International Journal of Environmental Research and Public Health
In the current digital environment, satisfying sexual needs via Internet pornography use has the ... more In the current digital environment, satisfying sexual needs via Internet pornography use has the potential to develop into a problem that affects one’s psychological health and daily functioning. The aim of this study was to examine potential cognitive and affective factors that could help explain the maintenance and exacerbation of self-defined problematic internet pornography use. Methods: 280 Pakistani men and women (mean age = 25.40; SD = 5.271, range 18–50) who were current pornography users were recruited through social networking sites (Facebook, Instagram, LinkedIn, WhatsApp groups) to participate in an online study about pathways to problematic pornography use (PPU). Structural equation modeling was used to estimate path analysis coefficients extending from predisposing variables (depression, anxiety, self-esteem, and loneliness) to PPU via the mediating variables of craving, dysfunctional sexual coping, and stimulus-specific inhibitory control. Results: Craving mediated th...
Introduction: Men suffering from one sexual problem sometimes report having another sexual proble... more Introduction: Men suffering from one sexual problem sometimes report having another sexual problem, but few studies have determined concordance rates among dysfunctions in non-clinical samples. Aim: This study determined comorbidities among sexual dysfunctions based on a binational sample of 4402 men from Hungary and the USA. Method: Participants completed an online 55-item questionnaire that included questions assessing erectile dysfunction (ED), premature ejaculation (PE), delayed ejaculation (DE), and lack of sexual interest (LSI). Main Outcome Measures: Concordance rates and odds ratios among sexual dysfunctions. Results: Approximately 8% of men suffered from two or more sexual problems; men with a severe sexual problem were significantly more likely to suffer from a second sexual problem; concordance between PE and ED ranged from 23-29%, with subtypes of lifelong vs acquired PE showing patterns similar to one another; and most men reporting DE reported minimal problems with LSI, although LSI was generally key to understanding all other dysfunctions. Conclusion: Documenting and understanding sexual comorbidities will help clinicians understand the often complex and intertwined nature of sexual problems and assist them in developing management protocols that address the various inadequacies in sexual response.
International Journal of Environmental Research and Public Health
This study focused on the relationships among social support, self-esteem, and depression in tran... more This study focused on the relationships among social support, self-esteem, and depression in transgender and cisgender individuals suffering from an incurable or curable sexually transmitted disease. Data were collected from 210 participants with an STI using a semi-structured interview along with culturally adapted standardized instruments. Results indicated no differences between transgender and cisgender groups in depression, although there were large differences in social support and self-esteem. Preliminary regression analysis identified only STI type and duration of STI as significant predictors of depression. However, when moderating roles for both social support and self-esteem were tested, each added to the explained variance and, equally importantly, revealed the effects of both gender status and social support on depression. These findings not only demonstrate how the compound stressors of gender minority status and STI type affect depressive symptoms, but also reveal the...
In a previous published paper, we initiated in this journal discussion about new perspectives reg... more In a previous published paper, we initiated in this journal discussion about new perspectives regarding the organization and functioning of the mind, as a premise for addressing the mind-body problem. In this article, we continue focussing discussion on two distinct but interrelated concepts, internal-mental existence/ entity and internal-mental reality. These two psycho-physiological subunits of the mind interact each other in the form of an internal-mental interaction, having no sense if one is isolated/ studied separately from the other. In other words, the mind (as a dynamic psycho-physiological construction) has no sense in the absence of this internal mental interaction that which takes places between internal-mental existence and internal-mental reality.
The mind (mental function) and sexuality represent two distinct environmental functions, but whic... more The mind (mental function) and sexuality represent two distinct environmental functions, but which are supported within the brain by a common (somatic-autonomic) neurobiological substrate. As a consequence, mental function takes on autonomic characteristics from the sexual-autonomic system (like autonomy, duality), while sexual function takes on features from mental functioning (such as lateralization). In this paper we discuss the lateralized action of two classes of sexual neuromodulators: hormones and pheromones. This process of lateralization is assimilated with the structural dichotomy of the mind. A relatively similar process but related to informational dichotomy of the mind will be presented in a forthcoming paper. Structural and informational dichotomies of the mind represent essential aspects that need clarification in order to continue the solving of the mind-body process, a work in progress articulated through a succession of papers.
