Treatment of most sexual dysfunctions begins with a medical history and workup to identify any physiological causes. In addition to a medical history and exam, it is also im­portant to evaluate any past sexual trauma or abuse that may cause or contribute to the dysfunction. After identifying causes for a sexual dysfunction, the next step is to deter­mine a plan of treatment. Such treatment may be multimodal, involving more than one type of therapy. Different types of therapies have different success rates. The highest suc­cess rates for treatment of sexual dysfunctions range from about 60% in those with pri­mary erectile disorder to 97% in premature ejaculation; rates of about 80% have been reported in treatment of orgasmic disorder in women.

Much of the current clinical research today focuses on developing new drugs to treat dysfunctions (even though a number of dysfunctions may be caused by or worsened by

Подпись:other medications). As we discussed in Chapter 13, the Food and Drug Administration (FDA) plays a major role in the approval of all new drugs in the United States. Many drug therapies used today for sexual dysfunctions, such as Wellbutrin or Viagra, were originally approved by the FDA to treat other diseases. There is also a brisk business in health supplements to aid in sexual functioning, including aphrodisiacs (see Sex in Real Life, “What Is an Aphrodisiac?” on page 467).

I I 1-6 times per week ТП Once a day or more

Подпись: © Jonathon Norok/PhotoEditTreating DysfunctionsПодпись: Since its introduction in 1998, Viagra has been represented by many spokes- people. Professional baseball player Rafael Palmeiro was a controversial spokesperson because many believed that Pfizer (Viagra’s manufacturer) was trying to appeal to a younger audience— Palmiero was only 37 at the time and never admitted to erectile problems. hypoactive sexual desire (HSD) Diminished or absent sexual interest or desire. sexual aversion Persistent or recurrent extreme aversion to and avoidance of all genital sexual contact.

Подпись: Males 2% 13% I I Less than once per month [TZI Less than once per week Подпись: Females

Figure 14.1

How frequently have you had sex in the last 12 months?

Data from The Global Study of Sexual Attitudes and Behaviors, funded by Pfizer, Inc. (© 2002 Pfizer, Inc.)

We will discuss illness and physical causes later in this chapter, but now let us turn to the symptoms and possible causes of various sexual dysfunctions and the current ther­apies used to treat them.