LETTER OF THE PRESIDENT

TO a year of the end of my mandate, a sonnet sends me to do Violante, that would say Lope. I am very I please with the given steps and I want to share my happiness with all and all, who since the FESS and out of her you have collaborated to do a more professionalized and richer Sexology. Behind it remains that epoch of long and interesting philosophical meetings that gave rise to the foundation of the FESS, bad times they ran: an uneven academic formation, a level of intrusismo high, a lack of so much conscience of the administration as of the remainder of the professionals of the health, they did quite hard to cross that desert. Nevertheless, pasito to pasito went imposing the profession. The obviedad of the need of the sexual education and the unfortunate alliance of the HIV, they permitted that the administration, up till then blind, to see the need to organize always preventive, educational campaigns, always generating fear, but something was something. The importance of the sexual education in the school to stopped questioning. Since then has gone advancing in the educational environment, any tortoise is faster, but the idea is there, we go walking. The FESS has not been alien this impulse, its companies have organized days and Congresses, and they have participated of active form in the creation of part of the programs that today they are being carry out in some autonomous regions. In the area of the clinic, in the middle of the eighty the urologists were incorporated. At night to the morning, they passed to give a palmate one to the patients in the back and to tell them that itself did not they worry that the erection already would appear, to establish prosthesis and to understand that any sexual problem could try that form. Never I will forget that time that quizzed an excellent urologist in one of the first days of Andrología. After congratulating him for the excellent data that had contributed on revascularización of the penis, I asked him on what percentage of successes al to try the penetration they had the people of their sample. He answered me that the doppler confirmed the revascularización, but that never was put in the private life of its patients. It was an epoch of professional war, the president of one of the companies of the FESS appeared in a round table in Antenna 3 and the urologist of shift attacked against him without contemplations, he defended not without logic, that the genital apparatus was its, something that nobody discussed. Just then, the Urology not yet had studied that behind a penis always there is a person and that the sexuality is thing of people. Nevertheless, the entrance of the urologists was a spring that watered years of drought in investigation. Many of them were forming, as could not be of another form, in Sexology and they contributed along with the vision organicista that never should be forgot; styles, habits of
investigation, quantity of publications and with them they brought to the pharmaceutical industry. Suddenly the study of the male sexual answer was taken up again, where after the discoveries of Masters and Johnson, barely had been deepened, and in only a decade, almost of the empty one, itself step al knowledge ultaestructural and biochemist of the male sexual answer. Then the blue diamond appeared, the or the Viagra. The Sexology again felt wronged. Suddenly some they thought about it collected of olives, the hotel business and other worthy professions to the ones that to be dedicated. The accounts were clear, if the majority of the patients that respond to a consultation of Sexology they present an erectile dysfunction and a sure medicine had appeared that solved the problem, touched ¿who has been carried my cheese? The apparently logical argument, only impregnated professionals of the Sexology dedicated exclusively to the formation, and that therefore, they do not have the experience that contribute the real patients. Thus, some associations of professionals of the Sexology did open campaign against the Viagra. It was not the case of the FESS, where since the principle was notified that which manna fallen of the sky, the medicines would bring a takes of conscience before the problematic sexual one and greater level of investigation. In fact, the FESS participated in the elaboration of the "Document of Consensus on Erectile Dysfunction" promoted by Pfizer and that met to 12 scientific associations of professionals of the health. Us do not we mistake. Since the FESS always we had conscience that the sexuality is thing of people, always we knew that the medicines would improve the physiology, but that the communication, the participation in couple and as would say Efigenio the "Ars Amandi" one must continue working it. 1 on the other hand, has been shown that the
pharmacological therapy is a lot more efficient if applies of form combined with the sexual therapy. Besides many patients are encouraged to face the situation but they prefer not to take medicines. In short, someone has to work with the couples independently of the existence of the medicines. Therefore, the cheese of the Sexology this full, juicy one and barely without leaving. Remains us a lot by investigating and numerous areas in which to improve our therapeutic strategies. But we should not forget that as the agents of health, aside from the primary prevention (fundamentally sexual education), secondary prevention (I diagnose premature and processing of the inconveniences of the
sexuality) and tertiary prevention (for example, to optimize the sexual answer of people with special physical needs or chronic illnesses), one of our important works should be the PROMOTION of the Sexual Health. Is therefore, that as the president of the FESS, if I should feel me especially proud of somewhat referring to our company in these moments, is for the active participation in the elaboration and execution of the project GASS-AP (Group of Support to the Sexual Health in Primary Attention). With this project intends, in the environment of the Primary Attention, to increase the clinical know-how and sexológicos of the professionals of the health, to introduce improvements in the procedures of clinical approach in the welfare units, to encourage the professionals of the health among others things to detect possible dysfunctions, to avoid the iatrogenia.. The project pivota on three areas: the informational one, the scientist-welfare one and the formative, being had placed in motion does several weeks. If the project functions like is predicted, me not the smaller doubt fits that is going to mark a milestone in the attention to the Sexual Health of our country. The Sexology will have a before and a later, through the project, when since the Primary Attention be understood what was shown with the study APPLAUDS carried out by Lorenzo Guirao and Luis Garcia weather Vane, where the importance to interrogate about the sexuality with the purpose to improve is shown the quality of life of the patients and of its couples, in part because to do To the cares sexual improvement the fulfillment of the associated pathologies and to a greater therapeutic adhesion (hypertension, diabetes, dislipemias. ..) and because the sexual dysfunctions constitute symptoms "sentries" of other hidden pathologies. Working in Primary Attention in this sense, will remove to the light a problematic sexual one that will contribute to have us without I breathe the professionals of the Sexology. Since the FESS we are contributing with our work to the profesionalización of the Sexology, in fact, in sanitary environments he is beginning to distinguish the sexologists-FESS implied in the sexual health since a scientific perspective, of other professionals that sexologists called themselves. Nevertheless, although the process has not been short, the work has not done more than beginning. Congresses with the organizing and scientific quality of that of Santander, they should serve as flagship of our professional task. Already the hostility has been surpassed and unfair competition with the Urology and the Andrología, we knew that they were necessary and they begin to be given account now of the same thing. In fact, in our Congresses always they were represented, now still more. In the same way we are guests to its Congresses, has begun the road of the loyal contribution in a field in which all we have something that to contribute and where exceeds hardly anybody. Time ago we begin to work in Primary Attention and that work continues giving fruits, of such form that permanently we are required for courses of formation and participation in scientific events. In short, we are growing and, since I took on the job, nine have been incorporated new associations to the FESS, and after the renewal of the new statutes, as more notable news, they can belong to the FESS people and not alone companies. The road practically is designed remains to continue working harshly and with severity, the FESS each day is larger and has better reputation, should take advantage of this moment to give him a new impulse to the vocalía of formation and
endorsement of courses and to incorporate new associates that be adjusted al professional profile that have come demanding. Summarizing, I believe that we should feel us proud because has been an excellent period, we expect that the next one be still better. Francisco Hair. President of the FESS.

3 LETTER FESS TO THE Spanish BISHOPS Since the FESS (Spanish Confederacy of Companies of Sexology) we contemplate with stupor and growing worry the current of sexofobia distilled and orchestrated so much conservative from positions in the world of the politics as of the catholic church. The eagerness to become in all the puddles of the Episcopal Conference and of the Mr. Fraga and its wandering demonstrations would induce to the smile if did not were for the message that carry prepared: frontal attack to the Sexual liberty al to be respected like the cause of all the wrongs of our company. The tail, the horns, the sulfur and the sin related to the Human Sexuality, they carry us in the tunnel from the time to past times that seemed surpassed after more than two decades of democracy.

But, it worries us still more, the coincidence of these statements with some facts perpetrated by members of the collective that represent the bishops and the Mr. Fraga. The sex abuse by the ones that have been condemned the councilmen of the Popular Party and the parsons of Cordoba and Pontevedra, we understand that itself not al is owed exercise of sexual liberty practiced by you said subjects, but more well al exercise of its power and the deprivation of the own liberty of the victims (smaller, do not we forget it). And we ask us if all this will not be to try to raise a curtain of smoke on the committed crimes by its fellows. Blaming to the liberty of the havocs that the violence of kind is causing in our company, seems us of a mezquindad and an improper baseness of people with highest level of responsibility in the public life of our country. We understand that itself obvian aspects (sexual discrimination, machismo) that have a marked influence in a way to be conducted the aggressors and that so much the church and certain conservative ideologies come reproducing and I encourage through the years. The sexist education, perpetuated in our company through our culture and our education yes they are in the base of the aggressions of kind and the sex abuse. The professionals of the Sexology, when we speak of Human Sexuality we refer to the same essence of the human being, essence that consider should be lived since a positive conception of the same one; just of an opposite way to as tries to be presented in these unfortunate demonstrations. And of course should be lived at liberty, when we speak of Sexual Liberty we are referring us to a series of values that go prepared al exercise of the own Liberty, like they are: The Respect, the Tolerance, the Responsibility, values that are sure none of the aggressors (sexual and of kind) has had in consideration, and a lot of we are afraid that to the authors of so lamentable demonstrations sound, how not, to music Celestial. Antonio Casaubón. Responsible for communication with the press

