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Effective treatment for anorgasmia depends on the cause. In the case of women suffering from psychological sexual trauma or inhibition, psychosexual counselling might be advisable and could be obtained through general practitioner (GP) referral.
Women suffering from anorgasmia with no obvious psychological cause would need to be examined by their GP to check for absence of disease. Blood tests would also need to be done (full blood count, liver function, oestradiol/estradiol, total testosterone, SHBG, FSH/LH, prolactin, thyroid function, lipids and fasting blood sugar) to check for other conditions such as diabetes, lack of ovulation, low thyroid function or hormone imbalances. The normal thresholds for these tests and timing in a woman's menstrual cycle is detailed in Berman et al., 2005.
They would then need to be referred to a specialist in sexual medicine. The specialist would check the patient's blood results for hormonal levels, thyroid function and diabetes, evaluate genital blood flow and genital sensation, as well as giving a neurological work-up to determine the degree (if any) of nerve damage.
Recently, it has been proposed to add a subtype of FOD, called reduced orgasmic intensity, and field trials are underway to assess the suitability of this proposal.
In the DSM-5, male hypoactive sexual desire disorder is characterized by "persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity", as judged by a clinician with consideration for the patient's age and cultural context. Female sexual interest/arousal disorder is defined as a "lack of, or significantly reduced, sexual interest/arousal", manifesting as at least three of the following symptoms: no or little interest in sexual activity, no or few sexual thoughts, no or few attempts to initiate sexual activity or respond to partner's initiation, no or little sexual pleasure/excitement in 75%-100% of sexual experiences, no or little sexual interest in internal or external erotic stimuli, and no or few genital/nongenital sensations in 75%-100% of sexual experiences.
For both diagnoses, symptoms must persist for at least six months, cause clinically significant distress, and not be better explained by another condition. Simply having lower desire than one's partner is not sufficient for a diagnosis. Self-identification of a lifelong lack of sexual desire as asexuality precludes diagnosis.
Several decades ago the medical community believed the majority of sexual dysfunction cases were related to psychological issues. Although this may be true for a portion of men, the vast majority of cases have now been identified as having a physical cause or correlation. If the sexual dysfunction is deemed to have a psychological component or cause, psychotherapy can help. Situational anxiety arises from an earlier bad incident or lack of experience. This anxiety often leads to development of fear towards sexual activity and avoidance. In return evading leads to a cycle of increased anxiety and desensitization of the penis. In some cases, erectile dysfunction may be due to marital disharmony. Marriage counseling sessions are recommended in this situation.
Lifestyle changes such as discontinuing smoking, drug or alcohol abuse can also help in some types of erectile dysfunction.
Several oral medications like Viagra, Cialis and Levitra have become available to help people with erectile dysfunction and have become first line therapy. These medications provide an easy, safe, and effective treatment solution for approximately 60% of men. In the rest, the medications may not work because of wrong diagnosis or chronic history.
Another type of medication that is effective in roughly 85% of men is called intracavernous pharmacotherapy and involves injecting a vasodilator drug directly into the penis in order to stimulate an erection. This method has an increased risk of priapism if used in conjunction with other treatments, and localized pain.
When conservative therapies fail, are an unsatisfactory treatment option, or are contraindicated for use, the insertion of a penile prosthesis, or penile implant, may be selected by the patient. Technological advances have made the insertion of a penile prosthesis a safe option for the treatment of erectile dysfunction which provides the highest patient and partner satisfaction rates of all available ED treatment options.
Pelvic floor physical therapy has been shown to be a valid treatment for men with sexual problems and pelvic pain.
The FDA has approved one medication for the treatment of disorders of female libido, flibanserin.
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.
HSDD, like many sexual dysfunctions, is something that people are treated for in the context of a relationship. Theoretically, one could be diagnosed with, and treated for, HSDD without being in a relationship. However, relationship status is the most predictive factor accounting for distress in women with low desire and distress is required for a diagnosis of HSDD. Therefore, it is common for both partners to be involved in therapy. Typically, the therapist tries to find a psychological or biological cause of the HSDD. If the HSDD is organically caused, the clinician may try to deal with that. If the clinician believes it is rooted in a psychological problem, they may recommend therapy for that. If not, treatment generally focuses more on relationship and communication issues, improved communication (verbal and nonverbal), working on non-sexual intimacy, or education about sexuality may all be possible parts of treatment. Sometimes problems occur because people have unrealistic perceptions about what normal sexuality is and are concerned that they do not compare well to that, and this is one reason why education can be important. If the clinician thinks that part of the problem is a result of stress, techniques may be recommended to more effectively deal with that. Also, it can be important to understand why the low level of sexual desire is a problem for the relationship because the two partners may associate different meaning with sex but not know it.
