Rowland Sexual Dysfunction in Men

1. Auflage 2012
ISBN: 978-1-61676-402-9
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 116 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

"By far the best professional book ever published about understanding, assessing, and treating male sexual dysfunction."
Sexual dysfunctions in men, such as erectile dysfunction, ejaculatory disorders, and low sexual desire, are typically sources of significant distress for men. This book, being published with the companion volume Sexual Dysfunction in Women provides general therapists with practical, yet succinct evidence-based guidance on the diagnosis and treatment of the most common male sexual disorders encountered in clinical practice. It assumes that mental health professionals and other clinicians without expertise in the field of sex therapy have much to offer these men by combining a multidisciplinary understanding of issues surrounding sexual problems with their general clinical knowledge and expertise. With tables and marginal notes to assist orientation, the book is designed for quick and easy reference while at the same time providing more in-depth understanding for those desiring it. The book can serve as a go-to guide for professional clinicians in their daily work and is an ideal educational resource for students and for practice-oriented continuing education.
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Autoren/Hrsg.

Rowland, David

Rowland, David L

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Allgemeinmedizin, Familienmedizin
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Urologie, Andrologie, Venerologie

Inhaltsverzeichnis

1;Sexual Dysfunction in Men;1
2;Preface;6
3;Acknowledgments;7
4;Table of Contents;8
5;1 Description;10
6;2 Theories and Models of Sexual Dysfunction;31
7;3 Diagnosis and Treatment Indications;36
8;4 Treatment;42
9;5 Final Thoughts and Notes;98
10;6 Case Vignette;100
11;7 Further Reading and Resources;104
12;8 References;106
13;9 Appendix: Tools and Resources;114

