From Big Medical Encyclopedia

SEXUAL PATHOLOGY (Latin sexus a floor + pathology) — the field of clinical medicine studying functional aspects of sexual frustration, including behavioural, personal and social.

The page is a part sexology (see). Unlike others a wedge, the disciplines which are engaged biol. aspects of sex life (urology, obstetrics and gynecology) or its psychopathological manifestations (psychiatry), S.'s problems include development of diagnostic methods, treatment and prevention of the disturbances connected first of all with the psychological and social and psychological parties of the sexual relations. Odndm from original positions of modern scientific S. is the principle of paired relationship providing need of assessment of a state and the nature of relationship of both sexual partners.

In the history of S.'s formation since 19 century it is possible to allocate several stages. Lalleman (Page F. Lalle-mand, 1836), Drayzdeyl (Ch. Drys-dale, 1854) and other supporters of a lokalizatsionizm, or mekhanitsizm, connected any patol. manifestation of sexuality, from the involuntary expirations of sperm to sexual perversions (see), with pathology of an urethra, hl. obr. its prostatic part. As reaction to limitation of a lokalizatsionizm at the end of 19 — the beginning of 20 century there was an encyclopedic direction, representatives to-rogo — O. Forel, Ellis (H. N of Ellis), etc. aimed to combine biological (including evolutionary), psychological, anthropological and ethnographic approaches in the Village. Within this progressive direction there was an idealistic doctrine connected with a name 3 later. Freida — psychoanalysis (see). In 1948 A. Kinzi's researches laid the foundation for a new, so-called parametrical stage in S.'s development, for to-rogo contrary to extreme subjectivity of psychoanalysis are characteristic objectivity during the collecting the facts and use of receptions of a statistical analysis of a sexual behavior. A. Kinzi, applying a method of poll, studied key parameters of sexual manifestations (e.g., duration of sexual intercourse, quantity of ejaculations, etc.) and opened correlative bonds between the main manifestations of sex life and a number of social factors (economic security, educational level, etc.). Continuation and completion of researches of A. Kinzi were Masters's researches and Johnson (W. N of Masters, V. E. Johnson, 1966, 1970), to-rye studied and analyzed all main fiziol. parameters of a copulative cycle (see. Sexual intercourse ) by means of the registration methods developed in the commonwealth with radio physics. These works promoted an otgranicheniye patol. sexual manifestations from normal.

Such scientists-Encyclopaedists as V. M. Bekhterev (questions of formation, diagnosis and treatment of sexual perversions), I. I. Mechnikov (demographic aspects of S., an otgranicheniye of normal manifestations of sexuality from pathological), L. Ya. Yakobzon (development of many clinical and social and psychological problems C.) participated in Russia in development of problems C. The critical relation to psychoanalysis is characteristic of domestic S. The broad statistiko-sociological examinations of sexual behavior conducted long before A. Kinzi by M. A. Chlenov (1907), I. G. Gelman (1926), S. Ya. Golosovker (1925, 1927), D. I. Lassom (1928), etc., created premises for objective studying of sexual frustration. In 50 — the 80th 20 century the Soviet scientists developed an integral technique seksol. inspections, providing statement of the developed diagnosis of sexual frustration taking into account character and degree uchastrsh all interested functional systems (from the urogenital sphere to a condition of mentality), are studied age and constitutional aspects, the nomenclature and syndromologic classification of all sexual frustration are created, effective methods of complex therapy are offered.

There are different views to the place of S. among other medical disciplines. As sexual disturbances can arise at urological, gynecologic, endocrine, mental and neurologic diseases, in representations of specialists of various countries and in practice of rendering medical aid by the patient with sexual frustration there were three concepts or models C. Supporters of the first — monodisciplinary, or reductive, models rasskhmat-rivat S. as the section of that medical specialty, to-ruyu they represent. Separate elements C. at the same time «are dissolved» within related medical subjects. Most brightly the reductionism of this concept is expressed in a position of nek-ry urologists, to-rye all reduce seksol. disturbances to damage of a prostate gland. Supporters of the second — multidisciplinary, or mnimo complex, models, that fiziol. the sexual relations assume normal functioning of hemadens, the urogenital device and innervatsionny, including difficult mental, mechanisms, consider that the doctors of all specialties who are engaged in diagnosis and treatment of defeats of appropriate authorities and systems shall develop problems C. (that is endocrinologists, urologists, gynecologists, neuropathologists and psychiatrists), and patients with sexual frustration shall be inspected consistently by the endocrinologist, the gynecologist, the urologist, the neuropathologist and the psychiatrist. At the same time character and specifics of sexual frustration is lost intersystems-ny, and the role of the sexopathologist comes down to duties of the dispatcher.