Boletín Informativo
FESS-AEES
Volumen 7. 2ª Época
Mayo 2004
Publicación Oficial de la
Federación Española de
Sociedades de Sexología y
de la Asociación Española
de Especialistas de Sexología
Editor:
Miguel Ángel Cueto Baños.
Consejo de Redacción:
Marta Arasanz Roche.
Juan José Borrás Valls.
Francisco Cabello Santamaría.
Antonio Casaubón Alcaraz.
Cristina Corbella Cazalet.
Olatz Gómez Llorens.
Mª José González de la Rosa.
María Pérez Conchillo.
Sergi Pérez Serer.
Teresa Ródenas Guaita.
Carlos San Martín Blanco.
Imprime:
Gráficas Rubin, S.L.
c/ Joaquín Costa, 8.
24002 León (España).
Secretaría:
CEPTECO
Plaza Cortes Leonesas, 9-6º D.
24003 León(España).
Telf.: 987 261 562.
Fax: 987 260 566.
email: cepteco@correo.cop.es
http://www.cop.es/colegiados/CL00395/
Dirección Editor:
CEPTECO.
Plaza Cortes Leonesas, 9-6º D.
24003 León (España).
Telf.: 987 261 562.
Fax: 987 260 566.
email: secretaria@fess.org.es
http://www.fess.org.es
This Bulletin does not hold responsible themselves of the aforesaid opinions by their EDITORIAL collaborators Querid@s compañer@s, without sinning of crowing we can say that they blow good winds for the sexology in our country. In doors of the VIII Spanish Congress of Sexology and II I find Latin American of Professionals of the Sexology, to celebrate in Santander, we can do balance of the new career of the scientific sexology initiated ten years ago (... and seems that was yesterday) with the V Spanish Congress of Sexology in Granada, that continued with the I SAW of Barcelona (1996), had its point of splendor with the World one of Valencia (1997) and It received a final recognition with the VII in Seville (2002). I can pass to enumerate a series of signs and trails that confirm the previous thing:
• The increment of the number of new companies inside the FESS.
• The co-organization of the Congress of Seville with the AEPS, confirming the unifying mood of our Confederacy and the significant contribution of the pharmaceutical industry, for that event and continued in the VIII Spanish Congress of Sexology of Santander.
• The role of the AEES and its members in favor of the profesionalización of the Sexology and its presence in national and international forums.
• The appointment of our companions (Juan José Borrás, Francisco Cabello and José Díaz Morfa) as permanent members of the International Academy of Medical Sexology, it "majetes" that are in the imposition of the band (...o, but well, for which is seen in the photo, ¿they seem a" band"?)
• The presence of members of the FESS and of the AEES (María Pérez, Francisco Hair and Juan José Borrás) occupying roles advisors or executives in the WHO, the WAS and the FLASSES.
• Answer in communication to the pastorale of the Episcopal Conference by incalificable.
• The participation of Cristina Corbella, Antonio Casaubón and Miguel Angel Cueto in the elaboration of the profile of the Psychologist Specialist in Sexology, like initiative of the Official School of Psychologists, profile that will be presented in the next Congress.
• The interest that has awoke our next Congress is declared in which one of the tables round seen on-line in the 7ª Convention of the Official School of Psychologists of Andalusia Oriental to celebrate in Malaga June 4.
• Presence of the FESS and the AEES, next to the SIX in an Act carried out April 13 in Seville and in which him was thanked al Counselor of Health the initiatives carried since its department on behalf of the sexology. But, besides changes of very significant attitude since the Administration of the State are perceived, and is spoken for the first time in our country of a Law of Sexual Health, the Law of Quality of the Teaching is suppressed, where was going to give
the teaching of sexology inside the classes of religion (?) , Being spoken of education in the equality and with the creation of a Department of Equality in Andalusia. In these changes, without doubt has had a lot that to see the work well carried out during years of each one of us. Therefore, it is the moment to share the satisfaction by seeing the fruits of our effort and to look at al future hopefully. But, with the conviction that we should continue working on behalf of the Sexology and the Sexual Health of our fellow citizens, and consequently, to assume the responsibilities that involves in itself this
beautiful challenge. A strong hug to tod@s,
Antonio Casaubón Alcaraz.
Vicepresidente de la AEES.
5 REPORT OF THE II MEETING OF EXPERTS IN ERECTION AND SEXUAL DYSFUNCTIONS Reckoned colleagues: Paris, was headquarters of June 28 al 1 of July of the second meeting of experts in sexual dysfunctions and erectile dysfunction to which I had opportunity to attend. They divided into 16 Committees, they were presented in an hour by committee, the conclusions of the work assigned previously since two years ago, and the revision of the recent publications in this environment. The committees were the following:

Committee Chairperson
Committee 1: Definitions, Classification and Epidemiology of Sexual
Dysfunctions.
R. Lewis, K. Fugl-Meyer.
Committee 4: Economical Aspects of Sexual Dysfunctions. R. Shabsigh, Y. Kimoto
Committee 2: Psychological and Interpersonal Dimension of Sexual
Functions and DysfunctionS.
Althof, S. Leiblum.
Committee 3: Educational, Socio-Cultural and Ethical Aspects of
Sexual Dysfunctions.
G. Wagner.
Committee 5: Clinical Evaluation and Symptom Scores of Sexual
dysfunctions.
R. Rosen, D. Hatzichristou.
Committee 6: Standards for Clinical Trials in Sexual Dysfunctions :
Research Designs and Outcomes Assessment.
M. Hirsch, J. Heiman.
Committee 7: Physiology - Pathophysiology of Women Sexual
Function.
I. Goldstein, E. Laan
Committee 8: Priapism, Peyronie's Disease and Penile
Reconstructive Surgery.
J. Pryor
Committee 9: Disorders of Orgasm in Men and Women, Ejaculatory
Disorders in Men.
Mac Mahon, C. Meston.
Committee 10: Experimental studies of Sexual Functions and
dysfunctions including Brain Imaging Studies
K. Mc Kenna.
Committee 11: Physiology, Molecular Biology of Erectile Function
and Pathophysiology of Erectile Dysfunction.
I. Saenz de Tejada
Committee 12: Endocrine Aspects of Men and Women Sexual
Dysfunctions Including Hormonal Treatment.
A. Morales, S. Davis.
Committee 13: Implants and Vascular Surgery, Mechanical Devices
for Erectile Dysfunction.
J. Mulcahy.
Committee 14: Pharmacological Treatment of Erectile Dysfunction. H. Padma-Nathan, G. Christ.
Committee 15: Future Treatment Targets. K.E Andersson.
Committee 16: Women Sexual Desire and Arousal Disorders, Sexual
Pain Disorders: Pathophysiology and Treatment.
R. Basson.Really, wine more investigation (1610 so alone works on sildenafilo in Medline to date 2/11/03), new medicines arrived and, above all, they came more patient. Three years ago they consulted for erectile dysfunction among a 6 to 10% of them affected and now we go for the 35% and, it more important, arrived the hour of the WOMAN, the always marginalized one in all the environments. Surely by the benefits collected with the processing of the erectile dysfunction, the industry, discovered the mine, does not want that escape him itself a so important vein. For that reason comience to be investigated on female sexuality. The ones that criticized the medicalización and the apparition of Viagra, now they maintain that intends to invent pathology where there is not. Evidently nobody doubts that something the things by commercial interests can be exaggerated, but to the poverty that characterizes the investigation on female sexuality (31 works on excitability until 1997), only does lack that some soothsayers complain, now that begin to blow favorable winds and, if continues the same dynamics that with the male, in brief we will know many things that at this time we do not know and ways will be opened To optimize the sexuality of the woman. In this framework, the presidency of the FESS conscious of the heavy blow suffered since the 97 by our Company, as for organization of events, a Congress was proposed that to break happiness line, calling to all the professionals that study some plot of the human sexuality and doing emphasis in the most prominent aspects of the present time, since a perspective multidisciplinar combining professionals of the Andrología, Urology, Psychiatry, Primary Attention, Teaching, Psychology and Sexology. After the success of the Congress,
that of greater participation of the national Congresses of our field to the present, an acceleration in our task has been able to be verified and since then has participated and elaborate an important number of initiatives. From among them, fits to emphasize our participation in the study, to national level, on habits and sexual settings. The participation next to the intervention Spanish Company in Sexology in the creation of the Own Qualification in Sexology of the University of Almería. The participation in the study VESAR, interesting project by which is devising a questionnaire on self-esteem and sexuality that promises to be more effective and useful that other instruments of evaluation utilized up to now. The participation in the different Forums of Sexual Health of the Man, seminars of formation to doctors of AP in which we participate professionals of the Urology/Andrología, Primary Attention, Endocrinología and Sexology. The participation in the committees advisors of the publications "International Magazine of Andrología, Reproductive and Sexual Health", "Integral Sexology", "Sexual Health" and "Latin-american Files of Sexology". Besides, the Dr. Díaz Morfa, of the Spanish Association of Clinical Sexology, one of our veteran associates, publishes the Magazine of "Sexual Therapy and of Couple". Also we are participating in the Guide of Good Practice in Clinic of the Organization Medical college Student on Sexual Health. Aside from the formative activities of the member associations that to enumerate them would do this still more illegible writing, the Days of Valencia have been organized, The Days on Family Violence of Santander, the Days "The desire to Be A Woman" in Cadiz and the Days on "Sexuality and Woman" in Seville. :We have participated in almost all the Congresses and scientific events of our environment. In consequence of all this, we have appeared more than 1.200 times (they are counted and me I have not made a mistake in the figure) in the mass media and many businesses are requesting our services as the advisors in the environment of the Sexology. In fact, some of our members they are participating in three clinical trials with medicines for different sexual dysfunctions. All in all we have a frantic activity, in this time the FESS has noticeable and shown its commitment with the Sexology since a scientific point of view. We continue fighting for the implementation of the school curriculum with the impartición adequate of sexual education and, in the clinical environment, we do not defend anything, the things simply go finding its place. On a prevalence of nearby sexual dysfunctions al 50%, only is necessary that the people become aware of the existence of professionals with adequate strategies to resolve its problems. The medicines have given the first step for this takes of conscience, but despite its shown efficacy and security (in recent dates even has been shown that the Viagra presents absence of risk in patients with cardiac shortage published by Glasser, Katz, Sweeney and Sherman, 2003), the adhesion to the pharmacological therapy is not good, if not an adequate relation of couple exists. 2 Since my point of view fits to emphasize the following thing:
- Of maximum interest the committees "Definitions, Classification and Epidemiology of Sexual Dysfunctions" where there is a good line of work, and typical aspects of the Sexology they are being imposed on the classical observations of slant exclusively urológico, though, not agreement exists still on the classification in the female environment and is far from arriving at an agreement.
- Clinical Evaluation and Symptom Scores of Sexual dysfunctions", where new questionnaires they were presented and tools of diagnosis. In this field a new apparatus was presented electrofisiológico of measure of the female excitability, of the one that in another report I will try to speak you with more detail.
- Physiology
- Pathophysiology of Women Sexual Function", to emphasize the study by emission of positrons of the female sexual answer and the new know-how on neuroendriconología they applied to the sexual answer.
- Future Treatment Targets", Here it was summarized toward where we go in the processing of the dysfunctions, like news, to stand out the huge open investigation lines quantity for the processing of the female sexual dysfunctions, question that itself had not been given before. Among the disappointing committees we have:
- Women Sexual Desire and Arousal Disorders, Sexual Pain Disorders: Pathophysiology and Treatment" that although was well, the conclusions save small details, they were the same that were exposed in Monaco two years before, even the plans proposed by R. Basson did not add anything that we did not know about the previous time. - Finally, in the only committee on education. "Educational, Associate-Cultural and Ethical Aspects of Sexual Dysfunctions", was spoken alone of intentions and of "expert", referring to the important work that performs and in which should deepen the WHO. It was indicated that the Integral Sexual Education is a priority, the Statement of the WAS of Valencia emphasized itself (1997) on Sexual Rights approved in Hong Kong (1999) and was spoken of the role of the school. In short as you will have been able to deduce told itself absolutely nothing, was the most reduced committee and in which less participation there was. Miscellany: I am carry out a satellite symposium on: ¿Are the Female Sexual Dysfunctions a constructo of the Pharmaceutical Industry? That turned out to be very interesting and also was spoken of how influences the industry of the cosmetics, of the fashion and of the plastic surgery in everything that signify sexual attraction. Indicating also a pioneers images exposition of the Sexology and milestones in the study of the human sexuality, that was perhaps of what more i liked. Paraphrasing to Rubén Hernández (former president of the WAS) al which I found me in Paris: "The panorama is highly encouraging. Observing the interest of the WHO and of the international agencies of Health in the area, encourages us to continue the work. Without doubt that the Century principles pioneers and the generation of the 70 do not we sow in the Sea".
Francisco Cabello.
Presidente de la FESS

