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性健康忧虑与性健康问题
Sexual
Health Concerns and Problems
中文翻译：彭晓辉(中国
武汉
华中师范大学生命科学学院，430079)完成时间：2006年3月
Translator：Xiaohui
Peng (Life Science College of CCNU, Wuhan, 430079, China)
校
对：吴敏伦(中国
香港
香港大学医学院)完成时间：2006年8月
性健康忧虑与性健康问题
性健康忧虑(Sexual Health Concerns)
只要涉及性的生活环境受到来自于个人和/或社会的干预限制，由于干预会影响到健康和生活质量，那么，性健康忧虑和性健康问题就会随时出现。性健康忧虑和性健康问题的种类繁杂，从被知觉到的“生命的组成部分”，到对健康、甚至对生命构成威胁的各种环境条件，不一而足。可是，所有这些性健康忧虑和性健康问题向包括卫生部门在内的社会各界，既提出了预防的要求也提出了完备的全面保健要求。
不仅因为性健康忧虑和性健康问题会损害性健康，并由此普遍损害个人、家庭和社会的健康，而且因为它们预示着会出现其他的健康问题，所以，投入精力重视性健康忧虑和性健康问题并找到解决它们的方案极为重要。此外，性健康忧虑和性健康问题可能会大规模地造成和/或无限期地延续个人、家庭、社会及人口的其他问题。
HIV/AIDS的全球流行。性健康忧虑和性健康问题会在个人的层面和社会的层面对人类行为产生影响。例如，自从HIV/AIDS流行以来，HIV主要通过无防护的性行为在全球传播，它已经导致了全球3.5千万人感染和1.9千万人死亡。AIDS全球广泛流行带给社会的效应达到了如此的程度，以至于有大约1.3千万儿童和青年人由于父母中一方或双方与HIV相关的死亡而成了孤儿。此外，泛美卫生组织估计当前在美洲区域内就有2.5百万HIV携带者。
HIV/AIDS的全球流行已经引起了公众对性传播疾病极其严重性的关注。每年有1百万人死于生殖道感染，其中除了HIV/AIDS感染，还包括性传播疾病(STIs)感染。有人估计全球每年发生3.33亿性传播疾病新感染病例。
暴力。世界银行全球发展报告(1993)估计，15-44岁的妇女由于被强奸和家庭暴力的原因，寿命折扣健康年限(Discounted Health Years of Life, DHYLs)大为缩短；而强奸和家庭暴力可能与性别不平等和不负责的行为有关。有研究显示，强奸受害者具有高比率的永久性强奸创伤后综合征(post-traumatic stress disorder)，并且构成了最大的单身群体。强奸受害者试图自杀和患抑忧症的可能性是一般人的9倍。此外，有50%-60%的强奸受害者会经历性功能障碍，其中包括惧怕性行为和性唤起障碍。一项基于秘鲁利马妇产科医院记录的研究显示，年龄在12-16岁的年轻母亲中有90%是被强奸而受孕的。在哥斯达黎加，一个帮助少女母亲的机构报告，该机构15岁以下的当事人中有95%是乱伦的受害者32。
因性别和个人身份(尤其涉及性别不平等者)受到这些暴力对待是普遍的，而专注于该事务和寻求解决这种暴力的重要意义已经在全球范围达成共识33。
性功能障碍。性功能的综合征近年来已经成为突出的问题。一些国家已经着手为一些群体就性功能障碍进行了流行病学研究。例如，有人报告在美国女性的性功能障碍流行率为43%，男性为31%34；性功能障碍与较低的生活质量有关联35，并且与其它的健康问题也有关联，例如：它与心脏病、高血压、糖尿病、用药不当、较高的愤怒指数和抑郁指数有关36。
尽管上述所提及的统计数据可能就够瞩目惊心了，它们只是公共卫生问题刚刚露出水面的冰山一角。为了减轻对性健康的危害范围和危害程度，任何行动方案都需要从超越卫生保健医疗模式的广视野和多维度的途径去展开。
性健康忧虑是一种生活处境(或者说是一种引起个人或公众担忧的性健康各种境况——译者注)，它需要由社会采取预防和教育措施加以解决，以保证社会成员获得和维持性健康。性健康问题既是指个体的、相互关系的也是指一个社会的生活状态层面的涉及性的疾病/身心不适/人际关系失调/社会弊端等的结果，它需要特别的措施来加以甄别、加以预防和/或加以治疗(处置)并最终加以解决。从对专业人员培训的需求层次上也可以区分性健康忧虑与性健康问题：为了解决性健康问题，通常需要对专业人员进行临床医学培训；然而，性健康忧虑则通常能够由不需要特殊的临床医学培训的各类专业人员来处理和管理。
本专家工作小组推荐下述的性健康忧虑和性健康问题，把处理这些事物作为推动社会达到性健康的手段(见表5)。
