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10 Sex Tips for the Best Action You’ve Ever Gotten – How to be best in bed.

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When it comes to knowing what makes your partner tick in the bedroom, tutorials on “mind-blowing sex positions” only get you so far. Stimulating and gratifying sex is all in the timing, the communication, and spontaneity, according to Dr. Bea Jaffrey—a clinical psychologist and psychotherapist based in Switzerland—and Mary Jo Rapini, a Houston-based psychiatrist and sex therapist. Keep scrolling to find expert suggestions from Rapini on what works in the bedroom and tips from Jaffrey’s new book on overcoming common sex issues, 159 Mistakes Couples Make in the Bedroom.

1. Tell Him What Turns You On

Research suggests that better communication is key to better sex, and no, we don’t necessarily mean dirty talk. Communicating what you like and don’t like can be instructional and informative as you get to know each other’s bodies. If he’s doing something you like, say so rather than relying on ambiguous gestures or noises. And if it’s something you’re not into, communicate that or guide him in a new direction. Want to try a different angle? Suggest one. If simultaneous orgasm is your goal and you’re close to climaxing, don’t be mum about it.

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2. Don’t Underestimate the Power of Praise

In a 2016 study published in the Journal of Sex Research, researchers analyzed answers from 39,000 heterosexual couples that were married or cohabiting for over three years. Sexual satisfaction reported to be higher among the couples who revealed that they gave each other positive affirmation during sex and were open enough about embarrassing moments during sex to joke about them and move on. Dr. Jaffrey notes that this lighthearted approach to sex is key, saying, “Don’t take life too seriously. Happy couples laugh together.”

3. Keep Things Spontaneous

Even great sex can start to feel monotonous over time if it’s more or less the same old routine. To mix things up, Marie Claire’s guy expert Lodro Rinzler suggests that “if you’re in bed with someone and have a sense of something new you or your partner might enjoy, be it some teasing, a change in position, anything…go for it. Men love it when women are spontaneous and confident in their ability in bed.”

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Dr. Jaffrey also recommends switching up the time and place to avoid falling into a rut of once-a-week “duty sex.” “Try new places to have sex, maybe on the sofa, in the car or on the kitchen countertops? Or how about the back row of a movie theater? Be careful though because sex is illegal in public places. Try role-playing…take a bath together. Be inventive, have fun.”

4. Think of Foreplay as a Long-Term Act

Jaffrey notes that setting the mood for sex is vital, for women especially, and that foreplay should start long before sex even begins: “I am talking here about the mental foreplay that happens days in advance, not the one that you have just before sex. Make sure to be attentive to your partner. Small gestures and nice comments are significant to setting the right mood for sex.” She also suggests keeping up communication during the day through texts or emails.

5. Exercise and Don’t Skimp on the D (the *Vitamin* D)

If anyone doubted the power of exercise, there’s a good chance the Class Pass subscription you passed up this year is affecting your sex drive. “Exercise improves circulation in the body, and that includes the blood flow to your genital area, consequently increasing the desire and lifting your mood”. We’re sure those endorphins don’t hurt.

And as for those of us city dwellers lacking in vitamin D? “Even during the summer, we don’t get enough vitamin D because we’re scared of the UV rays causing us skin cancer and premature aging,” says Dr. Jaffrey. “Though too much sun can be damaging to the skin, Vitamin D is essential for estrogen production in women and testosterone production in men. It boosts your libido so if you feel friskier during the summer, this is the reason.” Our pressing spring fever questions answered? We think yes.

6. Go for Morning Sex or Afternoon Delight

Dr. Jaffrey notes in her new book that a major reason for mismatched desire between couples is the way men and women handle stress during the week. Men, she says, see sex as a stress reliever while women want to have sex after they’ve had time to unwind. As a result, women tend to go to bed exhausted, their minds focused on preparing for the next day.

Her solution? “A better alternative is to have sex in the morning. Set the alarm 30 minutes before your usual time and see what happens. Men’s testosterone levels peak in the morning so you might be pleasantly surprised…Another alternative would be to have afternoon sex on weekends. Interestingly enough, women tend to ovulate in the afternoon, meaning that the optimal hormone level for female sexual desire happens at that time.”

“Men see sex as a stress reliever while women want to have sex after they’ve had time to unwind.”

7. Expand Your Vocabulary

The power of sexy banter in the bedroom gets underplayed, but it can be a serious mood-enhancer when you’re trying to liven things up together. Going about that, however, isn’t the easiest for people who aren’t used to actually vocalizing 50 Shades-esque fantasies. “What my [clients] benefit the most from is when they go to a bookstore or they go online and they find an erotic book,” says Rapini. She suggests that couples read from erotic books together, especially if they want to work on developing a “dirty talk” vocabulary that gives them the language cues without feeling self-conscious.Reading off scripts, she says, never works as well as if couples find a book they really like together and can build off of that jargon.

8. Experiment with Toys and Props

One way that Rapini counsels long-term couples on how to explore the unknown to enhance their sexual experience is to try shopping for products and toys together. That could mean anything from couples’ vibrators (she recommends the remote-controlled Fiera) to massage oils to body paint to blindfolds, though Rapini says another way to set the scene is to try adding music as sexy background noise. “Make massage part of your routine and start touching each other. Many couples will start feeling their libido rise after they do that,” she says.

9. Do Chores Together

Sure, as trivial as it sounds, doing housework together not only makes you better roommates that are less likely to blow up over a stack of dishes, but also helps couples have more satisfying sex. According to a 2016 study published in the Journal of Marriage and Family, sharing household duties encourages an “eroticism of fairness,” in which there’s a turn on from both genders sharing roles that are traditionally relegated to women exclusively. Scientific proof that partners who want to share cooking and cleaning duties are sexier in the bedroom? Say no more.

10. Focus on Quality Rather Than Quantity

There isn’t really one golden rule, but a recent study suggested that more sex doesn’t mean better sex and that the happiest couples have sex only once a week. So if you’re anxious about you and your partner not screwing like rabbits, there’s proof that the more energy you put into making regular weekly sex *better* will pay off in the long run.

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9 things your Man should do to be a super star in Bed.

Improve male sexual performance

If you’re looking to maintain sexual activity in bed all night, you’re not alone. Many men are looking for ways to enhance their sexual performance. This can include improving existing problems or searching for new ways to keep your partner happy.

Read More About: All you Need to Know About Orgasm

There are plenty of male enhancement pills on the market, but there are many simple ways to stay firmer and last longer without having to visit the pharmacy.

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Keep in mind that your penis works on blood pressure, and make sure your circulatory system is working at top shape. Basically, what’s good for your heart is good for your sexual health.

Keep reading to find other easy ways to improve your sexual performance.

1. Stay active

One of the best ways to improve your health is cardiovascular exercise. Sex might get your heart rate up, but regular exercise can help your sexual performance by keeping your heart in shape. Thirty minutes a day of sweat-breaking exercise, such as running and swimming, can do wonders to boost your libido.

Read More About: 10 Sex Tips for the Best Action You’ve Ever Gotten – How to be best in bed.

2. Eat these fruits and vegetables

Certain foods can also help you increase blood flow. They include:

  • onions and garlic: These foods may not be great for your breath, but they can help your blood circulation.
  • bananas: This potassium-rich fruit can help lower your blood pressure, which can benefit your important sexual parts and boost sexual performance.
  • chilies and peppers: All-natural spicy foods help your blood flow by reducing hypertension and inflammation.

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3. Eat these meats and other foods

Here are some more foods that can help you achieve better blood flow:

  • omega-3 fatty acids: This type of fat increases blood flow. You can find it in salmon, tuna, avocados, and olive oil.
  • vitamin B-1: This vitamin helps signals in your nervous system move quicker, including signals from your brain to your penis. It’s found in pork, peanuts, and kidney beans.
  • eggs: High in other B vitamins, eggs help balance hormone levels. This can decrease stress that often inhibits an erection.

Read About: Health benefits of sex

4. Reduce stress

Stress can wreak havoc on all areas of your health, including your libido. Stress increases your heart rate (in the bad way) and increases blood pressure. Both of these are damaging to sexual desire and performance. Psychological stress can also affect achieving an erection or reaching an orgasm. Exercise is a great way to reduce stress and improve your health. Talking to your partner about your stress can also calm you down, while strengthening your relationship at the same time.

