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Similarly erectile dysfunction medicines 100mg extra super levitra otc, in response to impotence juicing buy extra super levitra line the discovery of the traumatic sexual experiences one has growing a partner’s in?delity erectile dysfunction age at onset best purchase for extra super levitra, one woman may lose sexual up erectile dysfunction drugs prostate cancer order cheap extra super levitra online, 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]. Mechanistically treating sex- While these complaints are fairly ubiquitous and ual problems without considering or discussing important and while they obviously enhance or the quality of caring and love between partners is impede sexual enthusiasm, they tend not to be usually unsuccessful, if not immediately, then over identi?ed as legitimate outcome measures in time. Nevertheless, it is often the case that with successful treatment, these important sexual parameters change as well as the Methodological Problems in Sex Therapy formal targets of intervention. Moreover, for Outcome Studies many women, it is these behaviors that may well There tends to be a paucity of randomized con- constitute the most salient end points of treat- trolled sex therapy outcome studies. Outcome studies in this area without pleasure is an unsatisfactory compromise are notoriously dif?cult to design and conduct. A most prevalent female sexual complaint, with narrow mechanistic focus on genital function/ prevalence ?gures ranging from 30% to 35% [18]. In a later review of the ef?cacy of in treating female anorgasmia, what de?nes suc- sex therapy for sexual dysfunctions, Hawton [20] cess? Achieving orgasm once, achieving orgasm noted the variable outcome that is often found from manual or oral stimulation some speci?ed across studies. He observed that outcome is poorer percentage of occasions, achieving coital orgasm when the male partner has low desire than when with or without clitoral stimulation, etc.? The program J Sex Med 2005;2:793–800 Psychological Dimensions of Sexual Dysfunction 797 included interventions designed to enhance 32]. In addition to many of the factors mentioned communication between partners, increase sexual above, acquired orgasmic dysfunction may be the skills, and reduce sexual and performance anxiety. The ?ndings are limited, however, in that female orgasm problems include a combination of many of the women had multiple sexual dysfunc- sex education, sexual skills training, couple’s ther- tions and there was no control group. The penile–clitoral connection is Orgasmic Disorders maintained by the pressure and counterpressure No single factor has been shown to be strongly simultaneously exerted by both partners. In general, women with orgasm dif- rather goal-oriented treatment may increase per- ?culties tend to experience more sex guilt [24,25], formance pressure and anxiety in the woman. Women with established’ whereas situational anorgasmia stud- orgasmic dif?culties have been found to be less ies fall in to the ‘probably ef?cacious’ group. Heiman and Grafton-Becker [23] note reported treatments of coital anorgasmia may be that anorgasmic women often fear loss of control due to misdiagnosis. Different treatment with a sexual arousal disorder, that is, a lack of approaches have been shown to be effective for suf?cient physical or subjective arousal which the two subtypes. This treatment involves self-stimulation in which the woman becomes Psychological Treatment of Male Sexual Dysfunction more aware of the type of stimulation needed to increase her arousal and pleasure and subsequently Psychotherapy of Erectile Dysfunction generalizing this to partner sexual situations. Their 2- to female orgasmic disorder tend to be more dis- 5-year follow-up of this cohort indicated sus- tressed about and less satis?ed with their overall tained gains. For instance, studies, it appears that approximately two-thirds only 64% of men in Hawton et al. It has not been possible to statistically analyze the Integrated Treatment for Sexual Dysfunction precise contribution of any of these single inter- ventions to overall success. Medical treatments alone are sometimes insuf?- Wylie [37] conducted a prospective study with cient in helping couples resume a satisfying sexual 23 couples where the presenting complaint was life. Utilizing a combination package of modi?ed rent or step-wise combinations of psychological sex therapy and behavioral systems couple ther- and medical interventions. Too often, medical apy, 87% of men demonstrated improvement in treatments are directed narrowly at a speci?c their sexual symptom within six sessions of treat- sexual dysfunction and fail to address the larger ment. Patients indicated that they personal nonsexual variables such as quality of the discussed the dif?culty with the partner, practiced overall relationship; (iv) interpersonal sexual vari- the techniques learned during therapy, accepted ables such as the interval of abstinence and sexual that dif?culties were likely to recur, and read scripts; and (v) contextual variables such as current books about sexuality. To prevent relapse, McCarthy [38] has sug- There is an emerging literature that demon- gested that therapists schedule periodic “booster strates a synergistic bene?t from the use of both or maintenance” sessions following termination. It is regrettable that there are so few well-designed Psychotherapy with Rapid Ejaculation randomized control studies focusing on integrated Since the early 1970s, an array of individual, con- approaches to the treatment of sexual dysfunction. Masters and Johnson Although to date there are no approved reported on 432 men who were seen in their qua- pharmacological treatments for female sexual siresidential model utilizing multiple treatment dysfunction, undoubtedly they will evolve. J Sex Med 2005;2:793–800 Psychological Dimensions of Sexual Dysfunction 799 Conclusion and Recommendations Corresponding Author: Stanley E.
