对性功能障碍心理和行为治疗的思考

性兴趣或性反应不足以使自己或性交对象得到满意的性生活,就是性功能障碍.性功能障碍是相对于个人的满意程度而言的,并不是一个绝对的标志.男性性功能障碍主要有:(1)性欲抑制;(2)性兴奋抑制;(3)阳痿;(4)早泄;(5)射精不能或迟缓;(6)性交疼痛或性高潮抑制等.女性性功能障碍主要有:(1)性欲抑制或性兴奋抑制,又称性冷淡;(2)性高潮障碍或性高潮抑制;(3)阴道痉挛;(4)性交痛;(5)性生活及技巧适应困难等.所有这些性功能障碍又可以区分为原发性和继发性;器质性和心因性性功能障碍.有学者统计,在性功能障碍中,有70～80%的人属于心因性性功能障碍.对于这些人更有效的治疗应该是心理的调节和行为的治疗.     

性变态病因学研究

性变态是指有性行为异常的性心理障碍,其共同特征是对常人不易引起性兴奋的某些物体或情境有强烈的性兴奋作用,或者采用与常人不同的异常性行为方法满足性欲或有变换自身性别的强烈欲望,以及其它与性有关的常人不能理解的性行为和性欲、性心理异常。不包括单纯表现为性欲减退或亢进和性生理功能方面的障碍。性变态分为①性指向障碍。主要有:同性恋、恋物癖、自恋癖、乱伦、恋童癖、恋尸癖、恋老人癖、恋兽癖等;②性偏好障碍。主要有:异装癖、露阴癖、窥阴(淫)癖、摩擦癖、施虐癖、受虐癖、口淫、肛淫、排粪     

已婚妇女性爱艺术与性高潮的关系研究

目的:了解我市已婚妇女性爱艺术运用情况、性高潮情况及二者之间的联系。方法:通过对853名已婚妇女以自愿答卷、自行填表的形式进行问卷调查。结果:我市已婚妇女最喜欢的性交环境是在幽静舒适的房间;感觉最好的性刺激是丈夫亲昵的触摸,其次是拥抱、接吻和甜言蜜语;以一种体位完成性交的女性占了大多数;睡衣的选择以普通的套睡衣为最多;60%妇女对性欲的自我评价正常;能在性交时或性交后与丈夫交流的妇女分别占70%及60%以上;22.7%的妇女每次性高潮时都会发出喊叫声;17.5%的女性几乎每次性交都获得性高潮,46.3%的女性多数能获得性高潮。结论:在幽静舒适的房间,有丈夫亲呢的触摸或挑逗性语言,性交时及性交后与丈夫有交流,一般以多种体位完成性交,选择漂亮的晚装或裸睡,性交正常,高潮时发出喊叫声等性爱艺术方式能提高女性获得性高潮的频率,而在黑暗中性交的女性获得性高潮频率低。     

女性性欲亢进的整合性心理治疗——附一例报告

性是人的本能反应.女性与伴侣进行性生活时达不到性满足,而婚外性行为性欲亢进,不仅是生理需要,更主要是由于心理、社会因素导致.本案例以一女性性欲亢进为主要临床症状,了解其深层原因是来访者丧母的创伤和幼年性创伤所致.通过整合性心理治疗,达到症状疗愈及人格成长.提示性心理障碍的治疗必须坚持生物-心理-社会医学模式.治疗中治疗师与来访者建立良好的、安全的、稳定的、信任的治疗关系是性心理治疗的基础和关键.     

同性恋:消除岐视不等于正常

同性恋是指“在正常社会生活条件下对同性成员在思想、情感和性爱行为方面持续表现性爱倾向,而对异性缺乏性爱倾向或十分淡漠的现象”。同性恋是一种性心理障碍,同性恋是一种性变态。近年来社会上冒出一种颇为“新潮”的说法:“同性恋是一种正常的性行为”。甚至这种观点出现在一些报刊、一些电台的“夜谈”节目中。对此笔者认为有必要加以探讨。随着社会的文明进步,对同性恋也应该表示理解和宽容。我们应该了解同性恋者的内心世界和可悲处     

