* Approaching sexual response
* Stages of sexual response
* Sexual Dysfunctions
* Sexual Dysfunction Erectile
* Neurological Aspects
* Endocrine and sexual activity
* Risk Factors
Erectile dysfunction is the inability of a man to achieve and / or maintain an erection sufficient for satisfactory sexual intercourse. While formerly known as impotence, is now considered that the term “erectile dysfunction” is more appropriate, considering the negative connotations with which some people associated the word impotence. Many men have or will have an occasional erection problem at some point in their lives, while for others it becomes a frequent problem. Currently, this condition affects over 100 million men worldwide.
Erectile dysfunction should not be something shameful, does not mean that it is sterile or that you can not have an orgasm or ejaculation. Since it is shown that the capacity is not related to erectile orgasm and ejaculation, men with erectile dysfunction should stop being harassed by the myth that car! ECEN power and virility. Erectile dysfunction is treatable in most cases and while not a life threatening condition, yet still severe, can have a big impact on man’s self esteem and their relationships.
1. Approaching the sexual response. –
Sexual responses of men and women transform inert genitals in an effective team play. “The flaccid penis urinary erect phallus becomes the breeding, while the potential space dry vagina turns into an open receptacle, lubricated and congested” (Kaplan, 1974). In man progresses erection until ejaculation, whereas in women, the swelling and lubrication of the genitals culminates in orgasm, is how in the first part of the sexual response is genital vasocongestion. The second, orgasm, is basically a series of involuntary contractions of the muscles clonic genital. (Encarta, 1997).
In men, erection is caused by congestion of the blood vessels of the penis. Penile vessels expand and close special venous channels. The blood is enclosed in “caves” special, and this mechanism basically hydraulic enlarged organ. The autonomic nervous system is involved in this reaction: the nerves to – produce sympathetic dilation of arterioles, while likely controlling the sympathetic closure of venous valves (Kaplan, 1983). Orgasm in men is a different reaction and consists of the issue (that men perceive as a sense of inevitable ejaculation) and ejaculation (contractions of 0.8 second duration of striated muscles at the base of the penis: the bulbocavernosus and the ischio – cavernous) (Kaplan, 1983).
In women like two things happen, in response to sexual arousal occurs vasocongestion blood vessels of the lips and tissue around the vagina, which also causes vaginal lubrication. Furthermore, unlike man, female orgasm has only one phase (no emission phase) consisting of 0.8 seconds contractions of hamstring muscles and bulb – cavernosa, and also of the pubococcygeus. (Kaplan, 1983)
When these reactions of men and women, or any of its components, are impaired, the result is a sexual dysfunction.
Phases of sexual response. –
In what has been exposed, it is possible to see clearly that sex is a highly complex activity, which should be seen as a unit. However, in order to analyze the many aspects of this there have been several divisions. One is referred to intercourse stages, namely:
Excitement phase: The first sign of arousal in men is penile erection. A marked increase in size and increase in angle relative to the body. This erection may be due to stimulation of the penis as such or by a chain of erotic thoughts.
Masters and Johnson have termed primary reaction to sexual stimuli, changes in vasculature which occur in this phase. The secondary reaction would be several fibers and contraction of muscle groups. We found other changes in the excitation phase in man appears voluntary muscle tension across the board and may be some involuntary contraction of muscle groups. Displayed an increase in pulse rate and blood pressure increases, the testicles get stronger, rise and approach the body.
For there to the driver stage requires a minimal degree of sexual tension. After completion of the erection, this phase may continue for a few moments or even until many minutes, this depends on the variations of affective sexual stimulation.
In the study by Masters and Johnson remained erection for long periods subjects carefully controlling the variation and intensity of stimulation techniques. During a prolonged excitement phase, it was possible to make an erection to intentionally lose and win again repeatedly. So with such situations, the erection is maintained without achieving cup – full dilatation or her total loss.
Various stimuli psychosensorial have experimentally tested in the laboratory during the excitement phase. The erection can easily suffer, by the introduction of a sexual stimulus concomitantly maintained despite sexual stimulation. This may lead to partial or even complete, penile erection, while keeping the somatic stimulus.
The estapa of “Plateau”: The rise of female genitalia in humans occurs in the excitement phase. However, one can say that there is a gradual increase in the corona of the glans penis at the base, which occurs in the phase of “plateau” or plateau. It may be accompanied by increased redness of the region. At this stage, furthermore, the diameter of the testes increases by 50% and more channels become shorter sperm. The elevation of the testes shows that man has reached the “tipping point” and that her orgasm is imminent.
