Mental sexual disorders

Mental sexual disorders are most numerous, associated with neurodynamic disorders of formed or forming conditioned-reflex (less deep, subcortical) stereotypes of the sexual sphere and are characterized by the instability of sexual manifestations (erections, ejaculations, etc.) in direct dependence on the external situation (typical dissociation between the safety of spontaneous And a sharp weakening of adequate erections with partners ready for sexual intercourse) or the presence of sexual perversions (perversions) - painful violations of the orientation of sexual desire and (or) the conditions for its satisfaction.

All disorders of the psychic component of the copulative cycle are divided into secondary ones due to neurosis, psychopathy or psychosis (more often schizophrenia), a threat to the existence of the subject (disactusualization of sexual life in case of suspected malignant tumor), severe disability (due to loss of vision, amputation of legs, .), And primary-sexological (with the direct specific disorganization of the sexual sphere), which include sexual perversion.

Diagnosis of secondary sexual dysfunctions is based on the addition of sexopathological symptoms to the previously identified clinical picture of the underlying disease - neurosis, psychopathy, psychosis, etc. Thus, neurasthenia is characterized first (in the hypersthenic stage) by accelerated ejaculation, then rapid, but rapidly stopping erections and in the hyposthenic stage - a decrease in libido in combination with the weakening of erections and secondary anejaculatory phenomenon.

The course and prognosis are determined by the nature of the underlying disease, with neuroses the full recovery is achieved more often than with psychopathy.

Treatment, along with the elimination of etiological factors and the effect on the pathogenetic mechanisms of the underlying disease, should, from the moment of revealing the sexopathological deviations, provide for a system of psychotherapeutic influences aimed at sexual rehabilitation (disclosing the causal genesis, developing optimal methods of intimacy, etc.), if necessary, symptomatic medications , Application of the LD method (local decompression).

Etiology of primary-sexopogic disorders of the mental component: situational failures due to unfavorable circumstances (for example, when intimacy is attempted in unsuitable conditions), sexual psychotraumatism (sudden detection of repulsive details of an intimate toilet or physical appearance of a partner, partner's actions that go beyond the range of acceptability, etc. .). Predisposing factors are features of sensitivity, increased impressionability and vulnerability of the person.

Pathogenesis. Super-strong conditional-reflex complexes are formed, natural sexual stimuli are converted into a conditioned inhibition. The "neurosis of expectation of failure" is most often formed; For example, failure of the first in life attempt to intercourse, undertaken in unfavorable conditions, generates the fear of a repetition of failure and leads to the formation of a vicious circle, when each subsequent attempt with unrelentingly increasing anxiety first makes it all less likely, and then completely excludes the favorable completion of intimacy. In the final stages with latent deficiency of the personality structure, persistent reactive depression, hypochondriacal and other syndromes can form.

In men (more often young people with little or no sexual experience), depending on the form of the first failure, the initial symptom usually becomes the anticipated and usually unfailingly materialized fear of premature ejaculation (up to the ejaculation that comes before the sexual organs touch) or, on the contrary, Non-occurrence of ejaculation (anejaculatory phenomenon), weakness of erection. With the passage of time, regardless of the first manifestation, new sexopathological symptoms arise-weakening of libido, etc., and koitophobia is formed. In women, the most frequent primary sexual disorders are frigidity and vaginismus (see below). Usually, the primary sexopathological phenomena, as they progress, become overgrown with psychopathological symptoms, which form a picture of neurasthenic, hypochondriacal, senestopatic and other syndromes.

Treatment. In the initial stage, rational psychotherapy is carried out: elimination of existing erroneous sexual actions and preliminary playback of the stereotype that ensures the sexual intercourse. The latter can be at first inferior, but it must include all the elements necessary for the patient and his partner - the introvitis (in the first stages, at least vestibular), frictions, ejaculation, orgasm. In some cases it is useful to combine psychotherapy with the use of symptomatic medicines, for example 1 tablet (0.025 g) of thiori-dazine (melleril, sonapax) 2-3 hours before an intimate meeting. In the late stages of the pathological process, a step-by-step implementation of complex therapeutic tactics based on a detailed study of personality characteristics and sexual experience of both partners is required: after preliminary psychotherapeutic and medicamentous (and in some cases also physiotherapeutic) training, the main stage of sexual rehabilitation (using the entire therapeutic arsenal up to Removable prosthesis-erectors).

The prognosis is favorable with the timely provision of professional sexological care.