Stress can also trigger bad habits, such as smoking or alcohol consumption, which can harm your sexual performance.

See THE : Health benefits of masturbation

5. Kick bad habits

What you rely on to unwind, such as smoking and consuming alcohol, could also affect sexual performance. While studies suggest that a little red wine can improve circulation, too much alcohol can have adverse effects.

Stimulants narrow blood vessels and have been linked to impotence. Cutting down or quitting smoking is one of the first steps to improve performance. Replacing bad habits with healthy ones, such as exercise and eating well, can help boost sexual health.

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6. Get some sun

Sunlight stops the body’s production of melatonin. This hormone helps us sleep but also quiets our sexual urges. Less melatonin means the potential for more sexual desire.

Getting outside and letting the sun hit your skin can help wake up your sex drive, especially during the winter months when the body produces more melatonin.

7. Masturbation and longevity

Get Answers from a Doctor in Minutes, Anytime

Have medical questions? Connect with a board-certified, experienced doctor online or by phone. Pediatricians and other specialists available 24/7.

If you’re not lasting as long as you’d like in bed, you might need some practice. While sex is the best way to practice for sex, masturbation can also help you improve your longevity.

However, how you masturbate could have detrimental effects. If you rush through it, you could inadvertently decrease the time you last with your partner. The secret is making it last, just like you want to when you’re not alone.

8. Pay attention to your partner

Sex isn’t a one-way street. Paying special attention to your partner’s desires not only makes sex pleasurable for them, but it can also help turn you on or slow you down. Talking about this beforehand can help ease any awkwardness if you need to slow down during a heated moment.

Alternating pace or focusing on your partner while you take a break can make for a more enjoyable experience for both of you.

9. Getting more help

If you have erectile dysfunction, Peyronie’s disease, or other diagnosed disorders, you may need medical treatment. Don’t hesitate to talk to your doctor about how you can improve your sexual performance.

It’s never a bad decision to exercise, eat right, and enjoy your sex life to the fullest.


The Effect of good Sex on Our Brains

Sex! Sex! Sex! Having sex can flavor our nights, and days, with sweet pleasure and excitement, relieving stress and worry. And, of course, sex has been key to ensuring that the human race lives on. In this article, we ask, “How does sex impact what happens in the brain?” To Install Our Application Click HERE

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Sexual intercourse is known to impact the way in which the rest of our body functions.

Recent studies have shown that it can have an effect on how much we eat, and how well the heart functions.

As we have reported on Medical News Today, sex has been cited as an effective method of burning calories, with scientists noting that appetite is reduced in the aftermath.

Also, a study published in the Journal of Health and Social Behavior in 2016 found that women who have satisfying sex later in life might be better protected against the risk of high blood pressure.

Many of the effects of sex on the body are actually tied to the way in which this pastime influences brain activity and the release of hormones in the central nervous system.

Here, we explain what happens in the brain when we are sexually stimulated, and we look at how this activity can lead to changes in mood, metabolism, and the perception of pain.

Brain activity and sexual stimulation

For both men and women, sexual stimulation and satisfaction have been demonstrated to increase the activity of brain networks related to pain and emotional states, as well as to the reward system.

This led some researchers to liken sex to other stimulants from which we expect an instant “high,” such as drugs and alcohol.

The brain and penile stimulation

A 2005 study by researchers at the University Medical Center Groningen in the Netherlands used positron emission tomography scans to monitor the cerebral blood flow of male participants while their genitals were being stimulated by their female partners.

The scans demonstrated that stimulating the erect penis increased blood flow in the posterior insula and the secondary somatosensory cortex in the right hemisphere of the brain, while decreasing it in the right amygdala.

The insula is a part of the brain that has been tied to processing emotions, as well as to sensations of pain and warmth. Similarly, the secondary somatosensory cortex is thought to play an important role in encoding sensations of pain.

As for the amygdala, it is known to be involved in the regulation of emotions, and dysregulations of its activity have been tied to the development of anxiety disorders.

An older study from the same university — which focused on brain regions that were activated at the time of ejaculation — found that there was an increase in blood flow to the cerebellum, which also plays a key role in the processing of emotions.

The researchers liken the activation of the cerebellum during ejaculation to the pleasure rush caused by other activities that stimulate the brain’s reward system.

"Our results correspond with reports of cerebellar activation during heroin rush, sexual arousal, listening to pleasurable music, and monetary reward."

The brain and the female orgasm

In a study of the female orgasm that was conducted last year, scientists from Rutgers University in Newark, NJ, monitored the brain activity of 10 female participants as they achieved the peak of their pleasure — either by self-stimulation or by being stimulated by their partners.

The regions that were “significantly activated” during orgasm, the team found, included part of the prefrontal cortex, the orbitofrontal cortex, the insula, the cingulate gyrus, and the cerebellum.

These brain regions are variously involved in the processing of emotions and sensations of pain, as well as in the regulation of some metabolic processes and decision-making.

Another study previously covered on MNT suggested that the rhythmic and pleasurable stimulation associated with orgasm puts the brain in a trance-like state. Study author Adam Safron compares the effect of female orgasms on the brain to that induced by dancing or listening to music.

“Music and dance may be the only things that come close to sexual interaction in their power to entrain neural rhythms and produce sensory absorption and trance,” he writes.

“That is,” he adds, “the reasons we enjoy sexual experiences may overlap heavily with the reasons we enjoy musical experience, both in terms of proximate (i.e. neural entrainment and induction of trance-like states) and ultimate (i.e. mate choice and bonding) levels of causation.”

Sex and hormonal activity

So what does this all mean? In essence, it means that sex can impact our mood — normally for the better, but sometimes for the worse.

couple kissing in bed

Having sex has repeatedly been associated with improved moods and psychological, as well as physiological, relaxation.

The reason behind why we may feel that stressimpacts us less after a session between the sheets is due to a brain region called the hypothalamus.

The hypothalamus dictates the release of a hormone called oxytocin.

Higher levels of oxytocin can make us feel more relaxed, as studies have noted that it can offset the effects of cortisol, the hormone linked with an increased state of stress.

Not only does oxytocin make us calmer, but it also dampens our sense of pain. A study from 2013 found that this hormone could relieve headaches in individuals living with them as a chronic condition.

Another study from 2013 suggested that a different set of hormones that are released during sexual intercourse — called endorphins — can also relieve the pain associated with cluster headaches.

Can sex also make us feel down?

The answer to that, unfortunately, is “yes.” While s3x is generally hailed as a great natural remedy for the blues, a small segment of the population actually report an instant down rather than an instant high after engaging in this activity.

This condition is known as “postcoital dysphoria,” and its causes remain largely unknown. One study conducted in 2010 interviewed 222 female university students to better understand its effects.

Of these participants, 32.9 percent said that they had experienced negative moods after sex.

The team noted that a lifelong prevalence of this condition could be down to past traumatic events. In most cases, however, its causes remained unclear and a biological predisposition could not be eliminated.

“This draws attention to the unique nature of [postcoital dysphoria], where the melancholy is limited only to the period following sexual intercourse and the individual cannot explain why the dysphoria occurs,” the authors write.

Sex may lead to better sleep

Studies have shown that sexual intercourse can also improve sleep. After an orgasm, the body also releases higher levels of a hormone called prolactin, which is known to play a key role in sleep.

Researchers from Central Queensland University in Australia also hypothesized that the release of oxytocin during sex may act as a sedative, leading to a better night’s sleep.

In the case of men, ejaculation has been found to reduce activity in the prefrontal cortex, which is a brain region known to benefit particularly from a good night’s sleep.

In sleep, the prefrontal cortex exhibits the slowest brainwave activity compared with other brain regions, which supports the proper execution of cognitive functions during the daytime.

Researchers say that sex may lead to better cognitive functioning in older age, protecting people from memory loss and other cognitive impairments. Studies have shown that “older men who are sexually active […] have increased levels of general cognitive function.”

For women, being sexually active later in life appears to sustain memory recall, specifically. These effects may be due to the action of hormones such as testosterone and oxytocin, which are influenced by intercourse.

