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Comprehensive Textbook of Sexual Medicine
Nilamadhab Kar, Gopal Chandra Kar
SECTION 1: BASICS OF SEXUALITY
1:
Anatomy of Sex Organs
INTRODUCTION
SEX ORGANS OF MALE
Penis
Male Urethra
Scrotum
Testis
Male Pelvic Genital Organs
Prostate
Ductus Deferens
Seminal Vesicles
Neuronal Stimulus for Performance of the Male Sexual Act
Male Sexual Responses
ANATOMY OF FEMALE SEX ORGANS
External Genitalia
Vagina
Uterus
Uterine Tubes
Ovary
Female Reproductive Process
ROLE OF BRAIN IN SEXUAL BEHAVIOUR
Neurotransmitters in Sexual Functions
CONCLUSION
2:
Physiology of Reproductive System
INTRODUCTION
SEX DIFFERENTIATION
PHYSIOLOGICAL CHANGES AT DIFFERENT STAGES
Puberty
Pubertal Changes in Boys
Spermatogenesis
Regulation of Spermatogenesis
Oogenesis
Pubertal Changes in Girls
MENSTRUAL CYCLE
Regulation of Menstrual Cycle
Premenstrual Syndrome
HUMAN SEXUAL RESPONSE
PREGNANCY
MENOPAUSE
Male Menopause
3:
Genetic and Endocrinal Factors in Sexual Development
INTRODUCTION
GENETIC ROLE IN SEXUAL DEVELOPMENT
STUDY OF CHROMOSOMES
Buccal Smear
Lymphocyte Culture
Fibroblast Culture
CLINICAL APPLICATION OF CHROMOSOMAL STUDY
Diagnosis of Genetic Sex: Sex Chromatin
ABNORMALITIES IN CHROMOSOME NUMBER
Monosomy
Trisomy
Mosaicism
Polyploidy
TURNER'S SYNDROME
Clinical Features
KLINEFELTER'S SYNDROME
STRUCTURAL CHROMOSOME ABNORMALITY
Deletion
Duplication
Inversion
Isochromosome
Translocations
49XXX / 50XXXX
True Hermaphroditism
Testicular Feminisation: (Androgen insensitivity)
ENDOCRINAL FACTORS IN SEXUAL DEVELOPMENT
Male Sex Differentiation
Female Sex Differentiation
ABNORMALITIES OF SEX DIFFERENTIATION
Female Pseudohermaphroditism
Male Pseudohermaphroditism
Congenital Adrenal Hyperplasia (CAH)
Features
Investigations
Management
PRENATAL SCREENING AND DIAGNOSIS OF FETAL ABNORMALITIES
Ultrasound
Maternal Blood Test
Amniocentesis
Indications
Procedure
Usual Complications
Foetal Blood Sampling
Indications
Chorionic Villus Sampling
Procedure
Biochemical Markers
Genetic Counseling
CONCLUSION
4:
Psychosexual Developmentand Human Sexuality
INTRODUCTION
PSYCHOSEXUAL DEVELOPMENT
ORAL STAGE
Erikson's Stages of the Life Cycle
Object Relations Theory
Psychopathology Linked to the Oral Phase
Character Traits Linked to the Oral Phase
ANAL STAGE
Erikson's Stages of the Life Cycle
Object Relations Theory
Psychopathology Linked to the Anal Phase
Character Traits Linked to the Anal Phase
URETHRAL STAGE
Object Relations Theory
Psychopathology Linked to the Urethral Phase
Character Traits Linked to the Urethral Phase
PHALLIC STAGE
Oedipus Complex
Resolution in Males
Negative Oedipus Complex
Resolution in Females
Erikson's Stages of the Life Cycle
Object Relations Theory
Psychopathology Linked to the Phallic Phase
Character Traits Linked to the Phallic Phase
LATENCY STAGE
Erikson's Stages of the Life Cycle
Object Relations Theory
Psychopathology Linked to the Latency Phase
Character Traits Linked to the Latency Phase
GENITAL STAGE
Erikson's Stages of the Life Cycle
Object Relations Theory
Psychopathology Linked to the Genital Phase
Character Traits Linked to the Genital Phase
PARAPHILIAS AND NEUROSES
SEXUAL PREFERENCE
EVIDENCE
CONCLUSION
5:
Beauty of the Human Body: Its Meaning and Purpose
6:
Sexual Response Cycle and its Determinants
INTRODUCTION
DIFFERENT PHASES OF SEXUAL RESPONSE
Appetitive Phase
Biological Determinants
Disorders Associated with this Phase
EXCITEMENT PHASE
Response in Males
Response in Females
Biological Determinants
Disorders Associated with this Phase
PLATEAU PHASE
Response in Males
Response in Females
ORGASMIC PHASE
Response in Males
Response in Females
Multiple Orgasms
Biological Determinants
Disorders Associated with this Phase
RESOLUTION PHASE
Response in Males
Response in Females
Refractory Period
Disorders Associated with this Phase
FACTORS INFLUENCING THE SEXUAL RESPONSE CYCLE
CONCLUSION
SECTION 2: SEXUAL PRACTICES
7:
Child and Adolescent Sexual Behaviour
INTRODUCTION
SEXUAL DEVELOPMENT
CHILD AND ADOLESCENT RELATIONSHIP ISSUES
MASTURBATION
SEXUAL IDENTITY
Gender
MEDIA
HIV-AIDS
CHILD SEXUAL EXPLOITATION
Teen Pregnancy and Contraception
CONCLUSION
Sexuality Education
8:
Understanding Love
INTRODUCTION
What is Love?
