Anal sex is stimulation of the anus during sexual activity. It can be done in several different ways: manually, orally or by anal intercourse. Anal sex can be the primary form of sexual activity or it can accompany other types of stimulation. For instance, couples sometimes include manual stimulation of the anus (either lightly rubbing the rim or inserting a finger into the anus) during vaginal intercourse. Others use the tongue in a similar fashion for oral stimulation. Anal intercourse is the insertion of a man’s penis into his partner’s rectum. Although anal sex is often thought of as a strictly homosexual activity, many heterosexual couples enjoy it too.

Anal penetration can be pleasurable, but it can also be a source of physical discomfort. The muscle on the outside of the rectum, called the anal sphincter, ordinarily tightens if stimulated, which means that attempts at insertion of the penis, or even a finger, may be uncomfortable even if done slowly and gently. If penetration into the anus is forced, injury is possible. It is helpful to use a lubricant liberally and to relax and gradually dilate the sphincter by gentle manual stimulation before attempting penetration.

Some people clear the rectum with a small disposable enema before anal intercourse. Because the rectum contains infection causing bacteria, anything (fingers, objects, and penis) that has had contact with the anus should not subsequently be in contact with the vagina or mouth until it has been thoroughly washed.

Some people have strong negative attitudes toward anal sex, whether it takes place between homosexual or heterosexual couples. They may think of it as being unclean, unnatural, perverted, disgusting, or simply unappealing. It is sometimes regarded as the ultimate in depravity and has regularly been condemned by religious and secular authorities. Historically, religious objections originate from the fact that a woman cannot possibly get pregnant through anal sex, as some religions only approved of sexual intercourse for the purpose of reproduction.

Anal sex is subject to legal restrictions in some states, even between married couples. In general these statutes refer to anal sex acts as “crimes against nature”, going back to the view that heterosexual intercourse, with its reproductive potential, is the only natural, healthy, non-sinful way of having sexual relations. These laws are strongly biased toward the prosecution of homosexuals because penetrative anal sex is far more common among gay men than it is among heterosexual couples.

Despite religious and legal prohibitions to anal sex, many people, regardless of their sexual orientation, have engaged in anal sex and found it pleasurable. They regard it as a legitimate form of sexual expression and as one of the fulfilling ways in which people can express their desire and affection for each other. It is up to each couple to decide what is acceptable and enjoyable for them. If a couple’s attitudes or values make anal sex unacceptable, or if they do not enjoy it, they should feel no pressure to engage in it.

It is important to note that HIV, the virus causing AIDS, can be transmitted through anal sex, especially anal intercourse. In fact, the risk of HIV transmission is greater than it is in vaginal intercourse because the lining of the rectum tears more easily than the vagina does. The resulting skin breaks and bleeding increase the possibility of the transmission of bodily fluids containing the virus that causes AIDS. For those who choose to engage in either vaginal or anal penetrative sexual acts, using latex condoms is the best means of reducing the likelihood of HIV transmission.

Abstinence in the context of sex means deliberately refraining from sexual intercourse or more broadly from any sexual activity. People choose abstinence for a variety of reasons. Probably the most common reason – promoted by some sex educators, most parents and nearly all religious groups – is to deter teen pregnancy and the spread of sexually transmitted diseases. In addition, some groups encourage abstinence for ideological and moral reasons, such as religious values or personal beliefs.

Some people practice abstinence as a method of contraception. These individuals or couples may engage in non-coital sexual relations, sometimes called “petting,” stopping short of intercourse.

Some individuals are abstinent on a temporary basis, for instance, until they get married or find the right partner. Others are abstinent from intercourse and perhaps other forms of sexual contact as a safeguard against contracting or transmitting sexually transmitted diseases.

Abortion is the termination of a pregnancy. There are two major categories of abortion. Spontaneous abortion, called miscarriage if it occurs after the first few weeks of pregnancy, is the natural loss of a fetus without intentional human intervention. It is an extremely common event, often occurring before a woman even realizes that she is pregnant. Induced abortion, by contrast, is initiated intentionally. Induced abortions are of various kinds, including nonprofessional efforts by the pregnant woman or others to end an unwanted pregnancy. Medical abortion can be done using established medical procedures by a trained medical practitioner.

There are three main types of medical abortion. By far the most common procedure involves insertion of a cannula through a woman’s cervix and removing the fetus and placenta using vacuum aspiration. This procedure generally is used in the first trimester (i.e., the first three months after conception) and accounts for about 90 percents of all medical abortions. In this procedure, which takes about 5 to 10 minutes and can be performed in a physician’s office, the woman lies on an examining table with her feet in stirrups. A local anesthetic is administered to numb the woman’s cervix. In some cases, a general anesthetic may be used to induce sleep, but this is usually not necessary. The first step in the procedure involves the insertion of a speculum to hold the vaginal walls apart, followed by insertion of a cannula through the dilated cervix. The cannula is connected to a mechanical aspirator. The sucking action of the machine, similar to the device used by dentists to remove excess saliva during dental procedures, removes the contents of the uterus. To insure that the abortion is complete, the physician may insert a spoon-like instrument, called a curette, and checks the walls of the uterus. This ends the procedure.

About 10 percents of abortions are performed after the 12th week of pregnancy. Two alternative procedures are used with later-term pregnancies. The first is quite similar to the procedure described above, but, because the fetus is larger and more firmly attached to the uterine wall, in addition to using suction the physician inserts a forceps to remove fetal parts that may be too large to be successfully aspirated. The procedure takes up to 30 minutes and may involve the administration of pain medication to the woman. Alternately, in pregnancies that are past the twenty-second week of development, it is possible to induce labor chemically causing the fetus to be expelled through the vaginal opening. Unlike the other procedures, this procedure is generally performed in a hospital. A needle is inserted through the abdominal wall into the uterus and a labor-inducing medication (such as prostaglandin, urea, or saline solution or some combination of these) is injected. Within a few hours, the woman begins labor and the fetus is expelled.

Regardless of the method used, women who have undergone an abortion should be checked for blood pressure and heart rate, and monitored to insure that bleeding and discomfort are limited. One or more follow-up appointments may be arranged several weeks after the abortion to insure that the procedure has been successful and that the woman is healthy. In abortions performed before the 13th week of pregnancy, some follow-up surgery, for example, to remove a blood clot or to repair a tear in the cervix, is needed in only 0.5% of cases. In abortions performed between13 and 24 weeks, complications are somewhat more frequent, in part because of the use of a general anesthesia. The death rate for women who have medical abortions is one in 160,000. By comparison, in full term pregnancies, the death rate is one for every 16,000 successful deliveries.

In the years before abortion was legal, from the late 1800s until the famous Roe v. Wade Supreme Court decision of 1973, more pregnant women died from infections, retained placentas, poisoning, shock, profuse bleeding and other complications brought on by self-induced abortions or abortions performed by unqualified practitioners than from any other single cause. In parts of the world where abortion is still illegal, these remain a leading cause of maternal death. By contrast, today’s legal medical abortion is one of the most common and safest surgical procedures in the India Approximately 1.3 million women choose to have a medical abortion performed each year. Major complications and side effects occur in only about 1 percent of medical abortions. Some women experience menstrual-like cramping during an abortion and for up to an hour afterward. Most women report that this cramping is uncomfortable but not painful. Vaginal bleeding, similar to a menstrual period, generally occurs after an abortion is completed. For the most part, the earlier in pregnancy an abortion is performed, the less likely there will be medical complications.

Despite the limited complications and risks involved, medical abortion is one of the most controversial domestic issues in the world.

Aphrodisiacs are substances that arouse sexual desire or enhance sexual performance. For many centuries there has been a search for substances that could increase a person’s sexual powers or desire. Among the many substances that have been claimed to have such an effect are oysters, ginseng root, powdered rhinoceros horn, animal testicles, and turtles’ eggs. There is no evidence that an actual aphrodisiac response occurs with these or any other substances.

Just how certain foods or other substances come to be seen as an aphrodisiac is typically a matter of folklore rather than fact. In some cases the newness or rarity of a food or chemical invite people to endow it with magical powers of a sexual nature. In other instances, sexual strength is assumed to come from eating foods resembling a sex organ, such as bananas and oysters because of their vague resemblance to the penis and testicles. While the notion that the shape of an unrelated object should qualify it as a aphrodisiac seems absurd to most, people continue to view some foods as aphrodisiacs. In the case of oysters, probably the classic among the alleged aphrodisiacs, chemical analysis shows that it consists of water, protein and carbohydrates, plus small amounts of fat, sugar and minerals. None of these components is in any way known to affect sex drive or performance. The psychological impact of believing that oysters, raw bull’s testicles (“prairie oysters”, as they are called), clams, celery, or tomatoes are aphrodisiacs is sometimes strong enough to produce, at least temporarily, greater sexual desire or performance. The experience of enhanced arousal or performance is then falsely attributed to the wonder food, and this discovery is passed on to the next person wishing to experience new heights of sexual experience.

Eating certain foods to increase sexual power, while ineffective, is generally harmless. Other supposed aphrodisiacs, however, are not so innocuous. Spanish fly (cantharides) is one such substance. It is made from a beetle found in southern Europe. The insects are dried and heated until they disintegrate into a fine powder. When taken internally the substance causes irritation of the bladder and urethra, accompanied by a swelling of associated blood vessels, all of which produce a certain stimulation of the genitals that is interpreted by some men as a sign of lust. The drug can cause an erection, but usually without an increase in sexual desire. Furthermore, if taken in excessive amounts, it can cause violent illness and even death.

Alcohol is another substance that most people believe increases their sexual responsiveness. This is partly because alcohol has a control effect — it lowers the sexual inhibitions a person may ordinarily have, thus allowing sexual desire to emerge. Alcohol’s reputation as an aphrodisiac also stems from advertising and cultural myths. Television, radio and print ads often pair exciting sexual undertones with the brand of alcohol being advertised, suggesting to consumers that alcohol will help them create such sexually charged moments. Cultural myths, often propagated among high school and college-aged drinkers, suggest that alcohol will ease the way for sexual encounters to occur. Furthermore, the myths promise that, once underway, sexual experiences will exceed normal performance levels, thanks to the presence of alcohol. The fact is that alcohol acts as a central nervous system depressant, physically inhibiting the sexual response, including the capacity for erection and orgasm.

A number of illicit drugs, including LSD, heroin and morphine, cocaine and amphetamines, and marijuana have been claimed to increase sexual responsiveness and enhance the sexual experience. Like alcohol, these drugs break down inhibitions and act as sexual facilitators in a social sense, but these drugs are addictive and ultimately have the opposite effect on sexuality, and cause an array of other very serious problems.

A drug that is commonly believed not so much to increase the sex drive as to intensify or prolong the sensation of orgasm is amyl nitrate (snappers or poppers). Some people report that inhaling the drug at the instant of orgasm enhances the pleasure of the experience. This is particularly popular among homosexual men. Valid scientific data of its effectiveness as an aphrodisiac are lacking, and its side effects (dizziness, headaches, fainting) are known to be dangerous.

Yohimbine is a substance derived from the bark of the African yohimbe tree that has been reputed to have sexually stimulating properties for men. Studies of yohimbine have found that it has a tendency to enhance erectile functioning relative to placebo in men with erectile difficulties. There have not been consistent reports of yohimbine enhancing sexual desire or arousal. It is more likely to be used as a treatment for erectile dysfunction than as a true aphrodisiac.

Though not generally considered an aphrodisiac, testosterone supplements do affect sexual drive and can be used effectively in some cases of inhibited desire when endogenous levels of testosterone are extremely low. There are, however, negative side effects (especially for women), and such supplements should only be used under a doctor’s supervision.

Certainly, it seems reasonable to speculate that various chemicals and other substances might influence the centers of the brain that control sexual response. To date, however, about the only effects that drugs appear to have on sexual behavior are inhibitory rather than enhancing, and most foods believed to be aphrodisiacs have no physical effect at all. It would appear that most claims about aphrodisiacs are based on myth rather than scientific evidence, making their continued use more a statement about the desperate. Search for remedies than a tribute to their effectiveness.

Asexual refers to the absence of sexual activity or a low level of sexual response. Sexual union of male and female germ cells (such as the sperm and ova in humans) is the means of reproduction that is standard among mammalian and many non-mammalian species. However, many organisms reproduce through asexual means, such as budding, spore formation, or fission. Organisms that produce through these means are sexless.

Asexuality can also refer to a lack of interest or involvement in sex in sexual species. The priesthood in a number of religions, for example, requires abstinence or even monasticism among its members. While individuals who participate in religious abstinence may have normal sexual interest, they are required to take a vow of abstinence. Over time, lack of involvement in sexual activity may lead to a considerable drop in sexual interest. Vows of abstinence may also be taken outside of the arena of organized religion, although these are usually situational and time limited. Disinterest in sex also may be due to a sexual dysfunction; that is, a psychological or organic condition that blocks normal sexual behaviors and responses. Specifically, in the case of complete disinterest in sex, the condition may be diagnosed as sexual desire disorder.

In sexual desire disorder the individual has a persistent absence of sexual fantasies or desire for engaging in sex. Further, the individual exhibits an intense aversion to either heterosexual or homosexual genital sexual contact.

Additionally, persistent failure in sexual response may lead to the avoidance of sex or sexual situations. This can occur at any point in life but tends to occur more frequently among the elderly. These conditions can have an emotional origin, of varying severities, or they may have an organic cause. Often they are treatable through sex therapy and/or biomedical intervention. Intensive desire disorders, however, may reflect complicated psychological problems that are difficult to treat. In addition, some individuals may be biologically incapable of sexual interest or involvement in sexual activity and, although members of a sexual species, are themselves asexual. This, however, is a rare condition and most forms of sexual dysfunction respond to therapeutic intervention.

Breasts are part of the anatomy of both females and males. On the inside, a woman’s breast is made up of about 15-25 milk-producing sacs called milk glands, which are connected to milk ducts that converge inside the nipple. The remainder of the internal breast is composed of fatty tissue and fibrous connective tissues that bind the breast together and give it shape. On the outside of the breast there are nipples. Nipples, like all other anatomical structures, vary in appearance from woman to woman. They may stick out prominently, they may have a flattened appearance, they may be set a bit deeper in the breast, or they can be inverted. Each nipple is supplied with many nerve endings, which make it particularly sensitive to touch. There are thin muscle fibers in nipples that enable them to become erect. The darker pigmented area around each nipple is called the areola (plural: areola). The size and color of the areola vary from woman to woman. This area can be seen as an extension of the skin of the nipple onto the breast. It contains many nerve fibers and muscle fibers that help the nipple to stiffen and become erect. It is quite normal to have small bumps in the areola. These bumps are oil-producing glands that secrete a lubricant to make breast feeding easier. During pregnancy, areola darkens and remains at least somewhat darker after pregnancy.

Women’s breasts have three levels of significance: they can feed a baby; they can give erotic pleasure; and they play a large part in shaping a woman’s self-image.

In response to sexual stimulation, a woman’s breasts may undergo changes. Her nipples typically become erect during sexual excitement. As excitement proceeds, the areola begin to swell, continuing to the point where the earlier nipple erection may look less pronounced. The veins in the breast often become more visible as a result of the increased blood flowing into them, and, in women who have not breast-fed, there may also be a small increase in breast size.

Breasts are a part of sexual anatomy that is unrelated to reproduction, but, in American society, have a great deal of erotic allure and sexual symbolism. It is not at all unusual to see a large-breasted woman used in advertisements to sell everything from beer to cars to cologne (notably, these are primarily male markets). As a result of the almost universal association of a woman’s breasts with femininity, sexuality, and attractiveness, women and men have developed burdensome misconceptions about the meaning of breast size. We are bombarded on an almost daily basis with the not so subtle suggestion that a woman with large breasts has a definite sexual advantage; thus, conversely, a woman with small breasts must be less sexually interested and skilled.

The fact is that there is absolutely no evidence to suggest that breast size is related to a woman’s level of sexual desire, or to her sexual response. Actually, many women experience very little sexual pleasure from having their breasts fondled or caressed, and this is true for women with large and small breasts. Often it is the woman’s male partner who derives more pleasure out of fondling her breasts, and she may participate mainly because she knows her lover enjoys it. Furthermore, the women who do become sexually aroused when their breasts are touched do so regardless of their breast size.

Because of the enormous importance that American culture attaches to breasts, their size and shape, many women worry that their breasts are too small, too large, or just the wrong shape. Not only may this negatively affect their self-image and self-acceptance, it leads some women to try ineffective and even dangerous methods of breast augmentation or reduction.

Men’s breasts can give erotic pleasure (in some males), but they have little influence on self-image, and they do not produce milk. Men’s breasts do not increase in size under stimulation but some men will have noticeable nipple erection.

Bisexuals are men and women who achieve sexual or erotic attraction to members of both sexes. Usually, but not always, the bisexual person engages in sexual activity with partners of both sexes. Slang terms referring to bisexuals are “AC/DC” (based on the term used to describe two types of electrical current), “switch-hitters” (a baseball term describing a batter who hits from either side of home plate depending on who’s pitching), or people who “swing both ways” (another baseball phrase, but may also relate to swinging as sexual behavior).

Compared to heterosexuality and homosexuality, very little scientific study has been conducted on bisexuality. Based on the studies that have been done, it appears that bisexuals are not people whose orientation is fundamentally homosexual but who have some heterosexual sex on the side. Nor are they people whose orientation is fundamentally heterosexual but who enjoy homosexual sex on the side. Also, fundamentally, they are not people who, at one point in their lives, engage in sexual behavior with persons of one sex and then, at another point, engage in sexual behavior with persons of the other sex, although this pattern of sequential changes is sometimes called transitional bisexuality. Rather, bisexuals are people who are sexually attracted to persons of both sexes during the same general time period in their lives.

It is thought that people develop and experience bisexuality in a number of different ways. For some it begins as a form of experimentation that adds a spark to their sex lives, but it does not become the main arena of sexual activity. For others it is a deliberate choice to participate in whatever feels best at the moment. Three particular sets of circumstances have been thought to be conducive to bisexuality: (a) sexual experimentation in a relationship with a close friend is quite common among women and can also occur between two male friends or a male homosexual may develop a sexual relationship from a previously casual but friendly relationship with a woman. (b) Group sex is another avenue for bisexual experimentation. (c) Finally, some people adopt a bisexual philosophy as an outgrowth of a personal belief system. For instance, some women who have been active in the women’s movement find they are drawn closer to other women by the experience and translate this closeness into sexual expression.

Men who are bisexuals are likely to experience homosexual attraction and engage in homosexual experiences before they become aware of their bisexuality. For women, on the other hand, the trend is to experience heterosexuality first.

Although persons with a bisexual orientation do not fit simply into any one mold, there are a few patterns that may apply to many bisexuals. Some men and women seem to alternate their choice of sex partners randomly, depending on availability and circumstances. Some have committed relationships in this fashion, seeking a partner of the alternative sex when the current relationship ends. In other cases, a bisexual person may have simultaneous relationships with a man and a woman. Affairs during a lasting relationship may also be used to express one’s bisexual orientation. Most often, whichever of these patterns applies, people with bisexual orientation have a tendency toward more relationships with one gender than the other.

Researchers who have studied female bisexuality note that some women who identify themselves as bisexual say that they have some emotional needs that are best met by men and others that are best met by women. Some bisexual men offered this explanation too, but much more often the male bisexual explains his sexual lifestyle in terms of a need for variety and creativity.

People usually discover their bisexual orientation later in life than either heterosexuals or homosexuals. The majorities of people model the heterosexual lifestyle and drift into bisexual relationships without consciously thinking about it initially. Most individuals who discover their attraction to the same sex try to deny their interest and attempt to fit in with the more socially acceptable heterosexual lifestyle for a while. Usually by adolescence there is increasing internal conflict about their sexual preference that may not be fully resolved until adulthood.

Because it is commonly thought that people are heterosexual or homosexual, even by people with bisexual interests, these people seem to struggle for a longer period of time trying to conform to one lifestyle or the other. It is common for people to be well into their 20’s or 30’s before accepting their bisexual orientation. Society’s definitions of what is normal, appropriate, right and natural have an enormous influence on how bisexual people feel about their sexual orientation. Given the negative bias toward bisexuality, it is not unusual for women and men with a bisexual orientation to feel alienated from and oppressed by both the heterosexual and homosexual communities. For them, this can raise serious questions about their sexual identity. Bisexual people have problems similar to those that homosexual people have in “coming out” and making their orientation known to family and friends.

Someone who is bisexual may often find it harder to start and maintain relationships than people of heterosexual or homosexual orientation. Because bisexual people are both different and often misunderstood, those who do not have a bisexual orientation may be rejecting or feel that a relationship with a bisexual person could not be valid or rewarding. Jealousy, which can be a problem in any relationship, is particularly likely in a relationship in which one partner is bisexual. If both partners are bisexual the possibilities for jealousy may be even greater. The threat of such widespread competition can be very stressful to a couple that is not secure in their relationship.

There is much more to be learned about the nature of bisexuality and perhaps as bisexual people become more accepted in society, scientific studies will contribute new information to what is currently known.

Blue balls is a slang term referring to testicular aching that may occur when the blood that fills the vessels in a male’s genital area during sexual arousal is not dissipated by orgasm. When a man becomes sexually excited, the arteries carrying blood to the genital area enlarge, while the veins carrying blood from the genital area are more constricted than in the non-aroused state. This uneven blood flow causes an increase in volume of blood trapped in the genitals and contributes to the penis becoming erect and the testicles becoming engorged with blood. During this process of vasocongestion the testicles increase in size 25-50 percent.

If the male reaches orgasm and ejaculates, the arteries and veins return to their normal size, the volume of blood in the genitals is reduced and the penis and testicles return to their usual size rather quickly. If ejaculation does not occur there may be a lingering sensation of heaviness, aching, or discomfort in the testicles due to the continued vasocongestion. This unpleasant feeling has popularly been called blue balls, perhaps because of the bluish tint that appears when blood engorges the vessels in the testicles.

The condition usually does not last long and the level of pain associated with blue balls is usually minor and can be exaggerated. Most men have been socialized to ejaculate when they get an erection during sexual activity. Failure to ejaculate and to feel orgasm often adds frustration and disappointment to the reality of the physical sensation. Men who believe that they should ejaculate every time they have an erection are likely to exert pressure on their partner to proceed with sex without taking her feelings into consideration. Some men find that masturbation is a viable solution and some men are realizing that ejaculation is not a requirement in every sexual situation. This attitude allows both men and their partners to relax more and to learn that pleasure and meaning can exist without having to reach ejaculation and orgasm during every sexual encounter.

Men are not alone in experiencing the discomfort of unrelieved vasocongestion. Women’s genitals also become engorged with blood during sexual arousal and, like their male counterparts; women can experience pelvic heaviness and aching if they do not reach orgasm.

Circumcision is the surgical removal of the foreskin, the fold of skin that surrounds the glans of the penis. As a result of circumcision the glans of the penis is fully exposed when the penis is flaccid. The procedure can be performed at any age, but in Western societies it is usually done shortly after birth.

Not all males undergo circumcision. Today, it is done primarily for religious and cultural reasons. Another reason for circumcision is related to hygiene. Removal of the foreskin is said to help prevent the build up of a white, cheesy secretion that can possibly lead to irritation, infection, or offensive odor. This substance, called smegma, is a natural secretion from the glands in the coronal area of the penis and can accumulate under the foreskin of an uncircumcised penis. However, simply moving the foreskin back and washing the area daily can easily avoid this accumulation. Thus, circumcision can seem like a rather extreme remedy purely for the avoidance of smegma. Perhaps this custom has persisted because it has been suggested that smegma may be responsible for transferring a virus that may encourage cervical cancer. Although the rate of cancer of the cervix has been shown by some researchers to be considerably lower in the spouses of circumcised men, it is not certain that this is a cause-effect relationship. In any event, uncircumcised men who practice routine hygienic care (as well as their partners) are unlikely to be at any major health risk. Many parents who recognize that there is apparently no medical advantage to circumcision are now choosing not to have their sons circumcised.

There is no evidence to suggest that circumcision has any effect on male sexual functioning one way or another. Opponents of routine circumcision argue that removing the foreskin lessens the sexual sensitivity of the glans since it constantly rubs directly against clothing. There is simply no evidence demonstrating that circumcision makes a difference to sexual excitement, erection, and the ability to reach orgasm or the ability to have a pleasing and complete sex life with a partner.

The clitoris is the female sexual organ found where the labia minora, or inner lips, meet. It consists of a rounded area or head, called the glans, and a longer part, called the shaft, which contains cavernous bodies similar to those of the penis. The tissue of the inner lips normally covers the shaft of the clitoris, which makes a hood, or prepuce, to protect it. The only directly visible part of the clitoris is the glans, which looks like a small, shiny button. The size and shape vary considerably among women. It can be seen by gently pushing back the skin of the clitoral hood. There is a high concentration of nerve endings in the clitoris and in the area immediately surrounding it.

The abundance of nerve endings in the clitoris makes it very sensitive to direct or indirect touch or pressure. Stimulation of the clitoral area can be very pleasurable. In fact, providing its owner with sexual pleasure is the organ’s only known function, and the clitoris is the only organ in either sex with pleasure as its sole function. It has nothing to do with getting pregnant, with menstruation, or with urination.

When a woman becomes sexually aroused, both the glans and the shaft fill with blood and increase in size. The glans can double in diameter. There is no evidence that a larger clitoris means more intense sexual arousal. As erotic stimulation continues and orgasm approaches, the clitoris becomes less visible as it is covered by the swelling of tissues of the clitoral hood. This swelling is designed to protect the clitoris from direct contact, which, for some women, can be more irritating than pleasurable. It moves out again when the stimulation stops.

After orgasm the clitoris returns to its normal size within about ten minutes because the orgasm leads to a dispersal of the accumulated blood. If the woman doesn’t have an orgasm, the blood that has flowed into the clitoris as a result of sexual arousal may remain there, keeping the clitoris engorged for a few hours. Many women find this uncomfortable.

A woman’s clitoris can be stimulated through direct or indirect contact. During intercourse the penis does not contact the clitoris directly. The thrusting of the penis in the vagina, regardless of the position used, moves the labia minora, and it is this movement of the lips against the clitoris that usually creates the orgasm. Direct contact with the clitoris by touching it with a finger, vibrator, or a tongue can cause more discomfort than pleasure for many women. For these women, more general rubbing or licking of the area around the clitoris is likely to feel better. Other women enjoy very intense direct stimulation. There is great variability in sensitivity of the clitoris and each woman will discover what feels best to her.

Dyspareunia is the clinical name for painful intercourse. This condition can occur at any age, in both sexes, and the pain can appear at the start of intercourse, midway through, at the time of orgasm, or after intercourse is completed. The pain can be felt as burning, sharp, searing or cramping. It can be external, within the vagina, or deep in the pelvic region or abdomen.

The exact incidence of dyspareunia is unknown. Masters, Johnson, and Kolodny (Little, Brown and Co., 1986) found that about 15 percent of adult women have painful intercourse on a few occasions per year. They estimate that one to two percent of adult women have painful intercourse more often. Spector and Carey (1990) reviewed the literature on dyspareunia and reported incidence ranging between eight percent and 23 percent across studies.

The causes of dyspareunia, as with most sexual dysfunction, can be classified as either organic (physical or medical factors such as illness, injury or drug effects) or psychosocial (including psychological, interpersonal, environmental and cultural factors). The cause of a sexual dysfunction in a given individual may be a combination of several factors, and in some cases, the precise cause may not be identifiable at all.

Female dyspareunia can be caused by dozens of physical conditions. Any condition that results in poor vaginal lubrication can cause discomfort during intercourse. Among the more common culprits are drugs that have a drying effect (antihistamines, certain tranquilizers, marijuana) and disorders such as diabetes, vaginal infections, and estrogen deficiencies. Other causes of female dyspareunia include 1) blisters, rashes and inflammation around the vaginal opening or the vulva; 2) irritation or infection of the clitoris; 3) disorders of the vaginal opening, such as scarring from an episiotomy, intact hymen or remnants of the hymen that are stretched during intercourse, or infection of the Bartholin’s glands; 4) disorders of the urethra or anus; 5) disorders of the vagina, such as surgical scarring, thinning of vaginal walls (whether due to aging or estrogen deficiency), and irritation due to chemicals that are found in contraceptive materials or douches; and 6) pelvic disorders such as infection, tumors, abnormalities of the cervix or uterus, and torn ligaments around the uterus .

