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Sexual Attraction

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Sexual Arousal Disorder

Sexual arousal disorder is the persistent or recurrent inability to attain or maintain sexual excitement, which causes personal distress. This disorder includes poor vaginal lubrication, decreased genital sensation, and poor vaginal smooth muscle relaxation. Arousal disorders are primarily physiologic in nature and can often result from pelvic and colorectal surgery and other pelvic disorders, various medications, atherosclerosis, cigarette smoking, and vascular disease. This disorder most closely parallels ED in the male. In fact, a condition of hyperactive sexual arousal disorder, analogous to the priapism state in the male, has also been described.

Disorders of sexual desire

Sexual desire is an extraordinarily complicated aspect of human life and thus requires a multifaceted approach to its understanding. (20) Levine 22) has proposed a tripartite model wherein sexual desire is conceptualized as the product of the mind's capacity to integrate three separate elements drive, wish, and motive. Drive is the neurophysiological generator inducing the internal phenomenon labelled as 'horniness or randiness'. Wish is the cognitive component through which intellectual motives are translated into behaviours, for example 'it's our anniversary, so we should make love'. Motive refers to a combination of affective, transferential, and In men, the biological component underlying sexual desire is circulating levels of testosterone and, more specifically, bioactive or free testosterone. Schiavi et al.(23) found that men with hypoactive sexual desire had significantly lower levels of testosterone than matched controls. In women, however, hormone-behavioural relationships...

Disorders of sexual arousal in women

Typically, female arousal disorders are diagnosed in women with complaints of diminished lubrication or painful intercourse. There is considerable ambiguity regarding this diagnosis because, with the exception of postmenopausal women in whom diminished lubrication is a normal physiological change, symptoms of female arousal disorder are frequently subsumed under desire and or orgasmic disorders ( Table 4). Additionally, the definition of female sexual arousal disorder reflects the overemphasis of physical function (lubrication and pelvic vasocongestion) over psychological excitement and or pleasure. The correlation between physical and mental arousal is at best inconsistent and often puzzling. For instance, Palace (48 evaluated the effects of heightened autonomic arousal, noting that it significantly increased both physiological and subjective sexual arousal. These findings indicate that heightening autonomic arousal in an actual sexual setting might be useful for increasing sexual...

Female genital functions during normal sexual arousal External

The external female genitalia consist of the outer (majora) and inner (minora) labia containing erectile tissue that surround the vaginal introitus. Normally the outer labia meet and cover the introitus, but in some women the inner labia protrude even when they are sexually unaroused. Sexual arousal creates vasocongestion especially in the labia minora which protrude through the majora adding approximately 1 to 2 cm to the length of the vagina. The labia minora become erotically sensitive to touch and friction when engorged. With sexual arousal, the blood flow to the clitoris is increased probably by a mechanism involving its vipergic (VIP) and nitrinergic (nitric oxide) innervation leading to its tumescence (swelling) but, contrary to many inaccurate descriptions, without true erection (i.e. without rigidity). The enhancement of its blood flow is paralleled by an increased sensitivity to touch and friction especially of the glans.

Urogynecology History

Sexual dysfunction frequently occurs in conjunction with incontinence and prolapse, and it should not be ignored. Although some symptoms may be primarily hormonal in nature (i.e., decreased libido, vaginal dryness) and others primarily neurologic (i.e., decreased vaginal sensation, secondary anorgasmic), there is frequently a combination of etiologic factors. In addition, parameters defining normal sexual function have not yet been determined because of varying individual characteristics, as well as cultural factors.

From drive theory to object relations

Psychoanalysis started its life as a drive theory. By what means, Freud asked, did the instinctual life of the infant become tamed in the process of development so that the end result was the civilized man and woman of adult society To this he had two sets of answers. The first, roughly, was repression and sublimation. In the Oedipal situation the child experiences sexual desire for the opposite-sex parent. These feelings arouse anxiety ('castration anxiety'), and so are repressed, or diverted into harmless exploratory and creative sublimatory activities. If, however, the process of repression is excessive the consequence in adult life is emotional inhibition. When repression is insufficient, anxiety-based or psychosomatic disorders result, or, ultimately, psychosis. A second answer, coming later, and forged in the face of the horrors of the First World War, was to suggest that 'civilization' was only skin deep. Here Freud invoked the death instinct and regression. Eros, the love...

