Silvitra
"Generic silvitra 120mg on line, psychological erectile dysfunction wiki."
By: Denise H. Rhoney, PharmD, FCCP, FCCM
- Ron and Nancy McFarlane Distinguished Professor and Chair, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
https://pharmacy.unc.edu/news/directory/drhoney/
Clin obstet vaginal-cervical self-stimulation in women with complete Gynecol 1985; 28:134-141. Neural pathways mediating vaginal function: the vagus nerves and spinal cord oxytocin. Chur, Switzerland: Harwood Academic Publishers, striated muscular anal continence mechanism: Implications 1993; 525-578. Chur, Switzerland: Harwood Academic Publishers, signiicance of sacral and pudendal nerve anatomy. Autonomic efferent and visceral the female pelvic loor: disorders of function and support. Localization of nitric oxide synthase in spinal mice reveal a major sensory role for urothelially released nuclei innervating pelvic ganglia. Differential the rat to stimulation of the uterus, vagina, cervix, colon and regulation of the expression of estrogen, progesterone, and skin. Philadelphia: Lippincott-Raven Neurochemical characterization of the vestibular nerves in Publishers, 1997; 67-75. Subcutaneous Botulinum toxin type A reduces the human vagina by NoS and neuropeptide-containing capsaicin-induced trigeminal pain and vasomotor reactions nerves. Vaginal changes and sexuality in women with a sensory testing in patients with painful bladder syndrome. Bohm-Starke N, Hilliges M, Brodda-Jansen G, Rylander E, to noxious heat in patients with rheumatoid arthritis. Bohm-Starke N, Johannesson U, Hilliges M, Rylander E, pain processing in freely moving rats revealed by distributed Torebjork E. J Reprod Med the Prithvi Raj Lecture: presented at the third World 2004; 49:888-892. Granot M, Friedman M, yarnitsky D, Tamir A, Zimmer of vulvar vestibulitis syndrome. Association between quantitative sensory predictors of chronic lower genital tract discomfort. Am J testing, treatment choice, and subsequent pain reduction obstet Gynecol 2001; 185:545-550. Vulvodynia--a complex syndrome of vulvar thresholds in women with provoked vestibulodynia. Psychophysical evidence of hypersensitivity in subjects women with vulvar vestibulitis syndrome. Am J obstet Vestibular tactile and pain thresholds in women with vulvar Gynecol 2002; 187:589-594. Sonni L, Cattaneo A, De Marco A, De Magnis A, Carli P, “secondary” vulvar vestibulitis: one disease, two variants. New york: Churchill Livingstone, 2006; features in a general gynecologic practice population. Painful Bladder Syndrome have altered response to thermal stimuli and catastrophic reaction to painful experiences. Elevated tissue levels of interleukin- medication with vaginal antifungal drugs: physicians’ 1 beta and tumor necrosis factor-alpha in vulvar vestibulitis. J Reprod Med 1988; is rarely associated with human papillomavirus infection 33:695-698. Morin C, Bouchard C, Brisson J, Fortier M, Blanchette C, diagnoses in women presenting to a referral center for Meisels A. Vulvar vestibulitis syndrome: an exploratory case-control propionate 2% topical application for severe vulvar lichen study. Epidemiology of vulvar vestibulitis syndrome: an exploratory Mannose-binding lectin gene polymorphism and resistance case-control study. Vulvar vestibulitis and risk factors: candida in a young sexually active population: prevalence a population-based case-control study in oslo. Acta Derm and association with oro-genital sex and frequent pain at Venereol 2007; 87:350-354. Int J Gynaecol obstet 1999; vestibulitis: signiicant clinical variables and treatment 64:259-263. Is the antagonist gene polymorphism in women with vulvar assumed natural history of vulvar intraepithelial neoplasia vestibulitis. Urogenital atrophy: prevention response in women with vulvar vestibulitis syndrome. Interleukin- Epidemiology of surgically managed pelvic organ prolapse 1beta gene polymorphism in women with vulvar vestibulitis and urinary incontinence. Impact of genetic population of female subjects seen for routine gynecologic variation in interleukin-1 receptor antagonist and health care. Johannesson U, Blomgren B, Hilliges M, Rylander E, Bohm- approach to repair of apical and other associated sites of Starke N. The vulval vestibular mucosa-morphological pelvic organ prolapse with uterosacral ligaments. Br J obstet Gynecol 2000; 183:1365-1373; discussion 1373- Dermatol 2007; 157:487-493. Functional and anatomical outcome of anterior sacrospinous colpopexy for vaginal vault prolapse: a and posterior vaginal prolapse repair with prolene mesh. Functional and posterior compartment prolapse with Atrium polypropylene anatomic outcome after transvaginal rectocele repair using mesh. Dificulties in the differential diagnosis of vaginismus, function after surgery for stress urinary incontinence and/or dyspareunia and mixed sexual pain disorder. Vaginal comparison of Burch colposuspension versus anterior spasm, pain, and behavior: an empirical investigation of the colporrhaphy in women with stress urinary incontinence diagnosis of vaginismus. Female genital mutilation: an of thirty patients who underwent repair of posthysterectomy injury, physical and mental harm. J Psychosom obstet prolapse of the vaginal vault with abdominal sacral Gynaecol 2008; 29:225-229. J abdominal reconstructive surgery for the treatment of pelvic Sex Marital Ther 2001; 27:465-473. Female sexual dysfunction couples: partner solicitousness and hostility are associated in Lower Egypt. Eur J Pain with perception of experimental pain in vulvar vestibulitis 2005; 9:427-436. Am point examination in women with vulvar vestibulitis J obstet Gynecol 1992; 167:630-636. Psychological proiles and treatment sexual, and psychophysical characteristics of women with responses. J proiles of and sexual function in women with vulvar vestibulitis Reprod Med 2008; 53:413-416. Psychological proiles Automatic and deliberate affective associations with sexual among women with vulvar vestibulitis syndrome: a chart stimuli in women with supericial dyspareunia. Sexual arousal in women with thresholds, and psychosocial functioning in women with supericial dyspareunia. Effects of sexual arousal on genital and non-genital tibulitis: a multi-factorial condition. Behavioral approach with or without surgical intervention problems with social, psychological, and physical problems to the vulvar vestibulitis syndrome: a prospective in men and women: a cross sectional population survey. Disgust and Contamination Sensitivity in with lifelong vaginismus: process and prognostic factors. Psychosexual abuse, sexual knowledge, sexual self-schema, and trauma of an abnormal cervical smear. A uniied biosocial theory of personality and and fear of spiders: domain speciic individual differences its role in the development of anxiety states. The relationship between involuntary pelvic loor muscle activity, muscle awareness 285. Manual for the Illness Behaviour and experienced threat in women with and without questionnaire. Effects of appraisal of sexual stimuli on sexual arousal in women with and without 286.