性健康忧虑(Sexual Health Concerns)
下述的列表并不是一览无遗，却是性健康忧虑的相当有代表性的例子和例证。其中的每一项性健康忧虑为适当的信息、咨询和保健需要的评估提供了可能；政府和非政府机构以及包括卫生部门在内的公共机构据此务必要为性健康忧虑的信息、咨询和/或保健的需要采取相应的行动。
表6：性健康忧虑(Sexual
Health Concerns
| 1.涉及身体完整性和性安全的性健康忧虑 为了早期鉴别性健康问题，需要采取健康促进行为(例如：定期的体格检查和健康透视，乳房和睾丸自检)； 需要免除诸如性暴力(包括性辱虐和性骚扰)等这些所有形式的性强迫； 需要免除身体损伤行为(也就是女性生殖器官损毁)； 需要免除感染或传染性传播疾病(包括不只限于HIV/AIDS这样的性传播疾病)； 需要减轻生理或精神残障所引致的性功能障碍； 需要减少因药物、手术并发症或治疗对性生活所产生的有害影响； 2. 涉及性爱倾向的性健康忧虑 需要诸如涉及性反应和性快乐等有关性生理知识； 需要在尊重他人权利的价值体制下，认可以安全的和负责的方式终生享受性快乐的价值观； 需要以安全的和负责的方式促进性关系实践； 需要鼓励双方意愿下的、无剥削的、诚实的和相互愉悦的性关系实践和性快乐 3. 涉及性别的性健康忧虑 需要性别平等； 需要消除基于性别原因的所有形式的歧视； 需要尊重和容忍性别差异； 4. 涉及性取向的性健康忧虑 需要消除基于性取向的歧视； 需要在尊重他人权利的价值体制下以安全的和负责的方式表达性取向； 5. 涉及情感依恋的性健康忧虑 需要消除剥削、强迫、暴力或操纵的性关系； 需要关于家庭与生活方式选择的知识； 需要诸如加强个人性关系的决断、交往、自信和商议这样的生活技能； 需要尊重和负责的爱和亲昵举止表达； 预防与适当地调和夫妇失调和紧张的关系； 分居与离异的适当管理。 6. 涉及生殖的性健康忧虑 需要就生殖行为做到知情和负责任的选择； 无论年龄、性别和婚姻状态如何，需要就生殖行为做出负责任的决定和实践； 有权获得生殖健康保健服务； 有权获得安全的产育保健； 不孕/不育的预防与保健； |
性健康问题(Sexual Health Problems)
性健康问题要么是指个体的、相互关系的要么是指一个社会的(涉及性的疾病/身心不适/人际关系失调/社会弊端等的)健康后果，它需要特别的措施来加以鉴别、加以预防和/或加以治疗(处置)并最终加以解决。
在过去，为了表示性健康问题所使用的“病症”(pathology，疾病在生理结构和功能上的客观表现或过程——译者注)这个术语已经引起了颇大的争议。当用病症来表示性健康问题和性健康忧虑时，由于人所经历的性健康问题的种类不同，这个术语的通常和清晰的含义在卫生保健的其他领域常常含混不清。所以，本专家工作小组推荐使用术语“性问题”，而不使用“病症”来指称性健康问题。
专家工作小组的另一个建议是使用综合征标准分类法对性健康问题进行分类。(性的)临床综合征定义为严重阻碍个人行使性权利、以及个人的性健康恶化所导致的疾病体征及其症状征候群。
采用综合征标准分类法有许多优点。综合征容易为人所识别。当性健康问题以综合征的标准为人所熟知时，既容易让保健人员也容易让一般大众都意识到性健康问题的存在。综合征标准分类也更简洁和能够以流行病学的方法加以运用。有关以综合征标准分类的流行病学研究，有一些成果当前已经非常知名37。从类目上看，如果采用综合征分类法，从公共卫生的角度思量，它使得我们能够有效地采取措施解决诸如预防和治疗性传播疾病等性健康问题38。
另一方面，许多性健康问题由相当复杂的多种多样的病因所导致。例如，对于性功能障碍，即使当其综合征已经被识别出来时，尚需基于诊断来寻找其病因39。综合征标准分类法有助于提醒人们这个列举的种类只是综合征，而不是临床病因学分类体系。鉴于上述理由，本专家工作小组强烈建议把综合征标准分类法用于对性健康问题的分类。
临床综合征的分类是在专业人员之间被广泛创用的颇为人为的分类法。在所提及的临床综合征的分类中，有许多已经得到了广泛的认可，例如性功能障碍的临床综合征分类的认同过程就是一个很好例子。至于其他的分类，譬如强迫性行为综合征，其认同的过程尚在起步阶段。
所以，我们在此把性健康问题作为综合征提出来。每一个综合征为适当的信息评估、咨询服务、预防、早期诊断、进一步的诊断评价需要以及治疗课程、康复和/或保健等的需要提供了可能，这些都要求政府、非政府代理机构和包括卫生部门在内的公共机构做出相应的反应。性健康问题可以被划分为下述的综合征类型(见表6)：
表6：性健康问题(临床综合征)
| 1.