Psychosocial causes of dyspareunia may be as frequent and varied as organic ones. It is usually much more difficult to develop a clear understanding of how psychosocial factors contribute to sexual dysfunction, including dyspareunia. Many authorities believe that developmental factors such as troubled parent-child relationships, negative family attitudes toward sex, traumatic childhood or adolescent sexual experiences, and gender identity conflicts may all predispose one toward developing a sexual dysfunction. In cases of dyspareunia, if a child has been brought up to believe that sex is wrong and will cause pain, that person as an adult may well feel pain with intercourse. Similarly, a painful previous sexual experience can create an expectation of painful intercourse in future experiences. Personal factors such as anxiety, fears of pregnancy, intimacy and rejection, to name a few, may block the pathways of sexual response and lead to pain. Relationship problems or interpersonal conflicts such as power struggles, hostility toward a partner, preference for another partner, distrust, poor communication and lack of attraction to a partner can all emerge as pain during intercourse.

Other feelings and psychological conflicts may also affect sexual responsiveness, inhibiting or reducing vaginal lubrication, which can result in painful intercourse. Guilt, depression and poor self-esteem are commonly encountered in association with sexual dysfunctions. However, it is not always clear which came first, the feelings or the dysfunction. Because it is not unusual for people who have sexual problems to become depressed about them or to experience lowered self-esteem, identifying a problematic feeling does not always mean it caused the dysfunction.

Dyspareunia is generally thought of as a female sexual dysfunction but it also affects males. Typically, the pain is felt in the penis but it can also be felt in the testes or internally, where it is often associated with a problem of the prostate or seminal vesicles.

Organic causes of dyspareunia in males include inflammation or infection of the penis, the foreskin, the testes, the urethra, or the prostate gland. Less common is pain resulting when the tip of the penis is scratched by the tail of an IUD (intrauterine device, a form of female contraception). Men sometimes develop painful penile irritation when exposed to some vaginal contraceptive foams or creams. It is about equally as likely for the cause of male dyspareunia to be psychosocial in nature. Nearly all of the psychosocial issues that may contribute to female dyspareunia apply to men as well.

Dyspareunia can usually be treated once the probable causes have been identified. Organic diseases can typically be addressed after a thorough gynecological or medical examination, and psychotherapy can usually help with the psychosocial factors.

Ejaculation is the release of semen from the penis. It is a normal part of the male sexual response cycle. During sexual intercourse or masturbation, semen collects in the ejaculatory ducts, which are located where the ends of the vas deferential join the seminal vesicles within the prostate gland. When excitation reaches its peak, a spinal reflex causes the rhythmic contractions of the smooth muscles within the urethra, penis and the prostate gland, and propels the semen through the urethra out the tip of the penis in spurts. Once a man reaches a certain point of sexual arousal, he can no longer prevent ejaculation. This feeling of having reached the brink of control once these contractions start is known as ejaculatory inevitability.

The rhythmic contractions of the prostate, perineal muscles and shaft of the penis occur initially at 0.8-second intervals, just as in women, and account for the spurting action of the semen during ejaculation. The intervals between contractions become longer and the intensity of the contractions tapers off after the first three or four contractions.

The semen does not actually appear until a few seconds after the point of ejaculatory inevitability because of the distance the seminal fluid has to travel through the urethra. During ejaculation, the internal sphincter of the urinary bladder is tightly sealed to make sure that the seminal fluid travels forward and to prevent any urine from mixing with the semen.

Male ejaculation and orgasm are not one and the same process, although in most men and under most circumstances the two occur simultaneously. Orgasm refers specifically to the sudden and rhythmic muscular contractions in the pelvic region that release accumulated sexual tension and result in an intensely pleasurable sensation.

Sometimes ejaculation occurs involuntarily and unbeknownst to the man during sleep. This is known as nocturnal emission or, in slang terms as a “wet dream” and is particularly common in adolescents and young men.

In some cases, the fine-tuned process of ejaculation is disrupted. In a condition called retrograde ejaculation the bladder’s sphincter does not close off properly during ejaculation, so semen spurts backward into the bladder. This condition is usually found in some men who have multiple sclerosis, diabetes, or after some types of prostate surgery. It can also occasionally occur in men who do not have any serious problems. It is not physically harmful, but it does render the man infertile and he may have a different sensation during ejaculation. A retrograde ejaculation is also known as a “dry come” because the man may experience orgasm, but no semen is released from the penis.

Premature ejaculation, or rapid ejaculation, is a sexual response problem in which a man consistently feels he has little or no control over the timing of his buildup to ejaculation.

Retarded ejaculation, or delayed ejaculation, is a sexual response problem also known as ejaculatory incompetence in which a man is unable to ejaculate even though he is highly sexually aroused.

Finally, the subject of female ejaculation has sparked controversy among sexuality researchers. There is a body of research documenting that some women expel a fluid from the urethra at the time of orgasm through G-spot stimulation. It has been theorized that this fluid may come from a “female prostate,” rudimentary glands surrounding the urethra whose tissue corresponds to the male prostate gland. In fact, some suggest that the female prostate is the anatomical location of the G-spot. Not all researchers have been able to duplicate the female ejaculatory response in their studies, but among those who have, the composition of the ejaculate is subject to debate. Some researchers have demonstrated that the fluid emitted is not urine and does not contain any significant amount of urine. Others assert that the fluid is urine. Not all women experience the ejaculation-like response (estimates vary between 10 percent and 40 percent as to the number of women who have ever experienced ejaculation), but for those who do, it is perfectly normal.

Erogenous zones are parts of the body that, when stimulated, elicit sexual arousal. Precisely which body parts are sources of sexual arousal is a very individual experience. The genitals are the most obvious erogenous zones, but many parts of the body not involved in reproduction are sensitive to sexual touch. The largest sensory organ for both men and women is the skin itself, especially the inner thigh area, the neck, the breasts and nipples, and the perineum. Other erogenous zones include the eyelids, the ears, and the shoulders. Many people also find that having their feet stroked is arousing. Stroking, caressing and massaging of erogenous zones can be titillating forms of sensual pleasure in and of themselves, or they can be invitations to further sexual activity.

The mouth, including the lips and tongue, for most people, is an area of high erotic potential. Kissing is one act that uses the sensitivity of this region in a sexually stimulating way.

The anus, rectum and buttocks are also potentially erogenous zones. The anus is highly sensitive to touch and the insertion of a finger, object or penis in the anus and rectum is part of some people’s sexual activity. The buttocks are sometimes a target for spanking and stroking, which can feel very arousing to some people.

Deliberately exploring yourself and your partner is the first step in discovering which body parts are sexually responsive and the types of stimulation that feel best. Varying the pressure of touching and stroking the body from head to toe with different materials, such as a silk scarf, a soft brush, or a feather, may help to identify previously undiscovered erogenous zones.

Erotica is any material or device that arouses sexual interest or is used to enhance a sexual experience. Largely as a result of Gloria Steinem’s 1980 article, the term has come to be used by most to refer to material that contains loving interaction that goes beyond the mere sexual. Commonly, erotica is in the form of sexually explicit writing or visual images such as photographs, drawings and films. Devices made to vary or enhance pleasure during sexual activity, sometimes referred to as SEX TOYS are also considered erotica.

Sexually explicit written and visual material dates back as far as ancient times and has been known to exist in numerous cultures. With the advent of the modern legal system some sexually explicit material – depending on its degree of explicitness and based on the interpretation of the observer – has been classified as obscene. The Supreme Court has set standards of legal obscenity, which are always implemented on a state or local level, but they are extremely difficult to apply on a case by case basis. There is no formula for deciding when something is erotica or obscenity (also called pornography), thus decisions are often left up to communities and individuals.

There are many reasons why people are interested in the use of erotica. Viewing and reading erotica provides a source of knowledge and comparison about sexual anatomy and behavior. Some to spark sexual arousal rather quickly or to prolong it, depending on the person’s appetite at the time, uses erotic materials. Some people use erotic readings, pictures or movies to accompany masturbation. Like sexual fantasies, erotica triggers the imagination and allows people to deal with forbidden or frightening aspects of sex in the controlled environment of the imagination. Erotica gives people opportunities to rehearse in their thoughts acts that they hope to try or are curious about. Others use erotica primarily to heighten their sexual desire (but not as the main course), to turn on their partner, or simply to enrich a sexual experience with their partner.

Preference for one type of erotica over another is a matter of individual taste. Some people prefer the real-life action of films, whereas others prefer to let their imaginations expand on a drawing or photograph or find that stories or other written accounts of a sexually explicit nature offer greater erotic potential. Whatever the venue, there seems to be little difference in the sexual arousal that they help produce. In contrast, the content of erotica, rather than its style of presentation, does have a specific effect. People are more likely to be aroused by content to which they can relate, rather than by depiction of sexual acts that they find uncomfortable or offensive.

The sexual arousal that occurs with the use of erotica can be both psychological and physical. Many investigators have noted specific physiological changes in people while they watch erotic movies, read erotic passages, or listen to tape recordings of erotic stories. Men often experience erection and women undergo changes in vaginal blood flow or lubrication. It has been generally assumed that men responded more frequently and powerfully to erotica than women. However, research indicates that this is not necessarily the case. Both sexes are capable of responding to erotic material in much the same ways, although the type of erotica (style, content, and plot) may be important in determining its turn-on potential.

An erection occurs when the soft spongy tissue in the shaft of a man’s penis fills with blood, causing the penis to enlarge and stiffen. Spongy spaces (technically known as corpora cavernosa and corpora spongiosa) along the length of the penis fill with blood in response to physical stimulation, psychological stimulation, or both. This process requires that the blood supply and the nerve connections to the penis are working properly.

Dilation of the arteries that feed blood to the penis results in engorgement of the spongy tissue. Simultaneous contraction of the muscles at the base of the penis prevents the blood from draining out through the veins, thus maintaining the erection. Nerves in the spinal cord also control erection, which receive input from physical contact to the penis and/or surrounding areas, sexual thoughts, dreams, or images, and sex hormones.

Barring an erectile disease, and provided there is sufficient blood flow and nerve impulse, a man is capable of getting an erection when sexually stimulated. It is important to know that erections come and go. The ability of a man to get an erection is an automatic, normal function similar to his ability to breathe and blink his eyes.

An erection can take place in as little as several seconds or it can occur gradually over a longer period of time. In the later years of a man’s life, beginning in the 50’s and increasingly in the 60’s and 70’s, it can sometimes take longer to achieve an erection even with direct stimulation and a man may notice that his erection is not as firm as when he was a teenager. This is a normal part of aging, but causes some men distress because they measure their maleness or ability to please a partner by the firmness and speed with which they become erect. However, the older man has some advantages over the younger one because his ejaculatory control is usually greater, therefore he can maintain an erection for a considerably longer period of time without feeling the ejaculatory urgency common in younger men. This advantage may be lost in men who have prostate problems because they often experience leakage of the blood supply required to maintain an erection, and can have weaker ejaculations.

Men of all ages occasionally have concerns about the size of their erect penis and whether it is sexually adequate. Although a common worry, the size of a man’s erection is not related to his ability to please a partner or enjoy sex himself. In fact, continually thinking about penis size can interfere with achieving an erection, and with the giving and receiving of pleasure. There is rarely a relationship between the size of a flaccid penis and its size when erect. A small flaccid penis can show a remarkable change as it erects and a large flaccid penis sometimes changes very little in length or thickness, as it becomes erect. An erect penis is typically between five and seven inches long with a diameter between 1.25 and 1.5 inches. Of course there are variations in this range, which allow for some larger and some smaller penises.

It is not uncommon for a man’s penis to curve a bit when it is erect. The degree of the curve varies from man to man, but it generally causes no discomfort or interference with sexual activity. A very pronounced curve occurs in a condition called Peyronie’s disease. Although it is not certain, it is thought to be caused by the development of hard, fibrous, inflamed tissue in the shaft of the penis, and usually starts as pain during erection, caused by stretching of inflamed penile tissue. As the disease progresses, the pain subsides, and then fibrous tissue develops, causing the penis to curve to the left, right, or upward. The majorities of cases of Peyronie’s disease require medical attention and are generally curable.

Another erectile disorder, priapism, is the continual and pathological erection of the penis. It is usually caused by nonsexual factors such as spinal cord disease, leukemia or sickle cell disease, and, according to some reports, with the use of cocaine. Sometimes it happens for no known reason. In cases of priapism, the increased blood flow that causes an erection is unable to drain from the penis in the usual way because the release mechanism has been broken down by the disease or affected by drugs or other unknown factors. It is extremely painful and may require surgery if the problem does not respond to medical treatment.

Certain non-medical circumstances, such as painful stimulation of the penis, or disturbed emotional states such as fear, anger, guilt, anxiety, or shame can cause a man to lose his erection or prevent him from getting an erection in the first place. Emotional difficulties and the anticipation and worry about possibly losing an erection are common causes of a man’s erectile difficulties.

If a man repeatedly experiences difficulty achieving or maintaining erections, he should not despair. In the last 25 years much has been learned about treating erectile problems. The first step is to contact a competent doctor who can perform the necessary diagnostic tests to determine if medical factors are contributing to the problem. In addition to a thorough urological evaluation, the man and his partner should consult a sexual therapist. Regardless of the origins of the erectile problem (organic, psychological, or in some cases both), as with any change in normal functioning, there can be an emotional impact on the man and his partner.Through counseling, the unspoken fears and misunderstandings of both partners can be explored, resulting in improved self-esteem and Sexual Prowess.

Fellatio is a type of oral sex in which there is mouth contact with the penis. The term fellatio comes from the Latin word fellare, which means to suck. In fellatio the head and shaft of the penis are licked, kissed and sucked. The mucous membrane inside the mouth is similar to the lining of the vagina. The moist slippery feel of the mouth and tongue on the penis can be extremely pleasurable. Fellatio can be incorporated as part of a couple’s foreplay, meant to heighten sexual arousal, or it can be the main activity, meant to bring the man to orgasm. Fellatio is common among both heterosexual and homosexual couples, yet not everyone engages in it. Some women, and to a far lesser extent some men, simply do not feel comfortable with this type of oral sex. The historic Kinsey reports published in 1948 provided the first real evidence of how many people were having fellatio. (Kinsey’s report on FEMALE ORAL SEX was published in 1953). Comparing Kinsey’s data collected in the 1930’s and 1940’s to later (1970’s) studies including the Hunt Report, the Hite Report, the Spada Report, the Redbook Report and the Bell and Weinberg study entitled Homosexuality, shows that attitudes toward oral sex have changed over the years, indicating an increase in the practice of oral sex, fellatio and cunnilingus. It is difficult to identify precisely which factors have led to a greater acceptance of oral sex, but some likely contributors include the following: 1) Scientific and medical evidence has helped dispel the myths about harmful health effects of oral sex and made it clear that fellatio between disease-free people does not in and of itself lead to disease; 2) The major religions have relaxed their historical prohibitions about fellatio being sinful and unnatural; 3) Modern hygiene practices have resulted in both men and women bathing far more often than was true in earlier times, thus reducing offensive body odors and tastes that may be associated with oral sex; and, 4) Since the 1960s couples seem to be more willing to experiment and openly explore sexual practices and issues, just as society as a whole has shown an increasing acceptance of sexual expression.

Even if a couple includes fellatio in their sexual relationship, anxieties about performing fellatio on a man may still exist. The person performing fellatio may have concerns that the partner’s penis may be too large for her or his mouth or that it may cause gagging. Another common worry is that the man will urinate during fellatio, or if ejaculation occurs, that the taste or feel of semen in the mouth will be unpleasant.

Although an erect penis may be too large to fit entirely in one’s mouth, some form of mouth contact can usually be made on the penis regardless of size. How deep into the mouth a penis penetrates can be controlled by either the man or his partner placing their hand around the shaft of the penis. This technique allows the hand to act as a stopper to control the depth the penis enters the mouth, thereby reducing the risk of gagging due to deep penetration. A thick penis that may stretch the lips and mouth can be licked up and down the shaft and around the glans without trying to take the penis fully into the mouth.

With regard to the worry about a man urinating during fellatio, it is extremely unlikely that any man is going to urinate in his partner’s mouth by accident. While it is the case that most men can urinate until an erection is very firm or full, they can also control urination, whether erect or not. During ejaculation there is a reflex action that contracts a muscle in the neck of the bladder which leads to the penis preventing the flow of urine. Thus, men cannot ejaculate and urinate at the same time.

If a person giving fellatio is hesitant to have the man ejaculate into her or his mouth, the partner can signal when he is about to ejaculate and his penis can be removed from the mouth. For some, the slightly salty and chlorine-like taste of semen (which can intermingle with certain tastes from a partner’s recent meal) can create an unpleasant taste; others may find this unique taste part of the erotic experience of lovemaking.

If couples feel comfortable incorporating fellatio into their sexual relationship, communication about their concerns and preferences, along with experimentation with different techniques can allow for a pleasurable experience for both partners.

Frigidity in the past referred to a sexual dysfunction among females in the same way that the term impotence referred to the same broad phenomenon among males. Many clinicians now regard frigidity to be a sexist term that places the blame on the woman herself rather than on her sociocultural milieu, emotional experiences, or health status, all of which can contribute to sexual nonresponsiveness.

Female sexual dysfunction – which has replaced frigidity as a diagnostic category in psychiatry and psychology – refers to the inability of a woman to function adequately in terms of sexual desire, sexual arousal, orgasm, or in coital situations. The term frigidity continues to be used in everyday language, commonly as an insult or derogatory term for women who are unaffectionate or are seen as sexually nonresponsive. Very likely the term is most frequently used to explain lack of interest or rejection by a woman who originally was of interest to the person making the insult.

Fetishism is a fixation on an inanimate object or body part that is not primarily sexual in nature, and the compulsive need for its use in order to obtain sexual gratification. It is almost exclusively a male Paraphilia. The object of a fetish is almost invariably used during masturbation and may also be incorporated into sexual activity with a partner in order to produce sexual excitation. Inanimate object fetishes can be categorized into two types: form fetishes and media fetishes. In a form fetish, it is the object and its shape that are important, such as in the case of high-heeled shoes. In a media fetish, it is the material out of which the object is made that is important, such as silk or leather. Inanimate object fetishists often collect the object of their favor, and may go to great lengths, including theft, to acquire just the “right” addition for their collection.

Although the list of objects that fetishists can use for sexual gratification is inexhaustible, among the more common inanimate objects are panties, bras, slips, stockings or panty hose, negligees, shoes, boots and gloves. Common media objects include leather, rubber, silk, or fur. In some cases drawings or photographs of the fetish object may arouse fetishists, but more commonly the fetishist prefers or requires an object that has already been worn. The worn object does not serve as a symbolic reminder of the former owner, however, because it is the object that the fetishist relates to, not the person attached to it. Sometimes it is a body part, such as hair, feet, legs or buttocks that become fetish objects. These are examples of animate fetish objects.

The sexual acts of fetishists are characteristically depersonalized and objectified, even when they involve a partner. The focus of attention is exclusively on the fetish, whereas non-fetishists may at various times make a particular body part or an object part of their general sexual arousal and expression with another person, but not be fixated on it.

In some cases, the fetishist can become sexually aroused and orgasmic only when the fetish is being used. In other instances, a sexual response may occur without the fetish, but usually at a diminished level. When the fetish object is not present, the fetishist often engineers sexual arousal by fantasizing about it. For some fetishists, the fetish object must be used by a partner in a specific way for it to be effective. For example, the genitals must be rubbed by silk, or a partner must wear black garters and high-heeled shoes. In the majority of cases, the person with a fetish poses no danger to others and pursues the use of the fetish object in private, usually through masturbation.

As with many forms of sexual expression, there is a thin line of distinction between fetishism and sexual preferences. At one end is the compulsive, fixated fetishist and at other points along the scale are people who use a sexual aid or are particularly aroused by certain body parts, but do not depend on those things to achieve sexual satisfaction. For example a person is not described as a fetishist if sexual arousal is dependent upon having an attractive partner. Also, a man who is turned on by a woman in black lacy lingerie is not usually labeled as a fetishist as long as this is not the primary focus of his arousal.

The causes of fetishism are not clearly understood. Some learning theorists believe that it develops from early childhood experiences, in which an object was associated with a particularly powerful form of sexual arousal or gratification. Other learning theorists would not focus on early childhood, but on later childhood and adolescence and the conditioning associated with masturbation activity. Psychoanalytical theories of causality focus on concepts of penis worship and castration anxiety. Researchers have shown that in general fetishists have poorly developed social skills, are quite isolated in their lives and have a diminished capacity for establishing intimacy.

Fantasy refers to the mental image of a person, object, or situation, often but certainly not always involving a sexual component. Fantasies may be based upon past experiences or may be entirely imaginary. Commonly they include a combination of both. It is normal for individuals to fantasize. Human sexuality is a dimension of social life that is often rich with many different sorts of fantasies. Sexual fantasies often entail mental scenarios involving persons other than one’s regular partner and include sexual activities considered culturally inappropriate or unacceptable. People vary considerably in their ability to fantasize and in their enjoyment of this behavior. Fantasies may supplant reality for some or may serve as a poor substitute of sexual reality for others. Fantasies are often triggered by external stimulus such as an attractive stranger or an erotic picture, movie, or story.

Researchers have varying views on gender differences in fantasizing. Some argue that males are more prone to fantasize while others assert that fantasy is more common among women. Linda Wolfe studied a sample of 15,000 women ages 18-34, and less than three percent said they never fantasize. In Western societies, males more often use sexually explicit material as a part of fantasy, whereas females are more likely to rely upon romance stories. Females are more likely to prefer erotica with a “softer,” more imaginative side rather than the “harder,” more explicit forms preferred by many males. The male fantasy world relies heavily upon novel experiences filled with culturally-defined beautiful women who are always sexually available and free. Pornographic magazines such as Playboy and Penthouse, as well as a wide array of so-called harder publications (because they depict explicit sex acts), attempt to capitalize upon such fantasies.

Women often base their fantasies upon previous sexual experiences and tend to emphasize romance and intimacy. The onset of the women’s liberation movement has created a renaissance in erotic fiction aimed at women by women writers and film makers. In Women On Top, Nancy Friday maintains that women have started a sexual revolution for equality and should implement it with a rich fantasy life. In her study of over 10,000 women, Friday noted that in recent years women’s fantasies have relied more on active, assertive women giving pleasure, as compared to the fantasies containing more passive women receiving pleasure indicated by prior research. These findings suggest the importance of social environment (e.g., the impact of feminism) on the structuring of fantasy.

People generally fantasize when engaging in autoerotic sex or masturbation. In his research findings, the prominent sexologist Alfred C. Kinsey reported that fantasy accompanied masturbation for the majority (sixty-four percent) of females and virtually all males. About two percent of the women in his study sample reported achieving orgasm by fantasy alone. Older females were more prone to fantasize than younger females. Some people, particularly but not solely those from rural areas, have fantasies about sexual contact with animals.

Having a fantasy about a particular sexual practice or activity does not mean that a person actually wishes to engage in that behavior or that he/she would enjoy the behavior. While fantasy may enhance actual sexual practices, it should not be assumed that a fantasized behavior represents an unconscious desire. Thus, some women fantasize about being overpowered or even raped by a man, but this does not mean they actually want to be raped. Similarly, some men fantasize about multiple sexual partners, but would find it emotionally difficult to maintain several simultaneous relationships. In recent years, there has been a greater openness about fantasy and a greater recognition of how common this behavior is for both men and women. While fantasy often is treated as an individual behavior, partners sometimes “act out” shared fantasies to enhance their enjoyment of sex. Computers and the internet have contributed to a new arena of fantasy behavior, with extensive electronic exchange of pornography, interactive role-playing communication, fantasy-constructed chat rooms, and other forms of eroticized and non-eroticized fantasy communication among computer users.

Therapists have found that fantasy can be useful in helping patients overcome sexual problems. With the help of a therapist, the individual may, through fantasy, confront the fearful stages of intimacy and lovemaking and reduce or eliminate those fears and apprehensions.

Foreplay refers to a wide variety of erotic stimulation that precedes “real” sex or sexual intercourse. However, behaviors that commonly are labeled as foreplay are pleasurable sexual activities in their own right and need not be thought of only as preliminary to other activities. In the era of AIDS, there has been growing emphasis on sexual contact that does not lead to intercourse. Some forms of this behavior, in which orgasm occurs without inserting the penis into the vagina or any other body cavity, have been referred to as outer course.

As part of a broader sexual interaction, foreplay is considered to be an essential component that stimulates and prepares the body and the mind/emotions to move through the phases of the sexual response cycle in preparation for orgasm. Touch is a key element of foreplay because the surface of the body is covered with many receptor cells (nerve endings) that transmit pleasurable sensations to the brain. Some parts of the body, particularly the clitoris, penis, nipples, fingertips, palms, lips, tongues, and soles of the feet have more densely packed nerve endings.

These sites are sometimes called the erogenous zones, although, in fact, the entire surface of the skin has been referred to as the body’s largest sex organ because all forms of pleasure during foreplay are transmitted through the skin. Consequently, caresses, hugging, holding hands, and related acts of physical intimacy, in addition to expressing key cultural meanings about caring, safety, and arousal, are important acts of foreplay. Many people also find light touching or tickling of the surface of the skin to be especially stimulating. Back rubs and massages (with or without massage oil or other artificial lubrication) are considered to be very erotic by some. Others prefer more intensive hand to body caressing and exploration of the erogenous zones, commonly referred to as petting.

Individuals vary considerably in terms of which of the potential erogenous zones they find to be most sensitive. Some people like to have their neck stroked or kissed, an experience that conveys great pleasure and sexual excitement. Others enjoy having their fingers and/or toes nibbled or sucked. Many people find kissing to be the fundamental act of foreplay. Kissing involves a range of behaviors from very light lip-to-lip contact, to what is often referred to as “deep” or French kissing, in which partners rub their tongues against each other and over other mouth surfaces. Generally, kissing is considered to be an extremely intimate and pleasurable act because it involves direct face-to-face contact and because the mucous membranes that cover the lips and mouth have an especially dense supply of nerve endings.

Some individuals are particularly sensitive around their ears, inner thighs, or lower stomach, while breasts and nipples (for both women and men) often are highly preferred places for caressing and oral stimulation. In addition to various sites around the body, most people are quite responsive to manual or oral contact with their pubic area, although the precise spot that is most arousing varies. For men, the underside of the full length of the penis, the head of the penis, the scrotum, or the area between the end of the scrotum and the anus (called the perineum) are often quite sensitive. Oral stimulation and sucking of these areas is referred to as oral sex. Oral stimulation of the penis is called fellatio. For women, the clitoris, vulva, and surrounding areas are especially sensitive. Oral stimulation of these areas, especially to the point of orgasm, is known as cunnilingus. There has been considerable discussion in recent years of various highly sensitive spots within the woman’s vagina.

The most discussed is called the “G-spot”, named after its discoverer, Dr. Ernst Grafenberg. It is a small location inside the vagina on the anterior wall just behind the pubic bone. Stimulating this site is reported for some women to set off the production and ejaculation-like expulsion of fluid from the Skene’s gland, the female counterpart of the prostate gland. For both women and men, anal stimulation may be highly stimulating (although others may find manual, oral, or penile stimulation of the anus to be repulsive).

It is sometimes said that the human body’s most erogenous zone is the mind. Foreplay, as a result, is not merely an issue of physical stimulation but also one of emotional and mental stimulation. Some people, for example, are stimulated by the physical location and setting in which foreplay occurs. For some, public displays of affection are highly erotic. Most people are also responsive to verbal stimulation and can become aroused by compliments and strong expressions of affection and caring. Some have personal fantasies about particular locations or activities that they find highly stimulating (e.g., a warm fireplace on a cold night). Consequently, arranging locations or the role-playing of particular desired interactions (sometimes in costume) may be incorporated into foreplay.

Some fantasies may involve activities or circumstances, such as acts of dominance or submission, which are only pleasurable as fantasy and would be otherwise unacceptable. Generally, these activities require open communication, a fair degree of disinhibition, and a willingness to appease one’s partner. For some people, even light to moderate pain may be stimulating. Biting or light scratching are common acts of foreplay, but some people prefer spanking or other forms of light physical punishment. Bondage is also considered quite arousing by some people.

Acceptance or rejection of these behaviors varies, and unless a behavior is mutually enjoyable it will not contribute to providing the pleasure and sense of deep relaxation that is the central function of foreplay in human sexual interaction. Various rubber and electrical devices (such as vibrators), sometimes called “sex toys,” have become popular in recent years. These are readily available in many areas at stores that specialize in adult merchandise. Generally, these stores also sell sexually explicit magazines and videotapes, which some couples incorporate into their foreplay activities.

