and that men can enhance their reproductive strategy by mating frequently. Most men are first visually atttracted to a possible female sexual partner. They look for youthfulness and physical attractiveness in the form of regular features, smooth complexion, optimum stature, and good physique, and they value virginity and chastity. Partner variety is highly desired. Women, however, need to obtain high-quality mates with abundant resources and look for emotional and...

Model for understanding sexual response

For heuristic purposes, the sexual response cycle can be divided into four phases of functioning desire, arousal, orgasm, and satisfaction. Dysfunctions of sexual response found in both DSM-IV1,' and ICD-10(1.4) mirror this theoretical model, but also include another dimension, that of sexual pain disorders. These ideas are an elaboration of Masters and Johnson's psychophysiological research as well as the independent theoretical contributions of Kaplan (15 and LiefA16. Two assumptions underlie this model (1) each phase of sexual function has relatively discrete underlying psychophysiological mechanisms and (2) disturbances in one phase do not necessarily denote dysfunctions in another. This conceptualization, however, does not preclude a dysfunction in one area precipitating secondary impairments in another phase. For example, the loss of erectile capacity may eventually dampen a man's interest in engaging in any sexual activity. The strength of this four-phase model is that it...

Disorders of sexual aversion

These disorders are considered extreme forms of desire disorders differentiated by the emotion of intense aversion to or disgust with sexual activity, rather than the more typical lack of interest in sexual behaviour. The ICD-10 and DSM-IV criteria can be found in Table 2. There is generally a phobic element seen that leads clinicians to consider a traumatogenic aetiology more often than the other factors proposed for generalized hypoactive sexual desire. These may include early sexual abuse, painful experiences with coitus, or the perception of being assaulted by the partner.

Psychotherapysexual counselling

Psychotherapy aims to restore a man's potency to the optimal level possible within the limits of his physical well being and life circumstances. The goal is to surmount the psychological and relational barriers that preclude mutual sexual satisfaction. Psychodynamically oriented therapists view the dysfunction as a metaphor in which the man couple are trying simultaneously to conceal and express conflictual aspects of themselves or their relationship. In symbolic terms the dysfunction contains a compromised solution to one of life's dilemmas.(42) Alternatively, behaviour therapists understand the dysfunction as a maladaptive response to interpersonal or environmental situations, or past experiences. Sex therapy today involves integrating medical and psychotherapeutic interventions. The conventional role of the mental health clinician in the treatment of erectile dysfunction had been to treat those with psychogenic erectile problems. Now with the advent of efficacious, reversible, and...

Organic disease and the differential diagnosis of paraphilias Mental retardation

Mental retardation causes serious limitations to patients not only because of their cognitive deficits, but also because of the unusual environment in which they live and develop. Families and institutions become frustrated with the mentally retarded individual's limitations and the subsequent economic, social, and emotional burden placed on others. The mentally retarded individual's sex education is dramatically different from that of non-retarded people. Families fear the consequences of involvement of their mentally retarded daughters or sons in any sexual activity and, as a consequence, the message to the mentally retarded is simply never to be sexual. The mentally retarded person's intellectual limitations make it difficult to access those individuals identified as most attractive. However, because these individuals do nevertheless possess a biologically based sex drive, they find themselves having sexual desire but not having sexual outlets for their expression. Furthermore,...

Pharmacological Aspects

First-time users frequently experience unpleasant, or dysphoric, effects that may include nausea and vomiting. The frequent user experiences a rush, or warm flushing feeling, in the skin and lower extremities that is often equated with sexual orgasm. This intense euphoria lasts

The Patient Who Cannot Be Fit with a Pessary

Not all female candidates can be successfully fit with a pessary. Typical reasons for inability to be fit include vaginal scarring with loss of vaginal caliber or length from previous surgery, severe urogenital atrophy, vaginal pain, and markedly restricted or enlarged vaginal introitus. In those with significantly increased vaginal caliber, performing a perineoplasty and subsequent refitting with a pessary should be considered. For elderly women with severe genital prolapse who are not, and will not become, sexually active, and cannot be fit with a pessary, consideration should be given to a colpocleisis performed under regional or local anesthesia.

Surgical Approaches

We will typically perform an abdominal sacro-colpopexy in a patient with advanced prolapse in which the vaginal apex reaches significantly above the ischial spines on vaginal examination, for whom maintaining normal sexual activity is very important, someone who will require another abdominal procedure for their vaginal prolapse such as an abdominal paravaginal repair, and someone with significant vaginal wall scarring, large apical fascial defects, or significant foreshortening of the vaginal canal. Vaginal approaches are typically performed in post-menopausal women for whom sexual activity may not be as important and in whom other reconstructive procedures can be appropriately performed vaginally. Obliterative procedures are performed in elderly women who are not, and will not, be sexually active, and who request the least invasive procedure for advanced vaginal prolapse. Laparo-scopic approaches are reserved for surgeons request laparoscopic skills adequate enough to...

Abdominal Sacrocolpopexy

Abdominal sacrocolpopexy is considered by many to be the gold standard procedure for repair of vaginal vault prolapse. The resultant vaginal axis is the most physiologic of all reconstructive procedures. Because this procedure is performed through an abdominal incision, its associated morbidity is greater than with the vaginal approaches. Therefore, it is typically reserved for women in whom sexual activity is of great importance. The goal of the procedure is to elevate the vaginal apex with a mesh bridge to the sacral promontory (Figure 8-2.3). The procedure is begun through a transverse or vertical laparotomy incision. We place the sacral promontory sutures first, before

Prophylactic Vaccines

As the target population of a preventative HPV vaccine will most likely be healthy adolescents who are not yet sexually active, the primary concern of prophylactic vaccine development is safety. The use of a live attenuated virus vaccine has been shown to be safe and effective in the prevention of diseases, such as influenza, measles, mumps, and rubella. Yet, the difficulty of propagating large amounts of HPV combined with necessity of viral oncoproteins in the HPV replication process, has made this strategy impractical. Although, vaccines targeting the early viral antigens could prevent establishment of infection, current strategies for safe and effective prophylactic vaccination have focussed on inducing neutralizing antibodies against the major and or minor capsid proteins. HPV is transmitted through sexual intercourse, and animal models of papillomavirus infection do not mimic sexual transmission. Therefore, there has been great concern that animal models with cutaneous or oral...

