Universitätsklinikum Greifswald, Klinik und Poliklinik für Urologie, Greifswald, Germany.
Dtsch Arztebl Int. 2009 Dec;106(50):821-8. doi: 10.3238/arztebl.2009.0821. Epub 2009 Dec 11.
Among all types of sexual disturbance in men, disturbances of sexual function are the most important in clinical practice. These are classified by the segment of the sexual reaction cycle in which they arise (appetence, arousal, orgasm, and resolution). Partial functional impairment must be distinguished from dysfunction causing significant suffering and requiring treatment.
The authors' clinical experience is supplemented with a selective review of the literature on sexual dysfunction, its association with underlying diseases, and its impact on sexual and relational satisfaction.
The sexual history (including the partner's sexual history, as far as this can be obtained) is of prime importance in the diagnostic evaluation of sexual disturbances. This evaluation must take the multidimensionality and multiple functions of human sexuality into account. Chronic frustration of the fundamental psychosocial needs for acceptance, closeness, and security is a very important factor that has been neglected until now by the prevailing conceptions of the etiology and pathogenesis of sexual disturbances. Their treatment involves a combination of elements from sexual medicine and psychotherapy, along with somatic medical and pharmacotherapeutic intervention, if needed. The goal of syndyastic sex therapy, a further development of the previous therapies, is to fulfill these fundamental needs and thereby to improve the patient's sexual function and deepen his satisfaction with the relationship in its entirety.
It is essential to understand the different types of sexual disturbance in their biopsychosocial context as well as the significance of sexuality for the individual, and for the couple, with respect to reproduction, sexual pleasure, and bonding. Sexual disturbances are common, and patients therefore expect their physicians to be proficient in sexual medicine. The coverage of this subject in both undergraduate and postgraduate medical education in Germany needs to be improved.
在男性的所有类型的性障碍中，性功能障碍在临床实践中最为重要。这些障碍可以根据性反应周期的环节来分类（性欲、唤起、高潮和消退）。必须将部分功能障碍与导致明显痛苦并需要治疗的功能障碍区分开来。
作者的临床经验结合了对性障碍相关文献的选择性回顾，包括其与潜在疾病的关联以及对性和关系满意度的影响。
性病史（包括伴侣的性史，只要能获得）在诊断性功能障碍时至关重要。这种评估必须考虑到人类性行为的多维性和多种功能。慢性挫败接受、亲密和安全的基本心理社会需求是一个非常重要的因素，迄今为止，它一直被性障碍的病因和发病机制的现有观念所忽视。其治疗涉及性医学和心理治疗的元素结合，以及躯体医学和药物治疗干预（如果需要的话）。性协同治疗是以前的治疗方法的进一步发展，其目标是满足这些基本需求，从而改善患者的性功能，并加深他对整个关系的满意度。
了解不同类型的性障碍及其在生物心理社会背景下的意义，以及性对于个人和夫妻的重要性，包括生殖、性愉悦和联系，这一点至关重要。性障碍很常见，因此患者期望医生精通性医学。德国本科和研究生医学教育中对这一主题的涵盖需要改进。
