tailieunhanh - Handbook of sexual dysfunction - part 5

phân loại các rối loạn tình dục đã-được bắt nguồn từ giai đoạn của chu kỳ phản ứng tình dục, trên Cơ sở của công việc của Masters và Johnson (10) và Kaplan (33). Mô hình này mô tả một giai đoạn hưng phấn tình dục và ham muốn tình dục cho giai đoạn tiếp theo, đặc trưng bởi vasocongestion sinh dục | 130 Laan Everaerd and Both classification of sexual disorders has been derived from phases of the sexual response cycle on the basis of the work of Masters and Johnson 10 and Kaplan 33 . This model depicts a sexual desire phase and a subsequent sexual arousal phase characterized by genital vasocongestion followed by a plateau phase of higher arousal resulting in orgasm and subsequent resolution. It is assumed in this model that women s sexual response is similar to men s such that women s sexual dysfunction in DSM-IV mirrors categories of men s sexual dysfunction. In contrast to the third edition of the DSM manual subjective sexual experience is no longer part of the definition possibly in a further attempt to match norms and criteria for men s and women s sexual dysfunctions 34 . There are a number of serious problems with the current DSM-IV classification criteria. Firstly although the DSM-IV explicitly requires the clinician to assess the adequacy of sexual stimulation only when considering the diagnosis of FOD adequacy of sexual stimulation is a critical variable in evaluating each of the female sexual dysfunctions and FSAD in particular. Exactly what is adequate sexual stimulation Some sort of physical genital stimulation is a necessary but not necessarily sufficient prerequisite for arousal. For many women adequate sexual arousal involves physical as well as psychological and situational stimulation such as intimacy with a partner the exchange of confidences the sharing of hopes and dreams and fears and not only directly prior to the sexual event 35 . What if certain types of sexual stimulation have been adequate in the past but not anymore Is it evidence of FSAD or could it be explained in terms of habituation or an adaptation to changing life circumstances 16 And what is meant by completion of the sexual activity Is it masturbation to orgasm sexual contact with a partner sexual contact including coitus These are very different activities that are known to .