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Sexual Disorders

  1. Transexualism: Marked preoccupation with desire to have sex characteristics of opposite sex
  2. Transvestism: desire to wear clothes of opposite sex but no desire for sex change

Sexual Dysfunctions:

Disorders of sexual desire:
  1. Decreased sexual desire           :       frigidity in females
  2. Excessive sexual desire            :       Satyriasis in males, nymphomania in females

Erectile dysfunction:

Causes of Male Erectile Disorder/Impotence
  1. Local Genital Pathology
    1. Priapism
    2. Congenital malformations
    3. Surgical procedures on pelvic region, e.g. perineal prostatectomy
    4. Mumps
    5. Elephantiasis
    6. Hydrocele or varicocele.
  2. Endocrine Disorders
    1. Diabetes mellitus
    2. Dysfunction of pituitary-ad renal-testis axis
    3. Testicular atrophy, e.g. secondary to dystrophia myotonica, hemochromatosis, cirrhosis
    4. Thyroid dysfunction.
  3. Neurological Disorders
    1. ​Autonomic neuropathy, e.g. in diabetes
    2. Spinal cord lesions e.g. transverse mellitus myelitis
    3. 3rd ventricle tumors
    4. Brain damage, especially in temporal lobe
    5. Multiple sclerosis.
  4. Cardiovascular Disorders
    1. Leriche syndrome.​
  5. Any Severe or Debilitating Systemic Illness
  6. Alcohol And Drugs.
  7. Psychogenic: anxiety /mood disorder; early morning erections preserved
  8. Drugs.             
Drugs Causing Erectire Dysfuction
Classification Drugs
Diuretics Thiazides
Antihypertensives Calcium channel blockers
Methyldopa, Clonidine, Reserpine
b-Blockers, Guanethidine
Cardiac/anti-hyperlipidemic Digoxin, Gemfibrozil, Clofibrate
Antidepressants Selective serotonin reuptake inhibitors
Tricyclic antidepressants
Monoamine oxidase inhibitors
Tranquilizers Butyrophenones
H2 antagonists Ranitidine, Cimetidine
Hormones Progesterone, Estrogens,
Corticosteroids, GnRH agonists
5b-Reductase inhibitors
Cyproterone acetate
Cytotoxic agents Cyclophosphamide
Methotrexate, Roferon-A
Anticholinergics Disopyramide, Anticonvulsants
Recreational Ethanol, Cocaine, Marijuana

  1. Treatment of the under tying physical or psychiatric disorder, if present.
  2. Behaviour therapy: The methods commonly employed include the following:
    1. Relaxation training, e.g. Jacobson’s progressive relaxation technique.
    2. Assertiveness training.
    3. Systematic desensitization, aimed at reducing the phobic anxiety related to the sexual act, e.g. in sexual aversion  disorder.
    4. Biofeedback, using a penile plethysmograph. 
  3. Masters’ and Johnson’s Technique
    1. This is one of the most popular and successful methods of treatment for psychosexual dysfunctions.
    2. The patient is not treated alone, but both the partners are treated together.
    3. This is called as dual-sex therapy, where both the sexual partners are treated by a team of therapists (one male and one female), although later modifications of this technique use only one therapist.
    4. The goal of the treatment is symptom removal, using simple behavioural techniques.
Behaviour modification steps, depending on the type of psychosexual dysfunction. Brief examples of the techniques used are:

Sensate focus technique:
  1. This is used particularly for treatment of impotence, although it is also useful in management of other dysfunctions as well.
  2. The aim is to Erectile Dysfunction ‘discover’ on body (exclud-ing genital area) ‘sensate focuses’ (body areas where manipulation leads to sexual arousal).
  3. This is usually a general exercise before any sex therapy.
Squeeze technique (Seman’s technique):
  1. This has been used in treatment of premature ejaculation.
  2. The female partner is asked to manually stimulate the penis causing erection.
  3. When the male partner experiences ‘ejaculatory inevitability’, the female partner ‘squeezes’ the penis on the coronal ridge thus delaying ejaculation.
Oral drug therapy:
  1. Premature ejaculation may sometimes require treatment with fluoxetine, trazodone, or tricyclic antidepressants such as clomipramine (to retard ejaculation).
  2. Several drugs have been used in the treatment of impotence with varying degrees of efficacy, e.g. alpha-blockers (such as yohimbine, idazoxan), opiate antagonists (such as naltrexone), dopamine agonists (such as bromocrip-tine, apomorphine),
  3. Sildenafil citrate has been used for treatment of erectile dysfunction. It is a competitive and selective inhibitor of cGMP (cyclic guanos-ine monophosphate)-specific PDE-5 (phosphodiesterase type 5).
  4. It prevents the rate of breakdown of cGMP causing enhanced relaxation of cavernosal smooth muscle, increase in arterial flow in to corpus cavernosa, compression of subtunical veins, and hence penile erection.
  5. The typical dose is 50 mg (25- 100 mg), 1 hour before sexual activity.
Intracavernosal Injection of Vasoactive Drugs (11VD): Papaverine, an alkaloid and a vasoactive substance, has been used as an intracavernosal injection in the differential diagnosis of organic and non-organic impotence and also for treatment of impotence

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