There was substantial variation in the extent to erectile dysfunction jason buy 120 mg silvitra with amex which men in these five European countries endorsed various components of masculinity erectile dysfunction pills photos buy discount silvitra 120mg on-line. For example icd 9 code for erectile dysfunction due to diabetes cheap 120 mg silvitra visa, whereas 44% of German men cited “being in control of your own life” as an important component of masculinity erectile dysfunction treatment bay area purchase 120 mg silvitra with amex, only 17% of French men did so. As another example, 46% of Spanish men rated “being seen as a man of honour” as an important component of masculinity, but only 6% of German men did so. Given that masculinities are cultural and historical constructs, it is important to be aware that masculinities may vary as a function of cultural and historical differences. Masculinities may also vary within countries in relation to age, ethnicity, class, sexuality, and disability. Given the links between masculinities and health behaviour referred to earlier, we may therefore expect there to be variation across Europe in terms of how masculinity is related to health. How men perceive and actively define themselves as masculine impacts upon the value they place upon their health and how they manage their health within the healthcare system (Richardson, 2004). Indeed, it is against particular norms of masculine behaviour that men must constantly measure themselves – the dominant masculinity being the yardstick against which particular health practices are to be negotiated. It is crucially important however to consider and interpret gender and masculinities within the wider socio-cultural context of men’s lives and not in isolation from the social determinants of men’s health. As Ireland’s men’s health policy (Department of Health & Children, 2008, p14) highlights: 30 "It is imperative, however, that gendered health practices are not seen as inherent or intractable male characteristics, but rather, learned masculine behaviours that typically reflect wider cultural and institutional masculine ideologies such as those of schools or sporting organisations. The Commission on the Social Determinants of Health affirms that the conditions in which people grow, live, work have a powerful influence on health. It is important to acknowledge differences related to social class, ethnicity, sexual orientation etc, as well as similarities between men. How different men see themselves as being male is also crucial in acknowledging and respecting diversity within men. An appropriate men’s health policy has to face the multidimensional diversity within men and that there are many different ways to be a man. In the process of policy development men’s health should not be defined in a narrow biomedical framework, but should embrace a broader, social determinants view. In this respect, effective men’s health policy needs to draw on multiple strategies that target individual behaviors and that also focus on issues at the macro- economic, social, and environmental levels. In the case of socially excluded men health outcomes are very closely linked to education, employment, and housing. These factors are combined by issues such as social isolation and limited access to services for many deprived men. Permanent jobs are being replaced by short-term work contracts, rates of divorce are increasing, more children are born outside of marriage, and there is now a more level playing field in terms of equal opportunity in the workplace for men and women. There is much debate in Europe about men’s changing roles, the concept and different interpretations of the ‘new man’, and the degree to 31 which men are choosing to embrace or resist change and about their new vulnerability in health. Men’s health should be understood within a broad context, in the way that men actively construct their everyday life that impact on their health and in the framework of the culture in which men live and work. The positioning of men’s health within a mainstreamed equality/equity agenda may offer a more holistic approach than a focus on gender alone. In the Policy Brief of the European Observatory on Health Systems and Policies, Payne (2009, p iv) suggests that there are three basic approaches to address gender equality and gender equity: • Regulatory approaches at national level might address patient’s rights or create a duty for public sector organizations to address gender equality. Such a duty would require health ministries to consider the way in which health systems can reinforce inequality and to work towards the promotion of gender equality. For example, gender budgeting is an organizational approach that focuses on government expenditure and makes the gender impact of budgetary decisions explicit. For example, gender sensitive health indicators are intended to identify key differences between women and men in relation to health and in the social determinants of health, in order to support policy change. Gender mainstreaming represents a comprehensive strategy aimed at achieving greater gender equality. This is attained by integrating a gender perspective in to existing mainstream institutions and all programmatic areas or sectors (e. In the United Nations system, gender mainstreaming was defined and adopted in 1997. In line with the Amsterdam Treaty (1995) which put Gender Equality at the heart 32 of European policy priorities the Commission defines Gender Mainstreaming in the following way: "Gender mainstreaming is the integration of the gender perspective in to every stage of policy processes – design, implementation, monitoring and evaluation – with a view to promoting equality between women and men. It means assessing how policies impact on the life and position of both women and men – and taking responsibility to re-address them if necessary. This is