International Journal of Environmental Research and Public Health, 2021
Domestic abuse of women is a serious problem worldwide that has economic, physical, and psycholog... more Domestic abuse of women is a serious problem worldwide that has economic, physical, and psychological consequences, yet in many countries and cultures, victims often have little access to psychological support. Using a pre-post design, we investigated the effects of psychological intervention using an imagery-based therapy in women showing post-traumatic stress disorder (PTSD) resulting from spousal domestic abuse. Forty women, referred from outpatient clinics in Pakistan and meeting inclusion criteria, underwent individual trauma counseling for 10–12 weeks using the principles of Eidetic Therapy, an imagery-based therapy that circumvents heavy reliance on verbal skills and narratives. Women showed significant reductions in PTSD by the end of treatment. Predictors of treatment gains included type of abuse, PTSD level at the outset of therapy, and years in the relationship. Neither economic resources or literacy, nor abuser or victim characteristics, predicted the amount of improveme...
Journal of Mind and Medical Sciences is designed as a free online, open access, interdisciplinary... more Journal of Mind and Medical Sciences is designed as a free online, open access, interdisciplinary and peer-reviewed journal. The JMMS mission is to address ideas and issues related to mind and medicine, publishing scientific review and empirical papers regarding mental and medical health and disease. Our goal is to stimulate constructive debates among scholars, researchers, physicians, scientists and health professionals with respect to the latest discoveries and trends in the field. The journal pays special attention to interdisciplinary and integrative perspectives, focusing primarily on papers approaching mind and body as a unitary domain of study.
Finasteride is currently approved and largely used as a therapeutic option for androgenetic alope... more Finasteride is currently approved and largely used as a therapeutic option for androgenetic alopecia. Apparently a safe drug and effective at the onset of its application, several concerns have since appeared over the years regarding the frequency and magnitude of finasteride adverse effects, which in some cases appear irreversible even after drug termination. This paper discusses the use of finasteride for androgenic alopecia from two distinct perspectives. On the one hand, androgenic alopecia is a condition that especially affects a person's self-image and esteem, aspects that are subjectively-constructed and thus relative and changeable. On the other hand, this condition involves a multifactorial etiology, with androgens being only partly responsible. Because androgens have important and unique physiological roles within the body, any procedure that results in androgenic suppression should be advised with caution. Furthermore, adverse effects induced by finasteride are neither fully documented nor easily treated. Finally, as alternative therapeutic approaches (such as topical finasteride) become available, the oral administration of finasteride for androgenic alopecia should, in our opinion, be reevaluated. Due to such concerns, a detailed and informed discussion should take place with patients considering therapy with finasteride for androgenic alopecia.
Premature ejaculation is the most prevalent form of male sexual dysfunction, but its cause has no... more Premature ejaculation is the most prevalent form of male sexual dysfunction, but its cause has not been well established. Recent studies have indicated that in men with premature ejaculation, penile sensitivity is increased. To investigate whether penile hypersensitivity is a cause of premature ejaculation, we prospectively evaluated the penile sensitivity of 18 patients with a lifelong history of premature ejaculation from the ®rst coital experience and 15 controls, both in the¯accid and erect state. We used an SMV-5 vibrometer (Suzuki-Matsuoka, Teknologue, Tokyo, Japan), which automatically controls stimulatory strength; its precision and reproducibility are thus higher than analogue-type biothesiometers. At the styloid process of the ulna and medial maleolus of the tibia, there was no signi®cant statistical difference in vibratory threshold between the two groups (P b 0.05). Also we did not ®nd signi®cant statistical differences in sensitivity of the glans penis, dorsum of the penile shaft, or frenulum of the penis between the two groups, in either the¯accid or erect state (P b 0.05). According to our results, penile hypersensitivity, as measured by an SMV-5 vibrometer, does not appear to be a major factor contributing to premature ejaculation.
