I-Behav Sci (iBasel). 2016 Sep; 6(3): 17.
Ipapashwe kwi-intanethi 2016 Aug 5. doi: 10.3390 / bs6030017
Brian Y. Park,1 UGary Wilson,2 UJonathan Berger,3 Matthew Christman,3 UBryn Reina,4 UFrank Bishop,5 UWarren P. Klam,4 kwaye Andrew P. Doan4,5,*
Abstract
Izinto zesintu ezakhe zachaza ubunzima besini besilisa zibonakala ngathi azonelanga kwi-akhawunti yokunyuka ngokukhawuleza kwe-erectile dysfunction, ukulibaziseka ukunyuka, ukunciphisa ukoneliseka ngokwesondo, kunye nokunciphisa i-libido ngexesha lokwabelana ngesondo phakathi kwamadoda aphantsi kwe-40. Olu hlaziyo (1) lujonga idatha evela kwimimandla emininzi, umz. , ikliniki, i-biological (umlutha / urology), kwengqondo (imeko yesondo), intlalontle; kwaye (2) iveza uthotho lweengxelo zeklinikhi, zonke ngenjongo yokuphakamisa umkhombandlela onokubakho kuphando lwexesha elizayo lwale nto. Utshintsho kwinkqubo yengqondo ekhuthazayo iphononongwa njenge-etiology enokubangelwa kukungaziphathi kakuhle ngokwesondo. Olu hlaziyo luthathela ingqalelo ubungqina bokuba iipropathi zoonografi ezikwi-Intanethi ezizezinye (ubutsha obungenamda, ukubanakho ukunyuka ngokulula ukuya kwizinto ezigwenxa, ifomathi yevidiyo, njl.njl. -amaqabane obomi, anje ngesondo kunye namaqabane onqwenelekayo angangabhalisi njengelindelo lokuhlangana kunye nokwehla kokuvuka Iingxelo zonyango zibonisa ukuba ukuyeka ukusebenzisa iphonografi kwi-Intanethi ngamanye amaxesha kunokwanela ukuguqula imiphumo emibi, kugxininisa isidingo sophando olunzulu kusetyenziswa iindlela ezinezifundo ezisusa ukwahluka kwe-Intanethi. Okwangoku, inkqubo elula yokuqonda isifo yokuvavanya abaguli abanesifo esingamanyala esini.
Internet: ukungasebenzi kakuhle kwe-erectile, umnqweno ophantsi wesini, ukwaneliseka okuphantsi ngokwesondo, ukulibaziseka ukukhupha, iphonografi, iphonografi ye-Intanethi, izinto ezicacileyo ngokwesondo, iPIED
1. intshayelelo
1.1. ImiThambo kwi-Dysfunction ye-Sex-Without Answers Answers
Kude kube yiminyaka elishumi edlulileyo, amaxabiso e-ED ayephantsi kubantu abasebenzelana ngokwesondo phantsi kwe-40, kwaye abazange baqale ukunyuka ngokukhawuleza kude kube emva koko [1,2]. I-1999 enkulu yecandelo le-cross-sectional study lichaze ukungasebenzi kwe-erectile kwi-5%, kunye nesifiso esincinci sezesondo kwi-5% yabantu abasebenza ngokwesondo, iminyaka eyi-18 kwi-59 [3], kunye novavanyo lwe-2002 lwe-erectile-dysfunction study lichaze amazinga athile ka-2% kumadoda phantsi kwe-40 (ngaphandle kwesifundo esandulelayo) [2]. Ezi nkcukacha zahlanganiswa phambi kwe-intanethi "iisayithi ze-tube tube" zenze ukuba kube lula ukufikelela kwividiyo ezingabonwanga ngesondo ezingafunekiyo. Eyokuqala kwezi "tyiyibhubhu" zavela ngoSeptemba 2006 [4].
Ngokwahlukileyo, uphando olutshanje lwe-ED kunye nolwaphulo olunzulu lwesifiso sesondo ngokukhawuleza okwenyukayo kwezidakamizwa kumadoda phantsi kwe-40. Omnye umboniso ocacileyo weli bakala uhambelana no-ED, kwaye uthelekisa iipampuli ezinkulu, zonke ezo zihlolwe zisetyenziselwa umbuzo ofanayo (ewe / akukho) malunga ne-ED njengenxalenye yeSifundo seMhlaba soBucala kunye nokuziphatha (GSSAB). Kwi-2001-2002, ilawulwa kuma-13,618 amadoda asebenza ngokwesondo kumazwe akwa-29 [5]. Kwiminyaka elishumi kamva, kwi-2011, umbuzo ofanayo (yebo / awukho) kwi-GSSAB yalawulwa kwi-2737 amadoda asebenza ngokwesondo eKroatia, eNorway nasePortugal [6]. Iqela lokuqala, kwi-2001-2002, belineminyaka eli-40-80. Iqela lesibini, kwi-2011, yayingu-40 nangaphantsi. Ngokusekelwe ekufunyanweni kweengxelo zembali ezikhankanywe ngaphambili, amadoda adala aya kulindeleka ukuba abe namazinga aphezulu e-ED kunezinga elingafanelekanga lamadoda amancinci [2,7]. Nangona kunjalo, kwiminyaka elishumi nje, izinto zashintsha kakhulu. Ixabiso le-2001-2002 kumadoda amadala i-40-80 yayingama-13% eYurophu [5]. Ngama-2011, ama-ED amazinga aseYurophu abancinci, i-18-40, isuka kwi-14% -28% [6].
Kwiminyaka embalwa edlulileyo, uphando olusebenzisa izixhobo ezahlukeneyo zovavanyo luye lwabonisa ubungqina obuninzi bokunyuka okungenakwenzeka ngaphambili kweengxaki zesini phakathi kwababhinqa. Ku-2012, abaphandi baseSwitzerland bafumana amazinga e-ED ye-30% kwicandelo eliphambene namadoda aseSwitzerland aneminyaka eyi-18-24 esebenzisa i-Index Index ye-Erectile Function (IIEF-5) [8]. Ucwaningo lwe-2013 lwase-Italy luchaze omnye kwizigulane ezine ezifuna uncedo olutsha lwe-ED lwangaphantsi kwe-40, kunye neerhafu ze-ED eninzi malunga ne-10% ephezulu kunamadoda ngaphezu kwe40 [9]. Ucwaningo lwe-2014 kwi-Canada yasetsheni luchaza ukuba i-53.5% yabesilisa abaneminyaka eyi-16-21 babenempawu ezibonisa ingxaki yesini [10]. I-Erectile i-dysfunction yayiqhelekileyo (26%), ilandelwa ngumnqweno ophantsi wesini (24%), kunye neengxaki ze-orgasm (11%). Iziphumo zathatha abalobi ngothusayo, "Akucaci ukuba kutheni sifumane amazinga aphezulu aphezulu, kodwa ngokukodwa amaxabiso aphezulu phakathi kwabasetyhini nabasetyhini kunokuba bathathe inxaxheba kwabasetyhini bodwa, njengoko kuqhelekileyo kwiincwadi ezindala" [10] (p.638). Ucwaningo lwe-2016 ngeli qela elifanayo livavanya iingxaki zesini kwiintsholongwane (i-16-21 iminyaka) kwiimvula ezinhlanu ngaphezu kweminyaka emibini. Kwimiba, iingxaki eziqhubekayo (ubuncinane ubunqamlezo esisodwa) zazineliseko eziphantsi kwezesondo (47.9%), umnqweno ophantsi (46.2%), kunye neengxaki kwi-erectile function (45.3%). Abaphandi baphawule ukuba kwixesha lexesha leengxaki zezesondo zanqatshelwe amabhinqa, kodwa kungekhona kwindoda [11]. Uphononongo lwe-2014 olutsha lwe-ED kwi-servicemen esebenza ngokufanelekileyo luchaza ukuba amaxabiso aphindwe kabini phakathi kwe-2004 ne-2013 [12]. IiRhafu ze-ED zengqondo zikhuphule ngaphezu kwe-ED yeemveliso, ngelixa amaxabiso e-ED engahlanjululwayo ahlala eqinile [12]. Uvavanyo lwe-2014 lwengqamaniso yomsebenzi osebenzayo, obunempilo, amadoda asemasemagunyeni aneminyaka eyi-21-40 esebenzisa into emihlanu ye-IIEF-5 ifumane i-ED jikelele ye-33.2% [13], kunye namazinga aphakamileyo njenge-15.7% kubantu abangenayo i-posttraumatic disorder disorder [14]. Abaphandi baphinde baqaphele ukuba ukuxhatshazwa ngokwesondo kuya kuxhomekeka kwizinto ezichasene nokuxhamla [14], kwaye kuphela i-1.64% yabano-ED befuna iimfuno ze-phosphodiesterase-5 inhibitors ngokusebenzisa umkhosi [13]. Uhlalutyo lwesibini lwenkcazo yesigqeba somkhosi lubonisa ukuba iingxaki zokusebenza ngokwesondo zahlanganiswa "nokuxhalaba ngokwesondo" kunye "nomntu wesini somzimba"14]. I-2015 "UluNxibelelwano olufutshane" luchaze amazinga e-ED ngokuphakamileyo njengoko i-31% kubantu abesondo ngokobulili kunye neqondo eliphantsi lokunqwenela ngokwesini njengoko i-37% [6]. Okokugqibela, olunye uhlolisiso lwe-2015 kumadoda (iminyaka engama-age engama-36), yabika ukuba i-ED ehamba kunye nomnqweno omncinci wokubelana ngesondo ngokubambisana ngoku ngokuqhelekileyo kubonelela kwimizimba yabantu abafuna uncedo ngokuziphatha kakubi ngokwesondo, ohlala "basebenzisa imifanekiso engamanyala "[15].
Ngokwesiko, i-ED ibonwe njengengxaki exhomekeke kwiminyaka [2], kunye nokuphanda iingxaki ze-ED kumadoda phantsi kwe-40 baye bahluleka ukufumanisa iimeko ezixhomekeke ku-ED kumadoda amadala, njengokubhema, ukusela utywala, ukunyameka, ubomi obusondeza, isifo sikashukela, isifo soxinzelelo, isifo senhliziyo, kunye ne-hyperlipidemia [16]. I-ED isoloko ikwahlulwa njenge-psychogenic okanye i-organic. I-ED ye-Psychogenic idibene neemeko zengqondo (umz., Ukuxinezeleka, uxinzelelo, ukuxhalabisa, okanye ukuxhalaxwa komsebenzi) ngelixa i-ED yezinto eziphilayo ibangelwa kwiimeko eziphathekayo (umzekelo, i-neurological, i-hormonal, i-anatomical, okanye i-side effects)17]. Kuba amadoda phantsi kwe-40 ukuxilongwa okuqhelekileyo yi-ED yengqondo, kwaye abaphandi baqikelela ukuba kuphela i-15% -20% yamatyala evela kwimvelaphi yezinto eziphilayo [18].
Nangona kunjalo, ayikho into edibeneyo yokulungelelanisa i-ED ye-psychogenic ebonakala ilungele ukuphendula ngokukhawuleza kwenyuka kwimiba engxaki yobunini. Ngokomzekelo, abanye abaphandi baphoxisa ukuba ukunyuka kweengxaki zesini zolutsha kufuneka kube ngumphumo wokuphila okungenampilo, njengokunyanyisa, ukusetyenziswa kakubi kweziyobisi kunye nokubhema (izinto ezidlulileyo ezihambelanayo ne-ED). Kanti le miqobo yokuphila ayizange ishintshe ngokuthe ngqo, okanye iyancipha, kwiminyaka yokugqibela ye-20: Amanani amaninzi e-US amadoda aneminyaka elidala i-20-40 yenyuka kuphela i-4% phakathi kwe-1999 ne-2008 [19]; Iirhafu zokusetyenziswa kweziyobisi ezingekho mthethweni phakathi kwabemi base-US abaneminyaka eyi-12 okanye abadala baye bazinzile kwiminyaka yokugqibela ye-15 [20]; kunye namazinga okutshaya abantu abadala base-US benqabile ukusuka kwi-25% kwi-1993 ukuya ku-19% kwi-2011 [21]. Abanye abalobi banika iingcebiso zengqondo. Nangona kunjalo, kunokwenzeka njani ukuba uxhalaba kunye nokudandatheka ngenxa yokunyuka ngokukhawuleza ubunzima bezesondo zobutsha kunika ubudlelwane obunzima phakathi kwesifiso sozesondo kunye nokuxinezeleka nokuxhalaba? Ezinye izigulane ezixinezelekileyo nezixhalabisayo zichaza umnqweno omncinci wesondo xa abanye bebika intshiseko yesondo [22,23,24,25]. Ulwalamano oluphakathi kokudandatheka kunye no-ED mhlawumbi luyiyo-bidirectional kwaye isebenza ngokubambisana, kusenokubangelwa yintsebenziswano yesondo, ingakumbi kubafana abaselula [26]. Nangona kunzima ukulinganisa iirhafu zezinye iingqondo zengqondo ezicatshulwa kwiakhawunti ngokunyuka ngokukhawuleza ubunzima bezesondo zolutsha, ezifana noxinzelelo, ubudlelwane obuxinzelelekileyo, kunye nolwazi olungenamlinganiselo wesini, kungenakuphi na ukucinga ukuba le miba ikhona (1) ayikho i-bidirectional kunye (kunye ne-2) baye batya kwiimilinganiselo ezaneleyo zokuchazela ukunyuka okukhawulezayo kwintlupheko yobunzima bezesondo, ezifana nesifiso esincinane sesini, ubunzima be-orgasming, no-ED?