So, next time you’re about to slip between the sheets with that special someone, just know that this moment of passion will spark a whole neural firework show, releasing a special hormonal cocktail that will, at its best, charge a whole set of biological batteries.

All you need to know about orgasms

The orgasm is widely regarded as the peak of sexual excitement. It is a powerful feeling of physical pleasure and sensation, which includes a discharge of accumulated erotic tension.

Overall though, not a great deal is known about the orgasm, and over the past century, theories about the orgasm and its nature have shifted dramatically. For instance, healthcare experts have only relatively recently come round to the idea of the female orgasm, with many doctors as recently as the 1970s claiming that it was normal for women not to experience them.

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In this article, we will explain what an orgasm is in men and women, why it happens, and explain some common misconceptions.

Fast facts on orgasms

  • Medical professionals and mental health professionals define orgasms differently.
  • Orgasms have multiple potential health benefits due to the hormones and other chemicals that are released by the body during an orgasm.
  • Orgasms do not only occur during sexual stimulation.
  • People of all genders can experience orgasm disorders.
  • An estimated 1 in 3 men have experienced premature ejaculation.

 

What is an orgasm?

Orgasms can be defined in different ways using different criteria. Medical professionals have used physiological changes to the body as a basis for a definition, whereas psychologists and mental health professionals have used emotional and cognitive changes. A single, overarching explanation of the orgasm does not currently exist.

Influential research

Couple sharing an orgasm

Alfred Kinsey’s Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953) sought to build “an objectively determined body of fact and sex,” through the use of in-depth interviews, challenging currently held views about sex.

The spirit of this work was taken forward by William H. Masters and Virginia Johnson in their work, Human Sexual Response (1986) – a real-time observational study of the physiological effects of various sexual acts. This research led to the establishment of sexology as a scientific discipline and is still an important part of today’s theories on orgasms.


Orgasm models

Sex researchers have defined orgasms within staged models of sexual response. Although the orgasm process can differ greatly between individuals, several basic physiological changes have been identified that tend to occur in the majority of incidences.

The following models are patterns that have been found to occur in all forms of sexual response and are not limited solely to penile-vaginal intercourse.

Master and Johnson’s Four-Phase Model:

  1. excitement
  2. plateau
  3. orgasm
  4. resolution

Kaplan’s Three-Stage Model:

Kaplan’s model differs from most other sexual response models as it includes desire – most models tend to avoid including non-genital changes. It is also important to note that not all sexual activity is preceded by desire.

  1. desire
  2. excitement
  3. orgasm

Potential health benefits of orgasm

Nurse holding prostate model

The male orgasm may protect against prostate cancer.

A cohort study published in 1997 suggested that the risk of mortality was considerably lower in men with a high frequency of orgasm than men with a low frequency of orgasm.

This is counter to the view in many cultures worldwide that the pleasure of the orgasm is “secured at the cost of vigor and wellbeing.”

There is some evidence that frequent ejaculation might reduce the risk of prostate cancer. A team of researchers found that the risk for prostate cancer was 20 percent lower in men who ejaculated at least 21 times a month compared with men who ejaculated just 4 to 7 times a month.

Several hormones that are released during orgasm have been identified, such as oxytocin and DHEA; some studies suggest that these hormones could have protective qualities against cancers and heart disease. Oxytocin and other endorphins released during male and female orgasm have also been found to work as relaxants.

Types

Unsurprisingly, given that experts are yet to come to a consensus regarding the definition of an orgasm, there are multiple different forms of categorization for orgasms.

The psychoanalyst Sigmund Freud distinguished female orgasms as clitoral in the young and immature, and vaginal in those with a healthy sexual response. In contrast, the sex researcher Betty Dodson has defined at least nine different forms of orgasm, biased toward genital stimulation, based on her research. Here is a selection of them:

  • Combination or blended orgasms: a variety of different orgasmic experiences blended together.
  • Multiple orgasms: a series of orgasms over a short period rather than a singular one.
  • Pressure orgasms: orgasms that arise from the indirect stimulation of applied pressure. A form of self-stimulation that is more common in children.
  • Relaxation orgasms: orgasm deriving from deep relaxation during sexual stimulation.
  • Tension orgasms: a common form of orgasm, from direct stimulation often when the body and muscles are tense.

There are other forms of orgasm that Freud and Dodson largely discount, but many others have described them. For instance:

  • Fantasy orgasms: orgasms resulting from mental stimulation alone.
  • G-spot orgasms: orgasms resulting from the stimulation of an erotic zone during penetrative intercourse, feeling markedly different to orgasms from other kinds of stimulation.


The female orgasm

The following description of the physiological process of female orgasm in the genitals will use the Masters and Johnson four-phase model.

Excitement

When a woman is stimulated physically or psychologically, the blood vessels within her genitals dilate. Increased blood supply causes the vulva to swell, and fluid to pass through the vaginal walls, making the vulva swollen and wet. Internally, the top of the vagina expands.

Heart rate and breathing quicken and blood pressure increases. Blood vessel dilation can lead to the woman appearing flushed, particularly on the neck and chest.

Plateau

As blood flow to the introitus – the lower area of the vagina – reaches its limit, it becomes firm. Breasts can increase in size by as much as 25 percent and increased blood flow to the areola – the area surrounding the nipple – causes the nipples to appear less erect. The clitoris pulls back against the pubic bone, seemingly disappearing.

Orgasm

The genital muscles, including the uterus and introitus, experience rhythmic contractions around 0.8 seconds apart. The female orgasm typically lasts longer than the male at an average of around 13-51 seconds.

Unlike men, most women do not have a refractory (recovery) period and so can have further orgasms if they are stimulated again.

Resolution

The body gradually returns to its former state, with swelling reduction and the slowing of pulse and breathing.

The male orgasm

The following description of the physiological process of male orgasm in the genitals uses the Masters and Johnson four-phase model.

Excitement

When a man is stimulated physically or psychologically, he gets an erection. Blood flows into the corpora – the spongy tissue running the length of the penis – causing the penis to grow in size and become rigid. The testicles are drawn up toward the body as the scrotum tightens.

Plateau

As the blood vessels in and around the penis fill with blood, the glans and testicles increase in size. In addition, thigh and buttock muscles tense, blood pressure rises, the pulse quickens, and the rate of breathing increases.

Orgasm

Semen – a mixture of sperm (5 percent) and fluid (95 percent) – is forced into the urethra by a series of contractions in the pelvic floor muscles, prostate gland, seminal vesicles, and the vas deferens.

Contractions in the pelvic floor muscles and prostate gland also cause the semen to be forced out of the penis in a process called ejaculation. The average male orgasm lasts for 10-30 seconds.

Resolution

The man now enters a temporary recovery phase where further orgasms are not possible. This is known as the refractory period, and its length varies from person to person. It can last from a few minutes to a few days, and this period generally grows longer as the man ages.

During this phase, the man’s penis and testicles return to their original size. The rate of breathing will be heavy and fast, and the pulse will be fast.

Causes

It is commonly held that orgasms are a sexual experience, typically experienced as part of a sexual response cycle. They often occur following the continual stimulation of erogenous zones, such as the genitals, anus, nipples, and perineum.

Physiologically, orgasms occur following two basic responses to continual stimulation:

  • Vasocongestion: the process whereby body tissues fill up with blood, swelling in size as a result.
  • Myotonia: the process whereby muscles tense, including both voluntary flexing and involuntary contracting.

There have been other reports of people experiencing orgasmic sensations at the onset of epileptic medicine, and foot amputees feeling orgasms in the space where their foot once was. People paralyzed from the waist down have also been able to have orgasms, suggesting that it is the central nervous system rather than the genitals that is key to experiencing orgasms.

Disorders

A number of disorders are associated with orgasms; they can lead to distress, frustration, and feelings of shame, both for the person experiencing the symptoms and their partner(s).

Although orgasms are considered to be the same in all genders, healthcare professionals tend to describe orgasm disorders in gendered terms.

Female orgasmic disorders

Female orgasmic disorders center around the absence or significant delay of orgasm following sufficient stimulation.

The absence of having orgasms is also referred to as anorgasmia. This term can be divided into primary anorgasmia, when a woman has never experienced an orgasm, and secondary anorgasmia, when a woman who previously experienced orgasms no longer can. The condition can be limited to certain situations or can generally occur.

