Among all types of sexual disturbance in men, disturbances of sexual function are the most important in clinical practice. These are classified by the segment of the sexual reaction cycle in which they arise appetence, arousal, orgasm, and resolution. Partial functional impairment must be distinguished from dysfunction causing significant suffering and requiring treatment. This evaluation must take the multidimensionality and multiple functions of human sexuality into account. Chronic frustration of the fundamental psychosocial needs for acceptance, closeness, and security is a very important factor that has neglected until now by the prevailing conceptions of the etiology and pathogenesis of sexual disturbances.
Their treatment involves a combination of elements "Sexualmedizinisches institut charite" sexual medicine and psychotherapy, along with somatic medical and pharmacotherapeutic intervention, if needed. It is essential to understand the different types of sexual disturbance in their biopsychosocial context as well as the significance of sexuality for the individual, and for the couple, with respect to reproduction, sexual pleasure, and bonding.
Sexual disturbances are common, and patients therefore expect their physicians to be proficient in sexual medicine. The coverage of this subject in both undergraduate and postgraduate medical education in Germany needs to be improved. In addition to functional sexual disorders, Sexualmedizinisches institut charite may or may not be associated with organic pathology, disorders of sexual development, gender identity, sexual preference paraphilia and sexual behaviour Sexualmedizinisches institut charite occur in men 1.
Sexual disorders in men are categorized according to their occurrence in the cycle of sexual response into disorders of desire, Sexualmedizinisches institut charite erectile dysfunctionor orgasm premature or delayed ejaculation, or anorgasmiaalbeit with considerable potential for overlap and concurrence between these disorder groups.
International comparison Laumann, et al. A number of studies have also confirmed the negative effects of functional sexual disorders on relationships and quality of life 3 — 6.
Desire disorders increasingly present as a problem among men "Sexualmedizinisches institut charite" medical Sexualmedizinisches institut charite for sexual difficulties.
Erectile dysfunction is often presented as the primary complaint, but it is not uncommon for this to mask other problems such as exhaustion with or without substance abuserelationship difficulties, and, more rarely, disorders of sexual preference. Organic causes testosterone deficiency, hyperprolactinemia, medication-related side effects are important, but at times overemphasized in the somatic medical literature. The prevalence of erectile dysfunction has been well researched.
Braun and colleagues found erectile dysfunction in In relation to both distress and overall prevalence, a marked age effect was found 8 Tabelle 1. An important finding of these studies was the high coincidence with medical conditions in particular diabetes mellitus, cardiac disease, and hypertension. The onset of erectile dysfunction over the age of 40 can be an early warning sign of chronic ischemic heart disease 9e2.
Premature ejaculation is the commonest form of sexual dysfunction in men. It is defined as the persistent or repeated occurrence of ejaculation before, during, or shortly after penetration, over which the individual has Sexualmedizinisches institut charite or no control and not accompanied by a feeling of orgasmic satisfaction.
In seeking to present valid prevalence data one encounters two problems: On the one hand, the normal interval between penetration and ejaculation is to a large extent a subjective judgment, and subject to wide individual and cultural variation 11e4.
And on the other hand, this is an area in which it is particularly clear that biological dysfunction is not synonymous with a clinically relevant disorder. The aim of this article is to present an overview
Sexualmedizinisches institut charite male sexual dysfunction from a psychosexual medicine and interdisciplinary perspective.
Because of their prevalence, particular attention will be to the diagnosis and treatment of functional disorders, which are the subject of numerous treatment approaches.
The relational aspects of human sexuality accorded particular importance in a biopsychosocial sexological approach, which is underpinned
Sexualmedizinisches institut charite a selective literature review. Extensive research results from the last 15 years and the introduction of selective phosphodiesterase 5 inhibitors have led to changes in the diagnostics and treatment of male sexual dysfunction.
Invasive investigation is now almost obsolete. Medication is introduced early. Erectile dysfunction is generally regarded in the literature primarily as a vascular disorder, acting as a first sign of generalized atherosclerosis e6. The view of Sexualmedizinisches institut charite disorder has changed from an almost entirely psychogenic to an organically dominated, multifactorial etiology
Sexualmedizinisches institut charite A large proportion of studies on male sexual dysfunction is directed at the effects of pharmacological treatment on desire, erection and ejaculation, and remains purely at the Sexualmedizinisches institut charite of the functional disorder.