1.2. Ngaba iphonografi ye-Intanethi isebenzisa into kwiZinto eziNgasebenziyo ngokwesondo namhlanje?
Abaphandi baseKinsey Institute babengowokuqala ukubika i-pornography-eyenza i-erectile-dysfunction (PIED) kunye noonografi-zenze i-libido engavumelekanga, kwi-2007 [27]. Isiqingatha sezifundo ezifunyenwe kwimibhobho kunye neendawo zokuhlambela, apho i-video yezoonografi "yayiphambene nonke", ayikwazanga ukufezekisa ukulungiswa kwilebhu ekuphenduleni i-porno yevidiyo. Xa bethetha nezifundo, abaphandi bafumanisa ukuba ukugqithiswa okukhulu kwevidiyo ezibonakalayo kubangele ukuba kubangele ukunyamekela komsebenzi kunye nesidingo esandayo sokwenza izinto ezigqithiseleyo, ezikhethekileyo okanye "kinky" ukuze zivuswe. Abaphandi ngokwenene baphinde bahlaziya isifundo sabo ukuze bahlanganise iziqeshana ezihlukeneyo kwaye bavumele ukukhetha okunye. Ingxenye yesine yabathathi-nxaxheba abazange basabele ngokuqhelekileyo [27].
Ukususela ngoko, ubungqina buye banda ukuba i-intanethi ye-intanethi ingaba yinto ebangela ukukhawuleza ngokukhawuleza kwimivuzo yesondo. Phantse ezintandathu kwi-10 yeendwendwe ze-3962 zifuna uncedo kwi-Forum ye-MedHelp.org ED, ekhankanya ubudala, yayincinane kune-25. Kuloohlalutyo lweminyaka eyisibhozo yezithuba kunye namazwana, phakathi kwamagama aqhelekileyo axhumene nemeko yengqondo ye-ED (engekho i-ED ekhoyo), "i-pornography" ibonakala iqhele ngokubanzi [28]. Ucwaningo lwe-2015 kwizikolo eziphakamileyo zaseburhulumenteni zifumanise ukuba i-intanethi ye-intanethi isebenzisa i-frequency ehambisana nomnqweno wesini ophantsi [29]. Kwalabo abadla i-intanethi ye-intanethi ngaphezu kweyodwa ngeveki, i-16% ibike isifiso sesini esiphantsi, xa kuthelekiswa ne-0% kwabangewona abathengi (kunye ne-6% kulabo abadla ngaphantsi kwesinye ngeveki). Olunye uhlolisiso lwe-2015 yamadoda (ubudala beminyaka yobudala be-41.5) efuna unyango loxhatshazo oluxhatshazwayo ngokwesini, "oqhelekileyo usebenzisa iinthombe zoononophelo eziqhelekileyo") iiyure ezisixhenxe okanye ngaphezulu ngeveki, zifumene ukuba i-71% yayinezifo zesifo sezesondo, kunye ne-33% yokubika ubunzima be-sexism [30]. Ukuxhalabela malunga nokusebenza ngokwesondo kunokubangela ukuxhomekeka ngakumbi kwiimifanekiso engamanyala njengento yesondo. Kwisifundo se-2014 se-11 esebenza ngokugqithiseleyo (i-fMRI), i-19 ye-25 yabasebenzisi be-pornography abaxhomekeke kwi-intanethi (i-average age XNUMX). kuncitshiswe i-libido okanye umsebenzi we-erectile ngokukhethekileyo ekusebenzisaneni ngokobuhlobo kunye nabasetyhini (nangona bengenalo ubudlelwane nezinto ezicacileyo ngokwesini) "[31]. Oogqirha baye bachaza ukungasebenzi kakuhle kwesondo okunxulumene nephonografi, kubandakanya i-PIED. Ngokomzekelo, kwincwadi yakhe I-New Naked, unjingalwazi we-urology uHarry Fisch wabika ukuba iphonografi ye-Intanethi egqithisileyo isebenzisa ukungasebenzi kakuhle ngokwesondo kwizigulana zakhe [32], kunye nonjingalwazi wezifo zengqondo uNorman Doidge wanikela ingxelo kwincwadi yakhe Ubungqina Obuguqula ukuba ukususwa koonografi kwi-Intanethi kusebenzisa ukungabi namandla kunye neengxaki zokuvuselela ngokwesondo kwizigulana zakhe [33]. Kwi-2014, iBronner kunye neBen-Zion babike ukuba umsebenzisi we-intanethi oyinyanzeliso we-intanethi, obenomdla oye wanyuka waya kwi-pornography eyingozi kakhulu, wafuna uncedo kwisini esifanelekileyo sesini ngexesha lokwabelana ngesondo. Kwiinyanga ezisibhozo emva kokuyeka konke ukubonakala koononografi isigulane sichaze ukufumana i-orgasm ephumelelayo kunye ne-ejaculation, kwaye iphumelele ukuzonwabisa ubudlelwane obuhle ngokwesondo [34]. Kuza kubekho namhlanje, akukho mphandi ocele abantu abanengxaki yobundlobongela ukuba basuse ukutshintsha kwe-intanethi ye-intanethi ukuze kuphandwe ukuba ngaba kunengxaki kwiingxaki zabo zesini.
Nangona izifundo zokungenelela ezinjalo ziza kuba zikhanyisa kakhulu, ukuphononongwa kwethu kwincwadi kufumana iindidi ezininzi eziye zahambelana nokugqithisa iifrafikhi kunye nokukhangela, kunye neengxaki zokusebenza ngokwesini [27,31,35,36,37,38,39,40,41,42,43], kubandakanywa nobunzima be-orgasming, ukunciphisa i-libido okanye umsebenzi we-erectile [27,30,31,35,43,44], imiphumo emibi kwisini esahlukileyo [37], ukunciphisa ubumnandi bokuthandana ngokwesondo [37,41,45], ubuncinci besondo kunye nolwalamano nolweneliseko [38, 39, 40, 43, 44, 45, 46, 47], ukhetho lokusebenzisa iinthombe zoonopopasho ze-intanethi ukufezekisa nokugcina uvuko ngenxa yokulala nomlingane [42], kunye nobuchopho obukhulu ekusebenziseni imifanekiso engamanyala kulabo bavakalisa umnqweno omncinane ngesondo kunye namalingani [48]. Kwakhona, i-intanethi ye-intanethi isebenzisa imilinganiselo ehambelanayo nomnqweno wesini ophantsi kwi-high school [29]. Izifundo ezimbini ze-2016 zifanelwe ingqwalasela ecacileyo apha. Uphando lokuqala luthi luyifunde lokuqala lokumela abantu kwizibini ezitshatileyo ukuvavanya imiphumo yokusetyenziswa kweentlophu zoogqirha. Ingxelo yokuba ukusetyenziswa kwamanyala e-Wave 1 (2006) ngokuqhelekileyo kunye nokuxhatshazwa ngokungathandekiyo kunye nomgangatho womtshato wabathathi-nxaxheba kunye nokwaneliseka ngobomi babo besondo kwi-Wave 2 (2012). Imitshato echaphazeleka kakhulu yileyo yamadoda ayebukela iphonografi kumaziko aphezulu (kanye ngosuku okanye ngaphezulu). Ukuvavanya ukuguquguquka kwamanani amaninzi, ukuphindaphindiweyo koonografi kusetyenziswa kwi-2006 yimbini yesibini esomeleleyo yongxaki yomtshato kwi-2012 [47]. Ucwaningo lwesibili lubonisa ukuba luyilo kuphela oluhlolisayo ukuphanda ngokuthe ngqo ulwalamano phakathi kwezingxaki zesondo kunye namadoda kunye nokubandakanyeka ngengozi kwi-OSA (imisebenzi yezocwangciso zesini). Olu phando lwabesilisa be-434 luchaza ukuba ukwaneliseka kwezesondo ezantsi kunye nomsebenzi ophantsi we-erectile wawudibene neengxaki zoononopopasho ze-Intanethi ezisetyenziswayo [44]. Ukongezelela, i-20.3% yamadoda yathi esinye isisusa sokusebenzisa iifoto zoonografi "kwakuhlala kugxothwa kunye nomlingane wam" [44]. Kufunyaniso olunokuthi lubonise ukunyuka kweentlobo zoonografi, i-49% ichazwe ngezinye ixesha "ifuna umxholo wesondo okanye ibandakanyeke kwii-OSA ezingazange zithandeke kubo ngaphambili okanye ukuba zicinge"44] (p.260). Ekugqibeleni, ipesenteji ebalulekileyo yabathathi-nxaxheba (i-27.6%) zihlolisise ukusetyenziswa kwazo kwe-OSA njengengxaki. Nangona le ngxaki yokusetyenziswa kwezithombe ezingcolileyo zoonobumba ingabonakala iphakamileyo, esinye isifundo se-2016 kumadoda akwa-1298 ayebukele iphonografi kwiinyanga ezintandathu ezidlulileyo sichaze ukuba i-28% yabathathi-nxaxheba bazuze okanye ngaphezulu kwe-cutoff ye-hypersexual disorder [49].
Ukuhlaziywa kwethu kuqulethe amabini ama-2015 amaphepha athi i-intanethi ye-intanethi isebenziswanga ukunyuka kweengxaki zesini kwintlezana. Nangona kunjalo, loo mabango abonakala engekafiki ngexesha lokuphonononga okufutshane na maphepha kunye nokugxeka okusemthethweni. Iphepha lokuqala liqulethe ulwazi oluncedo malunga nendima enokuyenza yesimo sezesondo kwi-ED yolutsha [50]. Nangona kunjalo, lo mpapasho uphantsi kokugxeka ukungafani okungafaniyo, ukuchithwa kunye neendlela zokuziphatha. Ngokomzekelo, akuboneli iziphumo zesitekthi somlinganiselo wesiphumo somsebenzi we-erectile ngokubhekiselele kwi-intanethi ye-intanethi. Ukongezelela, njengoko ugqirha ophando luchaza ngokubhaliweyo ngokusemthethweni kwiphepha, abalobi beemviwo, "abazange banikeze umfundi ngeenkcukacha ezaneleyo malunga noluntu oluthatywayo okanye uhlalutyo luhlalutya ukulungiselela isigqibo sabo" [51]. Ukongeza, abaphandi baphanda iiyure zoononopopasho ze-intanethi zisetyenziswa ngenyanga yokugqibela. Nangona kunjalo izifundo kwi-intanethi yezilwanyana ezigqithisileyo ziye zafumanisa ukuba ukutshintsha kweeyure ze-intanethi zisebenzisa i-yedwa ngokungahambelani "neengxaki zobomi bemihla ngemihla", amanqaku kwi-SAST-R (Uvavanyo lweZilingo zoLwaphulo lweSondo), kwaye amanqaku kwi-IATsex (isixhobo ovavanya umlingo kwi-intanethi ye-intanethi) [52,53,54,55,56]. I-predictor engcono yinkqubo yokuzibandakanya ngokwesondo ngokuzithoba xa ukhangele i-intanethi ye-pornography (cue reactivity), i-correlate eqinisiweyo yokuziphatha komlingo kuzo zonke izilingo [52,53,54]. Kukho ubungqina obuninzi bokuthi ixesha elichithwe kwi-intanethi-yezemidlalo ayiyikuxela ukuziphatha komlutha. "Umlutha unokuhlolwa kuphela xa iinjongo, iziphumo kunye neempawu zengcamango zokuziphatha ziyingxenye yovavanyo" [57]. Amanye amaqela athando oluthathu, esebenzisa iinqununu ezahlukahlukeneyo "zokuxhatshazwa ngokwesini" (ngaphandle kweeyure zokusetyenziswa), ziye zadibanisa kakhulu neengxaki zesini [15,30,31]. Kuthathwe ndawonye, olu phando lubonisa ukuba kunokuba nje "iiyure zokusetyenziswa" nje, iinguqu ezininzi zichaphazelekayo ekuhloleni ukuxhatshazwa koonografi / ubundlobongela obufanayo, kwaye mhlawumbi nazo zichaphazeleka kakhulu ekuhloleni izidakamizwa eziphathelene nocansi.
