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RESPONSE IN THE FEMALE : THE PLATEAU PHASE

admin — Sat, 02 Jul 2011 11:42:03 +0000

The normal vagina is potential space but during this Stage , the upper two-thirds balloons out and forms a cavity to accommodate the erect penis. The lower one-third is narrowed because of vasocongestion and grips the penis firmly. The uterus also enlarges during this stage, and a remarkable yet consistent change takes place in the clitoris. The whole clitoris retracts upwards in front of the symphysis pubic bone, while the glans withdrawn beneath the foreskin. It is not easy to locate the body and the glans of the retracted clitoris with the finger and inexperienced males—often fumble searching for it.

The clitoral body retraction is a sure sign that the female is about to reach her orgasm if stimulation is continued, otherwise the clitoral body and glans promptly return to their original overhanging position. In fair women, the inner lips (labia minora) become congested and appear bright red in colour. The colour change is not so prominent in dark-complexioned women.

The Plateau Phase may last from 30 seconds to a few minutes before culminating in an orgasm. If the orgasm does not place, pelvic congestion may persist for a few hours and may lead, to tension and frustration.

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ADULT SEXUALITY: MIDDLE ADULTHOOD

admin — Sat, 28 May 2011 10:27:12 +0000

At around forty, people enter a period of transition from their younger years to what has traditionally been called “middle age.” It is a time when the visions and energy of youth begin to give way to hard realities and when most people first confront their own mortality and sense that time is running out. Some feel alarmed because their physique has folded and their youth “has flown the coop,” never to be regained (despite attempts at fancy diets, jogging, hair dye, and face-lifts). For most people, life must be reappraised in terms of goals, accomplishments, and experiences. As a result, a midlife crisis sometimes begins to take shape. From a sexual perspective, the male seems to be particularly vulnerable to the midlife crisis. Since rumor has it that after age forty a man is “over the hill” sexually, many men begin to check their sexual performance for signs of wear and tear. This is well-described in the following:

He notes that it takes more time to become aroused. Where it used to be a matter of seconds and a mere glance at the orbs of flesh colliding beneath a pair of tennis shorts, he may take minutes or more to reach erection as he gets older. He also notices, correctly, that he is slower on the comeback. In the sweet agonies of teen age he may have walked about with an erection all day, seldom completely losing it even after he made love or masturbated — a virtual prisoner of his hormones and tight-fitting pants. But now each sexual act has a definite beginning and end, and it may be a matter of hours or all day before he can reach erection again. Comparisons, stinging comparisons … he is not the boy he once was.

Once a man begins to question his sexual capabilities, the odds are that he will experience difficulty getting or keeping an erection. This, of course, “proves” the correctness of the underlying concern, and a vicious cycle is set in motion.

Some men turn to younger sexual partners to heat up their passion4 and Others succeed, at least to a certain degree, in blaming the problem on their wives. But the middle-aged male is in a precarious position of sexual vulnerability. If he goes to a physician to discuss the problem, he may be told (as several of our patients have been), “At your age, you shouldn’t worry about it anymore.”

The woman’s midlife crisis is less apt to include concern about her sexual capacity. For women who have chiefly been mothers, it is a time for an emerging identity, a freeing of the inner self as children reach a relative stage of greater independence. It is a bittersweet time in which a woman who has not established a career or nonfamily interests may mourn the passing of her offspring into their own maturity and may simultaneously look at available options for redirecting her talents and energy. As children leave home, the “empty-nest syndrome” may strike, causing depression and listlessness as the woman tries to deal with too much unstructured time and few sources of rewarding or interesting activities. Since these vulnerable feelings may be followed by or coincide with the menopausal years, it may be a particularly trying period for such women. Interestingly, recent research suggests that it is not only women who may be affected by the empty-nest syndrome. Roberts and Lewis point out that men are also sometimes distressed by their children’s departure from home, “discovering that their marriages and friendships had become empty shells about the same time that loved children were leaving.” Of course, having children leave home can have positive effects on a marriage, too — for instance, it gives couples a chance to focus on their own interaction and can create opportunities for freer, more relaxed sex as well.

There are more and more variations on the midlife transition today. Career-oriented women who postponed motherhood (and time off from work) until their mid-thirties may be anxious to reconfirm their work identity, but may have trouble finding a job or getting back on the “fast track.” Other mothers who refused to restructure their lives around childrearing and continued to work outside the home — either by choice or by economic necessity — may feel considerable guilt or exhaustion. Still other women find their lives complicated by divorce and face child-rearing as a single parent; alternatively, if they remarry a man with children of his own, the family interactions may become particularly complex.

