Most of the clinicians included in the treatment or study of sexual disorders are probably not very content with the current nomenclature, which is generally one-dimensional and not including all nuances and prospects of adult issues. The nomenclature does not deal with mental, relational, and situational constituents of human sexuality. Some of these issues, particularly the ones related to female sexuality.
A 26-year-old man who complains being distressed because ejaculating within 30 60 sec after penetration during sexual activity with his wife, but reports no quick ejaculation while masturbating technically encounters the diagnostic measures for premature ejaculation. However, the diagnosis of early ejaculation doesn't fully account the range and psychology of his sexual disfunction. The corresponding could be implied in the case of 67-year-old married male who started to obsessively masturbate around 2 years ago. He thinks about other men being around at times while masturbating, or at times he masturbates just without any thoughts, in different places, for example, while driving. Is his diagnosis sexual disorder not otherwise specified? Or obsessive-compulsive disorder? Do these diagnoses-labels help the clinician in any way?
The recent diagnostic system, paraphrasing Winston Churchill, is probably the worst diagnostic system except for all those that have been tried. It for certain could be better. Recently, Fagan proposed a systematic way in which clinician coordinate the mass of information about sex. We discuss it in more details for two reasons it clearly evidences that human sexuality, as other 6 Segraves and Balon areas, requires a more complex and sophisticated diagnostic system, and it illustrates one of probably many possible approaches.
Fagan suggests using the system of four perspectives, or four different ways to view a clinical case, which was originally developed by McHugh and Slavney (48) for all psychiatric disorders. He believes that these four perspectives are a more complex way of viewing clinical information and then communicating that information to clinicians, colleagues, and the individual with the clinical problem or disorder.
These four perspectives are:
1. The disease perspective
2. The dimension perspective
3. The behavior perspective
4. The life story perspective
The disease perspective is categorical, the patient either has or does not have the disease. As Fagan points out, this is the basis of the medical model, but not the entire story. This perspective turns to physiology, anatomy, and medicine to learn about patients sexual issue.
The dimension perspective focussing on measurement (dimensional gradation and quantification). Cases of the objects of measurements are intelligence quotient, behavioral patterns, mood, or personality traits.
The behaviour position focuses on the behaviour of an individual who is goal directed, or teleological. Fagan explains that the behavior perspective is to cognitive-behavioral clinician what the disease perspective is to physician.
Lastly, the life story view is what most people link with psychotherapy. It relies on the narrative told by the patient to give some meaning and management to their life.
Fagan emphasises that no single perspective is, in itself, more valuable than any other, and each perspective can add to the formulation. His proposal assists, in part, to handle various issues. First, human sexuality is much more compound than just attaining reliable erection and, as noted, the medical diagnosis does not include psychological, relational, and other factors. Second, not all sexually disordered behavior has a psychiatric diagnosis. Third, sexual diagnosis is an alternate and developing construct. Fourth, sexual diagnosis doesn't involve causality.
Fagan indicates that one should choose the primary perspective that best fits the patient and then mix the other perspectives into the formulation and treatment to make use of the additional contributions they may provide. He likewise underlines that perspectives are conjunctive and not disjunctive.
Fagan feels that applying the four perspectives is more facilitative in delineating sexual dysfunctions and conceptualising their handling. Some will probably find this proposal too composite or not compound enough, to a fault inclusive or not inclusive enough, not practical enough or too practical. Still, we feel that it is an interesting and thoughtful proposal, which may further induce and aid the debate about the diagnostic problems in the area of sexual dysfunctions.
Author Resource:-
David Crawford is the CEO and owner of a Male Enhancement Pills company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of http://www.maleenhancementgroup.com This article may be freely distributed if this resource box stays attached.
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