The male refractory period (MRP) continues to be a topic of discussion and debate within the fiel... more The male refractory period (MRP) continues to be a topic of discussion and debate within the field of sexual medicine. To date explanations rely on central descending (efferent) influences involving specific neurotransmitter systems. Herein we explore the issue of the male refractory period, identifying problems with current explanations, specifying the parameters of an adequate model, and suggesting possible mechanisms mediating this phenomenon. • We review the literature regarding existing explanations for the MRP and look to other systems of physiological regulation that might provide a model for the conceptualization of the MRP. • Our approach differs from traditional explanations in that it emphasizes the possible roles of various peripheral, rather than central, feedback (afferent) systems that affect peripheral autonomic functioning and response. • Yet our approach is consistent with other peripheral regulatory feedback systems controlling autonomic response related to such processes as heart rate, respiration, and gut motility. • Although direct empirical research supporting our approach is lacking, sufficient evidence exists to support the idea that such processes are not only possible but likely with respect to the male refractory period. We suggest several lines of research that might provide empirical support for this approach.
For many men, the treatment of sexual dysfunctions such as premature ejaculation may well be most... more For many men, the treatment of sexual dysfunctions such as premature ejaculation may well be most effective when pharmacotherapy is combined with psychotherapy. Yet the essential elements of psychotherapy that might best be combined with pharmacological-based therapy are currently unknown. Support for evidence-based studies that identify key components of psychotherapy that might improve positive long-term outcomes, including patient satisfaction, are needed. Pharmaceutical companies having a vested interest in achieving both treatment adherence and improved patient outcomes could benefit from such information.
Clomipramine (25 mg) taken as needed increases ejaculatory latency in men with rapid ejaculation ... more Clomipramine (25 mg) taken as needed increases ejaculatory latency in men with rapid ejaculation (RE), although only about half the men treated respond to this regimen. It would therefore be clinically advantageous to know the patient's potential responsiveness to an 'as needed' regimen prior to treatment. The present study attempted to identify a priori factors that might enable prediction of patients' response or nonresponse to 'as needed' clomipramine. Variables relevant to rapid ejaculation were examined in 23 men with RE, 12 of whom had responded to clomipramine. Logistic regression indicated that three factors assessed prior to treatment-initial ejaculation latency, overall sexual satisfaction, and ejaculation frequency each week-significantly improved the prediction of responsiveness to this treatment regimen. Specifically, RE men with initial ejaculatory latencies over 60 s, self-reported sexual satisfaction of 5 or higher (on a seven-point scale), and ejaculation frequency of twice or more weekly were more likely to benefit from 25 mg 'as needed' clomipramine. As such, men meeting these criteria might be considered for this treatment regimen. Those not matching these characteristics might better be considered for 20 or 30 mg clomipramine given on a daily basis.
Inhibited ejaculation (IE) is a poorly understood male sexual dysfunction having both somatic and... more Inhibited ejaculation (IE) is a poorly understood male sexual dysfunction having both somatic and psychological etiologies. This study investigated sexual response in 25 IE men with no probable somatic cause. Using a standard psychophysiological assessment procedure, these men were compared with sexually functional and other dysfunctional groups on two measures of sexual response: erectile response and self-reported sexual arousal. Within the sample of IE men, sexual response was investigated as a function of both diagnostic classification and relationship factors. Differences occurred between IE men and the other groups on erectile response and self-reported sexual arousal during psychosexual stimulation in the lab, with IE men reporting lowest levels of sexual arousal. Within the IE group, diagnostic classifications and relationship variables were also related to self-reported sexual arousal. These findings suggest that inhibited arousal may be fairly common among IE men having no apparent somatic etiology, and further that several specific relationship factors may provide potential strategies for enhancing arousal in these men.
Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Sp... more Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE. Aim. Develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method. Review of the literature. Results. This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. Brief assessment procedures are delineated and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion. Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the 2947
This definition will hopefully lead to the development of new tools and patientreported outcome m... more This definition will hopefully lead to the development of new tools and patientreported outcome measures for diagnosing and assessing the efficacy of treatment interventions, and encourage ongoing research into the true prevalence of this disorder, and the efficacy of new pharmacological and psychological treatments.
International Journal of Environmental Research and Public Health, 2021
Groups marginalized and/or isolated by minority status—including transgender individuals—are at s... more Groups marginalized and/or isolated by minority status—including transgender individuals—are at significant risk for loneliness and diminished quality of life (QoL), effects that can be mitigated to some extent by coping styles. In this study, we examined the relationships among coping styles, loneliness, and QoL outcomes in a marginalized but understudied gender minority group, namely, 200 transgender individuals living in communities in an emerging/developing non-Western geo-cultural region of South-Central Asia (Pakistan), comparing them against a reference group of 100 heterosexual cisgender individuals. Results indicated strong relationships among coping styles, loneliness, and QoL in both transgender and cisgender groups. Moderating variable analysis revealed that coping skills—whether adaptive or maladaptive—help explain differences in loneliness and QoL not only between trans- and cis-gender individuals, but also within just the transgender group. The implications of these f...
Physiologically, the somatic nervous system intervenes in external interaction between the body a... more Physiologically, the somatic nervous system intervenes in external interaction between the body and environment, while autonomic nervous system ensures the functioning of internal organs. We present in this paper a psycho-physiological perspective suggesting that mental function (somatic in nature, because coordinates environmental interaction) is closer to and more aligned with the physiologic functioning of autonomic nervous system (due to autonomy, duality, etc.). At opposite end, sexual function (autonomic in nature, erection for example being a parasympathetic vasodilatory reflex) seems to be compatible and even dependent by a somatic participation (erectile response is rather induced by environmental stimuli than internal visceral stimuli). The perspective presented here is that the mind and sexuality are two distinct relational processes which, being related to the same environmental stimuli/ peripheral afferents, should be supported by a common (somatic-autonomic) neurobiolo...
Cognition and sexuality are two distinct relational functions that are partially interconnected t... more Cognition and sexuality are two distinct relational functions that are partially interconnected through our mind. Even though medical sciences have progressed substantially over the past decades, the current understanding of the mind psycho-physiology is yet at an early stage. As an example, the “mind-body problem” draws attention to the fact that fundamental aspects related to the understanding of the mind are still unresolved. Thus, it continues to be unclear how abstract ideas and thoughts (which are immaterial in nature, unfolding in an intangible realm) interface (and in some cases, interfere) with the more concrete brain and body (which are physical in nature), thus resulting in an abstract/conscious control of concrete/biological functions of the body; such is the case with processes involved in both cognition and sexuality. Beginning with this seminal paper we therefore intend to approach the psychophysiology of the mind as an essential element to the understanding of the tw...
As a 5-α reductase inhibitor, Finasteride has proven effective in ameliorating two conditions doc... more As a 5-α reductase inhibitor, Finasteride has proven effective in ameliorating two conditions documented to be androgen dependent, namely male androgenic alopecia and benign prostatic hyperplasia. Therapeutic results are maintained as long as the drug is administered, with treatment cessation generally leading to the return of symptomatology for each condition. In addition, during the therapeutic phase, several adverse effects have been reported, some of which persist long or indefinitely after treatment cessation, known as “post-finasteride syndrome.” Herein we present and discuss the most common finasteride side effects, along with a psycho-neuroendocrine rationale that could explain the persistence of many adverse effects after treatment cessation. Moreover, we argue that finasteride adverse effects occurring during finasteride administration should be delineated from postfinasteride side effects (encountered after treatment cessation), suggesting the need to be addressed separat...