Relationship problems

A positive cervical smear test result can result in the woman feeling differently about her body and about sex. (29) A study of hypertension screening found decreased marital satisfaction in those with a high-risk result. (33 After a high-risk result for Huntington's disease, some people's personal relationships have broken down, (17) although others have reported improvements 23 Genetic testing, unlike other types of testing, may have health implications for the person's relatives, and problems may arise in these relationships. After a positive HIV diagnosis there are additional issues regarding possible infection of the person's sexual partner. The HIV-positive person may have to deal with the death of a sexual partner and friends, and bereaved reactions to AIDS-related deaths appear most severe among people who are themselves infected. Telling friends or relatives about the positive test result may also involve difficult communication about previously undisclosed sexual preferences.

History and Physical Examination

The patient is a 38-year-old G4P2 woman, with a 3-year history of increasing bladder dysfunction and a 6-month history of exteriorized vaginal and rectal prolapse. She stated that the exteriorized portion is quite large, and she brought two Polaroid photos of what appeared to be at least a fourth degree cystocele, as well as a rectal prolapse of a large amount of rectal mucosa. She also complains of urge urinary incontinence for 2 years. She voids 7 to 10 times per day wearing 1 to 2 pads per day, reporting 1 to 2 episodes of incontinence per day. She reported four or more episodes of nocturia per night with no enuresis or recurrent urinary tract infections, and voids with a normal flow. Her obstructive defecation symptoms have been present for 3 years with no fecal incontinence. She is sexually active. She had been fit with a vaginal ring pessary by her primary physician, which she wears without significant difficulties.

Health care in hospital

Patients have a uniquely dependent relationship not only on their dialysis machine but also with the staff involved in their treatment. Dialysis can have major effects on an individual's psychological and social functioning, particularly giving rise to vocational impairment, reduced sexual activity, and mood changes. (79) In addition to the physical limitations and demands of dialysis, patients are also faced with the need to adhere to strict recommendations regarding diet and fluid consumption, as well as complex medication regimens.

Screening for cervical cancer

Regular Pap smears are recommended for all women who are or have been sexually active and who have a cervix. B. Testing should begin when the woman first engages in sexual intercourse. Adolescents whose sexual history is thought to be unreliable should be presumed to be sexually active at age 18.

Clinical Presentation

Other vulvar dysesthesias can be difficult to distinguish from vestibulitis. The key difference is that vulvar vestibu-litis has provoked symptoms, with pain initiated by direct physical contact. Women with vestibulitis will often have great apprehension about sexual intercourse and largely cease activity secondary to the degree of pain. Distinctions have been made between women with primary vestibulitis, dyspareunia at the initiation of their sexual experience, and secondary vestibulitis (dyspareunia after a time of asymptomatic intercourse) because patients with primary vestibulitis do not tend to respond as well to treatment.4

Emergency contraception

Contraceptive failure, such as condom breakage, or other circumstances of unprotected sexual intercourse, such as a sexual assault. If menstruation does not occur within 21 days, a pregnancy test should be performed. B. Emergency contraception is effective for up to 72 hours after intercourse. The first two pills should be taken within 72 hours after sexual intercourse, followed 12 hours later by the remaining two pills.

Affective Interpersonal Aspects of Antisociality

Of interest to the study of human attachment, these nonapeptides are involved in sexual activity and associated adult pair bonding, parental behavior and infant attachment. More specifically, in the highly monogamous prairie vole, but not in the non-monogamous and less generally affiliative montane vole, oxytocin receptors are found in the nucleus accumbens and prelimbic areas associated with the dopaminergic reward circuitry. Two measures of pair bonding found in the monogamous prairie vole but not the montane vole include time spent preferentially in proximity to the mate (partner preference) and, in males, aggressiveness towards third parties after mating (mate guarding). In females oxytocin, but not vasopressin, administered into the lateral ventricle facilitates development of partner preference, even in the absence of mating. Furthermore, an oxytocin antagonist given prior to mating blocks partner preference but does not interfere with mating. In males, partner preference and...

Clinical premotor symptoms

Further autonomic disorders comprise sphincter-related bladder dysfunction in 30-90 of patients, with anticholinergic but not levodopa-responsive hyperactivity of the detrusor muscle, leading to nocturia, urinary frequency, and urgency (Soler, 2004). In addition, profound impairment within the realms of sexual behavior, arousal, orgasm, and drive, but not fantasy, are commonly reported by PD patients (Yu, 2004). Female PD patients mainly report difficulties with arousal, whereas males complain about erectile dysfunction and premature ejaculation, all of which result in difficulties reaching orgasm and or attaining sexual satisfaction in half of the patients (Bronner, 2004).