In the case of men, the therapy may depend on the subtype of HSDD. Increasing the level of sexual desire of a man with lifelong/generalized HSDD is unlikely. Instead the focus may be on helping the couple to adapt. In the case of acquired/generalized, it is likely that there is some biological reason for it and the clinician may attempt to deal with that. In the case of acquired/situational, some form of psychotherapy may be used, possibly with the man alone and possibly together with his partner.
Just as with erectile dysfunction in men, lack of sexual function in women may be treated with hormonal patches or tablets to correct hormonal imbalances, clitoral vacuum pump devices and medication to improve blood flow, sexual sensation and arousal.
Many practitioners today treat both men and women who have SSRI-induced anorgasmia with sildenafil, more commonly known as Viagra. While this approach is known to work well in men with sexual dysfunction, it is only recently that the effectiveness of sildenafil in women with sexual dysfunction is coming to light. A recent study by H. G. Nurnberg et al. showed a complete or very significant reversal of their sexual dysfunction upon taking sildenafil one hour prior to sexual activity. In this study, eight out of the nine women required 50 mg of sildenafil while the 9th woman required 100 mg of sildenafil.
Another option for women who have SSRI-induced anorgasmia is the use of vardenafil. Vardenafil is a type 5 phosphodiesterase (PDE5) inhibitor that facilitates muscle relaxation and improves penile erection in men. However, there is much controversy about the efficiency of the drug used in the reversal of female sexual dysfunction. Vardenafil is similar to sildenafil, but vardenafil is less expensive and may be covered under some insurance plans. A study by A.K. Ashton M.D. has shown that in the case of one particular woman, the effects of vardenafil as opposed to sildenafil have not only been comparable in the effectiveness, but that vardenafil is cheaper and reversal of sexual dysfunction requires a smaller dose. So far, vardenafil has been approved by the Food and Drug administration only for use in men.
The NIH states that yohimbine hydrochloride has been shown in human studies to be possibly effective in the treatment of male impotence resulting from erectile dysfunction or SSRI usage (e.g., anorgasmia). Published reports have shown it to be effective in the treatment of orgasmic dysfunction in men.
Cabergoline, an agonist of dopamine D₂ receptors which inhibits prolactin production, was found in a small study to fully restore orgasm in one third of anorgasmic subjects, and partially restore orgasm in another third. Limited data has shown that the drug amantadine may help to relieve SSRI-induced sexual dysfunction. Cyproheptadine, buspirone, stimulants such as amphetamines (including the antidepressant bupropion), nefazodone and yohimbine have been used to treat SSRI-induced anorgasmia. Reducing the SSRI dosage may also resolve anorgasmia problems.
There are several subtypes of female sexual arousal disorders. They may indicate onset: lifelong (since birth) or acquired. They may be based on context: they may occur in all situations (generalized) or be situation-specific (situational). For example, the disorder may occur with a spouse but not with a different partner.
The length of time the disorder has existed and the extent to which it is partner- or situation-specific, as opposed to occurring in all situations, may be the result of different causative factors and may influence the treatment for the disorder. It may be due to psychological factors or a combination of factors.
A physical exam of the genitals is applied to ensure that there are no anatomical problems. The urine will be examined for the presence of semen. If there are no sperm in the urine, it may be due to damage to the prostate as a result of surgery or prior radiation therapy.
Diagnosis is usually by way of a urinalysis performed on a urine specimen that is obtained shortly after ejaculation. In cases of retrograde ejaculation, the specimen will contain an abnormal level of sperm.
Especially in case of "orgasmic anejaculation", anejaculation can often be confused with retrograde ejaculation, and they share some fundamental aspects of the cause. Urinalysis is used to distinguish between them.
The ICD-10 defines fetishism as a reliance on non-living objects for sexual arousal and satisfaction. It is only considered a disorder when fetishistic activities are the foremost source of sexual satisfaction, and become so compelling or unacceptable as to cause distress or interfere with normal sexual intercourse. The ICD's research guidelines require that the preference persists for at least six months, and is markedly distressing or acted on.