The breathing rate increases, and continue to increase the blood pressure and heartbeat, is raising tensions of voluntary and involuntary muscles
Orgasm: Unlike the female orgasm, the male may be considered as carved in the same mold, while women are extremely varied. The central fact of the male orgasm is the rhythmic contractions, which are resulting in rapidly and are becoming increasingly distant and soft. Anyway, the man can identify subjectively the occurrence of orgasm just before you know it.
The ejaculation of semen that occurs during orgasm, is a more or less complicated. Before orgasm, shrinkage occurs spermatic channels carrying the fluid containing the sperm cells. The prostate gland, also working with fluids that are moving towards the urethra. Such fluids are accumulated in a bulb located in the urethra near the base of the penis. These changes are in the first stage of ejaculation, stage where it feels that orgasm occurs.
During the second stage, a series of contractions of the bulb, urethra and penis, projecting semen out under great pressure. That pressure decreases with age, being lower in older men.
The changes in the genitals during orgasm, are accompanied by other changes in the rest of the body, on blood pressure, respiration, etc.. These muscle contractions are often imperceptible to the subject, but not infrequently complain of muscle pain in various body parts.
2. Sexual Dysfunctions
2.1. Nature and causes of sexual dysfunction
In ancient times it was believed that only a deep neurotic conflict could affect sexual responses, and that the only vectors intercourse conflicts were severely pathogenic and regressive child-centered fear, illusion, unconscious of being traumatized if they enjoyed sex and it was only possible to cure these symptoms by resolving deep unconscious conflicts. (Kaplan, 1983).
Masters and Johnson suggested that roots often originate psychopathology in a much more immediate. Anxiety about their own performance, insecurities, stress, anxiety, etc., Can cause (and, indeed, cause) a large part of sexual difficulties (Kaplan, 1983). And this is quite logical, because in physiological terms “sexually destructive anxiety is the same when a man terrified by the possible repetition of Erectile difficulty induced by alcohol, or when due to return Oedipal taboos and fear of castration “(Kaplan, 1983).
Furthermore, sexual dysfunctions are closely related to health, so as arteriosclerosis, hypertension, depression, drugs, injuries and diabetes, are common causes of sexual dysfunction.
2.2. Sexual Dysfunctions features
As previously sexual dysfunction is roughly a deterioration in any phase of the sexual response components (or reactions), Kaplan (1983) describes six characteristics sexual dysfunctions, three man and three women :
Where frigid woman experiences no sexual pleasure sensations and erotic or no signals experiences physiological arousal (for example, the lubrication).
2.2.2. Female orgasmic dysfunction
Where women have sexual responsiveness, enjoys erotic feelings, and has good reaction vasocongestive but experiences a varying degree of difficulty having an orgasm
Where the woman’s body prevents sexual reactions because the attempted vaginal penetration causes involuntary spastic contraction of the entrance to the vagina.
2.2.4. Delayed ejaculation
Where man has an orgasm involuntary inhibition (analogous to a disorder female orgasmic dysfunction), the man with delayed ejaculation may feel sexual arousal and have a normal erection, but, even if you get a stimulus that should be quite sufficient, has difficulty to release your ejaculatory reflex.
2.2.5. Premature Ejaculation
Where the man climaxes quickly, due to lack of adequate voluntary control over the ejaculatory reflex.
Where man can not get or keep an erection long enough to develop a satisfactory sexual activity.
2.3 The impotence.
There are several parameters to classify:
A. As regards the shape:
Erectile Impotence: is one in which the impossibility of performing the sexual act is connected to the difficulty of penile erection.
Ejaculatory impotence: the difficulties are related to premature ejaculation, on one hand, and the inability of ejaculation and orgasm, on the other.
Procreative impotence: the difficulties associated with man’s ability to participate in fertilization.
Often they overlap, either as symptomatic or regarding the etiology.
B. According to the degree:
Total Impotence: where is the impossibility of full erection, the penis remains in its most flaccid state.
Partial Impotence: in which there is a decreased degree of erection which prevents or hinders the penetration of the penis into the vagina.
C. Time criterion:
Permanent impotence: when the subject has ever presented an erection in the course of his life.