This disorder seems to zinc causes erectile dysfunction order extra super levitra 100 mg otc be rare in men and more common in women Sexual Disorders and Gender Identity Disorder 179 C erectile dysfunction drugs malaysia buy 100mg extra super levitra visa. A person’s sex drive is determined by a combination of biological long term erectile dysfunction treatment order extra super levitra 100mg line, psychological erectile dysfunction treatment pune order extra super levitra amex, and so- ciocultural factors, and any of them may reduce sexual desire D. Most cases of low sexual desire or sexual aversion are caused primarily by sociocultural and psychological factors, but biological conditions can also lower sex drive signi?cantly 1. A number of hormones interact to produce sexual desire and behavior (a) Abnormalities in their activity can lower sex drive (b) These hormones include prolactin, testosterone, and estrogen for both men and women b. Sex drive also can be lowered by chronic illness, some medications (including birth control pills), some psychotropic drugs, and a number of illegal drugs 2. A general increase in anxiety, depression, or anger may reduce sexual desire in both women and men b. Certain psychological disorders also may lead to sexual desire disorders, in- cluding depression and obsessive-compulsive disorder 3. The attitudes, fears, and psychological disorders that contribute to sexual de- sire disorders occur within a social context b. Many sufferers of desire disorders are experiencing situational pressures (a) For example: divorce, death, job stress, infertility, and/or relationship dif- ?culties c. The excitement phase of the sexual response cycle is marked by changes in the pelvic re- gion, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and respiration 1. This disorder is characterized by repeated inability to maintain proper lubrica- tion or genital swelling during sexual activity b. Because this disorder co-occurs so often with orgasmic disorder, researchers usually study the two together; causes of the two disorders will be examined together 2. This disorder is characterized by repeated inability to attain or maintain an ad- equate erection during sexual activity b. According to surveys, half of all adult men experience erectile difficulty during intercourse at least some of the time C. Most cases of erectile disorder result from an interaction of biological, psychological, and sociocultural processes; even minor physical impairment of the erection response may make a man vulnerable to the effects of psychosocial factors 1. Additionally, the use of certain medications and substances may interfere with erections d. During the orgasm phase of the sexual response cycle, an individual’s sexual pleasure peaks and sexual tension is released as the muscles in the pelvic region contract rhyth- mically 1. This disorder is characterized by persistent reaching of orgasm and ejaculation with little sexual stimulation (a) Almost 30 percent of men experience rapid ejaculation at some time b. Psychological, particularly behavioral, explanations of this disorder have re- ceived more research support than other explanations (a) The dysfunction seems to be typical of young, sexually inexperienced men c. It also may be related to anxiety, hurried masturbation experiences, or poor recognition of arousal d. There is a growing belief among many clinical theorists that biological factors may also play a key role in many cases of this disorder (a) One theory states that some men are born with a genetic predisposition (b) A second theory argues that the brains of men with rapid ejaculation con- tain certain serotonin receptors that are overactive and others that are un- deractive (c) A third explanation holds that men with this dysfunction experience greater sensitivity or nerve conduction in the area of their penis 2. This disorder is characterized by repeated inability to reach or a very delayed orgasm after normal sexual excitement (a) This disorder occurs in 8 percent of the male population b. Biological causes include low testosterone, neurological disease, and head or spinal cord injury Sexual Disorders and Gender Identity Disorder 181 c. This disorder is characterized by persistent delay in or absence of orgasm fol- lowing normal sexual excitement (a) Almost 25 percent of women appear to have this problem (b) 10 percent or more have never reached orgasm (c) An additional 10 percent reach orgasm only rarely b. Women who are more sexually