Female orgasmic disorder can occur as the result of physical causes such as gynecological issues or the use of certain medications, or psychological causes such as anxiety or depression.

Male orgasmic disorders

Also referred to as inhibited male orgasm, male orgasmic disorder involves a persistent and recurrent delay or absence of orgasm following sufficient stimulation.


Male orgasmic disorder can be a lifelong condition or one that is acquired after a period of regular sexual functioning. The condition can be limited to certain situations or can generally occur. It can occur as the result of other physical conditions such as heart disease, psychological causes such as anxiety, or through the use of certain medications such as antidepressants.

Premature ejaculation

Ejaculation in men is closely associated with an orgasm. Premature ejaculation is a common sexual complaint, whereby a man ejaculates (and typically orgasms) within 1 minute of penetration, including the moment of penetration itself.

Premature ejaculation is likely to be caused by a combination of psychological factors such as guilt or anxiety, and biological factors such as hormone levels or nerve damage.

Common misconceptions

Young happy couple

A happy relationship is based on more than just the orgasm.

The high importance that society places on sex, combined with our incomplete knowledge of the orgasm, has led to a number of common misconceptions.

Sexual culture has placed the orgasm on a pedestal, often prizing it as the one and only goal for sexual encounters.

However, orgasms are not as simple and as common as many people would suggest.

It is estimated that around 10-15 percent of women have never had an orgasm. In men, as many as 1 in 3 reports having experienced premature ejaculation at some point in their lives.

Research has shown that orgasms are also not widely considered to be the most important aspect of sexual experience. One study reported that many women find their most satisfying sexual experiences involve a feeling of being connected to someone else, rather than basing their satisfaction solely on orgasm.

Another misconception is that penile-vaginal stimulation is the main way for both men and women to achieve an orgasm. While this may be true for many men and some women, many more women experience orgasms following the stimulation of the clitoris.

A comprehensive analysis of 33 studies over 80 years found that during vaginal intercourse just 25 percent of women consistently experience an orgasm, about half of women sometimes have an orgasm, 20 percent seldom or ever have orgasms, and about 5 percent never have orgasms.

In fact, orgasms do not necessarily have to involve the genitals at all, nor do they have to be associated with sexual desires, as evidenced by examples of exercise-induced orgasm.

The journey to an orgasm is a very individual experience that has no singular, all-encompassing definition. In many cases, experts recommend avoiding comparison to other people or pre-existing concepts of what an orgasm should be.

 

How does menopause affect sex drive?

Sexual problems are more common in postmenopausal women, which suggests that menopause can reduce libido.

The reduced sex drive is often caused by decreased estrogen levels, which can dampen arousal and result in sex being more painful.

In this article, we look at how menopause might affect someone’s sex drive, along with what can be done to improve libido.

 

Menopause and libido

What is menopause?

sad middle aged woman sitting on bed

Menopausal symptoms can have a negative effect on a woman’s relationship with her partner.

Menopause refers to when a woman stops having her period permanently, but it can affect more than a woman’s menstrual cycle.

Menopause can cause physical and emotional changes that impact a woman’s life, including her sex life.

Some symptoms and side effects associated with menopause include:

  • anxiety
  • bladder control issues
  • decreased sex drive and desire (libido)
  • depression
  • difficulty sleeping
  • thinning hair
  • weight gain

Each of these effects can impact a woman’s quality of life and relationship with her partner.

What is libido?

Libido refers to sexual interest and sexual enjoyment.

Some women going through menopause report reduced libido, but the causes vary from person to person.

According to one review, the reported rates of sexual problems in postmenopausal women are between 68 and 86.5 percent.

This range is much higher than in all women in general, which is estimated to be between 25 and 63 percent.

Why does menopause affect libido?

Decreased estrogen levels can result in reduced blood flow to the vagina, which can cause the tissues of the vagina and labia to become thinner. If this happens, they become less sensitive to sexual stimulation.

Decreased blood flow also affects vaginal lubrication and overall arousal. As a result, a woman may not enjoy sex as much and may have difficulty achieving orgasm. Sex may be uncomfortable or even painful.

Fluctuating hormone levels during perimenopause and menopause can also affect a woman’s mental health, which in turn, may cause a decrease in her libido.

Stress can also impact a woman’s libido, as she may be juggling a job, parenting, and be caring for aging parents. The changes in hormone levels a woman may experience during menopause may make her irritable or depressed, so dealing with everyday stress may feel more difficult.

According to an article published in the Journal of Women’s Health, women who have more significant side effects associated with menopause are more likely to report lower libido levels.

Examples of these side effects include hot flashes, depression, anxiety, trouble sleeping, and fatigue.

Other factors that make a woman going through menopause more likely to experience a reduced libido include:

  • history of chronic health conditions, such as heart disease, diabetes, or depression
  • history of smoking
  • engaging in low levels of physical activity

A woman should talk to her doctor about how these conditions could affect her sex drive.

 

Tips for improving libido

There are several steps a woman can take to increase her libido. These include medical treatments, lifestyle changes, and home remedies.

Medical treatments

middle aged couple enjoying a bike ride

Spending time together on shared hobbies, exercising, and planned dates will help increase a couple’s intamacy.

If a woman experiences changes to her vaginal tissue, such as thinning and dryness, she may wish to consider estrogen therapy.

Prescription estrogen can be applied directly to the vagina in the form of creams, pills, or vaginal rings. These usually contain lower doses of estrogen than regular birth control pills.

Some women may wish to take estrogen pills that contain higher levels of hormones. This treatment, known as hormone replacement therapy, might help reduce symptoms, such as hot flashes and mood changes, but may also carry risks.

A woman thinking about hormone replacement therapy should discuss it with her doctor before starting to take any medication.

One study found that women using hormone therapies reported higher levels of sexual desire compared with women who did not.

Less commonly, a doctor may prescribe testosterone therapy. However, not all women respond to this treatment, and the United States Food and Drug Administration (FDA) do not approve it for treating sexual disorders in women.

A woman may not experience any changes in her sex drive after using estrogen or testosterone therapies.

A woman may also choose to see a therapist who specializes in sexual dysfunction or enhancing sex. Sometimes, couples may want to attend therapy together.

Lifestyle changes

Some women may benefit from using water-soluble lubricants during sex. These can be purchased over-the-counter at most drugstores.

However, women should avoid non-water soluble and silicone-based lubricants, as these can break down condoms used to protect against sexually transmitted infections (STIs).

Increasing physical activity, such as getting 30 minutes or more of exercise on a routine basis, may help reduce menopause-related symptoms, including a low libido. Eating a healthful diet can also enhance a person’s overall sense of well being.

Changing sexual habits

There are many ways a person can foster a sense of intimacy with their partner, including:

  • Changing sexual routines: Try spending extended periods on foreplay, use vibrators or other sex toys to enhance an intimate experience, or engage in sexual activity or touching without the goal of orgasm.
  • Relieving stress together: There are many stress-relieving techniques a couple can do outside of the bedroom to increase intimacy. Examples include going on planned dates together, taking a walk, or spending time doing hobbies together, such as exercise, crafts, or cooking.
  • Practicing masturbation: Spending time alone and exploring what types of touch and sexual stimulation work well for an individual can help them talk to a partner about their needs and preferences. It can also help a person feel more comfortable with sexual activity without the pressure of a partner.

Natural remedies

Some women use natural supplements to try to increase their libido. It is important to keep in mind that the FDA do not regulate herbs and supplements, so women should be sure to choose a reputable brand.

Some natural remedies used to increase libido in women include:

  • black cohosh
  • red clover
  • soy

A woman should discuss these remedies with a doctor before taking them to ensure they will not interact negatively with other prescriptions and supplements she may be taking. Soy contains estrogen, so it may react with other estrogen therapies.

 

When to see a doctor

A woman should speak to her doctor whenever perimenopause or menopause is having a significant impact on her day-to-day activities, including sexual activity.

Sometimes, a doctor can recommend changes in health habits as well as discuss whether prescription medications may help relieve the symptoms, including a low libido.

