The sexual tipping point model of ED

The mind and body both inhibit and excite sexual response, creating a unique dynamic balance, which Perelman named the Sexual Tipping Point. The STP is the characteristic threshold for the expression of a sexual response for any individual and may fluctuate dynamically within and between individuals for any given sexual experience. This response is expressed in a bat-luc-o-nam-gioimanner that may be inhibited or facili-tated because of a mixture of both psychogenic and organic factors. The specific threshold for the sexual response is determined by multiple factors for a given moment or circum-stance, with one factor or another dominating, whereas others recede in importance. This etiological model can serve as a foundation to provide a fuller understanding of the inter-face between psychosocial factors and the medical and surgical treatment of ED Viagra New Zealand – visit website.

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The STP model can also be used to illustrate a combination treatment approach in which sexual coaching and sexual pharmaceuticals are integrated efficaciously into diagnosis and treatment that addresses physiology, psychology, and culture. At any moment in the intervention process, the clinician determines the most elegant solution that focuses the majority of effort on fixing the predominant factor but not ignoring the others. Using the STP model, clinicians can visualize various components of ED by understanding the predisposing, precipitating, and lasting psychosocial aspects of their patient’s diagnosis and management, as well as organic causes and risk factors.

Sexual coaching integrates sex therapy and other psychological techniques into office practice, improving effectiveness in treating ED. In this manner, the clinician becomes informed about the psychological forces of patient and partner resistance, which impact patient compliance and sex lives beyond organic illness and mere performance anxiety. There is a synergy to this approach that is not yet fully supported by empirical evidence but is rapidly gaining adherents.

Medicine and surgery currently emphasize evidence-based research. There is a seemingly inherent tension between this concept and the qual-itative “art and science” of psychotherapy. Table 10 of the World Health Organization 2nd Consultation on Erectile and Sexual Dysfunction, Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction Committee report provides an excellent summary of the existing evidence for combination treatment—primarily for ED —with a few female sexual dysfunction studies. There is a growing consensus that com-bination treatment will be the treatment of choice for all sexual dysfunction as new phar-maceuticals are developed for desire, arousal, and orgasm problems in both men and women.

This chapter discusses the diagnosis and case management of ED from the perspective of combination treatment, including: (a) definition; (b) etiology; (c) a focused sex history;

(d) partner issues; (e) pharmaceutical selection, patient preference, and expectations; (f) follow-up that uses sexual pharmaceuticals as “therapeutic probes,” illuminating causes of failure or non-response; (g) “weaning” and relapse prevention; and (i) referral.