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Viagra 50 mg capsule, to treat erectile dysfunction in adult males. "The key is to focus on what men really want," says Dr. David E. Schatz, professor of obstetrics, gynecology and reproductive medicine at Albert Einstein College of Medicine in New York City. "There's a myth out there that all men want erectile dysfunction and that medication is only going to help that. It could do the exact opposite." "It can give a guy life sentence," says Dr. Robert Zelman, a psychologist and sex therapist with the San Diego Sex Offender Treatment Program. "It's the ultimate punishment for a violation of the law chastity." According to the U.S. Department of Justice, sexual violence is the second-leading cause of injury-based death among women ages 15 to 44. Rape and childhood sexual abuse may be the main reason, but most common victims are women who engage in sexual behavior outside of marriage. And while most women who violate the law live in West, nearly half of those who receive a diagnosis of paraphilia treatment in prison—nearly twice the national average. While the sexual-assault and female-on-female crime rates are relatively low in the United States, they often go unrecognized, with the rape statistic used to suggest that all women are victims of sexual assault, says Jennifer Leffel, director of research and policy at AAMC. Because men face the threat of sexual assault at higher rates, their fears may be even more intense. The male-on-male crime rate is also very high—more than three times the national average. In an early study, the AAMC researchers found that 40 percent of those diagnosed with paraphilia—around 50 men—have raped, and that 30 percent have raped within the last three months. "I would argue these men are being victimized again and again," says Leffel. "A big part of the issue is that we fail to acknowledge there's a relationship between paraphilias and violence against women. If you look at studies of sexually paraphilic men who commit mass shootings or murders, they have had histories of rape, sexual coercion, coercive control, severe violence, etc." The "crisis" One of the key difficulties in addressing sexual dysfunctions is that the act so complex we don't fully understand it. As a result, many doctors struggle with interpreting the symptoms of male-on-male sexual activity, says Dr. Jennifer D. Stuetz, professor of psychiatry and behavioral sciences at the University of Michigan. Stuetz and her colleagues published a study in The Journal of Sexual Medicine last September that looked at the relationship between paraphilias and sexual dysfunction. The study found that in patients who had paraphilias, the risk of experiencing a sexual dysfunction increased with the severity of sexual dysfunction. One type paraphilia that was highly correlated with difficulty achieving a sexual erection or ejaculation was "autisticsaphilia," sexual interest in non-human animals. "There is a lot of controversy about what people like to call a problem: paraphilia is not disorder in the DSM [the psychiatric bible that helps classify illnesses] anymore than it's a disorder in the diagnostic manual to get married today," says Stuetz. "The problem is we are all at the mercy of our own experience [when diagnosing] and in the DSM it's only sexual dysfunction [of paraphilias] that gets labeled"

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