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Contents/Summary Women’s Body Comparison………………………………………….…..07 What Women Truly Look Like Under Their Cloths…………………....51 Ideal Weight Range………………………………………….……………..68 Average Bra Size………………………………………….………………...70 Anatomy of the Breasts………………………………………….………...72 Breast Size and Sensitivity………………………………………….…….80 Unrealistic Expectations………………………………………….……….92 Anatomy of the Vulva…………………………………….…….…………..97 Clitoral & Labial Size………………………………………….…………..117 Female Ejaculation, the Female Prostate, The G-Spot……………..135 The Hymen Revealed………………………………………….………….154 Locating Your Vagina………………………………………….………....160 Pelvic Examination (Speculum exam) ………………………………...179 Vaginoplasty Surgery (Labiaplasty) …………………………………...189 The Secret to Great Sex………………………………………….…….…225 What Do Women Want During Sex……………………………………..227 Casual Sex Truly Partaking………………………………………….…..239 Importance of Female Orgasm During Partnered Sex……………...243 The Truth About Vaginal Orgasms………………………………….….246 Are Our Lofty Expectations of Vaginal Intercours…………………..250 Positions for Sexual Intercourse……………………………………….268 The Truth About Size- Is Bigger Always Better……………………...277 Does Penis Size Matter………………………………………….………..300 Clitoral & Vulva Massage………………………………………….……..314 Tantra Massage (Lingam and Yoni) ……………………………………328 Tantric Sex………………………………………….……………………….365 How and Why Women and Girls Masturbate………………………….372 Orgasm (Sexual Climax) ………………………………………….……...383 The Pregnancy………………………………………….………………….429 Sex in Pregnancy…………………….…………………….………………444 What Happens in Labour………………………………….……….……..447 Mature and Old Women’s Sexual Activity….…….………….……….453 Bibliography / References…………………….…….……………….…..464
Beauty ideals are not a permanent and unchanging set of expectations, They are relative to their culture and era, and they shift over time. The ideal of beauty for women can be similar or sometimes much different in other parts of the world.
What men think about women's bodies matters a lot, at least to women. According to a recent study, women’s self-esteem regarding their body is largely influenced by male opinion, regardless of who the male is. This finding, although depressing, is not exactly what one would call a groundbreaking discovery. What is surprising, though, is that despite all this female preoccupation with what type of body most men prefer, the truth is men aren’t really all that bothered with a woman's actual size.
Female Self-Esteem
In a study now published in Social Psychological and Personality Science, researchers devised a way to measure how much a female’s self-esteem was influenced by male opinion without having to ask her directly. For the study, the researchers asked 74 heterosexual female undergraduates to look at images of models ranging in sizes from 8 to 10. These body types were chosen because they are larger than the average size 2 model and were thought to best represent the average 3
female undergraduate's size. The mean age of the volunteers was 18, and 73 percent identified themselves as white. The women were told that they were taking part in a study on the attractiveness of the female’s body and were asked to rate how attractive they found the images. One group was told that the images were chosen because men had found them to be attractive. Another group was told that the images were randomly taken from the media. In a second experiment, a group of women were told that men prefer ultra-thin women. After being shown the images, the women were asked to report their weight satisfaction.
Unsurprisingly, the women who were told that the images represented women deemed to be beautiful by a panel of ( completely fictional) men reported the highest weight satisfaction. Women who were told nothing about the images scored the same as those who were told that men preferred thin women, a result which surprised the researchers. “We did not expect women who were led to believe that men desired the ultra-thin women would necessarily feel worse about their bodies than the women who were not given any information,” the researchers wrote in the study. The overall results suggest that women are really concerned with what men think about their bodies, so much so that the opinion of an unknown and unseen male can completely change how they feel about themselves. But is all this concern a bit unnecessary? In an email, a lead researcher explained her take on the results. “I don't know that the association between women's body esteem and men's preferences is necessarily a good thing or a bad thing,” researcher said. “First, it is just one factor (out of many) 4
that influences women's body image. Second, men's preferences are likely important to heterosexual women because they are interested in attracting men for potential relationships” Although the preoccupation with men’s opinion is understandable, many studies suggest it’s unnecessary.
What Men Want A study conducted by researchers from the University of Iowa, found that the number one “essential trait” that men look for in a female partner is mutual attraction and love, NewScience reported. Yes, it’s true. Men just want someone to love them. As part of the same study, researchers in Iowa found that men are becoming more interested in intelligence and financial stability, and less interested in chastity. And although men still label beauty as a “preferred trait,” this doesn’t exactly mean thin. According to The Huffington Post, women constantly and consistency overestimate male preferences for slender figures, which is interesting because, evolutionarily speaking, women should be able to discern what body type men are most attracted to. This would allow them to strive to achieve this size and increase their chances of reproducing. But with the mysterious human species, this is not the case. However, researchers believe it's media, not nature, that’s to blame for this.
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The truth is, there is no “ideal” female body size in the eyes of men. Men typically prefer a woman with a certain waist to hip ratio, but this does not mean that she has to be a certain size to obtain it. At the end of the day, each man has his own personal preference for what he finds to be attractive.
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WOMEN’S BODY Body’s Comparison, Anatomy, Love Life, Pregnancy (explicite nonsexual and sexual art 18+)
Women’s Body Comparison Women body shape or female figure is the cumulative product of a woman's skeletal structure and the quantity and distribution of muscle and fat on the body. As with most physical traits, there is a wide range of normality of female body shapes. Attention has been focused on the female body as a source of aesthetic pleasure, sexual attraction, fertility, and reproduction in most human societies. There are, and have been, wide differences in what should be considered an ideal or preferred body shape, both for attractiveness and for health reasons. Women's bodies occur in a range of shapes. Female figures are typically narrower at the waist than at the bust and hips. The bust, waist, and hips are called inflection points, and the ratios of their circumferences are used to define basic body shapes. 7
Women’s Body Shape
Independent of fat percentage, weight or width, female body shapes are categorised in some Western cultures into one of four elementary geometric shapes, though there are very wide ranges of actual sizes within each shape: Rectangular: The waist measurement is less than 9 inches smaller than the hips and bust measurement. Body fat is distributed predominantly in the abdomen, buttocks, chest, and face. This overall fat distribution creates the typical ruler (straight) shape. Inverted triangle: Apple shaped women have broad(er) shoulders compared with their (narrower) hips. Apple shaped women tend to have slim legs/thighs, while the abdomen and chest look larger compared with the rest of the body. Fat is mainly distributed in the abdomen, chest and face. Spoon: The hip measurement is greater than the bust measurement. The distribution of fat varies, with fat tending to deposit first in the buttocks, hips, and thighs. As body fat percentage increases, an increasing proportion of body fat is distributed around the waist and upper abdomen. The women of this body type tend to have a relatively larger rear, thicker thighs, and a small(er) bosom. Hourglass or X shape (triangles opposing, facing in): The hips and bust are almost of equal size with a narrow waist. Body fat distribution tends to be around both the upper body and lower body. This body type enlarges the arms, chest, hips, and rear before other parts, such as the waist and upper abdomen. A study of the shapes of over 6,000 women, carried out by researchers at the North Carolina State University circa 2005, found that 46% were rectangular, just over 20% spoon, just under 14% inverted triangle, and 8% hourglass Another study has found "that the average woman's waistline had expanded by six inches since the 1950s" and that women in 2004 were taller and had bigger busts and hips than those of the 1950s.
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A woman's dimensions are often expressed by the circumference around the three inflection points. For example, "36-29-38" in imperial units would mean a 36″ bust, 29″ waist and 38″ hips. A woman's bust measure is a combination of her rib cage and breast size. For convenience, a woman's bra measurements are used. For example, though the measurements are not consistently applied, a woman with a bra size of 36B has a rib cage of 32 inches in circumference and a bust measure of 38 inches; a woman with a bra size 34C has a rib cage of 30 inches around, but a smaller bust measure of 37 inches. However, the woman with a 34C breast size will appear "bustier" because of the apparent difference in bust to ribcage ratio. Height will also affect the appearance of the figure. A woman who is 36-24-36 at 5 ft 2 in (1.57 m) height will look different from a woman who is 36-24-36 at 5 ft 8 in (1.73 m) height. Since the taller woman's figure has greater distance between measuring points, she will likely appear thinner or less curvaceous than her shorter counterpart, again, even though they both have the same BWH ratio. This is because the taller woman is actually thinner as expressed by her lower BMI, or body mass index, used to measure body weight in relation to height. The British Association of Model Agents (AMA) says that female models should be around 34-24-34 (86-61-86 cm) and at least 5 ft 8 in (1.73 m) tall.
With no use of Photoshop or any other light or camera tricks to give any false illusions, the women were pictured naked, fully comfortable and fully loving their own unique bodies. “Tell me something. When was the last time you opened up your browser and saw a beautiful image of a body shape that looked just like yours? When was the last time you saw an image of skin markings that looked just like yours? When was the last time you saw an image of breasts that looked just like yours? An ass that looked just like yours? Scars that looked just like yours? A belly that looked just like yours? Unless you’re a celebrity look alike and have real time Photoshop (like, a program that follows and moves with you)
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I’m going to guess that for the majority of us…it’s been a while. It’s been a while since we’ve (or maybe we’ve never) seen our body positively represented with that overwhelming flood of images that fills our social media feeds, televisions, and magazines. I think it’s time to change that.” “So much of the female body that we see is pushed up, pinned down. sucked in, tucked in, and airbrushed. Its only presentable state is when it’s altered, and so when we look at ourselves in the mirror (naked, untucked, and vulnerable) we say ‘My body must be wrong’…Your body ain’t wrong, girlfriend.”
On seeing the completed project said, I see it. I see the beauty. I see the diversity. I see the vulnerability. I see the power.” That showing their bodies won’t innately cause them harm. That their breasts won’t cause damage to those around them, or their bellies or thighs either. That their nudity, while making them vulnerable, does not make them at fault. And that lastly, their bodies are their vehicles through life, and to treat them with kindness.” This project was not set up to try to glorify or define one particular body shape or size. Its purpose is to point out that there is no “normal” body type, that certain body types are not “sexier” or “more beautiful” than others. This was a randomly selected group of women and the photos show that there are so many variations to body shape and size, not just the small selection of images that we regularly see presented to us through the media.
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Each one of them is unique and beautiful in their own special way—yes, they may seem similar to others, yet they are completely incomparable. No two are the same.
We are, each of us, exquisite and unique. Bodies should be celebrated, it’s time we worshipped them and appreciated all that they do for us, understanding that it’s all our tiny imperfections that make us so entirely unique in the world. Who we are is found on the inside. 11
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There is no such thing as normal, there is only diversity. Girls and women come in a wide range of colors, shapes, and sizes, as does their sexuality. While we accept diversity in other areas of our lives, when it comes to sex there is often an expectation of sameness. Social morality and the media often misrepresents and distorts female sexuality, resulting in many having unrealistic expectations of women and ourselves. Lets gain a better understanding of female sexuality.
What Women Truly Look Like Under Their Cloths The following series of photographs demonstrate how the female body comes in many different shapes, sizes, and colors. They demonstrate how pregnancy, increasing age and weight, decreased body weight/fat, surgical procedures, and physical disabilities alter the appearance of the female body. The full-body front and back views link to high-resolution photographs that reveal more clearly skin blemishes and scars; except for the very first front-view, for which only a small scale photograph exists. These photographs were acquired from the Female Anatomy website and are used for free. 51
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Note: These images were found in the public domain and they were meant to be distributed freely. Sex is Physical! Whether alone or with a partner, sex is a physical activity that utilizes the entire body, including the brain. An unhealthy body impairs a woman's sexual ability. Medical research has found that being underweight or overweight adversely affects a woman's sexuality. If you want to have more enjoyable sex you need a healthy body, and more importantly, a healthy body image. Sex is a reproductive activity. If your body determines you are underweight and becoming pregnant would be harmful to you and the developing baby, it automatically shuts down your reproductive organs, and as a result your sexuality. While you may feel more attractive when you "feel thin," and as a result are more receptive to partnered sex, your body may not be capable of the sex you desire. If you are starving yourself, you simply may not have the energy for sex. By design and necessity the female body stores fat, and is therefore naturally soft rather than firm and muscular. ""When girls finish growing, their bodies are 26 to 28 percent fat, compared to about 12 percent for boys," Frisch notes. A normal 5-foot-5-inch female weighing 125 pounds would carry as much as 35 pounds of fat. That's equivalent to 144,000 calories. In situations where a regular supply of food is not guaranteed, a woman needs to store that much body fat to cover the cost of pregnancy and nursing."
"At menarche, which in this country occurs at an average age of 12.5 to 12.8 years, girls' bodies contain about 22 percent fat. Improvements in nutrition, health, and living conditions have lowered menarche age from 17 years in 1800, to 14 years in 1900, to the present age, which has remained so since 1950." Source Additional information: Menarche 66
Sex is also a recreational sport with one, two, or more players. If you are obese then you aren't in the best physical condition to be engaging in a sporting event, which will adversely affect your ability to engage in sex. If you get out of breath climbing a flight of stairs, are you prepared to play baseball or basketball, walk around the block, or have sex? If many women are to experience orgasm, the sexual stimulation must continue uninterrupted for 20-60 minutes, especially during partnered sex. Are you up to the challenge? Can you walk on a treadmill for 20-60 minutes without stopping? If you have high cholesterol levels your arteries could become restricted with plaque, which restricts the blood flow to your reproductive and sexual organs, as you become older. While being a little over weight wont adversely affect your sexuality, being obese most likely will in the long term. Though it is better to have five extra pounds than to be short five pounds.
"Obese women suffered from a significant amount of sexual complaints, including decrease in desire, arousal, lubrication, orgasm, and sexual satisfaction, compared with the nonobese controls." "Obesity has been associated with many comorbidities, including hypertension, cardiovascular and pulmonary disease, arthritis, diabetes, and cancer." Source J Sex Med 2007;4;547
Here is some interesting statistics for American women:
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Women aged 20-29 were nearly 29 pounds heavier, women aged 40-49 were about 25½ pounds heavier, and women aged 60-74 were about 17½ pounds heavier on average in 2002 compared to 1960. Source
Ideal Weight Range It is difficult to learn what our ideal or appropriate weight range should be. This is because we come in so many different shapes and sizes. Women of the same height can have small, medium, or large frames, resulting in a wide range of appropriate weights for a given height. The experts can't agree on our ideal weight, as evidenced by all the different methods of calculating it that are available on the internet. To add to our confusion, our mind has it's own idea of what our ideal weight should be. Our body image will likely control our choice of an ideal body weight more so than any data we receive from the medical community. The emotional part of our brain may overrule the logical part.
To find your appropriate body weight range please visit the website linked to below. The linked to website provides more than one ideal weight range. Each range is based on different criteria and expectations, which will allow you to choose an appropriate weight range for you as an individual.
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Better Ideal Weight Body Calculations Pick a weight range, as your weight will likely change throughout the course of your menstrual cycle, as you don't want to be starving yourself at different times during your menstrual cycle. Choose clothing that fits you best when you are at your maximum recommended weight so your clothing isn't providing inappropriate negative feedback. You should also weigh yourself at the same time of day, as you are likely the lightest upon getting out of bed in the morning, assuming you haven't eaten a meal in the past 8 to 12 hours, and weigh the most after eating a large meal.
"In general, though, our society does tend to place more value on big breasts. Go through a day in our world - watch television, pick up a women's magazine, go to the movies, walk down the street. Guaranteed you'll see more big breasts than you'll know what to do with." From the book Breasts: Our Most Public Private Parts by Meema Spadola Are large breasts as common in the media and life as Ms. Spadola suggests, or is this merely the perception of a woman with average sized (34B) breasts? Are female celebrities more likely to have breasts that are above average in size? Are you required to have large breasts to be considered sexy? The advertising and news media seems to suggest these statements are true.
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The media uses women with medium to large breasts to sell merchandise and increase television ratings. This implies men and women prefer breasts of this size. It also suggests that women with small breasts could never attract anyone's attention, or so women with small breasts are often led to believe.
Average Bra Size What size bra does the average woman wear? According to the book How Big is Big: The Book of Sexual Measurements, published in 1982, meaning the numbers are a bit outdated, the percentage of women who wear each cup size is given in the following table. Cup Size A B C D Other
Percent of Women 15 44 28 10 3
At that time, the average bra size was a 36B. Many articles on the internet say the most common bra size is now a 36C*. Some bra manufacturers are reported to be saying this, but they are tight lipped about their sales figures. I wasn't able to locate a scientific reference that substantiates this claim. Today, women are more likely to be overweight, so you would expect the average cup size, and band size, to have increased at least a little. For now, lets assume the percentages given above are somewhat close to what women wear today.
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Even if an increasing number of women are buying bras with a C cup that doesn't necessarily mean women in general have larger breasts, as 70-80 percent of women are reported to be wearing the wrong size bra. Women frequently buy the size and style of bra they want to wear, not the one they should wear. Women who wear bras with a C cup may simply buy greater numbers of bras than those who buy other cup sizes. Women with above average sized breasts often have a hard time finding suitable bras and may have very limited options available to them, without the luxury of coordinating them with several different outfits.
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I have also heard that women with small breasts could be equally limited in their choices, especially given they probably don't want to be seen shopping for a bra in the little girl's section of their local store. It is also possible that increasing numbers of women with small breasts don't wear a bra, so they aren't buying them, or they are wearing them less often and buying fewer of them. Many of today's tops have built in shaping and support, which may lessen the need for women to wear a bra. There are many reasons why bras with a C cup may out sell the other sizes, and women having larger breasts is just one of them. Resource: Bra suppliers AAA to JJ Cup
Anatomy of the Breasts Introduction Despite the amount of attention the female breasts receive, it is interesting that there is so little information available on their anatomy and functionality. I had to search through several references to find one that went into any detail when addressing these topics. Surprisingly, books you would expect to cover these topics had little to offer. A book about breast-feeding contained little, and several books on breast cancer did not address these topics at all. This is perhaps because the female breasts have come to serve a purpose in American society other than what they are intended, which is, providing nourishment, emotional and physical contentment, and protection from disease for our children. Unfortunately, the most detailed reference appeared to be in a book discussing plastic surgery of the breast!
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From the book The Johns Hopkins Atlas of Human Functional Anatomy Fourth Edition. Copyright 1977,1980, 1986, 1997 The Johns Hopkins University Press. Edited By: George D. Zuidema, M.D. Basic Anatomy
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Each breast is made up of fifteen to twenty lobes of glandular tissue. The number of lobes is not related to the size of the breast. Each lobe is made up of thousands of tiny glands called alveoli or acini. These glands are connected together by a series of ducts, much like grapes on a vine. The alveoli (alveolus and acinus singular) produce milk and other substances during lactation. Each lobe feeds into a single lactiferous duct that travels out through the nipple.
As a result there are fifteen to twenty passages through the nipple, resulting in just as many openings in the nipple. Behind the nipple the lactiferous ducts enlarge slightly to form small reservoirs called lactiferous sinuses. Each sinus is 2-4mm (0.08-0.16in) in diameter. Fatty and connective tissues surround the lobes of glandular tissue. The amount of fatty tissue is depended on many factors including age, percentage of body fat, and heredity. Cooper's ligaments connect the chest wall to the skin of the breast, giving the breast its shape and elasticity.
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The nipple and areola are located near the center of each breast. They most often have a color and texture that is different from that of the surrounding skin. Their color varies from very pale pink to black, and darkens during pregnancy and lactation. Their texture can vary between very smooth to wrinkled and bumpy. The nipple usually projects outward from the surface of the breast. The areola is the like pigmented area surrounding the nipple. The size of both varies considerably from woman to woman, and some size variation is normal from breast to breast on the same women. The nipple and areola are composed of smooth muscle fibers and a dense network of nerve endings. The nipples become erect as the result of muscular contractions, not blood engorgement. Erect nipples are not by themselves an indication of sexual arousal. The nipples may become erect as a result of many forms of stimulation that are not sexual in nature, and a woman's nipples may not be erect when she is sexually aroused. The area of the areola is populated by several oil producing Montgomery's glands. These glands may form raised bumps and be sensitive to a woman's menstrual cycle. These glands act to protect and lubricate the nipple during lactation. Some nipples project inward or are flat with the surface of the breast. The later are referred to as inverted nipples and neither condition appears to negatively impact a woman's ability to breast-feed.
From the book A New View of a Woman's Body. Copyright 1981, The Federation of Feminist Women's Health Centers. Illustrated By: Suzann Gage, L Ac, RNC, NP Lactation While pregnancy prepares the breasts for lactation it does not trigger the production of milk. During pregnancy the breasts usually become larger as the number and size of the alveoli glands increases, as a result of increased estrogen levels. It is not until an infant has been nursing for a couple days that actual milk production begins. For the first couple of days the breasts release colostrum, which is important to a baby's health. When a baby starts suckling on a woman's nipple the resulting physical stimulation causes nerve impulses to be sent to the hypothalamus gland in the brain, which in turn tells the pituitary gland, also located in the brain, to release two hormones called oxytocin and prolactin. Prolactin causes milk to be produced and oxytocin causes muscle fibers that surround the alveoli to constrict, as well as the muscles of the uterus. When the muscle fibers around the alveoli constrict causing milk to be secreted it is referred to as "let-down" and can result in intense sensations within the breasts and the squirting of milk from the nipples. The sound of a crying baby can also trigger let-down, indicating how milk production is influenced by psychological and environmental conditions as well as actual nursing. Between feedings some milk, foremilk, is stored in the alveoli and lactiferous sinuses but the majority of the milk, hindmilk, is produced on demand. The breasts do not store milk, but rather produce it based on demand. The greater the demand, the more they produce. The breasts should never be compared to milk bottles! 75
This photo demonstrates how the milk exits the breasts through several milk ducts.
Sexual Versus Maternal
You may wonder why I have explained how the breasts produce milk before addressing their functioning during sex, since this is a website about sexuality. Believe it or not, I have explained the functioning of the breasts during sex in the process. It is common today to say the female breasts have two functions or roles in a woman's life, one is sexual and the other is maternal. This is not an accurate statement to make as the breasts work the same during sex and lactation. It is the breast's ability to feed our children that makes them capable of producing sexual pleasure.
There is no magic switch that changes the role of the breasts from sexual to maternal. I realize many women, and men, believe there is, but there definitely is not. This belief has resulted in women being at odds with, and at times embarrassed by, their breasts. When a woman nurses her baby she expects her breasts to respond and feel "different" from when her partner sexually stimulates her. She may not expect to feel "sexual" pleasure when her baby nurses even though 76
this is often the case. If you acknowledge the breasts have only one function or role in a woman's life, it will be easier to understand their role and function during sex and lactation.
Why are the nipples so often very sensitive to touch? The likely answer is, to reward a mother for nursing her children. Nature has built in a means of positive reinforcement that encourages women to breast-feed their children. It may not be instinct alone that compels women to care for their children. In addition, the uterine contractions resulting from nipple stimulation serve to cause the uterus to shrink rapidly in size, perhaps allowing the mother to be better prepared to care for and protect her newborn baby. It just so happens that orgasms also involve uterine contractions. The connection between nipple stimulation, sexual arousal, and orgasm some women experience is no accident and its primary purpose is not sexual, even though that is how it frequently benefits a woman. Keep in mind it is society that has defined it as sexual versus maternal. There is a reason for why our body functions as it does, that reason is not always in agreement with what society expects of it.
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A study by Masters and Johnson found amongst a group of twenty four women who nursed their baby for at least two months, their desire for sex returned at a faster rate than it did for the women who did not, they often experienced sexual arousal to the plateau stage, and three experienced orgasm while nursing. As mentioned above, the let-down reflex can cause some pretty intense sensations and there is the aforementioned chemical and electrical connection between the nipples and uterus.
Society Conflicting with Biology Unfortunately, at least one American woman has ended up in jail as a result of admitting to experiencing "sexual" sensations while nursing her baby. She called a "help-line" to find out if she was "normal" and found herself in jail and her baby taken from her instead. While the woman did eventually regain her freedom and custody of her baby, it was very traumatizing for them both I'm sure. A woman mentioned to me several years ago how her baby daughter was having trouble nursing. She attributed this difficulty with the baby girl perhaps becoming aware that female-female intimacy was considered inappropriate. I have to wonder if it was not actually the mother who was uncomfortable with the sexual sensations she was experiencing while nursing her "daughter" that caused the difficulties. This illustrates how people's misconceptions regarding women's breasts are having a significant and negative impact on women's lives, and as a result their children's.
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Sensitivity The sensitivity of a woman's breasts to stimulation varies considerably from one woman to the next. There are women who find their breasts extremely sensitive to their own and/or a lover's touch, while just as many do not experience any pleasant sensations at all. The reasons for this are thought to be both physiological and psychological in nature. Some women have more sensory nerve endings located in their nipples and breasts than others. A woman's relationship with her breasts also has an influence on their perceived sensitivity. If she likes her breasts and has a
positive relationship with them she is more open to the physical sensations they produce. As a result she is likely to perceive those sensations in a positive manner. If a woman does not like her breasts, for whatever reason, she is less open to and hence less aware of any sensations they may produce. If she is aware of any sensations she is less likely to perceive them as pleasurable. A woman's menstrual cycle often influences the sensitivity of her breasts, many experience periods of breast tenderness that makes any sexual stimulation unbearable. The sensitivity of the breasts to stimulation may flip-flop during pregnancy and nursing because of physical and physiological changes a woman experiences during this time. A mother may experience orgasm while her baby 79
nurses yet finds her breasts are insensitive to her partner's stimulation fifteen minutes later, or vise versa. As a result, there is no one rule that applies to all women regarding breast sensitivity.
The connection between breast stimulation, sexual arousal, and genital sensations some women experience is the result of the electrical and chemical connections mentioned above. These chemicals are released during nipple stimulation regardless of whether a teen or woman has ever been pregnant or nursed before. This is demonstrated by the fact that some women's breasts always produce a little bit of milk, starting at puberty, and by women who breast-feed adopted babies. If a woman engages in frequent nipple stimulation, simulating having a newborn baby nursing at her breast, she will likely start to lactate. A woman does not have to find her breasts sensitive to stimulation for this to occur. Some of our physical responses are hard wired and out of our control.
Breast Size and Sensitivity The size of a woman's breasts has no bearing on whether she enjoys having them sexually stimulated. Since breasts have become sexual objects in Western society, large breasts have become symbols of greater sexuality. A woman with large breasts is often seen as being more sexual than a woman with small breasts, and she is expected to be inherently more sexual as a result. Unfortunately, women with small breasts may have them overlooked by their partner because of this false expectation, and women with large breasts may find their breasts receiving too much attention. Despite this expectation, large breasts are not more likely to be sensitive to sexual stimulation; recent studies have found women with large breasts have less nipple and breast sensation than women with small breasts, perhaps because the nerve endings are distributed over a larger area. Keep in mind that a woman's emotional relationship with her breasts probably plays a larger part in whether she "enjoys" having them stimulated than their actual sensitivity to physical 80
stimulation. A woman's partner should be careful not to judge her breast's sensitivity, or her enjoyment of breast stimulation, based solely on their size.
Stimulating a Woman's Breasts How do you stimulate a woman's breasts and nipples? That depends on the individual woman but gently is perhaps the best way. Women often enjoy having their breasts lavished with love, which means gentle licks, nibbles, and caresses with lips, tongue, and fingers. Stimulate her entire breast, not just the nipple. Take your time. Get some body lotion or oil and massage it into her breasts. Her genitals may respond to breast stimulation, if they do, it is a good way to prolong sexual pleasure. While she is not likely to experience orgasm as the result of breast stimulation alone, it may be intensely enjoyable for her. Be aware of her menstrual cycle if she experiences breast tenderness. (Keeping a menstrual calendar is a good idea for women who need to keep their partner informed of cyclic changes in their body.) Be aware that there are women who need clitoral and nipple stimulation simultaneously in order to experience orgasm.
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There are women who enjoy intense if not painful breast stimulation, but such stimulation needs to be discussed prior to trying it. This enjoyment of intense stimulation may have more to do with the release of the hormones oxytocin and prolactin than with an enjoyment of pain itself. Hormones released during sex often increase a person's pain tolerance though. Intense stimulation of her nipples may result in a surge in the production of these hormones that may have a significant affect on her genitals. Some women discover they like for their breasts to be treated roughly while masturbating, and they can inform and instruct their partner how and when to do it correctly. Do not treat a woman's breasts like loaves of dough you are kneading or bite her breasts or nipples, unless she consents to this type of stimulation. Some women do enjoy this, but it is not something all women enjoy, and even those who do need to be in the right frame of mind if they are to enjoy it.
A woman's breasts are often extremely important to her so she may enjoy having them stimulated even if it is not physically enjoyable for her. Her partner's enjoyment and acceptance of her breasts may be very meaningful to her emotionally. This is why it is important not to neglect a woman's breasts, dashing past them on your way to her vulva and vagina. Some women do put their breasts off limits for emotional reasons; the most common is insecurity about their size. Women with small breasts who wear padded or push-up bras may be reluctant reveal their true size to their partner. Padded or push-up bras, worn daily, are about as good for sexual intimacy as is faking orgasm. 82
An example of a young woman with two perfectly normal breasts that just happen to be of different sizes. She is unique, not deformed.
What Size Do People Prefer?
Everyone prefers large breasts right? Wrong. Yes, large breasts are sexual symbols and they receive an enormous amount of attention, but they are not equally loved by all. First size is relative. For some large breasts are anything larger than AA and for others small is anything smaller than DD. Mathematically B/C is average. Of course in our competitive world no one wants to be average or below average. We, especially women, base their pass or fail as a woman solely on the size of their breasts. Unfortunately we often equate AA with an F-, and DD with an A+. This leads to a lot of misjudgment of women, and women of themselves. 83
What size do guys and gals really prefer? Well, it really does depend on the individual. Contrary to what many magazines report, a person's preference does not change every other month. One study found twenty five percent of men preferred large breasts, the same percentage preferred small breasts. The remaining fifty percent preferred other physical attributes, or had no preferences. Some are attracted to a woman's nipples, especially when they are large and erect. Others prefer women with little or no breast development, more than you would expect.
It has been my experience that men find women attractive for many reasons, but breast size is often of little importance. In fact, the majority of the women my male co-workers have found very 84
attractive and desirable just happened to have small breasts. Talking to the women whom these men found attractive, I sometimes discovered they did not feel they were attractive, often because they judged their desirability solely on the size of their breasts. This was even true of some women who had men lining up to date them. What is attractive in a woman is a complex picture and depends on the individual. Large breasts often receive a lot of attention, but not necessarily women with large breasts. There is a difference!
A Self Fulfilling Prophecy If large breasts are not a big deal, then why do they receive so much attention? For the most part it is a self-fulfilling prophecy. Society, specifically the mass media, says they are better so they are. We are programmed to notice and admire large breasts. While we notice breasts of all sizes, we respond to them differently. We are expected to respond to large breasts, and often do so openly.
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Actresses and models with large breasts receive a lot of attention, and their breasts receive equal attention, because it is expected. Equally famous women with small breasts receive the same amount of attention, but in a different way, their breasts usually are not mentioned or emphasized. As a group, the breasts of these women are overlooked simply because they are small. At present the number of popular actresses and models with small breasts greatly out numbers those with large breasts, we simply have been conditioned not to notice.
In some cases those we expect or envision as having large breasts actually do not. This is especially true of super models like Cindy Crawford and Kathy Ireland. They are super models so we expect them to have super sized breasts, when in reality they have average sized breasts. We have often been fooled by push-up bras and strategically placed tape, hands, or arms. We often force reality to conform to our expectations. Large Breasts and Porn
What about all the large breasted women in porn you ask? With all the surgically enhanced breasts in the adult entertainment business today you would expect everyone to prefer large breasts. I believe the key point here is that we are talking about sex. Large breasts are seen as more sexual so women with large breasts are seen as more sexual and as a result as having a greater sexual capacity. Sex attracts sex. On the surface it may seem pretty cut and dry, but really it is not. Popular "men's magazines" often feature large breasts; so large breasts must be the most popular right? 86
Wrong, all it means is, of those willing to buy a men's magazine, more prefer large breasts than small breasts, or simply do not care about the size of the model's breasts. What about all those men and women who do not buy magazines, or videos? In actually, even the most popular men's magazine is bought by only a small percentage of the population. The sales of men's magazines and adult videos are not an accurate method of measuring what men, or women consider desirable.
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The Role of the Internet
The Internet has had a major impact on what people have access to as far as sexually explicit material. Since it is a private affair a person can express their desires and wishes openly. As a result, many women with small breasts, as well as those with large breasts, have received a lot of attention. In some cases women with little or no breast development have posted pictures expecting no one to notice them. They were seeking approval, but they got much more. They found men and women who desired them because of their small breasts, not in spite of them. The women were often shocked to learn this because during their entire life up to that point they have been told they could not be found desirable. Now there are women who are famous because of their small breasts and have a large and supportive following. At least one website that predominately features women who have small breasts has gotten tens of millions of visits, not to mention tons of money, as a 88
result. If one broadens their perspective, they will find there is no disadvantage to having small or even tiny breasts. A woman is only as attractive as she feels she is, or more importantly, allows herself to be. It is more an issue of self-confidence than it is breast size.
Why Do Women Have Prominent Breasts? 89
Holarly people have often tried to explain why human females are the only mammals to have breasts that are prominent features even when they are not lactating. In all other species the breasts only develop during pregnancy and lactation, not during puberty. There is no apparent benefit. If a woman's breasts do not develop during puberty, she is still able to produce sufficient quantities of milk to provide for her children. Educated men have proposed women have prominent breasts as the result of natural or sexual selection.
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The believe is that since women with large breasts are considered more desirable they would have more suitors and as a result reproduce more often. The problem with this concept is it is based solely on modern Western society's ideals of what is considered attractive. It over looks the fact that breast size has seldom been of major importance in most societies. In the majority of societies breasts are just a source of nourishment for infants and young children. I have never heard of an instance where a woman with small breasts could not or would not be able find a partner. I believe the reason why women's breasts usually develop during puberty is likely the side affect of some biological necessity that is not readily apparent. Perhaps it is simply that human females experience a greater increase in estrogen levels during puberty than do other mammals. Most of the time, a breast is simply a breast.
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Unrealistic Expectations
The above photograph is presented for two reasons; first to show the degree to which size variations between a woman's breasts are "normal", and second in hopes of putting a woman's view of her own breasts into perspective. 92
The female breasts are very visible social sex symbols so they are often the primary source of a woman's anxiety about her body. Her breasts often define her in the public and private eye. Both men and women feel perfectly justified in making verbal comments about them. Women who have small breasts often envy women with large breasts and vise versa. A woman who has breasts that her peers admire, regardless of size, often finds fault with them. This is also true of women who are considered very attractive by the men and women around them. Actresses and models have undergone breast augmentation surgery even though they were already considered very attractive, because they were led to believe they were not as attractive as they should or could be. (While their breast size increased, their popularity sometimes sagged following surgery.) While their size is often the cause of a woman's discomfort, other qualities such as their firmness, nipple and areola size and coloration, projection, and shape are also the source of concern. Even so, we must not loose sight of the fact that many women love their breasts dearly regardless of their size and shape. Breasts are in part what make them a woman, and they enjoy being a woman. It is interesting to note that the author of the book Breasts: Our Most Public Private Parts, Meema Spadola, came to the same conclusion as I, that breasts are actually more important to women then men!
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Women often judge their breasts extremely harshly, far more so than men. They compare them to an unrealistic ideal. They are led to believe they should have perfectly round breasts that defy gravity by projecting straight outward from their body. There are some common shapes women's breasts conform to, round is just one of them, and probably not the most common. When they are round and project outward they are most often small in size. This is a fact dictated by gravity. I would guess most breasts are slopping or concave frontally and rounded at their bottom junction with the body. The above photograph gives an example of these two common shapes side by side. Women often view breasts with this second shape as flat or sagging, not as being normal and desirable. I have seen many instances where this was true. With the extreme social pressures women are under, it is often hard to convince them they have beautiful breasts if they feel otherwise.
From the book The Johns Hopkins Atlas of Human Functional Anatomy Fourth Edition. Copyright 1997. The Johns Hopkins University Press. Edited By: George D. Zuidema, M.D..
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From the book Clinical Anatomy Principles, Author: Lawrence H. Mathers, Jr. ... [et al]. Copyright 1996 by Mosby - Year Book.
From the book Atlas of Human Anatomy, Author: Luis Lopez-Antunez, M.D. ... [et al]. Illustrated By: Luis Amendolla Gasparo. Copyright 1971 by W.B. Saunders Company.
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From the book Clinical Anatomy Atlas, Editor: Emma D. Underdown. Copyright 1996 by Mosby Year Book.
This article was first published between October 17, 2004 and October 12, 2006.
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Anatomy of the Vulva
The shape and appearance of the female genitals vary considerably from one woman to the next. A woman's vulva is as unique in appearance as is her face. A person should not take the position that all women's genitals should look similar to those shown. Only a very small percentage of women will have genitals that look like those portrayed. I will use multiple illustrations to provide some indication of just how varied in appearance the vulva can be. Many of the illustrations are taken from life, most anatomy and sexuality books show what the author or illustrator felt was the correct or ideal shape. Few women's genitals are as symmetrical as those shown in these books. As such, they are usually inaccurate for the majority of women. Based on some anatomical illustrations, you have to wonder if the illustrator had ever actually seen the vulva of an adult woman, at least a living one.
Locating detailed descriptions of the anatomy and biology of the female sexual organs appears to be almost impossible. Almost every book I used as a reference, nearly ten, presented the same information, almost word for word. Each anatomical structure is usually described in a single sentence, or at most, a brief paragraph. The information published one hundred fifty years ago seems to be the basis for the information presented in books printed today. When new research is published, it is 97
usually presented in medical journals, using medical terminology, which the average person cannot read or comprehend. This goes to show how little effort has gone into researching the anatomy and function of the female sexual organs.
The external female sexual organs, genitals, are collectively know as the Vulva. The vulva is comprised of many different anatomical structures and is much more complex than most people realize.
The reason so many people have no idea as to the anatomy of the female genitals is that we as a society have reduced women's sexual anatomy down to nothing more than their vagina. We say girls and women have a 'vagina' instead of saying they have a 'vulva', which is both inappropriate and inaccurate. We have made the vagina the center of female sexuality when in fact, for the majority of women, their vulva is.
Since most sex education classes are more about reproduction than sex, the anatomy of the female genitals is often times not taught in school. Reportedly, very few men can identify all the different parts of a vulva when shown a picture of one. I suspect the majority of women are just as unaware of their own anatomy. Hopefully the information presented below will help people to become more aware of female sexual anatomy, and as a result, increased numbers of women will find sex more enjoyable and satisfying.
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From the book "Atlas of Human Sex Anatomy" by Robert Latou Dickinson M.D., F.A.C.S. The Williams & Wilkins Company.
The above illustration shows what the adult female genitals may look like when the labia majora are at rest, that is, not spread open. The visible structures are the, mons veneris, labia majora, pudendal cleft, perineum, and anus. While not depicted in this illustration, a significant percentage of women will have labia minora that are always visible as they project out between the labia majora. Sometimes the clitoris or clitoral hood is always visible as well. Illustrations showing vulvas with these characteristics can be found below and on the web page about clitoral and labial size. This illustration depicts what the illustrator, a doctor, determined was an average vulva, based on his research of European and North American women. The original is life size. The black outline shows the placement of the pelvic bones that create the pelvic outlet, or birth canal. The Mons Veneris is a pad of soft fatty tissue that covers the pubic bone. It is usually covered by a thick growth of hair after the onset of puberty. "Mons veneris" means "mound of Venus" in Latin. Venus was the name given to the Roman Goddess of love. Hence, "mons veneris" has come to mean, "Mountain of Love." It is so named because the fatty tissue located here is sensitive to estrogen, with the onset of puberty estrogen levels increase causing a distinct mound to form. It is often very visible when a woman is naked or wears tight clothing. It is thought to provide a protective cushion between the pubic bones of a woman and her partner during sexual intercourse, when penetration is from the front. The vulva of preadolescent girls appears to be positioned farther forward than that of adult women, as you can see a greater percentage of their labia majora and pudendal cleft when they are standing. This gives you the impression that the vulva moves, rotates, backwards toward the anus during puberty. The vulva does not actually move. What happens is, the formation of this mound of fatty tissue causes 99
the forward portion of the labia majora to be pushed out away from the pubic bone.
When a woman in standing, this results in her labia majora being pushed downward, becoming parallel to the ground, and out of sight when viewed from the front. Women with very little body fat may not have a pronounced mons veneris, resulting in their vulva appearing to be located further forward than that of other women. The opposite is true of women with high concentrations of body fat. The position of the clitoris, and 100
urethral and vaginal openings are defined by the bones of the pelvis. The skin covering the mons veneris contains many nerve endings. As a result, a woman may enjoy having this area caressed, as well as having the hair that covers it stroked and tugged on gently. Some women find they are able to experience orgasm when their mons veneris is massaged, or when they press it against a firm surface while masturbating. This is partly due to the clitoris being located beneath its lower boundary. A woman may find this area more sensitive to stimulation when it is as the skin is no longer protected by a layer of hair.
The Labia Majora are two folds of skin, in some cases they are more like mounds than folds, that define the pudendal cleft, and conceal and protect the more delicate structures of the vulva. The front portion of each labia majora is usually thicker than the rear, tapering down and merging with the perineum. The above illustration shows each labia majora having this triangle shape. The outer surfaces of the labia majora are sometimes of a different color than that of the surrounding tissue, and may be smooth or wrinkled in appearance. The skin may have the same wrinkled appearance as that of the male scrotum, their male counterpart. After the onset of puberty the outer surfaces are usually covered with hair. When a woman is sexually aroused, the labia majora may become bright red in color because of the increased blood flow to the area. The inner surfaces are smooth and shiny. The skin on the inner surfaces is highly populated with oil and sweat producing glands, and nerve endings. The oil and sweat 101
glands are responsible for the smooth shiny appearance and helping to keep the vulva clean and healthy. The color of the inner surfaces is often pink in color, but may be other colors as well, such as brown and blackish-brown. Between the inner and outer skin surfaces is a collection of fat and smooth muscle. Smooth muscles are those we do not have conscious control over. The size and shape of the labia majora vary considerably from one woman to the next. The labia majora of young girls are usually flat and smooth, having the same color as that of the surrounding tissue. With the onset of puberty and the subsequent increase in body fat, the labia majora often times become more prominent. Women with low percentages of body fat may have small flat labia majora and women with high percentages of body fat may have well defined rounded labia majora. The flat area between the pudendal cleft and the anus is called the Perineum. Some references state that the perineum is hairless, this is not true for all women. The skin of the perineum is populated by numerous nerve endings so some women may enjoy having this area caressed and massaged during sex. Anatomy references, versus sexuality references, say that the perineum extends from the anus up to the urethra, so there is some conflict in what actually constitutes the perineum.
The Anus is the opening into the rectum and lower intestine through which feces passes during a bowel movement. The anal tissues are rich with blood vessels and nerve endings. Many women find their anus to be very sensitive to stimulation. The sensitivity being the result of a protection mechanism intended to keep foreign objects out, to prevent injury and disease. Two sets of muscles encircle the anus just under the skin. The involuntary contraction of these muscles can make anal sex and intercourse painful or impossible. For many women their anus is an important part of 102
their sexual anatomy, sometimes being even more sensitive than their clitoris and vagina.
From the book "Atlas of Human Sex Anatomy" by Robert Latou Dickinson M.D., F.A.C.S. Copyright 1949 The Williams & Wilkins Company.
The above illustration shows what the vulva of a virgin may look like when the labia are drawn open to expose the inner genital structures. The illustration shown below reveals what a woman's vulva may look like following pregnancy and vaginal delivery. The visible structures in these illustrations are the, labia minora, prepuce, clitoral glans, frenum, vestibule, urethral meatus, vaginal introitus, fossa, fourchette, and hymen. They demonstrate how a woman's genitals may change in appearance throughout her live. There are several events in a woman's life that will likely affect the appearance of her vulva.
At birth an infant girl's vulva and breasts may appear to be swollen or enlarged. This is the result of her having been exposed to her mother's increased levels of hormones while in the womb. After a short period of time the girl's vulva, labia minora and majora, and breasts will shrink in size as the affects of the maternal hormones slowly wear off. At birth, a girl's clitoris is proportionally larger than it is likely to be during the remainder of her life. From the time a girl is one year of age until about the age of eight her genitals should not undergo any significant change in appearance, other than growing in proportion to her body. If they do, a doctor should be consulted. The next major changes to the vulva occur during puberty. The genital tissues are highly sensitive to hormones. As a girl's ovaries and other endocrine glands start producing increased levels of hormones, male and female, her vulva will likely undergo a major change. The thin tissues of the vulva will become thicker and more 103
elastic. Their coloration is likely to change as well. The structures of her vulva are likely to become larger and more pronounced. This includes her labia majora and minora, as well as her clitoris and hymen. Since pubic hair also develops at this time, a girl may not be aware of all the changes that take place. Teaching your daughter to examine her genitals with a mirror at a young age will make her more comfortable with her vulva, and perhaps more aware of these changes. Masturbation and non-penetrative sex can have a minor affect on the appearance of the female genitals. Since the average girl does not start masturbating until she is in her late teens, these changes are not likely to occur until after puberty. When a girl or woman is sexually aroused her genitals fill with blood, resulting in their temporary increase in size. If the engorgement with blood occurs frequently, the affects of this engorgement may become permanent. As with all other organs of the body, the more you use it, the larger it becomes, to a point. Daily masturbation and/or sex play may result in a slight increase in the size of the erectile organs of the vulva, labia and clitoris. This is normal and healthy. A doctor will not be able to tell if a girl or woman masturbates, even if this does occur.
The appearance of the entrance to the vagina, introitus, is likely to change when a woman starts having vaginal intercourse, or inserts fingers or other objects into her vagina. Using tampons should not have any significant affects on the appearance of the vulva or vagina. If a woman has a hymen, depending on the force applied to it when objects are inserted into the vagina, it will either stretch or tear. Over time the hymen may slowly disappear as it is repeatedly stretched open. If a woman has a hymen, it usually does not disappear completely until she delivers a baby vaginally. As the vaginal entrance becomes more elastic, surrounding folds of tissue may become more developed. If the vaginal muscles become stronger and more developed this too is likely to change the appearance of the vulva. Of course if the vaginal muscles become weak or torn, this to will change the appearance of the vulva as well. If a woman's introduction to vaginal penetration is slow and gentle, the changes to her vulva are likely to be gradual and perhaps unnoticeable. 104
When a woman becomes pregnant, the blood supply to her reproductive and sexual organs becomes greatly increased in order that they may be able to support the developing baby. As a result, a woman's vulva may increase markedly in size, her labia and clitoris may become much larger. Blood vessels may become more prominent and visible. The sensitivity of her vulva may become greater, this can be pleasurable or irritating for her. When a woman delivers a baby vaginally, her vagina and vulva must stretch to accommodate the baby's head, 9.5cm (3 3/4 inches) across. This can result in tears to the vaginal opening, labia, and clitoris. A doctor may make an incision at the vaginal opening, an episiotomy, to prevent tearing of the vagina and vulva, the resulting scar tissue changes the appearance of the vulva. Some of the changes that occur during pregnancy and delivery are likely to be permanent. The next major change to the vulva occurs during menopause. During this time period, the level of hormones in a woman's body decrease, and as a result, the tissues sensitive to hormones, the labia and clitoris, usually decreases in size, but not to their preadolescent size. The reverse of what occurred during puberty occurs during menopause. This can make sex more of a challenge, but does not necessarily eliminate the need or desire for it. If a woman continues to masturbate or engage in sex regularly, the changes are not as great, and sex is likely to be easier to accomplish and enjoy. Perhaps the greatest variation between the vulvas of women occurs in the size and shape of their Labia Minora. The labia minora are also called Nymphae. While the name literally means 'minor lips', for many women, their labia minora are large and prominent. Much larger than what most anatomy and sexuality references portray or mention. In addition, the labia minora may not be totally concealed by the labia majora as the references also state. Many women who have explored their vulva have come to believe their vulva is somehow deformed, because of the shape of their labia minora. The illustrations by Betty Dodson shown below reveal the normal variations in labial size and shape. There are women who do not have labia minora, or who only have one. While some women do have the heart shape labia typically shown in anatomy books, many if not most, do not. 105
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While the labia minora have many nerve endings, their sensitivity to stimulation varies considerably between women. Some women find them totally insensitive to sexual stimulation, others find sexual stimulation of their labia minora very pleasurable. When they become irritated, by infection, frictional irritation, or chemical irritation, they can become quite painful.
From the book "Sex for One: The Joy of Selfloving" by Betty Dodson. Copyright 1987, 1983, 1974 By Betty Dodson.
The illustrations shown above and below demonstrate the normal variations that occur in the size and shape of the vulva. They show the vulva of real women, women who posed for Ms. Dodson.
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As can be seen, the vulva comes in a multitude of shapes and sizes. No two are exactly alike. Each one is equally beautiful. For a woman to fully enjoy the pleasures of sex, she must love her vulva in its entirety. Betty's book is required reading for many reasons, these and other illustrations are just one of them. The Clitoris is a very complex and specialized organ. It has only one purpose, to give women sexual pleasure. It is as important to a woman, as is a penis to a man. The clitoris is formed from the same tissues as is a penis, and for the most part, functions the same as a penis. The only major difference between the two appears to be that the female urethra does not pass all the way through the body of the clitoris. The tissue that transports urine and ejaculate through the penis is present though, in the form of the labia minora. While the average clitoris is smaller than a penis, some clitorises are just as large as a small penis. Many clitorises look very similar to a penis, which unfortunately makes some people feel uncomfortable. Each labia minora attaches to the base of the clitoral glans. The point at which they attach is called the Frenum or Frenulum. The frenum indicates where the urethral outlet would have been located had the clitoris developed into a penis during fetal development. This attachment results in the clitoris being indirectly stimulated by the movement of the labia minora as the penis enters and exits the vagina during intercourse. For a small percentage of women, this stimulation is sufficient to produce an orgasm, when combined with the sensations caused by the penis caressing the vaginal wall. The frenum of the vulva and the frenum of the penis are not the same thing, "frenum" is simply the medical name for this type of anatomical structure. The tongue has a frenum as well, for example.
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The labia minora also merge with the Prepuce or Hood. The prepuce covers the clitoral body and all or part of the clitoral glans. While the labia minora merge with the prepuce, they are not made of the same tissue. Unlike the second and third illustrations shown here, the prepuce usually conceals the clitoral glans unless it is manually retracted, but the clitoral glans of some women is always partially or completely exposed as shown. The prepuce protects the very delicate and sensitive clitoral glans from constant stimulation and irritation. The information presented below on the prepuce is based on multiple articles about the prepuce of the penis. There is no detailed information available on the prepuce of the clitoris that I'm aware of. The information available on the prepuce of the penis is often vague and confusing, and at times, contradicting. I've done my best to make sense of the information presented in my references. The portion of the prepuce that covers the clitoral glans is just like the foreskin of the penis. It is comprised of two separate layers of skin, an outer layer that is an extension of the tissue along the body of the clitoris, and an inner layer made up of mucous membrane. During fetal development the prepuce and the glans are fused together, they are one. Sometime during late fetal development or childhood, both the glans and prepuce shed their outer layers of cells resulting in their separation. The shedding of these skin cells occurs throughout life, even after separation of the glans and prepuce. Glands on the underside of the prepuce, within the mucous membrane, produce enzymes that attack bacteria and protect the glans and prepuce from infection. There are also oil-producing glands located on areas of the clitoral glans that lubricate the glans and prepuce. These oil glands are less active in childhood than after puberty. The shedding of skin cells and the production of oil and enzymes results in the formation of smegma. Smegma is a white cheesy substance that may have a strong odor, in the female it is reported to be 'fishy' in nature. Because of the restricted space between the glans and hood, the smegma may collect under the prepuce in the form of small 'pearls' or kernels. Smegma, because of the oil and enzymes does not pose a health risk. It is recommended that while the prepuce and glans are fused together, that only smegma that has seeped out from under the prepuce be washed away with plain water. At some point the prepuce and glans should separate as the result of the skin cell shedding, masturbation, bathing, and bike riding etc. After separation occurs, the prepuce should be retracted so the glans can be washed with plain water. The use of soap appears to increase the likelihood of infection. If the prepuce and glans do not fully separate or if an infection develops between the glans and prepuce, adhesions may develop between the two. Parents should not forcibly retract the hood of their daughter's clitoris while bathing her vulva. The size of the prepuce varies considerably from one woman to the next. Its size is not necessarily based on the size of the clitoris. A short thin clitoris may have a long fleshy prepuce and a long thick clitoris may have a short thin prepuce. It is believed that most women can retract their prepuce far enough to expose all or part of their clitoral glans. Some women have a prepuce that is so long and/or has such a narrow opening that their clitoral glans is always hidden. A small percentage of women have reported that their long thick prepuce has prevented or impaired their ability to 109
experience orgasm, so they had it surgically trimmed or removed
The process of trimming or removing the portion of the prepuce that covers the glans is called circumcision. It is rarely necessary as there is no evidence to show the size of a woman's prepuce has any bearing on her ability to experience orgasm. It is more a cosmetic procedure that may have psychological benefits for some women.The above illustration shows the entire clitoris with most of the surrounding tissues removed. The three main parts of the clitoris are shown, the Glans, Shaft, and Crura. Some feel the Vestibule Bulbs should be considered as part of the clitoris, referring instead to them as the "bulbs of the clitoris." The clitoral glans is made up entirely of soft erectile tissue called corpus spongiosum. This is the same type of tissue that comprises the glans of the penis. When a woman experiences sexual arousal her glans fills with blood and becomes slightly larger, and usually more sensitive. It still remains soft to the touch even during sexual arousal, unlike the body of the clitoris. The surface of the glans is not covered with regular skin tissue, what is there is much like the mucous membrane of the adjoining prepuce. Tiny oil producing glands populate the surface of the glans, at least some areas of it. The oil they produce gives the glans its shiny appearance and allows the prepuce to glide effortlessly across the surface of the glans. If the glans dries out, undergoes cornification, it becomes dull and rough in appearance, as with a circumcised penis. The average size of the non-erect glans is about 4 - 5mm ( 0.15 - 0.2in, a little less than a quarter inch ) in diameter, but ranges from 1 - 15mm ( 0.04 - 0.6in, a little more than half an inch ) in diameter. There is more information about the size of the clitoris on the page about clitoral and labial size. The glans of the clitoris has just as many nerve endings as does the glans of the penis, just in a much smaller area. This results in the clitoris being extremely 110
sensitive. The size of a clitoris does not determine how sensitive it is, as the number of nerve endings is reportedly always the same regardless of size. Many women find direct clitoral stimulation painful. There are a small percentage of women who cannot tolerate any form of clitoral stimulation, they experience intense pain not pleasure when it is touched, even indirectly. The prepuce serves to protect the glans from direct stimulation, and the natural oil present reduces the friction between the two. This is probably why women generally masturbate by massaging the prepuce rather than the clitoral glans. While the clitoris is usually very sensitive, some women report their clitoris is insensitive to stimulation. The cause of this is unknown, but it may be the result of disassociation from one's body, diseases or illnesses that attacks the nervous system, or lack of use. The sensitivity of any sensory organ varies from one person to the next, the clitoris is no different. The body and crura (crus singular) of the clitoris are made up of two cylindrical shaped structures comprised of erectile tissue called corpora cavernosa. This erectile tissue is enclosed in a dense fibrous network of tissue. The body is the portion of the clitoris that hangs downward from the pubic bone, to which the glans is attached. In the body of the clitoris, the two cavernous bodies are joined to one another along their common side and the surrounding tissue makes it appear as if there is only one erectile structure. At the point where the body meets the pubic bone, the two cylinders separate and conform to the shape of the pelvic bones, forming an inverted "V". The size of the body of the clitoris varies from zero to about two inches. The size of the average clitoral body is about three quarters of an inch, making the average body and glans an inch in length. This is the portion of the clitoris you will be able to touch and feel with your fingers, beneath the prepuce. The crus are each about three inches in length making the average clitoris four inches in length; a lot bigger than most people realize. Due to the erectile nature of the body of the clitoris, the clitoris is capable of projecting outward from the body, becoming erect, when blood collects in it during sexual arousal. Smooth muscles within the corpora cavernosa relax during sexual arousal allowing blood to pool within its chambers as the result of chemical stimulation by nitric oxide. The degree to which the clitoris projects outward is dependent on the size of clitoris, and on the elasticity of the connective tissues, chordee, that normally keep the clitoris pointed downward. When the clitoris becomes engorged with blood, it feels firm to the touch. If you lightly grasp the body of the clitoris as a woman becomes sexually aroused, you will likely feel her clitoris become firm and erect. For some women with small clitorises, the only way to locate the body of the clitoris within the prepuce is by feeling it become erect while the surrounding tissues stays soft. A woman may be very aware of this change in her clitoris, and feel as if she has a "hard-on" because of its intensity. Just prior to a woman experiencing orgasm an increased amount of blood collects in the body of the clitoris resulting in a firmer erection, which causes the glans to move upward toward the pubic bone. This gives the impression that the glans is retracting up under the prepuce when it is actually just straightening out as a result of the increased blood trapped within. Some incorrectly say this is protection mechanism of the exquisitely sensitive glans, saying the clitoris retracts to protect itself from direct 111
stimulation that may be painful just prior to orgasm. The penis undergoes the same increased rigidity just prior to orgasm and it in no way protect the glans of the penis, it perhaps ensures the penis is at full length so the ejaculate is deposited as near the cervix as possible. Women who report experiencing waves of pleasure radiating outward from their clitoris during orgasm are perhaps feeling the pooled blood rapidly draining away from the clitoris in time with her orgasmic contractions. The Bulbs of the Clitoris are two erectile bodies that attach to the body of the clitoris and lay beneath the labia minora. They are called "Bulbus Vestibuli" in the above illustration. The length of the bulbs varied from 3 - 7cm (1.2 - 2.75 inches) in one study. The bulbs of the clitoris correspond to the singular bulbus penis in the male. They are made up of the same erectile tissue as the clitoral glans, corpus spongiosum. These structures fill with blood during sexual arousal, but unfortunately it appears that no one knows for sure their exact function during sex and orgasm. Because of their erectile nature and location near the vagina, they may firm up the vaginal introitus in preparation for intercourse. A woman may also be aware of their firmness and congestion during sex. The Vestibule is the triangle shaped area below the clitoris and above the vaginal introitus. The labia minora form the sides of the triangle. The urethral meatus is located within this area of the vulva. The Urethral Meatus is the opening into the urethra, through which urine, female ejaculate, and fluids from the female prostate exit the body. The size and shape of the urethral opening varies considerably from one woman to the next. It may not be as large and prominent as shown above, though sometimes it is larger. The urethral meatus can be very sensitive to sexual stimulation, so sensitive in fact that a woman may mistake her urethral opening for her clitoris, if she does not visually examine her vulva, going solely by sensitivity. Some women masturbate by massaging the urethral meatus and by inserting objects into the urethra. Stimulating the urethra, through the vaginal wall, can result in female ejaculation and the release of fluids from the female prostate. The Vaginal Introitus forms the mouth of the vagina. It is incorrect to say "vaginal opening" because unless there is something inserted into the vagina, the vaginal passage is closed. One problem with some of the illustrations on this page, and in anatomy books in general, is that the vaginal opening is always shown as a dark area, in affect indicating a dark empty space, a cave of sorts. The walls of the vagina are normally in contact with one another, the vagina is a potential space, not an opening as usually shown and portrayed. As the illustrations and discussion above reveal, its appearance is dependent on several factors. During the early stages of fetal development there is no opening into the vagina from outside the body. The thin tissue membrane that conceals the vaginal canal is called the Hymen. Usually at some point during fetal development this tissue divides, exposing the vagina to the outside world. When the opening forms, some or most of the concealing tissue remains. The tissue that still conceals the vaginal opening after birth is what we commonly refer to as the hymen. The opening(s) into the vagina come in many shapes, illustrations showing the common variations can be found on the page about the hymen. 112
Sometimes the hymen does not separate during fetal development and a girl is born with an imperforated hymen, meaning there is no vaginal opening. A minor surgical procedure is required to create an opening in the hymen. If this opening does not exist prior to the onset of menstruation, menstrual fluid collects in the uterus and vagina resulting in severe abdominal pains and cramps until the fluid is drained. Contrary to popular myth, the presence or absence of a hymen in no way indicates that a girl or women has or has not had vaginal intercourse. The hymen of some girls totally disappears prior to birth. The tissue of the hymen is very thin, it does not take much tension on the surrounding tissues to cause it to stretch open. Normal childhood activities like spreading the legs widely during gymnastics, riding a bicycle, playing on the jungle gym, and masturbating can result in the hymen disappearing prior to puberty. Later usage of tampons, and the insertion of fingers into the vagina may also stretch the hymen. Some hymen are elastic enough that when a penis is inserted slowly and gently, it may stretch versus tear, so that when the penis is removed, the hymen returns to it prior shape. It appears that about 50% of women experience bleeding when they first have intercourse. This explains the common practices of getting married while a girl is menstruating, inserting a fertilized bird's egg into the vagina, and the staining of the bed sheets with the blood from a chicken when proof of virginity was required. The Fourchette is the area where the labia majora join together below the vaginal opening. It is the forward edge of the perineum. The Fossa is the name given to the depression that exists between the perineum and hymen, below the vaginal opening
Enhancement of the Vulva While often controversial, women sometimes have a desire to change their clitoris and vulva, so as to make them look different, or in hopes that they will provide more pleasure during sex. For most women, their clitoris and vulva look and work fine just the way they are and they wouldn't dream of letting a doctor near them with a scalpel, but others have a strong desire for something different or better. While I present this information on my website I don't necessarily support these procedures. I just want to make people aware that they do exist. They all have risks associated with them, and none have any guaranteed benefits.
