Important new findings on sex and gender in the former Soviet Bloc! Sexuality and Gender in Postcommunist Eastern Europe and Russia is a groundbreaking look at the new sexual reality in Central, Eastern, and Southeast Europe after the fall of communism. The book presents the kind of candid discussion of sexual identities, sexual politics, and gender arrangements that was often censored and rarely discussed openly before the breakup of the Soviet Union in 1987. Authors from a variety of disciplines examine how the changes caused by rapid economic and social transformation have affected human sexuality and if those changes can generate the social tolerance necessary to produce a well-rooted democracy. The first theoretical and empirical body of work to sexuality in (post)transitional countries, Sexuality and Gender in Postcommunist Eastern Europe and Russia examines the effects of the profound social transformation taking place in the former Soviet Union. Through an interdisciplinary perspective, the book addresses vital issues of this transformation, including gender relations, gender roles and sex norms in transition, sexual representations in the media, patterns of adult sexual behavior, gay and lesbian issues, sex trafficking, health risks, and sex education. The book also presents a critical examination of whether the fall of communism has, in fact, induced changes in sexuality and gender relations. Sexuality and Gender in Postcommunist Eastern Europe and Russia examines the changes in sex and gender in countries in transition, including: the negative consequences of Serbia's state-directed non-development during the 1990s the causes and consequences of trafficking in women from the Russian Federation the ongoing debate over human rights for sexual minorities in Romania the effects of two Yugoslavian films released in the 1990s that feature transgender characters sexualities in transition in Croatia problems created by changes in sexual behavior among urban Russian adolescents the social and legal state of lesbians in Slovenia Sexuality and Gender in Postcommunist Eastern Europe and Russia fills in the gap in the current knowledge and understanding of the effects of the profound social changes taking place in Central, Eastern, and Southeast Europe. The book is an essential read for academics and researchers working in gender studies, political science, and gay and lesbian studies. Handy tables and figures make the information easy to access and understand.

Examine the major advances in sexual offender treatment over the last decade and promising new concepts in treatment, supervision, and research
Sex Offender Treatment: Accomplishments, Challenges, and Future Directions points the way toward humane, dignified, effective treatment regimes for sexual offenders. In addition to providing an essential overview of the current state of sex offender treatment, this book examines vital areas of service provision and research and points to future directions for the field.
On the medical/psychological front, this volume explores the importance of recognizing comorbid psychiatric factors in treatment and of exploring central nervous system function's role as a cause of sexually inappropriate behavior. In the legislative/justice arena it illustrates a "Circles of Support" proposal that mobilizes community resources to aid the adjustment of released offenders rather than branding them as dangerous to the community. And in the area of service provision, this book presents a treatment approach for residential programs that is inspired by research on childhood behavioral problems and special education.
This book will increase your effectiveness with: a model of multisystemic treatment for juvenile sex offenders a restorative justice approach for reintegrating adult offenders into the community a study of the physical/mental correlates of organic brain dysfunction a case report on the use of a pharmaceutical treatment (leuprolide acetate) for pedophiles

Tongzhi: Politics of Same-Sex Eroticism in Chinese Societies examines Chinese societies where the family-kinship system, rather than sexuality, is taken as the basis of an individual's identity. With Tongzhi, you will come to understand the variations of same-sex erotica in different Chinese societies. Examining past and present treatment of the subject, including instances of discrimination against homosexuals, Tongzhi explores same-sex eroticism in China, Hong Kong, and Taiwan, and explains the variations of categories and experiences of tongzhi in these countries. Just what is Tongzhi?Tongzhi is the most popular contemporary Chinese word for lesbians, bisexuals, and gay people. The word, which has very positive historical references, was a Chinese translation from the Soviet communist term comrade. It was appropriated by a Hong Kong gay activist in 1989 for the first Lesbian and Gay Film Festival in Hong Kong by its organizers, who wanted to employ an indigenous representation of same-sex eroticism. The term 'homosexual'was inappropriate because of its use as a medical term denoting sickness and pathology. Within a few years, tongzhi became a widely used term in Hong Kong and Taiwan and is often used interchangeably with the English term gay. But terms such as gay, lesbian, and queer are Anglo-Saxon in origin, with specific histories that cannot capture the indigenous features of Chinese same-sex relationships. Tongzhi implies and includes much more. S/Mers, transvestites, and other fetishists who are members of the Chinese sexual counterculture who may be quite heterosexual are also tongzhi. And the term has meaning beyond the sexual: it embodies a strong sentiment for integrating the sexual (legitimizing same-sex love), the political (sharing the goals of fighting heterosexism) and the cultural (reappropriating their Chinese identity). Tongzhi brings you fascinating insight into: the history of same-sex eroticism in China coming out in Chinese society how colonialism has affected sexual nonconformists in this region racial and sexual dynamics in Colonial Hong Kong the cultural politics of being a tomboy/girl in modern Hong Kong "queering the mainstream" with tongzhi identity politics sexual/cultural diversities and differences among contemporary Chinese societies . . . and much more Tongzhi shows how culture influences identity and demonstrates how you can develop relevant strategies for successful activist movements. Discussing political movements for gay/lesbian/bisexual rights and the societal implications of same-sex eroticism, this intelligent book provides you with a clear understanding of the attitudes toward and meanings of being tongzhi today.

