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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Flibanserin is the first and only medication approved for women for the treatment of HSDD. It is only slightly effective over placebo, having been found to increase the average number of satisfying sexual events per month by 0.5 to 1. The side effects of dizziness, sleepiness, and nausea occur about three to four times more often. Overall improvement is slight to none.
Bremelanotide (tentative brand name Rekynda), a melanocortin receptor agonist, has successfully completed phase III clinical trials for the treatment of HSDD. A New Drug Application is expected to be filed in the latter half of 2017.
Biological treatments physically alter primary and secondary sex characteristics to reduce the discrepancy between an individual's physical body and gender identity. Biological treatments for GID without any form of psychotherapy is quite uncommon. Researchers have found that if individuals bypass psychotherapy in their GID treatment, they often feel lost and confused when their biological treatments are complete.
Psychotherapy, hormone replacement therapy, and sex reassignment surgery together can be effective treating GID when the WPATH standards of care are followed. The overall level of patient satisfaction with both psychological and biological treatments is very high.
Psychosexual disorders can vary greatly in severity and treatability. Medical professionals and licensed therapists are necessary in diagnosis and treatment plans. Treatment can vary from therapy to prescription medication. Sex therapy, behavioral therapy, and group therapy may be helpful to those suffering distress from sexual dysfunction. More serious sexual perversions may be treated with androgen blockers or selective serotonin reuptake inhibitors (SSRIs) to help restore hormonal and neurochemical balances.
Until the 1970s, psychotherapy was the primary treatment for gender dysphoria, and generally was directed to helping the person adjust to the gender of the physical characteristics present at birth. Psychotherapy is any therapeutic interaction that aims to treat a psychological problem. Though some clinicians still use only psychotherapy to treat gender dysphoria, it may now be used in addition to biological interventions. Psychotherapeutic treatment of GID involves helping the patient to adapt. Attempts to cure GID by changing the patient's gender identity to reflect birth characteristics have been ineffective.
Selective serotonin reuptake inhibitors (SSRIs) are used, especially with exhibitionists, non-offending pedophiles, and compulsive masturbators. They are proposed to work by reducing sexual arousal, compulsivity, and depressive symptoms. However, supporting evidence for SSRIs is limited.
Pharmacological treatments can help people control their sexual behaviors, but do not change the content of the paraphilia. They are typically combined with cognitive behavioral therapy for best effect.
The FDA has approved one medication for the treatment of disorders of female libido, flibanserin.
Pharmacological interventions are used to lower the sex drive in general, which can ease the management of pedophilic feelings, but does not change sexual preference. Antiandrogens work by interfering with the activity of testosterone. Cyproterone acetate (Androcur) and medroxyprogesterone acetate (Depo-Provera) are the most commonly used. The efficacy of antiantrogens has some support, but few high-quality studies exist. Cyproterone acetate has the strongest evidence for reducing sexual arousal, while findings on medroxyprogesterone acetate have been mixed.
Gonadotropin-releasing hormone analogues such as leuprolide acetate (Lupron), which last longer and have fewer side-effects, are also used to reduce libido, as are selective serotonin reuptake inhibitors. The evidence for these alternatives is more limited and mostly based on open trials and case studies. All of these treatments, commonly referred to as "chemical castration", are often used in conjunction with cognitive behavioral therapy. According to the Association for the Treatment of Sexual Abusers, when treating child molesters, "anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan." These drugs may have side-effects, such as weight gain, breast development, liver damage and osteoporosis.
Historically, surgical castration was used to lower sex drive by reducing testosterone. The emergence of pharmacological methods of adjusting testosterone has made it largely obsolete, because they are similarly effective and less invasive. It is still occasionally performed in Germany, the Czech Republic, Switzerland, and a few U.S. states. Non-randomized studies have reported that surgical castration reduces recidivism in contact sex offenders. The Association for the Treatment of Sexual Abusers opposes surgical castration and the Council of Europe works to bring the practice to an end in Eastern European countries where it is still applied through the courts.