Constant Impotence: Impotence occurs when the moment of its inception to its demise.
Occasional impotence: When not in a constant but irregular in time.
D. Depending on the form of installation:
Impotence insidious episodes appear gradually, in a proportional increase in relation to sexual encounters.
Impotence Acute episodes appear at some point, well circumscribed in time, place and situation.
E. According to the object:
Impotence selective: it is one in which the episodes of impotence are given a particular partner and in a given situation.
Impotence is not selective: when behavior is manifested in all circumstances and with all partners.
D. According etiopathology:
impotence of organic order
3. Sexual Dysfunction Erectile
This is a “persistent and recurrent inhibition during sexual activity, manifested by the partial or complete failure of man to achieve or maintain an erection to completion of intercourse” (Kaplan. 1987. Pp. 473).
3.1 The difference between impotence and Erectile Dysfunction:
This would be one way of sexual impotence, which can be given with a nomenclature that includes the different categories above said. Within this distinguished, then, the primary sexual impotence where man has never been able to get an erection sufficient for vaginal penetration, secondary impotence, in this case the subject has achieved at some point of sexual penetration the vagina, but subsequently lost.
On the other hand, it is also remarkable selective impotence, here the man is able to have intercourse in certain circumstances but not in others. Regarding the etiology psychological conflicts that occur are related impotence “with an inability to express the sexual impulse because of fear, anxiety, anger or moral prohibition” (Kaplan, 1987, pp.176).
The use of the term “powerless” not only deepens the stigma, but that is completely wrong as a definition. Men with erectile problems are not powerless, only have diminished the ability to achieve and / or maintain penile rigidity. That’s why the term “erectile dysfunction describes the problem in a much more precise. Dysfunction can present a wide variety of grades, ranging from men who are” powerless “(in the purest sense negative) to those whose problem is so little that their partners are not even aware of their existence.
Among the organic bases include: glucose tolerance, hormones, liver and thyroid function, the determination of prolactin and FSH FH among others. It is therefore very important to determine it a good story etiology of dysfunction. Well as diseases: infectious and parasitic diseases, cardiovascular. Disorders: Renal and urological, liver, lung, nutrition, neurological and endocrine. And other factors such as poisoning, drugs, genetics, surgery.
Sexual Dysfunction Diagnosis Erectile:
The diagnosis is made in light of clinical judgment that takes into account the focus, intensity and duration of the patient’s sexual activity. The criteria involved are:
“Inhibition of recurrent and persistent sexual arousal during sexual activity, manifested by a partial or complete failure to obtain or maintain an erection to completion of intercourse.
Must coexist clinical trial that the individual performs sexual activities that are appropriate in type, intensity and duration.
The disturbance is not caused exclusively by organic factors (physical illness or drugs). “(Kaplan, 1987, pp.477).
Where tests are performed to determine the organic base or psychological disorder, the inquiry also gaining importance in the history of the subject.
It has been estimated that few men are impotent at age 35, between 2-4%. But at age 80, about 77% are.
The incidence of primary impotence in men of 35 years is 1%. Where the fear of getting it increases from 40 years, which is associated with the stigma attached to middle age where impotence arise with anxiety and the need to succeed in dating. Being in more than 50% of men treated for sexual disorders, impotence primary complaint.
Importantly, it is estimated that 90% of cases of impotence is a psychological cause.
3.4. General causes of erectile dysfunction
Normally, when a man is sexually excited, the penis increases in size, becoming erect and rigid, allowing it to penetrate the gender of their partner. The penis is usually measure between 7 and 10 cm long, upright size increases to about 17 centimeters, in fact, an erect penis contains six or seven times the volume of blood from a flaccid penis (Encarta, 1997).
Impotence can have psychological causes. For example, if a man has lost his job his sense of failure can lead to temporary impotence suffer. Often it can also be caused by disorders of the blood system, nervous system, brain or hormones, as well as damage or surgery in the pelvis or penis. However, the most common cause is iatrogenic. That is, impotence can be caused by medications taken to treat other disorders. Diuretics, tricyclic antidepressants, H2 receptor blockers, beta blockers, hormones, etc.. (Encarta, 1997)
You can determine if the cause of the impotence of a man responds only to psychological reasons, if you experience an erection normally during REM sleep is unlikely that there is any organic cause to suffer impotence when on consciousness. (Carlson, 1996). However, in some cases, an organic cause is not enough by itself to severe impotence can produce more vulnerable development are also present minor psychological factors. (Carlson, 1996)
The phenomenon erectivo
How does an erection
An erection is the result of a complex process that involves the blood vessels and the nervous system. The anatomy of the penis is especially designed to answer this process. The penis is composed of two structures that are initiated within the pelvis and develop in parallel to its extreme. These structures are composed of a spongy tissue with large amount of blood vessels.
