Category Archives: human sexual response

How To Enjoy Better Sex

Enjoying Better Sex

One of the more distressing and interesting pieces of information to emerge from the study of sexual dysfunction in recent years has been the discovery that erectile dysfunction is becoming more common in young men.

It turns out that although erectile dysfunction is more common in older men – as you might expect – it’s also surprisingly common in younger men. About 40% of men in their 40s have erectile dysfunction – an astonishingly high number.

Yet a study in the Journal of Sexual Medicine suggests that almost 26% of men under 40 have erectile dysfunction – and half of them have it in a very severe form.

This is quite amazing! We think of young men are sexually potent, constantly looking for sex, constantly needing sexual outlets, and always ready with an erection.

Yet if the data in this study is to be believed, then this fundamental problem needs to be addressed for the sake of the emotional and mental health of the young men concerned.

But why should this be so? Why should there be such a high predominance of erectile dysfunction in young men?

Assuming that causes of erectile dysfunction like diabetes which occur in older men are going to be less predominant in younger men, we are forced back to the conclusion that in fact, this epidemic of erectile dysfunction in young men must be caused by psychological issues.

It seems obvious to me that we are living in a society which is much more stressful than it used to be. It’s also possible that there is much more drug abuse than they used to be in society. In any event, both stress and drug abuse are recognized causes of erectile dysfunction, so if younger men are more predominantly stressed or more frequent users of drugs per capita of population than older men, then that could well be part of an explanation.

And yet, and yet… There’s no problem without a solution, and nowhere is that more true than in the arena of sexual dysfunction, where so much time and effort – let alone money – has been spent on remedies for sexual dysfunctions of all kinds that a solution, no matter how difficult the problem, is within almost everybody’s grasp.

The interesting thing about erectile dysfunction is that about 20% of the 18 million men in America currently affected by erectile dysfunction take prescription drugs – and of course these are well-known as a very effective treatment.

The most common are Viagra and Cialis. But the interesting thing is that a very significant minority of men who take these drugs still don’t get an erection. And when you look into this, it turns out this is because the fundamental basis of the erectile mechanism is psychological rather than physical.

Having said that, the experts also found that men are physically active have better erectile function: a calorie restricted diet and greater physical activity have been found to restore erectile function in even severe cases of ED.

Having said all of that, what about women? Surely there level of sexual dysfunction must also reflect the stress which society inflicts on us all these days?

For women, it turns out that low libido, or low sex drive, is the predominant sexual dysfunction. In fairness, it should be mentioned that there are plenty of sex experts who think low libido for women is perfectly normal, and not in actual fact any kind dysfunction at all.

The viewpoint that low sexual desire is a problem which needs to be solved with a medical solution is a reflection of how sexual activity can be medicalized. (What that broadly means is that drug companies and the medical profession can take ownership of psychological and sexual issues – mostly because there is profit to be made, rather than suffering to be averted.)

But there is a real problem here: in 2008, in a survey of over 30,000 women in the United States aged 18 or over, almost half of the women reported sexual problems. A full 10% of them complained about low sexual desire (aka hypoactive sexual desire disorder or HSDD) needless to say, one doctor described this as “a real diagnosis”.

In the sense that millions of women who go through the menopause may experience low sexual desire, I believe we are all less likely to think of young women as possibly subject to sexual dysfunction of this kind.

Yet women’s libido is a complicated issue. I think we all know that, both men and women alike! And Women Come First, a book by Ian Kerner, suggests that men can do a lot to get women in the mood by spending adequate time on foreplay. That in fact, low sexual drive in women may not be a problem. It may merely be a symptom – of inadequate sexual attention from men!

And interestingly enough, when you dig down into this, you’ll find that sometimes it isn’t the lack of sexual desire that’s the problem, but it’s about the women’s anxiety – their emotional response to the fact that they don’t feel much sexual desire.

Interestingly enough, however, almost 40% of women diagnosed with HSDD report depression. The question that would occur to most therapists here is – well, which came first, the depression or the low sex drive? In actual fact, the two probably go together in a feedback loop which ensures constant reinforcement.

We also recognize these days that contraceptive pills can cause low sex drive. In general, it’s probably much more functional to ask a woman what she needs to become orgasmic than to start offering medicalized solutions which do little to address the specific problems of an individual, but much to address the profits of the doctors or drug companies.

Yet it’s a common complaint among experts in the field that the pharmaceutical companies are producing diagnostic tools for “low sex drive” because they want to medicalize what might actually be a normal human condition.

As one therapist rightly observed, many people today – both male and female – feel a lot of pressure to be sexually active, perhaps too much pressure, leading them to a place of false expectation. Indeed, it could be that what we are expecting women to experience as a normal sex drive is in fact in reality hypersexualisation.

In other words, it’s possible that women are just being pressured into expectations about sex that are completely unrealistic. Combine those unrealistic expectations with hard, possibly stressful jobs, and you begin to build up a very different picture. “A lot of women say the best part of traveling is the hotel room with the giant bed and the clean sheets and no children crying and a husband who wants something from them,” said Steinhart. “Truthfully, women have always been this way.”