削弱性功能的临床综合征(性功能障碍) 性欲低下 性厌恶 女性性唤起功能障碍(旧称：阴冷) 男性勃起功能障碍(旧称：阳痿) 女性性高潮功能障碍 男性性高潮功能障碍 过早射精 (射精过快，旧称：早泄) 阴道痉挛 性交疼痛综合征(包括性交困难和其他性交疼痛症状) 2. 涉及情感依恋/情欲损害的临床综合征(也叫性反常行为) 露阴症 恋物症 挨擦症 恋童症 受虐症 施虐症 恋物性异装症 窥阴症 非特异性性反常行为 3. 涉及强迫性行为的临床综合征 强迫求偶与多性伴症 难获得性伴强迫固结症 强迫自体性行为症 强迫恋爱症 亲属间强迫性行为症 4. 涉及性别认同冲突的临床综合征 儿童期性别焦虑症 青春期性别焦虑症 成年期性别焦虑症 中间性综合征 非特异性性别认同综合征 5. 涉及暴力与受害的临床综合征 儿童/未成年人受性辱虐临床综合征(包括不仅限于创伤后心理压力紊乱症) 受性骚扰后临床综合征 受性暴力或被强奸后临床综合征 专注于性的事物临床恐怖症(例如：同性恋憎恶、性爱恐怖等) 涉及从事性行为或性暴力威胁或行为(例如：强奸另一个人)的临床综合征 施加于自身和/或他人的、冒HIV或/和其他性传播疾病感染风险的不安全性行为模式 6. 涉及生殖的临床综合征 女性不孕 男性不育 非意愿妊娠 流产并发症 7. 涉及性传播疾病的临床综合征(病因学分类见附件II) 生殖器溃疡 无滤泡型 滤泡型 口腔溃疡 无滤泡型 滤泡型 直肠溃疡 无滤泡型 滤泡型 流脓 尿道流脓 阴道流脓 直肠流脓 女性下腹部疼痛 无症状性传播疾病和寄生虫感染症 获得性免疫缺陷综合征(HIV感染II期) 8. 涉及其他疾病的临床综合征 继发于残障或身体虚弱的临床综合征 继发于生理或精神疾病的临床综合征 继发于用药或其他医学和外科干预的临床综合征 结肠直肠疾病 继发于其他疾病的临床综合征 |
Sexual Health Concerns and Problems
Sexual Health Concerns
Sexual health concerns and problems are present whenever life situations related to sexuality require interventions by individuals and/or society due to their impact on wellness and quality of life. The variety of these concerns and problems is very wide, ranging from conditions that are perceived as “part of life” to those that constitute a threat to well being and even, to life. However, all of them demand attention from all segments of society including the health sector both through prevention and appropriate comprehensive care.
Sexual health concerns and problems are important to address and find solutions for not only because they undermine Sexual Health, and therefore the general health of the individual, family and society, but also because their presence might signal other health problems. Moreover, Sexual Health concerns and problems may generate, and/or perpetuate other problems in the individual, family, community and population at large.
HIV/AIDS Pandemic. Sexual Health concerns and problems impact various areas of human activity at individual and social levels. For example, the global spread of HIV, mainly through unprotected sexual intercourse, has resulted in around 35 million infected people and over 19 million deaths worldwide since the beginning of the epidemic. Communities at large bear the effects of the AIDS pandemic to the extent that there are around 13 million children and young people orphaned as a result of HIV-related death of one or both parents. Furthermore PAHO estimates there are 2.5 million people currently living with HIV in the Region of the Americas.
