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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)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Sexually induced sneezing is a phenomenon characterized by sneezing during orgasm or sexual arousal.
The person experiences sneezing as a result of sexual thoughts, arousal, intercourse, or orgasm. Sneezing occurs independent of external nasal stimuli or allergens, and may occur at any point during a sexual experience. Both men and women are affected by the phenomenon.
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.
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).
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.
Narratophilia is a sexual fetish, in which the telling of dirty and obscene words or stories to a partner is sexually arousing. The term is also used for arousal by means of listening to obscene words and stories.
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.
Mysophilia relates to soiled or dirty material or people. Mysophiliacs may find dirt, soiled underwear, feces, or vomit to be sexually arousing.
It is possible for people with mysophilia to be aroused by unclean locales, such as an alleyway, or a dirty room/bathroom; wearing the same clothing for many days at a time; or not bathing, from mere days to several weeks.
Salirophilia is a sexual fetish or paraphilia that involves deriving erotic pleasure from soiling or disheveling the object of one's desire, usually an attractive person. It may involve tearing or damaging their clothing, covering them in mud or filth, or messing their hair or makeup. The fetish does not involve harming or injuring the subject, only their appearance.
It is related to wet and messy fetishism, bukkake, omorashi, mysophilia, urolagnia and coprophilia, but extends to other areas such as forcing the partner to wear torn or poorly fitting clothing and other actions which would render them normally unattractive.
The fetish sometimes manifests itself in the defacing of statues or pictures of attractive people, especially celebrities or fictional characters. It is common to refer to the practice involving ejaculating on a photo as "facepainting". The fetishist finds this sexually exciting, rather than mere vandalism. They sometimes form collections of defaced art for future enjoyment. A video of the fetishist ejaculating on a picture of someone or a photo depicting the result is known colloquially as a "tribute".
The term comes from the French for soiling, "salir". In cases where the fetish is obsessive it is called saliromania. It is frequently confused with salophilia, an attraction to salt or salty things (especially body sweat) that derives from the Latin for salt, "sal".
Nose fetishism, nose partialism, or nasophilia is the partialism (or paraphilia) for the nose. This may include the sexual attraction to a specific form of physical variation of appearance (such as shape and size), or a specific area (for example; the bridge or nostrils). The fetish may manifest itself in a desire for actual physical contact and interaction, or specific fantasies such as the desire to penetrate the nostrils.
Other fantasies may include the desire to observe or experience a transformation of a nose with reference to an element of a fictional work such as Pinocchio, or ideas concerning the transformation of the nose into that of another creatures' like a pig's snout as a means of sexually humiliating a partner or acquaintance. These fantasies may be assisted with use of props, role-play or transformation fiction, in the form of writing, artwork, or modified photographs of people (known as morphing).
Sigmund Freud interpreted the nose as a substitute for the penis.
Honeymoon rhinitis is a condition in which the sufferer experiences nasal congestion during sexual intercourse.
The condition appears to be genetically determined, and caused by the presence in the nose of erectile tissue which may become engorged during sexual arousal as a side effect of the signals from the autonomic nervous system that trigger changes in the genitals of both men and women.
A related condition called sexually induced sneezing also exists, where people sneeze, sometimes uncontrollably, when engaging in or even thinking about sexual activity.
A phenomenon presumably related to 'honeymoon rhinitis' is the occurrence of nasal congestion as a reported side effect of Viagra use.
A navel fetishist can be sexually aroused by a variety of stimuli, including key words, thoughts or specific forms of physical interaction with the navel.
Specific age groups, persons who participate in risky sexual behavior, or those have certain health conditions may require screening. The CDC recommends that sexually active women under the age of 25 and those over 25 at risk should be screened for chlamydia and gonorrhea yearly. Appropriate times for screening are during regular pelvic examinations and preconception evaluations. Nucleic acid amplification tests are the recommended method of diagnosis for gonorrhea and chlamydia. This can be done on either urine in both men and women, vaginal or cervical swabs in women, or urethral swabs in men. Screening can be performed:
- to assess the presence of infection and prevent tubal infertility in women
- during the initial evaluation before infertility treatment
- to identify HIV infection
- for men who have sex with men
- for those who may have been exposed to hepatitis C
- for HCV
Boot fetishism is a sexual fetish focused on boots. Boots have become the object of sexual attraction amounting to fetishism for some people and they have become a standard accessory in BDSM scenes (where leather, latex and PVC boots are favoured) and a fashion accessory in music videos. Boots are seen as perhaps the most fetishistic of all footwear and boots may be the most popular fetish clothing attire.