And there is now a widespread recognition that stress – that’s to say, the stress of working longer hours, and the threat of job insecurity – is exhausting for people. And why wouldn’t it be? It makes people – both men and women – feel older than their age, it diminishes libido, and in the end people under this much pressure are probably too tired to care whether they have sex anyway.

The good news, of course, is that such a reduction in sex drive doesn’t need to be permanent. We all recognize that our sexual drive and sexual energy tends to fluctuate throughout our lives.

Human Sexual Response

Human Sexual Response (1) –

The Excitement Phase

The very first sign of sexual arousal in men, of course, is erection of the penis – a marked increase in its size, and a rise in its angle of protrusion from the body.

man and woman on bed, man becoming aroused
The first sign of male sexual arousal is erection

Erection may be triggered by stimulation of the penis itself or by a sexually stimulating sight or by an erotic train of thought.

It occurs within a few seconds, regardless of the nature of the stimulation.

During erection a small penis may double or more than double in length. In a large penis, the lengthening is less marked. Thus there is less variation in length among erect than among flaccid penises.

Erection is due to the engorgement of the penis with blood; indeed, as we shall see, many of the most important sexual responses occurring in both men and women are the direct result of this kind of engorgement.

More blood flows into an organ than flows out of it; the result is engorgement or vasocongestion.

This change in blood supply, occurring not only in the penis but also in other male and female organs, is the primary reflex action to sexual stimuli.

The secondary reaction is a contraction of various muscle fibres, muscles, and groups of muscles.

The first sign of sexual response in women may seem to be different from either engorgement or muscular contraction; it is the moistening of the vagina with a lubricating fluid.

This lubrication occurs quite promptly – within ten to thirty seconds of the onset of sexual stimulation.

The lubrication appears with equal promptness whether the stimulus is direct stimulation of a woman’s genital region, or of her breasts, or is an erotic train of thought.

Bartholin’s glands do sometimes contribute a few drops of a lubricating fluid to the vaginal entrance – but only late in the response cycle, following prolonged sexual activity and following copious lubrication of the vagina from a “sweating reaction” occurring on the walls of the vagina. 

As sexual excitation continues, these drops coalesce to provide a lubricating film, readying the vagina for the entrance of the penis.

The increase in the size of the penis and the “sweating” of the vaginal walls may seem completely different responses, but they may have a common cause.

More blood enters the tissues around the vagina than can leave, producing vasocongestion.

Both the walls of the smaller blood vessels and the walls of the vagina are “semi-permeable membranes”; they hold fluids back under some conditions but let them seep through under others.

The droplets of moisture that appear on the surface of the vagina during sexual excitation, it seems probable, have seeped out of the congested blood vessels.

Thus engorgement with blood is the cause of both the male erection and vaginal lubrication.

The appearance of vaginal lubrication very early in the female response cycle is a point that deserves attention.

Some sex manuals state, and some men no doubt believe, that the appearance of vaginal lubrication signals a woman’s readiness to engage in sexual intercourse.

Increased lubrication of the vagina
Female arousal is signalled by increased lubrication of the vagina

This is true in a sense. The woman is beginning to respond, and lubrication does ready the vagina for the entrance of the penis.

Entry prior to the appearance of adequate lubrication can be difficult and uncomfortable, or even painful.

But, as we shall see, many more changes must follow before a woman is fully aroused erotically and emotionally ready for sexual penetration and orgasm. Important changes occur, for example, in the clitoris.

This organ is located just above the entrance to the vagina. Like the penis, it is a shaft with a bulb or “glans” at the tip.

Both the shaft and the glans vary in size from woman to woman. The size and location of the clitoris bear no relation whatever to a woman’s sexual responsiveness or her ability to achieve orgasm.

The glans of the clitoris is packed with sensitive nerve endings.

The stimulation of the glans thus contributes greatly to heightening a woman’s sexual response. Direct contact with the clitoris is not necessary in order to stimulate it.

The glans is covered with a hood or prepuce; and this hood is attached to the inner lips (minor labia) of the vagina.

Thus during ordinary sexual intercourse the rhythmic thrusting of the penis through the inner lips produces a rhythmic friction between the clitoral hood and the glans.

In addition, the clitoris is responsive to purely psychological stimuli, such as an erotic train of thought. In the laboratory, changes in the clitoris can be directly observed during purely psychological stimulation, even though the clitoris and other genital organs remain untouched.

Changes in the clitoris can also be observed following stimulation of the breasts.

The first of these changes is the swelling of the clitoral glans. In some women on some occasions, the glans may actually double in size.

In other women, the swelling may be so slight that it can only be observed with the help of a device which enlarges the object viewed by forty diameters or so.

The amount of swelling, however like the size and location of the clitoris – is not related to either sexual responsiveness or to ability to achieve orgasm.

The swelling of the glans of the clitoris, like the swelling of the glans of the penis, is no doubt the result of engorgement of the blood vessels inside it.