It is true that Sexualmedizinisches institut charite predominantly somatically focussed literature alludes in general terms to the role played by psychological and relational factors 10and consensus statements emphasize the importance of a full sexual history taking into account the relationship Sexual experience always comprises a synergy of biological, psychological and social factors, whose individual weighting "Sexualmedizinisches institut charite" interrelation where a sexual problem exists must be identified on an individual patient basis.
Of primary importance is the subjective meaning of sexuality and partnership, which in turn determines the effects of events and experiences within the intimate relationship 15e7. Against this background, any diagnostic approach which considers only the physical sexual function, for example, desire, erection, and ejaculation or the emotional for example, personality development and characteristics or the relationship is necessarily incomplete and inadequate as a means
Sexualmedizinisches institut charite planning the treatment of sexual dysfunction accompanied by distress.
Distress arises when a sense of ones own sexual inadequacy arises in the context of a relationship. The desire for relationship is innate and therefore ubiquitous 16e Positive social interactions which fulfil fundamental psychosocial needs such as the need for acceptance, belonging, closeness or warmth, promote confidence, reduce anxiety, promote security, and reduce stress and aggression.
This is supported by neurobiological data on the importance of attachment and relationship A factor hitherto largely neglected by etiopathogenetic approaches but which appears influential is the chronic frustration of basic psychosocial needs.
This leads not only to deterioration of the quality of relationship, but also affects sexuality in three areas: In a recent interview based study by Kleinplatz et al. Couples therapy makes Sexualmedizinisches institut charite language conscious, and translates it: This does not necessarily presuppose sexual functionality, nor is sexual functionality sufficient to create sexually satisfying experiences On Sexualmedizinisches institut charite other hand, recent studies of the placebo effect have shown that the effect of medicines is frequently enhanced by the supportive attention received in the consultation, in addition to Sexualmedizinisches institut charite attribution effect, which arises from a positive expectation of treatment.
If, reasonably enough, we accept the placebo effect of the good doctor-patient relationship, we should value all the more highly the health promoting potential of a functioning intimate relationship, and seek to influence it positively.
If one wants to attain a perspective commensurate with the complex realities of the situation, sexual history taking, as an important diagnostic tool requiring attention to details not usually elicited in the standard medical history, requires specialist knowledge and qualification 20e9e10 box. This study asked a representative sample of men aged 40—79 about erectile dysfunction and its effects on quality of life, health, and their relationship Sexualmedizinisches institut charite subgroup analysis of participants who completed an extensive interview including a full sexual history in the presence of their partner in total mennot only demonstrated the prevalence of the various functional disorders, but also found that Nevertheless, as many as a third of men described the paraphilia-like fantasies alone as inadequate, and in a significant proportion of these, there was a risk of harm to others for example pedophilic, exhibitionistic, or frotteuristic content of the fantasiessome of which had already been acted upon One example of this is the inappropriate treatment of erectile dysfunction arising in a severe but unrecognized disorder of "Sexualmedizinisches institut charite" preference with PDE 5 inhibitors 22e Functional sexual disorders in men are common complications of illness or its treatment, or early signs of disease.
For this reason Sexualmedizinisches institut charite is important across medical Sexualmedizinisches institut charite to include a sexual and relationship history into a general medical history, and where appropriate introduce additional enquiry and investigation FigureTable 2. This offers patients or couples wishing for change or treatment but reluctant to express this the opportunity Sexualmedizinisches institut charite discuss their concerns and receive early intervention.
The extent of treatment efficacy
Sexualmedizinisches institut charite dependent on the timing of diagnosis. The prognosis is good where distressing sexual dysfunction is recognized early Sexualmedizinisches institut charite first presentation and receives expert treatment. Otherwise, there is a danger that the problem will become chronic 1.
Using the example of the treatment of patients in Germany suffering from erectile dysfunction following radical prostatectomy for prostate cancer, Herkommer et al. There was also "Sexualmedizinisches institut charite" between the views of patients and clinicians regarding choice of treatment modality Questionnaires exploring the value to prostate cancer patients and their partners of relationship, nongenital sexuality exchange of caresses and genital sexuality sexual intercourse demonstrated that only importance of genital sexuality decreased in both partners before and after radical prostatectomy.
Relationship and the importance of physical closeness kissing and cuddling retained their importance Other studies confirmed this higher value placed on the fulfilment of the need for psychosocial closeness, intimacy,
Sexualmedizinisches institut charite security in comparison with the pursuit of purely sexual satisfaction In this it differs from all other
Sexualmedizinisches institut charite of treatment Table 4.