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The first enhancement method has become somewhat popular since the early 1980's. It is Genital Piercing. Thousands of women worldwide have had their genitals pierced so special metal rings and bars could be inserted. The reasons they do this are numerous, but the main reasons are decoration and sexual enhancement. The majority of women wear some form of makeup on their face to make themselves more attractive. Women with pierced genitals wear shiny metal rings and bars in the folds of their vulva to make it more attractive to themselves and their partner. It also serves to draw their partner's attention to this area. For many it is a celebration of their femininity. For women who have never liked their genitals, or who have felt disassociated from them, this can be a very rewarding and enlightening experience. The momentary pain associated with the actual piercing, and the aftercare procedures, result in these women thinking about and being more aware of their genitals than they have ever been before. Many of these women can't stop thinking about, looking at, and sometimes even showing off their newly pierced vulva. These are actually very positive things for a woman to do. Perhaps at no other time in their life have they been so aware of their genitals and sexuality. If the piercing is positioned so as to pass through the clitoral glans, a very rare piercing because of anatomical restrictions, or passes through the hood of the clitoris, the loose tissue surrounding the clitoral shaft, many women experience a totally new level and type of sexual sensation during masturbation, partner sex, and sometimes even during regular daily activities. Some of these women experience orgasm easier, and these orgasms are sometimes more intense. Sometimes these sensations are too intense for the woman to deal with during daily activities and require the removal of the jewelry. Some women don't experience these new sexual feelings, but there is no way to predict this beforehand. It is a matter of trial and error. Genital piercings do have risks associated with them. As with any surgical procedure, when the skin is cut, there is the risk of infection if proper sterility isn't practiced. The placement of the piercing is also critical to the success of the piercing. Because the piercings are located between the thighs there can be a lot of movement of the tissue there when walking. This can result in the piercing migrating out of the tissue resulting in the jewelry needing to be removed. If properly done and cared for, these piercing can be beneficial to the women who want them. They aren't likely to benefit women who don't want them for themselves, but get them at their partners request.
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Other women have Plastic Surgery performed on their clitoris or vulva to change its appearance, and sometimes to expose their clitoral glans to direct stimulation. The later procedure is commonly called "female circumcision" and refers to the practice of removing the clitoral hood, the loose fold of tissue that covers the glans of the clitoris. Many women have a hood that totally conceals the clitoral glans and prevents its direct stimulation by finger or tongue. Most women need this hood to protect their extremely sensitive glans from direct stimulation, as they would feel pain not pleasure if it were directly touched. Some women are able to expose the glans by pulling the hood back but desire not to have to do this, to free up their or their partners hands during sex. It is commonly accepted by sex therapists that there is no need for female circumcision, most women's clitorises work fine just the way they are. The women who have had this done do usually report favorable results, but it isn't a cure all for sexual dysfunction, and can make matters worse if done for the wrong reasons. After circumcision the exposed clitoral glans if usually very very sensitive, requiring women to relearn how to masturbate, and partners to relearn their sexual techniques. No woman should take this procedure lightly.
Some women find their inner labia, labia minora, to be too large, unattractive, and uneven. While large uneven inner labia are perfectly normal and common, some women still expect and desire small and symmetrical inner labia. Perhaps because this is how their labia looked prior to puberty. At least one reference states two thirds of women have inner labia that project out beyond their outer labia. Also, as with female breasts, one side is often larger than the other. Some women complain of pain during intercourse, caused by their large inner labia being drawn into the vagina where they are pinched by the thrusting penis. While most doctors seem reluctant to do this procedure, labioplasty, some do. The reason for their reluctance is they don't see a medical problem. They may exam several women a day with large uneven inner labia, but few report them as being a problem. If a doctor does perform this procedure, I'm not aware of it having a negative impact on a woman's life or sexual pleasure. Some women have had some of the fat removed from their pubic mound and outer labia to make their clitoris more prominent. This is suppose to help women experience orgasm during intercourse. I have also heard reports of women having their outer labia made fuller and more pronounced, versus flat and indistinct. These are new procedures and I think the jury is still out on them.
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While perhaps very rare, some women desire a larger clitoris and use steriodal creams and other forms of Steroids to cause this result. While perhaps a form of penis envy, it can also just be a believe that bigger is better. Since the clitoris is made up of the same tissues as the male penis, it is sensitive to testosterone. If exposed to increased levels of testosterone, the clitoris will become larger and take on the shape of a male penis, minus the urethra, and the woman will experience pronounced erections. The younger a woman is when she does this, the larger her clitoris will become, heredity place a part in this too. Steroids will also cause the clitoris to become much more sensitive to stimulation, perhaps too sensitive. These steroids can also cause other male traits to develop in women, like heavy body hair and a deep voice, not to mention aggression. There is no indication that the size of a clitoris has any affect on a woman's ability to achieve orgasm. Women who take steroids to increase their muscle mass for weight training and sports will also likely experience an increase in clitoral size. While perhaps not the reason for taking the steroids, I think many of these women like their larger clitoris, but I have heard of one such women asking a doctor to remove her enlarged clitoris. If a woman stops taking these steroids, her clitoris will shrink a little in size, but it will never return to its former size, and her erections will become less pronounced. Sometimes women are prescribed steroids to treat gynecological conditions, these steroids can also cause a woman's clitoris to become larger. I know of one woman who was very happy with this unexpected side affect. Perhaps the most extreme form of steroidal usage and surgical modification involves Female to Male Transsexuals. The steroids cause the clitoris to achieve a length of 2 to 3 inches, and then doctors create a small penis by releasing the clitoris from it surrounding tissue, and create a urethra out of the inner labia. The outer labia are sewn together to form a scrotum, complete with prosthetic testicles. While on the small size, they do assume the appearance of adult male genitals.
There are some women, again a rare few, who place their clitoris in a small Vacuum device to draw blood into the clitoris causing it to temporarily swell and increased in sensitivity. This is similar to what some men do when engaging in vacuum pumping, a vacuum cleaner isn't used for this. If done carefully and cautiously this can be a pleasurable experience for a woman. If done often, permanent enlargement can result, so I gather. 116
Clitoral & Labial Size
It may be hard for many to imagine why women should be concerned about the size and shape of their genitals. This is because we often do not envision women as having external genitals; everything is supposed to be inside their body and out of sight. Women have a vagina. This is what we are told in school and life. The fact that girls and women have a vulva is seldom mentioned. Only boys and men are supposed to have external genitals. What most people do not realize is women and girls do in fact have genitals that come in all shapes, colors, textures, and sizes. As young girls, women may come to see their genitals as nothing more than a smooth dimple between their thighs. What is there is small, smooth, pink, and While the genitals of young girls do vary they all look pretty much the same to the casual observer. (There are normal and healthy preadolescent girls who have very prominent labia and clitorises.) Young girls are not likely to know the vulva of their mother and other adult women often look much different from their own. Since pubic hair usually conceals the genitals of adult women even if girls see adult women naked they are likely to believe their genitals look the same. Not allowing girls to examine the genitals of their mother and other adult women, and by not permitting them to see pictures of vulvae, can have a very negative affect on their self-image later in life. 117
Puberty: The Time of Change During puberty a girl's genitals can undergo a major transformation. Before puberty the skin of the vulva is thin and easily injured and irritated. Even before noticeable breast development the tissues of the vulva start responding to increased hormonal levels by becoming thicker and larger. During puberty a girl's inner and outer labia, hood, clitoris, and hymen often increase markedly in size. Not only may the size of a girl's genitals change but also their shape, color, and texture. Since pubic hair also starts growing at this time girls are less likely to be aware of these changes unless they go looking with a mirror or notice while exploring with their fingers. Even if a girl bathes with other girls she is not likely to be aware that they too have experienced the same changes. Girls and women after all are not usually permitted to play genital show and tell; mutual exploration is not unusual among young girls. (Girls and women usually glance at the genitals of other girls and women when they have the opportunity, because of natural curiosity.) Following puberty a girl's genitals may look nothing like they did during childhood. If teenagers and women examine their genitals they may become concerned about these changes, feeling strange and perverse. They may feel they have deformed their genitals while masturbating, and as a result everyone who sees their genitals will know they masturbate. They may feel they are being punished for having sexual thoughts. It is for these reasons that girls and young teenagers should be made aware of these changes. They should know these changes are normal and necessary, as to help improve their self-image. You do not want them to feel a need to hide their genitals.
Exploring Forbidden Territory
In years past women would never think of looking at or even touching their genitals. This was strictly the responsibility of a doctor. Their own genitals were off limits. Today, women are more comfortable with their bodies and are more likely to explore their genitals. When they explore their genitals they may not be happy with what they find. Women usually have an unrealistic expectation of how their genitals should look. 118
Most anatomy books portray the female genitals as small and uniform. If the illustrations are in color the vulva is usually shown as being uniformly pink. As a result, it is reasonable to believe that many women feel uncomfortable with the appearance of their genitals even if they feel comfortable about looking at them. This may have major repercussions on their sexuality. We tend to hide that which we are ashamed of and embarrassed by. Since so many women do view their genitals with some degree of shame they feel very uncomfortable with the idea of looking at photographs of other women's genitals. They feel such pictures, and people looking at them, are inappropriate. The truth is these photographs hold the key to helping women come to appreciate and understand the normal diversity of the female genitals. A woman can spend all day in a woman's locker room and never see a single vulva, as pubic hair usually conceals them from view. The only means most heterosexual women have of seeing other women's genitals is through photographs and video, because women are not likely to compare their genitals with their friends. Wings of a Butterfly The area that seems to concern many women is the shape, size, and color of their inner labia, labia minora. For many women their inner lips are larger than their outer lips, labia majora. Many if not most women do not have the simple heart shaped labia shown in popular texts. The color of their labia may be brown or black rather than the presumed pink. They may be thick and wrinkled versus thin and smooth. As the photographs and illustrations on this page clearly show the inner labia come in a multitude of normal sizes and shapes. These photographs and illustrations more accurately demonstrate the natural diversity than perhaps any other source. Popular men's magazines do not usually show such diversity. The concern over labial size and shape is perhaps greater for women of nonCaucasian races as most anatomy books are based on Caucasian ideals. Women and doctors are not likely to be aware of the fact that girls and women of one racial group originating in South Africa normally have distinctive labia minora that project up to four inches passed the labia majora. These girls and women may be seen as deformed by themselves and their doctor. There appears to be an example of this on Dr. Alter's website. Labia that project beyond the outer labia are common and normal in all races of women, but it is not as common, being almost universal, as it is in these African girls and women. The amount of projection for all races of women can be up to a couple of inches when the labia are at rest, or more when the labia are spread open.
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Rubber Girl! The inner labia can be modified, as they have nothing in their structure to maintain their size and shape if they are distorted for any length of time. They are often very elastic and easy to stretch. Their internal structure is much like a sponge. If a woman happens to masturbate by pulling on her inner labia she can cause them to become longer and thicker. A rare few actually desire larger inner labia and pull on them regularly causing this result. Some have achieved this by piercing their inner labia and hanging small weights from inserted jewelry. Contrary to popular believe most girls or women's masturbation practices will not change the shape of their genitals, at least drastically. If a woman masturbates regularly she may develop larger blood vessels and erectile tissues, which will result in slightly larger genital structures. This is an indication of health not disease. Having large genital structures is not an indication of masturbation as some claim. Mine are Bigger than Yours! In some cultures women with large inner labia were/are considered very attractive so girls and women took to the habit of intentionally making them larger. They may have started the practice as very young girls and continued it into adulthood. They often employed ritual masturbation, sometimes mutual, in pairs and groups. Some used a handful of grass to allow for a better grip on their labia. Others wrapped their labia around a piece of animal horn or a small stick. They also applied naturally occurring irritants to cause the labia to swell and increase in size. Others used symbolism, like applying the ashes of burned bat wings to their labia. In these societies labia minora four to six inches (10-15cm) in length were considered most desirable. These practices shocked the early European explores, who were often representatives of European religions, and were quickly eradicated or driven underground. Estrogen Sensitivity The labia minora are very sensitive to estrogen and exposure to increased levels can result in their enlargement and increased sensitivity. This may occur during pregnancy. This can become a very uncomfortable condition requiring a doctor's attention. Prescription drugs and creams can cause this. Most large labia occur as the result of genetics, not environmental causes. How Big? Dickinson reports having examined a woman's labia minora that measured 7.5cm (3 inches) each, 15cm (6 inches) tip to tip, when spread open, and achieved a length of almost 11.5cm (4.5 inches), 23cm (9 inches) tip to tip, when placed under moderate force. He further reports 5 cases that measured between 5 and 7.5cm (2-3 inches) when spread open. See the illustrations shown at the bottom of the page.
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Size of the Labia Minora Based on examinations of 2,981 women Length
Number of Women
Percentage
0 to 2cm
0 to 3/4in
2,613
87.7
2cm
3/4in
146
4.9
3cm
1 1/4in
170
5.7
4 to 5cm
1 1/2 to 2in
32
1.1
5 to 6cm
2 to 2 1/3in
20
0.7
As gathered by Bergh, and presented by Dickinson.
Women Aren't Supposed to Have One of Those! It may shock many to learn that some normal and healthy genetic females have a penis, or at least a clitoris that looks like a penis. Actually, all females have a penis; we just prefer to call their penis a clitoris. While some object to this analogy it is accurate from a sexual and biological perspective. A penis and clitoris are made up of the same tissues and function the same because they develop from the same fetal structure. In males the penis is usually exposed to increased levels of androgens, one of which is testosterone, in the womb. This results in males having a more visible penis, but not necessarily a larger one. During part of their time in the womb all females also have a very large clitoris, in proportion to the rest of their body, because of the sequence in which things develop. In the end having a penis is not the sole privilege of men and boys despite what society may dictate.
What a Cute Baby ??? As a result of genetics or having been exposed to increased androgens in the womb 121
some infant girls are born with a clitoris that looks much like a "penis;" often to the dismay or embarrassment of her parents and the medical personnel. It is important to keep in mind she is still a normal and healthy "girl." She is not deformed or imperfect. Instead of reassuring the girl's parents that she is perfectly normal doctors often cut the girl's clitoris off or surgically reduce its size on the premise of correcting a mistake by nature. This is supposed to result in the girl growing up to be a normal and healthy adult woman; one who does not question her sexual identity. The truth is even if her large clitoris is removed she may still question her biological sex, as biological sex is the result of hormonal and genetic imprinting. If she is actually a he cutting off her "penis" will not change her true sex. A person's physical appearance may have no bearing on their true sex or sexual orientation, as male and female are physically slightly different versions of the same thing. A girl or woman may question the gender or gender role assigned her by society regardless of how her body looks. Parents should not consent to cosmetic surgery on or frequent examinations of the genitals of their children, of either sex. If there are no medical problems, there are no problems. More than Meets the Eye! The only real difference between a clitoris and penis is the average size of the portion we can see with our naked eyes. Three fourths of the clitoris is hidden from view. The average clitoris is about four inches in length, the same as a flaccid penis. Illustrations in the Anatomy area reveal the true size of the clitoris. The only other difference between the two is that the urethra of the clitoris does not extend all the way to the tip of the glans, as is the case even with some penises! Measuring Up! An article published in the Journal of Obstetrics and Gynecology in July 1992 states that the examination of "200 consecutive normal women at routine gynecological examination" revealed the average crosswise width of the clitoral glans to be 3.4 mm (0.13 inches) with a range of 2.4 to 4.4 mm (0.09 - 0.17 inches) and the lengthwise width was 5.1 mm (0.20 inches) with a range of 3.7 to 6.5 mm (0.15 - 0.26 inches). This means the average clitoral glans is smaller than a pencil eraser. The average total clitoral length including the glans and body was 16.0 mm (0.63 inches) with a range of 11.7 to 20.3 mm (0.46 - 0.80 inches). The clitoral index (CI), the product of the clitoral glans lengthwise and crosswise widths, was 18.5 mm2 (0.03 inches2). There was NO correlation between age, height, weight or use of oral contraceptives and clitoral size, but women who had given birth had "significantly larger measurements." Dr. Robert Latou Dickinson states in his book Atlas of Human Sex Anatomy, published in 1949, that "normal" clitorises had a crosswise width of 3 to 4 mm. (0.12 0.16 inches) and a lengthwise width of 4 to 5 mm (0.16 - 0.20 inches). Based on one hundred examinations, he found five percent of women had a clitoral glans that measured 0 to 2.5 mm (0 - 0.10 inches), seventy-five percent measured between 2.5 and 6.5 mm (0.10 - 0.26 inches) and twenty percent measured between 6.5 and 15 mm (0.26 - 0.59 inches). He mentions others who had given lengthwise measurements of 5.6, 6.7, and 8.0 mm (0.22, 0.26 and 0.31 inches). He attributes the variation in measurements to whether intersexed individuals were included in the sample data, which would account for a larger average size. The determination of 122
"normal" is often arbitrary. An article published in the Journal of Obstetrics and Gynecology in November 1979 states that clitoromegaly is defined as when there is a CI of greater than 35 mm2 (0.05 inches2), which is almost twice the size given above for an "average" sized clitoral glans, but is still relatively small, as a clitoris equal in size to a pencil eraser meets this definition. An article published in the Journal of Pediatric Endocrinology & Metabolism in Israel compared the clitoral size of newborn girls of two ethnic groups, Jews and Bedouins. They found a "significant difference in clitoral length (12.6%) between the Jewish group (5.87 +/- 1.48 mm) [0.23 +/-0.06 inches] and the Bedouin group (6.61 +/- 1.72 mm) [0.26 +/- 0.07 inches]". While statistically there is a significant size difference, 0.74 mm (0.02 inches) doesn't seem like much to me. It should be noted that at birth the clitoris is proportionally larger than it will be later in life, as a result of having been exposed to the maternal hormone levels, that is the clitoris will decrease in size soon after birth as the affects of those hormones diminish. I am not aware of comparisons between other ethnic groups. The visible portion of the clitoris of some girls and women is reported to measure up to about 2 1/2 inches (6.3cm) in length and nearly 1 inch (2.5cm) in diameter. When they are of this size, they look very similar to a penis. The only difference being a groove along the bottom side of the clitoris, where the urethra would be located on a penis. While urine may not travel out the tip of these large clitorises, they do look and function like a penis. These women, as well as women in general, are capable of experiencing erections, the sensation of having a "hard-on," producing ejaculate in their paraurethral glands, and even ejaculating. Women with large clitorises are even able to engage in intercourse, by inserting their clitoris into their partner's vagina or anus.
Will It Get Bigger? The structure of the clitoris does not lend itself to change easily, as the result of mechanical forces. The masturbation habits of most women are not likely to affect the size of their clitoris, other than perhaps causing a slight increase in its size do to better blood circulation if they masturbate on a regular basis. Again, a sign of health not disease. Using unusual force, such as drawing increased amounts of blood into the clitoris with a vacuum pump on a frequent basis, can result in an increase in size as the vascular structures are slowly stretched and enlarged to accommodate the additional blood. There probably are not too many women who do this, but with the advent of the Internet this may change. Since the intial writing of this article, the Food and Drug Administration (FDA) has approved a clit pump for the treatment of female sexual dysfunction. 123
The Idolized Clitoris There are some references that indicate a large clitoris was also considered attractive among some cultures, so again girls and women engaged in practices to cause this result. The validity of these claims is somewhat in doubt, but seem likely. It is not known whether the clitoris was actually enlarged by these practices or if the clitoris was more pronounced as the result of increased mobility caused by the stretching of the connective tissues. The clitorises of these women may have been more visible versus larger. Androgen Sensitivity The clitoris is very sensitive to androgens like testosterone. Prescription and nonprescriptionsteroidal drugs can cause a woman's clitoris to increase in size. Some clitorises achieve a maximum length of about 2 1/2 inches (6.3cm), if steroids are taken for an extended period of time and depending on the age of the woman. Female athletes who take steroids to increase muscles mass and strength often experience this side affect. As do female to male transsexuals. Sometimes steroids are prescribed to treat other medical conditions, like lack of libido, causing this result, but usually to a lesser degree. The vast majorities of large clitorises are the result of genetics, not drugs as some presume, believing a giant sized clitoris cannot be natural. Penis Envy? While there is no evidence to support the claim that a bigger clitoris functions better, a few women do have a form of penis envy. As more women are learning that their clitoris is much like a small penis and capable of being much larger, some are expressing a desire to enlarge their clitoris. Perhaps in hopes that if it were larger it would function better and be easier for their partner and themselves to find and stimulate. A few women may even desire a little penis of their own, even if they are happy being a feminine woman. In addition, if a woman feels better about the size of her clitoris, she is likely to be more sexual and more sexually responsive having acquired a larger clitoris, or even a smaller one. Our brains are our largest sexual organ after all. It is important to keep in mind the brain plays a larger part in female sexual pleasure than does the clitoris, regardless of the size of the clitoris. At this time, I am not aware of any safe and proven ways of making the clitoris larger that does not expose a woman to undesired side affects.
One Woman's Comments:
Thank you for the honest information about labial sizes & the photos on your site. I went on the web looking for something like this. I have always been acutely selfconsciousabout my labia minora, as they are about 3 cm [1.25 in] long & as far as I had ever seen, no other woman I knew of looked like this. I thought I was ugly and was very embarrassed. In high school I hated 124showering where anyone could see
me, and felt a lot of anxiety about this whole area of my body. Even as a married woman I have repeatedly asked my husband if I am ugly, if he thinks it is disgusting etc. When I asked my doctor about it, she dismissed my interest and just said it looks normal. But as you say on the site, all the books with diagrams etc. look nothing like me, so I couldn't see how I could be normal. My daughter is now six and I have noticed that her labia seem to be developing similar to my own. I thought "oh no!" Then I realized I should get some facts. I wanted information to share with her so she would understand her body and why it is built the way it is. I didn't want her to go through the same anxieties I did. I am thrilled to find your site. Thank you for putting this info out there. The following images demonstrate just how varied the female genitals are.
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New Anatomy Research
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""If it is permissible to give names to things discovered by me, it should be called the love or sweetness of Venus," urged one of the great and immodest anatomical explores of the Renaissance {Renaissance in Europe, 14th, 15th, and 16th centuries.} Like Adam, he claimed the privilege of naming what he had been the first to see: that which was "preeminently the seat of women's delight." This Columbus, not Christopher but Renaldus, announced with much fanfare in 1559 that he had rediscovered the clitoris. ("O my America, my new found land!")
In 1905 Sigmund Freud rediscovered the clitoris, or in any case the clitoral orgasm, by inventing its counterpart. After four hundred, perhaps even two thousand years, there was all of a sudden a second place postulated from which women derived sexual pleasure. In 1905, for the first time, a doctor claimed that there were two kinds of orgasm and that the vaginal sort was the expected norm among adult women. Both discoveries were and are controversial. Columbus's colleagues disputed his 127
claim to precedence, arguing that the organ about which he made such a fuss either had been discovered by someone else or had been common knowledge since Antiquity. Freud's discovery generated an immense polemical {polemical - an argument or controversial discussion} and clinical literature. More ink has spilled, I suspect, about the clitoris than any other organ, or at least about any organ its size. I shall no enter directly into these controversies. Instead I want to sketch the history of the clitoris in Western, predominantly medical, literature in order to make two points. In the first place, prior to 1905 no one though that there was any other kind of female orgasm than the clitoral sort. It is well and accurately described in hundreds of learned and more popular medical texts as well in a burgeoning pornographic literature. Thus, it is simply not true that, as Robert Scholes has argued, there has been "a semiotic coding {semiotics - the analysis of signs used in language} that operates to purge both texts and language of things [the clitoris as the primary organ of women's sexual delight] that are unwelcome to men." The clitoris, like the penis, was for two millennia both "precious jewel" and sexual organ, a connection not "lost or mislaid" through the ages, as Scholes would have it, but only - if then - since Freud. To put it differently, Master and Johnson's revelation that female orgasm is almost entirely clitoral would have been a commonplace to every midwife and had been anticipated in considerable detail by nineteenthcenturyinvestigators. For some reason, a great amnesia in this matter scientific circles descended on around 1900 so that hoary truths could be hailed as earthshatteringlynew in the second half of the twentieth century. My second point is that there is nothing natural about how the clitoris is construed. It is not self-evidently the female penis nor is it self-evidently opposed to the vagina. Nor have men always regarded clitoral orgasm as absent, threatening or unspeakable because of some primordial male fear of, or fascination with, female sexual pleasure. The history of the clitoris is part of the history of sexual differences generally and of the socialization of the body's pleasures. Like the history of masturbation, it is a story as much about sociability as about sex."
Reinventing the Clitoris
It is not just men who have thought they were the first to discover the clitoris. I have read women's accounts of how they discovered their own clitoris, believing they were the only person to have one. Sometimes this discovery occurred while they were young, other times when they are grandparents. How is it possible that someone is led to believe they are the first to discover an external anatomical structure that has existed for as long as we have as a species? Especially given its sensitivity to touch!
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If you have never heard of the existence of the clitoris, and you suddenly stumbled across one, while exploring your own or a partner's body, you would believe you were the first to discover it as well. A person can be led to believe they were the first to discover anything, if they are convinced no one else had done so before them. To create such a person, all you have to do is deny something exists, or simply act as if it does not. If and when someone does find it, they will be the first, or so they believe. Since our society acts like the clitoris does not exist, that means there are millions of people, male and female, who are potential discoverers of the clitoris. To hinder this discovery process, we make a woman's vulva off limits to her and her partner. If you cannot go into the forest, you cannot discover that which lies within. We would like to fault doctors and medical professionals for not knowing, or making available, more information about the clitoris, but are they to blame? Before a person becomes a doctor, they are a member of their community and adapt the standards of that community, which adapts the standards of that society. If an entire society does not acknowledge the existence of the clitoris how then can a single doctor or medical professional? If a society does not permit the discussion of sex, can a doctor openly discuss a purely sexual organ? If a doctor cannot examine a woman's clitoris and ask her questions about how it functions, how is he or she going to learn about the clitoris? If by examining a woman's clitoris a doctor risks going to jail for sexual assault, for touching her "sexually," is he likely to do so? If the majority of cadavers available at medical schools are male, how many doctors will be able to study the anatomy of women firsthand? Even if a doctor wants to be an expert on the anatomy and function of the clitoris, there are many social barriers in place to prevent them from doing so. With all of this in mind, the article titled The Truth About Women that appeared in the August 1, 1998 edition of the magazine New Scientist gave Dr. Helen O'Connell more credit than she warrants. This statement in not meant to diminish the importance of the information she did bring to light, even if she is not the first to do so. What this article does demonstrate is, how little the female authors knew about their own anatomy. Dr. O'Connell admits to the prior existence of much of the information she presented, in old French and German anatomy texts. Some of which 129
are presented on this website. In the medical journal that Dr. O'Connell's research results were first presented, she mentions how incomplete and inaccurate the information is on the anatomy of the clitoris in the majority of anatomy texts; which is unfortunately extremely true. If you look at Gray's Anatomy, the bible of anatomy, you can see that it hardly addresses the anatomy of clitoris in its text and illustrations. This is true for most anatomy books. The incomplete information presented in Gray's Anatomy is often copied word for word in later anatomy texts. With the passage of time, little new knowledge has been gained about the clitoris. The reason for this is, our society as a whole has deemed it inappropriate and unnecessary, since the clitoris serves no purpose, according Freudian thinking. What Dr. O'Connell has to say about the accuracy is perhaps not completely true. The information presented in each of these old references is likely based on the dissection of a single female body. It has always been harder to acquire the bodies of women than men, especially young women. As a result, the information presented is usually inaccurate for the majority of women, at least the details. Dr. O'Connell found there was a lot of variation between the women she dissected, if she had based her research results solely on any one of them, her results would be considered just as inaccurate when compared to someone else's results. What does Dr. O'Connell's research reveal or confirm about the anatomy of the clitoris and the surrounding structures? The resulting photographs, shown below, provide an exceptional record of the anatomy of the clitoris and the surrounding structures. I'm guessing the originals that were submitted for publication were in color, based on a statement in the original article. The erectile structures are usually much larger in premenopausal women. This means, the size of a woman's erectile structures are in part determined by hormone levels. An eighteen year old likely has a larger clitoris than a sixty-five year old. The urethra is surrounded on three sides by erectile tissue. There is no erectile tissue between the vagina and the urethra. It is perhaps inaccurate to consider the bulbs to be associated with the vestibule, as they are more closely associated with the clitoris and urethra. The body of the clitoris is 1 to 2 cm. (0.39 to 0.79 in.) wide. The body of the clitoris is 2 to 4 cm. (0.79 to 1.57 in.) long. The body and crura of the clitoris have a "deep pink" vasculature. The body of the clitoris projects outward from the pubic bone, versus lying against it as it is often shown. The crura are 5 to 9 cm. (1.97 to 3.54 in.) long. The bulbs are 3 to 7 cm. (1.18 to 2.76 in.) long. The bulbs have a "deep blue vasculature." They saw no evidence of the previously reported vestibular (Bartholin's) glands. The dorsal nerve of the clitoris is "noticeably large," being greater than 2 mm. (0.08 or 5/64th in.) in diameter. It is visible to the naked eye. 130
Dr. O'Connell's newer research article published June 2005.
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Female Body Fluids
This page will be used to present information about the different body fluids that a woman's body produces during sexual activities, or that play a part in these activities. Vaginal Secretions "Vaginal secretions contain many things, including sweat, sebum, and secretions from Bartholin's and Skene's glands at the vulva, endometrial, and oviductal fluids (which change with the menstrual cycle), cervical mucus, exfoliated cells, and secretions of the vaginal walls themselves, which increase with sexual arousal. All women's vaginal secretions include pyridine, squalene, urea, acetic acid, lactic acid, complex alcohols (including cholestrol), glycols (including propylene glycol) ketones, and aldehydes.
But a more detailed chemistry of the acids in vaginal secretions separates women into two groups. All women produce acetic acid, but one third of them produce shortchain aliphatic acids as well. The short-chain aliphatic acids, which include acetic, propionic, isovaleric, isobutyric, propanoic, and butanoic acids, are a pungent class of chemicals which other primate species produce as sexual-olfactory signals. Although no one has yet proven the acids' role in the mating behavior of humans, some researchers have referred to them [as] "copulins" and "human pheromones."
Like the volatile acids produced on the skin, the vagina's aliphatic acids come from the metabolic processes of resident bacteria, including Lactobacilli, Streptococci, and Staphylococci. For all women, the acid content varies with the menstrual cycle, rising from day one after menstruation and peaking mid-cycle, just before ovulation. The amounts vary more dramatically in the acid producers, however, and one study, whose authors describe their subjects as "young, healthy, and members of the socioeconomic class that attends a privately endowed university," determined that people can reliably smell changes in an acid-producing woman's vaginal secretions over the course of her cycle, but not in the secretions of non-acid producers. "
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Sebum "Sebum, skin oil, functions to reduce moisture loss through our skin, protect it from infection, and lubricate it in contact areas. It also makes hair shiny and waterproof and helps generate scents. Sebaceous glands occur all over the skin, except for the palms and soles, and are largest and most numerous on the back, forehead, face, ears, genitals, and anal region. Most connect to hair follicles, but some, such as the Meibomian glands (in the eyelids), Tyson's glands (in the foreskin), and the sebaceous glands around the nipples and along the edge of the upper lip, empty directly onto the surface of the skin. On some people, you can see the ones along the lip as pale yellow specks, or "Fordyce's spots." Sebum consists of 57.5% glycerides and free fatty acids, 26% wax esters, 12% squalene, 3% cholesterol esters, and 1.5% cholesterol, but despite its fatty waxy content, sebum production does not correlate with dietary fat intake. However, it does correlate with levels of testosterone and other androgens. Men produce more sebum than women and prepubertal boys, and uncastrated men produce more than eunuchs. Male sebum production increases fivefold during puberty, causing acne. But interestingly, newborns secrete sebum at adult levels for a short time after birth, and women secrete greater amounts during pregnancy and lactation." "Body surface odors come from microbial breakdown of sweat, sebum, and scaledoff skin cells. Different bacterial digest these materials into different sets of chemicals. Meanwhile, the mixture of bacteria species varies over different body 133
regions. As a result, the odor-determining chemical mixtures produced on the skin of different parts of the body also vary. "Especially strong scents will come from any areas where these desquamated epithelial cells can build up, such as on scalps, under toes-nails, in navels, and under foreskins. In these places, the bacteria have a feast, generating hefty quantities of local odorants. " "Substances such as smegma and toe cheese, then, are a mixture of skin secretions and dead cells, along with the bacteria that lives off of them and the cheesy, cabbage-y, and fishy-selling waste products they produce as a result." Sweat "The adult body contains from two to four million sweat glands, at densities of around one to two hundred per square centimeter of skin. Together, they typically put out from one to three quarts of perspiration per day, although a day of exertion and thirstquenchingin the heat can make a body sweat out fifteen quarts or more." "Most of our sweat glands are eccrine glands, the salt-retaining cooling sweat glands, most prevalent on the back, chest, forehead, palms, and soles. But we have another, older type of sweat gland, apocrine, which helps produce scents used for personal identification and mating. These scent glands concentrate most highly in the underarms, but also surround the nipples, genitals, and anus, and as many have noticed, they respond to stress. Apocrine sweat contains an odor resembling musk, a substance secreted as a scent by deer and other animals and used in perfume. This has led some observers to remark that our toilet ritual has us wash away our own sweat and substitute the sweat of deer. An experiment conducted at International Flavors and Fragrances in New York showed that women who sniff musk develop shorter menstrual cycles, ovulate more often, and conceive more easily." "Apocrine sweat has no odor when it arrives on the skin surface, but it is immediately broken down by bacteria, including Staphylococcus epidermis (the most prevalent), S. saprophyticus (more prevalent in winter), S. aureus (more prevalent in summer), Escherichia coli, and various species of Corynebacteria, Brevibacteria, Propionibacteria (more prevalent in men), Enterobacter, Klebsiella, and Proteus. These flora generate compounds such as androstenone ("stale urine" smell), androstenol (nice "musky" odor), and isovaleric acid (sweaty or "goatlike" smell)." Caution! Despite what ads tell us on television and in print, the bacteria present on our skin is most often beneficial. By using antibacterial soaps and the like you kill not only potentially harmful bacteria but also beneficial ones. Some doctors are concerned that we will decrease our resistance to many diseases if our body becomes unaccustomed to fighting off other less harmful strains. The vulva and vagina are home to a delicate balance between good and bad bacteria, killing off the good bacteria actually increases your chances for yeast infections, etc. Be aware of exactly what you put on your body, especially your vulva and vagina. Your body is quite capable of caring for itself if it is permitted to. 134
Definitions Endometrial: Pertaining to the mucus lining of the uterus. The inner most layer. Oviductal: Pertaining to the fallopian tubes. Exfoliated: Dead skin cells that have flaked off the surface of the skin. Sebaceous Glands: Oil producing glands that populate the surfaces of the skin. Androgens: A group of hormones associated with male secondary sexual characteristics. Desquamated: The process by which the outer layer of skin cells are shed. Epithelial: The outer layer of skin that covers the body. Eccrine: Oil producing glands that open directly out onto the surface of the skin. Apocrine: Oil producing glands that populate the hair covered areas of the body; they become active during puberty. They are located at the base of hair follicles. Responsible for the strong odors associated with sweating.
Female Ejaculation, the Female Prostate, and The G-Spot
From the book View of a Woman's Body Illustrated By: Suzann , L Ac, RNC, NP
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Female Body Fluids Before discussing female ejaculation I will first address female body fluids in general. Our society, as well as most others, views all form of liquid that are produced by the female body with great disdain. Women are not permitted to engage in any activity that would expose others to their body fluids, and they are viewed as less than feminine and desirable if they do. Female body fluids are considered harmful by many and there are societies in which menstruating women are thought to cause crops to fail and livestock to die. This creates a significant barrier to sexual pleasure for women, as female body fluids are a normal and necessary part of sex. Women are expected to maintain a dry pristine appearance regardless of the activities they participate in. Mothers once told their daughters it was unwise to engage in sports, as boys would see them sweaty and disheveled, and this was seen as unattractive. Today, deodorant and antiperspirant ads drive home the idea, "Do not let them see you sweat." Women are told they need special stronger deodorants made specially for them. Tampon and sanitary napkin advertising often emphasizes the product's ability to conceal a woman's menstruation from others more than their primary task of absorbing menses; yet in the process they remind us that women do menstruate. Most women would prefer to have their fingernails ripped out one by one rather than be seen having an "accident," menstruating in public. Society and the media serve to create a barrier between women and their sexual pleasure. Sweaty men are seen as sexual, virile. Their manhood is measured by their ability to produce large quantities of semen. They write their name in the snow with their urine and see who can ejaculate the furthest. For men making a mess with their ejaculate is seen as unavoidable, normal, and is never questioned. It is even idolized in adult movies. Men can ejaculate on the face, in the mouth, and on and in the body of their partner and it is seen as normal and desirable. If a woman gets her body fluids on her partner that is another story, she has made a dirty mess. This is an interesting double standard. If a man can cover his partner with his body fluids a woman should be able to do the same. Female sexuality is marred by these unwritten laws. Many women produce relatively large amounts of body fluids during sex. Especially if they are highly aroused for an extended period of time and/or experience female ejaculation. It is hard to relax and enjoy sex if you are worried about sweating heavily or producing too much vaginal lubrication. Since women have no control over the release of these body fluids some avoid sex all together rather than risk being seen as less than feminine by their partner. Before a woman can learn to ejaculate, enjoy ejaculating, and enjoy sex in general she must accept all her bodily fluids as normal. She must not question the nature or quantity of her wetness, be it sweat, vaginal lubrication, menses, ejaculate, or liquid from her bladder. These fluids are a normal and natural part of women's lives. There is nothing that is inherently bad or harmful about them. A woman cannot allow herself to ejaculate and experience potentially earth-shattering orgasms if she cannot let go when the pressure or urge to ejaculate arises. Ladies, give yourself permission to get wet and messy. Give yourself permission to have fun and enjoy sex. 136
As a result of the taboos concerning female body fluids the main motivation behind the studies into female ejaculation appears to be the determination of whether or not the expelled fluid is from the bladder. Some believe that if a woman ejaculates a liquid that is not from her bladder she is normal, but if is from her bladder then she has a medical problem and is abnormal. Why the great debate over the exact nature of this fluid squirting from women's bodies? Does it really matter whether it is liquid from the bladder or ejaculate? If a woman gets a thrill out of squirting liquid from her bladder at the moment of orgasm are we to say she has a problem? Do we mean to take this pleasure away from her? If a woman squirts liquid from her bladder at the moment of orgasm, let her, if she ejaculates uncontrollably, so be it. It is not our place to judge a woman's sexual pleasure.
The Female Prostate During early fetal development both male and female fetuses start out being physically female. This does not change until a male fetus begins to produce its own hormones around the eighth week of gestation. Only then does the physical development of the male and female bodies diverge, and then less than many may presume. This necessitates that female fetuses initially have structures that could develop into either "male" or "female" reproductive and
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sexual organs. This means the tissue that develops into the male prostate gland, the urogenital sinus, must also be present in women. This results in woman having a prostate gland too. The top image is a close-up of the individual glands that make up the female prostate. The female prostate, urethra, and vagina are actually part of a solid structure, as indicated in the illustration shown below. The female prostate is shown this way to help you identify its location. The bottom image allows you to more clearly see the location of the female prostate within the body. The first person known to have described the "female prostate" in Western medical literature was Reinier De Graaf (1641-1673) in the year 1672. He described it as a collection of functional glands and ducts surrounding the female urethra. He said the glands and ducts produced a "pituitoserous juice;" meaning it produces a thick mucous that is pale yellow or transparent in color. He said the function of this fluid was to make "women more libidinous with its pungency and saltiness and lubricates their sexual parts in agreeable fashion during coitus." Despite his observation modern Western medicine did not fully accept the concept of a "female prostate" until 2001 when the Federative Committee on Anatomical Terminology agreed to use this term in their next edition of Histology Terminology. Where did the female prostate disappear to for 329 years? Prior to the 20th century the term "female prostate" was commonly used within medical research literature but during the th20 century the female prostate was usually described as vestigial, i.e. not fully developed and non-functional, and was identified as either paraurethral or Skene's glands. While the components of the female prostate were known to exist they were not seen as structures of interest or importance; with a few exceptions. Since modern medicine did not see the female prostate playing an active and necessary role in reproduction it wasn't essential to understand its function. The female prostate is not believed to be affected by disease on a frequent basis and this likely contributed to the lack of interest within doctor offices and hospitals. When the female prostate became a medical concern by becoming enlarged or causing discomfort during urination or intercourse it was called female urethral diverticulum or female prostatitis. I wonder how many urinary tract infections (UTIs) have been incorrectly diagnosed and treated? The male prostate is an distinct organ that surrounds the male urethra but the female 138
prostate lies within the wall and along the length of the female urethra, as indicated in the illustrations shown above and below. It is part of and contained within the wall of the urethra, and the urethra is contained within the wall of the vagina. The average size of the female prostate is 1.3 inches long, 0.75 inches wide, 0.4 inches in height (3.3 x 1.9 x 1 cm), and weighs about 0.2 ounces (5.2 grams). Which means it is a relatively small organ about the size of a woman's thumb. Despite its smaller size "it possesses all the structural components of the male prostate." The image shown below demonstrates how the female urethra and vagina are contained within a common structure, as indicated by the circular outline that surrounds them. Anatomy illustrations usually lead us to believe they are two separate and distinct organs, which isn't true. They are drawn this way for the sake of visual clarity, but this can be misleading. This image helps us to understand why the female prostate is stimulated when the vaginal wall is stimulated, and why some women are susceptible to urinary tract infections (UTIs) after engaging in vagina intercourse. It also demonstrates how the vagina is a potential space rather than being an open cavity within the body.
The female prostate comes in many different shapes and sizes but the majority of women have a prostate that is positioned near the external urethral orifice, as shown above and below. When having this shape and placement it may cause the top wall of the vagina to project into the vaginal passage and the urethral meatus to project outward into the vestibule. When this occurs, you may not be able to see the actual glands of the prostate but you can see their affect on the surround tissues. In some women these projections are quite distinguished and noticeable, and increase during sexual arousal.
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From the book Eve's Secrets By Josephine Lowndes Sevely. Copyright 1987 Josephine Lowndes Sevely What Does the Female Prostate Do? We know little about the function of the female prostate and its role within the body. At present it is known to have two primary functions. The first is produce and store prostatic fluid in ducts, which is the function of an exocrine gland. The prostatic fluid contains prostate-specific antigen (PSA), prostate-specific acid phosphatase (PSAP or PAP), and fructose, a sugar. The numerous ducts of the prostate drain into the urethra. "Pure prostatic fluid has not yet been isolated and it has been studied only as a component of the female ejaculate..." The second function is the releasing of hormones into the blood stream, as a result of stimulation by the nervous system; a process performed by neuroendocrine cells. The only hormone known to be produced by the female prostate in this way, as of the year 2000, was serotonin. Serotonin plays an active role in many functions of the body. The female prostate is thought to be influenced by estrogens, as the male prostate is influenced by androgens, but I am aware that the male prostate is also influenced by DHEA, a precusor to both estrogens and androgens. PAP has been found on the underwear of women when it has been in constant contact with the vulva indicating the prostate is always producing prostatic fluid, and this fluid production begins with the onset of puberty. At this point, we simply need to acknowledge the existence of this organ and that it plays a role in the normal functioning of the female body; it isn't a figment of any one's imagination. What is Female Ejaculate? Female ejaculate is a fluid that is expelled from the body through the urethra during sexual activities. When released in small quantities it may be a mucous like fluid having a clear, milky, or yellowish coloration. As the volume of the expelled fluid increases it becomes like clear water. In small quantities it may have a distinct scent that is musky or pungent but when the fluid increases in volume and becomes clear 140
there is no longer a detectable scent. The fluid contains PSA and PAP, which are produced in the female prostate. Some of the components found in it, urea and creatinine, are also found in urine, but in much lower concentrations than are found in regular urine. When female prostatic fluids are found in urine they are in much smaller concentrations than in present in female ejaculate. The fluid released during ejaculation and urination are not the same though they may share some of the same substances. As the volume and appearance of female ejaculate changes it is likely that its composition changes too. Women who expel fluid during orgasm report the color, smell, consistency, and even taste, varies from one occurrence to the next. (It is safe for a person to taste their own ejaculate, and for couples who already exchange body fluids but not for couples needing to practice safe sex.) Some have found their menstrual cycle influences the type of fluid expelled. What you eat is likely to have an affect on it, as will how much liquid you have consumed. Some women report it is sometimes clear and odorless and other times thick and pungent. Others report it sometimes looks and smells like urine, which I have found to be true only when a woman tries too hard to ejaculate. It is safe to say most women's ejaculate will vary over time and during a single sexual episode. Do All Women Ejaculate? Given that all women have a prostate gland they all likely produce ejaculate even if they are not aware of it. The fluid may seep out and mix unnoticed with other body fluids rather than being a distinctive gush of liquid during sexual activity. The prostate probably contributes regularly to the moisture present at the vulva, as indicated by the presence of PAP on their underwear. In the absence of or in conjunction with sexual arousal the prostate may overflow causing the fluid to seep out through the urethra. This release of fluid could be caused by the blood engorgement of the surrounding tissues and the pressures placed on the vaginal wall during sexual arousal and internal stimulation. The fluid in the prostate would likely be released or expelled during orgasm when the pelvic muscles contract. While the volume of ejaculate released may vary from woman to woman it is likely present in all women and they do not have voluntary control over it. Where Does Ejaculate Come From? Very little medical research has addressed the source or sources of female ejaculate. The research that has been completed often provides conflicting results. Some research concludes it is only fluid from the female prostate while other research says it is mostly liquid from the bladder with trace amounts of fluid from the female prostate. It is my believe that in some cases all of the fluid emitted from a woman's urethra is from the female prostate, in other cases is a mixture of fluid from the female prostate and bladder, and in other cases it is only from the bladder. We simply do not know where the fluid originates from in every instance. How can you tell if a woman is releasing fluid from her bladder or prostate? This is a question that cannot be answered outside a medical lab. There is no accurate way of 141
determining whether a woman is voluntarily or involuntarily releasing liquid from her bladder or ejaculating prostatic fluid. These fluids all exit the body through the urethra so the visible source is the same for them all. I'm not aware of any color, taste, or scent test that can be applied to the expelled liquid that will accurately distinguish them from one another. We are left with no other choice than to see them as indistinguishable, the same. In her book The Clitoral Truth Rebecca Chalker states a simple smell test will tell you if it is urine or ejaculate. If the fluid has an acrid scent it is urine. This may be true but what difference does or should it make? My concern is that if a woman or her partner decides she is releasing liquid from her bladder then they may see it as undesirable and/or inappropriate. My position is, it does not matter what type of fluid is expelled, and being concerned about it creates a barrier to pleasure for women. It is okay to be curious about these fluids, that is only natural, but it is inappropriate to judge them.
If you read the information presented on the website of Dr. Gary Schubach he states his research has shown the majority of the fluid that is expelled originates in the bladder, but the expelled fluid is not quite normal urine. In his research the woman's bladder was emptied using a catheter prior to orgasm. During orgasm a catheter was in place and connected to a collection bag. Analysis of the fluid expelled during orgasm is the basis for his claim. There is one flaw with his methodology, the bladder sphincter is normally closed. If it were not, liquid in the bladder would simply flow out 142
and there would be no "ejaculation" of fluid. What is the significance of creating an artificial passage and collecting the fluid expelled from the bladder during pelvic muscles contractions? During orgasm does this passage normally exist even if only momentarily? Some claim otherwise or that ejaculate actually enters the bladder rather than exiting from it. Even if fluid does collect in the bladder during sexual arousal would it normally be expelled during orgasm? Are all women the same or are there "normal variations?" Dr. Schubach's research is important but it provides only part of the picture. The following series of images show how much the bladder, the bright white area in the lower right, increased in size during sexual arousal in one woman. Does it provide evidence to indicate the origin of female ejaculate in some instances? I know from personal experience that when my kidneys produce increased volumes of fluid it is clear and odorless when released from my bladder. Does sexual arousal in some women result in increased kidney output? These images were taken during research into the use of MRI to observe female sexual arousal and were not intended to provide evidence of the origins of female ejaculate.
How Much Liquid is Released? The amount of fluid released during ejaculation is reported to vary from a couple drops to almost two cups, 15 ounces [444 ml]. Two cups is a lot of liquid, can it really be that much? The average size of the female prostate is 1.3 inches long 0.75 inches wide 0.4 inches in height (3.3 x 1.9 x 1 cm). An elliptical container about this size when filled with water would hold 0.17 oz [5 ml] or 1 teaspoon. A cylindrical shape 0.75 inches across would hold 0.32 oz. If the female prostate can contain less than 0.4 oz where does the other 14.6 ounces come from? One study found women produced 30 to 50 ml [1 to 1.7 oz] [6 to 10 teaspoons] in 30 to 50 seconds. Okay, but 2 ounces is still a far cry from 15 ounces. Some believe the female prostate swells with fluid during sexual arousal, which would account for the greater volume of fluid. The prostate would need to increase in size by a factor of at least 9 if this is to be true. Interestingly enough the female bladder can hold about 16 ounces of fluid, and this is surprising close to the maximum amount of ejaculate reported. Keep in mind the female prostate will continue to produce fluid for as long as a woman is sexually aroused, and as result a woman could produce more than 0.2 to 2.0 oz of ejaculate if multiple releases of fluid occurs. If the female prostate fills and 143
empties at a rapid rate that would explain the larger volumes of fluid measured by some investigators. It would also mean the longer a woman's orgasm lasted the more she would ejaculate, as is often the case. If this is all true it is possible for a woman to ejaculate a considerable amount of fluid without it being liquid from the bladder. Obviously more research needs to be done to clarify this; perhaps using transvaginal ultrasound to observe the prostate during sexual arousal and orgasm. What Is and Who Has a G-Spot? The female prostate and the "Grafenberg spot" or "G-Spot" ARE NOT necessarily the same thing, or in the same location. And you thought all your worries would be over once you located the prostate gland. Some say the G-Spot is an area of high sensitivity located within the female prostate or is located further back along the urethra, closer to the bladder. The problem with any definition is the sensitivity of the G-Spot is unlikely to be constant. If a woman is not sexually aroused she may not have a G-Spot. If the same woman is highly aroused and her prostate gland is engorged with prostatic fluid she may have a very distinct G-Spot. There are perhaps women who are not aware of a G-Spot even though they ejaculate and experience a more intense orgasm when their prostate is stimulated. It is for these reasons that it is important for the reader not to form a concrete definition of what a G-Spot is. Each woman will create her own definition, one valid only for her. The next question for debate concerns whether or not "all" women have a G-Spot or G-crest. This is not really a valid question, as the G-Spot indicates the "sensitivity" of a non-specific area of tissue. The "G-Crest" defines the swollen "condition" of the female prostate during sexual arousal. At present there are no anatomical structure clearly associated with the "G-Spot." This is in part why people have trouble finding it. What one needs to look for are the female prostate and urethra. All women have these and it is likely they all produce at least a small amount of prostatic fluid that seeps out and mixes with the other fluids that are present in much larger quantities.
This photograph shows the texture of the front wall of then vagina when the prostate is engorged. The area encircled is normally inside the vagina and out of sight. This woman is using her hands and pelvic muscles to bring this area into full view. 144
How Do You Locate the Female Prostate? How does one locate the female prostate? Quite simply, you locate the urethra, as the female prostate is located within the wall of the urethra. The urethral meatus, or orifice, is located directly above the vaginal opening, below the clitoris. You can see it with your bare eyes, though it can be hard to locate in some women. The urethra extends back from the urethral meatus into the body along the front or upper wall of the vagina for 1.5 to 2 inches [3.8 to 5 cm]. While you can see the urethral orifice you cannot see the female prostate gland, though it may bulge visibly out into the vestibule and/or vagina. Using a speculum you might be able to see the swollen prostate gland projecting into the vagina. The video How to Female Ejaculate and others shows this projection. Adventures individuals may want to slip a finger or two into their own or their partner's vagina while they urinate so they can feel the urine passing through the urethra. This will help you locate its exact position. Once you have located the urethra you have a basis for seeking out a possible area along it that is highly sensitive to stimulation, a G-Spot. In her book Female Ejaculation & The G-Spot Deborah Sundahl presents information about the anatomy and location of the female prostate gland gathered by Dr. Zaviacic and published in 1999. He found 70% of women have a ramp-shaped prostate gland where the thickest part is situated near the urethral opening, 15% have a rampshapedprostate where the thickest part is located near the bladder, 7% have a prostate gland that is thickest near the middle of the urethra, and 8% of women have a "rudimentary prostate" that has few ducts and glands. This means one must explore the full length of the urethra, 1.5-2 inches (3.8-5 cm) along the upper wall of the vagina, when attempting to locate the G-Spot. This research also indicates more than 90% of women have a well defined prostate gland, even if they cannot locate it or do not ejaculate. The Importance of Clitoral Stimulation! The clitoris probably holds the key to female ejaculation for most women. If the clitoris is not stimulated a woman is less likely to become highly aroused. If she is not highly aroused her prostate may not fill with increased amounts of fluid. If her prostate is not swollen she may not have a G-Spot. If her clitoris is not stimulated she is less likely to experience orgasm and the rhythmic contractions of the pelvic muscles that expel and release the ejaculate. So quite simply before you can go exploring for the G-Spot you must master clitoral stimulation beforehand. There are women who are orgasmic and ejaculate when their G-Spot or vagina alone is stimulated but the majority need direct clitoral stimulation if they are to experience orgasm.
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What Do You Stimulate the Female Prostate With? Now that you know the location of the female prostate you will want to know how to stimulate it. The most versatile tools to use are your fingers. They are firm but flexible and have feeling and provide feedback. For solo explorers fingers have their limitations, as they may not be long enough and can tire relatively quickly. Plus, if one hand is stimulating your clitoris it limits access to your vagina with your other hand. So in addition to fingers, dildos and/or vibrators are usually required for finding and stimulating the G-Spot. (I will refer to both vibrators and dildos as dildos for the sake of convenience) Notice I used the plural 'dildos' not the singular 'dildo', as there is a chance you may have to try several different dildos to find the best one for you. Choosing a Dildo How do you pick out a dildo for G-Spot stimulation? Trial and error. The dildos that do have a good success rate are those that are curved near the tip, called G-Spot stimulators, and penis shaped dildos with a prominent ridge at the junction of the glans and shaft. Many women find hard plastic or glass dildos work best. Others find that makeshift dildos work great; such things as cucumbers, brush handles, mirror handles, etc. Some prefer a slim dildo that they direct at a specific area within their vagina but others prefer their vagina to be filled and stretched to the maximum by a large dildo. If you are going to buy a dildo to use for G-Spot stimulation be prepared to buy and try a couple different styles. Any woman who is seriously considering using dildos needs to be aware that she will most likely have a collection of favorites versus one special one. As a woman's mood and needs change so will her dildo needs. While women often start out with one many soon find they have a drawer full of them. Some women prize their collections. To Pee or Not to Pee Since the physical act of female urination is so similar to female ejaculation many women have found erotic enjoyment in urinating during sex, solo and with a partner. 146
Women seeking to learn to ejaculate may find themselves squirting liquid from their bladder rather ejaculating fluid from their prostate. This is because both urination and ejaculation require a woman to be able to surrender control and relax during orgasm. If you keep your bladder sphincter closed and tighten your pelvic muscles you cannot release liquid from your bladder or ejaculate. Women seeking to ejaculate are advised to push out when the urge to urinate or ejaculate comes over them at the point of orgasm. Doing this gives your body permission to ejaculate, but it also gives your body permission to release fluid from your bladder. You have no control over which occurs. You will just be aware of the intense physical sensations that occur. The sensations of both may be pleasant and indistinguishable. Hence learning to release liquid from your bladder at the point of orgasm may help a woman learn to ejaculate. Learning to release liquid from your bladder at the point of orgasm is likely to be easier when alone than when a partner is present. You will probably find it easier to relax, and you wont be as concerned about the resulting wetness. Doing this in the bathtub has some advantages. First you do not have to worry about the wetness, second soaking in warm water will help relax you, and third cleanup is a snap. Drink a couple glasses of water a short while before starting; allow your bladder to fill. It does not need to feel full, but you do not want it to be empty either. Lie back in the tub, or lay on several towels on your bed. Start to masturbate. Caress your clitoris. Slipping your fingers or a dildo into your vagina may feel nice. You do not need to necessarily move them back and forth inside your vagina only provide a feeling of pressure inside your vagina. Allow the sexual buildup to occur slowly. Practice tightening and relaxing your pelvic muscles, commonly called Kegel exercises. Think about the act of urinating, of letting go. Allowing your bladder to fill will result in you feeling the need to urinate. The closer you are to the point of orgasm the stronger the urge to empty your bladder is likely to become. Hold back on your orgasm until you feel you cannot hold the contents of your bladder a second longer. At the point of orgasm press out and relax your pelvic muscles, welcome the feeling of the liquid escaping from your bladder. The stronger the force behind the liquid, the greater the sensations are likely to be. So push and try to squirt liquid from your bladder. It takes practice to be able to let go spontaneously, since you have been conditioned to maintain strict control over your urination habits. It may also help to vocalize the release, make some noise. Intentionally crying out will help with the release. Scream "YES."
