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Sexual dysfunctions and paraphilias are disorders of either disturbance of processes in sexual functioning (sexual dysfunctions) or sexual behavior(s) (paraphilias). Human sexuality presents a very complex interaction of biology and psychology, which is reflected in complex physiological responses. A seemingly very simple event, such as erection, is regulated on the central nervous system and peripheral nervous system level, modified by various hormones, impacted by vascular changes, and influenced by various expectations, interpersonal issues, intrapsychic processes, not to mention the influences of medications and substances of abuse, the aging processes, diseases and personal habits. While there is a substantial body of literature on human sexuality in general and sexual dysfunctions and paraphilias in particular, there is mostly a lack of good evidence-based literature on most aspects of these disorders. The focus has definitely moved from psychology to biology and medicalization of human sexuality. The biological sciences, such as pharmacology, have contributed enormously to the developments in this area. However, an exclusive focus on biology and medical aspects of human sexuality is unwarranted and may trivialize a very complex area of human behavior. Even the clearly “biological” treatment approaches to sexual dysfunction may fail in certain situations due to various psychological factors. Thus, we caution the reader to always consider all factors, biological and psychological, in making the diagnosis and in planning treatment. In most cases, the judicious combination of biological and psychological treatment approaches will yield the most satisfactory results.

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The diagnoses of sexual dysfunctions and paraphilias are mostly descriptive, no diagnosis specific tests or examinations are usually available. The classification of sexual dysfunctions is based on the notion of connected yet separate and clearly defined phases of the sexual response cycle—desire, arousal/excitement, orgasm, and resolution. Thus, sexual dysfunctions are classified according to impairments of one of the first three “phases” (no impairment of the resolution phase has been identified). However, clinically these disturbances are not so clearly separated and frequently overlap or coexist (e.g., lack of libido with impaired orgasm). Interestingly, the present classification defines and uses only one end of the sexual functioning spectrum, the “lack” of functioning (e.g., lack of libido), though imprecisely and vaguely. Hypersexuality is not well-defined and not conceptualized as a dysfunction, but rather at times (if at all) as related to addiction, compulsivity, or impulsivity. Another important point in classifying and diagnosing sexual dysfunctions and paraphilias is the use of clinically significant distress or impairment as one of the defining criteria of these disorders. Thus, if the lack of sexual desire does not cause any distress or impairment, one should not qualify it as a dysfunction. There seem to be some individuals who have no interest in sex and are not distressed by it, thus they do not suffer from any sexual disorder according to the currently used diagnostic systems (they may present just one end of the spectrum of certain behavior, similar to rapid vs. absent ejaculation, discussed later).

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The current diagnostic system employs ...

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