7 SILDENAFILO AND SITUATIONAL ERECTILE DYSFUNCTION
This article is especially summarized to insert it in the bulletin of the FESS. Due to problems of space, they have withdrawn the graphics and the statistical prosecution. Who have interest in such aspects should consult the original article whose reference is:
Reference: Hair, F. (2002). Sildenafilo and situational erectile dysfunction. Latin-american files of Sexology, 2(8). SUMMARY Since the approval of Viagra by the FDA they have done themselves around 1400 studies with citrate of sildenafilo. To a large extent of them, itself not the etiología of the erectile dysfunction has kept in mind (OF), or on the contrary, has been differentiated of almost always arbitrary form among OF organic, psychic or mixed.
The patients included in samples of etiología psychic, in general they are diagnosed of depression or of absence of organic cause, what can carry to that of but that to ours to understand, they are not representative of the majority of subjects that present one of psicógena, besides is possible that in the depressive patient, they influence the alterations neurofisiológicas own of the depression in the genesis of that of. As opposed to previous studies, we present us to study the efficacy of the sildenafilo on an OF functional, in 50 healthy subjects with OF situational, that is to say, subjects that obtain erection in some circumstances but not in other (p. e., possibility to function with the habitual couple but not with a new companion). I am carry out a groups crusader design intrasujeto, being observed that the 93'18% they improve their sexual answer, in the 68'75% of the total of intents there was vaginal penetration. We do not find you differentiate significant between 25 and 50 mgr of sildenafilo, although they refer greater subjective satisfaction with 50 mgr (25 mgr average 2'63, 50 mgr average 2'67). The time of establishment of the processing correlates with success coital (r -0'71 p <0'01). All the subje cts that could penetrate in the eight occasions (61'36%) registered, they carried less than three months of evolution and all the ones that did not penetrate in any occasion (18'18%), they carried more than two years suffering intermittently the dysfunction. They will be necessary new studies to verify the maintenance of the efficacy of the sildenafilo long-term and to analyze what factors influence in the subjects that do not respond al processing, in spite of present not any different pathology from the anxiety of execution. KEY WORDS Sildenafilo, situational Erectile Dysfunction, anxiety of execution. INTRODUCTION The erection has a capital importance in all the cultures and epochs, having exalted in paintings prehistóricas, defined in Egyptian papyruses and deified, as is the case of the God Príapo. Still in the 17th century the erection was described like produced by spirits or "ventosidades vaporosas", until Dionis (1721) describes the presence of blood in cavernous bodies, being in recent years one of the fields of greater interest for the investigators, having established with plenty of precision the intimate mechanisms that intervene in the physiology of the erectile function. In Spain they exist between one and medium and two million subjects with erectile dysfunction, to state of the results obtained in the study multicéntrico "Study of Male Erectile Dysfunction" (EDEM; Martin Moral, Sánchez Cross, Sáenz Of Roof and Rodriguez Watches, 2001), where a prevalence of a 12'1% is specified by means of self-assessment and of the 19% if itself objective by means of questionnaires. In it USES affects from 10 to 20 million men (Padma-Nathan, Payton and Goldstein, 1987), and according to the Massachusetts Male Aging Study (Feldman, 1994), the 52% of the males between 40 and 70 years they suffer with greater or smaller intensity of erectile dysfunction, enlarging the percentage with the age, since a 39% is found at the age of 40 set against a 67% at the age of 70. The age is a fundamental factor, enlarging the incident of the severe erectile dysfunction, ten times over 8 of the 40 years with regard to lower ages (Moreira, Abdo, Towers, Wolf and Fittipaldi, 2001). Until some years ago, was considered to the Erectile Dysfunction as a problem of psychological origin in a 75 95% of the cases (Abraham and I Carry, 1979). Nevertheless, the apparition diagnostic of new methods, in the last decades, he has gone revealing causes of organic type to a large extent of the cases (Spark, White and Connolly, 1980; Virag, Bouilly and Frydman, 1985; Melman, Tiefer and Pedersen, 1988). By that reason, recently he has been classified etiológicamente the erectile dysfunction in organic, psicógena or mixed (National Institutes of Health Consensus Development Board on Impotence,1993). Thus, some authors establish that the erectile dysfunction of origin psicógeno supposes a 10% of the total (Stief, Bahren, Scherb and Gall, 1989). Hanash (1997), states that among the 20-30% of the erectile dysfunctions they would be psicógenas pure and the mixed they would be able to arrive al 66%, while Farré and Lasheras (1998) they stipulate some percentages of the 37% for organic, 33% mixed and 30% psicógenas pure (see Board
1). Classification of the Organic erectile dysfunctionI. Vasculogénica A. Arteriogénica
B. Cavernous C. Mixed
II. Neurogénica
III. Anatomical
IV. Endocrinológica Psicógena I. Generalized A. Apathy generalized 1. Primary loss of sexual excitability
2. Descent of the excitability related to the age
B. Inhibition generalized
1. Chronic inconvenience of the sexual intimacy
II. Situational A. Related to the couple 1. Loss of excitability in a specific relation
2. Loss of excitability related to the object of preference
3. Great central inhibition due to conflicts of couple or processing
B. Related to the execution
1. Associate with another sexual dysfunction (for example, fast ejaculation) 2. Anxiety of situational execution (for example, fear al I fail) C. psychological Affliction or problems of adaptation
1. Associate with a state of negative humor (for example, depression) or greater vital stress (for example, death of the couple). Board
1. Classification of the erectile dysfunction (taken of the Nomenclature Committee of the International Society for Impotence Research).

9 Although the differentiation among erectile dysfunction has been accepted universally psicógena, organic or mixed, by more well didactic questions, themselves not the criteria have been established clearly to comply to belong to an or another category. It results, therefore, very difficult to be adjusted to one of the three epígrafes, since, in erectile every dysfunction there is a psychological component, independently that a possible native organic cause exist. In fact, the clinical experience shows that before an erectile dysfunction must have occurred one of the following possibilities: 1. organic Start and maintenance psicógeno having disappeared the organic factor. This is the case, for example, of a dysfunction of etiología hormonal by deficit of free testosterone, in which after replacing the hormonal values, the impossibility for the erection persists. 2. start and maintenance psicógeno but in the evaluation an organic factor appears. For example, depressive patient that initiates an inconvenience of erection and in the evaluation an arterial hypertension is found or a diabetes. 3. organic start and worsening psicógeno persisting the organic factor. Very frequent situation where, for example, as a result of a diabetes the erectile dysfunction appears and before the dysfunction, the patient is depressed or well he generates anxiety of execution, what maintains and he aggravates the process. 4. start and organic maintenance. By way of example, a caused erection inconvenience case by a prostatectomía can be cited radical with recensión of the bandeletas (nervous package), where the start and the maintenance is organic. Even so the patient will present important secondary psychic repercussions. 5. start and maintenance psicógenos. The patient that begins its dysfunction coinciding with an intense stress and subsequently evolves toward a depression that perpetuates the problem of erection. Nevertheless, according to the own experience, the most common form of erectile dysfunction psicógena, would be that in which the patient does not respond due to a strong anxiety of execution. Concluding, in erectile every dysfunction are going to influence diverse factors: - Factors predisponentes of the dysfunction. - Factors precipitantes of the dysfunction. - Factors mantenedores of the dysfunction. Despite it it indicated, showing the multifactorialidad etiológica in the erectile dysfunction, almost all the studies carried out to evaluate the efficacy of the sildenafilo, they are adjusted to the theoretical classification of organic, psicógeno or mixed. In the Andalusian Institute of Sexology, the incident of inconveniences of the erection on the total of sexual dysfunctions supposes a 48%, of which a 69% are situational erectile dysfunctions, that is to say, subjects that obtain erection in some circumstances but not in other (the patient responds to the masturbation or fellatio but not to the penetration, when from time to time he goes well but of intermittent form problems appear, and also, the Possibility to have a satisfactory sexuality with the habitual couple, but not with a new companion or vice versa). In these cases the etiología is purely psychic, being the anxiety of execution or performance, the last factor that unchains the loss of the erection.
Anxiety unchained for which Abraham and I Carry (1978) they called generating factors of sexual anxiety, to know:
- Fear al I fail (sensation of fear to respond not of adequate form before the couple)
- Obligation of results (need of a lasting, very consistent erectile answer and of fast recovery. ..)
- Altruismo excesivo (estar más pendiente de la satisfacción de la pareja, perdiendo concentración en el erotismo propio).
- Autoobservación (estar observando el pene para ver como responde, es lo que Masters y
Johnson (1970) denominaron "rol de espectador").

10 Evidently, to treat these patients is necessary an intervention psicoterapéutica which always is not possible by multiple reasons: the patient does not have adequate cultural level for agree to the psicoterapia, not to have time (the average of sessions in the Andalusian Institute of Sexology is of twelve), prejudices for consult al sexologist or to any professional of the health, etc. Because of it, perhaps the citrate of sildenafilo could be an adequate therapeutic option in these cases. But up to now, just as we have mentioned previously, the studies carried out al effect, they do not discriminate in their samples to patients with Situational Erectile Dysfunction, only they refer, in some occasions, to patients classified of psicógenos by be not found any organic pathology in the evaluation or by having an equal or greater scoring of 12 in the scale of depression of Hamilton (Seidman, Roose, Menza, Shabsigh and Rosen, 2001), even they have themselves It recruited samples of people with stress postraumático (Reznik, Zemishalany, Kotler, Spivak and Weizman, 2002). It is understood easily, that nothing has to see the erectile dysfunction of whom suffers a greater depression, with respect to who exclusively al is afraid failure. It is presented therefore, to study the effect of the sildenafilo in patients with situational erectile dysfunction, with the objective to evaluate their efficacy and to analyze the most effective dose, besides valuing if they improve the levels of anxiety, desire and satisfaction. Ourselves leave from the hypothesis that the processing with sildenafilo can do that the patient lose the fear (anxiety of execution), al to have several relations coitales successful, what would permit to abandon the medicación after a time with satisfactory erections. It is keep in mind that the psychological processing al end and al tip, he consists of a desensibilización systematic in alive, the focalización sensory in terminology of Masters and Johnson (1970), consistent, of form summarized, in which the subject be accustomed progressively to have erections in a tranquil environment, without need to pass to the penetration, to which is agreed, once the patient has had several adequate erections he was Intercourse.