Learning to Ejaculate Moving on to ejaculation only requires a couple slight changes in technique. Empty your bladder first; you will want to let go without a full bladder producing the pressure or urge. The urge should still develop, just not be the result of a full bladder. The urge to ejaculate may not occur without there being stimulation of your prostate or urethra. This is likely to require the use of a dildo if you are alone. As you massage your clitoris, using your fingers or a dildo stimulate your urethra by massaging the top of your vagina; using only light pressure at first. Massage the full length of your urethra, from the opening of your vagina back into your vagina a couple inches. Keep up the 147
clitoral massage. Try different pressures and strokes. Massaging the urethral meatus may feel pleasant. Stimulating your urethra may cause you to feel the need to release liquid from your bladder and this is desired. Do not fight the urge, go with the flow, literally. Relax and breathe deeply. If you find a spot that is highly sensitive you may want to concentrate solely on it, but you may find it is too sensitive to stimulate directly. If your G-Spot is highly sensitive you may find you are only able to tolerate its stimulation when you are very close to orgasm, when your pain threshold has increased. Keep massaging your clitoris and urethra. Continue to the point of orgasm. A slow build up with lots of teasing may help produce the greatest urge and strongest orgasm. When orgasm occurs relax your bladder and press out as if urinating. If you ejaculate you will likely feel a new and strong sensation, if not, you will still experience a strong orgasm, so nothing is lost. You may not be aware of any increased wetness until after the orgasm has subsided. Being able to ejaculate may take practice even if you are able to squirt liquid from your bladder during orgasm. It is not known whether all women can ejaculate so you just have to experiment. In any event it should be a pleasurable experience. Stimulation by a Partner A woman's partner can bring her to an orgasm that includes ejaculation. If a woman already knows she is capable of ejaculating she should let her partner know, not pray that it will not happen again. She should discuss the increased wetness that occurs with her partner; at least prepare them for it. Hopefully they will see your ejaculations as desirable and erotic. If they do not, reeducating them about female fluids and ejaculation may persuade them to at least accept the ejaculations as normal even if they do not like the associated wetness. There is perhaps one big advantage to having a partner stimulate you to orgasm when you are trying to ejaculate, that is because they will not stop the stimulation unless you tell them too. If you are masturbating and you start to feel uncomfortable, out of control, you will likely stop immediately. This could prevent you from experiencing orgasm and ejaculation. With a partner you can agree beforehand that they will not stop, even if you say, "stop." (Doing this requires using a "safe word" that indicates, "Stop!" for real. This is a word you are not likely to say accidentally during sex, without thinking about it.) If you find you pull away you can ask that they hold or follow you so you cannot move away from the stimulation. Of course you should only do these things if you really trust your partner, as they need to be forceful without going to far. How do you stimulate your partner's prostate? Your hands are excellent tools to use. The best way to stimulate the inside of their vagina, along the upper wall, is to create a hook with your index finger. Imagine you want to signal to someone standing across the room that you want them to come toward you. You turn your hand palm up and signal with your index finger by making a hook, curling it up and straightening it repeatedly. You can do the same thing with two fingers inside the vagina. Massaging the upper wall of the vagina, from the opening back inside two inches. Start out with a very light touch. Press your fingers up and toward the front, pointing toward the pubic bone, or clitoris. Use the urethral opening as a guide. Use a generous amount of lubrication even if she is dripping wet. 148
Start out by getting her aroused with manual and/or oral clitoral stimulation. Continue the clitoral stimulation as you massage her prostate. Ask your partner if there is a specific spot or area that produces intense or enjoyable sensations when you massage it, her G-Spot. As you sense her getting closer to orgasm apply a firmer touch, if she enjoys it. Maintain a constant and steady rhythm. Follow through, continue the massage up through her orgasm. Then switch to a very light caressing touch as she comes down from her orgasm. If she experiences multiple orgasms her orgasms and ejaculations may become more intense, and the amount of ejaculation may increase. If she orgasms with your fingers inside her vagina her vaginal muscles may squeeze them very tightly, do not pull out but rather press in gently. You can also stimulate your partner to ejaculation using a dildo. This requires more verbal communication, as you cannot feel exactly what the dildo is doing. She needs to let you know what feels good, or bad. Some women may like for the tip of the dildo to be pointed at their urethra, others may prefer a full feeling. The stretching and pressure created by large dildos or an entire hand may stimulate the urethra enough to cause an ejaculation even if that is not the intent. A woman may also ejaculate during intercourse, with a penis or a dildo in a harness. What seems to work the best are positions that result in the penis or dildo stimulating the upper wall of the vagina. Like when a woman's partner kneels between her knees when she is on her hands and knees, or when she is on top controlling the direction and force of the thrusting. Some women may ejaculate during intercourse without even trying, while others may find it a challenge. It is more likely if she already ejaculates frequently during manual massage. Practice makes perfect. Some Health Concerns Unfortunately, there can be some possible negative side effects associated with massaging the urethra. The urethra is highly sensitive and is easily irritated. Even normal intercourse can irritate a woman's urethra resulting in painful urination and infection. This is especially true of virgins and women with tense pelvic muscles, as they are too tight and there is too much friction between their vagina and the thrusting penis or dildo. Intentionally stimulating the urethra increases the chances of there being irritation and infection. To help prevent infections and reduce the chances of irritation a woman should drink lots of water and urinate just before and right after urethral stimulation, or sex in general if you are prone to urinary tract infections. Just release a little bit of liquid from your bladder before sex if you are trying things with a full bladder. They also recommend women drink cranberry juice, or take a cranberry supplement available at health food stores, as its acidic level helps to ward off the bacteria that cause infections. If you experience irritation, painful urination, or infection, try using less pressure when massaging or stimulating the urethra. The urethra may become accustomed to the stimulation with time, but do not torture yourself or inflict multiple infections. Have fun but do not hurt yourself. Addressing the Wetness If you ejaculate there may be a small amount of liquid expelled or there could be a lot. If you are intentionally squirting liquid from your bladder or ejaculate repeatedly 149
there may be a liquid everywhere. Since you usually sleep where you have sex female ejaculation can present a logistical problem. If you only ejaculate a small amount simply keeping a couple towels near the bed may be the solution. If you gush then towels may not be enough. Having a plastic cover on the mattress and extra sheets may do the trick, though changing the sheets and cleaning up afterwards may not be the way you want to relax after sex. You can buy the disposable bed pads hospitals use, as they are absorbent and have a plastic backing. They are sometimes sold with incontinence supplies at your local store too. We sell in our store reusable cotton bed pads that remove the inconvenience associated with body fluids and sex. You can try having sex in the tub or shower or having a second bed or an air mattress to have sex on. For women who ejaculate every time, regardless of whether they want too, cleanup can be bothersome at times, and does take some getting use too. Just try to keep a positive attitude and be prepared with extra towels and sheets. A supportive partner always helps. Real or Faked? I hate to be the barer of bad news but chances are the women seen ejaculating in mainstream adult movies are likely releasing liquid from their bladder rather than ejaculating. They their ejaculations just as they fake their orgasms. They are intentionally squirting liquid fake from their bladder to simulate orgasm and true female ejaculation, or rapidly expelling liquid they place inside their vagina. The proof of this is the shear volume and/or the white color of the liquid they expel. Enjoy mainstream ejaculation videos but keep in the back of your mind that it is all fantasy.
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Some women prefer a large penis for psychological reasons. Since a man with a large penis is often seen as more manly, the woman who attracts his attention is often seen as more womanly and desirable. A woman may perceive her position in society is better if her partner is well endowed. She may feel she has bested her peers. A woman may find the sight of a large penis visually stimulating as well. Many women are fascinated with penises, not because they necessarily want one, but because they do not have one of their own. Their fascination often has nothing to do with size. Many women enjoy seeing and feeling their partner's penis becoming erect in their hand or mouth. Some lesbians are also fascinated with penises. They may not desire their partner to have a real one, but some do seek out male partners to fulfill their curiosity. One must keep in mind the brain is after all our largest sex organ.
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For some it is the challenge of finding out if they can really insert something so large into their vagina, a means of testing the limits of their body. While it is curiosity means of testing the limits of their body. While it is curiosity that motivates them, pleasure is pleasure is what keeps their attention, at least for some women.
In the end does the size of a man's penis really matter to his partner? The answer is no, at least for the vast majority of women. Most women do not choose a partner based solely on the size of his penis. What you have to keep in mind is, if women were only interested in the size of a man's penis, it would be less taxing on them to just go out and buy, or create, a dildo of the size they desired. Very few women place penis size on the top of their list when choosing a partner, even those who prefer a large or small penis for physical or psychological reasons.
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The Hymen Revealed
It appears that many if not most people are under the impression that the hymen is located within the vagina. It is, as the photographs and illustrations on this page reveal, part of the vulva, external genital organs. It is located outside the vagina. The hymen is a layer of tissue that partially conceals the vaginal orifice of some girls and women. The hymen is also referred to as a girl's "cherry" or maidenhead. During the early stages of fetal development there is no opening into the vagina. The layer of tissue that conceals the vagina at this time usually divides incompletely prior to birth. The size and shape of this opening or openings varies greatly from one girl to the next. There are girls who do not have a hymen at birth, as the tissue divides completely while they are still in the womb. Sometimes, this formation of an opening does not occur, resulting in an imperforated hymen. A doctor should examine an infant girl's vulva soon after birth to ensure her hymen is not imperforated, as should a girl's parents. (If menses is not permitted to flow freely from the body, extreme pain and cramping can result during menarche; a girl's first menstrual period.) The tissues of the vulva are generally very thin and delicate prior to puberty. Any activity that places tension on the vulvar tissues may stretch or tear the hymen. As a result, many girls and teens tear or otherwise dilate their hymen while engaging in physical activities such sports, horseback riding, inserting and removing tampons, and while masturbating. A girl may not know this has occurred, since there may be 154
little or no blood loss or pain experienced during this event. It may also occur when she is too young to remember or understand what has occurred.
The presence or absence of a hymen in no way indicates a girl's virginal state. No one can determine by physical examination alone whether a woman or teen has engaged in vaginal intercourse. Only about 50% of teens and women experience bleeding the first time they have intercourse, so blood stained bed sheets are not a reliable indicator of prior virginity. The hymen of some women tear on more than one occasion. There are even hymen that are elastic enough to permit a penis to enter without tearing, or tear only partially. This is usually true only if the dilation first occurs very gradually with fingers or other objects over an extended period of time. Virginity is a spiritual attribute, not a physical one. The hymen does not magically disappear when something is inserted into the vagina, it will only stretch or tear sufficiently to permit entry of whatever is being inserted. If for example, a teen inserts two fingers into her vagina while masturbating, her hymen may still tear when she has vaginal intercourse for the first time, since the average penis is larger than her two fingers. A woman who has had vaginal intercourse may still have hymeneal tissue present; this remaining tissue can be the cause of pain during intercourse. If a woman's current partner has a larger penis than her prior partners, or a couple tries a new technique or position during intercourse, her hymen may tear again, or for the first time. When doctors examine preadolescent and adolescent girls for evidence of sexual abuse, they look for injuries to the hymen; the hymen may still be intact except for a single tear. Remnants of the hymen are usually present until a woman delivers a baby vaginally. More photographs of the hymen can be seen in the medical article addressing childhood sex abuse linked to below: 155
Additional illustrations showing the different types of hymen can be found on the webpage linked to below:
This woman has engaged in vaginal intercourse
In the above photograph a thick ring of hymeneal tissue is visible, as indicated by the light pink edges of the tissue (inside the black circle); I believe the woman has engaged in vaginal intercourse. In some women this remaining hymeneal tissue impairs vaginal penetration or causes pain when objects are inserted into the vagina. In a very small percentage of women minor surgery is necessary to remove this barrier to penetration and pleasurable intercourse. 156
This is what the hymen of a female who has only had a small amount of sexual activity or object insertion would look like. Health professionals who examine hymens for signs of sexual abuse are usually most interested in the posterior part of the hymen, from the 3 o'clock to 9 o'clock position. This is normally where the hymen breaks when the vagina is first penetrated.
This is the vulva of a woman who has given birth. The hymen is completely gone, or nearly so. 157
One in 2000 girls is born with an imperforate hymen. A doctor will do surgery to create a hole in the hymen of such a newborn.
This is a rare cribriform hymen, characterized by many small holes. This type of hymen lets menstrual and other fluids out with no problem, but sexual activity and the insertion of tampons can be problematic. 158
This rare labial hymen looks like a third set of vulvar lips.
Some girls are born with only a tiny hole in their hymens. Surgery is also necessary for these newborns to create a larger vaginal opening. 159
Locating Your Vagina
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The process of locating their vaginal orifice is quite challenging and stressful for some girls and women. They have been told they have a vagina but are unable to conceptualize and accept this as fact. "They have told me I have a vagina but I don't believe them." This belief may cause a young woman to experience considerable anxiety when it becomes necessary to insert fingers, tampons, specula, medication, or penises into their vagina. In some cases the inability to grasp the concept of having a vagina leads to a condition called vaginismus. When anxiety and/or vaginismus occurs it is not the fault of the young woman but the things she has learned and experienced.
Unseen, Unused, and Perhaps Unwanted If you have never see or used your vagina how can it possible exist? Unlike the urethral and anal orifices, which are used daily from birth onwards, the vagina usually goes unseen and unused for the first ten to thirteen years of a girl's life. Not until a girl experiences her first menstrual period (menarche) does she have much need for a vagina. When menstruation begins a young woman may want to use tampons for comfort, to feel grown up, or because of peer expectation and pressure; perhaps feeling everyone else is using them.
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The use of sanitary napkins allows some young women to postpone the necessity of confronting their vagina, but this is not the only motive behind their use. If a teen uses sanitary napkins she may not feel compelled to locate her vagina until it comes time for penetrative sex, which may not occur until she is in her twenties, or later. The vagina is often shrouded in mystery. Far too often young girls are not taught to examine their vulva with a mirror, and the names and locations of all its different parts. In addition, a girl is not likely to see the vulva and vagina of others in use. A girl's mother and peers aren't likely to demonstrate the use of a tampon or help a girl find her vagina. "That would be too icky." She is even less likely to learn from others the pleasures her vulva and vagina can provide during sexual activities, alone and with a partner. She is unlikely to see how easily objects can enter the vagina. Young women seldom have a knowledgebase on which to draw when they seek to explore or use their vagina for the first time. As a result of the negative messages they receive some girls may not want to have a vagina. If you only know of the pain reportedly associated with first intercourse and childbirth could this result in you not wanting to have a vagina? What if you don't want to be a woman because of their perceived role within your family and community, you are told sex is for a man's pleasure and a woman merely submits to it dutifully, or the idea of partnered sex frightens you? If you are not comfortable with the idea of having a vagina isn't it possible this would increase the likelihood of you not finding one when you went looking? But There is No Hole! The common perception is that there is a "hole down there" that tampons and penises magically find their way into. The following two images demonstrate what we may expect the vaginal "opening" to look like. In these images there appears to be a "dark hole" for things to enter into, and as some fear, get lost.
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In the above images the vulva and vagina have been drawn open by the woman's hands, and she may be using her pelvic and abdominal muscles in a way that opens the vaginal passage further. These vaginas are not shown in their normal relaxed and closed state. We may come to expect the vagina to be an open space within the body because of the way it is frequently portrayed in illustrations used to show the anatomy of a woman's reproductive organs, as in the example shown below. Revealing the Hidden Passage The following four images demonstrate what a young women is more likely to see when she examines her vulva in hopes of locating her vagina. The same vulva is shown in each image but its appearance changes significantly depending on how and if the labia are spread apart. In none of these images is the vaginal orifice obvious to the observer; there is no hole or opening. The irregular shape of the tissues does a good job of concealing the vaginal orifice.
A woman may expect the tissues around her vaginal orifice to be perfectly smooth, as they are shown in anatomy illustrations. The internal walls of the vagina are not smooth but have lots of bumps and ridges, as shown in the following photograph. They form during puberty, as a result of increased estrogen levels, and exist because the vagina must be elastic enough to permit the insertion of an erect penis and the passage of a full term baby. These bumps and ridges are visible at the vaginal orifice in many women. This irregular surface can make it difficult to find the vaginal orifice.
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The following collection of photographs reveal what the vaginal orifice and/or vestibule looks like in several women. A copy of each photo is shown with the some of the structures identified. In the above photograph the woman has a pronounced urethral orifice. In most of the photographs the urethral orifice is not clearly visible and you cannot easily determine its location.
In the above photograph a thick ring of hymeneal tissue is visible, as indicated by the light pink edges of the tissue (inside the black circle); I believe the woman has engaged in vaginal intercourse. In some women this remaining hymeneal tissue impairs vaginal penetration or causes pain when objects are inserted into the vagina. In a very small percentage of women minor surgery is necessary to remove this barrier to penetration and pleasurable intercourse.
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The photo shown above demonstrates how the mucous membranes of the vulva look very much the same even if a woman has dark colored skin.
Exploring Uncharted Territory Many women have never explored their vulva and have no idea what to expect when they do, and the idea of examining their vulva may cause considerable anxiety. This unfamiliarity with their body may result in emotional distress when they explore sex alone and with a partner. It also presents a problem in that they don't know the normal and healthy characteristics of their vulva, which vary from vulva to vulva. For health reasons it is important for a woman to know what is normal for her, and to monitor her vulvar health on a regular basis. Caring for your body becomes much more difficult if you don't know how things normally look, feel, smell, and even taste.
If a woman is to locate her vaginal orifice she must first identify the surrounding structures. Locating the clitoris and labia has been addressed in the Q&A section of the website, and many more examples of the vulva can be seen in the Body Image section of the website. The structure and function of the vulva is addressed in the article about the anatomy of the vulva. The space between the inner labia is called the vestibule. Within this space are the urethral and vaginal orifices. As the above images clearly demonstrate this area may appear to be bumpy, soft, and moist without any obvious openings or orifices. The tissue in this area is not regular skin but rather mucous membrane. This mucous membrane will appear and feel the same as the inside of your cheek; soft, warm, and wet. Some women are hesitant to touch this tissue, as a result of negative feelings that have developed from messages received during childhood and adolescence. If as young girls they had been taught to rinse their vulva using their hands and plain water they would be accustomed to the feel of these tissues and this aversion is unlikely to exist. Strong & 165 Flexible!
In some ways the vulva and vagina are delicate but overall they are strong and flexible. Their soft and delicate appearance can be misleading even though they are designed for the acts of sexual intercourse and the birth of a baby. I don't believe anyone would describe the process of childbirth as kind and gentle. With very few exceptions the vagina will stretch to accommodate the passage of a baby's head, which can be nearly four inches (9.5 cm) in diameter. This means a finger, tampon, and erect penis will fit easily inside the vagina, after appropriate preparations. When the birth canal is too narrow to allow for the passage of a baby it is most often caused by the bones of the pelvis being too close together, or the baby being too large. Rarely is the vagina and hymen too small for a single finger or tampon to enter into them, even in virgins. If menstrual blood is flowing out then there is a passage that will stretch to accommodate the insertion of a lubricated finger or tampon applicator.
The Truth About Hymens The hymen has no actual functional purpose despite the significance it is assigned by society. It is excess tissue left over from when the vaginal orifice forms during fetal development. The hymen is usually very thin during childhood but during puberty the increasing levels of estrogen may cause it to enlarge and thicken. Frequently it is stretched open during childhood or adolescence without the girl or woman knowing, but in a small percentage of women it can be a major obstacle to vaginal penetration. That is why it is important to examine the vulva to see if a hymen is present and if it is resistant to stretching before attempting vaginal penetration. I would advise against waiting until after a failed attempt at vaginal intercourse before looking for your hymen. You can learn more about the hymen in the anatomy section of the book
A major misconception is that the hymen is a major obstacle to vaginal penetration. It is suppose to be a gate that must be forcibly torn apart before anything can enter the vagina. Young women are often told this will be a bloody and painful experience. This is an ineffective attempt at keeping girls virgins until marriage. Understandably, this message sometimes results in young women being afraid to insert objects into their vagina. 166
A survey on this website reveals only about 50% (1 out of every 2) women experience blood loss the first time they engage in vaginal intercourse and it is usually a very small amount. While the majority experience some discomfort or pain it is not often extremely painful. On a scale of 1 to 10 women report the pain was a 4, on average. The discomfort or pain they experienced may have been caused by the stretching of the vaginal and pelvic muscles and insufficient vaginal lubrication rather than the stretching or tearing of their hymen, but 30% recall feeling their hymen tear. The Pelvic Muscles Healthy muscles are always strong and flexible and this applies equally to the muscles of the pelvic outlet. We gain strong and flexible muscles through stretching and exercise. If the pelvic muscles are not strong and flexible they will not function correctly and sex will not be as enjoyable as it could be. This is because orgasm will be less intense and the amount of friction during intercourse will be too great or little. You can learn how to control and develop your pelvic muscles by doing Kegel exercises, as described on the pages about virginity. We must keep in mind that for the majority of women the pelvic and vaginal muscles do not experience or permit penetration for at least the first twelve years of their life; based on the survey about masturbation of this website. The pelvic muscles must "learn" how be penetrated and "allow" objects to enter the body rather than instantly being ready the first time they engage in intercourse or insert a tampon. The pelvic muscles of most women are going to provide firm resistance to penetration that can be overcome with patience and skill. The use of force is not necessary and can actually cause vaginismus to develop.
There are women who have pelvic muscles that are normally very relaxed so they are able to insert objects into their vagina without effort or discomfort. The first time they engage in intercourse they may expect to experience some discomfort but their partner's penis slips in effortlessly and they experiencing neither pain nor pleasure. Others have a medical condition called vaginismus that results in their pelvic muscles 167
contracting so tightly that it is impossible for even the smallest object to enter their vagina, and they experience pain that exceeds their expectations. Interestingly enough, both experiences may produce anxiety, as the woman's expectations of her first experience of intercourse are not met. Deborah Sundahl in her book Female Ejaculation & The G-Spot says women can test the strength of their pelvic muscles by placing a peeled ripe banana inside a plastic sandwich bag and carefully inserting it into their vagina. If your pelvic muscles are in good condition you should be able to contract your pelvic muscles and divide the banana into two pieces. But this is getting ahead of ourselves, as we have yet to find your vaginal orifice. No Pain! The exercises described below should not cause physical discomfort or pain. You will be locating your existing vaginal orifice, which means you will not be forcibly creating an opening in your body. You are going to learn how to use your vagina. If you experience pain during these exercises you are doing something incorrectly or there is a possible medical condition that needs to be addressed. Several young women have written to say they find it painful when they try to insert their finger into their vagina. It is my believe that most of them were likely pressing or pushing in the wrong place or were not adequately lubricated, as I doubt their anatomy and the function of their body is different from that of their peers. They may have been blindly trying to poke a hole into their vulva. If they had had access to the information presented below it is less likely they would have experienced this pain. No Poking! When trying to locate your vaginal orifice if you start poking blindly you may needlessly cause yourself pain, as the vulvar tissues can be very sensitive to touch. There are bones underlying some areas of the vulva and if you press too hard on them you may crush the overlaying soft tissues causing pain. Any discomfort or pain may cause the pelvic muscles to contract painfully, as a defensive mechanism. If your pelvic muscles contract this will create a barrier to penetration that is as hard as bone and impenetrable. The contraction of these muscles may cause intense pain even if you are not touching your vulva or vagina. Your pelvic muscles may also contract if you are uncomfortable exploring your body or fear causes yourself injury and pain. In this case it is necessary to address your emotional discomfort before exploring vaginal penetration so that you don't cause yourself physical discomfort. In the exercises described below I recommend you use the flat of your index finger rather than the tip when exploring your vulva. This is because you don't want potentially long or sharp fingernails pressing into your delicate tissues. There is also no need to force anything your body. Doing so is more likely to cause pain than reveal your vaginal orifice. You want to find the path of least resistance and allow your finger to slip inside your vagina. If there is no path of least resistance then your pelvic muscles are in contraction and you need to find out why, or at least learn how to relax them. If your pelvic muscles are in contraction the door to your vagina is locked shut, metaphorically and physically. Force will not overcome this barrier, but rather strengthen it. 168
Identifying the Cause of Pain My advise on this website has always been that if you experience pain then you should stop doing whatever it is that you are doing, as your mind and/or body are telling you that it is being harmed or could be harmed. I know girls and women are told it is suppose to hurt when an object enters their vagina for the first time but accepting this advise can cause harm. While the majority of women experience some degree of pain or discomfort the first time they engage in intercourse there is no arbitrary amount that is acceptable versus unacceptable. If your personal pain threshold is met or exceeded then it is best to stop. I highly recommend finding a cause and a solution rather than accepting pain as a normal part of vaginal penetration, because it isn't. If you should experience pain you will want to determine if the pain originates on or below the surface of the tissues that you are touching so that you can determine a possible cause. If you are unfamiliar with your vulva, as just about everyone reading this article will be, you may have trouble identifying the origin of this pain. You will likely have to explore and experiment with the aid of a mirror. You will want to move your fingers around and try different types of "light" touch and pressure. You should not be pushing or pressing your fingers against your vulva; there is no need to. You will also want to ensure your vulva is well lubricated to prevent the possibility of causing frictional irritation. This exploration will need to be unhurried and take place in a safe environment so your pelvic muscles don't contract, as a result of you feeling vulnerable. If the location of the pain is the point of contact between your finger and vestibule, but you are not applying pressure, then you may have vestibulitis, which is a generic term used to describe inflammation of the vestibule. If lightly touching the area of your vestibule with a lubricated cotton swap (Q-Tip) causes you discomfort or pain then this may confirmed this diagnosis, but you still need to consult a doctor for a formal diagnosis. Vestibulitis is a common medical condition, but unfortunately it can be challenging to find a cause and cure. Penetration should not be attempted until a cure is found. I advise against the use of a numbing agent, even if prescribed by a doctor, as it only masks the problem, and the pressure and friction caused by penetration may cause the problem to become worse.
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If sharp pain originates below the point of contact and spreads out beyond the point of contact, perhaps making you feel as if you have to urinate or have a bowel movement, then your pelvic muscles may be involuntarily contracting, which may mean you have vaginismus. Vaginismus means there is an inability to insert objects into the vagina without experiencing discomfort or pain, but there are numerous possible causes for this medical condition. If this is the first time you have tried to insert an object into your vagina the cause of this muscular contraction could be mild anxiety that will be resolved with practice and experience. The presenting symptoms of vaginismus vary greatly from individual to individual, and penetration is impossible until a cure is found.
If you locate a hymen with a narrow orifice when you do the visual exam then you may feel it stretch as your finger passes through it. If you are patient then you don't need to cause yourself unnecessary discomfort or pain. You can quickly learn when you have stretched your hymen as far it is willing, as the onset of discomfort will signal you have reached that point. Unless you have an unusually thick hymen it will slowly stretch as you gently apply pressure, not force, during repeated sessions of exploration that occur over a period of time; perhaps spanning several days to weeks. Accepting pain and repeated experiences of pain may cause vaginismus to develop, as a result of a rigid or sensitive hymen. Locating the Urethral Orifice In order to locate the vaginal orifice it will be helpful to know the location of the urethral orifice and fourchette, because the vaginal orifice is located between them. If you are trying to find your vagina you may wonder why it is so important to find your urethral orifice. There are two reasons. The first is that the urethral meatus can be extremely sensitive to touch and pressure. In some women it is more sensitive to touch than the clitoris and vagina. They may masturbate by stimulating their urethral meatus or enjoy it when their partner stimulates this area with their finger or tongue. The female prostate gland, commonly known 170as the G-Spot, is located in this area
and is the likely cause of this sensitivity. The second reason is that directly above and behind it, under the skin and soft tissues, lies the pubic bone. If you press against the urethral meatus you may experience intense pain, as you will be crushing these sensitive tissues against your pubic bone. The urethral orifice can be just as hidden from view as the vaginal orifice so simply looking at your vulva may not reveal its location. Perhaps the easiest way to locate your urethral orifice is to closely observe your vulva while you urinate. Some may be able to do this by holding a small mirror in a suitable position while seated on a toilet or bidet but many will find it easier if they squat or sit down inside their shower or tub. Urine is not harmful or dirty, if a woman is healthy, and while urinating in the shower or tub may sound gross, it isn't. When done you simply rinse the shower or tub out with clean water. You may want to do this in the morning when your bladder is full, or prior to a bathe or shower. If you do this in the shower or tub you will be able to lay the mirror on the bottom of the shower or tub leaving both of your hands free to hold your inner and outer labia open. When you are positioned to see your vestibule in the mirror start releasing urine from your bladder. If you cannot see where the urine exits your body then adjust the position of your labia. Contracting and relaxing your abdominal and/or pelvic muscles may cause the location of your urethral meatus to change. You may need to perform this exercise several times to find the urethral orifice, or to overcome any apprehension or anxiety the activity may cause. Some women may enjoy doing this for fun and to learn about their body. It would be a good idea to do this repeatedly until you feel comfortable doing it, as it will likely make finding your vaginal orifice easier. The photographs shown below reveal what a woman may see when she observes her vulva while urinating. In the photo shown on the left the point where the stream of urine is exiting the body is clearly visible. In this photo take note of how close the urethral orifice is to the vaginal orifice. The vagina begins immediately below the point where the urine is flowing from her body. This is because the urethra is located within the wall of the vagina. The urethra and vagina are a single organ rather than two separate ones. In some women the urethra will be located a little further away from the vagina and in others it will be even closer, and appear to be inside the
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vagina. This may cause some women to believe they urinate through their vagina. In the image on the right a small amount of urine is holding the urethral orifice open allowing us to clearly see its location. Learning the Path of Least Resistance To help prevent pain from occurring here is an exercise that may help. Before trying to locate your vaginal orifice by feel do the following. Make a fist with one hand and turn it so your thumb and index finger are facing towards you. Your thumb and index finger should form a circular shape. Now using the flat, not the tip, of your second index finger press softly against this circular structure. Move your finger around the circular shape while pressing softly and then gently. You should note that some areas are soft and others are hard. The hardness is caused by the underlying bones in your hand. If you move your finger towards the center of this circular ring you should notice the tissues are softer and more yielding. Now clench your fist tighter and try to press the flat of your finger into your fist. It doesn't go in easily does it? Now relax your fist and try it again. Notice the difference? This demonstrates what it may be like when your pelvic muscles are relaxed versus tense. Your hymen is made up of soft tissue and wont feel hard even if it resists penetration. Now repeat this exercise after wetting your index finger with saliva. When your finger is lubricated there should be much less friction between your finger and hand.
Simulating the Sensitive and Moist Vulvar Tissues The intense sensations resulting from stimulation of sensitive tissues can be overwhelming or scary for some; especially coming from "down there." These intense sensations could be mistakenly classified as pain rather than pleasure if you are not accustomed to touching your vulva. An exercise that may be helpful in avoiding this situation is to explore your lips and mouth. They are equally soft and sensitive to touch. Explore your lips with your finger in the manner described above and take note of the sensations you experience.
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They may be pleasant and tingly. Take note of the softness. Try different pressures and observe how the underlying teeth and jaw bones feel. If you press too hard you will experience pain. Now if you open your mouth a little and roll your lips back and cover your teeth with them you will create an approximation of a vulva. The sensitive lips of your mouth being like your labia and the inside of your cheeks being like the soft mucous membrane of your vestibule and vagina. Slip your finger into your mouth and take note of the softness, warmth, and wetness of the tissues on the inside of your cheeks. Now close your eyes and imagine that you are exploring your vulva. Use saliva to lubricate your lips and repeat.
Following the Flow There is another exercise that may help a girl or woman locate her vaginal orifice. If you have had at least one menstrual period then you can jump to the conclusion that there is a vaginal passage that extends between your cervix, the bottom portion of your uterus, and your vulva. Without this passage menstrual blood, menses, would never have appeared at your vulva. The point where your menses exits your body is the location of your vaginal orifice. It may help to imagine the flow of this fluid from your uterus to your vulva. This is the one time when menstrual cramps or uterine tension may be beneficial, as they indicate the place inside you where the fluid originates. Now connecting your uterus to your vulva may be a bit of a challenge, as nothing has stimulated your vagina to make you aware of it, unless of course you experience a vaginal ache and muscular tension during sexual arousal. Still, this is no better than trying to envisioning your stomach and intestines when you have an upset stomach and experience cramping. What may help is a visit our website called 3DVulva.com, as it allows you to see your anatomy three dimensionally. Flat two dimensional images are not of much help when you are trying to envision the organs inside your body. While rotating the 3D animation models around their axis examine your body and try to envision these organs inside you. Don't worry if this exercise doesn't work all that well for you, as long as you are able to accept that you have a vagina and know its general location within you.
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Since the point at which your menses leaves your body indicates the location of your vaginal orifice examining your vulva while menstruating is the next possible exercise for those who are willing and able. It would be great if all women felt comfortable with their menstrual fluid and the sight of blood but I know this isn't the case. Overcoming any aversion you may have to this fluid is beyond the scope of this article. If you are very uncomfortable with menstruation or blood please skip the next two paragraphs.
For those of you still reading jump in the shower or tub on your heaviest flow day, usually the first day of your period, with a mirror. Now rinse your vulva thoroughly with clean water and then pat it dry with a dry wash cloth or new sanitary napkin. Then squat down, spread your labia, and examine your vulva in the mirror. Observe your vulva and look for the first signs of menses appearing. Now it may seep out between some small folds or bumps rather than an obvious orifice or opening. Try to envision the path the menses has taken to get from your uterus to your vulva.
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Now lightly press the flat of your lubricated index finger against the point where the menses appears. While lightly pressing the flat of your finger against this point try to get your finger to follow the path that the menses has taken out of your body. Don't use force if your finger doesn't slip effortlessly inside your vagina, or you experience pain. Some women may need to repeat this exercise several times, or may enjoy doing it as a means of exploring their femininity. It is best to do this when you can relax and take your time. If you are not able to insert your finger into your vagina during this exercise don't be concerned. Locating the Fourchette The second structure you will want to identify before locating your vaginal orifice is your fourchette. This is the point where the outer labia come together below the vestibule. It is the forward edge of the perineum, the flat area between the anus and vagina that may be covered with varying amounts of hair. It is the point labeled "Posterior Labial Commissure" in the image shown below. Some women mistakenly press their finger or a tampon against this area when trying to insert them into their vagina. Your fourchette does not perform any particular function, it is simply an anatomical landmark. When inserting your finger into your vagina make sure it is resting on the mucous membranes within the vestibule and not against the perineum.
Are You Truly Ready? Before locating your vaginal orifice it would be beneficial if you can examine your vulva in a mirror and identify all the various parts, if you feel comfortable touching your vulva while bathing and when applying body or massage oil, if you are able to masturbate to orgasm using clitoral stimulation while looking at your vulva in a mirror, and if you can observe your vulva while urinating and menstruating. Being able to sleep nude and walk about the inside of your home when you are there alone while undressed will demonstrate you don't feel it necessary to hide your body from yourself, and possibly others. If you were raised in a healthy sexual environment you would already engage in these activities as a natural part of your daily life, as you 175 your sexuality. cared for your body and explored and embraced
Being able to engage in these activities without anxiety is highly beneficial and significantly increases the likelihood of locating your vagina, but does not guarantee it. For some women being able to do all these activities does not mean their pelvic muscles will allow objects to enter their vagina, as in case of women with vaginismus. Some cases of vaginismus are the result of women not learning how to engage in these activities or their childhood environment prevented them. Being able to engage in these activities demonstrates normal and healthy sexual development and ensures a woman can care for her body and enjoy her sexuality. Not being able to to engage in these activities and insert objects into your vagina increases the chances of you experiencing vaginismus.
A Finger Slides Inside Locating your vagina involves putting all the skills and information you have learned to use. You place the flat of your lubricated index finger against the area of your vestibule between your urethral orifice and fourchette. Now press very softly against this area and seek out your vagina by means of the path of least resistance. Move your finger in a slow circular motion within the area between your urethral orifice and fourchette. If your finger isn't gliding effortlessly over the tissues apply additional lubrication; never do this without plenty of lubrication. If you located a hymen during your earlier explorations keep in mind the location of the opening(s) and consider the best angle to slip your finger into or behind it. If your hymen is like the one shown on this website then you may need to slip your finger in from above before attempting to press inward towards your vagina. As when you experimented with your closed fist, seek out the path of least resistance and stop pressing if you feel resistance, discomfort, or pain. If you cannot find a path of least resistance your pelvic muscles are likely in contraction, or you are pressing against your pubic bones. If this occurs, imagine you want to stop the flow of urine from your bladder and contract the muscles of your pelvic outlet. Squeeze your pelvic muscles, relax them, then try again. If you cannot feel the muscles contract then you 176
haven't learned how to control them or they are in a constant state of contraction. Another technique to try is imagining you want to push your finger out of your vagina rather than in receive it in. Tighten your pelvic muscles, as if you are wanting to push your finger out, then relax them to receive your finger in. Squeeze, relax, receive your finger inside. Place a hand on your stomach to monitor these muscle and ensure they "do not" tighten when you contract your pelvic muscles.
Your vagina angles back towards the small of your back. This necessitates that your finger follow an arc when entering your body. Bend your index finger as if you were trying to form the letter "C" with it and your thumb. The desired arcing motion occurs when you rotate your hand at the wrist. Rotate your wrist rather than pushing in with only your finger. If you push in with your finger it will tend to straighten out and will not follow the natural path of your vagina. You have to envision your vagina angling back towards the small of your back, not straight in, up, or down. If you feel resistance then you are not following the natural path of your vagina or need to use additional lubrication. If your finger enters into your vagina then wiggle it slowly in a circular motion seeking out the passage of least resistance. You will feel the bumps and ridges that make up the walls of your vagina. Your pelvic muscles will be located about 1 inch (2.5 cm) inside your vagina. Beyond them your vagina should open up, as it enlarges to accommodate your cervix. Your vagina will be about the same length as your index finger, and you will most likely be able to touch your cervix. Your cervix will feel smooth and as firm as the tip of your nose. You will be able to move your finger to the front and back of your cervix allowing your finger to enter a little further. In the center of your cervix you will feel a small circular dimple, your cervical orifice; also called the cervical os. Some women find their cervix very sensitive to touch, perhaps painfully so.
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Moving on to Bigger Things Once you learn to insert one finger into your vagina you can use it to prepare your pelvic and vaginal muscles for the insertion of larger objects. When your finger is inserted into your vagina imagine your vagina is at the center of a clock. Gently but firmly press your finger towards each number on the clock face, in an outward direction. Keep in mind your pelvic bone will be in the twelve o'clock direction so your vagina will not stretch in that direction and you may cause yourself pain if you press your vagina against it, crushing your urethra. Your pelvic muscles, located about 1 inch (2.5 cm) inside, will likely provide the greatest resistance to penetration. Repeatedly squeeze and relax your pelvic muscles and apply additional lubrication if things do not feel slippery. Go slow and remember to stay relaxed, breath in and out in full breaths, and have fun. Once you can insert a single finger you can try inserting a "lubricated" tampon applicator. If you are not menstruating it would be unwise to actually insert a tampon, as it will absorb the little moisture that is present and dry out your vagina causing friction and pain when the tampon is removed. This subject is addressed on the page about tampon insertion and use. Those who have access to phallic shaped objects like dildos and butt plugs may be able to dilate their vagina using them. Butt plugs are nice in that they have a tapered shape and a base to hold onto. When inserting these objects use plenty of lubrication and only apply the pressure generated by "one finger," not your entire hand and arm. Repeat the squeeze and relax technique mentioned above and push the object out and then receive it in. Once you can insert the object try leaving it in place for 15 to 20 minutes to allow your body to become accustomed to the dilation. You should repeat this exercise until you can insert an object equal in diameter to an erect penis, 1 1/2 inches (3.8 cm), if you are wanting to explore intercourse.
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Pelvic Examination
Pelvic examination, also known as a pelvic exam or vaginal exam, is a physical examination of the female pelvic organs. Broadly, it can be divided into the external examination and internal examination. It is also called "Bimanual Exam" (i.e. using two hands) & "Manual Uterine Palpation" (palpation meaning an examination by touch). It is frequently used in gynecology. The pelvic exam is part of the physical examination of the pelvic area of a woman, which generally also includes the taking of a sample for a pap smear. This test includes three parts. These are the general inspection of the external genitalia, bimanual examination, and inspection of the vaginal canal using a speculum. External examination examination of anatomy skin lesion palpation of stomach area Internal examination Speculum exam - A speculum exam showing the ectocervix of a postmenarchal, nulliparous woman. Use of a speculum to locate the external cervical os. Examination for foreign bodies and cervical swabs are taken at this point in the exam. These swabs of the epithelium layer of the cervix are known as a Pap smear. Other vaginal swabs can be taken at this time to test for sexually transmitted diseases. The speculum examination is recommended for only women over 21 years old, irrespective of her sexual activity. The speculum is an instrument made of metal or plastic and is constructed with two flaps. Its purpose is separate and widen the
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vaginal opening and keep it open. This allows direct observation by the physician into the vaginal canal with the help of a lamp or a mirror.
The speculum must be inserted without the use of lubrication. There are different types of speculums used within the different characteristics of each patient such as age, sex life, and other factors. The first step is to open the vaginal opening with two fingers at the vulvo-perineal angle, then separate the fingers slightly and press down, then insert the speculum arranging the width of the tip of the flaps in anteroposterior. Then the speculum is moved into the vagina at an angle of 45°, following the natural contour of the posterior vaginal wall. When the speculum is in place, the fingers are removed and the device is rotated so that the flaps are horizontal. The flaps are then separated and locked into place when the cervical neck is completely visible.
Bimanual exam - Two fingers are inserted into the vagina until they isolate the cervix. Then the health care professional tests for cervical motion tenderness, as classically seen in pelvic inflammatory disease. The examiner presses down on the abdomen with the external hand, to locate the fundus of the uterus and the adnexal structures. The purpose of this exam is to 180
palpate organs which cannot be seen with visual inspection. The index and middle finger are inserted into the vagina. This maneuver allows the doctor to check the orientation, length and width of the vagina. Next, the cervix and vaginal fornices are palpated, to check position, size, consistency, mobility and sensibility. The other hand is placed in the pubis pressing it to feel the uterus between both hands. The most important characteristics to examine are the size of the uterus, presence of nodes or agglomerations, consistency, size, tilt, and mobility. With this technique, the ovaries are also palpable.
Discomfort - The exam should not be excessively uncomfortable, but a woman with a vaginal infection or vaginismus may feel pain when the speculum is inserted. Using the smallest available speculum may help. A woman with an untreated imperforate hymen may find it impossible to be examined. During the bimanual exam, the palpating of the ovaries may be painful. The pap smear may cause some cramping as well. Informed consent - For educational purposes, trainee doctors have performed pelvic exams on unconscious women. The subjects are those undergoing surgery for unrelated causes, and they were rarely informed the examination had occurred. This practice is forbidden in the United States, New Zealand, and the United Kingdom, which now require the patient to consent in advance. The practice still continues in Canada according to a study published in the Journal of Obstetrics and Gynecology. A spokeswoman for the University of Manitoba College of Medicine claimed in 2010 that the revised 2006 guidelines of the Society of Obstetricians and Gynaecologists of Canada forbade pelvic exams without consent, though the original impetus for the study of pelvic exams and consent was an incident in 2007. 181
Well-woman examination- A well woman examination is an exam offered to women to review elements of their reproductive health. It is recommended once a year for most women. The exam includes a breast examination, a pelvic examination and a pap smear but may also include other procedures. Hospitals employ strict policies relating to the provision of consent by the patient, the availability of chaperones at the examination, and the absence of other parties. Most healthcare providers also allow the patient to specify if they have any preferences towards the examiner's gender. The well woman examination by a medical professional is recommended at least once a year to women over 18 years old and/or women who are sexually active. Its importance lies in identifying potential early health problems. The most important tests included in an examination is the breast exam, pelvic exam and the pap test, although some doctors consider other tests in the examination, including measurement of blood pressure, HIV testing, and other laboratory tests such as urinalysis, CBC (Complete blood count) and testing for other sexually transmitted diseases. The procedure is important also to detect certain cancers, especially breast and cervical cancer. Breast examination
Pap smear The pap smear is a screening test to test for abnormalities such as cervical cancer and human papillomavirus infections, which require early treatment. To be viable, the patient should not be menstruating and had not used a vaginal contraceptive in the prior 24–48 hours. The procedure begins with the scraping of cells from the cervix and the uterine fornix, done during the speculum examination as there is access to the cervix. The scraping is done with a spatula, cervical brush or swab. Some women experience temporary bleeding from this procedure. The scrapings are placed on a slide,covered with a fixative for later examination under a microscope to determine if they are normal or abnormal. 182
The word "gynaecology" comes from the Greek γυνή gyne. "woman" and -logia, "study." Visual inspection - The breast examination begins with a visual inspection. With the patient in a prone or seated position, the medical professional will look at both breasts to check the color, symmetry, dimensions according to age, lean body mass, the physiological (pregnancy and lactation) and race, looking for abnormalities, such as bulges and shrinkage. One of these abnormalities is changed in the areola or nipple. If it is flattened or retracted (umbilicated), it is necessary to consider the possibility of a cancerous lesion which has caused the malformation. Palpation - Next, the breasts are palpated, again with the patient lying or sitting. The patient has to lift the arm and put one hand behind her head. With this position, the entire gland is palpated. It is also important to examine the armpits, because of masses that may be found there. The test is executed pressing the gland with two or three fingers against the chest wall, making a radial route or by quadrants. The nipple is also squeezed check for secretions, such as secretion of milk (galactorrhea), serous, blood or purulent secretions. If a node is detected, it is necessary to determine its place, size, shape, edges, consistency and sensitivity.
Palpation - Next, the breasts are palpated, again with the patient lying or sitting. The patient has to lift the arm and put one hand behind her head. With this position, the entire gland is palpated. It is also important to examine the armpits, because of masses that may be found there. The test is executed pressing the gland with two or three fingers against the chest wall, making a radial route or by quadrants. The nipple is also squeezed check for secretions, such as secretion of milk (galactorrhea), serous, blood or purulent secretions. If a node is detected, it is necessary to determine its place, size, shape, edges, consistency and sensitivity. 183
Self-examination - In addition to the yearly check by a professional, women over the age of 18 should also perform this examination monthly. It is important because regular and comprehensive examinations of the breasts can be used to find breast changes that occur between every clinical examination and detect early breast cancer. This auto examination should to be performed seven days after the onset of the menstrual period. If a woman finds a lump or notice any changes in her breast, she should seek medical attention promptly. Further examination of the breasts A mammogram or mammography is a special x-ray of the breasts. They are the procedure most likely to detect early breast cancer in asymptomatic women. Mammograms can show tumors long before they are large enough to palpate. They are recommended for women who have symptoms of breast cancer or who are at increased risk of developing the disease. They are performed with the patient standing, the breast pressed between two plastic plates, as the image is taken. The interpretation has to be performed by a specialist. Breast ultrasound is a complementary study of mammography. In many women the tissue that makes up the breast is very dense, representing fibrous tissue and glandular tissue, which produces milk during lactation. This limits the radiologist interpreting the study, so, in these cases, the ultrasound is helpful, since this is capable of distinguishing tumors in women with dense breast tissue, where identification is otherwise difficult. Additionally, it is advisable to follow up a mammogram that shows indications of tumors with an ultrasound, to confirm, before more invasive procedures are undertaken.
Examination The historic taboo associated with the examination of female genitalia has long inhibited the science of gynaecology. This 1822 drawing by Jacques-Pierre Maygnier shows a 184
"compromise" procedure, in which the physician is kneeling before the woman but cannot see her genitalia. Modern gynaecology no longer uses such a position. In some countries, women must first see a general practitioner (GP; also known as a family practitioner (FP)) prior to seeing a gynaecologist. If their condition requires training, knowledge, surgical procedure, or equipment unavailable to the GP, the patient is then referred to a gynaecologist. In the United States, however, law and many health insurance plans allow gynaecologists to provide primary care in addition to aspects of their own specialty. With this option available, some women opt to see a gynaecological surgeon for nongynaecological problems without another physician's referral.
As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynaecological examination is quite intimate, more so than a routine physical exam. It also requires unique instrumentation such as the speculum. The speculum consists of two hinged blades of concave metal or plastic which are used to retract the tissues of the vagina and permit examination of the cervix, the lower part of the uterus located within the upper portion of the vagina. Gynaecologists typically do a bimanual examination (one hand on the abdomen and one or two fingers in the vagina) to palpate the cervix, uterus, ovaries and bony pelvis. It is not uncommon to do a rectovaginal examination for complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynaecologists may have a female chaperone for their examination. An abdominal and/or vaginal ultrasound can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient's history. Diseases Examples of conditions dealt with by a gynaecologist are: Cancer and pre-cancerous diseases of the reproductive organs including ovaries, fallopian tubes, uterus, cervix, vagina, and vulva Incontinence of urine Amenorrhoea (absent menstrual periods) Dysmenorrhoea (painful menstrual periods) Infertility Menorrhagia (heavy menstrual periods); a common indication for hysterectomy Prolapse of pelvic organs 185
Infections of the vagina (vaginitis), cervix and uterus (including fungal, bacterial, viral, and protozoal) Other vaginal diseases There is some crossover in these areas. For example, a woman with urinary incontinence may be referred to a urologist.
Therapies As with all surgical specialties, gynaecologists may employ medical or surgical therapies (or many times, both), depending on the exact nature of the problem that they are treating. Preand post-operative medical management will often employ many standard drug therapies, such as antibiotics, diuretics, antihypertensives, and antiemetics. Additionally, gynaecologists make frequent use of specialized hormone-modulating therapies (such as Clomifene citrate and hormonal contraception) to treat disorders of the female genital tract that are responsive to pituitary and/or gonadal signals. For lists of gynaecological drugs (by the ATC classification system), see ATC code G01 and ATC code G02. Surgery, however, is the mainstay of gynaecological therapy. For historical and political reasons, gynaecologists were previously not considered "surgeons", although this point has always been the source of some controversy. Modern advancements in both general surgery and gynaecology, however, have blurred many of the once rigid lines of distinction. The rise of sub-specialties within gynaecology which are primarily surgical in nature (for example urogynaecology and gynaecological oncology) have strengthened the reputations of gynaecologists as surgical practitioners, and many surgeons and surgical societies have come to view gynaecologists as comrades of sorts. As proof of this changing attitude, gynaecologists are now eligible for fellowship in both the American College of Surgeons and Royal Colleges of 186
Surgeons, and many newer surgical textbooks include chapters on (at least basic) gynaecological surgery.
Some of the more common operations that gynaecologists perform include: 1. Dilation and curettage (removal of the uterine contents for various reasons, including completing a partial miscarriage and diagnostic sampling for dysfunctional uterine bleeding refractive to medical therapy) 2. Hysterectomy (removal of the uterus) 3. Oophorectomy (removal of the ovaries) 4. Tubal ligation (a type of permanent sterilization) 5. Hysteroscopy (inspection of the uterine cavity) 6. Diagnostic laparoscopy – used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide a definitive diagnosis of endometriosis. 7. Exploratory laparotomy – may be used to investigate the level of progression of benign or malignant disease, or to assess and repair damage to the pelvic organs. 8. Various surgical treatments for urinary incontinence, including cystoscopy and suburethral slings. 9. Surgical treatment of pelvic organ prolapse, including correction of cystocele and rectocele. 10. Appendectomy – often performed to remove site of painful endometriosis implantation and/or prophylactically (against future acute appendicitis) at the time of hysterectomy or Caesarean section. May also be performed as part of a staging operation for ovarian cancer. 11. Cervical Excision Procedures (including cryosurgery) – removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on Pap smear.
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In the UK the Royal College of Obstetricians and Gynaecologists, based in London, encourages the study and advancement of both the science and practice of obstetrics and gynaecology. This is done through postgraduate medical education and training development, and the publication of clinical guidelines and reports on aspects of the specialty and service provision. The RCOG International Office works with other international organisations to help lower maternal morbidity and mortality in under-resourced countries. Gynaecologic oncology is a subspecialty of gynaecology, dealing with gynaecology-related cancer. Gender of physicians Despite the patients being predominantly female, like all specialist areas of health, historically gynaecology has been dominated by male doctors. However, in recent times as many of the barriers to access the education and training required to successfully practice gynaecology were removed, women have started to outnumber the number of men in the field. There are a number of reasons for this, ranging from women being motivated to become gynaecologists after having bad experiences with male doctors to men choosing to specialize in different fields. Possible reasons reported for the decrease in male gynaecologists range from there being a perception of a lack of respect from other doctors towards them, distrust about their motivations for wanting to work exclusively with female sexual organs and questions about their overall character, as well as a concern about being associated with other male gynaecologists who have been arrested for sex offences and limited future employment opportunities. Surveys have also shown a large and consistent majority of women are uncomfortable being forced to have intimate exams done by a male doctor. They are also less likely to be embarrassed, so as a result talk more openly and in greater details, when discussing their sexual history with another woman rather than a man, leading to questions about the ability of male gynaecologists to offer quality care to patients. This, when coupled with more women 188
choosing female physicians has decreased the employment opportunities for men choosing to become gynaecologists.
As women are becoming presented with a choice of their doctor's gender, their preferences are starting to being questioned too. Almost 70% of respondents to an online poll agreed it is normal for a husband to 'hate' that his wife saw a male gynecologist. While there have also been reports of relationships having ended due to selection of a male gynecologist with some men feeling their partner's desire to have another man touching and penetrating their sexual organs for a routine checkup when there were capable and qualified women available an act of infidelity. Interviews with male gynecologists where the doctors openly admitted they liked being 'hit on' by some patients while performing intimate exams further underlined many of the suspicion towards men choosing to become gynecologists. In the United States, it has been reported that 4 in 5 students choosing a residency in gynaecology are now female. In Sweden, to counter the lack of demand for male gynecologists, women have had the right to choose their doctor removed from them. In Turkey, due to patient preference to be seen by another female, there are now few male gynaecologists working in the field. There have been a number of legal challenges in the US against healthcare providers who have started hiring based on gender of physicians. Dr Mircea Veleanu argued, in part, that his former employers discriminated against him by accommodating the wishes of female patients who had requested female doctors for intimate exams. A male nurse complained about an advert for an all-female obstetrics and gynecology practice in Columbia, Maryland claiming this was a form of sexual discrimination. Dr. David Garfinkel, a New Jersey-based ob-gyn sued his former employer after being fired due to, as he claimed, "because I was male, I wasn't drawing as many patients as they'd expected". So far, all legal challenges by male gynecologists to remove patient choice have failed due to there being protection in law for 'bona fide occupational qualification' which in previous cases 189
involving wash-room attendants and male nurses have recognized a justification for genderbased requirements for certain jobs.
Vaginoplasty Surgery Vaginoplasty is a plastic surgery procedure for both the vaginal canal and the tissues of its mucous membrane that tightens and strengthens those muscles and tissues while removing excess or damaged lining from the canal. The procedure is specifically designed to strengthen and enhance the function of the vulva-vaginal body structures.
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The procedure may take the form of reconstructive surgery. Reconstructive surgery is judged to be a medical necessity because the vaginal canal or its structures are damaged or absent, usually due to either a congenital cause such as vaginal atresia (having a deformed, absent or non-functioning vagina) or an acquired cause such as an illness (cancer) or a physical trauma (injury). When vaginal plastic surgery is performed to specifically construct or reconstruct the vulva-vaginal complex, either partially or totally, it is referred to as a neovaginoplasty. When the surgery is performed to specifically reshape the tissue and firm the muscles and lining of the vaginal canal for a more youthful appearance plus tighten up the canal after the stretching it endures through childbirth, then it is termed a vagina reduction for cosmetic reconstruction and is considered an elective surgical procedure. In layman’s terms, it is basically a “face lift” for the female genitalia. Sometimes it is referred to as a “vaginal rejuvenation”, especially when combined with a procedure called a labiaplasty, which is discussed here in depth. Two Categories of VP Surgery Medical Purposes Several decades ago, procedures for surgical vaginal surgery were developed originally as reconstructive means to repair birth defects. Certain conditions (e. g. Müllerrian agenesis or aplasia, vaginal agenesis, congenital adrenal hyperplasia) needed to be repaired or corrected so that young ladies could grow up with the ability to urinate normally, have a menstrual cycle and engage in sexual intercourse as an adult. Reconstructive surgery to correct functional problems has always been looked upon favorably by the American College of Obstetricians and Gynecologists (ACOG) because these surgeries and outcomes have been scientifically studied and evaluated for their effectiveness and safety for the patients. Cosmetic/Aesthetic Purposes Within the last few decades, however, it has also evolved into a set of cosmetic surgical procedures that plastic surgeons and cosmetic gynecologists are marketing as “designer vagina” rejuvenation procedures. These procedures are designed specifically to tighten up the canal that has become loose or slackened either from age or from the effects of childbirth; sometimes from both. It is often combined with a surgery to enhance the appearance of the “lips”, or labia, of the vulva called labiaplasty. Some of the surgeons who perform these procedures also make the claim that vaginal plastic surgery can even improve sexual sensitivity. Vaginal tightening surgery essentially is a procedure to change the aesthetics of normal anatomy to reshape it in order to make you feel better about yourself.
Methods of Performing Elective/Cosmetic Vaginal Procedures Labiaplasty Labiaplasty is a surgery to reduce the size or change the shape of the labia minora, majora or both. The labias are the four different folds of tissue that comprise the vulva. It is done either as a separate procedure or along with vaginal surgery. Some women are embarrassed because their thick labia are large enough that they seem to show through their clothing. Some experience pain when jogging, riding bikes and wearing jeans which rub against theirs. Labia reduction provides relief from pain and chaffing.
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Vaginal Rejuvenation A balloon vagioplasty is simple to perform under local anesthesia with great cosmetic results for vagina rejuvenation. This procedure includes vaginal and labial surgeries and other techniques.
Clitoral Unhooding Certain plastic surgeons are currently marketing a procedure in which they remove the tissue cover that is normally over the clitoris. Named clitoral unhooding, this procedure is being likened to a female version of circumcision. Laser technology is also being introduced into vaginal surgeries to replace surgeons’ use of traditional scalpels. G-Spot Amplification (Grafenburg Spot Amplification) G-spot Amplification is a fairly new plastic surgery procedure that involves the surgeon injecting the patient with collagen to increase her ability to feel pleasure. In the front wall of the vagina is a spot that is highly sensitive to stimulation; the erotic female G-spot considered to be the source of feminine orgasmic arousal. The collagen injection is placed into this front wall. “Revirgination” (Hymenoplasty) “Revirgination” is a cosmetic vaginal surgery that is highly controversial. The medical term for this surgery is hymenoplasty and its goal is to repair and rebuild the hymen that is broken when a woman becomes sexually active. Some cultures throughout the world have very strong religious convictions about virginity and its importance, so this procedure is highly controversial.