The basic ingredients of foreplay are physical and mental/emotional stimulation, trust, and the expression of caring. Acts of foreplay that some individuals or couples find highly erotic may be completely unacceptable to others. Consequently, open discussion, sensitivity, and acceptance are vital to a healthy approach to foreplay.

The G-spot (or Grafenberg spot) is a dime to half dollar sized, localized area of especially high sensitivity, situated beneath the surface of a woman’s vagina on the wall toward the front of her body. While location varies, the G-spot is typically located about half way between the pubic bone and the cervix, about three inches into the vagina. Researchers have found that some women experience sensitivity more generally along the upper vaginal wall, rather than in a definable spot. Because the G-spot is beneath the surface of the vaginal wall, it must be stimulated indirectly through the vaginal wall. Many women reportedly notice an urge to urinate when the spot is initially stimulated, but find continued stimulation (with an empty bladder), very pleasurable. Some go on to experience orgasm, and some expel a fluid along with the orgasmic contractions.

Named by researchers Perry and Whipple in honor of the German gynecologist Ernst Grafenberg, who first wrote about it, the G-spot’s existence, as well as its location, has been a source of great debate and controversy. Grafenberg himself identified the sensitive area as the point where the urethra (the tube that carries urine from the bladder) runs closest to the top of the vaginal wall. Perry and Whipple argue that the area is located higher up along the vagina, while Israeli sexologist Dr. Zwi Hoch, claims that the entire anterior wall of the vagina, rather than one particular spot, is filled with nerve endings capable of producing intense arousal when stimulated.

Other research seems to show that the G-spot does not exist at all for some women. Also under debate is the composition of the fluid (sometimes called female ejaculant) that is expelled by some women during orgasm from G-spot stimulation. Some researchers claim that it is urine; others assert that it is a substance corresponding to seminal fluid in males (but without the sperm, of course). Not all women with a G-spot ejaculate, and those who do, do not necessarily ejaculate with every G-spot orgasm.

It is relatively difficult for a woman to explore the G-spot on her own because most do not have fingers long enough to reach it. Inserting an appropriate, safe, clean object into the vagina is probably required for self-exploration. Or working with a trusted partner can make for enjoyable self-discovery of a woman’s G-spot. Through experimentation a woman can learn the type of stimulation that feels best to her. Penile stimulation is often more effective when done through steady and prolonged pressure, rather than with the usual penile thrusting, because the G-spot generally needs an intense and quite localized pressure. Gradually increasing the pressure will help identify the optimal pressure for erotic pleasure without causing pain. Some women are able to climax simply as a result of this pressure; in others it may act to significantly heighten arousal. Rear entry and female on top positioning for intercourse can be effective ways to produce more direct stimulation.

Gay is a term that has come to refer to individuals who exhibit not only a same-sex orientation and sexual preference (e.g., men who have sex with men), but also embrace a lifestyle based upon that orientation. In other words, gays have “come out of the closet” or are overt, as opposed to being covert homosexuals or claim heterosexual identity but have sex or desire sex with members of their own gender. Gay is sometimes distinguished from homosexual in emphasizing the cultural, social and identity aspects of homosexuality.

Although in recent years the term gay increasingly has come to be used to refer to both same-sex oriented males and females, it generally refers to the former. Indeed, many lesbian organizations reject the term gay as a self-designation, restricting it to males, although this view may be less common among younger lesbian women. Historically, the term gay stems from the Old Provencal word “gai,” meaning high spirited and mirthful.

Beginning in the seventeenth century, the term referred to the behavior of a playboy or dashing man about town. By the 19th century, the term had come to also refer to a woman of allegedly loose morals. The term gay did not attain prominence as a self-selected term for openly homosexual individuals until the late 1950s and early 1960s. It became increasingly common in this usage by the 1970s and was established in general usage by gays and non-gay individuals alike by the 1980s.

Gay men have established a distinctive subculture. Whereas the gay subculture in the United States and elsewhere has been in existence for some time, the AIDS epidemic that began in the early 1980s has particularly propelled it into the limelight. In recent years, this subculture has come under increased scrutiny by both the general public and scholars in the social sciences and humanities. Indeed, gay scholars are among the leading figures in an interdisciplinary field now referred to as Gay Studies.

This field of research and cultural commentary often takes on a social constructivist perspective, which is sometimes referred to as “queer theory”. Intentional use of terms like “queer” or “faggot” within the gay subculture reflects an effort to assert self-acceptance and deny the derision and rejection suffered by homosexuals in mainstream or “straight” society. Gay Pride marches are an expression of the effort among gays to affirm (both to themselves and to non-gays) their right to be gay and their pride and acceptance of their sexual orientation and various sub cultural “scenes” (i.e., diverse recreational and lifestyle subgroups). While scholars, many of them gay, have given increased attention to the white gay subculture, the gay subculture among persons of color has received comparatively little attention.

The gay community consists of numerous social and cultural institutions, including social and political clubs, community centers, businesses, book stores, publications and other media, cafes, bars, other recreation and vacation institutions, social support and therapy groups, an extensive health education and service structure, and geographically-bounded neighborhoods. It also includes social networks and groups, as well as families or married couples. Because of their stigmatized sexual orientation, gays and lesbians often choose to socialize with each other in a variety of public places, such as bars and cafes.

Due to strong patterns of homophobic or anti-gay discrimination in small cities and rural areas, gays tend to move to and form identifiable communities in large and, to a lesser degree, medium-sized cities. In the 12 largest U.S. cities, studies have found that 16 percent of individuals report some level of same-gender attraction or desire, and 9 percent report that they are gay or bisexual, compared to 7.5 percent and 1 percent respectively in rural areas.

San Francisco, New York, Chicago and Los Angeles appear to have the largest concentrations of gays in the United States. Within these and other urban centers, gays often choose to reside in specific neighborhoods such as the Castro District in San Francisco, Greenwich Village in New York, West Los Angeles, and New Town in Chicago. Neighborhoods with a high percentage of gay residents are sometimes referred to as “gay ghettos” or “gay-friendly”.

Gays have historically constituted a stigmatized social category in U.S. society. In most states and cities a gay person can legally be denied housing, employment, and public accommodations simply because of his sexual orientation. In response, many gays have created organizations that seek to further their rights, in much the same manner that African Americans and other ethnic minorities did during the 1950s and 1960s and women did during the 1970s and 1980s. The Stonewall Rebellion of 1969 in New York City was a watershed event that qualitatively expanded the political activism that had been growing in the gay community since the late 1950s. This event constituted a spontaneous and militant act of resistance to a police raid on the Stonewall Inn, a popular gay bar in Greenwich Village. Gay Pride Day is celebrated in June in cities throughout the country to commemorate the Stonewall Rebellion.

Subsequently, gay rights were codified through the passage of civil rights ordinances in Portland, Oregon and St. Paul Minnesota in 1974, in San Francisco in 1978, in Los Angeles and Detroit in 1979, and in New York City in 1986. Wisconsin passed a statewide gay rights law in 1981. In response, singer Anita Bryant and TV evangelist Jerry Falwell led extensive homophobic campaigns which contributed to the repeal of gay rights measures in Miami in 1977 and later in St. Paul and Wichita. Gays have formed various national organizations including the Lambda Legal Defense and Education Fund, the National Gay and Lesbian Task Force, and the Names Project (which commiserates those who have died of AIDS).

Victories won by the gay movement include the growing number of institutions and companies that provide same-sex partner health insurance and other benefits. At the political level, many gays and lesbians work in coalition with one another. Studies of voting patterns have found that 3.2 percent of voters nationwide identify themselves as gay, lesbian, or bisexual. In urban areas, this figure climbs to 8 percent.

Many gays also desire to have their committed relationships legally recognized as same-sex marriages. Presently, gays do not, for the most part, have the legal right to make medical, legal, and financial decisions on behalf of their partner should the need arise. Furthermore, they may not have access to their partner’s employee health insurance or retirement benefits. The onset of the AIDS epidemic has prompted many gays – often in coalition with lesbians and progressive heterosexuals – to agitate for HIV prevention programs and improved health care and treatment options for people living with AIDS, and to oppose discrimination against HIV infected individuals. The gay community played a leading role in pushing for changes in federal funding for HIV/AIDS research and services, and in accelerating access to new therapies of HIV/AIDS.

Genitals (or genitalia) are the sex organs in the pelvic region of both men and women. Male and female genitals are divided into external genitals (those visible outside the body) and internal genitals (those that are inside the body).

The male’s external genitals include the penis and the scrotum. The internal genitals include the testicles, or testes, epididymis and vas deferens (housed in the scrotum), the seminal vesicles, the prostate gland, the ejaculatory ducts, the Cowper’s gland, and the urethra. In terms of sexual play and sexual intercourse, the single most important part of a man’s genitals is undoubtedly his penis.

As with males, the female genitals are partly external and partly internal. The external sex organs of a woman are collectively called the vulva, and include the clitoris, two pairs of skin folds called the labia, the mons pubis, and the opening of the vagina and urine passageway located in the vestibule. The external parts of a woman’s genitals and the area immediately surrounding them are highly sensitive to physical stimulation and play a large role in lovemaking.

External genitals are sensitive to touch and when they are stimulated or when a man or woman becomes sexually aroused, the genitals undergo changes that make sexual pleasure, and at certain times, reproduction possible.

The complex female internal genitals include the hymen, Bartholin’s glands, the urethra, the vagina, the cervix, the uterus, two Fallopian tubes, and two ovaries. It is the vagina that is primarily involved in sexual activity, whereas the Fallopian tubes, ovaries, uterus, and to a lesser extent the cervix are the essential organs in reproduction. The role of the Bartholin’s glands is still not clearly understood.

A hymen is the thin piece of tissue that partially blocks the entrance to the vagina. It is sometimes called the maidenhead or cherry. It is named after the Greek god of marriage and has no known biological function. Although some women are born without a hymen, most have one, and the hymen varies in size and shape from woman to woman. The hymen usually does not cover the entire vaginal opening, since there must be some way for the menstrual fluid, or period, to leave the body.

The hymen has historically been a marker of a woman’s virginity. The belief that since the hymen blocked the vaginal opening, it should remain intact as long as a woman did not have sexual intercourse was widely propagated, especially in cultures where a woman’s virginity was highly valued. If an unmarried woman’s hymen was found to be separated, grave consequences could result, depending on each culture’s customs. In some Australian tribes it is the custom for a specially appointed older woman to perforate the hymen of a bride one week before her marriage. If it is found that the hymen has already separated from the vaginal walls prior to this ritual, the woman is subject to public humiliation, torture, and sometimes death.

But it is scientific fact that the hymen can be separated for reasons quite unconnected to sexual intercourse. It can separate when the body is stretched strenuously, as in athletics; it can be separated by inserting a tampon during menstruation or through masturbation; and sometimes it is separated for no apparent reason. A separated hymen is not an indication of having had intercourse, nor can it prove a loss of virginity. In fact, some women must have their hymen surgically removed before the birth of their first child because it is so flexible or small that it remains intact during intercourse.

When the hymen is separated, whether during first intercourse or at some other time, there may be some slight bleeding and a little pain. Both the bleeding and the pain are quite normal and both usually stop after a short time. Some women experience no discomfort at all during this process that is commonly referred to as “losing your cherry”.

It is important to remember that a woman can become pregnant even if her hymen is intact and no penis has entered her vagina. If sperm comes in contact with the labia or general vaginal area, it can move through the opening in the vagina and possibly lead to a pregnancy. An intact hymen should not be considered a form of birth control.

As with most information on sexuality, a woman learns about her hymen in many ways, but rarely from parents, physicians or informed adults in a supportive and sensitive manner. Rather, it seems that women learn about the hymen in ways that promote anxiety and uncertainty about their own bodies and behaviors. Knowing the facts about the hymen can help women dispel the myth that it proves virginity, freeing them from the negative effects of popular mythology. Having accurate information about the hymen can assist in normalizing a woman’s fears about her body and help promote greater self-acceptance.

AIDS is the final, life-threatening stage of infection with human immunodeficiency virus (HIV). AIDS stands for Acquired Immune Deficiency Syndrome. The name refers to the fact that HIV severely damages the immune system, the body’s most important defence against disease. Cases of AIDS were first identified in 1981, in the United States, but researchers have detected HIV in a specimen collected in 1959 in central Africa. Millions of AIDS cases have been diagnosed worldwide.

How AIDS affects the body
Cause — Two viruses that belong to a group called retroviruses cause AIDS. Researchers in France isolated the first AIDS virus in 1983 and in the United States in 1984. The virus became known as HIV-1. In 1985, scientists in France identified another closely related virus that also produces AIDS. This virus, named HIV-2, occurs mainly in Africa. HIV-1 occurs throughout the world.

HIV infects certain white blood cells, including T-helper cells and macrophages, that play key roles in the immune system . The virus attaches to CD4 receptor molecules on the surface of these cells, which are often called CD4 cells. HIV enters CD4 cells and inserts its own genes into the cell’s reproductive system. The cell then produces more HIV, which spreads to other CD4 cells. Eventually infected cells die.

Symptoms — People infected with HIV eventually develop symptoms that may be caused by other, less serious conditions. With HIV infection, however, these symptoms are prolonged and often more severe. They include enlarged lymph glands, tiredness, fever, loss of appetite and weight, diarrhea, yeast infections of the mouth and vagina, and night sweats.

HIV commonly causes a severe “wasting syndrome,” resulting in substantial weight loss, a general decline in health, and eventual death. In many patients, the virus infects the brain and nervous system, and may cause dementia, a condition characterized by sensory, thinking, or memory disorders. HIV infection of the brain may also cause movement or coordination problems.

Opportunistic infections — HIV makes infected people susceptible to illnesses that do not normally occur or that are normally not serious. These infections are called opportunistic because they take advantage of damage to the immune system. With the onset of an opportunistic infection or one of several other severe illnesses or with a marked decline in the number of CD4 cells, an HIV-infected person is considered to have AIDS.

There are many opportunistic illnesses that typically affect AIDS patients. In North America and Europe, Pneumocystis carinii pneumonia, yeast infections of the oesophagus (tube that carries food to the stomach), cytomegalovirus retinitis, Kaposi’s sarcoma, and tuberculosis are the most common. People with AIDS may contract several of these diseases.

Pneumocystis carinii pneumonia, which is an infection of the lungs, is the leading cause of death among AIDS patients. Yeast infections of the oesophagus cause severe pain when swallowing and result in weight loss and dehydration. Cytomegalovirus retinitis is an eye infection that can cause blindness. Kaposi’s sarcoma is a form of cancer that usually arises in the skin. The tumours may look like bruises, but they grow.

Another illness that defines AIDS in HIV-infected people is tuberculosis. For many decades, the number of cases of tuberculosis in the United States declined. However, in the mid-1980’s, doctors noticed a growing number of cases of tuberculosis in HIV patients. People with HIV are especially vulnerable to tuberculosis because of their damaged immune systems.

An HIV-infected person may develop AIDS from 2 to 15 or more years after becoming infected. In children born with HIV infection, this interval is usually shorter. Medical treatment can increase the interval by inhibiting the growth of HIV, preserving the immune system, and delaying the onset of opportunistic illnesses. A few people who have been infected with HIV for more than 12 years have not developed any symptoms or suffer only minor symptoms. Others have symptoms of HIV infection but none of the opportunistic illnesses. An infected person can transmit the virus to another person whether or not symptoms are present. Infection with HIV appears to be life long in all who become infected.

How HIV is transmitted
Researchers have identified three ways in which HIV is transmitted: (1) sexual intercourse, (2) direct contact with infected blood, and (3) transmission from an infected woman to her fetus or baby. The most common way of becoming infected is through intimate sexual contact with an HIV-infected person. HIV is transmitted through all forms of sexual intercourse, including genital, anal, and oral sex.

People who inject drugs into their bodies can be exposed to infected blood by sharing hypodermic needles, syringes, or equipment used to prepare drugs for injection. In the past, transfusion and transplant recipients and people with haemophilia contracted the virus from the blood, blood components, tissues, or organs of infected donors. However, screening and testing of both donated blood and potential organ donors have virtually eliminated this hazard. Medical workers can become infected with HIV by coming into direct contact with infected blood. This may occur through injury with a needle or other sharp instrument used in treating an HIV-infected patient. A few patients became infected while receiving treatment from an HIV-infected American dentist and from a French surgeon.

An infected pregnant woman can transmit the AIDS virus to her fetus even if she has no symptoms. Transmission may also occur from an HIV-infected mother to her baby through breast-feeding.

Studies indicate that HIV is not transmitted through air, food, or water, or by insects. No known cases of AIDS have resulted from sharing kitchens or utensils, bathrooms, locker rooms, shower rooms, living space, or classrooms.

Medical care for HIV infection and AIDS
Diagnosis — Tests for detecting evidence of HIV-1 in the blood became widely available in 1985. The tests for detecting HIV-2 became widely available in 1992. HIV tests determine the presence of antibodies to the AIDS virus. Antibodies are proteins produced by certain white blood cells to react with specific viruses, bacteria, or foreign substances that enter the body. The presence of antibodies to HIV indicates infection with the virus.

Tests that directly measure the amount of HIV in the blood have been developed. These tests enable doctors to predict the future health of people with HIV and estimate their survival time. In 1996, the first home tests for HIV became available in the United States. People send in a dried blood spot by post, then use an identification number to learn results confidentially by telephone.

People with HIV infection are diagnosed as having AIDS when tests indicate that they have fewer than 200 CD4 cells per microlitre (0.000001 litre) of blood or when they develop one or more opportunistic illnesses. All HIV-infected patients should have their health closely monitored by a doctor, and receive periodic blood tests to measure the levels of virus and CD4 cells in their blood.

Treatments have been developed, but no cure for HIV infection or AIDS has yet been found. Scientists have worked to understand how HIV infects and damages human cells since AIDS was identified. In one important discovery, researchers learned that HIV uses an enzyme called reverse transcriptase to reproduce in CD4 cells. Because this enzyme is not normally found in human cells, scientists focused on developing drugs that block its action. These efforts led to development of a class of antiviral drugs called reverse transcriptase inhibitors. The first of these drugs was zidovudine, commonly known as AZT.

AZT and other reverse transcriptase inhibitors produce toxic side effects, including severe anaemia that requires blood transfusions. HIV also develops resistance to these drugs when they are given singly. Doctors combine the drugs and vary the order in which they are given to improve their effectiveness.
In 1995 and 1996, the first three protease inhibitors–indinavir, ritonavir, and saquinavir–were approved for treating HIV. These antiviral drugs block the action of protease, another HIV enzyme not found in human cells. Protease inhibitors block a later step in HIV reproduction than do reverse transcriptase inhibitors.

In 1996, several studies showed that certain combinations of antiviral drugs could decrease HIV in the blood to undetectable levels. Although HIV appears to persist inside CD4 cells, the studies raised hope that combination therapy can control reproduction of the virus. The research also raised hope for an eventual cure. But the drugs must be taken in large quantities for a long time, and HIV may develop resistance to them. Doctors need to determine which combinations of drugs are safest and most effective over the long term.

Doctors also prevent and treat opportunistic infections in AIDS patients. Pneumocystis carinii pneumonia can be prevented with specific antibiotics. Doctors use biological substances called interferons to treat Kaposi’s sarcoma . Researchers believe any eventual cure for AIDS must stop the growth of the virus, prevent opportunistic illnesses, and restore normal function to the immune system.

Prevention. To prevent transmission of HIV, sexual contact with anyone who is or might be infected with the virus must be avoided. The most effective preventive strategies are to refrain from all sexual intimacy or restrict sexual intimacy to one uninfected person. Health authorities have recommended that a condom be used every time sexual intercourse occurs with a person who is infected with HIV or whose infection status is unknown. Drug users should never share hypodermic needles, syringes, or other injection equipment. Research has shown that AZT reduces the risk of transmission from an infected woman to her fetus or baby. Doctors administer AZT and other antiviral drugs to HIV-infected women during pregnancy and labour and to their newborn babies. Doctors advise HIV-infected women not to breast-feed their infants.

The tests to detect evidence of HIV-1 are used to screen all blood donated in many countries. These tests have greatly increased the safety of transfusions. Screening for HIV-2 began in 1992.

There are guidelines for preventing the transmission of HIV in treatment and care centres. Doctors, dentists, and other medical workers now wear gloves, masks, and other protective clothing during many examinations and procedures.

Researchers are working to develop safe, effective, and economical vaccines against HIV infection. However, even if HIV transmission were to stop, AIDS cases would still occur for many years. This is because millions of people worldwide are already infected with the virus and have yet to develop the disease. As a result, scientists are attempting to develop vaccines to boost the immune systems of people infected with HIV.

Social issues
AIDS is a relatively new disease that involves sex and drugs and mainly affects young adults. For these reasons, it has generated widespread social concern. Some efforts to deal with AIDS or to prevent HIV transmission have provoked controversy.

Education. Educating people about AIDS has become the chief approach to preventing infection. Some schools have set up health clinics that distribute condoms to students. However, some people oppose classroom discussion of condom use because they feel it implies acceptance of sexual intimacy outside of marriage.

Preventing drug abuse and educating drug users about AIDS are important approaches to controlling HIV infection. Efforts to educate drug users include health and sex education as well as needle and syringe exchange programmes. However, these types of programmes have been criticized as seeming to imply acceptance of drug use.

In many countries, national and local governments have provided funds for AIDS education, treatment, and research. Public health clinics offer counselling and HIV-antibody testing to people who have symptoms or are at risk of infection. In addition, these clinics may privately and confidentially notify an infected person’s sexual or needle-sharing partners of their risk. Once notified, they, too, can receive preventive counselling, testing, and medical services.

Public awareness. Many individuals and organizations, ranging from community-based groups to the Red Cross, have worked to increase public awareness of AIDS. They hope that greater awareness will result in more compassion and support for people with AIDS and adequate funding for AIDS prevention, research, and treatment.

Celebrities have helped raise public consciousness of AIDS. Many well-known people have participated in education and fund-raising efforts. The epidemic also has gained attention as a result of several well-known people becoming infected with HIV or dying from AIDS. These people include the actor Rock Hudson, who died of AIDS in 1985; the tennis champion Arthur Ashe, who died in 1993; and the ballet dancer Rudolf Nureyev, who died in 1993.

The World Health Organization (WHO), an agency of the United Nations that monitors the AIDS epidemic, has designated December 1 as World AIDS Day. Public agencies and schools around the world sponsor prevention programmes. Many individuals wear a red ribbon to show support for people with AIDS.

Discrimination. Some people infected with HIV have unjustly lost or been denied jobs, housing, medical care, and health insurance. Children with AIDS have been kept from attending school. To prevent discrimination, many countries include AIDS patients and people infected with HIV under laws protecting the rights of people with disabilities.

Preventing discrimination against AIDS patients is important not only for moral reasons but also to help maintain public health. When people are not afraid of discrimination, they are more likely to seek counselling and be tested for HIV infection. In many cases, this leads to less risky behaviour and earlier diagnosis.

AIDS around the world
Almost every nation has reported cases of AIDS. By the end of 1996, UNAIDS, the United Nations organization dealing with AIDS, estimated that there were 22.6 million people worldwide living with HIV infection or AIDS. Of these, 830,000 were children, with men accounting for 58 per cent and women 42 per cent of the remainder. Some 90 per cent of adults with HIV infection or AIDS were living in the developing world. India had the highest number of infections in the world, at over 3 million. This figure, however, represented less than 1 per cent of India’s population. In some African countries in the region south of the Sahara, over 10 per cent of all adults were reported to be infected with HIV.

In Africa, India, and Southeast Asia, transmission of HIV has occurred mostly among heterosexual men and women. In Africa, mass population movement resulting from poverty, war, and drought has accelerated the spread of the virus. In Asia, prostitution and intravenous drug use are major factors in the AIDS problem. Public health departments in many developing countries lack the resources to treat patients properly and to control the epidemic through education. Research has shown that the low social status of women in some countries contributes to the spread of AIDS, as women are unable to question their husbands’ extra-marital sexual activities or insist on using condoms.

History of AIDS
Scientists are not certain how, when, or where the AIDS virus evolved and first infected humans. Researchers have shown that HIV-1 and HIV-2 are more closely related to simian immunodeficiency viruses, which infect monkeys, than to each other. Thus, it has been suggested that HIV evolved from viruses that originally infected monkeys in Africa and was somehow transmitted to people.

Scientists believe HIV infection became widespread after significant social changes took place in Africa during the 1960’s and 1970’s. Large numbers of people moved from rural areas to cities, resulting in crowding, unemployment, and prostitution. These conditions brought about an increase in cases of sexually transmitted diseases, including AIDS. HIV may have been introduced into industrial nations several times before transmission was sustained and became widespread.

AIDS was first identified as a “new” disease by doctors in Los Angeles and New York City in 1980 and 1981. The doctors recognized the condition as something new because all the patients were previously healthy, young homosexual men suffering from otherwise rare forms of cancer and pneumonia. The name AIDS was adopted in 1982. Scientists soon determined that AIDS occurred when the immune system became damaged, and that the agent that caused the damage was spread through sexual contact, shared drug needles, and infected blood transfusions.

After HIV was isolated as the cause of AIDS in 1983 and 1984, researchers developed tests to detect HIV infection. These tests have also been used to analyse stored tissues from several people who died of undetermined causes from the late 1950’s to the 1970’s. Scientists have concluded that some of these people died from AIDS.

Cases of HIV infection reported worldwide have risen dramatically since the early 1980’s. By 1994, there were an estimated 4 million cases of AIDS worldwide. There were about 16 million adults and about 1 million children infected with HIV.

Efforts to control the spread of AIDS have had some success. For example, among homosexual men in the United States, HIV infection is spreading more slowly than it did in the early 1980’s. This is due entirely to education about prevention and the resulting changes in sexual behaviors, such as decreased numbers of sexual partners and increased use of condoms. HIV blood tests, which became available in 1985, caused a gradual decline in transfusion-related cases in the late 1980’s. The rate of AIDS in other groups rose, however, during the 1980’s. These groups include heterosexual men and women, children born to HIV-infected women, people who inject drugs, and younger homosexual men.

A hormone is a chemical substance produced by an endocrine gland that has a specific effect on the activities of other organs in the body. Sex hormones are substances secreted by the sex glands (ovaries and testicles) and the adrenal gland directly into the bloodstream. They are partially responsible for determining the sex of a fetus and for the proper development of sex organs. They also initiate puberty and later play a role in the regulation of sexual behavior.

The major sex hormones can be classified as estrogens or androgens. Both classes of hormones are present in males and females alike, but in vastly different amounts. Most men produce 6-8 mg of testosterone (an androgen) per day, compared to most women who produce 0.5mg daily. Estrogens are also present in both sexes, but in larger amounts for women.

Estrogens are the sex hormones produced primarily by a female’s ovaries that stimulate the growth of a girl’s sex organs, as well as her breasts and pubic hair, known as secondary sex characteristics. Estrogens also regulate the functioning of the menstrual cycle. In the majority of women, ovarian hormones appear not to play a significant role in their sex drive. In one study of women under the age of 40, 90 percent reported experiencing no change in sexual desire or functioning after sex hormone production was shut down because of the removal of both ovaries. Estrogens are important in maintaining the condition of the vaginal lining and its elasticity, and in producing vaginal lubrication. They also help preserve the texture and function of a woman’s breasts. In men, estrogens have no known function. An unusually high level, however, may reduce sexual appetite, because erectile difficulties, produce some breast enlargement, and result in the loss of body hair in some men.

Androgens are sex hormones produced primarily by a male’s testes, but are also produced in small amounts by the female’s ovaries and the adrenal gland, an organ found in both sexes. Androgens help trigger the development of the testes and penis in the male fetus. They jump start the process of puberty and influence the development of facial, body and pubic hair, deepening of the voice, and muscle development, the male secondary sex characteristics. After puberty, androgens, specifically testosterone, play a role in the regulation of the sex drive. Large deficiencies of testosterone may cause a drop in sexual desire, and excessive testosterone may heighten sexual interest in both sexes. However, testosterone levels are poorly correlated with sexual interest and drive when they are within the average range. Sex drive is much more likely to be affected by external stimuli (sights, sound, and touch) than by variations in sex hormones, except in extreme cases. In men, too little testosterone may cause difficulty obtaining or maintaining erections, but it is not clear whether testosterone deficiencies interfere with female sexual functioning apart from reducing desire.