The HIV/AIDS pandemic has brought to public attention the extreme seriousness of sexually transmitted infections. One million people die each year from reproductive tract infections, including sexually transmitted infections (STIs) other than HIV/AIDS. It has been estimated that 333 million new cases of STIs may occur globally each year.
Violence. The World Development Report (1993) of the World Bank estimated that women aged 15 to 44 years lose a significant amount of Discounted Health Years of Life (DHYLs) due to rape and domestic violence, which may be related to gender inequity, and irresponsible behavior. Studies show that rape survivors have high rates of persistent post-traumatic stress disorder and make up the largest single group diagnosed with the disorder. Rape victims are nine times more likely than non-victims to attempt suicide and to suffer major depression. Furthermore, 50 to 60 percent of the victims experience sexual dysfunction, including fear of sex and problems with arousal. A study based on the records of the Maternity Hospital of Lima, Peru, revealed that 90 percent of young mothers aged 12 to 16 had become pregnant because they had been raped. In Costa Rica, an organization working with adolescent mothers reported that 95 percent of its pregnant clients under 15 were victims of incest 32.
The impact and importance of gender related problems (in particular those related to gender inequality) are widespread, and the importance of addressing the issue and solving the problem has been recognized worldwide 33.
Sexual Dysfunctions. The problem of sexual syndromes has recently been highlighted. The prevalence of sexual dysfunctions has been established for some populations. For example, in the United States, a prevalence rate of 43% for females and 31% for males is reported 34. Sexual dysfunctions have been correlated with lower levels of quality of life 35, and to other health problems: heart disease, hypertension, diabetes, associated medications, and high indexes of anger and depression 36.
Although the above mentioned figures may seem very dramatic, they are only the tip of the iceberg in a field that is just emerging as a public health issue. Any actions to reduce the magnitude and severity of situations affecting Sexual Health require a comprehensive and ample approach that surpasses the curative paradigm of health care.
Sexual health concerns are life situations that require preventive and educational actions by society to ensure its members attain and maintain Sexual Health. Sexual Health problems are the result of conditions, either in an individual, relationship, or a society, that require specific action for their identification, prevention and/or treatment and therefore, eventual resolution. The necessary level of training for professionals also differentiates these two categories. Sexual problems usually need clinically trained professionals for their solution, whereas sexual concerns can be addressed and managed by a variety of professionals often not needing specialized clinical training.
The expert working group recommends that the following sexual concerns and problems be addressed as a means of advancing societies towards Sexual Health (See Box V).
The following list is not exhaustive but rather examples and illustrations of sexual concerns. Each of these concerns allows the appropriate assessment of information, counseling and/or care needs that demand actions from governmental and non-governmental agencies and institutions including the health sector.
TABLE
6. Sexual Health Concerns
| 1.Sexual
Health concerns related to body integrity and to sexual safety Need
for health-promoting behaviors for early identification of
sexual problems (e.g., regular check-ups and health screening,
breast and testicular self-exam). Need for freedom from all forms of sexual coercion such as sexual violence (including sexual abuse and harassment). Need for freedom from body mutilations (i.e. female genital mutilation). Need for freedom from contracting or transmitting sexually transmitted infections (including but not limited to HIV/AIDS). Need for reduction of sexual consequences of physical or mental disabilities. Need for reduction of impact on sexual life of medical and surgical conditions or treatments. 2. Sexual Health concerns related to eroticism Need for knowledge about the body, as related to sexual response and pleasure. Need of recognition of the value of sexual pleasure enjoyed throughout life in safe and responsible manners within a values framework respectful of the rights of others. Need for promotion of sexual relationships practice in safe and responsible manners. Need to foster the practice and enjoyment of consensual, non-exploitive, honest, mutually pleasurable sexual relationships 3. Sexual Health concerns related to gender Need for gender equity. Need for freedom from all forms of discrimination based on gender. Need for respect and acceptance of gender differences. 4. Sexual Health concerns related to sexual orientation Need for freedom from discrimination based on sexual orientation. Need for freedom to express sexual orientation in safe and responsible manners within a values framework respectful of the rights of others. 5. Sexual Health concerns related to emotional attachments Need for freedom from exploitative, coercive, violent or manipulative relationships. Need for information regarding choices of family options and lifestyles. Need of skills, such as decision-making, communication, assertiveness and negotiation, that enhance personal relationships. Need for respectful and responsible expression of love and intimacy. Prevention and appropriate care of couple maladjustment and distress. Appropriate management of separation and divorce. 6. Sexual Health concerns related to reproduction Need to make informed and responsible choices about reproduction. Need to make responsible decisions and practices regarding reproductive behavior regardless of age, gender and marital status. Access to reproductive health care. Access to safe motherhood Prevention
and care for infertility. |
Sexual Health Problems
Sexual problems are the result of conditions, either in an individual, relationship, or a society, that require specific action for their identification, prevention and/or treatment and therefore, eventual resolution.