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Benefits and Risks of Vaginoplasties Women who have experienced reduction in sexual pleasure due to loosening of vaginal muscles have reported good results with their resumption of sexual relations after they have recovered completely from their vaginal surgeries. Their partners are experiencing friction again and having no trouble maintaining an erection; the women also are experiencing sexual pleasure again. These women do caution others who are considering having the surgery to take the advice of their surgeons about how much tightening is needed and not to ask to be tightened too much or sex will become painful. Labia reductions resulted in more comfort when sitting, moving and wearing figure-hugging clothing. Improved mental health through a healthier, happier self-image has also been reported a benefit also. Health insurance does not cover cosmetic vaginal procedures. Nevertheless, it is better to choose a surgeon with a lot of experience and good references even if that surgeon costs more than others than to choose a surgeon based on low cost. Quality of the surgical results is more important (and safer) than price. Choosing a higher priced but reputable doctor whose reputation for safe, clean operations is excellent is much safer than selecting a cheaper doctor who may have some botched surgeries in the past. Be aware that surgery in a metropolitan area will generally always cost more than in a smaller, more rural community. There are some specific risks involved in these surgeries. The most common include: Post-surgical bleeding Post-surgical infection Post-surgical scarring Ongoing pain Smoking increases infection risks and impedes healing: stop a month before surgery. 193
Other risks include: Temporary and Permanent changes in genital sensations (decreased clitoral, vaginal sensations) Dyspaureunia (painful vaginal contractions/painful intercourse) Tissue adhesions Hypersensitivity in clitoris Pudenal Neuralgia (chronic pain in the pelvis resulting from the entrapment of this nerve following pelvic surgery) If a woman has learned the risks, has realistic expectations of the surgical outcomes, and has vetted a surgeon carefully, she is ready to have her procedure. If she is expecting this type of surgery to save her marriage, keep her boyfriend from cheating or make all her problems go away, she is doomed to disappointment. Most female genital cosmetic surgeons offer a free consultation for those considering surgery on their vagina. If the woman thinks this decision through ahead of time, writes down all questions and concerns before going to the appointment, then covers them all with the doctor, she will have all the information she needs to make an informed decision about whether or not this surgery is right for her. Making the Decision for Vaginal Tightening Surgery and Choosing a Surgeon Today our entire culture is bikini waxed, “Sex in the City”-ed, twerked and oversexualized to the point where young and ever younger women are “comparing” themselves to some nonexistent standard and feeling that they are abnormal. When you are considering whether or not to undergo some form of vaginoplasty surgery, reflect for some time on whether or not the problem that is making you even consider surgery is one that bothers you a great deal or not very much. Then consider this: all surgery carries risks of real physical harm. 194
Why would you put yourself in harm’s way for something that does not bother you very much? If the problem bothers you a great deal but the idea of surgery scares you, consider counseling as your first option. You may just need to become more secure and comfortable with yourself and develop a better self-image. If that is not the answer for you and the surgical risks are acceptable, then make your appointment to consult with a surgeon. In your consultation, it is important that you be completely honest and open with the doctor about your concerns and feelings about your own genitalia. Talk about the expectations you have for your surgical outcomes, ask if the same results could be obtained through non-surgical means and ask if your expectations are realistic and achievable.
Methods of Performing Medically Necessary Vaginal Surgery Procedures In the most general terms, vaginal plastic surgery, is performed by removing excess lining. The surgeon also tightens the muscles and surrounding soft tissues in the vaginal area. In fertile women, the procedure does not adversely affect their ability to continue to have their menstrual cycle and to conceive a child when their ovaries and uterus are preserved in their normal condition. In some cases, giving birth vaginally after having one and healing from the procedure is even possible. When surgeries are performed to repair, rebuild or totally construct parts of the vulvavaginal complex the surgeon uses tissue which is derived from the patient (autologous tissue) to construct the new genital parts and area. 195
These autologous tissues are derived from: Skin flaps Skin graphs Oral mucosa Vaginal labia Penile skin Penile tissue Scrotal skin Intestinal mucosa Skin that includes hair follicles must have them removed (depilated) either electrolytically or by scraping manually in the operating room before being attached for its new purpose. Some of the primary medical vaginal procedures include: Balloon Vaginal Surgery Buccal Mucosa Vaginoplasty Surgery Colovaginoplasty Vecchietti Procedure McIndoe Technique Penile Inversion Wilson Method Don Flap Correction (Labia Minora Flap) Hymenotomy and Hymenorrhaphy Balloon Vaginal Surgery This technique is the fastest method by which a surgeon can create a neo-vagina for the patient. A laparoscope is used to insert a foley catheter into a woman’s rectouterine pouch (an extension of the peritoneal cavity her body naturally has between the rear wall of her uterus 196
and her rectum). Gradual distention of the balloon while applying traction stretches and creates the neo-vagina. The procedure also successfully treats vaginal aplasia. It is particularly effective when traditional laparoscopic surgery is neither safe nor feasible. One particular advantage this procedure is the control the surgeon has in creating the new length and depth dimensions of the gentialia.
Buccal Mucosa Surgery This relatively new approach treats vaginal agenesis using the healing qualities of the body’s buccal mucosa tissues (from the inside of the cheek) to make a lining. Post-operatively, the patient benefits from minimal scarring and a shorter recovery period. After harvesting the donor tissue from the cheek and forming it onto a stent, the surgeon places it into the vaginal space already created and sutures it to the perineal skin and labia minora temporarily during the patient’s recovery. The sutures dissolve. Risks are complications like infection or damaging scars in the mouth. The surgeon must also avoid damaging the Stenson’s duct that carries saliva through the mouth. Colovaginoplasty This technique requires removing a section of the sigmoid colon to form a vagina and using the colon’s vascular pedicle as the vaginal tissue. It is performed on women who have androgen insensitivity syndrome. The chief benefit is that it provides good depth and width to the neovagina it creates. The primary complication is a significant one and that is why it is used only as a last resort: the patient is at risk of developing diversion colitis. Vecchietti Procedure This surgical procedure is used in the treatment of Müllerrian agenesis. The surgeon laparoscopically threads a small sphere made of plastic (the “olive”) against the area by sutures.
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The threads then are drawn up through the vaginal skin, the abdomen and through the navel where the threads are all attached to a traction device. The average time in the operating room for this procedure is 45 minutes, depending on the patient’s needs and health condition. With the “olive” in place, the traction device is drawn tight daily so the “olive” is pulled upwards and stretches the walls of the vagina at a rate of at least 1.0 centimeter per day until within a week it should be the desired size.
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McIndoe Technique The surgeon first creates a pocket of space between the patient’s rectum and bladder, and then performs split-thickness skin grafts to gather tissue for covering a mold which is inserted into the surgically created space.
One of the primary differences between this technique and the Vecchietti procedure is the source of the lining tissues used for the neo-vaginas. Both techniques have their own positives and negatives and the choice of procedure depends entirely upon the patient’s health, indicating factors and desired post-operative outcomes. Penile Inversion Penile inversion and Colovaginoplasty are the two primary procedures used for genital corrections on transsexual patients. This is the “transitional surgery” utilized for sexreassignment. With penile inversion surgery, the skin of the patient’s penis is placed into the body to create the new vagina. It is the most common form of plastic surgery for transwomen patients. After first creating an internal “vaginal” cavity in the patient’s pelvic tissues, the surgeon uses a flap technique to remove the skin of the penis, keeping its blood supply and nerves intact. The penile erectile spongiform tissue is removed. The skin is then formed into a labia minora and a vestibule area before being inserted into the “vaginal” cavity. The surgeon uses the highly sensitive glans tip of the penis to form the neo-clitoris, carefully maintaining its vascular and nerve systems. The male urethra is shortened to a size suitable for the female anatomy.
Wilson Method This surgical method is also used for “transitional surgery” and is a three step procedure. It follows the same steps as the penile inversion surgery through its first two steps, stopping with the creation of the vaginal vault. At this point, the new genitalia is left raw and unfinished, but is packed with a sterile stint. Five to seven days later, the procedure resumes for the third and final stage with the surgeon using a skin graft from the patient’s buttocks to line the neo199
vagina. The clitoral hooding, labia minora and anterior frenulum are all created from the skin of the penis. The clitoris is created from the glans tip of the penis while the labia majora is created from the scrotum. Don Flap Correction (Labia Minora Flap) Similar to the penile inversion process, a new vagina is made for treatment of vaginal agenesis by suturing the patient’s labia minora together. Another technique is to use the clitoral hood as a one-piece horseshoe-shaped flap. Later, though, labiaplasty to restore genital appearance and an appropriately sized vagina is needed. Considered procedures, a Hymenorrhaphy is the procedure used to restore and replace a ruptured hymen. Hymenotomy is the procedure of penetrating or creating an opening in a previously impenetrable or imperforable hymen.
Purposes for Elective/Cosmetic Vaginal Rejuvenation SurgerToday’s surgery is offered by plastic surgeons and gynecologists for aesthetic and cosmetic reasons as well as for medical ones. Doctors are touting the same benefits from these procedures that other cosmetic surgeries supply: confidence, self-esteem, comfort and getting more pleasure from life. Plastic surgeons and gynecologists who offer these procedures market them as “vaginal rejuvenation” surgeries. Designed to tighten lax muscles and tissues that have led to decreased friction and satisfaction during sexual intercourse, to correct feelings of vaginal sagging and heaviness that makes women uncomfortable, incontinent and less secure about their sexually, and to increase sexual satisfaction. Many women undergo these surgeries to enhance their genitalia’s appearance, rekindle their own sexuality and improve their physical and mental health. After the tremendous stretching that is undergone during childbirth, a woman’s vagina will never be as tight again as it was before five to nine pound human beings pushed their little heads and bodies through it. Some women experience more than just vaginal loosening. They suffer vaginal prolapse and require treatment to correct the problem. Ageing also causes sagging and muscle laxity, reducing the ability to feel as much sensation during intercourse and decreasing sexual satisfaction and this can also be a reason for vaginal tightening surgery 200
when lovers are not experiencing enough friction during coitus, making it harder to maintain an erection and reach climax, decreasing male satisfaction as well. Vaginal rejuvenation surgery can increase tightness and thereby increase friction.
Women’s genitals, like men’s, have a wide range of naturally occurring normal appearances that are all considered anatomically correct. There is no right, wrong or ideal labia and vagina. Yet in our sex-focused society, women are bombarded with images on television, Facebook, Twitter, movie screens, pornography, YouTube and many other media sources of models, porn stars, and photo shopped images of “perfect” beauty. Labiaplasty is becoming a much more popular procedure than it once was, with younger and younger women asking surgeons to “reshape” their labias to make them look “nice”. There are times when cosmetic vaginal procedures are medically indicated. One such time is for patients who are victims of the barbaric practice of female cutting who need repair or reversal of the damage that has been done to them. Other times are for patients with labial hypertrophy, labial growth that has been asymmetrical and is now painful and problematic, and labias that cause the patient chronic irritation in tight clothes or vigorous activity. You can find more information about large labia here.
Vaginoplasty
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Vaginoplasty is any number of genitoplasty surgical procedures done to the vagina, vulva or related structures; this includes surgery done to the labia majora, labia minora, clitoris, urethra, cervix, uterus, bartholin's gland, rectum, perineal musculature, lymphatics, urethral sphincter, anal sphincter, large blood vessels, and nerve tissue. Malignant growths and abscesses are removed and vaginoplasty recreates a normal vaginal structure and function. Vaginoplasty is also used to correct congenital defects to the vagina, urethra and rectum. Vaginoplasty can correct uterine and vaginal prolapse. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma. It will correct protrusion of the urinary bladder into the vagina and protrusion of the rectum into the vagina. Female infants born with a 46,XX genotype but have genitalia affected by congenital adrenal hyperplasia will undergo the surgical creation of a vagina. Vaginoplasty is commonly used to treat women with the congenital absence of the vagina. Other reasons for the surgery include issues involving a microphallus, those who have Mayer-Rokitansky-Kustner disorder, and women who have had a vaginectomy after malignancy or trauma. It is done to reduce the size of the entrance of the vagina in some cases. In some instances, it is used to alter the appearance of the vulvar region.
Medical uses Vaginoplasty is the description of the following surgical interventions: treatment of Congenital adrenal hyperplasia. separation of congenitally fused urethra and vagina repair of a urethra that is short 202
vaginal construction vaginal reconstruction vaginal vault prolapse vaginal suspension and fixation operations on cul-de-sac repair of cystocele and rectocele genital prolapse retropubic paravaginal repair the repair of a cystocele using a graft or prosthesis the repair of a cystocele and a rectocele in the same procedure using a graft or prosthethic device the repair of a rectocele using a graft or prosthetic material the vaginal construction using a graft or prosthetic material the vaginal reconstruction using a graft or prosthetic material the vaginal suspension and stabilization using with graft or prosthetic material hymenorrhaphy
The grafts used in vaginoplasty can be an allogenic, a heterograph, an autograft, xenograft, or a autologous material.
Risks and complications In adults, rates and types of complications varied with gender reassignment vaginoplasty. Necrosis of the clitoral region was 1-3%. Necrosis of the surgically created vagina was 3.74.2%. Vaginal shrinkage occurred was documented in 2-10% of those treated. Stricture, or narrowing of the vaginal orifice was reported in 12-15% of the cases. Of those reporting 203
stricture, 41% underwent a second operation to correct the condition. Necrosis of two scrotal flaps has been described. Posterior vaginal wall is rare complication. Genital pain was reported in 4-9%. Rectovaginal fistula is also rare with only 1% documented. Vaginal prolapse was seen in 1-2% of people assigned male at birth undergoing this procedures. The ability of emptying the bladder was affected after this procedure with 13% reporting improvement, 68% said that there was no change and 19% reported that voiding got worse.Those reporting a negative outcome experienced in which loss of bladder control and incontinence were 19%. Urinary Tract infections occurred in 32% of those treated. Techniques Non-surgical vagina creation was used in the past to treat the congenital absence of a vagina. The procedure involved the wearing of a saddle-like device and the use of increasing-diameter dilators. The procedure took several months and was sometimes painful. It was not effective in every instance. Reconstructive surgery for congenital adrenal hyperplasia Adrenal hyperplasia is a congential endocrine disorder in genotypical females that influences the formation of the external genitalia. Most parents choose reconstructive surgery for their infant females to reverse the virilization effects of the disorder. The virilization occurs because there is a 21-hydroxylase deficiency. Corrective vaginoplasty is scheduled at the age of one to two-years-old as single feminizing genitoplasty. Specific procedures include: clitoral reduction, labiaplasty, normalizing appearance, vagina creation. initiating vaginal dialation. When the girl enters puberty, a reevaluation is done and continued dilation is performed by the girl. A normal sized vagina can be achieved in months 204
McIndoe surgical technique A canal is surgically constructed between the urinary bladder and urethra in the anterior portion of the pelvic region and the rectum. A skin graft is used from another area of the person's body. The graft is removed from the thigh, buttocks, or inguinal region. It is then wrapped around a mold and placed into the surgically created canal. Other materials have been used to create the lining of the newly created vagina. These have been cutaneous skin flaps, amniotic membranes, and buccal muscosa. Bowel vaginoplasty Bowel vaginoplasty is one commonly used surgical method to create an artificial vagina. Sex reassignment surgery Sex reassignment surgery to create a vagina consists of using segments from the large intestine or small intestine. In addition, penile-scrotal skin flaps are also used. Nongenital fullthickness graft (FTG) or split-thickness skin grafts from other parts of the body have been used. Inversion of the penile skin is the method most often selected by surgeons performing gender reassignment surgery. The inverted penile skin uses inferior pedicle skin or abdominal skin for the lining of the created vagina. The skin is cut to form an appropriate-sized flap. The skin flap is sometimes combined with a scrotal or urethral flap. Sex reassignment therapy is often part of the treatment plan.
Elective Vaginoplasty Critics have labeled such surgery as the "designer vagina". The British Medical Journal strongly criticized the "designer vagina" citing its increasing incidence coming from the media and commercial providers. Similar concerns have been expressed in Australia. Canadian physicians have published policy statements against elective vaginoplasty based upon the risks associated with unnecessary cosmetic surgery. The World Health Organization describes any medically unnecessary surgery to the vaginal tissue and organs as Female genital mutilation. 205
Vaginal rejuvenation is a form of elective plastic surgery. Its purpose is to restore or enhance the vagina's cosmetic appearance.
Labiaplasty Labiaplasty (also known as labioplasty, labia minora reduction, and labial reduction) is a plastic surgery procedure for altering the labia minora (inner labia) and the labia majora (outer labia), the folds of skin surrounding the human vulva. There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their genitals because they believe they do not fall within a normal range. Labiaplasty corrects the congenital absence of the labia in female infants with congenital adrenal hyperplasia. It can be performed as a discrete surgery, or as a subordinate procedure within a vaginoplasty. Some surgeries are needed for discomfort occurring from chronic labial irritation that develops from tight clothing, sex, sports, or other physical activities. Balloon vaginoplasty In this procedure, a foley catheter is laparoscopically inserted to the rectouterine pouch whereupon gradual traction and distension are applied to create a neovagina. Laparoscopic peritoneal pull through vaginoplasty A simple new laparoscopic peritoneal vaginoplasty was described in a series of 36 patients with long term replicable excellent results culminating in normal vaginal development. A total of 36 patients with congenital absence of vagina (MRKH syndrome) were treated with laparoscopic peritoneal pull through technique of Dr. Mhatre (modification of Davidov’s procedure) between 2003 and 2012. The new technique of laparoscopic peritoneal vaginoplasty described by the author has not only produced excellent results due to peritoneal 206
metaplasia, but it has also resulted in the formation of normal vagina. This new surgical technique is comparatively simple with no morbidity. The neovagina has an acidic pH and normal cytology. Average operative time was 1-1.5 hrs. Average hospital stay was three days; there were no intra-operative and post-operative complications. All the patients had adequate vaginal length of about 7 to 8 cm, admitting a full-size Sims’ speculum. The neovagina offers patients good coital function with natural lubrication and pleasure, a function which is otherwise denied by nature in the context of their earlier quandary.
The post-operative outcome of vaginoplasty is variable; it usually allows coitus (sexual intercourse) after a week, although sensation might not always be present. In fertile women, menstruation and fertilization may be possible when the uterus and the ovaries are functioning. Vecchietti procedure In treating müllerian agenesis, the Vecchietti procedure is a laparoscopic surgical technique that produces a vagina of dimensions (depth and width) comparable to those of a normal vagina (ca. 8.0 cm. deep). A small, plastic sphere (“olive”) is threaded (sutured) against the vaginal area; the threads are drawn though the vaginal skin, up through the abdomen, and through the navel. There, the threads are attached to a traction device, and then daily are drawn tight so that the “olive” is pulled inwards and stretches the vagina, by approximately 1.0 cm. per day, thereby creating a vagina, approximately 7.0 cm. deep by 7.0 cm. wide, in 7 days. The mean operating room (OR) time for the Vecchietti vaginoplasty is approximately 45 minutes; yet, depending upon the patient and her indications, the procedure might require more time. The outcomes of Vecchietti technique via the laparoscopic approach are found to be comparable to the procedure using laparotomy. In vaginal hypoplasia, traction vaginoplasty such as the Vecchietti technique seems to have the highest success rates both anatomically (99%) and functionally (96%) among available treatments. Wilson Method The penile-inversion technique of the Wilson Method is different from the traditional penileinversion technique in that it is a three-stage surgery, comprising a two-stage initial vaginoplasty. The Wilson Method surgery is initially performed like a traditional penile inversion, until the vaginal-vault creation step, in which the vault of the vagina is left unfinished, as a raw surface, and is packed with a sterile stent, which, after 5–7 days, then is lined with a skin graft harvested from the buttocks. The penile skin is used to create the labia minora, clitoral hooding, and the anterior fourchette (frenulum); the glans penis is used to create the clitoris, and the scrotum is used to create the labia majora. 207
The size, colour, and shape of labia vary significantly, and may change as a result of childbirth, aging and other events. Conditions addressed by labiaplasty include congenital defects and abnormalities such as vaginal atresia (absent vaginal passage), Müllerian agenesis (malformed uterus and fallopian tubes), intersex conditions (male and female sexual characteristics in a person); and tearing and stretching of the labia minora caused by childbirth, accident and age. In a male-to-female sexual reassignment vaginoplasty for the creation of a neovagina, labiaplasty creates labia where once there were none.
A 2008 study in the Journal of Sexual Medicine reported that 32 per cent of women who underwent the procedure did so to correct a functional impairment; 31 per cent to correct a functional impairment and for aesthetic reasons; and 37 per cent for aesthetic reasons alone. According to a 2011 review, also in the Journal of Sexual Medicine, overall patient satisfaction is in the 90–95 percent range. Risks include permanent scarring, infections, bleeding, irritation, and nerve damage leading to increased or decreased sensitivity. A change in requirements of publicly funded Australian plastic surgery requiring women to be told about natural variation in labias led to a 28% reduction in the numbers of surgeries performed.nUnlike public hospitals, cosmetic surgeons in private practise are not required to follow these rules, and critics say that "unscrupulous" providers are charging to perform the procedure on women who wouldn't want it if they had more information. Images of vulvae are absent from the popular media and advertising and don't appear in some anatomy textbooks, while community opposition to sex education limits the access that young women have to information about natural variation in labias. Many women have limited 208
knowledge of vulval anatomy, and are unable to say what a "normal" vulva looks like. At the same time, many pornographic images of women's genitals are digitally manipulated, changing the size and shape of the labia to fit with the censorship standards in different countries. The Observer wrote in 2011 that some medical researchers raised concerns about the procedure and its increasing prevalence rates, with some speculating that exposure to pornography images on the Internet may lead to body dissatisfaction in some women. However, the researchers noted that research evidence for this speculation was lacking.
The external genitalia of a woman are collectively known as the vulva. This comprises the labia majora (outer labia), the labia minora (inner labia), the clitoris, the urethra, and the vagina. The labia majora extend from the mons pubis to the perineum. The size, shape, and color of women's inner labia vary greatly. One is usually larger than the other. They may be hidden by the outer labia, or may be visible, and may become larger with sexual arousal, sometimes two to three times their usual diameter. Size of the labia This photo demonstrates normal female genital appearance, with enlarged labia minora and excess tissue in the clitoral hood region. While this is indeed "normal" this patient complained of inability to wear tight clothing and discomfort with intercourse due to pulling and stretching of the labia minora. This patient was a 20-year-old female who had not yet had children. 209
The size of the labia can change because of childbirth. Genital piercing can increase labial size and asymmetry, because of the weight of the ornaments. In the course of treating identical twin sisters, S.P. Davison et al reported that the labia were the same size in each woman, which indicated genetic determination. In or around 2004, researchers from the Department of
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Gynaeology, Elizabeth Garret Anderson Hospital, London, measured the labia of 50 women between the ages of 18 and 50, with a mean age of 35.6: Measurements
Mean [Standard deviation]
Clitoral length (mm)
5.0 – 35.0
19.1 [8.7]
Clitoral glans width (mm)
3.0 – 10.0
5.5 [1.7]
Clitoris to urethra (mm)
16.0 – 45.0
28.5 [7.1]
Labia majora length (cm)
7.0 – 12.0
9.3 [1.3]
Labia minora length (mm)
20 – 100
60.6 [17.2]
Labia minora width (mm)
7.0 – 50.0
21.8 [9.4]
Perineum length (mm)
15.0 – 55.0
31.3 [8.5]
Vaginal length (cm)
6.5 – 12.5
9.6 [1.5]
Tanner Stage (n)
IV
4.0
Tanner Stage (n)
V
46
Color of the genital area Same color compared to the surrounding skin (n)
9.0
Color of the genital area Darker color compared to the surrounding skin (n)
41
Rugosity of the labia (n)
Smooth (unwrinkled) 14
Rugosity of the labia (n)
Moderately wrinkled 34
Rugosity of the labia (n)
Markedly wrinkled
2.0
Surgery Contraindications Labia reduction surgery is relatively contraindicated for the woman who has active gynecological disease, such as an infection or a malignancy; the woman who is a tobacco smoker and is unwilling to quit, either temporarily or permanently, in order to optimize her wound-healing capability; and the woman who is unrealistic in her aesthetic goals. The latter should either be counselled or excluded from labioplastic surgery. Davison et al write that it should not be performed when the patient is menstruating to reduce potential hormonal effects and the increased risk of infection. Sex reassignment surgery In sexual reassignment surgery, in the case of the male-to-female transgender patient, labiaplasty is usually the second stage of a two-stage vaginoplasty operation, where labiaplastic techniques are applied to create labia minora and a clitoral hood. In this procedure, the labiaplasty is usually performed some months after the first stage of vaginoplasty. Anaesthesia Labial reduction can be performed under local anaesthesia, conscious sedation, or general anaesthesia, either as a discrete, single surgery, or in conjunction with another, gynecologic or cosmetic, surgery procedure. The resection proper is facilitated with the administration of an anaesthetic solution (lidocaine + epinephrine in saline solution) that is infiltrated to the labia 211
minora to achieve the tumescence (swelling) of the tissues and the constriction of the pertinent labial circulatory system, the hemostasis that limits bleeding. Procedures Edge resection technique The original labiaplasty technique was simple resection of tissues at the free edge of the labia minora. One resection-technique variation features a clamp placed across the area of labial tissue to be resected, in order to establish hemostatis (stopped blood-flow), and the surgeon resects the tissues, and then sutures the cut labium minus or labia minora. This procedure is used by most surgeons because it is easiest to perform. The technical disadvantages of the labial-edge resection technique are the loss of the natural rugosity (wrinkles) of the labia minora free edges, thus, aesthetically, it produces an unnatural appearance to the vulva, and also presents a greater risk of damaging the pertinent nerve endings. Moreover, there also exists the possibility of everting (turning outwards) the inner lining of the labia, which then makes visible the normally hidden internal, pink labial tissues. The advantages of edgeresection include removal of the hyper-pigmented (darkened) irregular labial edges with a linear scar. Another disadvantage of the trim or "amputation" method, is that it is unable to excise redundant tissues of the clitoral hood, when present. Complete amputation of the labia minora is more common with this technique, which often requires additional surgery to correct. In addition, the trim method does not address the clitoral hood. Clitoral hood deformities are common with this approach, again requiring additional corrective surgery. Some women complain of a "small penis" when the trim procedure is performed, owing to the un-addressed clitoral hood tissue and completely removed (amputated) labia minor. Most plastic surgeons do not perform this procedure, and instead favor the extended wedge approach, which is technically more demanding, but produces a more natural result and is able to create a natural and proportioned appearance to the vulva. Reconstructive procedures are often required after the trim (amputation) labiaplasty.
Central wedge resection technique Labial reduction by means of a central wedge-resection involves cutting and removing a partial-thickness wedge of tissue from the thickest portion of the labium minus. Unlike the edge-resection technique, the resection pattern of the central wedge technique preserves the natural rugosity ("wrinkled" edge) of the labia minora. If performed as a full-thickness resection, there exists the potential risk of damaging the pertinent labial nerves, which can result in painful neuromas, and numbness. A partial thickness removal of mucosa and skin, leaving the submucosa intact, decreases the risk of this complication. F. Giraldo et al. procedurally refined 212
the central wedge resection technique with an additional 90-degree Z-plasty technique, which produces a refined surgical scar that is less tethered, and diminishes the physical tensions exerted upon the surgical-incision wound, and, therefore, reduces the likelihood of a notched (scalloped-edge) scar. The central wedge-resection technique is a demanding surgical procedure, and difficulty can arise with judging the correct amount of labial skin to resect, which might result in either undercorrection (persistent tissue-redundancy), or the overcorrection (excessive tension to the surgical wound), and an increased probability of surgical-wound separation. The benefit of this technique is that an extended wedge can be brought upwards towards the prepuce to treat a prominent clitoral hood without a separate incision. This leads to a natural contour for the finished result, and avoids direct incisions near the highly-sensitive clitoris. De-epithelialization technique Labial reduction by means of the de-epithelialization of the tissues involves cutting the epithelium of a central area on the medial and lateral aspects of each labium minus (small lip), either with a scalpel or with a medical laser. This labiaplasty technique reduces the vertical excess tissue, whilst preserving the natural rugosity (corrugated free-edge) of the labia minora, and thus preserves the sensory and erectile characteristics of the labia. Yet, the technical disadvantage of de-epithelialization is that the width of the individual labium might increase if a large area of labial tissue must be de-epithelialized to achieve the labial reduction.
Labiaplasty with clitoral unhooding Labial reduction occasionally includes the resection of the clitoral prepuce (clitoral hood) when the thickness of its skin interferes with the woman’s sexual response or is aesthetically displeasing. The surgical unhooding of the clitoris involves a V–to–Y advancement of the soft tissues, which is achieved by suturing the clitoral hood to the pubic bone in the midline (to avoid the pudendal nerves); thus, uncovering the clitoris further tightens the labia minora. Laser labiaplasty technique Labial reduction by means of laser resection of the labia minora involves the de-epithelialization of the labia. The technical disadvantage of laser labiaplasty is that the removal of excess labial epidermis risks causing the occurrence of epidermal inclusion cysts.
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Labiaplasty by de-epithelialization Labial reduction by de-epithelialization cuts and removes the unwanted tissue and preserves the natural rugosity (wrinkled free-edge) of the labia minora, and preserves the capabilities for tumescence and sensation. Yet, when the patient presents with much labial tissue, a combination procedure of de-epithelialization and clamp-resection is usually more effective for achieving the aesthetic outcome established by the patient and her surgeon. In the case of a woman with labial webbing (redundant folding) between the labia minora and the labia majora, the de-epithelialization labiaplasty includes an additional resection technique — such as the five-flap Z-plasty ("jumping man plasty") — to establish a regular and symmetric shape for the reduced labia minora. Post-operative care This photo demonstrates the appearance of the labia minora and clitoral hood just after surgery in the operative theater. Note that the inner labia are less prominent than before surgery. Post-operative pain is minimal, and the woman is usually able to leave hospital the same day. No vaginal packing is required, although she might choose to wear a sanitary pad for comfort. The physician informs the woman that the reduced labia are often very swollen during the early post-operative period, because of the edema caused by the anaesthetic solution injected to swell the tissues.
She is also instructed on the proper cleansing of the surgical wound site, and the application of a topical antibiotic ointment to the reduced labia, a regimen observed two to three times daily for several days after surgery. The woman’s initial, post-labiaplasty follow up appointment with the surgeon is recommended within the week after surgery. She is advised to return to the surgeon’s consultation room should she develop hematoma, an accumulation of blood outside the pertinent (venous and arterial) vascular system. Depending on her progress, the woman can resume physically unstrenuous work three to four days after surgery. To allow the wounds to heal, she is instructed not to use tampons, not to wear tight clothes (e.g. thong underwear), and to abstain from sexual intercourse for four weeks after surgery. This photo was taken 1 week after an extended wedge labiaplasty with clitoral hood reduction. The inner and outer labia can be seen as edematous, with the most swelling noticed in the clitoral hood area. Medical complications to a labiaplasty procedure are uncommon, yet occasional complications — bleeding, infection, labial asymmetry, poor wound-healing, undercorrection, overcorrection — do occur, and might require a revision surgery. An over-aggressive resection might damage 214
the nerves, causing painful neuromas. Performing a flap-technique labiaplasty occasionally presents a greater risk for necrosis of the labia minora tissues. Criticism Labiaplasty is a controversial subject. Critics argue that a woman's decision to undergo the procedure stems from an unhealthy self-image induced by their comparison of themselves to the prepubescent-like images of women they see in commercials or pornography. In Australia, the Royal Australian College of General Practitioners has issued guidelines on referring patients with dissatisfaction with their genitals to specialists. A change in requirements of publicly funded Australian plastic surgery requiring women to be told about natural variation in labias led to a 28% reduction in the numbers of surgeries performed. Unlike public hospitals, cosmetic surgeons in private practise are not required to follow these rules, and critics say that "unscrupulous" providers are charging to perform the procedure on women who wouldn't want it if they had more information. Increasing numbers of women in Western countries are also using Brazilian waxing to remove pubic hair, and choosing to wear tight-fitting swimwear and clothing. This has led to increased numbers of women complaining of pain and discomfort from chafing of the labia minora, as well as cosmetic concerns around how the appearance of genitals. In many countries, media regulation classifies "hardcore" and "softcore" pornography - demanding that magazines with "hardcore" pornography be wrapped in black plastic and sold only to people over 18 who show photo ID. Sales of magazines in black plastic tend to be low, and, any magazine publishers choose to comply with the "softcore" standards. In Australian magazines, images of vulvas that do not look like "a single crease" are digitally modified to comply with the censorship standard. An Australian pornographic actress says that images of her own genitals sold to pornographic magazines in different countries are digitally manipulated to change the size and shape of the labia according to censorship standards in different countries. [12][18][19]
Community opposition to sex education limits the access that young women have to information about natural variation in labias. Linda Cardozo, a gynaecologist at King's College Hospital, London, told the newspaper that women were placing themselves at risk in an industry that is largely unregulated. Nina Hartley says that "she’s seen every type of vulva in her three decades working in the industry. When young women start out in porn, producers don’t send them off for a routine labiaplasty." In the United States, a labiaplasty surgeon can earn up to $250,000 a month. Simone Weil Davis, professor of American studies, told Shameless magazine in 2005 that surgeons are 215
perpetuating the idea that there is a right way for women's genitalia to look; because most women see only their own vaginas or pornographic images, it is easy to make them doubt themselves. The feminist organization, the New View Campaign, has spoken out against the existence of unregulated cosmetic surgery clinics as business enterprises, which it says trade on women's sexuality by appealing to their low self-esteem, thereby creating health risks. Although female genital mutilation – the practice of cutting off a woman's labia and sometimes clitoris, and in some cases creating a seal across her entire vulva – is illegal across the Western world, Davis argues that "when you really look carefully at the language used in some of those laws, they would also make illegal the labiaplasties that are being done by plastic surgeons in the U.S." The World Health Organization (WHO) defines female genital mutilation as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons." The WHO writes that the term is not generally applied to elective procedures such as labiaplasty. The American College of Obstetricians and Gynecologists (ACOG) published an opinion in the September 2007 issue of Obstetrics & Gynecology that several "vaginal rejuvenation" procedures were not medically indicated, and that there was no documentation of their safety and effectiveness. ACOG argued that it was deceptive to give the impression that the procedures were accepted and routine surgical practices. It recommended that women seeking such surgeries must be given the available surgical-safety statistics, and warned of the potential risks of infection, altered sensation caused by damaged nerves, dyspareunia (painful sexual intercourse), tissue adhesions, and painful scarring. In the UK, Lih Mei Liao and Sarah M. Creighton of the University College London Institute for Women's Health wrote in the British Medical Journal in 2007 that "the few reports that exist on patients’ satisfaction with labial reductions are generally positive, but assessments are shortterm and lack methodological rigour." They wrote that the increased demand for cosmetic genitoplasty (labiaplasty) may reflect a "narrow social definition of normal." The National Health Service performed double the number of genitoplasty procedures in the year 2006 than in the 2001–2005 period. The authors noted that "the patients consistently wanted their vulvas to be flat, with no protrusion beyond the labia majora ... some women brought along images to illustrate the desired appearance, usually from adverts or pornography that may have been digitally altered." The Royal Australian and New Zealand College of Obstetricians and Gynæcologists published the same concern about the exploitation of psychologically insecure women. The International Society for the Study of Women’s Sexual Medicine produced a report in 2007 concluding that "vulvar plastic surgery may be warranted only after counseling if it is still the patient's preference, provided that it is conducted in a safe manner and not solely for the purpose of performing surgery".
Hymenorrhaphy Hymenorrhaphy refers to the practice of thickening the hymen, or, in some cases, implanting a capsule of red liquid within the newly created vaginal tissue. The newly created hymen is created to cause physical resistance, blood, or the appearance of blood, at the time that the individual's new husband inserts his penis into her vagina. This is done in cultures where a high value is placed on female virginity at the time of marriage. In these cultures, a woman may be punished, perhaps violently, if the community leaders deem that she was not virginal at the time of consummation of her marriage. Individuals who are victims of rape, who were virginal at the time of their rape, may elect for hymenorrhaphy. 216
Hymenorrhaphy or hymen reconstruction surgery is the surgical restoration of the hymen. The term comes from the Greek words hymen meaning "membrane", and raphḗ meaning "suture". It is also known as hymenoplasty, although strictly this term would also include hymenotomy. Such procedures are not generally regarded as part of mainstream gynecology, but are available from some plastic surgery centers, particularly in the USA, South Korea and Western Europe, generally as day surgery. The normal aim is to cause bleeding during post-nuptial intercourse, which in some cultures is considered proof of virginity.
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Varieties of the operation The term may cover at least three significantly different types of procedure: Suturing of a tear in the hymen such as might be caused by sexual assault, soon after the assault, to facilitate healing. A purely cosmetic procedure in which a membrane without blood supply is created, sometimes including a gelatine capsule of an artificial bloodlike substance. This operation is intended to be performed within a few days before an intended marriage. Use of a flap of the vaginal lining, complete with its blood supply, to create a new hymen. Patients are advised to refrain from penetrative sex for up to three months following this procedure. Availability and legality Some hymen reconstruction operations are legal in some countries, while other countries ban all hymenorrhaphy. In the United States of America, hymen restoration is available in private clinics and becoming more common, In France, some of the cost is reimbursed by the state in cases of rape or trauma Vaginal tightening is the tightening of the pelvic muscles to achieve or maintain the right degree of elasticity of the pelvic floor muscles. These muscles must be able to contract to maintain continence, and to relax allowing for urination and bowel movements, and in women, for sexual intercourse as well as for giving birth. They also support and protect the organs of the abdomen and hold the bladder in its proper place.
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The pelvic muscles can become stretched or weakened due to ageing and more specifically due to pregnancy. This often happens after a difficult childbirth which overstretches or tears the pelvic muscles and can also be the result of giving birth to several babies within a very short time span. Their under use can also cause pelvic floor weakness. Like for any other muscle, pelvic muscles need exercise to work well. In the same vein, the change in hormones related to menopause could weaken these muscles, as well as damage caused through long term straining, chronic constipation or cough or overweight. Vaginal tightening can be achieved in different ways, all effective in their own way and can be complementary. Causes The pelvic floor muscles, region of the body called the perineum, is a group of muscles and ligaments. Its main muscle is the Pubococcygeus muscle or PC muscle. It is a hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx (tail bone) forming the floor of the pelvic cavity and supporting the pelvic organs. This set of muscles, also known as the muscles of the perineum, forms the floor of the pelvic cavity and supports the pelvic organs such as the bladder, uterus and colon and intestine. These muscles act like a rubber band, they need to be tense but neither too tight to avoid pelvic floor muscle disorder nor too loose, because in both cases they will lose the right degree of elasticity and therefore their main function and could potentially create a pelvic floor dysfunction. Consequences Pelvic floor dysfunctions may include any of a group of clinical conditions that includes urinary incontinence, fecal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and several chronic pain syndromes, including vulvodynia. The three most common and definable conditions encountered clinically are urinary incontinence, anal incontinence and pelvic female genital prolapse. For example, when the pelvic muscles have too much tension (hypertonic) they will often cause pelvic pain, or urgency and frequency of the bladder and bowels. When they are lowtone (hypotonic) they will contribute to stress incontinence and pelvic organ prolapse. You can also have a combination of muscles that are too tense and too relaxed.
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Symptoms of hypertonic pelvic muscles: Urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying Vaginismus Constipation, straining, pain during or after bowel movements Unexplained pain in your low back, pelvic region, hips, genital area, or rectum Pain during or after intercourse, orgasm, or sexual stimulation Uncoordinated muscle contractions causing the pelvic floor muscles to spasm Symptoms of hypotonic pelvic muscles: Stress incontinence Urge incontinence Pelvic organ prolapse Treatments Pelvic floor physiotherapy: Continence and women's health or pelvic floor physiotherapists hold post graduate qualifications specialising in pelvic floor muscle training. They can assess a patient's pelvic floor function and tailor an exercise program to meet its specific needs. They can also prescribe other treatment options such lifestyle modification and biofeedback. Vaginoplasty: Vaginoplasty is a reconstructive plastic surgery and cosmetic procedure for the vaginal canal and its mucous membrane, and of vulvovaginal structures that might be absent or damaged because of congenital disease (e.g. vaginal hypoplasia) or because of an acquired cause (e.g. childbirth physical trauma, cancer). Vaginal rejuvenation: A "vaginal rejuvenation" is a non-reconstructive vaginoplasty that restores the muscle tone and desired aesthetic of the vagina, by removing external tissues and tightening the supportive structures of the vulvovaginal complex, in an effort either to reduce or to reverse the effects of aging and parturition (childbearing). The advantages may be increased comfort and an improved self-image (mental health); the potential disadvantages are decreased clitoral and genital sensation, and complications, such as infection, tissue adhesions, and scarring. Kegel exercise: Pelvic floor exercise, or Kegel exercise, consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the "Kegel muscles".
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Yoga, Pilates: Other forms of exercise also help to tighten the pelvic muscles, like yoga and pilates, as these all incorporate working on the pelvic floor muscle and strengthening the core muscles which together will help keep the participants' pelvic floor muscles tighter. Orgasm: An orgasm is the sudden discharge of accumulated sexual tension during the sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region that will tone the pelvic muscles. As pelvic floor muscles become stronger, so will the orgasms. A Healthy diet: To keep the pelvic muscles strong, it is also needed to feed the muscles properly daily to ensure its correct growth and repair. Medicinal plants: Plants have been used for centuries for their beneficial properties specific to human health or animal. Some of these plants have very strong astringent properties that have the ability to tighten the pelvic floor muscles. The best-known and most used natural herbal ingredients for this purpose are the Kacip Fatimah (Labisia pumila). They are used in many vaginal tightening products, like creams, gels, pills, tablets, capsules, essential oils, sticks, wands, soaps, washes, suppositories and many other forms. Pelvic toning devices: A pelvic toning device, also referred to as a Kegel exerciser, pelvic floor toner, pelvic floor muscle toner or pelvic toner, pelvic floor stimulator, pelvic exercisers, pelvic device, pelvic floor exerciser, is a medical or pseudo-medical device designed to help women exercise their pelvic floor muscles and improve the muscle tone of the pubococcygeus or vaginal muscle. Pelvic toning devices fall into a number of different types: Electrical muscle stimulation: Electrostimulation or electrical muscle stimulation triggers muscle contractions using electric impulses, through an internal vaginal probe, to train the perineal muscles with no pain and no special efforts, while doing it by yourself at home and adapting the intensity of the electric impulses at will. Biofeedback devices are designed to help women exercise their pelvic floor muscles and improve their vaginal muscle tone. This method involves placing a sensor, also known as an electrode or probe into the vagina. The vaginal probe, connected to a visual and/or sound system, lets the user see and/or hear the contraction. According to the colour of the light or the intensity of the sound, they will know whether the muscular contraction is done properly or not. The biofeedback allows the user to correct the contraction while doing the exercises, as well as allowing them to gradually increase the effort and duration, this is why they are called pelvic floor trainers, pelvic muscle trainers, pelvic trainers. Barbells, vaginal weights or cones designed to be held in the vagina. The action of passively/actively retaining the device internally improves muscle tone. Purposes for Medically Necessary Vaginal Surgery There are multiple medical and congenital conditions that require treatment with surgery in order for the patient to lead a normal adult sexual life. Patients may be born with these conditions or may experience a trauma, illness or accident that requires surgical repair or reconstruction. These conditions and surgeries are recognized and approved by the ACOG and covered either in full or partial by most health insurance plans.
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Agenesis occurs when the vagina of a female stops developing before it is complete. This is caused by the failure of the vaginal plate to form its canal. A congenital disorder that affects one in around 5,000 — 6,000 women, this condition requires neovaginoplasty surgery to correct it and allow the woman to lead a normal adult life. Vaginal aplasia, also known as Mayer-Rokitansky-Küster-Hauser Syndrome, is the incomplete development or complete absence of the vagina and/or the uterus of the female. Also a congenital disorder, a neovaginoplasty is also the solution for this condition. Müllerrian agenesis, another congenital disorder, is so named because of the failure of the female’s Müllerrian duct to develop properly. The results of this failure are that no uterus develops and the vagina’s upper portion develops various malformations. At puberty, the female displays amenorrhoea (ceasing or failure of menstruation) and gonadeal failure (sex hormones in extremely low levels). Vaginal reconstruction will allow the woman to have a normal sex life but she will be unable to bear children. Congenital adrenal hyperplasia is a disorder that is inherited and caused by adrenal insufficiency. In this particular form of insufficiency, the production enzyme for cortisol and aldesterone is deficient. These two key adrenal steroid hormones are important to sexual development so when the production of cortisol and its partner is impeded, the adrenal gland works overtime to replace them with the overproduction of androgens (the male steroid hormones). The result is that females who have CAH develop the external genitalia of a male instead of a female and males may not have fully developed or ambiguous genitalia. Between the young ages of twelve months to three years of age, corrective surgery is usually required to construct a clitoris and/or vagina in the girls Medication to treat the enzyme deficiency is also necessary. 222
Androgen insensitivity syndrome is a condition in which a person suffers from a partial to complete inability of the body’s cells to respond to androgens, or male sex hormones. The unresponsiveness of the person’s cells to androgenic hormones is serious and can impair or even completely prevent a developing fetus’ male genitalia from becoming masculinized. It will later impair secondary sexual characteristics’ development when the child reaches puberty. It is the largest factor in creating under masculinized genitalia. A child with androgen insensitivity syndrome lacks the androgen needed to bind with androgen receptors and do the task of delivering the necessary dihydrotectosterone hormones to the body in order to complete the development of the body’s genitalia. The result is the intersex, sexually ambiguous or transsexual child. Treatment and condition management is done through hormone replacement therapy, sex assignment (choosing to raise a sexually ambiguous infant as male or female), psychological counseling, sexual reassignment surgery (sex change operation) and genitoplasty. Controversy Surrounding Vaginal Plastic Surgery Many surgeons and others in the medical field are cautious and maintain a healthy level of skepticism about the true benefits achieved through vaginal rejuvenation surgeries. The reason for this widespread skepticism is the complete lack of any scientific studies and data on the safety and effectiveness of such procedures combined with the risks that the surgeries entail for the patients. None of the cosmetic surgeries outlined in this article are accepted as normal and routine surgical procedures by the American College of Obstetricians and Gynecologists (ACOG). They have never been evaluated (the way all scientific medical procedures routinely are) for peer-reviewed medical journals. In fact, some of the procedures are actually trademarked as a proprietary brand and the gynecologist who developed them refuses to publish them.
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For these reasons, ACOG considers them to be “unproven”. Their primary concern about this issue is that women considering undergoing one of these procedures need to be completely informed about the lack of any scientific data verifying surgical results claims before they make their decision.
Women’s groups are concerned that more young women plus young teens (under the age of 18) are having labiaplasty surgery, responding to societal pressure to cosmetically alter themselves instead of providing sex education so girls know what the variations of normal female anatomy look like. Boys get quick locker room looks at other adolescent males but girls’ parts are all tucked away out of sight. Many therapists, counselors and family doctors are concerned that young women are being pressured with the hard sell by the plastic surgery community into becoming unhappy and discontent with themselves when they do not need to be. Still others are concerned when they attend cosmetic surgery conferences and hear doctors discuss how to achieve a great aesthetic look but say very little about maintaining sensation so the woman continues to experience sexual arousal without pain or discomfort. Your Decision Vaginal plastic surgery was once the domain of individuals with medical needs for vaginal construction and reconstruction. Now the procedure is ideal for the modern woman who knows her own body with all its needs and wants, and plans to correct unwanted issues that age and child bearing have caused in her feminine parts. 224
Lost sensation and lack of stimulation during intercourse, experiencing her partner slipping out of her vagina during intimacy, feeling too loose “down there” and not being able to keep tampons in are all just some of the problems she experiences. She does not “need” this surgery, as many women never have it and live perfectly happy lives without it. She “wants” this surgery, because it will improve her quality of life and she is willing to accept the risks involved to achieve this goal. This is the ideal candidate for this surgery. Vaginal surgeries and rejuvenation procedures are not meant to be a cure for sexual dysfunction. They do not create a fabulous sex life overnight. The procedures can improve your quality of life, your genital comfort, and your satisfaction with your most intimate appearance as well as producing new sensations in your sexual experiences. If your expectations are realistic and you are comfortable accepting the surgical risks involved, you know what to anticipate during the surgery and recovery, and know the plan outcomes for your “vaginoplasty before and after”, then your decision is basically made. Vaginal surgery and vaginal rejuvenation has the highest growth rate of any plastic surgery procedure in this field today. Demographically, the age distribution of patients undergoing the procedure indicates the majority of recipients are women who have completed their child bearing and are seeking to rejuvenate themselves. Find the best trained and most experienced surgeon available to you and schedule a free consultation appointment. 225
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The Secret to Great Sex - Is Knowing There is No Secret I am sorry if I disappoint you, but there is no single sexual philosophy or technique that will result in great sex and powerful orgasms for every woman, or even the majority of women. I realize this is contrary to what many claim and others believe. The reason being, no two women are exactly alike in their sexual needs and desires. Every woman is unique unto herself, physically and mentally. Each woman must discover for herself what is appropriate and best for her. No one can predict with any degree of accuracy what will sexually satisfy a woman. To claim you can is misleading and harmful to women. For a woman to believe that such a secret exists unknowingly limits her sexual potential and greatly impedes her efforts to discover sexual happiness. Describing Female Sexuality Should Not Serve to Define It
Unfortunately, in the process of describing female sexuality you can inadvertently define it. An incomplete description of female sexuality often results in a narrow definition of female sexuality. If a person asks ten women to describe their sexuality and publishes these descriptions in a book, those who read it will often assume these ten women have defined female sexuality in its entirety. If the possibility of other forms of female sexuality existed, additional women would have been included, or so the reader may believe. This can have an extremely detrimental affect on the female reader who does not see herself described within those pages. She may feel there is something wrong with her that she must change. If her partner expects her to be like these ten women, they too may assume something is wrong with her. It is not the woman who must change, but rather the book, it needs to be expanded to include her unique definition of sexuality. An Incomplete View Books and magazines that are reported to contain the secrets to great sex often have a very narrow view of what women want and enjoy. This is because the authors of these books and articles have been exposed to a very limited number of women and their sexuality. Given the number of women on this planet, and all the different cultures and situations, a sampling of one thousand women is minuscule. What is true of women in one area of the world may not be true in another. These books and magazines are not incorrect, only incomplete. They each apply to only a small percentage of women, combined they still do not apply to all women.
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Expanding Your Horizons Book and magazine articles that address female sexuality should not be used for a purpose other than the gathering of ideas. If you want to try something new, or have not found something that works, they give you some new ideas to try. You should never consider them the Holy Grail of sex, and define your sexuality based on their content. If you try what they recommend and it does not work, or you do not enjoy it, then move onto something else. Never judge yourself or your partner based on the contents of these books and magazines; each woman must write her own book.
Accepting Diversity One thing I try to make clear in my writings on this website is the diversity of women. I do not profess to know the secrets to great sex for every woman. What I attempt to do is educate readers about the varying needs and wants of women, and the possible causes for this diversity. I try to provide ideas and basic concepts without defining a woman's sexuality; at least I hope I have done so. As such, the contents of this website should never be used to define female sexuality. It 226
is just a small collection of information that will hopefully allow men and women to experience greater sexual happiness, whatever that may entail.
What Do Women Want During Sex? The answer depends on the individual. When we ask women what their favorite and most disliked sexual activities are, we learn:
The most popular activity, receiving cunnilingus, is also the most disliked by some women
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The most popular activity is NOT the favorite activity of 4 out of 5 women*
The most disliked activity, anal intercourse, is the favorite of some women
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Favorite Activity During Intercourse Kissing 4%
Cuddling 3%
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Hand-Jobs 4%
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Vulva Massage 4%
Outercourse 8%
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Sensual Massage 12%
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Vaginal Intercourse 21%
Anal Intercourse 6%
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Fellatio 7%
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Cunnilingus 7%
Solo Masturbation 10%
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Mutual Masturbation 12%
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BDSM 2%
Two additional surveys provide further insight:
The survey exploring location of primary erogenous zone tells us how to sexual arouse a woman, which varies among women. The survey asking women if they require direct clitoral stimulation if they are to experience orgasm indicates the answers is yes for the vast majority of women, but there are nuances to their expectations.
The apparent disparity between the surveys is explained by the facts that arousal must precede orgasm, if not sexual desire, and experiencing orgasm isn't necessarily a woman's primary motive for sex. It may be necessary to provide appropriate mental stimulation, or context, before a woman experiences sexual arousal, which precedes sexual desire, culminating in the necessity of clitoral stimulation if they are to experience orgasm. Some women experience spontaneous or primary sexual desire that initiates everything else, whereas others experience responsive or secondary desire that requires a less direct approach to sex.**
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Which may mean, a "date night" away from stress and distractions must precede a relaxing shower, preceding a romantic movie, preceding stimulation of primary physical erogenous zones, which ultimately precedes direct clitoral stimulation if orgasm if desired.*** The only way to discover what a woman likes and dislikes is through communication (asking questions), research (reading up on techniques), experimentation, and practice.
These survey results tell us the probability of a woman liking or disliking a sexual activity, but don't take in to account their believes and level of experience, or their partner's sexual knowledge and skill. This information doesn't address the nonsexual motives and desires that compel women to have sex; physical pleasure and enjoyment may not be their primary motive. The four activities that are more disliked than liked, hand-jobs, fellatio, anal intercourse, and BDSM, could be so because of improper technique and false expectations. Before ruling them out, 238
couples may want to consider why women don't enjoy them, and what they can do to correct this, if she is open to exploring them initially or further. * The survey participants likely have greatly varying levels of experience, which would influence their likes and dislikes. ** My surveys exploring sexual desire indicate 65-66% of women are "actively sexual" and 1113% are "passively sexual". An opinion piece in NewScientist, promoting a book, indicates the majority of women experience "responsive desire". The disparity may be the result of my survey results being primarily representative of young women, which would create an age and generational bias, and wording and context of the questions. *** Unless you are young and horny, or in a new and exciting relationship, sex often requires scheduling and a commitment of time. The young may also be stressed and overwhelmed, necessitating the same.
Casual Sex: Is Everyone Truly Partaking? Jump to Orgasm Inequality There has been a lot of media attention directed at the subject of hookup sex, and the inequality of orgasms between men and women who participate.
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Based on some reports, we may be led to believe most college-age adults are engaging in casual sex, possibly on a regular basis. This may result in men and women engaging in sex with a partner only to conform to their perception of the current social definition of "normal."
The following news articles reveal the truth, that today's young adults aren't much different from their parents, when it comes to casual sex. "Researchers compared responses from national representative surveys of 18- to 25-year-olds taken in 2002-2010 and in 1988-1996. They found that in both groups, about 31 percent said they'd had one sexual partner in the last year. Only half reported having more than two sexual partners after age 18. In other words, college kids don't appear to be getting more promiscuous." —The Truth About College Students and Casual Sex Revealed "In the media there’s been a lot of discussion about college students ‘hooking up’ and ‘friends with benefits’ and those kinds of terms we hear today," Caron said. "I think people would be surprised to know that things haven’t really changed much from 20 years ago."" — UMaine professor's book looks at the sex lives of college students Our survey indicates 29% of women (1 out of 3) have engaged in sex with a male partner within 24 hours of first meeting, and 12% (1 out of 8) have done the same with a female partner.* Contrary to what older generations may claim, casual sex is nothing new to Western culture: The Fox Guards the Henhouse The orgasm inequality is the result of couples engaging in "sex," which is commonly and narrowly defined as penile-vaginal intercourse, and does not last nearly long enough for many woman to experience orgasm.** Women often require 20 minutes or more of appropriate stimulation if they are to experience orgasm.
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Young women may also feel compelled to perform oral sex on their male partner, so as not to appear a "prude," but do not feel comfortable requesting oral sex, fearing they will be labeled "too sexual," having done so.
If a woman desires to experience orgasm during a forthcoming sexual experience, she should make her desire known at the onset, and request a sexual activity that is more likely to result in that outcome, which very well may be mutual masturbation or oral sex, not intercourse. 241
If she doesn't desire orgasm, she should perhaps make this known, so the guy doesn't feel compelled to make an extra effort, potentially frustrating them both. It is common for young women not to experience orgasm, experiencing them only half-the-time, on average. Couples should be aware of this, and not have false expectations of their experiences.
Women should never fake orgasm, as doing so indicates to their partner that they did everything correctly, and should do exactly the same each and every time.
Perhaps the simplest solution to the orgasm inequality is for men and women to have a small Pocket Rocket style vibrator available in their nightstand or purse. They can even be used during a quickie.
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* Our survey, and those linked too, may not be representative of the general population.
Importance of Female Orgasm During Partnered Sex My ongoing survey that asks women about the importance of their orgasms during sex with a partner confirms my prior statements about orgasm being a little more important to their partner than themselves, but reveals the opposite situation is also common.
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For the 163 women with a partner they indicate: Orgasm is more important to them than their partner - 18% (1 out of 6) Orgasm is equally important to them and their partner - 47% (1 out of 2) Orgasm is more important to their partner than themselves - 35% (1 out of 3) For 5%, 1 out of 20 women, orgasm is extremely important to them but unimportant to their partner, and for 6% (1 out of 17) their orgasms are extremely important to their partner but unimportant to them.
While all couples should have this conversation outside the bedroom, perhaps utilizing text messaging, early in the relationship, half of you need to have this conversation. I don't want to overstate the importance, but for more than 1 out of 10 couples, their relationship may depend on it.
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Young couples have the advantage of computers and smart phones as a means of communication, allowing for nonverbal communication at a distance, something their parents didn't have. You may want to begin the conversation by sharing this article with your partner.
To the women whose orgasms are more important to them than their partner, your partner gets away with what you allow them to get away with. Women in general allow their partner to get away with a lot, trying too hard to always make their partner happy, even at their own expense. Yes, your partner should ask about and fulfill your needs, but some of us are uninformed or incorrectly informed; true sex education is taboo in many cultures, even if porn is readily available. Ladies, especially young ladies, why are you trying to hold onto a partner who isn't interested in fulfilling your needs? No, love and practice doesn't always change the end result, nor is it always your fault. Remember, this isn't Hollywood.
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Any computer programmers reading this? Perhaps you can develop a smart phone app that allows couples to indicate when they are in the mood for sex or intimacy, and if a) they desire orgasm, b) don't desire orgasm but want to give their partner an orgasm, c) want to explore sexual pleasure not orgasm, d) want to explore non-sexual intimacy, or e) fill in the blank. Perhaps there needs to be the ability to negotiate a forthcoming sexual experience, and the ability to indicate "maybe," "let me think about it," or "I've changed my mind." Couples should have to indicate their interest in sex AND what they do or don't want to do, before this information is mutually revealed between partners. A partner should be able initiate a conversation by prompting, querying, their partner without revealing their expectations. For privacy and mutual consent reasons, there must be a mutually shared password; no shared password, no exchanges occur.
The Truth About Vaginal Orgasms: They are More a Myth than Reality for Many Women In 1976, The Hite Report revealed 26% of women, 1 out of 4, experienced orgasm regularly during vaginal intercourse, when there was no accompanying manual stimulation of their clitoris. While this study was conducted thirty-five years ago, I have not seen (see below) any evidence that suggests this has changed. The study also found:
19% (1 out of 5) rarely experienced orgasm during intercourse 16% (1 out of 6) did so if there was manual stimulation of their clitoris at the same time 24% (1 out of 4) did not experience orgasm during intercourse at any time 12% (1 out of 8) had never experienced orgasm under any condition 3% (1 out of 33) had never engaged in vaginal intercourse.
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In October 2000, a Glamour Magazine article later revealed, in response to the question, "Do you need extra stimulation to orgasm?":
I need "a hand" 38% I can do it just from intercourse 28% I need oral sex 21% Other 10% I need a vibrator 3%
During the 24 years between surveys, the number of women who regularly experienced orgasm, as a result of vaginal-penile stimulation alone, did not changed significantly, 28% versus 26%. The majority of women, 62%, required direct stimulation of their clitoris, if they were to experience orgasm. It is not known whether "other" included other forms of clitoral stimulation, so the percentage may have been even higher. As a positive side note, it appears more than twice as many women, 38% versus 16%, were receiving manual clitoral stimulation during vaginal intercourse, and experiencing orgasm, in 2000 than in 1976, indicating The Hite Report, and subsequent media reports, may have influenced our sexual behavior. Additional and current information concerning the sensitivity of the vagina and frequency of orgasm can be found in the articles about Female Sexual Arousal and Orgasm, Anatomy of the Vagina, Sexually Stimulating the Vagina, and The Secret to More Female Orgasms.