Speaking with a doctor can also rule out any other underlying medical conditions that may cause a reduced libido. These conditions include urinary tract infections, uterine prolapse, endometriosis, or pelvic floor dysfunction.

 

Outlook

woman speaking with a doctor

A doctor will be able to rule out other conditions that may be responsible for a reduced sex drive.

While some women do experience a decreased libido in menopause, others do not.

Some women may even experience a heightened libido after menopause. This can be due to reduced stresses over pregnancy and fewer child-rearing responsibilities.

If a woman’s libido is impacted after menopause, she should talk to her doctor about treatments that could enhance her quality of life.

Premature ejaculation: Treatments and causes

Premature ejaculation is a form of sexual dysfunction that can adversely affect the quality of a man’s sex life. It is when an orgasm or “climax” occurs sooner than wanted.

There may occasionally be complication with reproduction, but premature ejaculation (PE) can also adversely affect sexual satisfaction, both for men and their partners.

In recent years, the recognition and understanding of male sexual dysfunction has improved, and there is a better understanding of the problems that can result from it.

The information here aims to demystify the causes of PE and outline effective treatment options.

Fast facts on premature ejaculationHere are some key points about premature ejaculation.

  • In the majority of cases, an inability to control ejaculation is rarely due to a medical condition, although doctors will need to rule this out.
  • PE can lead to secondary symptoms such as distress, embarrassment, anxiety, and depression.
  • Treatment options range from reassurance from a doctor that the problem might improve in time, through to home methods of “training” the timing of ejaculation.

Treatment

[Man looking sad about premature ejaculation]Premature ejaculation, in some cases, can lead to depression.

In most cases, there is a psychological cause, and the prognosis is good.

If the problem occurs at the beginning of a new sexual partnership, the difficulties often resolve as the relationship goes on.

If, however, the problem is more persistent, doctors may recommend counseling from a therapist specializing in sexual relationships, or “couples therapy.”


No medications are officially licensed in the United States for treating PE, but some antidepressants have been found to help some men delay ejaculation.

A doctor will not prescribe any medicines before taking a detailed sexual history to reach a clear diagnosis of PE. Drug treatments can have adverse effects, and patients should always discuss with a doctor before using any medication.

Dapoxetine (brand name Priligy) is used in many countries to treat some types of primary and secondary PE. This is a rapid-acting SSRI that is also licensed to treat PE. However, certain criteria must be met.

It can be used if:

  • vaginal sex lasts for less than 2 minutes before ejaculation occurs
  • ejaculation persistently or recurrently happens after very little sexual stimulation and before, during, or shortly after initial penetration, and before he wishes to climax
  • there is marked personal distress or interpersonal difficulty because of the PE
  • there is poor control over ejaculation
  • most attempts at sexual intercourse in the past 6 months have involved premature ejaculation

Side-effects from dapoxetine include nausea, diarrhea, dizziness, and headache.

Topical drugs

Some topical therapies may be applied to the penis before sex, with or without a condom. These local anesthetic creams reduce stimulation.

Examples include lidocaine or prilocaine, which can improve the amount of time before ejaculation.

However, longer use of anesthetics can result in numbness and loss of erection. The reduced sensation created by the creams may not be acceptable to the man, and the numbness can affect the woman, too.

Home remedies

Two methods that can be helpful for men are:

  • The start-and-stop method: This aims to improve a man’s control over ejaculation. Either the man or his partner stops sexual stimulation at the point when he feels he is about to have an orgasm, and they resume once the sensation of impending orgasm has subsided.
  • The squeeze method: This is similar, but the man gently squeezes the end of his penis, or his partner does this for him, for 30 seconds before restarting stimulation.

A man tries to achieve this upward of three or four times before allowing himself to ejaculate.

Practice is important, and if the problem continues, it may be worth talking to a doctor.

Exercises

Researchers have found that Kegel exercises, which aim to strengthen the pelvic floor muscles, can help men with lifelong PE.

Forty men with the condition underwent physical therapy involving:

  • physio-kinesiotherapy to achieve muscle contraction
  • electrostimulation of the perineal floor
  • biofeedback, which helped them understand how to control the muscle contractions in the perineal floor

They also followed a set of individualized exercises.

After 12 weeks of treatment, over 80 percent of the participants gained a degree of control over their ejaculation reflex. They increased the time between penetration and ejaculation by at least 60 seconds.

Causes

A number of factors may be involved.

Psychological factors

Most cases of PE are not related to any disease and are instead due to psychological factors, including:

  • sexual inexperience
  • issues with body image
  • novelty of a relationship
  • overexcitement or too much stimulation
  • relationship stress
  • anxiety
  • feelings of guilt or inadequacy
  • depression
  • issues related to control and intimacy

These common psychological factors can affect men who have previously had normal ejaculation. These cases are often called secondary, or acquired, PE.

Most cases of the rarer, more persistent form—primary or lifelong PE—are also believed to be caused by psychological problems.

The condition can often be traced back to early trauma, such as:

  • strict sexual teaching and upbringing
  • traumatic experiences of sex
  • conditioning, for example, when a teenager learns to ejaculate quickly to avoid being found masturbating

Medical causes

More rarely, there may be a biological cause.

The following are possible medical causes of PE:

  • diabetes
  • multiple sclerosis
  • prostate disease
  • thyroid problems
  • illicit drug use
  • excessive alcohol consumption

PE can be a sign that an underlying condition needs treatment.

Symptoms

Medically, the more persistent form of PE, primary or lifelong PE, is defined by the presence of the following three features:

[Man feeling bad about premature ejaculation]Premature ejaculation can cause significant distress.
  • Ejaculation always, or nearly always, happens before sexual penetration has been achieved, or within about a minute of penetration.
  • There is an inability to delay ejaculation every time, or nearly every time, penetration occurs.
  • Negative personal consequences arise, such as distress and frustration, or avoidance of sexual intimacy.

Psychological symptoms are secondary to the physical ejaculatory events. The man, his partner, or both may experience them.

Secondary symptoms include:

  • decreased confidence in the relationship
  • interpersonal difficulty
  • mental distress
  • anxiety
  • embarrassment
  • depression

Men who ejaculate too soon can experience psychological distress, but results of a study of 152 men and their partners suggest that the partner tend to be less worried about PE than the man who has it.

Diagnosis

The manual used by psychiatrists and psychologists for making a clinical diagnosis (known as the DSM-V) defines PE as a sexual disorder only when the following description is true:

Ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it. The condition is persistent or occurs frequently and causes significant distress.”

However, a more loosely defined form of PE is one of the most common kinds of sexual dysfunction.

A doctor will ask certain questions that are intended to help them assess symptoms, such as how long it takes before ejaculation occurs. This is known as latency.

Questions might include:

  • How often do you experience PE?
  • How long have you had this problem?
  • Does it happen in every sexual encounter, or only at certain times?
  • How much stimulation brings on an ejaculation?
  • How has PE affected your sexual activity?
  • Can you delay your ejaculation until after penetration?
  • Do you or your partner feel annoyed or frustrated?
  • How does PE affect your quality of life?

Results from surveys suggest that PE affects between 15 percent and 30 percent of men. However, there are far fewer medically diagnosed and diagnosable cases. This statistical disparity does not in any way diminish the discomfort experienced by men who do not meet the strict criteria for diagnosis.

Primary or lifelong PE is thought to affect around 2 percent of men.

All you need to know about orgasms

The orgasm is widely regarded as the peak of sexual excitement. It is a powerful feeling of physical pleasure and sensation, which includes a discharge of accumulated erotic tension.

Overall though, not a great deal is known about the orgasm, and over the past century, theories about the orgasm and its nature have shifted dramatically. For instance, healthcare experts have only relatively recently come round to the idea of the female orgasm, with many doctors as recently as the 1970s claiming that it was normal for women not to experience them.

In this article, we will explain what an orgasm is in men and women, why it happens, and explain some common misconceptions.

Fast facts on orgasms

  • Medical professionals and mental health professionals define orgasms differently.
  • Orgasms have multiple potential health benefits due to the hormones and other chemicals that are released by the body during an orgasm.
  • Orgasms do not only occur during sexual stimulation.
  • People of all genders can experience orgasm disorders.
  • An estimated 1 in 3 men have experienced premature ejaculation.

What is an orgasm?