Love versus Mere Liking
Real Love and “In -Love” Experience/Falling in Love
Love and Addiction
LOVE STYLES
Love in the Attachment Framework
Love as a Basic Emotion
Gender and Romantic Attitudes
COMPONENTS OF LOVE
Intimacy, Passion and Commitment
Intimacy as an Interpersonal Process
Dimensions of Marital Commitment
Investment Model
Positive Illusion in Romantic Relationships
Giving and Receiving of Love
FEATURES OF AN IDEAL CASE OF LOVE
BARRIERS TO LOVE
Problems in Communication of Love
CONCLUSION
9:
Couple Relationship and Sexuality
INTRODUCTION
RELATIONSHIP MAPS
Understanding
Intimacy
Cohesion
Trust
Affection
Role Functioning
Communication
Relationship Power
NEW CHALLENGES FOR COUPLES' SEXUALITY
Sexual Abuse
Violence and Affairs
Suspicion
Gay/Lesbian Couples
CONCLUSIONS
10:
Sexual Methods
INTRODUCTION
EROTIC DREAMS AND SEXUAL FANTASY
Functions of Dreams and Fantasies
MASTURBATION
Techniques of Masturbation
Male
Female
SHARED TOUCHING
Types of Touch
Kissing
Touching
Manual Stimulation of Genitals
Manual Stimulation of Female Genitals
Manual Stimulation of Male Genitals
Other Sexual Stimulations
ORAL—GENITAL SEXUAL ACTS
Cunnilingus
Fellatio
GENITAL-ANAL SEXUAL ACTS
GENITAL—GENITAL (SEXUAL INTERCOURSE) POSITIONS
Man-on-Top Position
Coital Alignment Technique (CAT)
Woman-on-top Positions
Side-to-Side Positions
Rear Entry Positions
Sitting and Standing Positions
Other Varieties
Femoral Sex
AFTER PLAY
CONCLUSION
11:
Sexuality in the Kama Sutra of Vatsyayana
INTRODUCTION
CLASSES OF HUMAN BEINGS
For Replay
Embraces, 4 kinds
Kissing
TECHNIQUES OF COITUS
Normal Position
Woman on Top or Astride Position
Side by Side Position
Sitting and Standing Positions
Rear Entry Positions
Attitudes of Flexion
Extended Attitudes
Mare's Position
Genital Oral Positions
CONCLUSIONS
12:
Cultural Variations in Sexual Practices
INTRODUCTION
MORALITY AND SEX
SEXUAL KNOWLEDGE
Sex Education
CULTURAL SENSITIVITY TO SEXUALITY
SEXUALITY AND MARRIAGE
Being Single
Living Together
Single Parenthood
Sexuality in Later Life: Second Honeymoons and Marriages
Child Marriages
Teenage Sexual Activity
SEX AND REPRODUCTION
Contraception and Termination
LEGAL ISSUES
Age of Consent
Sexual Abuse of Partners
Sexual Harassment
SEX INDUSTRY
VARIATIONS OF SEXUAL BEHAVIOURS AND PREFERENCES
Homosexuality
Sexual Preferences
CULTURE SPECIFIC SEXUAL PHENOMENA
Dhat Syndrome
Koro
Hijras of India
Sex as a Cure
Marriage to Spirits
CONCLUSION
SECTION 3: SEXUAL DYSFUNCTIONS
13:
Sexual Dysfunctions in Males
INTRODUCTION
SEXUAL DESIRE DISORDERS
Hypoactive Sexual Desire Disorder
SEXUAL AVERSION DISORDER
SEXUAL AROUSAL DISORDERS
Erectile Disorders
Aetiology
Assessment
Pharmacotherapy
Surgical Intervention
Psychosexual Psychotherapies
ORGASMIC DISORDERS
Male Orgasmic Disorder
Aetiology
Treatment
Premature Ejaculation
Treatment
Pharmacotherapy
Psychosexual Intervention
SEXUAL PAIN DISORDERS
Dyspareunia
Excessive Sexual Desire
SEXUAL DYSFUNCTION DUE TO GENERAL MEDICAL CONDITION
SUBSTANCE-RELATED SEXUAL DYSFUNCTION
Sexual Dysfunction due to Dependence Causing Substances
Iatrogenic Sexual Dysfunction
PRIAPISM
SEXUAL DYSFUNCTION IN PSYCHIATRIC DISORDERS
CONCLUSION
14:
Sexual Dysfunction in Females
INTRODUCTION
CLASSIFICATION
DISORDERS OF SEXUAL DESIRE
Aetiology
Physiological Causes
Management
DISORDERS OF AROUSAL
Aetiology
Vasculogenic
Neurogenic
Endocrine Factors
Systemic Diseases
Drugs
Psychosocial and other Factors
Management
ORGASMIC DISORDERS
Aetiology
Organic Factors