HYPOTHESIS
The situational erectile dysfunction happens in organically healthy subjects, of such form that in some occasions they have a satisfactory sexual answer, alternating with occasions or couples where the erection is not possible. Since that perspective, a medicine of efficacy tested as the sildenafilo (some 13 million treated men), should help the erection in subjects that do not have any physical alteration, what constitutes our conceptual hypothesis. As experimental hypothesis is established the following thing:
- The administration of sildenafilo should permit the intercourse in the majority of the occasions.
- The anxiety should diminish after the administration of sildenafilo.
- The degree of sexual satisfaction should be increased after the administration of sildenafilo. Of complementary form intends to study the incident of possible adverse effects of the medicación and to analyze the dosificación more adequate.

METHOD
• Participating: they were recruited 50 patients from 18 to 75 years from among who they respond al Andalusian Institute of Sexology and Psychology by presenting an erectile dysfunction and, after the pertinent clinical interview, a situational erectile dysfunction is diagnosed. Criteria of inclusion:
A. Subjects that accept to participate in the study.
B. Subjects with stable couple over six months al start of the study. 11
C. Subjects that in the last three months have had al less four sexual relations without possibility to penetrate.
D. Subjects that in the last three months have had al except a sexual relation with penetration or an adequate erection with the fellatio or masturbation, independently of the couple with whom they have had sexual relations.
E. Subjects with an upper scoring al eneatipo four in the GRISS.
F. Subjects motivated to carry out the processing. Criteria of exclusion:
A. Subjects less than 18 years.
B. Subjects that present any physical pathology.
C. Subjects that are taking some medicación although be of preventive form.
D. Subjects with different psychic pathology from the anxiety of execution, ruling out besides, subjects with scoring over 75 in the scales of pathological personality of the Millon.
E. Subjects that do not present another dysfunction sexual associate.
F. Subjects whose couple is pregnant before the start of the study or during the puerperio
• Instruments of evaluation: Interview semi-structured of the author, SAI-AND (Sexual Arousal Inventory Expanded; Hoon, Hoon and Wincze, 1977), GRISS (Golombok Rust Inventory or inventory of sexual satisfaction; Rust and Golombok, 1985), and MILLON.
• Procedure: Design of groups intrasujeto (simple blind). The patients are divided into two groups. In the first phase a group will receive 50 mgr of citrate of sildenafilo and the other group 25 mgr during its next four relations coitales. In the second phase, the group that received 25 mgr will receive 50 mgr of citrate of sildenafilo and vice versa, the following four relations coitales. The citrate of sildenafilo is contributed for the investigator in the shape of capsules of the same size and color, independently of the dose, not being able the subject to differentiate them. Before the first dose all the are passed questionnaires, after the four first relations are passed the GRISS and the SAI-AND, and after the four last relations are passed again again the GRISS and the SAI-AND. The data were processed with the SPSS. RESULTS
- The 93'18% improved its sexual answer, what al is contrasted to diminish the eneatipos of the GRISS in the scale of erectile dysfunction
- In the 68'75% of the total of sexual relations there was vaginal penetration.
- The 61'36% of the subjects could carry out the intercourse in the eight intents.
- The 72'7% in three of four intents of penetration.
- There is not you differentiate significant between 25 and 50 mgr (p 0'131), although they refer greater subjective satisfaction with 50 mgr (25 mgr, average 2'63, 50 mgr average 2'67; p 0'131 and p 0'158). - 96'12% of success in smaller evolutions to six months. - The time of establishment of the processing correlates with success coital (r -0'71 p <0'01). All the subjects that could penetrate in the eight occasions (61'36%) carried less than six months of evolution and all the ones that did not penetrate in any occasion (18'18%), they carried more than two y ears suffering the dysfunction.

12
- The global initial anxiety passes from the percentile 50'5, before initiating the processing, al 14'8 independently of the dose.
- The satisfaction passes from the percentile 30'8 al 82, with 50 mgr and al 76 with 25 mgr.
- Six abandonments of which four due to problems of couple and two by desmotivación and lack of answer.
- The most noticeable adverse symptom was the facial blush (22'7%), followed by the nasal congestion (6'8%) and migraines (4'5%). In no case alteration in the perception of colors was detected neither priapismo.
DISCUSSION AND CONCLUSIONS With the results obtained they are confirmed all the hypothesis presented. Thus, we can conclude that the majority of the subjects with Situational Erectile Dysfunction they improve with the sildenafilo. As consequence diminishes the anxiety and enlarges the sexual satisfaction. Of form collateral, we appreciate that as soon as possible the processing is established, more probability exists to have satisfactory sexual relations. Practically all the patients improve their erectile answer, but a 38'64% they cannot penetrate in all the occasions, existing a clear correlation between the time of evolution of the dysfunction and the ingesta of the sildenafilo. Set against almost a 100% of successes before the six months of evolution, the 18'8% of the subjects that do not respond al sildenafilo, they carry more than two years without taking any measure to resolve the problem. It turns out to be interesting to verify that the time of contact in couple does not mark you differentiate significant as for the results, that is to say, gives equal to carry a lot of time living together (in our sample a patient carried 32 years) or that he be a matter of a couple recently formed, the result he is going to depend of the time elapsed between the apparition of the dysfunction and the establishment of the processing. He does not surprise that the majority of the subjects improve its sexual answer with the sildenafilo, if perhaps, what really calls the attention, is the inefficiency of the processing in some patient (18'8%), despite have not no organic problem and to respond occasionally of adequate form. This it can be explained because the situation frustrante, consequent with the erectile dysfunction, conditions the fear al I fail. After several occasions where the failure erectivo is repeated, the condicionamiento will go doing more intense and any stimulus (a sexual relation in this case), will produce of form reflects a strong anxiety. Besides the subject will be a victim of what in the model of Barlow (1986), demand of execution is called. Continuing this author, the process would be the following one: the demand of execution on the part of the couple, does that the subject generate some negative attitudes toward the relation, with control lack perception. The subject concentrates
on the consequences of its impossibility to penetrate but that centered in the erotic thing, what enlarges its anxiety, involving a loss or absence of erection and therefore tendency to the sexual avoidance. This tendency to the avoidance, or the reseñada lacks of attention in the erotic thing, behaves that itself not desire be generated (although the subject initiate the sexual relation with the idea of "to comply" or thinking about being compensated of the previous failure), and if there is not sexual desire, the nitric oxide does not free itself, with which the sildenafilo will be little cash. This it can be the explanation to the high efficacy of the sildenafilo in the starts of the dysfunction, period in which not yet a process of avoidance has been established and the anxiety of execution is not very high. Himself should not be forgot that the anxiety supposes an increase of the tone alfaadrenérgico, with which the blood flow in the penis decreases (Hedlund, Andersson and Mattiasson, 1984; Diederichs, Stief, Lue and Tanagho, 1990; Christ, Stone and Melman, 1991), what competes with the effect of the silodenafilo. From there, the poor results when has elapsed a lot of time (in our sample two years) and the anxiety and avoidance they are hardly written down. By way of summary, can be deduced for the present study, that the sildenafilo is especially efficient in subjects with erectile dysfunction of little time of evolution, which has been measured in the course of eight sexual relations, remains for future studies, to value the maintenance of the long-term results, once suppressed the medicación, business that will be undertaken with quickness.

13
REFERENCIAS
Abraham, G. y Porto, R. (1979). Terapias Sexológicas. Madrid: Pirámide.
Barlow, D.H. (1986). Causes of sexual dysfunction : The role of anxiety and congnitive interference.
Journal of Consulting and Clinical Psychology, 2, (54), 140-148.
Christ, G.J., Stone, B. y Melman, A. (1991). Age dependent alterations in the efficacy of phenylephrine-
induced contractions in vascular smooth muscle isolated from the corpus cavernosum of impotent
men. Canadian Journal of Physiology and Pharmacology, 69, 909-913.
Dionis, P. (1721). Traité general des accouchements. Liège: Ed. F. Broncard.
Diederichs, W., Stief, C.G., Lue, T.F. y Tanagho, E.A. (1990). Norepinephrine involvement in penile detumescence.
The Journal of Urology, 143, 1264-1266.
Farré, J.M. y Lasheras, M.G. (1998). Psiquiatría y Disfunción Eréctil. Madrid: Ed. Garsi
Feldman, H.A. (1994). Impotence and its medical and psychosocial correlates: results of the
Massachsuset male aging study. The Journal of Urology. 151, 54 -91.
Hanash, K.A. (1997). Comparative results of goald oriented therapy for erectyle dysfunction. Journal
of Urology, 157, 2135-8.
Hedlund, H., Andersson, K.E. y Mattiasson, A.. (1984). Pre- and post-junctional adreno and muscarinic
receptor function in the isolated corpus spongiosum urethrae. Journal of Autonomic Pharmacology,
4, 241-246.
Hoon, P., Hoon, E. y Wincze, J. (1977). A test of reciprocal inhibition: are anxiety and sexual arousal in
woman mutually inhibitory? Journal of Abnormal Psychology, 86, 65 -74.
Martin-Morales, A., Sanchez-Cruz, J.J, Saenz de Tejada, I., Rodriguez-Vela, L, Jimenez-Cruz, J.F., y
Burgos-Rodríguez, R. (2001). Prevalence and independent risk factors for erectile dysfunction in Spain:
results of the Epidemiologia de la Disfuncion Erectil Masculina Study. Journal Urology,166 (2):569-574.
Masters, W.H. y Jonson, V.E.(1970). Incompatibilidad sexual humana. Buenos Aires: Inter-Médica.
Melman, A., Tiefer, L. y Pedersen, R. (1988). Evaluation of first 406 patients in urology departament
based center for male sexual dysfunction. Urology, 32, 6-10.
Moreira, E.D., Abdo, C.H., Torres, E.B., Lobo, C.F., y Fittipaldi, J.A. (2001). Prevalence and correlates of
erectile dysfunction: results of the Brazilian study of sexual behavior. Journal Urology, 58 (4), 583-588.
National Institutes of Health Consensus Development Panel on Impotence. (1993). Jama, 270, 83-90.
Padma-Nathan, H., Payton T.P. y Goldstein, L. (1987). Treatment for organic impotence : alternatives
to the penile prosthesis. Houston : ASSN.
Reznik, I., Zemishalany, Z, Kotler, M., Spivak, B., Weizman, A. y Mester, R. (2002). Sildenafil citrate for the
sexual dysfunction in antidepressant-treated male patiens with posttraumatic stress disorder. A preliminary
pilot open-label study. Psychotherapy & Psychosomatics, 71(3), 173-176.
Rust, J. y Golombok, S. (1985). The Golombok Rust inventory of sexual satisfaction (GRISS). British
Journal of Clinical Psychology, 24, 63-64.
Seidman, S.N., Roose, S.P., Menza, M.A., Shabsigh, R. y Rosen, R. (2001). Tratamiento de la disfunción
eréctil en varones con síntomas depresivos: resultados de un ensayo controlado con placebo con
citrate de sildenafilo. American Journal of Psychiatry, 158, 1623-1630.
Spark, R.F., White, R.A. y Connolly, P.B. (1980). Impotence is not always psychogenic: Newer insights
into hypothalamic-pituitary gonadal dysfunction. Journal of the American Medical Association, 243,
750-755.
Stief, C.G., Bahren, W., Scherb, W. y Gall, H. (1989). Primary erectile dysfunction. The Journal of
Urology, 141, 315-319.
Virag, R., Bouilly, P. y Frydman, D. (1985). Is impotence an arterial disorder? A study of risk factors in
440 impotent men. Lancet 1, 181-184.