Diagnostic Classifications

In 2000, a new classification of FSD was developed by a consensus panel of experts in the field of sexual medicine5 (Table 5-1.1). The categories include sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders. I - Sexual desire disorders II - Sexual arousal disorders

Physiology of Female Sexual Function

The underlying physiologic processes in both normal female sexual function and FSD are not yet well understood. Normal female sexual function is based on an interaction between intact anatomic, vascular, and neurologic factors. Sexual arousal is marked by physiologic changes secondary to increased genital blood flow, which leads to vaginal congestion and lubrication, facilitating intercourse. The normal vascular response is a result of cavernosal and arteriole smooth muscle relaxation via the androgen-dependent nitric oxide synthase system during sexual stimulation and arousal. This produces a vascular engorgement of the vestibule and clitoris. Vaginal lubrication is a transudate of serum that results from this normal increase of pelvic blood flow with arousal. Patients with arousal disorders may complain of decreased vaginal lubrication and dyspareunia. Normal sensation is also critical in allowing sexual arousal, and the ability to achieve orgasm requires an intact

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).

The Brain And Spinal Cord And Ms

The brain is involved in many aspects of sexual functioning, including sexual desire, the perception of sexual stimuli and pleasure, movement, sensation, cognition, and attention. Throughout the sexual response cycle, sexual messages are communicated between the brain, spinal cord, and the genitals. Because MS can cause lesions along myelinated pathways, it is not surprising that changes in sexual function are reported so frequently by people with MS.

Coping With Msrelated Changes In Sexual Response

Coping with Lowered Libido If you are in an intimate relationship, focus on the sensual aspects. Sensual contact is nongenital it includes back rubs, gentle stroking of nongenital body zones, and other touching that you find physically and emotionally pleasing. During periods of diminished sex drive, partners often neglect the sensual, nonsexual aspects of their physical relationship.

Biological determinants of normal sexual function

The clitoris, which is an organ whose sole function is for inducing female sexual arousal pleasure. 3. Orgasms, in both male and female, provide intense euphoric rewards for undertaking sexual arousal to completion. The female is able to have multiple serial orgasms. 7. Ability of the female to undertake sexual arousal and coitus independent of season, hormonal status, or ovulation. Human females (unlike other primates) can and often do willingly partake of sexual activity and coitus when they are menstruating, pregnant, or menopausal.

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

To date, no treatment interventions based on the recent theoretical formulations of Barlow(39) (about the role of anxiety and cognitive processing in arousal disorders) and of Bancroft(40 (about the coexistence of mental excitation and inhibition of sexual arousal) have been reported. But as these notions are further elaborated, they may be translated into innovative treatment concepts.

Transvestic fetishism

The transvestic fetishist frequently partially cross-dresses but, when viewed by the average adult male, is seen as a male wearing women's garments. As transvestic fetishism continues, the male becomes more adept at cross-dressing and begins to venture outside the privacy of his home into public settings. The long-time transvestic fetishist, the effeminate egodystonic homosexual, and the male-to-female transsexual may look very similar owing to their somewhat exaggerated stereotypical female make-up and clothes. However, the sexual behaviour of transsexuals is markedly different from that of the other three categories in that the transsexual generally has a low sex drive and is more intrigued by assuming the role of a female, or indeed becoming a female, while the others enjoy assuming a feminine role concurrent with maintaining a masculine sexual identity.

Organic disease and the differential diagnosis of paraphilias Mental retardation

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, intellectual limitations often lead the mentally retarded to spend more time with other retarded people or with children, where they feel more of an intellectual compatibility and hence find it easier to relate to these people. This may lead to sexual interaction with a child but does not necessarily lead to paedophilia, although it might if this interaction is repeated over time. In other cases, mentally retarded individuals may develop an interest in sexual behaviours which do not involve social interaction with a partner, such as fetishism, exhibitionism, or zoophilia.