The perception of need

The perception of need varies depending upon the perspective of the person expressing the need. It is common clinical experience that patients and psychiatrists differ in their view of what the patients need. Surveys of people with major mental illnesses indicate that they commonly consider their most important needs to be financial security, friends, jobs, a good place to live, freedom from medication side-effects, and a sexual partner. Maslow defined a 'hierarchy of needs', that he believed form the basis of much human motivation.*4.) Individuals give first priority to meeting basic physiological needs for food and water before addressing safety needs such as shelter. Only when those needs are addressed do they address needs for human relationship and self-actualization. Surveys of homeless mentally ill people provide a good example. These individuals, who have very wide arrays of needs, invariably indicate that they place the need for mental health services far down on their list...

Coroners and brain death

But what if there appears to be a dispute between family members Can one restrict the information There is no case law, but it would probably be acceptable to restrict information to next of kin who can decide what to do with it. What of an unmarried partner They seem to be treated as next of kin, which is not unreasonable since we often do not know the true status of claimed next of kin. What if the diagnosis is AIDS Here the GMC states that a doctor has a duty to see that a sexual partner of an AIDS patient is informed, even if disclosure is refused this must cover where consent is unavailable. Finally, what of notifiable diseases Here there is a legal requirement to inform the relevant authority which overrides the duty to the patient.

Prevention and Treatment

Abstinence, monogamous relationships, and condoms properly used can prevent transmission of the disease. All sexually active women are advised to get tested for Chlamydia each year, or twice yearly if they have multiple partners or if their partner has multiple partners. Several antibiotics offer effective treatment and prevent serious complications if the disease is diagnosed and treated promptly. Azithromycin can be given as a single dose, whereas tetracyclines and erythromycin are less expensive alternatives. The sexual partner is treated at the same time.

Causes of ageing effects

Found that sexual activity correlated more with age than with levels of free testosterone. Rowland et al.(22) studied 39 healthy males aged 21 to 82, assessing questionnaires and erectile response to visual stimuli. Erection decreased with age and this reduction was related to decreased penile threshold to electrical and vibrotactile stimulation. However, these latter measures correlated with age, so that cause could not be distinguished from effect. In a definitive study of male ageing, Feldman et a .(23) incriminated vascular disease as the cause of elderly erectile failure but did not assess neurological factors.

Symptomatology of Urogenital Atrophy

Typical symptoms of vaginal atrophy include vaginal dryness, vaginal irritation, as well as loss of vaginal caliber and depth in more advanced degrees of atrophy. The initial symptoms of vaginal atrophy can be promptly reversed with local estrogen therapy. However, the more long-term effects of urogenital atrophy such as loss of vaginal caliber and depth are less likely to be readily reversible. This has recently become a clinically important issue, because male erectile dysfunction can be treated pharmacologically, whereas the female partners' advanced urogenital atrophy has not been taken into account. Any attempt at sexual intercourse after a long hiatus of inactivity in a post-menopausal woman can result in sexual dysfunction and even vaginal trauma including lacerations upon attempted penetration. It is thus critical that both partners be considered when initiating erectile dysfunction therapy in the male.

Longitudinal aspects of atypical early development

One possibility is that the two groups are relatively similar in earlier years, but that different life circumstances promote more comfort for one group continuing to live as males. Treatment intervention to change cross-gender behaviour may be decisive. Transsexuals were rarely treated as children. Different prevalence rates may also be key. Whereas the incidence of transsexualism may be one in 10 000 males,(35) the incidence of homosexuality may be between 2 and 3 per cent.(3) Thus if there are overlapping behaviours between the two in early years, probability would predict that the vast majority of cross-gendered males will emerge as homosexual, rather than transsexual. However, this does not explain the behavioural overlap between prehomosexual boys and pre-transsexual boys who will later be sexually attracted only to females (the latter living as lesbian women after sex reassignment surgery).

Treatment 24 week trial of antibiotics

Irritative symptoms may respond to nonsteroidal anti-inflammatory agents, muscle relaxants, anticholinergics, hot sitz baths, normal sexual activity, regular mild exercise, and avoidance of spicy foods and excessive caffeine and alcohol. Serial prostatic massage may be helpful.

Sickness Behaviour As Behavioural Defence

Up to this point we have considered ways in which an organism can avoid the deleterious effects of the pathogen, either reflexively or by learning about pathogen-associated stimuli. A remaining question is what happens to behaviour as a result of infection and does this behaviour assist the organism to rid itself of the pathogen and return to a healthy state. As indicated above, there is a well-characterized profile of behavioural change observed in sick animals, called sickness behaviour (Table I). This profile of behavioural change includes decreased general activity (especially locomotor activity), decreased food intake 32-34 , increased slow-wave sleep 35,36 , altered sexual activity 37 , decreased environmental 38 and social exploration 39 , impaired cognitive function 40,41 , and decreased interest in pleasurable stimuli (so-called anhedonia ) 42 , As mentioned previously, Hart 2 argued that the typical profile of behavioural change experienced by organisms infected with a...

The law relying on status

Another example of law, this time in a private area, that is dependent upon status is the ability of some people to enter into sexual relations. For most people, this is a matter that is dependent upon their own consent. So, it is rape for a man to have anal or vaginal sexual intercourse with a woman or a man who does not consent (which happens to be the current English definition). It is an offence for a man or a woman to assault indecently another person without their consent. A homosexual act by a man is not a crime provided the other consents (and the act is in private). This would suggest that the critical question is whether the victim is competent to make the decision. For example, does she or he understand what sexual intercourse is so that her or his apparent assent is indeed consent However, this is not the case in all instances. This is for two reasons. First, there is an age of consent. Below the relevant age, the consent of the victim is irrelevant, however competent she...