However, there is no evidence whatsoever to suggest that because women have less testosterone than men do, they have lower sexual interest than their male counterparts. Aging, illness and certain cancer treatments can affect our bodies’ delicate hormonal balance, causing changes in sexual interest and functioning. Familiar to most are the changes that occur when a woman goes through menopause. Estrogen production drops throughout this process as a woman exits her child-bearing years. The major sexual impact of decreased estrogen is a shrinking of the vagina and thinning of the vaginal walls, along with a loss of elasticity and decreased vaginal lubrication during sexual arousal. Some women experience only slight changes in sexual functioning, while others have dryness and pain with intercourse, or genital soreness for a few days after sexual activity, if they don’t use a vaginal lubricant or take some form of hormone replacement.

Researchers investigating the effects of hormone replacement therapy on women’s sexual functioning have shown that taking estrogen often allows sexual functioning to return to normal. In addition, androgens have been prescribed for postmenopausal women to enhance their sexual desire.

Perhaps less well known is the fact that men sometimes experience lowered testosterone levels, which can be responsible for sexual dysfunction. How this hormonal decrease affects the man’s sex drive and erections remains unclear. But urologists, as a treatment for these difficulties, sometimes recommend testosterone replacement. There is a great deal yet to be learned about which men and women may require and benefit from hormone replacement therapy.
It is tempting to try to understand sexual behavior solely in terms of hormones. In many animal species hormones that control the female’s willingness to mate and the courtship and sexual behavior of the male tightly regulate patterns of sexual behavior. In humans, however, there is a more complicated relationship between hormones and sexual behavior. Although a substantial testosterone deficiency usually reduces sexual interest in men and women, there are cases in which that effect is not seen. Similarly, although many men with below normal testosterone levels have difficulty with erections, not all do. Women who have low amounts of estrogen in their bodies do not lose their ability to be sexually aroused or to have orgasms. In short, sex hormones are not the only factors affecting sexual interest or behavior. If you are concerned about your hormone levels and whether they may be effecting your general health or your sexual functioning, consult your doctor for some easily performed and (almost) painless laboratory blood work.

Homosexuality in Western popular thought over the course of the 20th century has generally referred to sexual acts between individuals of the same sex. There has been and continues to be a common belief that individuals are either homosexual or heterosexual, both in terms of their sexual orientation and behavior. In reality, many individuals engage in a wide spectrum of sexual behaviors at any given stage in their lives or over the course of their lives.

While there are individuals who at any given point in time may engage in exclusively other-sex or same-sex sexual behaviors, others may exhibit a pattern of “bisexuality” that involves varying degrees of both other-sex or same-sex behavior. Furthermore, an individual who at one point in his or her lifetime engages exclusively or primarily in other-sex behavior may opt to engage exclusively or primarily in same-sex behavior, or vice versa at a later point in time. In his now classic studies on male and female sexuality in U.S. society, published respectively in 1948 and 1953, Alfred C. Kinsey, a prominent pioneer in sexual research, argued that humans couldn’t be easily put into invented categories such as “heterosexual” and “homosexual.” Somewhat later, Michel Foucault, a prominent French philosopher and psychologist, argued that the category “homosexual” is a social construct that is only a little over 100 years old.

Indeed, not until 1926 was the term first seen in print, in the New York Times. Foucalt asserted that the practice of sodomy became transformed into an explicit social category referred to as homosexuality. This term has been interpreted in a wide variety of ways, ranging from a form of psychodynamic pathology to an alternative sexual lifestyle engaged in by sensitive and enlightened individuals who often refer to themselves as gays or lesbians. According to this social constructivist perspective, homosexuality did not exist in ancient Greece or various other indigenous societies in which same-sex behaviors of one sort or another reportedly occurred. Indeed, the ancient Greeks did not even have an equivalent for the terms “homosexual” or “heterosexual,” although same-sex sexual behavior was not only practiced but extolled.

At any rate, same-sex behaviors include oral-genital intercourse, anal intercourse, insertion of dildoes, mutual masturbation, hugging, kissing, stroking, and various other activities. To a large extent, same-sex oriented people engage in many of the same forms of sexuality as do other-sex oriented people.

Until recently, most theorists and therapists tended to view homosexuality as a deviant or aberrant form of behavior — a view still widely held by the general public and by certain religious groups. Cross-cultural evidence demonstrates that same-sex behavior in many societies may be regarded as different but not morally defective or psychologically abnormal. Indeed, various indigenous groups, such as the Sambia on the island of New Guinea, actually have a form of socially-institutionalized and approved form of homosexuality in which adolescent males engage in same-sex acts, such as fellatio, before marrying a woman and rearing a family.

Some males may choose to restrict their behavior to same-sex acts after adolescence and some married males may occasionally engage in same-sex acts. By contrast, Western psychology and psychiatry, at least until relatively recently, have tended to regard same-sex behavior as abnormal and the product of inappropriate gender socialization.

Although Freud argued that humans are born with a bisexual nature which in time becomes mediated by culture, the American Psychiatric Association up until 1973 had designated homosexuality as a pathological form of behavior. The Association lifted its claim that homosexuality is abnormal in 1974, and now maintains that there is no scientific evidence that demonstrates the effectiveness of any therapies that attempt to transform homosexuals into heterosexuals. In 1994, the American Medical Association, a traditionally conservative organization, called for “a non-judgmental recognition of sexual orientation by physicians.”

While the causes of homosexuality as a sexual orientation remain controversial, many sex researchers believe that it may be the product of a complex interaction of sociocultural and biological factors. While the evidence still remains highly tentative, there is cause to believe that some individuals exhibit a greater biopsychological predisposition to engage in same-sex acts than others. A team of National Cancer Institute researchers in a study of over 100 homosexual men found that many of their uncles and male cousins were also homosexual, suggesting an hereditary factor. In its comparison of the DNA of 40 pairs of same-sex oriented brothers, it was learned that almost all shared genetic markers in the Xq28 region of the X chromosome. Research on the DNA of 36 lesbian sisters did not reveal a corresponding pattern.

People who prefer to engage in same-sex behavior vary widely in terms of their lifestyles. While many continue to remain circumspect and even secretive about their sexual orientation for a variety of reasons, others have chosen to “come out of the closet” and participate in the gay and lesbian subcultures which have become more visible and politically active both domestically and internationally. Despite a growing understanding of the nature of homosexuality, myths about people who prefer to engage in same-sex behavior continue to abound. Contrary to the common belief that homosexuals tend to recruit children and unsuspecting adults into same-sex behavior, homosexuals, like heterosexuals, discover their sexuality as a process of maturation.

The vast majority of individuals who engage in same-sex behavior are reared in heterosexual homes. Due to the pervasive patterns of homophobia or anti-homosexual sentiments and behaviors that exist in the larger society, many same-sex oriented individuals experience considerable psychic ambivalence and even distress in the process of coming to terms with their sexuality. Teens exhibiting a same-sex orientation are reportedly three times more likely than their other-sex oriented peers to attempt suicide. Homophobia also causes a high level of violence and discrimination targeted at gays and lesbians, and disproportionate rates of alcoholism and other substance abuse among gays and lesbians.

Contrary to popular stereotypes, few homosexuals in the U.S. can be characterized as assuming only a masculine or only a feminine role in sex. Research suggests that homosexual behavior tends to fall into the following three categories in terms of frequency: (1) oral-genital acts, hugging, and kissing; (2) anal sex; and (3) alternative acts such as “fisting” (in which a hand, but not in the form of a fist, is inserted into the partner’s rectum). Although homosexuality is often popularly associated with transvestitism or cross-dressing, heterosexual cross-dressers appear to be about as common as homosexual cross-dressers. Furthermore, homosexual men do not appear to be any more prone to pedophilia (sexual attraction to children) than do heterosexual men.

Various surveys indicate that homosexuals have more partners over the course of their lifetimes than do heterosexual or “straight” individuals. Nonetheless, many homosexuals form long-term, monogamous relationships. Indeed, the AIDS epidemic has prompted many homosexuals to choose a lifestyle emphasizing an exclusive sexual relationship with a single partner rather than one emphasizing multiple-partner relationships.

Cross-culturally, women appear to participate in same-sex relationships less often than men. Same-sex relations among women, however, tend to be more acceptable in certain indigenous communities and Third World countries. In some African communities, prosperous trader women may choose to marry women and even establish families with them by having a son or trusted male employee impregnate their wives. Despite the existence of female homosexuality in all societies both today and in the past, women who engage in same-sex practices have tended to be ignored in Western historical studies. The recent renaissance of gay and lesbian studies has played an important role in changing awareness of homosexuality.

Impotence is a man’s inability to achieve or maintain an erection of sufficient firmness for penetration during intercourse. Health professionals prefer the term erectile inhibition or erectile dysfunction to the term impotence due to the sweeping negative connotation the term impotence projects onto men.

Erectile difficulties can be divided into two types: primary and secondary. A man who has never had an erection sufficient for intercourse suffers from primary erectile dysfunction. A man who has some history of normal erections during intercourse, but has developed a persistent inability to obtain or maintain erections, has secondary erectile dysfunction. Secondary erectile dysfunction is more common, and treatment is more successful than in cases of primary erectile dysfunction.

A male’s ability to get an erection is an automatic process, a reflex that is not under the man’s conscious control (i.e. he can’t just “will it” or “make it” happen). When a man has difficulty getting or maintaining an erection, the blood that should flow into the penis and engorge it, making it firm and erect, fails to do so, even though the man may feel excited and stimulated.

The causes of erectile difficulty can be physical, psychological, or a combination of both. As we age, our bodies gradually slow down and it is normal for an older male to take longer (and to require more direct penile stimulation) to become erect than a younger male. Men of any age may experience single instances of erectile failure at some time or another. Poor health, stress, anxiety, fatigue, certain medications, or alcohol consumption may all be responsible for an occasional erectile difficulty.

Erectile dysfunction should not be considered a serious problem unless it occurs consistently or for a long period of time, causing significant stress to the individual or to his relationship.

If you are having concerns about erectile functioning you should first consult the services of a doctor who specializes in men’s sexual problems. Following this consultation your doctor can determine which factors are affecting your erectile difficulties and suggest treatment.

The term incest refers to sexual contact between close blood relatives for whom such behavior is forbidden by law, custom or religion. Taboos against incest have been found in virtually all human societies, although some exceptions have been documented, including the Incan society and the societies of ancient Iran and Ancient Egypt.

Intercourse, or coitus, refers in a strict biological sense to the insertion of the male’s penis into the female’s vagina for the purpose of reproduction. Sexual intercourse is found among all mammalian species. Intercourse has traditionally been viewed as the natural endpoint of all sexual contact between a man and a woman. However, the meaning of the term has been broadened in recent years to include a wider range of behaviors and a wider set of motivations and intentions. In both popular and professional usage, intercourse now labels at least three different sex acts, two of which are not directly tied to conceiving a child.

These three types of intercourse are: vaginal intercourse, involving vaginal penetration by the penis, possibly to the point of male ejaculation and female orgasm; oral intercourse, involving oral caress of the sex organs (male or female), possibly to the point of orgasm; and anal intercourse, involving insertion of the male’s penis into his partner’s anus. The latter two of these behaviors may be the endpoints of a sexual encounter or they may be acts of foreplay leading to each other or to vaginal intercourse. Moreover, intercourse is not limited to partnerships between individuals of opposite genders. Same-sex or homosexual encounters, involving oral or anal penetration or stimulation, are also referred to as sexual intercourse.

Some writers also include digital (use of fingers or hands) intercourse or mutual masturbation as yet another form of intercourse. In addition to recognizing a wider array of behaviors as constituting different types of intercourse, sex researchers and therapists have come to recognize that humans engage in sexual intercourse for many reasons beyond procreation. Sexual intercourse is among the most intimate behaviors possible between two people, and, for many people, it is also one of the most pleasurable and emotionally satisfying.

All of the types of intercourse mentioned above may produce orgasm for one or both partners. Orgasm is a complex physical and emotional release that can last from a few seconds to over a minute. Generally, it is followed by a significant sense of well-being and both physical and emotional relaxation. While the experience of orgasm is generally similar among men and women, there are some differences. Male orgasm commonly follows a series of penile thrusts, rhythmic contractions of the prostate gland and the set of muscles surrounding the penis, testicle elevation, and ejaculation of semen from the penis.

For almost all males, ejaculation is followed by a recovery period (that tends to grow longer with age) before it is possible to ejaculate again. Female orgasm is variable, ranging from a single brief period of mildly pleasurable contractions of the uterine and vaginal walls to multiple episodes (approximately 0.8 seconds apart) of physically intense waves that cover the entire body and can last for long periods of time.

Libido is the term that the noted founder of psychoanalysis, Sigmund Freud, used to label the sexual drive or sexual instinct. He noted that the sexual drive is characterized by a gradual buildup to a peak of intensity, followed by a sudden decrease of excitement. As he studied this process in his patients, Freud concluded that various activities like eating and drinking, as well as urination and defecation share this common pattern. Consequently, he regarded these behaviors as sexual or libidinous as well. Freud also became interested in the development of the libido, which he saw as the basic and most powerful human drive. He believed that the development of the libido involved several distinct and identifiable stages.

During infancy, he noted, sexual drive is focused on the mouth, primarily manifested in sucking. He labeled this the oral stage of libidinous development. During the second and third years of a child’s life, as the child is undergoing toilet training, focus and erotically tinged pleasure shifts to rectal functions. Freud labeled this the anal stage. Later, during puberty, focus shifts again to the sex organs, a period of development he labeled the phallic stage in the maturation of the libido. During the later stage of development, libidinal drives focus at first on the parent of the opposite sex and add an erotic coloring to the child’s experience of his/her parents.

Parental disapproval of uncontrolled libidinal drive, Freud believed, leads to the development of a human psyche that is composed of three components; the id, the ego and the superego. He concluded that the id, or basic set of instincts and drives (including the libido but also other drives like aggression), provides the psychic energy needed to initiate activities. The ego, an executive function, directs the day-to-day fulfillment of libidinous and other desires in socially acceptable and achievable ways. The superego labels the learned and internalized social standards of behavior, including an awareness of banned or punishable behaviors. During wakeful periods, strong boundaries separate these three arenas, but during sleep and fantasy the boundaries weaken, giving rise to open expression of otherwise controlled libidinous desires.

Conscious awareness of these unrestrained desires and fantasies can cause the person to feel sexual guilt or shame. Freud believed that an individual’s personality is established early on in life and is determined by the ways in which basic drives and impulses such as libido are satisfied. Failure to satisfy libidinal and other drives leads to their repression with resulting consequences for the development of an individual’s personality and psychological health.

Subsequent generations of psychoanalysts questioned Freud’s work on the libido. Several stressed the point that Freud had overemphasized biological development and underemphasized the impact of cultural and social factors on sexual attitudes and practices. Carl Jung, a Swiss psychiatrist and psychoanalyst, broke with Freud’s view of the libido by rejecting the idea that sexual experiences during infancy are the principal determinants of adult emotional problems. Jung developed an alternative theory of the libido that viewed the will to live rather than sexual desire as the strongest drive. Jung emphasized the distinction between introverted and extroverted personality types.

Extroversion typifies individuals whose attention is strongly directed (but not exclusively) outward from themselves to other people and to the world around them. Extroverts tend to feel comfortable in social situations and tend to be gregarious. Introversion labels the opposite characteristics, including directing attention inward toward internal processes and thoughts. Introverts tend to be self-reliant, introspective, thoughtful and comparatively uncomfortable in large social groups. Jung used the term libido to label the mental energy responsible for creating and sustaining introversion/extroversion. He did not believe individuals were strictly introverted or extroverted, but tended to mix these qualities in varying amounts.

Many contemporary psychologists view libido as a basic human potential that, while rooted in human biology (e.g., hormones), is shaped largely by culture and experience. In other words, the basic human drive to reproduce and the biologically based potential to derive pleasure from behaviors associated with physical contact (e.g., nerve endings in the skin and mucous membranes) are given shape and form by one’s experiences growing up in a particular family within a particular society. How sexual motivations are structured, and through which acts sexual drives are fulfilled, as well as whether certain behaviors are labeled and avoided as inappropriate, are determined primarily by these social influences.

Lubrication refers to a process that occurs within 10 to 30 seconds of a woman becoming sexually aroused in which the vascular engorgement of the tissues that lie beneath the vaginal wall produce a vaginal lubrication on the inner walls of the vagina. It can result from physical stimulation, such as during sexual foreplay, or from merely thinking about sexual activity. Lubrication is a preparatory process during sexual activity that significantly facilitates sexual intercourse by allowing greater ease of movement as the sex organs rub against each other and create friction.

In everyday language, this often is referred to as “getting wet,” and it is a sign to both the female and the male of growing physical preparedness and desire for sexual contact. Females vary considerably in the quantity of lubricating fluid that is produced, with some women experiencing a type of sexual dysfunction that involves little or no mucus production. When women do not produce enough lubricating fluid, engaging in sexual contact is often uncomfortable or painful. Manual or oral stimulation of the vagina may assist in the production and release of lubricating fluid. Failure to produce lubrication may be a sign of an emotional or physical problem that is in need of professional intervention, although it may also signal a lack of interest in a particular partner.

Lack of lubrication tends to be a more common problem with aging, particularly during and after menopause. Estrogen replacement therapy often reduces the problem and helps to maintain the viability of the vagina as well. Women who are menopausal or postmenopausal and experience decreased lubrication may want to consult their physician or gynecologist to discuss estrogen replacement therapy and other treatment options.

It is possible to use artificial lubricants such as various commercially sold jellies and creams to assist in achieving adequate lubrication. Most health professionals recommend a water-based lubricant such as KY Jelly or Astroglide over a petroleum-based product such as Vaseline. Water-based lubricants are more easily absorbed by and are less irritating to the delicate tissues in and around the genitals. Individuals who engage in anal intercourse, in which the penis is inserted into the partner’s anus, should use artificial lubrication because of the lack of lubricating glands in the anus. Many males also use artificial lubricants to facilitate masturbation.

Lesbian refers to a woman whose primary emotional and sexual relationships are with other women. The term is derived from Lesbos, the Mediterranean island that was the birthplace of Sappho, a 6th century BC female poet and devotee of the goddess Aphrodite. Landmark research by Kinsey found that approximately six percent of women in the U.S. are lesbians. More recent studies suggest that between four and nine percent of women are lesbians, at least during some part of their lifetimes. The work of Kinsey and others suggests that, overall; lesbians in the U.S. parallel the general population in terms of race, ethnicity, education level, income, and social class membership. People have debated what it means to be a lesbian. Some, adopting what has been termed an “essentialist” perspective, argue that sexual orientation and individual sexuality are core features of a person’s being, much like height, race, or sex. Social constructivists counter that sexuality differs from one culture to another and from one age to the next based on social context. Social constructivists maintain that concepts like heterosexuality and homosexuality or lesbian, gay and straight, are of recent vintage. Consequently, the meaning of the term lesbian is neither fixed nor permanent but has undergone and will continue to undergo redefinition over time. Like the term gay, lesbian is often used to refer to self-identified “out of the closet” women, rather than all women who engage in same-sex sexual behavior.

Compared to gay men’s’ lifestyles and associated patterns of sexuality, much less is known about these matters when it comes to lesbians. Since AIDS has not constituted a major health problem for lesbians, they have not been the focus of scholarly study or media attention in recent years to the same extent as gay men. Many of the problems involved in studying lesbians stem from issues of defining and locating representative individuals that reflect the entire lesbian population. Despite the relative paucity of research, evidence indicates that few lesbians can be characterized as assuming only a masculine (or “butch”) or only a feminine (or “femme”) role in emotional and sexual relationships.

Some women choose to adopt lesbianism in the aftermath of the dissolution of a heterosexual relationship. They may choose to rear their children in the same household with their female partner. Conversely, many lesbians discover their sexual orientation during adolescence and some may have never even engaged in heterosexual activity. “Coming out” often constitutes a lengthy and painful process for many women who choose to adopt a lesbian lifestyle. A woman’s acceptance of her lesbian identity generally follows involvement in one or more homosexual relationships. As a result of their financial resources and education, white middle-class lesbians have been able to organize themselves politically to a greater extent than working-class lesbians, particularly those who are women of color. As a result, far more is known about the lifestyles of the former than the latter. Indeed, many white middle-class lesbians are strong advocates of a form of feminism referred to as lesbian-feminism. For these women, lesbianism constitutes a political choice, one entailing a conscious rejection of patriarchy and traditional male-dominant gender roles. Contrary to popular stereotypes, however, the majority of feminists are not lesbians. Also, contrary to such stereotypes, many lesbians have close friendships with both gay and “straight” men.

To further their interests and defend their rights, lesbians have formed various national, regional, and local organizations. Lesbians established the Daughters of Bilitis in 1955 in order to create a structure facilitating their coming out. Women in the Mattachine Society have addressed key women’s issues while lesbian mothers formed the Lesbian Mothers Union. Although, like gay males, lesbians tend to migrate to large and medium-sized cities, they are more likely than gay men to remain living in small cities and even rural areas, where they have formed communes and lesbian family living arrangements of various sorts. Even in urban areas, lesbians are often the objects of discrimination, including within the workplace. Studies indicate that 25 percent of lesbians have experienced job discrimination based on their sexual-orientation, and over 60 percent anticipate possible negative consequences in the work place. The military, in particular, has been notorious in its discriminatory policies towards lesbians and gays.

Although white middle-class lesbians often are open to working in coalition with women of color, various African-American and Hispanic lesbians have formed organizations of their own. Lesbians of color constitute a “triple minority” as a result of their gender and racial/ethnic status and their sexual orientation. Many lesbians of color feel that they must subordinate their lesbian identity to their racial/ethnic identity. In addition to hostility from the larger society, lesbians of color often experience hostility within their racial/ethnic communities because they are seen as contributing to cultural genocide based on the belief that they have chosen not to engage in biological reproduction. Aging lesbians experience discrimination from both the larger society as well as from within the lesbian community. A lesbian senior citizen may be denied access to retirement centers or nursing homes because of her sexual orientation. Younger lesbians sometimes internalize ageist attitudes from the wider society which lead them to marginalize their older counterparts.

Some studies suggest that lesbian couples have sex less often than heterosexual or gay men. Furthermore, research indicates that lesbian lovemaking tends to focus more on the entire body (hugging, kissing, stroking) and less on the genitals (cunnilingus, insertion of dildos) than is true for heterosexual or gay couples. Most lesbians who desire to have children undergo artificial insemination, but some have turned to in vitro fertilization or adoption. Children born into lesbian families may have one, two, three or more parents. Various lesbian family arrangements have evolved, such as a lesbian couple and a male (often gay) sperm donor who together raise a child, or families made up of a close circle of lesbian friends. All of these individuals may not reside together, but still consider themselves to be family members.

Masturbation is the deliberate stimulation of one’s own genitals to achieve sexual arousal and pleasure. It is done at least occasionally by a majority of both men and women. In one recent national study, 95 percent of men and 89 percent of women reported having masturbated. It is the first overt sexual act for the majority of men and women, although more women than men engage in sexual intercourse before they ever masturbate. Most men who masturbate tend to do so more often than women, and they are more likely to report always or usually experiencing orgasm when they masturbate (80 percent to 60 percent respectively). It is the second most common sexual behavior (coitus being first), even for those who have a regular sexual partner.

Most children – often from the time they are infants onward – find the occasional stimulation of their genitals sensually pleasing, but do not come to understand this behavior as “sexual” until late childhood or adolescence. During adolescence, the percentage of both sexes who report masturbating increases dramatically, especially for males. Most people continue to masturbate in adulthood, and many do so throughout their lives.

The term masturbation conjures up many myths about its damaging and debasing nature. Its negative images may be traced as far back as the word’s Latin origin, masturbare, which is a combination of two Latin words, manus (hand) and stuprare (defile), thus “to defile with the hand.” The built-in notion of shame and uncleanliness implied by the defiling portion of the word has remained in the modern translation.

In short, masturbation in general is not harmful, the way a person does is harmful also the frequency. We advice not to masturbate at all, but in certain cases its advised once in 2-3 weeks with very soft hands.

Menstruation refers to the periodic vaginal discharge of blood and bodily cells that are shed from the lining of a woman’s uterus. Menstruation begins at puberty and marks the onset of a woman’s capacity to bear children, although other health factors may limit this capacity. Menstruation usually begins between 10 and 16 years of age, depending on a variety of factors, including the young woman’s general health, nutritional status, and body weight relative to height. Menstruation continues approximately once a month until a woman is about 45 to 50 years of age, again depending on health and other influences. The end of a woman’s ability to menstruate is called menopause and it marks the completion of a woman’s childbearing years. The average length of the menstrual cycle is 28 days, but ranges from 21 to 40 days. The length of the cycle may also vary for a woman during different phases of life, and even from one month to the next depending on a variety of factors, including the woman’s physical, emotional, and nutritional health.

Menstruation is part of the regular process that prepares a woman’s body each month for pregnancy. This cycle involves several phases that are controlled by the interactions of hormones secreted by the hypothalamus, anterior pituitary gland, and ovaries. At the beginning of the cycle, the cell lining of the uterus begins to develop and thicken. This lining will serve as the anchor for the developing fetus if the woman is impregnated. Hormones signal an ovum or egg in the ovary to begin developing. Soon, an ovum is released from the woman’s ovary and begins to move through the Fallopian tube toward the uterus. If the ovum is not fertilized by a sperm during the course of vaginal intercourse (or through artificial insemination), however, the lining of the uterus separates from the uterine wall and begins to decompose. The blood system washes the lining away and it and the blood are discharged through the woman’s vagina. The period of discharge or bleeding, known as the menstrual period (or just “period”), lasts from three to seven days. If a woman becomes pregnant, her monthly menstruation ceases for the duration of the pregnancy. Consequently, missing a menstrual period is a likely although not a definitive sign that a woman is pregnant. Pregnancy can be confirmed with a simple blood or urine test.

Unless a girl has been prepared for the onset of menstruation, this can be an upsetting time. Girls who are ignorant of their body and normal reproductive processes may assume that menstruation is evidence of a disease or even a punishment for misbehavior. Girls who are not taught to think of menstruation as a normal body function may experience considerable shame and a feeling of being unclean during their first menstruation. Even when menstruation is finally recognized as a normal process, feelings of uncleanliness may linger well into adulthood. In recent years, however, better education about anatomy and physiology has led to acceptance of menstruation. In fact, many women have come to view menstruation with pride as a distinctly female process. Some families even have a private celebration to honor the maturation of the young woman.

Nonetheless, many women experience physical discomfort several days before their menstrual period. About half of all women suffer from dysmenorrhoea, which is a painful menstruation. This is especially common during the early adult years. Symptoms of menstrual discomfort may include tenderness of the breasts, sore nipples, retaining fluid (bloating), and irritability. Some women experience quite intense discomfort, including cramps caused by contractions of the smooth muscles of the uterus, headaches, Mittelschmertz or pain in the midsection, nervousness, fatigue, stuffy nose, and crying spells. In its most severe form, often involving depression and anger, this condition is known as premenstrual syndrome or PMS, and may require medical attention.

In several court cases in Great Britain and France, attorneys have used the occurrence of PMS to successfully argue for diminished capacity during the commission of violent crimes. While in the past, PMS was dismissed as a psychosomatic condition, and continues to be the subject of derisive humor, today it is recognized as having organic causes. Several medications have been developed to treat the symptoms of PMS.

Some women experience a condition known as amenorrhea, or failure to menstruate over a protracted period of time. This condition can be caused by various factors including stress, rapid weight loss, regular strenuous exercise, or illness. Conversely, some women experience excessive menstrual flow, a condition known as menorrhagia. Not only may the flow of blood be particularly heavy, but it may extend for a longer than normal period.

Attitudes toward menstruation vary widely from society to society and even within a particular society. Many societies view women as contaminated or polluted during menstruation and seclude them from the community based on the fear that everything they touch will be polluted. In such settings, there may be diverse derogatory euphemisms to refer to menstruation. In U.S. society, examples of the latter include “the curse” and being “on the rag.” Menstruation is one of the justifications that has been offered for denying women access to clerical roles in some religions. Cleansing rituals at the end of menstruation are prescribed in a number of societies. However, other societies treat menstruation as a natural or normal bodily function and do not punish or restrict women during their menstrual period.

