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性健康憂慮與性健康問題
Sexual
Health Concerns and Problems
中文翻譯：彭曉輝(中國
武漢
華中師範大學生命科學學院，430079)完成時間：2006年3月
Translator：Xiaohui
Peng (Life Science College of CCNU, Wuhan, 430079, China)
校
對：吳敏倫(中國
香港
香港大學醫學院)完成時間：2006年8月
性健康憂慮與性健康問題
性健康憂慮(Sexual Health Concerns)
只要涉及性的生活環境受到來自於個人和/或社會的幹預限制，由於幹預會影響到健康和生活品質，那麼，性健康憂慮和性健康問題就會隨時出現。性健康憂慮和性健康問題的種類繁雜，從被知覺到的“生命的組成部分”，到對健康、甚至對生命構成威脅的各種環境條件，不一而足。可是，所有這些性健康憂慮和性健康問題向包括衛生部門在內的社會各界，既提出了預防的要求也提出了完備的全面保健要求。
不僅因為性健康憂慮和性健康問題會損害性健康，並由此普遍損害個人、家庭和社會的健康，而且因為它們預示著會出現其他的健康問題，所以，投入精力重視性健康憂慮和性健康問題並找到解決它們的方案極為重要。此外，性健康憂慮和性健康問題可能會大規模地造成和/或無限期地延續個人、家庭、社會及人口的其他問題。
HIV/AIDS的全球流行。性健康憂慮和性健康問題會在個人的層面和社會的層面對人類行為產生影響。例如，自從HIV/AIDS流行以來，HIV主要通過無防護的性行為在全球傳播，它已經導致了全球3.5千萬人感染和1.9千萬人死亡。AIDS全球廣泛流行帶給社會的效應達到了如此的程度，以至於有大約1.3千萬兒童和青年人由於父母中一方或雙方與HIV相關的死亡而成了孤兒。此外，泛美衛生組織估計當前在美洲區域內就有2.5百萬HIV攜帶者。
HIV/AIDS的全球流行已經引起了公眾對性傳播疾病極其嚴重性的關注。每年有1百萬人死於生殖道感染，其中除了HIV/AIDS感染，還包括性傳播疾病(STIs)感染。有人估計全球每年發生3.33億性傳播疾病新感染病例。
暴力。世界銀行全球發展報告(1993)估計，15-44歲的婦女由於被強姦和家庭暴力的原因，壽命折扣健康年限(Discounted Health Years of Life, DHYLs)大為縮短；而強姦和家庭暴力可能與性別不平等和不負責的行為有關。有研究顯示，強姦受害者具有高比率的永久性強姦創傷後綜合征(post-traumatic stress disorder)，並且構成了最大的單身群體。強姦受害者試圖自殺和患抑憂症的可能性是一般人的9倍。此外，有50%-60%的強姦受害者會經歷性功能障礙，其中包括懼怕性行為和性喚起障礙。一項基於秘魯利馬婦產科醫院記錄的研究顯示，年齡在12-16歲的年輕母親中有90%是被強姦而受孕的。在哥斯大黎加，一個幫助少女母親的機構報告，該機構15歲以下的當事人中有95%是亂倫的受害者32。
因性別和個人身份(尤其涉及性別不平等者)受到這些暴力對待是普遍的，而專注於該事務和尋求解決這種暴力的重要意義已經在全球範圍達成共識33。
性功能障礙。性功能的綜合征近年來已經成為突出的問題。一些國家已經著手為一些群體就性功能障礙進行了流行病學研究。例如，有人報告在美國女性的性功能障礙流行率為43%，男性為31%34；性功能障礙與較低的生活品質有關聯35，並且與其他的健康問題也有關聯，例如：它與心臟病、高血壓、糖尿病、用藥不當、較高的憤怒指數和抑鬱指數有關36。
儘管上述所提及的統計資料可能就夠矚目驚心了，它們只是公共衛生問題剛剛露出水面的冰山一角。為了減輕對性健康的危害範圍和危害程度，任何行動方案都需要從超越衛生保健醫療模式的廣視野和多維度的途徑去展開。
