[The sexual health of men from a sexual-medical perspective].

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A. Demographics

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Moskovskaya Oblast' Konakovo girl Cuddles Fun
Moskva Moscow girl Натали Serious
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Chai Nat girl Pornwimol Sripa
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Permskaya Oblast' Perm' girl Nadezhda Serious
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United Kingdom United Kingdom , Carl Marriage
United Arab Emirates Dubayy Bur Dubai, ash Dating
Australia Western Australia Perth, sami
Canada Quebec Montreal, Amer
Hungary Budapest Budapest, Istvan Marriage
Germany Berlin Berlin, Thomas Serious
Croatia Splitsko-Dalmatinska Split, Stipe Serious
Israel HaMerkaz (Central) Rehovot, MOUZES
Netherlands Limburg Maastricht, ardi
Argentina Distrito Federal , Vito Marriage
Germany , Dicki
Italy Sardegna , andrea Serious
United Kingdom England Birmingham, Jason Serious
United States , carl
Egypt Al Qahirah Cairo, Doha Serious
Russia Tul'skaya Oblast' , Boris
United Kingdom England Swindon, John Fun
Sweden Vasterbottens Lan Umea, Christer
Germany Germany , Albi
United States South Carolina Loris, ervin powers
Ireland Clare Ennis, Paul Serious

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B. A Brief Historical Perspective

Berberich, Hartmut A. Bosinski, Kurt Loewit, Klaus M. In addition to functional Poliklinik fr Urologie: men, disturbances of sexual function are the most sexual disorders, which may or may kiel be associated Dr.

Rsing, important in clinical practice. These are classified by Prof. Praxis fr Urologie, and sexual behaviour can occur in men 1. Frankfurt a. Berberich; from dysfunction bosinski significant suffering and Sektion fr requiring treatment.

Epidemiology Sexualmedizin Sexual disorders in men are categorized kiel to im Universitts- Methods: The authors clinical experience is supple- their occurrence in the cycle of sexual response into klinikum Schleswig- sexualmedizin with a selective review of the literature on Holstein, Campus Kiel: bosinski of desire, arousal erectile dysfunctionor Prof.

Medizinische Psychologie und Results: The sexual history including the partners Laumann et al. Sexualmedizin Loewit; dimensionality and multiple functions of human national comparison Laumann, et al. Chronic frustration of the funda- some similarities, but also significant intercultural Sexualwissenschaft und Sexualmedizin, mental psychosocial needs for acceptance, closeness, variations corroborating the biopsychosocial etiology Charit and security is a very important factor that has been of these disorders.

A number of studies have Universittsmedizin neglected until now by the prevailing conceptions of the also confirmed the negative effects of functional sexual Berlin: Prof. Beier etiology and pathogenesis of sexual disturbances.

Their treatment involves a combination of elements from sexual medicine and psychotherapy, along with Desire disorders somatic medical and pharmacotherapeutic intervention, Desire disorders increasingly present as a problem if needed. The goal of syndyastic sex therapy, a further among men seeking medical help for sexual difficul- development of the previous therapies, is to fulfill these ties. Erectile dysfunction is often presented as the fundamental needs and thereby to improve the patients primary complaint, but it is not uncommon for this to sexual function and deepen his satisfaction with the mask other problems such as exhaustion with or with- relationship in its entirety.

Sexual disturbances non-equivalence in the are common, and patients therefore expect their physi- Erectile dysfunction precise nature of treatments and cians to be kiel in sexual medicine. The coverage The prevalence of erectile dysfunction has been well practitioners between of this subject in both undergraduate and postgraduate researched. The Massachusetts Male Aging Study countries.

The German medical education in Germany needs to be improved. Braun and colleagues treatment delivered in found erectile dysfunction in DOI: TABLE 1 reported distress.

It is defined as bosinski persistent or repeated occurrence of ejaculation before, during, or shortly after penetration, over which the individual has little or no control and not accompanied by a feeling of orgasmic satisfaction.

In seeking to present valid prevalence data one encounters two problems: On the one hand, the normal interval between penetration and ejaculation is to a large extent a subjective judgment, and subject to wide individual and cultural variation 11, e4. And on the other hand, this is an area in which it is particularly clear that biological dysfunction is not synonymous with a clini- cally relevant disorder.

Because of their prev- Requirements for a sexual history alence, particular attention will be paid to the diagnosis 1, 15, 16 and treatment of functional disorders, which are the subject of numerous treatment approaches.

The Sex as a taboo topicovercoming the barriers to relational aspects of human sexuality are accorded speaking for patient couple and doctor particular importance in a biopsychosocial sexological Subjective perception and distress why is the patient approach, which is underpinned by a selective literature presenting now and how are things, concretely?

How review. Background and diagnosis Couple centeredness prompting with questions such Sexualmedizin research results from the last 15 years and as how does your partner experience the situation? Even if there is no partner, relational experiences treatment of male sexual dysfunction. Invasive investi- and desires are present.

Medication is intro- Exploration of illnesses, treatments and medication duced early. Success is measured in terms of function, The significance of the three dimensions reproduction, which in turn is measured using questionnaire instru- desire, and relationship for the individual and their inter- ments such as the IIEF International Index of Erectile play or effects within the relationship Functionits short version IIEF-5or the Cologne How are fundamental psychosocial needs being fulfilled Erectile Dysfunction Questionnaire Klner Erfas- or frustrated, in general and in the specific area of sungsbogen der Erektilen Dysfunktion, KEED 8, 12, sexuality?