Other Pharmacological Actions

Antipsychotics produce striking effects on the reproductive system. Amenorrhea and increased libido have been reported in women, whereas decreased libido and gynecomastia have been observed in men. Some of these actions are undoubtedly the result of a drug-associated blockade of dopamine's tonic normal

Technique principal features Neutrality and abstinence

Based in the classical framework of libidinal theory, Freud made an explicit injunction against the analyst giving in to the temptation of gratifying the patient's sexual desire.(31 Obviously, this is primarily an ethical issue. However, within the psychoanalytic context it also justifies the analyst's stance of resisting the patient's curiosity or using the therapeutic relationship in any way that consciously or unconsciously could be seen as motivated by the need to gratify their own hidden desires. Within this classical frame of reference, the patient must also agree to forgo significant life changes where these could be seen as relevant to current psychotherapeutic work. In practice, such abstinence on the part of the patient is rare. Yet long-term psychodynamic treatment may founder if the emotional experiences of the therapy are obscured by the upheavals of significant life events.

Chapter References

Hallstrom, T. and Samuelsson, S. (1990). Changes in women's sexual desire in middle age the longitudinal study of women in Gothenberg. Archives of Sexual Behavior, 19, 259-68. 19. Sherwin, B., Gelfand, M., and Brender, W. (1985). Androgen enhances sexual motivation in females a prospective cross-over study of sex steroid administration in the surgical menopause. Psychosomatic Medicine, 47, 339-51.

Evaluation of erectile dysfunction

Complete blood count and chemistries should be obtained. Serum testosterone measurement is recommended in all impotent patients over age 50. In patients younger than 50 years, serum testosterone determination is recommended only in cases of low sexual desire or abnormal physical findings. Serum prolactin should be measured in patients with low sexual desire, gynecomastia, and or testosterone less than 4 ng mL.

AReductase Inhibitors

Finasteride (Proscar) is a 5a-reductase inhibitor that blocks the conversion of testosterone to DHT in target tissues. Since DHT is the major intracellular androgen in the prostate, finasteride is effective in suppressing DHT stimulation of prostatic growth and secretory function without markedly affecting libido. It is approved for the treatment of benign prostatic hyperpla-sia. Although there is usually some regression in the size of the prostate gland following administration of finasteride, clinical response may take 6 to 12 months. If the obstructive symptoms are severe, there is often not enough time to allow this compound to work. The principal adverse effects of finasteride are impotence, decreased libido, and decreased volume of ejaculate. The compound is generally well tolerated in men.

Adverse Reactions Contraindications and Interactions

Headache and GI symptoms are the most frequently reported side effects. It is possible to reduce GI side effects, such as nausea, abdominal discomfort, and diarrhea, by taking the extract with food. Theoretically, decreased libido or erectile dysfunction could also occur. Because of saw palmetto's possible hormonal effects (and lack of indications for use), pregnant and nursing women should avoid it. It is important to rule out prostate cancer in those taking saw palmetto for BPH, since the symptoms are similar. The effect of saw palmetto on prostatic cancer would likely be beneficial but not curative. No drug interactions have been reported.

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

Sadistic Personality Disorder Dsmiiir Appendix A

The sadistic person's threatening behavior will often escalate to interpersonal violence if he or she thinks that the person being subordinated is resisting control or is no longer intimidated. It is thought that there may be nonviolent forms of Sadistic Personality Disorder, that is, those individuals may not resort to physical violence in relationships although they may still be psychologically abusive, and they still may harbor deep fascinations for weapons of violence, torture, and literature and media with such themes (Millon & Davis, 2000). Notably, a diagnosis is not typically given if the sadistic behavior has been directed toward only a single individual, like a spouse, nor should it be given if the behavior is exhibited solely for purposes of sexual arousal (a diagnosis of Sexual Sadism should be given in such cases although it is highly debatable whether a comorbid diagnosis of Sadistic Personality Disorder should not also be given). B. The behavior in A has not been...

Antiparkinsonian Therapy And Hypersexuality

Sandyk18 reported on two men with PD and ED, ages 70 and 73, who experienced sexual arousal and nocturnal erections after receiving treatment for PD with transcra-nial administrations of AC-pulsed electromagnetic fields (EMFs) of 7.5 picotesla flux density. The first patient received EMF treatment for two consecutive days. He reported a decrease in parkinsonian symptoms after the first treatment and experienced sexual arousal and awakening during the night with several repetitive spontaneous erections lasting 15 to 20 min. During the second treatment, he experienced sexual arousal. The patient experienced nocturnal erections during the following three nights. The second patient had two successive EMF treatments for four days. This patient reported sexual arousal associated with nocturnal erection.

