Arousal disorder in .NET framework

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Arousal disorder
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De nitions of female sexual arousal disorder (FSAD) have undergone signi cant changes In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) FSAD was de ned as: Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response to sexual
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Combined genital and subjective arousal disorder
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Absence of or markedly diminished feelings of sexual arousal (sexual excitement and sexual pleasure) from
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23
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any type of sexual stimulation as well as complaints of absent or impaired genital sexual arousal (vulval swelling, lubrication) [11, p 982]
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Prevalence
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The prevalence of FSAD is based on the conventional de nitions of arousal, namely genital measures mostly lubrication As such, most epidemiologic research has focused on the genital arousal disorder Furthermore, many epidemiologic investigations have not included the distress factor in their investigations, making it dif cult to give accurate estimates on how large the problem really is The epidemiologic investigations of the prevalence of arousal problems show considerable differences between the different investigations, ranging overall from 6% up to 49% of the women who were asked, with a majority of prevalence ranging between 13% and 24% [13 19] Two studies have demonstrated that the prevalence of FSAD is increased with increasing age, peaking after the age of 50 years [18,20] In a Swedish study it was found that, in women aged 50 or more, approximately 25% complained of lubrication problems, while 6 11% of women aged 18 49 experienced lubrication problems [18]
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Persistent sexual arousal disorder
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With the 2003 consensus a new category of female arousal disorder was described and recommended for inclusion in the diagnostic system, namely persistent sexual arousal disorder (PSAD) [11] It is de ned as: Spontaneous, intrusive and unwanted genital arousal (eg tingling, throbbing, pulsating) in the absence of sexual interest and desire Any awareness of subjective arousal is typically but not invariably unpleasant The arousal is unrelieved by one ore more orgasms, and the feelings of arousal persist for hours or days [11, p 982] (PSAD will be discussed at the end of this chapter) For all de nitions, FSAD can be divided into primary arousal problems, meaning that the woman has never experienced suf cient arousal despite suf cient desire and sexual stimulation, and secondary arousal disorder, in which the woman experiences decreased arousal but has previously been able to become aroused The secondary arousal disorder can be generalized (it appears in all sexual situations) or situational (it only appears in some situations) It is considered to be a disorder only if the woman is distressed by the problem [5], and assessment of relative distress is recommended as a part of the diagnosis Furthermore, the degree of subjective distress may have implications for treatment motivation and, in the end, treatment outcome [12] At the present time, the DSM-IV or the rst consensus report are the most widely accepted classi cations The revised de nitions remain recommendations as they have not been included into the DSM or World Health Organization s International Classi cation of Disease (ICD-10) There is an ongoing evolvement of de nitions of sexual disorders based on research and clinical data The revised de nitions provide greater speci city and re nement of the variety of sexual arousal disorders These more speci c and detailed diagnoses may be included in future diagnostic systems Clinical studies are being conducted to obtain more empirical evidence for the de nitions proposed In the meantime, it is hoped that the new de nitions will be helpful in the clinical diagnosis and treatment of arousal disorders
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Pathophysiology
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Biologic factors
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As described in 19, lubrication and genital congestion rely on intact nerve mediation and vascular function, as well as the hormonal milieu, which is crucial for a moistened vagina Therefore, disruptions to any of these parameters may result in impaired genital arousal response An estrogenized milieu is strongly correlated with the ability to lubricate, and genital arousal disorders are therefore correlated to the menopausal transition [21 23] Furthermore, genital arousal disorder may be associated with medical diseases (for example, neurologic conditions affecting the autonomic nervous system, diabetes mellitus with neuropathy and vascular complications) and medical therapies (for example, surgical procedures or radiation damaging tissue structures and autonomic nerves and vessels) Recurrent urinary tract infections also affect the arousal response as well as recurrent vaginal infections, which create irritation, pain, and decreased lubrication
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