性健康憂慮是一種生活處境(或者說是一種引起個人或公眾擔憂的性健康各種境況——譯者注)，它需要由社會採取預防和教育措施加以解決，以保證社會成員獲得和維持性健康。性健康問題既是指個體的、相互關係的也是指一個社會的生活狀態層面的涉及性的疾病/身心不適/人際關係失調/社會弊端等的結果，它需要特別的措施來加以甄別、加以預防和/或加以治療(處置)並最終加以解決。從對專業人員培訓的需求層次上也可以區分性健康憂慮與性健康問題：為瞭解決性健康問題，通常需要對專業人員進行臨床醫學培訓；然而，性健康憂慮則通常能夠由不需要特殊的臨床醫學培訓的各類專業人員來處理和管理。
本專家工作小組推薦下述的性健康憂慮和性健康問題，把處理這些事物作為推動社會達到性健康的手段(見表5)。
性健康憂慮(Sexual Health Concerns)
下述的列表並不是一覽無遺，卻是性健康憂慮的相當有代表性的例子和例證。其中的每一項性健康憂慮為適當的資訊、諮詢和保健需要的評估提供了可能；政府和非政府機構以及包括衛生部門在內的公共機構據此務必要為性健康憂慮的資訊、諮詢和/或保健的需要採取相應的行動。
表5：性健康憂慮(Sexual
Health Concerns
| 1.涉及身體完整性和性安全的性健康憂慮 為了早期鑒別性健康問題，需要採取健康促進行為(例如：定期的體格檢查和健康透視，乳房和睾丸自檢)； 需要免除諸如性暴力(包括性辱虐和性騷擾)等這些所有形式的性強迫； 需要免除身體損傷行為(也就是女性生殖器官損毀)； 需要免除感染或傳染性傳播疾病(包括不只限於HIV/AIDS這樣的性傳播疾病)； 需要減輕生理或精神殘障所引致的性功能障礙； 需要減少因藥物、手術併發症或治療對性生活所產生的有害影響； 2. 涉及性愛傾向的性健康憂慮 需要諸如涉及性反應和性快樂等有關性生理知識； 需要在尊重他人權利的價值體制下，認可以安全的和負責的方式終生享受性快樂的價值觀； 需要以安全的和負責的方式促進性關係實踐； 需要鼓勵雙方意願下的、無剝削的、誠實的和相互愉悅的性關係實踐和性快樂 3. 涉及性別的性健康憂慮 需要性別平等； 需要消除基於性別原因的所有形式的歧視； 需要尊重和容忍性別差異； 4. 涉及性取向的性健康憂慮 需要消除基於性取向的歧視； 需要在尊重他人權利的價值體制下以安全的和負責的方式表達性取向； 5. 涉及情感依戀的性健康憂慮 需要消除剝削、強迫、暴力或操縱的性關係； 需要關於家庭與生活方式選擇的知識； 需要諸如加強個人性關係的決斷、交往、自信和商議這樣的生活技能； 需要尊重和負責的愛和親昵舉止表達； 預防與適當地調和夫婦失調和緊張的關係； 分居與離異的適當管理。 6. 涉及生殖的性健康憂慮 需要就生殖行為做到知情和負責任的選擇； 無論年齡、性別和婚姻狀態如何，需要就生殖行為做出負責任的決定和實踐； 有權獲得生殖健康保健服務； 有權獲得安全的產育保健； 不孕/不育的預防與保健； |
性健康問題(Sexual Health Problems)
性健康問題要麼是指個體的、相互關係的要麼是指一個社會的(涉及性的疾病/身心不適/人際關係失調/社會弊端等的)健康後果，它需要特別的措施來加以鑒別、加以預防和/或加以治療(處置)並最終加以解決。
在過去，為了表示性健康問題所使用的“病症”(pathology，疾病在生理結構和功能上的客觀表現或過程——譯者注)這個術語已經引起了頗大的爭議。當用病症來表示性健康問題和性健康憂慮時，由於人所經歷的性健康問題的種類不同，這個術語的通常和清晰的含義在衛生保健的其他領域常常含混不清。所以，本專家工作小組推薦使用術語“性問題”，而不使用“病症”來指稱性健康問題。
專家工作小組的另一個建議是使用綜合征標準分類法對性健康問題進行分類。(性的)臨床綜合征定義為嚴重阻礙個人行使性權利、以及個人的性健康惡化所導致的疾病體征及其症狀徵候群。