Erection the conversion of the flaccid urinary penis to the rigid sexual penis

The three lengthwise erectile chambers of the penis are arranged with a side-by-side dorsal pair of corpora cavernosa above the single ventral corpus spongiosum. The corpora cavernosa are covered by the tunica albuginea, a 2-mm thick fibrous membrane which is resistant to stretch. The corpus spongiosum surrounds the length of the penile urethra and is enlarged at its base to form the urethral bulb and distally to create the glans penis. While it becomes engorged with blood during arousal it is not involved in the rigidity of the erection but merely protects the urethra from closure. The unaroused penis is flaccid because the pudendal arterial blood flow into the erectile tissues is limited by the high sympathetic constrictive tone in the smooth muscle of the vessels of corpus cavernosum. On sexual arousal, the sympathetic tone is reduced, the neural innervation of the arteries and cavernosal chambers is activated to release vasoactive intestinal peptide ( VIP), a peptidergic...

The Psychodynamic Perspective

Example of massive repression in action. Histrionics are more likely to turn the tables, projecting hypersexual interest onto their accuser and deflecting attention from themselves. With righteous indignation, they may maintain that they cannot express how hurt they are by such a suggestion, thereby leaving their prospective suitors feeling angry, confused, or even amazed. For Yvonne, this tendency is perhaps seen with her insistence that she is not like the other girls, as she insists forcefully that she is an artist, dancing presumably for the aesthetic value. Histrionics may also use sexualization to distract themselves from feelings of anxiety or emptiness or to compensate for their perception that women lack power in a male-dominated world. By evoking sexual desire in others, by creating demand but rarely satisfying it, histrionics level the interpersonal playing field. Whatever the reason, their pervasive use of sexuality has caused many analytic writers to remark that these...

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...

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...

Paraphilia not otherwise specified

Partialism involves an exaggerated sexual interest in a specific part of the body. Heterosexual males have an exaggerated sexual arousal to breasts and buttocks, the body parts that most easily discriminate males from females. Homosexuals, likewise, are attracted to the genitals, buttocks, and chest areas of other males, areas of the body that discriminate males from females. Partialism may also involve an exaggerated sexual interest in a portion of the body less likely to be a culturally supported sexualized part of the body, such as leg muscles, feet, or hands. Individuals involved in public masturbation recurrently go to public settings such as cinemas, bars, and or the carparks of shopping centres. In these public settings, they conceal the fact that their penis is outside their clothing and masturbate while watching females. Public masturbators appear to need the stimulation of viewing women unknown to them to achieve sexual arousal. Arousal is also increased by knowledge of the...

Causes Of Hypersexual Behavior

Different mechanisms have been suggested to explain hypersexuality in response to antiparkinsonian therapy. The dopaminergic system, which is widely distributed in the central nervous system (CNS) and pelvic organs, is necessary for male sexual arousal and ejaculation, as documented in animal experiments and human studies.65 The serotonergic system, which is also widely distributed in the CNS, has an inhibitory role in the sexual response cycle. Dopaminergic agents such as levodopa, bromocrip-tine, and pergolide may promote sexual behavior by activating the dopaminergic system and lowering serotonin concentrations at postsynaptic sites.25

Analgesic Antiinflammatory And Antispasmodic Activity

Origanum compactum Benth., a species native to North Africa and locally named 'za'atar , was used traditionally against affections of the respiratory organs as an antispasmodic and anticatarrhal drug and, especially in Morocco, as a spasmolytic drug in the gastrointestinal tract, as antacid, antidiarrhoeal agent, vermifuge and aphrodisiac (van den Brouke and Lemli, 1980 Bellakhdar et al, 1988 Hmamouchi et al., 2000). In order to scientifically validate the traditional medicine data, van den Brouke and Lemli (1980) surveyed extracts of O. compactum on antispasmodic effects in different smooth muscle preparations in vitro. It was found that water macerates of O. compactum significantly inhibited smooth muscle response induced by any of the tested spasmo-gens (acetylcholine, histamine, serotonine, BaCl2, nicotine . . . ) in the guinea-pig ileum. The structure activity relationship revealed that the antispasmodic effect of O. compactum was almost completely explained by its essential oil...

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)

Indications and contraindications

Many problems with sexual function would be suitable for couple therapy, including those couples where there is a disparity in sexual desire, or those where one partner has a specific phobia for sex. In some such cases there is also a need for individual therapy, especially where one partner is the survivor of earlier childhood sexual abuse.