Generally, the walls of these vessels are constricted which prevents excess blood in the flaccid penis and keeps most of the time.
When a man experiences sexual stimulation, blood vessels expand, allowing more blood to flow much faster into the penis. Thus, the blood entering the penis erection occurs
From the point of view of the erection itself, we can say that this is a more or less durable in which the penis remains firm and elongated, and that this mechanism is due to automatic reactions controlled by the autonomic nervous system.
We can distinguish two types of erection:
Cortical and Erection
In the first stimulations are present mainly psychic phenomena. In the second, we assume some contact on the male genitalia, especially the glans.
Anatomical – Physiology
The anatomical structure of the penis (Figure 1) is the ideal support for the glass – dilation primary physiological response to sexual stimulation.
The penis consists of three cylindrical bodies of erectile tissue: the corpora cavernosa and the corpus spongiosum. The corpora cavernosa are two (right and left) located in the dorsal plane, parallel to each other, measuring 15 to 16 inches in flaccid state and 20-21 centimeters in erection. The spongy body further contains erectile tissue, urethra.
The three structures are surrounded by a single fibrous layer, the tunica albuginea and surrounded by dense pods.
In the penile base or root, the corpora cavernosa diverge to attach the pubic rami and ischium (the pubic arch). Each is surrounded by the hamstring muscle – cavernous fluted nature. The spongy body, in turn, is encased by a skeletal muscle constituting the spongy bulb.
The two corpora cavernosa and the corpus spongiosum, are the erectile tissue of the penis which receives arterial blood from the internal pudendal arteries. These branches are dorsal penile arteries, which are close to the dorsal surface of the tunica albuginea penis, and furthermore, the cavernosal arteries run longitudinally through each corpus cavernosum, both arteries bulb – urethral run longitudinally through the corpus spongiosum in ventral direction with respect to the urethra. These arteries terminate in small capillaries which open directly into the cavernous spaces.
The venous return is performed by the superficial dorsal vein and deep dorsal vein .. The thickness of the corpora cavernosa are many compartments separated by strips or bands of fibrous tissue tubrculas calls. These compartments are intermingled with arterioles which supposedly contains intima small bumps in the state of contraction of partially occlude the lumen, retaining blood in the cavernous sinuses. When arterioles dilate, blood flow in the penis increases and sinuses are filled. It is believed that the penile veins contain valves that impede the outflow of blood. It is also believed that the hamstring muscle contraction – cavernous erection aid venous constriction secondary to this mechanism gives little value at present.
Not all times given the glass – is a cause dilation of erotic type. They are also able to determine the physical exertion erection as lifting a heavy load (partial erection, usually) and have been erections due to irritative processes. There are still spontaneous erections occurring type waking the subject, plus erections during sleep.
Sexual feelings can arise in the internal structures, such as irritated areas of the urethra, bladder, prostate, seminal vesicles, testes and efferent vessels.
One of the causes of the “sexual needs”, is probably the saturation of the sexual organs and secretions. Infections and inflammations of these organs, sometimes causing almost continuous sexual desire. From a sensory standpoint, the glans peripheral sensory system contains a highly organized, which transmits to the central nervous system, a sense mode, which can be termed sexual sensation.
The impulses can enter the spinal cord from areas adjacent to the penis to increase stimulation during sex. For example, stimulation of the anal epithelium, the scrotum and perineal structures in general can send impulses to the spinal cord, which increase sexual sensation.
Therefore the male sexual act, resulting from an inherent reflection mechanism integrated in the lumbar and sacral spinal or mechanisms may be initiated due to a psychic stimulation or direct sexual stimulation.
The penis is a closed tube, consisting of three vascular tissue bundles together by connective tissue and covered by loose skin. Two large bundles of tissue, the corpora cavernosa, forms the top of the penis and contain numerous compartments that fill with blood during sexual arousal, causing erection and penile rigidity. The sacral nerves control blood flow into the corpus cavernosum, they are located below the third fabric beam, the spongy body. This beam is pierced by the urethra. The end of the penis holds a widening rich in sensory nerve endings which is called the glans, which is covered by a layer of skin called the foreskin retractable.
