FEMALE SEXUAL DYSFUNCTIONS

FSD

Prof. IHAB YOUNIS

About 40% of women are affected by sexual problems, with a higher prevalence of 50% in perimenopausal and post-menopausal women

A woman’s sexual responsi-veness is not the same as a man’s. Ignoring its complexity can make difference look like dysfunction

Types & Definitions

1.Hypoactive sexual desire disorder 27-52%

Persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity

2.Sexual arousal disorder

11%-30% (<60 y)

Persistent or recurrent Inability to attain, or to maintain adequate lubrication-swelling response of sexual excitement until completion of the sexual activity

3.Orgasmic disorder

20%(Eur) -29%(Am)

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual

excitement phase

4.Sexual pain disorders:

Vaginismus 6%

Dyspareunia17%24%(PM)

Involuntary vaginal spasms that interfere with penetration

Pain during intercourse

HYPOACTIVE SEXUAL DESIRE DISORDER

HSDD

• HSDD is the most common FSD

• Prevalence

ranged from

26.7% among

premenopausal

women to 52.4%

among naturally

menopausal

women

 

PATHOPHYSIOLOGY

• Dopamine is the key neurotransmitter in the modulation of sexual desire

• Steroid hormones increase available dopamine,

-Testosterone potentiates the synthesis

of nitric oxide, which controls dopamine

release

- Estradiol facilitates dopamine release

• Increasing levels of serotonin (e.g. as with

the, SSRIs) can diminish the effects of dopamine on sexual function

• Endogenous opioids (e.g. Endorphin), which give the sense of pleasure and reward, also modulate the perceived intensity of sexual desire in humans

• Following the experience of orgasm, desire decreases and requires a certain time span to be regained

• Therefore, they may have an inhibitory effect on sexual desire

causes

1- Low Testosterone

• Low testosterone does not only cause low libido, but also causes decreased sexual receptivity and pleasure, fatigue, lack of motivation, and an overall reduced sense of well being

• It is common in menopausal women or after bilateral oophorectomy

• It is not uncommon for pre-menopausal women to experience HSDD. This may be due to the fact that testosterone concentrations begin to decline as early as the late 20s in women and continue to fall at a constant rate of about 50% of their peak level by menopause

2-Low Estrogen

• Menopause can cause vaginal dryness, inability to lubricate, or dyspareunia

• In this case, oral estrogen replacement is often prescribed for the relief of hot flashes, mood changes, and sleep disturbances to improve quality of life

• The reason for this is that oral estrogen increases circulating levels of sex hormone binding globulin (SHBG) which lowers the level of free testosterone

• Oral estrogen also suppresses FSH and LH, reducing ovarian synthesis and lowering total testosterone levels

3-Indirect hormonal effects

• Hormone imbalances related to pregnancy, the postpartum phase and lactation

• Menopause: Natural or surgical

• The use of certain medications e.g. anti-depressants

4-Psychosocial factors

• Women with HSDD were 2.5 times more likely to feel dissatisfied with their marriage or partner than normal women

• 80% of patients with mood (e.g.depression) or anxiety disorders reported reduced sexual desire. However, patients with depression often do not appear to be distressed by their lack of interest in sex

5-Medications• SSRIs• Antihypertensive agents are proposed

to affect sexual function via central adrenergic inhibition and blockade of adrenergic receptors

• Antipsychotics are dopamine blockers, and may increase prolactin levels

• Oral contraceptives may have negative effects in a minority of women. But because of the wide variety of hormonal medications available the results of studies are not conclusive

6-Medical conditions

• Chronic illnesses e.g. diabetes mellitus, and cancer

• Painful intercourse due vaginal/pelvic floor conditions, such as vestibulitis, vulvodynia, or endometriosis; or bladder conditions, such as interstitial cystitis or urinary incontinence