Iphepha le sibini lichaze ukulungelelanisa okuncane phakathi kwexesha le-intanethi ye-intanethi esetyenziswayo kunyaka odlulileyo kunye namazinga e-ED kumadoda asebenza ngokwesondo aseNorway, ePortugal naseCroatia [6]. Aba babhali, ngokungafani nala maphepha adlulileyo, bavuma ukuphakama okuphezulu kwe-ED kumadoda e-40 nangaphantsi, kwaye ngokwenene bafumene i-ED kunye ne-low-rate ye-sex desire rates ephakamileyo njenge-31% kunye ne-37%, ngokulandelanayo. Ngokwahlukileyo, uphando lwe-intanethi yangaphambi kokusasazwa kwi-2004 ngenye yabalobi bephepha babika amazinga e-ED kuphela kwe-5.8% kumadoda 35-39 [58]. Sekunjalo, ngokusekelwe kwimizekelo yokubala, abalobi banokugqiba ukuba i-intanethi ye-intanethi isebenzisa ayibonakali ingozi ebalulekileyo ye-ED yolutsha. Okubonakala kubonakale ngokugqithiseleyo, ngenxa yokuba amadoda asePutukezi abahlolisayo babika amaxabiso angaphantsi kweentsebenzo zesini ngokwesilinganiselo namaNorway nakwaseCroatia, kwaye kuphela i-40% yasePortugal ibiza ukusebenzisa i-intanethi ye-intanethi "kwiihlandlo eziliqela ngeveki ukuya kwimihla ngemihla", xa kuthelekiswa namaNorway , I-57%, kunye ne-Croatians, i-59%. Eli phepha liye lagxeka ngokusemthethweni ngenxa yokuhluleka ukusebenzisa amacebo amaninzi anakho ukuhlanganisa ulwalamano oluchanekileyo nolungathandangayo phakathi kwezinto ezikhoyo ezaziwa okanye ezixhomekeke kumsebenzi [59]. Ngokuqinisekileyo, kwiphepha elinxulumene nesingxaki esifanelekileyo sesini esichaphazelekayo ebandakanya abaninzi abathathi-nxaxheba abavela kwiPortugal, eCroatia naseNorway, amadoda abuzwa ukuba zeziphi izinto ezikholelwa ukuba zinegalelo ekunqongopheni kwabo ngesondo. Phakathi kwezinye izinto, malunga ne-11% -22% ukhethe "Ndiyisebenzisa kakhulu imifanekiso engamanyala" kunye ne-16% -26% inyulo "Ndiyidlala ngokugqithiseleyo" [60].
Kwakhona, uphando lwongenelelo luya kuba luncedo kakhulu. Nangona kunjalo, ngokubhekiselele kwizifundo zokulungelelanisa, mhlawumbi isicwangciso esiyinkimbinkimbi sezinto eziguqukayo kufuneka siphenywe ukuze sikwazi ukucacisa izinto ezisemngciphekweni ekusebenzeni kwiingxaki zesini zobutsha ezingakaze zenzeke. Okokuqala, kungenzeka ukuba umnqweno ophantsi wesondo, ubunzima be-orgasming kunye neengxaki kunye neengxaki ze-erectile ziyingxenye yendlela efanayo ye-intanethi echaphazelekayo, kunye nokuba zonke ezi ngxaki kufuneka zidibaniswe xa uphando malunga nokubambisana kunye ne-intanethi.
Okwesibini, nangona kungaboni kakuhle ukuba yiyiphi into ebangela ukuba ubunzima beengxaki ezinjalo, iziphambathiso ezithembisayo zokuphanda kunye kunye nexesha lokusebenzisa iifoto zoonopopasho ze-intanethi zingabandakanya (i-1) iminyaka yezoonografi-ezixhaswa ngokubhekiselele kwi-pornography-free toast; (2) umlinganiselo we-ejaculations kunye neqabane kunye ne-ejaculations kunye ne-intanethi ye-intanethi; (3) ubukho bentengiso ye-intanethi / ubundlululo; (4) inani leminyaka yokusasaza i-intanethi ye-intanethi. (5) ngaluphi ubudala obuqhelekileyo bokusebenzisa i-intanethi ye-intanethi yaqala nokuba ingaqala ngaphambi kobuntwaba; (6) umendo wokunyusa i-intanethi ye-intanethi; (7) ukunyuka kweentlobo ezigqithisileyo ze-intanethi, kunye njalo.
2. IiNgxelo zeKliniki
Nangona iimeko zokulungelelanisa zilula ukuqhuba, ubunzima bokuzihlukanisa izinto ezichanekileyo ekusebenziseni ukunyuka kokungabikho komsebenzi ngokwesini kwi-40 kukhombisa ukuba uphando lwongenelelo (apho izifundo zisusile ukutshintsha kwe-intanethi ye-intanethi). unxulumano phakathi kokusetyenziswa kwayo kunye nobunzima bezesondo. Ezi zilandelayo iingxelo zeklinikhi zibonisa indlela ukubuza izigulane ezinobungakanani obuhlukeneyo kunye nezinye ezingachaziyo ukucima i-intanethi ye-intanethi usebenzisa ukunceda ukuhlukanisa iziphumo zayo kwiingxaki zesini. Ngezantsi sixela ngeenkonzo ezintathu ezisebenzayo zomsebenzi. Ababini babona udokotela ngenxa yokungasebenzi kwayo erectile, ukungathandeki kwesini, kunye nobunzima obungachazwanga ekuphumezeni i-orgasm kunye namaqabane. Iziganeko zokuqala ezikhankanywe (1), (6) kunye (7), ezidweliswe kumhlathi owandulelayo. Isibini ekhankanywe (6) kunye (7). Bobabini babekhululekile ukuxilongwa kwempilo yengqondo. Siphinde sinike ingxelo yesithathu yomsebenzi osebenzayo obone ugqirha ngezizathu zempilo yengqondo. Wathetha uguquko (6).
2.1. Ingxelo yeKlinikhi yokuqala
Umsebenzi oneminyaka eyi-20 osebenzayo owawufunwa yi-serviceman yaseCaucasia eneengxaki ekufezeni i-orgasm ngexesha lokulala kwisithuba seenyanga ezintandathu ezidlulileyo. Oko kwenzeka okokuqala ngenkathi esetyenziswe ngaphesheya kwezilwandle. Wayekrexeza malunga neyure engenayo i-orgasm, kwaye ipenisi yakhe yahamba ingekho. Ubunzima bakhe ukugcina ukulungiswa nokufezekisa i-orgasm kuqhutywe kulo lonke ixesha lokuthunyelwa kwakhe. Ukususela ekubuyeni kwakhe, wayengenako ukuhlambalaza ngexesha lokulala nomyeni wakhe. Unako ukufezekisa ukulungiswa kodwa ayikwazi ukuyisebenzisa, kwaye emva kwe-10-15 min wayeza kulahleka ukulungiswa kwakhe, okwakungekho yimeko phambi kokuba abe nemiba ye-ED. Oku kubangela iingxaki ebuhlotsheni bakhe kunye nomyeni wakhe.
Isigulane sagunyazisa ukugcoba i-masturbating rhoqo "iminyaka", kunye kanye okanye kabini phantse phantse kwiminyaka emibini edlulileyo. Wavuma ukujonga i-intanethi ye-pornography yokuvuselela. Ekubeni wafumana i-intanethi ephakamileyo, wayethembela kuphela kwi-intanethi ye-intanethi. Ekuqaleni, "i-soft porn", apho umxholo ungabandakanyi ukulala, "wenza inkohliso". Nangona kunjalo, ngokuthe ngcembe wayedinga umzobo ogqithiseleyo okanye obuthathakayo kwi-orgasm. Wachaza ukuvula amavidiyo amaninzi ngexesha kunye nokubukela iindawo ezikhuthazayo. Xa elungiselela ukuthunyelwa malunga nonyaka odlulileyo, wayekhathazekile ngokungahambi kwintlobano yesini esahlukileyo. Ngoko, wathenga umdlalo wesondo, owawuchaza ngokuba "ngumfazi oyinyumba". Okokuqala le fowuni yayishukumisayo kangangokuthi yafikelela kwi-orgasm ngemizuzu. Nangona kunjalo, njengokuba kunjalo nge-intanethi ye-intanethi, ngokusetyenziswa kwandiso, wayedinga ixesha elide kwaye elide ukuze ahlalise, kwaye ekugqibeleni wayengenakukwazi ukuguqula. Ukususela ekubuyeni esuka ekuthunyelweni, waxela ukuqhubeka nokushaya umlenze omnye okanye ngaphezulu kweentsuku ngokusebenzisa iinthombe zoononopopasho ze-intanethi kunye nokudlala. Nangona ebemzimbeni nangokwemvakalelo ethandwa ngumlingani wakhe, isigulane sichaza ukuba ukhethe i sixhobo kwisondo sangempela kuba wayefumene okukhuthaza. Wala naluphi na olunye ulwalamano. Kananjalo wayephika nayiphi na inkxalabo yabantu kunye / okanye abaqeqeshiweyo. Wachaza imvakalelo yakhe "echaphazelekayo" ngenxa yokuba wayekhathazekile ukuba kukho into engalunganga ngokuzalwa kwakhe kwaye wayefuna ulwalamano lwakhe nomyeni wakhe ukuba asebenze. Wayeqala ukucinga ukuba wayengakhange amthande.
Ngokomzimba, wayengenayo imbali yokugula okukhulu, ukuhlinzwa, okanye ukuxilongwa kwempilo yengqondo. Wayengathathi naliphi na imithi okanye isongezelelo. Wayephika ukusebenzisa iimveliso zecuba kodwa wayesela iziphuzo ezimbalwa kwimibutho kanye okanye kabini ngenyanga. Wayengakaze amnyama ngenxa yokuxiliswa kotywala. Wachaza amanxeba amaninzi ezesondo ngexesha elidlulileyo, kodwa ukususela ekuthatheni kwakhe umnyaka owodwa umyeni wakhe wayeyintombi yakhe yesondo kuphela. Waliphika imbali yezifo ezithathelwana ngesondo. Ekuhloliseni ngokomzimba, iimpawu zakhe ezibalulekileyo zaziqhelekileyo, kwaye ukuhlolwa kwakhe kofuzo kwakuqhelekile kungabonakali izilonda okanye izihlwele.
Ekugqibeleni kokutyelela, kuye kwacaciswa ukuba ukusebenzisa umdlalo wesondo obenokubangela ukuba afune ukutshatyalaliswa kweentlungu zakhe kunye nokubukela i-pornography ye-intanethi ye-intanethi yayitshintshile umda wakhe wokuvuselela ngokwesondo. Wacetyiswa ukuba ayeke ukusebenzisa i-toy kunye nokubukela i-pornography ye-hardcore ye-intanethi. Wayebhekiswe kwi-urology ukuze ahlalutye. Ngethuba elibonwa yi-urologist kwiiveki ezimbalwa kamva, wayedula kwi-intanethi ye-intanethi isebenzisa kakhulu, nangona wathi wayengeke ayeke ngokupheleleyo. Wayeka ukusebenzisa ithoyilo. Wayephinda ahlambulule ngesondo kunye nomlingane wakhe, kwaye ubudlelwane babo bebuphucule. Uvavanyo lwe-urologist luqhelekile.
2.2. Ingxelo ye sibini
Umntu oneminyaka eyi-40 ubudala wase-Afrika waseMelika wasebenzisa i-serviceman ngeminyaka eyi-17 yomsebenzi oqhubekayo osebenzayo obunzima ekufezeni ukulungiswa kweenyanga ezintathu zangaphambili. Wachaza ukuba xa ezama ukulala nomfazi wakhe, wayenzima ukufumana ukulungiswa kunye nobunzima bokulondoloza ixesha elide. Ukususela ekubeni umntwana wabo omncinane washiya ekholeji, ezintandathu ezintandathu ngaphambili, wayezifumanise ngokuphandula ngenxa yokunyusa ubumfihlo. Wayeyidlwengula yonke iiveki ngokwemyinge, kodwa okwenyuka ukuya kweyesibini ukuya kweyesithathu ngeveki. Wayesoloko esebenzisa i-intanethi ye-intanethi, kodwa ngokuqhelekileyo wayesebenzisa, ixesha elide lithathwa ukuba lithengise ngezinto eziqhelekileyo. Oku kukhokelela kuye usebenzisa izinto ezibonakalayo. Kungekudala emva koko, ukulala nomfazi "kwakungekho nje evuselela" njengaphambili kwaye ngamanye amaxesha wafumana umfazi "engathandeki". Wenqaba ukufumana le micimbi ngaphambili kwiminyaka esixhenxe yomtshato wabo. Wayenemibandela yomtshato kuba umfazi wayekrokrela ukuba wayenomdla, ephikisayo.
Imbali yakhe yonyango yayibaluleke kakhulu kwixinzelelo, eyayifunyaniswa ngaphezu kweminyaka emibini ngaphambili kwaye yayilawulwa kakuhle nge-diuretic: 25mg ye-chlorthalidone imihla ngemihla. Akazange athathe enye imithi okanye isongezelelo. Ukuhlinzwa kwakhe kuphela kwaba yi-appendectomy eyenziwa iminyaka emithathu ngaphambili. Wayengenayo izifo ezithathelwana ngesondo okanye i-diagnostic health. Wavuma ukutshaya iipakethi ezintathu zokubhema ngeveki kwiminyaka engaphezu kweyishumi kunye nokusela isiphuzo ezimbini kwiiveki. Ukuhlolwa komzimba kubonakalisa iimpawu ezibalulekileyo kwizigaba eziqhelekileyo, ukuhlolwa kweemvakalelo eziqhelekileyo, kunye nokubonakala ngokuqhelekileyo kwezesondo ngaphandle kwezilonda okanye izilwanyana.