Sex Offender Treatment: Biological Dysfunction, Intrapsychic Conflict, Interpersonal Violence assists sex therapists, counselors, psychiatrists, and psychologists working in sex offender treatment in providing more effective services. You'll gain timely knowledge of sex offending behavior and treatment approaches that will stimulate your thinking and help you improve your research and treatment methodologies. From Sex Offender Treatment, you'll acquire valuable insight and a cross-cultural viewpoint as you explore chapters written by international scholars who have set the standards of care for sex offender treatment. Contributors aim to improve the effectiveness of sex offender treatment throughout the world by challenging you to conduct more research that will provide a better understanding of sex offenders and improve treatment approaches. Authors presented their contributions at the Third International Congress on the Treatment of Sex Offenders held in Minneapolis, Minnesota. The book begins with a Standards of Care for the Treatment of Sex Offenders. This guides you in increasing the effectiveness of the treatment you provide to sex offenders. The Standards of Care helps you analyze new data and gain a basis for successful sex offender treatment. Following chapters probe into the nature of interpersonal violence and aggression and a further understanding of pedophilia and exhibitionism. You will begin to more thoroughly understand sex offending behavior as you read about: motives contributing to sexual aggression and the confluence model of sexual aggression the background and clinical characteristics of paraphilic individuals and sex offenders a case study of sex offenders, victims, and their families the "abuse to abuser hypothesis" in regard to pedaphilia assessment, psychosexual profiling, and treatment of exhibitionist behavior the treatment of sex offenders with mental retardation the relationship between sex offender treatment success and learning difficulties incest offender perceptions of treatment as used to generate an explanatory theory of the sexual abuse treatment process.Chapters in Sex Offender Treatment emphasize the importance of good assessment techniques, issues affecting victims and families of sex offenders, why treatment does not work for some sex offenders, medical problems associated with sex offenders, and working with special populations of sex offenders. Counselors, researchers, educators, sex offender treatment personnel, forensic psychologists and psychiatrists, and sex therapists will find Sex Offender Treatment crucial for gaining insight into sex offenders'motives and behaviors. You can then use these perspectives to more effectively interact with sex offenders and to more accurately analyze sex offending behavior.

An exploration of the diverse presentations of gender dysphoria and how it affects an individual's physical, psychological, social, and sexual adjustment, Gender Dysphoria provides comprehensive and applicable treatment approaches available for a wide spectrum of presentations of this disorder. The need for evaluating and treating gender dysphoria in the context of the gender dysphoric client's overall mental and physical health is stressed. International experts in the clinical management of gender dysphoria contribute valuable information on contemporary approaches in assessment, psychological and medical treatment, and adjustment of individuals with gender identity disorders. In Gender Dysphoria, clinicians will find important information on hormone therapy options and their physical results and side effects, and the effectiveness of sex reassignment surgery in improving a gender dysphoric client's adjustment. This comprehensive book covers a wealth of topics essential for clinicians who treat gender dysphoria, including: terminology and classification of gender identity disorders a validation of the "Cross-Gender Questionnaire," a newly developed clinical assessment tool reported regrets of post-surgical transsexuals the affective component of gender dysphoria in young boys a model for identifying and treating gender identity disorder in females a thorough description of a comprehensive treatment approach for a wide spectrum of presentations of gender dysphoria Filled with useful information on the clinical management of gender identity disorders, Gender Dysphoria meets the practical needs of clinical sexologists, psychotherapists, counselors, social workers, physicians, sex researchers, social scientists, and specialists who evaluate and treat gender dysphoria.