14 THE EVALUATION AND THE PROCESSING OF ADDICTION AL SEX
Summary
The addiction al sex is a problematic one with a long past but with a short history for which concerns to its study, evaluation and processing. We do not have statistics on the prevalence of this dysfunction in Spain nevertheless should not be very distant to the figures that the studies performed in US offer us, and that situate the frequency of this dysfunction in some figures that oscillate among a 3% to 6%, (Meats, 1992). As a result of the addiction, the addicts experience a deep psychological anguish, they put in danger their economic incomes and they ruin their more significant labor, family, and social relations. It is frequent that the addiction al sex coexist with the
consumption of some psychotropic substance and that, if the patient does not receive he helps therapeutic for its chemical dependence, this contribute to experience fallen in the sexual addiction. Although they can recognize the consequences that
involves their problem, is used to being frequent that the addicted al sex they cannot maintain a control of their compulsion without an adequate processing. Key words: Addiction al sex, diagnostic criteria, evaluation, .- 1 processing The diagnostic
Criteria to define the addiction al sex 1.1.-Aproximación to a definition of sexual addiction does Not exist agreement among the professionals of the sexual health at the moment of to define the addiction al sex. What is addiction al sex?, ¿to be
Masturbated compulsively we qualify as addiction al sex?, ¿Is a parafilia a sexual addiction?, ¿A sexual aggressor is an addicted one al sex?, ¿The consumption of pornography in their different media of diffusion (Internet, magazines, videos, erotic lines. ..) supposes an addiction?, ¿Fantasear continuadamente about sex without consummating in practice such fantasies is a sexual addiction?, ¿Are the experiences of sexual exchange a way dissembled Making up an addiction al sex?, ¿Who fixed the criteria to value as much as sex is too much? Some of these questions perhaps they obtain not answer in this article due to the negative literature al regarding this "novel" addiction. The pretension of the same one is to offer a most minimum light to the professionals of the health that be faced to this type of problematic and to stir up the reflection to stimulate the debate and the investigation on the theme. We said "novel" addiction of way entrecomillada since is not a recent neither own illness of our time. It was described for the first time in 1896 by Kraff- Ebbing as "sexual psychopathy" and scarcely 30 years ago Patrick Meats (1970) approached al development of the indicators for an adequate diagnostic one and the first therapeutic counsels. Not neither many years ago Kaplan (1979) undertook to the problematic one of the inconveniences of the sexual desire deepening in the opposite extreme of the problem that worries us (the inhibition of the sexual desire and its different modalities). In its exposition only destined some lines al called "hyperactive sexual Desire" alerting of the importance of establishing a correct differential diagnosis among the true primary hyperactive sexual desire ("ninfomanía" or "donjuanismo") and the high levels of sexual desire pertaining to the manic states and hipomaniacos, where an adjusted diagnostic one and its therapeutic one with you leave lithium tends regular the sexuality irritated.

15
In the same way also alerted of the differential diagnosis of the compulsive sexual states and obsessive where in the most extreme cases, despite be masturbated 10 or more times al day, in reality such patients do not feel a sexual excessive or constant desire. Its tension or interior anguish is alleviated with the sexual activity, the sexual activity is converted then in a compulsion and not in a true one "hyperactive sexual desire". In 1987, the American Association of Psychiatry recognized the existence of an illness called "Addiction al sex". Its sintomatología was summarized by the Dr. Schwartz (old collaborator of Masters and Johnson) as "A sexual worry that interferes in the work and the family life, maintaining the constant desire of carrying out sexual acts to very brief intervals". Patrick Meats (1992) us about to a conceptual delimitation on this phenomenon characterizing to a sexual addiction as that sexual conduct that behaves these three elements: - Shame by the behaviors performed
- Concealment
- Obsession (frequent repetition of the conduct) Exist thus same antecedents in the Statistical Manual and Diagnosis of the Mental Inconveniences, (DSM III-R, 1987), where they were offered a list nine criteria to define the chemical dependence, although In their last version (DSM-IV, 1995) the criteria are reduced to 7. These criteria well could be used to diagnose another type of addictions and they could be modified and applied al sexual behavior (board I). A boss desadaptativo of use or I consume of sex that involves a deterioration or clinically significant discomfort, expressed for three (or more) of the ítems following in some moment of a period continued of 12 months:
1 Tolerance, defined by any of the following ítemes: to A need of markedly growing quantities of sex to obtain the stimulation or the effect desired b The effect of the same quantities of sex It diminishes clearly with its use or I consume continued
2 Abstinence: is used or consumes sex to alleviate or to avoid the symptoms of abstinence (dissatisfied sexual impulse, irritability, agitation, etc.)
3 it is used or consumes sex frequently in greater quantities or during a period more long than
initially intended.
4 a persistent desire Exists or fruitless efforts to control or to interrupt the use or I consume of sex.
5 a lot of time in activities related to the obtaining of sex is employed (p. ej., to visit various places to alternate, frequenting places of environment, peep-shows, navigating internet in pages of sex, etc.), in the consumption of the sex (p.ej. being masturbated, having sexual relations, etc.) or in the recovery of the effects of the sex.
6 Reduction of important social, labor or recreational activities owed al use or I consume of sex.
7 it continues using or consuming sex in spite of having psychological or physical conscience of problems recidivantes or persistent, that seem caused or irritated by the use or I consume of sex (p. ej., feeling of fault, deterioration of the relation of couple, risk of ETS.) Board
1.- Proposed of criteria for the diagnosis of "addiction al sex" 16
1.2.-Criterios for the diagnosis of the addiction al sex Any behavior that is maintained to produce gratification and to escape from the internal anguish can become compulsive and to constitute an addictive inconvenience. The pathological play (compulsive gambling) the compulsive purchase (addiction to the purchases), or the ingesta of compulsive food they comply also with these criteria. The most common characteristics than have been discovered in any addictive inconvenience are the following: compulsividad, understood as the loss of the ability to elect freely to continue or to stop with a behavior any, the persistence in the behavior in spite of the adverse consequences, just as loss of the health, the employment, the marriage, or the liberty and the obsession with the activity. The great majority of the patients with problematic of addiction al sex they declare several of the previous criteria and the replacement of the words would suffice "substance" by "sex" to verify the similarity of this addictive inconvenience al boss sintomatológico of a substances abuse problem. It weights al scarce and anecdotal clinical background with relation to this syndrome, would be surely numerous the voices that would propose the inclusion of this
inconvenience in the manuals of classification (DSMIV, ICD-10).
1.3.-Pautas for an efficient evaluation we should aim that they not protocols validated in terms of reliability exist neither validity to proceed to evaluate a situation of addiction al sex, nevertheless al to revise the literature al respect we can find the coincidence of various authors at the moment of to reckon the convenience to explore the following aspects in the course of an interview or by means of a scale of autoinforme. They not protocols validated in terms of reliability exist neither validity The majority of the scales of autoinforme they base their questions in base to the following aspects (Board III) : The presence or absence of:
1 Feelings of fault 2 A boss of abuse: prostitution, masturbation, pornography in all their variant..
3 A double life or excessive secrecy in the addictive activities
4 Need of greater variety and frequency to feel the same levels of excitement or relief
5 Risks for the health: to contract ETS, threats, compulsion or violence
6 Worry by you determined sexual thoughts
7 economic, family, labor, social Deterioration or of couple
8 The diagnostic criteria offered in the board 1 Board III.
- evaluative Elements in the autoinformes referring to the Addiction al sex we should
conclude that is done necessary therefore the validation of scales that help to differentiate the problem and their gravity and they guide the processing. It is convenient besides to analyze the factors desencadenantes internal and external of the chain stimulus-impulse-answer. The instruments of autorregistro are an important element to value the frequency and duration of the problem as well as the strategies of employed control.
17
1.4.-Otros associated problems al diagnostic Is used to being still frequent that the sex
awake taboo and that the people be reluctant to comment their sexual problems. It is estimated that only a third of the people that suffer a sexual dysfunction they respond to request processing and is more than probable that in the case that occupies us still greater doubts exist at the moment of to request aid among others reasons by the scarce therapeutic offering that al exists respect. In our country they are escasísimos the centers that offer therapeutic specialized for this problematic one and very is reduced the scientific literature al respect. Not any publication translated exists al Spanish about such addiction. We do not know really if among the sexual dysfunctions the addiction al
sex is the one that presents a smaller incident or that the Spanish company yet has not become aware of such problematic with what it implies in the therapeutic level. Besides we should add that the ignorance that exists still among the professionals of the health about this question is notable.
2.- The processing while the processing of any chemical addiction pursues the final abstinence of the substance, in the case of the addiction al sex the abstinence is restricted al behavior of compulsive character. Some programs of processing advise the abstinence of any sexual behavior during a time that oscillates between 30 and 90 days so that the patient convince himself that he can dispense with the sex if he wants. During this time he is used to being frequent that some patients experience the same one sintomatología that corresponds to a syndrome of abstinence. Independently of which be the cause, to treat the addiction al sex is possible. The processing are used to combining therapy of psychological type (with cognitive-conductual cut techniques) that include the control of stimuli, the cognitive reevaluation of the erroneous beliefs with respect al sex or techniques of type aversivo as the sensibilización concealed, the training in problems resolution strategies or social abilities, the recondicionamiento orgasmic and the training in empathy by mentioning to some, along with support farmacólogico (inhibiting medicines of the Of the serotonin or antiandrogénicos) in the most serious cases. The work of group type can result cash by the social support that offers the group and the so much common occasion to share experiences for the addict as for the coadicto (couple). The group work favors the relations with people affected of the same problem so that the group aid to counteract the isolation and the feelings of stigmatization, guilt and low so common self-esteem among the sexoadictos. Likewise the group constitutes the adequate educational context for the prevention of fallen, the information about the sexuality, the development and the strengthening of social abilities and the alternatives solutions discovery to its problems. Due to that a sensitive proportion of addicted al sex frequently they have been object of sex abuse in its infancy, they possess a beliefs and a sense of the sexual health distorted that is done necessary to modify by means of the reevaluation cognitive and high dose of sexual education. The support that can offer the couple (if there be it) is done indispensable for an efficient recovery and this becomes one of the better indicators of favorable forecast. The possibility of them fallen should always have it present the addict. As a result of the previous thing, the training in prevention of fallen supposes a crucial part of the intervention so that the patient be able in every moment to be capable of recognizing the antecedents or the situations that cause the shot in his compulsive sexual impulse. The cycle of the sexual addiction begins with a series of obsessive thoughts that are defined like worrying and obsessive ideas, desires and emotions that disturb al subject. This is used to carrying partner the presence of anxiety and negative ideas of if same that to reduce they prompt al subject toward the addictive behavior. Just then the addict is used to experiencing a dissociation of his feelings and emotions and only he seeks the behavior that appease the anxiety moment in which he enters a state of alteration that already only pursues the behavior he desires-