However the development of observation by scientific S. which is saved up in years disprove an initial hypothesis, according to a cut any sexual frustration is a complication, result of an endocrinological, gynecologic or psychoneurological disease, and, therefore, sanitation of such disease will automatically lead to elimination of sexual frustration. The assumption of absolute secondariness of sexual deviations did not pass test time. The most frequent a wedge, forms of sexual pathology as the numerous facts testify to it, differ in a qualitative originality and a polisindromnost. So, at most of patients with sexual frustration the combination of a syndrome of a delay of pubertal development or a syndrome of paracentral segments comes to light (see. Paracentral segments syndrome ) with various psychogenic syndromes, and any of syndromes in itself does not cause disturbance of sexual functions. At the address of the patients suffering from sexual frustration to doctors of various specialties (the urologist, the neuropathologist, the psychiatrist, the gynecologist, the endocrinologist, the dermatovenerologist), as a rule, do not carry out timely complex treatment, the disease accepts a long current, resistant forms form therapeutic. Inadequate therapy, in particular massive hormonal therapy, in some cases leads to disturbance of hormonal balance, suppression of a spermatogenesis, development of a diencephalic syndrome. Therefore the only adequate model providing full compliance diagnostic and methods of treatment to specific features of sexual frustration should be considered a third — cross-disciplinary, or integral (system), model, according to a cut the sexual pathology on the basis of experience of a row a wedge, specialties (urology, gynecology, endocrinology, psychiatry, neuropathology) creates own specific phenomenology and methods of a research and is allocated in the independent industry of medicine. In 1972 at a meeting of WHO on S.'s teaching undoubted advantages of integral model C. and expediency of allocation of S. in independent a wedge, discipline were recognized.

The basic the wedge, method of a research in S. is the method of the structural analysis of sexual frustration developed by the Soviet researchers on the basis of the theory of functional systems of an organism of P. K. Anokhin; this method, however, is accepted not by all. All copulative cycle (see. Sexual intercourse ) it is divided into intervals of time (stages), within to-rykh certain sexological phenomena consistently are implemented. Their implementation is provided by functional complexes — components of a copulative cycle. In a reproductive system of the man four components, each of allocate to-rykh it is characterized by anatomic substrate and the carried-out partial (private) task (useful result, according to P. K. Anokhin):

1. The neurohumoral component is connected with activity of deep structures of a brain and all system of closed glands. It provides expressiveness sexual desire (see) and the corresponding excitability of all parts of the nervous system regulating sexual activity.

2. The mental component connected with activity of bark of a great brain defines an orientation of sexual desire, facilitates emergence erections (see) until an introitus (introduction of a penis to a vagina) also provides forms of manifestation of sexual activity, specific to the person, to W. h compliance of behavioural reactions to conditions of a specific situation and to moral and ethical requirements. Interaction and mental components provides it-rogumoralnoy unity of the biological and social nature of sexual reactions of the person because the sexual constitution determines only a level fiziol. requirements and opportunities of an organism, but not real sexual behavior of the personality.

3. Erektsionny component, anatomo-fiziol. substrate a cut are the segmented spinal centers of an erection with their extra-spinal departments, and also penis (see), the body providing the hl which is final ispolnitelnykhm. obr. mechanical party of sexual intercourse.

4. The Eyakulyatorny component (see. Ejaculation ), based on integration of several structural elements, from a prostate with its own nervous device to paracentral segments of a cerebral cortex, provides main biol. a problem of sexual activity — allocation of the men's impregnating beginning.

In a reproductive system of the woman allocate three components of a copulative cycle. The first two components are similar at both floors, and to the third and fourth components of a copulative cycle at men there corresponds the genitosegmentarny component at women, substrate a cut are female generative organs and the nerves regulating their activity, neuroplexes and the centers. Functional safety of a genitosegmentarny component is important for completeness of sexual satisfaction of the woman.

Under the influence of pathogenic factors each of components can undergo patol. to the change which is shown the syndromes specific to each of them. For identification of these syndromes the method of the structural analysis serves. At the same time in the beginning establish degree of functional safety of each component, and in case of its defeat identify a specific wedge, forms of syndromes. Use of specially developed general and specific criteria, and also the register of standard syndromes of sexual frustration allows to solve both problems. As the patients who addressed the sexopathologist, as a rule, have no isolated defeat only of one component, at the second stage of the structural analysis establish the nature of mezhsnndromny interaction. Develop the receptions allowing to separate rod syndromes from the syndromes contributing, accompanying and complicating the course of sexual frustration.