This important volume brings together findings in the psychological and medical treatment of sex offenders. It disseminates research from experts around the world in the field of sex offender treatment, making this knowledge available to researchers and clinicians everywhere. Professionals struggling to find effective methods for treating their patients will find Sex Offender Treatment a valuable tool for their daily work. Chapters in Sex Offender Treatment cover a variety of topics. Authors examine such areas as psychodynamic and psychiatric disorders associated with the sex offender, findings on pharmacologic interventions, treatment techniques and the public perception of sex offender treatment, and cautionary notes for those who provide therapy for sex offenders.Within these areas, some specific themes addressed include: types of personality disorders and implications for more effective treatment the effectiveness of antiandrogen treatment and the promising results of other pharmacotherapies techniques for developing insight in incest perpetrators a study of adult male incest offenders'perceptions of the treatment process an adolescent treatment program using a family communication approach hypotheses regarding sexual offenders and men who batter, using psychodynamic and feminist theory Full of practical strategies and useful information, Sex Offender Treatment is a book professionals will reach for again and again.

The failure to deal with social-sexual issues may impair the progress of recovery in a chemically dependent individual and his or her family. The failure to deal with sexual compulsivity in intravenous drug abusers may seriously impair our ability to deal with AIDS. The failure to deal with chemical dependence may render family therapy ineffective in the treatment of sex offenders. Despite the connection between chemical dependency and intimacy dysfunction, the intimacy concerns are rarely recognized in the diagnosis, treatment, and aftercare of the chemically dependent person and his or family. In this pioneering work, experts in the fields of chemical dependence and human sexuality provide professionals with information and skills to deal with intimacy dysfunction issues--offering hope for improving treatment and rehabilitation of chemically dependent individuals and their families. Typical intimacy dysfunctions are explored, as well as treatment methods and strategies that have proven to be effective. A valuable resource guide, this comprehensive volume addresses the key issues in the multidisciplinary approach to the study of chemical dependency and intimacy dysfunction.

Sex Offender Treatment: Biological Dysfunction, Intrapsychic Conflict, Interpersonal Violence assists sex therapists, counselors, psychiatrists, and psychologists working in sex offender treatment in providing more effective services. You'll gain timely knowledge of sex offending behavior and treatment approaches that will stimulate your thinking and help you improve your research and treatment methodologies. From Sex Offender Treatment, you'll acquire valuable insight and a cross-cultural viewpoint as you explore chapters written by international scholars who have set the standards of care for sex offender treatment. Contributors aim to improve the effectiveness of sex offender treatment throughout the world by challenging you to conduct more research that will provide a better understanding of sex offenders and improve treatment approaches. Authors presented their contributions at the Third International Congress on the Treatment of Sex Offenders held in Minneapolis, Minnesota. The book begins with a Standards of Care for the Treatment of Sex Offenders. This guides you in increasing the effectiveness of the treatment you provide to sex offenders. The Standards of Care helps you analyze new data and gain a basis for successful sex offender treatment. Following chapters probe into the nature of interpersonal violence and aggression and a further understanding of pedophilia and exhibitionism. You will begin to more thoroughly understand sex offending behavior as you read about: motives contributing to sexual aggression and the confluence model of sexual aggression the background and clinical characteristics of paraphilic individuals and sex offenders a case study of sex offenders, victims, and their families the "abuse to abuser hypothesis" in regard to pedaphilia assessment, psychosexual profiling, and treatment of exhibitionist behavior the treatment of sex offenders with mental retardation the relationship between sex offender treatment success and learning difficulties incest offender perceptions of treatment as used to generate an explanatory theory of the sexual abuse treatment process.Chapters in Sex Offender Treatment emphasize the importance of good assessment techniques, issues affecting victims and families of sex offenders, why treatment does not work for some sex offenders, medical problems associated with sex offenders, and working with special populations of sex offenders. Counselors, researchers, educators, sex offender treatment personnel, forensic psychologists and psychiatrists, and sex therapists will find Sex Offender Treatment crucial for gaining insight into sex offenders'motives and behaviors. You can then use these perspectives to more effectively interact with sex offenders and to more accurately analyze sex offending behavior.

