Doctorweblog. About Health & Medicine

A woman who can’t reach orgasm during intercourse often wonders if there is something physically wrong with her that prevents her from reaching orgasm. A self-induced orgasm answers that question in a few minutes, and it is here that a vibrator may be truly useful. There is certainly nothing wrong with, and virtually no difference between, an orgasm reached with a vibrator and one reached during sexual intercourse. More importantly, a self-induced orgasm gives the emotional and physical foundation for having orgasms during intercourse.

A vibrator, therefore, can tear down the barriers of guilt, shame and prudery that prevent so many women from finding the sexual fulfilment that they deserve. Some women have for years subconsciously imposed the same kind of paralysis on their sex organs as on their minds. A vibrator provides intense sexual excitement, which is sufficient to overwhelm emotional obstacles, and makes the brain and the genital organs respond explosively in unison.

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Whether sexual intercourse is on the agenda or not, a man’s generalized kissing and cuddling will sooner or later lead to his touching, caressing and kissing a woman’s breasts, nipples and clitoris, and a woman will be encouraged to do the same for a man’s scrotum and penis. Petting, or love play using fingers, is more than just romantic. It is vital to the escalating spiral of sexual excitement necessary for satisfying sexual intercourse.

Masturbation Can be Fun-Masturbation is an option, a way of mutually enhancing a couple’s sexual enjoyment. Masturbation is generally helpful to sexuality in all areas of your life. That doesn’t mean to say that if you don’t masturbate you’re abnormal; you’re not inadequate or deficient.

Remember that masturbation does not reflect badly on your marital sex; in fact, there is some evidence showing that people who masturbate without guilt are freer in expressing their sexuality, more aware of the nature of their own sexual response, and therefore enjoy sex more than those who are guilt-ridden. Moreover, masturbation is a good alternative to intercourse for women in late pregnancy or just after childbirth, or following gynaecological surgery; also, when a man can’t get an erection.

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Physical attractiveness Even though physical appearance is not necessarily at the top of the list of qualities women consider important, most women will confess to being attracted to certain aspects of their partner’s body, though not normally their genitals.

Power and wealth Visible evidence of dominance, which is expressed in today’s world by being in possession of money and status, are turn-ons for the majority of women.

Romance and intimacy Expressions and manifestations of an intimate or romantic interlude such as champagne, moonlight and flowers, are also arousing to most women.

Erotic literature Though women will confess to enjoyment of erotic literature in the form of romantic novels, sexually explicit material, however, has been found also to excite many women.

In terms of the stimuli that excite them, men and women differ markedly. Men, generally, are stimulated by what they see. Women, on the other hand, are very different; as a general rule, they respond very little and very slowly to visual stimuli. Women are more interested in men in the context of their personalities.

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Right before orgasm there is a sense of ejaculatory inevitability for an instant. Many men have described the onset of this sensation as “feeling the ejaculation coming”. From the onset of this sensation there is a brief interval, two to three seconds at the most, during which a man feels the ejaculation coming but is no longer able to prevent, delay, or in any way control the process. This experience of inevitability develops as seminal fluid is collecting in the prostatic urethra, just before the actual emission of seminal fluid begins. While a woman’s orgasm can be interrupted by extraneous stimuli, once initiated, a man’s orgasm cannot be delayed until emission has been completed.

Just prior to ejaculation, the glans may change colour; its mottled, reddish purple colour may become darker. (This is reminiscent of the pre-orgasmic discoloration of the labia minora in a woman.) A drop of fluid may form at the urethral opening of the penis prior to ejaculation. This is not seminal fluid but secretions from Cowper’s glands. The size of the testes increases slightly and they also become elevated. At this point, it is increasingly difficult for the penis to return to its resting state without ejaculation.

Muscle contractions occur at a late stage of sexual excitement and may be involuntary or voluntary, depending on body position. Spasms of a man’s hands and feet can occur — rarely if the man is on top — but more commonly when he is supine.

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Trichomoniasis is a common cause of vaginitis. The causative organism is Trichomonas vaginalis, a flagellated protozoan. Sexual intercourse is the principal method of transmission. Transmission may occur through contaminated fomitcs.