Neurological determinism of sexual function is more than the excitement of the nerve pathways below. The vessel congestion sexual reflexes – motor, sensory excitation localized, etc., Are called short circuits. They are only part of a more variable and unpredictable that offers lots of potential motor responses and complex excitations emanating from all the senses, affective impressions and intellectual affinities.
In studying sexual neurological processes that we ignore the higher areas include associative processes that must be considered when studying the sexual phenomenon in its entirety. In this regard, the system is little known upper neuropsychic sexual activity, since studies with neurotransmitters are very recent. The results, though somewhat hasty, could indicate that dopamine has a stimulatory action of sexual responses while serotonin exert the opposite effect. Supporters of this theory have shown that high levels of prolactin (high prolactin levels is usually accompanied by an underactive dopamine) can lead to impotence in men.
Anyway, we must consider the system as a unit anatomic – physiological nervous regulation of sexual function.
The excitation produced in any branches spread throughout the system and therefore, a malfunction of an element will be felt in sexual activity in its entirety.
Reflex erections that appear as responses to tactile stimulation of the erogenous zones appear without discrimination between sexual stimulation and sexual stimulus. In contrast psychological erection occurs in response to stimuli mediated by the central nervous system and, therefore, probably depends not only on external factors such as visual, but also accompanying cognitive processes. Psychological factors often play a role in male sex and can start it – even if not all – since we have to focus our attention, from a neurological point of view, on three factors:
The sexual act of a man is inherent reflex mechanism integrated in the lumbar and sacral spinal mechanisms may begin direct sexual stimulation.
Erection is induced by stimulation of nerves pre – sacral and pelvic exams. This reaction is the result of the addition of stimulus pulses afrentes psychic and brought to the central nervous system via the pudendal nerve.
With regard to the sexual organs, the sympathetic system, and – nice play an important role for which both are in homeostasis. The sympathetic nervous system is composed of fibers emerging from the portion thoraco – lumbar spinal with communication of higher brain centers. The system – friendly acts on the same tissues and structures that the sympathetic system, but its action is opposite. It originates in specific brain nuclei associated with certain cranial nerves and the sacral region of the cord.
In states satisfying the system – sympathetic plays an important role, while under conditions of fear, worry and anxiety, blood directed toward somatic structures by the action of the sympathetic causes reduced irritability of the sexual organs and the resulting decrease activity or sexual desires.
Erection is accused of stimuli for – nice that originate in the center for sympathetic vasodilator. These incentives range from the sacral region of the spinal cord to the penis through nerve sparing. That function is influenced by inhibition of sympathetic vasoconstrictor center. As shown, this function by virtue of being regulated by the autonomic nervous system of the individual overrides any effort to dominate the symptom of impotence, causing, on the contrary, an increase in inhibition.
Normally the man who wants to maintain a relationship does not focus its attention on the erection, or do, the fear of not having it, it affects the point that if it occurs, is going to be weak. It breaks the harmony of sexual function automatically emerging cortical inhibition, including physical and psychological components and suggests the existence of a mediation controlled by the temporal lobe.
Despite the limitations to the study of the action of the central nervous system, which is related to the “sexual knowledge” and possibly work to integrate, analyze and interpret various forms of sexual feelings and to initiate a response.
In a full central nervous system libido level sufficient to overcome the hypothalamic-way through and goes to the centers of the spinal erectors, which stimulate penile erection. This, feedback through sensory impulses, temporal lobe, maintaining and increasing the burden libidinous in a process called reverberating circuit that keeps the sexual and individual action.
The hypothalamic – pituitary (Figure 2) is widely recognized as connected with sexual behavior.
Endocrine and sexual activity
Transmitting endocrine stimuli acting through the blood in the form of specialty chemicals (hormones). In terms endocrine sex glands are constantly exchange with the pituitary gland (or pituitary) and with the environment and with other glands. For an overview of endocrine problems relating to sexual activity should remember the pituitary (Figure 2). In this regard the anterior lobe of this is also master gland, because of the many indications that it has on other glands.
Of the pituitary hormones start regulating the activities of the gonads – luteinizing hormone that has its action on the testis determining testicular hormone production. Moreover, the functions of the hypophysis are regulated by the hypothalamus through the bloodstream.