Finally-a thorough and unbiased examination of the psychological and sociological aspects of masturbation This book shows that masturbation is a critical component in the development of sexual health, explores the power-both negative and positive-of the act, and outlines viable ideas for future research. It also presents a concise historical overview of societal attitudes toward masturbation and reports on changes in masturbatory behavior in the twentieth century, including the trend toward an earlier age when women begin to masturbate and the increased recognition of masturbation as a source of sexual pleasure irrespective of relationship status or other sexual activity. The book will also familiarize you with some surprising information about the relationship between masturbation and HIV risk among samples of women attending college and low-income African-American women. Finally, Masturbation as a Means of Achieving Sexual Health examines the connections between masturbation and other sexual activity, sexual fantasy, and desire. Written with a minimum of jargon, Masturbation as a Means of Achieving Sexual Health examines: societal attitudes toward masturbation-from pre-biblical Egyptian and Babylonian civilizations to biblical times, the Christian era, Hindu civilization, ancient China, and more generational perspectives on masturbation the relationship between masturbation habits and sexual health in low income African-American women the factors associated with masturbation as practiced by college students the complex interrelationship of sexual fantasy, desire, and masturbation ways that masturbation can be utilized as a therapeutic tool in sex therapy

Examine the major advances in sexual offender treatment over the last decade and promising new concepts in treatment, supervision, and research
Sex Offender Treatment: Accomplishments, Challenges, and Future Directions points the way toward humane, dignified, effective treatment regimes for sexual offenders. In addition to providing an essential overview of the current state of sex offender treatment, this book examines vital areas of service provision and research and points to future directions for the field.
On the medical/psychological front, this volume explores the importance of recognizing comorbid psychiatric factors in treatment and of exploring central nervous system function's role as a cause of sexually inappropriate behavior. In the legislative/justice arena it illustrates a "Circles of Support" proposal that mobilizes community resources to aid the adjustment of released offenders rather than branding them as dangerous to the community. And in the area of service provision, this book presents a treatment approach for residential programs that is inspired by research on childhood behavioral problems and special education.
This book will increase your effectiveness with: a model of multisystemic treatment for juvenile sex offenders a restorative justice approach for reintegrating adult offenders into the community a study of the physical/mental correlates of organic brain dysfunction a case report on the use of a pharmaceutical treatment (leuprolide acetate) for pedophiles

Tongzhi: Politics of Same-Sex Eroticism in Chinese Societies examines Chinese societies where the family-kinship system, rather than sexuality, is taken as the basis of an individual's identity. With Tongzhi, you will come to understand the variations of same-sex erotica in different Chinese societies. Examining past and present treatment of the subject, including instances of discrimination against homosexuals, Tongzhi explores same-sex eroticism in China, Hong Kong, and Taiwan, and explains the variations of categories and experiences of tongzhi in these countries. Just what is Tongzhi?Tongzhi is the most popular contemporary Chinese word for lesbians, bisexuals, and gay people. The word, which has very positive historical references, was a Chinese translation from the Soviet communist term comrade. It was appropriated by a Hong Kong gay activist in 1989 for the first Lesbian and Gay Film Festival in Hong Kong by its organizers, who wanted to employ an indigenous representation of same-sex eroticism. The term 'homosexual'was inappropriate because of its use as a medical term denoting sickness and pathology. Within a few years, tongzhi became a widely used term in Hong Kong and Taiwan and is often used interchangeably with the English term gay. But terms such as gay, lesbian, and queer are Anglo-Saxon in origin, with specific histories that cannot capture the indigenous features of Chinese same-sex relationships. Tongzhi implies and includes much more. S/Mers, transvestites, and other fetishists who are members of the Chinese sexual counterculture who may be quite heterosexual are also tongzhi. And the term has meaning beyond the sexual: it embodies a strong sentiment for integrating the sexual (legitimizing same-sex love), the political (sharing the goals of fighting heterosexism) and the cultural (reappropriating their Chinese identity). Tongzhi brings you fascinating insight into: the history of same-sex eroticism in China coming out in Chinese society how colonialism has affected sexual nonconformists in this region racial and sexual dynamics in Colonial Hong Kong the cultural politics of being a tomboy/girl in modern Hong Kong "queering the mainstream" with tongzhi identity politics sexual/cultural diversities and differences among contemporary Chinese societies . . . and much more Tongzhi shows how culture influences identity and demonstrates how you can develop relevant strategies for successful activist movements. Discussing political movements for gay/lesbian/bisexual rights and the societal implications of same-sex eroticism, this intelligent book provides you with a clear understanding of the attitudes toward and meanings of being tongzhi today.