Erectile dysfunction is generally regarded in Detailed history of sexual behaviour and experience the literature primarily as a vascular disorder, acting as genital and non-genital sexual activity, masturbation, a first sign of generalized atherosclerosis e6.

The sexual preferences [gender, age, practices], fantasies, view of this disorder has changed from an almost behaviours, self-image entirely psychogenic to an organically dominated, Life history and sociosexual development multifactorial etiology A large proportion of The history taking is already a part of the treatment, as studies on male sexual dysfunction is directed at the one can safely assume that no such frank bosinski effects of pharmacological treatment on desire, erection with the individuals and his partners sexuality will have and ejaculation, and remains purely at the level of the taken place previously functional disorder.

The discovery of highly effective oral medications by the pharmaceutical industry have. It is accompanied by kiel. Distress arises when a sense true that the predominantly somatically focussed litera- of ones own sexual inadequacy arises in the context of ture alludes in general terms to the role played by a relationship.

The bosinski for relationship is innate and psychological and relational factors 10and consen- therefore ubiquitous 16, e Positive social interac- sus statements emphasize the importance of a full tions which fulfil fundamental psychosocial needs such sexual history taking into sexualmedizin the relationship This is sup- completely neglecting psychosocial and psychosexual ported by neurobiological data on the importance of relationship aspects.

Similarly, MRI Sexual experience always comprises a synergy of studies hint at a specific neuronal correlate for love biological, psychological and social factors, whose A factor hitherto largely neglected by etiopatho- individual weighting and interrelation where a sexual genetic approaches but which appears influential is the problem exists must be identified on an individual chronic frustration of basic psychosocial needs.

This patient basis. Of primary importance is the subjective leads not only to deterioration of the quality of relation- meaning of sexualmedizin and partnership, which in turn ship, but also affects sexuality in three areas: reproduc- determines the effects of events and experiences within tion, desire, and relationship.

In a recent interview the intimate relationship 15, e7. Against this back- based study by Kleinplatz et al. Sexuality as the lationship is necessarily incomplete and inadequate as a deepest act of communication is kiel a new idea, and means of planning the treatment of sexual dysfunction the extension of tactile communication during sex to.

Physical investigation Type of investigation To exclude Indication Clinical examination Physical examination, pulse, Urogenital, neurological and General physical examination with respiratory rate, exercise ECG cardiovascular disease attention to specific risk factors e.

Couples therapy makes this language relationships characterized by trust, empathy, and hope conscious, and translates it: attraction, acceptance, are therapeutically effective e If, reasonably closeness, and security are communicated and embod- enough, sexualmedizin accept the placebo effect of the good ied in sexual body language, as well as in other ways.

If one wants to attain a perspective commensurate Aristotle elucidates in his Nikomachean Ethics the with the complex realities of the situation, sexual idea of becoming close to one another synoikeios- history taking, as an important diagnostic tool requiring thai in the sense of belonging together. He distin- attention to details not usually elicited in the standard guishes this from the relationship with a significant medical history, requires specialist knowledge and other found between members of a couple syndyasti- qualification 20, e9, e10 Box.

This does not necessarily history taking was emphasized by the results of the presuppose sexual functionality, nor is sexual Berlin Men Study Berliner Mnnerstudie. This study functionality sufficient to create sexually satisfying asked a representative sample of men aged experiences A subgroup being fulfilled in a unique way bosinski sexual body- analysis of participants who completed an extensive language.

Their chronic frustration via dysfunctional interview including a full sexual history in sexualmedizin presence or absent intimate physical contact, plays a key role in of their partner in total mennot only demon- the development and maintenance of psychosomatic strated the prevalence of the various functional disorders, including all functional sexual disorders, and disorders, but also found that On the used in the arousal phase of masturbation which could other hand, recent studies of the placebo effect have be classified as paraphilias for example fetishistic, shown that the effect of medicines is frequently masochistic, sadistic, or exhibitionistic fantasies.

From enhanced by the supportive attention received in the the perspective of sexual medicine, paraphilia-like consultation, in addition to the attribution effect, which arousal patterns are not in themselves pathological, arises from a positive expectation of treatment.

Even while the importance of the fantasy in the process of the Drug Commission of the German Medical Associ- arousal was frequently reported by participants to be ation Arzneimittelkommission der deutschen rzte- moderate, and only occasionally as strong.

Generalization from this population to the background Treatment population is inappropriate due kiel likely selection bias. The biopsychosocial etiology of sexual dysfunction Nevertheless, as many as a third of men described the calls for a biopsychosocial approach to treatment, paraphilia-like fantasies alone as inadequate, and in a involving the methods of narrative medicine as well significant proportion of these, there was a risk of harm as organic and pharmacological approaches Table 3.

These data which radical prostatectomy for prostate cancer, Herkommer represent a tiny group, as the men were over 40et al. There was unexplored. One example of this is the inappropriate also discrepancy between the views of patients and treatment of erectile dysfunction arising in a severe but clinicians regarding choice of treatment modality kiel For this reason it is important across medi- importance of genital sexuality decreased in both cal specialties to include a sexual and relationship partners before and after radical prostatectomy.

Rela- history into a general medical history, and where bosinski tionship and the importance of physical closeness kiss- priate introduce additional enquiry and investigation ing and cuddling retained their importance Other Figure, Table 2.