阳痿综合分析

阳痿是一种男性性功能障碍，在男性性功能障碍中最是常见的。阳痿是指在有性欲的状态下，阴茎不能勃起进行性交或阴茎虽能勃起，但不能维持足够的硬度及时间以完成性交。阳痿是常见的令人苦恼的男性性机能障碍，精神压力超过生理影响，是影响家庭和睦或已婚夫妻离异的最重要原因之一。     

性心理障碍的心理治疗(附二例报告)

近几十年来各种心理治疗趋于整合,我们采用整合性心理治疗,即行为治疗中的厌恶疗法(用一种阴性刺激,如电击,催吐剂或言语责备与病态的行为反复多次结合,以达到消除这种行为)合并领悟性心理治疗,治疗了两例性心理障碍,取得了较为满意的疗效,现报告如下:     

阴茎部分切除术对阴茎癌患者性功能影响

目的:通过比较术前和术后的性功能和满意度改变,评价阴茎部分切除术对阴茎癌患者性功能影响。方法:本研究对25名阴茎部分切除患者进行术前及术后6个月国际勃起功能指数问卷调查,评价患者术后勃起功能、性高潮、性欲、性交满意度及性生活总体满意度。结果:阴茎部分切除患者术后6个月勃起功能、性高潮、性欲较术前降低(P0.05),交往满意度和总体满意度较术前明显降低(P0.01)。结论:阴茎部分切除术后患者性功能明显降低。     

海洛因依赖者性功能损害及临床意义

对186例(男98例,女88例)吸注阿片类毒品海洛因成瘾者的性心理和性行为进行了临床研究。结果表明海洛因依赖者性心理、性行为和性功能明显障碍,表现为吸注海洛因成瘾后98.6%性欲减退或丧失,性交次数由吸毒前平均5.6±1.4/周减少为0.3±0.1次/周,性行为方式由吸毒前94.8%以性交为主改变为84.6%非性交接触为主;其中男性海洛因成瘾者勃起功能障碍发生率达32.2%,女性月经异常率达95.1%,性心理和性功能改变与吸毒水平呈正相关。结果提示,吸毒人群性心理和性功能变化在毒品依赖形成过程中具有重要发病学意义。对90例性功能障碍海洛因依赖者进行性功能康复临床治疗结果显示,性心理和性功能的恢复水平与脱毒治疗近期疗效呈正相关。     

性交恐怖症

性交恐怖属一类罕见的性心理障碍(Psychosexual disorder),它以成熟的男女进行性交活动时,出现严重的焦虑恐怖情绪同时迴避或拒绝性交,终致性交无法进行为特征。不少人因此婚姻失败,终生独身,饮恨一生。兹报告2例,以飨读者。例1,女性,27岁,大学教师。因婚后年余害怕性交,夫妻关系不睦来门诊咨询。患者出生教师家庭,性格开朗,活跃,家族中无精神疾病史。从小受到"性交是肮脏的,下贱的","性交在为男人服务"等观念的影响,视阴部为禁区,从不轻易触及。成年后     

Toward a Trauma-Informed Approach to Adult Sexuality: A Largely Barren Field Awaits its Plow

In the 35 years since the diagnosis of posttraumatic stress disorder was named, a body of knowledge has developed that defines psychological trauma and its effects. The growing subfield surrounding trauma was in the vanguard of bridging the gap between neuroscience and clinical psychology by developing perspectives that are inquisitive about brain function and by identifying signature disruptive dysregulations of the nervous system that traumatic experience may elicit. While we have anecdotal awareness of how these dysregulations affect adult sexual life, there is little formal research or scholarly literature in the mental health or medical fields about these effects. What little does exist tends to focus on the impact of sexual trauma, leaving out the vast array of other important categories of traumatic experience affecting sexual function. This article recommends increased research and education about all forms of trauma as well as the development of specific therapeutic methodologies to advance sexual healing in a sizeable client population suffering from sexual difficulties engendered or affected by such experiences.     