Orgasms can be defined in different ways using different criteria. Medical professionals have used physiological changes to the body as a basis for a definition, whereas psychologists and mental health professionals have used emotional and cognitive changes. A single, overarching explanation of the orgasm does not currently exist.

Influential research

Couple sharing an orgasm

Alfred Kinsey’s Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953) sought to build “an objectively determined body of fact and sex,” through the use of in-depth interviews, challenging currently held views about sex.

The spirit of this work was taken forward by William H. Masters and Virginia Johnson in their work, Human Sexual Response (1986) – a real-time observational study of the physiological effects of various sexual acts. This research led to the establishment of sexology as a scientific discipline and is still an important part of today’s theories on orgasms.

Orgasm models

Sex researchers have defined orgasms within staged models of sexual response. Although the orgasm process can differ greatly between individuals, several basic physiological changes have been identified that tend to occur in the majority of incidences.

The following models are patterns that have been found to occur in all forms of sexual response and are not limited solely to penile-vaginal intercourse.

Master and Johnson’s Four-Phase Model:

  1. excitement
  2. plateau
  3. orgasm
  4. resolution

Kaplan’s Three-Stage Model:

Kaplan’s model differs from most other sexual response models as it includes desire – most models tend to avoid including non-genital changes. It is also important to note that not all sexual activity is preceded by desire.

  1. desire
  2. excitement
  3. orgasm

Potential health benefits of orgasm

Nurse holding prostate model

The male orgasm may protect against prostate cancer.

A cohort study published in 1997 suggested that the risk of mortality was considerably lower in men with a high frequency of orgasm than men with a low frequency of orgasm.

This is counter to the view in many cultures worldwide that the pleasure of the orgasm is “secured at the cost of vigor and wellbeing.”

There is some evidence that frequent ejaculation might reduce the risk of prostate cancer. A team of researchers found that the risk for prostate cancer was 20 percent lower in men who ejaculated at least 21 times a month compared with men who ejaculated just 4 to 7 times a month.

Several hormones that are released during orgasm have been identified, such as oxytocin and DHEA; some studies suggest that these hormones could have protective qualities against cancers and heart disease. Oxytocin and other endorphins released during male and female orgasm have also been found to work as relaxants.

Types

Unsurprisingly, given that experts are yet to come to a consensus regarding the definition of an orgasm, there are multiple different forms of categorization for orgasms.

The psychoanalyst Sigmund Freud distinguished female orgasms as clitoral in the young and immature, and vaginal in those with a healthy sexual response. In contrast, the sex researcher Betty Dodson has defined at least nine different forms of orgasm, biased toward genital stimulation, based on her research. Here is a selection of them:

  • Combination or blended orgasms: a variety of different orgasmic experiences blended together.
  • Multiple orgasms: a series of orgasms over a short period rather than a singular one.
  • Pressure orgasms: orgasms that arise from the indirect stimulation of applied pressure. A form of self-stimulation that is more common in children.
  • Relaxation orgasms: orgasm deriving from deep relaxation during sexual stimulation.
  • Tension orgasms: a common form of orgasm, from direct stimulation often when the body and muscles are tense.

There are other forms of orgasm that Freud and Dodson largely discount, but many others have described them. For instance:

  • Fantasy orgasms: orgasms resulting from mental stimulation alone.
  • G-spot orgasms: orgasms resulting from the stimulation of an erotic zone during penetrative intercourse, feeling markedly different to orgasms from other kinds of stimulation.

The female orgasm

The following description of the physiological process of female orgasm in the genitals will use the Masters and Johnson four-phase model.

Excitement

When a woman is stimulated physically or psychologically, the blood vessels within her genitals dilate. Increased blood supply causes the vulva to swell, and fluid to pass through the vaginal walls, making the vulva swollen and wet. Internally, the top of the vagina expands.

Heart rate and breathing quicken and blood pressure increases. Blood vessel dilation can lead to the woman appearing flushed, particularly on the neck and chest.

Plateau

As blood flow to the introitus – the lower area of the vagina – reaches its limit, it becomes firm. Breasts can increase in size by as much as 25 percent and increased blood flow to the areola – the area surrounding the nipple – causes the nipples to appear less erect. The clitoris pulls back against the pubic bone, seemingly disappearing.

Orgasm

The genital muscles, including the uterus and introitus, experience rhythmic contractions around 0.8 seconds apart. The female orgasm typically lasts longer than the male at an average of around 13-51 seconds.

Unlike men, most women do not have a refractory (recovery) period and so can have further orgasms if they are stimulated again.

Resolution

The body gradually returns to its former state, with swelling reduction and the slowing of pulse and breathing.

The male orgasm

The following description of the physiological process of male orgasm in the genitals uses the Masters and Johnson four-phase model.

Excitement

When a man is stimulated physically or psychologically, he gets an erection. Blood flows into the corpora – the spongy tissue running the length of the penis – causing the penis to grow in size and become rigid. The testicles are drawn up toward the body as the scrotum tightens.

Plateau

As the blood vessels in and around the penis fill with blood, the glans and testicles increase in size. In addition, thigh and buttock muscles tense, blood pressure rises, the pulse quickens, and the rate of breathing increases.

Orgasm

Semen – a mixture of sperm (5 percent) and fluid (95 percent) – is forced into the urethra by a series of contractions in the pelvic floor muscles, prostate gland, seminal vesicles, and the vas deferens.

Contractions in the pelvic floor muscles and prostate gland also cause the semen to be forced out of the penis in a process called ejaculation. The average male orgasm lasts for 10-30 seconds.

Resolution

The man now enters a temporary recovery phase where further orgasms are not possible. This is known as the refractory period, and its length varies from person to person. It can last from a few minutes to a few days, and this period generally grows longer as the man ages.

During this phase, the man’s penis and testicles return to their original size. The rate of breathing will be heavy and fast, and the pulse will be fast.

Causes

It is commonly held that orgasms are a sexual experience, typically experienced as part of a sexual response cycle. They often occur following the continual stimulation of erogenous zones, such as the genitals, anus, nipples, and perineum.

Physiologically, orgasms occur following two basic responses to continual stimulation:

  • Vasocongestion: the process whereby body tissues fill up with blood, swelling in size as a result.
  • Myotonia: the process whereby muscles tense, including both voluntary flexing and involuntary contracting.

There have been other reports of people experiencing orgasmic sensations at the onset of epileptic medicine, and foot amputees feeling orgasms in the space where their foot once was. People paralyzed from the waist down have also been able to have orgasms, suggesting that it is the central nervous system rather than the genitals that is key to experiencing orgasms.

Disorders

A number of disorders are associated with orgasms; they can lead to distress, frustration, and feelings of shame, both for the person experiencing the symptoms and their partner(s).

Although orgasms are considered to be the same in all genders, healthcare professionals tend to describe orgasm disorders in gendered terms.

Female orgasmic disorders

Female orgasmic disorders center around the absence or significant delay of orgasm following sufficient stimulation.

The absence of having orgasms is also referred to as anorgasmia. This term can be divided into primary anorgasmia, when a woman has never experienced an orgasm, and secondary anorgasmia, when a woman who previously experienced orgasms no longer can. The condition can be limited to certain situations or can generally occur.

Female orgasmic disorder can occur as the result of physical causes such as gynecological issues or the use of certain medications, or psychological causes such as anxiety or depression.

Male orgasmic disorders

Also referred to as inhibited male orgasm, male orgasmic disorder involves a persistent and recurrent delay or absence of orgasm following sufficient stimulation.

Male orgasmic disorder can be a lifelong condition or one that is acquired after a period of regular sexual functioning. The condition can be limited to certain situations or can generally occur. It can occur as the result of other physical conditions such as heart disease, psychological causes such as anxiety, or through the use of certain medications such as antidepressants.

Premature ejaculation

Ejaculation in men is closely associated with an orgasm. Premature ejaculation is a common sexual complaint, whereby a man ejaculates (and typically orgasms) within 1 minute of penetration, including the moment of penetration itself.

Premature ejaculation is likely to be caused by a combination of psychological factors such as guilt or anxiety, and biological factors such as hormone levels or nerve damage.

Common misconceptions

Young happy couple

A happy relationship is based on more than just the orgasm.