EVALUATION

Female Decreased Sexual Desire Screener

1. In the past was your level of sexual desire or interest good and satisfying to you? y/n

2. Has there been a decrease in your level of sexual desire or interest? y/n

3. Are you bothered by your decreased level of sexual desire or interest? y/n

4. Would you like your level of sexual desire or interest to increase? y/n

5. Do you feel any of the following has contributed to your current decrease in sexual desire or interest?

An operation, depression, injuries, or other medical condition? y/n

6. Medication, drugs or alcohol you are currently taking? y/n

7. Pregnancy, recent childbirth, menopausal symptoms? y/n

8. Other sexual issues you may be having (pain, decreased arousal or orgasm)? y/n

9. Your partner’s sexual problems? y/n10. Dissatisfaction with your relationship or partner? y/n11. Stress or fatigue? y/n

• If the answer is "no" to any of questions 1-4: patient may not qualify for the diagnosis of HSDD

• If the answer is "yes" to all of 1-4 questions: patient may qualify for the diagnosis of HSDD

• If the answer to any question 5-8, or 11 is "yes" add: You should also seek consultation with your health care provider to determine if a medical condition or problem is contributing to your current decrease in sexual desire or interest

• If the answer to question 9 is "yes" add: Your partner may need to seek consultation with his health care provider

• If the answer to question 10 is "yes" add: You and your partner should consider professional counseling

• Screener is based on Validation of the DSDS, Clayton et al: J Sex Med

2009;6:730-738

TREATMENT

1-Testosterone

• Intrinsa skin patch

• Releases 300 µg/day

• It is worn just below

the umbilicus & changed

twice weekly

• Sexual activity increased by an average of 19% in placebo users, vs. a 73% increase for Intrinsa patch postmenopausal users

Contraindications

• Breast cancer

• Pregnancy

• Breastfeeding

• Naturally menopausal women

Side effects

• FDA declined to approve it for lack of information on long term side effects

• Irritation of skin at patch application site• Acne• Excessive facial hair growth• Voice deepening• Breast pain• Weight gain• Hair loss

2-Bupropion (Wellbutrin)

• It is an antidepressant and

smoking cessation aid

• Bupropion SR 150 mg daily is

given for 12 weeks

• The thoughts/desire score showed a greater than twofold increase in patients treated with bupropion compared to those receiving a placebo

Contraindications

• Conditions that lower the seizure threshold e.g. alcohol or benzodiazepine disconti-nuation, anorexia nervosa, bulimia, or active brain tumors & individuals taking MAO inhibitors

Side effects• Seizure: It is highly dose-dependent• Hypertension in less than 1% of patients

3-Flibanserin (Female Viagra)

• As with Viagra, the effects of

flibanserin were discovered

accidentally after it was trialed as an anti-depressant

• The results of four Phase III studies involving more than 2,000 pre-menopausal women suffering from HSDD showed that:

• Women using the drug said that the average number of times they had "satisfying sexual experiences" rose from 2.8 to 4.5 times a month

• Women with the placebo said the number of times rose to 3.7 times a month

• Flibanserin must be taken once a day and takes up to 4 weeks to have an effect

Mechanism of action

• It may enhance dopamine actions and reduce serotonin actions

• The FDA refused to license it because the studies showing its effectiveness were not enough

4 -Bremelanotide• A double blind, placebo-controlled, randomized

study of 80 married women with FSAD demonstrated that bremelanotide 20 mg nasal spray increased sexual arousal and intercourse satisfaction when compared with the placebo group. The manufacturer cited blood pressure elevation with intranasal administration of bremelanotide as a reason for not pursuing approval for sexual dysfunction

5-Apomorphineh

• Oral apomorphine 3 mg daily was tried in patients compared with placebo for arousal and desire

• The orgasm, enjoyment, and “satisfied by frequency” scores improved during treatment with daily apomorphine compared with baseline and placebo (P <0.05)