Ekupheleni kolu vavanyo, imiba yakhe yayibangelwa ukuphakanyiswa kwezesondo ekukhutshweni koonobumba obuninzi be-intanethi kunye nokuhlaziya i-masturbation. Wacetyiswa ukuba ayeke ukubukela i-hardcore ye-pornography ye-intanethi kwaye unciphise i-masturbation frequency. Kwiinyanga ezintathu kamva, isigulane sichaza ukuba uzame "kunzima kakhulu" ukuphepha i-pornography ye-intanethi ye-intanethi kwaye ikwazi ukugcoba ngaphantsi, kodwa "akakwazi ukuyenza". Wathi xa wayesekhaya yedwa, wafumana ukujonga i-intanethi ye-intanethi, ekugqibeleni yayiza kubangela ukuphinga. Ukungaboni kwakhe kwenza ukuba azive ngathi "ulahlekile", okwamenza wamcasula waza wenza ukuba afune ukwenza oku ngakumbi, kwimeko apho wayejonge phambili umfazi wakhe ephuma endlwini. Wanikwa ukuhanjiswa kwindlela yokuziphatha ngokwesondo, kodwa wenqaba. Wayefuna ukuzama ukusebenza ngokuziphatha kwakhe.
2.3. Ingxelo yeKlinikhi yesithathu
Umlingisi oneminyaka eyi-24 owayengumNyuli woLwandle wangeniswa kwi-unit health health unit emva kokuzama ukuzibulala. Ngethuba lokuvavanya kunye nokunyanga kwakhe wavuma ukusela utywala nangona wayelulekwa ukuba angasebenzisi utswala xa ephathwa ngamachiza anxamnye neengxaki. Imbali yakhe kunye nokunyamezela ukunyamezela kwakuhambisana noxinzelelo lwe-Alcohol Use Disorder ngenxa yokusetyenziswa kwakhe ngelixa bethatha i-antidepressants. Njengenxalenye yesahlulo somlweliso kwimbali yakhe wabuzwa malunga nokugembula, ukudlala i-intanethi kunye nokulutha koonwabo. Utyhile ukuba wayekhathazekile ngokusetyenziswa kwakhe kwezonografi, ukuchitha ixesha elide (5 + ha ha) ngokujonga i-pornography e-intanethi malunga neenyanga ezintandathu. Kwakhona waqonda ukuba wayencipha umdlalo wesondo kumfazi wakhe, wabonakaliswa ukungakwazi kwakhe ukugcina izinto eziqhubekayo, ukhetha ukujonga iifoto ezingcolileyo apho engenayo imiba erectile. Xa wayesazi ukusetyenziswa kwakhe ngokugqithisileyo kweentlekisa, wayeka ukuwujonga ngokupheleleyo, wathi kumdlali-ndlebe naye wayesaba ukuba xa wayeyibona ngandlela-thile uya kuzifumanisa. Wachaza ukuba emva kokuyeka ukusebenzisa imifanekiso engamanyala erectile ukungasebenzi kwakhe kwanyamalala.
Isishwankathelo, iinkqubo zokungenelela ezenzelwe ukutyhila ingxaki ngokususa uguquko lwe-intanethi yokusetyenziswa kwezithombe zoonografi zifuneka kakhulu ukuphanda ubunzima bezesondo ezingachazwanga kwi-intanethi yabasebenzisi be-pornography phantsi kwe-40. Njengoko kuphakanyiswe iingxelo zethu zeklinikhi, kunye nempumelelo yeeklinikhi Doidge [33] kunye noBronner noBen-Zion [34] ngasentla, olo phando lunokuthi bacele inxaxheba kwisifundo nge-PIED, ubunzima bokufikelela kwi-orgasm kunye nomlingane, kunye / okanye umnqweno wezesondo ophantsi / ukwaneliseka ekupheliseni i-intanethi ye-intanethi.
3. Ingxoxo
3.1. Impendulo yesini ngesondo ngoBongo
Nangona ukuphendula ngesondo ngesondo kunzima, iingingqi ezincinci zengqondo zibaluleke kakhulu ekufezekiseni nasekugcineni imiyalelo [61]. I-nuclei ye-Hypothalam idlala indima ebalulekileyo ekulawuleni ukuziphatha ngokwesondo kunye nokunyulwa ngokusebenza njengendawo yokudibanisa yengqondo kunye negalelo lombhobho [62]. I-nuclei ye-hypothalamic eyenza i-erectile ingenayo i-pro-erectile input evela kwi-mesolimbic indawo ye-dopamine, equka indawo ye-ventral (VTA) kunye ne-nucleus accumbens (NAc) [62]. Isiphaluka se-VTA-NAc sisisombululo esisisigxina somvuzo, kwaye sisenza isiseko sesekethe edibeneyo, eyinkimbinkimbi ebizwa ngokuthi "inkqubo yokuvuza" [63]. Impendulo yomntu kumvuzo wendalo, njengokwabelana ngesondo, ilawulwa ngokuyinhloko nge-eyelimbic dopamine endleleni, efumana i-excitatory and inhibitory input evela kwezinye izakhiwo zomlenze kunye ne-correx ye-prefrontal [64]. Ukuchithwa kuxhomekeke ekusebenziseni i-neurons ye-dopaminergic kwi-VTA kunye ne-dopamine receptors kwi-NAc [65,66]. Iziphumo zogxobhozo ezisuka kwezinye izakhiwo ze-limbic (amygdala, hippocampus) kunye ne-prefrontal cortex yenza umsebenzi we-dopaminergic kwi-VTA nase-NAc [62]. Umvuzo wokuphendula i-dopamine neurons iphinda iphrojekthi kwi-storum ye-dorsal, ummandla osebenze ngexesha lovuko kunye ne-penile tumescence [67]. I-Dopamine agonists, efana ne-apomorphine, iboniswe ukuba ibangele ukulungiswa kwamadoda kunye nomsebenzi oqhelekileyo we-erectile [68]. Ngaloo ndlela, i-dopamine yokubonakalisa kwinkqubo yokuvuza kunye ne-hypothalamus inendima ephambili ekuvukeleni ngokwesondo, isishukumiso sezesondo kunye nokuchithwa kwe-penile [65,66,69].
Siphakamisa ukuba ukusetyenziswa koonografi okungapheliyo kwe-intanethi kuqhubelele ekusebenziseni i-erectile ukungasebenzi kwaye kuphuculwa ukunyuka kwi-servicemen echazwe ngasentla. Sifumanisa i-etiology evela kwingxenye evela kwi-intanethi ye-intanethi-eyenziwe utshintsho kwiisekethe ezilawula umnqweno wesini kunye nokuchithwa kwe-penile. Bobabini abaxhamla kwi-intanethi kwiimifanekiso zoononografi ze-Intanethi ngokusetyenziswa kwe-glutamate kunye nokunciphisa impendulo yenkqubo yomvuzo kwimbuyekezo eqhelekileyo inokubandakanywa. Ezi zimbini zenguqu zengqondo zihambelana nokunyamekela okungapheliyo kwembuyekezo yomhlaba kunye neziyobisi zokusetyenziswa kakubi, kwaye zixhaswa yi-dopamine surges kwinkqubo yokuvuza [70,71,72].
3.2. Iimifanekiso zoonografi ze-Intanethi njengeStimulus engavamile
Ngokuqinisekileyo, uphuhliso olubaluleke kakhulu kwintsimi yokuziphatha ngokwesini ingxaki yindlela i-intanethi echaphazela ngayo nokukhuthaza ukuziphatha ngokwesondo [73]. I-24 ngosuku ngokuhamba ngeekhompyutha, iipilisi kunye nee-smartphones, kwaye kucetyiswa ukuba i-intanethi yeyona nto ivuselela ngokugqithiseleyo, ukunyaniseka kwezinto ezinokwenziwa kweengqondo zethu. ukuphishekela ngenxa yobuchule bayo bokuziphendukela kwemvelo [74,75]. Izinto ezicacileyo zobulili sele zihlala ixesha elide, kodwa (i-1) yezoonografi zevidiyo zivusa kakhulu ukuziphatha ngokwesini kunezinye iindlela zoonografi [76,77] okanye i fantasy [78]; (2) iindibano ezibonwayo zesondo ziboniswe ukuba zivuselele ukuvusa, ukukhawuleza ngokukhawuleza, kunye neyomzimba kunye nokulungiswa komsebenzi xa kuthelekiswa nolwazi oluqhelekileyo, mhlawumbi ngenxa yokuba ingqwalasela yamalungu omnxeba angabonakalisa kunye nokuvusa inkululeko yokubeletha [75,79,80,81,82,83,84]; kunye (3) ukukwazi ukukhetha izinto ngokuzikhethela kwenza iifayili engamanyala e-intanethi iphakame ngaphezu kweqoqo elikhethiweyo [79]. Umsebenzisi ongamanyala angakwazi ukugcina okanye ukuphakamisa ukuvuswa kwesondo ngokukhawuleza ukuchofoza kwimeko yomdlalo, ividiyo entsha okanye ayizange ihlangane nhlobo. I-2015 yokuhlola i-intanethi yeempembelelo ze-intanethi kwixesha lokunciphisa ukulibala (ukukhetha ukuxhaswa ngokukhawuleza ngenxa yokubambezeleka kwemivuzo yexabiso elithe xaxa) ithi, "Ixesha elinokoqobo kunye nobukhulu bezinto zesini kunye nemivuzo engokwemvelo yomeleleyo yenza i-intanethi ibe ngumsebenzi oyingqayizivele kwinkqubo yomvuzo wengqondo. ... Ngoko ke kubalulekile ukuphatha imifanekiso engamanyala njengento ekhethekileyo yokufumana umvuzo, ukunyaniseka, kunye nokuqhubela umlingo "[75] (iphe. 1, 10).
Iirejista zobungqina njengezakhono, zandisa intengo yembuyekezo, kwaye inemivuzo engapheliyo ekukhuthazeni, ukufunda nokukhumbula [85]. Njengemvakalelo yesondo kunye neendawo ezivuzayo zokusebenzisana ngokwesondo, intsha iyanyanzelisa kuba ibangela ukugqitywa kwe-dopamine kwimimandla yengqondo ehambelana kakhulu nomvuzo kunye nokuziphatha okujoliswe kuyo [66]. Nangona abasebenzisi boononografi be-intanethi bexinzelelekileyo babonisa ukukhetha okunamandla kwiimifanekiso zentando yesini kunezolawulo oluphilileyo, i-dACC yabo (idibanisa i-cortex yangaphambili) ibonisa ukuqhubela phambili ngokukhawuleza kwimifanekiso kunezolawulo eziphilileyo [86], ukukhangela ukukhangela imifanekiso yamanxeba angaphezulu. Njengombhali-mbhali uVoon wachaza malunga nesifundo se-2015 yeqela lakhe kwizinto ezintsha kunye nokuhlala kwindlela yokunyanzelisa i-intanethi yabasebenzisi be-intanethi, "Ukubonelela okunomsoco wemifanekiso yesondo ekhoyo kwi-intanethi [kunokuncedisa] umlutha, okwenza kube nzima ukubaleka" [87]. Umsebenzi weMesolimbic dopamine unokuphuculwa ngeepropati ezongezelelweyo eziqhelekileyo ezinxulumene ne-intanethi ye-intanethi isebenzisa njengokuthi, ukuphulwa kwezinto ezilindelweyo, ukulindela umvuzo, kunye nesenzo sokufuna / ukurhweba (ngokubhekiselele kwiimifanekiso engamanyala e-intanethi) [88,89,90,91,92,93]. Ukuxhalabisa, okuye kwaboniswa ukwandisa isondo [89,94], unokuhamba kunye nokusetyenziswa koonografi. Ngamafutshane, i-intanethi ye-intanethi inikezela zonke ezi mpawu, ezibhalisa njengezakhono, zivuselela i-dopamine bursts, kwaye zikhuthaza ukuvuswa kwezesondo.
3.3. Iimifanekiso zoonografi ze-intanethi Sebenzisa njenge-Self-Reinforcing Activity
Njengoko inkqubo yokuvuza ikhuthaza izilwanyana ukuba zikhumbule kwaye ziphinda ziphathe kakubi, ezifana nesondo, ukutya kunye nokuzibandakanya, ukusetyenziswa kwezithombe ezingcolileyo ze-intanethi kungasenza umsebenzi wokuziqinisa.95]. Inkqubo yomvuzo inobungozi ekufundeni kwezilwanyana [96], ngakumbi kwiminyaka eselula, njengomngcipheko omkhulu wokulutha [97,98] kunye nokusetyenziswa kwexesha elizayo "loonografi" oluphambukayo (isilwanyana kunye noonografi bezingane) [99]. Imizila emininzi yophando iye yaqala ukucacisa ukungena kwiindawo ezingenanto zokufunda ngesondo kunye nokulutha [100,101]. Ngokomzekelo, ukuziphatha ngokwesini kunye neziyobisi ezinomlutha kusebenze iiseti ezifanayo ze-neurons ngaphakathi kwenkqubo yesistim yohlawulelo (NAc, i-amolgdala ye-basolateral, indawo engaphaya kwayo)102]. Ngokwahlukileyo, kukho ukungafani okuncane phakathi kweminye imivuzo yemvelo (ukutya, amanzi) kunye neziyobisi eziluthayo, ezifana ne-cocaine kunye ne-methamphetamine [102]. Ngaloo ndlela, ukusebenzisa i-methamphetamine kubhalela iindlela ezifanayo kunye ne-neural substrates njengokuba umvuzo wendalo wokuvuselela ngokwesondo [103]. Kwesinye isifundo, iilcocaine eziluthayo zaphantse zifana neendlela zokwenza umqondo wengqondo xa zibukela iiposografi kunye neziqulatho ezinxulumene nokuxhatshazwa kwabo, kodwa iipateni zokusebenza zengqondo xa ukujonga iziganeko zendalo zihluke ngokupheleleyo [104].