Menopause is a natural physical transition that every woman experiences as she ages. It is often loosely defined as the final cessation of menstruation in a woman’s life. This implies an abrupt and complete transition, although the actual process is typically quite gradual. While most women undergo this change between the ages of 48 and 52, some women stop menstruating as young as their late thirties or early forties, and others continue to menstruate into their mid-fifties. The process leading up to menopause begins with a slow-down in the function of the ovaries, generally about five years before the last menstrual period, and additional physical and emotional changes continue for several years after the last period. During this time, there is a change in the hormonal balance, with a decrease in the amount of estrogen produced by the ovaries. Finally, there is such a low level of estrogen production that periods become irregular, eventually stopping altogether. As the menstrual cycles cease, the level of progesterone also decreases. Together, these hormones influence and regulate a number of physical and emotional functions, and with changing levels of both, many women experience more than just the cessation of menstruation.

Menopause sets in motion a number of physiological changes that may impact a woman’s sexual functioning. The decreased levels of estrogen and progesterone during and after menopause cause the lining of the vaginal walls to thin and become more rigid. In addition, the production of vaginal lubrication drops off, contributing to discomfort during intercourse. Estrogen replacement therapy helps to counter these changes for many women, but risks may outweigh the benefits for women with cardiovascular disease, breast cancer, or uterine cancer in their histories. Estrogen suppositories or creams, which contain much lower doses of estrogen and are used over much shorter periods of time, are another option for maintaining the viability of the vagina. For women who cannot, or prefer not to use estrogen treatments, water-based vaginal lubricants effectively alleviate vaginal dryness at the time of intercourse.

Menopause need not signal the end of a woman’s sexual interest or activity, as was assumed to be true in the past. It is not the loss of estrogen, but the beliefs and attitudes about sex and menopause, or aging, that seem to be important to sexual desire and activity. In recent years it has become clear that not only does interest in and capacity for sex continue well beyond menopause, but that many women report an increased enjoyment of sex because worries about unwanted pregnancy are no longer a concern.

Some women experience this as a smooth transition with little physical discomfort, while others experience many uncomfortable accompanying symptoms such as hot flashes, night sweats, mood swings, irregular heavy bleeding, osteoporosis, and vaginal dryness (which may lead to painful sexual intercourse). As many as 80 percent of women going through menopause experience some negative physical reactions. Women experience worse symptoms if they are undergoing severe emotional stress or have certain dietary habits that include excessive caffeine, sugar, or alcohol consumption. Hot flashes are one of the most uncomfortable problems that menopausal women complain about. While most women experience hot flashes lasting two or three minutes, others last longer, even up to an hour. Roughly 80 percent of women going through menopause experience hot flashes, and for about 40 percent of those women the symptom are so distressing that they seek medical attention.

Some women have noticed that drinking coffee or alcohol can at times bring on hot flashes. Some women find relief from certain symptoms with the help of hormonal replacement therapy, in which various regimens of estrogen, progesterone and androgens are taken. In addition to the hormonal treatments, other remedies that have been found helpful for the depression, irritability and anxiety experienced by some women include the use of tryptophan (an amino acid that has a calming effect, also naturally occurs in hot milk, beef, tuna, chicken, eggs and spinach), mild herbal teas (such as camomile and valerian root, taken at bedtime), regular exercise and relaxation.

As with any health issue, menopause is yet another life experience that is eased with good self-care, exercise and a healthy diet. Whole grains, legumes, vegetables, fruits, seeds and nuts, smaller portions of meat and unsaturated oils are all preferable to a diet laden in salt, sugar, caffeine, alcohol, dairy products (other good sources of calcium include green leafy vegetables, beans, peas, soybeans, fish, carob, and chicken stock made with bones), and fats.

Premature menopause can result from a variety of causes. One of these is the surgical removal of both ovaries as part of a hysterectomy to treat ovarian cancer or other cancers of the reproductive system, severe endometriosis, life-threatening infections, or to protect women from perceived risk of future cancer. About 5 percent of all women inherit a tendency toward early menopause from their mothers and are born with thousands fewer eggs than most women. Others inherit an autoimmune disorder in which their own immune system destroys healthy ovarian cells for as yet unknown reasons. These women tend to experience an earlier onset of menopause and range of symptoms than seen in the majority of other women.

The unpleasant side effects of going through menopause may be amplified by the meanings that menopause has for a woman. Some may see menopause as a sign of getting old; others may grieve the loss of their childbearing years. This phase of life may occur at the same time as other significant life changes: children may be entering college, parents may be getting older and may require more care, and women may begin to experience significant losses of relatives or spouses through death. The experience of menopause may be eased by viewing it in the context of other stresses that might be occurring in a woman’s life. Often allowing one to grieve the losses that are being experienced will paradoxically offer some relief to the adjustment to this normal phase of life. Finding someone supportive to talk to, such as someone older who has successfully made this transition, may be helpful. A holistic approach that addresses the physical, medical and emotional challenges that accompany menopause will ease the transition into what can continue to be a very enjoyable and rewarding time of life.

Male menopause is a relatively recent concept referring to a kind of emotional or psychological crisis that occurs for some men during their 40s, 50s or early 60s. Because men do not menstruate, menopause is a somewhat inappropriate term for this male phenomenon. It is also referred to as mid-life crisis. Male menopause or mid-life crisis typically manifests itself as symptoms of depression for no obvious reason, intense reflection on the direction one’s life has taken as well as on what the future holds, and perhaps some personality and behavioral changes that may put a strain on relationships.

Just as estrogen production diminishes in women during menopause, so does testosterone production in males during this stage of life. The physical consequences are much less dramatic for men than for women, but some men do experience changes. These include taking longer to achieve an erection, less strongly felt ejaculation, and a longer refractory period (after ejaculation, the time it takes for a man to be able to ejaculate again). Most men also experience gradually declining levels of strength and endurance. On the other hand, ejaculatory control is likely to be increased, and the man remains fully able to cause a pregnancy. Furthermore, regular physical conditioning can combat much of the decline in strength and endurance.

For some men, the physical changes of mid-life signal a threat to their masculinity and virility, setting in motion psychological distress and behavioral changes. There are those men who experience mid-life as so threatening that they seek to prove their youthfulness, strength and virility by seeking out multiple sexual encounters, perhaps with younger partners, or by participating in strenuous physical activities.

Not all men experience male menopause, and of the men that do; only about 25 percent are profoundly affected. The duration of a mid-life crisis is highly variable. It may be concentrated into a few months, or it may last up to several years. Generally, having a supportive and understanding family and being able to discuss the ongoing concerns of mid-life will help men negotiate this sometimes troubling time without major residual problems.

Nymphomania is a layperson’s term used to label a woman whose sex drive or sexual activity is subjectively deemed too high. This is not a scientifically meaningful term because there are no specific criteria defining how much sexual desire or activity is too much. The clinical conditions that include the concept of high levels of sexual desire and/or activity are hypersexuality and sexual addiction or compulsivity. The central features of these disorders are that sexual activity is an insatiable need, often interfering with other areas of everyday functioning; sex is impersonal, with no emotional intimacy; and despite frequent orgasms, sexual activity is generally not satisfying.

The label of nymphomania is used in a pejorative and derogatory manner, almost exclusively in reference to women. To many men, the idea of a woman with a greater sex drive than their own is somewhat threatening, so they may use the label to preserve their own egos by “proving” that the woman is abnormal. Similarly, men with sexual dysfunction might accuse their partners of being oversexed in an effort to hide their own fears or sense of inadequacy, just as some women who object to the frequency of their partner’s sexual advances might accuse him of being oversexed. The difference is that the double standard, which exists in our society, congratulates a man who is highly sexed and has many partners, calling him a “stud”, whereas a woman with the same behavior is often called a “nympho”, which carries a negative connotation.

Oral Sex or oral-genital sex means both mouth contact with the vagina, which is called cunnilingus, and mouth contact with the penis, which is called fellatio. Cunnilingus comes from a Latin word for vulva (a woman’s exterior sex organs), cunnus, and from the Latin word for licking, lingere. Fellatio comes from the Latin word fellare, meaning to suck. Either form of oral sex can be done with one partner stimulating the other individually, or both partners can stimulate each other’s genitals simultaneously. Oral sex given simultaneously is commonly called 69, or, the French translation, soixante-neuf. This is because the body position of a couple having mutual oral sex resembles the numeral 69.

Cunnilingus and fellatio are common sexual behaviors for both same sex couples and couples of different sexes. There are various combinations of positions and techniques used in oral sex, but it is the mouth and tongue that provide the pleasure in all cases. Kissing, licking, sucking and nibbling can feel good anywhere on the genitals of both men and women. The pressure (light, firm, and in between), speed (fast, slow, or changing), and the type of motion used can be varied endlessly to produce different sensations. In both practices, the warm, moist feeling of the mouth and the tongue on the genitals can be very erotic. Some enjoy a teasing, stop-start approach, while others prefer a more steady type of stimulation. In one fellatio technique, known as the Snaky-Lick Trick, the “trick” is to tease the underside of the penis head almost imperceptibly with the very tip of the tongue, just making ever so slight tongue contact with this sensitive area in one light upward lick, and then backing off for about fifteen seconds between each lick. This trick has been said to result in a powerful ejaculation in a very short time. Other methods of fellatio include sucking the glans or shaft of the penis by engulfing it in the mouth, licking at various parts of the penis and scrotum, or nibbling anywhere along the genitals. Many men enjoy having the scrotum lightly stroked during fellatio and the area just beneath the scrotum is often quite sensitive to touch or oral massage.

Some people are uncomfortable performing fellatio because they have a sensation of gagging when they take the erect penis into their mouth. This real physiological event, known as the gag reflex, is triggered by pressure at the back of the tongue or in the throat. If a man, in his excited state, pushes his penis too far into his partner’s mouth, the gag reflex may take over. One way to avoid this problem is for the person giving the oral sex to grasp the penis along the shaft to control how much of it enters the mouth. Another common objection to fellatio is having the man ejaculate in his partner’s mouth. A couple can agree in advance to have the man remove his penis from his partner’s mouth before ejaculation. Others don’t mind. They either rinse the ejaculate from their mouth right away or they swallow it. The ejaculate, on average about 4 cc, consists of proteins and sugars and reportedly contains less than 36 calories.

Cunnilingus, like fellatio, can be performed in many ways. Women’s preferences vary, but commonly enjoyed techniques include gentle tongue movements over the clitoris, more rapid, focused licking, or sucking the clitoris either gently or in a rougher fashion. Other forms that women enjoy are oral stimulation of the clitoris combined with fingering of the vagina; licking and kissing of the lips just outside the vagina; having the tongue thrust in and out of the vaginal opening; and having the clitoris stimulated by hand (her own or her partner’s) while oral stimulation is directed at other parts of the genitals.

Not everyone has or enjoys oral sex. Many people who try it enjoy oral sex, but others have reservations about it. These reservations tend to fall into three arenas: first, that oral sex is unhygienic; second, that there is a taboo against it; third, that it is not a true expression of femininity or masculinity.

With regard to the matter of hygiene and oral sex, neither vaginal fluid nor semen is harmful in any way. This of course is true only in persons who are not infected with a sexually transmitted disease (STD). Everyone should be sure that they themselves and their partners are free from STDs before engaging in any sexual activity. No disease can be passed by oral sex that wouldn’t be transmitted by any other kind of sex. If one partner has a STD the other is likely to catch it whatever they do together sexually. In short, oral sex between healthy people is safe and clean. Another hygiene aspect that concerns some people is genital odor. Simply washing the genitals is sufficient to prepare you for any sex, including oral sex. It is not necessary for women to douche before having oral sex, but some women choose to do so. However, douching can wash away the helpful bacteria that naturally protect the vagina. In addition to a man’s natural genital odors, the genitals often take on the smells of recently eaten foods. As with women, thorough washing can reduce this odor, and besides, many people find some degree of genital odor in their partner stimulating.

The notion that oral sex is taboo discourages some people from ever trying it. Oral sex has long been frowned upon and often deemed illegal. The basis for the social disapproval and legal restrictions lies in age-old religious prohibitions, which to some are still very powerful. People who accept and practice almost any of the major Western religions can therefore feel confused and guilty about engaging in oral sex, despite their knowledge that it is a safe and appropriate form of sexual expression. In the end, each individual must decide for him or her self whether to stick to the teachings of his or her religion or to act in favor of what seems personally right for them.

For some people, the issue is not conflict with their religious beliefs as much as it is a belief that it somehow compromises their masculinity or femininity. Some people incorrectly think that cunnilingus and fellatio are homosexual acts, even if experienced by heterosexual couples. While homosexual couples do engage in oral sex, so do a majority of heterosexual couples. The activity itself is neither homosexual nor heterosexual. Apart form the misconception about oral sex and homosexuality, women sometimes feel that performing oral sex can make them feel submissive, as if they are giving a service and are thereby inferior. Men sometimes feel that performing oral sex on their partner reduces their masculinity because their penis is not involved. Couples should openly discuss these issues, and if necessary seek the help of a qualified therapist.

Fortunately, many people are free of negative feelings about oral sex and have chosen to include it in their sexual repertoire. However, it is just as okay to choose not to participate in oral sex as it is to do so. Oral sex, just like any other sexual behavior, is a matter of personal preference.

Orgasm is the sudden discharge of accumulated sexual tension resulting in rhythmic muscular contractions in the pelvic region that produce intensely pleasurable sensations followed by rapid relaxation. It typically lasts for several seconds. Orgasm is also in part a psychological experience of pleasure and abandon, when the mind is focused solely on the personal experience. It is sometimes called climaxing or coming.

In Masters and Johnson’s original research of the human sexual response cycle, orgasm is the third of four stages, occurring after the plateau phase and before the resolution phase. Another widely accepted model of the sexual response cycle, developed by Helen Singer Kaplan, M.D., PhD, involves just three stages: desire, excitement and orgasm.

Orgasms vary from person to person and for each individual at different times. Sometimes orgasm is an explosive, amazing rush of sensations, while others are milder, subtler, and less intense. The differences in intensity of orgasms can be attributed to physical factors, such as fatigue and length of time since last orgasm, as well as to a wide range of psychosocial factors, including mood, relation to partner, activity, expectations, and feelings about the experience.

There are several physiological components of orgasm. First, orgasm is a total body response, not just a pelvic event. Brain wave patterns have shown distinct changes during orgasm, and muscles in many different areas of the body contract during this phase of sexual response. Some people experience the involuntary contraction of facial muscles resulting in what looks like a grimace or an expression of discomfort or displeasure, but it is actually an indication of high sexual arousal.

The most characteristic physical feature of orgasm is the sensation produced by the simultaneous rhythmic contractions of the pubococcygeus muscle (pc muscle). Along with contractions of the anal sphincter, rectum and perineum, the uterus and outer third of the vagina (the orgasmic platform) for women, and the ejaculatory ducts and muscles around the penis for men, this constitutes the reflex of orgasm. The first few contractions are intense and close together, occurring at about 0.8-second intervals. As orgasm continues, the contractions diminish in intensity and duration and occur at less frequent intervals.

Despite the anatomical differences between male and female genitals, orgasms in men and women are physiologically and psychologically, or subjectively, very similar. In fact, studies have been done in which “experts” could not reliably determine gender when reading descriptions of orgasms with all anatomical references removed.

Women have described the sensations of orgasm as beginning with a sense of suspension, quickly followed by an intensely pleasurable feeling that usually begins at the clitoris and spreads throughout the pelvis. The genitals are often described as becoming warm, electric or tingly, and these physical sensations usually spread through some portion of the body. Most women also feel muscle contractions in their vagina or lower pelvis, often described as “pelvic throbbing”.

The subjective feeling of orgasm in men has been described quite consistently as beginning with the sensation of deep warmth or pressure that corresponds to ejaculatory inevitability, the point when ejaculation cannot be stopped. It is then felt as sharp, intensely pleasurable contractions involving the pc muscles, anal sphincter, rectum, perineum and genitals. Some men describe this part as a sensation of pumping. Finally, a warm rush of fluid or a shooting sensation describes the actual process of semen traveling through the urethra during ejaculation. It is important to note that orgasm and ejaculation are not one in the same event. Although they typically occur together, a man may have an orgasm without ejaculating.

A major difference between the female and the male orgasmic phase is that far more women than men have the physical capability to have one or more additional orgasms within a short time without dropping below the plateau of sexual arousal. Being multi-orgasmic depends on both continued stimulation and sexual interest. Because neither of these is present every time for most women, multiple orgasms do not occur with every sexual encounter. On the other hand, upon ejaculation, men enter a recovery phase called the refractory period. During this time, further orgasm or ejaculation is physiologically impossible. However, some men can learn to have an orgasm without ejaculating, thereby making it possible to experience multiple orgasms.

A Paraphilia is a condition in which a person’s sexual arousal and gratification depend on fantasizing about and engaging in sexual behavior that is atypical and extreme. A Paraphilia can revolve around a particular object (e.g., children, animals, underwear) or around a particular act (e.g., inflicting pain, exposing oneself). Most of the paraphilias are far more common in men than in women. The focus of a paraphilia is usually very specific and unchanging. For example, for someone who derives sexual pleasure from exposing his genitals, watching others engaging in sexual activity will not generally provide sexual gratification.

A paraphilia is distinguished by a preoccupation with the object or behavior to the point of being dependent on that object or behavior for sexual gratification. In most cases, types of sexual activity outside the boundaries of the paraphilia lose their arousal or satisfaction potential unless the person fantasizes about the paraphilia at the same time.

Although many of the paraphilias seem so foreign or extreme that one could not imagine how the object or behavior can be arousing to anyone, they are easier to understand if one thinks of those behaviors that, in less extreme versions, are quite common and not considered abnormal. For instance, having a partner “talk dirty” occasionally may be a “turn-on” for some people, but when talking dirty is the only way that sexual arousal or satisfaction can occur, it would be considered a paraphilia. Others want to be bitten, scratched, or spanked, or find that watching their partner undress is highly arousing. Viewing a nude person or watching sexually explicit videos can be arousing for most people. Each of these acts is innocuous unless magnified to the point of psychological dependence.

There are numerous paraphilias. Some of the major types will be briefly defined here. Fetishism is a fixation on an object or body part that is not primarily sexual in nature, and the compulsive need for its use in order to obtain sexual gratification. The fetish object is almost invariably used during masturbation and may also be incorporated into sexual activity with a partner in order to produce sexual excitation. Fetishists usually collect the object of their favor, and may go to great lengths, including theft, to acquire just the “right” addition for their collection. Some of the more common objects that have served as fetishes include women’s undergarments, high-heeled shoes, or specific materials, like silk, leather or fur. Some people have a fetish for particular body parts such as feet, hair or legs. See FETISHISM for a more complete explanation.

Transvestism is a paraphilia in which heterosexual males repeatedly and persistently get sexual pleasure from dressing in women’s clothing. Transvestism is not simply dressing up in the other sex’s garments for fun or for temporary effect. The transvestite needs to cross-dress to achieve full sexual and emotional release. This is very different from the female impersonator or the drag queen (male homosexuals who occasionally dress in women’s clothing), both of whom usually playing social roles rather than expressing are sexual needs.

Voyeurism is deriving sexual satisfaction from watching people undressing or nude, or observing them during sexual acts without their knowledge or consent. Voyeurs (from the French verb meaning “to see”) or Peeping Toms are usually unmarried males in their 20s and 30s. They generally prefer to peep at women who are strangers and they are often most sexually excited when the risk of being discovered is high. Many voyeurs confine their sexual activity to masturbation while peeping or while fantasizing about previous peeping escapades.

Exhibitionism is the compulsive act of inappropriately exposing one’s sex organs to unsuspecting strangers for the purpose of sexual arousal and gratification. Also known as “indecent exposure” and “flashing,” this paraphilia is found almost exclusively in males and the peak age of occurrence is reported to be in the twenties. Many exhibitionists have erectile difficulties in other forms of sexual activity and seem to be pushed by an uncontrollable urge that leads to their impulsive behavior. For some, the primary intent of exhibitionism is to evoke shock or fear in their victims, not necessarily to achieve an erection or to ejaculate. They derive their pleasure from the visible reaction of their victims. It is generally agreed that the exhibitionist is unlikely to rape or assault his victims, but there are exceptions to this rule, especially when an exhibitionist is unsatisfied with his victim’s response. Police catch more exhibitionists than any other category of paraphiliacs. The risk of being caught may be an important element of the turn-on, leading some exhibitionists into behavior almost guaranteed to result in arrest, such as repeatedly performing at the same street corner.

Sadomasochism is a paraphilia that combines sadistic and masochistic roles in sexual interaction. Sadism is the intentional infliction of pain on another person or the threat to do so, for sexual excitement. Masochism is a condition in which a person derives sexual gratification from being subjected to pain or to the threat of pain. A sadomasochist is a person who can derive sexual pleasure from either role.

Forms of sadism run the gamut from the fairly common carefully controlled play-acting with a willing partner, in which the mild forms of pain that result from such acts as spanking or biting are not actually experienced as painful (think of having one’s back scratched – the same intensity can sometimes feel good and sometimes hurt depending on the circumstances), to the very rare assaultive behaviors that may include torture, rape, or even murder. Some extreme sadists require an unwilling victim to derive pleasure; others become sexually aroused only when they see their victim suffering.

Likewise, masochism can range from mild versions to extremes. In the mild renditions, activities might include bondage (being tied up for the purpose of sexual arousal), being spanked, or being overpowered by physical force. The crucial point is that they are mainly symbolic enactments done under carefully controlled conditions with a trusted partner. At the opposite end of the spectrum are genuinely painful activities such as whippings, semi-strangulation, being trampled and self-mutilation.

Although sadomasochistic acts in their extreme forms can be physically and psychologically dangerous, the majority of people engaging in these behaviors do so with an understanding of the risks and stay within carefully predetermined limits.

Pedophilia is a condition in which an adult’s preferred or exclusive method of sexual excitement is fantasizing or engaging in sexual activity with prepubescent children. About two thirds of the victims of pedophiles are girls, most often between the ages of 8 and 11. Pedophilia predominately occurs in males, but there have been documented cases of women who have repeated sexual contact with children. The popular stereotype of the child molester as a stranger who lurks around playgrounds with a bag of candy to lure victims is not entirely correct. It is not uncommon that the pedophile is a relative, neighbor, or acquaintance of the victim. Pedophiles commonly fall into three distinct age groups: over 50, the mid-to-late 30s, and the teens. Most are heterosexual and many are married fathers. Strictly speaking, the person who has only isolated sexual contact with children is not a pedophile and may be inappropriately expressing sexual frustration, loneliness, or personal conflict. There is no single pattern of sexual activity that fits all pedophiles.

Engaging in sexual contact with animals is known as bestiality. When the act or fantasy of sexual activity with animals is a repeatedly preferred or exclusive means of sexual gratification, it is called zoophilia. Bestiality usually involves curiosity, a desire for novelty, or a desire for sexual release when a partner is unavailable. Zoophilia sometimes involves sadistic acts that may harm the animal.

Making repeated obscene telephone calls for the purpose of sexual excitement is considered a paraphilia. The relative safety and one-sided anonymity of the telephone provides an idealized setting for masturbatory fantasies with no worries about face-to-face contact. There are three basic types of obscene phone calls. In the first, the caller boasts about himself and describes in detail his masturbatory act. In the second type, the caller directly threatens the victim (“I’ve been watching you” or “I’m going to find you”). In the third type, the caller tries to get the victim to reveal intimate details about her life. Sometimes the obscene phone caller repeatedly calls the same victim, but more often, unless the victim shows a willingness to stay on the phone and play his game, he’ll move on to others.

There are some paraphilias that are relatively rare. Apotemnophilia refers to the sexual attraction to amputations. Coprophilia and urophilia refer respectively to sexual excitement deriving from contact with feces and urine. Klismaphilia is sexual excitement resulting from the use of enemas. Frotteurism is sexual arousal resulting from rubbing the genitals against the body of a fully clothed person in crowded situations, and necrophilia is sexual arousal derived from viewing or having sexual contact with a corpse.

It is unclear what causes a paraphilia to develop. Psychoanalysts theorize that an individual with a paraphilia is repeating or reverting to a sexual habit that arose early in life. Behaviorists suggest that paraphilias begin through a process of conditioning. Nonsexual objects can become sexually arousing if they are repeatedly associated with pleasurable sexual activity. Or, particular sexual acts (such as peeping, exhibiting, bestiality) that provide especially intense erotic pleasure can lead the person to prefer that behavior. Although the origins of most paraphilias are not understood, in some cases there seems to be a predisposing factor such as difficulty forming person-to-person relationships.

Whatever the cause, paraphiliacs rarely seek treatment unless an arrest or discovery by a family member traps them into it. In most cases, the paraphilia results in such immense pleasure that giving it up is unthinkable. Treatment approaches have included traditional psychoanalysis, hypnosis, and behavior therapy techniques. Research on the outcome of these therapies has been incomplete, but often they have not be very successful. More recently, a class of drugs called antiandrogens that drastically lower testosterone levels temporarily have been used in conjunction with these forms of treatment. The drug lowers the sex drive in males and reduces the frequency of mental imagery of sexually arousing scenes. This allows concentration on counseling without as strong a distraction from the paraphiliac urges. Increasingly, the evidence suggests that combining drug therapy with cognitive behavior therapy can be effective.

A penis is the male sexual and reproductive organ, consisting of a head, called the glans, and the shaft or body. A fold of skin called the foreskin covers the glans. The foreskin is like a hood and can be rolled back to expose the head of the penis. The body or shaft of the penis is made up of three cylinders of soft, spongy tissue, which contain many small blood vessels. The entire penis contains many nerve endings that make it sensitive to touch, pressure, and temperature. The glans, however, has a higher concentration of nerve endings than the shaft of the penis and is thus particularly sensitive to physical stimulation. Two other areas that are highly sensitive are the rim that separates the glans from the shaft of the penis, called the coronal ridge, and the small triangular region on the underside of the penis where a thin strip of skin called the frenulum attaches to the glans. During sexual excitement, the blood vessels of the spongy tissue fill with blood and swell up. The rapid, forceful dilation of these blood vessels throughout the entire penis causes it to become firm and grow in size. This transition from a soft (flaccid) penis to a harder, stiffer penis is called getting an erection. The penis usually returns to a softer (non-flaccid) state shortly after ejaculation or after the penis is no longer being stimulated. The erect penis is inserted into a woman’s vagina during the sexual act called intercourse or coitus. When a man reaches the pinnacle of sexual excitement, his orgasm is often accompanied by spurts of semen from the opening at the tip of the glans. This is called ejaculation. The semen that is released from the penis during ejaculation contains sperm, the reproductive cell capable of fertilizing an ovum or egg, the female reproductive cell. When one of the millions of sperm encounters an egg inside a woman’s body, their union can produce a pregnancy. The appearance of the penis varies considerably from one male to another. There can be differences in color, shape, size, and the status of the foreskin (circumcised or uncircumcised). A man’s weight, build and height bear no relation to the size of his penis in either the soft or erect state, nor is penis size related to his foot, hand or nose size. Art and the media, particularly men’s magazine’s and erotic books and movies, often portray male genitals in “larger than life” dimensions, giving men an unrealistic standard of comparison that can contribute to their concerns about their penis size. Concerns about penis size are common among men of all ages.

When a penis is soft it usually hangs loosely away from the body and averages about 3.5 to 4.5 inches in length and one inch in diameter, though some are smaller and some are larger. The same penis can vary in size even when soft. For instance, cold air, cold water, fear, anger or anxiety causes the penis, scrotum and testicles to be pulled closer to the body, thereby shortening it. By the same token, a soft penis can actually lengthen in warm conditions and when a man is completely relaxed. Although the size of the non-erect penis differs widely from one male to another, this variation is less apparent in the erect state. Masters, Johnson and Kolodny (1986) in their book Sex and Human Loving state that erection can be thought of as “the great equalizer” because men with a smaller non-erect penis usually have a larger percentage volume increase during erection than men who have a larger flaccid penis. The great interest in penis size is related to several different things. First, it shows a concern for being “normal” – the same as everyone else, or certainly no worse. Second, it is related to a wish to be sexually adequate. Many people in our society believe that “bigger is better” and the myth that a big penis will provide more sexual satisfaction to a woman is widespread. Actually, penile diameter has little physiological effect for the woman because the vagina can gradually adjust to fit a penis of any circumference (remember, it is designed, under the right conditions, to allow a baby to pass through the same opening). The length of the penis, which determines the depth of vaginal penetration, is relatively unimportant, because it is the first one-third of the vagina that has the most nerve endings and is most responsive to physical stimulation. Penis size may, however, have positive or negative psychological significance to a woman. Some women prefer a large penis; others are put off by what they think is “too large” or “too small”. Third, men may feel that a larger penis gives them an element of status and makes them more sexually attractive.

