Advice and treatment

David Goldmeier can advise and treat on a wide range of sexual dysfunctions. One of the key features of consultations is that they are undertaken in a friendly and sympathetic manner.

 


Some useful definitions

These should help your understanding of the medical and psychological terms in the area of sexual medicine.

 

Sexual Health

Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships. Sexual health should encompass having pleasurable and safe sexual experiences, free of coercion, discrimination and violence (World Health Organisation).

 

Sexual Medicine

The branch of medicine involving the prevention, diagnosis and treatment of sexual dysfunctions.

 

Psychosexual therapy

Psychological therapies used to manage sexual problems - these include sex therapy, as well as mindfulness meditation.

 

Sexual dysfunction

Refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity.

 

Mindfulness

Mindfulness is a form of meditation. It is a method used to cultivate attention and to notice being in the moment in a non-judgemental way. It has been shown to significantly alter the structure and function of the brain.

 

Many people find being present in the moment difficult. Therefore, learning mindfulness techniques and continuing to practice them long-term can be hard work. However, mindfulness can also have a significantly positive effect on one's mood, immune system, and pain control and may have a very positive effect on female and male sexual dysfunctions.

David Goldmeier discusses mindfulness in the following paper: http://www.ingentaconnect.com/content/ben/cpsr/2010/00000006/00000001/art00002

 


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Specific sexual dysfunctions

Men and Women

Hypoactive Sexual Desire Disorder

This is the persistent or recurrent deficiency of (or absence of) sexual fantasies and desire for sexual activity that causes distress.

 

Sexual Aversion Disorder

Persistent or recurrent aversion to, and avoidance of, all (or almost all) sexual contact with a sexual partner. It is often associated with a debilitating fear of sex.

 

Sexual problems in patients with HIV

These can be caused by a wide range of problems, related both physically and psychologically to HIV. Typical examples are lowered testosterone levels and fear of disclosure to partners.

http://sti.bmj.com/content/81/4/284.1.full

http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2009.01622.x/abstract

 


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Men

Erectile dysfunction

This is the consistent or recurrent inability to obtain and/or maintain a penile erection sufficient for sexual performance. This may be caused by physical/medical conditions e.g. narrowing of the arteries, or by psychological issues such as fear of failure and anxiety.

 

Premature (rapid) ejaculation

Premature ejaculation is persistent or recurrent ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it (also called rapid ejaculation). This usually occurs in less than a minute or two. This may have always been present or it may have begun after some time of normal sexual activity http://www.ncbi.nlm.nih.gov/pubmed/16409670

 

Delayed ejaculation

This is the persistent or recurrent difficulty/delay in or absence of attaining orgasm following sufficient sexual stimulation which causes personal distress.

http://www.ncbi.nlm.nih.gov/pubmed/16509998

 

Retrograde ejaculation

This is backward passage of semen into the bladder at orgasm. It is usually caused by failure of the bladder neck to close. It can be confirmed by finding sperm in the first-passed urine.

 

Hypersexual disorder or sexual addiction (usually but not always in men)

Sexual addiction or hypersexual disorder (HD) encompasses excessive normal (ie non-paraphilic or non-deviant) behaviour.

http://www.ncbi.nlm.nih.gov/pubmed?term=goldmeier%20d%20%20addiction

 


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Women

Female Sexual Arousal Disorder (FSAD)

This may be genital or subjective.

Genital arousal disorder is the persistent or recurrent inability to attain or maintain genital engorgement and/or genital lubrication. Subjective arousal disorder is a similar disability in attaining or maintaining a subjective feeling of excitement at sex. A woman may have both genital and subjective arousal disorders.

 

Female Orgasmic Disorder(FOD)

FOD is the persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women may orgasm from either clitoral or vaginal stimulation. The diagnosis of FOD should be based on the clinician's judgement that the woman's orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives.

 

Vulvodynia

Vulvodynia has been defined by the International Society for the Study of Vulval diseases as a vulval discomfort, most often described as a burning pain, occurring in the absence of relevant visible findings, or a specific, clinically identifiable, neurological disorder. Patients can be further classified by whether pain is provoked or unprovoked.

 

Vaginismus

This is the persistent or recurrent difficulty of the woman to allow vaginal entry of a penis, a finger or any object, despite the woman's expressed wish to do so. It often causes sexual pain and may be difficult to differentiate from vulvodynia. http://www.ncbi.nlm.nih.gov/pubmed/19541697

Persistent Genital Arousal Disorder (PGAD)

This has also been called the persistent sexual arousal disorder and the restless genital syndrome. PGAD is genital arousal that is unbidden (not related to sexual desire), intrusive and unwanted. It is unpleasant and causes at least some degree of distress. It may be either understood as a type of neuralgia or associated with significant anxiety or depression. http://www.ncbi.nlm.nih.gov/pubmed/19451319

 


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Useful Links

 

British Association of Sexual Health and HIV (BASHH) Sexual dysfunction group

British Society of Sexual Medicine (BSSM)

Sexual Advice Association

British Society for Study of Vulval Diseases- vulvodynia


 

 

 

Sexual Problems

 


Some useful definitions

Sexual Health

Sexual Medicine

Psychosexual therapy

Sexual dysfunction

Mindfulness


Specific sexual dysfunctions

Men and Women

Hypoactive Sexual Desire Disorder

Sexual Aversion Disorder

Sexual problems in patients with HIV


Men

Erectile dysfunction

Premature (rapid) ejaculation

Delayed ejaculation

Retrograde ejaculation

Hypersexual disorder or sexual addiction (usually but not always in men)


Women

Female Sexual Arousal Disorder (FSAD)

Female Orgasmic Disorder(FOD)

Vulvodynia

Vaginismus