The hypothalamicpituitaryadrenal axis

Space constraints preclude a more comprehensive discussion of this rich literature, but a few additional points are certainly worth interjecting. First, a robust preclinical literature has documented the depressogenic and anxiogenic effects of exogenously administered CRF in laboratory animals. When CRF was directly injected into the central nervous system it produced effects reminiscent of the cardinal symptoms of depression in patients, including decreased libido, reduced appetite and weight loss, sleep disturbances, and neophobia. Indeed, newly developed CRF1-receptor antagonists represent a novel putative class of antidepressants. Such compounds exhibit activity in virtually every preclinical screen for antidepressants and anxiolytics currently employed. A second CRF receptor, the CRF2 receptor, has now been identified. Interestingly it exhibits genetic polymorphism, i.e. it occurs in more than one naturally occurring isoform or splice variant. It is believed to utilize the...

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...

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.

Menopause

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.

Year Product

Jamaican sarsaparilla has been exported from the island as a raw material since the 19th century. It has been listed in the U.S. Pharmacopeia from as early as 1820 to 1910, and is regarded as GRAS, generally recognized as safe. It has a wide range of claims energy restorer, tonic and aphrodisiac, antibiotic, hormone regulator, blood purifier, general health restorer for nervous system disorders, for premenstrual syndrome, and for use after childbirth 4-6 . Chainy Root, which may be a corruption of China Root, is like sarsaparilla from the Western Hemisphere. It is less used than sarsaparilla but is regarded locally as a tonic and aphrodisiac and prepared in tonic wines and other extracts. Recent research on some Chinese species confirm that these are antibiotics, effective in the treatment of venereal diseases and leptospirosis, anti-cancerous, and also aid short-term memory 7-9 .

Clinical Evaluation

The first step in the diagnostic work-up is identification of the problem. Unfortunately, few women volunteer any history of FSD, and therefore information should be actively elicited as part of the routine medical history. A simple approach for a clinician could be, Many woman report that once they reach menopause, they experience changes in sexual function Have you noticed any changes in your sexual function or desire The idea is to offer an open-ended question and opportunity for the patient to realize 1) she is not alone, 2) you are interested in helping her, and 3) successful treatments are available. Various questions regarding the length of time since the onset of sexual dysfunction, libido issues, ability to become sexually aroused, poor lubrication, ability to achieve orgasm, and dyspareunia should be asked to further classify the sexual dysfunction (e.g., hypoactive sexual desire disorder). Any history of abuse should be elicited. The history should also include any...

Notation

Incidence 4 23, conc. range 2.4-20 g kg, 0 conc. 12 g kg, country Nigeria768 see also areca nut, bacon, barley, beans, beefburger, beer, betel nut, bondakaledkai, bread, buckwheat, butter, cassava, cereals, cereals (breakfast), cheese, chestnut, chips (yam), chocolate, cocoa, cocoa beans, cocoa hazelnut cream, coffee beans (green), coix seed, congressbele, cottonseed, cowpeas, dates, drink, figs, fish, flakes (corn), flour, flour (gram), flour (maize), flour (wheat), food, food (infant), fruit products, fruits (apricot), fruits (lemon), fruits (mango), Ga Kenkey, gram, grits (maize), gruel, herbs and medicinal plants, hot dog, Incaparina, jam (bean), Job's-tears, jowar, juice (apple), juice (mango), kheri, kidney (hare), kidney (pheasant), kidney (roe deer), kubeba, legume, lentils, linseeds, liver (hare), liver (pheasant), liver (pig), liver (roe deer), maize, maize and beans, maize dough, maize products, marzipan (almond paste), mchuzi mix, meal (cottonseed), meal (maize), meal...

Herbal Medicines

The basis of an ancient ointment called Narcissimum. The powdered flowers have been used as an emetic in place of the bulbs, and in the form of a syrup or infusions for pulmonary catarrh. A decoction of the dried flowers acts as an emetic, and has been considered useful for relieving the congestive bronchial catarrh of children, and also useful for epidemic dysentry. In France, narcissus flowers have been used as an antispasmodic. A spirit has been distilled from the bulb, used as an embrocation and also given as a medicine and a yellow volatile oil, of disagreeable odour and a brown colouring matter has been extracted from the flowers, the pigment being quercetin, also present in the outer scales of the onion. The Arabians commended the oil to be applied for curing baldness and as an aphrodisiac (Grieve, 1998). Conveniently, the bulbs of N. tazetta have also been used as a contraceptive (Matsui et al., 1967). The influence of daffodil on the nervous system has led to giving its...