Common use in the general population of sexual enrichment AIDS and drugs to enhance sexual experience

BACKGROUND: We describe the prevalence of ever and current use of sexual enrichment aids and of using drugs to enhance the sexual experience, and correlates of that usage. STUDY POPULATION: Participants in a random-digit dial survey conducted in the Seattle area between 2003 and 2004 among residents age 18 to 39 years of age with fluency in the English language. RESULTS: Use of sexual enrichment aids and drugs to enhance sexual experience during a typical 4-week period were reported by 27% and 13%, respectively, of participants. Among those reporting using a drug to enhance their sexual experience, the most commonly used drugs were alcohol (83.7%), marijuana (34.7%), ecstasy or "sextasy" (ecstasy combined with sildenafil) (8.2%), and sildenafil (7.5%). Persons reporting use of sexual enrichment aids and drugs to enhance sexual experience were more likely to engage in sexual behaviors associated with a higher risk of acquiring and transmitting a sexually transmitted infection (STI),such as having nonmonogamous partnerships and multiple partners in the previous 12 months and sexual repertoire. CONCLUSION: Whether use of sexual enrichment aids and drugs to enhance sexual experience is causally associated with STI risk or merely an additional marker of high-risk behavior or sensation seeking cannot be discerned from a single cross-sectional survey. However, these behaviors occurred frequently, and usage was common across all age, gender, ethnic, sexual, and income groups. Further studies in STI and other populations are required.     

Does Practice Make Perfect? Sexual Experience and Psychomotor Stimulants Influence Female Sexual Motivation Through Medial Preoptic Area Dopamine

Purpose

The purpose of our review is to draw parallels between the effects of psychomotor stimulants and repeated mating encounters on sexual behavior gathered from a number of different paradigms that take into account the complexity of sexual behavior of fully receptive female rats. Animal models are useful for developing treatments for sexual dysfunction disorders; however, little progress has been made in the development of treatments specifically for women.

Recent Findings

Research in female rats using a growing number of paradigms may provide a framework for future treatment development. During a mating bout, sexual behavior in female rats continually swings from approach to avoidance and back until abruptly ceasing at the end of behavioral estrous. Specific behaviors are influenced by both motivation and response to somatosensory stimulation. A number of recently published studies comparing behavior in sexual naïve female rats to those with repeated mating experience indicate that experience enhances sexual motivation. Methamphetamine and caffeine administration also enhance sexual motivation. However, other stimulants such as methylphenidate impair sexual motivation. We conclude that a constellation of female sexual behaviors tend to cluster together to reflect sexual motivation.

Summary

We propose that dopaminergic actions in the medial preoptic area (mPOA) are key for increased or decreased sexual motivation, which can be influenced by the readiness of genital tissue to respond to stimulation. Our model suggests that, like in male rats, dopamine type-1 receptor activation in the mPOA is important for sexual motivation and genital blood flow, whereas dopamine type-2 receptor activation is important for avoidance of sexual stimulation. In summary, the comparison between psychostimulant- and experience-induced shifts in sexual behavior informs our understanding of female sexual motivation, including how neurophysiological response to male cues affects sexual behavior.

     

Human Asexuality: What Do We Know About a Lack of Sexual Attraction?

Purpose of Review

This paper reviews the recent literature on human asexuality, which is generally defined as an absence of sexual attraction.

Recent Findings

Recent work has focused on exploring whether asexuality is best conceptualized as a mental health difficulty, a sexual dysfunction, a paraphilia, a sexual orientation, or as an identity/community, and this literature is reviewed. The authors conclude that asexuality may best be thought of as a sexual orientation and that asexuality as an identity and a community is an important component of the asexual experience.

Summary

Overall, the term asexuality likely describes a heterogeneous group of individuals, with a range of experiences. Asexuality is likely a normal variation in the experience of human sexuality, and future research into asexuality might inform our understanding of sexuality in general.

     

Infantile perineal protrusion

Infantile perineal protrusion, a relatively newly recognized condition, is underreported in both the dermatologic and pediatric literature. The name "infantile perineal protrusion" has evolved based on the typical anatomic location, morphologic features, and prevalence in prepubertal children. It occurs in 3 settings: constitutional (sometimes genetic or familial); functional (after constipation, diarrhea, or other irritant exposure); or associated with lichen sclerosus et atrophicus. Recognition of infantile perineal protrusion by dermatologists and pediatricians has many implications regarding proper diagnosis and management. The condition may be mistaken for condyloma acuminata or as a sign of trauma, leading to an erroneous investigation of sexual abuse. In this article, we report two new cases and make a thorough review of the literature to elucidate the mechanisms, diagnosis, classification, and management to clarify this often misdiagnosed condition.     