Psychosocial Factors
Specific Developmental Factors
Interpersonal Factors
Management
SEXUAL PAIN DISORDERS
DYSPAREUNIA
Aetiology
Psychological Factors
Management
VAGINISMUS
Aetiology
Diagnosis
Management
CONCLUSIONS
15:
Sexual Addiction
INTRODUCTION
DIAGNOSIS
Screening Tests
Comparison with Drug/ Chemical Dependency
TYPES OF SEXUAL BEHAVIOUR SEEN IN SEXUAL ADDICTION
Coaddiction
Comorbidity
Family History
MANAGEMENT
Self-help Groups
Psychotherapy
Pharmacotherapy
CONCLUSION
SECTION 4: SEXUAL DISORDERS
16:
Disorders Associated with Sexual Development and Orientation
INTRODUCTION
PREVALENCE
ETIOLOGY
Biological Factors
Genetic Factors
Hormonal Studies
Neuroanatomical Studies
Familial and Social Factors
Psychological Factors
CLINICAL FEATURES
Sexual Maturation Disorder
Egodystonic Sexual Orientation
Sexual Relationship Disorder
Differential Diagnoses
Course
MANAGEMENT
CONCLUSION
17:
Gender Identity Disorders
INTRODUCTION
Terminology
EPIDEMIOLOGY
CLINICAL FEATURES AND DIAGNOSIS
Differential Diagnosis
AETIOLOGY
TREATMENT
Course and Prognosis
CONCLUSION
18:
Disorders of Sexual Preference
INTRODUCTION
Epidemiology
INDIVIDUAL PARAPHILIAS
Fetishism
Patterns of Fetishism
Legal Aspects
TRANSVESTISM (EONISM)
Types of Transvestism
Legal Aspect
EXHIBITIONISM
Types of Exhibition
Legal Aspects
PEDOPHILIA
Types of Pedophilia
Victims
Long-term Effects
Autonepiophilia or Infantism
FROTTEURISM
SADISM
Lust Murder
Legal Aspect
MASOCHISM
Types of Masochism
Compulsive Neurotic Masochist
Psychopathic Masochist
Female Masochist
Legal Aspect
VOYEURISM
Telephone Scatologia
Undinism
Mizoscopia
Troilism
Legal Aspect
ZOOPHILIA
NECROPHILIA
NECROPHAGIA
MASTURBATION
HYPOXYPHILIA
COPROPHILIA
KLISMAPHILIA
MYSOPHILIA
HYBRISTOPHILIA
GERONTOPHILIA
FORMICOPHILIA
INFUNDIBULATION
NARRATOPHILIA
PORNOGRAPHOMANIA
EROTOGRAPHOMANIA
COPROLALIA
PYGMALIONISM
ECOUTEURISM OR ECOUTAGE
SEXUAL PYROMANIA
CISVESTISM
BIASTOPHILIA
OTHER PARAPHILIAS
AETIOLOGY OF PARAPHILIAS
Psychoanalytic Theories
Behavioral Theories
Cognitive Behavioral Theories
The Abused-abuser Hypothesis
Biological Factors
Comprehensive Theories
MANAGEMENT
General Considerations
ASSESSMENT
Patterns of Sexual Arousal
Subjective Report
Behavioral Observations
Psychophysiological Indexes
Assessment of Heterosocial Skills
Assessment of Heterosexual Skills
Social Functioning
Cognitive distortions
PSYCHOLOGICAL TREATMENT
Elimination of Deviant Sexual Arousal: Aversion Therapy
Types of Aversive Therapy Used
Faradic Aversion
Olfactory Aversion
Shame Aversion
Covert Sensitization
Increasing Heterosexual Arousal
Masturbatory Reconditioning
Directed Masturbation
Satiation Therapy
Relapse Prevention
Treatment Approaches
PHARMACOTHERAPY
Specific Serotonin Reuptake Inhibitors (SSRIs)
Antiandrogens
Hormonal Agents
CONCLUSION
19:
Homosexuality
INTRODUCTION
Definition and Concept
Ego-dystonic and Ego-syntonic Homosexuality
Incidence and Prevalence
ETIOLOGICAL THEORIES
Biological Theories of Homosexuality
Psychoanalytic Theories of Homosexuality
Neo-Freudian View of Homosexuality
Social Learning Theories
TREATMENT
Reconstructive Therapy
Cognitive Behaviour Therapy
Phase I
Phase II
Phase III
Phase IV
Other Interventions
Journaling
Emotional Tracing
Defragmentation
Spiritual Intervention
OTHER ISSUES
Religion and Homosexuality
Violence and Homosexuality
Legal status of Homosexuality
CONCLUSION
SECTION 5: SEXUAL PROBLEMS IN SPECIFIC POPULATIONS
20:
Sexual Disorders in the Elderly
INTRODUCTION
NORMAL SEXUALITY IN THE ELDERLY