assertive and more comfortable with masturba- tion tend to have orgasms more regularly c. Female orgasmic disorder appears more common in single women than in mar- ried or cohabiting women d. Most clinicians agree that orgasm during intercourse is not mandatory for nor- mal sexual functioning (a) Lack of orgasm during intercourse was once considered to be pathologi- cal according to psychoanalytic theory e. This disorder typically is linked to female sexual arousal disorder, and the two tend to be studied and treated together f. Once again, biological, psychological, and sociocultural factors may combine to produce these disorders (a) Biological causes (i) A variety of physiological conditions can affect a woman’s arousal and orgasm 1. These conditions include diabetes and multiple sclerosis (ii) The same medications and illegal substances that affect erection in men also can affect arousal and orgasm in women (iii) Postmenopausal changes also may be responsible (b) Psychological causes (i) The psychological causes of hypoactive sexual desire and sexual aversion, including depression, also may lead to female arousal and orgasmic disorders (ii) In addition, memories of childhood trauma and relationship distress also may be related (c) Sociocultural Causes (i) Sexually restrictive culture was the leading sociocultural theory of female sexual dysfunction for decades 1. Sexually restrictive histories are equally common in women with and without disorders b. Two sexual dysfunctions do not ?t neatly in to a speci?c phase of the sexual response cycle B. Most clinicians agree with the cognitive-behavioral theory that vaginismus is a learned fear response c. A variety of factors can set the stage for this fear, including anxiety and igno- rance about intercourse, trauma of an unskilled partner, and childhood sexual abuse (a) Some women experience painful intercourse because of infection or dis- ease, leading to “rational” vaginismus d. This disorder is characterized by severe pain in the genitals during sexual ac- tivity (a) As many as 14 percent of women and about 3 percent of men suffer from this condition b. Dyspareunia in women usually has a physical cause, usually injury sustained in childbirth c. The last thirty-?ve years have brought major changes to the treatment of sexual dys- function B. It was believed that sexual dysfunction was caused by a failure to negotiate the stages of psychosexual development b. Therapy focused on gaining insight and making broad personality changes and generally was unhelpful 2. Behavior therapists attempted to reduce fear by employing relaxation training and systematic desensitization b. These approaches had moderate success but failed to work in cases where the key problems included misinformation, negative attitudes, and lack of effective sexual technique 3. This text, published by William Masters and Virginia Johnson, revolutionized treatment of sexual dysfunction b. This original “sex therapy” program has evolved in to a complex, multidimen- sional approach, including techniques from cognitive-behavioral, couples, and family systems therapies along with a number of sex-speci?c techniques c. Increase of sexual and general communication skills Sexual Disorders and Gender Identity Disorder 183 g. In addition to the universal components of sex therapy, speci?c techniques can help in each of the sexual dysfunctions: a. Hypoactive sexual desire and sexual aversion (a) These disorders are among the most difficult to treat because of the many issues that feed in to them (b) Therapists typically apply a combination of techniques which may include: (i) Affectual awareness, self-instruction training, behavioral tech- niques, insight-oriented exercises, and biological interventions, such as hormone treatments b. Rapid, or premature, ejaculation (a) Premature ejaculation has been successfully treated for years by behav- ioral procedures, such as the “start-stop” or “pause” procedure and the “squeeze” technique (b) Some clinicians favor the use of ?uoxetine (Prozac) and other serotonin- enhancing antidepressant drugs (i) Because these drugs often reduce sexual arousal or orgasm, they may be helpful in delaying premature ejaculation (ii) Many studies have reported positive results with this approach e. Vaginismus (a) Speci?c treatment for vaginismus takes two approaches: (i) Practice tightening and releasing the muscles of the vagina to gain more voluntary control (ii) Overcome fear of intercourse through gradual behavioral exposure treatment (b) Most women treated for vaginismus using these methods eventually re- port pain-free intercourse g. Dyspareunia (a) Determining the speci?c cause of dyspareunia is the ?rst stage of treat- ment (b) Given that most cases are due to physical causes, medical intervention may be necessary X. Over the past 30 years, sex therapists have moved beyond the approach ?rst devel- oped by Masters and Johnson a. Treatment now includes unmarried couples, those with other psychological dis- orders, couples with severe marital discord, the elderly, the medically ill, the physically handicapped, clients with a homosexual orientation, or clients with no long-term sex partner 2. Recently, therapists began paying attention to excessive sexuality, sometimes