Bringing sex research into the 21st century: genetic and epigenetic approaches on female sexual function.

Behavioral genetic evidence offers a useful way to disentangle some of the multifactorial etiological pathways toward the now clearly multidimensional construct of female sexual dysfunction (FSD) and has already shown its potential in providing a better understanding of the heterogeneous factors underlying FSD. Understanding the genetic basis and therefore physiologic key mechanisms of sexual function and dysfunction has the potential for improved treatments (i.e., the development of new medication) and ultimately prevention. However, genetic epidemiologic research into FSD is scarce and highlights the need for more in-depth exploration using larger samples and more accurate phenotypes. Knowledge gained from genetic studies also highlights the importance of environmental factors and gene-environment interactions in disease development and maintenance. Exploration of DNA epigenetic patterns that regulate gene expression profiles could therefore provide the missing link between epigenomic state and FSD, and as such may offer a new biological framework for the multifactorial pathoetiology underlying FSD.

Historical revolutions in sex therapy: a critical examination of men's sexual dysfunctions and their treatment.

History, recent and ancient, presents innumerable methods intended to ensure or restore male sexual performance. Although these methods have regularly claimed to be "revolutionary," they have often been remarkably similar, and of questionably efficacy. This article provides a critical account of key historical trends in the treatment of male sexual dysfunctions in order to contextualize and critique the current treatment field. The author uses historical analysis to contextualize contemporary sex therapy techniques, arguing that even clinically verified contemporary revolutions, such as the advent of Viagra and similar drugs, may not present broadly efficacious standalone cures. Using critical historical analysis to illustrate the limitations of single-method treatments, the article argues for the value of comprehensive, biopsychosocial therapy methods. A common tendency--to seek a 'magic bullet' solution to sexual dysfunctions--is apparent throughout history, the author argues. While Viagra differs biomedically from historical treatments, it may appeal to the same logic, raising the question of whether it constitutes a truly revolutionary development in treatment. The article concludes with a set of recommendations regarding the implementation of biopsychosocial practice in sex therapy.

"It is caused of the womans part or of the mans part": the role of gender in the diagnosis and treatment of sexual dysfunction in early modern England.

Philip Barrough wrote in 1590 that barrenness 'is caused of the womans part or of the mans part'. By the eighteenth century, however, barrenness was perceived as a female disorder distinguished from male impotence. Few historians have addressed the uncertainty surrounding early modern definitions of infertility, choosing instead to adopt set terms that fit comfortably with modern ideas. This article will highlight the difficulties surrounding the gender distinction of the terms 'barrenness' and 'impotence' during this period. Moreover, the discussion will examine the role of gender in diagnosing these disorders to sufferers. The article will argue that ideas of gender were more central to diagnosis of poor sexual health than to effectual treatment. Although it appears that barrenness and impotence were treated with separate remedies, many treatments were described as effectual for both sexes. Additionally, the ingredients used in such recipes were often sexual stimulants explained without reference to gender.

Sigmund Freud and his impact on our understanding of male sexual dysfunction.

INTRODUCTION: Sigmund Freud was one of the most influential thinkers and theorists of the 20th century. His groundbreaking work laid the foundation to many concepts and theories relevant to modern sexual medicine. AIM: To evaluate Freud's approaches to the understanding of male sexual dysfunction both in their historical context and with respect to their significance for contemporary research and therapy of sexual problems. METHODS: After a brief biographical sketch, two of Freud's writings, the widely acclaimed "Three Essays on the Theory of Sexuality" from 1905, and a short article entitled "The Most Prevalent Form of Degradation in Erotic Life" from 1912, were analyzed, especially for their relevance to present treatment concepts of male sexual dysfunction. RESULTS: In Freud's clinical practice "psychical impotence" was a highly prevalent complaint. In his view, this dysfunction was caused by an inhibition due to an unresolved neurotic fixation leading to an arrest of the libidinal development. The result is a splitting of the tender and the sensual dimension of sexuality, most notably in the so-called madonna-whore complex. The degree of this dissociation (total or partial) determines the severity of the ensuing sexual dysfunction. In Freud's rather pessimistic view, the erotic life of civilized people tends to be characterized by some degree of this condition. CONCLUSIONS: While some of Freud's theories are obsolete today, many parts of his work appear to be astonishingly modern, even in the light of current neurobiological research and recent models of sexual dysfunction. Above all, Freud was an extremely gifted observer of human behavior who shows us that in many cases, sexual dysfunctions are no isolated phenomena, but have their roots in biographically based intrapsychic or interpersonal conflicts.