Another component of the midlife crisis for both sexes that has been generally overlooked is the phenomenon of sexual burnout, which may affect as many as 20 percent of people in this stage of the life cycle. Unlike occupational burnout, which occurs largely in reaction to a person’s intense investment of time and energy in his or her work coupled with chronic, unrelenting emotional pressure, sexual burnout stems from tedium and satiation with the same sexual-routines. More than simply boredom, which can certainly be one of its precursors, sexual burnout is typically marked by a sense of physical depletion, emotional emptiness, and a negative sexual self-concept. Caught in the throes of sexual burnout, the middle-aged adult develops a feeling of sexual helplessness and hopelessness, as though nothing can be done to rekindle erotic passion or pleasure. Sexual burnout occurs not only in married couples but also in singles who have previously been very active sexually.

Sexual burnout is not the same as the sexual lack of interest that often accompanies depression. Depression is typically marked by disturbances in sleep and appetite and by a general loss of pleasure in all or almost all usual activities or pastimes. People experiencing sexual burnout do not have these symptoms. While the prognosis for sexual burnout is generally good, since most people recover spontaneously from this syndrome over time, about 10 percent of those affected remain sexually inactive on a relatively permanent basis. Perhaps this indicates that they are happier with celibacy than with cultural stereotypes that prescribe sexual participation as obligatory for a “healthy” adulthood, or perhaps it shows their inability to overcome the negative effects of the sexual burnout syndrome.

Of course, not everyone experiences a full-blown midlife crisis, and for some, the forties and fifties are a time of happiness and sexual satisfaction. One woman told us, “I’d never want to be twenty-one again — being forty-five is more fun!”

Most men have “discovered” their sexuality in a joyous way by their twenties, but — at least in past generations — a sizable number of women did not awaken from their socially programmed sexual dormancy until their thirties or forties. Given the traditional limits set on female sexual behavior and feelings (“nice, girls don’t. . .”) and given the traditional division of marital responsibilities (domestic and childbearing duties are “female,” career orientation is “male”), this pattern should come as no surprise. As a result, many women undergo a process of sexual self-discovery in mid-adulthood, perhaps including being orgasmic for the first time. The woman in this phase of the life cycle is just as likely as her mate to seek out extramarital sexual opportunities, although this fact is not written about extensively.

The sexual problems of mid-adulthood are not restricted to heterosexuals, although little attention has been given to the middle-aged homosexual population in America. Here, too, a wide variety of patterns is seen. Gay men in their forties may find that it becomes more difficult to attract younger partners on physical grounds alone. As a result, some homosexual males turn to paid male prostitutes, others become relatively celibate, and still others form long-term relationships that provide companionship and emotional support as well as sexual opportunity Gay men who were previously in heterosexual marriages — including many who were fathers — often decide to divorce and change to an exclusively homosexual life.

It has been noted that some gay males who have put an emphasis on conquests, techniques, and the ideals of the youth culture develop much anxiety about aging. These men sometimes resort to face-lifts or hair transplants to retain the illusion of their youthfulness (as some heterosexual men do, too) and they often develop depression or become alcoholic as a reflection of the negative sense of self they experience as their aging becomes more apparent. However, most homosexual men do not encounter such difficulties; generally, they have the same types of problems as they grow older that heterosexuals have.

Lesbians are often able to make an easier transition into middle-adulthood because of the fact that more of them are in lasting, one-to-one relationships. Nevertheless, while concern over physical attractiveness may not be quite as strong an issue as it is for some gay males, there can be intense jealousy that arises in these relationships “whenever the relationship is threatened by other women who might intrude and attempt to disrupt the coupling”

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GAMES TO RESTORE TENDERNESS – GAME 6: EXPRESSING LOVE (PART 3)

admin — Tue, 07 Apr 2009 11:33:27 +0000

“And I love myself right now, and I love you right now.”

“Loving you makes me love myself.”

“And loving you makes me love myself.”

“I’m so glad I can love you and feel loved by you.”

“And I’m so glad I can love you and feel loved by you.”

“I love you so much, my dearest.”

“And I love you so very much, my darling.”

“I need so much love.”

“And I need so much love, too.”

“You are the most important person in my life.”

“And you are the most important person in my life.”