18 once satisfied the same one or well to happen unexpectedly the ideas of fault and remorse or a new compulsive need that be capable to surpass in stimulation the previous. The implications for the intervention that of all the previous thing are deduced, they are that to
block the addictive cycle the subject should be capable of interrupt such cycle in the first phase, that that al corresponds start of the stress, the impulse or the pain that of new al impels him compulsive behavior, otherwise the interruption of the cycle in upper stadiums of
the cycle results of the all with every certainty to a new addictive behavior (to see graphic I)
Vicente Ángel Briet.
Profesor de la Universidad de Alicante.
Gráfico I; El ciclo de la adicción al sexo
Referencias bibliográficas:
Carnes, P.J (1991); Don´t Call it love: recovery from sexual addiction. New York: Bantam Books,
Carnes, P.J (1992); Out of the Shadows: understanding sexual addiction. Minneapolis: CompCare publishers.
Carnes, P.J (1989); Contrary to love: helping the sexual addict. Minneapolis: CompCare publishers.
Carrobles, J.A.; Sanz, A (1991).; Terapia sexual. Ed. UNED, fundación universidad empresa.
Kafka, M.P.; Prentky, R.A. (1997); Compulsive Sexual Behavior Characteristics. American Journal of
Psychiatry, 154,
Kaplan, H.S. (1979); Trastornos del deseo sexual. Ed. Grijalbo,
Labrador y otros (1994); Guia de la sexualidad. Ed: Guias Espasa,
Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM III-R y DSM IV) (1987 y 1995). Ed Masson
-Weiss, D. (1995); 101 Practical Exercises for Sexual Addiction. Discovery Press. ColoradoSprings.

19 PSYCHOLOGICAL EVALUATION PROTOCOL PROPOSAL IN SEX ABUSE Reference: Cueto, M.A.(2002) Gazette of Psychology. COP Andalusia Oriental. 16, 14-22. Summary we enter in the dark side of the sexuality with this type of aggression: the childlike sex abuse. The sexuality is a positive component of the human being. The childlike sexuality is very extensive, as various as that of
the adults and the childlike sexual demonstrations are used to being healthy when they are carried out of exploratory form and consented to a context socializador. Nevertheless, we affirm that the childlike sex abuse is somewhat negative. It is a type of violence that attentive against the integrity of the smaller one and can generate him pathologies of diverse kind. Sadly, it been present in all the cultures, social classes or races. In this exposition we will present diverse protocols of action before the sex abuse and we will carry out, finally, our interview protocol proposal and evaluation according to our experience in CEPTECO (Central Psychological of Therapy of Conduct) of Lion. Al to evaluate the sex abuse we find us in quicksands where is difficult to value the reliability and credibility of the witness, in this case the smaller one; since its memory is conditioned by emotional aspects in intimate conducts and is used to being mediatizada by people to the ones that wants and we want him. With this protocol we intend:
• to Do an efficient and fast appraisal of methodical form and ordinate to avoid a second
victimization eluding the repetitive actions in a possible subsequent judicial process.
• Sistematizar the appraisals in sex abuse. Our methodology itself center in diverse phases of the evaluation that we will divide them into:
• to Analyze the different tests of sex abuse.
• To Value the hypothesis in the statements and not reliable and reliable variables of the testimony of abuses by means of the use of the interview with the smaller one as central axis of our conclusions. We intend that the interview be systematic, fast and reliable.
• We Offer our model of appraisal of the credibility and validity based on the structure of the testimony, the details and emotions prepared, and the errors by memory next to the consistency of the statement.
• We will Not refer in this exposition to the form to devise the psychological expert report since we comment it in 1999 next to Carbajo. Key words: sex Abuse, credibility, victimization, testimony, psychological evaluation. Introduction a scientific consensus in two basic criteria Exists that define the sex abuse:
• Relation of inequality between aggressor and victim by means
of the compulsion strategies use, force, surprise, seduction or deceit.
• Use of the victim as sexual object with or without physical contact with caresses, sexual petitions, pornography or exhibitionism.

20 The rates of prevalence according to studies retrospectivos, in Spain, is of 15% children, 22% girls (López, 1995) similar to them found by Finkelhor and other (1990) in US with a 27% of women and 16% men. The sex abuse perceived generates a significant discomfort to a high percentage of the childlike population, interferes in its normal development and is used to to be carried out by other smaller in the 20% of the cases (López, 1997). It is used to to be committed in the family environment, by a male, by members of the own family or very close people to the smaller and in the 44% of the cases has not been limited to a remote act (López, 1995). The stripe of age is situated more frequently between the 6 and 12 years (Vázquez and Street, 1997). Not coincidence between the legal and psychological concept exists. By definition, in the psychological concept is understood that only the smaller one can suffer sex abuse; nevertheless in the legal one also the adults would be able to suffer them if does not exist neither violence neither intimidation. They are omitted in the legal concept some more subtle conducts of seduction and only they are reflected the deceit and the abuse of authority. Why a protocol of evaluation of the sex abuse we Present a protocol of sex abuse to smaller due to that our experience tells us that the psychological evaluations present certain abuse toward the smaller one since frequently we find us with:
• A secondary or tertiary victimization on the part of the:
- Professional: is permitted that the smaller one be evaluated by various psychologists in various different moments and in some cases with Scarce formation. - Institutional: scarce sensibility, when intervenes, of the judicial apparatus toward the smaller one. It tends him to permit that among the fact that relates and the judgment, if there is it, even al less two years (Sánchez and other, 2002).
• A high emotional price: tends Itself minusvalorar the consequences that for the smaller one can have the abuse and tends itself to doubt even of the truth of its statements. Al the same as the Institute of Psychology, Sexology and Medicine Espill of Valencia, with the one that from time to time we have collaborated, we intend to create a methodology of efficacy and efficiency by means of the development of a specific format of interview. Our methodology intends:
• to Protect al smaller normalizando the procedure of psychological evaluation al to carry out an interview with guarantees, of form specialized and continuing a sequence. We use the recording in video/audio as possible tests expert to avoid new testimonies of the smaller one and for the learning and improvement of the evaluators. We are used to using general and open questions.