International Journal of Environmental Research and Public Health
In the current digital environment, satisfying sexual needs via Internet pornography use has the ... more In the current digital environment, satisfying sexual needs via Internet pornography use has the potential to develop into a problem that affects one’s psychological health and daily functioning. The aim of this study was to examine potential cognitive and affective factors that could help explain the maintenance and exacerbation of self-defined problematic internet pornography use. Methods: 280 Pakistani men and women (mean age = 25.40; SD = 5.271, range 18–50) who were current pornography users were recruited through social networking sites (Facebook, Instagram, LinkedIn, WhatsApp groups) to participate in an online study about pathways to problematic pornography use (PPU). Structural equation modeling was used to estimate path analysis coefficients extending from predisposing variables (depression, anxiety, self-esteem, and loneliness) to PPU via the mediating variables of craving, dysfunctional sexual coping, and stimulus-specific inhibitory control. Results: Craving mediated th...
Introduction: Men suffering from one sexual problem sometimes report having another sexual proble... more Introduction: Men suffering from one sexual problem sometimes report having another sexual problem, but few studies have determined concordance rates among dysfunctions in non-clinical samples. Aim: This study determined comorbidities among sexual dysfunctions based on a binational sample of 4402 men from Hungary and the USA. Method: Participants completed an online 55-item questionnaire that included questions assessing erectile dysfunction (ED), premature ejaculation (PE), delayed ejaculation (DE), and lack of sexual interest (LSI). Main Outcome Measures: Concordance rates and odds ratios among sexual dysfunctions. Results: Approximately 8% of men suffered from two or more sexual problems; men with a severe sexual problem were significantly more likely to suffer from a second sexual problem; concordance between PE and ED ranged from 23-29%, with subtypes of lifelong vs acquired PE showing patterns similar to one another; and most men reporting DE reported minimal problems with LSI, although LSI was generally key to understanding all other dysfunctions. Conclusion: Documenting and understanding sexual comorbidities will help clinicians understand the often complex and intertwined nature of sexual problems and assist them in developing management protocols that address the various inadequacies in sexual response.
International Journal of Environmental Research and Public Health
This study focused on the relationships among social support, self-esteem, and depression in tran... more This study focused on the relationships among social support, self-esteem, and depression in transgender and cisgender individuals suffering from an incurable or curable sexually transmitted disease. Data were collected from 210 participants with an STI using a semi-structured interview along with culturally adapted standardized instruments. Results indicated no differences between transgender and cisgender groups in depression, although there were large differences in social support and self-esteem. Preliminary regression analysis identified only STI type and duration of STI as significant predictors of depression. However, when moderating roles for both social support and self-esteem were tested, each added to the explained variance and, equally importantly, revealed the effects of both gender status and social support on depression. These findings not only demonstrate how the compound stressors of gender minority status and STI type affect depressive symptoms, but also reveal the...
In a previous published paper, we initiated in this journal discussion about new perspectives reg... more In a previous published paper, we initiated in this journal discussion about new perspectives regarding the organization and functioning of the mind, as a premise for addressing the mind-body problem. In this article, we continue focussing discussion on two distinct but interrelated concepts, internal-mental existence/ entity and internal-mental reality. These two psycho-physiological subunits of the mind interact each other in the form of an internal-mental interaction, having no sense if one is isolated/ studied separately from the other. In other words, the mind (as a dynamic psycho-physiological construction) has no sense in the absence of this internal mental interaction that which takes places between internal-mental existence and internal-mental reality.
The mind (mental function) and sexuality represent two distinct environmental functions, but whic... more The mind (mental function) and sexuality represent two distinct environmental functions, but which are supported within the brain by a common (somatic-autonomic) neurobiological substrate. As a consequence, mental function takes on autonomic characteristics from the sexual-autonomic system (like autonomy, duality), while sexual function takes on features from mental functioning (such as lateralization). In this paper we discuss the lateralized action of two classes of sexual neuromodulators: hormones and pheromones. This process of lateralization is assimilated with the structural dichotomy of the mind. A relatively similar process but related to informational dichotomy of the mind will be presented in a forthcoming paper. Structural and informational dichotomies of the mind represent essential aspects that need clarification in order to continue the solving of the mind-body process, a work in progress articulated through a succession of papers.