Simultaneously with the swelling of the clitoral glans, the clitoral shaft also increases in diameter.

The time at which these changes occur depends upon the nature of the sexual stimulation to which the woman is responding.

If her mons veneris – that is, the area surrounding her clitoris – is being stimulated directly, the engorgement of the clitoral glans and shaft may occur quite promptly after the appearance of vaginal lubrication.

If the stimulus is breast manipulation or an erotic train of thought, the clitoral response generally takes somewhat longer.

A series of changes also occurs in the female breasts during this initial or “excitement phase” of erotic response. The first of these changes is an erection of the nipples. This erection is caused by contraction of muscle fibres.

Often one nipple erects first and the other follows immediately, or after a considerable delay.

In addition, the nipples increase both in length and in diameter as a result of blood-vessel engorgement similar to the engorgement of the penis and clitoris.

The pattern of veins ordinarily visible on the surface of the breasts becomes more distinct, and veins previously invisible may make their appearance during this engorgement process.

The female breasts also increase in size late in the excitement phase; this is a sign of heightened sexual tension preliminary to the transition to the next phase of sexual response.

The swelling of the breasts is more noticeable in women who have not breast-fed babies. Late in the excitement phase, too, the areolas – that is, the rings of darker skin surrounding the nipples – become engorged and swell.

Response of the male breast is less consistent.

However, at least partial nipple erection was observed in three-fifths of the men participating in studies. It generally occurred late in the excitement phase.

The outer lips (major labia) at the entrance to the vagina respond in several ways during the excitement phase. In an unexcited state, they generally meet in the mid-line of the vagina, protecting the inner lips and the other structures within.

During excitation they open a bit, and may be displaced a bit upward, toward the clitoris.

These changes are likely to occur quite late in the excitement phase. In women who have not had a baby, the outer lips also thin out and flatten themselves against the surrounding tissues.

In women who have had several babies, and especially in those who have developed varicose veins in their outer lips, the outer lips become noticeably distended and engorged with blood instead of flattening.

In extreme cases there may be a two-fold or even three-fold increase in size, so that the outer lips come to resemble a sort of curtain surrounding the vaginal opening. In these cases, too, the lips tend to open outward toward the sides as erotic tension increases, so that they do not interfere with the entry of the penis.

The inner lips (minor labia) also tend to swell during the excitement phase; indeed, it may be the swelling of the inner lips that produces the opening-out of the outer lips, an invitation for the entry of the penis.

The vagina, too, responds. It can be thought of as a cylinder or “barrel”, which remains in a collapsed state in the absence of erotic stimulation. Studies have established that the outer third of this barrel reacts in one way and the inner two-thirds in a very different way during the successive phases of sexual response.

As sexual tension mounts during the excitement phase, the inner two-thirds of the vaginal barrel begins to expand, and then relaxes again. Slowly the demand to expand overcomes the tendency to relax, and the clinically distended vaginal barrel of the sexually responding woman is established.

The cervix and uterus are pulled up and back at about this time, producing a “tenting” of the vaginal walls surrounding the cervix. The net result of these and other changes is a dramatic “ballooning” of the inner two-thirds of the vagina.

I am struck as  I write this by the somewhat detached almost “magician-like perspective” that this scientific approach lends to something as sensitive and delightful as lovemaking. We must never forget the fact that at the end of the day two people in love may be swept along by their feelings and emotions rather than the mechanics of sex!

The diameter at the widest point of the ballooning may be three times the diameter of the erotically unstimulated vagina; and the total length of the vaginal barrel may be increased as much as a full inch. (The swelling of the inner lips of the vagina also contributes to this lengthening.)

The ballooning is accompanied by a change in the appearance of the vaginal walls; the wrinkles, or “rugae”, are smoothed out and the colour of the walls changes from a normal purplish red to a darker purple, indicating engorgement of the surrounding blood vessels.

In addition to these responses in the sex organs and breasts, there are many indications that the entire body, in both women and men, is participating in this gradual process of sexual arousal.

In both women and men, the voluntary muscles tend to tense up, and there may also be some contraction of groups of involuntary muscles.

The pulse rate speeds up, and the blood pressure rises. Most remarkable of all, perhaps, a “sex flush” often appears upon the skin.

This sex flush appears first on the upper portion of the abdomen, then spreads up over the breasts. It often takes the form of a measles-like rash. The time of appearance is variable. In most men, and in some women, it does not appear until later in the response cycle, and in some it does not appear at all.

But about three-quarters of the women, and one-quarter of the men, exhibit the sex flush prior to orgasm on at least some occasions. So if a man wishes to know if he has given a woman an orgasm, this is not a reliable indicator.

Changes are also noted in the male testes and scrotum during this first phase of sexual response.

There is a tensing and thickening of the skin of the scrotum; and the whole scrotal sac is elevated and flattened toward the body.

The spermatic cords, by which the testes are suspended, shorten, so that the testes are pulled farther up in the sac.

Just as the nipple of one breast often becomes erect before the other, so one of the testes often rises before the other.