Teenage mothers and child abuse

At least in Western industrialized countries, early child-bearing or teenage pregnancy predicts many undesirable outcomes for the children, including low school attainment, antisocial school behaviour, substance use, and early sexual intercourse. The children of teenage mothers are also more likely to become offenders. For example, Morash and Rucker(17) analysed results from four surveys in the United States and the United Kingdom (including the Cambridge Study) and found that teenage mothers were associated with low income families, welfare support, and absent biological fathers, that they used poor child-rearing methods, and that their children were characterized by low school attainment and delinquency. However, the presence of the biological father mitigated many of these adverse factors and generally seemed to have a protective effect. In the Cambridge Study, teenage mothers who went on to have large numbers of children were especially likely to have convicted children. In the...

Definitions of offences

Murder may have an overt or hidden sexual motive, ranging from the common case of jealousy or the desire to be rid of a sexual partner to the uncommon case of the necrophiliac A fetishist may steal a sexual object A peeper may enter a garden to spy on females undressing in a bedroom. He commits no offence, but by misunderstanding of his motives he may find himself charged with being on enclosed premises. (P

Hepatocellular Carcinomaintroduction

Spread transmission of viral hepatitis, specifically of types B and C, during the 1970s and early 1980s, when illicit use of intravenous narcotics, needle sharing, unsafe sexual activity, and transfusion of unsafe blood and blood products were common practices (Bruix et al. 2001). Patients with liver cirrhosis are at greatest risk for developing HCC and should be monitored every 6 months to detect the tumor at an asymptomatic stage (Bruix and Llovet 2002). The Barcelona-Clinic Liver Cancer (BCLC) group has developed a system that stratifies patients into four categories based on performance status, severity of liver dysfunction caused by the underlying cirrhosis, and the kind of tumor involvement, thus simultaneously setting prognosis and guiding treatment (Llovet et al. 1999a). In the BCLC staging classification, patients who have early-stage HCC, who have a good performance status, Child-Pugh class A or B cirrhosis and an asymptomatic single tumor smaller than 5 cm or as many as...

Phylogeny And Epidemiology Of Htlv1 And Htlv2

Epidemiological data indicate that the PTLV is transmitted in utero to a very small degree, but at a rate of 10 to 30 percent via breastfeeding. The virus is also transmitted via sexual intercourse, with male to female infection occurring much more effectively than the opposite. The virus is also spread via intravenous drug abuse and the transfusion of cellular but not plasma products. There are no reported incidences of infection occurring via needle stick or other laboratory or clinical work-related injuries.12,16

The EPOR modela human sexual response cycle model

The most successful model was that formulated by Masters and Johnson.(20) In the laboratory, they observed the changes that took place in the male and female body and especially the genitals during sexual arousal to orgasm either by masturbation or by natural or artificial coitus with a plastic penis that allowed internal filming of the female genitalia. After studying approximately 7500 female and 2500 male arousals to orgasm in some 382 female and 312 male volunteers over 11 years they (stimuli from somatogenic or psychogenic sources raise sexual tensions), the plateau ( P) phase (sexual tensions intensified), the orgasmic (O) phase (involuntary pleasurable climax), and finally the resolution (R) phase (dissipation of sexual tensions). The great success of this EPOR model was its wide compass it could characterize the sexual responses of women and men, both heterosexual and homosexual, ranging from simple petting to vaginal or anal coitus with orgasm. However, it had several...

Chapter References

The new sex therapy active treatment of sexual dysfunctions. Brunner-Mazel, New York. 18. Hite, S. (1976). The Hite report a nationwide survey of female sexuality. Dell, New York. 29. Hawton, K., Catalan, J., Martin, P., and Fagg, J. (1986). Long-term outcome of sex therapy. Behavior Research and Therapy, 24, 665-75. 31. Hawton, K. (1995). Treatment of sexual dysfunctions by sex therapy and other approaches. British Journal of Psychiatry, 167, 307-14. 42. Althof, S. (1989). Psychogenic impotence treatment of men and couples. In Principles and practice of sex therapy update for the 1990s (ed. S. Leiblum and R. Rosen), pp. 237-65. Guilford Press, New York. 45. Hawton, K., Catalan, J., and Faff, J. (1992). Sex therapy for erectile dysfunction characteristics of couples, treatment outcome, and prognostic factors. Archives of Sexual Behavior, 21, 161-75, 50. Fisher, S. (1973). The female orgasm. Basic Books, New York. 51. Heiman, J. and Grafton-Becker, V. (1989)....

Example of Cervical Cancer Screening

The leading etiologic factor in the development of prein-vasive and invasive cervical cancer is infection with specific types of HPV transmitted by sexual contact. Thus, women who are not sexually active rarely develop cervical cancer, whereas sexual activity at an early age with multiple sexual partners is a strong risk factor. About 95 of women with invasive cervical cancer have evidence of HPV infection.44-47 Many women with HPV infection, however, never develop cervical cancer thus, this infection is necessary but not sufficient for the development of cancer.48

Vaginitis or Vulvitis

Vaginal discharge, if present, is usually thick and adherent, with white curds. 3. Other causes. In sexually active adolescents, the most common causes include bacterial vaginosis ( fishy, foul-smelling discharge), candidal vulvovaginitis (white, cottage-cheese'-appearing discharge), and trichomoniasis (malodorous yellow, frothy discharge).