In the past, the use of the term “pathology” to denote sexual problems has created considerable controversy. The usual and clear cut meaning of the term pathology in other areas of health care is frequently lost when it is applied to sexual problems and concerns due to the nature of the problems experienced. Therefore the expert working group recommends the use of the term “sexual problem” rather than “pathology” to refer to Sexual Health problems.
Another recommendation is the use of syndrome level classification. Clinical syndromes define a cluster of symptoms and complaints that seriously inhibit the exercise of the individual's sexual rights and alter his/her Sexual Health.
There are a number of advantages of taking a syndromic approach. Syndromes are easy to identify. Awareness of the presence of the problem both in health personnel and the general public is easier to create when problems are known at a syndrome level. A syndrome level classification also is more succinct and can be used for epidemiological considerations. Much of what is currently known about epidemiology of some of these categories is at a syndrome level 37. In categories such as sexually transmitted infections preventive and curative actions can be taken effectively from a public health perspective if a syndromic approach is taken 38.
On the other hand, many sexual problems are caused by a rather complex variety of etiologies. For example, in sexual dysfunctions the need for etiology based diagnosis persists even when the syndrome has been identified 39. A syndrome level classification helps in reminding that the listed categories are syndromes, not etiologically classified clinical entities. For the above reasons the expert working group strongly recommends that a syndromic approach to the classification of Sexual Health problems be undertaken.
Clinical syndromes are rather artificial categories that are created with broad agreement between professionals. There is considerable consensus in many of the clinical syndromes presented in the proposed classification: sexual dysfunctions are a good example of the process of consensus. In other categories such as compulsive sexual behavior syndromes, process of consensus is still in its initial building stages.
Sexual problems, therefore, are presented here as syndromes. Each of these problems allows the appropriate assessment of information, counseling, prevention, early identification, need for further diagnostic evaluation, and course of treatment, rehabilitation and/or care needs that demand actions from governmental and non-governmental agencies and institutions including the health sector. Sexual problems are divided into the following syndrome categories (See Table 7):
Table 7. Sexual Health
Problems(Clinical Syndromes)
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1. Clinical Syndromes that Impair Sexual Functioning (Sexual dysfunctions) Hypoactive sexual desire Sexual aversion Female sexual arousal dysfunction Male erectile dysfunction Female orgasm dysfunction Male orgasm dysfunction Premature ejaculation Vaginismus Sexual pain syndromes (including dyspareunia and other pain conditions) 2.Clinical Syndromes Related to Impairment of Emotional Attachment/Love(also known as Paraphilias) Exhibitionism Fetishism Frotteurism Pedophilia Sexual masochism Sexual sadism Fetishist transvestism Voyeurism Unspecified paraphilia 3. Clinical Syndromes Related to Compulsive Sexual Behavior Compulsive cruising and multiple partners Compulsive fixation on an unattainable partner Compulsive autoeroticism Compulsive love affairs Compulsive sexual behavior in a relationship. 4. Clinical Syndromes Involving Gender Identity Conflict Childhood Gender Dysphoria Adolescent Gender Dysphoria Adult Gender Dysphoria Intersex syndromes Unspecified Gender Identity Syndrome 5. Clinical Syndromes Related to Violence and Victimization Clinical syndromes following being sexually abused as a child/minor (Including but not limited to post-traumatic stress disorder) Clinical syndromes following being sexual harassed Clinical syndromes following being sexual violated or raped Clinical phobia focused on sexuality (e.g., homophobia, erotophobia) Clinical syndromes related to engaging in threat or acts of violence focused on sex or sexuality (e.g., raping another person) Patterns of unsafe sexual behavior placing self and/or others at risk for HIV infection or/and other sexually transmitted infections. 