This offers patients or couples studies confirmed this higher value placed on the fulfil- wishing for change or treatment but reluctant to express ment of the need for psychosocial closeness, intimacy, this the opportunity to discuss kiel concerns and and security in comparison with the pursuit of purely receive early intervention.

Kiel extent of treatment effi- sexual satisfaction The prog- Beier and Loewits method of couples nosis is good where distressing sexual dysfunction is therapy focuses on basic psychosocial needs In recognized early at first presentation and receives this it differs from all other forms of treatment Table expert treatment.

Otherwise, there is a danger that the 4. The primary aim of therapy is not to restore sexual problem will become chronic 1.

Gather- sensate focus ing self instigated new experi- ences; physical treatment where appropriate. Modified according to Beier et al.

The couple achieves this by Effective medication and mechanical aids are is by no prescribing themselves a break in medication as well as means contraindicated but sexualmedizin on the contrary comple- new experiences focussing on physical contact and mentary, used at the right moment.

Increasingly, both partners are able to let go, A 59 year old man presents to the sexual medicine their genital organs are reclaimed as organs of clinic with his partner with persistent erectile dysfunc- communication, orgasm loses its negative associations tion despite regular use of a PDE 5 inhibitor following and is experienced as the expression of mutual desire nerve sparing radical prostatectomy for prostate cancer. I feel relaxed, as though effect. Their distress is significant, and physical a burden was falling away from me, The female partner is emotionally and physically They are much desired sexual intercourse, which the sexualmedizin sees afraid of hurting each kiel.

The subject of sexuality as a particularly intense form of closeness, becomes is avoided. The health giving of cancer, the current state of the relationship and their benefits of sexuality are once again within reach. Sex has always been an important part of the Conclusions relationship for both parties, even if to different A sexual bosinski if possible with the partners involve- degrees, with a clear delineation of roles. Following ment is centrally important in the diagnosis of sexual surgery, this has changed, with sex now being initiated difficulties and must respect the multidimensionality sporadically by the female partner, with him bosinski and sexualmedizin of human sexuality.

Treatment resigned in the face of his missing erection and she draws on sexual medical and psychotherapeutic tech- reporting feeling guilty at his stroking her to orgasm. Couples sex therapy focuses primarily on with the pill, and miss moments bosinski sexual contact basic psychosocial needs, with the aim of improving such as they used to enjoy. In ten hours of couples ther- satisfaction in the sexual relationship. The key moment sexuality and its disorders requires not only under- in treatment is the recognition for both partners that standing of the biopsychosocial context, but also a will- despite incompleteness physical and emotional trau- ingness and ability to reflect on ones own sexuality.

This is indispensable because of the requirement to be in men with erectile dysfunction and depressive symptoms. Similarly, the ability to address the ques- Impact of erectile dysfunction ED on sexual life of female partners: assessment with the Index of Sexual Life ISL ques- tion of ones own basic psychosocial needs is essential tionnaire.

J Sex Med ; 5: Fisher WA, Rosen RC, Eardley I, Sand M, Goldstein I: Sexual This way of thinking and working is unfamiliar to experience of female partners of men with erectile dysfunction: many doctors, because, as sexual medicine remains un- the female experience of mens attitudes to life events and taught in a majority of undergraduate medical courses sexuality FEMALES study. J Sex Med ; 2: It is however teachable and learnable.

For the convenience of researchers, an Adobe Acrobat PDF file of this chapter is available for download above click the PDF sexualmedizinwhich reflects the actual pagination of the book. This will allow scholarly writers to cite actual page numbers in kiel printed bosinski for quoted material, bosinski well as its availability on the Web bosinski the URL if desired.

See also How to Use This Encyclopedia. Noonan, Ph. Located in central Europe, Germany embracessquare mileskm 2 and is slightly smaller in size than the state of Montana. Denmark and the Baltic Sea mark its borders on the north, the Netherlands, Belgium, Luxembourg, and France bosinski the west, Austria and Switzerland in the south, and Poland and the Czech Republic on the east.

The climate is temperate and marine. In JulyGermany had an estimated population of Age Distribution and Sex Ratios : years : Life Expectancy at Birth : Total Population : Ethnic Distribution : German: For additional details from www. Julius Caesar defeated Germanic tribes in 55 and 53 B. After Charlemagne, ruler of the Franks from tohad consolidated Saxon, Bavarian, Rhenish, Frankish, and other lands, the eastern part sexualmedizin the German Empire.

The Republic of Bosinski faced a disastrous economic collapse brought on by war reparations to France and its allies. In the aftermath of the war, Germany bosinski split into an eastern portion under Communist control, and a western democratic republic.

The long-lasting tension between richer and poorer regions will mask the remarkable differences that have developed in sexual habits. Possibly the unexpected unification, together with the increasing immigration, will lead to sexualmedizin turbulences on the sexual front.

Germany, bossinski well as the predominantly German-speaking countries of Austria and Switzerland, has always received large numbers of immigrants. For many centuries, its geographic situation in the middle of Europe meant that the country functioned as a transit land and clearinghouse for people of other nations. Fascist rule with its tenet of Aryan bosinski interrupted this mobility for a dozen years and the Iron Curtain for four decades.

Diverse cultural traditions sexualmedizin ethnic backgrounds currently form a contradictory mixture, apparently productive as well as unstable. In this region, the following events occurred within the 20th century: the invention of sexology, a sexual repression of extreme cruelty, and most recently, a fundamental sexual liberation. The leadership in sexual reasoning was suddenly lost when the Nazi government annihilated the symbiosis with the Jews, who until then had fruitfully and uniquely assimilated themselves into German culture.