the way to make gender equality a concrete reality in the lives of women and men creating space for everyone within the organizations as well as in communities - to contribute to the process of articulating a shared vision of sustainable human development and 5 translating it in to reality. It can be used to identify gender biases in policies, program design, management, implementation and review processes. Gender analysis can be considered as a policy planning and advocacy tool of focusing on the impact of gender within the context of other social, age-related, cultural and economic influences on health. Specifically, this should produce better health outcomes for men by: • Producing better-targeted programs • Facilitating more effective use of resources • Encouraging more sensitive practice • Enabling people to use services effectively Equity-focused health impact assessment uses the health impact assessment process to firstly determine the potential differential and distributional impacts of a policy, program or project on the health of the population as well as specific groups within that population; and secondly, to assesses whether the differential impacts are remediable and unfair. The equity dimension of this type of health impact assessment is about assessing whether identified differential health impacts are inequitable - the result of factors that are remediable and unfair, i. The minimum criteria for differential impacts that should be considered include: • age; • gender; • socioeconomic position; • culture and ethnicity; • level of health and disability. This approach can increase the likelihood of success because it offers opportunities to situate actions to address men’s health issues in their context. A number of attempts have been made in Europe to systematize evidence regarding the effectiveness of interventions in different types of settings (e. By focusing on the settings where different groups of men live in, well targeted policies can create environments that positively affect the behavior of men that occurs in it, and intervene to create change in those settings that foster behaviors that have negative consequences. Settings are more than containers of target male populations for interventions – passive recipients of service. The interaction of people within a particular setting and also among other settings in which they "live" is a basic element of such a policy. The community, defined by geography, culture or social stratification, is a valuable resource for health, so one of the key policy options is to strengthen social capital among communities of men through a community development approach. Traditionally, men have neither involved in community development activities nor have they mobilized themselves collectively to improve their health. These deprived men have the worst health profiles and are most likely to die prematurely. The integration of these groups of men in to community and social networks is essential in terms of improving their health. By using community resources for empowering deprived men to take control of their lives may enable them to change the circumstances that contribute to their disadvantage. Measures that support and enable men to be more involved and active as fathers have beneficial effects not just for fathers themselves, but also for their wives/partners and children, and society as a whole. Schools are important settings for the delivery of early interventions with regard to men’s health policy initiatives. The literature on men’s health draws attention to the critical influence that behaviours and values developed early in 35 life have on men’s health practices in later life. Appropriate policies are needed to consider possible gender differences in learning and development in the context of the ‘under-achievement’ of boys in schools; the need for improved links between schools and homes/communities; the need to address the high drop-out rate for boys. Work–life balance is increasingly seen as an issue that impacts on men as well as women. An important health policy task is to identify men’s health aspects of occupational health and safety. Men who fall in to these categories need special attention within the health system. Specific policy measures should be developed for marginalized subgroups of men (e. Health communication can contribute to all aspects of disease prevention and health promotion of men and is relevant in a number of other contexts, including: • health professional-patient relations with the different groups of male population, • individual men’s exposure to, search for, and use of health information, 36 • the dissemination of individual and population health risk information, that is, risk communication, • the education of different groups of men about how to gain access to the public health and health care systems For individual men, effective health communication can help raise awareness of health risks, provide the motivation and skills needed to reduce these risks, help them find support from other people in similar situations, and affect or reinforce attitudes. Health communication also can increase demand for appropriate health services and decrease demand for inappropriate health services. An audience-centred perspective is needed in men’s health policy reflecting the realities of different men’s everyday lives and their current practices, attitudes, beliefs, and lifestyles. A good communication strategy has to consider the experience of different men with the health care system, attitudes toward different types of health problems, and willingness to use certain types of health services. Health information specific to men should be developed and evaluated on the relevant health topics, such as diet and physical activity, and medical conditions, such as prostate cancer.
Order discount silvitra. Where does gold come from? - David Lunney.