Navel fetishism, belly button fetishism, or alvinophilia is a partialism in which an individual is sexually attracted to the human navel.
According to a study, it is a moderately prevalent fetish among individuals. While in 2012, it was the second most popular fetish search on Google as per their global monthly averages.
With the advent of industrialization came the mechanization of massage therapy, the steam powered 'Manipulator’ table massager created in the late 1860s and other devices similar in nature were becoming more available in the mid 19th century. Doctors could now increase their patient load by either investing in a portable vibratory device or having one installed in their office. This new technology also allowed husbands whose wives had been diagnosed with hysteria to partake in the treatments at home. This kind of treatment to induce what is now realized to be an orgasm in women was not considered a sexual act as, with the androcentric model for sexuality, it wasn't considered a true sexual act unless there was penetration and ejaculation. Other mechanized forms of treatment in the mid 19th century included Hydrotherapy with a pelvic douche massager, where cold water was blasted at a high pressure at a woman's abdomen. These devices were harder to sell to doctor’s offices because of the expense and the equipment needed to produce the right amount of water pressure, so spas took up the practice offering it not just as muscle therapy but also for treatment of hysteria.
Dendrophilia (or less often arborphilia or dendrophily) literally means "love of trees". The term may sometimes refer to a paraphilia in which people are sexually attracted to or sexually aroused by trees. This may involve sexual contact or veneration as phallic symbols or both.
Hysteria, in the colloquial use of the term, means ungovernable emotional excess. Generally, modern medical professionals have abandoned using the term "hysteria" to denote a diagnostic category, replacing it with more precisely defined categories, such as somatization disorder. In 1980, the American Psychiatric Association officially changed the diagnosis of "hysterical neurosis, conversion type" (the most extreme and effective type) to "conversion disorder".
While the word "hysteria" originates from the Greek word for uterus, "hystera", the word itself is not an ancient one, and the term "hysterical suffocation" - meaning a feeling of heat and inability to breathe - was instead used in ancient Greek medicine. This suggests an entirely physical cause for the symptoms but, by linking them to the uterus, suggests that the disorder can only be found in women. Historically, hysteria was thought to manifest itself in women with a variety of symptoms, including: anxiety, shortness of breath, fainting, insomnia, irritability, nervousness, as well as sexually forward behaviour. These symptoms mimic symptoms of other more definable diseases and create a case for arguing against the validity of hysteria as an actual disease, and it is often implied that it is an umbrella term, used to describe an indefinable illness. Through to the 20th century, however, the label hysteria was applied to a mental, rather than uterine or physical, affliction. Hysteria is no longer thought of as a real ailment.
The history of hysteria has seen the approach of Ilza Veith, in which there is one disorder constant across time, and in which Freud is the hero with history becoming a steady progress towards his insights, replaced in the 1990s by scholarship based on closer knowledge of the original source texts. Through its lack of use as a medical diagnosis the term ‘hysteria’ now has connotations of mass panic, imagined or real. The term when applied to a singular person can mean that they are emotional or irrationally upset; when applied to a situation, it denotes it as funny.
The United States Preventive Services Task Force (USPSTF) recommends screening for gonorrhea in women at increased risk of infection, which includes all sexually active women younger than 25 years. Extragenital gonorrhea and chlamydia are highest in men who have sex with men (MSM). Additionally, the USPSTF also recommends routine screening in people who have previously tested positive for gonorrhea or have multiple sexual partners and individuals who use condoms inconsistently, provide sexual favors for money, or have sex while under the influence of alcohol or drugs.
Screening for gonorrhea in women who are (or intend to become) pregnant, and who are found to be at high risk for sexually transmitted diseases, is recommended as part of prenatal care in the United States.
Testing may be for a single infection, or consist of a number of tests for a range of STIs, including tests for syphilis, trichomonas, gonorrhea, chlamydia, herpes, hepatitis and HIV. No procedure tests for all infectious agents.
STI tests may be used for a number of reasons:
- as a diagnostic test to determine the cause of symptoms or illness
- as a screening test to detect asymptomatic or presymptomatic infections
- as a check that prospective sexual partners are free of disease before they engage in sex without safer sex precautions (for example, when starting a long term mutually monogamous sexual relationship, in fluid bonding, or for procreation).