Staphylococcus Saprophytics In Prostate

Bacterial cystitis is common in women, promoted by a relatively short urethra, use of a diaphragm, and sexual intercourse. Middle-aged men are prone to infection because enlargement of the prostate gland partially obstructs their urethra. Placement of a bladder catheter commonly results in infection Taking sufficient fluid to void urine at least four to five times daily, wiping from front to back. Single dose of antimicrobial medication with sexual intercourse may help prevent bacterial cystitis in women. Short-term antimicrobial therapy usually sufficient. Longer treatment for pyelonephritis

Antiparkinsonian Therapy And Hypersexuality

With the advent of antiparkinsonian therapy, reports of increased libido and sexual performance, hypersexual behavior (with or without concomitant hypomania), and rarely paraphilias have appeared in the literature.11-25 Comparisons cannot be made among studies, as different criteria were used to collect data. Due to the small size of the studies, the incidence of increased sexual drive in patients receiving treatment with antiparkinsonian therapy cannot be determined. The data does not provide a basis for identifying patients who might develop adverse sexual behavior in response to antiparkinsonian medications. Since the initial reports were conducted, medication regimens and dosages have changed. This also affects applicability of reports to current patient care. Other reviews described increase in sexual interest and or activity in some patients after L-dopa treatment. Barbeau11 reported an increase in libido in four men after L-dopa therapy. However, erections were not sustained,...

Conjunctiva Inclusion Conjunctivitis

Image Inclusion Conjunctivitis

Epidemiology Inclusion conjunctivitis is very frequent in temperate countries. The incidence in western industrialized countries ranges between 1.7 and 24 of all sexually active adults depending on the specific population studied. Etiology Oculogenital infection (Chlamydia trachomatis serotype D-K) is also caused by direct contact. In the newborn (see neonatal conjunctivitis), this occurs at birth through the cervical secretion. In adults, it is primarily transmitted during sexual intercourse, and rarely from infection in poorly chlorinated swimming pools. Prognosis The prognosis is good when the sexual partner is included in therapy.

The Psychodynamic Perspective

Modern psychodynamic theorists have sought to distinguish between the hysterical character and the histrionic personality as presented in various editions of the DSM. Most analysts see the two as existing on a spectrum of severity. Kernberg (1992), for example, places the hysterical personality at a higher level of functioning and the histrionic personality at a lower, infantile level of functioning. The higher level hysteric, Kernberg states, is more socially adaptive, with more genuine, authentic, and predictable emotions. Affective control, he elaborates, is lost only in connection to others with whom there exist intense sexual or competitive conflicts. Gabbard (1994, pp. 559-560) paints a similar picture Histrionics are more florid, more labile, more impulsive, and more sexu-alized and seductive hysterical personalities, in contrast, are more subtle in their exhibitionism and express sexuality in a more coy or engaging manner. Whereas hysterical personalities can be successful,...

Hormone Replacement Therapy

The tissues of the distal vagina and urethra are of similar embryonic origin, and both are sensitive to the trophic action of estrogens. Postmenopausal atrophy of these tissues may result in painful sexual intercourse, dysuria, and frequent genitourinary infections. Unlike the vasomotor complaints, these symptoms seldom improve if untreated. Treatment with a combination of minimally effective dosages of an estrogen and a progestin is recommended. Estrogen can be administered orally or in a topical preparation with equivalent efficacy. Progestins are given orally.

Physiology Of Penile Erection

In addition to the integrated participation of the peripheral nerves, central neural pathways are involved in the process. These central mechanisms interact during normal sexual activity and require complex coordination between the autonomic nervous system and the somatic outflow at the level of the spinal cord.

Specific techniques in behaviouralsystems couple therapy

He challenged her that she would not reciprocate if he approached her in this way, and his challenge was translated into a task for her to accept his affection. The couple were able to use this exchange of tasks, and both their emotional and their sexual relationship improved.

The structural theory the dualdrive theory and the Oedipus complex The id infantile sexuality and the Oedipus complex

Freud(4) was particularly impressed by the regularity with which his patients reported the emergence of childhood memories reflecting seductive and traumatic sexual experiences on the one hand, and intense sexual desires and related guilt feelings on the other. He discovered a continuity between the earliest wishes for dependency and being taken care of (the psychology, as he saw it, of the baby at the mother's breast) during what he described as the 'oral phase' of development the pleasure in exercising control and struggles around autonomy in the subsequent 'anal phase' of development (the psychology of toilet training) and, particularly, the sexual desire towards the parent of the opposite gender and the ambivalent rivalry for that parent's exclusive love with the parent of the same gender. He described this latter state as characteristic of the 'infantile genital stage' (from the third or fourth to the sixth year of life) and called its characteristic constellation of wishes and...

Immediate Questions

Are there associated complaints (eg, fever, drainage or discharge between urinations, abnormal urine odor or color, or changes in volume or frequency of urination) Fever, dark and foul-smelling urine, frequency, and urgency are all symptoms associated with UTIs. If patient is sexually active and experiencing discharge or dyspareunia, consider STDs (eg, gonorrhea, chlamydia).

Trichomoniasis and Giardiasis

Trichomoniasis is a genital infection produced by the protozoan Trichomonas vaginalis. Infections frequently are asymptomatic in the male, whereas in the female vaginitis characterized by a frothy pale yellow discharge is common. Relapses occur if the infected person's sexual partner is not treated simultaneously.

The Sadistic Personality

Sadistic Borderline Personality Disorder

As with masochism, the acceptance of a sadistic personality has waxed and waned over time. The term sadism was coined by Krafft-Ebing (1867, 1937) in response to the works of the famous French author, the Marquis de Sade, who derived sexual pleasure by dominating others and causing them pain. Krafft-Ebing defined sadism as the experience of sexual, pleasurable sensations (including orgasm) produced by acts of cruelty, bodily punishment, afflicted on one's own person or when witnessed in others, be they animals or human beings (1937, p. 80). Furthermore, he held that the innate desire to humiliate and hurt (p. 82) was characteristic of all humans. In claiming that the origins of sadism extend beyond the merely sexual, Krafft-Ebing was only recognizing what human beings have known for centuries There exists a certain class of persons for whom the ability to aggressively inflict psychological and physical suffering is not a means to an end, but an end in itself.

