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Searching for Research October 16, 2010

Posted by Dev in Musings.
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I mentioned in my post yesterday that I was interested in chastity and orgasm denial as a potential therapeutic intervention for a mild form of erectile dysfunction (ED) that Ab had been experiencing, as a resulting of a lengthening refractory period and his masturbatory activities. I was curious if there was actually any research on this topic and so, using the resources of the National Library of Medicine, I conducted a literature search. Literature on chastity, either as an intervention or even just a topic of discussion, is non-existent. I found studies on a variety of slightly-out-there subjects, including surveys of voluntary eunuchs (men who are castrated in the absence of a compelling medical reason) but no one is writing about chastity. If someone is looking for a thesis topic, chastity is a field that is wide open.

I did, however, find an interesting article by Rösing and colleagues on “Male Sexual Dysfunction Diagnosis and Treatment From a Sexological and Interdisciplinary Perspective” published in the December 11, 2009 issue of Deutsches Ärzteblatt International. Fortunately, the article is available online and published in English, since my German is a little rusty these days. 🙂

They have a useful definition of sexual disorders:

Sexual disorders in men are categorized according to their occurrence in the cycle of sexual response into disorders of desire, arousal (erectile dysfunction), or orgasm (premature or delayed ejaculation, or anorgasmia), albeit with considerable potential for overlap and concurrence between these disorder groups.

Thinking about the various blogs and forums that I read and participate in, all of us have come to chastity for a variety of reasons. For some people it is just a kinky game or a fantasy come true. But others, many of us, in fact, are looking to fix a problem or enhance a relationship. Rösing et al. touch on this with this comment:

Desire disorders increasingly present as a problem among men seeking medical help for sexual difficulties. Erectile dysfunction is often presented as the primary complaint, but it is not uncommon for this to mask other problems such as exhaustion (with or without substance abuse), relationship difficulties, and, more rarely, disorders of sexual preference. Organic causes (testosterone deficiency, hyperprolactinemia, medication-related side effects) are important, but at times overemphasized in the somatic medical literature. (Emphasis mine.)

As I have noted many times in this blog, the prevailing approach among physicians is to treat sexual dysfunction pharmacologically; while that may be effective in the short run, it does not necessarily address the larger problems that may be present. Further, there are those of us in the world who don’t necessarily believe that a pill is the panacea for everything. It would seem that Rösing et al. agree with me:

Extensive research results from the last 15 years and the introduction of selective phosphodiesterase 5 inhibitors have led to changes in the diagnostics and treatment of male sexual dysfunction. Invasive investigation is now almost obsolete. Medication is introduced early. Success is measured in terms of function…The view of this disorder has changed from an almost entirely psychogenic to an organically dominated, multifactorial etiology. A large proportion of studies on male sexual dysfunction is directed at the effects of pharmacological treatment on desire, erection and ejaculation, and remains purely at the level of the functional disorder. The discovery of highly effective oral medications by the pharmaceutical industry have quite literally created a “potent” new market…In clinical practice, however the norm is to focus in a shorthand way on “functional repair,” marginalizing or completely neglecting psychosocial and psychosexual (relationship) aspects. (Emphasis mine.)

Further:

Sexual experience always comprises a synergy of biological, psychological and social factors, whose individual weighting and interrelation where a sexual problem exists must be identified on an individual patient basis… Against this background, any diagnostic approach which considers only the physical (sexual function, for example, desire, erection, and ejaculation) or the emotional (for example, personality development and characteristics) or the relationship is necessarily incomplete and inadequate as a means of planning the treatment of sexual dysfunction accompanied by distress. Distress arises when a sense of ones own sexual inadequacy arises in the context of a relationship. The desire for relationship is innate and therefore ubiquitous.

They quote a recent study by Kleinplatz et al., published in 2007:

…men and women over 65 and in long term relationships cited factors such as authenticity, intense emotional connection, communication, and a sense of being accepted as characteristics of “great sex.”

No mention of orgasm as being a characteristic of “great sex”! Of course, the respondents were men and women over 65 and they may have given up on orgasm completely, but I still think their list of important factors is interesting.

Apparently in Germany, couples therapy is known as “syndiastic,” which derives from the Greek word syndyastikós (“orientated towards mutuality in a couple relationship”). Hmm…sounds an awful lot like, “Her pleasure is my pleasure,” or “Our shared mutual pleasure,” which I have written about before.

Rösing et al. theorize on how to put this into action:

Basic psychosocial needs are therefore capable of being fulfilled in a unique way via sexual “body-language.” Their chronic frustration via dysfunctional or absent (intimate) physical contact, plays a key role in the development and maintenance of psychosomatic disorders, including all functional sexual disorders…Recent studies of the placebo effect have shown that the effect of medicines is frequently enhanced by the supportive attention received in the consultation, in addition to the attribution effect, which arises from a positive expectation of treatment. …If, reasonably enough, we accept the placebo effect of the good doctor-patient relationship, we should value all the more highly the health promoting potential of a functioning intimate relationship, and seek to influence it positively. (Emphasis mine.)

Or, more succinctly stated:

The biopsychosocial etiology of sexual dysfunction calls for a biopsychosocial approach to treatment, involving the methods of “narrative medicine” as well as organic and pharmacological approaches.

Once again, we can’t just throw a pill at it…and this is why:

…long term use of solely pharmacological or mechanical treatments were associated with less satisfaction with therapy among patients than estimated by urologists.

More on satisfaction in the sexual relationship:

Questionnaires exploring the value to prostate cancer patients and their partners of relationship, nongenital sexuality (exchange of caresses) and genital sexuality (sexual intercourse) demonstrated that only importance of genital sexuality decreased in both partners before and after radical prostatectomy. Relationship and the importance of physical closeness (kissing and cuddling) retained their importance. Other studies confirmed this higher value placed on the fulfillment of the need for psychosocial closeness, intimacy, and security in comparison with the pursuit of purely sexual satisfaction. (Emphasis mine.)

They sum up, quite nicely, why overall, sex is important:

The ubiquitous human desire for the fulfillment of basic psychosocial needs is fundamental, and must be taken as seriously by medicine as the investigation of pathogenetic mechanisms. In relation to sexual dysfunction, this implies the restoration to patients of the health promoting effects of sexuality.

Unfortunately, they also explain why no one is going to be throwing a bunch of money at research that pursues this view of sexual function and dysfunction:

Although efforts are being directed at conducting controlled, clinical trials and randomized controlled multicentre studies in psychosexual medical research, it is an unfortunate truth that nowhere near such generous resources are available for this area as for that of commercially exploitable pharmaceutical research. But this must not lead, for ethical reasons, to the withholding from patients plausible and clinically tried and tested treatments.

Oh well.

I am working on a letter to Dr. Rösing and his colleagues asking if he has ever heard of or considered chastity as an intervention for male sexual dysfunction. I’ll keep everyone posted.

References:

Rösing D, Klebingat KJ, Berberich HJ, Bosinski HA, Loewit K, Beier KM. Male sexual dysfunction: diagnosis and treatment from a sexological and interdisciplinary perspective. Dtsch Arztebl Int. 2009 Dec;106(50):821-8. Epub 2009 Dec 11. Review. PubMed PMID: 20049092; PubMed Central PMCID: PMC2801066.

Kleinplatz PJ, Ménard AD. Building blocks toward optimal–sexuality: constructing a conceptual model. The Family Journal: Counseling and therapy for couples and families. 2007;15:72–78.

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