PHYSIOLOGICAL CHANGES WITH AGING IN MEN
PHYSIOLOGICAL CHANGES IN THE FEMALE
PHYSICAL ILLNESSES IN THE ELDERLY
DISORDERS IN THE ELDERLY
CONCLUSION
21:
Sexual Problems in Physical Disorders
INTRODUCTION
Diagnostic Criteria for Sexual Dysfunction due to a General Medical Condition1
ERECTILE DYSFUNCTION DUE TO GENERAL MEDICAL CONDITION
MEDICAL CONDITIONS IMPLICATED IN ERECTILE DYSFUNCTION18
CLINICAL ASSESSMENT
Laboratory Test
Cavernosometry
Endocrinologic Tests
TREATMENT
Treatment Unrelated to Cause of Impotence
Intracavernous Penile Self-injection Therapy
Peyronie's Disease
Congenital Penile Curvature
Penile Revascularisation
Penile Prosthesis
Suction Devices
Dyspareunia due to a General Medical Condition
Hypoactive Sexual Desire Disorder due to a General Medical Condition
Orgasmic Disorder
Female Orgasmic Disorder
CONCLUSION
22:
Sexual Dysfunctions in Psychiatric Disorders
INTRODUCTION
Neurobiological Basis of Sexual Behaviour
Mechanism of Sexual Dysfunction in Psychiatric Disorder
Psychiatric Illnesses Associated with Sexual Dysfunctions
Primary psychiatric disorders
Developmental delays and disorders
Substance related disorders
Neuropsychiatric disorders
Schizophrenia
Acute versus Chronic Schizophrenia
Sexual Contents in Psychosis
Depressive Disorders
Mania
Anxiety Disorders
Somatoform Disorders
Eating Disorders
Personality Disorders
Mental Retardation
Substance Related Disorder
Alcohol
Opioids
Cannabis
Cocaine
Sedative, Hypnotic and Anxiolytics
Amphetamine and other CNS Stimulants
Neuropsychiatric Syndromes
Epilepsy
Dementia
Other Neuropsychiatric Syndromes
MANAGEMENT ISSUES
CONCLUSION
SECTION 6: EVALUATION AND MANAGEMENT
23:
Evaluation of Sexual Problems
INTRODUCTION
CONCERNS DURING SEXUAL HISTORY TAKING
Concerns of Patients
Concerns of Clinicians
SEXUAL HISTORY TAKING
Specific Questions
Current Sexual History
Early Sexual History
History of Physical Conditions and Medications
Physical Examination
Investigations
Frequent Complaints in Sexual Clinics
Desire
Arousal
Orgasm
Penetration
Satisfaction
Questionnaires for Evaluation of Sexual Dysfunctions
CONCLUSIONS
24:
Evaluation of Erectile Dysfunction
INTRODUCTION
SURGICAL EVALUATION OF ERECTILE DYSFUNCTION
NEUROLOGICAL EVALUATION
Biothesiometry
Sacral Evoked Response (SER)– Bulbocavernous Reflex Latency (BCR)
Dorsal Nerve Conduction Velocity
Genito-cerebral Evoked Potential Studies
AUTONOMIC NERVOUS SYSTEM
Heart Rate Variability and Blood Pressure Response
Normal Parameters
Sympathetic Skin Response
Smooth Muscle EMG
SPACE (Single Potential Analysis of Cavernous Electrical Activity)
VASCULAR EVALUATION
Arteriogenic Dysfunction
Penile Brachial Index (PBI)
Penile Plethysmography (Penile Pulse Volume Recording)
Combined Intracavernosal Injection (ICI) and Stimulation Test
Duplex Sonography
Doppler Ultrasound
Examination of Penile Arteries
Localization of Vessels
Criterion for Normative Study
Penile Blood Flow Velocity
Percent Arterial Dilatation
Blood Flow Acceleration
Cavernosal Arterial Occlusion Pressure (CASOP)
Radio Isotope Penography and Magnetic Resonance Imaging
Arteriography
VENOOCCLUSIVE DYSFUNCTION
Combined Intracavernous Injection and Stimulation Test (CIS)
Duplex Ultrasound
Cavernosometry and Cavernosography
Method
CONCLUSION
25:
Comprehensive Sexuality Education
INTRODUCTION
Terminology
Youth the World Over Face Common Challenges
The Need for Comprehensive Sexuality Education
Will Sexuality Education Encourage Experimentation?