6. Clinical Syndromes Related to Reproduction Sterility Infertility Unwanted pregnancy Abortion complication 7. Clinical Syndromes Related to Sexually Transmitted Infections (An etiological classification is included in Appendix II) Genital ulcer Non-vesicular Vesicular Oral ulcer Non-vesicular Vesicular Rectal ulcer Non-vesicular Vesicular Discharge Urethral discharge Vaginal discharge Rectal discharge Lower abdominal pain in women Asymptomatic sexually transmitted infections and infestations (including HIV) Acquired Immunodeficiency Syndrome (secondary to HIV infection). 8. Clinical Syndromes Related to Other Conditions Clinical syndromes secondary to disability or infirmity Clinical syndromes secondary to physical or mental illness Clinical syndromes secondary to medication or other medical and surgical interventions Colorectal conditions Clinical syndromes secondary to other conditions |
注释 NOTES
32 Interactive Population: Violence against Girls and Women:
http://www.unfpa.org/modules/intercenter/violence/gender2f.htm
33 Again, only to illustrate: At least 60 million girls are “missing” from the population due to son-preference, via either sex-selective abortions or neglect. 2 million girls between 5 and 15 years old are put on the commercial sex market every year. Nearly 600 million women are illiterate compared with about 320 million men. Source UNFPA documents:
http://www.unfpa.org/modules/intercenter/reprights/empower.htm
34 Laumann, E. O., Paik, A. & Rosen, R. C.. Sexual Dysfunction in the United States: Prevalence and Predictors JAMA. 1999;281:537-544.
35 Laumann, E. O., Paik, A. & Rosen, R. C.. Sexual Dysfunction in the United States: Prevalence and Predictors JAMA. 1999;281:537-544 . McCabe MP Intimacy and quality of life among sexually dysfunctional men and women. J Sex Marital Ther, 23(4):276-90, 1997, Winter. Litwin, M.S., Nield, R.J., Litwin, M.S., Nield, R.J., & Dhanani N. Health-related quality of life in men with erectile dysfunction. J Gen Intern Med, 13(3): 159-66 1998 Mar. Fugl-Meyer, A.R., Lodnert, G., Bräholm I.B., & Fulg-Meyer, K.S. On life satisfaction in male erectile dysfunction Int J Impot Res, 9(3):141-8 1997 Sept.
36 Feldman, H.A., Goldstein, I. Hatzichristou, D.G., Krane, R.J. & McKinlay, J.B. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994 Jan;151(1):54-61.
37 For instance, the prevalence of sexual dysfunctions is known at a syndrome level: i.e. Laumann, E. O., Paik, A. & Rosen, R. C.. Sexual Dysfunction in the United States: Prevalence and Predictors JAMA. 1999;281:537-544.
38 “The difficulties related to the timely collection of disease specific data have led to the concept of collecting information about syndromes. This syndromic approach is used successfully by the poliomyelitis eradication program, which collects data on acute flaccid paralysis (AFP) caused by several infectious or non-infectious diseases, but that will trigger an immediate response from the poliomyelitis surveillance system. The same approach could be applied in areas where rapid laboratory diagnosis cannot be obtained (such as at the periphery of many health systems). Although lacking specificity, the syndromic approach offers: a simple and stable case definition; reliability (as it reports what is actually seen); immediate reporting (as there is no laboratory delay); a wider surveillance coverage allowing for the detection of emerging diseases; and, in some cases, the avoidance of disease-associated stigma. This approach is complementary to a disease-specific list of notificable diseases, and is also being considered in the context of the revision of the International Health Regulations”. An integrated approach to Communicable Disease Surveillance Epidemiological Bulletin, Vol. 21 No.1, March 2000: http://www.paho.org/English/SHA/eb_v21n1-vigil.htm
39 The current availability of effective medications to improve erectile functioning illustrates the advantage a syndromic approach to diagnosis. While a male erectile dysfunction syndrome can be effectively symptomatically treated (i.e. improving the erectile function) with medications such as sildenafil, doing so without a proper etiological diagnostic evaluation can obscure the causative factors, and delay the diagnosis of frequent conditions such as diabetes mellitus or hiperlipidemia or, impose a life treatment to a person who might benefit from treatments that can remove the etiologic factors (e.g. performance anxiety). (Cfr. Rubio, E. & Díaz, J. Las Disfunciones Sexuales In: CONAPO (Editor). Antología de la Sexualidad Humana Vol. 3. CONAPO, Mexico 1994.
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