There is no evidence that pedophilia can be cured. Instead, most therapies focus on helping the pedophile refrain from acting on their desires. Some therapies do attempt to cure pedophilia, but there are no studies showing that they result in a long-term change in sexual preference. Michael Seto suggests that attempts to cure pedophilia in adulthood are unlikely to succeed because its development is influenced by prenatal factors. Pedophilia appears to be difficult to alter but pedophiles can be helped to control their behavior, and future research could develop a method of prevention.
There are several common limitations to studies of treatment effectiveness. Most categorize their participants by behavior rather than erotic age preference, which makes it difficult to know the specific treatment outcome for pedophiles. Many do not select their treatment and control groups randomly. Offenders who refuse or quit treatment are at higher risk of offending, so excluding them from the treated group, while not excluding those who would have refused or quit from the control group, can bias the treated group in favor of those with lower recidivism. The effectiveness of treatment for non-offending pedophiles has not been studied.
There are many ways a person may go about receiving therapy for ego-dystonic sexual orientation associated with homosexuality. There is no known therapy for other types of ego-dystonic sexual orientations. Therapy can be aimed at changing sexual orientation, sexual behaviour, or helping a client become more comfortable with their sexual orientation and behaviours. Human rights groups have accused some countries of performing these treatments on egosyntonic homosexuals. One survey suggested that viewing the same-sex activities as compulsive facilitated commitment to a mixed-orientation marriage and to monogamy. Treatment may include sexual orientation change efforts or treatment to alleviate the stress. In addition, some people seek non-professional methods, such as religious counselling or attendance in an ex-gay group.
According to the World Health Organization, fetishistic fantasies are common and should only be treated as a disorder when they impair normal functioning or cause distress. Goals of treatment can include elimination of criminal activity, reduction in reliance on the fetish for sexual satisfaction, improving relationship skills, or attempting to remove deviant arousal altogether. The evidence for treatment efficacy is limited and largely based on case studies, and no research on treatment for female fetishists exists.
Cognitive behavioral therapy is one popular approach. Cognitive behavioral therapists teach clients to identify and avoid antecedents to fetishistic behavior, and substitute non-fetishistic fantasies for ones involving the fetish. Aversion therapy can reduce fetishistic arousal in the short term, but is unlikely to have any permanent effect.
Antiandrogens and selective serotonin reuptake inhibitors (SSRIs) may be prescribed to lower sex drive. Cyproterone acetate is the most commonly used antiandrogen, except in the United States, where it may not be available. A large body of literature has shown that it reduces general sexual fantasies. Side effects may include osteoporosis, liver dysfunction, and feminization. Case studies have found that the antiandrogen medroxyprogesterone acetate is successful in reducing sexual interest, but can have side effects including osteoporosis, diabetes, deep vein thrombosis, feminization, and weight gain. Some hospitals use leuprolide acetate and goserelin acetate to reduce libido, and while there is presently little evidence for their efficacy, they have fewer side effects than other antiandrogens. A number of studies support the use of SSRIs, which may be preferable over antiandrogens because of their relatively benign side effects. None of these drugs cure sexual fetishism, but they can make it easier to manage.
Relationship counselers may attempt to reduce dependence on the fetish and improve partner communication using techniques like sensate focusing. Partners may agree to incorporate the fetish into their activities in a controlled, time-limited manner, or set aside only certain days to practice the fetishism. If the fetishist cannot sustain an erection without the fetish object, the therapist might recommend orgasmic reconditioning or covert sensitization to increase arousal to normal stimuli (although the evidence base for these techniques is weak).
Sexual maturation disorder is a disorder of anxiety or depression related to an uncertainty about one's gender identity or sexual orientation. The World Health Organization (WHO) lists sexual maturation disorder in the ICD-10, under "Psychological and behavioural disorders associated with sexual development and orientation".
Sexual orientation, by itself, is not a disorder and is not classified under this heading. It differs from ego-dystonic sexual orientation where the sexual orientation or gender identity is repressed or denied.
Female sexual arousal disorder (FSAD) is a disorder characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity. The diagnosis can also refer to an inadequate lubrication-swelling response normally present during arousal and sexual activity. The condition should be distinguished from a general loss of interest in sexual activity and from other sexual dysfunctions, such as the orgasmic disorder (anorgasmia) and hypoactive sexual desire disorder, which is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time.