Content of Sexuality Education Programmes
Abstinence only or Abstinence Plus?
Successful Approaches to Sexuality Education
The Dutch Approach
The Swedish Approach
Peer Education Approach
Youth Information Centres
Health Melas and Camps
Gaining Support for Programmes
CONCLUSION
26:
Psychological Management of Sexual Dysfunctions
INTRODUCTION
SPECIFIC PSYCHOLOGICAL INTERVENTIONS
Sex Counseling
COUPLE SEX THERAPY (SENSATE FOCUS STAGES)
The Stages
Stage One
Stage Two
Stage Three
Stage Four
Stage Five
Stage Six
STOP-START TECHNIQUE
SQUEEZE TECHNIQUE
TREATMENT OF SPECIFIC CONDITIONS
Inhibited Sexual Desire
Ejaculatory Failure
Female Orgasmic Dysfunction
Vaginismus
CONCLUSION
27:
Pharmacological Treatment of Psychosexual Disorders
INTRODUCTION
PHARMACOTHERAPY OF MALE SEXUAL DISORDERS
Pharmacotherapy of Erectile Dysfunction
Self-Injection Therapy
Oral Medications
Inhibitors of Phosphodiesterase-5 (PDE5)
Sildenafil Citrate
Doses and Administration
Precautions
Adverse Events
Newer PDE5 Inhibitors
Tadalafil
Vardenafil
Efficacy of PDE5 Inhibitors
Other Oral Agents
Yohimbine
Phentolamine
Apomorphine
Trazadone
Transdermal and Transurethral Medication
Hormone Replacement Therapy for Erectile Dysfunction
Pharmacotherapy for Premature Ejaculation
Pharmacotherapy for Hypoactive Sexual Desire Disorders
Pharmacotherapy for Hyperactive Sexual Desire Disorders
PHARMACOTHERAPY FOR FEMALE SEXUAL DISORDERS
Pharmacotherapy for Desire Disorders in Females
Hormones
Sildenafil
CONCLUSION
28:
Surgical Interventions for Erectile Dysfunction
INTRODUCTION
VASCULAR SURGERY
Causes
Investigations
Tests for Diagnosing Vasculogenic Impotence
Arterial tests
Venous tests
Therapy for Vasculogenic Impotence
PENILE REVASCULARISATION
Summary
PENILE PROSTHESIS
Indications
Historical Note
Types of Prosthesis
Non-Inflatable Prosthesis
Inflatable Penile Prosthesis
Indian Penile Prosthesis
Preoperative Preparation
Operative Technique
Complications
Results
Summary
VACUUM ERECTION DEVICES
Procedure
29:
Gender Reassignment Surgery
INTRODUCTION
ETIOLOGY AND DIFFERENTIAL DIAGNOSIS
MANAGEMENT OF GENDER DYSPHORIA
Hormone Replacement Therapy
Female to Male
Male to Female
Gender Reassignment Surgery Female to Male
Gender Reassignment Surgery Male to Female
Moral and Legal Issues
CONCLUSION
SECTION 7: RELATED MEDICAL TOPICS
30:
Infertility
INTRODUCTION
General Factors that Affect Fertility
Requirements for Normal Fertility
CAUSES FOR INFERTILITY
Causes for Infertility in the Male
Varicocele
Anatomical Abnormalities
Endocrine Disorders
Causes for Infertility in the Female
Ovulatory Factors
Tubal/Peritoneal Factors
Uterine Factors
Immunologic Causes
Cervical Factors
Unexplained Infertility
DIAGNOSIS
History and Examination
Investigations in Males
Investigations in the Female
Transvaginal Sonography
Tests for Tubal Factors
Tests for Peritoneal Factors
Tests for Cervical Factors
Immunological Investigations
TREATMENT
Treatment of Male Infertility
Treatment of Female Infertility
Ovulatory dysfunction
Tubal and Peritoneal Factors
Cervical Factor
Uterine Factor
Unexplained Infertility
Assisted Reproductive Techniques (ART)
31:
Contraception
INTRODUCTION
Contraceptive Methods
THE TEMPORARY METHODS
Natural Methods of Contraception
Barrier Contraceptives
Physical Methods
Chemical Methods
Intrauterine Contraceptive Devices (IUCD/IUD)
Contraindications for IUD
Oral Contraceptive
Non-oral Hormonal Contraceptives
Emergency Contraception
PERMANENT METHODS