Sexualmedizin German-speaking sexual science has never recovered from this loss of genius. The structure of and changes sexual,edizin gender differentiation in Germany resembles that of other Western countries. The long-term trend, since the first feminist movement in the s, sezualmedizin an egalitarian tendency sexualmediain regard to political, economic, as well as sexual participation. The trend was interrupted by the Nazi regime, which tried to push women back into household and nursing activities.

World War II brought women back into the industrial workplaces and to autonomous decision making in all social domains. Today, there kiel many endeavors to emancipate women and, possibly, men. Political rights and the wording of laws and official texts are strictly gender neutral. Affirmative action, quotas, governmental subsidies, and similar programs support and proclaim an egalitarian policy.

But sexualmediin are numerous barriers to putting these incentives into everyday practice Lautmann Equality remains a task for generations to come. Jurisprudence says that every human being from birth on is granted a status as a person with their own rights.

Corporal punishment is strictly forbidden, abrogating a traditional customary right of adults. Formal education is gender neutral. Girls and boys are given equal opportunities at schools.

The principle of coeducation has been implemented thoroughly. Some feminists are currently recommending a partial return to gender-specific classes in order to overcome certain problems in the learning sexkalmedizin mathematics and technical sexualmedizin.

After puberty, men and women enjoy a high level of sexual autonomy. Some youngsters leave the parental house before majority age 18 to share a flat with other adolescents. The perception of gender roles is clear for many adolescents. They fixate on these roles, while other factors and, above all, their individuality, are neglected as one-sided.

The actual or intended esxualmedizin between men and women kiel partly kiel as threatening, especially in the west. The bosinski of women with a habitual feeling of disadvantage on account of their sex is much greater in the west.

Adolescents in the east see themselves to a lesser extent than in the west as men or women, and experience relations between the sexes as less conflict-ridden.

Feminist thinking was hardly disseminated in East Germany and did not influence girls as they grew up to develop a critical perception of men, who in turn did not experience a resulting feeling of insecurity. They blsinski events in their lives, their success and failure, less to their membership of one of the sexes and more to their overall personality. German women experience no discrimination in their academic or training period. They also do not have problems securing a good job. In the former East Germany, where many more women held full-time jobs and were paid equally before the Union, their salaries are now about Only 5.

Although possible paternity leaves are sexualemdizin available to men, only 1. Men cite a variety of reasons for their disinterest in these leaves, including fears of damaging effects to their career, possible loss of their job, and the financial cost of an unpaid leave. As ofwomen accounted for only 1. End of update by J. Pastoetter ]. In Germany, the basic ideologies and configurations of the erotic kieo do not differ very sexulmedizin from those found in western and northern Europe and in the WASP population of the United States of America.

With respect to sexual behaviors, the most important cleavage runs between the two principles of Romantic Love versus Hedonism. Bosinski binds together personal love and sexual attraction. This principle is founded in the Christian idea that the spiritual community dignifies the genital encounter.

The prosaic concept of hedonism emphasizes the erotic quality of the body and the satisfaction of desires. The sexual drive is a natural need. One may give way to it without making many preconditions, calculating only costs and gratifications.

Similarly, there are two ideal types of intimate sexualmedizin. Affective solidarity is the bodinski of a stable and universal relationship between two human beings whose individual disparities are balanced through a mutually complementary performance. On the other hand, contractual partnership is based on sexualmedizin calculation of mutual benefits.

The relationship lasts as long as the balance remains positive for both participants. The contractual element allows for negotiations about sexual relations. Sexual phenomena are generally conceptualized from a naturalistic point of view developed in the 19th century. In this view, innate programs, hormones, and so on direct the sexual response.

Psychoanalytic and sociological approaches are not prominent, with the exception of a behavioristic learning theory. Since the Reformation in the 16th century, Kiel has been the arena of fierce conflicts between the two main religious denominations, including long wars. Thus, the sexual morals of Protestantism and Catholicism exist side by side sexualmedlzin all their differences and sexualmedizin.

Many surveys show that the sexual teachings of the churches do not effectively direct the behaviors of the sexually active population, although they may have some effect on the attitudes.

Instead, the churches exert a considerable influence on sexual politics. They are accepted as an expert voice in moral debates, but to a diminishing extent. In the new, controversial legislation sinceno-fault divorce, liberalization of abortion, and sexual autonomy, the ecclesiastical positions were overruled.

The current growing immigration rate, which includes, for example, 1. The Islamic and paternalistic view of family values, gender differentiation, same-sex relations, and the like is opposed to the secularized Boxinski view. Immigrants of the second generation experience tensions between intra- and extrafamilial worlds. Moreover, kiel combination with low social prestige, an explosive mixture arises, bursting kiel violence against women, gays, and other persons kiel as weak.

The parental family and the school have the mandate to give the necessary instructions about kiel. To a certain degree, both institutions are reluctant to perform that task. Sex education, if publicly discussed, immediately becomes a political controversy, where the right-left continuum corresponds to the poles of repressive versus emancipative doctrines. School curricula provide for the instruction of sexual issues from the first elementary secualmedizin onwards. Since there is no special course, the matter can be addressed in various fields, such as biology, religion, politics, and so on.

The outcome, in spite of existing detailed syllabi, is a sporadic sex education. The teachers think of themselves as not being competent enough. As a kiel of fact, the academic training is entirely insufficient; only a tenth of the pedagogic students kie, offered suitable courses.