Why do most women require clitoral stimulation? The answer for the most part lies in the anatomy of our sexual organs. A man's primary erogenous zone is most often his penis, a woman's is her clitoris. Considering the common embryological origin and structure of the two organs, this would 247
seem to make perfect sense. The reason they are so sensitive is they are highly populated with nerve endings. The greater the number of nerve endings an area of the body has, the more sensitive it is to stimulation. The clitoral glans is often reported to have more nerve endings than the penile glans, in a much smaller area. This results in a very sensitive organ, perhaps even more so than the penis. Given that so few women masturbate by stimulating their vagina alone, it would appear it is not as sensitive to sexual stimulation as their clitoris. Analysis of the anatomy of the vagina reveals that it is not as densely populated with nerve endings as is the clitoris, and the nerves endings that are present are usually located in the outer third of the vagina. The reason the vagina is not highly populated with nerve endings is likely because it also serves as the birth canal. It would seem counter productive to have an extremely sensitive vagina, when it came time for a woman to give birth. During vaginal intercourse, a man's penis is being directly stimulated by the walls of his partner's vagina, the movement of her inner labia is at best indirectly stimulating a woman's clitoris. The thrusting penis may then move the labia about, tugging on the clitoris itself. Since the size and shape of women's inner labia varying so much, and given that some women do not have them, it seems unlikely that all clitorises would receive the same amount of stimulation during vaginal intercourse. Structure suggests, the suspensory ligament of the clitoris may transmit pressure and movement of the pubic mound, outer labia, bulbs of the clitoris, and introitus to the clitoris. A woman's clitoris may also be stimulated by her partner's pelvic bone and mound as he presses in toward her body on the forward stroke. During intercourse, a man's primary erogenous zone is being directly stimulated on all sides and a woman's primary erogenous zone is being indirectly stimulated in an inconsistent manner, should we be surprised that the man usually experiences orgasm but the woman does not?
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Another factor to consider is time. A man on average can masturbate to orgasm in three minutes, a woman in five minutes(*). Under what may be considered ideal conditions, a man usually reaches orgasm two minutes before a woman. Take this information and apply it to intercourse, where the man is receiving direct stimulation and the woman is receiving indirect stimulation and you can see how this time difference can grow astronomically. If a woman does not receive the same intensity of stimulation, and for the same duration, as she does while masturbating, it is easy to see how she would never reach orgasm during intercourse. It becomes very improbable, no matter how long the man continues to thrust. The ingredients for an orgasm just are not there.
A Question of Time * Here is a quote from the book The Clitoral Truth by Rebecca Chalker: "It takes many women far longer than men to become fully aroused - as long as a half-hour in many cases. California sexologists William Hartman and Marilyn Fithian monitored over 20,000 orgasms and found that it takes an average of twenty minutes for women to reach orgasm in the laboratory. For many women, it can take up to a half-hour or more of sustained stimulation to move into orgasmic range."
My statement about women being able to masturbate to orgasm in five minutes is only meant to make a point; that even for women who can quickly masturbate to orgasm, they still usually take longer than the average man to do the same. I certainly would not say there is a benefit to reaching orgasm so quickly, unless you are trying to hide what you are doing, which is often the case for children, teens, and women living with partners and family. 249
The five minute time period was obtained from the book How Big is Big by Dr. Zev Wanderer & Dr. David Radell that used information from two other sources. I do not feel couples should expect sex to last less than half an hour or that there is a benefit in being able to. We spend far too little time showing our partner physical affection as it is without trying to make every sexual experience a quickie. If you do not have half an hour or more to make love to your partner, then you need to make the time.
This article was first published between October 17, 1998 and October 11, 1999
Are Our Lofty Expectations of Vaginal Intercourse
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Rear-entry Intercourse, "doggy style." From the book Masters and Johnson on Sex and Human Loving. Copyright 1982, 1985, 1986 William H. Masters, M.D., Virginia E Johnson, and Robert C. Kolodny, M.D. In Search of Nirvana We are led to believe that if a heterosexual couple engages in vaginal intercourse they will discover nirvana, the ultimate in sexual fulfillment. Intercourse is said to be the absolute best sexual experience. It is after all what defines sex. It is "sex." We expect to experience intense sexual pleasure and an emotional connection with our partner during or as a result of this activity. The physical joining of our bodies should result in the merging of our spirits. While all of this is certainly possible, it is just as likely to occur during other activities. The rewards vaginal intercourse has to offer are no more, or less, than those possible when holding hands, kissing, giving a massage, and during mutual masturbation, outercourse, and oral sex. The physical simply cannot guarantee the spiritual. Intercourse should never be considered the ultimate sexual experience, but rather all sexual activities should be seen as potentially equally rewarding. The reason they are "potentially" equal is, we must take into consideration the uniqueness of the individuals involved.
Striving for Adulthood Young adults often feel pressured into engaging in vaginal intercourse to demonstrate they have achieved adulthood. We have "sex" to prove we are men and women, that we are no longer 251
children. We keep having sex because that is what adults do. This is what society tells and expects of us, as adults. On a personal level, we may come to realize after having intercourse for the first time that nothing has changed. We may not feel differently about our partner or ourselves. We may be left wondering what the big deal was. Participating in intercourse for the first time at the age of twenty or thirty may not cause us to feel anymore "adult" than if we had done so at the age of twelve. Intercourse may not fulfill our lofty expectations. Couples should not engage in intercourse for the sole reason of achieving or demonstrating adulthood, as it is unlikely to fulfill their expectations. As many adults discover, adulthood is something we are always striving to achieve, but find is always just out of reach. We may engage in sex with a partner, graduate from school, vote, serve in the military, start a career, marry, have children, and buy a home, and in the case of women, start wearing a bra and menstruating, but find these events leave us wanting more. Adulthood is achieved not so much by what we do, but by how others judge us. Unfortunately, in our modern society, seldom does anyone ever tell us when we have achieved adulthood. We are left forever in a state of perpetual limbo, clearly no longer a child, but not quite an adult either.
Adulthood is a social status that no physical accomplishment can guarantee, without social recognition of that event. Many cultures have public ceremonies to provide a clear demarcation between childhood and adulthood, so a person is not left wondering when they have achieved adulthood. It should be noted that the concept of "adolescence" came into existence only recently in western culture, and leaves young people in limbo for ever increasing periods of time. When loss of virginity was closely linked with a public marriage ceremony, it was a clear indicator of passage into adulthood, and usually took place when couples were in their early to mid teens. Since a person may have partnered sex for the first time at any stage of their life, it is no longer a clear indicator of adulthood in today's society. Since we all live such varied lives, there is no common indicator of adulthood that applies to everyone. 252
Unrealistic Expectations Vaginal intercourse is one aspect of female sexuality that has a lot of misinformation and confusion surrounding it. There is a common expectation that women should experience orgasm without difficulty during intercourse. Many women believe that in order for them to be a good sexual partner they should. Women frequently believe there is something wrong with them, because everything they have been told supports this believe. The media leads us to believe a woman should be squealing with delight and multi-orgasmic the moment a penis enters her vagina. This results in women faking pleasure and orgasm, to save face in front of their partner, to appear normal, mature, and to make their partner feel good about themselves. This takes an enormous emotional toll on women. As a result, sex becomes something many women avoid rather than looking forward to, understandably. The same expectations and consequences apply equally to men.
Freud Led Many Astray Thanks to Freud and others, many people have been led to believe "mature women" have vaginal orgasms and "immature girls" have clitoral orgasms. We are told girls may masturbate but women should only desire and enjoy vaginal intercourse. This simply is not a reasonable expectation, as the clitoris is most often a woman's primary erogenous zone, as a result of having the greatest density of nerve endings. The vagina does not have this high concentration of nerve endings, and is usually less sensitive to stimulation. Anatomy, not sexual maturity, dictates that the majority of women require clitoral stimulation if they are too experience orgasm. It is my understanding that prior to Freud everyone knew the clitoris was most often the center of female sexual pleasure. Freud basically made up his theories, and they were never proven to be true. 253
Vaginal Orgasm The presence of female prostate glands, commonly known as the G-Spot, and the associated nerves, lends support to the idea that clitoral and vaginal orgasms are uniquely different types of orgasms. Not only may the stimulation feel different, so may the resulting orgasm. Some women experience both while others experience one but not the other. A person should not take the position that women must experience both, or that one is better than the other. Women that experience both, or one or the other, are not automatically happier or more satisfied lovers.
At present, I would say clitoral orgasms are the most common experience, as mentioned on the page about vaginal orgasms. We are just now learning about, and accepting, what some women have always known, that is the existence and role of the female prostate gland in female sexual pleasure. Many women have prevented vaginal orgasms from occurring, as there is often a sensation much like the urge to urinate, prior to experiencing them, and many need to unlearn this response. No Easy Answers Unfortunately, the truth concerning vaginal intercourse can be very confusing. There are women who are very orgasmic during vaginal intercourse and love experiencing it. Another group of women find it boring and devoid of any pleasurable sensations at all. A third, and perhaps larger, group of women falls in between, they enjoy vaginal intercourse to varying degrees but are unable to experience orgasm as the result of vaginal stimulation alone, or do so infrequently. Many women discover intercourse feels "nice" but not "wonderful." Regardless of how a woman experiences vaginal intercourse she is perfectly normal, whatever that is. 254
Trial and Error The only way for a woman to find out how her mind and body respond to vaginal intercourse is through experimentation and practice. There is no way to predict if a woman will be orgasmic as the result of vaginal stimulation alone, and this will likely change over time and with different partners and techniques. Factors like the shape and size of their partner's penis, the amount of vaginal lubrication, the strength of a woman's pelvic muscles, the presence or absence of a GSpot, and the level of emotional involvement can all influence how enjoyable intercourse is. A woman's potential for enjoying intercourse is therefore not etched in stone. As a woman's emotional and physical states change, so do her sexual capabilities and desires. Couples should be open to the idea that penile-vaginal intercourse does NOT have a place in their sexual experiences together, for them intercourse is more a reproductive than recreational activity. Note: Self exploration and preparing the vagina for intercourse are addressed on the pages about virginity.
Man-on-top, face-to-face intercourse position. From the book Masters and Johnson on Sex and Human Loving. Copyright 1982, 1985, 1986 William H. Masters, M.D., Virginia E Johnson, and Robert C. Kolodny, M.D. Vaginal Sensitivity The reason why women experience vaginal intercourse differently is partly the result of varying degrees of vaginal sensitivity. The vagina's sensitivity to different types of stimulation, touch, friction, and pressure, varies from woman to woman. The sensitivity of an individual woman's vagina varies as well. The inner two-thirds of the vagina is usually less sensitive to touch and friction than the outer third, and is most often sensitive to only pressure. Sensitivity also changes over time, as hormone levels change during the menstrual cycle, pregnancy, and with the use of prescription medications, including birth control. The type of stimulation an individual woman enjoys varies as a result. She may prefer the friction of fingers caressing her vaginal walls, a deep thrusting penis, the fullness of a large dildo, or other forms of vaginal stimulation. Since a woman has no control over the sensitivity of her vagina, and the type of stimulation she is most sensitive to, she and her partner should not fault her if her vagina is totally insensitive, or is sensitive to a form of stimulation other than penile, she is hardly alone. Additional Anatomical Factors 255
While many have assumed the size and placement of the clitoris and inner labia influence a woman's orgasmic potential during intercourse, no correlation between these factors has been found to exist. A woman with a very small clitoris is just as likely or unlikely to experience orgasm during intercourse, and other forms of sexual activity, as a woman with a large clitoris. The distance between the clitoris and vaginal opening also does not influence a woman's orgasmic potential, though some misguided doctors have used surgery to shorten this distance; causing disastrous results not understanding the complexity of the vulvar anatomy. Others have assumed the clitoris should be sufficiently stimulated by the movement of the inner labia, this movement being caused by the thrusting penis. Since the size and shape of the inner labia, if a woman has inner labia, vary considerably from one woman to the next, this could not possibly be true of all women.
The inner labia may not even be in contact with the penis during intercourse, as they are typically located nearer the clitoris than the vagina. When indirect forms of stimulation do occur, they are seldom in sufficient intensity and duration to result in orgasm. It is even possible that "vaginal orgasms" result from G-Spot stimulation rather than clitoral stimulation, meaning the clitoris and labia do not play a part in these orgasms. Disassociation Another factor that affects vaginal sensitivity is disassociation, the absence of a conscious connection between the vagina, or clitoris and vulva, and the brain. Social believes and expectations usually do not permit young girls and teens to explore and stimulate their vulva and vagina, and they may be reprimanded or punished when they do. Instead, they are taught to 256
ignore, deny, or otherwise be unaware of these sensations, as if they did not exist at all. Since these are "bad places" only "bad sensations" can come from them, so they do their best to block them out. As a result of not touching and stimulating these areas the brain and body do not learn how to transmit and interpret nerve impulses from them. This may impair a woman's ability to experience sexual pleasure.
A woman or her partner may touch and stimulate her vulva and vagina yet she feels nothing, because her brain does not know how to process this form of stimulation. If the nerve impulses are weak, because the nerve pathways are undeveloped from lack of use, they may feel little or nothing. If the nerve impulses are strong, they may feel pain rather than pleasure, because the sensations are beyond the limits of what the brain expects and can handle. The sensations they experience may not be pleasurable or erotic, but rather associated with something bad, which means they can't be good or pleasurable sensations. They in turn learn to avoid partnered sex, or participate in the activity only because they are expected to, believing everyone else enjoys it. Interfering with or preventing sexual development can have major repercussions on a woman's sexual pleasure. The way to overcome this is through exploration and stimulation. By stimulating these areas while looking at them in a mirror and concentrating on the point being touched, a woman may learn how to connect with and be more aware of, and sensitive to, vulvar and vaginal stimulation. This is best done when alone in a quiet room with no distractions. The use of a dildo may be appropriate for vaginal stimulation, though the feedback provided by the fingers would be beneficial. The formation of this connection is unlikely to occur during a single fifteen-minute session. The key is frequent stimulation, five to fifteen minutes each day, and perseverance. Something to keep in mind is, as a five-year-old there would be no time limits or expectations 257
placed on these exploration sessions. Any discoveries would be a total surprise. This means a woman should set no limits or expectations and simply be open to whatever happens. The Role of Emotions Our emotional state can significantly influence our physical pleasure. Our brain can cause a state of intense physical arousal, which alters our physical experience. This is particularly true when there is considerable emotional involvement, as when having sex with a new partner, a person we love deeply, or a person we find extremely sexually attractive. This may also occur during puberty, when hormone levels are high and on a hair trigger.
Chemicals released by the body when we are very excited in turn stimulate the brain causing a state of euphoria. We experience a "natural high." Not only do we feel wonderful as a result, we are also capable of experiencing increased levels of pleasure. The physical and emotional pleasure we experience can continue to intensify the longer we have sex, ending only when we must stop because of physical exhaustion. There are women who experience orgasm during vaginal intercourse because their brain finds the activity extremely stimulating. Their thoughts are more the cause of orgasm than the physical stimulation. The idea of what they are doing, or whom they are doing it with, more than the physical act, triggers orgasm. This is not meant to suggest or imply the pleasure many women experience during vaginal intercourse is all in their head, it's not. It simply means the brain can have a significant influence over whether a woman experiences pleasure and orgasm during vaginal intercourse, and sex in general. 258
Arousal and orgasm does occur in the absence of physical stimulation. Many if not most women experience sexual arousal and orgasm while dreaming about sex at night, a wet dream, and during their daily activities. During sexual dreams sexual arousal is a common occurrence, but I do not believe this is the case for orgasm, for the majority of women. Most cannot will themselves to have an orgasm, it is not often that simple. For most, pleasure and orgasm result from equal parts of mental and physical stimulation.
One variation of the woman-on-top, face-to-face intercourse position. From the book Masters and Johnson on Sex and Human Loving. Copyright 1982, 1985, 1986 William H. Masters, M.D., Virginia E Johnson, and Robert C. Kolodny, M.D. Clitoral Stimulation It is the popular consensus today that the majority of women must have their clitoris directly stimulated during vaginal intercourse if they are to have a reliable chance at experiencing orgasm. If a woman's clitoris happens to rub against her partner's body during intercourse, the resulting stimulation is not usually sufficient in intensity or duration for orgasm to occur, unless a special effort is made to maintain this stimulation. When clitoral stimulation is left to chance, orgasm is much less likely. If a woman or her partner does not directly stimulate her clitoris she is much less likely to experience orgasm. According to a survey on this website, the average rate of orgasm increases from 37% to 60% during intercourse when additional clitoral stimulation is provided. The best means of doing so is by caressing and massaging the clitoris with hands and fingers, or a vibrator. Because of the position of our body's during intercourse, it is often easier for a woman to caress her clitoris than it is for her partner, and she is usually more proficient at it. This is in part why masturbation is so important to women and couples, as it extremely beneficial for a woman to know how to stimulate herself to orgasm. The sexual positions that permit direct clitoral stimulation during intercourse are those in which a woman is on top, or where her partner is behind or beside her. While women may enjoy feeling the weight of their partner on them in the missionary position, this position is not very conducive to orgasm, as their clitoris is not easily accessible. When a woman is on top, she can reach down and stimulate her clitoris as she slowly rocks her hips, thrusting is not necessary. She can in turn use her pelvic muscles to grasp and stimulate her partner's penis. If a woman is obviously enjoying the activity it is more likely to be enjoyable for her partner. A woman can bring herself to 259
orgasm, then her partner, if they both so desire. The expectation that a couple's orgasms occur at the same time is more likely to impair rather than enhance sexual pleasure and fulfillment. Orgasm Not Required An orgasm is only enjoyable if a woman desires to have one, and it is certainly acceptable for her not to. Keep in mind orgasm is simply one form of pleasure, nor necessarily the best. It is certainly possible for vaginal stimulation to be very enjoyable for a woman in the absence of orgasm. Even if vaginal intercourse is not an orgasmic experience for her, she may enjoy and look forward to it because of the emotional bond between her and her partner.
She enjoys the closeness and intimacy of the sexual act, more so than the physical sensations she experiences. There are also women who are happy if her partner experiences pleasure and orgasm, even if they do not. They enjoy giving their partner pleasure, not just receiving it, and receive emotional pleasure in return. This too is certainly acceptable, if not done to extreme, as at some point a woman must demand that it is her turn, for pleasure not necessarily orgasm. Note: Men too should not see their own orgasm as a requirement of intercourse and sex as men fake orgasm too. Intercourse, or any sexual activity for that matter, may not be an appropriate activity for a couple if one partner does not enjoy it physically and/or emotionally and the other is uncomfortable knowing this. Men and women are usually very uncomfortable using or being used as a masturbation aid, at least when it occurs regularly or all the time. Even so, social and partner expectations may cause persons who do not enjoy certain sexual activities to withhold this fact from their partner, trying to live up to those false expectations. What they do not realize is, they are presuming their 260
partner enjoys the activity, which certainly may not be the case. Couples end up going through the motions of sex even though neither partner finds what they are doing enjoyable, resulting in both losing interest. In addition, sex cannot be fulfilling if you cannot be honest with and accepting of your partner, unless of course you are totally self centered.
Another variation of the woman-on-top, face-to-face intercourse position. From the book Masters and Johnson on Sex and Human Loving. Copyright 1982, 1985, 1986 By William H. Masters, M.D., Virginia E Johnson, and Robert C. Kolodny, M.D. Body Position Body position during vaginal intercourse can have a major impact on the amount of pleasure a woman experiences, as well as her partner. A change in position may result in a woman going from feeling nothing at all to being orgasmic. The reason being, the entire vagina is not equally sensitive to stimulation, and as a result the angle and depth of penetration can determine whether a woman experiences intercourse as being pleasurable, as can the size and shape of her partner's penis. The location of a woman's area of vaginal sensitivity, if she has one, will determine the positions she finds most enjoyable. In addition, the amount of clitoral stimulation a woman experiences will also be dependent on body position. While couples do not need to be acrobats, exploration of different sexual positions is recommended if the missionary or other common positions don't work for you. If a woman has a G-Spot, she may enjoy intercourse the most when her partner's penis presses into or rubs against it, which is more likely to occur when they are penetrating her from behind, or when she is on top controlling the angle of entry. Some women find anal intercourse stimulates their G-Spot and they ejaculate during this activity, but not necessarily during vaginal intercourse. It should be noted that our bodies are designed to have intercourse when a woman is bent at the waist and her partner penetrates her from behind, the "doggy" position. This is the "normal" or "natural" position, not the missionary as is commonly accepted. It is my understanding that this is the position used by couples in many tribal and non-industrialized societies. Unfortunately, some have proposed only "animals" have sex in this position in an attempt to raise humans above other creatures, which has resulted in other positions not only receiving unpopular press, but also 261
persons of different cultures. Do not allow false social believes and expectations to restrict your pleasure. The "spoon position". From the book Masters and Johnson on Sex and Human Loving. Copyright 1982, 1985, 1986 William H. Masters, M.D., Virginia E Johnson, and Robert C. Kolodny, M.D.
Rhythm Couples may want to consider experimenting to see if rhythm plays a part in a woman's enjoyment of intercourse. A woman may prefer long fast strokes, short fast strokes, long slow strokes, or short slow strokes. She may enjoy any combination of these. What a woman enjoys may vary depending on her level of sexual arousal, her nearness to orgasm. She may want it long and slow at first to allow arousal to build but then a steady fast pace when she nears orgasm. Experimentation and practice is the key to learning what works best. Do not forget, what worked yesterday may not work today or tomorrow. Skill and Stamina Being an active participant during intercourse requires skill and stamina. Young men quickly learn this when their penis keeps slipping out, they get sweaty, their muscles start to ache, and they tire quickly. This is something women are sometimes very surprised to learn when they get on top or explore using a dildo in a harness. It may look easy in movies but intercourse is a very physically demanding activity, especially if one tries to do it for any length of time. The old in out is not as easy as it looks. The only way to learn how to do it correctly is through practice and patience. A sense of humor is essential during sex and intercourse, as you will undoubtedly have funny and potentially embarrassing things occur, like slipping out and not being able to get it back in by yourself. Sex is never as easy as it looks in the movies where all the mistakes are edited out. A Penis is Not Always Best A woman may enjoy having her vagina stimulated by her partner's fingers, hand, vibrators, dildos, etc., but find penile stimulation is not at all pleasurable. There may exist within the vagina only a small area that is sensitive to stimulation, and as a result a penis attached to a man may not be the best tool to use if a person seeks to stimulate this area. By exploring other forms of stimulation a woman is able to take advantage of these potential areas of sensitivity. The size, shape, and texture of the object inserted can be chosen so as to provide the appropriate stimulation. Men 262
should not take it as an indication of personal failure when their partner prefers a dildo or other objects to their penis for vaginal stimulation. Hopefully, men are primarily concerned with their partner's pleasure, not by how it is obtained. A couple may also need to adapt to the unique needs of the male partner. Lesbians and Vaginal Penetration One misconception surrounding vaginal intercourse involves lesbians. We often assume lesbian couples do not engage in vaginal intercourse and penetration. We are more likely to envision them hugging and kissing than having "sex." Within some segments of the lesbian community vaginal stimulation is taboo, as it is too closely associated with men and penises. While many lesbian couples do not engage in vaginal penetration or intercourse, a significant number do. The reason they do is quite simply because they enjoy it, it feels good.
They are not pretending to be a man and woman, though sometimes they engage in role-playing. They are naturally using all the body parts at their disposal to experience sexual pleasure. Dildos, alone and in a harness, just happen to be an enjoyable and proficient way of stimulating the vagina. Wearing a dildo in a harness is pleasurable for some women, as having a "penis" and penetrating their partner gives them a sense of power and control; this applies to heterosexual as well as lesbian women. Vaginal stimulation is potentially enjoyable for all women, regardless of their sexual orientation. While we may assume there is a difference between what lesbian and heterosexual women do sexually, this is not true. They potentially have the same interests, needs, and desires and engage in the same activities as a result. Every type of sexual activity heterosexual women engage in, lesbian women engage in as well, and vise versa. The fact that the vast majority of women, 263
lesbian, bisexual, and heterosexual, are raised in heterosexual families and communities results in the same role models and sexual expectations, not to mention the same anatomy and sexual diversity. The anatomy of a woman's partner does not affect her wants and needs. Society, social groups, and women themselves should be careful not to restrict what women can do with their partner based on their sexual orientation or their partner's anatomy. Learning from Lesbians Something men and their female partners can learn from lesbians is the use of fingers and hands to stimulate a woman's vagina. Lesbians do not have a organic penis so they often rely on their flexible and sensitive fingers and hands to stimulate the vagina in ways no penis ever could. They use their fingers not just to thrust in and out, but also to slowly explore every detail. They caress the vaginal walls and awaken hidden nerve endings. They may seek out and explore her G-spot or slowly stretch and fill the vagina with their entire hand. For some women, a single finger is all they need and desire, so discuss things prior to getting too carried away. Use plenty of lubrication, trim and file your fingernails, and perhaps use Nitrile, vinyl, or latex surgical gloves. A woman's partner may actually feel closer to her when they use their hands instead of their penis to give her pleasure, as they can observe her pleasure with greater ease and are less distracted by their own body and desires.
Side-to-side, face-to-face intercourse position. From the book Masters and Johnson on Sex and Human Loving. Copyright 1982, 1985, 1986 William H. Masters, M.D., Virginia E Johnson, and Robert C. Kolodny, M.D. The Pressures Placed on Men A penis is made of flesh and blood and our expectations of it are seldom realistic. We must not forget there is a living breathing man attached to that penis. In the rush to fulfill women's sexual needs we may expect too much from men and their penises. This is not meant to suggest men are inferior to women, it is just that a penis functions only as well as a clitoris. We place enormous pressure on men by expecting them to achieve and maintain an erection while delaying ejaculation for extended periods of time. From an evolutionary and reproductive perspective this probably is not a realistic expectation. When men fail to achieve these unrealistic goals we not only deal them an emotional blow but, also take away their pleasure in the process by causing them to feel guilty. We do not allow them 264
to enjoy their orgasms if they occur prior to their partner's. Fear of failure is causing teenagers and men to be unable to achieve an erection, or their erection quickly diminishes, when they attempt intercourse. They may be so nervous and agitated they ejaculate quickly. As a result, men are becoming the ones with the "headache." This is why Viagra is in such demand, even by those who are not impotent.
Note: By learning and using Kegel exercises, men may voluntarily learn better control over their erections and orgasms, increasing not only their own pleasure, but also their partner's. While not a reliable means of birth control, not ejaculating may have its benefits, on occasion. Women often judge themselves based on the performance of their partner's penis, causing themselves undo feelings of failure. A woman is led to believe that if her partner finds her attractive and desirable his penis will automatically be erect when they desire intercourse, and even when they do not. While some may see their partner as over-sexed, they also expect frequent erections to demonstrate how desirable they are. When a woman's partner does not experience an erection, she often feels at fault. If women are looking to their partner's penis for validation they simply will not find it. While a woman may see her partner's inability to achieve an erection as a personal failure, she may project these feelings onto her partner. She does not want to feel at fault so she blames and perhaps belittles them. While she may say it is not a reason for concern, her expressions and actions may state otherwise. Because we seldom want to look inward, blaming others is much easer to do, and is perhaps a self-protection mechanism. A woman may reject her partner rather than addressing her own feelings of failure. This is very harmful to women, and their relationships with men. Vibrators 265
Many couples have found placing a vibrator on or near a woman's clitoris during intercourse increases the likelihood of orgasm, yet placing a vibrator directly against a woman's clitoris may not be necessary or desired. Placing one against the pubic mound or outer labia often results in sufficient clitoral stimulation for orgasm to occur without the need for direct clitoral stimulation, as the vibrations pass through the tissues to the clitoris.
A wand shaped vibrator like The Magic Wand is one possible choice. Rechargeable vibrators may be more convenient as there is no power cord to get in the way. The small but powerful battery powered Pocket Rocket works very well, and is mentioned again below. If the vibrator is powerful, to soften the vibrations, place a small folded towel between a woman's clitoris and the vibrator. Vibrators should be seen as a way of enhancing sexual pleasure, not as taking away from it. Dildos and Harnesses While we may assume only women and lesbians would have a use for a dildo in a harness, men can and do use them too. By using a dildo in place of their penis men can actually relax and enjoy sex with their partner to a greater degree, because there is far less pressure to perform, i.e. stress. There is simply much less for them to worry about. They do not have to be concerned about ejaculating too quickly or loosing their erection. They can literally lie back and relax. By removing some of the fear and self-doubt many men experience they will find increased sexual happiness. When and if a man seeks to experience orgasm a couple can engage in whatever sexual activities they desire, including penile-vaginal intercourse. 266
While some may be concerned about the possible loss of physical intimacy, this will not occur. The amount of physical contact decreases very little by using a dildo. Emotional intimacy is always of greater importance. If a couple has the appropriate mind set, not holding to the false expectation that a "man" must have an erection and ejaculate for there to be "sex," intimacy will not be adversely affected. Keep in mind, penile/vaginal contact does not guarantee intimacy. There may actually be increased intimacy because there will be fewer things to distracted a couple. He will not be worrying about not lasting long enough and she will not be worrying about taking too long. If they experience increased pleasure with fewer fears, sex is going to be more pleasurable and fulfilling for both. Using a dildo in a harness may simply make partnered sex more fun and enjoyable. The use of a dildo in a harness can increase the number sexual activities a couple can explore and the length of those activities. A woman can sit straddling her partner, and possibly caress her clitoris, while rocking her hips for as long as her heart desires; allowing her partner to observe and share in her pleasure with fewer distractions. A couple can take turns doing the pelvic rocking or thrusting and extend the duration of intercourse. They can simply cuddle while the woman enjoys the feeling of her vagina being filled. A woman can explore and discover if bigger really is better, or switch to smaller when necessary. A couple can explore changing roles by having the woman wear the harness and penetrate her partner. This allows "heterosexual" men to explore fellatio and anal penetration. A dildo and harness will enhance rather than take away from a couple's sexual experiences, if they are open to the idea. As an interesting side note, there are lesbians who feel they are better sexual partners because their penis, a dildo in a harness, is always erect and they never have to worry about ejaculating too quickly, but as a consequence their partner may expect marathon and acrobatic sex. 267
Women naturally have varying needs and desires when it comes to penetrative sex. A couple can choose a dildo of a size, firmness, and texture that fulfill a woman's individual needs and desires during each sexual activity. She may prefer a small flexible dildo during fellatio and anal intercourse but a large firm one during vaginal intercourse, as an example. If a woman finds deep penetration painful, she can choose a dildo of appropriate size. If she desires more stimulation, she can choose one with bumps and ridges. She can choose a dildo shaped in a way that stimulates her G-Spot. It should be noted that silicone dildos are perhaps the best choice of materials, as well as dildos made from cyberskin, but these are more expensive and harder to care for than silicone. A couple should invest in a high quality harness and dildos because the cheap plastic ones simply do not work; the all in one $20 specials belong in the trash not the bedroom. A $100 investment will serve a couple for many years. Important Note: Men can use their fingers, as mentioned above, to stimulate their partner's vagina. It is not necessary to use a penis or dildo to stimulate the vagina for it to be pleasurable for both. Using a dildo in a harness is just one option available to couples.
Positions for Sexual Intercourse Survey Results: Glamour Magazine When asked "What positions do you prefer?" 1,500 women indicated:
Missionary 30%
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You (woman) on top 28%
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Doggie-Style 21% 270
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On your sides 16%
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Other 5%
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See Our Survey: Ladies, What Position do You Prefer? These surveys indicate that while an individual woman may have a preferred sexual position during intercourse, women as a whole do not. A woman is just as likely to enjoy being on top, or having her partner enter her from behind, as she is to have her partner lay on or over her. While the missionary position is assumed to be the most commonly used position, which it may very well be, women do not in general find this position more pleasurable than others.
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The Truth About Size: Is Bigger Always Better?
The Average Human Vagina Do you secretly suspect that your vagina is above average? It may be, but how would you know? Though ladies share a lot, one thing that we tend to keep to ourselves is the appearance of our female anatomy. (Which we hardly ever see anyway. Pop quiz ladies: could you recognize your own in a line-up?) So how do you know if your lady parts are normal? Fortunately, researchers are on the case. Before we dig in, let’s take a minute to define some terms. ‘Vagina’ and ‘vulva’ are not two words for the same anatomy. The word vagina (DXS explainer here) is derived from the Latin word for “sheath”. It is the internal cavity within the female body*. (A high school anatomy teacher was recently investigated for using this word in an anatomy class. Because, of course, 10 th -graders don’t have vaginas, aren’t interested in vaginas, and certainly have no need to know what vaginas are. Vagina: it’s not a dirty word.) So, are you normal? Are you average? Yes. No. Most likely. It turns out that there is so much variation among female anatomy that doctors, surgeons, and researchers find it difficult to define exactly what normal is – or even if it exists. And a few at least have been trying. In 1991 a group of three researchers published a paper that described a method for casting a mold of the vagina using material more commonly used to make dental impressions. In short, liquid polymer goo is injected into a willing woman’s vagina with a kind of caulk gun. She waits ten 277
minutes. Then with the help of KY, squatting and pushing, and the string from a tampon that was inserted before the material dried, the mold is removed. Though this paper included only two participants, a few years later the same researchers (plus a couple of others) published another study that examined vaginal molds of 39 women. In these women, all Caucasian, vaginal lengths ranged from almost 7 to almost 15 centimeters (2.75–6 in) with diameters between 2.4 and 6.5 cm (~1–2.5 in). A later study classified the diversity of vaginal shapes: conical, parallel sides, heart, slug, and pumpkin seed. (I can’t be the only one hoping that my vagina looks like a pumpkin seed instead of a slug.) And if you are thinking that maybe you really ARE above average because you have evidence that a seven inch penis can fit in yours, please remember that these studies are performed on women who are not sexually aroused. The vaginal wall lengthens during arousal as increased blood flow pushes the cervix and uterus upward. How do we know this? Well, MRI sex videos help (NSFW). To me, the most interesting paper to use the mold technique compared vaginal shapes among 23 African-American, 39 Caucasian, and 15 Hispanic women. The researchers found that the Hispanic ladies’ vaginas were wider overall, longer in the back, and shorter in the front than the vaginas of the other women. The study also noted that the Caucasian women had a much larger vaginal opening than did the African American women. Fascinating. Of course, molds don’t always perfectly capture the likeness of the intended object. In 2006, a group of doctors and researchers employed MRI scans in an attempt to better quantify the normal vagina. Again they found that “No one dimension characterized the shape of the human vagina.” Vagina quantification fail. Until these studies, knowledge of female pelvic anatomy was largely based on old descriptions of a few female cadavers. I for one am a little disturbed that it has taken so long for basic female anatomy to become interesting enough for serious study. But we haven’t even gotten to the best part yet. Next up, the human vulva. Does Vagina Size Matter? The age-old question of whether or not size matters is typically directed at men, but this is a somewhat hidden concern for women as well. Though they might not talk about it, some women may worry about the size of their vagina and how it affects sexual pleasure, particularly after having a baby. Not a lot of research has been done in this area and because there are so many variables at play in women’s sexuality it is difficult to tell if vagina size and sexual pleasure are linked. The vagina is a very “elastic” organ, says Christine O’Connor, MD, director of adolescent gynecology and well women care at Mercy Medical Center in Baltimore. It is small enough to hold a tampon in place, but can expand enough to pass a child through. This is because the walls of the vagina are similar to those of the stomach, they have rugae, meaning they fold together to collapse when unused, then expand when necessary. “It doesn’t stay one particular size, It changes to accommodate whatever is going on at that time.”
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The most commonly used measurements regarding the size of vaginas come from Masters and Johnson’s work from the 1960s. They looked at 100 women who had never been pregnant and found that vagina lengths, unstimulated, range from 2.75 inches to about 3¼ inches. When a woman is aroused, it increased to 4.25 inches to 4.75 inches. Regardless of how long the vagina is, the area that is thought to be important for most women’s sexual response is the outer onethird.
So how does length relate to sexual satisfaction? No one seems to know for sure. The main issues he sees women have is discomfort during sex. This typically occurs if the vagina is too short or tight or they have a prolapse, where the uterus, bladder, or other organs fall out of place, typically after childbirth. “It probably doesn’t matter, There is such a wide range of normal, one can be completely assured that in the absence of prolapse, length has no impact on sexual satisfaction.” What may make a difference, is what he calls the genital hiatus -- the vaginal opening. The complaints he hears from his patients are typically after childbirth. “Women will come in describing a change in sexual function and say it feels loose and they feel less satisfied,” he says. “But just having a baby changes the sexual experience, so it may not have to do with the changes in the vaginal opening.” The vaginal opening likely changes only slightly after birth. In 1996, doctors began using a measurement called the pelvic organ prolapse quantification system as a way of helping them see how well they were doing repairing that area after childbirth. This was the first time there was a true before-and-after measurement. Doctors have used the system to look at populations of women and found that there is a slight increase in the size of the opening after vaginal deliveries. The issue may be more related to muscular weakness or injury in that area. “Women who are able to contract the pelvic floor muscles can increase or decrease the size of the hiatus,” he says. “Increasing pelvic floor muscle tone can reduce looseness.” 279
Kegel exercises can be very effective at strengthening these muscles, and they may generally improve sex. A study published in the Australian & New Zealand Journal of Obstetrics and Gynaecology in 2008 found that women who regularly performed Kegel exercises reported greater sexual satisfaction than women who didn’t do Kegels. The problem with Kegels is that many women don’t know how to do them properly.
“When I ask someone to do a bicep curl, they can do it,” he says. “But a pretty significant subset of the women who say they do Kegels, when I ask them to show me what they are doing, aren’t doing [the exercise] properly or can’t connect between the brain and those muscles.” To find the muscles you use to do Kegels, either insert a finger into the vagina and squeeze the surrounding muscles or stop the flow when urinating. After you’ve found the muscles, practice contracting them for five to 10 seconds, and then relax. If you can’t hold for that long, work your way up. Repeat the process 10 to 20 times, three times a day. While exercising, be sure to breathe normally and try not to use the muscles in your legs, stomach, or bottom. Some women sustain nerve injury during birth and can’t feel these muscles. Others just don’t use the proper technique. There are even physical therapists who specialize in helping women perform Kegels properly. Worrying about size and whether or not it changes over time is the wrong concern. Factors like sufficient lubrication and arousal and a good relationship with a partner have a much greater impact on sexual enjoyment for women. 280
A 2010 study published in the International Urogynecology Journal bears out her opinion. Researchers used medical records, an exam, and questionnaire of 500 gynecological patients aged 40 and older to see if there was a correlation between vaginal length and opening size and sexual satisfaction. The researchers found that desire, arousal, orgasm, pain, and sexual satisfaction were not linked to vagina size. Instead, the best predictors of sexual inactivity were advanced age, higher BMI, and not being in a committed relationship. “It is not an exact physical fit you are looking for in terms of sexual function. “It is more about the communication between the two partners and making sure both are getting what they need out of the experience and are comfortable.”
Human vaginal size The dimensions and shape of the human vagina are of great importance in medicine and surgery; there appears to be no one way, however, to characterize the vagina's size and shape. In addition to variations in size and shape from individual to individual, a single woman's vagina can vary substantially in size and shape during sexual arousal and sexual intercourse. Parity is associated with a significant increase in the length of the vaginal fornix. The potential effect of parity may be via stretching and elongation of the birth canal at the time of vaginal birth. Although the dimensions of the human vagina have not been the subject of intensive research to the same extent as research into human penis size, a number of research studies have been made of the dimensions of the human vagina.
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Dimensions in the baseline state A 1996 study by Pendergrass et al. using vinyl polysiloxane castings taken from the vaginas of 39 Caucasian women, found the following ranges of dimensions:
lengths (measured using rods): 6.86 to 14.81 cm (2.7 to 5.83 inches); widths: 4.8 to 6.3 cm (1.88 to 2.48 inches); introital diameters: 2.39 to 6.45 cm (0.94 to 2.53 inches)
A second study by the same group showed significant variations in size and shape between the vaginas of women of different ethnic groups. Both studies showed a wide range of vaginal shapes, described by the researchers as "Parallel sided, conical, heart, [...] slug" and "pumpkin seed" shapes. Barnhart et al., however, were unable to characterize the shape of the vagina as a "heart, slug, pumpkin seed or parallel sides" as suggested by the previous studies. A 2003 study by the group of Pendergrass et al. also using castings as a measurement method, measured vaginal surface areas ranging from 65.73 to 107.07 cm2 (10.19 to 16.60 sq. inches) with a mean of 87.46 cm2 (13.56 sq. inches) and a standard deviation of 7.80 cm2 (1.21 sq inches)
Research published in 2006 by Barnhart et al., gave the following mean dimensions, based on MRI scans of 28 women:
Mean length from cervix to introitus: 6.27 cm (2.46"). Mean width: o at the proximal vagina: 3.25 cm (1.27"); o at the pelvic diaphragm: 2.78 cm (1.09"); 282
o
at the introitus: 2.62 cm (1.03")
Dimensions during sexual arousal Lawrence, citing Masters and Johnson's Human Sexual Response (1966), states that pages 73 and 74 of that book show that typical vaginal depth in Masters and Johnson's participants ranged from 7–8 cm (2.8–3.1 in) in an unstimulated state, to 11–12 cm (4.3–4.7 in) during sexual arousal with a speculum in place. Isn’t it funny that many women don’t know the depth, that is the length, of their vagina? When asked, they often say “15 cm. or so”. With that length they obviously relate to the length of a penis in erection. In fact the length of the vagina has a direct size-relation with the length of the forefinger with an average of 8 cm. How is it then possible that an erected penis can fit? A relaxed vagina The vagina is in fact a tube of stretchable mucous tissue, much like the mouth. When aroused, muscles around the vagina relax . (Contrary to the muscles of the penis that contract and stiffen the erection.) So the “relaxed” vagina can take the volume of the erected penis during intercourse, also helped by the lubrication of the arousal. Also when the cervix will lift up and move out of the way. If not aroused enough the penis can hit the cervix.
This explains why intercourse can be painful when the woman is not aroused.Nevertheless intercourse with “very well endowed men” is a problem. Also a mouth can only take a certain size of apple. 283
The truth about the vaginal orgasms In general, the length of an erected penis is not what gives pleasure to the woman but the girth. This is because the sensitive tissue of the clitoris envelopes the vagina. What we see as clitoris is only the tip, comparable to the glans of the penis. So with the movement of intercourse with a rather thick penis these sensitive clitoral tissues are rubbed from the inside and this explains a vaginal orgasm. This knowledge dates from 1998 when the true anatomy of the clitoris was finally determined! Isn’t that amazing? The average depth of your vagina The average depth of a vagina - it is something to wonder about. Take a guess about your own length.. how deep do you think it is? Off course is the depth for each woman different, but statistics say that on average a vagina is only 3 to 4 inches (7,5-10 cm) deep. And now think of the average length of a penis… That doesn’t add up… the average penis is considerably longer. The reason is that the vagina elongates during intercourse to accommodate the entire length of the penis. When you’re sexually aroused, the upper two-thirds of the vagina will stretch out. The vagina also lubricates to help ease penetration. A little too deep? Then in some cases it’s still possible that a penis hits the cervix. This may be an indication that you are not aroused enough. When you’re more aroused, your vagina will elongate and the cervix will lift up and move out of the way. Other times, contact with the cervix can happen if a penis is larger than average or if the thrusting is too deep. Talking with your partner about it — "that's a little too deep" — and/or changing sexual positions could be helpful.
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Another thing to keep in mind is that your vagina is not an open canal. When you’re aroused the vagina walls open apart. Vaginal depth in natal females typically ranges from 7 to 14 cm, or about 3 to 5-1/2 inches. Some of the best data concerning vaginal depth in natal females come from Masters and Johnson's Human Sexual Response (1966). The diagrams below are taken from pages 73 and 74 of that book. Typical vaginal depth in Masters and Johnson's participants ranged from 7-8 cm in an unstimulated state, to 11-13 cm during sexual arousal with a speculum in place. Nulliparous in the figures below refers to women who have not given birth. Thirty years later, Pendergrass, Reeves, Belovicz, Molter, and White (1996) found slightly higher numbers. They measured vaginal depth in 39 women, only one third of whom were nulliparous. They found an average vaginal depth of 11.5 cm (4-1/2 inches), with a range of 6.8 cm to 14.8 cm (2-3/4 to 6 inches). Erect penile length in males averages 13 to 15 cm, or about 5 to 6 inches. Wessels, Lue, and McAninch (1996) reported an average erect length of 12.9 cm in a group of 80 normal men. Harding and Golombok (2002) reported an average erect length of 15.3 cm in a group of 312 gay men. In the latter study, measurements were taken by the men’s partners, which may account for the somewhat higher figure reported. Consequently, penile length probably exceeds vaginal depth in many, perhaps most, heterosexual couples.
Vagina size (depth) Just how deep can something be inserted into a human vagina? We have seen it on porn movies where women insert very long objects into their vaginas. However, can the average women do something similar as their porn star counterparts? The vagina is an elastic organ and it has the 285
capacity to stretch in size or volume to accommodate the penis during intercourse and to deliver a baby vaginally. When it comes to human vagina size, not all women are created equal. Some women have the vaginal capacity to accommodate a fairly long object. Other women have shallow vaginas that can barely accommodate their partner’s penis. Regardless of what can be inserted into the vagina, there are limits, it is not virtual space where you can insert a refrigerator and the kitchen sink at the same time. The body has the ability to stretch and it does to the limits of each woman individually. The following are statistics and averages of vaginal size. Learn how much a vagina can accommodate and just how much capacity do women have within their vaginal cavity. You will find some interesting facts about your own body or that of your partner or women in general.
What type of vaginas do men prefer? Very seldom do we hear in public men’s preference towards a woman’s genitalia and its aesthetics do to censorship and taboo’s. Usually men’s comments go censored through fears that it might make women feel insecure about their most intimate body part. However, hiding and censoring what the other half prefers, it offers not help for women, as they do not know how they should look down there for their partner. Men are human and as such have an opinion and personal preference, as too what they like and dislike including when it comes to female genitalia. Individual preferences do exist for both genders, it is what makes us individuals and not clones mimicking one person or entity. 286
Therefore, there will be men who like tight young small pink vaginas, while there might be other men who like it all loose as a goose. Herein, you will notice and gain an insight as to what men prefer and what they like and dislike about female genitalia. After all, we all share our bodies with the opposite sex and there is no reason why we mustn’t know what one gender or the other prefers. Both genders have preferences and we should accept them as a way of understanding each other. Do female genital looks matter to men in general This can be a very touchy and taboo subject to handle. There will be many women who simply do not want to go there, because of personal insecurities they have towards the appearance of their genitalia. Therefore, this subject can be insightful for women who wish to know how men thing and their personal desires or it can be a burden to find out what men truly want or desire from women’s sex organ appearance. We have conducted many surveys and they all lead to the same answer, looks in-fact does matter when it comes to women and their sex organ appearance. Given that men are visual creatures, what they see, translates into a desire or preference for individual men. The better looking a woman is in her physique, including all body parts, the more desirable she becomes to the opposite gender.
When conducting this study, we found that most men had a personal preference for pretty female genitals. Indicating that “yes” looks do count when it comes to genital appearance, that they prefer 287
vulvas that are more symmetrical and even with a clean look. Nothing hanging out or looking odd that would distort or give of an ugly appearance to the intimate organ of a woman. The study indicates that 84% of men stated that looks matter when it comes to female genitalia. While only 16% of men said that no, it does not matter how a vulva looks to them. Therefore, we have here that out of every 100 men, 84 want their partner to have pretty genitalia and only 16 of them simply do not care how their partner looks between her legs. Overall, we can understand the concept of beauty and ugliness. There are female genitals that look exceptionally pretty by having the perfect color tone, shape and size. Then there are those that look unappealing by having excessively long inner lips or their color is not correct and even having disease, which makes them ugly. So in essence, we can firmly state that looks matter when it comes to female sex organs.
Genital size: How well women measure up! The Vagina Institute has been conducting and researching vulva-vaginal size and overall female genital dimensions since 1995. This is the core foundation of the Vagina Institute; the information presented within this site is of a global study. Women of all ethnicity’s, statures, ages, etc, have contributed to the world’s largest study of human female genital dimensions. For all the women and men who have always wanted to know what the perfect dimensions of female genitalia are, what is considered ideal for beauty, for intercourse or to the opposite side, what is ugly, what is dysfunctional? This site is for you; see every aspect of the female genitalia measured and the results provided for you to compare yourself or your partner’s reproductive organ. The clitoris, inner and outer vaginal lips, the vagina, etc, have all been measured and 288
analyzed. We all know the importance of size and how it matters and how it affects our body’s physical.
The ideal human vagina! The ideal human vagina through the passage of time does not erode in our minds and remains a constant as it has beauty to admire. Whether its 3000 years in humanities past or in our present days, the ideal and perfect vagina still endures. Individuals have personal preferences and thus what holds beauty will be considered as something with value. Unfortunately, not all vaginas have beauty so some are not ideal to what a person desires on their body or view on their partner’s body. To define the ideal and perfect human vagina, we must accept personal desires and preferences to the aesthetic beauty, which some vaginas have, and some do not. Therefore, an ideal vagina will always have beauty as its core foundation.
Sexual Arousal and Orgasm What happens to our bodies when we get turned on sexually? Answering this question is important for several reasons. First, it’s always a good idea to have an understanding of how your own body works, including the sexual parts. That way, you can be comfortable with the way your body responds as you get sexually excited and you will also have a better idea if something is wrong that you should see a doctor about. Second, while no two people are exactly the same in the way they respond sexually, knowing what happens to the male and female body during the process of sexual arousal and orgasm will give you some idea of how a sexual partner’s body responds when he or she is sexually excited. Having a basic understanding of your own body’s 289
sexual response and your partner’s sexual response can be an important building block for a mutually satisfying sexual relationship. Sexual arousal usually begins in the brain. That is, your brain responds to a sexy thought or image, or having a feeling of closeness or affection toward a partner, or the touch of a partner by sending signals to the rest of your body, especially the genital area. For both men and women, one of the major components of physical sexual arousal is increased blood flow to the genital area causing the clitoris to swell and harden in women and the penis to become erect in men. Also, for both women and men, the heart beats faster, blood pressure increases, and breathing becomes more rapid. So in some basic respects, the process of male and female sexual response is quite similar. But because males and females have different reproductive organs we need to look at how sexual arousal affects the genital area separately.
Women For women, a number of things happen as sexual arousal triggered in the brain increases blood flow to the genital area. The vagina becomes lubricated with fluid that seeps through the walls of the vagina. Due to the increased blood flow, the clitoris swells slightly and hardens, becoming more visible and sensitive to touch. As sexual arousal continues and increases, the outer third of the vagina tightens and the opening becomes a little smaller. As a women gets close to having an orgasm, the clitoris retracts, becoming a little less visible. For most women, having an orgasm requires some form of stimulation of the clitoris or clitoral area. The orgasm consists of a series of 3 to 15 contractions of the muscles around the vagina. The first few contractions are the most intense, coming about a second apart, and then they becomes weaker and farther apart. During the orgasm, the woman’s uterus and anus may also rhythmically contract. 290
Men The most obvious physical sign of sexual arousal in men is erection of the penis. The increased blood flow into the penis causes it to stiffen. As the spongy tissue inside becomes filled with blood, pressure is put on the veins inside the penis which prevents blood from flowing out which helps to keep the penis hard. As the process of sexual arousal continues, the penis may become even harder and the head (tip) a little larger. Once the penis has become erect, a few drops of clear non-urinary fluid may come out of the urethra where urine comes out. The testicles move closer to the body.
For men, orgasm occurs in two basic stages. In the first stage, seminal fluid (semen) flows to an area near the base of the penis called the urethral bulb. Once this happens, the man usually has a feeling that he is about to ejaculate. This is sometimes called “the point of no return” because once the semen has reached this area, the man will not be able to stop himself from ejaculating. In the second stage, the urethral bulb and muscles in the pelvic area go through a series of contractions (5 to 8 on average), causing the semen (often called “cum”) to be pumped out of the penis. The semen may squirt or dribble out. The first few contractions are stronger and are about one second apart. During orgasm, a man’s body may stiffen up or he may have mild muscle contractions. Once he has finished ejaculation, his body will relax and the penis goes back to its usual size. Differences in the Speed of Sexual Response From the descriptions of arousal and orgasm above we can see that there are some major similarities in the ways that males and females become sexually aroused and then have orgasms. However, we need to keep in mind that there can be differences in the sexual responses of men and women. On average, the time it takes to become aroused and have an orgasm is shorter for men than for women. This is important to know because it means that in a relationship between a man and a 291
woman, the man may need to try to slow himself down and not expect that his female partner will become sexually aroused as quickly as he does. The partners in same sex relationships are more similar to each other biologically than is the case with opposite sex couples but that does not mean that the pace of sexual arousal of two men in a gay relationship or two women in a lesbian relationship will necessarily match perfectly. In other words, everyone has their own pace of sexual arousal. How fast we become aroused and have an orgasm can change from one day to another depending on a wide range of factors including how relaxed or stressed-out we are, whether we are tired or feeling well rested, whether we have drunk a lot of alcohol or smoked cigarettes, and, probably most importantly, whether we are feeling positively or negatively towards our partner.
So at hand, is a question, does size matter? The answer is always yes! Size of the human female sex organ does matter to women themselves and to men. It is a question of proving stimulation (visual and physical) during any sexual activity. As well as functioning for reproductive purposes too, there is a fine balance between what works and what does not. We must not forget that perfect dimensions lead to pretty sex organs and all other dimensions lead to odd or dysfunctional sex organs
Understanding Sexuality Sex can be pretty confusing. You may have been told that sex is a sacred act between two married people who love each other very much. But then you turn on your TV and you see quite a different story - people having casual or meaningless sex, using it to get revenge or to control people, or using it to advertise everything from soft drinks to vacuum cleaners. 292
The point is, there’s a lot of bad information floating around about sex. And while you may have already had “The Sex Talk” with your parents, you may still have a few questions. Your parents, your teachers or your doctor would likely be happy to answer your questions, but let’s face it, some of this stuff can be pretty embarrassing: Fantasies A sexual fantasy is a picture (image) or thought in your mind that is sexually exciting or pleasurable to you. Sometimes a fantasy is sparked by someone you see or have seen (in real life or in a magazine or video) or that you know. Sometimes a fantasy just pops into your head for no apparent reason. Most people have sexual fantasies from time to time. Some people have sexual fantasies every day and some people hardly ever have them. Usually when a person masturbates, he or she will fantasize. Sexual fantasies vary from one person to another. Because it is formed in our minds, a sexual fantasy can consist of anything our imagination can dream up. Typically though, a person will fantasize about sexual activity with a partner or someone the person finds sexually appealing. Sometimes the fantasy will simply be about a certain person or type of person in an erotic or sexual context.
In most cases, people enjoy their sexual fantasies. In some cases, though, people may have fantasies that they don’t like or feel ashamed about. Keep in mind that just because you have had a fantasy about a particular person or a particular type of sexual activity, this does not mean that you would want to, or should, experience the fantasy in real life. 293
Wet Dreams It is very common for people to have dreams of a sexual nature when they are sleeping. Many people start to have dreams with sexually arousing images or scenarios when they are going through puberty. Sometimes boys going through puberty will have sexual dreams that cause them to have erections and to ejaculate while they sleep. This is called a “wet dream”. Sometimes the boy will wake up with no memory of his dream but will find semen (Cum) on his pajamas or sheets. Usually, as he grows older, the boy will continue to have sexual dreams but will wake up before he ejaculates in his sleep. Of course, girls and women have sexual dreams too. When a girl has a sexual dream her vagina may become lubricated and her clitoris more sensitive.
The Bottom Line Do what you need to do to answer your questions. Read books, fantasize, and ask a trusted friend lots of questions. Or if you’re comfortable, you can talk to your doctor, a school nurse, or a pharmacists - remember, unless you are in danger or have broken the law, whatever you talk about with your health care provider is confidential. Just remember that getting answers to your questions will help you grow as a healthy, mature sexual being. You might find it embarrassing to ask questions about sex, but just think: If and when you decide to have sex, don’t you want to be sure that you’ve done your homework? If you think it’s embarrassing to ask questions now, just think how embarrassing it would be later! If sex was just about orgasms, you could just enjoy it without ever having to talk about it. But there are so many things that come along with sex: pain, messy emotions, awkwardness, confusing feelings, not to mention unwanted pregnancies and sexually transmitted infections (STIs). It’s like a 1000-piece model airplane that comes in a box with no instructions…so you’re going to have to get some help once in a while. 294
But sex and sexuality can be really difficult to talk about, so here’s a few pointers that might help get you started. Use them only if they make sense to you and to your situation. Who do you talk to? Ideally, the first person you try talking to should be someone you trust and feel comfortable with. It doesn’t necessarily have to be your sexual partner or a parent. Think of all the people you know: aunts, uncles, cousins, stepparents, godparents, doctors, pharmacists, teachers, guidance counsellors, religious leaders, personal friends, family friends. But be careful about confiding in friends who belong to your social circle: they may accidentally (or not so accidentally) let your news slip, even if they promise not to.
If you can’t bring yourself to talk to anyone you know, a youth hotline or support group can give you someone who will listen and help, and you won’t have to worry about them blabbing to everyone you know. A lot of times, it feels safest to talk to a complete stranger. After you’ve talked with someone you trust, they may be able to help you break the subject wih more challenging people, like your parents. Where do you talk? Choose a private place where you can rant, rave or shed tears without feeling self-conscious. Depending on your personality and what you want to talk about, a private room at home, a park bench, or a quiet restaurant may fit the bill. Avoid having these discussions by phone or by email cyberhugs just don’t cut it when you need the real thing.. 295
10 Ways to Have Better Sex
1. It cleans itself. Step away from the soap and harsh cleansers, gals. Your vagina keeps itself clean. "It's lined by a variety of glands that produce the fluids needed to both lubricate and cleanse the vaginal area," says Lisa Stern, APRN, a nurse practitioner who works with Planned Parenthood in Los Angeles. "The vast majority of vaginal infections I see in my office are self-induced—generally by women who think they're doing a good thing by washing their vagina with soap and water, or worse, with douche." Bath products, particularly those with chemical dyes or fragrances, can irritate the vagina and wash away the beneficial lubricants and flora (bacteria and yeast) that are normal and natural, she says. When these beneficial compounds get washed away, anaerobic bacteria and yeast proliferate and can cause symptoms like discharge, odor and itching. Lesson learned: While a little mild soap on the labia area is OK, your body does a fine job of keeping the insides clean. 2. It grows in size when aroused. "The average length of a vagina is 3 to 4 inches long," says Lissa Rankin, MD, gynecologist and author of What's Up Down There? Questions You'd Only Ask Your Gynecologist If She Was Your Best Friend. Sounds sort of small, and possibly unaccommodating to your well-endowed husband or partner, right? Fear not, nature makes room. "It can double in length when aroused," Dr. Rankin explains. But she adds that many women still have pain during sex when their partner is on the larger side. She recommends using plenty of lubricant and going slow. "Encourage your partner to have fun with foreplay," she says. "The more aroused you feel, the less intercourse will hurt." 3. Just like your face, your vagina also wrinkles with age. It's a fact of life: The appearance of your lady parts may change with age. "The labia may become less plump as estrogen levels wane, fatty pads in the labia shrink and less collagen can lead to more sagging," says Dr. Rankin. "The skin of the vulva may darken or lighten and the clitoris may shrink. It's normal either way." Scary? Nah. "These changes, which are often related to decreasing levels of estrogen, do not affect how much pleasure your girl parts can bring you." 296
4. You can't lose something in your vagina (like a tampon). Everyone's heard the myth that things can get "lost" in there. "The vagina is bounded at the inner end by the cervix and by the vagina's own tissue," says Stern. In other words, your vagina is not connected to another area of your body so don't worry about anything going missing! However, "Sometimes a tampon can get lodged deep inside the vagina, like if it's accidentally left in place during intercourse. If this happens, your healthcare provider should be able to remove it easily with a speculum and forceps," she says. 5. Some women ejaculate with orgasm. "It definitely happens, and it's not uncommon," says Dr. Rankin. "It seems to be a learned skill and happens more commonly as women get older and learn how their bodies work." So how does it happen? "There are glands around the urethra—the tube between the bladder and the outside world—that probably secrete fluid, particularly when the anterior wall of the vagina (a.k.a. the G Spot) is stimulated." Beverly Whipple, PhD, RN, a sexuality researcher and professor at Rutgers College of Nursing, describes this area as " 'the female prostate,' a collection of glands, blood vessels, nerves and spongy tissue that, when stimulated, seem to create fluid in some women."