Ukongezelela koko, ukuziphatha ngokuphindaphindiweyo ngokwesondo kunye nokulawulwa kwe-psychostimulant ngokuphindaphindiweyo kukukhuthaza ukulawulwa kweDelta FosB, into ebhaliweyo eyenza ukukhuthaza utshintsho oluninzi lwe-neuroplastic olwenza ukuba inkqubo ye-dopamine ye-mesolimbic ibe yinto enombuzo [103]. Kuzo zombini ukusetyenziswa kweziyobisi kunye nomvuzo wesondo, lo mgaqo-miselo kwi-NAC neurons efanayo uxolelana nge-dopamine receptors [103]. Le nkqubo yenza ukuba umntu okhuselekileyo axhomekeke kwi-stimuli ehambelana nomsebenzi (ukwandiswa kwengxolo)105]. Ukubonakaliswa kwimixholo ehambelanayo ke kubangela ukuba unqwenela ukubandakanya ukuziphatha (ukwanda "kokufunayo"), kwaye kunokukhokelela ekusebenziseni ukunyanzelisa [106]. Xa kuthelekiswa nomvuzo wesini kwizinto zokuxhaphazwa, abaphandi Pitchers et al. waphetha ngokuthi, "Imbuyekezo yendalo kunye neziyobisi ayiguquguquli ngendlela efanayo ne-neural pathway, iguqulela kwi-molecular molecules, kwaye mhlawumbi ibe ne-neurons efanayo kwi-NAc, ukuba ifuthe kwimpembelelo yokukhuthaza kunye" nokufunwa "kwezo zombini iintlobo zembuyekezo "[103]. Ngendlela efanayo, ukuhlaziywa kwe-2016 yi-Kraus, iVoon nePotenza yaqinisekisa ukuba, "Iinkqubo eziqhelekileyo ze-neurotransmitter zinganceda [ukunyanzelisa ukuziphatha ngokwesondo] kunye nokuphazamiseka kwezidakamizwa, kunye nokuphonononga kwezinto ezikhoyo ngokugqithisileyo kubonisa ukufana okumalunga nokukhanga nokukhathazeka" [107].
Okwangoku, ingozi yempilo ye-intanethi ye-intanethi ayiqondwa kakuhle njengalezo zokusetyenziswa kotywala kunye nokusetyenziswa kwecuba, kunye nokusetyenziswa koonografi ku-intanethi kuboniswa ngokubanzi njengokuziphatha okuqhelekileyo kunye nokwandiswa koluntu [108,109]. Mhlawumbi le nto kutheni abantu bephuza ukudibanisa iifografi zabo ekuboneni ubunzima bezo zesini. Emva koko, "Ngubani ongaboni iifoto ezingamanyala kule mihla?" Njengomnye wamaservicemen wabuza ugqirha wakhe. Wayejonga ukunyuka kwakhe kwengxaki njengento eqhelekileyo, mhlawumbi nokuba ubungqina bokuba libido ephezulu [110]. Nangona kunjalo, kukho ubungqina obukhulayo bokuthi yayiyinkcazo yeenkqubo ezinxulumene nomlutha [31,52,54,73,86,107,111,112,113,114,115,116,117,118,119,120,121,122]. Abaphandi baseFinland bafumana "ukuzizonwabisa kwabantu abadala" kuba yinto eqhelekileyo yokusetyenziswa kwe-intanethi ngokunyanisekileyo [123], kunye nokufundwa kwexesha elilodwa kwenkqubo ye-intanethi kubonisa ukuba i-intanethi ye-intanethi inokuba neyona nto iphezulu yokulutha [124], kunye nokudlala i-intanethi kwisibini esondeleyo kwizifundo zombini. Okwangoku, i-intanethi yokudlala i-intanethi (i-IGD) isetyenziselwe ukuqhubela phambili ukufunda I-Diagnostic and Statistical Manual of Disabilities (DSM-5) [125], ngoxa i-intanethi yecala lokuxhatshazwa kwezilwanyana ezingcolileyo. Nangona kunjalo, ngombono we-UK umphandi uGriffiths, "isiseko sobungqina bentengiso yesondo ngokuqinisekileyo sihambisana ne-IGD" [73]. Enyanisweni, iingcali ezahlukeneyo zoxilongo zibiza ukuba i-intanethi iyimfuneko yokuba ithathwa njengengxaki ebanzi ngokubanzi kunye neentlobo zoonografi [118,126,127,128]. Ukuphononongwa kwe-2015 kwanokugqitywa ukuba ukugqithisa i-intanethi ye-intanethi kufuneka kuqaphele njengengxube ye-intanethi ye-intanethi, e-DSM [118].
Kuyathakazelisa, yethu isevisi ye sibini idibana neendlela ezininzi ezicetywayo ze-IGD kwi-DSM-5, ehlengahlengiswayo kwi-intanethi ye-intanethi. Wabonisa oku kulandelayo: (1) ukukhathazeka nge-intanethi ye-intanethi; (2) ukulahlekelwa ngumdla kwisini kunye nomlingani wakhe woqobo ngokwenjongo; (3) iimpawu zokurhoxisa ezifana nokucaphuka kunye nentukuthelo; (4) efuna uonografi ukuze akhuphe iimvakalelo zakhe ezimbi; (5) ukukwazi ukuyeka ngaphandle kweengxaki ezinzima; kunye (6) ukunyuka kwezinto ezibonakalayo.
3.4. Iintetho ze-Neuroadaptations ezinxulumene ne-Intanethi ye-Intanethi-Iingxaki zobulili ezithintekayo
Siyicinga ukuba iifoto-mzobo-ezibangelwa iingxaki zesondo zibandakanya ukungahambi kakuhle kunye nokunyaniseka kwisistim se-brain motivation [72,129] kunye ne-coral correlates nganye, okanye zombini, sele zichongiwe kwizifundo zakutshanje kwi-intanethi yabasebenzisi boonografi [31,48,52,53,54,86,113,114,115,120,121,130,131,132,133,134]. Siphule le ngxenye yengxoxo yethu kwiingxenye ezintathu ezidibeneyo.
3.4.1. Ukhuthazo olwandisiweyo lweNtshutshiso ye-Intanethi (ukungabi nakakhulu)
Ukunyaniseka kubhekiselele kwimpendulo ehambelanayo, emiselweyo kwiinkalo ezinxulumene nokusetyenziswa. Ukufunda ngokuqinisekileyo kuququzelela indlela yokuphucula i-dopamine yokuphucula i-mesolimbic response which results in the distribution of levels of pathological levels of stimulence to cue-cessed to seek drugs and rewards [135,136,137]. Inkqubo ye-mesolimbic dopamine ifumana iziphumo ze-glutamate ezivela kwimimandla eyahlukeneyo yecortical and limbic. Iingcamango zamanje zibonisa i-synthses ye-glutamaterg ehambisana nokufuna kunye nokufumana umvuzo othile oguqulwayo, ophucula impendulo ye-eyelimbic system ye-dopamine ukuya kuloo mvuzo [100,138]. Le mibutho yamandla enamandla efundayo ixhomekeke "kwintliziyo-ntshukumo" (okanye "intshukumo yokukhuthaza") inkolelo yokulutha.
Ngokumalunga noqhagamshelwano lwe-servicemen kunye nabalingani, kunokwenzeka ukuba njengoko beveze ukuvusa kwabo ngokwesondo kwi-intanethi ye-intanethi, isondo sobudlelwane besahlukanise asisakwazi ukuhlangabezana nezilindelo zabo kwaye akuzange kubangele ukukhululwa kwe-dopamine eyaneleyo ukuvelisa nokugcina izilungiso [50,62,139]. Njengoko iPrause kunye nePfaus bhala, "iingxaki ze-Erectile ziyakwenzeka xa ukunyaniseka kwezesondo zobomi bengafani nomxholo obanzi [kufumaneke kwi-intanethi]" [50]. Izifundo zoluntu kunye nezilwanyana zibonisa ukuba xa kulindeleke ukuba kungalindelekanga (iphutha elichazayo), umsebenzi owenziwe nge-elelimbic dopamine pathway [140,141,142,143]. Izifundo zoxilongo ziye zaxela ukuba iingcamango eziboniswe ngokugqithiseleyo nokungabikho komvuzo wezonyango zingabonakalisa iziphumo ezingavumelekanga kwi-dopamine release [72]. Iyahambelana nephutha elibi lokubikezela, i-Banca et al. yabika ukwehla komsebenzi wokuhlaselwa ngokusesikweni ekuphenduleni ukungaphumeleli komfanekiso wesondo omele ulindeleke (emva kwesigqibo esifanelekileyo) [86]. Banca et al. Kwakhona kwaxelwa ukuba, xa kuthelekiswa nokulawula okunempilo, abasebenzisi be-pornography abakhokhisayo be-intanethi baye baxhasa ukukhethwa kwimiqathango ecwangcisiweyo (imizekelo engabonakaliyo) ehlobene nemifanekiso yesondo [86]. Oku kufunyaniswa kukubonisa ukuba abasebenzisi be-intanethi be-intanethi bangacetyiswa kwiingcamango ezingahambelani nomxholo wesondo, imibutho enokuba nzima kakhulu ukucima [87].
Ucwaningo lwe-2014 fMRI nguVoon et al. inikeza inkxaso ye-incentive-salience (sensitization) imodeli ngokubhekiselele kubasebenzisi boonografi be-intanethi be-intanethi [31]. Xa kuthelekiswa nokulawula okunempilo, abasebenzisi be-pornography abaxhomekeke kwi-intanethi babenomsebenzi wokwenza iifilimu ezicacileyo zobulili kwi-ventral striatum, i-amygdala kunye ne-dorsaal yangaphakathi yangaphakathi ye-cingulate cortex. Le nethiwekhi yenethiwekhi efanayo iyasebenza ngethuba lokusasazeka kunye nokukhwela izidakamizwa kumxhaphazi weziyobisi [144]. Voon et al. Kwakhona kwaxelwa ukuba, "Ngokuthelekiswa namavolontiya anempilo, [abasebenzisi bokugqithisa i-intanethi ye-intanethi] babenomnqweno omkhulu wesini okanye bafuna ukucacisa amagama kwaye bafumana amanqaku amanqaku amanqaku amanqaku amaninzi, oku kubonisa ukuhlukana phakathi kokufuna nokuthanda" [31] (iphe. 2). Kwimodeli yokukhuthaza ukukhutshwa komzimba, ukuhlukana phakathi "kokufunayo" nokuthi "ukuthanda" kuthathwa njengesicatshulwa semfundo yezilwanyana [106]. Njengoko umlingo we-intanethi ocacileyo we-intanethi uyaqhubeka, ukukhuthazwa kunye nezifiso zokusebenzisa ("ukufuna") ukwandisa, ngelixa ukuzonwabisa kusetyenziswa ("ukuthanda") kunciphisa. Apha, ababukeli bezithombe zoonografi ze-Intanethi "bathandile" ukukhwabanisa kwe-tamer, kodwa "bafuna" amagama angacacileyo. Kuyafana ne-servicemen yethu, ininzi yezifundo zeVoon et al (iminyaka engama-25) "yayinokukhubazeka okukhulu kwezesondo kunye neengxaki ze-erectile ebuhlotsheni obusondeleyo kodwa kungekhona ngezixhobo ezicacileyo zobulili ezibonisa ukuba iziphumo ezinqwenelekayo zesondo zichazwe ngokucacileyo iziqulatho kwaye kungabi nesifiso esenziwe ngokubanzi ngesini "31] (iphe. 5). Uphononongo olunxulumene neentlobo ezininzi zezifundo ezifanayo zifumene ukunyaniseka okubonakalayo ekusebenziseni i-intanethi ye-intanethi yabasebenzisi abanjengoko kwafunyanwa kwizifundo zezilwanyana kwizidakamizwa zokuxhatshazwa [111]. Iqela lophando lagqiba ukuba, "Ezi zifundo zihlanganisane zinika inkxaso yokukhuthaza intsholongwane yokubangela ukunyanzeliswa phantsi kweempendulo ezixhasayo kwizesondo kwi-CSB [indlela yokuziphatha ngokwesondo]" [111].
