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Key Clinical Updates in Psychosexual Disorders

Bremelanotide is FDA-approved for the treatment of hypoactive sexual desire disorder in premenopausal women; however, the mechanism of action is unclear and subjective improvement is low.

Wheeler LJ et al. Obstet Gynecol. [PMID: 32541291]

The stages of sexual activity include excitement (arousal), orgasm, and resolution. The precipitating excitement or arousal is psychologically determined.

In a well-adjusted person, arousal stimuli lead to vasocongestive and orgasmic responses. These can be considered as separate stages that can produce different syndromes responding to different treatment procedures.


There are three major groups of sexual disorders.

A. Paraphilias

In these conditions, the excitement stage of sexual activity is associated with sexual objects or orientations different from those usually associated with adult sexual stimulation. The stimulus may be a woman’s shoe, a child, animals, instruments of torture, or incidents of aggression. The pattern of sexual stimulation is usually one that has early psychological roots. When paraphilias are associated with distress, impairment, or risk of harm, they become paraphilic disorders. Some paraphilias or paraphilic disorders include exhibitionism, transvestism, voyeurism, pedophilia, incest, sexual sadism, and sexual masochism.

Exhibitionism is the impulsive behavior of exposing the genitalia to unsuspecting strangers in order to achieve sexual excitation. It is a childhood sexual behavior carried into adult life.

Transvestism consists of recurrent cross-dressing behavior for the purpose of sexual excitation. Such fetishistic behavior can be part of masturbation foreplay.

Voyeurism involves the achievement of sexual arousal by watching the activities of an unsuspecting person, usually in various stages of undress or sexual activity. In both exhibitionism and voyeurism, excitation leads to masturbation as a replacement for sexual activity.

Pedophilia is the use of a child of either sex to achieve sexual arousal and, in many cases, gratification. Contact is frequently oral, with either participant being dominant, but pedophilia includes intercourse of any type. Adults of both sexes engage in this behavior, with exact prevalence unknown but likely far less common among females.

Incest involves a sexual relationship with a person in the immediate family, most frequently a child. In many ways it is similar to pedophilia (intrafamilial pedophilia). Incestuous feelings are common, but cultural mores are usually sufficiently strong to act as a barrier to the expression of sexual feelings.

Sexual sadism is the attainment of sexual arousal by inflicting pain upon the sexual object. Much sexual activity has aggressive components (eg, biting, scratching). However, forced sexual acquiescence (eg, rape) is an act of aggression.

Sexual masochism is the achievement of erotic pleasure by being humiliated, enslaved, physically bound, and restrained. It may be life-threatening, since neck binding or partial asphyxiation usually forms part of the ritual. The practice is much more common in men ...

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