Neurotransmitters and their Enzymes

Low MAO monkeys living in a natural environment were more playful, active, social, aggressive, dominant, and sexually active than monkeys with high MAO levels (Redmond, Murphy, & Baulu, 1979). College students with low MAO reported more hours spent socializing than high MAO students (Coursey et al., 1979) but the results with self-report measures of extraversion have been inconsistent.

Female Sexual Dysfunction and Colorectal Surgery

After CRS, sexual dysfunction in women may be attributed to disorders of desire, arousal, orgasm, and or pain. Sexual desire has been shown to maintain or improve in 76 to 80 of women after CRS and is often accompanied by increased frequency in sexual activity and sexual satisfaction.13,14 Such an improvement may be expected, because general health is likely to improve after surgery. However, previous studies have demonstrated that up to 78 of women complain of decreased or complete loss of libido after surgery.15 Factors such as impaired body image, concerns of partner negative reaction, fear of stool leakage, and use of a stoma are known to adversely impact sexual function, and may account for these findings. Among these factors, the negative impact of a stoma has been specifically addressed by several studies. Gloeckner and Starling16 conducted an interview with 40 subjects with a permanent stoma (24 men, 16 women) and found that 60 of the patients had impaired sexuality after...

Case Study IV Tamoxifen and Breast Cancer

Overall, this trial showed that tamoxifen use was associated with fewer ER+ breast cancers in pre- and postmenopausal women with a high-risk profile.61 However, there is a cautionary note for sexually active premenopausal women taking tamoxifen, because tamoxifen was initially developed as a fertility drug.65 Also, results from the Breast Cancer Prevention Trial showed that tamoxifen does not increase the risk of other cancers (besides endometrial), but may increase the risk of cataracts. Similar findings to the Breast Cancer Prevention Trial have appeared in other trials (Table 23.4), such as the Italian Randomized Trial of Tamoxifen and The International Breast Cancer Intervention Study 1.66'67 Preliminary analysis of the Italian study revealed no difference between the tamoxifen and placebo groups68 however, by the end of the trial, women in the tamoxifen arm did have a lower risk of breast cancer.66 On the other hand, the Royal Marsden Hospital Tamoxifen Chemoprevention trial...

Adolescent Biological Vulnerability

Young age at first intercourse has long been associated with risk for invasive cancer. The risk of invasive cancer increases twofold in women who initiate sexual intercourse under the age of 18 years as compared with those initiating sexual intercourse after 19 years when controlling the number of lifetime sex partners (23). This finding suggests that there is a certain biological vulnerability of the cervix of young women to HPV infection. The adolescent cervix is structurally different from the cervix of adult women (6). It frequently has a mosaic appearance with different cellular components including relatively large areas of columnar and metaplastic squamous epithelium. Although, the adult cervix also contains these components, the predominant cell type in adults is the mature squamous cell. Both columnar and metaplastic squamous cells are vulnerable to HPV probably for a variety of reasons of which thinness of the epithelium may be one factor. Once sexual activity is initiated,...

Paraphilia not otherwise specified

Necrophilia is an exceedingly infrequent paraphilic behaviour. Of 5873 men evaluated for possible paraphilia, only nine reported being sexually attracted to sexual activities with the body of a dead female. Tabje.3 indicates that necrophilia is infrequently comorbid with other paraphilias. This suggests that necrophilia may not be a true paraphilia, but instead a reflection of another major psychiatric disorder. Public masturbation involves individuals who expose their penises in public places with the intent of reaching sexual climax. Public masturbation appears to lie between exhibitionism and voyeurism, in that it has diagnostic characteristics of both these activities. (19 Individuals with coprophilia (sexual interest in faeces) and or urophilia (sexual interest in urine) generally incorporate faeces and or urine into their sexual activities. Coprophiliacs and or urophiliacs are either heterosexual or homosexual males whose early developmental histories involve their developing a...

Intervention and psychological treatment

The treatment of child sexual abuse requires a psychoeducational component, so that the nature of sexual exploitation and the way in which children become coerced into sexual activity can be understood by the child without a sense of personal blame. Cognitive-behavioural treatments have been particularly helpful, especially when combined with a programme of intervention for the non-abusive caretaker (normally the mother). (23 This kind of treatment has been shown to be more effective than time alone, as has group therapy for children and young people. Abusers should be assessed for their potential to respond to psychological treatment. (19

Non Venereal Genital System Diseases

The genital tract is the portal of entry for numerous infectious diseases, both venereal and non-venereal (venereal, from Venus, the goddess of love non-venereal means not transmitted by making love). This section discusses some examples of non-venereal genital diseases. The term venereal disease (VD), formerly meaning disease transmitted almost exclusively by sexual intercourse, is now often used interchangeably with sexually transmitted disease (STD), which includes all diseases spread by sexual intercourse, even if commonly transmitted by other routes as well. STDs will be discussed later in this chapter.

Disorders of sexual behaviour

Reduced sexual activity and interest is the most common disorder of sexual behaviour associated with dementia, though it is the least likely to come to the attention of the clinician. It probably plays a part in the high rates of divorce seen, for example, in young couples after one partner has sustained a brain injury. Psychological effects, in particular the change in the patient's role in the partnership as a result of dementia, as well as the physiological effects of brain injury on erectile function, contribute to impotence and reduced libido.