The high importance that society places on sex, combined with our incomplete knowledge of the orgasm, has led to a number of common misconceptions.

Sexual culture has placed the orgasm on a pedestal, often prizing it as the one and only goal for sexual encounters.

However, orgasms are not as simple and as common as many people would suggest.

It is estimated that around 10-15 percent of women have never had an orgasm. In men, as many as 1 in 3 reports having experienced premature ejaculation at some point in their lives.

Research has shown that orgasms are also not widely considered to be the most important aspect of sexual experience. One study reported that many women find their most satisfying sexual experiences involve a feeling of being connected to someone else, rather than basing their satisfaction solely on orgasm.

Another misconception is that penile-vaginal stimulation is the main way for both men and women to achieve an orgasm. While this may be true for many men and some women, many more women experience orgasms following the stimulation of the clitoris.

A comprehensive analysis of 33 studies over 80 years found that during vaginal intercourse just 25 percent of women consistently experience an orgasm, about half of women sometimes have an orgasm, 20 percent seldom or ever have orgasms, and about 5 percent never have orgasms.

In fact, orgasms do not necessarily have to involve the genitals at all, nor do they have to be associated with sexual desires, as evidenced by examples of exercise-induced orgasm.

The journey to an orgasm is a very individual experience that has no singular, all-encompassing definition. In many cases, experts recommend avoiding comparison to other people or pre-existing concepts of what an orgasm should be.

What you need to know about delayed ejaculation

Delayed ejaculation refers to a difficulty or inability of a man to reach an orgasm and to ejaculate semen. The causes can be physical or psychological.

if a man takes longer than 30 minutes of penetrative sex to ejaculate, despite a normal erection, it is considered delayed ejaculation.

Delayed ejaculation affects around 1 to 4 percent of men.

It can result in distress for both the man and his partner. It can trigger anxiety about general health, low libido, and sexual dissatisfaction. Relationship problems include a fear of rejection for both parties and concern for couples who wish to start a family.

Most men will experience delayed ejaculation at some point in their lives, but for some, it is a lifelong problem.

Fast facts on delayed ejaculationHere are some key points about delayed ejaculation. More detail and supporting information is in the body of this article.

  • Delayed ejaculation is a form of sexual dysfunction affecting a man’s ability to reach an orgasm.
  • The average time it takes for ejaculation to occur upon stimulation varies between individuals, with no strict figure given for what is “normal”.
  • Most causes are psychological, but organic reasons are also possible and are ruled out first during diagnosis.
  • No pharmacological therapies are available for psychological causes of delayed ejaculation.

Causes

man sitting on side of bed with woman in the background looking sad

“Does he really desire me?” Partners of men having difficulty reaching orgasm may be troubled by such questions.

Delayed ejaculation can have a psychological or biological cause. There can also be overlap between the two. It can be a lifelong condition, where a man has always had difficulty reaching an orgasm, but more commonly, delayed ejaculation occurs after a period of normal function.

Physical causes of delayed ejaculation include:

  • Medication side effects: Delayed ejaculation may be an adverse effect of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), anti-anxiety drugs, blood pressure medication, painkillers, and other medications.
  • Alcohol or the use of certain recreational drugs can have an impact.
  • Nerve damage, including stroke, spinal cord injury, surgery, multiple sclerosis, and severe diabetes, can lead to abnormal ejaculatory function.
  • Increasing age can decrease the sensitivity of the penis to sexual stimulation.

An acquired case is usually determined as having a psychological cause if it only happens in specific situations. For example, it is more likely that delayed ejaculation has a psychological basis if a man is able to ejaculate normally when masturbating, but experiences a delay during sex with a partner.

Some psychological factors that may underlie delayed ejaculation include:

man sitting on edge of bed with head in hands

Men with a persistent problem of delayed ejaculation are likely to be distressed by it.

  • early life history including abuse, difficulties bonding, neglect by parents, negative sexual upbringing
  • unexpressed anger
  • unwillingness to enjoy pleasure
  • religious belief, perhaps that sexual activity is a sin
  • fear of, for instance, semen or female genitalia, or of somehow hurting or defiling a partner through ejaculation
  • fear of pregnancy
  • issues of lost confidence or performance anxiety – for example, anxiety about body image that interrupts the process of sexual stimulation

Certain types of masturbatory behavior may play a role in developing delayed ejaculation.

One specialist in delayed ejaculation found a relationship between the condition and the following masturbatory patterns:

  • masturbating more often, typically more than three times a week
  • having a style of masturbation that cannot be matched by sexual intercourse, particularly a high speed, high pressure, or high-intensity form
  • if the partner’s hand, mouth, or vagina is unable to easily duplicate the learned style
  • the sex partner differs from the fantasy used during masturbation to reach an orgasm

Dr. Michael Perelman, clinical professor of psychiatry, reproductive medicine and urology at the Weill Medical College of Cornell University, New York, observed that most men he had seen with delayed ejaculation reported no problems reaching an orgasm and ejaculating via masturbation.

Some men with the condition needed to employ an “idiosyncratic” form of self-manipulation to reach orgasm, such as rubbing the penis against the bed sheets, masturbating with pressure on a particular spot when reading erotic books, and even masturbating by “urethral instrumentation” – inserting a foreign body down into the opening of the penis.

Diagnosis

Delayed ejaculation is diagnosed when a man is concerned about a marked delay or infrequency of achieving ejaculation during most sexual encounters over a period of 6 months or more, and when other problems have been ruled out.

To reach a diagnosis, a doctor will speak with the individual about symptoms and how often they occur. They will then rule out other potential medical problems, such as infections, hormonal imbalance, and so on. This may involve using blood and urine tests.

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Treatment

a therapist takes notes with a patient

Professional counselors may try to treat delayed ejaculation by identifying the source of the problem.

Treatment for delayed ejaculation depends on the cause. For instance, if SSRIs are the issue, an alternative drug may be prescribed.

If excessive alcohol or non-prescription drug use are factors, reducing or eliminating these may help. If there are other medical conditions, managing the primary condition, such as a neurological problem, may help resolve the delayed ejaculation.

Primary cases of delayed ejaculation may not be straightforward to treat. They often require the help of professional counselors such as psychologists, psychotherapists, psychosexual counselors, sex therapists, or couple’s therapists.

Psychologists recognize that there is no single intervention that works for all patients and that the key to successful treatment is to identify the source of the problem and to use appropriate, targeted therapy to deal with the psychological factors that trigger or contribute to the problem.

Some medications may help improve the symptoms of delayed ejaculation, but none have yet been specifically approved to treat it.

Drugs with some reported benefits include:

  • Cyproheptadine (Periactin), an allergy medication
  • Amantadine (Symmetrel), a drug used to treat Parkinson’s
  • Buspirone (Buspar), an anti-anxiety medication

Outlook

Successful treatment depends on the cause of the delayed ejaculation and the type of treatment.

Anyone who has concerns about sexual function speaks with a doctor so that the right course of action can be taken.

What is sexual addiction?

Sexual addiction is a condition in which an individual cannot manage their sexual behavior. Persistent sexual thoughts affect their ability to work, maintain relationships, and fulfil their daily activities.

Other terms for sexual addiction are sexual dependency, hypersexuality, and compulsive sexual behavior. It is also known as nymphomania in females and satyriasis in men.

While sexual addiction shares some features with substance addiction, the person is addicted to an activity, not a substance. Treatment may help, but without treatment, it may get worse.

An estimated 12 to 30 million people in the United States (U.S.) experience sexual addiction. It affects both men and women.

Fast facts on sexual addiction

  • Sexual addiction prevents people from managing their sexual behavior. Why it happens is unclear.
  • It can have a severe impact on a person’s life, but key bodies, such as the American Psychological Association (APA), have not yet established it as a diagnosable condition.
  • Typical behaviors include compulsive masturbation, persistent use of pornography, exhibitionism, voyeurism, extreme acts of lewd sex, and the failure to resist sexual impulses.
  • Treatment centers and self-help groups can help with sexual addiction.

What is sexual addiction?

The American Society of Addiction Medicine describes addiction as “a primary, chronic disease of brain reward, motivation, memory, and related circuitry.”