6. Your vagina may change dramatically after childbirth. "Post-childbirth the vagina doesn't so much look different as it feels different," says Dr. Rankin. "As a gynecologist, I can almost always tell if a woman has delivered vaginally or not. I need a larger speculum for a woman who has had two kids than for a childless woman. But from the outside, you can't tell unless a woman has torn during childbirth, in which case she may have a faint scar at the site of her tear or episiotomy." If you're uncomfortable with the way your vagina has stretched and changed after childbirth, Rankin has a one-word recommendation: Kegels! "These exercises can really help," she says. A refresher course: You can do them anywhere, anytime. Just squeeze the muscles you use to start and stop the flow of urine, holding for a few seconds at a time, and repeating in sets of 10—or more, if you're up to the task! 297
7. The vagina is like a bicep, use it or lose it. "It's true that the vagina stays healthier when you're using it with some regularity," says Dr. Rankin. "Not only does sex keep the sensitive vaginal tissue healthy, but it's almost as if your yoni has a memory. If you keep reminding your vagina that it has a purpose beyond reproduction, it's likely to rise to the occasion." Case in point: If you neglect your vagina for too long (no sex, no Kegel exercises, etc.), the vaginal walls can become fragile, she says. And when menopause strikes, it may scar and close off a bit. But sex isn't the only answer: Your doctor can suggest specific exercises and instruments that can help the vagina stay in tip-top shape. 8. Vaginal discharge varies from woman to woman. Dr. Rankin notes that the average amount of vaginal discharge a woman of reproductive age secretes over a period of eight hours weighs 1.55 grams (a gram is equivalent to about 1/4 teaspoon). But, some women produce much less and others produce much more—and the variations are completely normal! "You produce the greatest amount of discharge (1.96 grams) around the time of ovulation," she says. "Of course, every woman is different. Some women have ectropion, when the mucous-producing glands that are usually on the inside of the cervix evert onto the outside of the cervix. If your cervix has this normal feature, you may produce more cervical mucous, which increases the amount of vaginal discharge you have. Some women produce very scant amounts of discharge and others make much more. In the absence of infection, it's normal either way." And the color? It varies, too—and just because there's a pigment to it, doesn't mean you have an infection. "Normal vaginal discharge is whitish, but may appear yellowish when it dries," she says. "But if your vaginal discharge appears greenish when wet, you have itching or burning, your discharge smells extra-fishy or you think you're at risk for STDs, get it checked just to be on the safe side."
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Dear Alice, I was wondering about the depth of the vagina. I've read statistics that say that the average vagina is only 3 to 4 inches deep. This seems way too small to me, since the average penis is considerably longer than that. Wouldn't that mean that most penises would crash into the cervix repeatedly during intercourse? Since this obviously doesn't happen, my question is this: does the vagina actually elongate during intercourse to accommodate the entire length of the average penis?
Dear Reader, Yes, just as the vagina has the capacity to expand, allowing for the passage of a baby during childbirth, the vagina also has the ability to elongate during intercourse to accommodate a penis. As you mentioned, for some women, the depth from the vaginal opening to the tip of the cervix is 3 to 4 inches when they are not sexually aroused. Other women may have a vaginal depth of five to seven inches. Regardless, during arousal, blood flows to the genital area, and sexual excitement causes the upper two-thirds of the vagina to lengthen by forcing the cervix and uterus to ascend. The vagina also lubricates to help ease penetration. Some people think that the vaginal canal is a continuously open space. However, this is a misperception. Think of the vaginal canal as if it were a balloon that is not filled with any air. The walls, which have the potential to expand and elongate, gently touch one another. When something is placed inside, they mold around the width and accommodate the length of a penis, tampon, finger(s), or sex toy. Sometimes during penetration, a penis or other object inserted in a vagina does hit the cervix. This may be an indication that the woman is not physiologically aroused enough; when she is more aroused, her vagina will elongate and her cervix, the neck of the uterus, will lift up and move out of the way. Other times, contact with the cervix can happen if a penis is larger than average or if the thrusting is too deep. Communicating with a partner about the discomfort — "Ouch, that's a little too deep" — and changing sexual positions may be helpful. 299
Does Penis Size Matter?
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Yes Virginia, size does matter.* This having been said, one must not forget there is more than one size. If you have not already guessed, we are talking about the size of man's penis, or a woman's dildo. The Average Penis Size Penis size is a great concern for a lot of people, every man has wondered if his size is normal or not. Porn, myths and exaggeration (specially on the net) are making people less confident about the sizes of their penises, and true information is not that easy to find on on line. This section has the aim to show some serious studies on the issue, most of them carries out by professionals, and give a realistic idea about what is Average and therefore normal. As a first approximation we can see from these studies that the average penis size in flaccid state is 9.1cm (3.6′) long and 9.6cm (3.8′) thick (circumference at the thickest point), but due to the great disparity of the averages [7.76-11.76] it would be more realistic to say that average flaccid penis size is somewhere between 8.5 and 9.5 centimiters (3.3-3.75 inches) and between 9 and 10 cm (3.5-3.9 inches). Note that the first two as well has the study carried by Dr Acuña refer to self reported measures, while the rest are measured by professionals. First we start with this table in which 21 flaccid penis size studies are shown:
This chart shows studies on erect penis size: 301
It is even more evident here how self reported surveys give statistically larger averages that those studies done by professionals. The average shown in yellow takes into account the size of the population studied, so these studies rise the average by being the biggest. That’s why we shouldn’t say anything else than the average erect penis size is somewhere between 14 and 15 cm long (5.5′ – 5.9′) and between 11.5 and 12cm thick. Summing up we can say that a real men penis size is difficult to find due to the variability of penis size and the lack of good and big studies. Studies with an asterisk have some kind of bias, Herbenick, Kinsey and sizestudy are selfreported and in LifeStyles the subjects are self-selected. This study does, it is inspired and tries to give a different approach to the penis size issue. As can be seen in the AVERAGES section it isn’t easy to find a good value for the mean size, it is rather better to talk about intervals. Just the same way we buy clothes using sizes (XS, S, M, L, XL) and every size fits different people who aren’t the very same size or in the same weight, the idea is that the same may apply to penises.
This sizes described here are just a tool used to illustrate how common this groups (that we could also consider XS, S, M, L, XL) are, and to give us flexibility when classifying them, because a penis can be considered big for being thick without being long or the other way round Let’s then define the SIZES, taking always into account that these are guideline values: 302
FLACCID ERECT PERCENTAGE
SIZE 1 … to 5,5 cm … to 10 cm 5%
SIZE 2 5.5 to 8 cm 10 to 13 cm 20%
SIZE 3 8 to 10,5 cm 13 to 16 cm 50%
SIZE 4 10,5 to 13 cm 16 to 19 cm 20%
SIZE 5 13 cm to … 19 cm to … 5%
The figures shown have been taken from the averages estimating a standard deviation and assuming that penis size (as many other biological parameters) is more or less normally distributed. Below you can see an approximate representation done with a tool provided by a web page to discuss about penis size.
This sizes show how very big and very small penises exist but are very rare, most men are within a normal range, the same way that there is very tall people out there but you barely see them. We don’t see penises that often in western societies, and almost never on erect state, the only ones come from porn or models selected to do so. That, often misrepresents real size the same way that someone who only knew people from watching NBA would think everyone is 2m (6’6”) tall. Modesty of our society makes this even more important, people with small penises is more likely not to shower on public, not to urinate in public, etc the same way hung guys are more likely to do the opposite. Even when looking at amateur porno, who is more prone to upload his amateur video? The hung guy or the one with a small one?
Size 1
Flaccid Erect Percentage
up to 5.5 cm up to 10 cm 5% of men
Size one covers what is usually called the small ones. About 5% of men are in Size1, that is 1 in every 20 men, so they are not so rare. As it’s said in the Sizes page, Size 1 includes that men with penis sizes up to 5.5cm (2.2′) in flaccid state and up to 10cm (4′) when erect, the girth would usually be around 10cm as well in erect state. These penis although small, are usually the ones that grow proportionally the most, you can see that on average they double their size, while the biggest ones tend to grow less. This phenomena is sometimes known as that erection is the great equalizer, i.e. there’s less variation between erect penises than between the flaccid ones. Think it this way, flaccid penises vary from 3 (letting micro penis out) to 15cm which is a 5 times difference, while erect 303
penises oscillate from 8 to 22cm which is less than 3 times more. So it is not weird to find examples of impressive evolutions:
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Size 2
Flaccid Erect Percentage
5.5 to 8 cm 10 to 13 cm 20% of men
These are the low average ones or the kind of small, men in here probably wonder if they’re small or not but the truth is that one of every 4 of their friends is just that big or smaller These penises are 5.5/8cm flaccid which is more or less the length of a thumb and are not horizontal like Size 1 but hang down total or partially at room temperature
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Sizes 2 are 10/13cm long when erect, which means that grabbing the shaft leaves just the head, or just little more, out:
Size 3 Flaccid Erect Percentage
8 to 10.5 cm 13 to 16 cm 50% of men
This is the average size, this range is the only true average we can assure due to the disparity found in articles. And here is where you see the magic of the normal distribution, in just a 3cm (1.2′) range you find 50% of men !!!! Here is where you probably are, wondering if it is small, just average or maybe even above average! Size 3 penises usually hang down totally and get to the bottom of the testicles or a bit lower:
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Erect these penises are 13 to 16 cm long and 11 to 12.5 cm around
Size 4 Flaccid Erect Percentage
10.5 to 13 cm 16 to 19 cm 20% of men
Size 4 covers from high average to big, guys in here know they’re bigger than most of their friends and can’t have complexes. So they feel comfortable with their penises and thus are more likely to show it off at the beach, the locker room… which added to the fact that Sizes 1 and 2 are much less likely to do so can mislead some people about what is average.
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Erect these penises range from 16 to 19 cm: 308
Size 5 Flaccid Erect Percentage
More than 13 cm More than 19 cm 5% of men
Size 5 is the size of the big ones, only 1 in every 20 men has a Size 5 penis. However it is the most comon size to find on the internet, almost every single porn star is here for sure. We consider size 5 penises those which are bigger than 13cm (5.1′) when flaccid and bigger than 19 cm (7.5′) erect. The upper limit is not clear and it seems to be men with extremely large penises out there, this means that 22-23cm (9′) penises exist but they are very very rare. These penises look big and heavy, and as we can see below they can be considered in this Size because of length, girth or both
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A question that is frequently asked is, whether bigger is better. The answer to that question is, sometimes bigger is better while other times smaller is.
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The size a woman desires or prefers may be dependent on her present situation, or the activity she is contemplating. If she is considering vaginal intercourse for the first time any penis may look large and intimidating. If a woman is contemplating anal intercourse she may make her decision based on the size her partner's penis, the perceived discomfort it may cause. If she would like to orally stimulate her partner she may prefer a small penis, because a large one causes her to choke or makes her jaw muscles ache. A woman's penis preference is therefore not necessarily set in stone. 311
Is there a physical bases for some women to prefer a large penis? The answer is yes. This may have little or nothing to do with the length of a penis, but with its girth. A large penis is often large around, in addition to being long. While men may pride themselves on the length of their penis, its circumference may be of greater importance to women. A woman's sensitive genital tissues are located around the perimeter of the vagina. These sensitive genital tissues are her clitoris, and its outlying structures. Even a woman's G-Spot, if she has one, is located within a couple inches of the vaginal entrance.
The more pressure that is exerted on these structures the more enjoyable vaginal intercourse may be for a woman. On the other hand, pounding on a woman's cervix may not be enjoyable for her, and can be painful for some.
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Note: Our surveys, which don't necessarily reflect women in general, only those who participate, indicate women may enjoy deep penetration. Sixty-five percent of women say they enjoy deep penetration, with thirty-two percent saying it is "yummy," but eleven percent or 1 out of 10 do not, or find it painful. Interestingly enough, a "large penis" isn't required for "deep penetration," as the average vaginal-vulvar passage is only 4 to 4 1/2 inches (10-11 cm) in length. As a result of the desire to be filled, a vaginal ache, which many women experience during sexual arousal, some do desire and enjoy the sensation of having something large stretch and fill their vagina. The larger the object, the more filled and satisfied they feel. This is why some women use large dildos and engage in vaginal fisting. As a result of experimentation and experience some women find their orgasms are more intense when their vagina is filled to capacity. They may start out with a single finger or small dildo, but find these do not fulfill their desire to be filled as much as something larger. In some of these instances, even the largest of penises is not large enough to fulfill their needs.
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Some women prefer a large penis for psychological reasons. Since a man with a large penis is often seen as more manly, the woman who attracts his attention is often seen as more womanly and desirable. A woman may perceive her position in society is better if her partner is well endowed. She may feel she has bested her peers. A woman may find the sight of a large penis visually stimulating too. Many women are fascinated with penises, not because they necessarily want one, but because they do not have one of their own. Their fascination may have nothing to do with size. Many women enjoy seeing and feeling their partner's penis becoming erect in their hand or mouth. Some lesbians are fascinated with penises; they may not desire for their partner to have a real penis, but some do seek out male partners to fulfill their curiosity. One must keep in mind the brain is after all our largest sex organ.
Other women prefer a small penis. As mentioned above, a large penis may cause a woman to experience discomfort when performing fellatio. A woman may want to perform fellatio, but finds it is too taxing when her partner has an averaged sized penis, let alone a large one.
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The physical discomfort outweighs the emotional pleasure and benefit. Women in general enjoy performing oral sex less than men, perhaps in part for this reason. Some women will only orally stimulate their partner's penis when it is flaccid, or in the process of becoming erect. A large penis may also cause discomfort during anal and vaginal intercourse. A woman who enjoys anal intercourse may prefer a small penis as it is easier for her to accommodate within her body. Women who are concerned about decreased vaginal muscle tone, commonly called becoming "loose," may not want a partner with a large penis. As can be seen, larger is not always better.
Some argue that size does not matter. If this were the case, what happens to all those giant sized dildos sold in adult novelty stores? Do adult mail order businesses stock a product that does not sell? While some of these are bought as gag gifts for soon to be married women, many likely get used for their intended purpose.
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In Dickinson's book Atlas of Human Sex Anatomy there are illustrations that depict old dildos that are up to three inches (7.6cm) in diameter. I believe simple curiosity compels many women to seek out objects larger than your average size penis. It may be the rumors of the increased pleasures that pique her curiosity. For some it is the challenge of finding out if they can actually insert something so large into their vagina, a means of testing the limits of their body. While it is curiosity that motivates them, pleasure is what keeps their attention, at least for some women.
In the end does the size of a man's penis truly matter to his partner? The answer is no, at least for the majority (60%) of women. Most women do not choose a partner based solely on the size of his penis. Very few women place penis size on the top of their list when choosing a partner, even those who prefer a large or small penis for physical or psychological reasons. After all, how does a woman know how large a man's penis is, when she chooses him as a potential sexual partner? * For those not familiar with American movies, there is a movie about Christmas in which the statement, "Yes Virginia, there is a Santa Claus." is made. This movie is based on a letter that appeared in The New York Sun in 1897. This article was first published February 9, 2006
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Clitoral & Vulva Massage
Clitoral massage is an excellent skill to have at your disposal when making love to a woman. While most couples engage in a little diddling of the vulva and clitoris prior to intercourse, few would consider making it the main course. If you really want to impress your female partner, consider making her the center of attention by giving her a clitoral massage.
Couples with temporary and permanent physical disabilities can employ clitoral massage. Pregnant women may experience an increased desire for sex and orgasm but find themselves 317
unable to engage in vaginal intercourse. Partners with paralyses may not be able to perform the physical motions required of intercourse. Men who are impotent may still desire to give their partner sexual pleasure and orgasm. Teens and adults who are not ready to have vaginal intercourse can still give each other sexual pleasure. It is important to realize that sex can exist in the absence of an erection and intercourse. Locating Her Clitoris The first requirement of clitoral massage is knowing where your partner's clitoris is, and what it looks like and what it feels like when flaccid and erect. The only way to learn these things is to go exploring. With the lights on, have your partner undress; she may want to wear a comfortable shirt. She should then lay on a bed, sit in a chair, or sit on the bed while reclining on some pillows placed against the headboard. Make sure that you have easy access to her vulva while ensuring you are both comfortable. Sit or kneel so you are facing her, usually off to one side. If she is sitting in a chair or at the end of the bed, you may want to sit in a chair or kneel on the floor. You can also have her sit between your legs, both of you facing the same direction. You need to get close to the subject at hand. You may also want to have a light close by, or a flashlight, to illuminate her vulva so as to be able to see everything clearly. You will also want to have a small handheld or freestanding mirror available so your partner can see her vulva and clitoris, and what you are doing.
Start by examining her vulva as it looks normally, with her outer labia at rest. Gently examine everything with your fingers. Caress versus poke. Notice the softness of her skin and pubic hair and the color and texture of her skin. Caress her vulva with the flat of your hand, your fingers molding to her body. If your partner has a lot of pubic hair, you may want to trim it with scissors. There is no need to shave the pubic area. Then gently spread the outer labia with your fingers, 318
examine what lies within. Identify her inner labia, clitoris, and urinary and vaginal orifices. She can also assist by holding her outer labia open with one or both hands. If you cannot identify her clitoris, ask her if she knows where it is and can point it out to you. Because of the vast variations in genital anatomy, some individual structures may not be easily identifiable, for men as well as women. There are women who do not have inner labia, or have only one. A well-developed clitoris will be easy to see, but many are so small and hidden by surrounding tissue that a woman may only know where it is by knowing where it is most sensitive to her touch, where she rubs while masturbating. If you both have trouble locating the clitoris, look at the illustrations on the Anatomy pages.
Once you locate her clitoris, try to identify all it's different parts: shaft\body, glans, and hood\prepuce. Depending on the size and tightness of her hood you may not be able to retract it far enough to expose the clitoral glans. If this is the case, you may be able to feel it under her hood. If her glans is small, you may only be able to detect the shaft of her clitoris when she is erect, but not the glans itself. There are shafts that are very thin and hard to detect. In this case, you may only be able to identify it when you feel it become erect between your fingertips. She may be able to tell you when you have grasped her clitoral glans in your fingertips if you are not able to feel it. Be very gentle when examining her clitoris, most are extremely sensitive. Watch and Learn The next step for beginners or as a warm-up for the experienced is for your partner to masturbate to orgasm. She should go slowly at first, demonstrating her different strokes, the amount of pressure applied, and frequency of her strokes. This is so you can get an understanding for what she likes and is most responsive too. It will take lots of practice and repeated masturbation 319
sessions for you to become as good at masturbating her as she is. Her masturbating to orgasm before you begin the massage helps to put her in the mood and makes her more responsive to additional sexual stimulation. There are women who find their genitals overly sensitive after orgasm, so you may need to gently massage other areas of her body for several minutes before you begin or continue the clitoral massage. Some women are only able to have one orgasm in the beginning, so go slow and just try to make her feel good if you discover this is true for your partner. If your partner is reluctant to masturbate in your presence, this is perfectly okay and is not a requirement. Suggest it, but do not place any pressure on her.
To the women reading this please rest assured that masturbating in front of your partner is perfectly normal, a lot of women do it. Masturbation is not just a solo activity. Women are very beautiful when they masturbate and share their orgasms with their partner. You cannot do it wrong or make a fool of yourself. You will not lose any of the intimacy you experience when you masturbate alone. I believe most people know their partner masturbates, so you are not going to shock them by admitting to it, they most likely masturbate too. If you maintain eye contact with your partner while masturbating, I think you will be blown away by the experience. Clitoral Sensitivity, and Lubrication You know where her clitoris is, so now what you ask? Well, first I must mention clitoral sensitivity and the possible need for additional lubrication. The sensitivity of the clitoris varies greatly from woman to woman. There are women who experience pain if their clitoris is touched directly, others do not find their clitoris sensitive to touch at all. Others may require a very light touch in the beginning but need a firmer touch the closer they are to reaching orgasm. It is best to start out with a very light touch then slowly increase the amount of pressure as you see her become more aroused. Watch her body movements and listen to the noises she makes to see if you are 320
applying too much pressure or not enough. Be careful, you almost never want to squeeze the clitoris tightly, perhaps firmly, but almost never aggressively. A few women may enjoy a firm squeeze at the point of orgasm, but talk to her about this before actually trying it. She will either see stars, or smack you across the head. Ticklishness can be an indication of nervousness or too light of a touch; have her breath deeply and relax.
Depending on the sensitivity of your partner's clitoris and the amount of natural lubrication, you may need to apply additional lubrication before beginning the massage. Try it without at first, but if she pulls away or reports she is too sensitive, or feels nothing, apply a generous coating of lubrication to her entire vulva. Use water-based lubricants like K-Y Jelly. (Use of petroleum-based lubricants can result in infection.) You can also use the new silicone sexual lubricants; NOT the type used to lubricate cars etc. When you first try clitoral massage have additional lubrication on hand just in case. You will almost never want to touch her clitoral glans directly without your finger(s) being lubricated, but this may not be a part of the massage in any event. You may also want to consider wearing latex or vinyl gloves. They will make your fingers very slick, which will come in handy if your partner's clitoris is extremely sensitive, or if you have rough skin on your fingers. They also come in handy if you insert your finger(s) into her vagina during the massage, fingernails can scratch the vaginal walls. Most pharmacies carry vinyl and latex gloves and are an inexpensive over the counter item. Maintain Physical Contact Always maintain physical contact with the person receiving the massage once you begin. It is very disruptive of the physical bond that develops if you take both hands off her body at the same time, and placing them back can be somewhat of a shock. With practice you may become aware of the 321
sexual energy that flows between you and your partner. Sounds strange, but it is true. Have everything you need within reach of your free hand. It is also a good idea to touch her knee, then slide your hand up to her inner thigh, then finally her up to her vulva, so as not to penetrate her personal space too quickly. Placing your cold hands directly on her vulva may be a shock and ruin the mood. Warm, in a bowl of warm water, any lubricant you may use prior to applying them to her vulva.
Basic Techniques You will be massaging her clitoris using one, two, or three fingers. The size and prominence of her clitoris will determine how many fingers you use. If you are able to locate and feel her clitoral shaft with your fingers, you will use your thumb and index finger. If she has a well-developed clitoris you may want to use your thumb, your index finger, and the finger next to that. If you cannot grasp the shaft and glans of her clitoris because it is small or hidden, you will use just the tip of your index finger, or perhaps your thumb. If you can grasp her clitoris with two or three fingers you will want to do the following. Very gently grasp the shaft of her clitoris with your thumb and index finger. Gently slide the loose tissue covering her clitoris around, primarily back and forth, getting a feel for the shape and firmness of her clitoris. Determine how much the tissue along her shaft slides around. You do not want to grasp the glans at first if possible; if her clitoris is small you will not be able to avoid it. As you slide your fingers back and forth along her shaft, the hood should also be sliding back and forth, stimulating her glans. Go slow and watch your partner for indications of whether or not she is enjoying what you are doing. Try to maintain eye contact with her if possible, or as much as possible. If you cannot tell by body language, then ask her if what you are doing feels good. Ask her whether you should be going slower or faster, or applying a firmer or lighter touch. After you make the suggested change, ask again. If she does not know, just experiment but keep communicating. 322
If you cannot grasp her clitoris, you will want to place the tip of your index finger on top of her clitoral body or hood. Experimentation will indicate which is most sensitive. You will want to gently move the tissue under your finger around in small circles, or back and forth to stimulate her clitoris. Hopefully you will feel the firm structures of her clitoris under your fingertip, when she is aroused and erect, even if her clitoris is really small and hidden. Continue to stroke her clitoris. If she is enjoying what you are doing just continue in a steady rhythm. As she becomes more and more aroused you may want to slowly and gently increase the amount of pressure you are applying, but always be gentle. The speed of your strokes can vary to, very slow in the beginning, then possibly faster as she nears orgasm. Your fingers should always be grasping the loose skin covering the body of her clitoris, causing it to slide back and forth along the shaft. Continue until she reaches orgasm. As soon as she has an orgasm switch to a very very light stroke, as her clitoris is likely to be very sensitive, or move your fingers to her labia. After a couple minutes you can begin again or stop. Never stop the massage abruptly unless she reports she is too sensitive to touch, in which case caress her vulva or inner labia for few minutes. Maintain physical contact as she comes down from her orgasm. She may experience orgasm quickly and easily, but this may not always be the case. It will take practice and time for you both to get comfortable with this technique. You will want to limit the massage periods to 15-20 minutes if she does not experience orgasm initially. Make her feel good, but do not irritate her clitoris or strain yourself. You both need to be relaxed. If your partner is really enjoying herself but does not experience orgasm within 15-20 minutes, you can continue the massage for another 10-25 minutes, as long as you are both comfortable with it.
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Pleasure Yes - Orgasm Maybe Be careful not to make this a tedious act, if either of you become uncomfortable or frustrated it will ruin the moment and the sexual bond necessary for it to be a pleasant experience for both of you. If she does not experience orgasm and is very aroused, switch to a sexual activity that you know will result in orgasm. If she is only able experience orgasm while masturbating, allow her to do so, even if you must leave the room. If she is happy to just cuddle, that is okay too. Sexual Fantasy During the massage it may be necessary for the woman to be fantasizing about something sexual. It may be best if she does not think about the massage itself. If she does find that she needs to fantasize, she should try to have the same fantasy as when masturbating alone. She will probably need to close her eyes for this as her partner's presence may distract her. This will be easier to do if the massage feels pleasurable, if not she should provide guidance until her partner discovers a technique that works for her. Stimulating the Clitoral Glans Depending on the sensitivity of her clitoral glans you may want to stimulate it directly, or indirectly through the hood. If her hood covers her glans, you can gently grasp the glans through her hood with your thumb and index finger. There are women who have a clitoral glans that is always fully or partial exposed. Depending on its sensitivity, you may be able to apply the tip of your finger directly to the glans, sliding it across the surface, using a very light touch and lots of lubrication. If a woman's hood does not cover her glans, massaging the body of her clitoris by grasping the loose tissue there may not provide sufficient stimulation to the glans; in this case try direct stimulation. Some women cannot retract their hood to expose the glans, but if you place your 324
finger at the opening to her hood and massage her clitoral glans, she may experience greater stimulation.
Vaginal and Anal Massage You can provide a vaginal massage while you are giving a clitoral massage. While one hand stimulates her clitoris, the other can be used to stimulate her vagina. By inserting your finger into her vagina, and stimulating the top of her vaginal wall, pointing your finger toward her pubic bone, you can stimulate her G-spot, urethral sponge. The finger movement for G-Spot stimulation is the same as that when indicating to a person that is across the room that you want them to come to you, the palm of your hand facing up, creating a hook with your index finger. This can produce very strong orgasms and pronounced ejaculations of fluid from the urethra. You can explore the vagina and locate areas that are sensitive to digital stimulation, or she may simply enjoy the feeling of something being in her vagina, not moving at all, or very slowly. Caress the vaginal walls; do not just thrust your fingers in and out. You can insert more than one finger depending on her flexibility and desire to be filled. You can employ the use of dildos of different sizes and shapes. You can also insert your entire hand into her vagina, which is commonly called fisting, which can result in a very strong sexual response from her. This is often much easier for female couples, as they usually have smaller hands. Fisting is an advanced skill that takes a lot of practice and sensitivity; a woman must open up for the fist rather than her partner pushing or forcing their fist inside her body. You can also incorporate anal massage. Initially this entails massaging the outside of the anus, no penetration. There are women who are more responsive to anal massage than vaginal massage, or they find the combination to be very intense and enjoyable. After massaging her anus for several minutes you can insert the tip of one finger, moving it slowly in and out. After her anus relaxes you can insert your entire finger, then more fingers if she so desires. 325
A finger used to stimulate her anus should never be used to stimulate her vulva and vagina afterwards because of bacteria present in her rectum. The use of vinyl or latex gloves will allow you to switch back and forth, as long as you change the glove before switching from anus to vulva. Once her anus relaxes, you can insert a butt plug or a dildo with a flared base. Basic Massage Tips A good way to start off a clitoral massage is by giving a full body massage. Spend an hour warming up to the clitoral massage. This will help stimulate and awaken the nerves of the body and help both partners to relax. Use only a light gliding touch for this type of massage. Press down lightly with the flat of your hand, your fingers molding to the shape of her body. Never squeeze, something most people do while giving a massage. If you find an area of tightness, apply a light pressure while moving your hand(s) in a circular or back and forth motion. You want to slowly and gently dissipate the tightness, but do not spend a lot of time trying to release the tightness during an erotic massage. Start on the back of the body, at the head, and work your way towards her feet, have her roll over and do her front, from her feet up, never breaking the physical contact. Do not massage her breast or genitals until the very end. After massaging her head, facial muscles, work your way down to her vulva, stopping at her breasts and nipples along the way. Then begin the clitoral massage. For the massage turn the heat up and play some soft relaxing music. If she should fall asleep this indicates she is tired and needs to recharge.
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Let her take a nap or sleep through the night. If this occurs on a Friday or Saturday night, continue the massage in the morning. I recommend couples buy regular massage books, not erotic massage books as technique is more important than sexy pictures. A regular massage will be erotic if done correctly. While good ones are expensive, massage tables are great to have, especially if the person giving the massage cannot sit, or bend their knees, for any length of time. They also provide easy access to the person receiving the massage.
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General Comments What I have presented here are basic guidelines to help a couple get started with clitoral massage. The intent of clitoral massage is to make her clitoris the center of attention. Since her clitoris is most likely her primary sexual organ, besides her mind, she is likely to find this sexual act very conducive to sexual pleasure and orgasm. Since women's bodies and mental makeup vary greatly it is impossible for me to explain "how-to" for every couple. The only sure way for couples to figure out how to give and receive a clitoral massage is through open minds and practice. I have had women respond very favorably to this massage technique within a few minutes, but this may not be the case for all. Practice makes perfect.
Not Always the Secret There are women who find their clitoris is too sensitive or totally insensitive to touch. They are perfectly normal. If you try clitoral massage and give it a fair try and it does not work, move on. Perhaps vaginal and/or anal massage may be pleasurable for her.
Tantra Massage The massage includes various techniques from different schools of massage with elements from yoga, bioenergetics, and sexual therapy. According to the Tantric Massage Association, it was developed in the 1980s by Andro Andreas Rothe, founder of Diamond Lotus Tantra Lounge, the first Tantra institute in Germany (1977). The client or recipient of a tantra massage plays a passive role in the process. The process combines the feeling of well-being associated with deep relaxation with the therapeutic confrontation of sexual issues. Also according to the Tantric Massage Association, tantra massage is based on ideas taken from the work of Wilhelm Reich, Carl Jung, Carl Rogers and Alexander Lowen. Other sources of inspiration included the work of Mantak Chia, Joseph Kramer (who developed the "lingam massage"), and Annie Sprinkle (who 328
developed the "yoni massage"). According to the published information on their website, tantric massage does not require any kind of sexual exchange. In Sanskrit, Yoni means place of birth, source, origin. Lingam means symbol of Shiva. As Shiva is represented as an endless fire, Lingam-yoni denotes origin of an endless fire which created the universe. The yoni is the creative power of nature and represents the goddess Shakti. The lingam stone represents Shiva, and is usually placed on the yoni. The lingam is the transcendental source of all that exists. The lingam united with the yoni represents the nonduality of immanent reality and transcendental potentiality.attempted to make tantra massage a taxable erotic massage.
Erotic massage or sensuous massage is the use of massage techniques by a person on another person's erogenous zones to achieve or enhance their sexual excitation or arousal and to achieve orgasm. Massages have been used for medical purposes for a very long time, and their use for erotic purposes also has a long history. In the case of women, the two focal areas are the breasts and pubis, while in case of men, the focal area is the male genitals. When the massage is of a partner's genitals, the act is usually referred to as mutual masturbation. Today, erotic massage is used by some people on occasion as a part of sex, either as foreplay or as the final sex act, or as part of sex therapy. There is also a large commercial erotic massage industry in some countries and cities. 329
Commercial erotic and sexual massage An erotic and sexual massage may be provided by independent providers, providers of broader sexual services, or through organized massage parlors or brothels. It takes many forms, from massage techniques that aim to integrate the sexual, spiritual and physical, to massage whose purpose is the achievement of an orgasm through a handjob, oral sex, or sexual intercourse. A 'happy ending' is a colloquial term for the practice of a provider offering sexual release to a client. This is sometimes offered as an addition to any other type of massage, typically in the form of a handjob. The 2009 documentary Happy Endings? follows women who worked in Asian massage parlors in Rhode Island. The film focuses on "full service" massage parlors, although "rub and tug" massage parlors (where only handjobs are offered) are also covered, Prostitution in Rhode Island was legal at the time of filming.
Sex therapy Erotic massage may be used in sex therapy as a means of stimulating the libido or increasing the ability of a person to respond positively to sensual stimulus. In some cases, erotic massage can be a form of foreplay without sexual gratification, intended to heighten the sensitivity of an individual prior to another engagement where sexual arousal and fulfillment is intended. In other cases, erotic massage may be used professionally to help men address issues of premature ejaculation. Methods employed may teach the recipient to relax the musculature of his pelvis and thus prolong arousal and increase pleasure. In the Western medical tradition, genital massage of a woman to orgasm by a physician or midwife was a standard treatment for female hysteria, an ailment considered common and chronic in women. In 1653, Pieter van Foreest advised the technique of genital massage for a disease called "womb disease" to bring the woman into "hysterical paroxysm". Such cases were quite profitable for physicians, since the patients were at no risk of death but needed constant treatment. However, the vaginal massage procedure (generally referred to as 'pelvic massage') was tedious and time-consuming for physicians. The technique was difficult for a 330
physician to master and could take hours to achieve "hysterical paroxysm". Referral to midwives, which had been common practice, meant a loss of business for the physician, and, at times, husbands were asked to assist. Development of the vibrator A solution was the invention of massage devices, which shortened the needed treatment from hours to minutes, removing the need for midwives and increasing a physician's treatment capacity. Already at the turn of the century, hydrotherapy devices were available at Bath, and by the mid-19th century, they were popular at many high-profile bathing resorts across Europe and in America. By 1870, a clockwork-driven vibrator was available for physicians. In 1873, the first electromechanical vibrator was used at an asylum in France for the treatment of hysteria. While physicians of the period acknowledged that the disorder stemmed from sexual dissatisfaction, they seemed unaware of or unwilling to admit the sexual purposes of the devices used to treat it. In fact, the introduction of the speculum was far more controversial than that of the vibrator. By the turn of the 20th century, the spread of home electricity brought the vibrator to the consumer market. The appeal of cheaper treatment in the privacy of one's own home understandably made the vibrator a popular early home appliance. In fact, the electric home vibrator was on the market before many other home appliance 'essentials': nine years before the electric vacuum cleaner and 10 years before the electric iron. A page from a Sears catalog of home electrical appliances from 1918 includes a portable vibrator with attachments, billed as "very useful and satisfactory for home service".
Sexual stimulation is any stimulus (including bodily contact) that leads to, enhances and maintains sexual arousal, and may lead to orgasm. Although sexual arousal may arise without physical stimulation, achieving orgasm usually requires physical sexual stimulation. The term sexual stimulation often implies stimulation of the genitals, but may also include stimulation of other areas of the body, stimulation of the senses (such as sight or hearing) and mental stimulation (i.e. from reading or fantasizing). Sufficient stimulation of the penis in males and the clitoris in females usually results in an orgasm. Stimulation can be by self (e.g., 331
masturbation) or by a sexual partner (sexual intercourse or other sexual activity), by use of objects or tools, or by some combination of these methods. Some people practice orgasm control, whereby a person or their sexual partner controls the level of sexual stimulation to delay orgasm, and to prolong the sexual experience leading up to orgasm. Physical sexual stimulation Physical sexual stimulation usually consists of the touching of parts of the human body, especially erogenous zones. Masturbation, erotic massage, sexual intercourse, a handjob or fingering are types of physical sexual stimulation. Physiological reactions are usually triggered through sensitive nerves in these body parts, which cause the release of pleasure-causing chemicals that act as mental rewards to pursue such stimulation. Physical sexual stimulation may also involve the touching of other people's body parts and may trigger similar physiological reactions.
Non-penetrative sex or outercourse is sexual activity that usually does not include sexual penetration. It generally excludes the penetrative aspects of vaginal, anal, or oral sexual activity, but includes various forms of sexual and non-sexual activity, such as frottage, mutual masturbation, kissing, or cuddling. Some forms of non-penetrative sex, particularly when termed outercourse, include penetrative aspects, such as penetration that may result from forms of fingering or oral sex. People engage in non-penetrative sex for a variety of reasons, including as a form of foreplay or as a primary or preferred sexual act. Heterosexual couples may engage in non-penetrative sex as an alternative to penile-vaginal penetration, to preserve virginity, or as a type of birth control. While non-penetrative sex (or outercourse) is usually defined as excluding sexual penetration, some non-penetrative sex acts can have penetrative components and may therefore be categorized as non-penetrative sex. Oral sex, for example, which can include oral caress of the genitalia, as well as penile penetration of the mouth or oral penetration of the vagina, may be 332
categorized as non-penetrative sex. Oral sex may also be considered outercourse solely because it is not vaginal or anal intercourse. The words penetration and penetrative may be restricted to penile-vaginal penetration, and, in this way, the definition of outercourse additionally includes penetrative anal sex, with the term outercourse used to contrast the term sexual intercourse as vaginal sex. Definitions restricting the terms non-penetrative sex and outercourse to whether penile penetration has occurred, or to nonpenetrative sexual acts that do not involve exchanges of potentially infectious body fluids, also exist. The term heavy petting covers a broad range of foreplay activities, typically involving some genital stimulation.
Mutual masturbation (also called manual intercourse) usually involves the manual stimulation of genitals by two or more people who stimulate themselves or one another. This may be done in situations where the participants do not feel ready, physically able, socially at liberty, or willing to engage in any penetrative sex act, or a particular penetrative sex act, but still wish to engage in a mutual sexual activity. It is also done as part of a full repertoire of sexual activity, where it may be used as foreplay, while, for others, it is the primary sexual activity of choice. Types of mutual masturbation include the handjob (the manual sexual stimulation of the penis or scrotum by a person on a male) and fingering (the manual sexual stimulation of the vagina, clitoris or other parts of the vulva, by a person on a female). Sexual stimulation of the genitals by using the feet may also be included, and so may manual stimulation of the anus. 333
Like frottage in general, mutual masturbation may be used as an alternative to penile-vaginal penetration, to preserve virginity or to prevent pregnancy. It might result in one or more of the partners achieving orgasm. If no bodily fluids are exchanged (as is common), mutual masturbation is a form of safe sex, and greatly reduces the risk of transmission of sexual diseases. In partnered manual genital stroking to reach orgasm or expanded orgasm, both people focus on creating and experiencing an orgasm in one person. Typically, one person lies down pant-less, while his or her partner sits alongside. The partner who is sitting uses his or her hands and fingers (typically with a lubricant) to slowly stroke the penis or clitoris and other genitals of the partner. Expanded orgasm as a mutual masturbation technique reportedly creates orgasm experiences more intense and extensive than what can be described as, or included in the definition of, a regular orgasm. It includes a range of sensations that include orgasms that are full-bodied, and orgasms that last from a few minutes to many hours compared with the direct act of penetrative sexual intercourse.
Exclusively non-penetrative Non-penetrative sex may sometimes be divided into acts that are exclusively non-penetrative and those that are not. Exclusively non-penetrative sexual acts include:
Axillary intercourse: (slang: "bagpiping", in reference to the underarm manner in which bagpipes are played; directing traffic, or pit-wank, a variant of the term tit-wank, are also terms for axillary intercourse). It is a sexual variant where the penis is inserted in the other person's armpit. Erotic massage: rubbing of the body to create pleasure and relaxation. This can be done between two or more people of any gender and sexual orientation. It can involve the use of oils (heated or otherwise) or just the individual's hands. It is also known as sensual massage. Footjob: sexually stimulating one individual's penis with another individual's feet. In some cases it can be part of a foot fetish. One individual places their feet around the penis and 334
caresses it until orgasm is achieved. Variations where the clitoris is stimulated by feet also occur. Handjob: the manual sexual stimulation of the penis by a person on a male, often used as a form of mutual masturbation. Intercrural sex: when the penis is stimulated by placing it between another individual's thighs. Lubrication may be used to allow the penis to move more freely between the thighs. Intergluteal sex: stimulation of the penis using the buttocks, often used as a form of mutual masturbation. It differs from anal sex because no penetration of the anus occurs. The penis is stimulated by moving between the buttocks. Kissing: the touching of one person's lips against another person's can be regarded as a sexual act, especially deep kissing (French kissing) where one person inserts his tongue into the partner's mouth. Kissing may also be done on other parts of the body and is commonly a part of foreplay. Mammary intercourse: the stimulation of the penis by placing the penis between the breasts and moving the penis up and down to create pleasure. Stimulation of nipples: when one partner caresses (either manually or orally) the nipples of their partner. Any individual can participate in this act and it can be done in pairs or groups.
Non-exclusively non-penetrative
Fingering: stimulation of the vagina, vulva, clitoris in particular, or anus, with the fingers. It is often used as a form of mutual masturbation. Oral sex: stimulation of the genitals using the mouth and throat. It is known as fellatio when the act is performed on a penis, and cunnilingus when performed on female genitalia Stimulation using a vibrator: a partner or group of individuals may stimulate each other's genitals using a vibrator.
Tantric or Tantra massage will make you feel as if you are in a trance, where physical boundaries dissolve, time disappears, worries and problems no longer seem important, or are forgotten altogether. Your tantrica or "goddess" will begin the massage by having you recline on your back with pillows under your head and a towel covered pillow supporting your hips. Your legs will be slightly apart, your knees just a little bent. Your abdomen, thighs, feet, toes, chest, nipples and fingers are then gently massaged using warm aromatic oil. No part of your body will escape the "godddesses" attention. Your energy flow is stimulated and senses awakened as your body's sensitivity gradually increases. According to Tantric ideals, your entire body will be massaged, including particularly sensitive areas. These "sensitive areas" are explained in elaborate detail and explicit diagrams under "Lingam" or "Yoni" massage. Perceptions of sensuality and lust are located here, but these "intimate areas" are an important source of joy and fulfillment in life. You will feel relaxed, yet wide awake. You will be coached to breathe properly, as you sink into yet deeper level of relaxation. During this extraordinarily loving ceremony you will be completely nurtured and pampered in the arms of your goddess, providing you with a feeling of comfort and sense of well-being. This incomparable sensation has been described by some as if they were "walking on clouds".
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Touching a Man The male body must first be understood before it may be played in the same manner as a virtuoso commands a musical instrument. Unfortunately most women have only marginal or little understanding of the male anatomy. The inevitable ineptitude often produces sour notes. [Conversely the same can be said about men and their level of appreciation for the female body, but this is another subject entirely.] The problem stems from the fact that male and female genitalia are entirely different from one another. Understandably, the result is that it’s difficult for a woman to know how to best touch a man. Despite the fact that a woman’s clitoris is something of counterpart to a man’s penis, stimulating each to the pinnacle of arousal involves very different techniques. This circumstance 336
results in a host of faulty assumptions, guesswork and experimentation. While some women may mimic the techniques they might have seen in “Blue” movies, others may attempt to refer to what they’ve read in a range of publications. Ultimately the majority simply proceed by trial and error, in the hope that their partners response will serve as a guide. The drawback with this methodology is that many men are not able to effectively communicate their desires verbally or may be embarrassed to make use of “show & tell". Quite a few men may not even be aware of the most effective techniques themselves.
Not surprisingly many men feel that women aren't sufficiently skilled at handling penises. Specific complaints range from grips which are too limp, to a lack conviction and exuberance. Women seem hesitant to apply pressure, and often pull or tug at inappropriate moments; continuously disrupting the all important rhythm. Often women have little sense of how to control the ebb and flow of orgasmic sensations. A woman’s hands are capable of amazing erotic pleasuring, much more than most anyone can imagine. It’s little appreciated that this is an acquired talent. Subtle techniques, the male genitalia as well as adjacent erotic zones must first be understood..
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Lingam Massage
The Sanskrit word for the male sexual organ is Lingam and is loosely translated as "Wand of Light." In Tantra or Sacred Sexuality, the Lingam is respectfully viewed and honored, as a "Wand of Light" that channels creative energy and pleasure.
Orgasm is not the goal of the Lingam massage although it can be a pleasant and welcome side effect. The goal is to massage the Lingam, also including testicles, perineum and Sacred Spot (prostate) externally, allowing the man to surrender to a form of pleasure he may not be accustomed to. From this perspective both receiver and giver relax into the massage. 338
Men need to learn to relax and receive. Traditional sexual conditioning has the man in a doing and goal oriented mode. The Lingam Massage allows the man to experience his softer, more receptive side and experience pleasure from a non-traditional perspective.
Beginning the Massage Have the receiver lie on his back with pillows under his head so he can look up at his partner (giver). Place a pillow, covered with a towel, under his hips. His legs are to be spread apart with the knees slightly bent (pillows or cushions under the knees will also help) and his genitals clearly exposed for the massage. Before contacting the body, begin with deep, relaxed breathing. Gently massage the legs, abdomen, thighs, chest, nipples, etc., to get the receiver to relax. Remind the receiver to breathe deeply and to sink deeper into relaxation. Pour a small quantity of oil on the shaft of the Lingam and testicles. Begin gently massaging the testicles, taking care to not cause pain in this sensitive area. Massage the scrotum gently, causing it to relax. Massage the area above the Lingam, on the pubic bone.
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Massage the perineum, the area between the testicles and anus. Take time when massaging the shaft of the Lingam. Vary the speed and pressure. Gently squeeze the Lingam at the base with your right hand, pull up and slide off, then alternate with your left hand. Take your time doing this, right, left, right, left, etc. Then, change the direction by starting the squeeze at the head of the Lingam and then sliding down and off. Again, alternate with right and left hands.
Massage the head of the Lingam as if you are using an orange juicer. Massage all around the head and shaft. In Tantra there are many nerve endings on the Lingam that correspond to other parts of the body. It is believed that many ailments may be cured by a good Lingam massage. The Lingam may or may not go soft as you perform this technique. Do not worry if it doesn't get hard again. You will probably find that it will get hard, then go soft, get hard again, etc., which is a highly desirable Tantric experience, like riding a wave, bobbing up and down. Hardness and softness are two ends of the pleasure spectrum. If it appears that the receiver is going to ejaculate, back off, allowing the Lingam to soften a little before resuming the massage. Do this several times, coming close to ejaculation, and 340
then backing off. It is important to remember that the goal is not orgasm in and of itself. Men can learn the art of ejaculatory mastery and control by coming close to ejaculation and then backing off on the stimulation. Deep breathing is key here and will soften the urge to ejaculate.
Eventually ejaculatory mastery will allow you to make love as long as you want and you can become multi-orgasmic without losing a drop of semen. Orgasm and ejaculation are two different responses that you can learn to separate. The result is a very expanded sex life. The Sacred Spot Find and massage the male Sacred Spot. There is a small indentation about the size of a pea or maybe larger midway between the testicles and anus. Be gentle and push inward. He will feel the pressure deep inside and it may be uncomfortable at first. Eventually, as this area is worked on and softened, he will be able to expand his orgasms and master ejaculatory control. You can massage his Lingam with your right hand and massage his Sacred Spot with your left hand. Try pushing in on this spot when he nears ejaculation. The man may have strong emotions come up during access to the Sacred Spot. Be the best friend and healer he could have in that moment. You, the giver, are creating a place of trust and intimacy.
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Ending the Massage When he feels complete (with the massage), gently remove your hands cover him and keep him warm. Most importantly, allow him to rest quietly for at least five to ten minutes.
Any man can become "multi-orgasmic". It only requires a basic understanding of male sexuality and certain techniques. Most men’s sexuality is focused on the goal of ejaculating, rather than on the actual process of lovemaking. Once a man becomes multi-orgasmic he will not only be able to better satisfy himself, but also more effectively satisfy his partner. Technically, multiple orgasms occur in succession, without complete loss of sexual arousal in between. Women are blessed with the ability to have multiple orgasms. Not many are aware that men with proper training, can actually do the same. In the case of women, multiple orgasm means resuming sexual stimulation shortly after a first orgasmic climax, usually immediately or within a few minutes, so that a second climax may be reached. If the woman does indeed experience further climaxes during the same sexual encounter, she is said to be multi-orgasmic.
Most men mistakenly believe that being able to regain their erection as soon as possible after ejaculation and reaching another climax within some arbitrary period of time qualifies as being 342
multi-orgasmic. This is false because the true multi-orgasmic male does not lose his erection between orgasms. Multiple male orgasms include only orgasm and not ejaculation. The only exception being, when ejaculation accompanies the final orgasm in a multi-orgasmic experience.
Female (Yoni) Massage
Although it is rarely considered or appreciated, the face down position is perhaps best for massaging the female body. This is not to imply that the front should be neglected, only that the back should be paid more attention. Why is the back so important? There are two primary reasons. The first is simply a design of nature. In the natural world males always approach (and join) with the female from the rear. Evolution has designed the female genitalia to be entered from the rear, as opposed to the face to face, western "missionary" position. Nerve endings of the female genitalia are genetically arranged to be most responsive from the rear. The inside of the thighs and labial lips are more sensitive to touch, when stroked from the rear (as opposed to the front). Some would argue that face to face intercourse is more intense and fulfilling. This may be true on a purely emotional level, even without optimizing the physiological connection. It's simply a matter of which is more important, the mind or the body. During love making the mind is often capable of reaching significantly higher levels than the physical being.
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Another reason that massage from the back may have an advantage, is that a woman often feel more comfortable and relaxed, as her body is less exposed. The feeling of the "face down" position is conducive in fostering a sense of well being, which in turn makes it easier for the woman to "let herself go". A carefully arranged and nurturing atmosphere is essential to achieving the greatest possible pleasure. Plan on at least one hour (at a very minimum) of completely undisturbed and uninterrupted time. The massage can be conducted on a reasonably firm bed; a platform design is still better. The room should be warm and draft free. A significant amount of oil (1-3 oz.) should be expended during the massage. Always keep in mind that you can never apply too much oil. Do not spare the oil, lavish it! Use only specially formulated massage oils [we use citrus scented water soluble grape-seed oil in our studio]. A wide range of scents are available, of which the most pleasing should be selected. Be sure to arrange a number of bath size towels to protect the bedding from the excess oil. Soothing music and candlelight will greatly enhance the atmosphere. Turning off the telephone is absolutely essential! Prior to the massage, it may be desirable to take a short shower, as opposed to a hot bath. A bath often tends to loosen the outermost layer of skin, which when waterlogged will shed (creating gritty particles) and interfere with the massage. Beginning the massage Instruct the receiver lay face down; her face resting either on her own crossed forearms or a flat pillow. You (the giver) will be seated on the edge of the bed or platform. The receiver's midsection may be covered with a towel, for the purpose of warmth and modesty depending on the depth of your relationship. Begin the massage by exposing the receiver's shoulders and neck. Pour a liberal amount of oil into the palm of your hand, and rub both hands together vigorously so as to warm the hands as well as the oil. Avoid pouring the oil directly onto the skin, unless it has been previously heated. Although you are performing a sensual massage, the pressure you exert may be firm enough to have some therapeutic value. Be sure to use sufficient pressure so as not to tickle the receiver.
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Most particularly the neck, shoulders, arms, hands, back, buttocks and legs. The genital region will require the least pressure and the greatest sensitivity. The massage should be performed in a radiating manner... neck and shoulders, arms and hands, individual fingers, back, thighs, calves, feet and toes. As the receiver becomes progressively more relaxed, the towel covering her waist may be removed. The buttocks may now be massaged in a circular motion, followed by long vertical strokes beginning at the waist and ending at mid thigh. Each stroke moving progressively further inside the thigh, toward the labial lips. Alternately stroke the base of the crease between the buttocks, brushing along the anus (rosebud). After stroking the rosebud, allow your hand to glide down to the labia. This should be repeated in an up and down motion (from above the rosebud to the labia and back up again). Do not penetrate the anus or vagina during this phase of the massage. Position the receiver's legs somewhat apart. Too wide is not necessary. Gently grasp and stroke the labial lips with your fingers. After the lubrication seeping from the receiver's vaginal opening becomes more evident, begin to stroke the clitoral hood. If the clitoris is already exposed and swollen, begin to rub it directly, using the pads of two fingers (index and pointer). Be very careful not scratch with your fingernails! Vary the amount of stimulation to clitoris, through speed and pressure. Ask the receiver which she prefers. The answer may vary from one individual to another. As her level of excitement grows begin gently reach into her vagina [which should be quite open at this point] and massage sides of the vaginal opening. You may continue to stimulate the clitoris with the pad of your thumb. Or you might massage her rosebud with the pad of your thumb, while twirling the clitoris with two other fingers. Do not enter her anus unless she desires this. In which case it is recommended to use a latex glove, to be sure that there is no possibility of irritating this most sensitive area (even short and well manicured fingernails may cause discomfort).
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After becoming aroused some women may reflexively begin to raise their pelvis, by pulling in their knees closer to their chest. This position not only raises their rear end, but further exposes the clitoris, vaginal opening and rosebud. Caressing and stroking these magical elements simultaneously, or alternately can produce a virtually endless cycle of orgasms. Thanks to the Internet there are literally volumes of information to be found on this subject. Those interested in furthering their knowledge will find many valuable resources online. Surprisingly not only men, but also more than a few women don't completely understand or appreciate the process. This circumstance should be of little surprise to anyone considering that there has been, and continues to be a good deal of disagreement even among "experts" on the subject of female orgasm. The questions are innumerable... How does it happen? Is every woman able to have this experience? What does climax feel like? Are there variations of orgasm? Why does it take longer for females to achieve climax? What happens during climax After a woman becomes sexually aroused, her heart beats faster while her breathing quickens. Often, she'll tighten various muscles all over her body. Her breasts usually enlarge somewhat, the nipples tend to stand out while the areolas become noticeably enlarged. Some women flush red on their face, neck and chest. The visible part of the clitoris also swells slightly.
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Secretions occur inside and at the opening of the vagina. Her labia flatten and open. The vagina lengthens and widens internally, changing what was a potential space into more of an actual space. These vaginal changes are mainly a result of a rush of blood to the pelvic area -- called engorgement -- which provides a generally pleasurable warmth in a female's genital area. As her arousal increases, so does engorgement as well as most of the changes mentioned above becoming more pronounced. The one area that doesn't follow this pattern is the clitoris. Instead of continually swelling, it actually begins to retract under the clitoral hood and decreases in length by about 50%. This is a sign that orgasm is imminent for most women, as long as optimal stimulation continues. The orgasm itself begins with strong muscle contractions. These contractions can be finished within four seconds or last up to about 15 seconds. They tend to occur at intervals of 0.8 seconds. Also, the inner two-thirds of the vagina usually open up even more, while the uterus contracts. During orgasm, skin flushing generally reaches its maximum. Muscles may keep contracting, while blood pressure, heart rate and respiratory rate continue to rise. Some women make sounds reflecting the pleasure they are experiencing. Signs confirming orgasm Rhythmic muscle contractions occur in the outer third of the vagina, the uterus and anus. The first muscle contractions are the most intense, and occur at a rate of about 1 per second. As the orgasm continues, the contractions become less intense and occur at a more random rate.
A mild orgasm may have 3 -5 contractions, an intense orgasm 10 -15. 347
The "sex flush" (redness) becomes even more pronounced and may cover a greater percentage of the body. Muscles throughout the body may contract during orgasm, not just those in the pelvic area. Some women will emit or spray some fluid from their urethra during orgasm. This is often called female ejaculation. A woman's facial expression may indicate that she is in pain when she is having a pleasurable orgasm. At the peak of orgasm the entire body may become momentarily rigid.
What does orgasm feel like? Women who have never experienced orgasm, and women who are not sure if they have, often ask, "What does an orgasm feel like?" This is a hard, if not impossible, question to answer. Imagine trying to explain to someone what it feels like to sneeze or yawn. Not easy to do. How our senses and brain interpret physical stimuli is subjective, that is dependent solely on the individual's perceptions. Subjective reports frequently mention a sensation of tingling in the spine, brain, and genital areas. While some women relay an experience being on the verge of passing out, others report a level of enjoyment only somewhat less than that of "the earth moving". If a woman has experienced some form of nerve damage, she may not be able to tell if she has had an orgasm. Female sensual receptors Although it's true that the entire body is in some way involved during climax, the key sensual receptor will always be the clitoris. Without engaging the clitoris directly or indirectly, there can be no prospect of orgasm. It seems difficult, particularly for men to understand that something as diminutive as the clitoris could be so vitally important. How could this tiny, almost external appendage be infinitely more sensitive than the vagina itself?
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Intuition would make you believe that the lining or walls of the vagina are somehow more akin to the tip penis. Following that logic these two matching surfaces would engage one another during intercourse... resulting in ultimate mutual pleasure, physically and emotionally. Yet for some reason mother nature has played a trick. During intercourse primarily the emotional element comes into play, as the female creates a physical union with male. There is a simple but not necessarily well known explanation for this circumstance. Unlike the glands of the penis, the vagina has relatively few sensual receptors. Ironically, the deeper the penetration, the fewer the receptors. The relatively few nerve receptors which do exist in the vagina are actually located to the upper third; which in many women may be only marginally sensitive at best. For a woman to achieve climax the clitoris must be stimulated in some fashion. This can be accomplished in two ways, directly or indirectly. With the indirect method the males pubic bone may push up against the clitoris while thrusting during intercourse. Or the penis may rub against the vulva, which because of its proximity to the clitoris, may result in indirect stimulation. Considering these circumstances it should be evident that indirect stimulation of the clitoris is not very efficient. It's actually a testimonial to the clitoris's remarkable sensitivity that indirect stimulation is even sufficient to produce climax for about 30 - 40% of women. Depending on the result of any particular survey. By most accounts the clitoris is the counterpart of the tip or "glans" of the penis, with three primary differences: a) the urethra does not pass though the clitoris. b) it's smaller in size. 3) it's significantly more sensitive due to the greater number of nerve receptors (per square inch) than those found on the glans of the penis. In this case it should be fair to assume that it's not possible for the majority of women to reach climax solely as a result of intercourse in the missionary position (face to face). What might be the alternative? 349
Any position which allows the male partner easy and unrestricted access to the clitoris. For example: with the male laying on his back, and the female straddling his waist (facing him). In this position it's easily possible for the female to engage in thrusting, while allowing the male to directly stimulate her clitoris with his fingers. Another alternative... more secure couples may decide to engage in intercourse with the male entering from the rear. With the female positioned in a forward kneeling position, she would have one hand free. This would allow her to stroke her clitoris to the point of full climax in concert with the thrusting action of her partner. The Application of this technique may make it possible for the couple to coordinate their efforts of reaching that elusive and highly prized "simultaneous" orgasm.