採用綜合征標準分類法有許多優點。綜合征容易為人所識別。當性健康問題以綜合征的標準為人所熟知時，既容易讓保健人員也容易讓一般大眾都意識到性健康問題的存在。綜合征標準分類也更簡潔和能夠以流行病學的方法加以運用。有關以綜合征標準分類的流行病學研究，有一些成果當前已經非常知名37。從類目上看，如果採用綜合征分類法，從公共衛生的角度思量，它使得我們能夠有效地採取措施解決諸如預防和治療性傳播疾病等性健康問題38。
另一方面，許多性健康問題由相當複雜的多種多樣的病因所導致。例如，對於性功能障礙，即使當其綜合征已經被識別出來時，尚需基於診斷來尋找其病因39。綜合征標準分類法有助於提醒人們這個列舉的種類只是綜合征，而不是臨床病因學分類體系。鑒於上述理由，本專家工作小組強烈建議把綜合征標準分類法用於對性健康問題的分類。
臨床綜合征的分類是在專業人員之間被廣泛創用的頗為人為的分類法。在所提及的臨床綜合征的分類中，有許多已經得到了廣泛的認可，例如性功能障礙的臨床綜合征分類的認同過程就是一個很好例子。至於其他的分類，譬如強迫性行為綜合征，其認同的過程尚在起步階段。
所以，我們在此把性健康問題作為綜合征提出來。每一個綜合征為適當的資訊評估、諮詢服務、預防、早期診斷、進一步的診斷評價需要以及治療課程、康復和/或保健等的需要提供了可能，這些都要求政府、非政府代理機構和包括衛生部門在內的公共機構做出相應的反應。性健康問題可以被劃分為下述的綜合征類型(見表6)：
表6：性健康問題(臨床綜合征)
| 1.
削弱性功能的臨床綜合征(性功能障礙) 性欲低下 性厭惡 女性性喚起功能障礙(舊稱：陰冷) 男性勃起功能障礙(舊稱：陽痿) 女性性高潮功能障礙 男性性高潮功能障礙 過早射精 (射精過快，舊稱：早洩) 陰道痙攣 性交疼痛綜合征(包括性交困難和其他性交疼痛症狀) 2. 涉及情感依戀/情欲損害的臨床綜合征(也叫性反常行為) 露陰症 戀物症 挨擦症 戀童症 受虐症 施虐症 戀物性異裝症 窺陰症 非特異性性反常行為 3. 涉及強迫性行為的臨床綜合征 強迫求偶與多性伴症 難獲得性伴強迫固結症 強迫自體性行為症 強迫戀愛症 親屬間強迫性行為症 4. 涉及性別認同衝突的臨床綜合征 兒童期性別焦慮症 青春期性別焦慮症 成年期性別焦慮症 中間性綜合征 非特異性性別認同綜合征 5. 涉及暴力與受害的臨床綜合征 兒童/未成年人受性辱虐臨床綜合征(包括不僅限於創傷後心理壓力紊亂症) 受性騷擾後臨床綜合征 受性暴力或被強姦後臨床綜合征 專注於性的事物臨床恐怖症(例如：同性戀憎惡、性愛恐怖等) 涉及從事性行為或性暴力威脅或行為(例如：強姦另一個人)的臨床綜合征 施加於自身和/或他人的、冒HIV或/和其他性傳播疾病感染風險的不安全性行為模式 6. 涉及生殖的臨床綜合征 女性不孕 男性不育 非意願妊娠 流產併發症 7. 涉及性傳播疾病的臨床綜合征(病因學分類見附件II) 生殖器潰瘍 無濾泡型 濾泡型 口腔潰瘍 無濾泡型 濾泡型 直腸潰瘍 無濾泡型 濾泡型 流膿 尿道流膿 陰道流膿 直腸流膿 女性下腹部疼痛 無症狀性傳播疾病和寄生蟲感染症 獲得性免疫缺陷綜合征(HIV感染II期) 8. 涉及其他疾病的臨床綜合征 繼發於殘障或身體虛弱的臨床綜合征 繼發于生理或精神疾病的臨床綜合征 繼發於用藥或其他醫學和外科幹預的臨床綜合征 結腸直腸疾病 繼發於其他疾病的臨床綜合征 |
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
5. 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 |
注釋 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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