They hesitate to speak frankly to their children; and many parents wish that teachers would refrain from doing bosinski Glueck As in other Western countries, the mass media and peer-group conversation are the primary sources for spreading sexual knowledge. The censoring of magazines, books, and films does not occur, except for pornographic material. There are laws to prevent minors from being exposed to sexual matters, but the general media are full of instructive articles and illustrated stories.

Public television has developed a high standard of feature programs dealing with sexual sexualmedizin. Sex-related problems and questions are presented to audiences and discussed by experts. Presumably, these widely watched features and talk shows have raised the level of knowledge and value consciousness about most variants of sexuality. Nine out of ten men and seven out of ten women in Germany admit to having performed masturbation.

Younger women are more mobile than older men. The frequency of orgasm has not changed in keeping with sexual liberalization, but the attitude towards it, its experience, and its function within a relationship have changed. The sexist emphasis on male and female potency measured in terms of orgasm has become fragile, and the compulsion to have orgasm is being resisted. There is a growing aversion to orgasm achieved with all manner of tricks and used as a measure of male or female performance, celebrated as a victory in joint conflict, and feared as a stress-obsessed prestige event.

Instead, the individual quality of a steady relationship is sought, linked with closeness, trust, warmth, carefree pleasure, and unpredictable, uncalculating, uncalculated affection within the total erotic form. Cuddling is back in fashion; compulsive or cheap commonplace sex is out.

There are many common aspects in partner and sexual behavior between western and eastern Germans. However, noticeable differences continue to exist. These differences are not so much on the level of behavior as on the level of desire, the experience of sex, and sexual attitudes. More eastern than western German females look forward to their first sexual intercourse and they start somewhat earlier. Sexually inexperienced boys and girls in eastern Germany clearly want to have more sexual experiences than those in the west.

Females from eastern Germany begin sexual relations earlier than those of the same age in the west. Western German males, on the other hand, link sexual intercourse more firmly than males from eastern Germany to a steady relationship; then again, twice as many have sex with occasional partners.

It is possible that they are quicker than eastern German males to detach sexuality from a person or relationship, at least occasionally. More adolescent females in eastern Germany regard their sexual activity to be gratifying and enjoyable. This refers both to masturbation, which they experience with more pleasure, and especially to sexual intercourse.

The differences are not the frequency of orgasm, but rather the sexual experience, the joy of sexual arousal, the subjective quality of the entire erotic form, and the feelings of happiness experienced during intimacy.

In both eastern and western Germany, young females are less appreciative of their latest incidence of sex if they did not achieve orgasm; however, the experience of eastern girls not experiencing orgasm is hardly less positive than that of western girls who do experience orgasm. In the west, some adolescent females feel sexually unsatisfied during sexual intercourse and are not happy, even though they had an orgasm.

In eastern Germany, on the other hand, women are also sexually satisfied and happy, even if on the last occasion they did not experience orgasm. In addition, it can be seen that among eastern German adolescents, virtually all the differences between the sexes, as regards the experience of sex is concerned, have been dispelled, whereas they continue to exist among western German adolescents.

In the same time span, single households quintupled. A third Most of the latter are located in small communities of less than 5, people; most of the former live in the big cities with more than , people. Nearly half of the 1.

It appears likely that by , a third of this age group will be living alone. Single females are more likely to earn the highest academic degree Abitur , have a job, and a higher paid one. Single males and females live in bigger apartments than their married peers. Interestingly, they have about the same social network as married couples, and keep closer contact with their parents. Nearly half of them are convinced that it is important to have a family and children.

One third experience the single lifestyle as being forced on them. In the New Lands, the to year-olds have sexual intercourse less often than the year-olds. Ninety percent of all heterosexual sex acts take place in long-term relationships.

Although the number of longtime singles is quite high, the truth might be in between, since many are only living temporarily as singles. More recent numbers are not available. In the near future, hundreds of thousands of singles will reach an age where traditionally younger family members take care of the older members.

Although Germany has had a national nursing insurance for several years, many doubt it is sufficiently funded. Voluntary solidarity communities are an alternative, but the question is whether people who have lived their life for a long time alone will be able to share responsibility in a larger group.

Most people who maintain a steady sexual relationship will live together in one residence, although not all men and women who share a residence are necessarily having sex with each other. The housing situation in Germany allows living together. Frequently, occupational mobility may lead to a separation of partners. Increasingly, German couples, especially in the New Lands, prefer cohabitation to marriage. In cohabitation, women have more freedom to build their own career, especially if they are also childless.

Meanwhile, public opinion is shifting in favor of cohabitation. Adolescent mothers and female students with children have suddenly disappeared as if by magic. The once-low marriage age has rapidly risen and is set to reach that prevalent in western Germany, with the result that the establishment of families is being delayed. Female and male adolescents in eastern Germany are more likely to have grown up with both parents employed full-time than their counterparts in western Germany, and this is, thus, the model on which they base their own lives.

Work and family are not seen as alternative, mutually exclusive values, but are only acceptable when organized in conjunction with each other. This is a demand being made on both society and the relationship.

For the first time since , the number of weddings in rose over the previous year: , couples married in , an increase of 3. In the Old Lands former West Germany the increase was 2. The reasons for marriage have changed dramatically in the last ten years; love and partnership are no longer the most important factors, having yielded to economic stability.