The historical response to female sexuality.

In the past, medical attitudes to female sexuality were grotesque, reflecting the anxiety and hypocrisy of the times. In the medieval world, the population feared hunger, the devil, and women, being particularly outraged and threatened by normal female sexuality. The 19th century attitude was no better as academics confirmed the lower intellectual status of women, particularly if they ventured into education. The medical contribution to this prejudice was shocking, with gynaecologists and psychiatrists leading the way designing operations for the cure of the apparently serious contemporary disorders of masturbation and nymphomania. The gynaecologist, Isaac Baker Brown (1811-1873), and the distinguished endocrinologist, Charles Brown-Séquard (1817-1894) advocated clitoridectomy to prevent the progression to masturbatory melancholia, paralysis, blindness and even death. Even after the public disgrace of Baker Brown in 1866-1867, the operation remained respectable and widely used in other parts of Europe. This medical contempt for normal female sexual development was reflected in public and literary attitudes. There is virtually no novel or opera in the last half of the 19th century where the heroine with "a past" survives to the end. The wheel has turned full circle and in the last 50 years new research into the sociology, psychology and physiology of sexuality has provided a greater understanding of decreased libido and inadequate sexual response in the form of hypoactive sexual desire disorder (HSDD). This is now regarded as a disorder worthy of treatment.

Testosterone therapy in women with gynecological and sexual disorders: a triumph of clinical endocrinology from 1938 to 2008.

INTRODUCTION: Although the term "medicalization" has been used by some to describe contemporary testosterone use in women with sexual disorders and testosterone deficiency syndrome, testosterone therapy for women with various gynecological and sexual disorders has been practiced since the late 1930s. AIM: The study aimed to perform a historical review of testosterone use in women with sexual and gynecological disorders. This review is necessary to bridge important knowledge gaps in the clinical use of testosterone in women with sexual health concerns and to provoke new thoughts and understanding of the multidisciplinary role of testosterone in women's overall health. METHODS: Review of medical literature on androgen therapy in women was carried out from 1938 through 2008. RESULTS: Approximately 70 years ago, clinicians from various disciplines relied on personal experience and clinical observations for outcome assessment of testosterone therapy in women. These early reports on testosterone use in women with sexual medical problems served as a foundation for the development of contemporary approaches and subsequent testosterone treatment regimens. Testosterone use was reported for sexual dysfunction, abnormal uterine bleeding, dysmenorrhea, menopausal symptoms, chronic mastitis and lactation, and benign and malignant tumors of the breast, uterus, and ovaries. CONCLUSIONS: Health-care professionals engaged in the management of women's health issues have observed the benefits of androgen therapy throughout much of the 20th century. Despite this clinical use of testosterone in women for more than seven decades, contemporary testosterone therapy in women is hotly debated, misunderstood, and often misrepresented in the medical community.

History of the International Society of Sexual Medicine (ISSM)--the beginnings.

INTRODUCTION: This is the first article in a series of articles outlining the history of what became the International Society for Sexual Medicine (ISSM). AIM: This first article deals with the beginning meetings of the group of world scientists who first met to discuss corpus cavernosal revascularization and other new ideas regarding the etiology and treatment for impotence (as it was known then) in New York City in 1978, and subsequently in Monaco in 1980. METHODS: Strict adherence to documented historical sources including books published from the meeting, published peer review literature where appropriate, programs from the actual meetings, detailed written notes by the authors taken at the time of the meetings, and letters of correspondence between key members of these meetings were used in preparing this historical review. The memories of the two authors, although still good in their opinion, did not serve as the source of the material that is presented. RESULTS: This first meeting was the impetus for the third meeting to be held 2 years later in Copenhagen, Denmark in 1982. This meeting and the subsequent meetings in 1984 and 1986 in Paris, France and Prague, Czechoslovakia, respectively, became the formative years for the budding society, which will serve as the time format for the authors' next article. CONCLUSIONS: This article outlines the discussions that occurred at these two meetings and presents a history of this early society that would eventually become the ISSM.