Modelling the human sexual response cycle

A direct way of investigating normal sexual function is to observe and measure the body changes that take place when men and women become sexually aroused. From these data, models have been constructed of the normal sequence of changes during sexual arousal and coitus. The first models described a simple sequence of increasing arousal and excitement culminating in rapid discharge by orgasm, displayed graphically as an ascent, peak, and then descent. (l7 As the investigations became more sophisticated, understanding of the body responses grew and the models became more detailed and complex. J, ,11,18,,19)

The Case of Lenore Borderline Personality Disorder

When she was on the streets, she would engage in sex with anyone who offered to buy her a meal, give her smokes or whiskey, or tell her he loved her. When she would return home, her mother would most often ignore her. At other times, she would yell hysterically, wailing about the worry and concern Lenore's absence had caused. These emotional outbursts would often follow an especially brutal weekend at the hands of her husband.

Anal squamous cell carcinoma

Epidemiological evidence has suggested that anal cancer may be associated with anal sexual activity. Male homosexual activity and HIV infection are strongly associated with the incidence of anal squa-mous carcinoma. Most specifically, human papillomavirus has been shown to be an important aetiological factor in anal, cervical, vulval, and penile squamous tumours.

Antidepressants and Female Sexual Dysfunction

Although numerous medications can have an adverse impact on sexual function, few classes of medications have been demonstrated to have more impact on sexual function than antidepressants. Although many of the various classes of antidepressant agents can affect sexual function, the selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, sertraline, or fluoxetine, have been shown to adversely affect libido, arousal, as well as the ability to reach orgasm.27 Under a physician's care, options may include switching agents, dose reduction, or drug holiday. Bupropion (Wellbutrin) may be an effective alternative.28 In addition, studies have suggested that the use of sildenafil with selective SSRI medications may effectively combat the FSD associated with the SSRI. It is also important to recognize that FSD may present with many of the same symptoms as depression, such as poor energy and lack of interest. We have seen numerous patients who were misdiagnosed as having depression,...

Chanchroid Causative Agent

Sexually active individuals should be tested at least once a year so that transmission can be halted and complications prevented. cryptosporidiosis are transmitted by the fecal-oral route in those individuals who engage in oral-genital and -anal contact as part of sexual activity.

Treatment of Simple Rectovaginal Fistulas

Rectovaginal Fistula

Opening is closed with interrupted Vicryl sutures. The internal anal sphincter is mobilized bilaterally and reap-proximated midline. The portion of the tract containing the fistulous opening is excised and the new edge of the flap brought distally and sutured in place using Vicryl sutures. Perioperative antibiotics are administered for 24 hours. Bulking agents are advocated to prevent trauma from stool to the repair. Tampons and sexual intercourse are prohibited for 6 weeks postoperatively. Success rates are reported between 71 to 100 .6

Sexual pain disorders

Sexual pain disorders are divided into two dysfunctions non-organic dyspareunia and vaginismus. Dyspareunia, genital pain in either a male or female, is characterized by recurrent and persistent genital pain before, during, and after sexual activity. Exclusively a female dysfunction, vaginismus is an involuntary spasm of the musculature of the outer third of the vagina which makes penetration difficult or impossible. Non-organic dyspareunia and vaginismus may only be diagnosed in the absence of detectable physical pathology. However, when the aetiology is entirely physical there is likely to be a conditioned psychological response that may require subsequent psychological intervention after medical treatment. (79 Tabje.8 and Iable.9 list the DSM-IV and ICD-10 diagnostic criteria for sexual pain disorders. Pain during and after sexual activity is always the presenting problem in dyspareunia, although penetration is not always necessary to induce pain. It ranges from mild to unbearable...

Modifying the EPOR model into the DEOR model

The first weakness of the EPOR model is that it was derived from the study of a highly selected group of American men and women volunteers who could arouse themselves to orgasm in a laboratory, on demand, and allow themselves to be watched filmed or measured for scientific and altruistic (or perhaps exhibitionistic) purposes. The second weakness was the lack of interobserver agreement about the changes observed and of confirmation of their sequential reliability. Robinson (21) examined the E phase and P phase, and concluded convincingly that the P phase was simply the final stage of the E phase. Helen Kaplan, (22) a New York sex therapist, proposed that before the E phase there should be a 'desire phase' (D phase). This proposal came from her work with women who professed to have no desire to be sexually aroused, even by their usual partners. She suggested that the desire must occur before sexual arousal can begin. Kaplan's subjects were attending a clinic and no studies were ever...

Female genital functions during normal sexual arousal External

There is a triangular area of mucous membrane that surrounds the urethral meatus, extending from just below the glans of the clitoris to the entrance of the vagina. This area has been called the 'periurethral glans'(30) and is thought to be capable of erotic stimulation, especially during penile thrusting, as it is known that the tissue is pushed and pulled into the vagina by the movement.(30) The periurethral glans is actually part of the corpus spongiosum if we accept the findings of van Turnhout et al.(43) which suggest that it is the homologue of the the male glans. The extent, mobility, density of innervation, and sensitivity of this erotic site may explain why some women find it easy to reach orgasm during penile thrusting alone.

Mechanism of Infection

Pathogenesis Human Papilloma Virus

The pathogenesis of cervical cancer is initiated by HPV infection of the cervical epithelium during sexual intercourse. Virions penetrate the epithelium through microabrasions and invade the basal cells of stratified epithelia of the uterine cervical transformation zone, establishing their genomes as a stable, low copy number of viral episomes (50-100 genomes per cell) in an initial burst of replication (Fig. 3 see Color Fig. 3 (Color Plate 4, following p. 50). HPV life cycle. The pathogenesis of cervical cancer is initiated by HPV infection of the cervical epithelium during sexual intercourse. Virions penetrate the epithelium through microabrasions and invade the basal cells of stratified epithelia. Initiation of replication is facilitated by interaction of E1 with E2. Because the virus replicates using the host machinery, it must force the keratinocytes into S phase, despite signals for terminal differentiation of the squamous epithelium. This is achieved by three viral oncoproteins...