• Sistematizar el procedimiento para conseguir una mínima intervención y evitar el excesivo
número de sesiones de evaluación para que sea más rápida y eficaz. Paliar, así mismo, las
posibles secuelas que podría sufrir el menor por el propio abuso o por el comportamiento de
los adultos a su cargo. Igualmente aprovechar para dar orientaciones a los responsables de
los menores sobre cómo protegerle y ayudarle, evitando, en lo posible, la magnificación de
un hecho que, quizá, podría no haber supuesto un problema importante para el menor.
• Analizar la fiabilidad y validez de las declaraciones de la forma más concisa y científica
posible. No solemos usar muñecos anatómicos y, si lo hacemos, el testimonio ha de seguirse
de verbalizaciones claras y evidentes.
21
Indicadores poco fiables en agresiones y abusos sexuales
En contra de la opinión generalizada, no existe ningún indicador verbal o no verbal que nos
indique la credibilidad o falsedad de la declaración salvo que conozcamos íntimamente al
testigo. Sólo existen algunos estudios que señalan que ciertas variables no tan controlables como
movimientos de articulaciones o expresiones microfaciales pueden darnos pistas sobre la
veracidad de las alegaciones. Se necesitan más estudios para comprobar qué variables serían
relevantes en este caso. Sólo ha habido un niño del que con sólo observar su nariz podríamos decir
si mintió o no.
Son varias las variables del testimonio en abusos sexuales que son poco fiables:
• Conductas verbales: volumen, tono, claridad, ritmo, duración.
• Conductas no verbales: mirada, sonrisa, proximidad, orientación, tono postural, aspectos
faciales, gestos.
• Alteraciones psicofisiológicas: tampoco las medidas o valoraciones emocionales durante el
relato nos acercarían a un mejor conocimiento de la credibilidad. Por otra parte, los resultados
del polígrafo no son fiables ya que existen personas que falsean los resultados y el coste
a nivel técnico y humano es muy alto.
• Otras valoraciones menos fiables: No hay síntomas específicos en el abuso sexual ni existe una
relación causal directa entre uno o varios síntomas. Y aún cuando el listado de síntomas fuera
fiable, con excesiva frecuencia se detectan durante el proceso que sigue a la denuncia.
Pero, ¿qué causó la alteración del menor, el abuso o el estrés derivado por la reacción de los
adultos a su alrededor o el posible procedimiento judicial posterior? No son tampoco fiables
las drogas de la verdad, hipnosis y regresión, estilometría, interpretación de los sueños, recuerdos
durante la terapia individual o en grupos con iguales (puede darse inducción), juegos
con muñecos anatómicos (no existen diferencias entre diversos grupos salvo un mayor número
de conductas sexuales).Reliable indicators of abuses and sexual aggressions Is difficult to test the sex abuse since only the testimony of the victim is used to include itself and the negative of the presumed selfish one. Nevertheless, on the part of:
• The victim:
- Is used to being reliable the testimony and the statements. The smaller they are used to maintaining it in secret hiding the abuses. It tends to value the credibility of the testimony, not of the witness, and if the events described correspond to facts really lived. The
children over 4-5 years are considered efficient and trustworthy witnesses and they have sufficient comprehension between the truth and the lie (Faller, 1990-93; Myers, 1994; Bussey and Grimbeek, 2000 and Koriat and other, 2001).
- Medical Tests: only a very low percentage present this type of probative indications and from time to time they can be symptomatic.
• Other sources: - Confessions of the selfish one (the majority deny it and only some they confirm them partly) or other confessions of ocular witnesses
or presents in the revelation can be us of great utility. Hypothesis of the testimony is studied in the statement the adaptation of the events described with him really lived, if a witness has lived or experienced what declares. Two they exist possible hypothesis in the testimony: • Truth: what tell be us certain as memory of something perceived. 22 • what affirm the witness be erroneous or an internal elaboration generated or externally. It can be for: - Incapacity: intellectual, mental, sensory or motórica
that him imposibilite to distinguish or to express it lived and it imagined. Problems exist mnésicos in less than 5 years. - Deceit: to declare in false consciously to obtain a benefit or to avoid a price. - Sugestionabilidad: memories distorted by external social influences. The hypothesis of truth only is seen confirmed when the others they can be rejected, and they are these the ones that should be verified. Phases of the interviews Of the errors we have learned that the sex abuse evaluation interview
should continue a determined sequence. We are used to carry out between 2 and 6 interviews:
• Initially we try to maintain a good one rapport with the smaller one:
- For it after presenting us mutually in the presence of the adult that him accompany by him we explain the motives of doing the interview, in the case that be pertinent, and we ask him authorization to transmit the information that its testimony offer us. If it comes accompanied by someone that know the facts, another professional of the team of CEPTECO him interview aside taking note of the details that possess on legal, family data, of the abuses, other characteristics of the smaller one and we ask him authorization for the recording of the interview. - We Request al smaller, follow, that a theme of interest relate us or a story that have him turned out pleasant to value its level of development. - Him is put to somewhat objective test telling him that the smaller one does not know to encourage him to express that "does not know" encouraging him to ask us if doubts something and we
congratulate him because of it. We are used to commenting him: "you know better than I what happened, I gave always the truth, do not do suppositions, if do not know something I gave do not I know, if I repeat a question does not he mean that your first answer be ill, if some question do not want to answer it can do it without problems, when
mistake me, correct me and if agree not with me, tell it me". - Subsequently we comment him something that can observe and that be not certain and we see the degree of sugestionabilidad that is produced. • In second place we listen the free story of the smaller one on the abuses. For it we use the cognitive interview (Memon and Bull, 1991
and Diges and Alonso, 1995) where we value processes and cognitive concepts (memory, scripts, mental models) and we develop it by means of 4 strategies: reinstauración cognitive of the context, emphasis in the recovery of all kinds of details, memory since different perspectives and since different starting points. According to Koriat and
other (2001) the smaller are used to reporting with greater accuracy when itself is not pressured them to obtain information and is reinforced them so that its story be truthful. In fact, we intend that the smaller one tell us what really recalls, that, though supposes a limitation, is more convenient than forcing him to obtain all the
information losing accuracy in the story.
• Subsequently we ask him explanations in the case that we have doubts on the testimony by means of the strategy of "not to understand" what counts us so that do us enlargements on the facts related. Said questions we do them specific and open. We avoid questions that have an answer of itself or not.
• Finally we are used to asking him that write us what the method has commented us by means of that desire (drawing or story) for the following session, where we will value the consistency and repetition in fact. Finally, we say good-bye of the smaller one congratulating him for the effort that is causing count us what happened.
Likewise, we give advice and orientation to the family on how confront this fact and to protect him better. 23 Methods of appraisal of the content of the statements The methods of appraisal of the content of the statements were used, initially, by the German psychology by means of the Analysis of the Reality of the Statement. It is practiced
since a decade ago. It is based on two fundamental suppositions:
• to Invent a history supposes greater cognitive demand. We base us on the Analysis of the Testimony to validate a story. • To be Agreed of something invented is more difficult than recalling it lived. It is used to compare stories in several occasions spaced by the time for
see if are maintained constant. Various methods exist to value the content and the validity of the statements in the specific theme of sex abuse:
• SALT (Sex Abuse Legitimacy. Gardner, 1987). Is a listing of actions and allegations that fictitious and real cases discriminate. Especially it designed when has access al presumed selfish and this is known by the smaller one. Is comprised of criteria of high, low and moderate value diferenciador.
• Model conceptual of Yung, 1992. It does an analysis of characteristics and prominent details in the statement.
• Prosecution of the information (OR´Donohue and Fanetti, 1996). It studies the modification hypothesis development in the memories and how processed the smaller one the same.
• NCAC (National Children´s Advocacy Center. Meats, Wilson and Nelson-Gardell, 1999). It is a
guide on how analyze all the allegations and tests obtained valuing the characteristics, coherence of the revelation, emotional style and motivacional.
• Guide of Mapes for the evaluation of the credibility and of the validity (Mapes, 1995). It compares and contrasts the
statements of the smaller one, values details, complications, organization, the possible slant of the interviewers, the environmental factors and sintomatología suffered.
• SVA-CBCA. Analysis of Validity of the Statement (Steller and Köehnken, 1989 and Raskin and Esplin,
1991). It is based on the criteria of the Dr. Undeustsch: criterion of reality (the statements of real events have greater number of peripheral details) and criterion of sequence (the true statements present more changes in peripheral aspects as the moment of the day and the
duration of the incident). The SVA is composed of three elements: Interview semiestructurada with open questions for slant not the statements of the smaller one, the analysis of the video by means of CBCA (analysis of contents based on criteria) and a list of validity that
values the cognitive and linguistic level of the smaller one, if the interview was done adequate, motives for a false statement and other evidences. The CBCA is divided at the same time in 19 criteria with 5 different categories. Nevertheless, they said study of contents
based on criteria is not sufficiently validated according to recent studies (Walls and other, 2002). The study of the final validity is done by means of 11 criteria included in 4 categories. All the procedures share the characteristic that the contents evaluated do not have
the same weight, but they depend on multiple factors (age of the smaller one, complexity of the facts, passing of time or the number of times that has had that to relate them). Appraisal of the credibility in the content of the statements A revelation is credible when the
conducts, affections and cognitions of the smaller one they are understandable and they are in harmony with the narration exposed. In Spain not a protocol arrived at by consensus among professionals on the appraisal of the credibility exists still of smaller in sex abuse.
The degree of accuracy depends on the characteristics of the event (frequency, intensity or duration), of the time that have elapsed, of the circumstances in which recall, the factors emotional associates and the motivation to report.
24 to Value the credibility is a puzzle where they should insert, like assembly metodológico, the different pieces of the story: a conscientious study of the summary, a good interview well structured and free of slants, to analyze the competence to declare of the witness and to value the accuracy and credibility in the story.
We in CEPTECO work with a strategy that is ourselves useful and that is vouched for by diverse studies, and adapted of the previous methods, especially of the CBCA. We think that is an efficient method of work that has shown a smaller slant of the interviewer and that can indicate a greater index of credibility of the statements (Offe, 2001). For said verification we study the existence or not of the following data to the ones that we give an appraisal of omitted by NP = not pertinent, 0 = Absent and 1=Presente. We value the following criteria: 1 Structure of the testimony: we Analyze the coherence and logical consistency in the narration and its production. If all the story makes sense can think that is certain. 2. Details contextuales: is based on that the reality lived is more concrete and richer in peripheral details that the fantaseada. For them we analyze:
• prior space-temporary Context and subsequent that describes.
• Victim-selfish Interaction and
conversations. If the reproduction of the same is literal and that differentiate more roles, greater probability has the certain story to be.
• Complications and misfortunes. They reinforce the validity of the story. Is the most certain variable in the empirical investigations.
• If the details besides are unusual and superfluous more truthful will be the statement.
• Progressiveness and pecularities they do more credible the possibility of the abuse.
3 Emotions prepared: Explanations on their mental state and mental attribution of the selfish one during the abuses lived.
4 Appraisal of the facts: Capacity of the smaller one to devise an explanation with diverse contents that, in principle, would be able to think that they damage their credibility. For it we study:
• spontaneous Corrections and failures in the memory in some part of the incident or of their own testimony.
• Initial Guilt by the consequences for the defendant when is known.
• Guilt by participating in sexual acts. They reproach to itself by a reprehensible conduct socially.
• Pardon or I discharge al attacking and resistance and indecision in the revelation. Done not they accuse him, if is the ancestor, in other negative conducts. Normally, the real victims are unwilling to relate the facts, they present
fear to not to be believed, by the threats received, or they feel shame.

25 Appraisal of the validity in the content of the statements A testimony is valid or truthful only when the memory is a correct representation of what happened and is adapted to the reality happened. It supports al analysis of the statement and analyzes processes contextuales referred to the characteristics of the interview, motivation to report and consistency of the statement. 1 psychological Evaluation of the witness: we Value a series of indispensable cognitive abilities so that the same one be credible:
• Attention and precision of the memory: The children and the girls over 5-6 years can provide a credible testimony if they are interviewed for professionals qualified.
• Distinction between fantasy and reality.
• Vulnerability for the so much suggestion of the adults that surround al witness as of the interviewer.
• Capacity of truth. The smaller do not be used to lying.
• Adaptation of the language and of the knowledge, the coherence conductual and emotional during the story.
• They Been mental: to rule out pathologies invalidantes. 2 Characteristics of the interview:
• Type of questions. Ruling out the testimony if has had you ask alluring, tendentious, repetitive or coercive, or a slant of the interviewer.
• Global Adaptation of the interview al evolutionary level of the boy.
• Exposition of the rules: the interviewer affirms not to know what occurred, truth asks him and permits him to be able to answer "do not I know" and not to be left to manipulate (to correct al interviewer, to avoid sugestionabilidad). 3 Motivation to report on the abuse:
• Pressures: For report in false,
of bribe for reveal not the abuses.
• Prior Relation among victim and abused before the accusation.
• Context of the revelation or initial report.
• Contamination of the story for some external source or contact with other professionals.
• Absence of the Syndrome of Alienation Parental.
• Dispute or lawsuit by the custody and secondary benefits added by the victim or the attendant.
• Retractions. Valuing the fear to the retaliations or by feeling of fault. 4 Consistency of the testimony:
• Other statements: ocular witnesses, confession of the perpetrator, seductive conduct referred by the mother, if is the ancestor.
• Other evidences: medical tests, photographic tests, subsequent inconveniences, frequent episodes of subsequent sexual excitement al abuse.
• Constancy through the time. The coincidences they value themselves, aggregates, contradictions. It is used to coinciding the fundamental event, role or activity performed by the witness, people that participated in the fundamental event, the place of the facts, directly prominent objects for the action, conditions of light and global position of the body in the case of corporal actions. Valuing contradictory data since the initial report.