Females

While over 60 studies have been undertaken to examine whether the changing hormonal levels of the menstrual cycle influence the sexual arousal of the female, (3Z neither oestrogen or progesterone have been found convincingly to play a direct role in influencing the sexual activity of the human female apart from their indirect functions in the maintenance of the structures and functions of the female genitals, especially the vagina. Androgens, secreted by the female's adrenal cortex, have a concentration 10 times less than those in the male. The variation of the androgen levels in the plasma during the menstrual cycle is small and it is the free androgen level that must be taken into account. Androgens maintain the adult female pubic and axillary hair, clitoris, and probably labia and periurethral glans. The role of androgens in female sexuality is controversial and not clear cut. (38) Some propose that, as in the male, it is the major hormonal influence on the female libido. Removal...

Internal

On sexual arousal, the blood supply to the vaginal walls is increased by the liberation of VIP from the vipergic neural innervation while the venous vessels are probably constricted by the release of the vasoconstrictor neuropeptide Y. (3 d4 Within seconds this creates blood-vessel engorgement and a plasma transudate leaks out of the capillaries and percolates between the cells of the epithelium saturating its small reabsorptive capacity. The newly formed vaginal fluid creates a lubricating film on the vaginal surface which is essential for painless penile penetration. Poor or inadequate lubrication can lead to dyspareunia and subsequent sexual dysfunction. On cessation of sexual arousal or after orgasm the blood flow returns to the basal level and the fluid is reabsorbed back into the blood following the continuous absorption of sodium ions by the epithelial cells. The cul-de-sac of the vagina is expanded during sexual arousal and the cervix is lifted clear of its posterior wall...

Assessment

In evaluating male patients with hypoactive sexual desire, the clinician should routinely obtain a total and free testosterone level and consider procuring a prolactin level. In both male and female patients, a thorough medical and pharmacological history should be elicited. This strategy will identify temporal relationships between the dysfunction and the onset of endocrinological disease, medication use, medical treatment, or substance abuse. Sexual desire is assessed by enquiring into the patient's quality and quantity of sexual imagery in daytime fantasies and night dreams, desire to engage in sexual behaviour both alone and with a partner, and frequency of sexual activity, alone or with a partner. For DSM-IV and ICD-10, the individual's life context must be considered, namely age, health, and partner status.

Sexual sadism

Sexual sadism involves achieving sexual arousal by repeatedly inflicting psychological or physical suffering on a consenting or non-consenting partner (DSM-IV code 302.84 in ICD-10 sadism is coded with masochism as F65.5).(34) Sadists are not simply interested in subduing their partners for sex, but instead prefer inflicting pain far in excess of what would be necessary to accomplish compliance with sexual activity. Sexual sadists, like sexual masochists, attempt to develop an ongoing relationship with a sexual partner who enjoys the experience or is reluctant to report the experience to others. In these relationships, the sadist generally accelerates his or her sadistic behaviour when their prior sadistic behaviour with their partner is tolerated. As these relationships persist, more extensive sadistic assault is required to produce the fright and fear that sadists want to see in their partners.

Hormonal effects

Response to hormonal treatment is variable between patients. This is particularly notable and potentially problematic for males. As with people born female, breast development spans a continuum. Patients may erroneously believe that more hormone will result in greater breast development. They neglect the fact that people born female have quite adequate female hormone production but the limiting factor is tissue response. In addition to breast development, male patients report increased hip and buttock fat, skin softening, and loss of sex drive and erection capacity. Androgen treatment to the female results in voice deepening, facial hair growth, general body hair growth, menses cessation, clitoral hypertrophy, and increased sex drive.

Figure 331

Are a frequent side effect and may be lessened by taking the medication with food. As many as one-third of patients taking SSRIs may complain of sexual dysfunction, including decreased libido, delayed ejaculation, and anorgasmia. The SSRIs tend to be weight neutral with the exception of paroxetine (Paxil), which is associated with weight gain. No correlation has been made between plasma levels of the SSRIs and efficacy.