Couples without children also have a higher per capita income and a higher standard of living than couples with children. Sociologists and psychologists think that more and more people have learned through experience that a successful job life is emotionally less fulfilling than a satisfying relationship in filling the emptiness of their private lives. While the Kettenehe , chain marriage or serial monogamy, is popular, few German couples believe any longer that filing a declaration of divorce as soon as major marital problems occur is the only remedy for relationship problems.

They realize that they will not only get rid of a husband or wife, but also of a good deal of their life together, friends and relatives included. The number of therapists who specialized in marriage therapy has increased significantly over the last 15 years. Catholic-sponsored offices for marriage therapy rose from in to in in the Old Lands. The Protestant Diakonische Werk now has offices that offer free counseling. The New Lands divorce rate peaked in with The highest divorce rate in the Old Lands came in with The divorce rates were Overall, the divorce rate rose by 2.

More than half of the divorces involved minor dependents. Four of five divorced husbands had another partner within ten months, while half of all women were still single after three years.

Two thirds of all divorce petitions were filed by wives. According to sociologists, factors for the growing rate of divorce include a decline in the social stigma of divorce since the sexual revolution in the s and the growing financial independence of gainfully employed women.

Couples without a church wedding or children, and couples who do not own their home are more likely to divorce, with infidelity cited as the most frequent reason. Nine of ten German women and two thirds of German men hold fidelity as the most important value in a relationship.

But the same percentage believes that it is not possible to remain faithful to the same person all life long. This new term actually refers to a very old and traditional way of life. In the agricultural world of Old Europe, few newlywed couples possessed the financial means required to establish their own household. Only wealthy farmers, burghers, and aristocrats could afford to pay the brideprice or supply their daughters with a dowry sufficient for the newlywed couple to establish their own household.

Most others fell into the mass of poor farmers, day laborers, and servants, the younger sons and daughters of aristocrats who in earlier times had to join a monastery or convent, the voluntary or involuntary spinsters and bachelors, and those who were allowed to marry but not to set up their own household. In a sense, LAT relations are only new if we forget history.

If a couple can only find work in different cities, it may well be more economical to maintain two separate households instead of absorbing the time and cost of daily commutes. LATs also include singles who share a committed relationship, but prefer to maintain their separate modest household, in which each has privacy and the flexibility of being together or apart. Oral stimulation of the genitals, both fellatio and cunnilingus, has become a customary practice.

Since hygienic standards and opportunities are high, there are no longer aesthetic scruples. Personal hygiene education in early childhood blocks the unaffected dealing with this aperture of the body. Same-sex genitality as an institution is rooted in a changeable history.

Before the advent of Christianity, German tribes repressed such acts with capital punishment. From the Middle Ages on, there were meeting places in some metropolitan cities, such as Cologne, which, however, were not large enough, compared with London or Paris, to develop an urbanity suitable for a real subculture. From the early 19th century, Swiss and German writers gave expression to the voice of love between men.

The term homosexual was created, interpretations of same-sex relations were published, and civil liberties for homosexuals were demanded. The foundations for the modern concepts, lesbian and gay, were laid in Germany. In , this hopeful development was suddenly interrupted by the Nazi government.

The persecution was based on racial-biological and demographic beliefs. Enforced with jail and concentration camps, it was the fiercest ever seen in modern times. It was not until the s that the gay and lesbian existence could recover from this knockout blow. Today, homosexuality is societally established as never before in history.

Not even the menace of AIDS has reversed the trend. Despite the numerous victims of HIV, one may say that the life chances of homosexual and bisexual people continue to be enhanced. Same-sex relations between consenting adult men were completely depenalized some 20 years ago. Same-sex relations among women were only criminalized in Austria in earlier decades. Currently, any differentiation between homosexual and heterosexual has been removed from the penal code, as is the case in Switzerland since and in the former East Germany since Contemporary political demands include an antidiscrimination amendment to the Constitution and the legalization of marriages of same-sex couples.

The state has long since abstained from open denial of rights and privileges, e. They are given as much equality, meaning tolerance, as necessary, but not as much equality as possible in terms of integration. Residual discrimination remains in niches like the military and the Church.

And it is difficult to intervene in the antihomosexual policies of the private sector of the economy. Homosexual lifestyles are possible even here, as long as they are restricted to the private sphere. So there are many occasions for homoerotic feelings, even for sexual encounters between friends.

The same-gender contact of youngsters has been reduced, but has not disappeared, in the last decades, because of coeducational schools and acceleration, including the earlier start of heterosexual coitus cohabitarche.

Moreover, the age of coming out for homosexuals has been getting ever lower, so that today this often occurs during adolescence. Turning to gender roles, the theory of the third sex proposed by Magnus Hirschfeld has faded away. Today, gays are thoroughly masculine, lesbians quite feminine. Sometimes, they play with the possibilities of cross-gender behavior, onstage or in subculture situations. But their personal identity is confined to their biological sex. In lesbian subculture, the rigid separation into butch or femme has diminished.

Uncertainties of gender, intergenerational longings, and love relations between the social classes are no longer the prerequisites of a homosexual preference. Transgression of class, generation, and gender frontiers contributed to earlier sex scandals, and even constituted their kernel. Today, the only and really subversive moment in homosexuality is its negation of compulsory heterosexuality. The homosexual desire as it has crystallized throughout the 20th century signifies precisely the same-sex relationship.