Ucwaningo lwe-2015 lwama-fMRI kwi-hypersexual men's e-Seok ne-Sohn lucacisiwe kwaye lwandiswa kwiziphumo zeVoon et al. [U31] noMechelmans et al. [U111], nje ichazwe [120]. U-Seok no-Sohn babike ukuba xa kuthelekiswa nokulawulwa kwama-hypersexu babenomsebenzi obaluleke kakhulu wengqondo xa bebonakaliswa kwimifanekiso yesondo ye-5. Ngoxa iVoon et al [31] uhlolisise umsebenzi owenziwe ngumbono kwi-DACC-ventral-amygdala yenethiwekhi yomsebenzi, uSeok noSohn bavavanya umsebenzi kwi-cortex ye-preforeal cortex (DLPFC), i-nucleus ye-corsulate, i-parietal lobe, i-downor cingulate gyrus, kunye ne-thalamus. U-Seok noSohn bongezelela ukuba ubuqhetseba bokuxhatshazwa ngokwesondo ngokuhambelanayo nokusebenziselwa ukukhutshwa kwe-DLPFC kunye ne-thalamus. Ukufunyanwa kweyesithathu kukuba ukuthelekiswa nokulawulwa kwabangqingiliyo kwakunomsebenzi omkhulu kakhulu kwi-DLPFC kwiinkcukacha zesondo, kodwa ncinane kakhulu ukusetyenziswa kwe-DLPFC ukuba kungenzi nto. Ezi zibuko ezingavumelekanga ze-cortex ezisebenzayo kubantu abanomlutha apho ukwanda kweentlupheko kwizikhokelo zokuxhatshazwa kuhambelana nomdla omncinci kwimisebenzi evuyisayo yesiqhelo [145]. Oku kufunyaniswa kukuhambelana neengcamango zethu zokuba ukuxhatshazwa kunye nokunyaniseka kwenkqubo yokukhuthazwa kwengqondo kubandakanyeka ekusebenziseni uonografi ngokunyanzeliswayo, kwaye kunokunxulumene neentlobo zoononophala-ezibangelwa ukuxhatshazwa ngokwesondo.
Isifundo se-2016 fMRI-reactivity kwizifundo zobuninzi bezilwanyana ezingcolileyo zobulili obugqithisileyo zandisiwe kwiziphumo zangaphambilini [54]. UBrand et al. yaxela ukuba umsebenzi we-ventral striatum wawungaphezulu kwimiba ekhethekileyo yoonopopasho xa kuthelekiswa nezinto ezingafaniyo zoononopopasho. Ukongezelela, umsebenzi ogqithiseleyo we-ventral striatum wezinto eziphathekayo zoononopopasho wawuxhomekeke kwiimpawu ezizimeleyo zokusebenzisa umlingo we-intanethi ye-intanethi. Enyanisweni, iimpawu ze-intanethi yoxilongo (njengoko zihlolwe yi-S-IATsex) zazingezo zinto ezibonakalayo ezibalulekileyo ekuphenduleni i-action striatum impendulo kwiimifanekiso ezikhethiweyo ezingabonwayo. Ezinye izinto eziguqukayo, njengexabiso leveki ye-intanethi, ukukhutshwa ngokwesondo, ukuziphatha kakubi ngokobuxhatshazo ngokubanzi, iimpawu zokudandatheka kunye nobuzwe obuthile, kunye nezibonakaliso zobukhulu bezenzo zangoku zesondo, azizange zihambelane nomsebenzi we-ventral striatum. Ngokucacileyo, kwakusisiseko esilungileyo esichazwe ngokucacileyo iimpawu ze-intanethi yoxilongo. UBrand et al. waphetha ngokuthi, "Ezi ziphumo zigcizelela ukufanisana phakathi kwe-IPA [inzuliso ye-intanethi ye-intanethi] nezinye izilingo zokuziphatha kunye neengxaki ezinxulumene nezinto" [54].
Ucwaningo lwe-2016 fMRI (Klucken et al.) [121] uqhathanisa amaqela amabini amadoda ahlukeneyo: izifundo ezinokuziphatha ngokunyanisekileyo kwezesondo (CSB) kunye nokulawula okunempilo. Ixesha eliqhelekileyo eliqhelekileyo lichithe ukubukela izinto eziphathekayo zesondo ngeeveki zingu-1187 min kwiqela le-CSB kunye ne-29 min yeqela lolawulo. Abaphengululi baveze zonke izifundo kwiinkqubo zokumisa iinkqubo apho iziganeko ezingaphathi hlangothi (izikwere zemibala) ziqikelele ukuboniswa komfanekiso okhulayo. Ukuthelekiswa nokulawula izifundo nge-CSB kubonakalisa ukwenziwa komsebenzi we-amygdala ngexesha lokuboniswa kwesicatshulwa esifanelekileyo esichaza umfanekiso wesithunzi. Oku kufunyaniswayo okuhambelanayo neengxelo zengxelo kukhulise ukusetyenziswa kwe-amygdala xa abasebenzisa izidakamizwa bezonyango bazibandakanya kwiziqulatho ezinxulumene nokusetyenziswa kweziyobisi [146]. Voon et al. Kwakhona kwaxelwa ukuba iividiyo ezicacileyo zenze i-amygdala enkulu kusebenze kwizifundo ze-CSB kunokuba zilawulwe ngokusemgangathweni. Olu phando luya kuguqulwa nophando lwezilwanyana oludibanisa i-amygdala kwisimo sengxaki esithintekayo. Ngokomzekelo, ukuvuselela i-opioid circuitry kwi-amygdala iphakamisa intshukumo yokukhuthaza umgangatho wesigxina esifanelekileyo, ihamba kunye nokunciphisa ngokukhawuleza kokuthandwa kwesinye isicatshulwa esisodwa [147]. Nangona iqela le-CSB eKlucken et al. [U121] wayenomsebenzi omkhulu wokwenza isicatshulwa ekuqaliseni umfanekiso wesondo, ukuvuswa kwabo ngokwesondo okungekho nto kwakungekho ngaphezu kolawulo. Okuthakazelisayo, ezintathu zezifundo ezingamashumi amabini ze-CSB zichazwe "ingxaki ye-orgasmic-erection disorder" xa udliwano-ndlebe luchothoza i-Axis I kunye ne-Axis II ukuxilongwa, ngelixa kungekho zifundo zolawulo ezichazwe iingxaki zesini. Oku kufundwayo kukhumbula iVoon et al., Apho izifundo ze-CSB zazinomsebenzi omkhulu wokusebenzisa i-amygdala-ventral striatum-dACC ekuboniseni iifom zezesondo ezicacileyo, kodwa i-11 ye-19 ibike ubunzima be-erectile okanye i-arousal ne-partner partners. Klucken et al. Kwakhona kwafumanisa ukudibanisa kokunciphisa phakathi kwe-ventral striatum kunye ne-prefrontal cortex kwizifundo nge-CSB xa kuthelekiswa nokulawula. Ukudibanisa kwe-PF-coupled-PFC kuye kwachazwa ngokuphazamiseka kwezidakamizwa kwaye kukholelwa ukuba kuhambelana nokulawulwa kwempembelelo yokukhubazeka [145].
Ucwaningo lwe-2013 EEG nguSteele et al. ingxelo ephezulu ye-P300 kwimifanekiso yesondo, ngokuphathelele kwimifanekiso engathathi hlangothi, kubantu abakhalayo ngeengxaki zokulawula i-intanethi ye-intanethi [48]. Abahlukumezi bezinto ezibonakalayo baphinde babonise ukuphakama kwe-P300 xa bebonakaliswe kwiimpawu ezibonakalayo ezibandakanya ukuxhatshazwa kwabo [148]. Ukongeza, uSteele et al. babike ukulungelelanisa okubi phakathi kwe-P300 amplitude kunye nomnqweno wesondo kunye nomlingane [48]. Ukukhwabanisa okukhulu kwi-intanethi ye-intanethi ehambelana nomnqweno ongaphantsi wesondo wobudlelwane bezesondo, njengokuba kubikwe nguSteele et al., Uhambelana neVoon et al. ukufumana "ukunciphisa i-libido okanye umsebenzi we-erectile ngokukodwa ekusebenzisaneni ngokobuhlobo kunye nabasetyhini" kubasebenzisi boononografi be-intanethi be-intanethi [31]. Ukuxhasa ezi ziphumo, izifundo ezimbini zokuhlola umnqweno wesini kunye nomsebenzi we-erectile "kuma-hypersexuals" kunye nabasebenzisi be-pornography abaxhomekeke kwi-Intanethi babika imibutho phakathi kwamanyathelo okuxhatshazwa ngokwesini kunye nokunciphisa umnqweno wokubelana ngesondo kunye neengxaki zesini [15,30]. Ukongezelela, uphando lwe-2016 lwabantu be-434 abajonga i-intanethi ye-intanethi ubuncinane kanye emva kweenyanga ezintathu zokugqibela bhengeze ukuba ukusetyenziswa ngxaki kunxulumene namazinga aphezulu okungaxhatshazi, kodwa ukwaneliseka kokweneliseka ngokwesondo kunye nomsebenzi oswelekileyo we-erectile [44]. Ezi ziphumo zifanele zijongwe ngokubhekiselele kwizifundo ezininzi ze-neuropsychology eziye zafumanisa ukuba ukuvuthwa kwezesondo kwi-intanethi yeengcinga kunye nokuthanda ukujonga iifoto zoonografi zihambelana nobunzima be-cybersex kunye neengxaki ezixeliweyo kwimpilo yemihla ngemihla ngenxa yokugqithisa i-intanethi ye-intanethi isebenzisa [52,53,54,113,115,149,150]. Kuthathwe ndawonye, izifundo ezininzi kunye nezohlukeneyo kwi-intanethi yabasebenzisi be-pornography zihambelanisa ne-incentive-salience theory of addiction, apho utshintsho kwixabiso elithandekayo le-incentive lihambelana nezinguqu ekusebenzeni kwimiba yengqondo echaphazelekayo kwinkqubo yokukhuthaza [31,106]. Ukuqokelela, ngokulungelelanisa neengcamango zethu, iingxelo ezahlukahlukeneyo zithi ingxelo enkulu yokubhekiselele kwiimpawu zobulili ezingcolileyo, ukuthanda ukujonga, kunye nokunyanzelisa ukusetyenziswa koonografi kuhambelana nokuxhatshazwa ngokwesini kunye nokunciphisa umnqweno wesini.
3.4.2. Ukunciphisa Umvuzo Wokubaluleka (Ukunyaniseka)
Ngokuchasene neempendulo eziphathekayo kwiimifanekiso zoonopopasho ze-intanethi zichazwe nje, ukunyaniseka kukunciphisa umonakalo wokubaluleka komvuzo kwixesha eliqhelekileyo elincinci [70,151,152,153], ezifana nesondo esahlukileyo [31,48]. Oku kuncipha kukunyamezela [70], kwaye ifakwe kwizinto zombini kunye nokuziphatha kakubi [153,154,155,156], kubandakanye nezinye iintlobo zezobisi ze-intanethi [157,158,159] .Ukunyamezela kwethu kwi-intanethi ye-intanethi kwanda ngokukhawuleza, okukhokelela ekubukeni izinto ezigqithiseleyo. Iqiniso lokuba i-video yoonografi ozikhethele yona iyakhupha ngakumbi kunokuba ezinye iifoto ezingamanyala zingabangela ukuba uhlala okanye ubekezele [27,75,79,81,160]. Ngokomzekelo, amadoda ajonga ifilimu yesondo kunokuba ifilimu engathathi hlangothi kamva ibonisa impendulo engaphantsi kwimifanekiso yezesondo, ukubonakaliswa kwendlela yokuhlala [161]. Kungekudala emva kokuba iifotopi zevidiyo zifumaneke, abaphandi bafumanisa ukuba xa ababukeli befumana ukufikelela kwi-libitum kwiimifanekiso-mpapasho zevidiyo ezihlukeneyo zandula ngokukhawuleza zize zenze iifoto ezingcolileyo [162]. Ividiyo ezininzi zoonografi zijongwa, ngakumbi umnqweno wee-hardcore themes [27,43,162], okubonisa ukuba ukunciphisa ukuphendula ngesondo. (Kwakhona, isiqingatha sezifundo ze-Kinsey Institute ezazihlala zidla iifoto zoononopasho zevidiyo zibonisa ukuphendula okuncinci kwi-lab, kwaye yabika isidingo sokwenza izinto ezintsha kunye neentlobo [27] kunye nesiqingatha sabasebenzisi boononografi abasandul 'ukutshanje baye bathuthela kwizinto ezingazange zithandeke ngaphambili okanye zifumene zihlazo [44] (kwiphepha le-260).) Kwesinye isifundo, ukwaneliseka ngokwesondo kunye nabalingani, njengoko kubalwa ngothando, ukubonakala komzimba, ukufuna ukwazi ngesondo, kunye nokuziphatha ngokwesondo, kwakuxhomekeke kwizinto ezingamanyala [43]. Kwizilwanyana ezinamabini ezixhasayo ngokukhawuleza kakhulu kunye ne-amphetamine impairs-bonding through the activation of eyelimbic dopamine receptors [163], kwaye kunokwenzeka ukuba namhlanje iphakamisa kakhulu iphonografi kwi-Intanethi izisa umphumo ofanayo kwabanye abasebenzisi.