Although female sexual dysfunction is currently a contested diagnostic, it has become more common in recent years to use testosterone-based drugs off-label to treat FSAD. While drug companies are technically not allowed to market these drugs for off-label uses, sharing the information with doctors at CME conferences has proved to be an effective way to navigate around the FDA approval process.
Ego-dystonic sexual orientation is an ego-dystonic mental disorder characterized by having a sexual orientation or an attraction that is at odds with one's idealized self-image, causing anxiety and a desire to change one's orientation or become more comfortable with one's sexual orientation. It describes not innate sexual orientation itself, but a conflict between the sexual orientation one wishes to have and the sexual orientation one actually possesses.
Estrogens are responsible for the maintenance of collagen, elastic fibers, and vasoculature of the urogenital tract, all of which are important in maintaining vaginal structure and functional integrity; they are also important for maintaining vaginal pH and moisture levels, both of which aid in keeping the tissues lubricated and protected. Prolonged estrogen deficiency leads to atrophy, fibrosis, and reduced blood flow to the urogenital tract, which is what causes menopausal symptoms such as vaginal dryness and pain related to sexual activity and/or intercourse. It has been consistently demonstrated that women with lower sexual functioning have lower estradiol levels.
Androgen therapy for hypoactive sexual desire disorder (HSDD) has a small benefit but its safety is not known. It is not approved as a treatment in the United States. If used it is more common among women who have had an oophorectomy or who are in a postmenopausal state. However, like most treatments, this is also controversial. One study found that after a 24-week trial, those women taking androgens had higher scores of sexual desire compared to a placebo group. As with all pharmacological drugs, there are side effects in using androgens, which include hirutism, acne, ploycythaemia, increased high-density lipoproteins, cardiovascular risks, and endometrial hyperplasia is a possibility in women without hysterectomy. Alternative treatments include topical estrogen creams and gels can be applied to the vulva or vagina area to treat vaginal dryness and atrophy.
Sexual dysfunction (or sexual malfunction or sexual disorder) is difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm. According to the DSM-5, sexual dysfunction requires a person to feel extreme distress and interpersonal strain for a minimum of 6 months (excluding substance or medication-induced sexual dysfunction). Sexual dysfunctions can have a profound impact on an individual's perceived quality of sexual life. The term "sexual disorder" may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed "disorder of sexual preference".
A thorough sexual history and assessment of general health and other sexual problems (if any) are very important. Assessing performance anxiety, guilt, stress and worry are integral to the optimal management of sexual dysfunction. Many of the sexual dysfunctions that are defined are based on the human sexual response cycle, proposed by William H. Masters and Virginia E. Johnson, and then modified by Helen Singer Kaplan.
Sexual sadism disorder is the condition of experiencing sexual arousal in response to the extreme pain, suffering or humiliation of others. Several other terms have been used to describe the condition, and the condition may overlap with other conditions that involve inflicting pain. It is distinct from situations in which consenting individuals use mild or simulated pain or humiliation for sexual excitement. The words "sadism" and "" are derived from Marquis de Sade.
Psychosexual disorder is a term which may simply refer to a sexual problem that is psychological, rather than physiological in origin. "Psychosexual disorder" was a term used in . The term of psychosexual disorder (Turkish: "Psikoseksüel bozukluk") used by the TAF for homosexuality as a reason to ban the LGBT people from military service.
Human fetishism has been compared to Pavlovian conditioning of sexual response in other animals. Sexual attraction to certain cues can be artificially induced in rats. Both male and female rats will develop a sexual preference for neutrally or even noxiously scented partners if those scents are paired with their early sexual experiences. Injecting morphine or oxytocin into a male rat during its first exposure to scented females has the same effect. Rats will also develop sexual preferences for the location of their early sexual experiences, and can be conditioned to show increased arousal in the presence of objects such as a plastic toy fish. One experiment found that rats which are made to wear a Velcro tethering jacket during their formative sexual experiences exhibit severe deficits in sexual performance when not wearing the jacket. Similar sexual conditioning has been demonstrated in gouramis, marmosets and Japanese quails.