Under the DSM-5, fetishism is sexual arousal from nonliving objects or specific nongenital body parts, excluding clothes used for cross-dressing (as that falls under transvestic disorder) and sex toys that are designed for genital stimulation. In order to be diagnosed as "fetishistic disorder", the arousal must persist for at least six months and cause significant psychosocial distress or impairment in important areas of their life. In the DSM-IV, sexual interest in body parts was distinguished from fetishism under the name partialism (diagnosed as Paraphilia NOS), but it was merged with fetishistic disorder for the DSM-5.
The ReviseF65 project has campaigned for the ICD diagnosis to be abolished completely to avoid stigmatizing fetishists. Sexologist Odd Reiersøl argues that distress associated with fetishism is often caused by shame, and that being subject to diagnosis only exacerbates that. He suggests that, in cases where the individual fails to control harmful behavior, they instead be diagnosed with a personality or impulse control disorder.
The first-line method for sperm retrieval in men with spinal cord injury is "penile vibratory stimulation" (PVS). The penile vibratory stimulator is a plier-like device that is placed around glans penis to stimulate it by vibration. In case of failure with PVS, spermatozoa are sometimes collected by electroejaculation, or surgically by per cutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE).
The American Psychiatric Association permits a diagnosis of "gender dysphoria" if the criteria in the DSM-5 are met. The DSM-5 moved this diagnosis out of the sexual disorders category and into a category of its own. The DSM-5 states that at least two of the criteria for gender dysphoria must be experienced for at least six months' duration in adolescents or adults for diagnosis. The diagnosis was renamed from "Gender Identity Disorder" to "Gender Dysphoria", after criticisms that the former term was stigmatizing. Subtyping by sexual orientation was deleted. The diagnosis for children was separated from that for adults, as "gender dysphoria in children". The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing, or ability to express it in the event that they have insight.
The International Classification of Diseases (ICD-10) list three diagnostic criteria for "transsexualism" (F64.0): Uncertainty about gender identity which causes anxiety or stress is diagnosed as sexual maturation disorder, according to the ICD-10.
As sexual anhedonia is the source of considerable dissatisfaction among its sufferers, several treatment methods have been devised to help patients cope. Exploration of psychological factors is one method, which includes exploring past trauma, abuse, and prohibitions in the cultural and religious history of the person. Sex therapy might also be used as a way of helping a sufferer realign and examine his or her expectations of an orgasm. Contributing medical causes must also be ruled out and medications might have to be switched when appropriate. Additionally, blood testing might help determine levels of hormones and other things in the bloodstream that might inhibit pleasure. This condition can also be treated with drugs that increase dopamine, such as oxytocin, along with other drugs. In general, it is recommended that a combination of psychological and physiological treatments should be used to treat the disorder.
Other drugs which may be helpful in the treatment of this condition include dopamine agonists, oxytocin, phosphodiesterase type 5 inhibitors, and alpha-2 receptor blockers like yohimbine.
The question of whether to counsel young children to be happy with their assigned sex, or to encourage them to continue to exhibit behaviors that do not match their assigned sex—or to explore a transsexual transition—is controversial. Some clinicians report that a significant proportion of young children diagnosed with gender dysphoria later do not exhibit any dysphoria.
Professionals who treat gender identity disorder in children have begun to refer and prescribe hormones, known as a puberty blocker, to delay the onset of puberty until a child is believed to be old enough to make an informed decision on whether hormonal gender reassignment leading to surgical gender reassignment will be in that person's best interest.
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).
There is no generally agreed upon diagnostic criteria for POIS. One group has developed five preliminary criteria for diagnosing POIS. These are:
1. one or more of the following symptoms: sensation of a flu-like state, extreme fatigue or exhaustion, weakness of musculature, experiences of feverishness or perspiration, mood disturbances and / or irritability, memory difficulties, concentration problems, incoherent speech, congestion of nose or watery nose, itching eyes;
2. all symptoms occur immediately (e.g., seconds), soon (e.g., minutes), or within a few hours after ejaculation that is initiated by coitus, and / or masturbation, and / or spontaneously (e.g., during sleep);
3. symptoms occur always or nearly always, e.g., in more than 90% of ejaculation events;
4. most of these symptoms last for about 2–7 days; and
5. disappear spontaneously.
POIS is prone to being erroneously ascribed to psychological factors such as hypochondriasis or somatic symptom disorder.
Most psychologists believe that paraphilic sexual interests cannot be altered. Instead, the goal of therapy is normally to reduce the person's discomfort with their paraphilia and limit any criminal behavior. Both psychotherapeutic and pharmacological methods are available to these ends.