Regarding reproductive system itself, we know that the testes have two groups of specialized cells, namely Leydig cells, which are responsible for synthesis and secretion of testosterone and the germinal epithelium, which occurs spermatogenesis.
There are nerves connecting the hypothalamus with all regions of the brain. Also receives nerves that come from the erogenous zones (genitals and nipples), of the viscera (internal organs) and the limbic system. The hypothalamus has vascular connections with the anterior lobe of the pituitary. These blood vessels are called hypothalamic-pituitary portal system, and connect the capillary beds of the hypothalamus with the beds of the anterior lobe of the pituitary.
Leydig cells are under the direct control of the ICSH hormone stimulating hormone (interstitial cell) that is indistinguishable from luteinizing hormone (LH) and are sensitive to chorinica gonadotropin (CG). The epithelium is maintained and teleogerminal directly stimulated by hipofiario follicle stimulating hormone (PSH) and indirectly by the hormone androgen ICCH through Leydig cell.
3.6.2 Role of testorterona
Testosterone is usually responsible for male characteristics of the body. It is produced by stimulation of the placenta to the fetus and no longer occurs in childhood, reappearing after 11 or 13 years. Thus, increasing production from puberty and adulthood, up to 40 years. There low, reaching 80 years to the fifth of the maximum.
It is not clear by which initiates action of testosterone at puberty. Some refer to time some action on the hypothalamus, which would cease to secrete gonadotropin inhibitory factor. The anterior pituitary starts producing gonadotropin and testicular function increases. Testosterone is responsible for the growth of the penis, scrotum and testicles, and the appearance of secondary sex characteristics.
What are the causes of erectile dysfunction
In men with erectile dysfunction, the chemical reactions that produce the erection does not normally occur, so that the blood vessels do not relax enough and the penis can not fill with blood. Some time ago it was believed, erroneously, that erectile dysfunction was a psychological problem or an inevitable consequence of aging. Although that age may be a cause, erectile dysfunction is not inevitable when a man ages. On the contrary, we now know that most cases of erectile dysfunction are associated with physical conditions.
The most common risk factors for erectile dysfunction include:
Conditions that impede normal blood flow to the penis, such as high blood pressure, high cholesterol, diabetes and atherosclerosis.
Injuries nerve injury or disease that disrupts the connection between the nervous system and the penis: spinal cord injuries, multiple sclerosis, stroke or prostate surgery (cancer) or colon.
Psychological problems such as anxiety and stress.
Other conditions, such as kidney or liver disorders, depression or hormonal disorders.
Medicines that can cause erectile dysfunction as a side effect, including any of these categories: diuretics, antihypertensive, cholesterol lowering drugs, diabetes drugs, antidepressants, some medications used to treat cancer, nonsteroidal anti-inflammatory and anti-epileptics.
Smoking, excessive alcohol and / or drug use.
More specific causes of erectile dysfunction can be consulted your urologist.
Erectile dysfunction can be treated Yes, the good news is that, regardless of the cause, most cases of erectile dysfunction are treatable. Today there are several treatment options from which to choose
We conclude that the phenomenon of erection is controlled from the neurological point of view, for the various levels that the central and peripheral nervous system occur, ie, the reflex erection will occur at the level of spinal and peripheral nerves can be inhibited by factors related to the sympathetic and friendly, and is influenced by factors such cortical related affective and cognitive aspects of sexual behavior
NATURAL improves erectile function FOLLOWS intracavernous injections of vasoactive drugs International Journal of Impotence Research. Vol 9, No, 4, December, 1997.
Antidepressant-induced sexual dysfunction reuptake inhibitors of serotonin. Journal of Sex and Marital Therapy. Vol 24, No, 1, 1998.
RESISTANCE IN COUPLE THERAPY: INTEGRATION OF SYSTEMIC AND ANALYTICAL APPROACHES. Journal of Couples Therapy. Vol 7, No, 1, 1997.
Psychotropic drugs and sexual function. J. Bobes, S. Dexeus, J. Gibert, 2000. MEN WHO KNOW LOVE, Dr. Adrian Sapetti.
Impotence is reversible; Dr. Rossello Barbara, Dr. S. K. Wilson help manual for the couple; Editorial TIBIDABO
Psychology – Sexology
University of Barcelona