Possible boot fetishism has been reported in two different primates from the same zoo. Whenever a boot was placed near the first, a common chimpanzee born in captivity, he would invariably stare at it, touch it, become erect, rub his penis against the boot, masturbate, and then consume his ejaculate. The second, a guinea baboon, would become erect while rubbing and smelling the boot, but not masturbate or touch it with his penis.
Erotophobia is a term coined by a number of researchers in the late 1970s and early 1980s to describe one pole on a continuum of attitudes and beliefs about sexuality. The model of the continuum is a basic polarized line, with erotophobia (fear of sex or negative attitudes about sex) at one end and erotophilia (positive feelings or attitudes about sex) at the other end.
The word erotophobia is derived from the name of Eros, the Greek god of erotic love, and Phobos, Greek (φόβος) for "fear".
Biastophilia (from Greek "biastes", "rape" + "-philia") and its Latin language-derived counterpart raptophilia (from Latin "rapere", "to seize"), also paraphilic rape, is a paraphilia in which sexual arousal is dependent on, or is responsive to, the act of assaulting an unconsenting person, especially a stranger. Some dictionaries consider the terms synonymous, while others distinguish raptophilia as the paraphilia in which sexual arousal is responsive to actually raping the victim.
The source of the arousal in these paraphilias is the victim's terrified resistance to the assault, and in this respect it is considered to be a form of sexual sadism. Biastophilia is accepted as potentially lethal, other such paraphilias including, but not being limited to asphyxiophilia, autassassinophilia, hybristophilia, and chremastistophilia.
Under the name paraphilic coercive disorder, this diagnosis was proposed for inclusion in DSM-5. This diagnosis, under the name "paraphilic rapism", was proposed and rejected in the DSM-III-R. It has been criticized because of the impossibility of reliably distinguishing between paraphilic rapists and non-paraphilic rapists, and because this diagnosis, under the term "Paraphilia NOS" (not otherwise specified), non-consent had been used in Sexually Violent Person/Predator commitment.
Czech sexology standardly use a concept of pathologic sexual aggressivity instead. This term is strongly distinguished from sadism. This disorder is understood as a coordination anomaly of the sexual motivation system (SMS), a "courtship disorder" according to Kurt Freund or displacement paraphilia by John Money, or a missing segment of SMS.
Frotteurism is a paraphilic interest in rubbing, usually one's pelvic area or erect penis, against a non-consenting person for sexual pleasure. It may involve touching any part of the body, including the genital area. A person who practices frotteuristic acts is known as a "frotteur". Toucherism is sexual arousal based on grabbing or rubbing one's hands against an unexpecting (and non-consenting) person. It usually involves touching breasts, buttocks or genital areas, often while quickly walking across the victim's path. Some psychologists consider toucherism a manifestation of frotteurism, while others distinguish the two. In clinical medicine, treatment of frotteuristic disorder involves cognitive behavior therapy coupled with the administration of a SSRI.
The prevalence of frotteurism is unknown. The DSM estimates that 10%–14% of men seen in clinical settings for paraphilias or hypersexuality have frotteuristic disorder, indicating that the population prevalence is lower. However, frotteuristic acts, as opposed to frotteuristic disorder, may occur in up to 30% of men in the general population. The majority of frotteurs are male and the majority of victims are female, although female on male, female on female, and male on male frotteurs exist. This activity is often done in circumstances where the victim cannot easily respond, in a public place such as a crowded train or concert.
Usually, such nonconsensual sexual contact is viewed as a criminal offense: a form of sexual assault albeit often classified as a misdemeanor with minor legal penalties. Conviction may result in a sentence or psychiatric treatment.
As the disorder progresses in life, it can increase in severity, and cause other behaviors or actions in late adolescence and adulthood. “A strong and persistent cross-gender identification in adolescents and adults [can cause a] disturbance manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex” (APA, 2000). This can cause severe conflict for the individual living in a society which endorses and enforces adherence to strict gender roles. In a more persistent disassociation with one’s own body or gender, someone can go to more extreme lengths to feel as though they are fulfilled or satisfied with themselves. This can lead these individuals to engage in behavior that displaces their emotions. These individuals may also seek to undergo sex reassignment surgery. “Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex in adolescents and adults [can cause a] disturbance manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex” (APA, 2000).