- as a check prior to or during pregnancy, to prevent harm to the baby
- as a check after birth, to check that the baby has not caught an STI from the mother
- to prevent the use of infected donated blood or organs
- as part of the process of contact tracing from a known infected individual
- as part of mass epidemiological surveillance
Early identification and treatment results in less chance to spread disease, and for some conditions may improve the outcomes of treatment. There is often a window period after initial infection during which an STI test will be negative. During this period, the infection may be transmissible. The duration of this period varies depending on the infection and the test. Diagnosis may also be delayed by reluctance of the infected person to seek a medical professional. One report indicated that people turn to the Internet rather than to a medical professional for information on STIs to a higher degree than for other sexual problems.
For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection. Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent condom use. For pregnant women, guidelines vary: screening women with age or other risk factors is recommended by the U.S. Preventive Services Task Force (USPSTF) (which recommends screening women under 25) and the American Academy of Family Physicians (which recommends screening women aged 25 or younger). The American College of Obstetricians and Gynecologists recommends screening all at risk, while the Centers for Disease Control and Prevention recommend universal screening of pregnant women. The USPSTF acknowledges that in some communities there may be other risk factors for infection, such as ethnicity. Evidence-based recommendations for screening initiation, intervals and termination are currently not possible. For men, the USPSTF concludes evidence is currently insufficient to determine if regular screening of men for chlamydia is beneficial. They recommend regular screening of men who are at increased risk for HIV or syphilis infection.
In the United Kingdom the National Health Service (NHS) aims to:
1. Prevent and control chlamydia infection through early detection and treatment of asymptomatic infection;
2. Reduce onward transmission to sexual partners;
3. Prevent the consequences of untreated infection;
4. Test at least 25 percent of the sexually active under 25 population annually.
5. Retest after treatment.
Traditionally, gonorrhea was diagnosed with gram stain and culture; however, newer polymerase chain reaction (PCR)-based testing methods are becoming more common. In those failing initial treatment, culture should be done to determine sensitivity to antibiotics. All people testing positive for gonorrhea should be tested for other sexually transmitted diseases such as chlamydia, syphilis, and human immunodeficiency virus.
Epididymitis can be classified as acute, subacute, and chronic, depending on the duration of symptoms.
Diagnosis is typically based on symptoms. Conditions that may result in similar symptoms include testicular torsion, inguinal hernia, and testicular cancer. Ultrasound can be useful if the diagnosis is unclear.
Epididymitis usually has a gradual onset. Typical findings are redness, warmth and swelling of the scrotum, with tenderness behind the testicle, away from the middle (this is the normal position of the epididymis relative to the testicle). The cremasteric reflex (elevation of the testicle in response to stroking the upper inner thigh) remains normal. This is a useful sign to distinguish it from testicular torsion. If there is pain relieved by elevation of the testicle, this is called Prehn's sign, which is, however, non-specific and is not useful for diagnosis.
Before the advent of sophisticated medical imaging techniques, surgical exploration was the standard of care. Today, Doppler ultrasound is a common test: it can demonstrate areas of blood flow and can distinguish clearly between epididymitis and torsion. However, inasmuch as torsion and other sources of testicular pain can consistently be determined by palpation alone, some studies have suggested that the only real benefit of an ultrasound, which is a fairly expensive procedure (~US$300 to US$800 in 2013), is to assure the patient that he does not have testicular cancer. Nuclear testicular blood flow testing is rarely used.
Additional tests may be necessary to identify underlying causes. In younger children, a urinary tract anomaly is frequently found. In sexually active men, tests for sexually transmitted diseases may be done. These may include microscopy and culture of a first void urine sample, Gram stain and culture of fluid or a swab from the urethra, nucleic acid amplification tests (to amplify and detect microbial DNA or other nucleic acids) or tests for syphilis and HIV.
People with sexual obsessions can devote an excessive amount of time and energy attempting to understand the obsessions. They usually decide they are having these problems because they are defective in some way, and they are often too ashamed to seek help. Because sexual obsessions are not as well-described in the research literature, many therapists may fail to properly diagnose OCD in a client with primary sexual obsessions. Mental health professionals unfamiliar with OCD may even attribute the symptoms to an unconscious wish (typically in the case of psychoanalysts or psychodynamic therapists), sexual identity crisis, or hidden paraphilia. Such a misdiagnosis only panics an already distressed individual. Fortunately, sexual obsessions respond to the same type of effective treatments available for other forms of OCD: cognitive-behavioral therapy and serotonergic antidepressant medications (SSRIs). People with sexual obsessions may, however, need a longer and more aggressive course of treatment.