ANORGASMIA

• Orgasm is a variable, transient peak sensation of intense pleasure creating an altered state of consciousness, usually accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions and myotonia that resolves the sexually-induced vasocongestion (sometimes only partially), usually with an induction of well-being and contentment

• Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulation necessary to trigger an orgasm

• Although the clitoris and vagina are the most common sites of stimulation that result in an orgasm, stimulation of other body sites (eg, breast, nipple, or mons) can trigger an orgasm, as can mental imagery, fantasy

• The G-spot is:

- An ill-defined region, located on the anterior vaginal wall, in its upper outer third, suggested by Grafenberg

- This area is sensitive to tactile touch, which, when applied, is claimed to result in an intense female orgasm and female ejaculation during orgasm

- Debate regarding the existence

of the G-spot and female

ejaculation as true clinical

entities is still ongoing

How frequent is anorgasmia in Egypt? (My Work)

• In all women - 17% do not have orgasm at all - 5% rarely have orgasm• In genitally cut women - 2% do not have orgasm at all - 32% have orgasm infrequently• In Non genitally cut women - 8.5% have orgasm infrequently

• 70-80% of women achieve orgasm only through direct clitoral stimulation. Clitoral orgasms are easier to achieve because the tip or glans of the clitoris alone has more than 8,000 sensory nerve

• Copulatory vocalizations were reported to be made most often before and simultaneously with male ejaculation

• These data clearly demonstrate a dissociation of the timing of women experiencing orgasm and making copulatory vocalizations and indicate that there is at least an element of these responses that are under conscious control, providing women with an opportunity to manipulate male behavior to their advantage

What do women do when they do not reach orgasm ? (My Work)

• Fake it : 75% (56 % in America)

• Tell my husband : 17 %

• Do nothing : 35 %

Reasons for faking an Orgasm

REASONS (MY WORK)

REASONS USA

Not to hurt husband's feelings : 59%

Orgasm was unlikely or taking too long : 71%

To avoid husband’s criticism : 35%

They wanted the sex to end : 61% 

Guilt feelings :14%Partner was unskilled :

25%

Husband will find another wife :12%

Not in the mood : 18%

Etiology

I- Biological Factors:

1.General medical conditions, such as heart or kidney disease, can damage patients’ quality of life and are often associated with depression

2. Atherosclerosis and its related risk factors (smoking, diabetes, hypertension, and peripheral vascular disease) affect genital blood flow which is critical to the female sexual response

3.Anorgasmia is often seen as a side effect of using psychotropic medications:

- Anorgasmia is reported in at least one-

third of patients who receive SSRI

- Also it is reported

with antipsychotics

and mood stabilizers

4. Heavy alcohol consumption and illicit drugs can also interfere with orgasmic ability

5.Hormonal changes due to menopause or other disorders:

- Lower estrogen levels may cause a weakening of the pelvic muscles, affect the responsiveness of nerves that act as receptors for external sexual stimuli, and reduce vaginal lubrication

- Low testosterone has also been found to be reduce arousal and experiences of orgasm

6-Recently, studies investigating genetic factors have been conducted. Dunn et al. estimate the heritability for difficulty reaching orgasm to be 34%. Furthermore, a certain gene (GRIA1) has been found to be associated with difficulty achieving

orgasm

II- Psychosocial Factors

1-Poor body image and genital image (the way a woman feels about the size, shape, odor, and function of her genitals) can contribute to anorgasmia

2- Relationship problems and lack of proper communication with the partner about clitoral stimulation techniques

3- Anorgasmic women often demonstrate negative attitudes toward sex and masturbation, and tend to experience guilt following sexual activities

4- The effect of past sexual abuse on women’s orgasmic functioning is important to examine

5-Additional psychosocial factors associated with orgasm capacity include:

• Age: older women may experience orgasm difficulty due to changes in their body and the belief that, at an older age, sexual desire and activity are improper