“Amrita” …meaning nectar of the goddess. A liquid most treasured and revered in ancient Tantric literature. What exactly does it mean? Even modern medicine isn’t exactly sure, much less in agreement. There is a good deal of mythology surrounding the biological reality of what has been only recently termed as “female ejaculation”. The primary source of much erroneous information about the nature of female ejaculation seems to be attributable to those who seek to sensationalize and exploit this relatively unexplored phenomenon, while others have been overly gullible in accepting purely anecdotal evidence. It's widely believed that there is a female counterpart to the male prostate; technically known as “Skene’s” glands. Just as the male prostate, the ducts from these glands empty into the urethral canal. The liquid produced by the Skene’s glands is not urine, but a thin clear fluid containing glucose and prostatic acid. This chemical makeup is much more similar to semen (without sperm), than it is to urine. During sexual arousal the Skene’s glands may be stimulated in a way as to release secretions into the urethral canal. These secretions are ultimately expelled through the urethral opening (just as 350
in male ejaculation). This fluid "release" is entirely unrelated to “vaginal” secretions, who’s primary, but not exclusive purpose is the lubrication of the vagina.
While there have been numerous claims of vast quantities of liquid expelled during ejaculation, all fail to offer a biologically compelling explanation as to the source, or reservoir used to store or produce such copious supplies of juices. Skene’s glands are smaller in size than the male prostate, and it would only seem logical to assume that the amount of “ejaculate” would be commensurate. Regardless of the true quantity, it is a fact, that it is possible for some women to expel (or ejaculate) prostatic fluid. Where is this mysterious gland? The Skene’s gland is embedded in the wall of the urethra, and can be indirectly felt through the upper vaginal wall, 2- 3” from the entrance of the vagina. Using the pads of one or more fingers, it can best be identified as area of ridges. The center of this ridged surface, about the size of a dime to half dollar, is known as the Grafenberg spot or Gspot. In some women this may be more noticeable than others, particularly when in an un-aroused state. During arousal the G-spot (which is made of erectile tissue) fills with blood and swells to 2-3 times it’s normal size. After arousal it is usually more easily identified and stimulated. Not all women are sensitive to stimulation or find it pleasurable. Since indirect pressure is applied to the bladder, some woman will feel the sensation to urinate. Breaking this psychological barrier makes it possible for some women to expel prostatic fluid, as a direct result of simultaneous stimulation of the G-spot and muscle contractions surrounding the urethra. 351
For a woman seeking to stimulate this area on her own, it would be advisable to do so in a squatting position. The theory being that humans having evolved from quadrupeds, a female’s sexual organs are biologically better designed for entry from the rear Unlike the currently widely accepted missionary position (face to face), rear entry has the advantage of exerting more direct pressure and stimulation onto the G-spot, by the penis. Secondly there is a greater chance of outward ejaculation (by the female), since the urethral canal is not compressed in a way as to inhibit the flow of fluid out of the urethral opening. Although the ability of the female to ejaculate depends on a number of factors, it must be recognized that it is not for everyone. Just as many men are not receptive to prostate stimulation, many women are not sensitive to, or do not necessarily enjoy G-spot stimulation. For those who desire to pursue the experience, the following points should be considered as essential for success.
Locating the G-spot [see illustration) The ability to derive pleasurable sensations from G-spot massage. Overcoming the fear of urinating, during arousal and G-spot stimulation. Emptying the bladder immediately prior to experience, since most women fear that they will urinate as soon as they relax their PC muscles. This will allow the woman to relax (or “let go”) and ejaculate. Assure that the urethral tract not unduly pressured; compressing the urethra may result in the emptying of ejaculate directly into the bladder (as opposed to the urethral opening).
Unlike the male's Lingam it is possible for a woman to exercise and tone her Yoni. Quite surprisingly there are actually a few exercises to chose from, including "vaginal weight lifting". Unfortunately the benefit derived will vary for each individual. Before we begin to examine the 352
various exercise alternatives and objectives, let us first consider the central object of our discussion.
The vagina is an elastic muscular tube projecting inside a female. It is usually slightly shorter and thinner than an average male penis, at about 4 inches (100 mm) long and 1 inch (25 mm) in diameter (although there is wide anatomical variation) but its elasticity causes it to be able to accept larger penises and give birth to offspring. It connects the vulva at the outside to the cervix of the uterus on the inside. If the woman stands upright, the vaginal tube points in an upwardbackward direction and forms an angle of slightly more than 45 degrees with the uterus. The vaginal opening is at the back end of the vulva, behind the opening of the urethra. Above the vagina is Mons Veneris. The vagina, along with the inside of the vulva, is reddish pink in color. Length, width and shape of the vagina may vary. With arousal, the vagina lengthens rapidly to an average of about 4 in.(8.5 cm), but can continue to lengthen in response to pressure. As the woman becomes fully aroused, the vagina tents (expanding in length and width) while the cervix retracts. The walls of the vagina are composed of soft elastic folds of mucous membrane skin which stretch or contract (with support from pelvic muscles) to the size of the penis. With proper arousal, the vagina may stretch/contract to accommodate virtually any penis size. The pubococcygeus muscle or PC muscle is a hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx (tail bone) forming the floor of the pelvic cavity and supporting the pelvic organs. It is part of the levator ani group of muscles. It surrounds the rectum, the vagina and bladder openings. The PC-Muscle consists of three layers. It surrounds the vagina. The illustration shows the location of the PC-Muscle, as it stretches roughly from the pubis to the anus. It controls urine flow and contracts during orgasm. It aids in urinary control and childbirth. 353
Milking the Lingam The primary difference between Kegels and "milking the lingam" is that there's more to the method than just clenching your Yoni muscles. There is not just one muscle to manipulate, but several rows (imagine rings) of muscles lining the inside of the Yoni. With practice, you can learn to manipulate these muscles individually, in tandem or in sequence. Even from side to side. Practice is best accomplished with a Jade Egg. The idea is not to just squeeze, but to learn to give massage that you can control.
You can massage only the tip of your lover's Lingam with your Yoni muscles until he is almost ready to climax and then release and massage only the base. Then again returning to massaging the tip of the Lingam. These exercises will also assist with making the vagina and surrounding area more awake and alive. This will lead you to heightened awareness of clitoral-vaginal sensations. Diminished elasticity Although not the only reason, childbirth (particularly multiple) and natural aging will result in a reduction of vaginal elasticity and tone. The result will manifest itself in a number of ways: Postpartum vaginal stretching Vaginal weakening Diminished sensation or friction during intercourse Urinary incontinence
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Vaginal Exercises Kegels (isometric exercises) are named for the physician who devised them, are designed to strengthen the PC-muscles.
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Slowly contract the muscles, drawing inward and upward. Don’t stop breathing when you do the exercise, but exhale gently as you tighten the muscles around your vagina and anus. When you release the muscles don’t bear them down. Let the tension go gently. At first you can do it 10 to 15 times twice a day. In weeks you can work this up to 60 times. Once you are used to tightening and releasing the muscles, hold them for a count of 3 while squeezing. Then slowly relax for three seconds. Work up till 10 seconds. You can also squeeze and relax the muscles rapidly, in a pulsing motion. Work the PC-muscles in various positions: sitting, standing, lying down, kneeling. You can do this any time: waiting for the buss, driving the car or watching television. The PC-muscles are muscles like any other. So increase the number of contractions only gradually, otherwise you might get sore. It will take a few weeks before you’ll notice that you have more control.
The art of pleasuring one's partner has been discussed in great detail throughout this website. Combining these experiences can result in a geometric progression over each individual technique. Creating the proper space is essential to achieving the most perfect result: As with most other tantric techniques it’s best performed on a stable and firm surface. While a bed is generally too soft, a yoga or exercise mat (large enough for two) will work quite well. The room itself should be comfortably warm (when naked) and draft free. A few candles will serve nicely for the purpose of intimate illumination. A pre-programmed selection of inspirational mood music will help to complete the atmosphere.
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A dish of high quality massage oil (or two individual dispensers) should be within easy reach, as well as two latex gloves and jellied water based lubricant.
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Seating Positions: There are a variety of ways the couple may decide to sit. Regardless of your choice there are two considerations of equal importance in making that decision: comfort and easy accessibility. Since you can expect to remain in the selected position for more than a short length of time, you must be certain that the position is not awkward for you. This may take some experimentation in the beginning. Just as important as comfort will be an easy accessibility to your partners body, particularly the genital area.
One position which perhaps offers the best compromise, is to sit cross legged from one another. If desirable one partner may use the back of a couch or wall to support their back. You may use flat firm pillows to sit on (in addition to the floor mat) and to help support your back. Remember, comfort is essential to achieving the perfect experience! Beginning the massage: It's usually best for one partner to begin by stroking the other, after which the roles are reversed. During this early phase the sensual massage should be limited in its intensity, with no more than incidental contact to the genitals. The primary purpose is to gradually elevate the feeling of desire and excitement within each partner. The couple should spend at least 10 – 15 minutes stroking one another is this manner. After the couple becomes sufficiently aroused (warmed up), each partner will now begin to shift their focus onto the genital area of the other. If for example the female is the giver she will begin to perform lingam massage on her partner. If the male is the giver he will perform yoni massage. While pleasuring one another the couple should attempt to make as much eye contact with one another as possible. This may be difficult as each partner may be distracted by the erotic vision of their own, as well as their partner's genitals being stimulated. 358
Although it may not seem fair, but the female will need to assume responsibility for her male partners level of excitement (ejaculation control). It is essential that she not wait for her partner to make it known verbally that he is about to climax. The female does not have the same problem as she is free to orgasm as many times as she likes. The ultimate experience: Those who seek a yet higher level of excitement and unique pleasure, may consider simultaneous anal and lingam/yoni massage. Momentarily stopping mutual massage, each member will slip on one latex glove (which should already be within reach). Jellied lubricant should now be generously applied to the index or middle finger of each gloved hand. It's desirable that each partner begins to simultaneously rub, and gently probe the other's anus. The couple should continue to maintain eye contact with one another. The emotional sensation, as well as physical impact of this experience is nothing short of profound. The very idea and new found sensation, of fondling one another’s anal opening is quite indescribable. It may take time and patience, but even a reluctant sphincter will allow a loving probing finger to enter. The anus may exhibit the somewhat schizophrenic tendency of pulling and pushing the intruding finger, all at the same time. Not certain of embarrassing or rejecting it. In time the finger will be “allowed” to enter. After this happens do not begin pull it in and out, but only feel your way around this new environment. The female partner should be crooking her finger in order to contact her partner's prostate, using the pad of her finger to gently massage the protruding surface.
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Begin to resume mutual genital massage. Each partner will vividly notice the other's anal contractions. When the female senses the male's impending climax, she may simply reduce stimulation to the lingam (while pressuring the prostate with her inserted finger). Alternatively, she may allow the male reach his climax, with a possibility of timing the event with her own orgasm. The result will be more intense than anything the couple has ever experienced. Yoni is the Sanskrit word for the vagina that is loosely translated as "sacred space" or "Sacred Temple." In Tantra, the Yoni is seen from a perspective of love and respect. This is particularly important for men to learn. Before beginning the Yoni Massage it is important to create a space for the woman (the receiver) in which to relax, from which she can more easily enter a state of high arousal and experience great pleasure from her Yoni. Her partner (the giver) will experience the joy of giving pleasure and witnessing a special moment. The Yoni Massage can also be used as a form of "safe sex" and is an excellent activity to build trust and intimacy. Some massage and sex therapists use it to assist women to break through sexual blocks or trauma. The goal of the Yoni massage is not solely to achieve orgasm, although orgasm is often a pleasant and welcome side effect. The goal can be as simple as to pleasure and massage the Yoni. From this perspective both receiver and giver can relax, and do not have to worry about achieving any particular goal.
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When orgasm does occur it is usually more expanded, more intense and more satisfying. It is also helpful for the giver to not expect anything in return, but simply allow the receiver to enjoy the massage and to relax into herself.
The Massage Have the receiver lie on her back with pillows under her head so she can look down at her genitals and up at her partner (giver). Place a pillow, covered with a towel, under her hips. Her legs are to be spread apart with the knees slightly bent (pillows or cushions under the knees will also help) and her genitals clearly exposed for the massage. This position allows full access to the Yoni and other parts of the body. Before contacting the body, begin with deep, relaxed breathing. Both giver and receiver should remember to breathe deeply, slowly and with relaxation during the entire process. The giver will gently remind the receiver to start breathing again if the receiver stops or begins to take shallower breaths. Deep breathing, not hyperventilating, is most important. Gently massage the legs, abdomen, thighs, breasts, etc., to encourage the receiver to relax and for the giver to prepare for touching her Yoni. Pour a small quantity of a high-quality oil or lubricant on the mound of the Yoni. Pour just enough so that it drips down the outer lips and covers the outside of the Yoni. Begin gently massaging the mound and outer lips of the Yoni. Spend time here and do not rush. Relax and enjoy giving the massage. Gently squeeze the outer lip between the thumb and index finger, and slide up and down the entire length of each lip. Do the same to the inner lips of the Yoni/vagina. Take your time. It is helpful for giver and receiver to look into each other's eyes as much as possible. The receiver should tell the giver if the pressure, speed, depth, etc. need to be increased or decreased. Limit 362
your conversation and focus on the pleasurable sensation, too much talking will diminish the effect. The Crown Jewel The clitoris is an amazingly complex structure, similar in function to the male's glans, but surprisingly - up to four times more sensitive. The glans portion of the clitoris holds 6,000 - 8,000 sensory nerve endings, more than any other structure in the human body. This hypersensitive node has only one purpose: pleasure. Nothing exceeds its ability to receive and transmit sensations of touch, pressure or vibration. The glans are the "crown jewel" of the clitoral system!
Stroke the clitoris with clockwise and counter-clockwise circles. Gently squeeze it between thumb and index fingers. Do this as a massage and not to get the receiver off. The receiver will undoubtedly become very aroused but continue to encourage her to relax and breathe. Slowly and with great care, insert the middle finger of your right hand into the Yoni (there is a reason for using the right hand as opposed to the left. It has to do with polarity in Tantra). Very gently explore and massage the inside of the Yoni with this finger. Take your time, be gentle, and feel up, down and sideways. Vary the depth, speed and pressure. It is important to remember that this is a massage in which you are nurturing and relaxing the Yoni. With your palm facing up, and the middle finger inside the Yoni, move the middle finger in a "come here" gesture or crook back towards the palm. You will contact a spongy area of tissue just under the pubic bone, behind the clitoris. This is the G-spot or in Tantra, "the sacred spot". She may feel the need to urinate, experience a little discomfort or most hopefully pleasure. Vary the pressure, speed and pattern of movement. You can move side to side, back and forth, or in 363
circles with your middle finger. You can also insert the finger that's between your middle finger and pinky. Most women should have no problem and will enjoy the increased stimulation from two fingers. Take your time and be very gentle. You may use the thumb of the right hand to stimulate the clitoris as well. An option to try if the receiver wants it is to insert the pinky of the right hand into her anus. [In Tantra, it is said that when your pinky is gently massaging her anus, the next finger and middle finger in her Yoni and your thumb on her clitoris, "You are holding one of the mysteries of the universe in your hand."] You can use your left hand to massage her breasts, abdomen, or clitoris. If you massage the clitoris it's usually best to use the thumb in an up down motion, with the rest of the hand resting on, and massaging the mound. The dual stimulation of right and left hands will provide much pleasure for the receiver. Continue massaging, using varying speed, pressure and motion, all the while continuing to breathe deeply and looking into each other's eyes. She may have powerful emotions come up and may cry. Just keep breathing and be gentle. Some women have been sexually abused and need to be healed. A giving, loving and patient partner can be of immeasurable value to her. If she has an orgasm, keep her breathing, and continue massaging if she wants. More orgasms may occur, each gaining in intensity. In Tantra this is called "riding the wave." In ending the massage, slowly, gently, and with respect, remove your hands. Allow her to relax and enjoy the afterglow of the Yoni massage. Cuddling or holding is very soothing as well. As you learn to master the Yoni Massage your sex life will be greatly enriched and you will learn a great deal about feminine sexuality.
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Tantric Sex Tantric sex, which is not the same as Buddhist tantra (Vajrayana), is the ancient Indian spiritual tradition of sexual practices. It attributes a different value to orgasm than traditional cultural approaches to sexuality. Some practitioners of tantric sex aim to eliminate orgasm from sexual intercourse by remaining for a long time in the pre-orgasmic and non-emission state. Advocates of this, such as Rajneesh, claim that it eventually causes orgasmic feelings to spread out to all of one's conscious experience.[141][142]
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Advocates of tantric and neotantric sex who claim that Western culture focuses too much on the goal of climactic orgasm, which reduces the ability to have intense pleasure during other moments of the sexual experience, suggest that eliminating this enables a richer,
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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.
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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, sexual and cosmic energies.
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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.
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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.
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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. "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.
Imagine yourself being disrobed within the soft glow of scented candlelight; helped into a rose petal covered bath. To relax in place where your Tantrica will soothe and lavish the most careful attention upon every inch of your aching body. Particularly those often neglected areas will be lovingly attended to.
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Using a variety of soaps, scented oils and sponges your body will be caressed and relaxed. Soft hands and adept fingers will move about and caress every minute part of your physical being, massaging your head and temples, neck, shoulders, ever further down to your most sensitive area. Even your feet and toes will not escape attention.
The warm water will melt away your stress and relieve your anxiety. In time you will begin to think only of the sacred space you and your Tantrica will soon be sharing. You will begin to feel reborn...as your newly invigorated body is gently dried with fluffy warm towels, knowing that you are only beginning your adventure.
How and Why Women and Girls Masturbate 372
Masturbation is Rewarding! Masturbation is extremely beneficial to women throughout their life, from infancy to maturity. Masturbation provides women with the opportunity to explore their body while at the same time giving them a high degree of sexual freedom. It allows them the opportunity to experience sexual pleasure without relying on a partner, and to release sexual energy and tension when "they" choose too. Masturbation can be very empowering for women, as it gives them increased control over their body and sexuality. Masturbation is a great teaching tool, it teaches women about their body, how it responds to sexual stimulation. For many normal and healthy women masturbation is their primary or only means of experiencing orgasm. Many women experience their most intense orgasms while masturbating, because they can provide the ideal mental and physical stimulation they require, without worrying about the wants of their partner. While a woman will not always have a sexual partner, she will always have herself. Why Learning Early in Life is Important Masturbation is the first and most import sexual skill a girl or woman should learn, as it frequently holds the key to enjoying other forms of sexual activity. Ideally, this skill is learned prior to puberty, but too often it is not learned until a woman is in her late teens, early twenties, or later. The reason it should be learned or at least known about prior to puberty is, so adolescent girls have a constructive means of addressing their developing sex drive. It also increases their awareness of their ever-changing body, providing some sense of control over it. If a teen knows how to masturbate she is less likely to be compelled to seek out a sexual partner before she is emotionally and physically ready; while girls may start menstruating between the ages of ten and fourteen, their body is not truly prepared for pregnancy, childbirth, and nursing until late in their teens. Masturbation provides young women with an option other than sexual frustration and sex with a partner.
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Learning to masturbate to orgasm at a young age is usually easier than later in life, when we have learned social mores and expectations, which frequently create barriers to sexual pleasure and orgasm. As we become older and more educated we tend to think about things too much. It is better to learn how to masturbate, and potentially experience orgasm, prior to knowing what you are doing and how others view those activities. Things teens and women have learned and experienced may and do prevent them from learning how to experience sexual pleasure and orgasm. When masturbation is learned early in life, girls often continue even if they feel guilty or fear being punished, because of the pleasure and relaxation it brings them: innocence and naivety do have their benefits. How Do Women and Girls Masturbate? Women and girls masturbate in an endless list of ways. They may massage their clitoris and vulva with hands and fingers, or rub their vulva up against pillows, bed cloths, stuffed animals, and furniture. Some use water spray, vibrators, and dildos to stimulate their vulva and/or vagina. The vagina appears to play a smaller role than the clitoris during a woman's masturbation activities, but vaginal insertion is by no means rare or unusual. Vaginal and G-Spot stimulation is most often used in conjunction with clitoral stimulation. Some women employ nipple and/or anal stimulation in addition to clitoral and vaginal stimulation. Fantasy often plays a major role in a woman's masturbation activities, as the brain is the largest and most important sexual organ, and as a result physical stimulation alone is frequently not sufficient to produce orgasm. The Right Way? It is important to understand there is no "correct" or "right" way to masturbate. Some women feel they should be able to masturbate to orgasm using a different or more correct method, because 374
they hear other women do it that way. It is important to keep in mind that each woman's anatomy is a little different and her psychological makeup is a lot different, which results in every woman masturbating differently, even if they use the same basic technique. While many women can masturbate to orgasm employing several techniques, others find they can reach orgasm only when they use the same method each time. There is nothing wrong with this. Partly because of conditioning and partly because of differences in woman's bodies, learning new techniques can be difficult or even impossible. If you are orgasmic with your current masturbation technique feel free to experiment, but do not feel you must reach orgasm in other ways too. Remember, masturbation should be fun and enjoyable, no matter how you do it.
For the Wrong Reasons There are women who masturbate for the wrong reasons, which results in them not masturbating as often as they could, should, or would. We often have negative feelings about masturbation and feel guilty when we do. Women are sometimes concerned by the fact that they masturbate and the frequency at which they do so. This often results in them not masturbating as often as would be emotionally and physically beneficial to them. Some of those reasons are explored below. A Question of Need: Women often use the word "need" to describe their masturbation habits. Some women say, "I need to masturbate weekly." or "I need to masturbate daily." By saying they "need" to masturbate they are unknowingly trying to justify their frequency of masturbation. If they did not have to they would not, at least not as often. 375
They are implying they do not have a choice. Other women say, "I only need to masturbate once a month." or "I do not need to masturbate very often." These women are unknowingly saying that while they would prefer not to masturbate at all they sometimes will as a last resort. A woman who feels comfortable masturbating would not avoid masturbating. She would not forego masturbating for so long she felt she absolutely had to or go crazy with sexual frustration. By using the word "need" to describe their masturbation habits women are saying they feel masturbation is inappropriate, even though they may masturbate frequently. A woman who is comfortable masturbating is more likely to say, "I enjoy masturbating daily." or "I masturbate once a week." Lack of Peer and Social Support: In spite of the sexual revolution female masturbation is still somewhat taboo. Even though popular songs, movies, and television shows make mention of female masturbation, or the use of vibrators, it is not a common topic of discussion. Madonna's touching of her genitals on stage was seen more as an obscene gesture than as a public display of a normal sexual act. In my experience, men and women are more likely to make mention of boys and men masturbating than girls and women. This is in part due to a lack of slang words to describe female masturbation. It is given that men and boys masturbate, but for girls and women, even though it is commonly accepted that it is okay for them to, they are not expected to. If a woman does not know that her peers masturbate and that they presume that she does she is less likely to do it. Even if it is acceptable to do something people are less likely to do it if they do not know their peers do it. Since women do not generally talk about it, it is presumed that they do not masturbate.
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Only Single Women Masturbate: There is a negative social stigmatism attached to the label of being a "single woman." The majority of women I know refuse to go to a public social event alone. How often do you see a woman by herself at a restaurant, the movies, or the theater, compared to men? It is "okay" to be single, but everyone would prefer to see you with a partner. It is socially acceptable to be a single man but less so to be a single woman. Since there are so few single women, and only single women need to masturbate, there are not many women who masturbate. While this is hardly true, it does describe the premise behind why some women do not masturbate. They do not because if they have a partner they do not feel they should have to, or if they are single masturbating would substantiate their single status. If they were not single they would not have to masturbate. Instead of masturbating they go in search of a sexual partner. This results in many unhappy unions and sexually unsatisfied women. Masturbation Equals Infidelity: Since masturbation is seen as a "solo childhood" activity some women with partners do not feel it is appropriate for them. Some view masturbation as a form of adultery when you have a partner. Plus, if you have a partner it is believed your sexual activities with them should fulfill all your sexual needs. While a nice ideal, in real life, their partner, no matter how good and loving they are, does not fulfill the sexual needs of many women. For women with partners it is important for them to understand it is perfectly okay and normal to masturbate, and they should do so without feeling guilty. Their peers and partner most likely do. Having a Partner Equals Less Masturbation: For many, if not most women, the frequency at which they masturbate should not decrease when they go from being single to having a sexual partner. While this may be the expectation some women actually find they masturbate more when they have a partner as having a partner makes them feel more sexual and increases their desire for sexual pleasure and orgasm. Having a partner does not mean masturbation is no longer fulfilling or there are not times when you want to enjoy some solitary pleasure. When you have a partner they do not need to be the sole means of having an orgasm and they do not need to be 377
present during all your orgasms, nor is it necessarily beneficial if they are. You are not denying your partner anything by having orgasms alone.
Masturbation is not a sexual activity you engage in only when you are alone, it is also a means of "sharing pleasure" with your partner. Many enjoy watching their partner give himself or herself pleasure and get intense pleasure from sharing this activity with them. As a result of watching your partner masturbate you develop a better understanding of what forms and techniques of stimulation they find most enjoyable. Knowing your partner can experience orgasm without your involvement helps to reduce some of pressure you may feel and allows sex to be more enjoyable for both partners. Couples, especially those in their teens, who do not wish to risk pregnancy and sexually transmitted diseases, will find masturbating together allows them to experience and share sexual pleasure without those risks. During pregnancy both partners can masturbate together when vaginal intercourse is no longer possible or desired. Masturbation should always be considered a normal part of partnered sex. Knowing how to masturbate to orgasm is important to women because it is often necessary for them to stimulate their clitoris during intercourse if they desire to have an orgasm. Many sexual positions do not provide a woman's partner with easy or comfortable access to her vulva. A woman's partner may be facing in the wrong direction or their arms cannot reach her vulva. It is simply easier for the woman to provide the stimulation. It is also easier for a woman to stimulate her clitoris because there is no need for verbal communication with her partner and she provides herself with the ideal stimulation she requires each and every time. A woman stimulating her clitoris should not be taken as indication that her partner is not a good and caring person, or has poor sexual skills. If it means anything it is that a woman has taken responsibility for her own sexual pleasure.
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A Perfect Partner Equals Perfect Sex: There are times in all relationships when your partner is not available for sex when you desire it, even when they sleep beside you. Couples frequently have different levels of sexual desire and expectations regarding physical intimacy. This is why women frequently masturbate secretively in the shower, or masturbate silently in the early morning hours while their sleeping partner lies beside them. Masturbating when you have a partner is normal and a woman should not feel ashamed for doing so; most women have probably done it at some point in their relationship. It is often a necessity. Forgoing masturbation and sexual pleasure because you have a partner does harm to you and your relationship because you will slowly begin to blame your partner for your sexual frustration. As your sexual frustration grows so does your frustration with the relationship. An affair or divorce may soon follow. Women are Less Sexual than Men: While it is extremely untrue, the majority of people believe women are less sexual than men. We are led to believe women think about sex and desire sex much less often than men. Society frequently creates outcasts of women who are openly sexual. This results in women believing they should not have strong sexual feelings and desires. Unfortunately, many women are ashamed to admit they have a strong sex drive, that they become "horny." This results in women introverting and denying their own sexual feelings and desires. While a woman's desire for sex may change with time, as the result of hormonal influences, they are just as sexual as men. If a woman accepts that she is as equally sexual as a man she is more likely to feel comfortable with her desire to masturbate and the frequency at which she does.
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Low or Absent Sex Drive: Even though women are very sexual beings sexual desire should not be the primary motivation for them to masturbate. The main reason a woman masturbates should be because it simply feels good. Women with strong sex drives may masturbate frequently but they do so because it feels good, not because they are driven to. If it did not feel good it is not likely that they would. A woman should not forgo masturbating just because she does not have a strong sex drive. Even if you have no desire for partner sex you should still enjoy giving yourself pleasure. The fact that preadolescent girls masturbate proves that a hormonally induced sex drive is not the only reason to masturbate. Young girls do it for no other reason than it feels good and helps them relax. Since it does feel good there is no reason to expect adult women not to. There is nothing wrong with a woman giving herself pleasure on a daily basis, or less often if she so desires. For masturbation to be pleasurable it does not have to end in orgasm. Masturbation may involve no more than placing your hands against your vulva when you go to sleep at night because it feels good. Note: A low or absent sex drive and/or lack of genital sensitivity can be an indication of low testosterone levels or sensitivity. The Growing Acceptance of Female Masturbation I do not want readers to get the impression based on the above statements that all women have negative views of masturbation or that all women need to masturbate more often. Women are increasingly developing very positive attitudes towards masturbation. Eighty to ninety percent of young women do it at least occasionally. If given the opportunity women will often discuss their masturbation habits with pride, without the least amount of guilt. It appears that more young girls are being permitted to masturbate by their parents. This results in increasing numbers of adult 380
women who find masturbation as normal as breathing. In addition, I see accounts of mothers who cannot contain their pride at seeing their daughter learning to masturbate at a young age. This positive attitude is transferred to their daughters. These statements are intended only to help women feel better about masturbation, not to make them feel that they have to masturbate to be happy, or that they need to masturbate daily to benefit from it. I just want women to see masturbation as normal, regardless of whether they masturbate, because their peers, siblings, and daughters most likely do.
Children and Privacy I believe every article or book I have read that endorses childhood masturbation recommends parents tell their children it is a normal activity one engages in when alone. It is an activity one does in "private." I can understand why they recommend this but they overlook one major point, young children have no privacy. If you bathe, dress, wipe their nose and bottom, and walk into their bedroom unannounced, how much privacy do children have? Is it then reasonable to expect them to understand the concept of privacy or private? As a result, we send mixed signals to our children. Young children will likely believe their parents really do not want them to masturbate. If it is normal, why hide it? Why do their parents not want to see them masturbating if it normal and everyone does it? If it really is normal, parents need to treat it as such. Children may consider what they do at home and with their parents and siblings as private as well, as they are not in public. They may masturbate in the living room when no one is around but when someone walks in they may be accused of not doing it private. One young girl started to masturbate in front of her older sister. When her sister told her she should not do so, her reply was that since they were both girls, it was okay. If you sleep, bathe, dress, and use the bathroom together, why hide masturbation? Children often have a different and more honest view of sex and masturbation than do adults.
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It is perhaps best to recommend children masturbate in their bedroom or when they bathe versus telling them to do it in private. Set appropriate times and places. If they do it at other times or places, do not scold them, distract them with something else. If you have nothing better for them to do, then it is perhaps best to leave them alone.
Parents should be as supportive of their child's sexual activities as their individual circumstances permit. Having witnessed several children explore their genitals and masturbate in public with no harm being done to them or those around them, parents may not need to be as concerned about the possibility of this occurring as they may believe. If anyone does act inappropriately in these situations it is the adults, not the child. Fetal Sexuality: Who Could Have Imagined? The following quote was printed in the book The Clitoral Truth by Rebecca Chalker; it originally appeared in a letter in the American Journal of Obstetrics and Gynecology 175, Sept 1996 page 753. "We recently observed a female fetus at 32 weeks' gestation touching the vulva with fingers of [her] right hand. The caressing movement was centered primarily on the region of the clitoris. Movements stopped after 30 to 40 seconds, and started again after a few moments. Further, these light touches were repeated and were associated with short, rigid movements of the pelvis and legs. After another break, in addition to this behavior, the fetus contracted the muscles of the trunk and limbs, and the climax, clonicotonic movements [rapid muscle contractions] of the body, followed. Finally she relaxed and rested. We [several doctors and the mother] observed this behavior for about 20 minutes." 382
This raises the possibility that infant girls, as well as boys, may have some sexual awareness at birth. They may already know what sexual pleasure is and how to obtain it. Is it possible that fetal thumb sucking and masturbation are equally necessary and beneficial to the developing fetus? When an infant girl touches her vulva is she just then becoming aware of it or is she demonstrating what she learned or knew prior to birth? What are the psychological consequences of pushing her hand away? Would we do the same if she were sucking on her thumb? This one obscure record of fetal sexuality challenges our perceptions of human sexuality, if it does not in fact destroy them.
Orgasm (Sexual Climax) Orgasm (from Greek ὀργασμός orgasmos "excitement, swelling"; also sexual climax) is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region characterized by sexual pleasure. Experienced by males and females, orgasms are controlled by the involuntary or autonomic nervous system. They are often associated with other involuntary actions, including muscular spasms in multiple areas of the body, a general euphoric sensation and, frequently, body movements and vocalizations. The period after orgasm (known as the refractory period) is often a relaxing experience, attributed to the release of the neurohormones oxytocin and prolactin as well as endorphins (or "endogenous morphine"). Human orgasms usually result from physical sexual stimulation of the penis in males (typically accompanying ejaculation), and the clitoris in females. Sexual stimulation can be by self-practice (masturbation) or with a sex partner (penetrative sex, non-penetrative sex, or other sexual activity). The health effects surrounding the human orgasm are diverse. There are many physiological responses during sexual activity, including a relaxed state created by prolactin, as well as changes in the central nervous system such as a temporary decrease in the metabolic activity of 383
large parts of the cerebral cortex while there is no change or increased metabolic activity in the limbic (i.e., "bordering") areas of the brain. There is also a wide range of sexual dysfunctions, such as anorgasmia. These effects impact cultural views of orgasm, such as the beliefs that orgasm and the frequency/consistency of it are important or irrelevant for satisfaction in a sexual relationship, and theories about the biological and evolutionary functions of orgasm.
In a clinical context, orgasm is usually defined strictly by the muscular contractions involved during sexual activity, along with the characteristic patterns of change in heart rate, blood pressure, and often respiration rate and depth. This is categorized as the sudden discharge of accumulated sexual tension during the sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region. However, definitions of orgasm vary and there is sentiment that consensus on how to consistently classify it is absent. At least twenty-six definitions of orgasm were listed in the journal Clinical Psychology Review.
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There is some debate whether certain types of sexual sensations should be accurately classified as orgasms, including female orgasms caused by G-spot stimulation alone, and the demonstration of extended or continuous orgasms lasting several minutes or even an hour. The question centers around the clinical definition of orgasm, but this way of viewing orgasm is merely physiological, while there are also psychological, endocrinological, and neurological definitions of orgasm. In these and similar cases, the sensations experienced are subjective and do not necessarily involve the involuntary contractions characteristic of orgasm. However, the sensations in both sexes are extremely pleasurable and are often felt throughout the body, causing a mental state that is often described as transcendental, and with vasocongestion and associated pleasure comparable to that of a full-contractionary orgasm. For example, modern findings support distinction between ejaculation and male orgasm. For this reason, there are views on both sides as to whether these can be accurately defined as orgasms. Achieving orgasm Orgasms can be achieved by a variety of activities, including vaginal, anal or oral sex, nonpenetrative sex or masturbation. Orgasm may also be achieved by the use of a sex toy, such as a sensual vibrator or an erotic electrostimulation. It can additionally be achieved by stimulation of the nipples, uterus, or other erogenous zones, though this is rarer. In addition to physical stimulation, orgasm can be achieved from psychological arousal alone, such as during dreaming (nocturnal emission for males or females) or by orgasm control. Orgasm by psychological stimulation alone was first reported among people who had spinal cord injury. Although sexual function and sexuality after spinal cord injury is very often impacted, this injury does not deprive one of sexual feelings such as sexual arousal and erotic desires.
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A person may experience multiple orgasms, or an involuntary orgasm, such as in the case of rape or other sexual assault. An involuntary orgasm from forced sexual contact often results in feelings of shame caused by internalization of victim-blaming attitudes. The incidence of those who experience unsolicited sexual contact and experience orgasm is very low, though possibly underreported due to shame or embarrassment; such orgasms additionally happen regardless of gender. Scientific literature focuses on the psychology of female orgasm significantly more than it does on the psychology of male orgasm, which "appears to reflect the assumption that female orgasm is psychologically more complex than male orgasm," but "the limited empirical evidence available suggests that male and female orgasm may bear more similarities than differences. In one controlled study by Vance and Wagner (1976), independent raters could not differentiate written descriptions of male versus female orgasm experiences". In males- General variabilities In men, the most common way of achieving orgasm is by physical sexual stimulation of the penis. This is usually accompanied by ejaculation, but it is possible, though also rare, for men to orgasm without ejaculation (known as a "dry orgasm") or to ejaculate without reaching orgasm (which may be a case of delayed ejaculation, a nocturnal emission or a case of anorgasmic ejaculation). Men may also achieve orgasm by stimulation of the prostate (see below). Two-stage model The traditional view of male orgasm is that there are two stages: emission following orgasm, almost instantly followed by a refractory period. In 1966, Masters and Johnson published pivotal research about the phases of sexual stimulation. Their work included women and men, and, unlike Alfred Kinsey in 1948 and 1953, tried to determine the physiological stages before and after orgasm. 386
Masters and Johnson argued that, in the first stage, "accessory organs contract and the male can feel the ejaculation coming; two to three seconds later the ejaculation occurs, which the man cannot constrain, delay, or in any way control" and that, in the second stage, "the male feels pleasurable contractions during ejaculation, reporting greater pleasure tied to a greater volume of ejaculate". They reported that, unlike females, "for the man the resolution phase includes a superimposed refractory period" and added that "many males below the age of 30, but relatively few thereafter, have the ability to ejaculate frequently and are subject to only very short refractory periods during the resolution phase". Masters and Johnson equated male orgasm and ejaculation and maintained the necessity for a refractory period between orgasms.
Subsequent and multiple orgasms There has been little scientific study of multiple orgasm in men. In contrast to the two-stage model of male orgasm, Kahn (1939) equalized orgasm and ejaculation and stated that several orgasms can occur and that "indeed, some men are capable of following [an orgasm] up with a third and a fourth" orgasm. Though it is rare for men to achieve multiple orgasms, Kahn's assertion that some men are capable of achieving them is supported by men who have reported having multiple, consecutive orgasms, particularly without ejaculation. Males who experience dry orgasms can often produce multiple orgasms, as the refractory period is reduced. An increased infusion of the hormone oxytocin during ejaculation is believed to be chiefly responsible for the refractory period, and the amount by which oxytocin is increased may affect the length of each refractory period. Another chemical which is considered to be responsible for the male refractory period is prolactin, which represses dopamine, which is responsible for sexual arousal. Because of this, there is currently an experimental interest in drugs which inhibit prolactin, such as cabergoline (also known as Cabeser or Dostinex). Anecdotal reports on cabergoline suggest it may be able to eliminate the refractory period altogether, allowing men to experience 387
multiple ejaculatory orgasms in rapid succession. At least one scientific study supports these claims, although cabergoline is a hormone-altering drug and has many potential side effects. It has not been approved for treating sexual dysfunction.
Another possible reason for the lack or absence of a refractory period in men may be an increased infusion of the hormone oxytocin. It is believed that the amount by which oxytocin is increased may affect the length of each refractory period. A scientific study to successfully document natural, fully ejaculatory, multiple orgasms in an adult man was conducted at Rutgers University in 1995. During the study, six fully ejaculatory orgasms were experienced in 36 minutes, with no apparent refractory period. Later, P. Haake et al. observed a single male individual producing multiple orgasms without elevated prolactin response. A man might refrain from ejaculation by putting pressure on the perineum, about halfway between the scrotum and the anus, just before ejaculating. This can, however, lead to retrograde ejaculation, i.e., redirecting semen into the urinary bladder rather than through the urethra to the outside. Men who have had prostate or bladder surgery, for whatever reason, may also experience dry orgasms because of retrograde ejaculation. In females Study for Pasadena Lifesavers, prismacolor, 1968. Judy Chicago created the Pasadena Lifesavers, a series of abstract paintings that blended colors to create an illusion that the shapes "turn, dissolve, open, close, vibrate, gesture, wiggle," to represent her own discovery that she was multi-orgasmic.
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General orgasmic factors and variabilities In women, the most common way to achieve orgasm is by physical sexual stimulation of the clitoris; general statistics indicate that 70–80 percent of women require direct clitoral stimulation (consistent manual, oral or other concentrated friction against the external parts of the clitoris) to achieve orgasm, though indirect clitoral stimulation (for example, via vaginal penetration) may also be sufficient. The Mayo Clinic stated, "Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulation necessary to trigger an orgasm." Clitoral orgasms are easier to achieve because the glans of the clitoris, or clitoris as a whole, has more than 8,000 sensory nerve endings, which is as many (or more in some cases) nerve endings present in the human penis or glans penis. As the clitoris is homologous to the penis, it is the equivalent in its capacity to receive sexual stimulation. One misconception, particularly in older research publications, is that the vagina is completely insensitive. However, there are areas in the anterior vaginal wall and between the top junction of the labia minora and the urethra that are especially sensitive. With regard to specific density of nerve endings, while the area commonly described as the G-spot may produce an orgasm, and the urethral sponge, an area in which the G-spot may be found, runs along the "roof" of the vagina and can create pleasurable sensations when stimulated, intense sexual pleasure (including orgasm) from vaginal stimulation is occasional or otherwise absent because the vagina has significantly fewer nerve endings than the clitoris. The greatest concentration of vaginal nerve endings are at the lower third (near the entrance) of the vagina.
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Sex educator Rebecca Chalker states that only one part of the clitoris, the urethral sponge, is in contact with the penis, fingers, or a dildo in the vagina. Hite and Chalker state that the tip of the clitoris and the inner lips, which are also very sensitive, are not receiving direct stimulation during penetrative intercourse. Because of this, some couples may engage in the woman on top position or the coital alignment technique to maximize clitoral stimulation. For some women, the clitoris is very sensitive after climax, making additional stimulation initially painful. Masters and Johnson argued that all women are potentially multiply orgasmic, but that multiply orgasmic men are rare, and stated that "the female is capable of rapid return to orgasm immediately following an orgasmic experience, if restimulated before tensions have dropped below plateau phase response levels". Though generally reported that women do not experience a refractory period and thus can experience an additional orgasm, or multiple orgasms, soon after the first one, some sources state that both men and women experience a refractory period because women may also experience a period after orgasm in which further sexual stimulation does not produce excitement. After the initial orgasm, subsequent orgasms for women may be stronger or more pleasurable as the stimulation accumulates. Clitoral and vaginal categories Discussions of female orgasm are complicated by orgasms in women typically being divided into two categories: clitoral orgasm and vaginal (or G-spot) orgasm. In 1973, Irving Singer theorized that there are three types of female orgasms; he categorized these as vulval, uterine, and blended, but because he was a philosopher, "these categories were generated from descriptions of orgasm in literature rather than laboratory studies". In 1982, Ladas, Whipple and Perry also proposed three categories: the tenting type (derived from clitoral stimulation), the A-frame type (derived from G-spot stimulation), and the blended type (derived from clitoral and G-spot stimulation). In 1999, Whipple and Komisaruk proposed cervix stimulation as being able to cause a fourth type of female orgasm.
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Female orgasms by means other than clitoral or vaginal/G-spot stimulation are less prevalent in scientific literature and most scientists contend that no distinction should be made between "types" of female orgasm. This distinction began with Sigmund Freud, who postulated the concept of "vaginal orgasm" as separate from clitoral orgasm. In 1905, Freud stated that clitoral orgasms are purely an adolescent phenomenon and that upon reaching puberty, the proper response of mature women is a change-over to vaginal orgasms, meaning orgasms without any clitoral stimulation. While Freud provided no evidence for this basic assumption, the consequences of this theory were considerable. Many women felt inadequate when they could not achieve orgasm via vaginal intercourse alone, involving little or no clitoral stimulation, as Freud's theory made penilevaginal intercourse the central component to women's sexual satisfaction. The first major national surveys of sexual behavior were the Kinsey Reports. Alfred Kinsey was the first researcher to harshly criticize Freud's ideas about female sexuality and orgasm when, through his interviews with thousands of women, Kinsey found that most of the women he surveyed could not have vaginal orgasms. He "criticized Freud and other theorists for projecting male constructs of sexuality onto women" and "viewed the clitoris as the main center of sexual response" and the vagina as "relatively unimportant" for sexual satisfaction, relaying that "few women inserted fingers or objects into their vaginas when they masturbated". He "concluded that satisfaction from penile penetration [is] mainly psychological or perhaps the result of referred sensation". Masters and Johnson's research into the female sexual response cycle, as well as Shere Hite's, generally supported Kinsey's findings about female orgasm. Masters and Johnson's research on the topic came at the time of the second-wave feminist movement, and inspired feminists such as Anne Koedt, author of The Myth of the Vaginal Orgasm, to speak about the "false distinction" made between clitoral and vaginal orgasms and women's biology not being properly analyzed. 391
Clitoral and vaginal relationships - G-spot § Society and culture Accounts that the vagina is capable of producing orgasms continue to be subject to debate because, in addition to the vagina's low concentration of nerve endings, reports of the G-spot's location are inconsistent—it appears to be nonexistent in some women and may be an extension of another structure, such as the Skene's gland or the clitoris, which is a part of the Skene's gland. In a January 2012 The Journal of Sexual Medicine review examining years of research into the existence of the G-spot, scholars stated that "[r]eports in the public media would lead one to believe the G-spot is a well-characterized entity capable of providing extreme sexual stimulation, yet this is far from the truth". Possible explanations for the G-spot were examined by Masters and Johnson, who were the first researchers to determine that the clitoral structures surround and extend along and within the labia. In addition to observing that the majority of their female subjects could only have clitoral orgasms, they found that both clitoral and vaginal orgasms had the same stages of physical response. On this basis, they argued that clitoral stimulation is the source of both kinds of orgasms, reasoning that the clitoris is stimulated during penetration by friction against its hood; their notion that this provides the clitoris with sufficient sexual stimulation has been criticized by researchers such as Elisabeth Lloyd. Australian urologist Helen O'Connell's 2005 research additionally indicates a connection between orgasms experienced vaginally and the clitoris, suggesting that clitoral tissue extends into the anterior wall of the vagina and that therefore clitoral and vaginal orgasms are of the same origin.
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Some studies, using ultrasound, have found physiological evidence of the G-spot in women who report having orgasms during vaginal intercourse, but O'Connell suggests that the clitoris's interconnected relationship with the vagina is the physiological explanation for the conjectured Gspot. Having used MRI technology which enabled her to note a direct relationship between the legs or roots of the clitoris and the erectile tissue of the "clitoral bulbs" and corpora, and the distal urethra and vagina, she stated that the vaginal wall is the clitoris; that lifting the skin off the vagina on the side walls reveals the bulbs of the clitoris—triangular, crescental masses of erectile tissue. O'Connell et al., who performed dissections on the female genitals and used photography to map the structure of nerves in the clitoris, were already aware that the clitoris is more than just its glans and asserted in 1998 that there is more erectile tissue associated with the clitoris than is generally described in anatomical textbooks. They concluded that some females have more extensive clitoral tissues and nerves than others, especially having observed this in young cadavers as compared to elderly ones, and therefore whereas the majority of females can only achieve orgasm by direct stimulation of the external parts of the clitoris, the stimulation of the more generalized tissues of the clitoris via intercourse may be sufficient for others. French researchers Odile Buisson and Pierre Foldès reported similar findings to that of O'Connell's. In 2008, they published the first complete 3D sonography of the stimulated clitoris, and republished it in 2009 with new research, demonstrating the ways in which erectile tissue of the clitoris engorges and surrounds the vagina, arguing that women may be able to achieve vaginal orgasm via stimulation of the G-spot because the highly innervated clitoris is pulled closely to the anterior wall of the vagina when the woman is sexually aroused and during vaginal 393
penetration. They assert that since the front wall of the vagina is inextricably linked with the internal parts of the clitoris, stimulating the vagina without activating the clitoris may be next to impossible. In their 2009 published study, the "coronal planes during perineal contraction and finger penetration demonstrated a close relationship between the root of the clitoris and the anterior vaginal wall". Buisson and Foldès suggested "that the special sensitivity of the lower anterior vaginal wall could be explained by pressure and movement of clitoris's root during a vaginal penetration and subsequent perineal contraction".
Supporting a distinct G-spot is a study by Rutgers University, published 2011, which was the first to map the female genitals onto the sensory portion of the brain; brain scans showed that the brain registered distinct feelings between stimulating the clitoris, the cervix and the vaginal wall – where the G-spot is reported to be – when several women stimulated themselves in a functional magnetic resonance (fMRI) machine. "I think that the bulk of the evidence shows that the G-spot is not a particular thing," stated Barry Komisaruk, head of the research findings. "It's not like saying, 'What is the thyroid gland?' The G-spot is more of a thing like New York City is a thing. It's a region, it's a convergence of many different structures." Commenting on Komisaruk's research and other findings, Emmanuele Jannini, a professor of endocrinology at the University of Aquila in Italy, acknowledged a series of essays published in March 2012 in The Journal of Sexual Medicine, which document evidence that vaginal and clitoral orgasms are separate phenomena that activate different areas of the brain and possibly suggest key psychological differences between women. Other factors and research Regular difficulty reaching orgasm after ample sexual stimulation, known as anorgasmia, is significantly more common in women than in men (see below). In addition to sexual dysfunction 394
being a cause for women's inability to reach orgasm, or the amount of time for sexual arousal needed to reach orgasm being variable and longer in women than in men, other factors include a lack of communication between sexual partners about what is needed for the woman to reach orgasm, feelings of sexual inadequacy in either partner, a focus on only penetration (vaginal or otherwise), and men generalizing women's trigger for orgasm based on their own sexual experiences with other women.
Masters and Johnson found that men took about four minutes to reach orgasm with their partners. Women took about 10–20 minutes to reach orgasm with their partners, but four minutes to reach orgasm when they masturbated. Scholars state "many couples are locked into the idea that orgasms should be achieved only through intercourse [vaginal sex]" and that "[e]ven the word foreplay suggests that any other form of sexual stimulation is merely preparation for the 'main event.'... ...Because women reach orgasm through intercourse less consistently than men, they are more likely than men to have faked an orgasm". Sex counselor Ian Kerner stated, "It's a myth that using the penis is the main way to pleasure a woman." He cites research concluding that women reach orgasm about 25% of the time with intercourse, compared with 81% of the time during oral sex (cunnilingus). In the first large-scale empirical study worldwide to link specific practices with orgasm, reported in the Journal of Sex Research in 2006, demographic and sexual history variables were comparatively weakly associated with orgasm. Data was analyzed from the Australian Study of Health and Relationships, a national telephone survey of sexual behavior and attitudes and sexual health knowledge carried out in 2001–2002, with a representative sample of 19,307 Australians aged 16 to 59. Practices included "vaginal intercourse alone (12%), vaginal + manual stimulation of the man's and/or woman's genitals (49%), and vaginal intercourse + manual + oral (32%)" and the "[e]ncounters may also have included other practices. Men had an orgasm in 95% of encounters and women in 69%. Generally, the more practices engaged in, the higher a woman's 395
chance of having an orgasm. Women were more likely to reach orgasm in encounters including cunnilingus". Other studies suggest that women exposed to lower levels of prenatal androgens are more likely to experience orgasm during vaginal intercourse than other women.
Anal and nipple stimulation In both sexes, pleasure can be derived from the nerve endings around the anus and the anus itself, such as during anal sex. It is possible for men to achieve orgasms through prostate stimulation alone. For women, other than nerve endings found within the anus and rectum, anal pleasure may be achieved through indirect stimulation of the clitoral "legs" — extensions of the clitoris that flank the urethra, urethral sponge, and vagina, and extend back toward the pubis. Indirect stimulation of the clitoris through anal penetration may be caused by the shared sensory nerves; especially the pudendal nerve, which gives off the inferior anal nerves and divides into two terminal branches: the perineal nerve and the dorsal nerve of the clitoris. The G-spot area, considered to be interconnected with the clitoris, may also be accessible through anal penetration; besides the shared anatomy of the aforementioned sensory nerves, orgasm by stimulation of the clitoris or G-spot area through anal penetration is made possible because of the close proximity between the vaginal cavity and the rectal cavity, allowing for general indirect stimulation. Achieving orgasm solely by anal stimulation is rare among women. Direct stimulation of the clitoris, G-spot area, or both, during anal sex can help some women enjoy the activity and reach orgasm from it. The aforementioned orgasms are sometimes referred to as anal orgasms, but sexologists and sex educators generally believe that orgasms derived from anal penetration are the result of the anus's proximity to the clitoris or G-spot in women, and the prostate in men, rather than orgasms originating from the anus itself. Author Jack Morin, however, has postulated that "anal orgasm" has nothing to do with the prostate orgasm, although the two are often confused.
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On rare occasions, stimulation of the breast area during sexual intercourse or foreplay, or solely having the breasts fondled, creates mild to intense orgasms, sometimes referred to as a breast orgasm or nipple orgasm, in some women. According to one study, by Herbert Otto, which questioned 213 women, 29% of them had experienced an orgasm of this kind at one time or another. Research suggests that the sensations are genital orgasms caused by nipple stimulation, and may also be directly linked to "the genital area of the brain". An orgasm is believed to occur in part because of the hormone oxytocin, which is produced in the body during sexual excitement and arousal. It has also been shown that oxytocin is produced when a man or woman's nipples are stimulated and become erect. A study published in the July 2011 The Journal of Sexual Medicine was the first to map the female genitals onto the sensory portion of the brain, and concluded that sensation from the nipples travels to the same part of the brain as sensations from the vagina, clitoris and cervix. "Four major nerves bring signals from women's genitals to their brains," said researcher Barry Komisaruk of Rutgers University. "The pudendal nerve connects the clitoris, the pelvic nerve carries signals from the vagina, the hypogastric nerve connects with the cervix and uterus, and the vagus nerve travels from the cervix and uterus without passing through the spinal cord (making it possible for some women to achieve orgasm even though they have had complete spinal cord injuries)." Komisaruk cited one reason for this possibility to be oxytocin, which is also released during labor and triggers uterus contractions. Nipple stimulation triggers uterine contractions, which then produce a sensation in the genital area of the brain. Komisaruk also relayed, however, that preliminary data suggests that nipple nerves may directly link up with the relevant parts of the brain without uterine mediation, acknowledging the men in his study who showed the same pattern of nipple stimulation activating genital brain regions.
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Medical aspects - Physiological responses Masters and Johnson were some of the first researchers to study the sexual response cycle in the early 1960s, based on the observation of 382 women and 312 men. They described a cycle that begins with excitement as blood rushes into the genitals, then reaches a plateau during which they are fully aroused, which leads to orgasm, and finally resolution, in which the blood leaves the genitals. In the 1970s, Helen Singer Kaplan added the category of desire to the cycle, which she argued precedes sexual excitation. She stated that emotions of anxiety, defensiveness and the failure of communication can interfere with desire and orgasm. In the late 1980s and after, Rosemary Basson proposed a more cyclical alternative to what had largely been viewed as linear progression. In her model, desire feeds arousal and orgasm, and is in turn fueled by the rest of the orgasmic cycle. Rather than orgasm being the peak of the sexual experience, she suggested that it is just one point in the circle and that people could feel sexually satisfied at any stage, reducing the focus on climax as an end-goal of all sexual activity.
Males As a man nears orgasm during stimulation of the penis, he feels an intense and highly pleasurable pulsating sensation of neuromuscular euphoria. These pulses are a series of throbbing sensations of the bulbospongiosus muscles that begin in the anal sphincter and travel to the tip of the penis. They eventually increase in speed and intensity as the orgasm approaches, until a final "plateau" (the orgasmic) pleasure sustained for several seconds. The length of a man's orgasm has been estimated at 10–15 seconds on average, though it is possible for them to last up to 30 seconds. During orgasm, a human male experiences rapid, rhythmic contractions of the anal sphincter, the prostate, and the muscles of the penis. The sperm are transmitted up the vas deferens from the testicles, into the prostate gland as well as through the seminal vesicles to produce what is known as semen. The prostate produces a secretion that forms one of the components of ejaculate. Except for in cases of a dry orgasm, contraction of the sphincter and prostate force stored semen 398
to be expelled through the penis's urethral opening. The process takes from three to ten seconds, and produces a pleasurable feeling. Ejaculation may continue for a few seconds after the euphoric sensation gradually tapers off. It is believed that the exact feeling of "orgasm" varies from one man to another. Normally, as a man ages, the amount of semen he ejaculates diminishes, and so does the duration of orgasms. This does not normally affect the intensity of pleasure, but merely shortens the duration. After ejaculation, a refractory period usually occurs, during which a man cannot achieve another orgasm. This can last anywhere from less than a minute to several hours or days, depending on age and other individual factors.
Females A woman's orgasm may last slightly longer or much longer than a man's. Women's orgasms have been estimated to last, on average, approximately 20 seconds, and to consist of a series of muscular contractions in the pelvic area that includes the vagina, the uterus, and the anus. For some women, on some occasions, these contractions begin soon after the woman reports that the orgasm has started and continue at intervals of about one second with initially increasing, and then reducing, intensity. In some instances, the series of regular contractions is followed by a few additional contractions or shudders at irregular intervals. In other cases, the woman reports having an orgasm, but no pelvic contractions are measured at all. Women's orgasms are preceded by erection of the clitoris and moistening of the opening of the vagina. Some women exhibit a sex flush, a reddening of the skin over much of the body due to increased blood flow to the skin. As a woman nears orgasm, the clitoral glans retracts under the clitoral hood, and the labia minora (inner lips) become darker. As orgasm becomes imminent, the outer third of the vagina tightens and narrows, while overall the vagina lengthens and dilates and also becomes congested from engorged soft tissue. Elsewhere in the body, myofibroblasts of the nipple-areolar complex contract, causing erection of the nipples and contraction of the areolar diameter, reaching their maximum at the start of orgasm. A woman experiences full orgasm when her uterus, vagina, 399
anus, and pelvic muscles undergo a series of rhythmic contractions. Most women find these contractions very pleasurable. Researchers from the University Medical Center of Groningen in the Netherlands correlated the sensation of orgasm with muscular contractions occurring at a frequency of 8–13 Hz centered in the pelvis and measured in the anus. They argue that the presence of this particular frequency of contractions can distinguish between voluntary contraction of these muscles and spontaneous involuntary contractions, and appears to more accurately correlate with orgasm as opposed to other metrics like heart rate that only measure excitation. They assert that they have identified "[t]he first objective and quantitative measure that has a strong correspondence with the subjective experience that orgasm ultimately is" and state that the measure of contractions that occur at a frequency of 8–13 Hz is specific to orgasm. They found that using this metric they could distinguish from rest, voluntary muscular contractions, and even unsuccessful orgasm attempts.
Since ancient times in Western Europe, women could be medically diagnosed with a disorder called female hysteria, the symptoms of which included faintness, nervousness, insomnia, fluid retention, heaviness in abdomen, muscle spasm, shortness of breath, irritability, loss of appetite for food or sex, and "a tendency to cause trouble". Women considered suffering from the condition would sometimes undergo "pelvic massage" — stimulation of the genitals by the doctor until the woman experienced "hysterical paroxysm" (i.e., orgasm). Paroxysm was regarded as a medical treatment, and not a sexual release. The disorder has ceased to be recognized as a medical condition since the 1920s. Brain There have been very few studies correlating orgasm and brain activity in real time. One study examined 12 healthy women using a positron emission tomography (PET) scanner while they were being stimulated by their partners. Brain changes were observed and compared between 400
states of rest, sexual stimulation, faked orgasm, and actual orgasm. Differences were reported on the brain changes associated with men and women during stimulation. However, the same changes in brain activity were observed in both sexes in which the brain regions associated with behavioral control, fear and anxiety shut down. Regarding these changes, Gert Holstege said in an interview with The Times, "What this means is that deactivation, letting go of all fear and anxiety, might be the most important thing, even necessary, to have an orgasm." While stroking the clitoris, the parts of the female brain responsible for processing fear, anxiety and behavioral control start to relax and reduce in activity. This reaches a peak at orgasm when the female brain's emotion centers are effectively closed down to produce an almost trance-like state. Holstege is quoted as saying, at the 2005 meeting of the European Society for Human Reproduction and Development: "At the moment of orgasm, women do not have any emotional feelings."