Sexual Motivation: A Comparative Approach in Vertebrate Species

Purpose of the Review

We review three different components of sexual motivation: appetitive behaviors, sexual incentive motivation, and paced mating in rats, mice and voles. These components occur in semi-natural or natural conditions. We also described behaviors in other species that are indicative of sexual motivation.

Recent Findings

Sexual motivation is the mechanism responsible for activating, directing, and causing persistence of behaviors directed towards a sexual incentive. Appropriate sexual motivation is crucial for the survival of any species that reproduces sexually, but not for the survival of any individual. We describe the possible role of the social decision-making network in sexual motivation whereby dopamine is involved in wanting sex, opioids are involved in liking sex, and oxytocin is involved in pair bond formation. Brain areas and neuromodulators in the social decision-making network are common across vertebrate lineage.

Summary

Understanding the variables involved in sexual motivation in different species can lead to a framework of basic mechanisms of sexual motivation, and such a framework could help us understand human sexual motivation.

     

同伴教育：促进健康性行为的有效教育途径

同伴教育是指具有相同年龄、性别、生活环境和经历、文化和社会地位或由于某些原因使其具有共同语言的人在一起分享信息、观念或行为技能的教育形式。当代青年面临严重的性健康问题,每年全世界感染艾滋病及其他性传播疾病的青少年人数众多,未婚先孕、意外怀孕等问题也严重影响青少年的学习和生活。同伴教育者由于其年龄、性别、生活环境和经历、文化和社会地位的相似而比成年教育者更值得信赖,使得同伴教育有助于减少青少年危险的性行为。此外,作为同伴教育者,在同伴教育中也能从中获得更多的益处。     

Experiences of rosacea and its treatment: an interpretative phenomenological analysis

Rosacea is a skin disorder which causes flushing and redness of the face. Relatively few people with rosacea receive specialist dermatology treatment or psychological support. Despite this, individuals with rosacea can experience social anxiety, depression and embarrassment, and decreased quality of life. Whilst questionnaire based studies have been used to investigate the type of distress that people living with rosacea might experience, there are no studies that have sought to gain an in‐depth understanding of the experiences of living with this visible skin condition. Therefore, this study used face‐to‐face interviews to learn about participants' complex, individual experience of life with rosacea. A qualitative approach called interpretative phenomenological analysis (IPA) was used to guide the interviews and analysis. This approach to research focuses on individual accounts and has been extensively used to investigate illness experience. In this study nine participants took part in detailed semi‐structured interviews. Three overarching themes were gleamed from these interviews; self‐consciousness, which focused on the fear of others assigning blame to participants for having caused their own symptoms; avoidance, concealment, and hiding emotions, referring to the coping strategies participants employed in response to rosacea; and inconsistencies in treatment, which focused on the need for medical professionals to assess the emotional wellbeing of patients with rosacea. The findings are consistent with qualitative findings from patients with other skin conditions that demonstrate that self‐conscious emotions can be a significant part of the experience of life with a skin condition. Healthcare professionals need to take care to assess for the presence of such concerns in rosacea, and where unhelpful thoughts or beliefs are reported, patients may benefit from dermatology specific psychological support.     

Gender Differences and Similarities in Sexual Desire

Sexual desire can be operationalized as the motivation to seek out solitary or partnered sexual experiences. A large body of evidence suggests that men experience sexual desire more strongly and more frequently than do women; however, it is not clear whether sexual desire is truly gendered or if gender differences are influenced by how sexual desire is operationalized and assessed. Moreover, little research has examined similarities and differences in trait versus state sexual desire in women and men. Recent changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflect the movement away from situating desire as the onset of the traditional linear model to framing desire as a state emerging from sexual excitement. We examine evidence for gender differences and similarities in trait and state sexual desire in both clinical and nonclinical populations. We conclude that sexual desire emerges similarly in women and men and that other factors may influence the observed gender difference in sexual desire. We then discuss the implications of conceptualizing desire as responsive for sexual medicine practitioners.