• Education: correlates with anorgasmia

• Social class: correlates with anorgasmia

• Shame about sexuality due to religious beliefs or familial inhibitions:Increase incidence of anorgasmia

TREATMENT

• There are no Food and Drug Administration (FDA)-approved medications for this disorder

• First , treat the underlying medical conditions e g in anorgasmia due to hormonal changes associated with menopause, partial androgen replacement (avoiding doses that could cause masculinization) can restore sexual responsiveness

• Tibolone, a selective tissue estrogenic activity regulator with estrogenic, progestogenic, and androgenic properties, did improve orgasm domains in multiple studies of postmenopausal women

• Trials are needed to assess whether androgen therapy can treat disorders of orgasm in women who are not postmenopausal

• Changing medications that may be causing anorgasmia(eg SSRI) can reverse it eg the use of moclobemide(Aurorix) instead of SSRI can improve anorgasmia

• Cabergoline(Cabergolobe tab), a dopaminergic agent, was found helpful when administered prior to intercourse

• Sildenafil showed mixed results and appears to be effective in some populations of women, but additional large-scale studies are needed

• Oxytocin is another potential therapy for anorgasmia that warrants further study

• Alprostadil(Prostaglandin E1), 400 mg vaginal cream applied prior to intercourse was found effective in a controlled trial

The use of medical devices :

1- The Eros-Clitoral Therapy Device($395)

• It is the only such treatment approved by the FDA for FOD

• The device works by

applying a gentle vacuum

to the clitoris, which

increases its blood flow

• It increased lubrication in 70% and increased ability to have orgasm in 60% of patients in a small study

2-Slightest Touch(140$)• It stimulates nerve pathways to the genital

area• Electrode pads are appllied above the ankles• It gently stimulates the sexual nerve pathways taking the woman

to a pre-orgasmic plateau where she swings on the edge of orgasm for as long as she wants

PERSISTENT GENITAL AROUSAL DISORDER

• First documented in 2001(it may be the counterpart of priapism)

• It will be included in DSM-5 expected in May, 2013

• Incidence:rare

SYMPTOMS

• Very intense arousal persists for days or weeks at a time

• Arousal is sudden and unpredictable• Orgasm can sometimes provide temporary relief,

but within hours the symptoms return. • Failure or refusal to relieve the symptoms often

results in waves of spontaneous orgasms• The symptoms can be debilitating, preventing

concentration on ordinary tasks

• Some situations, such as riding in a car or train,

vibrations from mobile phones, and even going

to the toilet can aggravate the syndrome

unbearably causing pain

• It is common for sufferers to lose some or all sense of pleasure over the course of time leading to avoidance of sexual relations

• The condition may last for many years and can be so severe that it has been known to lead to depression and even suicide

POSSIBLE CAUSES AND TREATMENT

• There is not enough knowledge to define a cause

• It has a tendency to strike post-menopausal women, or those who have undergone hormonal treatment

• Additionally, the condition can sometimes start only after the discontinuation of SSRIs

• In some cases, the syndrome was caused by pelvic arterial-venous malformation with arterial branches to the clitoris. surgical treatment was effective in this case

• In other situations the symptoms can sometimes be reduced by the use of antidepressants, antiandrogens, and anesthetising gels

• Psychotherapy with cognitive reframing of the arousal as a healthy response may also be used.