Leseproben

1 Description The ability to have a fulfilling sexual relationship is important to almost all men’s mental health and psychological well-being. Not only is this a biologically and socially defining characteristic for men in our society, but studies suggest that men in such relationships tend to have greater longevity and to report a higher quality of life and overall satisfaction (McCabe, 1997; Palmore, 1985). Men whose sexual relationships are disrupted because of their inability to respond adequately, typically experience a number of psychological symptoms, including lack of confidence, anxiety, and distress. Even the nonspecialized therapist can be helpful by understanding the etiology, diagnosis, and treatment practices for various dysfunctions Although a select few therapists specialize in the treatment of sexual problems, most do not; therefore, the likelihood that a client or patient may approach a general therapist who counsels and treats patients with a variety of issues is quite high. Even the generalist can be helpful to men in need of sexual guidance and advice. Important to this process is an understanding of the components of sexual response, its etiology and diagnosis, and current treatment practices. 1.1    Terminology Sexual response is complex: It requires specific preconditions, involves multiple behavioral responses, and includes an array of psychosocial factors that have affective, cognitive, and relationship dimensions. Masters and Johnson (1966) succeeded in providing a rudimentary characterization of physiological sexual response, analyzing it into arousal, plateau, orgasmic, and resolution phases. Subsequent models introduced a role for sexual desire as a component of sexual response (Kaplan, 1979), with a more recent refinement that distinguishes between such constructs as spontaneous desire and arousability, the latter referring to sexual interest derived from a specific individual, object, or context as opposed to an “unprompted” desire. Further conceptualization has included separate pain-pleasure dimensions (Schover, Friedman, Weiler, Heiman, & LoPiccolo, 1982), as well as attention to other subjective factors such as the feelings, motivations, and attitudes that surround the sexual act (Byrne & Schulte, 1990). Recently, emphasis has also been given to the role of the dyadic relationship, an approach that seeks to understand and treat sexual dysfunction in its relational context (Schnarch, 1988, 1991). Healthy sexual relationships, however, are not characterized merely by the absence of dysfunctional response. Key elements of healthy sexual relationships include passion, intimacy and caring, and commitment (Sternberg & Barnes, 1988). Healthy sexual relationships involve more than just the absence of dysfunctional response; many problems include larger relationship factors beyond sexual response issues Passion typically involves such characteristics as sexual feelings, physical attraction, and romantic love. Intimacy and caring deal with dimensions of affection and expressiveness – the willingness to communicate and share beliefs, attitudes, and feelings. Commitment refers to the decision to be with one partner and to work hard to maintain the relationship. Because many sexual problems are rooted in a couple’s disparate expectations and emotional struggles, including the different ways in which these elements are often played out by each of the sexes, most sexual problems benefit not just from attention to specific sexual response issues but to larger relationship factors as well. There are several different types of sexual disorders. In the field of sexology, distinctions are made among the sexual dysfunctions, the gender identity disorders, and atypical and paraphilic behaviors. Sexual dysfunction refers to disruption or inadequacy of normal sexual responding and is the topic of this book. Gender identity disorders refer to cross-gender identity or the lack of assimilation of, or satisfaction with, the gender identity consistent with one’s biological sex or assigned gender identity. Paraphilias refer to sexual arousal and behaviors that are directed toward inappropriate objects/partners or are carried out in inappropriate situations (e.g., fetishism, pedophilia, frotteurism, voyeurism, etc.). 1.2    Definition The classification of sexual dysfunctions has evolved from the conceptual models discussed above and is related to the specific axes or dimensions important to functional sexual response (American Psychiatric Association, 2000). These include: lack of desire, also known as hypoactive sexual desire disorder; problems with either physiological sexual arousal (e.g., erection) or subjective sexual arousal (i.e., actually feeling aroused); disorders of ejaculation/orgasm, most commonly premature ejaculation and inhibited ejaculation. Although not part of this review, problems with painful intercourse and sexual aversion are also included in the diagnostic classification system. Typically, the scope of the sexual problem is characterized as either situation- (including person) specific or generalized, and as either lifelong or acquired. An acquired sexual dysfunction may result from either pathophysiological developments or sexual experiences. Several classification systems are currently in use to define and characterize sexual dysfunctions: The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR), the proposed 5th edition of the DSM (DSM-5), and the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10) classifications are included in Table 1. Characteristics of each dysfunction, along with alternate terminology and prevalence estimates are provided in Table 2. Table 1 Comparison of Terminology Across Diagnostic Manuals for Sexual Dysfunctions in Men   DSM-IV-TR (codes) ICD-10 (codes) DSM-5 proposed (as of May 15, 2011)   Sexual Desire Disorders     HSDD (302.71) Loss or lack of sexual desire (F52.0) Hypoactive sexual desire disorder in men Sexual Arousal Disorders     Male erectile disorder (302.72) Failure of genital response (F52.2) Erectile disorder Orgasm Disorders     MOD (302.74) Orgasmic dysfunction (F52.3) Delayed ejaculation Premature ejaculation (302.75) Premature ejaculation (F52.4) Early ejaculation   Note. DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (APA, 2000); HSDD = Hypoactive sexual desire disorder; ICD-10 = International Statistical Classification of Diseases and Related Health Problems, 10th Edition (World Health Organization, 1992); MOD = Male orgasmic disorder. Although sexual dysfunctions in men and women generally parallel one another, the prevalence of the various dysfunctions differentiates the sexes; and, because of differences in physiology and evolution, they are often manifested in different ways (Lewis et al., 2004). For example, anorgasmia and lack of sexual desire are more common among women, whereas rapid ejaculation/ orgasm and physiological arousal problems (e.g., erection in men versus lubrication in women) are more common among men. In broad terms, no matter what the problem, men’s sexual problems typically have three elements: (1)  A functional impairment of some type is evident. For example, the man and his partner are unable to enjoy intercourse because he is unable to get or keep an erection, or because he ejaculates very quickly. (2)  The man’s sense of self-efficacy is low, as he is typically unable to correct or control the problem through psychobehavioral changes. For example, the man just cannot seem to get interested in sex, or he is unable to delay his ejaculation. (3)  The man and/or his partner suffer negative consequences from the condition. For example, the man is bothered or even obsessed by the problem, perhaps to the point of avoiding intimacy; or the partner is distressed by the situation, not knowing what to do, perhaps feeling frustrated and unattractive, and so on. The challenge in the field of sexology, however, is that although there is only “one” unified sexual response in the patient’s view – the man typically does not distinguish among the desire, erection, and ejaculation phases of the response – the physiology underlying the functional impairment associated with each of these phases is quite distinct. Thus, dysfunction within each phase has its own prevalence, etiology, diagnosis, and treatment. To provide greater depth and understanding, this book takes a dual approach, dealing with common and...