Preface

**Section 5 Circumcision and Sexual (Dys)function 77**

Chapter 5 **A "Snip" in Time: Circumcision Revisited 79**

Götz Egloff

**VI** Contents

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes a plethora of sexual dysfunctions in males and females illustrating the diversity and heterogeneity of sex‐ ual disorders. The characterization of a sexual dysfunction is a complex issue needing exten‐ sive clinical, psychological and psychiatric expertise to come to a reliable diagnosis and includes many factors including partner, individual vulnerability and genetic, cultural, reli‐ gious and several medical factors. Sexual functioning and dysfunctioning involve complex interactions of biological, sociocultural and psychological factors. In any case, problems caused by interfering factors, like drugs, medicines, medical conditions or external stressors, should be excluded before making a dedicated diagnosis.

The present volume illustrates various aspects involved in sexual (dys)functioning showing the breadth of the field. Chapter 1 gives an introductory view on the field, introduces the various chapters and shortly discusses progress in premature ejaculation and female sexual interest and arousal disorder. Chapter 2 deals with an important male sexual problem, erec‐ tile dysfunction. Apart from an overview of the problems and causes of erectile dysfunc‐ tions, an extensive study is described where patients with various cardiovascular risks were assessed on erectile problems using an extensive range of variables analyzed. Not surpris‐ ingly, a high incidence of erectile dysfunction was found in patients with high cardiovascu‐ lar risk factors. Interestingly, erectile dysfunction improved more if these cardiovascular risk factors were strictly controlled. Such a study illustrates the importance of lifestyle factors in the sexual well-being of males. In Chapter 3, an impressive overview is given on the role of testosterone and particularly the lack or diminished levels of testosterone (hypogonadism) in every aspect of sexual development and life. Ageing appears an important factor that is associated with a gradual decrease in the amount of testosterone produced, and also life‐ style (obesity, metabolic syndrome, and the use of anabolic steroids) may lead to hypogo‐ nadism and associated sexual dysfunctions and complaints. In Chapter 4, sexual dysfunctions occurring during major depression are discussed. Several sexual problems oc‐ cur both in male- and female-depressed patients. Many antidepressants and particularly se‐ lective serotonin reuptake inhibitors (SSRIs) induce sexual side effects in depressed patients that further deteriorate the often-already present sexual problems. This is one of the main reasons of treatment cessation. New antidepressants lacking these sexual side effects are badly needed. The contribution describes an animal model in rodents with predictive and face validity towards human (male) sexual behaviour and sensitivity towards sexual side effects of potential antidepressants. Development of new antidepressants without such (sex‐ ual) side effects is a time-consuming and costly trajectory, but it is expected that such medi‐ cation will become available in the next decade. In the final chapter, a nice overview is given of circumcision and the ideas, rituals and beliefs about its function. There are many opinions

about the role of circumcision in sexual functioning and dysfunctioning, and the chapter nicely explains a lot of ideas and opinions on these items, including psychological, religious and medical theories. It gives a welcome, broad overview of the many aspects involved in thinking about sex and its dysfunctions.

#### **Professor Dr. Berend Olivier**

Professor Emeritus Pharmacology of the Central Nervous System Faculty of Sciences, Department of Psychopharmacology Utrecht University, Utrecht, the Netherlands

> Adjunct Professor Department of Psychiatry Yale University School of Medicine New Haven, USA

**Sexual Dysfunction: Introduction and Perspective**

about the role of circumcision in sexual functioning and dysfunctioning, and the chapter nicely explains a lot of ideas and opinions on these items, including psychological, religious and medical theories. It gives a welcome, broad overview of the many aspects involved in

**Professor Dr. Berend Olivier**

Pharmacology of the Central Nervous System

Utrecht University, Utrecht, the Netherlands

Faculty of Sciences, Department of Psychopharmacology

Professor Emeritus

Adjunct Professor

New Haven, USA

Department of Psychiatry

Yale University School of Medicine

thinking about sex and its dysfunctions.

VIII Preface