• The symptoms of the condition have also been linked with pudendal nerve entrapment. Regional nerve blocks demonstrated varying degrees of success in most cases

• In one recent case, relief of symptoms was noted from treatment with, varenicline, a treatment for nicotine addiction

Vaginismus

• Involuntary muscle spasm of outer third of

the vagina

• In severe cases, the adductors of the thighs, the rectus abdominis, and the gluteus muscles may be involved

• It may be 1ry or 2 ry

Pubococcygeus PC=

Variations of vaginismus

• Some women are unable to insert anything at all

• Some women are able to insert a tampon and complete a gynecological exam, yet are unable to insert a penis

• Others are able to partially insert a penis, although the process is very painful

• Some are able to fully insert a penis, but tightness interrupts the normal progression from arousal to orgasm and bring pain instead

• Some women are able to tolerate years of uncomfortable intercourse with gradually increasing pain and discomfort that eventually interrupts the sexual experience

ETIOLOGY

I-Psychological causes

1-Misinformation & ignorance (90%)

2- Fears of:

• Pain

• Not being completely healed following pelvic trauma

• Tissue damage (ie. "being torn")

• Getting pregnant

3-Anxiety or stress :performance pressures, previous unpleasant sexual experiences, guilt

4-Partner issues:Abuse, emotional detachment, fear of commitment, distrust

5-Traumatic events:Past emotional/sexual

abuse, witness of violence or abuse

6-Childhood experiences:Overly rigid

parenting, unbalanced religious teaching,

exposure to shocking sexual imagery

7-Idiopathic

II- Physical Causes

1-Medical conditions:Urinary tract infections or urination problems, yeast infections, STDs, endometriosis, genital or pelvic tumors, cysts, cancer, vulvodynia / vestibulodynia, pelvic inflammatory disease, lichen planus, lichen sclerosus, eczema, psoriasis, vaginal prolapse, pain from normal deliveries or c-sections

2-Age-related changes:Menopause and hormonal changes causing vaginal atrophy and inadequate lubrication

TREATMENT

1 -Sex therpy & dilatation

• Vaginismus is highly treatable with high success rates (75-100%)

-Steps of therapy:

• Step 1: normal reproductive anatomy and physiology of the sexual act are explained

• The patient is made comfortable with her genitals by asking her to look at the area in the mirror

• She is taught Kegel exercises (contraction & relaxation of pubococcygeus muscle several times a day) which help control the pubococcygeus muscle that surrounds the entrance to the vagina

• Step 2: she is advised to insert her fingers into her vagina and move them around initially one finger, later two fingers. Penetrative sexual intercourse is prohibited during the period

• Step 3: Dilators insertion(Diameter 2-4cm)

• Step 4: Vaginal containment with

lubrication and local anesthesia

(e.g. 5% lignocaine jelly) is advised

• Step 5:Vaginal containment involved the patient in female superior position, guiding penile penetration with her hands and the couple remaining still, concentrating on the pleasant sensations they experience

2-Botox

• An analgesic (e.g.Voltaren) is administered i.m. 30 minutes before the injection

• 25 IU BT diluted in 1 ml of saline, is injected into the bulbospongiosus muscle

• Satisfactory intromission on the 2nd day after injection was reported

• The toxin has a long-duration of action of up to 6 months

Advantages• It is usually the treatment of choice for

refractory cases

• It helps the dilation treatment and consequently allows for coitus by training the muscles that it's not painful to insert something in the vagina

• Patients can go through the treatments under sedation (general or local anesthesia) so it can be painless (but add risks associated with anesthesia)

Disadvantages

• The idea of having an injection inside the vagina can be very scary and intolerable for women with primary vaginismus

• Its effects are not permanent so you may have to repeat the injections after a while but its side effects instead will be permanent

• Botox is not yet licensed for use in the treatment of vaginismus in Egypt

Side Effects

• The most serious one being the paralysis of the wrong muscle

• An allergic reaction

• Urinary stress incontinence

• Flatus, and fecal incontinence intermittently

THANK YOU

LESBIANISM

ETYMOLOGY

• Comes from the Greek island “Lesbos” home of Sappho, a female poet whose erotic lyrics embraced women

SOME IMPORTANT DEFINITIONS• Sex: refers to a person’s biological status (male,

female, or intersex) i.e., combinations of features that usually distinguish male from female e.g. genitalia and sex chromosomes

• Gender: refers to the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex

• A “Lesbian” is a woman with sexual acts or romantic desire towards females

• A “Gay” is a man with sexual acts or romantic desire towards males

• Gender identity: refers to an individual's internal sense of being male or female

- It develops early in childhood and normally

solidifies by age 2.5 years

- Most homosexual individuals have a firmly

established gender identity that is consistent

with their anatomy i.e. A male homosexual

understands himself to be a man, just as

does a heterosexual man

• Gender role: is defined as the outward manifestations that reflect the gender identity, e.g. if a person considers himself a male and is most comfortable referring to his personal gender in masculine terms, then

his gender identity is male.

