LNSLNS We thank your correspondents for their constructive feedback, which shows the importance, as well as the multiple aspects, of the topic of male sexual dysfunction. It was important to us to explain this complexity and to show the associations between biology, psychology, and sociocultural situations. However, it was clear from the outset that it was not possible to explain every point of interest in great detail; for this reason, some disorders are mentioned only in the form of graphically presented overviews (for example, the induration penis plastica or sexually transmitted infections). We did not mention a possible association between erectile dysfunction and obstructive sleep apnea, but we thank our correspondents for doing so. In the context of this article we did not intend to provide a comprehensive overview of how cultural differences affect sexual experiences and behaviors. We apologize for having created the impression that this is not an important topic in our view and assure our readers that the opposite is the case.

Our article focused in particular on the investigation of possible physical causes for sexual dysfunction; we laid out the multiple therapeutic options in tables and in a figure. We did not intend to provide a new comparison and evaluation of individual therapeutic approaches, because our objective was to make a contribution to improving sexual satisfaction for couples and not the isolated treatment of an individual function. Even though statistics aim to make us believe that this is not so, our case study shows that the reality for many patients is different. Research studies that focus on satisfying basic needs contribute to a complex perspective on the subject and are of use in sexual therapeutic -encounters—where the use of medications or aids also has its place. It is by no means a given in clinical medical practice that a sexual history (box) precedes the treatment, but much is attempted “ex juvantibus.” We remain critical of the suggestion of one of our correspondents, that changing partners may be the way forward—this cannot really be a medical recommendation in order to find out how sexual functioning is affected. The authors understand sexuality as component of a relationship between two partners; in no culture does sexuality focus merely on functioning because basic needs apply across cultures, and sexuality as body language, in addition to the fulfillment of sexual needs, has an important contribution to make in terms of how the other person feels accepted and valued. Unilateral sexual satisfaction at the expense of the other person will always be associated with a change in the couple relationship and thus confront couples with the need to make a pertinent decision. The authors do not see “new alternatives” such as cybersex, as an equivalent for experiencing feelings in a real relationship through a physical connection with a partner and as a substitute for gathering live insights that cannot be replicated in cyberspace. In sexual medical practice, persons present who suffer from their sexual disorder—whatever origin it may have—because they do not feel right, valued, accepted, or approved of, because they do not want to or cannot trust others. It is our responsibility as doctors to be open to these patients—as in all other medical specialties—to help them understand the causes, to raise their awareness of the multifunctionality and multidimensionality of sexuality, in order to improve their satisfaction with their lives in spite of changed or impaired sexual functioning.
DOI: 10.3238/arztebl.2010.0352

Dr. med. Dirk Rösing
Universitätsklinikum Greifswald
Anstalt öffentlichen Rechts
Klinik und Poliklinik für Urologie
Fleischmannstr. 42–44
17475 Greifswald, Germany
roesing@uni-greifswald.de


Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
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. 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