Male Sterilization
Vasectomy
Sperm Test following Operation
Female Sterilization
Tubal Ligation
Tubal Occlusion
Failure Rates of Various Contraceptive Methods
CONCLUSION
32:
Sexually Transmitted Diseases
INTRODUCTION
SYPHILIS
Transmission
Pathogenesis
Classification
Congenital syphilis
Acquired syphilis
Clinical Stages of Syphilis
Primary Stage
Secondary Stage
Tertiary Stage
Diagnosis
Treatment
CHANCROID
Clinical Features
Diagnosis
Treatment
LYMPHOGRANULOMA VENEREUM (LGV)
Pathogenesis
Clinical Features
Primary Stage
Secondary Stage
Late Stage
Anorectal Syndrome
Genital Elephantiasis
Diagnosis
Treatment
Medicinal Treatment
Surgical Treatment
GENITAL HERPES
Clinical Findings
Primary Infection
Recurrent Infection
Diagnosis
Treatment
GONORRHOEA
Pathology and Pathogenesis
Clinical Features
Gonorrhoea in the Male
Gonorrhoea in the Female
Complications of Gonococcal Urethritis
Diagnosis
Treatment
Granuloma Inguinale (Granuloma Venerum, Donovanosis)
Clinical Features
Diagnosis
Treatment
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Causative Agent
Immunopathology
Modes of Transmission
Clinical Manifestations
Center for Disease Control (CDC) Classification of HIV Infection3
Acute Infection
Asymptomatic Stage (CD4 count more than 500/cmm)
Persistent Generalised Lymphadenopathy (PGL)
AIDS—Related Complex (ARC)
Investigations
Treatment
Drugs used in the Treatment
Counselling
Psychological Impact of Seroconversion
Who could be a counsellor?
Pre-Test Counselling
Post-Test Counselling
Negative and Indeterminate Result
Positive Result
CONCLUSION
SECTION 8: SEXUAL ABUSE
33:
Childhood Sexual Abuse
INTRODUCTION
Definition and Concept
EPIDEMIOLOGY
Indian Scene
ETIOLOGY
SEXUAL OFFENDERS/ABUSERS
Characteristics
Psychopathology
Predisposing Factors
PSYCHOPATHOLOGY/PSYCHOLOGICAL CONSEQUENCES
Risk Factors
Childhood Outcome
Adult/Long-term Outcome
Indian Scene
PHYSICAL CONSEQUENCES(SEXUALLY TRANSMITTED DISEASES)
ARRIVING AT A DIAGNOSIS
Interview Techniques
Associated Psychological Aids
Mental Status Examination (MSE)
Physical Examination
TREATMENT
Types of Treatment
Approach of the Family
OUTCOME STUDIES
Associated Issues
Indian Scene
CONCLUSIONS
34:
Adult Sexual Abuse
INTRODUCTION
RAPE
Myths and Misconceptions about Rape
Rape Patterns
EMOTIONAL REACTIONS TO RAPE
Acute Phase: Disorganization
Long Term Process: Reorganization
Medical Attention
Psychological Consequences in Male Partner of the Victim
PSYCHOLOGICAL INTERVENTION
An Overview of the Information Needed
SPECIFIC PSYCHOTHERAPIES
Cognitive Behavioral Therapy
Cognitive Therapy
Relaxation Therapy
Rational-Emotive Therapy
Group Therapy
Supportive Psychotherapy
Family or Couple Therapy
Existential Therapy
Humanistic Therapy
Psychodynamic Therapy
Hypnosis
Management of Marital Rape
SEXUAL HARASSMENT AT WORK
Forms of Presentation
Legal Definition of Sexual Harassment
Management of Victims of Sexual Harassment
Management of Perpetrators of Sexual Abuse
Prevention of Sexual Abuse
CONCLUSION
SECTION 9: SOCIO-CULTURAL ISSUES RELEVANT TO SEXUALITY
35:
Common Sexual Misconceptions and their Management
INTRODUCTION
How Misconceptions Develop
FEW EXAMPLES OF MISCONCEPTIONS
Misconceptions about Anatomy and Physiology
Penis related Misconceptions
Misconceptions about Sexual Functioning
Misconceptions about Semen (Dhat)
Misconceptions about Masturbation
Misconceptions about Contraception and Pregnancy
Misconceptions about Infertility