Amitriptyline

Amitriptyline is a tricyclic antidepressant, which can be used for pain management. Pain modulation seems to be the result of decreased serotonin and norepinephrine reuptake in the central nervous system. It stabilizes mast cells and has a moderate anticholinergic effect. Amitriptyline may improve the IC symptoms in 64 to 90 of patients.44 Amitriptyline works better for patients with a substantial pain component to their symptoms and anesthetic bladder capacity greater than 600 mL.45 The starting dose is 10 to 25mg at suppertime, and may be increased on a weekly basis to 75 to 100mg,but the lowest dosage often results in satisfactory improvement. The side effects of amitriptyline may include weight gain, fatigue, decreased libido and ability to achieve orgasm, palpitations, and anticholinergic side effects. It may also affect thyroid function. Hepatotox-icity and bone marrow suppression can rarely occur.

Baby food

See also acha, areca nut, barley, beans, beefburger, beer, betel nut, bondakaledkai, bread, buckwheat, butter, cassava, cereals, cereals (breakfast), cheese, chestnut, chips (yam), chocolate, cocoa, cocoa beans, cocoa hazelnut cream, coffee beans (green), coix seed, congressbele, cottonseed, cowpeas, dates, drink, figs, fish, flakes (corn), flour, flour (gram), flour (maize), flour (wheat), food, food (infant), fruit products, fruits (apricot), fruits (lemon), fruits (mango), Ga Kenkey, gram, grits (maize), gruel, herbs and medicinal plants, hot dog, Incaparina, jam (bean), Job's-tears, jowar, juice (apple), juice (mango), kheri, kidney (hare), kidney (pheasant), kidney (roe deer), kubeba, legume, lentils, linseeds, liver (hare), liver (pheasant), liver (pig), liver (roe deer), maize, maize and beans, maize dough, maize products, marzipan (almond paste), mchuzi mix, meal (cottonseed), meal (maize), meal (peanut), meal (pistachio), meal (posho), meat (luncheon), meju, melon seeds, milk...

Sexual dysfunction

Study suggested that about 70 of people with MS had sexual dysfunction compared with 40 in non-neurological disabling conditions and 12 in the general population.431 This study suggested that neurological damage was the single most common primary cause of sexual dysfunction. Nonetheless it must also be recognised that sexual behaviour will also be affected by many other impairments such as pain, sensory dysfunction, motor impairments, bladder dysfunction, bowel dysfunction, mood disturbance etc. Furthermore, physiological sexual dysfunction must always be considered in the much wider context of sexual behaviour and relationships. This section not only covers erectile dysfunction and disorders of sexual arousal mechanisms, but also covers wider aspects of sexual behaviour and social relationships that are probably of much greater importance.

Igfi T

'Sickness behaviour' (fever, weakness, malaise, listlessness, inability to concentrate, depression, lethargia, anhedonia and loss of appetite) Panic patients (social phobia) Prolonged wakefulness Behavioural changes (anorexia, adipsia, sleepiness and depression in social, sexual and general activity) Sexual arousal, aggression, emotional tone, cognition, dominant behaviour (especially violent offenders) High testosterone (men women) Low testosterone (men women) Depression Major depression State of health

Other Agents

Other herbal remedies or so-called natural products purportedly can enhance male sexual activity. Some may contain yohimbine. Natural prosexual agents of herbal origin include Epidemicum sagthatum, Tribulas terrestris, and Murira puama. Their use in folk medicine in China and other countries is likely due to their sexual stimulating properties and their aphrodisiac effects. Ginkgo biloba extract also has been used in the therapy of ED and sexual dysfunction.

Vasopressin

Stimulation of the medial amygdala and release of endogenous vasopressin duplicates these effects, which can be blocked by the intraventricular application of vasopressin antagonists. Stimulation of vasopressinergic neurons produces alterations in sexual behavior, in a pattern consistent with the idea that the medial amygdala organizes the appetitive phase of recognition of an appropriate partner and sexual arousal.