Important new findings on sex and gender in the former Soviet Bloc! Sexuality and Gender in Postcommunist Eastern Europe and Russia is a groundbreaking look at the new sexual reality in Central, Eastern, and Southeast Europe after the fall of communism. The book presents the kind of candid discussion of sexual identities, sexual politics, and gender arrangements that was often censored and rarely discussed openly before the breakup of the Soviet Union in 1987. Authors from a variety of disciplines examine how the changes caused by rapid economic and social transformation have affected human sexuality and if those changes can generate the social tolerance necessary to produce a well-rooted democracy. The first theoretical and empirical body of work to sexuality in (post)transitional countries, Sexuality and Gender in Postcommunist Eastern Europe and Russia examines the effects of the profound social transformation taking place in the former Soviet Union. Through an interdisciplinary perspective, the book addresses vital issues of this transformation, including gender relations, gender roles and sex norms in transition, sexual representations in the media, patterns of adult sexual behavior, gay and lesbian issues, sex trafficking, health risks, and sex education. The book also presents a critical examination of whether the fall of communism has, in fact, induced changes in sexuality and gender relations. Sexuality and Gender in Postcommunist Eastern Europe and Russia examines the changes in sex and gender in countries in transition, including: the negative consequences of Serbia's state-directed non-development during the 1990s the causes and consequences of trafficking in women from the Russian Federation the ongoing debate over human rights for sexual minorities in Romania the effects of two Yugoslavian films released in the 1990s that feature transgender characters sexualities in transition in Croatia problems created by changes in sexual behavior among urban Russian adolescents the social and legal state of lesbians in Slovenia Sexuality and Gender in Postcommunist Eastern Europe and Russia fills in the gap in the current knowledge and understanding of the effects of the profound social changes taking place in Central, Eastern, and Southeast Europe. The book is an essential read for academics and researchers working in gender studies, political science, and gay and lesbian studies. Handy tables and figures make the information easy to access and understand.

Finally--a thorough and unbiased examination of the psychological and sociological aspects of masturbation
This book shows that masturbation is a critical component in the development of sexual health, explores the power--both negative and positive--of the act, and outlines viable ideas for future research. It also presents a concise historical overview of societal attitudes toward masturbation and reports on changes in masturbatory behavior in the twentieth century, including the trend toward an earlier age when women begin to masturbate and the increased recognition of masturbation as a source of sexual pleasure irrespective of relationship status or other sexual activity. The book will also familiarize you with some surprising information about the relationship between masturbation and HIV risk among samples of women attending college and low-income African-American women. Finally, Masturbation as a Means of Achieving Sexual Health examines the connections between masturbation and other sexual activity, sexual fantasy, and desire.
Written with a minimum of jargon, Masturbation as a Means of Achieving Sexual Health examines: societal attitudes toward masturbation--from pre-biblical Egyptian and Babylonian civilizations to biblical times, the Christian era, Hindu civilization, ancient China, and more generational perspectives on masturbation the relationship between masturbation habits and sexual health in low income African-American women the factors associated with masturbation as practiced by college students the complex interrelationship of sexual fantasy, desire, and masturbation ways that masturbation can be utilized as a therapeutic tool in sex therapy

Deliver effective services to this growing population! This volume presents the first collection of reports on the impact of HIV/AIDS on the transgender community worldwide. It includes a thorough description of the unique HIV risks of transgender people and exposes their largely neglected health and social service needs. This unique book also reports on the first generation of prevention interventions targeting this community, discusses guidelines for providing sex reassignment services to HIV-positive transsexuals, and encourages collaboration between communities at risk, researchers, and people in the helping professions.The social stigma faced by this population adds to their risk of HIV infection. Low self-esteem, rejection, neglect, employment discrimination, disenfranchisement, and a desire for acceptance and validation are all contributing factors. Yet, as the editors point out, "On the positive side, the transgender community has been able to mobilize and empower itself, and has found a voice that no longer can be ignored. We call on transgender and nontransgender people alike to work together to advance HIV prevention and promote our sexual health."In Transgender and HIV you'll encounter: extensive discussions of the health, social service, and HIV prevention needs of the transgender community tips on how to work with marginalized communities in an empowering way explorations of the sexuality of both male-to-female and female-to-male transsexuals first-ever findings on sex reassignment surgery on HIV-positive individuals guidelines for surgery on HIV-positive transsexualsTransgender and HIV provides much-needed and often-requested information on HIV prevalence, risks, prevention, and care for this increasingly visible community.