By this, homosexuals were confronted with the possibility and necessity of forming lasting partnerships. Meanwhile, a considerable portion of this population follows a quasi-conjugal lifestyle. Two men or two women establish one household, and share income, leisure time, and friends. The couple, especially a lesbian one, may enlarge to a family with children from a former marriage, sometimes from adoption or fostering. There is no separation of rights, duties, and prestige according to the traditional roles of husbands and wives.

Gay and lesbian couples attach great value to egalitarian decisions. On the other hand, their stability is endangered by the lack of institutionalization and public recognition. Too many details of daily life have to be negotiated.

Most couples admit some form of sexual contacts with third parties. Homosexuality as an accessible form of erotic preference enjoys a high degree of social visibility that was increased but not generated by the public reaction to AIDS. There are more occasions than ever before to learn about homosexuality, to discuss it, and to confront oneself with such experiences. In many sectors of everyday life, the questions of homosexuality are addressed: at school, in the family and peer group, at work, and during leisure activities.

So a latent desire can quite easily manifest itself, and one can look for possible partners. Many doors open to the homosexual world.

Special guides list the commercial and the hidden places where homosexuals meet. Nationwide associations address cultural and professional interests for Christians, adolescents, teachers, medical people, writers, and the like.

On the one hand, only a tiny minority of this minority affiliates with such an organization. Homosexuals have conducted numerous experiments with gender roles, forms of coupling, and techniques of sexual outlet. Some of their inventions have gained significance for nonhomosexuals: the social autonomy of women explored in the economically independent existence of lesbians; body image and sensitivity of men explored via some feminine components in gay performance; the remasculinization of men in the s experienced in the so-called clone style.

Homosexual relations, of course, are not a model for the general public; nevertheless, they give a striking example for the plasticity of erotic configurations. Female homosexuality had never been prosecuted. The argument is that all social commitments and responsibilities should be strengthened in a time of progressive social fragmentation.

The most probable choice will be the registry office Standesamt where all heterosexual marriages must be performed to be legal. The Eingetragene Lebenspartnerschaft will include such fundamental rights and obligations as the right to choose a common family name, the legal status of next of kin, the right to see the partner in hospital, the obligation to pay maintenance, a so-called kleines Sorgerecht small law of custody for children in the partnership , and rulings for divorce, rent law, and inheritance.

A homosexual foreign partner will have the same rights as a heterosexual foreign partner with regard to permission to work and immigration of family members. Income and inheritance tax laws, as well as laws pertaining to tax advantages for maintenance payments when a couple gets divorced, fall within the sovereignty of the 16 German states.

On December 1, , the Bundesrat, with its conservative majority, rejected the second law involving these ancillary rights. The main law was, however, passed in the Bundesrat.

Bisexuality, in the narrow sense of having homosexual and heterosexual relations during the same phase of a sexual biography, occurs quite often, presumably more often than exclusive homosexuality. Nevertheless, the concept is obscure and psychologically underdeveloped. Most experts agree with the thesis that they have never seen a genuine bisexual, i. Since this judgment refers mostly to a population of therapy clients, and since the universe of bisexual people has not yet been empirically investigated, the question of what types of bisexuality really exist remains open.

There are quite a few sexual biographies where phases of intimate relations with a woman alternate with relations with a man. For transvestites, there are no institutionalized roles in German society. The dichotomy of two and only two sexes is highly crystallized.

So transvestites very seldom gain public attention. They are generally considered deviants, but do not constitute a social problem. The phenomena of transvestism, transsexuality, and homosexuality are today clearly separated. Behaviors of cross-dressing and making-up as the other gender do not irritate public opinion, and the individual reaction contains a greater degree of amusement than of worry. Furthermore, since the s, some transvestites have won high prominence as entertainers in stage shows.

For some people, transgressions of the valid definitions of gender lead to a considerable amount of hostility. Transgenderists and transsexuals are, therefore, marginalized even today, when legislation, medicine, and the mass media have acknowledged their right to live as they are and accommodate their outward appearance to their gender identity.

German law provides some procedures for people who wish to change the sex designation ascribed to them shortly after birth. They may choose between officially changing their name or also altering their sex status. The second step presupposes the surgical adaptation of the genitals. In addition, the surgery presupposes expert evidence given by a psychologist or physician testifying that the person is able to live in the long term in the chosen gender role. Several hospitals in the country have specialized in this sort of medical support and are quite willing to deliver it.

At present, several juridical initiatives are being directed towards normalizing transsexuality. Support groups have been organized and receive state subsidies.

New sociological research describes the life world of gender-changing people Hirschauer ; Lindemann The leading German sexologist is pleading for depathologizing the phenomenon Sigusch But this will remain a utopia as long as transsexuals themselves apply for medical help, psychotherapy, hormonal treatment, and surgery to gain a healthy condition.

It provides for two possibilities, which may be applied either successively or independently of each other. The first possibility is for a transgendered person to change his or her first name without changing the assigned sex. The second possibility entails legal recognition of gender reassignment in all official documents including passport, birth certificate, and so on.

Moreover, the applicant must be unmarried and must be permanently incapable of reproduction. End of update by H. Bosinski ]. The criminal law prohibits sexual acts with young people under age 14 and under age 16 if the acts are exploitative. Moral crusades initiated by some feminist groups argue with increasing numbers of child sexual abuse cases.

With some lag, the figures in the official statistics rose after decreasing for three decades. The common construction and terminology throws together three distinguishable interactions: parent-daughter incest , men-children abuse , and intergenerational love pedophilia Lautmann These forms vary in ingredients and consequences. Sexual violence against women is the other big topic exciting the public opinion during recent years. The punishment of rape in the roughly 2, convictions per year is quite severe.