Cognitive behavioral therapy, at times, can help people with paraphilias develop strategies to avoid acting on their interests. Patients are taught to identify and cope with factors that make acting on their interests more likely, such as stress. It is currently the only form of psychotherapy for paraphilias supported by evidence.
Antiandrogens are used in more severe cases. Similar to physical castration, they work by reducing androgen levels, and have thus been described as chemical castration. The antiandrogen cyproterone acetate has been shown to substantially reduce sexual fantasies and offending behaviors. Medroxyprogesterone acetate and gonadotropin-releasing hormone agonists (such as leuprolide acetate) have also been used to lower sex drive. Due to the side effects, the World Federation of Societies of Biological Psychiatry recommends that hormonal treatments only be used when there is a serious risk of sexual violence, or when other methods have failed. Surgical castration has largely been abandoned because these pharmacological alternatives are similarly effective and less invasive.
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.
It can depend on one or more of several causes, including:
- Sexual inhibition
- Pharmacological inhibition. They include mostly antidepressant and antipsychotic medication, and the patients experiencing that tend to quit them
- Autonomic nervous system
- Prostatectomy - surgical removal of the prostate.
- Ejaculatory duct obstruction
- Spinal cord injury causes sexual dysfunction including anejaculation. The rate of being able to ejaculate varies with the type of lesion, as detailed in the table at right.
- old age
Anejaculation, especially the "orgasmic" variant, is usually indistinguishable from retrograde ejaculation. However, a negative urinalysis measuring no abnormal presence of spermatozoa in the urine will eliminate a retrograde ejaculation diagnosis.
Thus, if the affected man has the sensations and involuntary muscle-contractions of an orgasm but no or very low-volume semen, ejaculatory duct obstruction is another possible underlying pathology of anejaculation.
Puberty usually occurs from the ages of 10 to 16 years of age and varies between boys and girls with girls normally starting earlier than boys (Shiel, Stoppler 2012). During the time of puberty is when sexual maturation starts to occur. Numerous physical changes happen during the period of puberty. Girls start to develop breasts, have growth of pubic hair and eventually begin having menstrual cycles. Boys have an enlargement of testicles and penis, growth of pubic hair, deepened voices and muscular development. Along with physical changes during puberty there are many mental changes happening. During the adolescence stage of life, boys and girls start developing thoughts related to sexual identity and start to explore and experiment with sexual behaviors. This stage of life is when sexual maturation starts to develop and one’s gender identity and sexual orientation is being developed. This is a timeframe that can possibly become confusing for the youth going through this stage of adolescence. Feelings of frustration, anxiety or depression may occur. This could be the first signs of disorder during sexual maturation.
Sexual maturity is a natural progression during the pubertal stages of adolescence. It is the timeframe where youth explore and experience sexual thoughts, situations and behaviors which ultimately lead to the identification of their gender and sexual orientation. During this timeframe abnormal feelings and thoughts can affect the progression of maturity. These abnormal occurrences would be identified as sexual maturation disorder.
It is thought that people who suffer from this disorder, suffer from a dysfunction in the release of the chemical dopamine in the nucleus accumbens, the brain's primary reward center. This part of the brain is thought to play a role in pleasurable activities, including laughter, addiction, and music. Additionally, it is thought that depression, drug addiction, high levels of prolactin, low testosterone, and uses of certain medications might play a role in inhibiting dopamine. A spinal cord injury or chronic fatigue syndrome might also occasionally cause this disorder. Age may also be a cause of this disorder.
A sudden-onset sexual anhedonia can also be a symptom of sensory neuropathy, which is most commonly the result of pyridoxine toxicity (e.g., from large doses of vitamin B6 supplements).
In this case, the sexual dysfunction promptly resolves spontaneously once the B6 supplementation is stopped.
Increased serum prolactin (PRL) concentration in patients brains from psychiatric medicine can also affect sexuality.
Psychiatric medicine is known to cause the brain to form more dopamine receptors for the dopamine blocking effect. The normal amount of dopamine released during sex is insufficient to stimulate the larger number of dopamine receptors.
There is no standard method of treating or managing POIS. Patients need to be thoroughly examined in an attempt to find the causes of their POIS symptoms, which are often difficult to determine, and which vary across patients. Once a cause is hypothesized, an appropriate treatment can be attempted. At times, more than one treatment is attempted, until one that works is found.
Affected individuals typically avoid sexual activity, especially ejaculation, or schedule it for times when they can rest and recover for several days afterwards. In case post-coital tristesse (PCT) is suspected, patients could be treated with selective serotonin reuptake inhibitors.
