Male sexual dysfunction: diagnosis and treatment from a sexological and interdisciplinary perspective.

BACKGROUND: Among all types of sexual disturbance in men, disturbances of sexual function are the most important in clinical practice. These are classified by the segment of the sexual reaction cycle in which they arise (appetence, arousal, orgasm, and resolution). Partial functional impairment must be distinguished from dysfunction causing significant suffering and requiring treatment. METHODS: The authors' clinical experience is supplemented with a selective review of the literature on sexual dysfunction, its association with underlying diseases, and its impact on sexual and relational satisfaction. RESULTS: The sexual history (including the partner's sexual history, as far as this can be obtained) is of prime importance in the diagnostic evaluation of sexual disturbances. This evaluation must take the multidimensionality and multiple functions of human sexuality into account. Chronic frustration of the fundamental psychosocial needs for acceptance, closeness, and security is a very important factor that has been neglected until now by the prevailing conceptions of the etiology and pathogenesis of sexual disturbances. Their treatment involves a combination of elements from sexual medicine and psychotherapy, along with somatic medical and pharmacotherapeutic intervention, if needed. The goal of syndyastic sex therapy, a further development of the previous therapies, is to fulfill these fundamental needs and thereby to improve the patient's sexual function and deepen his satisfaction with the relationship in its entirety. CONCLUSIONS: It is essential to understand the different types of sexual disturbance in their biopsychosocial context as well as the significance of sexuality for the individual, and for the couple, with respect to reproduction, sexual pleasure, and bonding. Sexual disturbances are common, and patients therefore expect their physicians to be proficient in sexual medicine. The coverage of this subject in both undergraduate and postgraduate medical education in Germany needs to be improved.

[Sexuality--psychosomatic representation of the relationship]. / Sexualitäit--Psychosomatik der Beziehung.

A salutogenic understanding of sexuality as a means of non-verbal communication embodiing essential basic needs, e.g. for acceptance, closeness, warmth, security, as they are sought in all relationships, is explicated from the point of view of sex therapy. Hence, a relation-oriented or syndyastic sex therapy focuses on the fulfillment of these basic needs and desires in general as well as by sexual commmunication in particular and thus creates favourable conditions for relieving sexual dysfunctions. Couples learn to relate sexuality with basic needs and connect it to lust, thus enhancing quality of life as well as psychosomatic well-being and health.

[Position of sexual medicine in medical specialties]. / Zur Stellung der Sexualmedizin innerhalb der medizinischen Fächer.

The position of sexual medicine among the different medical subspecialities is discussed. Sexuality is seen under its socio-communicative, reproductive and lust-aspects which in turn influence specific characteristics of sexual medicine, as e.g. its biopsychosocial way of thinking, its focus on the couple, the alloying of different forms of therapy and especially the stressing of the communicative meaning of sexual behaviour as a form of non-verbal communication. Hence therapeutic interventions aim at the restoration of the sexual relationship as a means of fulfilling fundamental needs and desires as for acceptance, warmth, security and so on and thus exceed the cure of the sexual dysfunction. Sexual Medicine should be integrated into the study of medicine as a subject of its own.