The importance of taking extra precautions to beta blocker causes erectile dysfunction order 120mg silvitra visa maximise road safety and reduce risks of road accidents caused by hypoglycaemic incidents is highlighted impotence when trying for a baby buy silvitra 120mg on line. They must be otherwise qualifed to erectile dysfunction at age 18 cheap silvitra 120mg without prescription dive and meet several criteria as outlined in consensus guidelines for recreational diving with diabetes developed in 2005 erectile dysfunction quotes buy 120 mg silvitra overnight delivery. People with diabetes are at higher risk than the general diving population of medical complications such as myocardial infarction, angina and hypoglycaemia. The decreased activity experienced in a long plane trip, together with the amount of food given en route often results in increased blood glucose levels. These return to normal once a more usual lifestyle has been resumed at the destination. Extra precautions before and during travel include: • a medical consultation at least 6 weeks before the proposed travel to allow time to assess control and alter management as required • checking of routine immunisation status and other medical conditions • having a covering letter from their doctor and extra supplies of food, medication and monitoring equipment • getting advice about special insurance • fnding out about Australian air security guidelines. If not using an Australian carrier, it is advisable for the patient to check with the chosen airline for applicable security guidelines. General practice management of type 2 diabetes 105 • All diabetes supplies including testing equipment, insulin and glucagon delivery devices (syringes, pen needles and insulin pump consumables) carried on board must be in the hand luggage of the person who has diabetes and whose name appears on the airline ticket. It is not advisable to pack extra insulin in checked-in luggage as insulin exposed to extreme cold of the aircraft holds will lose effcacy. The prescriptions must include the traveller’s name, name and type of medication, and contact details of attending medical practitioner. Supplementary photographic proof of identity such as a driver’s licence may also be requested. The letter must stress the importance of the patient having to carry medications with them and include the frequency of dosage. For those using an insulin pump, the letter must stress the need for the pump to be worn at all times. They will be required to present the insulin at the security point and carry proof of their condition and their need for insulin. Rights of people with diabetes during security check People with diabetes who use an insulin pump are not required to remove their pump at the security point. If security staff requests this, the person with diabetes has the right to request access to a private consultation room which security staff are required to provide. People with diabetes are also entitled to make this request if discussion about their condition is required. Clinical context The aim of glycaemic control in patients at the end of life changes from preventing and managing long-term complications of diabetes to preserving quality of life. Terminally ill patients often have multiple factors affecting their glycaemic control (see Box 10). Glucose-lowering therapy should be tailored to minimise the risks of hypoglycaemia and hyperglycaemic states and symptoms. Factors affecting glycaemic control in patients with type 2 diabetes at end of life • Stress response to severe or • Poor appetite/smaller meals sustained illness • Poor nutrition • Organ failure • Cachexia • Malignancy • Dehydration • Chemotherapy • Diffculty taking medications (e. Blood glucose levels beyond 15 mmol/L may cause polyuria and increase risks of infection. Hypoglycaemia can also cause discomfort and confusion and impaired cognitive function. If not recognised and treated it can severely impair quality and even duration of life. Although there is little evidence about optimal blood glucose range, it is generally agreed that a range of 6–15 mmol/L is appropriate for most palliative care patients to optimise patient wellbeing and cognitive function. In most cases, tight glycaemic control to meet general targets is no longer appropriate in patients nearing the end of life. Ideally, discuss dying with patients and their families prior to the need for end-of- life care so that the important considerations can be addressed in advance care planning. Diabetes medications at end of life Insulin alone is a simpler option for patients and their carers than combinations of tablets and insulin. Consider switching patients from combinations to insulin alone, once or twice daily. Avoid long-acting sulphonylurea preparations (glibenclamide, glimepiride) if small meals are being taken. Algorithm for an end of life diabetes care management strategy Discuss changing the approach to diabetes management with patient and/or family if not already explored. If the patient remains on insulin, ensure the diabetes specialist nurses are involved and agree with monitoring strategy. It may be necessary to perform some tests to ensure unpleasant symptoms do not occur due to low