However, his gender role is male

only if he demonstrates typically

male characteristics in behavior,

dress, and/or mannerisms

• Gender orientation: refers to an individual's desires and preferences regarding the sex of intimate partners.

- Like gender identity, gender orientation is

based on deeply held conscious and

unconscious psychological constructs

- Individuals tend to have a range of

preferences and desires rather than falling

into neat, mutually exclusive categories i.e.

a person can be exclusively heterosexual,

mainly heterosexual, bisexual, mainly

homosexual, exclusively homosexual

HISTORICAL BACKGROUND

•Throughout history, lesbian relationships have often been regarded as harmless and incomparable to heterosexual ones and they were not met with the harsh punishment in some societies as homosexual

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• As a result, little in history has been documented to give an accurate description of how female homosexuality has been expressed

• When early sexologists in the late 19th century began to categorize and describe homosexual behavior, they were hampered by a lack of knowledge about , so they classified lesbians as women who did not adhere to female gender roles and designated them mentally ill

PREVALENCE

Sexual orientationMen women

Bisexual0.6%0.8%

Mainly homosexual0.5%0.1%

Entirely homosexual0.7%0.3%

•How frequent is homosexuality

•In USA

•In Britain

Sexual orientationMenWomen

Bisexual0.5 %2.8 %

Mainly homosexual0.7 %0.6 %

Entirely homosexual1.2 %0.8 %

ETIOLOGY

• There are two main theories as to what causes homosexual attractions

1- The genetic theories

2- The bio logical theories

1- THE GENETIC THEORIES

• A study found 52% of monozygotic brothers and 22% of the dizygotic twins were concordant for homosexuality

• Another study found 20% concordance in the male monozygotic twins and 24% concordance for the female monozygotic twins

• A 2010 study of all adult twins in Sweden showed that the choice of sexual partner was influenced by the following factors:

• Environment shared by twins (including familial and societal attitudes): 0 F –17 M%

• Genetic factors :19 F –39 M %• Unique environment for each twin

(circumstances during pregnancy and childbirth, physical and physical trauma, peer groups and sexual experiences):61F –66 M%

2-THE BIOLOGIC THEORIES

1- Early fixation hypothesis

•Intrauterine hormone exposures(eg drug intake) may determine sexual orientation by changing the masculinization of the brain in homosexual men

•This hypothesis is supported by both the observed differences in brain structure and cognitive processing between homosexual and heterosexual men

2- Brain studies

•Some studies reported:

- A difference in the size of the supraciasmic

nucleus and anterior commissure between

homosexual and heterosexual men

- INAH3(an area of the hypothalamus )was

smaller in homosexual men than in heterosexuals

•These studies are of no real value because these areas are not known to be related to sexual activity, sample size was small, mostly made on cadavers of AIDS patients, some of the researchers were gay

Does childhood sexual abuse (CSA) affect sexual orientation?