Rehabilitation of the patient with sexual frustration is possible only on the basis of understanding as from standard syndromes (e.g., delays and disharmony of pubertal development, various types of aktsentuation and patol. development of the personality, hron. prostatovesiculites, etc.) there is a sexual frustration, characteristic only of this patient. Determination of level of pathogenic influences (urogenital, neuroendocrinal, behavioural) and types an intersyndrome-nykh of interactions (synergy, antagonistic, compensatory) allows the sexopathologist to carry out complex treatment with clear understanding of what receptions on what substrate when (at what stage) and how to influence really to help the patient.

Creation of specialized network seksol. offices in the USSR it is begun in 1963. Then at a seminar in Gorky the first group of sexopathologists was trained. The special order of the Minister of Health of the USSR defined measures of improvement to lay down. - the prof. of the help to the patients suffering from sexual frustration and organizational bases of providing seksol. help to the population. It is established that the doctors who had special training on S. Sozdan system specialized seksol shall render medical aid by the patient suffering from sexual frustration. help to the population: all republican, regional and regional centers and the large cities of the country are organized seksol. offices and consultations concerning marriage and a family, and also a number of specialized hospitals.

Seminars, specialized cycles of improvement, training at jobs, a clinical internship and a postgraduate study belong to the main forms of preparation and improvement of sexopathologists in the USSR (on bases Moscow in-that psychiatry, Kiev research in-that diseases of kidneys and urinary tract, in-t of improvement of doctors in Kharkiv, Leningrad, Kazan, etc.).

For coordination of scientific research in the field of sexual pathology in 1973 the All-Union scientific and methodical center for questions C. on the basis of department of sexual pathology Moscow on - uchno-research in-that psychiatry of M3 of RSFSR was organized. Along with it on the basis of department of sexual pathology and a spermatology Kiev research in-that diseases of kidneys and urinary tract in 1978 the Republican scientific and organizational center for questions C. coordinating scientific research in USSR is organized.

Problems C. are discussed on the international congresses of sexologists, to-rye since 1974, after the I International sexological congress in Paris, convoked regularly bucketed in 1 — 2 years. In 1978 on the III International congress on medical sexology in Rome the International sexological association is founded.

In the crust, time of department which are carrying out postdegree specialization and improvement of doctors in S. exist in the majority of the developed countries, in S., nek-ry from these countries, it is included in the program of dodiplomny preparation. Textbooks and the guides to S. are published in the USSR, ChSSR, the USA, Yugoslavia, Germany, Poland, Venezuela, Denmark. Theoretical and practical achievements of the Soviet specialists are reflected in the fundamental managements «General sexual pathology» (1977), «Private sexual pathology» (1983).

Questions C. in the USSR are taken up in magazines «Urology and Nephrology», «Magazine of Neuropathology and Psychiatry of S. S. Korsakov», etc., and abroad — in «Fertility and Sterility», «Journal of Reproduction and Fertility» ^ by «Medical Aspects of Human Sexuality», «Andrologie», «Sexualmedizin».

Bibliography: Vasilchenko G. S. About some system neurosises and their pathogenetic treatment, M., 1969; In and-silchenko G. S., etc. Some questions of the organization of sexological service, in book: Vopr. organizations psikhiat. the help, under the editorship of V. V. Kovalyov, page 49, M., 1982; Diagnosis, treatment and prevention of sexual frustration, under the editorship of A. A. Portnov, M., 1978; The General sexual pathology, under the editorship of G. S. Vasilchenko, M., 1977; Svyadoshch A. M. Female sexual pathology, M., 1974; Private sexual pathology, under the editorship of G. S. Vasilchenko, t. 1 — 2, M., 1983; Handbook of sex therapy, ed. by J. LoPiccolo a. L. LoPiccolo, N. Y. — L. 1978;;; Hastings D. Impotence and frigidity, L., 1963; Human sexuality in medical education and practice, ed. by of Page E. Vincent, Springfield, 1968; H y-n i e J. <Lekarska sexuol5gia, Martin, 1970; To about s t i 6 A. Osnovi medicinske seksolo-gije, Beograd — Zagreb, 1966; M a. s-t e r s W. H. a. Johnson V. E. Human sexual inadequacy, B., 1970, bibliogr.; Silverman H. L. Marital counseling, Springfield, 1967; The teaching of human sexuality in schools for health professionals, ed. by D. R. Mace a. o., Geneva, 1974; Wagner G. Green R. Impotence, N. Y. — L., 1981.

G. S. Vasilchenko.