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DescriptionSymptoms of small penis tabletki na powiększenie penisa HSDD can be either lifelong or acquired. When HSDD is lifelong, the absence of sexual desire is a typical state for the person. Acquired HSDD occurs when a change is experienced in sexual appetite. An individual with a generalised lack of desire does not have a sexual appetite under any circumstances. On the other hand, an individual who experiences selective desire in certain situations or with specific partners is classified as situational type. For example, a person might feel desire toward a partner they have an affair with, but not with their established partner. It is important to note that males with inhibited sexual desire appear to use fantasy in a different way to females with this complaint. Females with desire phase problems show low levels of fantasy, whereas men with desire phase problems show a high level of sexual fantasy.Males may use sexual fantasy to enhance their sexual performance due to response anxiety. Response anxiety is experienced when there is widespread pressure to feel sexually aroused, but arousal does not occur. Sexual fantasies may be constructed to help generate sexual arousal that is difficult to achieve without the use of fantasy. Clinical Examination Clinical assessment of HSDD should take into account a variety of factors related to the individual and the couple, including: • Level of emotional intimacy; • Mental and physical health; • Sexual context; • Relationship issues or concerns; • Thoughts during sexual interactions; and • Messages from families of origin. Emotional intimacy The belief that emotional intimacy is highly relevant to the experience of sexual desire is not new. Accepting it as a legitimate driving force, rather than searching in vain for a means of experiencing spontaneous sexual thoughts and sexual neediness, is perhaps new to some. Some 50% of women believe that insufficient emotional intimacy is a relevant factor in their low desire. Assessment of a couple’s emotional intimacy typically includes questions about their ability to trust, be vulnerable, not be judgemental or highly critical, and to have a sexually attractive balance of power and assertiveness in the relationship.If there is greater desire and response with a new partner, the challenge may then be to remember the behaviours and interpersonal atmosphere that first led to desire for the established partner. Mental and physical health Assessment and management of overall mental health is vital, as is assessment of well-being at the time of sexual interaction. This includes energy levels, self-esteem, sense of attractiveness, body image, and freedom from stressful distractions and preoccupations. Depression is strongly associated with reduced sexual function. Antidepressants, especially those that are highly serotonergic, may lessen sexual desire. Various medical conditions can also impact on a person’s level of desire. Sexual context A detailed assessment of a couple’s usual sexual context may lead the health professional to recommend changes. Factors that may be assessed include: • Time of day; • Time since last sexual activity; • What happens in the hours preceding sexual opportunities; and • What needs to be done after sexual activity. The couple Throughout the assessment process, the health professional will evaluate the couple’s emotional contracts, styles of communication, level of discord, conflict resolution style, and ways of defining problems. When evaluating emotional contracts, the health professional will look at what is important for the couple to feel good emotionally, i.e. what is needed filmy pornograficzne and what they do to feel happy. Western philosophy and psychology generally agree that happiness is good for people and distress is bad, that people seek happiness, and that it is easier to be happy when others are happy as well. To attain such conditions, it is useful to try to maximise pleasant emotions over the long term. Openness to emotion is also recognised as being important, because it permits emotional information to be recognised and coped with, thereby promoting conditions that foster happiness. The health professional will also assess both sexual and nonsexual relational factors. Thoughts during sexual interaction The health professional may assess the individual’s ability to focus on sexual stimuli to determine if help is needed. Distractions regarding day-to-day stresses are common. Other distracting feelings include: • Stress; • Resentment; • Sense of obligation regarding imposed sexual frequency or type of sexual interaction; and • Prediction of negative outcome such as unwanted pregnancy, further proof of infertility, or lack of sexual satisfaction. Intergenerational system Family of origin factors and intergenerational factors are assessed through the use of a genogram. A genogram examines different aspects of familial functioning. Instances of incest, parentification, triangulation and other dysfunctional patterns of familial relationships that impact intimacy and sexuality will often need to be assessed. Empirical tools A health professional may use several tools to evaluate female clients. For general sexual dysfunction, the Female Sexual Function Index (FSFI) may be used, or the Sexual Interest and Desire Inventory-Female (SIDI-F) may be used for HSDD. The FSFI is a validated 19-item self-report questionnaire and contains 6 domains, including desire, arousal, lubrication, orgasm, satisfaction and pain. Higher scores on the FSFI reflect better sexual function. The SIDI-F contains thirteen items, which will be rated by the health professional (relationships-sexual, receptivity, initiation, desire-frequency, affection, desire-satisfaction, desire-distress, thoughts-positive, erotica, arousal-frequency, arousal-ease, arousal-continuation and orgasm). There are 4, 5, or 6 possible options for each item and each item contributes a score of points toward a SIDI-F total score. The score assigned to an option is based on clinical judgment about the relationship between the particular option and symptom severity. Higher scores on any particular item indicate increased levels of sexual functioning. As yet, tools have not been developed for men. Treatment Because HSDD can be caused by any number of factors, including biological, psychological and social factors, there is no quick and easy method of treatment. Rather, the treatment of HSDD depends greatly on the individual, and must be comprehensive, flexible and individualised. It is therefore one of the most complex and difficult sexual problems to treat. Medical and psychological treatments can often be used in combination. Medical therapies Some prescription medications are sometimes used for sexual purposes. For example, bupropion sustained release (SR), an antidepressant, has a positive effect on various aspects of sexual function in women diagnosed with hypoactive sexual desire disorder. Bupropion SR is used to counteract HSDD caused by another group of commonly used antidepressants called selective serotonin reuptake inhibitors (SSRIs). The side effects of many commonly used prescription medications can be a factor in HSDD. To overcome the sexual side effects of medications, a health professional may suggest: • Waiting to see if the symptoms disappear; • Lowering the dose; • Substituting another medication; • Adding a supplementary medicine to act as an antidote; or • Discontinuing the medication for brief periods. It is important that individuals do not make changes to their medication usage without first consulting their doctor. Testosterone is important for sexual appetite in men and women as it promotes sexual desire, curiosity, fantasy, interest and behaviour. Testosterone deficiency in men can be treated with an assortment of products, with varying results. However, testosterone deficiency in women cannot yet be treated with medication. The relationship between testosterone and sexual desire in women is complicated. HSDD in women cannot be diagnosed by assessing the level of circulating sex hormones such as testosterone; some women with low testosterone levels do not experience desire problems, and most women with HSDD have normal testosterone levels. Testosterone does increase sexual desire and well-being in postmenopausal women with HSDD.
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