Ngokuhambelanayo nesiphakamiso sokuba ezinye iinkqubo zemivuzo yokusebenzisa i-intanethi ye-intanethi zingabonakaliyo ekuphenduleni isondo esahlukileyo (kunye ne-hyper-active to cues for Internet pornography usetyenziso), isifundo se-XMUMX se-fMRI sabasebenzisi be-pornography abangenayo i-intanethi yi-Kühn kunye UGallinat wafumanisa ukuba i-statate efanelekileyo ye-striatum yayincinci ngeeyure ezininzi kunye neminyaka ye-intanethi yokubukela i-Internet [134] .Ukugqithwa kubonakala kubandakanyeka ekuziphatheni kokuzibandakanya kunye kwaye kuthethwa ngamandla kwiindawo ezikhuthazayo ezinxulumene nothando lobubele [164,165]. Kwakhona, iinjongo ezinkulu ze-intanethi zisebenzisa i-intanethi, i-down activation kwi-leftamen ekhohlo xa ubukela ngesondo ngokucacileyo iifoto (0.530 s exposure). Ukusetyenziswa kwe-putamen kudibaniswa nokuvuswa kwesondo kunye ne-penile tumescence [67,166]. Ababhali bacetyiswa ukuba zombini iziphumo "zihambelane neengcamango zokuthi ukugqithisa ngokukrakra kwiimpawu zoononophelo kubangelwa ukuthotywa kwempendulo yendalo ye-neural kwi-stimuli"134]. Kuyathakazelisa ukuba amadoda anomdla "ophezulu ekuhlambiseni okanye ukugqithisa okubi" achaza ukukhathazeka okukhulu malunga nokusebenza kwabo ngokwesondo, ubungakanani bepenis, kunye nokukwazi ukugcina ukulungiswa kunabanye abasebenzisi bezoonografi be-intanethi [42]. Njengokuxilongwa, ukujonga uonografi okugqithiseleyo kunokunciphisa ukuphendula ngokwesondo kwabanye abasebenzisi, ngaloo ndlela ukuqhuba isidingo sokwanda kwezinto ezigqithiseleyo okanye ezinomxholo ukwenza [27]. Kwakhona, uphando lwe-2016 luchaze ukuba isiqingatha samadoda esasihlolisisiwe siye sathuthela kwimpahla "engazange ibenomdla kubo ngaphambili okanye ukuba bayicinga njengento enyanyekayo" [44].
Ucwaningo lwe-2015 EEG ngu Prause et al. xa kuthelekiswa nababukeli be-intanethi ye-intanethi (ithetha i-3.8 h / iveki) abaye bacinezeleka ngokujonga kwabo ukulawula (ithetha i-0.6 h / iveki) njengoko bejonga imifanekiso yesondo (ukucaciswa kwe-1.0) [130]. Kufunyanwe ukuba okufana noKühn noGallinat, ababukeli bezithombe zoononophala kwi-intanethi babonisa ubungqina obuncinane be-neural (LPP) kwimifanekiso yesondo kunezolawulo [130]. Iziphumo zophando zombini zibonisa ukuba ababukeli be-intanethi bafuna ukuba babuke iimpendulo zobuchopho xa befaniswa nokulawulwa kwempilo okanye ukulinganisela abasebenzisi bezoonografi kwi-Internet [167,168]. Ukongezelela, iKühn noGallinat babike ukuba iiposenti eziphezulu ze-intanethi zisebenzisa idibene kunye nokusebenza okungaphantsi komsebenzi phakathi kwe-striatum kunye ne-prefrontal cortex. Ukungasebenzi kweli phepha liye lahambelana nokukhetha okungalunganga kokuziphatha kungakhathaliseki ukuba yintoni isiphumo esibi [169]. Ngokuhambelana noKühn noGallinat, uphando lwe-neuropsychological lubonisa ukuba izifundo ezinomgangatho ophezulu ekubhekaneni noxilongwane lwe-inthanethi ziye zanciphisa umsebenzi wokulawula ulawulo xa zijongene nezinto eziphathekayo zoonwabo [53,114].
Ucwaningo lwe-2015 fMRI ngo-Banca et al. ingxelo yokuba, xa kuthelekiswa nokulawula okunempilo, izifundo zoonografi ezingenayo i-intanethi zinobukhetho obukhethekileyo kwiimifanekiso zentlobano zesini [86]. Nangona ukufunwa kwezinto ezitshintshileyo kunye nokufuna ukuvakalelwa kuhambelana nomngcipheko omkhulu kwiindidi ezininzi zokulahla [170], Banca et al. akafumani nantlukwano kwimilinganiselo efunwa yinjongo phakathi kwabasebenzisi bokugqithisileyo be-intanethi kunye nokulawula okunempilo. Ababhali bacetyisa ukuba ukhetho oluthile oluthile lube lucacile kwi-intanethi ye-intanethi, kwaye akufuneki ukuveliswa kwezinto eziqhelekileyo-86]. Ezi ziphumo zihambelana noBrand et al. (2011), efumene ukuba "inani lezicelo zesini" lisetyenziselwa ukukhwabanisa ngokusebenzisa i-question ye-IATsex, ngelixa iimbalo zobuntu zingabandakanyekanga nokuxhatshazwa kwe-inthanethi [53]. Banca et al. Kwakhona kwaxela ukuba abasebenzisi bokugqithisileyo be-intanethi babonisa ubungqina obukhulu kwi-corsulate cortex yangaphambili (dACC) yokujonga ngokuphindaphindiweyo imifanekiso yesondo efanayo [86]. Ngokuqhelekileyo, isantya se-DACC isenzo semifanekiso yesondo sasinxulumene nokukhethwa ngokukhethekileyo kwenzelwa yezesini zesini [86]. I-DACC ibandakanyeka kwi-cue reactivity cation and desire, kunye nokuvavanywa kwemivuzo ekulindelwe ngokungazalwanga [144,171]. Voon et al. luchaze umsebenzi weDACC ophuculweyo kwizifundo zoononografi ezingxamisekileyo ze-Intanethi ngokuphendula amavidiyo achaza ngesondo [31]. Iziphumo zikaBanca et al. Zibonisa ukuba iindawo ezintsha ezifunayo kwi-intanethi yabasebenzisi boonografi be-intanethi zixhaswa ngokukhawuleza ngokukhawuleza kwisenzo sezesondo. Abaphengululi baphetha ngokuthi, "Sibonisa ngokunyanisekileyo okokubonakalayo ekliniki yokuba [ukusetyenziswa kweeposenti zoonopopayi ze-intanethi] zibonakaliswa ngokufuna izinto eziqhelekileyo, imeko kunye nokujwayela ukuziphatha ngokwesini"86]. Kuhlolisiso oluthile, ezininzi zezifundo ezifanayo ziye zaxela iingxaki zesondo kunye neengxaki ze-erectile kwimisebenzi yesondo, kodwa kungekhona ngexesha loonografi lwe-intanethi lisetyenziselwa [31]. Oku kuthetha ukuba i-intanethi ye-intanethi-eyenza ubunzima bezesondo ingaba yingxenye ngenxa yokulindelwa kwezinto ezitshintshileyo ezingahambelani nomsebenzi wesondo ohlukeneyo. Kuthathwe ndawonye, uKühn noGallinat [134], Prause et al. [U130] kunye neBanca et al. [U86] yabonisa ukuba abasebenzisi be-pornography abahlala rhoqo be-intanethi babonisa (1) ukusetyenziswa kancinci kwengqondo ngokuphendula ngokufutshane kwimifanekiso yesondo; (2) ukhetho olukhethekileyo lwenkcubeko yamanxeba; (I-3) ngokukhawuleza kwe-DACC kwiimeko zesini; kunye (kunye ne-4) engaphantsi kwengubo ebomvu kwi-caudate. Ezi ziphumo zixhasa uxolo lokuba i-intanethi ye-intanethi isebenzise inokunciphisa umonakalo wembuyekezo, ekhokelela ekunyuseni ukunyamezela nokunyamezela kunye nesidingo sokwenyusa okukhulu ukuvuselelwa ngokwesondo.
Uphando oluphando lwe-psychogenic ED lunikezela inkxaso eyongezelelweyo yendima yomvuzo wenkohlakalo kwi-erectile dysfunction kunye ne-libido ephantsi. I-dopamine agonist apomorphine yenza i-penile erections kumadoda ane-psychogenic ED [172]. Xa uvavanyo lwe-2003 lwama-fMRI luqwalasela iipatheni zobuchopho ngelixa amadoda anama-psychogenic ED kunye nokulawula okunamandla babonayo iifilimu zesondo, abo abane-ED engqondweni yengqondo bahluke kakhulu kwiinkalo ezinamandla. Xa i-dopamine i-agonist apomorphine ilawulwa kumadoda ane-ED engqondweni, yavelisa iipatheni zokusebenza zengqondo ezifana nezo zibonwa ngamandla okulawula: ngokunyuka kakhulu kwandisa umsebenzi wokuhlaselwa kunye nomsebenzi we-hypothalamic kunye nokucima kwe-cortical [173]. Ngaphezu koko, uphando lwe-2012 MRI lufumene ulungelelwano oluqinileyo phakathi kokunciphisa i-statal and matter hypothalamic grey kunye ne-ED [174]. Uphando lwe-2008 luchaze amadoda ane-psychogenic ED yabonisa umsebenzi ongenangqondo ngokubhekiselele kwifilimu yesondo [175].
3.4.3. Iimifanekiso zoonografi ze-intanethi kunye nesimo socansi
Ngenxa yokuba i-servicemen yethu ixele ukuba ifumene ii-erections kunye nokuvuselela i-Intanethi, kodwa ngaphandle kwayo, uphando luyafuneka ukuze kuthintelwe imeko yezesondo ngokungafanelekanga njengegalelo ekunyukeni kwamazinga okusebenza kweengxaki zesondo kunye nomnqweno ophantsi wesini emadodeni aphantsi kwe40. Umdumo kunye noPfaus baye bacinga ukuba ukuvuswa kwesondo kunokuba yimeko ethile kwimifanekiso engamanyala e-Intanethi engasebenzisi ingatshintshiyo kwimeko yeqabane lokwenyani. "Kucingelwa ukuba ukufumana uninzi lwezesondo phakathi komxholo we-VSS [inkuthazo yesini] kunokukhokelela ekuphelisweni kwempendulo ye-erectile ngexesha lokudibana kwezesondo ... Xa ulindelo oluphezulu lokufezekisa lungafezekiswanga, ukuvuselelwa ngokwesondo okwenziweyo akusebenzi"50]. Isimo sengqondo esinjalo esingavumelekanga ngesondo sifana nesimo sokukhuthaza-salience. Imizila emininzi yophando eyenziwe yandisa i-dliamam i-mesolimbic kwi-sensitization kuzo zombini iziyobisi kakubi kunye nomvuzo wesondo [100,103]. Ukusebenzisa i-dopamine i-D1 receptors, amava omntu wesini kunye nokuvezwa kweengqondo zengqondo kubangela ukuba utshintsho oluninzi oluhlala ixesha elide kwi-NAc lubalulekile ekuphuculeni ukufunwa kokubili umvuzo [103].
Umsebenzisi we-intanethi we-intanethi namhlanje unokugcina amanqanaba aphezulu evukisayo, kunye ne-dopamine ephakamileyo, ixesha elide ngenxa yomxholo wencwadana engenamkhawulo. Iindidi eziphezulu ze-dopamine ziye zathinteka kwiimeko zokuziphatha ngokwesondo kwiindlela ezingalindelekanga kwiimodeli zezilwanyana zombini [176,177] nabantu. Kubantu, xa izigulane zikaParkinson zinyulwe i-dopamine agonists, abanye babika i-uncharacteristic yokunyaniseka kweentlobano zesini kunye nokubonakalisa imisebenzi enkulu ye-neural kwimifanekiso yesondo, ehambelanayo nomnqweno wesini wesondo [178]. Izifundo ezimbini ze-fMRI zangoku zivakalise ukuba izifundo ngokuziphatha ngokunyanisekileyo kwezesondo zilungele ukuseka imibutho emiselweyo phakathi kwamagama angathathi hlangothi kunye nesicatshulwa esicacileyo sezesondo kunokulawula [86,121]. Ngokuphindaphindiweyo kwi-intanethi ye-pornography, "ukufunwa" kunokunyuka kwi-intanethi yezinto ezingcolileyo kunye neendidi ezilindelekileyo, izinto ezinzima ukuzinza ngexesha lokwabelana ngesondo. Ngokuhambelana neengcamango zokuthi i-intanethi ye-intanethi isebenzise inokulindela ukulindela ngokwesondo, uSeok noSohn bafumanisa ukuba ukuthelekiswa nokulawulwa kwabantu abaxhatshaxayo babenomsebenzi omkhulu kwi-DLPFC ekusebenzisaneni ngesondo, nangona kungaphantsi kwe-DLPFC kusebenze kwi-stimuli engeyiyo yesini [120]. Kwakhona kubonakala ukuba i-intanethi ye-intanethi isebenzayo inokumisela ukuba umsebenzisi alindele okanye "afune" intsha. Banca et al. ingxelo yokuba izifundo ngokuziphatha ngokunyanzelekileyo ngokocansi zikhethwa ngokukhethekileyo kwiimifanekiso zentlobano zesini kwaye zibonisa ukuziphatha okuphezulu kwi-corsulate cortex yangaphambili yokujonga imifanekiso efanayo yesondo [86]. Kwamanye abasebenzisi, ukhetho oluthile lokuvelisa luvela kwisidingo sokunqoba ukwehla kwe-libido kunye nomsebenzi we-erectile, oya kuthi unokukhokelela ekuthandweni koononopopasho olutsha [27].
