LNSLNS The authors’ interdisciplinary approach and their challenge to consider the different types of sexual disturbances from a biopsychosocial perspective are very welcome. Unfortunately, the importance of the physical examination is neglected.; Peyronie´s disease is not even mentioned as a pathology (1). Other examples of pathologies that may affect a man’s sex life (2) include algopareunia subsequent to scarring, adhesions, inflammations/infections, or trophic disorders in the genital area, or the effects of circumcisions performed for different (e.g. medical, cultural oder religious) reasons.

The authors have missed an opportunity to mention the cultural influences of migrants. Currently, some 7 million foreigners permamentely reside in Germany—approx. 10% of the total population. A majority of these maintain their religious beliefs, traditions, and cultures, and many are Muslims. Islam is not a religion that is based on abstinence or asceticism; temporary marriages, some forms of polygamy, and rapid divorces are all permitted. In spite of this, due to historical and cultural traditions, unfaithfulness or sex before marriage among Muslim women are often severely penalized and affect couples’ sexual lives (3). Specialists in sexual medicine should therefore possess a certain amount of knowledge about their patients’ “sexual culture”.

Unfortunately, the authors failed to mention the increasing use of condoms—important in the era of AIDS—and their importance for people’s sexual lives and sexuality.

The authors rightly emphasize the importance of taking a sexual history and including both partners; they at least partly try to explain the theory underlying these statements. However, the article barely offers any practical pointers to help doctors with their medical practice. It is thus not surprising—although the authors found this unsatisfactory—that everyday practice focuses on the functional aspects of erectile dysfunction since this approach yields improvements in more than 60% of patients. It remains to be seen whether a therapeutic approach that focuses primarily on the couple and the sexual history can compete in terms of effectiveness.
DOI: 10.3238/arztebl.2010.0350c

PD Dr. med. M.J. Mathers, FEBU
Urologische Gemeinschaftspraxis Remscheid
Kooperationspraxis der Klinik für Urologie und Kinderurologie
Helios-Klinikum
Wuppertal, Universität Witten/Herdecke
Fastenrathstr. 1
42853 Remscheid, Germany
irtima@t-online.de

Prof. Dr. med. T. Klotz, MPH
Klinik für Urologie, Andrologie und Kinderurologie
Am Klinikum Weiden
Söllnerstr. 16
92637 Weiden, Germany
theodor.klotz@kliniken-nordoberpfalz.ag
1.
Klotz T, Mathers MJ, Sommer F: Induratio penis plastica – eine verschwiegene Erkrankung. Dtsch Arztebl 2007; 104: 263–7. VOLLTEXT
2.
Mathers MJ, Schmitges J, Klotz T, Sommer F.: Einführung in die Diagnostik und Therapie der Ejaculatio praecox. Dtsch Arztebl 2007; 104: 3475–80. VOLLTEXT
3.
Haeberle EJ: The Sex Atlas. The Seabury Press, New York, 1978.
4.
Rösing D, Klebingat KJ, Berberich H, Bosinski H, Loewit K, Beier K: Sexual dysfunctions in men – Diagnosis and treatment from a sexological interdisciplinary perspective [Sexualstörungen des Mannes – Diagnostik und Therapie aus sexualmedizinisch-interdisziplinärer Sicht]. Dtsch Arztebl Int 2009; 106(50): 821–8. VOLLTEXT
1. Klotz T, Mathers MJ, Sommer F: Induratio penis plastica – eine verschwiegene Erkrankung. Dtsch Arztebl 2007; 104: 263–7. VOLLTEXT
2. Mathers MJ, Schmitges J, Klotz T, Sommer F.: Einführung in die Diagnostik und Therapie der Ejaculatio praecox. Dtsch Arztebl 2007; 104: 3475–80. VOLLTEXT
3. Haeberle EJ: The Sex Atlas. The Seabury Press, New York, 1978.
4. Rösing D, Klebingat KJ, Berberich H, Bosinski H, Loewit K, Beier K: Sexual dysfunctions in men – Diagnosis and treatment from a sexological interdisciplinary perspective [Sexualstörungen des Mannes – Diagnostik und Therapie aus sexualmedizinisch-interdisziplinärer Sicht]. Dtsch Arztebl Int 2009; 106(50): 821–8. VOLLTEXT