But many women do not go to the police even though officers have recently been taught sensitivity in dealing with victims. Legislation has hesitated to criminalize marital rape. Many young people are afraid of sexual violence. A quarter of the to year-old males in western Germany, compared to a tenth of those in the east, and more than half of adolescent females in the west, compared to a third in the east, reported that they had personally experienced sexual violence, sexual molestation, or sexual interference.

A fifth of women in eastern Germany have experienced rape or attempted rape. There are many cases of verbal and bodily molestation of women. Some women train in techniques of self-defense. Sexual molestation in the workplace or elsewhere is penalized as an insult, but seldom prosecuted. Some feminists are campaigning for legal recognition of a special offense of sexual harassment. However, the German legislature usually resists the demands to adapt the penal code to social problems addressed by moral crusades.

More than , women offer sexual services to men, either as a professional or casual job, or to obtain money to buy drugs. The organization of the activity varies. The most respected form is to use an apartment with a telephone and to receive the visitors there after having advertised in a paper.

Working in a brothel provides less autonomy for the women, but perhaps equal comfort. Other women wait in bars or hotels for clients. Dangerous, hard, and least profitable in comparison with the other forms is soliciting on the streets. Male homosexual prostitution is not as common, but it is organized in quite similar ways.

Some call boys offer their services equally to men and women. The demand from lesbians is extremely small, if any. The law forbids prostitution only under special circumstances, in certain areas, in the neighborhood of schools, and the like.

It is also forbidden to further prostitution and to recruit minors. These statutes are enforced in a very incomplete and selective way. The law forbids hardcore pornography that includes violence, children, or animals, and the sale of all sorts of sexual materials to minors.

Consumption is also quite high, with more than 78 million hardcore videotapes rented in Eighty percent of the videotapes rented and purchased are of American origin. Contraception is regarded positively and for the most part is correctly practiced throughout Germany.

Three quarters of year-olds and nine tenths of year-olds have experience with the contraceptive pill. Some sexually inexperienced females take the pill as a precautionary measure, while others prefer to refrain from sexual intercourse because they are not on the pill.

Similarly, many male adolescents also avoid sexual intercourse if a condom is not available. Almost everybody regards contraception as a joint responsibility. The current types of contraception are well known among adolescents. The IUD and diaphragm are less popular. The pill was easily accessible and free of charge in East Germany; it was prescribed by doctors, even to year-old girls.

Two thirds have used condoms; one fifth have used the IUD. Another fifth prefer the rhythm method, a method half of all women have never exercised. Although hormonal contraception is not decreasing in significance, and acceptance of the pill has actually increased among both men and women, the condom, which was completely out of fashion in East Germany, has been rediscovered as a result of AIDS.

However, the condom has not become a rival to the pill or the IUD. PLoS One Aug 22;2 8 :e Epub Aug August A functional endophenotype for sexual orientation in humans. Neuroimage Nov 18;33 3 Epub Sep November PubFacts points are rewards to PubFacts members, which allow you to better promote your profile and articles throughout PubFacts. Each member is given 20 PubFacts points upon signing up. You can purchase additional points at any time. What can I do with PubFacts Points?

Translated from the original German by Dr. Sandra Goldbeck-Wood. Berliner Mnner-Studie. United States: prevalence and predictors. Urologe ; Urologe [A] ; Stuttgart; New York: Schattauer Corresponding author Dr. For e-references please refer to: www.

Herz ; Eur Urol ; Montorsi F: Prevalence of premature ejaculation: a global and regional perspective. J Sex Med ; 2 Suppl 2: Urologe[A] ; MMW Fortschr Med ; 8: Dtsch Arztebl ; 96 33 : A Bun- desgesundheitsbl-Gesundheitsforsch-Gesundheitsschutz ; Dtsch Arztebl ; 97 8 : A Montagu A: Krperkontakt.

Stuttgart: Klett-Cotta Arzneimittelkommission der deutschen rzteschaft: Stellenwert von Antidepressiva in der Depressionsbehandlung.

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bosinski kiel sexualmedizin

Are you Hartmut A Bosinski? Kiel this Author. Toggle navigation. Bosinski In Join Now. Register this Author 8 Publications. Subliminal sexual stimuli facilitate genital response in women. Kiel Sex Behav Oct 30;39 5 Epub Dec View Article. October Kirsten Westphal ]. Authors: Hartmut A G Bosinski. April Correspondence letter to sexualmedizin editor : Subspecialty Training in Sexual Medicine.

Dtsch Arztebl Int Sexualmedizin 21; 12 Epub Mar March February Gender identity disorders: bosinski and surgical aspects. September Homosexual women have less grey matter in perirhinal cortex than heterosexual women. PLoS One Aug 22;2 8 :e Epub Kiel August Kiel functional endophenotype for sexual bosinski in humans. Neuroimage Nov 18;33 3 Epub Sep November Sexualmedizin points bosinski rewards to PubFacts sexualmedizin, which allow you to better sexualmedizin your profile and articles throughout PubFacts.

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Hartmut Bosinski of Universitätsklinikum Schleswig - Holstein, Kiel (UKSH) | Read 44 publications Sexualmedizinische Aspekte bei Intersexsyndromen. Article. xualmedizin (Beier und Bosinski) eine wichtige Voraussetzung für das Reinhard Wille in Kiel die Sexualmedizinische Forschungs – und.

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