The birth of sexual medicine: Paolo Mantegazza as pioneer of sexual medicine in the 19th century.

INTRODUCTION: It is generally assumed that modern sexual medicine was founded by German psychiatrists and dermatologists. Fequently mentioned are, for example, Richard von Krafft-Ebing and Iwan Bloch. History of modern sexual medicine began, indeed, decades earlier so that nowadays we look back over 150 years-not 100 years-of research, praxis, and teaching. AIM; The goal of this report is an acknowledgement of the achievements of the Italian professor of pathology and anthropology, Paolo Mantegazza (1831-1910). METHODS: In several European countries, literary historical studies about the history of sexual science and sexual medicine have been conducted for over more than 30 years. RESULTS: It became evident that Paolo Mantegazza possesses already the whole width of modern sexual-medical activities, from laboratory experiments to cultural-critical and ethnological studies. Curiously enough, his books, translated in many languages, were almost completely forgotten after his death. CONCLUSIONS: Modern sexual medicine originates in the second half of the 19th century, decades before the studies of Albert Moll, Havelock Ellis, Sigmund Freud, Iwan Bloch, or Magnus Hirschfeld. But its present name was coined generally only three or four researcher generations later.

The birth and development of sexual medicine: reflections of my personal journey.

INTRODUCTION: The phrase "sexual medicine" has become commonplace, as there is now the International Society for Sexual Medicine, the British Society for Sexual Medicine, the European Academy for Sexual Medicine, and the Journal of Sexual Medicine. The historic origin of the phrase "sexual medicine" is somewhat obscure. AIM: The goal of this report is to provide my own individual journey as a physician to recall the use of the phrase "sexual medicine." METHODS: Literature review, personal historic recall. RESULTS: Gorm Wagner has identified an early publication/journal article [corrected] in the German language from 1908 that includes [corrected] "Sexualmedizin" in its title [corrected] Later journals between 1914 and 1933 are entitled "Sexualwissenschaft (Sexual Science)," but do not specifically use the term "Sexual Medicine" [corrected] I have no recollection of having heard the term "sexual medicine" before a meeting in 1970 on nonconsummation. I met Dr. Eric Trimmer, editor of "Medical News," who discussed with me the idea of introducing a new journal devoted to sexual issues. I suggested the title "British Journal of Sexual Medicine." The term "sexual medicine" was preferred because it encompassed both organic and psychological issues of sexual function and its problems. The British Journal of Sexual Medicine was published in 1973 to 1985. Other titles using Sexual Medicine appeared in other texts over the years. CONCLUSIONS: From my perspective, including a search of the literature in the English language published in or before 1970 that failed to find any reference to sexual medicine, I conclude that the phase "sexual medicine" was popularized in the 1970s.

On the way to a scientia sexualis: 'On the relation of the sexual system to the psyche in general and to cretinism in particular' (1826) by Joseph Häussler.

At the beginning of the nineteenth century, several works were published by physicians trying to explain, in an increasingly systematic manner, the emergence of psychic derangements with sexual disorders. A contribution to this development was provided by Joseph Häussler with his monograph 'On the relation of the sexual system to the psyche in general and to cretinism in particular' (1826). Häussler was interested in whether the sexual system was the cause of psychic disturbance. He accused some sexual behaviours and exercises (e.g., onanism and unsatisfied sexual instinct) of being causes, but, nonetheless, accepted that morphological deviations of the sexual organs could also evoke mental diseases. Furthermore Häussler attempted to determine if stimulation of the sexual system could cure psychic illnesses. Finally, he dealt with sexual conditions in the mentally ill. A complete chapter was devoted to cretins and their sexuality.