Sexual addictionSexual addiction is an inability to control sexual urges, leading to impaired relationships and quality of life.

A person with sexual addiction is obsessed with sex or has an abnormally intense sex drive. Their thoughts are dominated by sexual activity, to the point where this affects other activities and interactions. If these urges become uncontrollable, the person can have difficulty functioning in social situations.

In some cases, a person with a healthy and enjoyable sex life may develop an obsession. They may find themselves stimulated by acts and fantasies that most people do not consider acceptable.

In some cases, the person may have a paraphilic disorder, such as pedophilia. This is a diagnosable disorder.

A paraphilic disorder involves sexual arousal caused by stimuli that most people do not find acceptable, for example pedophilia. It involves distress and dysfunction.

Sexual addiction has not been fully established as a medical condition, although it can adversely affect families, relationships, and lives. One difficulty with identifying sexual addiction is that people have different levels of sex drive, or libido. One person may consider their partner a “sex addict” only because they have a higher sex drive.

More research is needed to determine whether or not sexual addiction exists as a disorder.

Symptoms

Some attempts to define the characteristics of sexual addiction have been based on literature about chemical dependency. Sexual addiction may share the same rewards systems and circuits in the brain as substance addiction.

However, people with sexual addiction may be addicted to different types of sexual behavior. This makes the condition harder to define. It also suggests that the disorder stems not from the individual acts, but rather an obsession with carrying them out.

Sexual addiction also appears to involve making rules to feel in control of the condition, and then breaking them to make new rules.

Activities associated with sexual addiction may include:

  • compulsive masturbation
  • multiple affairs, sexual partners, and one-night stands
  • persistent use of pornography
  • practicing unsafe sex
  • cybersex
  • visiting prostitutes or practicing prostitution
  • exhibitionism
  • voyeurism

Behaviors and attitudes may include:

  • an inability to contain sexual urges and respect the boundaries of others involved in the sexual act
  • detachment, in which the sexual activity does not emotionally satisfy the individual
  • obsession with attracting others, being in love, and starting new romances, often leading to a string of relationships
  • feelings of guilt and shame
  • an awareness that the urges are uncontrollable, in spite of financial, medical, or social consequences
  • a pattern of recurrent failure to resist impulses to engage in extreme acts of lewd sex
  • engagement in sexual behaviors for longer than intended, and to a greater extent
  • several attempts to stop, reduce, or control behavior
  • excessive time and energy spent obtaining sex, being sexual, or recovering from a sexual experience
  • giving up social, work-related, or recreational activities because of a sexual addiction
  • sexual rage disorder, where an individual becomes distressed, anxious, restless, and possibly violent if unable to engage in the addiction

Studies have demonstrated a strong link between alleged sexual addiction and risk-taking. Sexual addiction may cause a person to persist in taking risks even if there may be health consequences, such as sexually transmitted infection (STI), physical injury, or emotional consequences.

Complications

Untreated, compulsive sexual behavior can leave the individual with intense feelings of guilt and low self-esteem. Some patients may develop severe anxiety and depression.

Other complications may include:

  • family relationship problems and breakups
  • financial problems
  • STIs
  • legal consquences, if the sexual act is illegal or publically disruptive, such as in exhibitionism

Causes

The causes of sexual addiction remain unclear.

Addiction takes root in the reward center of the brain. It may occur when certain parts of the brain mistake pleasure responses for survival mechanisms.

The midbrain is the section of the brain that handles the body’s reward system and survival instincts. As sexual activity creates a rush of dopamine, the “feel-good” chemical in the brain, this triggers the feeling of pleasure. The midbrain then mistakes this feeling of pleasure as being central to survival.

One possibility is that, in people with sexual addiction, the frontal cortex, or the brain’s center of logic and morality, is impaired by the midbrain.

Studies on rats have linked lesions of a section of the brain called the medial prefrontal cortex (mPFC) with compulsive sexual behavior. This may shed some light the causes of hypersexuality in humans.

Some studies have found a higher frequency of addictive sexual behavior in people from dysfunctional families. A person with sexual addiction is more likely to have been abused than other people.

A significant number of people recovering from sexual addiction have reported some type of addiction among family members. It can occur alongside another addiction.

Diagnosis

Symptoms of sexual addiction may resemble those of other addictions, but the diagnostic criteria for sexual addiction remains in dispute. For this reason, there are different sets of criteria for diagnosing the condition.

Hypersexuality is not a formal diagnosis, according to the American Psychiatric Association’s (APA’s) Diagnostic and Statistic Manual of Mental Disorders, 5th Edition (DSM-V), due to a lack of evidence supporting its existence as a condition.

However, the International Classification of Diseases, Tenth Edition (ICD-10) provides a category into which hypersexuality can fit: “F52.8: other sexual dysfunction not due to a substance or a known physiological condition.”

Excessive sexual drive, nymphomania, and satyriasis are all included under this category.

The Semel Institute for Neuroscience and Human Behavior, UCLA, suggested in a 2012 study that to in order for a sexual addiction to qualify as a mental health disorder, an individual must:

“Experience repeated sexual fantasies, behaviors, and urges that last upwards of 6 months, and are not due to factors, such as medication, another medical condition, substance abuse, or manic episodes linked to bipolar disorder.”

As more examples of sexual addiction and its consequences have emerged, the disorder has become more widely accepted as a legitimate mental condition.

Sexual addiction or advanced libido?

One challenge is to distinguish sexual addiction from a high sex drive.

Two key features can help health professionals to do this:

  • consistent failure to control the behavior
  • continuation of the behavior despite the harm caused

A qualified psychiatric doctor will be able to distinguish between an advanced libido and a pattern of dependency on sexual stimulation or other paraphilic disorder that requires medical attention.

Suggested criteria

Dr. Aviel Goodman, director of the Minnesota Institute of Psychiatry, has proposed criteria similar to those used in substance addiction.The criteria would diagnose sexual addiction when significant damage or distress is caused by a pattern of behavior.

To receive a diagnosis, a person should show at least three of the following traits during a 12-month period. The behaviors relate to tolerance and withdrawal issues. They would not adjust to the changing personal circumstances caused by sexual addiction.

  • The behavior needs to increase in frequency and intensity to achieve the desired effect.
  • Continuing at the same level or intensity fails to produce the desired effect.
  • Discontinuing the behavior leads to withdrawal syndrome, including physiological or psychological changes.
  • Similar behavior is engaged in to relieve or avoid withdrawal symptoms.

Other possible criteria include:

  • engaging in the behavior for a longer time or at a higher intensity or frequency than intended
  • having a persistent desire to cut down or control the behavior, or making unsuccessful efforts to do so
  • spending a lot of time on activities needed for preparing to engage in and recovering from the behavior
  • giving up or reducing important social, occupational, or recreational activities because of the behavior
  • continuing the behavior despite knowing that it is likely to cause or worsen a persistent physical or psychological problem

Treatment

Addiction can be difficult to treat, as a person with an addiction will often rationalize and justify their behaviors and thought patterns. People with a sex addiction may deny there is a problem.

Sexual addiction treatmentSexual addiction can be controlled by attending self-help meetings.

Current treatment options aim to reduce any excessive urges to engage in sexual relations and to encourage the nurturing of healthful relationships.

The following treatment options are available:

  • Self-help organizations, such as Sex Addicts Anonymous, Sexaholics Anonymous, Sexual Compulsives Anonymous, and Sex and Love Addicts Anonymous, offer 12-step programs to help the individual in self-managing the condition.
  • Residential treatment programs are available for individuals with various addictive disorders. These are in-patient programs, during which the individual lives on-site at the facility and receives care from specialized therapists.
  • Cognitive behavioral therapy (CBT) provides a variety of techniques that help the individual change their behavior. CBT can equip a person to avoid relapses and reprogram harmful sexual behaviors.
  • Prescription medications, such as Prozac, may be prescribed to reduce sexual urges, but the drug has not been approved by the U.S. Food and Drug Administration (FDA) to treat this condition.

The support of friends and family is crucial for a person recovering from an addiction. Sexual addiction, due to its behavioral nature, can be difficult for others to understand and tolerate, especially if it has already led to damage in relationships.

However, a strong support network helps to reduce destructive behavior and the risk of relapse.

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