• No causal connection has been established between a history of child sexual abuse and homosexuality in women

• A woman who hates men because she was molested by a man does not gain the capacity to be aroused by women

• However, several studies have reported higher percentages of CSA experiences for lesbian women. For example, a study found that 17% of the lesbian women and 7% of the heterosexual women reported a history of CSA

• In another study of molested women 10 of 18 reported a lesbian sexual orientation and 8 reported a heterosexual orientation

• Another study found that 77% of lesbians / bisexuals claimed sexual activity with an adult as a child, compared to 15% of heterosexual women

SEXUAL PRACTICES AMONG LESBIANS

• A study conducted on 100 lesbians about the techniques they used in their last 10 sexual encounters, the following results were obtained:

100% reported kissing, sucking on breasts, and manual stimulation of the clitoris

More than 90% reported French kissing, oral sex, and fingers inserted into the vagina

80% reported tribadism(rubbing vulva against another woman’s body)

• In 2003, data based on a sample from the UK of 803 lesbians reported that:

The most commonly cited sexual practices between women were oral sex, digital vaginal penetration, mutual masturbation, and tribadism

Like older studies, the data also showed that vaginal penetration with dildos are rare

• Lesbian couples typically express female characteristics, including

Less emphasis on genital contact

More rapidly decreasing frequency of sexual contact

More emphasis on emotional intimacy and nurturance

More exclusivity in relationships

A greater inclination to long-term stability in relationships

SEXUAL PREFERENCES AMONG LESBIANS

• This study proposes that feminine lesbians who primarily date masculine lesbians will be more likely than masculine lesbians who mainly date masculine lesbians to perceive their partners as the masculine sex-role, both in a global and sexual situational sense. It is hoped that these findings may help shed light and facilitate understanding of lesbian sex-roles

TYPES OF LESBIANS

• FemmeA feminine lesbian who is attracted to masculine, or butch lesbians

• Lipstick Lesbian

A femme that is attracted to other feminine

lesbians

• Butch

A woman who adopts what would be considered masculine characteristics. Often the "dominant" partner in a lesbian relationship, and especially of a butch/femme lesbian relationship

Dressing masculinely does not make a woman into a lesbian, contrary to popular belief

• Stone Butch

A lesbian who gets her pleasure from pleasing her partner. She does not like to be touched sexually

• Pillow Queen

A lesbian who prefers to receive sexual pleasure without returning the favor because it's all about her

SEXUALITY TRANSITIONS IN WOMEN (SEXUAL FLUIDITY)

• Many homosexual women have previous heterosexual relationships, marriages, and children. Some women return to heterosexual relationships following dissolution of a lesbian relationship

• Data indicate that 36 % of women in their 40s with same-sex partners previously had been married to men. That percentage grew to more than half for lesbians in their 50s, and 75 % for those 60 and older

• In a 2004 study, the female subjects (both Homo or heterosexual) became sexually aroused when they viewed heterosexual as well as lesbian erotic films. Among the male subjects, however, the straight men were turned on only by erotic films with women, the gay ones by those with men

• The study concluded that women's sexual desire is less rigidly directed toward a particular sex, as compared with men's, and it's more changeable over time

TREATMENT

Can lesbianism be treated?

•The Western view is that lesbianism is not a disorder to be treated and cured; it is just a sexual orientation. They claim that lesbians are neither mentally, nor physically ill. Lesbianism is a trait, may be, just as your liking for a particular food item

• If somebody feels that she should be cured from lesbianism, then it is a clear sign that she is not a lesbian at all. This means that she has misidentified her sexuality and became a lesbian, then proper counseling could help to regain the right path

OLD THERAPIES1-Aversion therapy:

•Homosexuals had electrodes attached to genitals and were then shown homosexual pornography

• As the pornography played, the patients were injected with emetic drugs and administered electric shocks

•The shocks and emetics would then cease and the homosexual imagery would be replaced by heterosexual pornography, during which time the patient would not be abused

• Since 1994, the American Psychological Association (APA) has declared that it is a dangerous practice that does not work. Since 2006, the use of aversion therapy to treat homosexuality has been in violation of the codes of conduct and professional guidelines of the APA and American Psychiatric Association

2-Psychoanalytic therapy

3-Spiritual interventions, such as "prayer and group support and pressure"

THANK YOU