called hypersexuality or sexual addiction 3. Finally, the use of medications to treat sexual dysfunction is troubling to many ther- apists a. These disorders are characterized by unusual fantasies and sexual urges or behaviors that are recurrent and sexually arousing B. For most paraphilias, the urges, fantasies, or behaviors must also cause great distress or impairment 1. For certain paraphilias, however, performance of the behavior itself is indicative of a disorder even if the individual experiences no distress or impairment a. Relatively few people receive a formal diagnosis but clinicians believe that the pat- terns may be quite common F. Some experts argue that, with the exception of nonconsensual paraphilias, paraphilic ac- tivities should be considered a disorder only when they are the exclusive or preferred means of achieving sexual excitement and orgasm G. Although theorists have proposed various explanations for paraphilias, there is little for- mal evidence to support them H. None of the treatments applied to paraphilias has received much research or proved clearly effective 1. Psychological and sociocultural treatments have been available the longest, but today’s professionals are also using biological interventions I. The key features of fetishism are recurrent intense sexual urges, sexually arous- ing fantasies, or behavior that involves the use of a nonliving object, often to the exclusion of all other stimuli b.
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Vascular disease, hypertension, peripheral neuropathy and obesity are all more common in people with diabetes than in the general population. This impairs endothelium-dependent relaxation of penile smooth muscle preventing optimal blood flow to and from the penis, and maintenance of an erection. Bartholin glands, which open on the inner surfaces of the labia minora, may be considered functionally within the context of the external genitals, although their anatomic position is not in fact external. The appearance of the female genitalia varies considerably from one woman to another, including variations in size, pigmentations, shape of the labia, location of the clitoris, and location of the urethral meatus and the vaginal outlet (Kolodney et al. It begins at the internal meatus and runs anteroinferiorly behind the symphysis with a gentle ventral curvature firmly adherent to the anterior wall of the vagina. Except during the passage of urine, the urethral lumen is stellate in shape and completely occluded. The female urethra is much more readily dilatable than the male urethra (Walsh et al. The clitoris itself contains very sensitive nerves that react when stimulated by either psychological or physiologic factors. It is located at the point where the labia majora meet anteriorly and is made up of two small erectile cavernous bodies enclosed in a fibrous membrane surface and ending in a glans or head. The clitoris is richly endowed with free nerve endings, which are extremely sparse within the vagina. The clitoris is not known to have any function other than serving as a receptor and transducer for erotic sensation. The tip of the clitoris is covered by a small area of tissue usually referred to as the clitoral hood. The size and shape of this hood varies among women and is not related to the amount of sexual pleasure that a woman can receive when she is sexually stimulated (Kolodney et al. The internal genitalia of the female (Figure 3) include the vagina, cervix, uterus, fallopian tubes, and ovaries. These structures may show considerable variation in size, spatial relationship, and appearance as a result of individual differences as well as reproductive history, age, and presence or absence of disease. The mouth of the cervix provides a point of entry for spermatozoa into the upper female genital tract and also serves as an exiting point for menstrual flow. The endocervical canal contains numerous secretory crypts that 22 Literature Review produce mucus. The consistency of cervical secretions varies during various phases of hormonal stimulation throughout the menstrual cycle. At the time of ovulation, for example, cervical secretions become thin and watery; at other times of the cycle, these secretions are thick and viscous, forming a mucous plug that blocks the cervix (Victor, 1980). The vagina is a soft tube that is several inches long and can extend during sexual intercourse. The walls of the vagina are completely lined with a mucosal surface that is now known to be a major source of vaginal lubrication; there are no secretory glands within the vaginal walls, although there is a rich vascular bed. The lining of the uterus and the muscular component of the uterus function quite separately. The myometrium is important in the onset and completion of labor and delivery, with hormonal factors thought to be the primary regulatory mechanism. The endometrium changes in structure and function depending on the hormonal environment. Under increasing estrogenic activity, the endometrium thickens and becomes more vascular in preparation for the possible implantation of a fertilized egg. The fallopian tubes or oviducts originate at the uterus and open near the ovaries, terminating in fingerlike extensions called