The primary aim of therapy is not to restore sexual function but to broaden the understanding of sexuality relationship dimensionto enable new experiences of sexual physical communication, and to improve the sexual satisfaction within overall relationship.
Effective medication and mechanical aids are is by no means contraindicated but is on the contrary complementary, used at the right moment. Modified according to Beier et al. A 59 year old man presents to the sexual medicine clinic with his partner with persistent erectile dysfunction despite regular use of a PDE 5 inhibitor following nerve sparing radical prostatectomy for prostate cancer.
Questions about feelings surrounding the experience of cancer, the current state of the relationship and their sexuality, as well as earlier experiences break the silence. Sex has always been an important part of the relationship for both parties, even if to different degrees, with a clear delineation of roles. In ten hours of couples therapy the focus is placed on more conscious use of body language and its associated meaning.
The health giving benefits of sexuality are once again within reach. Treatment draws on sexual medical and psychotherapeutic techniques as well as organic and pharmacological elements. Couples sex therapy focuses on basic psychosocial needs, with the aim of Sexualmedizinisches institut charite satisfaction in the sexual relationship. This way of thinking and working is unfamiliar to many doctors, because, as sexual medicine remains untaught in a Sexualmedizinisches institut charite of undergraduate medical courses in Germany 20e10 and elsewhere, it has never been learned.
It is however teachable and The seminar has run continuously ever since e9. The ubiquitous human desire for the fulfilment of basic psychosocial needs is fundamental, and must be taken as seriously by medicine as the investigation of pathogenetic mechanisms.
In relation to sexual dysfunction, this implies the restoration to patients of the health promoting effects of sexuality. Although efforts are being directed at conducting controlled, clinical trials and randomized controlled multicentre studies in psychosexual medical research, it is an unfortunate truth that nowhere near such generous resources are available for this area Sexualmedizinisches institut charite for that of commercially exploitable pharmaceutical research.
But this must not lead, for ethical reasons, to the withholding from patients plausible and clinically tried and tested treatments. It is "Sexualmedizinisches institut charite" be hoped that the Medical Associations of other German federal states as well as the German Medical Association will follow this example.
This is important both for doctors and patients in search of qualified service provision in this area. The translation of terms referring to sexual therapies is complicated by non-equivalence in the precise nature of treatments practitioners between countries.
The authors declare no Sexualmedizinisches institut charite of interests in the terms of the Sexualmedizinisches institut charite of the International Committee of Medical Journal Editors. National Center for Biotechnology Sexualmedizinisches institut chariteU. Journal List Dtsch Arztebl Int v. Published online Dec Find articles by Hermann J. Author Sexualmedizinisches institut charite Article notes Copyright and License information Disclaimer.
Received Jul 30; Accepted Apr 8. See letter " Correspondence letter to the editor: See letter " Correspondence reply: This article has been cited by other articles in PMC. Abstract Background Among all types of sexual disturbance in men, disturbances of sexual function are the most important in clinical practice.
It is essential to understand the different types of sexual disturbance in their biopsychosocial context as well as the significance of sexuality for the individual, and for
Sexualmedizinisches institut charite couple, with respect to reproduction, sexual pleasure, and bonding.
A "sexual medical” expert opinion (sexualmedizinisches Gutachten) in psychotherapeutic medicine and professor at the Charité university professor "Sexualmedizinisches institut charite" sexual sciences and founding member of the former Frankfurt Institute for Sexual. Institute for Sexology and Sexual Medicine of the Charité—University Berlin.
Begehrens im Diskurs sexualmedizinischer Primärprävention [If preferences. host-wig.info found on host-wig.info English; |; 3 Documents Institut fÃ¼r Sexualwissenschaft und Sexualmedizin - CharitÃ©.
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Int J Impot Res. It is however teachable and learnable. Central stimulant of testosterone synthesis, release and storage of proerectile neurotransmitters oxytocin, dopamine, NO , testosterone withdrawal leads to apoptosis of the smooth muscle cells of the corpora cavernosa. Sexual problems among women and men aged 40—80 y: This study asked a representative sample of men aged 40—79 about erectile dysfunction and its effects on quality of life, health, and their relationship The relational aspects of human sexuality are accorded particular importance in a biopsychosocial sexological approach, which is underpinned by a selective literature review.
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