Male orgasm

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 ejaculation and usually cannot have an erection or another ejaculation until some time has passed. This varies with age and can be anything from minutes, when young, to hours or days when older.(20) It is not known where this inhibitory mechanism resides but animal work suggests that it may be in the brain rather than the spinal cord. Some men claim to be able to learn to inhibit ejaculation and yet have repeated serial orgasms. (40)

Voyeurism

Voyeurism, like most of the paraphilias, is an extension and exaggeration of normal sexual behaviour. Normally, we enjoy watching our sexual partners undress and are excited by watching them become aroused as they participate in sexual activity with us. The voyeur becomes aroused by this behaviour so frequently as a youth that it becomes entrenched, with sexual arousal and satisfaction being difficult to achieve in the absence of this particular stimulus. Furthermore, risk of apprehension and potential newness of each observed victim contribute to the magnification of the voyeur's excitement. Voyeurs choose environments where there is a high likelihood of satisfying their sexual interests, such as peering into apartment buildings or crowded residential neighbourhoods. Once a voyeur has found an environment where his efforts are particularly successful, he is very likely to return to that situation repeatedly. He approaches windows of homes, conceals himself in department store...

Hypogonadism

Testicular failure may occur before puberty and present as delayed puberty and the eunuchoid phenotype, or after puberty, with the development of infertility, impotence, or decreased libido in otherwise fully virilized males. The source of hypogonadism can be testicular, as occurs in primary hypogonadism, or it may result from abnormalities of the hypothalamic-pituitary axis, as in secondary hypogonadism.

Balsamico

Poonac, popcorn, ragi, raisins, rice, sausages, sesame products, sesame seeds, shiro, snacks, sorghum, soybeans, spices, spices (ammi), spices (cardamom), spices (chilli), spices (chilli powder), spices (coriander), spices (cumin), spices (curry), spices (fennel), spices (fenugreek), spices (garlic), spices (ginger), spices (Indian cassia), spices (ingwer), spices (mustard), spices (nutmeg), spices (paprika), spices (pepper), spices (pepper, cayenne), spices (saffron), spices (turmeric), sugar, sunflower seeds, taharna (fermented cereal product), vegetables, wheat, wine see also beans, bread, cereals, cocoa beans, cowpeas, figs, fish shrimp, flour (maize), food, fruits, grains, herbs and spices, lentils, maize, noodles, nuts, nuts (almond), nuts (brazil), nuts (cashew), nuts (hazelnut), nuts (peanut), nuts (peanut brittle), nuts (peanut butter), nuts (peanut products), nuts (pecan), nuts (pine), nuts (pistachio), nuts (walnut), oil, oil seeds, paste (fig), peas, phane, poppadoms,...

Apricots

Dates, drink, figs, fish, flakes (corn), flour, flour (gram), flour (maize), flour (wheat), food, food (infant), fruit products, fruits (apricot), fruits (lemon), fruits (mango), Ga Kenkey, gram, grits (maize), gruel, herbs and medicinal plants, hot dog, Incaparina, jam (bean), Job's-tears, jowar, juice (apple), juice (mango), kheri, kidney (hare), kidney (pheasant), kidney (roe deer), kubeba, legume, lentils, linseeds, liver (hare), liver (pheasant), liver (pig), liver (roe deer), maize, maize and beans, maize dough, maize products, marzipan (almond paste), mchuzi mix, meal (cottonseed), meal (maize), meal (peanut), meal (pistachio), meal (posho), meat (luncheon), meju, melon seeds, milk products, milk (buffalo), milk (camel), milk (cow), milk (human breast), milk (sheep), millet, muesli, nut cocktail, nuts, nuts (almond), nuts (brazil), nuts (cashew), nuts (coconut), nuts (coconut products), nuts (grogannut), nuts (hazelnut), nuts (peanut), nuts (peanut brittle), nuts (peanut...

Treatment

Once a complete diagnostic evaluation has been performed, the patient's sexual dysfunction can be accurately classified. One should note that there is often overlap of symptoms, such as hypoactive sexual desire and arousal insufficiency. It is also important to educate the patient and partner about normal physiologic response and sexual function, especially as it pertains to such issues as aging and childbirth. It is important to identify to the patient any obvious reversible causes of FSD or potential lifestyle changes that may be beneficial to her sexual function, such as stopping smoking, eating a healthy diet, regular exercise, improving partner communication, and stress reduction, because clearly there is a correlation between the patient's general health and her sexual function. In women receiving DHEA therapy, care should be taken to monitor androgen levels on a regular basis and to adjust the dose accordingly. Side effects of acne and hirsutism were relatively rare in these...

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