International Journal of Environmental Research and Public Health, 2021
Domestic abuse of women is a serious problem worldwide that has economic, physical, and psycholog... more Domestic abuse of women is a serious problem worldwide that has economic, physical, and psychological consequences, yet in many countries and cultures, victims often have little access to psychological support. Using a pre-post design, we investigated the effects of psychological intervention using an imagery-based therapy in women showing post-traumatic stress disorder (PTSD) resulting from spousal domestic abuse. Forty women, referred from outpatient clinics in Pakistan and meeting inclusion criteria, underwent individual trauma counseling for 10–12 weeks using the principles of Eidetic Therapy, an imagery-based therapy that circumvents heavy reliance on verbal skills and narratives. Women showed significant reductions in PTSD by the end of treatment. Predictors of treatment gains included type of abuse, PTSD level at the outset of therapy, and years in the relationship. Neither economic resources or literacy, nor abuser or victim characteristics, predicted the amount of improveme...
Journal of Mind and Medical Sciences is designed as a free online, open access, interdisciplinary... more Journal of Mind and Medical Sciences is designed as a free online, open access, interdisciplinary and peer-reviewed journal. The JMMS mission is to address ideas and issues related to mind and medicine, publishing scientific review and empirical papers regarding mental and medical health and disease. Our goal is to stimulate constructive debates among scholars, researchers, physicians, scientists and health professionals with respect to the latest discoveries and trends in the field. The journal pays special attention to interdisciplinary and integrative perspectives, focusing primarily on papers approaching mind and body as a unitary domain of study.
Finasteride is currently approved and largely used as a therapeutic option for androgenetic alope... more Finasteride is currently approved and largely used as a therapeutic option for androgenetic alopecia. Apparently a safe drug and effective at the onset of its application, several concerns have since appeared over the years regarding the frequency and magnitude of finasteride adverse effects, which in some cases appear irreversible even after drug termination. This paper discusses the use of finasteride for androgenic alopecia from two distinct perspectives. On the one hand, androgenic alopecia is a condition that especially affects a person's self-image and esteem, aspects that are subjectively-constructed and thus relative and changeable. On the other hand, this condition involves a multifactorial etiology, with androgens being only partly responsible. Because androgens have important and unique physiological roles within the body, any procedure that results in androgenic suppression should be advised with caution. Furthermore, adverse effects induced by finasteride are neither fully documented nor easily treated. Finally, as alternative therapeutic approaches (such as topical finasteride) become available, the oral administration of finasteride for androgenic alopecia should, in our opinion, be reevaluated. Due to such concerns, a detailed and informed discussion should take place with patients considering therapy with finasteride for androgenic alopecia.
Premature ejaculation is the most prevalent form of male sexual dysfunction, but its cause has no... more Premature ejaculation is the most prevalent form of male sexual dysfunction, but its cause has not been well established. Recent studies have indicated that in men with premature ejaculation, penile sensitivity is increased. To investigate whether penile hypersensitivity is a cause of premature ejaculation, we prospectively evaluated the penile sensitivity of 18 patients with a lifelong history of premature ejaculation from the ®rst coital experience and 15 controls, both in the¯accid and erect state. We used an SMV-5 vibrometer (Suzuki-Matsuoka, Teknologue, Tokyo, Japan), which automatically controls stimulatory strength; its precision and reproducibility are thus higher than analogue-type biothesiometers. At the styloid process of the ulna and medial maleolus of the tibia, there was no signi®cant statistical difference in vibratory threshold between the two groups (P b 0.05). Also we did not ®nd signi®cant statistical differences in sensitivity of the glans penis, dorsum of the penile shaft, or frenulum of the penis between the two groups, in either the¯accid or erect state (P b 0.05). According to our results, penile hypersensitivity, as measured by an SMV-5 vibrometer, does not appear to be a major factor contributing to premature ejaculation.