Xa umsebenzisi ebeka imeko yakhe yokuvuselela inkanuko yesini kwi-Intanethi, isondo kunye namaqabane okwenyani anokubhalisa njenge "angahlangabezani nokulindelweyo" (ukubikezela umvuzo ongalunganga) kukhokelela ekwehleni ngokuhambelanayo kwi-dopamine. Idityaniswe nokungakwazi ukunqakraza ekuvuseleleni ngakumbi, oku kuqikelelweyo okungagungqiswanga kunokuqinisa umbono wokuba isini esabelana ngesondo asibalulekanga kunokusetyenziswa kwamanyala e-Intanethi. Imifanekiso engamanyala kwi-Intanethi ikwabonelela ngombono wababukeli ngokubanzi awufumaneki kwisini esahlukeneyo. Kuyenzeka ukuba xa umntu osebenzisa iphonografi anokuchaphazeleka aqinise ubudlelwane phakathi kokuvuka kunye nokubukela abanye abantu bezokwabelana ngesondo kwizikrini ngelixa evukile kakhulu, ubudlelwane bakhe phakathi kokuvuselela inkqubela kunye nobomi bokwenyani obabubambisene nabo bungadibana.
Uphando malunga nokumiselwa kwesigqibo sokwabelana ngesondo kubantu kuphelelweyo, kodwa kubonisa ukuba ukuvuswa kwesondo kufanelekile [179,180,181], ngakumbi ngaphambi kokudala [182]. Kwindoda, ukuvuswa kungenziwa imeko ethile kwiifilimu [183], kunye nemifanekiso [184]. Ukusebenza ngokwesondo kunye nokukhangwa kwindlovukazi (engeyiyo yabantu) inokuthi ifakwe kwisimo esincinci esingaqhelekanga ngokwesini, kubandakanywa iziqhamo / izitho zomncuba, izivumba ezivuthayo, ezifana ne-cadaverine, kunye nabalingani bobulili obufanayo, kunye nokugqoka iigebengu [177,185,186,187]. Ngokomzekelo, iimpuku ezazifunde ngesondo kunye ibhatyi ayizange isebenze ngokuqhelekileyo ngaphandle iibhatyi zabo [187].
Ngokuhambelana nalezi zifundo, i-young age ubudala apho abantu baqalisa ukusetyenziswa rhoqo kwe-intanethi ye-intanethi rhoqo, kunye nokukhetha kwabo ngokukhethekileyo ngokobulili obudibeneyo, ubunconywa obungaphantsi kwabo baxela kwizesondo ezidibeneyo, kunye nokuphakama kwabo kwi-intanethi ye-intanethi. [U37]. Ngokufanayo, amadoda anika ingxelo yokunyuka kokusetyenziswa kwezitho zoonografi ezingabonakaliyo (apho abadlali bengabhinxi iikhondom) kunye nokusetyenziswa kwayo ngexesha elidlulileyo, bazibandakanya kwisondo esingasakhuselekanga ngesondo ngokwaso [188,189]. Ukusetyenziswa kwangaphambili kwezinto ezingamanyala kungaphinda kuhlotshaniswe neenkanuko zokumisa kwizinto ezikhuthaza kakhulu [99,190].
Ukuhlaziywa yiPfaus kubonisa ukuba imeko yokuqala iimeko eziphambili kwiitemplates zesondo: "Kuya kucacisa ngakumbi ukuba kukho ixesha elibalulekileyo lokuphuhliswa kokuziphatha ngocansi olwenza malunga namava okuqala omntu kunye nokukhupha ngokwesondo kunye nomnqweno, ukugcoba, isondo okanye isondo isondo ngokwazo "[191] (iphe. 32). Ukuphakanyiswa kwexesha eliphambili lokuphuhlisa lihambelana nombiko weVoon et al. ukuba abasebenzisi abancinci abancinci be-intanethi be-intanethi babonisa umsebenzi omkhulu kwi-ventral striatum ekuphenduleni kwividiyo ezicacileyo [31]. I-ventral striatum ngummandla oyintloko ochaphazelekayo ekukhuthazeni umvuzo wendalo kunye neziyobisi [103]. Voon et al. Kwakhona kwaxelwa ukuba iinthombe zoononophala ze-intanethi eziphosakeleyo ze-Intanethi ziqale zibukele i-intanethi ye-intanethi ngaphaya kwexesha (ineminyaka engama-13.9 ubudala)31]. Uphononongo lwe-2014 lubonise ukuba malunga nesiqingatha samadoda asekholejini ngoku baxela ukuba babonakala kwi-intanethi ye-intanethi ngaphambi kobudala be-13, xa kuthelekiswa ne-14% kuphela kwi-2008 [37]. Ngaba ukwanda kweefoto zoononophala ze-intanethi ezisebenzisayo ngexesha lophuhliso olubalulekileyo lukhuphula ingozi yeengxaki ze-Internet ezinxulumene noonografi? Unokukunceda ukucacisa i-2015 yokufumanisa ukuba i-16% yamadoda aseNtaliyane aselula asebenzisa i-intanethi ye-intanethi ngaphezu kweyodwa ngeveki echaza isifiso sesini esifanelekileyo, xa kuthelekiswa ne-0% kwabangewona abathengi [29]? U-serviceman wethu wokuqala wayengu-20 kuphela kwaye wayesebenzisa i-intanethi ye-intanethi kuba wayenokufikelela kwi-Intanethi ngokukhawuleza.
Abesilisa banokuphumelela ngempumelelo impendulo yabo yesondo kwibhubhoratri eneempendulo zemiyalelo, kodwa ngaphandle kokuqiniswa ngakumbi, imeko enjalo eyenziwa yibhubhoratri iyanyamalala emva kwezilingo [176]. Olu hlobo lwe-neuroplasticity lungabonisa indlela ezimbini zokubanjiswa kweenkonzo ezibuyiselwayo kunye nokusebenza ngokwesondo kunye namaqabane emva kokushiya itekisi yesondo kunye / okanye ukusika i-intanethi ye-intanethi. Izimpendulo zokunciphisa okanye ukucima izimo ezinokuthi zikhutshwe ngokukhenketho kunye nokusebenza ngokwesondo kunye namaqabane.
4. Izigqibo kunye neNcomelo
Izinto zesiko ezakhe zachaza ubunzima bezesondo emadodeni zibonakala ngathi azonelanga kwi-akhawunti yokunyuka ngokukhawuleza kokungasebenzi kakuhle ngokwesondo kunye nomnqweno ophantsi wesini emadodeni aphantsi kwe-40. Zombini ezoncwadi kunye neengxelo zethu zeklinikhi zigxininisa isidingo sophando olubanzi lwezinto ezinokubakho kwi-Intanethi. Ngokufanelekileyo ngokuba nezifundo zisuse ukwahluka kwamanyala e-Intanethi ukuze kuboniswe iimpembelelo zokutshintsha kokuziphatha. Ucwaningo lwe-2015, umzekelo, lufumene ukuba amaxabiso okulibaziseka ukuphuculwa (ukukhetha ukwaneliseka kwangoko ngaphezulu kokulibaziseka kwembuyekezo yexabiso elikhulu) yehlile xa abathathi-nxaxheba abasempilweni bezama ukuyeka ukusebenzisa iphonografi kwi-Intanethi iiveki ezintathu (xa kuthelekiswa neqela elilawulayo elazama ukuyeka ukutya abakuthandayo ngexesha elinye) [75]. Ukuzibini kokuziphatha kunye nemeko yenkcazo ekhutshwayo yimiba ephambili.
Ngelixa izinto ezingezizo ezesondo zokungasebenzi kakuhle zithathwa njengemvelaphi yengqondo, kwaye ke eli phondo leengcali zezempilo yengqondo, ukungasebenzi kakuhle kwesondo ngoku okungacacanga kumadoda amancinci (i-ED, ubunzima be-orgasming, umnqweno wesini ophantsi), ukuya kuthi ga kwinqanaba ngokuyeka iphonografi kwi-Intanethi, akuveli "kuxinzelelo lokusebenza" (Oko kukuthi, ukungasebenzi kakuhle ngokwesini, ikhowudi ye-ICD-9 302.7), nangona ukusebenza koxinzelelo kunokuhamba nabo. Abaphandi bexesha elizayo baya kudinga ukuthathela ingqalelo iipropathi ezizodwa kunye nefuthe lokusasaza i-Intanethi ngokuhambisa iphonografi. Ukongeza, ukusetyenziswa gwenxa kwe-Intanethi ngexesha lokufikisa, okanye ngaphambili, kunokuba yinto eyahlukileyo.
Ukuphononongwa kwethu kunye neengxelo zekliniki zibalaselisa imfuneko yokusetyenziswa kwezixhobo zokuhlola ukuchonga ubuninzi beengxaki ezingekho zesini, kunye neengxaki ze-intanethi ezinxulumene noonografi kumadoda aphilileyo. Olu hlobo lokugqibela luya kuhlaziywa nje ngokuguqula indlela yokuziphatha. Ngenxa yokuba ubuninzi beengxaki zezocansi ze-intanethi azixhomeke ngokukodwa kwi-diagnostic esemthethweni, ababoneleli bezempilo abanakuzikhumbuza rhoqo, beshiya izigulane zengozini. Kule nkalo, ukuze kuhlolwe izigulane ngokuchanekileyo, kunokubaluleka ukuhlukanisa iifoto ezingcolileyo-ezingekho kwiimifanekiso engamanyala-zancedisa ukuphinga. Ngokwesiko, ukuba izigulane zazingekho ubunzima kunye nezenzo, zivusa kwaye zithe gqolo xa zihlaziya umzimba, kodwa iingxaki ezixeliweyo ngexesha lokwabelana ngesondo, zithathwa ukuba zineengxaki zengqondo, ezingengobungozi. Nangona kunjalo, izigulane ezincinci zibuzwa malunga nobuchule bazo ezinokuthi "ukuhlaziya i-masturbation" kubhekisela ku "ukukrexeza ngokunceda i-intanethi", ngoko ke kuhlolwe njengokuba "noxhala lokusebenza", xa ubunzima babo bobudlelwane bobulili be-intanethi be-intanethi. Abanikezeli bezonyango abanokuzicoca ngonyango bangayisebenzisa ukuba babuze, "nokuba isiguli singakwazi ukufezekisa kwaye sigcine i-erection eyanelisayo (kunye nesigxina njengoko kufunwayo) xa uhlambalaza ngaphandle kokusebenzisa iinthombe zoonopopasho ze-Intanethi". Ukuba akakwazi, kodwa unokufezekisa lula ezi njongo nge-intanethi ye-intanethi, ngoko ukungaxhatshazwa kwakhe ngokwesondo kunokunxulumaniswa nokusetyenziswa kwayo. Ngaphandle kokusebenzisa uvavanyo olulolo hlobo, kukho umngcipheko wokuxilongwa kobuxoki "bokukhathazeka komsebenzi", kunye nomngcipheko wokuba ulungise amayeza angenasiphelo kunye (ekugqibeleni mhlawumbi awusebenzi) i-phosphodiesterase-5 inhibitors. Ezinye izibonakaliso zeengxaki zentsebenzo enxulumene noonografi-ntanethi zingabikho ukulahlekelwa kwexesha lokuhlwa kunye / okanye ukulungiswa ngokukhawuleza. Uphando olongezelelweyo kule ndawo luvumelekile.
Ukongezelela, ngelixa ababoneleli benonophelo bezempilo kufuneka baqaphele ingxaki zobudlelane, ukuzithoba, ukuxinezeleka, ukuxhalaba, i-PTSD, uxinzelelo kunye nezinye iingxaki zempilo yengqondo, kufuneka baqaphele ngokucinga ukuba impilo yengqondo engafaneleyo yimbangela yokungasebenzi kakubi ngokwesini kwintle phantsi kwe40. Ubudlelwane phakathi kwezi zinto kunye nokungasebenzi kwezesondo kumadoda amancinci kunokuba yi-bidirectional kunye no-co-occurring, okanye kunokuba ngumphumo wesifo esingasebenzi [26].
izifinyezo
Isishwankathelo esilandelayo sisetyenzisiwe kulo mbhalo wesandla:
| CSB | Ukuziphatha ngokwesini okunyanzelekileyo |
| I-DLPFC | i-corors |
| DSM | I-Diagnostic and Statistical Manual of Disabilities |
| ED | I-erectile dysfunction |
| fMRI | ukucatshulwa kwemifanekiso yamagnetic |
| IIEF | Ikhompyutheni yamazwe ngamazwe e-Erectile Function |
| MRI | imaginance magnetic resonance |
| NAc | nucleus accumbens |
| I-OSAs | izinto zesini ezikwi-intanethi |
| PTSD | uxinzelelo lwasemva kokubeleka |
| PIED | I-erectile dysfunction |
| VTA | indawo yezentlalo |
Umbhali Wemivuzo
U-Brian Y. Park no-Warren P. Klam baqokelela idatha yesigulana; Bonke ababhali baba negalelo ekubhaleni iphepha.
Iimbambano Zomdla
Ababhali bavakalise ukuba akukho kungqubana komdla. Izimvo kunye namanqaku omboniso achaziweyo zezo zababhali 'kwaye ayibonisi isikhundla okanye imigaqo-nkqubo ye-NAVY yaseMelika okanye iSebe lezoKhuselo.
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