or high blood glucose. Because of the measurement error you would need a range around that mean of, for example, 6. That would allow for measurement variation as well as some individualisation and negotiation with the patient, in a more person-centred approach. B Supportive evidence from well-conducted cohort studies: • evidence from a well-conducted prospective cohort study or registry. C Supportive evidence from poorly controlled or uncontrolled studies: • Evidence from randomized clinical trials with one or more major or three or more minor methodological faws that could invalidate the results. Conficting evidence with the weight of evidence supporting the recommendation E Expert consensus or clinical experience. This plan should Educators Association, provided be reviewed at regular intervals 2006 Assist in development of a sick day care plan and (174) Australian Diabetes None preparation of a home sick day management kit for Educators Association, provided patients to use during episodes of sickness 2006 *Refer to earlier in Appendix A for an explanation of the Grade. They incorporate the patient’s needs, goals, how these are to be achieved, and reference to any resources used. Templates are available via medical software and various general practice networks and Medicare Locals. General practice management of type 2 diabetes 125 Support for the annual cycle of care The annual cycle of care is a method of incentivising quality diabetes care. However, the scope of annual cycle of care recommendations is less than the guideline recommendations. Completion of an annual cycle of care requires assessment of a number of parameters (see Table B. Patients and practitioners need to discuss desired outcomes and agree on goals to achieve these. For practitioners – Support payments are provided for completing the annual cycle of care. For practices – When more than 50% of practice patients with diabetes have completed their annual cycle of care, practices are automatically paid a quality outcome payment. While it specifcally relates to management of your diabetes, your other health problems will also be considered. This care plan utilises the skills of many health professionals to help you to have the best of healthcare and for you to manage your diabetes. This plan focuses on proven therapies that, with support and care, may help prevent complications. Diabetes is best treated early and may be diffcult to treat when complications arise. It is important that you and your healthcare team monitor your diabetes and report anything that is untoward. We particularly urge you to report any chest pains, unexplained weakness, foot problems, visual changes, or any symptom that concerns you. Emergency contact at [insert name] Medical Centre for diabetes – [name] [contact number] This document should be brought along with you to each visit to the dietitian, diabetes educator, practice nurse, other health professional and to the doctor when your review is due. Treatment To participate in structured care system at the [insert name] Medical Centre. Thereafter reviews will depend on response to therapy and complexity of all health issues. Identifcation at an early stage can prevent kidney problems and/or progression to kidney failure Foot examination Foot risk = low/ To identify potential and active foot intermediate/high problems (e. Patients indicate how much each issue affects them personally, on a scale of 0 (not a problem) to 4 (serious problem). Individual items scored ?3 (indicating a somewhat serious or serious problem area) should be discussed with the patient. Item scores can also be added and standardised to a score out of 100 (by multiplying the total by 1. Scores ?40 indicate severe diabetes-related distress and warrant further exploration and discussion with the patient. General practice management of type 2 diabetes 139 Please read each question carefully.
Thyroid function and human their relationship with angiotensin-converting enzyme and reproductive health erectile dysfunction frequency age buy discount silvitra 120mg line. Erectile dysfunction is razodone and hypnotic suggestion in the treatment of non- common among men with acromegaly and is associated with organic male sexual dysfunction erectile dysfunction market cheap silvitra 120 mg without prescription. Single and combined ef- undecanoate on sexual potency and the hypothalamic-pituitary- fects of growth hormone and testosterone administration on gonadal axis of impotent males erectile dysfunction drug purchase discount silvitra on line. Testosterone replacement sexual function cost of erectile dysfunction injections buy silvitra 120 mg lowest price, bone turnover, and muscle gene expression in therapy for hypogonadal men with major depressive disorder: healthy older men. Transdermal testosterone dysfunctions: results from basic research and clinical studies. Erectile dysfunc- nary tract symptoms in obese men with hypogonadism and tion in patients with hyper- and hypothyroidism: how common and metabolic syndrome. Hyperthyroidism and erectile safety of two different testosterone undecanoate formula- dysfunction: a population-based case-control study. For the complete report please refer to Sexual Medicine: Sexual Dysfunctions in Men and Women, edited by T. There are limited outcome data on the ef?cacy of psychological interventions for male and female sexual dysfunction and the role of innovative combined treatment paradigms. To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research. An International Consultation assembled over 200 multidisciplinary experts from 60 countries in to 17 committees. The recommendations of committee members represent state-of-the-art knowledge and opinions of experts from ?ve continents were developed in a process over a 2-year period. Concerning the Psychological and Interpersonal Committee of Sexual Function and Dysfunction, there were nine experts from ?ve countries. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Medical and psychological therapies for sexual dysfunctions should address the intricate biopsychosocial in?uences of the patient, the partner, and the couple. The biopsychosocial model provides a compelling reason for skepticism that any single intervention (i. There is need for collaboration between healthcare practitioners from different disciplines in evaluation, treatment, and education issues surrounding sexual dysfunction. In many cases, neither psychotherapy alone nor med- ical intervention alone is suf?cient for the lasting resolution of sexual problems. Assessment of male, female, and cou- ples’ sexual dysfunction should ideally include inquiry about: predisposing, precipitating, maintaining, and contextual factors. Treatment of lifelong and/or chronic dysfunction will be different from acquired or recent dysfunction. Research is needed to identify ef?cacious combined and/or integrated treatments for sexual dysfunction. Sex Therapy; Hypoactive Sexual Desire Disorder; Female Sexual Arousal Disorder; Female Orgasmic Disorder J Sex Med 2005;2:793–800 794 Althof et al. Nonetheless, an individual’s vulnerability o most individuals, it seems obvious that psy- to a particular set of circumstances can precipitate Tchological and interpersonal factors play a sexual dysfunction. For instance, repeated humil- major role in both the etiology and maintenance iation from one’s spouse may cause one man to of sexual problems. The ways in which love and lose his erection while another man may be un- affection are expressed in one’s family of origin, affected. Similarly, in response to the discovery of the traumatic sexual experiences one has growing a partner’s in?delity, one woman may lose sexual up, the religious, cultural, and societal messages desire while another may become more sexually about sex and the ever-increasing impact of the driven. While initially a precipitating event may media on one’s beliefs and behavior clearly play a be problematic and distressing, it need not neces- role in promoting sexual health or dysfunction. However, repetitive or traumatic problem- ual disruption stems from personality and consti- atic sexual experiences damage self-con?dence and tutional/biological dispositions to psychiatric and ultimately result in sexual dysfunction, even in medical illness as well as the ability to develop and reasonably resilient individuals. We highlight the salient psycho- sexual information or stimulation, psychiatric logical and interpersonal issues that contribute to disorders, relationship discord, loss of sexual the development of sexual health and dysfunction chemistry, fear of intimacy, impaired self-image and offer a four-tiered paradigm for understand- or self-esteem, restricted foreplay, poor commu- ing the evolution and maintenance of sexual symp- nication, and lack of privacy may prolong and toms. Additionally, we will critically review the exacerbate problems, irrespective of the original ef?cacy of psychological interventions for male predisposing or precipitating conditions. Main- and female sexual dysfunction, the role of innova- taining factors also include contextual factors that tive combined treatment paradigms, and offer can interfere or interrupt sexual activity, such as recommendations for clinical management and environmental constraints or anger/resentment research. Each of these four factors con- tributes to, or diminishes, both the individual’s and the couples’ ability to sustain an active and satis- Etiological Background of Sexual fying sexual life. Often there is not a clear distinc- Dysfunction—Predisposing, Precipitating, tion between predisposing and precipitating and and Maintaining Factors precipitating and maintaining factors. For instance Sexual dysfunction is typically in?uenced by a as a common predisposing factor, anxiety can variety of predisposing, precipitating, maintain- increase an individual’s vulnerability to sexual dys- ing, and contextual factors [2]. Predisposing fac- function; it can also serve as a maintaining factor tors include both constitutional (e. Such Anxiety played a signi?cant role in early psycho- predisposing factors are often associated with a dynamic formulations of sexual dysfunction and greater prevalence of sexual dysfunctions and later became the foundation for the etiological emotional dif?culties in adult life. While some concepts of sex therapy established by Masters individuals appear less vulnerable and more resil- and Johnson [3] and Kaplan [4]. Kaplan believed ient in the face of stressors, others are more that sexually related anxiety became “the ‘?nal’ susceptible. For any single individual, it is More recent studies ?nd sexually dysfunctional impossible to predict which factors under what individuals exhibit heightened levels of anxiety J Sex Med 2005;2:793–800 Psychological Dimensions of Sexual Dysfunction 795 suggesting a central role of anxiety in the subjec- Depression and Sexual Function tive experience and maintenance of sexual disor- The relationship between depression and sexual ders. Some studies highlight the signi?cance of functioning is of considerable interest to clinicians anxiety as a trait or stable personality factor, while and researchers as both affective and sexual dis- others have indicated that elevated anxiety levels orders are highly prevalent, are believed to be are con?ned to the sexual sphere. Correlational comorbid, and may even share a common etiology evidence exists for the relationship between erec- [10,11]. However, this between depressive mood and sexual dysfunction does not imply causality. While the ing the sequence of cognitive-affective processes exact direction of causality is dif?cult to ascertain, during sexual arousal in dysfunctional and func- the data not only indicate a close correlational tional men and, to a lesser extent, women. Con- relationship between depression and sexual disor- trary to the clinical studies’ ?ndings for an ders but also support a functional signi?cance of inhibition effect of anxiety, the laboratory evi- mood disorders in causing and maintaining sexual dence indicated that anxiety (as induced in the dysfunction. Compared with functional controls, lab setting) either facilitates or does not affect sexually dysfunctional men and women exhibit sexual arousal in functional subjects. The evi- both higher levels of acute depressive symptoms dence for sexually dysfunctional subjects is more and a markedly higher lifetime prevalence of affec- mixed [5]. His model empha- Interpersonal Dimensions of Sexual Function sizes the role of cognitive interference in male and Dysfunction arousal. In general, what appears to distinguish functional from dysfunctional responding is a Clinically, it has been observed that sexual prob- difference in selective attention and distractibil- lems are sometimes the cause and sometimes the ity. What sex therapists consider performance result of dysfunctional or unsatisfactory relation- demand, fear of inadequacy, or spectatoring are all ships. These observations generally stem from forms of situation-speci?c, task-irrelevant, cogni- clinical data rather than controlled research with tive activities which distract dysfunctional individ- community samples. Often, it is dif?cult to deter- uals from task-relevant processing of stimuli in a mine which came ?rst—a nonintimate and sexual context [7]. For women, the relationship nonloving relationship, or sexual desire and/or between anxiety and sexual performance is mixed, performance problems leading to partner avoid- with the suggestion that it is more negative than ance and antipathy. In addition, but primarily Level 3, 4, and 5 research, the results indicate that the anxiety–sexual response ?ndings demonstrate a signi?cant relationship relationship is complex and that the term “anxiety” between sexual and relationship functioning. The available evidence indicates suggests better long-term outcome when relation- that the level and the nature of anxiety and its ship issues are treated and resolved. Whereas ship and sexual dif?culties should be dealt with moderate levels and relatively “safe” settings may concurrently so that unresolved relationship issues catalyze sexual arousal, higher levels, less personal do not undermine the ef?cacy of the sexual dys- control, or a chronic history of anxiety seem to function treatment. Love and Intimacy Finally, the emphasis on frequency counts of various sexual acts or initiations as a primary out- It would be neglectful to discuss psychological and come measure is also questionable as it ignores interpersonal contributions to sexual function and both positive changes in sexual satisfaction and dysfunction without including some reference to physical and emotional intimacy. While cul- tures vary enormously in the degree to which they consider love important for marriage, or even, the Women’s Sexual Complaints and Dysfunction and importance of love at all in committed relation- Dysfunctions: Overview ships, most individuals in Western countries Female sexual complaints range from a lack of, or believe that emotional intimacy and feelings of diminished sexual desire or interest to pain dur- love enhance and sustain sexual satisfaction and ing both genital and nongenital sexual activities pleasure. In addition to formal sexual diagnoses, While not typically discussed in scienti?c dis- many women report sexual dissatisfactions that course or evidence-based research, love is a vital do not involve actual physical impairment but ingredient for many individuals in fostering and rather, complaints involving lack of pleasure, maintaining strong and satisfying interpersonal enjoyment, satisfaction, and passion [16,17].