The male refractory period (MRP) continues to be a topic of discussion and debate within the fiel... more The male refractory period (MRP) continues to be a topic of discussion and debate within the field of sexual medicine. To date explanations rely on central descending (efferent) influences involving specific neurotransmitter systems. Herein we explore the issue of the male refractory period, identifying problems with current explanations, specifying the parameters of an adequate model, and suggesting possible mechanisms mediating this phenomenon. • We review the literature regarding existing explanations for the MRP and look to other systems of physiological regulation that might provide a model for the conceptualization of the MRP. • Our approach differs from traditional explanations in that it emphasizes the possible roles of various peripheral, rather than central, feedback (afferent) systems that affect peripheral autonomic functioning and response. • Yet our approach is consistent with other peripheral regulatory feedback systems controlling autonomic response related to such processes as heart rate, respiration, and gut motility. • Although direct empirical research supporting our approach is lacking, sufficient evidence exists to support the idea that such processes are not only possible but likely with respect to the male refractory period. We suggest several lines of research that might provide empirical support for this approach.
For many men, the treatment of sexual dysfunctions such as premature ejaculation may well be most... more For many men, the treatment of sexual dysfunctions such as premature ejaculation may well be most effective when pharmacotherapy is combined with psychotherapy. Yet the essential elements of psychotherapy that might best be combined with pharmacological-based therapy are currently unknown. Support for evidence-based studies that identify key components of psychotherapy that might improve positive long-term outcomes, including patient satisfaction, are needed. Pharmaceutical companies having a vested interest in achieving both treatment adherence and improved patient outcomes could benefit from such information.
Clomipramine (25 mg) taken as needed increases ejaculatory latency in men with rapid ejaculation ... more Clomipramine (25 mg) taken as needed increases ejaculatory latency in men with rapid ejaculation (RE), although only about half the men treated respond to this regimen. It would therefore be clinically advantageous to know the patient's potential responsiveness to an 'as needed' regimen prior to treatment. The present study attempted to identify a priori factors that might enable prediction of patients' response or nonresponse to 'as needed' clomipramine. Variables relevant to rapid ejaculation were examined in 23 men with RE, 12 of whom had responded to clomipramine. Logistic regression indicated that three factors assessed prior to treatment-initial ejaculation latency, overall sexual satisfaction, and ejaculation frequency each week-significantly improved the prediction of responsiveness to this treatment regimen. Specifically, RE men with initial ejaculatory latencies over 60 s, self-reported sexual satisfaction of 5 or higher (on a seven-point scale), and ejaculation frequency of twice or more weekly were more likely to benefit from 25 mg 'as needed' clomipramine. As such, men meeting these criteria might be considered for this treatment regimen. Those not matching these characteristics might better be considered for 20 or 30 mg clomipramine given on a daily basis.
Inhibited ejaculation (IE) is a poorly understood male sexual dysfunction having both somatic and... more Inhibited ejaculation (IE) is a poorly understood male sexual dysfunction having both somatic and psychological etiologies. This study investigated sexual response in 25 IE men with no probable somatic cause. Using a standard psychophysiological assessment procedure, these men were compared with sexually functional and other dysfunctional groups on two measures of sexual response: erectile response and self-reported sexual arousal. Within the sample of IE men, sexual response was investigated as a function of both diagnostic classification and relationship factors. Differences occurred between IE men and the other groups on erectile response and self-reported sexual arousal during psychosexual stimulation in the lab, with IE men reporting lowest levels of sexual arousal. Within the IE group, diagnostic classifications and relationship variables were also related to self-reported sexual arousal. These findings suggest that inhibited arousal may be fairly common among IE men having no apparent somatic etiology, and further that several specific relationship factors may provide potential strategies for enhancing arousal in these men.
Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Sp... more Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE. Aim. Develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method. Review of the literature. Results. This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. Brief assessment procedures are delineated and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion. Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the 2947
This definition will hopefully lead to the development of new tools and patientreported outcome m... more This definition will hopefully lead to the development of new tools and patientreported outcome measures for diagnosing and assessing the efficacy of treatment interventions, and encourage ongoing research into the true prevalence of this disorder, and the efficacy of new pharmacological and psychological treatments.
International Journal of Environmental Research and Public Health, 2021
Groups marginalized and/or isolated by minority status—including transgender individuals—are at s... more Groups marginalized and/or isolated by minority status—including transgender individuals—are at significant risk for loneliness and diminished quality of life (QoL), effects that can be mitigated to some extent by coping styles. In this study, we examined the relationships among coping styles, loneliness, and QoL outcomes in a marginalized but understudied gender minority group, namely, 200 transgender individuals living in communities in an emerging/developing non-Western geo-cultural region of South-Central Asia (Pakistan), comparing them against a reference group of 100 heterosexual cisgender individuals. Results indicated strong relationships among coping styles, loneliness, and QoL in both transgender and cisgender groups. Moderating variable analysis revealed that coping skills—whether adaptive or maladaptive—help explain differences in loneliness and QoL not only between trans- and cis-gender individuals, but also within just the transgender group. The implications of these f...
Physiologically, the somatic nervous system intervenes in external interaction between the body a... more Physiologically, the somatic nervous system intervenes in external interaction between the body and environment, while autonomic nervous system ensures the functioning of internal organs. We present in this paper a psycho-physiological perspective suggesting that mental function (somatic in nature, because coordinates environmental interaction) is closer to and more aligned with the physiologic functioning of autonomic nervous system (due to autonomy, duality, etc.). At opposite end, sexual function (autonomic in nature, erection for example being a parasympathetic vasodilatory reflex) seems to be compatible and even dependent by a somatic participation (erectile response is rather induced by environmental stimuli than internal visceral stimuli). The perspective presented here is that the mind and sexuality are two distinct relational processes which, being related to the same environmental stimuli/ peripheral afferents, should be supported by a common (somatic-autonomic) neurobiolo...
Cognition and sexuality are two distinct relational functions that are partially interconnected t... more Cognition and sexuality are two distinct relational functions that are partially interconnected through our mind. Even though medical sciences have progressed substantially over the past decades, the current understanding of the mind psycho-physiology is yet at an early stage. As an example, the “mind-body problem” draws attention to the fact that fundamental aspects related to the understanding of the mind are still unresolved. Thus, it continues to be unclear how abstract ideas and thoughts (which are immaterial in nature, unfolding in an intangible realm) interface (and in some cases, interfere) with the more concrete brain and body (which are physical in nature), thus resulting in an abstract/conscious control of concrete/biological functions of the body; such is the case with processes involved in both cognition and sexuality. Beginning with this seminal paper we therefore intend to approach the psychophysiology of the mind as an essential element to the understanding of the tw...
As a 5-α reductase inhibitor, Finasteride has proven effective in ameliorating two conditions doc... more As a 5-α reductase inhibitor, Finasteride has proven effective in ameliorating two conditions documented to be androgen dependent, namely male androgenic alopecia and benign prostatic hyperplasia. Therapeutic results are maintained as long as the drug is administered, with treatment cessation generally leading to the return of symptomatology for each condition. In addition, during the therapeutic phase, several adverse effects have been reported, some of which persist long or indefinitely after treatment cessation, known as “post-finasteride syndrome.” Herein we present and discuss the most common finasteride side effects, along with a psycho-neuroendocrine rationale that could explain the persistence of many adverse effects after treatment cessation. Moreover, we argue that finasteride adverse effects occurring during finasteride administration should be delineated from postfinasteride side effects (encountered after treatment cessation), suggesting the need to be addressed separat...
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Papers by David Rowland