fimbriae. The fallopian tube is the usual site of fertilization; the motion of cilia within the tube combined with peristalsis in the muscular wall results in the transport of the fertilized ovum to the uterine cavity (Victor, 1980). Sexual response cycle in females the Master and Johnson (1996) sexual response cycle (Figure 4) is regarded as the most acceptable and consistent description of the physiologic and behavioural aspects of the female sexuality (Spark, 1991). They classified the phases as excitement, plateau, orgasm, and resolution phases by using extensive laboratory studies. These phases are observed in 23 Literature Review both sexes, although the demarcation between stages is somewhat arbitrary for both sexes and is dependent on factors such as age and general well being (Figure 4). Excitement phase This phase occurs in response to sexual stimulation because of either touch (i. The psychogenic stimuli has both facilitatory and inhibitory effects with the degree of stimulation necessary to achieve physiologic arousal being affected by psychological stimulation (Masters and Johnson, 1966). Libido is equally affected by general health, neurotransmitters, serotonin, dopamine, depression, anxiety, relationship issues, and medication. Both sexes show increases in muscle tension, breathing rate, heart rate, and blood pressure. In women, the excitement stage is characterized by vaginal lubrication, with vasocongestion leading to a transudate of fluid (Kolodney et al. Other changes include expansion of the inner two-thirds of the vagina and elevation of the uterine body, cervix, and labia majora with clitoral enlargement. There is nipple erection as well as the swelling of the breast (Masters and Johnson, 1966). Plateau phase This phase consists of a high level of sexual arousal which precedes the threshold levels required to trigger orgasm. The duration of the plateau phase varies considerably, depending on the length of time necessary to reach orgasm. If stimulation is ineffective during this phase, the body will show a gradual reduction of the physiologic phenomena that are characteristic of this phase. In women, the process of vaginal expansion, clitoral engorgement, and nipple erection continues. A redness known as a sex flush may spread over parts of the abdomen, breasts, and chest wall. Extragenital features of this stage seen in men and women include further changes in tachypnea, tachycardia, elevated blood pressure, and generalized myotonia. With continued stimulation, the individual will enter the orgasmic phase of sexual response (Masters and Johnson, 1966). Orgasm phase the orgasm phase as theorized by Masters and Johnson (1966) is triggered by a neural reflex arc once the orgasmic threshold is reached. If no major psychological issues emerge, the individual will progress through one or more orgasms. Intensity and duration of the orgasm vary from individual to individual and depend on arousal, psychological, and physiologic features. In the female, orgasm is also experienced as rhythmic muscular contractions of the uterus, anal sphincter, and the outer one-third of the vagina. Resolution phase the resolution phase in males involves a refractory period immediately after ejaculation. The length of this refractory period varies and tends to be affected by factors such as arousal, age, and general physical health. The resolution phase in women does not involve a refractory period after the initial orgasm and could potentially produce the experience of several successive orgasms with persistent stimulation. During the resolution stage, vasocongestion and the changes that have occurred during the previous phases tend to reverse. The process is generally more rapid for men than for women (Masters and Johnson, 1966). Female sexual dysfunction has been perceived as a field of sexual medicine that has not been scrutinized by the medical profession, but the reality is that substantial amount of work has been done but remains obscure as it is often available in locations that some feel unsure about designating it as medical information (Angel, 2010). In the early 20th century, American psychiatry became more professionalized and medicalized; from the 1930s, it also became significantly psychoanalytic and thus psychoanalysis dominated discussions of female sexuality and its problems (Lunbeck, E. Hitschmann and Bergler (1936) defined the condition as the inability of a woman to have a vaginal orgasm. This strict definition of frigidity as failure to reach vaginal orgasm was very limited in scope and other aspects of the female sexual function domains. However, this concept shaped subsequent debate about vaginal and clitoral orgasms in those days. Moreover, the woman desiring clitoral stimulation, as opposed to vaginal intercourse, became representative of women 26 Literature Review who behaved like men and denied their maternal obligations, behaviour that led to neurosis, isolation, and social disintegration. In the postwar period, the connotations of female sexual problems as mental disorders continued in part due to the important role played by the American Psychiatric Association‘s Diagnostic and Statistical Manual (Angel, 2010).
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