Sometimes, shortly after birth, the foreskin is removed from the penis in a procedure known as circumcision. The decision to perform a circumcision is often made for religious reasons, and in some rare cases it is necessary in order to release a foreskin that is too tight around the penis. Many physicians and parents also feel removal of the foreskin promotes better hygiene, although with little evidence to support this claim, some now choose to forego circumcision of infant boys.

Pornography is broadly defined as written or visual material that stimulates sexual feelings whose primary purpose is to arouse the observer or reader. It is also referred to as porn, smut and obscene material. The actual term “pornography” comes from porneia, the Greek word for prostitute, and means “the writings of and about prostitutes”.

Defining the type of material that qualifies as pornography is more difficult. It is a relative term, subject to interpretation based on people’s opinions. Standards of obscenity have been defined legally in a consistent way. Technically, pornography is not illegal. Sexually explicit material that is judged in violation of the penal code is defined as obscene. These works are often called “hard core pornography”, but even that is not illegal unless tested by the courts and found to be obscene. The U.S. Supreme Court arrived at a definition of obscenity in the 1957 case of Roth vs. United States, and a number of lower courts have added their definitions since. Broadly speaking, erotic material is legally obscene if, for the average person, 1) its predominant appeal is to a prurient interest in sex; 2) it is contrary to the contemporary standards of the community; 3) it is without social value, or judged to be without artistic, literary, or scientific value.

These standards may be helpful to an extent, but they are extremely difficult to apply in any objective way. For one thing, standards vary from community to community and judgments about the artistic or literary value of material cannot be made by the use of a simple formula. Whereas hard core pornography is understood to be strictly for commercial use, with no pretense to artistic merit, works of art are sometimes claimed to be obscene despite the defense of artistic value.

Much of the controversy surrounding pornography is related to society’s concern about how pornography affects people. One common worry is that the use of pornography promotes sex crimes and that sex offenders are avid consumers of obscene material. Research, however, does not show any consistent pattern. Data from studies conducted in the 1970s and1980s have consistently shown that the use of pornography is not related to an increase in sex crimes and that sex offenders in general have had significantly less exposure to pornography than non-offenders. Some later work in this area has not agreed with these earlier findings.

Another popular belief is that only perverted individuals would be interested in pornography. Findings from the historic Kinsey study showed that between 14 and 60 percent of females and between 36 and 77 percent of males were stimulated by viewing sexy movies, reading and hearing erotic stories, and viewing pictures, drawings or other portrayals of sexual activity. The Redbook survey (1974) reported that 60 percent of the 100,000 married women they surveyed had seen a pornographic movie, and 42 percent of these women had used pornography in their sexual practices at least occasionally. When the magazine Psychology Today asked 20,000 readers whether they had ever used erotic material for arousal, 92 percent of the male respondents and 72 percent of the females reported that they had. In 1970, the U.S. Commission on Obscenity and Pornography conducted one of the few scientific interviews of adults in the U.S. regarding pornography. Eighty-four percent of the men and 69 percent of the women indicated that they had used such material at some time. Finally, the tremendous popularity of magazines such as Playboy, Penthouse and Hustler provides undeniable testimony to the widespread use of erotica.

Furthermore, the U.S. Commission on Obscenity and Pornography reported that ordinary people did not change their types of sexual practice or values about what was acceptable as a result of viewing pornography. It also reported that there was a general increase in sexual activity within the 24-hour period after viewing pornography, but it was generally with the regular partner, or in the case of those without a partner, masturbation. It is noteworthy, however, that neither the Commission nor the authors of the other studies observed the effects of continuing exposure to pornography over a period of years. Thus it is not known what, if any, differences would be evidenced in the long run.

Another important concern about pornography is that some types portray women in a degrading, dehumanizing and exploitive manner. And, in fact, men are done a disservice when they are portrayed as interested only in sex (the more unusual the better), always ready for sex (with extraordinary anatomy and endurance), but incapable of sensitivity and tenderness. Some men may not object to this characterization, but most women do not appreciate the way some pornography depicts their gender as objects serving men.

Perhaps one reason why some pornography exploits women is because, throughout history, it has mainly been created by men for men. Erotic works from the Stone Age on reveal typical male sexual interests and fantasies, and depict various interpretations of the idealized woman. It is principally for this reason that pornography has been assumed to arouse women less than it does men. But with the contemporary phenomenon of women creating pornography, the question arose of whether men and women respond differently to pornographic material. Kinsey speculated that there could be some neurophysiological reason for a difference, but a West German research team studied the responses of men and women to pornography and found them to be comparable emotionally, physically and behaviorally. Psychologist Julia Heiman’s work found that there are both sex differences and other differences in responses, but women are not inherently less capable of responding to pornography. Women and men, she found, respond more to that which they like.

As with many issues, our society is not in agreement about the topic of pornography. Pornography is mass produced and widely available, yet is just as widely distrusted and condemned. We have laws against obscenity but cannot define it. We believe that somehow pornography is harmful, yet can find no evidence of harm. On the one hand, our culture seems unable to satisfy its demand for pornography; on the other hand, many people believe it should be controlled in some way for the general good. It would most likely require a major cultural shift for society to feel comfortable about repealing all legislation against pornography. Equally, it would take as large a shift to enforce total prohibition. Ultimately, it is an individual’s personal beliefs that determine what is acceptable and what is obscene.

Pregnancy is the nine-month process in which a baby develops inside a woman’s womb or uterus. Pregnancy results from intercourse or from in vitro fertilization when a sperm from the male penetrates the woman’s ovum or egg when it has been released from one of her ovaries. This process is called fertilization and the resulting cell is called a zygote. The zygote undergoes cell division and keeps dividing as it passes through the Fallopian tube and is implanted in the uterus. This occurs in about one week’s time and the implanted ball of eight cells is then called a blastocyst. With the blastocyst implanted in the endometrium of the uterine wall, the woman may be said to have conceived and to be pregnant. The endometrium provides the fertilized egg with a natural nesting place and immediate nutrition. Also at this time, the placenta – a very important exchange and filtering system – begins to develop between mother and baby. Oxygen and nourishment from the mother’s blood are filtered through the placenta to the baby, and waste products from the child are returned to the mother through the placenta. The baby and the placenta are connected by the umbilical cord.

A few days after conception, a transparent sheath called the amniotic sac begins to grow around the baby. The amniotic sac fills with special fluid, which acts as a cushion to keep the developing baby safe from outside bounces and shocks. Each day the fluid in the sac is exchanged for new fluid in a continual replacement system. Typically, just before the birth of the baby the sac breaks, releasing about a quart of water through the vagina. When the amniotic sac releases the fluid, it is said the woman’s “water broke” and the birth of the baby, its passage from inside the mother out into the world, is imminent. In a normal pregnancy this usually occurs in the ninth month.

Pregnancy is divided into three-month periods, called trimesters. The first trimester is the first, second, and third months of pregnancy; the second trimester is the fourth, fifth and sixth months; and the third and last trimester is the seventh, eight, and ninth months. Despite the woman’s unchanged external appearance during the first trimester of pregnancy, many important developments are taking place within her body. By the end of the first month, the developing embryo is about one-tenth of an inch long, has a beating heart, has the beginnings of a head, spinal cord, nervous system, lungs and the buds of arms and legs. During this phase of critical development the embryo is particularly sensitive to influences which could cross the placenta, such as drugs (including alcohol) or certain infections.

During the second and third months of the first trimester the embryo continues to develop such features as bone cells, eyes, ears, nose, fingers, feet and toes. The refinement of body parts also includes teeth sockets, and the beginning of fingernails. The budding of the clitoris, and the budding of the penis and scrotum are also taking place during the second month, but the sexual organs are not refined enough to distinguish as male or female until sometime in the third month. The extraordinary process of creation continues day after day, yet the fetus, as it is called at eight weeks, is still only two to four inches long and weighs less than one ounce. But it is already looking unmistakably human.

During the second trimester the major body systems and organs are still being refined. Facial features are molded, eyebrows and eyelashes begin to appear and the eyelids can open and close. Facial expressions, such as frowning, lips that open and close and turning of the head begin to appear, but it is not clear that these gestures can be interpreted to mean anything. The skin of the fetus is very thin and transparent, clearly showing the blood vessels lying just below. Roughly halfway through pregnancy, muscles have developed enough to allow the fetus to move its arms and legs. This is the time when a woman begins to notice the first fluttery fetal movements, a stage termed “quickening”. During the second trimester, the heartbeat of the fetus can be heard with a stethoscope and the fetus will grow rapidly, reaching approximately 2 pounds in weight and 14 inches in length.

During the third trimester it is typical for the fetus to toss and kick quite a bit, making its presence obvious to the mother. These movements are a sign that the nerve fibers of the fetus are developing properly. They are necessary for muscular and skeletal growth, and for the development of fine motor ability. In the seventh month and the first part of the eighth the fetus gains weight and grows tremendously. It generally triples in weight and increases in length by 5 or 6 inches. The expectant mother’s abdomen becomes exceedingly large toward the end of pregnancy and may cause some back pain and frequent urination due to the fetus applying pressure to the mother’s bladder. In the eighth and ninth months the baby’s organs and structures are developed enough to function on their own. During the final month of pregnancy the baby, who has been in an upright position, gradually turns completely over until its head is pointing downward. It is then ready to be born, as soon as contractions of the uterus begin to push the baby out through the vaginal canal and into the waiting world.

Sometimes complications arise during pregnancy. One common complication is miscarriage. Miscarriage is the spontaneous separation and discharge through the vagina of a developing fetus before it is ready to be born. Miscarriage seems to be the body’s natural solution to a pregnancy that is not developing properly. Most miscarriages occur early in the first trimester and it is estimated that about 20 percent of all pregnancies end in miscarriage.

Early miscarriages are usually not physically painful. The main signs are cramping and bleeding, much like a heavy menstrual flow. Medical care following an early miscarriage is recommended in order to insure that all of the fetal tissue is removed form the woman’s body. Because there is a risk of infection if some tissue remains, a doctor may suggest a procedure called dilation and curettage (D and C) to remove it.

It is estimated that 75 percent of all miscarriages occur during the first trimester of pregnancy. The remainder occurs in the second trimester. Any fetus passed out of the body after the end of the second trimester (24th week) is called a premature birth. Signs of second trimester miscarriage are severe, labor-like cramps and heavy bleeding followed by the discharge of the developing fetus. Medical attention is required to be certain that all fetal tissue has passed out of the body.

Generally an egg and sperm dividing or implanting improperly cause miscarriages. Sometimes a woman’s hormonal level is lower than necessary, causing the lining of the uterus to weaken and to become unable to hold a fertilized egg. Often, however, the exact cause of miscarriage remains unknown. In the majority of cases, having a miscarriage does not affect a woman’s ability to get pregnant again. Miscarriage at any stage of pregnancy can be an emotionally difficult experience for couples. It is very common to experience sadness, depression, and a sense of loss as a couple’s feelings of joy and hope about the pregnancy turn to loss, grief, and often feelings of blame and guilt. Providing each other with support or seeking support from other couples who have experienced a miscarriage, or from a professional, are healthy ways to help work through the feelings resulting from experiencing a miscarriage.

Another pregnancy complication is an ectopic pregnancy. An ectopic pregnancy is the growth of the fertilized egg outside the uterus. They usually occur in a Fallopian tube (which is why they are referred to as a “tubal pregnancy”). On rare occasion a fertilized egg can implant in a woman’s abdomen, in an ovary, or in the cervix. Ectopic pregnancies result in the death of the fetus and can be fatal to the mother as well. They may cause sudden bursting of the Fallopian tube, massive internal bleeding, sharp pain and weakness resulting from the loss of blood. These problems typically occur late in the first trimester, usually between the eighth and twelfth weeks. An ectopic pregnancy may show as a “positive pregnancy test” and a physician may not see any early signs of abnormality when examining the woman. Typical signs of ectopic pregnancy are pain and cramping on the lower right or left side of the abdomen, bleeding through the vagina, weakness, dizziness or fainting (signs of internal bleeding) and a regular period, even after a pregnancy has been detected. If any of these signs appear, a non-intrusive ultrasound examination can show whether the fetus is growing in the uterus or elsewhere. Surgery is usually performed as soon as the condition is diagnosed to avoid the possible bursting of a Fallopian tube and heavy bleeding that can seriously harm the mother. Intervention generally involves the removal of the burst Fallopian tube, though sometimes the tube can be repaired. After such surgery a woman can still become pregnant, but her chances will be reduced by the absence of one tube. Also, a woman’s chances of having another ectopic pregnancy increase after having one such pregnancy.

Toxemia is another relatively common pregnancy complication. Also known as pre-eclampsia, toxemia is a condition that occurs in some women during the fifth or sixth month of pregnancy. The exact cause of toxemia is not certain, but many doctors believe poor nutrition is a large contributor. Symptoms of toxemia include weight gain and rising blood pressure, then swelling of the hands and ankles due to water retention, abdominal pain, headache and poor vision. Toxemia affects the developing baby because the placenta does not do its job properly, resulting in a smaller baby, premature delivery or delivery by caesarian. Toxemia can be managed through rest and a properly balanced diet with the avoidance of excess salt. Toxemia must be treated and monitored by a physician because if left unchecked it could lead to the death of the fetus and even the mother.

Pregnancy can be both a scary and a joyous time for a woman and her partner. The changes that pregnancy brings are not only physical but deeply emotional. Depending on the circumstances of the pregnancy (whether it is wanted or not), it may bring up feelings of confusion, denial or anger; or it may lead to emotional growth, maturity and a special feeling of completeness, despite periods of moodiness and feeling low that accompany many pregnancies.
It is not uncommon for pregnant women to feel unhappy about the changes in their bodies as pregnancy progresses. Nor is it unheard of for men to feel jealous, neglected and resentful of the great amount of attention and interest their wives receive during pregnancy. With good communication and a loving relationship these feelings usually pass without leaving a residue of major problems about the self or the marriage. The powerful feelings aroused in both women and men as a result of pregnancy may result in a change in their relationship. For some it may be an unhappy change, particularly if an unplanned pregnancy affects finances, living space, employment or responsibilities. The stress may be felt by one partner or by both and resolution should be attempted via communication, honesty, and working at adjusting together throughout the pregnancy.

In many cases pregnancy brings a couple closer together. The excitement of becoming a family together and the anticipation of being a mother or a father may create a different sense of responsibility toward each other and foster a level of love and warmth not previously experienced.

Pregnancy often has an influence on a couple’s sexual activity, although it has no uniform effect on sexual feelings or function. Some women find that pregnancy is a time of heightened sexual awareness and pleasure, whereas others notice no change or a decline in sexual feelings. Variations in sexual functioning are also found during different stages of pregnancy. Not surprisingly, women with morning sickness and high levels of fatigue during the first trimester often have neither the interest nor the energy to be sexually active. The second trimester is a time when women may notice heightened sexuality both in terms of desire and physical response. In the last trimester some couples find that a bulging belly makes sexual intercourse difficult; for others adjustments in sexual positions or non-coital sex solve this problem. Some couples agree to voluntarily abstain from sexual activity near the end of pregnancy because of concern about injuring the baby. Though there is usually little danger of injuring the fetus or the mother, it is best to follow the advice of a doctor who has been treating the woman throughout her pregnancy regarding safe sexual practices at all stages of pregnancy.

The Prostate Gland is an essential part of the male reproductive system. The prostate gland, as it is commonly called, is not really a gland at all, but an organ that consists of about 70 percent glandular tissue and 30 percent fibromuscular tissue. In an adult male, it is about the size and shape of a walnut and weighs about 20 grams. It is located directly beneath the male bladder and in front of the rectum. A thick fibrous capsule surrounds the prostate.

In the adult male, the glandular tissue of the prostate secretes a fluid that contributes 20-30 percent of the total volume of the seminal fluid released when a man ejaculates. This prostate fluid is continuously generated by the prostate but increases during sexual excitement. The combination of spermatozoa, seminal vesicle fluid and prostatic fluid, in addition to a tiny amount of fluid from some minor glands, constitutes semen. The prostate gland fluid is a thin, milky substance that gives semen its characteristic color and odor. Contents of these secretions include calcium, zinc, citric acid, acid phosphatase, albumin, and prostatic specific antigen. These substances aid in the lubrication of the urethra, and protection, nourishment, and mobility of the sperm in the normally acid environment of the female vagina.

The prostate grows very little from birth until puberty, but at puberty it undergoes a growth spurt, increasing in weight and doubling its size. In general, the size of the prostate remains constant for the next 30 or more years. In some men, in fact, the prostate never again increases in size. Unfortunately, however, this is not the case for most men, who will develop some form of nonmalignant enlargement of the prostate, medically known as benign prostatic hyperplasia, or BPH. According to estimates by the American Foundation for Urologic Disease, more than half of men aged 50 and above have enlarged prostates. This number steadily increases with age, and by age 80 it is estimated that 80 percent of men have prostatic enlargement. If the prostate gland is enlarged it may partially block the flow of urine through the ureters causing a backpressure in the kidneys. Untreated, this condition can lead to chronic kidney disease. Fortunately, there are increasing numbers of medical and nutritional treatment approaches to this common male disorder.

The major health problems associated with the male prostate gland may be divided into three main categories: (1) enlargement of the prostate, called benign prostatic hyperplasia, or BPH; (2) prostatitis or inflammation of the prostate; and (3) prostate cancer. Prostate cancer is currently the second leading cause of death from cancer in men (the first being lung cancer). It is considered the sixth leading cause of death overall among men. For these reasons the Cancer Society and the Urological Association currently recommend that healthy men begin an annual program of rectal examination after age 40 and a rectal exam and a simple blood test to monitor prostate-specific antigen levels (called PSA) after age 50. Men at higher risk for prostate cancer, including African-Americans and those with a family history of the disease, should begin both rectal and PSA testing annually at age 40. The Urological Association has formulated and validated a brief symptom index that is becoming the standard test to assess symptoms of BPH, If you are a male, 40 to 50 years old, you should discuss with your family practitioner any of your urinary or prostate concerns and establish an annual testing program.

PSA and PSA Testing are medical terms related to the male prostate gland. Prostate Specific Antigen (PSA) is a protein produced by cells in a man’s prostate gland. The level of this antigen present in the prostate gland can be measured by a simple blood test.

Many physicians consider the PSA test a valuable tool to aid in the early detection of prostate cancer and to monitor the results of treatment approaches to its cure. Generally, the accepted guidelines for a normal PSA test are 0-4 monograms. Test results between 4 and 10 are most likely to be associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate, which is common in men over 40 years of age, or prostatitis, an inflammation of the prostate. A PSA level over 10 is thought to be high and suggests further evaluation for possible prostate cancer.

Although the highest PSA values are generally found in advanced stages of prostate cancer, there have been reports of very high values as a result of vigorous stimulation of the prostate, as might occur in a long bike ride. Thus, high PSA readings are not always indicative of prostatitis or prostate cancer. A high PSA level merely indicates additional evaluation should be undertaken.

PSA levels are known to be age-dependent, and deviation from the average range for one’s age group may represent a normal deviation and may or may not be indicative of any disease of the prostate gland. A simple 7 question symptom index developed and validated by The Urological Association is available on line: http://pcimed.com/aua.html. This index is a useful tool for assessing symptoms related to urinary and possible prostate problems common in men over 40 years of age.

Puberty is the period of physiological and anatomical development when the organs of sexual reproduction mature and become functional. This is not to be confused with adolescence, which is a socially defined period of psychological development that is sociocultural. Puberty may or may not coincide with adolescence and in some cultures adolescence does not exist. In females, the onset of menstruation and the development of the breasts mark this maturation. In males, the biological markers of puberty are the enlargement of the external genitalia and the production of semen. In both sexes, the development of these primary sexual characteristics is accompanied by the onset of a variety of secondary sexual characteristics. In males, these include the appearance of facial and other body hair, including in the pubic area and in the armpits, as well as the deepening of the voice tone. In females, hair develops in the pubic area and in the armpits, and the hips begin to broaden. For both sexes this is also a period of rapid development of the sweat glands. Generally, these changes prepare the body for sexual reproduction, but they also have important social and emotional aspects.

Among boys, puberty tends to begin at about age 13, but may not start until 16 years of age. Puberty tends to begin earlier in females, often two years earlier than boys. However, the commencement of puberty varies among girls no less than among boys, and may not begin until age 14 or 15. Heredity can influence the onset of puberty, as can psychological and physical health. Some studies have shown that earlier-maturing individuals achieve better social adjustment to puberty than do later-maturing individuals. This may be due to anxiety about being different from one’s peers and accompanying social pressure for conformity common during the adolescent years. Conversely, some youths undergo a peculiarly early pubescent transition, a condition called pubertus praecox. The functioning of the anterior pituitary, adrenals, or the gonads causes this condition.

The beginning of puberty is controlled by the release of growth hormone by the pituitary gland. This biochemical substance produces rapid growth, which is characteristic of puberty. Girls most commonly begin a rapid growth period between the ages of 12-14 years, but some start this growth spurt as early as age nine. By the time they are 14; most girls have reached their adult height. Menstruation generally begins about three-fourths of the way through this rapid growth period. Breast changes and the growth of body hair precede the beginning of menstruation by about one year. The pattern for boys is somewhat different. The period of rapid adolescent growth for boys begins after age 12 and continues for about four years. The onset of the various features of puberty for boys occurs throughout this period. Boys commonly do not reach their adult height until several years after girls and may continue to grow and to develop secondary sex characteristics, such as chest hair, well into the late teen years. Other hormones also shape pubescence. In boys, androgen and in girls, estrogen sparks the development of secondary sex characteristics.

Puberty is a time of physical, emotional, and social exploration and self-discovery. Associated with the physical changes that characterize puberty is a growth in sexual interest. For most youths, this involves increased attentiveness to the opposite sex or heterosexual attraction; for others it involves an enhanced same-sex interest or homosexual attraction. Because of social disapproval, young people who find themselves sexually attracted to members of their own sex may undergo considerable emotional distress, isolation, and sexual guilt. However, the onset of bodily changes (at different times and at different rates among different youths), the beginnings of sexual interest and incipient romantic attractions, and the lack of a clear social role can contribute to uncertainty and confusion among both heterosexual and homosexual youths. Feelings of sexual attraction are part of the search for self-understanding and part of the normal developmental process called puberty.

Performance anxiety or fear of performance is a common sexual problem in which anxiety about engaging in sexual activity becomes an overriding block to the spontaneous flow of sexual feelings and thoughts. The fear of sexual performance, or, more accurately, the fear of not performing sexually, can affect sexuality in a variety of ways. Performance anxiety can result in avoidance of sexual encounters, lowered self esteem, relationship discord and sexual dysfunction.

Typically, an awareness of performance anxiety produces so much preoccupation with the anxiety itself that the person becomes less fully involved in the sexual interaction, bringing about the very failure that is feared. In one common scenario, as the anxious person worries about how to be sexually responsive and spontaneous (how to be a “good lover”), he or she focuses on each detail of the lovemaking. The person may focus on how rapidly the partner is breathing, whether a shift in position is required, or how much lubrication or erection is present. The sexual interaction is dissected so deliberately that enjoyment is virtually impossible. Sexual encounters that proceed in this fashion have a high probability of being unfulfilling for one or both partners. Anticipation of the next sexual encounter arouses the same anxiety coupled with the memory of the previous failure and often leads to avoidance of sexual activity altogether, or at least to minimizing the amount of sexual interaction that occurs. This may result in one member of a couple mistakenly interpreting the situation as a form of rejection. The underlying avoidance, however, is usually not to reject one’s partner, but to save face in a way that helps the person feel more in control and less guilty about being inadequate.

Take, for example, erectile dysfunction. It is a disorder that can develop as an outgrowth of performance anxiety. Isolated episodes of not getting an erection or of losing an erection at an inopportune time are so common that they are almost a universal occurrence among men. Such isolated episodes do not mean that a man has a sexual dysfunction. They may occur as a result of a temporary physical stress (having a cold, being tired, having consumed a large meal or too much alcohol), or may relate to other problems like tension, lack of privacy, or nervousness about a new partner. If the man does not take such incidents in stride and becomes upset by his failure to respond physically, he may set the stage for difficulties in future sexual experiences by worrying about his ability (or inability) to perform.

Fears of sexual performance (“Will I lose my erection?” “Will I satisfy my partner?”) are likely to put a damper on sexual arousal and cause loss of erection. Eventually the fears may become so pervasive that they will become a self-fulfilling prophecy and the man will experience an actual inability to get or keep an erection. Over the long run, performance fears may lead to a lowered interest in and avoidance of sex, loss of self-esteem, and attempts to control the anxiety by working hard to overcome it (which usually reduces sexual spontaneity and causes sex to be even more of a “performance”).

In addition, fears of performance often cause one or both partners to become spectators during their sexual interaction, watching and evaluating their own or their partner’s sexual response. When in the role of spectator because of performance fears, a person usually becomes less involved in the sexual activity itself. The reduced intimacy and spontaneity of the situation combined with the pre-existing fears usually stifles the capacity for physical response. This cycle tends to feed on itself: erectile failure leads to performance fears, which lead to the spectator role, which results in distraction and loss of erection, which heightens the fears of performance. Unless this cycle is broken there is a strong possibility that sexual dysfunction will be firmly established.

Fears of sexual performance are not limited to men or to worries about physical responsivity such as the speed with which vaginal lubrication or an erection is attained, or the length of time that it is maintained. Fears can also reflect anxiety about one’s sexual response on a broader level, such as how much passion, tenderness, intimacy and sensitivity a person feels toward his or her partner. In these cases, a person having no apparent problems in the physical side of sexual responsiveness may be distressed by an internal perception of inadequate or inappropriate sexual performance. In some instances, of course, these feelings are a true reflection of a lack of affection for one’s partner. But in other cases, a person who expects that sex should always be a monumental, blissful communion with his or her partner, then acts on surging passionate impulses, may feel anxious about having been too selfish and not concerned enough with his or her partner’s feelings and response. Paradoxically, reigning in the spontaneous sexuality in favor of a more measured and synchronized style of lovemaking often backfires, resulting in a disappointing and sterile sexual experience.

Fears of sexual performance are very common and can usually be easily resolved, especially when professional help is sought early in the discovery of the fears. Sex therapists generally agree that the best approach to breaking the cycle of performance anxiety is to talk about the fears or concerns with your partner. This simple suggestion, though often difficult to do, can be the beginning of improved communication and better sexual functioning. If the problem persists, seeking the help of a Sex therapist would be the next step in the treatment of performance anxiety.

The perineum is the area of skin rich in nerve endings that is located below the anus (the opening for bowel movements). For women, the perineum extends to the vaginal opening; for men it extends to the base of the testicles.

Because the perineum is so rich in nerve endings it often feels pleasing to have it touched or stroked. If one is comfortable with being touched on the perineum, its stimulation can be incorporated into a couple’s lovemaking to further enhance sexual arousal. To make stimulation smoother and more comfortable, it is often helpful to lubricate your fingers before stroking the perineum during lovemaking. As long as the stimulation remains outside the body on the perineum, any type of lubricant (petroleum-base or water-base) will do. However, because this kind of stimulation is often associated with insertion of the finger into the vagina or anus, or both, a water-base lubricant is recommended and preferred.

The term sexual positions refer to the different ways in which couples physically position themselves for sexual intercourse. Theoretically there can be countless sexual positions, but in fact, most are variations on about half a dozen basic positions. On the one hand, popular mythology propagates the belief that the man-on-top position is the only normal and acceptable coital position; on the other is the myth that not only are there scores of sexual positions, but that no one may be deemed a competent lover until he or she has mastered them all. The myth further suggests that the more physically challenging the position, the greater the sexual satisfaction will be. None of these myths is true. No special significance is attached to any particular position, and competence in lovemaking is measured by fulfillment, not by the extent of one’s sexual repertoire.

The most common sexual positions are man-on-top, woman-on-top, side-by-side, and rear-entry. Some heterosexual couples and some gay men also practice anal intercourse. They may all be modified by performing them lying down, sitting, standing, kneeling, or any combination of these. Each couple’s inventiveness and comfort level determines their choice of positions.