Initial reports indicated that it was difficult to observe the effects of orgasm on men using PET scan, because the duration of male orgasm was shorter. However, a subsequent report by Rudie Kortekaas, et al. stated, "Gender commonalities were most evident during orgasm... From these results, we conclude that during the sexual act, differential brain responses across genders are principally related to the stimulatory (plateau) phase and not to the orgasmic phase itself." Research has shown that like in women, the emotional centers of a man's brain also deactivate during orgasm, but to a lesser extent than in women. Brain scans on both sexes have shown that the pleasure centers of a man's brain show more intense activity than in women during orgasm. Human brain wave patterns show distinct changes during orgasm, which indicate the importance of the limbic system in the orgasmic response. Male and female brains demonstrate similar changes during orgasm, with brain activity scans showing a temporary decrease in the metabolic activity of large parts of the cerebral cortex with normal or increased metabolic activity in the limbic areas of the brain. EEG tracings from volunteers during orgasm were first obtained by Mosovich 401
and Tallaferro in 1954. These research workers recorded EEC changes resembling petit mal or the clonic phase of a grand mal. Further studies in this direction were carried out by SemJacobsen (1968), Heath (1972), Cohen et al. (1976), and others. Sarrel et al. reported a similar observation in 1977. These reports continue to be cited. Unlike them, Craber et al. (1985) failed to find any distinctive EEG changes in four men during masturbation and ejaculation; the authors concluded that the case for the existence of EEG changes specifically related to sexual arousal and orgasm remained unproven. So disagreement arises as to whether the experiment conducted by Mosovich & Tallaferro casts a new light on the nature of orgasm. In some recent studies, authors tend to adopt the opposite point of view that there are no remarkable EEG changes during ejaculation in humans.
Health Orgasm, and sexual activity as a whole, are physical activities that can require exertion of many major bodily systems. A 1997 study in the BMJ based upon 918 men age 45–59 found that after a ten-year follow-up, men who had fewer orgasms were twice as likely to die of any cause as those having two or more orgasms a week. A follow-up in 2001 which focused more specifically on cardiovascular health found that having sex three or more times a week was associated with a 50% reduction in the risk of heart attack or stroke. (Note that as a rule, correlation does not imply causation.) There is some research suggesting that greater resting heart rate variability is associated with orgasms through penile-vaginal intercourse without additional simultaneous clitoral stimulation. A small percentage of men have a disease called postorgasmic illness syndrome (POIS), which causes severe muscle pain throughout the body and other symptoms immediately following ejaculation. The symptoms last for up to a week. Some doctors speculate that the frequency of POIS "in the population may be greater than has been reported in the academic literature", and that many POIS sufferers are undiagnosed. 402
Dysfunction and satisfaction The inability to have orgasm, or regular difficulty reaching orgasm after ample sexual stimulation, is called anorgasmia or inorgasmia. If a male experiences erection and ejaculation but no orgasm, he is said to have sexual anhedonia (a condition in which an individual cannot feel pleasure from an orgasm) or ejaculatory anhedonia. Anorgasmia is significantly more common in women than in men, which has been attributed to the lack of sex education with regard to women's bodies, especially in sex-negative cultures, such as clitoral stimulation usually being key for women to orgasm. Approximately 25% of women report difficulties with orgasm, 10% of women have never had an orgasm, and 40% or 40–50% have either complained about sexual dissatisfaction or experienced difficulty becoming sexually aroused at some point in their lives. A 1994 study by Laumann et al. found that 75% of men and 29% of women always have orgasms with their partner. Women are much more likely to be nearly always or always orgasmic when alone than with a partner. However, in a 1996 study by Davis et al., 62% of women in a partnered relationship said they were satisfied with the frequency/consistency of their orgasms. Additionally, some women express that their most satisfying sexual experiences entail being connected to someone, rather than solely basing satisfaction on orgasm.
Kinsey's Sexual Behavior in the Human Female showed that, over the previous five years of sexual activity, 78% of women had orgasms in 60% to 100% of sexual encounters with other women, compared with 55% for heterosexual sex. Kinsey attributed this difference to female partners knowing more about women's sexuality and how to optimize women's sexual satisfaction than male partners do. Like Kinsey, scholars such as Peplau, Fingerhut and Beals (2004) and Diamond (2006) found that lesbians have orgasms more often and more easily in sexual interactions than heterosexual women do, and that female partners are more likely to emphasize the emotional aspects of lovemaking. In contrast, research by Diane Holmberg and Karen L. Blair 403
(2009), published in the Journal of Sex Research, found that women in same-sex relationships enjoyed identical sexual desire, sexual communication, sexual satisfaction, and satisfaction with orgasm as their heterosexual counterparts. Specifically in relation to simultaneous orgasm and similar practices, many sexologists claim that the problem of premature ejaculation is closely related to the idea encouraged by a scientific approach in early 20th century when mutual orgasm was overly emphasized as an objective and a sign of true sexual satisfaction in intimate relationships. If orgasm is desired, anorgasmia may be attributed to an inability to relax. It may be associated with performance pressure and an unwillingness to pursue pleasure, as separate from the other person's satisfaction; often, women worry so much about the pleasure of their partner that they become anxious, which manifests as impatience with the delay of orgasm for them. This delay can lead to frustration of not reaching orgasmic sexual satisfaction. Psychoanalyst Wilhelm Reich, in his 1927 book Die Funktion des Orgasmus (published in English in 1980 as Genitality in the Theory and Therapy of Neurosis) was the first to make orgasm central to the concept of mental health, and defined neurosis in terms of blocks to having orgastic potency. Although orgasm dysfunction can have psychological components, physiological factors often play a role. For instance, delayed orgasm or the inability to achieve orgasm is a common side effect of many medications. Menopause may involve loss of hormones supporting sexuality and genital functionality. Vaginal and clitoral atrophy and dryness affects up to 50%–60% of postmenopausal women. Testosterone levels in men fall as they age. Sexual dysfunction overall becomes more likely with poor physical and emotional health. "Negative experiences in sexual relationships and overall well-being" are associated with sexual dysfunction.
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The Female Sexual Arousal and Orgasm Cycle Explored Based on 2,137 responses to an online poll, this is what their readers had to say about their frequency of experiencing orgasm during sex: I have an orgasm (or five) every time I have sex - 43% I've had "the moment" a few times - 38% Still waiting for that one - 19% To be honest, I am surprised 43% reported experiencing orgasm every time they experience sex, which for some could be masturbation, but on the other hand, the 19% who have not experienced orgasm exceeds the 10% commonly reported. I suspect Jane magazine has a young readership, which may explain a better success rate during sex with a partner, and higher than expected preorgasmic rate. Many young women don't learn to masturbate to orgasm until their late teens or early twenties, often times after being sexually active with a partner for several years. Young men today have access to the Internet, which may provide some enlightenment on how to pleasure a woman, versus prior generations, who acquired their sexual knowledge from locker room conversations and Penthouse Forum, and similar magazines. The 38% of women who experience orgasm irregularly, and some of the 19% who have never experienced orgasm, may have inexperienced sexual partners, and/or experience the reality that every woman isn't going to be in the mood, or able to experience orgasm, every day of her life, which brings the 43% into question, but perhaps this later group only participates in sex when they are in the mood, or they are always in the mood, being young and all. Overall, the data and comments provide some insight into how varied women's experiences with orgasm really are. One size does not fit all. 405
"[A]mong 3,237 respondents aged 18-26 years in heterosexual relationships of >= 3-month duration...Men were more likely than women to report having orgasms most or all the time: 87% versus 47%. A total of 15% of young women reported having orgasms less than half the time or never, whereas only 2.6% of young men reported having orgasms with that regularity." Regularity of Orgasm Men Most or all the time 87.1 More than half the time 7.4 Half the time 2.9 Less than half the time 1.5 Never or almost never 1.1 Number of Survey Participants 1,338
Women 46.8 20.8 17.1 9.0 6.4 1,899
The above statistics are for residents of the U.S., statistics for residents of Australia are available. The Australian data includes information on teenagers, age sixteen to nineteen.
A Complex Process Female sexual arousal and orgasm are complex processes involving the entire woman, mind and body. The brain receives in sexual stimuli from the body, processes it, and based on past learning and experience causes the body to respond to it. The brain may start the sexual arousal process in response to thought, visual stimuli, audible stimulation, olfactory stimuli, taste, and hormonal triggers. 406
The body may start the arousal process as the result of a woman or her partner touching her genitals, breasts, and other erogenous zones. The mind and body, while able to experience sexual arousal separately, do not experience orgasm independently.
Orgasm requires the mind and body to work together. Mental thought alone may result in orgasm, but you still experience and feel the orgasm in your body. All the sexual stimulation and arousal may originate in one or the other, but orgasm takes place in both. A Reflex Response at Birth At birth, we respond to sexual stimulation based on instinct and reflex responses. If we feel safe and our basic material needs are met, we will most likely respond to sexual stimuli very easily. This is perhaps why the simple acts of nursing and exposing the genitals to air results in sexual arousal in infants. At birth we are very sensitive to sexual stimuli, and our minds have not learned "appropriate sexual response," and orgasm is likely controlled more by physical stimuli than mental thought processes. Orgasm may be a purely physical reflex response at birth, as is the case with urination. A Learned Response in Adulthood By the time puberty rolls around we have been taught "appropriate" sexual response. We perhaps know that any sexual response is bad. We may have been so isolated from our physical sexual self's that we are not aware of when we are sexually aroused. This is more true of girls than boys, as boys experience a telltale erection, and touch their primary sexual organ several times each day while urinating. Society most often doesn't acknowledge the existence of the female genitals, 407
the vulva and clitoris, nor are girls permitted and encouraged to touch them on a regular basis; it is as if they don't exist. Historically speaking, girls have been desexualized whereas male sexuality has been promoted.
We know what "good girls" and "bad girls" are. We know who a suitable spouse or partner is, even if we do not think of them in overtly sexual terms. Female teens and women may choose a partner based purely on nonsexual criteria, then wonder why sparks don't fly in the bedroom. They may perceive sexual desire and arousal as "being in love." Girls and women may not permit themselves to be in situations that result in their feeling "sexual," if they categorize those feelings as undesirable. They may tune out sexual feelings, denying they occur, or respond so negatively to sexual stimuli that sex with a partner becomes impossible. There are women who do not have strong negative feelings toward sex, who are openly sexual. They enjoy being sexually aroused, seeking out sexual stimuli freely. They do not care who causes them to feel aroused, they simply enjoy it. Of course, society often views "sexual girls" and "sexual women" negatively, labeling them "sluts" and "whores." In our confused society, the woman who shuns all sexual feelings is considered more "normal" than one who is openly sexual. This statement is less true than it was thirty-forty years ago, but is still true to varying degrees, depending on the society and community you live in. Today, women are permitted to be sexual, but only in a limited number of circumstances, but still, less so than men. In the past, women were expected to remain virginal, today they are expected to be "sexual virgins." Sexual arousal and orgasm may be mental perceptions rather than physical experiences for women, more so than it is for men, as the result of the greater restrictions placed on them. A man's ability to achieve an erection and ejaculate is a symbol of his manhood, a woman's sexual arousal and sexual enjoyment may be seen as "out of control" and "wanton." This is perhaps why women are often times less orgasmic than men, as one has to speculate both are equally orgasmic at birth. 408
Much More Than A Physical Response The traditional view of female sexual arousal, presented below, has focused on the physical changes associated with a woman's genitals and reproductive organs. It was believed that sexual desire led to physical sexual arousal and orgasm. Research has determined sexual desire is not one of the primary reasons why women say they participate in sex. Women were also believed to be acutely aware of the physical changes that occurred in their genitals during sexual arousal. Additional research has shown a low correlation between when a woman perceives she has experienced sexual arousal and when she has experienced the physical changes associated with sexual arousal. Women are not necessarily aware of when vaginal lubrication and blood engorgement of their vulva has occurred. Our survey indicates the majority of women are very aware of what it feels like to be sexually aroused, but it appears their brain may filter this information out, at times leaving them unaware. A woman's perception of sexual arousal appears to be very much dependent on context, whether her brain believes it is appropriate and desired. Rather than a simple linear or straightforward concept of female sexual arousal, with a beginning and end, there is now a much more complex circular model, with many possible variables involved. Sexual Arousal is an Emotional State Primarily as a result of being male, I believe, and partly because I don't address sexual aversion disorder in any detail, I've always assumed in my writings that women would respond to sexual 409
stimulation in a physical -sexual- manner, or not at all. In reality, a woman's emotional response to sexual stimulation may include any and all emotional states, and recent evidence is that this emotional response weighs heavily in a woman's overall sexual response and experience. A woman's emotional response appears to control a woman's experience of sex, her perception of sex and sexual pleasure, and whether she experiences sexual arousal, pleasure, and orgasm. A woman's emotional response, and perception of her bodily response to sexual stimuli, may not indicate her true body state, her reflex bodily responses. For women, sex may, at times, be an "out of body" experience. When everything is in harmony, it is a very physical -sexual- experience.
Physiology of Women's Sexual Function: Basic Knowledge and New Findings "Sexual arousal is an emotional state and, similar to other emotions, it possesses distinct antecedents (e.g., sexual stimuli) and patterns of expression (e.g., psychological, physiological, behavioral) serving to regulate behaviors fundamental to sexual reproduction. "Moreover, women's experience of sexual arousal is not primarily related to experience of physiological responding [physical sensations resulting from physical sexual arousal] and is mediated by additional cognitive and emotional mechanisms. It is not clear how much appraisal of subjective sexual arousal is influenced by perception of genital responding, or vice versa, but these measures are highly positively correlated in women. "Therefore, there is a difference between experiencing sexual arousal and perceiving physical changes. "...[T]he information women use to appraise their emotional state of sexual arousal; women attend more to external, situational cues when appraising their emotional states than men do" 410
The Physical Changes Webmaster's Note: The information presented below is primarily based on research published by Masters and Johnson in 1966 and 1986. As a result, it is a little dated. A lot of presumptions were made back then, which haven't turned out to be true of all women. The information presented isn't wrong, simply not all encompassing. In recent years, more attention has been directed at understanding female sexual function, more often than not, from the perspective of dysfunction. The information presented below represents only part of the story, and the truthfulness of the story is still being determined. To acquire a broad understanding of female sexual response, please read through the website, as female sexual response has proven to be much more complex than originally envisioned.
There are two physical changes the body must undergo if a woman is to experience sexual arousal and orgasm. The first is "vasocongestion," the pooling of blood in the breasts and genitals. This results in the breasts and genitals becoming larger, the body feeling warm or hot to the touch, the change in color of the breasts and genitals, areas of the body feeling full, congested, or swollen, and vaginal lubrication. The second is "Myotonia" or "neuromuscular tension," the build up of energy in the nerve endings and muscles of the entire body. Myotonia is the "sexual tension" I refer to in my advice for pre-orgasmic women. Myotonia is not "bad tension" experienced as the result of negative feelings. You may experience strong myotonia as the feeling of fullness or tightness in your body prior to orgasm, the point of no return. Some women when confronted with strong myotonia cannot allow themselves to go over the edge, let go, and hence they do not experience orgasm. Additional information on vasocongestion and myotonia is available from Go Ask Alice.
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It should be noted that any disease, medication (prescription and non-prescription), drug, or illness that affects the blood flow, muscles, or nerves can restrict or prevent myotonia and vasocongestion. If you cannot experience myotonia and vasocongestion you may not be able to experience sexual arousal and orgasm. If you have an injury, disease, or illness that directly affects the circulatory, nervous, or muscular systems, you may experience orgasmic impairment. If you have been diagnosed with one of these, please see the health, disability, question and answer sections for more information. If you feel you are not able to experience sexual arousal, or only in a limited way, please seek a doctor's advice.
The Sexual Response Cycle "Three representational variations of female sexual response. Pattern 1 shows multiple orgasm; pattern 2 shows arousal that reaches the plateau level without going on to orgasm (note the resolution occurs more slowly); and pattern 3 shows several brief drops in the excitement phase followed by an even more rapid resolution phase." From the book Masters and Johnson on Sex and Human Loving Page 58. Copyright 1982, 1985, 1986 By William H. Masters, M.D., Virginia E Johnson, and Robert C. Kolodny, M.D. Sexologists have divided the sexual response cycle into four phases, excitement, plateau, orgasm, and resolution. (Some include sexual desire as a preceding fifth phase.) These are arbitrary definitions, an individual is not likely to be aware of their body experiencing each distinct phase. The amount of time a person spends in each phase, and even the order in which they experience them, may vary. 413
A woman on a date may become sexually aroused several times, even without her knowing, without her ever reaching the plateau phase. She may experience arousal and the plateau phase during an intense session of dancing, but return to her un-aroused state during the ride home. Once home she may quickly experience arousal and orgasm, as the result of direct genital stimulation, without experiencing the plateau phase. The manner in which a person experiences each phase is unique to them, and even this will change depending on their mood and other influences. The Arousal Phase Female arousal described: "A combination of objective [physical] and subjective [mental] signs; the bodily reactions as vulvar swelling, vaginal lubrication, heavy breathing and increased sensitivity of the genitalia, combined with the subjective experience of feeling pleasure and excitement". Arousal may be accompanied by these physical responses to mental and/or physical stimuli:
Vaginal lubrication begins first, within 10-30 seconds. The inner two thirds of the vagina expands. The uterus and cervix are pulled upwards. The labia majora flatten and spread apart. The labia minora increase in size. The clitoris increases in size. The nipples may become erect, as a result of muscle contractions. When highly aroused the breasts may increase in size. 414
Moisture "seeps" from the vaginal walls, as a result of increased blood flow and congestion; a process called "transudation." Small droplets of moisture form, collect together, and seep or flow out of the vagina.
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This most often, but not always, results in the vulva becoming moist or wet too. The quantity, thickness, and smell of a woman's vaginal lubricant varies between women, and with the same woman depending on many factors, including her current menstrual state, and what she has eaten. The presence of vaginal lubrication does not indicate a woman is fully prepared for sexual intercourse, nor does its absence indicate she is not sexually aroused. Some women produce very little moisture, and require the application of additional lubrication. (The use of petroleumbased lubricants and "oils" will cause condoms to fail, and possibly result in vaginal infections.) While it may be perfectly normal, if you experience continual vaginal dryness, you should bring this to the attention of your doctor, as it could be an indication of non-sexual health concerns, such as cardiovascular disease in older women. Some women produce so much moisture they get everything soaking wet, reducing the pleasure they and their partner experience, not to mention causing potential embarrassment when it occurs in a public place. This too is normal, and is the result of normal variations in women's bodies. There is no safe means of decreasing the amount of vaginal lubrication, though several cultures consider a dry vagina desirable during intercourse, and use drying agents; the safety of which is questionable, and likely increases the spread of disease through injury to the vaginal tissues. Following sexual arousal, the vagina reabsorbs some of this moisture, maintaining a "just moist" environment.
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Masters and Johnson report they never observed a woman experience orgasm who did not first experience the dramatic change in labial coloration. If a woman did experience this color change, she was more than likely to experience orgasm; based on their small sample of women.
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The Plateau Phase During the Plateau phase a woman may experience:
A marked increase in sexual tension. Increased vasocongestion in the vagina causes the outer third of the vagina to swell, resulting in the vaginal opening decreasing in size, perhaps 30%. The inner two thirds of the vagina balloons out. A woman may experience a strong desire to be filled, a vaginal ache. The amount of vaginal lubrication may decrease during this stage, especially if prolonged. The clitoris becomes increasingly engorged, the glans moves toward the pubic bone, becoming more concealed by the hood. The labia minora increase considerably in thickness, perhaps 2-3 times. The increased size of the inner labia may spread apart the outer labia resulting in the vaginal opening becoming more prominent. The color of the labia minora change considerably. Going from pink to red for women who have not given birth, from bright red to deep wine in women who have. The actual colors may vary, but not the marked change in color. The areola, the pigmented area around the nipples, begin to swell. The breasts may increase in size 20-25%, for women who have not breast-fed a child, for women who have, there is less or no increase in size. 50-70% of women experience a "sex flush" on their chests and other body areas resulting from increased blood flow near the surface of the skin. The heart rate increases, perhaps beating noticeably. There is a marked increase in the amount of sexual tension in the thighs and buttocks. 418
A woman's body is now fully ready for vaginal intercourse.
If you consider all the physical changes associated with the internal and external sexual organs, you can see women are not fully prepared for intercourse until late in the plateau phase. A woman's body signals her readiness by opening up her vulva, exposing her vaginal opening. Vaginal wetness alone does not indicate readiness. This perhaps indicates that women require romance and prolonged foreplay prior to vaginal intercourse(*).
The Orgasmic Phase Female orgasm described: "A variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually accompanied by involuntary, rhythmic contractions of the pelvic striated [voluntary] circumvaginal musculature, with concomitant [at same time] uterine and anal contractions and myotonia that resolves the sexually induced vasocongestion (sometimes only partially), usually with an induction of well-being and contentment".
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During the Orgasmic phase a woman may experience:
Rhythmic muscle contractions occur in the outer third of the vagina, the uterus, and anus. The first muscle contractions are the most intense, and occur at a rate of a little more than 1 per second (0.8 seconds). As the orgasm continues, the contractions become less intense, and occur at a more random rate. A mild orgasm may have 3-5 contractions, an intense one 10-15. The "sex flush" becomes even more pronounced, and may cover a greater percentage of the body. Muscles throughout the body may contract during orgasm, not just those in the pelvic region. Orgasm also takes place in the brain, as indicated by monitoring brain waves. Some women will emit or spray fluid from their urethra during orgasm, and this is commonly referred to as female ejaculation. Myotonia may be evident throughout the body, especially in the face, hands, and feet. A woman's facial expression may indicate that she is in pain, rather than experiencing a pleasurable orgasm. At the peak of orgasm the entire body may become momentarily rigid.
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What Does an Orgasm Feel Like? Women who have never experienced orgasm, and those who are not sure if they have, often ask, "What does an orgasm feel like?" This is a hard, if not impossible, question to answer. Imagine trying to explain to someone what it feels like to sneeze or yawn. Not easy to do. How our senses and brain interpret physical stimuli is subjective, that is dependent solely on the individual's mental perceptions. While we can measure the physical stimuli, we cannot measure how a person perceives it. Even if a woman is attached to monitoring equipment while she is experiencing 15 strong orgasmic contractions, over a 10 second period of time, how do we know she experiences it more intensely than another woman, who experiences a 5 contraction orgasm lasting 4 seconds? The woman having the ten-second orgasm may be wondering why her orgasms are so weak! If a woman has experienced nerve damage she may not be able to tell if she has experienced orgasm. Here is Masters and Johnson's description of female orgasm: "Women often describe the sensations of an orgasm as beginning with a momentary sense of suspension, quickly followed by an intensely pleasurable feeling that usually begins at the clitoris and rapidly spreads throughout the pelvis. The physical sensations of the genitals are often described as warm, electric, or tingly, and these usually spread through the body. Finally, most women feel muscle contractions in their vagina or lower pelvis, often described as "pelvic throbbing.""
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. Types of Orgasms While all orgasms are organically the same, varying only in strength and length, a woman may not experience (perceive) them as such. How a woman experiences orgasm during masturbation is often totally different from how she experiences them during sex with a partner. In fact, women often report their most "satisfying" orgasms occur during masturbation, perhaps because they are then the center of attention, and not worrying about or distracted by a partner. A woman may experience orgasm differently if her vagina is empty rather than when a penis or fingers are inserted. She may be more aware of her vaginal contractions when her vagina has something to clamp down on, or when it is empty and contracts on itself. Women experience total body orgasms, clitoral orgasms, vaginal orgasms, uterine orgasms, as well as a long list of other types of orgasms. While electronic gadgets may say they are all the same, women will beg to differ. Vaginal Orgasm Masters and Johnson, and others, believe all healthy women are capable of experiencing orgasm while being stimulated by vaginal intercourse alone, because the thrusting penis will push and pull on the inner labia, resulting in indirect stimulation of the clitoris. Other sexologists do not agree with this hypotheses. While it may be technically possible, surveys continually indicate this isn't a reality for many women, especially on a regular basis.
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If women's masturbation habits are any indication, vaginal stimulation alone is less likely to result in orgasm than activities that directly stimulate their clitoris. Ninety percent of women masturbate by stimulating their clitoris, ten percent are reported to stimulate only their vagina. (Several teens and women have mentioned how vaginal stimulation alone, during masturbation, wasn't pleasurable for them, even though they initially believed it was the "proper" method of masturbation, as it simulated "sex.") Is it reasonable to believe women masturbate in any way other than what works best? Even if a woman's clitoris was not her primary sensory sex organ, habit alone may dictate that she is most orgasmic during clitoral stimulation. As I mention above, a woman's body is not fully prepared for intercourse until she is highly aroused, and at the plateau phase. If a woman is highly aroused then it seems possible that indirect simulation of her clitoris, combined with vaginal stimulation, could result in orgasm. If there is a strong emotional bond between a woman and her partner, that psychological stimulation alone may result in an orgasm. The same may not be said of a woman who tries to go from a low degree of sexual arousal all the way to orgasm, by means of indirect clitoral combined with direct vaginal stimulation. If a woman's vagina is insensitive to penile thrusting, she may find indirect stimulation of her clitoris alone is not enough to push her over the edge, even if she is highly aroused. Multiple Orgasms If a woman experiences one orgasm, she may be able to experience additional orgasms during the same sexual experience, as long as adequate stimulation continues. Practice seems to make this more likely, as the more sexual a woman is, the more sexual she can be. Though for some, it appears to occur without effort or expectation. Our surveys indicate multiple orgasms, at least during masturbation, aren't as common as the medi a and porn may indicate. 423
We have two additional surveys, one that asks women how many orgasms they have experienced during up to one hour of sexual stimulation, and a second that asks how often they experience one orgasm within a minute of another. Fifty-eight percent indicate they have experienced an orgasm within a minute of another orgasm. These two surveys don't tell us if these orgasms were experienced during masturbation or sex with a partner. The clitoris may be extremely sensitive after the first orgasm, requiring very light or indirect stimulation. A woman may need only to slip a little ways away from the point of orgasm, becomes less aroused, before she can have another. In this case, deep breathing may help a woman recover more quickly, enabling her to move onto her next orgasm. Many multiple orgasms occur during masturbation, as there is nothing or no one to distract a woman from her pleasure, and a vibrator may be utilized. An electric vibrator does not get tired, unlike a woman's own hand, or that of her partner. A male partner who has himself experienced orgasm, may find himself incapable of continuing his stimulation of his partner, as a result of the chemicals released following orgasm. The Resolution Phase During the Resolution phase a woman may experience:
If sexual stimulation continues, a woman may experience one or more additional orgasms. The vagina, and vaginal opening, return to their normal relaxed state. The breasts, labia, clitoris, and uterus return to their normal size, position, and color. The clitoris and nipples may be so sensitive that any stimulation may be uncomfortable. The "sex flush" disappears. 424
There may be heavy sweating, and breathing. The heart may beat rapidly. If orgasm does not occur, a woman will still experience most of what is listed above, but at a much slower rate. The blood trapped in the pelvic organs, not having been dissipated by orgasmic muscle contractions, may result in a feeling of heaviness, and pelvic discomfort.
Are Orgasm Necessary? Is orgasm necessary for female sexual happiness? While it is true that there are millions of women who have lived happy and fulfilling lives having never experienced orgasm, their lives probably would have been more enjoyable if they had. Orgasm is a normal bodily function. If a woman does not experience orgasm, she may find herself feeling very uncomfortable after sex, because of the excess blood trapped in her pelvic organs. (In our survey, 54% experience discomfort, 75% feel frustrated.) Some report, women develop back pains and other health problems as a result of this unreleased sexual tension. Doctors in the past used genital massage and vibrators to bring their female patients to orgasm, as a means of treating female health problems. While orgasm is not necessary for female happiness, it does make life more enjoyable. Balancing the Desire for Orgasm For women who are pre-orgasmic, and for those who experience orgasm only with difficulty, achieving a balance between their desire for orgasm, and their sexual happiness, can be a challenge. Lets face it, there is a lot of social pressure on women to experience orgasm. The 425
mass media is full of references to the joys of orgasm. Women want to experience orgasm not only for their own benefit, but to make their partner happy, and to be like their peers, or at least their perception of their peers.
To a certain extent, orgasm has become a chore, versus a simple pleasure, for many women. When women try too hard to achieve orgasm, sex becomes unpleasant and frustrating, a task, for them and their partner. If you become too preoccupied with the mechanics of orgasm, you can loose out on the intimacy of sex. The focus of fulfilling sex should never be orgasm, orgasm is only one small part of a healthy and balanced sexual relationship. When a woman experiences orgasm, real or faked, she is indicating to her partner that they have done a good job, that they do not need to do anything differently next time. A woman who fakes orgasm is telling her partner that they do not need to change their sexual technique, which is perhaps totally opposite of what she should be telling them. Women who fake orgasm face becoming so frustrated by their inability to orgasm, and their partner's lack of skill, they soon find themselves avoiding sex altogether. Women tend to blame themselves for everything that goes wrong in a relationship, so their inability to orgasm is seen as their fault, so they make the sacrifice. After faking orgasm for a period of time, women are afraid to tell their partner, fearing it will upset them, so they don't. When you have faked orgasm, and decide to tell your partner, you have to admit not only to not having had orgasms, but also to lying to your partner, to hiding something from them, and to fooling them. The barrier to telling your partner the truth increases with each faked orgasm.
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Faking Orgasm - Glamour Magazine - October 2000 Newer Statistics are Presented Below Based on 1,500 responses to an online poll at Glamour.com
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In response to the question, "How often do you fake orgasm?" the women responded: I never fake it - 45% 1%-25% of the time - 34% 26%-50% of the time - 10% 51%-75% of the time - 7% 76%-100% of the time - 4% When fifty-five percent of women admit to doing something they are not suppose to be doing, that is fake orgasm, it indicates a serious problem. In this case, the problem is that society is leading women to believe they should always have an orgasm, and that there are negative consequences when they do not. An orgasm is no longer simply an orgasm. Orgasm has become the benchmark by which we measure the quality of our sexuality, and even our social standing within our community. Society leads us to believe "normal" women always have orgasms, and her "caring partner" always stimulates her to orgasm. In the past, we ignored female orgasm, today we perhaps place too much emphasis on it. It is important for women to realize this is a social problem, not a personal one. No woman is going to have an orgasm every time she experiences sex with a partner, or even masturbation. This is just the way it is. Making orgasm the sole goal of sex can actually make sex less enjoyable, and possibly boring, if not extremely frustrating. Note 2011: Our surveys indicate 51%-54% of site visitors, who have experienced sex with a partner, have faked orgasm at least once.
December 2011: CNN Online Article - When is a woman more likely to fake it? Exploring the why, and why you shouldn't. 428
The Pregnancy
Every parent is different, just as every baby is different. So there can’t be many rules to having a baby. But you will find a lot of information in these pages which should help you to decide what you will do, how you will cope and, most of all, how you can best enjoy both pregnancy and your baby. Chapter is about what you can do to make sure you and your baby stay healthy during your pregnancy. The book then takes you through pregnancy, birth and the first two weeks of caring for your baby. You may want to read some chapters several times, or look up specific things which interest or concern you. To find a topic quickly, just look at the index at the back of the book. If there is anything which puzzles you, or if you need further explanation, don’t hesitate to ask your doctor, midwife or health visitor.
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Pregnancy, also known as gravidity or gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur by sexual intercourse or assisted reproductive technology.
It usually lasts around 40 weeks from the last menstrual period (LMP) and ends in childbirth. This is just over nine lunar months, where each month is about 29½ days. When measured from conception it is about 38 weeks.
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An embryo is the developing offspring during the first eight weeks following conception, after which, the term fetus is used until birth Symptom of early pregnancy may include a missed periods, tender breasts, nausea and vomiting, hunger, and frequent urination. Pregnancy may be confirmed with a pregnancy test.
Pregnancy is typically divided into three trimesters. The first trimester is from week one through 12 and includes conception. Conception is when the sperm fertilizes the egg. The fertilized egg then travels down the fallopian tube and attaches to the inside of the uterus, where it begins to form the fetus and placenta. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). The second trimester is from week 13 through 28. Around the middle of the second trimester, movement of the fetus may be felt. At 28 weeks, more than 90% of babies can survive outside of the uterus if provided high-quality medical care. The third trimester is from 29 weeks through 40 weeks. Prenatal care improves pregnancy outcomes. Prenatal care may include taking extra folic acid, avoiding drugs and alcohol, regular exercise, blood tests, and regular physical examinations. Complications of pregnancy may include high blood pressure of pregnancy, gestational diabetes, iron-deficiency anemia, and severe nausea and vomiting among others. Term pregnancy is 37 to 41 weeks, with early term being 37 and 38 weeks, full term 39 and 40 weeks, and late term 41 weeks. After 41 weeks, it is known as post term. Babies born before 37 weeks are preterm and are at higher risk of health problems such as cerebral palsy. Delivery before 39 weeks by labor induction or caesarean section is not recommended unless required for other medical reasons.
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Normally the initiation of pregnancy is considered to be the first day of the woman's last menstrual period. Using this date the resulting fetal age is called the gestational age. This choice is a result of inability to discern the point in time when the actual creation of the fetus happened. In in vitro fertilisation, gestational age is calculated by days from oocyte retrieval + 14 days.
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Through an interplay of hormones that includes follicle stimulating hormone that stimulates folliculogenesis and oogenesis creates a mature egg cell, the female gamete. Fertilization is the event where the egg cell fuses with the male gamete, spermatozoon. After the point of fertilization, the fused product of the female and male gamete is referred to as a zygote or fertilized egg. The fusion of male and female gametes usually occurs following the act of sexual intercourse. Fertilization can also occur by assisted reproductive technology such as artificial insemination and in vitro fertilisation. Fertilization is sometimes used as the initiation of pregnancy, with the derived age being termed fertilization age. Fertilization usually occurs about two weeks before the next expected menstrual period.
The sperm and the egg cell, which has been released from one of the female's two ovaries, unite in one of the two fallopian tubes. The fertilized egg, known as a zygote, then moves toward the uterus, a journey that can take up to a week to complete. Cell division begins approximately 24– 36 hours after the male and female cells unite. Cell division continues at a rapid rate and the cells then develop into what is known as a blastocyst. The blastocyst arrives at the uterus and attaches to the uterine wall, a process known as implantation. The development of the mass of cells that will become the infant is called embryogenesis during the first approximately ten weeks of gestation. During this time, cells begin to differentiate into the various body systems. The basic outlines of the organ, body, and nervous systems are 433
established. By the end of the embryonic stage, the beginnings of features such as fingers, eyes, mouth, and ears become visible. Also during this time, there is development of structures important to the support of the embryo, including the placenta and umbilical cord. The placenta connects the developing embryo to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The umbilical cord is the connecting cord from the embryo or fetus to the placenta.
After about ten weeks of gestational age, the embryo becomes known as a fetus. At the beginning of the fetal stage, the risk of miscarriage decreases sharply. At this stage, a fetus is about 30 mm (1.2 inches) in length, the heartbeat is seen via ultrasound, and the fetus makes involuntary motions. During continued fetal development, the early body systems, and structures that were established in the embryonic stage continue to develop. Sex organs begin to appear during the third month of gestation. The fetus continues to grow in both weight and length, although the majority of the physical growth occurs in the last weeks of pregnancy.
During pregnancy, the woman undergoes many physiological changes, which are entirely normal, including cardiovascular, hematologic, metabolic, renal, and respiratory changes. Increases in blood sugar, breathing, and cardiac output are all required. Levels of progesterone and oestrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and therefore also the menstrual cycle. Pregnancy is typically broken into three periods, or trimesters, each of about three months. Obstetricians define each trimester as 14 weeks, for a total duration of 42 weeks, although the average duration of pregnancy is 40 weeks. While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time.
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THE SIGNS OF PREGNANCY
The earliest and most reliable sign of pregnancy, for women who have a regular monthly cycle, is a missed period. Sometimes women who are pregnant have a very light period, losing only a little blood. Other signs of pregnancy are listed below. Feeling sick – you may feel sick, or even be sick, not necessarily in the morning, but at any time. If you are being sick all the time and can’t keep anything down, tell your doctor. Changes in your breasts – often the breasts become larger and feel tender, rather as they may do before a period. They may tingle. The veins may show up more and the nipples may darken and stand out. Needing to pass water more often. You may find that you have to get up in the night to do so. Being constipated. An increased vaginal discharge without any soreness or irritation. Feeling tired. Having a strange taste in your mouth – many women describe it as metallic. ‘Going off ’ certain things like tea or coffee, tobacco smoke or fatty food, for example. Some women don’t even need these signs. They just ‘know’ that they are pregnant.
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KNOWING THAT YOU’RE PREGNANT
You may feel very happy or excited when you discover that you are pregnant, but you shouldn’t worry if you don’t. Even if you have been looking forward to pregnancy, it is not unusual for your feelings to take you by surprise. And if your pregnancy was unplanned, then you may feel quite confused. Give yourself a little time to adjust to the idea of being pregnant.
Even though you may feel rather anxious and uncertain now, this does not mean that you won’t come to enjoy your pregnancy or to welcome the idea of the baby. Discuss your feelings with your midwife or doctor who will help you to adjust to your pregnancy, or, in England and Wales, will give you advice if you are not happy to continue with it. You may want to share the news with family and friends immediately or wait a while until you’ve sorted out how you feel. Others in your family/extended family may have mixed feelings.
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You’ll need to talk about these feelings. But do begin to think about your antenatal care (that is, the care you’ll receive leading up to the birth of your baby) and where you would like to have your baby. The earlier you begin to organise this, the more chance you will have of getting what you want.
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How the baby develops
Doctors and midwives in the UK time pregnancy from the first day of a woman’s last
menstrual period, not from conception. So what is called ‘four weeks’ pregnant’ is actually about two weeks after conception. Pregnancy normally lasts for 37 to 42 weeks from the first day of your last period. The average is 40 weeks. If you’re not sure about the date of your last period, then an ultrasound scan (see page 56) may give a good indication of when your baby will be due. In the very early weeks, the developing baby is called an embryo. Then, from about eight weeks onward, it is called a fetus, meaning ‘young one’.
WEEK 3 (Three weeks from the first day of your last menstrual period.) The fertilised egg moves slowly along the fallopian tube towards the womb. The egg begins as one single cell. This cell divides again and again. By the time the egg reaches the womb it has become a mass of over 100 cells, 439
called an embryo, and is still growing. Once in the womb, the embryo burrows into the womb lining. This is called implantation.
WEEKS 4-5
The embryo now settles into the womb lining. The outer cells reach out like roots to link with the mother’s blood supply. The inner cells form into two and then later into three layers. Each of these layers will grow to be different parts of the baby’s body. One layer becomes the brain and nervous system, the skin, eyes and ears.Another layer becomes the lungs, stomach and gut. The third layer becomes the heart, blood, muscles and bones. The fifth week is the time of the first missed period when most women are only just beginning to think they may be pregnant. Yet already the baby’s nervous system is starting to develop. A groove forms in the top layer of cells. The cells fold up and round to make a hollow tube called the neural tube. This will become the baby’s brain and spinal cord, so the tube has a ‘head end’ and a ‘tail end’. Defects in this tube are the cause of spina bifida. At the same time the heart is forming and the baby already has some of its own blood vessels. A string of these blood vessels connects baby and mother and will become the umbilical cord.
WEEKS 6-7 There is now a large bulge where the heart is and a bump for the head because the brain is developing. The heart begins to beat and can be seen beating on an ultrasound scan. Dimples on the side of the head will become the ears and there are thickenings where the eyes will be. On the body, bumps are forming which will become muscles and bones. And small swellings (called ‘limb buds’) show where the arms and legs are growing. At seven weeks the embryo has grown to about 10 mm long from head to bottom. (This measurement is called the ‘crown–rump length’.)
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A face is slowly forming. The eyes are more obvious and have some colour in them. There is a mouth, with a tongue. There are now the beginnings of hands and feet, with ridges where the fingers and toes will be. The major internal organs are all developing – the heart, brain, lungs, kidneys, liver and gut. At nine weeks, the baby has grown to about 22 mm long from head to bottom.
WEEKS 10-14 Just 12 weeks after conception the fetus is fully formed. It has all its organs, muscles, limbs and bones, and its sex organs are well developed. From now on it has to grow and mature. The baby is already moving about, but the movements cannot yet be felt. By about 14 weeks, the heartbeat is strong and can be heard using an ultrasound detector. The heartbeat is very fast – about twice as fast as a normal adult’s heartbeat. At 14 weeks the baby is about 85 mm long from head to bottom. The pregnancy may be just beginning to show, but this varies a lot from woman to woman.
WEEKS 10-14 Just 12 weeks after conception the fetus is fully formed. It has all its organs, muscles, limbs and bones, and its sex organs are well developed. From now on it has to grow and mature. The baby is already moving about, but the movements cannot yet be felt. By about 14 weeks, the heartbeat is strong and can be heard using an ultrasound detector. The heartbeat is very fast – about twice as fast as a normal adult’s heartbeat. At 14 weeks the baby is about 85 mm long from head to bottom. The pregnancy may be just beginning to show, but this varies a lot from woman to woman.
WEEKS 15-22 The baby is now growing quickly. The body grows bigger so that the head and body are more in proportion and the baby doesn’t look so top heavy. The face begins to look much more human and the hair is beginning to grow as well as eyebrows and eyelashes. The eyelids stay closed over the eyes. The lines on the skin of the fingers are now formed, so the baby already has its own individual fingerprint. Finger and toenails are growing and the baby has a firm hand grip. At about 22 weeks, the baby becomes covered in a very fine, soft hair called ‘lanugo’. The purpose of this isn’t known, but it is thought that it may be to keep the baby at the right 441
temperature. The lanugo disappears before birth, though sometimes just a little is left and disappears later. At about 16 to 22 weeks you will feel your baby move for the first time. If this is your second baby, you may feel it earlier – at about 16 to 18 weeks after conception. At first you feel a fluttering or bubbling, or a very slight shifting movement, maybe a bit like indigestion. Later you can’t mistake the movements and you can even see the baby kicking about. Often you can guess which bump is a hand or a foot and so on.
WEEKS 23–30 The baby is now moving about vigorously and responds to touch and to sound. A very loud noise close by may make it jump and kick. It is also swallowing small amounts of the amniotic fluid in which it is floating and passing tiny amounts of urine back into the fluid. Sometimes the baby may get hiccups and you can feel the jerk of each hiccup. The baby may also begin to follow a pattern for waking and sleeping. Very often this is a different pattern from yours so, when you go to bed at night, the baby wakes up and starts kicking. The baby’s heartbeat can now be heard through a stethoscope. Your partner may even be able to hear it by putting an ear to your abdomen, but it can be difficult to find the right place. The baby is now covered in a white, greasy substance called ‘vernix’. It is thought that this may be to protect the baby’s skin as it floats in the amniotic fluid. The vernix mostly disappears before the birth. At 24 weeks, the baby is called ‘viable’. This means that the baby is now thought to have a chance of survival if born. Most babies born before this time cannot live because their lungs and other vital organs are not well enough developed. The care that can now be given in neonatal units means that more and more babies born early do survive. At around 26 weeks the baby’s eyelids open for the first time. The eyes are almost always blue or dark blue. It is not until some weeks after birth that the eyes become the colour they will stay, although some babies do have brown eyes at birth. The head to bottom length at 30 weeks is about 33 cm.
WEEKS 31-40 The baby is growing plumper so the skin, which was quite wrinkled before, is now smoother. Both the vernix and the lanugo begin to disappear. By about 32 weeks the baby is usually lying downwards ready for birth. Some time before birth, the head may move down into the pelvis and is said to be ‘engaged’, but sometimes the baby’s head does not engage until labour has started. 442
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SEX IN PREGNANCY Many people worry about whether it is safe to have sex during pregnancy. There is no physical reason why you shouldn’t continue to have sexual intercourse right through a normal pregnancy, if you wish. It doesn’t harm the baby because the penis cannot penetrate beyond the vagina. The muscles of the cervix and a plug of mucus, specially formed in pregnancy, seal off the womb completely.
Later in pregnancy, an orgasm, or even sexual intercourse itself, can set off contractions (known as Braxton Hicks’ contractions,). You will feel the muscles of your womb go hard. There is no need for alarm as this is perfectly normal. If it feels uncomfortable, try your relaxation techniques or just lie quietly till the contractions pass. If you have had a previous miscarriage, ask your doctor or midwife for advice. Your doctor or midwife will probably advise you to avoid intercourse if you 444
have had heavy bleeding in pregnancy, and you should definitely not have intercourse once the waters have broken since this risks infection in the baby.
While sex is safe for most couples in pregnancy, it may not be all that easy. You will probably need to find different positions. This can be a time to explore and experiment together. The man on top can become very uncomfortable for the woman quite early in pregnancy, not just because of the baby, but because of tender breasts as well. It can also be uncomfortable if the man’s penis penetrates too deeply. So it may be better to lie on your sides, either facing or with the man behind. Many couples find that a position in which the woman is on top is most comfortable.
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Some couples find making love extra enjoyable during pregnancy while others simply feel that they don’t want to have intercourse and prefer to find other ways of being loving or of making love. It’s important to talk about your feelings with each other.
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Antenatal care and antenatal classes
Throughout your pregnancy you will have regular care, either at a hospital antenatal clinic
or with your own GP or community midwife. This is to check that you and the baby are well and so that any problems can be picked up as early as possible. This is the time to get answers to any questions or worries and to discuss plans for your baby’s birth. Most women have their first, and longest, antenatal check-up around the 8th to 12th week of pregnancy. The earlier you go the better. You should allow plenty of time as you will probably see a midwife and a doctor, and may be offered an ultrasound scan.
Occasionally, the doctor might consider it necessary to do anreasons for this with the doctor. By putting one or two fingers inside your vagina and pressing the other hand on your abdomen, your doctor can judge the age of your baby. Most doctors prefer to use an ultrasound scan for this purpose (see page 56) either at the first or a later visit. Later visits are usually shorter. Your urine and blood pressure, and often your weight, will be checked. Your abdomen will be felt to check the baby’s position and growth. And the doctor or midwife will listen to your baby’s heartbeat. You can also ask questions or talk about anything that is worrying you. Talking is as much a part of antenatal care as all the tests and examinations.
WHAT HAPPENS IN LABOUR
There are three stages to labour. In the first stage the cervix gradually opens up (dilates). In the second stage the baby is pushed down the vagina and is born. In the third stage the placenta comes away from the wall of the womb and is also pushed out of the vagina. 447
THE FIRST STAGE
The dilation of the cervix Contractions at the start of labour help to soften the cervix. Then the cervix will gradually open to about 10 cm. This is wide enough to let the baby out and is called ‘fully dilated’. Sometimes the process of softening can take many hours before what midwives refer to as ‘established labour’. This is when your cervix has opened (dilated) to at least 3 cm.
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THE SECOND STAGE
The baby’s birth This stage begins when the cervix is fully dilated and lasts until the birth of the baby. Your body will tell you to push. Listen to your midwife who will guide you. Position Find the position that you prefer and which will make labour easier for you. You might want to remain in bed with your back propped up with pillows, or stand, sit, kneel or squat (squatting will take practice if you are not used to it). If you are very tired, you might be more comfortable lying on your side rather than your back. This is also a better position for your baby. If you’ve suffered from backache in labour, kneeling on all fours might be helpful. It’s up to you. Try out some of these positions at antenatal classes or at home to find out which are the most comfortable for you. Ask the midwife to help you. Pushing You can now start to push each time you have a contraction. Your body will probably tell you how. If not, take two deep breaths as the contractions start and push down.
Take another breath when you need to. Give several pushes until the contraction ends. As you push, try to let yourself ‘open up’ below. After each contraction, rest and get up strength for the next one. This stage is hard work but your midwife will help you all the time, telling you what to do and encouraging you. Your companion can also give you lots of support. Ask your midwife to tell you what is happening. This stage may take an hour or more, so it helps to know how you’re doing. The birth As the baby’s head moves into the vaginal opening you can put your hand down to feel it, or look at it in a mirror. When about half the head can be seen, the midwife will tell you to stop pushing, to push very gently, or to puff a couple of quick short breaths blowing out through your mouth. This is so that your baby’s head can be born slowly, giving the skin and muscles of the perineum (the area between your vagina and back passage) time to stretch without tearing.
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Sometimes the skin of the perineum won’t stretch enough and may tear. Or there may be an urgency to hurry the birth because the baby is getting short of oxygen. The midwife or doctor will then ask your permission to give you a local anaesthetic and cut the skin to make the opening bigger. This is called an episiotomy. Afterwards the cut or tear is stitched up again and heals.
Once your baby’s head is born, most of the hard work is over. With one more gentle push the body is born quite quickly and easily. You can ask to have the baby lifted straight on to you before the cord is cut, so that you can feel and be close to each other immediately. Then the cord is clamped and cut, the baby is dried to prevent him or her from becoming cold, and you’ll be able to hold and cuddle your baby properly.
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Your baby may be quite messy, with some of your blood and perhaps some of the white, greasy vernix which acts as a protection in the womb still on the skin. If you prefer, you can ask the midwife to wipe your baby and wrap him or her in a blanket before your cuddle. Sometimes some mucus has to be cleared out of a baby’s nose and mouth or some oxygen given to get breathing underway. Your baby won’t be kept away from you any longer than necessary. Once the baby’s head is born, the body usually follows quite quickly and easily with one more push. You can have your baby lifted straight on to you before the cord is cut. Your baby may be born still covered with some of the white, greasy vernix which acts as a protection in the womb
THE THIRD STAGE
The placenta After your baby is born, more contractions will push out the placenta. This stage can take between 20 minutes and an hour but your midwife will usually give you an injection in your thigh, just as the baby is born, which will speed it up.
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The injection contains a drug called Syntometrine or Syntocinon which makes the womb contract and so helps prevent the heavy bleeding which some women may experience without it. You may prefer not to have the injection at first, but to wait and see if it is necessary. You should discuss this in advance with your midwife and make a note on your birth plan.
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Mature and Old Women’s Sexual Activity
Most women remain sexually active in midlife and beyond. However, sexual functioning in older women and their partners is widely variable. Somatic symptoms, psychological issues, partner’s physical and psychological status, and relationship status, may greatly affect sexuality. Any attempt to accurately understand the nature of aging women’s sexuality must include a consideration of all of these inter-related factors. Many older women desire and enjoy an active sex life. For some women, the freedom from the hassle of monthly periods and worries about pregnancy help them enjoy sex more than ever after menopause.
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True sexual intimacy is only achievable by individuals who have the capacity for emotional intimacy. It is not surprising that maturity and independence are more likely to be attained by men and women who are also chronologically mature. It is also likely that lasting or long-term relationships are fairly exclusive to “older” couples since these terms require by definition that a relationship exist for many years. Nevertheless, older age does not effectively predict that someone is in a long-term relationship just as older age is not a guarantee that someone actually has achieved independence and emotional maturity. Older age can be considered a necessary but not sufficient component to maturity.
The subject of sexuality in older people remains largely taboo in many cultures, yet older women the world over are known to have sexual desire and to engage in sexual activity Although some aspects of sexual functioning decline with age, the extent of this decline depends to a large extent on how this is defined. Indeed, in a recent large study of older adults in the United States of America in which a broad definition was applied, women between the ages of 57 and 74 showed no decline in sexual activity and self-rated physical health was found to be more strongly associated than age with reported sexual functioning. Sexuality in all its forms can be an important part of your health and identity. However, in western societies sexuality is often considered the domain of the young, and the idea of older women having and enjoying sex sits uncomfortably with many people. It is only since the work of Kinsey and other sexuality researchers in the late 1940’s, that perceptions of older people’s sexuality started to change. But it is still the case today that it is more acceptable for older men than older women to be sexual. The ideas of older women’s sexuality often stem from Victorian times, where the woman was passive in her sex life, and sex was mainly for reproductive purposes. Hence, the idea was that sex would stop after the menopause. 454
The menopause is often described as a very negative time for women, especially in medical literature. On the other hand, many feminists and women-centred writers celebrate the 455
menopause and subsequent years as a time of positive change, without the commitment to childrearing, and a time to find new fulfilment. The experience for each individual woman is probably somewhere in the middle.
Hormonal changes in the menopause, such as a drop in oestrogen levels (oestrogen is the ‘female’ hormone responsible for development of female characteristics) within your body, can bring about physical changes such as vaginal dryness, which can affect your sex life. But at the same time, there are many ways of adjusting to these bodily changes that can lead to new ways of lovemaking.
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Many women actually enjoy sex more in later life, maybe because they are more experienced, and know what they want and enjoy. In addition, there may be more opportunity for spontaneous sex, for instance if you have children who have now left home. Overall, women in their late 40s are said to be much more likely to have fulfilling sex lives and multiple orgasms than women half their age.
Women’s sexual response is thought to be different from men, and many women do not have ‘spontaneous desire’, meaning it may not be until starting to engage in some sort of sexual activity that they start to feel sexual desire, and many women do not have any sexual feelings or thoughts, unless engaging in sexual activity. Because women’s sexuality is so complex, it might actually be more appropriate to try and solve occurring problems with counselling first, rather than medications.
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The assumption that women’s sexuality is very complex and different to men’s was confirmed recently by a maybe surprising source: Pfizer, the manufacturer of Viagra abandoned an eightyear long study involving 3,000 women in 2004, which was supposed to prove that Viagra improved sexual function in women. The leading researchers of the study conceded that ‘there’s a disconnect in many women between genital changes and mental changes…with women, things depend on a myriad of factors. Funny, that doesn’t feel like too much of a surprise.
Physical intimacy and sexual functioning are significant predictors of older women’s degree of satisfaction with their long-term committed relationships (although the association is likely to be bidirectional). Yet the degree to which sexuality is expressed in older age is also dependent on sociocultural context. In some cultures, older women may feel that they have to conceal their sexuality to fit social norms.
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Population ageing has triggered a re-examination of many ageist stereotypes, notably the assumption that older people invariably abandon more active social roles. In the future, this reassessment of social norms is likely to extend to the sphere of sexuality in older age and to be reinforced by medical advances such as improved treatments for erectile dysfunction.
Yet evidence concerning differences in sexual behaviour between older and younger women and the impact these differences may have on sexual health remains sparse. Furthermore, although some studies have been conducted in low-resource settings, most research has been undertaken in countries with well-developed health systems. In addition, the few large population-based studies that have been conducted so far have had very low response rates and have yielded inconclusive evidence.
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As people age, differences in their health status and in their level of social participation and functioning become accentuated. Some older women will have health problems that limit their sexual functioning and others will not; many will have the self-esteem to openly express their sexuality and others will be more reticent. However, as the proportion of older people in the population increases, more and more older women are likely to challenge traditional ageist stereotypes. Still, many other women will face serious health problems or live in cultural settings where sexuality in older age is frowned upon and where traditional gender roles limit their ability to express their sexual needs. Older women need access to health services that take account of all these factors. Yet the problems these women face can be compounded by the failure of healthcare workers and policy-makers to accept that older women have sexual needs and by a lack of evidence-based information on how to help women overcome their problems in the area of sexual health.
Towards the end of their lives, many older people lose the ability to live independently. Although there is a trend towards home-based care, some will require institutionalization. Their sexuality will not be left at the door and health-care workers will need to be trained on how to attend to the sexual health needs of those in their care. On the other hand, older people who are institutionalized are vulnerable and need to be protected from abuse. Ethical dilemmas can arise when dementia is also involved. More research and better guidance on how to manage these delicate and complex situations are needed. Although the data are sparse, the importance of sexual health among older women is becoming increasingly evident. There is also growing interest in the health of women in later life and in women’s health concerns beyond those limited to reproduction. These concerns are likely to evolve quickly as the number and proportion of older women in the population increase. International and national policies and programmes on sexual health will need to be adapted to better meet the changing sexual needs of older women Despite a correlation between sexual desire and other sexual function domains, only 1 in 5 sexually active women reported high sexual desire. Approximately half of the women aged 80 460
years or more reported arousal, lubrication, and orgasm most of the time, but rarely reported sexual desire. In contrast with traditional linear model in which desire precedes sex, these results suggest that women engage in sexual activity for multiple reasons, which may include affirmation or sustenance of a relationship
Although the findings may appear ambiguous, researchers clarify that regardless of partner status or sexual activity, 61 % of all women in this cohort were satisfied with their overall sex life. Investigators say that among the study participants, the percentage of sexually satisfied women actually increased with age, with approximately half of the women over 80 years old reporting sexual satisfaction almost always or always
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This finding is contrary to traditional belief that low sexual satisfaction accompanies older age. Not only were the oldest women in this study the most satisfied overall, those who were recently sexually active experienced orgasm satisfaction rates similar to the youngest participants. A considerable amount of clinical research on sexual dysfunction in older women has been conducted. Some of these studies have dealt with post-menopausal changes. A recent survey of older women undertaken in 29 countries showed that lack of interest in sex, failure to achieve orgasm and poor vaginal lubrication were the most commonly reported causes of sexual dysfunction. However, poor health, rather than chronological age, may underlie some of these problems. Many chronic health conditions, including urinary incontinence, depression, cancer, cardiovascular disease and diabetes, are more common among the elderly. These conditions themselves and their treatments, such as mastectomy and hysterectomy, can affect sexual functioning either physiologically or by undermining a person’s bodily image or selfesteem. In resource-poor settings, inadequately treated conditions such as incontinence and vaginal fistula can lead women to become withdrawn and reclusive.
But achieving full sexual health involves more than merely addressing vulnerabilities and risks and treating clinical conditions. The sexual needs and desires of older women need to be 462
acknowledged and respected, regardless of their marital status or sexual orientation. For health systems, the implications of this are far-reaching Across the life course, an individual’s sexuality is affected by physical and social transitions. In women, the menopause marks a period of important physiologic change. In some settings it also entails a shift in social role and a change in self-image. During this period, women may benefit from access to health education to learn how to adjust to these changes and to find ways to express their sexuality. To facilitate this adjustment health professionals, in turn, will need to develop a better understanding of sexual needs in older age and a greater willingness to discuss sexuality openly with older patients, who may feel uncomfortable bringing up the subject, but for other women, physical changes, illness, disabilities, and some medicines make sex difficult or hard to enjoy. Sexual activity declines with age in women, which is also the case for men. This survey and others have shown that men are more likely than women to be sexually active after midlife, and the gap widens with increasing age. This is partly because men are more likely to have a partner in later life, due to women’s longer life spans. At older ages, there are more women than men. In addition, a large survey of adults ages 57 to 85 found that more than one in three women (35%) rated sex as “not at all important” to their lives, compared with only 13% of men.
“In this study, sexual activity was not always necessary for sexual satisfaction. Those who were not sexually active may have achieved sexual satisfaction through touching, caressing, or other intimacies developed over the course of a long relationship. “Emotional and physical closeness to the partner may be more important than experiencing orgasm. A more positive approach to female sexual health focusing on sexual satisfaction may be more beneficial to women than a focus limited to female sexual activity or dysfunction”, 463
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