Another patient, in whom POIS was suspected to be caused by cytokine release, was successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs) just prior to and for a day or two after ejaculation. The patient took diclofenac 75 mg 1 to 2 hours prior to sexual activity with orgasm, and continued twice daily for 24 to 48 hours.
One POIS patient with erectile dysfunction and premature ejaculation had much lower severity of symptoms on those occasions when he was able to maintain penile erection long enough to achieve vaginal penetration and ejaculate inside his partner. The patient took tadalafil to treat his erectile dysfunction and premature ejaculation. This increased the number of occasions on which he was able to ejaculate inside his partner, and decreased the number of occasions on which he experienced POIS symptoms. This patient is thought to have Dhat syndrome rather than true POIS.
In one patient, the POIS symptoms were so severe, that he decided to undergo castration in order to relieve them. The POIS symptoms were cured by the castration.
Two patients, in whom POIS was suspected to be caused by auto-immune reaction to their own semen, were successfully treated by allergen immunotherapy with their own autologous semen. They were given multiple subcutaneous injections of their own semen for three years. Treatment with autologous semen "might take 3 to 5 years before any clinically relevant symptom reduction would become manifest".
Treatments are not always successful, especially when the cause of POIS in a particular patient has not been determined. In one patient, all of whose routine laboratory tests were normal, the following were attempted, all without success: ibuprofen, 400 mg on demand; tramadol 50 mg one hour pre-coitally; and escitalopram 10 mg daily at bedtime for 3 months.
DSDs are medical conditions involving the way the reproductive system develops from infancy (and before birth) through young adulthood. There are several types of DSDs and their effect on the external and internal reproductive organs varies greatly.
A frequently-used social and medical adjective for people with DSDs is "intersex". Parents with DSD children and clinicians involved in DSD treatment usually try to make clear distinctions between biological sex, social gender, and sexual orientation. This helps reduce confusion about the differences between being intersex, being transgender, and being gay/lesbian.
The most common DSD is congenital adrenal hyperplasia (CAH), which results in a person with female (XX) chromosomes having genitals that look somewhat masculine. In mild cases CAH results in a slightly enlarged clitoris, while in more severe cases it can be difficult to decide (just by looking) whether a baby is male or female (this is called having ambiguous genitals). Nevertheless, if they are old enough to know the difference, most children with CAH think of themselves as girls. CAH is caused by a problem with the adrenal glands and is usually treated by taking a daily medication to replace or supplement the missing adrenal hormones. (When this adrenal problem occurs in people with male (XY) chromosomes, the result is over-masculinization and premature puberty).
Another common DSD is androgen insensitivity syndrome (AIS), which means that a person with male (XY) chromosomes does not respond to testosterone in the usual way. This results in a body that to some degree has a feminine appearance. In Complete Androgen Insensitivity Syndrome (CAIS) the result is a totally feminine appearance, including typical female breast development. Consequently, most young women with CAIS are unaware of their condition until the early teen years when they fail to menstruate. In the milder form, called Partial Androgen Insensitivity Syndrome (PAIS), the genitals can vary from mostly female to almost completely male. Some people with PAIS think of themselves as girls/women, others regard themselves as boys/men, and some consider themselves mixed-gender.
One of the more unusual DSDs is 5-alpha-reductase deficiency (5ARD). It is caused by a shortage early in life of an enzyme that activates testosterone. In this condition, a person with male (XY) chromosomes has a body that appears female before puberty. After puberty begins, other testosterone-activating enzymes become available and the body soon takes on a masculine appearance, with the scrotum and penis usually reaching typical or nearly-typical size. If 5ARD is diagnosed at a young age, the child is often raised as a boy (a 1996 Brazilian study suggested that the majority of adults with this condition consider themselves men but this has been questioned in some more recent research).
In addition to CAH, CAIS, PAIS, and 5ARD there are several rarer types of DSDs, and in some cases it is not possible to make a clear diagnosis of the underlying condition.
The penis and clitoris are essentially the same organ (differing only in size, and generically called the phallus). In typical males, the urethra is located at the tip of the penis, while in typical females the urethra is located below the base of the clitoris. When the phallus is of intermediate size, it is possible also to have a urethral opening located along the shaft; this condition is known as hypospadias.
Open-minded parenting, appropriate and conservative medical intervention, and age-appropriate child involvement in the treatment plan contribute greatly to successful outcomes for the entire range of DSDs.