Male Sexual Dysfunction: Pathophysiology and Treatment PDF

Preface

Sexual interaction is the physical manifestation of our emotional need for acceptance, our need for affirmation, and our need for life. These drives may be as strong in us now as in our earliest ancestors. Such deeply rooted influences have invariably linked a man's self-worth to his ability to perform sexually—making sex a very important concern, indeed.

Many real advances in the understanding of the physiology of male sexual function have been attained in the last three decades. The erectile mechanism has been correctly delineated on molecular, cellular, and functional levels, from the role of the vascular elements involved in the normal sexual response to the progress made in the comprehension of the neuroendocrine, behavioral, and psychological mechanisms that govern sexuality. This greater knowledge has fostered the development of similarly innovative advances in the investigation and treatment of male sexual dysfunction.

Sexual complaints are astonishingly common among men of all ages, ethnicities, and cultural backgrounds. In 1995, it was estimated that more than 152 million men worldwide suffered from some degree of erectile dysfunction, and this number is expected to reach a formidable 322 million by the year 2025. Although erectile dysfunction is the most commonly highlighted type of male sexual dysfunction, there are many other sexual disorders that influence the parameters of desire, ejaculation, orgasm, and penile detumescence. Premature ejaculation, for example, is actually the most frequent male sexual dysfunction, but it is often confused with erectile dysfunction by many patients. Thus, the treating physician must possess a full understanding of all physiological aspects of normal sexual function as well as the manifestations and mechanisms of its disorders. With such a wide range of sexual disorders of varying nature and contributing factors from almost every system of the body, however, the successful practice of sexual medicine can only be delivered by a truly multidisciplinary team that involves the intricate coordination of the andrologist, urologist, sex therapist, psychiatrist, and, often, the radiologist.

This first edition of Male Sexual Dysfunction: Pathophysiology and Treatment comprehensively summarizes our most current knowledge of normal and abnormal male sexual function from all clinical aspects, including historical, psychosocial, and behavioral as well as medical and surgical perspectives. The chief goal of this work has been to compile a complete desk reference that will not only educate its reader with the science behind these complex disorders, but will also equip them with practical tools to approach the management of these conditions rationally and effectively. It is hoped that all sexual medicine professionals, both new and seasoned, will benefit from the updated information in this volume. Written by more than sixty world authorities, the book's forty-three chapters are organized into four logically sequential parts addressing the physiology, pathophysiology, investigation and treatments of male sexual disorders. A multitude of original illustrations, step-by-step algorithms, imaging studies, and comprehensive, well-organized tables complement the discussions and further elucidate these complex topics.

While some methods of investigating male sexual dysfunction, such as advanced vascular and neurological assessments, have largely fallen out of general favor since the revolutionary advent and subsequent widespread use of phosphodiesterase inhibitors, these techniques are carefully described in this volume—not simply for historical value, but because they often remain invaluable for patients who do not respond to phosphodiesterase inhibitors and those who cannot tolerate such medications. By taking the time and effort to establish the true etiologic basis and particular nature of an individual's sexual dysfunction, it may be possible to discover psychologically, medically, or even surgically reversible pathologies. For such patients, the selection of appropriate treatment modalities, including other systemic or locally applied drugs, nonsurgical devices, surgical procedures, and psychological or behavioral interventions, is of great importance, and thus is detailed thoroughly.

Some additional highlights of this book are several novel chapters dedicated to the in-depth description of state-of-the-art advances in penile revascularization, phallic reconstruction, and tissue/ mole cular engineering, as well as often controversial topics, such as male circumcision and the differences and similarities between male and female sexual function and dysfunction. Also critically reviewed is the abundant assortment of complementary and alternative medicine options available to patients without medical sanction.

Above all, it must be remembered that the patient's quality of life is paramount. In order to provide the safest and most effective treatment, the patient must be evaluated as a whole person; thus, judicious consideration of the myriad potentially contributing pathological factors, including family dynamics and interpersonal relationships, should be employed in all cases. Open lines of communication among the patient, his partner, and the treating professional must be achieved and maintained if rendered treatment is to be successful. Yet, many practitioners who do not specialize in sexual medicine may still feel awkward dealing with the intimate nature of sexual dysfunction in the office, as do many patients. It is the professional responsibility of the clinician, however, to bridge this gap of embarrassment by asking appropriate questions and drawing problems into the open with sensitivity and compassion. By providing a solid, scientific foundation of the pathophysiological factors that may cause sexual dysfunction and clearly outlining current practices for the investigation and treatment of these conditions, it is hoped that this book will allow its readers to approach the management of male sexual dysfunction with broader knowledge and greater confidence, so that no further men will have to suffer their sexual inadequacies in silence.