Sexual Function after Pelvic Surgery

Pelvic surgery to correct prolapse may affect sexual function for a number of reasons including narrowed vaginal canal, poor lubrication, and fear of urinary incontinence. Some studies suggest that sexual dysfunction can occur up to 20 of the time after surgery for prolapse or incontinence. It is thought that the vaginal dissection may lead to pelvic floor neuropathy affecting the pudendal nerve, which subsequently affects vaginal sensation and orgasm. Hysterectomy has been associated with sexual dysfunction. It is thought that removal of the cervix alters the upper portion of the vaginal canal and causes a neuropathy, which is the source for dyspareunia as well as anor-gasmia. However, studies in the literature are conflicting as to the exact cause of sexual dysfunction after hysterec-tomy.22 Another possible cause for dyspareunia is poor estrogenization of the vaginal mucosa in those women who undergo surgical menopause at the time of a hysterectomy. Techniques used to repair the...

Available Qualityof Life Assessment Tools

Male factor is frequently the principal reason a patient is not sexually active. Thus, questions related to sexual activity should be assessed as a change from preoperative baseline rather than an overall score. 5. Sexual function has significant generational differences. For many elderly patients, requesting information regarding their sexual activity is considered offensive. Many patients do not consider sex pleasurable, and their practices - even at sexual peak - were very conservative. For example, many elderly women are not comfortable with genital self-contact.

Modelling normal sexual functionthe sex survey

Surveys give a selective picture of sexual function. Results depend on the formulation of the questions, they rely on self-reports, and they represent only those prepared to describe their sexual behaviour. It is known, for example, that females tend to under-report their premarital sexual experiences (12) while males tend to over-report their lifetime partners.( 9 Berk et al.(1J studied the recall by 217 university students of their sexual activity over a 2-week period assessed by questionnaires answered 2 weeks after the recording period, and by daily diaries kept over the same 2 weeks. Subjects reported more sexual activity in the questionnaires than in their diaries. Women reported giving and having more oral sex than the men. Clearly, data from questionnaire surveys should be treated cautiously. The American survey*15 was conducted face to face with 3159 selected individuals who spoke English in representative households by 220 trained interviewers (mainly women). Nearly 80 per...

Horney Feminist Psychology and Humanism

Once and for all we should stop bothering about what is feminine and what is not. Such concerns only undermine our energies. Standards of masculinity and femininity are artificial standards. All we definitely know at present about sex differences is that we do not know what they are. Scientific differences between the two sexes certainly exist, but we shall never be able to discover what they are until we have first developed our potentialities as human beings. Paradoxical as it may sound, we shall find out about these differences only if we forget about them.

Diagnosis and differential diagnosis

The most cost-effective method of diagnosing paraphilias is to conduct a comprehensive psychiatric history, to use psychophysiological assessment methods to determine sexual interest, and to differentiate organic or psychiatric disorders that can impact on an individual's sexual interest and activity. Interviewing the potential paraphiliac, especially a paraphiliac who has been involved in felonies, requires a non-judgemental clinician. The first step in the interview process is to obtain a client's consent to assessment, with special reference to laws that may legally require the therapist to break confidentiality should a paraphiliac reveal a specific victim that he has sexually abused or a victim he plans to molest. This issue is relevant when a child molester reveals specific names of children that he or she has molested. To proceed with the interview without first explaining this mandatory reporting requirement would be unethical. A number of methods can be used by the therapist...

The Female Sexual Response

The female sexual response, as described in the mid 1960s by Masters and Johnson,6 begins with excitement, leading to plateau, orgasm, and finally, resolution. In 2000, Dr. Rosemary Basson,7 a pioneering researcher in the field of FSD, proposed a new, nonlinear female sexual response cycle. Dr. Basson suggested that the sexual response is driven by the desire to enhance intimacy, and begins with a state of sexual neutrality8 (Table 5-1.2). As the woman seeks a sexual stimulus and responds to it, she becomes sexually aroused. Arousal leads to desire, thus stimulating a woman's willingness to receive or provide additional stimuli. Emotional and physical satisfaction are gained by an increase in sexual desire and arousal. Emotional intimacy is then ultimately achieved. Various biological and psychological factors can negatively affect this cycle, thus leading to FSD.

Case Presentation

An AIDS-causing virus could have been contracted during sexual intercourse, or from a blood-contaminated razor blade used for scarification. Contracting such a virus from unsterile instruments during her emergency cesarian is a possibility, but this seems less likely because of the short time span before presenting with severe immunodeficiency. 4. Despite the absence of symptoms, both her baby and the baby's father could have the disease.The baby's risk of infection was reduced but not eliminated by the emergency cesarian section, and infection could have occurred subsequently if it were breast fed.The mother's very low CD4+ cell count suggests a high level of viremia and, therefore, increased risk of transmitting the disease. She could have infected the baby's father during sexual intercourse, or he could have infected her. More than 100 needle and syringe exchange programs, operating in at least 30 states and the District of Columbia, help prevent spread of HIV and other blood-borne...


Several menopause-related changes in sexual function occur that have been described in the literature diminished sexual responsiveness, dyspareunia, decreased sexual activity, decrease in sexual desire, and a dysfunctional male partner. Sarrel29 described the underlying cause of biological changes that occurred with sexual dysfunction to be estrogen deficiency. The postmenopausal ovary has been shown to be responsible for up to 50 of the testosterone believed to be associated with libido. Many clinicians believe that a combination of both estrogen and testosterone is required to improve female sexual function.

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