26 Finally the story is catalogued of credible, indeterminate or not credible. We propose this criterion of appraisal of the credibility of the statements as part of a general protocol of action to avoid a second victimization of the smaller one. Although the Analysis of contents based on criteria is not a quantitative method to evaluate the truth of a testimony due to the subjetividad in the classification, difficulty in the classification of criteria and its ponderación, seems us valid for the analysis of the credibility and validity of the story. Nevertheless, still a long road remains us by traveling through to analyze objectively the credibility of it related. Bibliography Alonso, J. and other (1999) Guide of action of the psychologist in the sex abuse and other abuses in the infancy. COP of Catalonia. Alonso-Quectuty, M.L. (1991) Lie and testimony: the forensic report of the credibility. Yearbook of legal psychology, 55-66. - (1999) Evaluation of the credibility of the statements of smaller victims of crimes against the sexual liberty. Roles of the psychologist, 73, 36-40. Arruabarrena, M.I. and Paul, J. (1996) Abuse to the children in the family. Madrid. Pyramid. Suffice, B. (1991) sex Abuse in the children. Barcelona. Herder. Canton, J. and Cortez, SEA. (1997) Bad deals and childlike sex abuse. Madrid. 21st century. - (2000) Guide for the evaluation of the childlike sex abuse. Madrid. Pyramid. Married, J. and other (1997) Children mistreated. Madrid. Díaz of Saints. Snail, JUL. (1998) Manual of integral aid to the sexual aggression victims women. Barcelona. Freemason. - (1999) Manual of social, legal, police, and sanitary action set against domestic violence. Barcelona. Masson. Cueto, M.TO. and Carbajo, E. (1998) Model of expert psychological report on sexual abuse against minors in Borrás, J. and Pérez, M. (eds.) Sexuality and Human Rights. Valencia. Nau. - (1999) psychological expert Report in sex abuse to smaller. Sexual therapy and of couple, 4, 58-75. Cueto, M.TO. (2001) basic Information of sex abuse to smaller in Minutes I Days of Sexology of Castille and Leon. - (2001) Credibility of the declarations in victims of sexual abuse in Abstracts book. XVth World Congress of Sexology. Díaz-gardens, J.TO. and other (eds) (2000) sex Abuse in the infancy. Madrid. Díaz of Saints. Diges, M. and Alonso-Quecuty, M.L. (1993) experimental forensic Psychology. Valencia. Promolibro. Echeburúa, E. and other (1998) Evaluation of the validity of the sex abuse victims testimony in the infancy. Spanish magazine of Forensic Psychiatry, Forensic Psychology and Criminology, 5, 7-16. Echeburúa, E. and Guerricaechevarría, C. (2000) sex Abuse in the infancy: victims and attacking. Barcelona. Ariel. Fariña, F. and Maple, R. Psychology and judicial investigation. Madrid. Foundation University-Business. Filkelhor, D. and other (1990) Sexual abuse in to national survey of adult men and women: prevalence, characteristics and risk factors. Child Abuse and Neglect, 14, 19-28. Gardner, R.TO. (Comp.) (1987) The parenteral alienation syndrome between fabricated and genuine child sex abuse. Cresskill (N.J.) Creative Therapeutics. Oven, P. (coord.) (2001) childlike sex Abuse. Manual of formation for professionals. Madrid. Save the Children.
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28 CLINICAL STUDY ON COUPLES IN CRISIS Data accumulated during the last ten years on heterosexual couples. Number of treated couples: 503 Number of couples that surpass the crisis: 379 Number of couples that decide to be separated: 124 Percentage of for months MAIN separations CONCLUSIONS 1. In the months of
September and January is increased the demand of processing. - The increment of September is related to the conflicts arisen during the vacation period. - The increment of January is related to discrepancies arisen during the festivals of Christmas. 2. The 27% of the couples in crisis they decide to break the relation during the holidays of summer. 3. The 22% of the couples in crisis they decide to break the relation by relational discords and divergences arisen during the Christmas festivals. 4. Among the couples that decide to be separated, the 20% they do it of mutual agreement, the 55% they do it for female initiative, and the 25% they do it for male initiative. 5. On a sample of 116 people that left their couple to be implied in a new relation, the 48% they repent of their decision. 6. Analyzing its operation they can be established three different variables from crisis of couple: - divergent Couples - Couples saturated - Couples disillusioned

29 DIVERGENT COUPLES Are used to carrying 15 ó 20 years of contact and during that time each one of them has evolved of different form. Each which has its own interests and during the remainder of the year they are installed in its respective vital projects with the sufficient autonomy as so that the contact result more or less comfortable. They do the love very few times but not even they find it to lack, until, normally during the holidays, they realize the far away thing that are. Then they tell themselves the one al another that that cannot be, that should pass more together time and they decide to revive their sexuality with very diverse results. To some it serves them to be given account that already no sense makes to maintain the bond and other they decide that is worth while to work to regenerate the relation. These are the ones that are used to responding in September al terapeuta of couple. And the other they are the ones that will continue a year more its divergent roads until in a new occasion in which themselves incremente the time of contact they be questioned again the relation.

30 COUPLES SATURATED
Of the three variant is used to being the most serious one and the one that presents worse forecast. Is a matter of tired couples to endure the multiple conflicts appeared during the years of contact well be for question of character,
project of life or scale of values. The crisis by saturation they are used to presenting from the 5 years of contact (when they are bilateral) or from the 10 years (when they are unilateral), presenting each one of them casuistic different that we are going
to try to summarize. Bilateral saturation is produced because the two components of the couple have few things in common except an initial sexual desire that goes deteriorating with the contact and the conflicts. As a result of it to the extent that the
passionate phase goes consuming and the conflicts go accumulating, the relational tension goes growing until arrives a day that no longer they are borne. Evidently the crisis by saturation can be produced at any moment of the year, but naturally the holidays are a factor of complementary risk because, al to increase the hours of contact and with them the possibilities of graze and discrepancies, is easier than the parts they reach its respective threshold of saturation and they come to the conclusion that no sense makes to continue maintaining a relation that damages to both without benefiting Nobody. Unilateral saturationThis variant one is produced when the couple has obtained its equilibrium at the cost of that one of the parts renounce, in greater or smaller degree, to its form to be to avoid conflicts of relation. In those cases a false joint of couple is produced in which the part that sacrifices its identity goes accumulating frustration and resentment until al tip of the years, comes to the conclusion that does not be worth while to stop being one same to be able to be with the other and decides to leave the relation or to present its restructuring on more egalitarian parameters. The unilateral saturation are more frequent in the women that in the men because, according to the bosses sexistas that have dominated in our culture, the women have been educated to be patients and comprehensive with the couple, while the men, according to the principles of the double morale, privileges they have been permitted and liberties that no longer can maintain for the simple reason that the women already Them do not they accept. Therefore they are many ones that when carry 15 ó 20 years enduring an unjust model of relation enter crisis with them same for enter not crisis with their couples, or they enter crisis with the couple to be able to recover their self-esteem, coherence and interior liberty. And is used to being on holiday when is clearer still than the sacrifice for the benefit of the harmony of the family only is not socially unjust, but highly destabilizing for the psychological equilibrium. Then it is when many decide that the hour to act has arrived, which always produces important conflicts; because in the same proportion that are saturated, its couples are usual to a plan that benefits them and al that are not going to renounce without putting up a fight.

30 COUPLES DISILLUSIONED
Is the most frequent one, but the less serious of the crisis, because is used to producing among young couples that carry few together years, with which is possible that be limited to an emotional problem without family implications because many yet have not had time to have children or they have determined not to have them. The crisis of the disenchantment is one of the earliest than they should confront all the couples to be consolidated as such and is not infrequent that arise already in the first or second holidays that pass together. These couples are formed by people that are attracted physically and they have a good level of sexual joint, but whose anxieties and characters are not too much coincidentes. Because of it, to the extent that the passionate phase is consumed, that is used to lasting the first two or three years, both go becoming aware of that, save to do the love, they prefer to pass the time in company of more people, because alone they are bored. They do not know what to do, where to go, or what to be told, therefore, to this type of couples the "charm" of the holidays is used to service for the disenchantment of the relation, although by fortune for them they will not have to pass for a phenomenon that I have qualified as law of saturation of the contact, that is typical of the crisis of the divergent couples and the couples saturated, because is used to producing in the couples Stable of long duration. Law of saturation of the contact
1º The positive stimuli go losing importance as a result of our innate capacity of accustoming us to the gratifying experiences.
2º The negative stimuli go gaining importance as a result of our innate difficulty to accept
unpleasant experiences without us produce frustration and resentment.
3º The combination of both factors does that with the years, the virtues of the couple value itself less and the defects more, by which each time turns out to be more difficult to do a positive appraisal of the global
balance of the contact.

FINAL REFLECTION
The crisis they can be surpassed when both parts are capable of analyzing what is occurring and when instead of seeking guilty they prefer to seek solutions. All the couples have crisis but not all the couples enter crisis because of it. By
fortune each problem surpassed and each resolved conflict is a source of important energy that the couple can invest in its strengthening and regeneration.

DECALOGUE FOR THE PREVENTION OF THE CRISIS OF COUPLE
1. It tries to be sincere since the sensibleness.
2. Thinks that what occurs between two never is responsibility of one alone.
3. It thinks that the selfishness of the other only can be detected since the own selfishness.
4. You do not endeavor so that understand you the other but to understand al another.
5. Do not you confuse a couple for always with being always with the couple.
6. Do not you confuse the stability with the routine.
7. Recalls that the couple functions better with reinforcements that with efforts.
8. Recalls that the couple cannot function only with sex but neither without sex.
9. It recalls that to live together implies to grant.
10. Recalls that the couple that hard is the one that mature. Antoni Bolinches Psychological Institute Antoni Bolinches

31 STUDY ON THE ATTITUDES AND THE SEXUAL HABITS IN SPAIN HABITS AND BOSSES DURING THE ACT
In terms of behavior, has been observed in the study, that the Spaniards show to continue some habits and bosses, that denote a certain planning in the sexual practices: If we take as point of reference the chosen moment for the act we discover that, according to:
• The day of the Week: one of each two Spaniards is used to having sexual relations with certain asiduidad in a/you concrete day/s of the week (in this sense, the weekend is presented like the period by excellence)
• A moment in concrete: the 77% of them interviewed is used to reserving a concrete moment of the day for their sexual practices (being the night the moment preferred). Nevertheless, in relation al place, we should emphasize that:
• A 66% of them interviewed is used to doing the love in the same place; on the contrary, only a 33% they present an attitude more trasgresora in this aspect.
• A 52% of them they interviewed affirms not to give him importance to the ambientación of the place where are going to have the sexual relations.

PLANNING IN THE ACT TO
the question on if specific situations are sought to incite to the couple to carry out the act, there is always for the Spaniards and, according to the study, a higher probability of have sexual relations in: the escapades of weekend (67% of them interviewed affirms that is very probable), before sleep (49%), after a supper out of house and, finally, After the celebration of an event. The preliminary play are a habitual practice in the sexual relations of the Spaniards (a 93% of them interviewed affirms that they exist in their intent the east relation of "semi-planning" of the sexual relations is a more own behavior of the youngest public (18 to 24 years), of those that do not live with their couple and, finally, those that they have established recently a stable relation (less than 10 years). This experience of the sexual relations is justified more because, inside this segment, a greater one exist proactividad toward the planning by the major physical distancing (do not they share flat), those that have more sporadic contacts or, the ones that have a fixed place to maintain sexual relations.
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