Myths about the causes of Impotence
Misconceptions regarding Child Sexual Abuse
Miscellaneous
EFFECT OF MISCONCEPTIONS
MANAGEMENT
CONCLUSION
36:
Contemporary Media and Human Sexuality
INTRODUCTION
Gender-Role Construction by the Media and Societal Forces
NUDITY AND THE ‘BRAVE NEW WORLD’
MARKET DRIVEN ORGASM
‘HUM DO HAMARE DO’
‘THEY CALL US DYKES IN USA’
‘MORE LIGHT’
‘ITS ALL IN THE PILL’
‘BEING MODERN IS BEING SEX POSITIVE’
‘THE TAIL WAGS THE DOG’
CONCLUSIONS
37:
Gender Related Issues in Community Life
INTRODUCTION
Historical Growth
GENDER CONCEPT
Culturalistic View
Role
DIFFERENTIAL SOCIALIZATION
GENDER DISCRIMINATION
Discrimination at Developmental Period
Marriage
Motherhood (Parenthood)
Health
Body Image
Morality
Work
Politics
State
Male Discrimination
CONCLUSION
SECTION 10: LEGAL ASPECTS
38:
Medicolegal Aspects of Sexual Offences
INTRODUCTION
MEDICOLEGAL EXAMINATION OF A VICTIM OF SEXUAL OFFENCE
Preliminary Requirements
Consent
MEDICAL HISTORY
General Medical History
Sexual History
Marital and Obstetric History
History of the Incident
MEDICAL EXAMINATION
General Examination
Injuries
Local Examination
Local Physical Examination
Vulva
Hymen
Vagina
EVALUATION OF VICTIMS IN UNNATURAL SEXUAL OFFENCES
Sodomy
Tribadism
Bestiality
Buccal Coitus
SPECIAL CIRCUMSTANCES
False Charges
Victim below the Age of 16
Male Rape
MEDICOLEGAL EXAMINATION OF THE ACCUSED OF SEXUAL OFFENCE
Preliminary Particulars
EXAMINATION
Local Examination
COLLECTION OF EVIDENCE
General Principle
Procedure for Collection of Evidences
Clothings
Droppings
Stains, Smear and Attached Foreign Particles
Nail Scraping
Hairs
Blood
Urine
Saliva
Saliva from Bite Mark
Genital and Anal Swabs
Semen
39:
Legal Issues in Sexual Medicine
INTRODUCTION
SEXUAL OFFENCES
OFFENCES RELATING TO PERSON AND MENTAL ORDER
Section 304B IPC—Dowry Death
Section 354 IPC—Outrage of Modesty
Section 509 IPC—Insulting the Modesty of a Woman
Section 366 IPC—Kidnapping
Section 366A IPC—Kidnapping of Minor Girl
Section 366B IPC—Kidnapping
Section 367 IPC—Kidnapping
Section 370 IPC—Buying and Selling of Persons
Buying Girls for Marriage
Section 372 IPC—Prostitution
Explanation I
Explanation II
Adoption of Daughter by Dancing Girl
Devadasi
Section 373 IPC—Prostitution
Explanation I
Explanation II
Section 375 IPC—Rape
Rape
Exception: Rape by Husband
Section 376 IPC—Punishment for Rape
Section 376A IPC—Sexual Intercourse with Own Wife without her Consent
Section 376B IPC—Sexual Seduction taking Advantage of Official Position
Section 376C IPC—Sexual Seduction Taking Advantage of Official Position
Section 376D IPC—Sexual Seduction Taking Advantage of Official Position in Hospital
Explanation I
Explanation II
Explanation III
Determinants of Medical Inferences
Genital Injuries
Signs of Struggle
Semen in Vagina
Seminal Staining on Clothes
Bloodstains
Veneral Disease
Evidence in the Male Organs
Impotency
Age, Insanity and Intoxication
False Charges
Section 493 IPC—Concubine
Section 494 IPC—Bigamy—Marrying Again during Lifetime of Husband or Wife
Exception
Section 495 IPC—Concealment of Former Marriage
Section 497 IPC—Adultery
Comment
Ingredients
Connivance
Section 366 IPC and 498 IPC—Elopement with an Adult Unmarried Woman
Wife Cannot be Punished as Abettor
Section 498A IPC—Cruelty and Harassment to Married Woman
Explanation
Section 496 IPC—Fraudulent Marriage
Ingredients
Sections 493 IPC and 496 IPC— Deception; and fraudulent abuse of the marriage