In females, the condition may present as an offensive vaginal discharge which is commonly frothy, light yellow in colour and profuse. Pruritis is the presenting symptom in some patients. Symptoms may appear from 4 days to 4 weeks after sexual contact. Many patients are asymptomatic; in about 10%, no evidence of cervicovaginal inflammation can be seen. Trichomonads are occasionally detected in cervical smears.

In males, trichomoniasis is usually asymptomatic. It may cause a mild urethritis, prostatitis or epididymitis.

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In females, herpetic infection may be complicated by urinary retention due either to local pain or to neurogenic bladder due to radiculitis. Herpes may cause an extensive necrotising lesion of the cervix which causes a sanguineous vaginal discharge and may resemble cervical carcinoma.

HSV infection may produce no symptoms and asymptomatic viral shedding from the cervix or other sites may occur.

Relapse may be attributed to emotional or physical stress, fever, trauma, hormonal changes, menstruation, sunlight, alcohol etc. Relapses are characterised by a milder prodromal period, lesions of 4 to 5 days average duration healing in 1 to 2 weeks and a milder degree of lymphadenopathy.

HSV has a high morbidity and mortality in neonates. The infection can be transmitted from mother to infant during parturition if the mother is actively shedding the virus. A higher rate of neonatal infection occurs if primary infection occurs late in the pregnancy and there is insufficient time for maternal antibody to develop and be transferred to the foetus.

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Primary syphilis

The primary lesion or chancre usually develops at the point of inoculation after an incubation period averaging 21 days (ranging from 10 to 90 days). The chancre is typically firm, painless, punched out and clean. The adjacent lymph nodes are discretely enlarged, firm and non-suppurating. Anorectal chancres may occur in homosexual men.

Untreated, early clinical syphilis usually resolves spontaneously leading to latent disease which may proceed to late destructive lesions.

Secondary stage

The interval between the appearance of the primary chancre and the onset of secondary manifestations varies from 6 to 8 weeks. Constitutional symptoms including fever, headache, malaise and general aches and pains may precede or accompany the signs of secondary syphilis.

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Patients with acute PID usually present with mild to severe lower abdominal pain or discomfort. Other common symptoms are vaginal discharge, dysuria, deep dyspareunia, pain on defaecation, fever with or without chills and menstrual irregularities.

A patient with chronic PID may have symptoms such as chronic lower abdominal pain, dyspareunia, menstrual irregularities or infertility.

Some patients with pelvic inflammatory disease may have no significant symptoms or signs. Practitioners must be alert to the possibility of PID in patients at risk even in the absence of clinical signs and laboratory evidence of infection.

Examination may reveal lower abdominal tenderness, unilateral or bilateral adnexal tenderness with or without a mass, cervical motion tenderness (elicited by gentle movement of the cervix), purulent vaginal discharge and fever. In some cases clinical examination is negative.

Complications include pyosalpinx, tubo-ovarian abscess and peri-hepatitis (Fitz-Hugh-Curtis syndrome). PID is a major cause of tubal damage leading to ectopic pregnancy and infertility.

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Distribution in the population

Follow-up

At least one post-treatment visit is essential to assess the response to treatment, to perform appropriate follow-up investigations and to confirm that sexual contacts have been investigated. At this visit the practitioner should reinforce counselling.

There is an increasing amount of evidence that a man’s (and a woman’s) ability to be a good lover is affected by the attitudes to sexuality acquired during infancy and childhood.

In our type of society, childhood interest in sexuality, and a child’s curiosity about its own body and that of others, is discouraged, often punished. At the same time we do nothing to discourage children from seeing violence, greed, and deceit in life and, more particularly, on television screens. We are assured that children are sufficiently discriminating to know that the violence is not real. We are told, by experts, that the violence will not serve as a model for behaviour and that the children will not become violent, greedy, or deceitful by imitation.

We may witness violence to the human body, but we may not see the touching and the loving nature of human sexuality. We can see (all too often) the human body being threatened and brutalized in plays, documentaries, and news films but we are prevented from seeing the human body in loving situations, except when at least partially clothed and, even then, certain activities are proscribed. We may only see a woman’s body provided the genital area (and preferably her breasts) are hidden. We may see a man’s body, muscular, sweaty, and bare to the waist, but we may not see a man’s genitals, and the idea of seeing his erect penis is scandalous.

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