The man-on-top position is the most common of all intercourse positions in Western cultures. It is also called the missionary position after the 19th century Christian missionaries who believed that the man on top was the only natural and proper position for intercourse. They encouraged their foreign converts to abandon their so-called “animal” positions in favor of the man-on-top position. In the man-on-top position the woman lies on her back with her legs spread. Either the man or the woman guides the penis into the vagina. The man can lie flat on the woman if his weight is not uncomfortable on her, or he can support some or all of his weight on his elbows, hands or knees. Some women find that without this, the weight of the man on them restricts their pelvic movements. The woman can wrap her legs around the man’s hips or back, or even put them up over his shoulders. The further up her legs are the deeper the penetration the man can make as he thrusts. Some women, however, do not care for the deep penetration this position encourages.

The man-on-top position somewhat limits the ways a man can use his hands to caress his partner, but the woman can use her hands freely to caress the man or stimulate her clitoris. It is a very good position for seeing each other and kissing during intercourse.

For the woman-on-top position the man lies on his back and the woman lowers herself onto his erect penis. Either the man or the woman may guide the penis into the vagina. The woman can remain squatting on her knees facing the man, she can straighten her legs, or she can turn around and face her partner’s feet. Couples may also arrive at this position by rolling over from a man-on-top or side-by-side position. On top the woman can regulate the depth of penetration of the penis and the rate of thrusting. This position also allows for maximal indirect stimulation of the clitoris by the penis, and some women reach orgasm more easily when they are on top than when they are underneath the man. Couples may like this position because they both can move their hands more freely to caress each other than in most other positions. They can also see more of each other. Some women find that penetration is too deep in this position, but they can regulate the depth by limiting how far down they lower themselves. Also, with vigorous movements the penis may slip out of the vagina, which may be frustrating.

The woman-on-top position is less often recommended if the woman is trying to become pregnant because the man’s semen naturally tends to run out of her vagina. Of course, women who prefer this position can simply change positions immediately after her partner has ejaculated. Moreover, this is a good position for the later months of pregnancy because it allows intercourse without the woman’s growing belly getting in the way. For the same reason it is a good position for men with large stomachs.

The side-by-side position is a position in which the partners have intercourse lying on their sides facing each other. A couple can start off in this position or arrive at it by rolling over from man or woman on top. Deep pelvic thrusting is difficult when a couple is side by side and some couples prefer not to use the position for that reason. On the other hand, both partners’ hands are free to caress each other and the face to face position allows them to kiss. Because energetic thrusting is difficult when side by side, this is a particularly good position for people who need to avoid strenuous activity. It is also a useful position during pregnancy because the woman’s belly gets in the way less than, for example, in the man-on-top position.

Rear entry intercourse is when the man’s penis enters the woman’s vagina when she has her back to him. It is not the same as anal intercourse, which is intercourse with a man’s penis inserted in his partner’s rectum . Rear entry intercourse can be done with the woman standing but bending over and supporting herself, or with the woman on her hands and knees and the man kneeling behind her (commonly known as doggy style). Or rear entry can be done with both partners lying on their sides, her back to his front.

Rear entry allows for deep penetration and vigorous pushing if the couple wants that. The man’s hands are free to caress the woman and he can reach her clitoris easily. It is more difficult for the woman to caress the man in this position than in others because she has to reach behind her. The drawbacks of rear entry intercourse are that the penis entering from behind gives very little stimulation to the clitoris and some couples do not like the lack of face-to-face intimacy.

Which sexual positions a couple uses depends on a variety of factors. Each partner’s physical comfort with a position certainly influences its use, as might their inhibitions about experimenting with unfamiliar positions. Sometimes the capacity to prolong or hasten orgasmic response determines what position a couple may choose. In some cases, circumstances (e.g. amount of space or time available) dictate the position for intercourse. Some couples will use one position almost to the exclusion of all others, perhaps because they mutually find it to be the most satisfying. Other couples may regularly use several positions or experiment with positions but not regularly include them in their lovemaking. Whatever the choices made, couples may find that the position influences the emotional as well as the physical aspects of lovemaking.

Ancient books of sexual wisdom and techniques such as the Kama Sutra and its associated texts, the Ananga Ranga, The Perfumed Garden and The Tao, offer ways of enhancing sensuality through innovative techniques and positions. In most people’s minds, the words Kama Sutra evoke images of exotic, erotic and perhaps even impossible lovemaking positions. In fact, the work describes only about two dozen positions, and many of these are easy to accomplish if the woman is reasonably flexible. The majority of the positions described in the Kama Sutra involve the woman lying on her back with her legs in a variety of positions (e.g. the Yawning Position, The Splitting of a Bamboo, Fixing of a Nail), but there are a few woman-on-top postures as well (e.g. The Swing, The Pair of Tongs).

The Ananga Ranga, another text from ancient India (late 15th or early 16th Century), was written by Kalyana Malla to protect marriage from the sexual tedium that can set in. It describes various groups of lovemaking positions such as “uttana-bandha” (supine positions with the man on top), “tiryak-bandha” (side-by-side positions), “Upavishta” (sitting positions), and “purushayita-bandha” (role-reversal or woman-on-top positions).

The Perfumed Garden came from the late 15th century male-dominated North African culture and offered ample and often evocative instruction on what a man could do to and with his wife or mistress, but barely touched on her experiences. Many of the 11 postures are quite gymnastic in nature and probably cannot be sustained by a couple for very long.

In the Taoist counterpart to the Kama Sutra, the author describes 26 positions for lovemaking, nearly all of which are variations on four basic postures. These basic postures are the Intimate Union (man-on top), the Unicorn’s Horn (woman-on-top), Close Attachment (side-by-side and face-to-face), and the Fish Sunning Itself (rear entry). Although the positions are likely to seem similar to those in the other ancient (and even modern) texts, the beautiful names given to the positions (Butterflies in Flight, Swallows in Love, A Phoenix Playing in a Red Cave) reflect the Taoist tenet that life is a balance of opposites in which everything that occurs has an equal and opposite reaction. Sexual union exchanges the forces of Yin, which is negative, passive and nourishing, and Yang, which is positive, active and consuming.

With the exception of coitus, sexual positions for gay and lesbian couples do not differ much from those of heterosexual couples. Gay men may engage in anal intercourse more often than heterosexual couples and gay women may be more likely to introduce sexual aids into their lovemaking. However, the vast array of sexual positions that same or opposite sex couples may experience remains basically the same.

Sex aids or Sex toys are devices made to vary or enhance pleasure during sexual activity. They are used primarily on the genitals or around the genitals, but some can be used on other parts of the body as well. People use them when they are on their own or with partners. On the whole, people who use sex aids do not use them every single time they engage in sex nor do they always use the same aid on each occasion.

The list of sex aids is a long one. They are usually sold in special erotica shops or through mail order catalogues. Some of the more common ones include the following:
Vibrators — Vibrators are electrical machines powered by batteries or plugged into electrical outlets. They come in different sizes and shapes; some have variable speed controls to allow the user to personalize the intensity of the stimulation.

The more popular kinds of personal vibrators are battery powered, cylindrical or penis shaped in different diameters and lengths, and sometimes come with attachments for different parts of the body.

The sexual sensations produced by a vibrator can be both intense and rapidly felt. Vibrators must be used gently on sensitive body tissue. Some people use a towel between the skin and the vibrator to cut down on the intensity of the sensation. Using a water-based lubricant can also make a vibrator more comfortable and stimulating.

Vibrators, especially AC-powered models, are never to be used in or with water, and battery powered models may overheat if used for extended periods of time.
Ben Wa Balls — This device, which originated in the orient, consists of a set of two metal balls. One is solid and is placed in the vagina near the cervix; the other one is partially filled with mercury and is also placed in the vagina, near the first one. Any movement causes the mercury filled ball to hit the deeper one, spreading vibrations through the vaginal area. Women primarily use them on their own, but they can also be incorporated into sexual activity with a partner.

Cock Rings — A cock ring is a metal, leather, or rubber ring-shaped device, usually from 1 1/2 to 2 inches in diameter. The testicles and the erect penis are slipped through the ring, which fits tightly, putting pressure on the dorsal vein of the penis. The idea is that the cock ring will keep the blood that has engorged the penis from flowing out. The man will therefore retain his erection longer and, theoretically, be able to prolong his sexual activity. Some men also wear cock rings when they want their genitals to look larger under their pants. Proper fit is important so that the penis and testicles do not get bruised. Caution is needed not to wear the rings too tightly or for an extended period of time, since they act as a tourniquet limiting blood flow and can cause severe damage to the genitals.

Erotic Creams, Lotions and Oils — These come in various scents and flavors and are primarily designed to make caressing and massage more sensuous, though some are used as lubricants for intercourse. The sensations and scents of creams, lotions and oils on the skin can be arousing for some people. The flavor of the cream or oil is often important for couples who want to have oral sex or like to kiss their partner’s body all over.

French Ticklers — French ticklers are devices that fit over the penis and are designed to tickle and increase sensation in the vagina during intercourse. These devices are pre-shaped (unlike condoms, which come rolled up) and their surfaces are equipped with ridges and small probes. French ticklers can be reused after thorough washing. It is important to note that while they fit over the penis in a fashion similar to condoms, they are NOT birth control devices

Leather Garments and Accessories — Leather has a distinctly erotic appeal for some people. It is a common element in sadomasochistic (S&M) fantasies used to express dominance. Some people get excited if threatened by someone who is clothed in leather or who is using leather implements. The dominant person (sadist) in these scenarios also usually derives pleasure from the wearing or use of leather. Leather is also used in bondage and discipline (B&D) in the form of harnesses or straps.

Masturbators — These are devices with soft, usually latex sleeves, often designed to resemble the female vagina, into which a man can place his erect penis. If this sexual aid is an electrically or battery powered model, it can be controlled by the user to operate at varying desired speeds to create a rhythmic motion, stimulating the man to reach orgasm and ejaculate.

Penis Extenders — A penis extender is a hollow penis-shaped device that is placed over the end of the penis to make it seem larger. Usually it is held in place by straps or a harness that goes around the waist.

All does not readily accept the use of sex aids and sex toys. For the most part sex toys are designed solely to increase pleasure. Because our society is in conflict over the rightness of sexual pleasure, it is not surprising that sex toys are subject to numerous myths and controversies. Some of the more common misconceptions are: that the use of sexual aids is a sign of being a pervert; that using sexual devices in a relationship is a sign that the relationship is not going well; people who use sexual aids become addicted to them; and homosexuals use sex aids more that heterosexuals do. None of these, of course, is true.

Nonetheless, many people feel ambivalent about using sex aids. They may feel that using mechanical devices during intimate moments is unnatural, depersonalizing or replacing their partner. While these concerns may have merit, it is generally not simply the use of sex aids that contributes to ill feelings, but how they are used and what their use means to an individual or to a couple. If the use of sexual aids objectifies or depersonalizes sexual experiences, there may be a problem in the relationship that requires attention. If people are using sexual devices as a crutch because they feel inadequate or inferior, then their negative feelings may need to be explored. Under circumstances like these, the use of sexual devices can be unhealthy substitutes for interpersonal relationships.

Some couples find that a healthy relationship can comfortably accommodate the addition of sex toys. Others may find that after some experimentation they prefer to do without them. Still others may feel that their sexual value is threatened by the use of sex aids. An insecure individual may wonder if his or her partner is using a sex aid because of dissatisfaction with him or her.

These issues and any others that may be raised as a result of introducing sexual aids may be seen as an opportunity for individuals and couples to explore their feelings and discover the problems in their relationships. It is important to consider, however, that using sex aids is normal and not using sex aids is normal. It is simply a matter of individual preference.

Although the majority of sex aids and toys are sold to people who use them just to enhance their pleasure, some can be used in the treatment of sexual problems. Videos, audiotapes and written material can be helpful in assisting an individual or a couple to overcome anxiety or lack of information. Also, sexual devices can be particularly helpful for some disabled people whose disability inhibits their sexual expression. In order to improve communication and intimacy, marital and sex therapists suggest that couples who have concerns or fears about the use of sex aids or toys should be encouraged to talk openly with their partner about their feelings.

Sex and Aging has become an issue of growing popular and media discussion, especially as the average life span in developed countries has grown longer and the number of people over 60 years of age has grown appreciably as well. At the same time, with changing dietary and activity patterns, and new medical treatments, many people in their senior years are relatively healthy and desirous of continuing an active life, including an active sex life. While prior to the 1960s the topic of sex in later life was consciously ignored in the media, not included in most sex research, and considered an inappropriate issue for public discussion, today it is receiving increasing attention.

Indeed, the first serious book on the topic was not published until the 1960s, and the first reliable study did not appear until 1966 with the publication of the seminal work of sex researchers Masters and Johnson. Even now the topic of sexuality and aging is often treated with tremendous sentimentality or with derisive humor, and it is hard for some people to conceive of sexual desire and passion among the elderly except in terms of lechery. While perhaps receding in the popular imagination, the image of the “dirty old man” that chases after young women has not disappeared. Moreover, until recently, feelings of sexuality and sexual need among those over 60 years of age might be cause for guilt feelings, based on the culturally constructed assumption that people were supposed to “mature out of” sexual interest and become sexual neuters as they entered into their so-called “golden years.”

New studies, like The Starr-Weiner Report on Sex and Sexuality in the Mature Years (1981) and E. Brecher’s Love, Sex, and Aging (1984) have provided new information about sexual behavior and attitudes among those over 60 years of age. The understanding of normal sexual needs and practices among the elderly that emerges from this research contradicts earlier assumptions and stereotypes. Generally, this research has found that age typically does not significantly diminish the need and desire for sex, that regular sexual activity is standard when a partner is available, and that most elderly believe that sex contributes to both physical and psychological health. Furthermore, studies have shown that physical capacity for male erection and male and female orgasm continue almost indefinitely, and that achieving orgasm is desired but not always achieved. Research has also found that sexual practices are varied and include masturbation and oral sex, in addition to intercourse, and, for many, sexual satisfaction increases rather than decreases as individuals enter into their senior years. In terms of problems, impotence and failure to achieve orgasm as well as failure to find suitable partners are important sources of frustration. These studies have led to the realization – now generally accepted among psychologists and sex therapists – that sexual interest and the need for sexual contact continue throughout the life cycle, although patterns differ somewhat for women and men.

Differences in sexual patterns between males and females are found throughout the life cycle. While capacity for erection in males begins while they are still in the womb, reproductive ability (i.e., the production of semen) begins at about age 13, but may not start until the boy is 16 years of age. As this suggests, there is considerable normal variation among males, as well as females, in the onset of various changes in sexuality. Boys reach the height of their sexual functioning at about age 18, followed by a slow drop in their capacity for erection and ejaculation from that point on. The drop in male steroid hormones only becomes measurable by about age 30. With declining hormonal production, there is a slow decline in the speed of physiological responsiveness and a lengthening of the refractory period — the time needed after ejaculation for the penis to again be able to achieve an erection. By age 40, most men begin to experience a decrease in physiological responsiveness, sexual arousability and functioning. There continues to be a gradual decline through the 50’s. Although there is wide variability, at this point males generally are only half as sexually active as they were at the peak of their capacity in their late teens and early twenties. During the late 40s and increasing gradually thereafter, the urgency of sexual interest declines, erection is less frequent and more difficult to sustain, the turgidity of the erection diminishes, ejaculation is less forceful, and refractory time is lengthened. After age 40, many men begin to experience periodic inability to achieve an erection and the frequency of this incapacity increases over time and becomes quite common by the 60s. However, although by the 60s all of the changes noted above are quite noticeable in almost all men, the pleasure they derive from sex may not be significantly affected. Indeed, recent studies show that most men (unless they have certain health problems) are able to participate in and enjoy sex their entire life span, and many are able to produce viable semen until quite late in life (Pablo Picasso reportedly fathered a child at 90 years of age). Thus it is not completely surprising to discover that, in recent years, elderly men in senior housing apartments have become a regular source of clients among prostitutes.

Various factors can limit sexual interest and capacity in men as they age. There are a number of organic problems of the heart and circulatory system, glands and hormonal system, and the nervous system that can, to varying degrees, diminish male capacity for and interest in sex. And the side effects of many medications used to treat some of these organic conditions can themselves compound the problem. Masters and Johnson originally reported that as much as 90 percent of male impotence has a psychological origin. Due to more sophisticated urological testing procedures it is now estimated that only about 40 percent of erectile problems are purely psychological. The majority of causes of male impotence have their origin in hormonal, vascular or neurological factors. Regardless of the causes of erectile difficulty, there is always a psychological effect on the male. Men who experience an inability to achieve or sustain an erection on several occasions may be so anxious about inadequacy that a self-defeating process is initiated that causes them to avoid sexual situations and sexual arousal. Other psychological factors, including depression, lowered self-esteem associated with overall loss of physical strength and the onset of physical signs of aging, anxiety, and substance abuse can all contribute to male impotence.

The capacity for sexual reproduction begins earlier in females than in males, often two years earlier. However, the commencement of puberty varies among girls and may not begin until age 14 or 15. Women differ from men in that the decline in sexual responsiveness with aging is quite gradual. As women age, hormonal production diminishes the lining of the vaginal wall begins to thin and becomes more rigid, and the production of vaginal lubrication drops. The latter change, in particular, can contribute to discomfort during intercourse, but a woman’s capacity to achieve orgasm can remain at near peak levels well into her senior years, even though the length of time needed to achieve orgasm may increase. Women who remain sexually active, in fact, may be less likely to experience a drop in available vaginal lubrication. These changes are quite minimal until menopause – the most dramatic organic change that a woman undergoes as she ages. Menopause usually occurs between 45 and 55 years of age, although it may begin earlier in women who have had a hysterectomy. A significant drop in the production of the hormone estrogen brings on menopause. With menopause, ovulation (the production and release of eggs), menstruation and fertility end. In the past, menopause was assumed to mark an end in women’s interest in sex. This view emerged from the assumption that women generally do not enjoy sex, and that they only engage in sex to have children. In recent years it has become clear that not only does interest and capacity for sex continue well beyond menopause, but that many women report an increased enjoyment of sex because worries about unwanted pregnancy are no longer a concern. Women on average live seven years longer than men, and thus one of the primary challenges for heterosexual women as they age is the lack of available male partners, especially in a society that traditionally has looked down on women having relationships with younger men.

Sex Response Cycle refers to the set of physiological and emotional changes that lead to and follow orgasm. Different researchers have constructed various models of the phases of the sex response cycle. Usually, these models include three, four, or five distinct phases, with the exact components of each phase differing across models. Helen Singer Kaplan proposed the Triphasic Concept of human sexual response involving three stages: desire, excitement, and orgasm. In his book Human Sexual Response, Lief described five sexual response phases: desire, arousal, vasocongestion, orgasm, and satisfaction.

William Masters and Virginia Johnson, prominent sex researchers and therapists, suggested that there are four identifiable phases in the sex response cycle: excitement, plateau, orgasm, and resolution. Using various instruments designed to monitor changes in heart rate and muscle tension, Masters and Johnson were able specify the bodily changes that characterize each of these phases.

The first phase, excitement, can last for just a few minutes or extend for several hours. Characteristics of this phase include: an increasing level of muscle tension, a quickened heart rate, flushed skin (or some blotches of redness may occur on the chest and back), hardened or erect nipples, and the onset of vasocongestion, resulting in swelling of the woman’s clitoris and labia minora and erection of the man’s penis. Other changes also occur. In the woman, the vaginal walls begin to produce a lubricating liquid, her uterus elevates and grows in size, and her breasts become larger. At the same time, the woman’s vagina swells and the muscle that surrounds the vaginal opening, called the pubococygeal muscle, grows tighter. These changes prepare the woman’s body for orgasm and were called the “orgasmic platform” by Masters and Johnson. Additional changes in men include elevation and swelling of the testicles, tightening of the scrotal sac, and secretion of a lubricating liquid by the Cowper’s glands.

The second phase, known as the plateau, is characterized primarily by the intensification of all of the changes begun during the excitement phase. During this period, the woman’s clitoris may become so sensitive that it is painful to the touch. The plateau phase extends to the brink of orgasm, which initiates the reversal of all of the changes begun during the excitement phase.

The peak of sexual excitement is reached during the third phase. Involuntary muscle contractions, heightened blood pressure and heart rate, rapid intake of oxygen, sphincter muscle contraction, spasms of the carpopedel muscles in the feet, and sudden forceful release of sexual tension characterize the orgasmic phase. For men, orgasm generally climaxes in the ejaculation of semen, which contains millions of sperm. Ejaculation consists of two steps. During the first phase, called the emission phase, seminal fluid builds up in the urethral bulb of the prostate gland. As the fluid accumulates, the male senses he is about to ejaculate. This is often experienced as inevitable and uncontrollable. During the second phase, called the expulsion phase, the urinary bladder closes to block the possibility of urine mixing with the semen. At this point, muscles at the base of the penis begin a steady rhythmic contraction that finally expels the semen from the urethral opening at the head of the penis. For women, orgasm also consists of rhythmic muscle contractions, in this case of the uterus, at about the same pace as in men. Tightening of the woman’s muscles puts pressure on the man’s penis and assists in male orgasm. For both sexes, barring the presence of some form of sexual dysfunction, orgasm is an intensely pleasurable experience. Indeed, some see it as the most pleasurable experience possible.

In the final phase, the resolution, the body returns to normal levels of heart rate, blood pressure, breathing, and muscle contraction. Swelled and erect body parts return to normal and skin flushing disappears. The resolution phase is marked by a general sense of well being and enhanced intimacy and possibly by fatigue as well. Many women are capable of a rapid return to the orgasmic phase with minimal stimulation and may experience continued orgasms for up to an hour. Males, especially as they age, experience a refractory period of varying duration after orgasm. During this period, men cannot achieve orgasm, although partial or full erection may sometimes be maintained. The duration of the refractory period can vary from just a few minutes to several days and there is great variability in the length of the refractory period both within and between men.

Sensate focus is a series of specific exercises for couples which encourage each partner to take turns paying increased attention to their own senses. These exercises were originally developed by Masters and Johnson to assist couples experiencing sexual problems, but can be used for variety and to heighten personal awareness with any couple. When used in the treatment setting, sensate focus is done in several stages over the course of therapy. The first stage usually begins around the third therapy session, after the nature of the sexual problem has been discussed and the couple has a clear understanding of the rationale for the treatment. In the first stage, the couple has two sessions in which they take turns touching each other’s body, but with the breasts and genitals off limits. The purpose of the touching is not to be sexual but to establish an awareness of sensations by noticing textures, temperatures and contours while doing the touching, or to simply be aware of the sensations of being touched by their partner. The person doing the touching is told to do so on the basis of what interests them, not on any guesses about what their partner likes or doesn’t like. The couple is instructed that if sexual arousal does occur, they are not to proceed to intercourse. Masters and Johnson recommend that the initial sessions of sensate focus be as silent as possible because talking can detract from the awareness of physical sensations. Of course, the partner being touched must let his or her partner know, either verbally or nonverbally, if any touch is uncomfortable.

In the next stage of sensate focus, touching is expanded to include the breasts and genitals. The person doing the touching is instructed to begin with general body touching, not to immediately move to the genitals or breasts. Again the emphasis is on awareness of physical sensations and not the expectation of a sexual response, and intercourse and orgasm are still prohibited. The couple is asked to take turns trying a “hand riding” technique as a means of nonverbal communication. By placing one hand on top of the partner’s hand while being touched, one can indicate if he or she would like more or less pressure, a faster or slower pace, or a change to a different spot. Masters and Johnson caution that these nonverbal messages should be conveyed in such a way that the person being touched does not take over full control, but simply adds some additional input to the touching, which is still primarily done based on the interests of the toucher.

In the next phase of sensate focus, instead of taking turns touching each other, the couple is asked to try some mutual touching. The purpose of this exercise is to practice a more natural or real life form of physical interaction (people don’t usually take turns touching and being touched), and to help each partner shift attention to a portion of his or her partner’s body and away from watching his or her own response. Couples are reminded that no matter how sexually aroused they feel, intercourse is still off limits.

The next stages of sensate focus are to continue with the mutual touching, then at some point to move into the female-on-top position without attempting insertion of the penis into the vagina. In this position, the woman can rub the penis against her clitoral region, vulva and vaginal opening regardless of whether or not there is an erection. In a subsequent session, she may progress to putting the tip of the penis into the vagina if there is an erection, all the while focusing on the physical sensations and stopping or moving back to non-genital touching if either partner becomes orgasm oriented or anxious. After completing a session or two at this level, couples are usually comfortable enough to proceed to full intercourse without difficulty.

These fairly simple techniques are used as part of a comprehensive program of psychotherapy and can have a dramatic effect, even in cases where severe sexual dysfunction has been present for many years. Professionals generally agree that there are various dynamics to account for the profound effects of these seemingly simple exercises. For one, sensate focus exercises are a form of invivo desensitization whereby a feared situation is gradually mastered by breaking it into discrete steps that are experienced under safe conditions. Furthermore, the explicit instruction against sexual arousal and orgasm frees each partner of the pressure to produce an adequate sexual response in him- or her- self or in his or her partner. It is also important that they are given permission to experience pleasure. Thus, sensate focus is a learning experience whereby pleasurable responses are reinforced and sexual anxiety is diminished because the fear of failure is removed.

An additional therapeutic feature of sensate focus relates to the psychodynamics of the couple’s psychosexual problems. Masters and Johnson, along with renowned sex therapist Helen Singer Kaplan, noted that in gently caressing each other, the couple may be confronted with one or both partners’ anxiety about physical intimacy. Both the anxiety that is aroused and the defenses this anxiety elicits become important avenues for psychotherapeutic exploration, and can be very important in understanding and improving a couple’s relationship in general, which most likely will have a significant influence on their sexual functioning.

Sex Therapy involves the therapeutic treatment of sexual disorders such as impotence, premature ejaculation, retarded ejaculation, hypoactive sexual desire, painful coitus, and orgasmic disorders. These problems, while not subjects of polite conversation until relatively recently, have been found to be extremely common, and further, to be sources of considerable emotional distress and interpersonal conflict in relationships. Masters and Johnson , pioneers in the sex therapy field, have stated that at one time or another half of all marriages have significant sexual problems. Other studies have suggested that at some point in their lives 10 percent of women are anorgasmic, 7 percent of men are impotent, and 18 percent of men suffer from premature or retarded ejaculation. Inhibited sexual desire, a condition characterized by loss of interest in sex, is thought to trouble one in five adult women during their lives. Additionally, surveys of married couples find that over half complain of encountering interferences that block their full enjoyment of sex.

While universally emphasizing correcting sexual misinformation, the importance of improved partner communication and honesty, anxiety reduction (including fear of performance failure), sensual experience and pleasure, and interpersonal tolerance and acceptance, sex therapy includes three different levels of intervention to address the various sexual problems mentioned above, depending on the nature and causes of the problem involved. Sex therapists believe that many sexual disorders are rooted in learned patterns and values. These are termed psychogenic disorders. As they are growing up, children observe interaction between their parents and others and are the objects of various messages about their sexuality. Conflict or other problems, including sexual problems in marriages, can be transmitted to children and result in the formation of unhealthy attitudes about sex, about sex organs, or about the body in general. Moreover, parents, religious institutions and societal norms may convey very repressive attitudes about sexuality that contribute to the formation of diverse sexual dysfunctions. Problems of this nature are believed by sex therapists to constitute the majority of sexual disorders. An underlying assumption of sex therapy is that relatively short-term outpatient therapy can alleviate learned patterns, restrict symptoms, and allow a greater satisfaction with sexual experiences. In cases where significant sexual dysfunction is linked to a broader emotional problem such as depression or substance abuse, intensive psychotherapy and/or pharmaceutical intervention may be appropriate. Substance-induced sexual dysfunction, for example, can involve loss of interest in sex, inability for the male to become erect, impaired orgasm, and pain during intercourse. Various medications also can produce symptoms of sexual dysfunction. Finally, there are a number of medical conditions that can cause sexual dysfunction, including various neurological problems (e.g., multiple sclerosis), endocrine conditions (e.g., diabetes mellitus), vascular conditions, and several different infections. These are termed biogenic conditions.

In his book Human Sexual Response, Lief described five sexual response phases: desire, arousal, vasocongestion, orgasm, and satisfaction. Sexual dysfunction can occur in any of these areas. If the dysfunction is a chronic problem, such as a woman who has always experienced pain during intercourse, it is called primary dysfunction. If the dysfunction is situational, such as a man who previously had no difficulty achieving erection but begins to experience this problem at the beginning of a new relationship, it is called secondary dysfunction. Primary or secondary dysfunction can occur in any of the five domains of sexual response. Dysfunctions associated with sexual desire include hypoactive sexual desire disorder and sexual aversion disorder. In the first of these, the individual has a persistent absence of sexual fantasies or desire for participation in sexual activity. In the second disorder, there is a complete or near complete aversion to contact with a partner’s genitals. These conditions often reflect serious emotional problems, although individuals may be responsive to intensive psychotherapy combined with sexual therapy.