Sections 494 IPC and 496 IPC—Fraudulent marriage
OFFENCES RELATED TO PUBLIC TRANQUILITY
Section 294 IPC —Obscene Behaviour in Public
Section 354 IPC—Indecent assault
Sexual Harassment
OFFENCES RELATING TO PUBLIC SERVANTS
UNNATURAL OFFENCES
Section 377 IPC—Intercourse Against the Order of Nature
OTHER LEGAL ISSUES RELEVANT TO PRACTICE
Consent
Examination of a Female Client
Section 53 CrPC Sub-Sec 2
Report on Potency
Explanation
Indications
Rules
Potency Certification
Child Sexual Abuse
The Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act 1994
Miscellaneous/ Anomalous Sexual Behaviours
Internet and Pornography
CONCLUSIONS
REFERENCES
APPENDIX - I
APPENDIX - II
APPENDIX - III
APPENDIX - IV
APPENDIX - V
APPENDIX—VI
SECTION 11: OTHER RELATED TOPICS
40:
Sexuality and Psychopathology
INTRODUCTION
SEXUAL CONTENT IN PSYCHOPATHOLOGY
Abnormal Sexual Behavior
Celibacy, Sexual Apathy, Libidinal Impotence, Anhedonia and Related Concepts
Hypersexuality, Pansexuality Sexual Promiscuity and Sexual “Acting out”
Autoeroticism, Masturbation and Autocastration
Overt Homosexual Behavior, Mutual Masturbation
Fornication, Seduction, Cohabitation, Adultery and Prostitution
Incest
Rape
Sexuality in Abnormalities of Thinking
Preoccupation with Heterosexual Matters
Incestuous Thoughts and Impulses
Homosexual Wishes and Fears
Ideas of Reference
Delusions of Sexual Metamorphosis
Delusions of Change of Size/Shape of Genitals
Delusions of being Sexually Persecuted
Delusions Concerning Sexual Conduct of Others
Delusions about One's Own Sexual Conduct
Delusional ‘Sexualization’ of Body Parts
Delusions of Pregnancy
Hysterical Pseudocyesis
Obsessions with Sexual Content
Abnormal Sexual Perceptions
Auditory Hallucinations
Visual Hallucinations
Olfactory Hallucinations
Genital Hallucinosis
Somatic Passivity
SEXUALITY AS CAUSE OF PSYCHOPATHOLOGY
Oedipal Complex and the “Neurotic” Disorders
Psychopathology Following Abnormal Sexual Experiences
Psychopathology Associated with Rape
Psychopathology following Sexual Harassment
SYNDROMES WITH SEXUALITY RELATED PSYCHOPATHOLOGY AS THE PROMINENT SYMPTOM
Koro
Dhat Syndrome
Syndromes of Love and ‘Madness’
De Clerambault's Syndrome: (Erotomania; phantom lover syndrome)
Othello Syndrome (Delusional Jealousy, Sexual Jealousy, Pathological Jealousy or Erotic Jealousy)
Nymphomania
Satyriasis (Don Juanism)
CONCLUSION
41:
Research on Clinical Sexuality in India
INTRODUCTION
Methodology
STUDIES ON PREVALENCE OF SEXUAL PROBLEMS
Sexual Problems in Males
Sexual Problems in Females
Sexual Problems in Couples
Sexual Problems with Infertility
Child Sexual Abuse
SPECIFIC SEXUAL DISORDERS
Erectile Dysfunctions
Homosexuality
Gender Identity Disorder
Eunuch/Transvestite (Hijras)
Dhat Syndrome
Koro
Sexual Addiction Syndrome and Paraphilias
Genital Self Mutilation
Comorbidities and Sexual Problems Associated with other Psychiatric Disorders
Sexual Dysfunction Secondary to Organic Causes
DEVELOPMENT OF INSTRUMENTS
STUDIES ON TREATMENT
Premature Ejaculation and Erectile Dysfunction
Homosexuality
Managemnt Issues: Other Disorders
Dhat Syndrome
Koro
Transsexualism
Masturbatory Guilt
Compulsive Masturbation
Heterosexual Communication Disturbances
Miscellaneous Topics
REVIEWS
CONCLUSION
42:
History of Sexual Medicine
INTRODUCTION
HISTORY OF SEXUAL MEDICINE AS IT UNFOLDS
Indian Subcontinent
Elsewhere in the World
Recent History from India
CONCLUSION
INDEX
TOC
Index
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