Gain a better understanding of the biological, psychological, and social aspects of sex offenders, their crimes, and the treatments that can help them The treatment of sexual offenders varies from culture to culture and nation to nation. Sexual Offender Treatment: Biopsychosocial Perspectives assists sex therapists, counselors, psychiatrists, and psychologists working in sex offender treatment around the world in providing more effective services. This book looks at the behavior of sexual offenders and offers treatment approaches that will stimulate your thinking and help you improve your research and treatment methodologies. This valuable and informative book introduces and discusses the formation of the new International Association for the Treatment of Sexual Offenders, which will advance the existing knowledge about the nature of sexual offenders and sexual offenses, work to improve treatment methods and disseminate information about improved methods, and scientifically evaluate therapeutic methods advocate for the right of sex offenders to effective treatment.Sexual Offender Treatment: Biopsychosocial Perspectives presents an overview of recent research in the treatment of sexual offenders as presented at the 5th International Conference on the Treatment of Sexual Offenders in 1998 in Caracas, Venezuela. This book explores: the recently revised Standards of Care for the Treatment of Sexual Offenders self-perceived aggression in relation to brain abnormalities in a sample of incarcerated sexual offenders self-concepts and interpersonal perceptions of sexual offenders in relation to brain abnormalities brain abnormalities and violent behavior group family interventions for the treatment of adult male child molesters the experiences of adult and adolescent female sex offenders a 7 step system to treat pedophiles who are mentally retarded, mentally ill or physically handicapped Sexual Offender Treatment: Biopsychosocial Perspectives provides you with valuable insights and a cross-cultural viewpoint as you benefit from the expertise and experience of international scholars who have set the standards for the treatment of sex offenders.

This important volume brings together findings in the psychological and medical treatment of sex offenders. It disseminates research from experts around the world in the field of sex offender treatment, making this knowledge available to researchers and clinicians everywhere. Professionals struggling to find effective methods for treating their patients will find Sex Offender Treatment a valuable tool for their daily work. Chapters in Sex Offender Treatment cover a variety of topics. Authors examine such areas as psychodynamic and psychiatric disorders associated with the sex offender, findings on pharmacologic interventions, treatment techniques and the public perception of sex offender treatment, and cautionary notes for those who provide therapy for sex offenders.Within these areas, some specific themes addressed include: types of personality disorders and implications for more effective treatment the effectiveness of antiandrogen treatment and the promising results of other pharmacotherapies techniques for developing insight in incest perpetrators a study of adult male incest offenders'perceptions of the treatment process an adolescent treatment program using a family communication approach hypotheses regarding sexual offenders and men who batter, using psychodynamic and feminist theory Full of practical strategies and useful information, Sex Offender Treatment is a book professionals will reach for again and again.

The failure to deal with social-sexual issues may impair the progress of recovery in a chemically dependent individual and his or her family. The failure to deal with sexual compulsivity in intravenous drug abusers may seriously impair our ability to deal with AIDS. The failure to deal with chemical dependence may render family therapy ineffective in the treatment of sex offenders. Despite the connection between chemical dependency and intimacy dysfunction, the intimacy concerns are rarely recognized in the diagnosis, treatment, and aftercare of the chemically dependent person and his or family. In this pioneering work, experts in the fields of chemical dependence and human sexuality provide professionals with information and skills to deal with intimacy dysfunction issues--offering hope for improving treatment and rehabilitation of chemically dependent individuals and their families. Typical intimacy dysfunctions are explored, as well as treatment methods and strategies that have proven to be effective. A valuable resource guide, this comprehensive volume addresses the key issues in the multidisciplinary approach to the study of chemical dependency and intimacy dysfunction.