Sexual arousal disorders are found in both males and females. Males may be interested in sex but suffer from impotence or erectile dysfunction, while females are unable to maintain the lubrication-vaginal swelling response of normal sexual excitement. In their book, Human Sexual Inadequacy, Masters and Johnson asserted that 90% of impotency cases were psychogenic in origin. Even in older men, they maintained, emotional issues rather than medical problems are the main causes of impotence. Masters and Johnson reported great success in treating impotence with short-term therapy, especially when it had its roots in fear of failure and performance anxiety. Since their work in the late 1960’s, continued medical research and improved diagnostic techniques indicate that only 40% to 50% of male impotence is caused solely by psychogenic factors.

In males, orgasmic dysfunction includes both premature and retarded ejaculation (in which ejaculation may be completely absent despite stimulation and arousal). Retarded ejaculation may have psychogenic as well as organic causes, or may be a consequence of drug abuse or a side effect of a medication. Unlike retarded ejaculation, which is rare, premature ejaculation is fairly common. Therapy involves anxiety reduction and ejaculation control training. One approach to help with ejaculatory control is called the Valsalva Maneuver .

Using this procedure, when a man senses he is about to ejaculate, he holds his breath and flexes his muscles as if he is having a bowl movement. Performed correctly, this procedure enables the man to delay ejaculation and allows him to feel in more control of his body. The Valsalva Maneuver is best tried in the context of a therapy which can also address the male or couple’s anxieties about the experience. Inhibited female orgasm, a fairly common problem, is often caused by emotional or relationship problems. Sex therapy for this problem addresses underlying misinformation, psychological inhibitions, conflicting beliefs and values about women’s right to sexual pleasure, and related issues. Partners counseling may be effective in addressing communication, control, and sensitivity issues, while couples sexual training can address sexual interaction issues. Couples may be provided with instruction on alternative sexual arousal and satisfaction behaviors such as the Sensate Focus technique, given home assignments to practice the new strategies, and prompted to report outcomes to their therapist. Sometimes groups of couples with similar problems are brought together to provide support for open communication and behavioral change.

The organization of sex therapy varies. In some cases, a single therapist sees both partners. In heterosexual partnerships, a therapeutic team consisting of a male and a female therapist working together may be used. Alternately, some therapists emphasize self-treatment based on instruction, brief counseling, and the use of education aids like films and tapes. Sex therapy, like any other therapeutic process, should begin with a thorough history of the patient’s problem(s). Due to the possibility of both biogenic and psychogenic factors in male impotence, a consultation with a urologist specializing in impotence is often recommended to identify and treat any biogenic factors before proceeding with psychotherapy.

Sexual guilt refers to a feeling of grave responsibility and deep remorse associated with participation in or even thoughts and fantasies about sexual activity. Individuals who feel guilt related to sex or particular sexual activities generally believe that sex (or a specific sex act) is immoral, sinful, or unclean. The understanding of guilt associated with sexual activities began with the work of the psychoanalyst Sigmund Freud. While many people, including many psychologists and psychiatrists, reject a Freudian approach, his ideas are of interest as a starting point for understanding sexual guilt. Freud maintained that libido, or the sexual instinct, is one of the core drives in human behavior and personality formation. From birth, a child receives messages from its parents about what are and are not acceptable ways of expressing sexual desire, as well as messages about approved or disapproved attitudes toward sexual issues. These social hindrances on the free and open expression of basic desires contribute to the formation of three distinct aspects of the human personality, according to Freud.

First, there is the id, a combination of the most primitive drives and the psychic energy needed to initiate actions designed to satisfy these desires, including the desire for sex. Next, there is the ego, which refers to an executive function in the human mind that takes in information from the body’s sense organs about the external world and directs the day-to-day fulfillment of sexual and other desires in socially acceptable and achievable ways. Finally, there is the superego, consisting of the learned and internalized social standards of behavior received from parents and others, including an understanding of banned or punishable behaviors. The superego is our conscience; it consists of internally held values about what is right and commendable, on the one hand, and what is wrong and condemn able on the other.

Transgression of superego standards leads to guilt feelings as well as to a sense of remorse, anger directed at oneself, and a loss of self-esteem. These transgressions need not be actual behaviors, such as participation in banned sexual activities. They may occur in dreams or fantasies as well. Normally, when we are awake, the mind maintains strong boundaries between the id, ego, and superego, but during sleep and in fantasy these boundaries may weaken, allowing open expression of otherwise controlled sexual or other desires. Conscious awareness of these unrestrained desires and fantasies is another source of sexual guilt.

While Freud thought of his analysis of the forces that shape personality as universal, cross-cultural studies suggest that many of his ideas are most applicable to Western societies, especially to the Judeo-Christian tradition. Western missionaries, for example, were surprised to discover that the Japanese traditionally did not evidence much guilt associated with participation in sexual activities; rather, guilt in Japanese society was generally associated with a failure to fulfill internalized values about responsibility to one’s family. This realization has led to considerable discussion of the relationship between Christianity and its emphasis on moral absolutes (e.g., sins) and the emergence of sexual guilt. The early Christian church, for example, banned sexual intercourse even among married couples during many days of the year (e.g., for 40 days before both Easter and Christmas and from the time of conception until 40 days after the birth of a child). Further, enjoyment of sex and sex for nonprocreative purposes have been condemned within this tradition (although certainly not by all Christians). Some observers have suggested that the strong restrictions placed on sex and the constant emphasis on sex as a moral shortcoming in Western culture may only have succeeded in fostering an underlying obsession with sexual objects and activities.

Some psychologists differentiate two forms of sexual guilt. The first is called “morning-after guilt”, which involves conscious recognition of feeling sinful after the breach of a specific internalized value, such as having sex outside of marriage. The second type is “latent guilt”, stemming from a pervasive belief that sex in general is inherently wrong or dirty. Individuals with latent guilt commonly believe that sex is personally degrading and associate it with base, animal instincts. Individuals with these values tend to view sex as an expression of lack of self-control. In such instances, a person may feel guilty even without actual involvement in sexual activities. Such a person is sometimes described as having a guilt-laden personality. This personality configuration often is associated with an inability to enjoy or consciously desire sex, lack of awareness of sexual feelings, inability to admit sexual arousal, and inability to experience orgasm, which have, in turn, been found to be common sources of problems in marriages and in other relationships. Further, latent guilt has been found to be highly associated with a diagnosis of sexual dysfunction, depression, or diverse psychosomatic illnesses.

Other negative outcomes have also been found to be associated with sexual guilt. Failure to admit or accept one’s sexuality can block a person from taking precautions (such as the use of condoms) to avoid unwanted pregnancy or exposure to a sexually transmitted disease including HIV/AIDS. Consequently, individuals who have a high level of sexual guilt may be at a heightened health risk because they are emotionally unable to employ safer sex behaviors that involve taking conscious responsibility for sexual acts. Additionally, guilt-laden individuals who are victims of rape may blame themselves, and as a result be unable to report the crime to the police or to seek medical attention or emotional support. Moreover, confusion about one’s sexuality and the appropriateness of sexual contact may lead some guilt-laden individuals to communicate mixed signals to potential partners. These individuals unconsciously engage in a conflicting type of sexual seduction. Giving vent to underlying sexual drives, they may seek to attract others, only to act cold and unresponsive once the other person begins to express interest. If sexual contact takes place, the event may be viewed as a major moral failure and the individual may feel revulsion or hatred toward the seduced partner. The end result of such episodes, which for some individuals becomes a regularly repeated life pattern, is enhanced sexual guilt.

If a behavior is condemned by adults, there is the potential for individuals who have engaged in that behavior, or have had similar experiences, to feel guilty. For example, if sexual play with peers, a widespread activity among preadolescent children, is believed to be wrong by adults, children who participate in such play may experience guilt. Penile erection and the onset of vaginal lubrication, normal biological processes that have several causes other than sexual stimulation, may present additional occasions of sexual guilt in children if parents blame the child or define such experiences as wrong. Masturbation, an almost universal practice among males and a very common one among females, is another potential occasion of guilt among the young. Recent studies have noted considerable levels of sexual guilt associated with masturbation among the elderly as well. In both instances, masturbation produces guilt because it is defined as an inappropriate behavior by adults or by society in general.

Some anthropologists, like Ruth Benedict, have argued that guilt is not a prominent personality characteristic in all societies. While guilt may be an important means of social control in some societies, others emphasize shame. Although these two emotional states are similar, there is one notable difference: shame involves embarrassment in the eyes of others, while guilt arises from the violation of internalized values, even if no one else knows about the transgression. Benedict argued that there are “guilt cultures” and “shame cultures.” It has been suggested that certain types of child-rearing practices produce a predominance of guilt, while others lead to feelings of shame in response to the violation of social expectations.

Sadomasochism is a paraphilia that combines both sadistic and masochistic sexual behavioral patterns. The main characteristic of sadomasochism is the eroticizing of pain. What appears to the outsider to be painful, even very painful, is experienced as somewhat painful but mostly pleasurable and very sexually arousing to the sadomasochist. The sadist in the sadomasochistic pair is the person who inflicts the pain or punishment; the masochist is the person who submits to the pain, humiliation or control of his or her partner.

Sadomasochistic sexual encounters usually occur in the context of scripted scenes that simulate interactions between master or mistress and slave, employer and servant-maid, teacher and student, owner and horse or dog, and parent and child. Sadomasochists may wear black leather or rubber attire. Some gay males and heterosexuals engage in a genre of sadomasochism known as “leathersex”, wearing key chains or colored handkerchiefs symbolizing the role being played. Wearing keys on the left side indicates that the individual is a sadist; on the right indicates that he or she prefers the role of masochist.

Sadomasochists tend to alternate between the masochistic and sadistic roles. In milder form, without overt cruelty or bodily punishment, dominance and submissive behaviors may be found in many relationships, or may be an element of fantasy life. Although sadomasochistic acts in their extreme forms can be physically and psychologically dangerous, the majorities of people engaging in these behaviors do so with an understanding of the risks and stay within carefully predetermined limits.

The scrotum is part of the male’s external genitals. Also called the scrotal sac, the scrotum is a thin-walled, soft, muscular pouch underneath the penis containing two compartments to hold the testicles. Each testicle (small ball-like structures, which produce sperm and hormones) is connected to a cord, called the spermatic cord, which consists of blood vessels, tubes, and nerve and muscle fibers. Under certain conditions, such as exercise, exposure to cold, and sexual arousal in particular, the muscle fibers in the scrotum cause the entire sac to contract and wrinkle up, drawing the testicles closer to the body. In response to heat or total relaxation, the scrotum becomes very loose and soft, with a smooth surface, and the relaxed muscle fibers cause the testicles to hang farther from the body.

These changes in the scrotum illustrate the primary function of the scrotum, which is to act as a natural climate control center for the testicles. The temperature in the scrotum is a degree or two lower than the usual body temperature of 98.6 degrees Fahrenheit. The testicles need this lower temperature in order to carry out their job of producing viable sperm. If the testicles are kept at body temperature or higher for a prolonged period, infertility or sterility can result. The scrotum continually monitors the environment for temperature changes and responds automatically in the way that is best for the production of healthy sperm.

A male’s scrotum is very sensitive to touch and can be a source of sensual pleasure. Some men enjoy having their scrotum stroked and fondled during sexual activity with their partner. A gentle massaging of the scrotum from underneath, cupping the testicles in the palm of the hand is often sensually pleasing to a male. Some men report that they have learned to delay an impending ejaculation, thereby prolonging sexual play, by firmly but gently pulling down on their testicles. This is one technique used in tantric intercourse to prolong the sexual experience.

Taboo refers to practices that are generally prohibited because of religious or social pressures. Our English word taboo comes from “tabu” which means “forbidden” in Polynesian. This discussion is confined to sexual taboos, which are sexual practices that have been prohibited because of their perceived negative or harmful effects on society. Some sexual behaviors have been taboo throughout history and remain so today. These include behaviors such as incest and rape, as well as many paraphilias such as pedophilia (sexual abuse of children by unrelated adults), necrophilia (sexual arousal from viewing or having sex with a corpse), and bestiality (sexual relations with an animal). Other sexual behaviors that were once taboo no longer are, even though they may not be as approved as some other behaviors that have been accepted as “natural” or “normal”. Included in this category are masturbation, oral and anal sex, homosexuality, some forms of bondage, and sex with a menstruating woman. This change can in part be attributed to societies’ gradual acceptance of what constitutes normal and harmless sexual experiences between consenting adults.

Incest is a behavior that is considered taboo and illegal in nearly all societies. Incest refers to any kind of sexual contact (oral, anal, or vaginal sex, fondling, or masturbation) between members of the same family. Definitions of what constitutes a family member vary, but ordinarily they include not only parents and siblings, but grandparents, uncles and aunts, nieces and nephews, step kin, and in most cases, first cousins. The incest taboo is thought to protect families and society from the negative effects of inbreeding, once common among European royalty and in some other societies.

Masturbation has historically been a taboo, but is now viewed as normal by nearly all medical authorities and social scientists. Even the majority of people in our society now understand masturbation to be a common sexual behavior that is not harmful. A number of studies in the last several years indicate that attitudes toward masturbation have relaxed considerably compared to earlier times. Even with this increasing acceptance of masturbation as a natural experience of human sexuality, it is not uncommon for people of all ages to have concerns, questions and guilt over their self-pleasuring experiences. The idea of one pleasuring him- or herself through some form of direct physical stimulation has been the source of great controversy for many generations. Some religions have referred to this sexual taboo as an “unnatural act” because it had no reproductive goal. Others have focused more on proper sex being the union of the body and spirit of a married couple. Though the Bible has no clear-cut prohibitions against this sexual activity, both traditional Judaism and Christianity generally regard masturbation as sinful. The Catholic Church in the Vatican paper “Declaration on Sexual Ethics” (December 29, 1975) noted that “masturbation is an intrinsically and seriously disordered act.” Thus, masturbation has been described as “self-abuse,” “defilement of the flesh,” and “self-pollution.”

Although menstruation is a normal part of the female reproductive cycle, it is the subject of considerable misunderstanding as a taboo. Menstruation is the sloughing off of the uterine lining that builds up during the previous month. It occurs about once a month in most women between the ages of approximately 12 and 48. In ancient times, a menstruating woman was regarded as unclean and liable to pollute foods she handled, or cause crops to wither. The primary reason for this taboo seems to be the fear of blood. It is thought that menstrual taboos were enforced by men who connected a woman’s monthly cycle with the turning of the tides, the changing of the seasons and other events that were mysterious to them.

Superstition and taboos around a woman’s monthly cycle continue to persist in our contemporary society. A common superstition in western culture is the belief that walking under a ladder will bring you bad luck. This myth supposedly evolved from earlier times when people would not walk under a bridge in case a menstruating woman was nearby because they feared her blood would fall on their head. The belief that the normal process of menstruation is somehow dirty or evil is still evident in the slang expressions of a woman having the “curse” or being “on the rag”. It is often seen by men and women as a physical or emotional handicap that makes women “inferior” to men, and many couples view intercourse during menstruation as messy and sloppy and avoid intimate activities for hygienic reasons, although this is not medically necessary.

Bestiality and necrophilia are strong sexual taboos and are forbidden by all major religions. They are considered illegal in the United States and almost everywhere else in the world. Historically, the primary reason for opposition to these behaviors was related to the fact that they were not procreative acts. Furthermore, sexual relations between humans and animals or corpses violated the notion that proper sex was to take place between a married couple. In more modern times society has found both of these practices abhorrent because of the fear of spreading diseases, and because in neither case does someone wishing to practice these illegal social taboos have the willing permission of their sexual partner.

Tantra, like yoga or Zen, is a path to enlightenment, which has its roots in India. It is nicknamed the “science of ecstasy” and focuses on heightening and prolonging the special awareness and rapport that exists between lovers during lovemaking. This view holds that the greatest source of energy in the universe is sexual, and places high value on ritualized intercourse. Sexual orgasm is seen as a cosmic and divine experience.

Tantric philosophy also teaches that everything is to be experienced playfully, yet with awareness and a sense of sacredness in every gesture, every sensory perception, and every action. The path of Tantra is a spiritual one, which includes and appreciates the experience of our sexuality and sensuality as a conscious meditation, as a flowing together of the physical, erotic and cosmic energies.

If you were a devoted student of tantric philosophy, you would go through an extensive program of physical, sexual and mental exercises to heighten your sensory awareness. Through slow and thoughtful practice in lovemaking techniques you would learn to comfortably extend the time of lovemaking. In this way you would train yourself to be aware of not only your own feelings but also those of your partner. The spiritual part of tantra is to use your sexual energy to merge ecstatically with your partner and through him or her to become one with the cosmos or god.

A heterosexual couple practicing tantric intercourse seeks to prolong their sexual arousal. Following slow sensual touching a couple might move to having very slow intercourse. The man might place his penis just an inch or so inside his partner’s vagina and without thrusting allow it to remain in this position for a full minute. Then he may gently withdraw from her vagina and rest his penis softly on her clitoral area. Usually the clitoris is the most sensitive part of a female’s genitals and it is located just above the vaginal opening. After resting in this position for another minute the couple may decide to have him again slide his penis back in. During subsequent cycles of resting and entering the vagina, the male would rest outside the vagina and then eventually rest just inside the vagina. During the rest times, the couple might just lie silently together, or gently caress each other as they focus on the experience of their union. Throughout this experience both partners may be highly aroused, hovering close to the point of reaching orgasm on several occasions.

The art of prolonging the pleasures of lovemaking without reaching orgasm is described in the Kama Sutra, the Hindu sex manual written in the 4th century, (and available in many bookstores). “Karezza” is the term used to define a male’s practice of pleasuring his partner and prolonging their intercourse by perpetuating his state of climax without actually ejaculating. These so called “dry orgasms”, orgasms without ejaculation, are pleasurable, and still allow the sexual act to continue. The art of Karezza incorporates breathing control, meditation, work with postures, and finger pressure into the sexual act. Though sexually biased in its description as written (remember it was the 4th Century), the original focus of Karezza, prolonging the state of climax for a couple’s mutual enjoyment, easily translates to both partners actively participating in learning to prolong their enjoyment before reaching orgasm.

The uterus, or womb as it is commonly called, is part of the female internal genitals. It is a hollow, muscular organ about the size of a closed fist (three to four inches long and three inches wide) and is shaped like an upside-down pear. It holds the fetus during pregnancy. It also expands during pregnancy to about 11-12 inches in length.

The upper end of the uterus is connected to the Fallopian tubes, and the lower, narrow end, called the neck, becomes the cervix, which extends into the back of the vagina. The upper portion is the larger part, and it is here where a fetus grows and is nourished during pregnancy. The uterus is very thick-walled and quite elastic, as is demonstrated by its ability to expand enough to hold a growing fetus, then return to approximately its prior size after the birth of the baby.

The uterus is made up of three special layered linings of tissue and muscle. The innermost layer is called the endometrium. After the onset of puberty, the endometrium lines the main body of the uterus and is where a fertilized ovum implants at the earliest moment of pregnancy. It provides a nesting place with immediate nutrition for the fertilized egg. If a woman is not pregnant, this lining is not needed, so it separates from the uterus and leaves the body as the menstrual flow during the menstrual period. This process is repeated monthly. Immediately a new lining begins to form in case a pregnancy occurs during the woman’s next cycle. Except during a pregnancy or some abnormal circumstances, this series of events continues uninterrupted from puberty to menopause.

The second, middle layer of the uterus is the powerful muscular layer called the myometrium. This gives the uterus its great strength and elasticity. The myometrium contracts during the birth process and forces the fetus out of the uterus into the birth canal. The third layer of the uterus is called the perimetrium. It is a thin external covering for the other two layers. The uterus is held loosely in place in the pelvic cavity by several sets of ligaments: the broad ligament, the round ligament and the uterosacral ligament.

Although the uterus is not directly involved in sexual activity, it does undergo changes during sexual excitement. When a woman is sexually aroused, the uterus lifts upward, increases in size and remains enlarged until orgasm or until stimulation stops. The expansion and lifting of the uterus occurs because a lot of blood flows into its walls during sexual excitement. Orgasm dissipates the accumulation of blood, rapidly returning the uterus to its normal size. During and after menopause, the reduced supply of estrogen causes the uterus to shrink in size. It no longer enlarges in response to sexual stimulation as it once did, but the feelings of sexual excitation, orgasm and fulfillment remain, and a woman can enjoy intercourse as much as she did before menopause.

In some cases, there can be problems with the tissues or supporting structures of the uterus. Endometriosis is the growth of the endometrium in places outside the uterus. For reasons not fully known, this lining sometimes grows in places such as the ovaries, Fallopian tubes or intestines. This condition can cause pain, and it interferes with the fertilization and pregnancy process. Women who have endometriosis and want to have children are usually encouraged not to wait too long before trying to get pregnant because the disease usually worsens over time. Symptoms vary, but pain during menstruation and pain in the reproductive organs are common signs. Medical treatment is essential for this condition. Hormones can usually treat endometriosis, and if surgery is required it can be done using a laparoscope. Treatment of endometriosis no longer requires a major incision or hysterectomy as was often the case in the not too distant past.

Another condition affecting some women is a tipped or displaced uterus. Some women are born with their uterus tilted forward or backward. It may never cause any problems, but it can occasionally lead to difficulties in getting pregnant and it may cause lower back pain. If a physician determines that it is causing a problem, the uterus can be tipped into its correct position. Straightening out the uterus can often enable a woman to become pregnant, if that was the reason for the failure to conceive.

A prolapsed uterus is different from a tipped uterus. A prolapsed uterus means that the uterus has moved through a supporting wall or structure into a place where it does not belong. The weakening of the structures and walls that support the uterus and hold it in place causes it to drop. Typically, a prolapsed uterus will drop into the vagina. It causes pain and therefore interferes with general functioning, including enjoyment of sex. It can also interfere with conception, or occur during pregnancy after several pregnancies have weakened supporting ligaments. Fortunately, for a woman suffering from a prolapsed uterus, modern surgical techniques can easily correct the problem and restore normal functioning and sexual enjoyment.

The vagina is the female internal sex organ that begins on the outside at the vaginal opening and extends about three to five inches inside, ending at the cervix, or neck of the uterus (womb). The vagina consists of three layers of tissue. The mucosa is the layer on the surface that can be touched. It consists of mucous membranes and is a surface similar to the lining of the mouth. Unlike the smooth surface of the mouth lining, the vagina contains folds or wrinkles. The next layer of tissue is a layer of muscle, concentrated mostly around the outer third of the vagina. The third, innermost layer consists of fibrous tissue that connects to other anatomical structures.

In the sexually unstimulated state, the vagina is shaped like a flattened tube, the sides of which are collapsed on each other. It is not a continually open space, or “hole” as often thought by both women and men. It is a potential space. Because of its muscular tissue, the vagina has the ability to expand and contract, like a balloon, allowing a baby to pass through during childbirth, or adjusting to fit snugly around a tampon, a finger or any size penis.

The internal walls of the vagina itself do not have a great supply of nerve endings, thus are not very sensitive to touch. The outer one-third of the vagina, especially near the opening, contains nearly 90 percent of the vaginal nerve endings and therefore is much more sensitive to touch than the inner two-thirds of the vaginal barrel.

During sexual excitement, droplets of fluid appear along the vaginal walls and eventually cover the sides of the vagina completely. The vaginal tissue does not contain any secretory glands itself, but is loaded with blood vessels, which when engorged with blood as a result of sexual arousal, press against the tissue, forcing natural tissue fluids through the walls of the vagina. The fluid is not only a sign of sexual arousal, but serves as a lubricant for intercourse if that is what is to follow. Without this natural lubricant, or an artificial one, a woman would most likely find penetration painful.

Sometimes the process of vaginal expansion and lubrication does not occur exactly as described or exactly when a woman would like. The causes of too little vaginal lubrication can be physical, emotional, or some combination of the two. Physically, for example, it may be the result of a hormonal deficiency, or an infection or cyst in the vagina. Sometimes a woman who is using a birth control pill that is high in progesterone can experience lessened vaginal lubrication. In other cases, emotional problems in a relationship with a partner may be the reason behind too little vaginal lubrication. In these situations, feelings may block natural physical responses. This kind of experience is not unusual. Partners may be able to deal with the situation on their own, or it may be helpful to discuss the problem with a qualified therapist.

Vaginal lubrication typically decreases as women age, but this is a natural physical change that does not normally mean there is any physical or psychological problem. After menopause, the body produces less estrogen, which, unless compensated for with estrogen replacement therapy, causes the vaginal walls to thin out significantly. The vagina also tends to become slightly shorter and narrower, and it takes longer to produce even a reduced amount of lubrication. The vagina also loses its ability to expand as easily during sexual excitation. A woman not using estrogen replacement may use artificial lubricants, and engaging in longer periods of foreplay may help post-menopausal women avoid pain with intercourse.

Sometimes after childbirth a woman’s vagina may lose some of its muscle tone, loosen a bit, and feel larger. For some women this means that they may not feel the pleasure they once did from their partner’s penis making contact with the vaginal walls. The partner may also notice that he is not held as tightly by the vagina. There are specific exercises that women can do after childbirth to strengthen and tighten the muscles around the vagina and improve the tone and feeling. These exercises, called Kegel exercises after the physician who developed them, require the woman to contract the muscles used to stop the flow of urine. The contraction is held for 3-5 seconds, repeated ten times in a series, and the series is usually repeated several times a day. These voluntary contractions can also be done during intercourse, and some women and men find it sexually enhancing.

Virginity is the state of never having had sexual intercourse. It is viewed positively or negatively depending on one’s gender, one’s age, one’s culture and one’s own personal beliefs and attitudes. In some cultures virginity has no special significance, and young people, of both sexes, engage in coitus very early and there is no special status associated with not doing so. In others, virginity is required of both sexes, and in many it is required of women only. Violation may result in severe punishment. For example, proving a bride’s virginity became a public matter wherein the bed sheets used by the couple on their wedding night were hung out the window for the wedding guests to view. A bloodstained sheet was a sign that the groom penetrated the bride’s intact hymen, causing it to bleed. Though not medically true, the theory was that the hymen would be unbroken if she were still a virgin.

In some North American cultures, retaining virginity until marriage has been an important goal. Many parents and some sex educators disapprove of loss of virginity until marriage and are especially adamant about teens remaining virgins. A chief motivator of this standard is concern about the welfare of young people, particularly young women, who are at risk for pregnancy. A number of religious groups also are in favor of virginity until marriage, but their sanctions against premarital coitus are based more on the churches’ ideology.

Not all adolescents and young adults are comfortable with the idea of virginity, however. Peer pressure often dictates that being a virgin is an undesirable indication of immaturity or prudishness. Losing one’s virginity is seen as a rite of passage into the adult world of sexuality.

Like most sexual behaviors, remaining a virgin or not is a personal choice. Nowadays there may be more ambiguity about the goal or milestone for which virginity is being maintained. Until recently, marriage was the clear-cut boundary separating sanctioned intercourse from sinful intercourse. In modern relationships where the goal may not always be marriage, new standards are set based on depth of caring, commitment, or some other agreed upon concepts. An interesting framework for describing some of the different sexual philosophies among unmarried virgins and nonvirgins was developed by D’Augelli and D’Augelli in 1971. According to these authors, inexperienced virgins are individuals who have had little dating experience until college and have usually not thought much about sex; adamant virgins are people who firmly believe that intercourse before marriage is wrong; potential nonvirgins are individuals who have not yet found the right situation or partner for coital sex and often seem to have a high fear of pregnancy; engaged nonvirgins are those whose coital experience has usually been with one partner (typically someone they love or care deeply about) and only in the context of a committed relationship; liberated nonvirgins are people who have more permissive attitudes toward premarital intercourse and value the physical pleasures of it without demanding love as a justification; and confused nonvirgins are those who participate in intercourse without an understanding of its motivation, its meaning in their lives, or its effect on themselves or others.

The issue of virginity is often subjected to a double standard based on gender. In our society, boys are typically encouraged to, and congratulated for, engaging in intercourse. Losing their virginity tends to elevate their status in their peer group and sometimes even in the eyes of their fathers or other older males. Girls, on the other hand, are cautioned not to lose their virginity and their reputations often suffer if they do engage in sexual intercourse. One wonders then to whom the boys are supposed to be losing their virginity.