“I’d do almost anything for you.” “And I’d do almost anything for you.” “I’ll always love and honor you.” “And I’ll always love and honor you.” “I’ll cherish you until I die.” “And I’ll cherish you until I die.” Husband and wife kiss softly and tenderly.

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GAMES FOR ABSTINENT COUPLES – HOMOSEXUALITY

admin — Tue, 07 Apr 2009 11:27:23 +0000

As a matter of fact, it was in playing the game “Indecent Proposal” that they first became aware of their built-in conflict. They both realized that they wouldn’t be jealous if their spouse had an extramarital heterosexual affair, but would be quite envious about a homosexual affair. Considering why this was so led to a series of shocks and insights. I neither encouraged nor discouraged their homosexuality; however, I recognized that it was the only way in which either might have an authentic sex or love life.

Homosexuality (like other forms of alternate sexual orientation) is rarely changeable. My theories about this are in line with classical psychoanalytical concepts, which hold that sexual orientation is conditioned during the “stage of discovery”— between two and three years of age, which is when children discover the differences in sexual anatomy between boys and girls. How parents respond to the child’s sexual discovery and curiosity, what kind of sexuality they themselves model, and how the parents and siblings relate to the particular child, all have an impact on sexual orientation. There may be personality traits that predispose a child toward a homosexual orientation, but I believe that the family environment is the most crucial factor.

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GAMES FOR UNATTRACTED COUPLES – GAME 2: HOW DO YOU REPEL ME? (PART 3)

admin — Tue, 07 Apr 2009 11:21:53 +0000

Having the couple do the exercise while in the act of love-making serves to bring out the primitive erotic elements that have been submerged by the surface negativity, while at the same time facilitating an awareness of what is being displaced onto the other mate.

For example, they may realize that their objection to their spouse’s fat hips has to do with repressed memories about a parent’s fat hips, or to childhood taunts about their own fat hips by siblings and schoolmates. Or, they may discover that being repelled by hair is associated with repressed memories about a parent’s or sibling’s hair. By tracing the transference to its source, the intensity of the transference may be lessened, and sexual feelings enhanced.

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GAMES FOR PERVERSE COUPLES – GAME 3: LOOK, MOM—I HAVE A PENIS!(PART 2)

admin — Tue, 07 Apr 2009 11:15:12 +0000

“Yes, Mom.”

“Now, I’ve washed your back, your underarms, your rear, and your penis. You wash the rest.” “Yes, Mom.”

She sits on a very high stool (or such), so as to give the impression that she is sitting high above him, just as a mother does. She may also be dressed in a mother’s type of dress— an old-fashioned one, and wearing makeup and hair in a motherly way (in a bun) as well. She sits with arms folded, as if ready to judge and rebuke.

The son proceeds to play with himself as Mom watches.

“Look, Mom, I have a penis.”

“So I see.”

“It’s a very special penis.” “Is it?”

“It is! It really is! Look at my penis.” “I’m looking.”

“See what it can do? It can get big like this.” “That’s a wonderful penis you’ve got.” “And it can swing from side to side like this.” “What a wonderful swing.” “And up and down, too.”

“Oh, my dear—how amazing!”

“That’s nothing. Wait until you see what it can do next!” “What’s that, I wonder?” “You’ll see.”

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GAMES FOR OBSESSIVE-COMPULSIVE COUPLES – GAME 5: DETAILED MEDICAL EXAMINATION (PART 1)

admin — Tue, 07 Apr 2009 11:00:44 +0000

Players: Doctor and patient. Activists: Both.

Setting: “Doctor’s office” in the home. Aim: Appeal to the fantasy of “playing doctor,” which children of a certain age act out and which represents a natural curiosity about sexual details. Obsessives are big on details, so this game is designed to take the “detail orientation,” eroticize it, and transform it into something more meaningful.

Game Plan: In this game, the husband and wife take turns playing doctor and patient. If they are an “odd couple,” the control freak should play the doctor first, because he or she will relish that role more than the other, whereas the slob will relish the role of patient more.

At the appointed time the doctor comes out of his or her office (a converted bedroom, den, or basement will do) and asks the patient to come in. The patient does, and the doctor asks the visitor to get undressed and lie on the examining table.

“Now, this isn’t going to hurt. I’m going to give you a thorough physical examination. Please bear with me,” says the doctor.

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PROCTOCOLITIS, PROCTITIS, AND ENTERITIS: TREATMENT

admin — Fri, 27 Mar 2009 11:11:20 +0000

Treatment of these infections is directed at the underlying cause. For proctitis caused by bacterial infection with gonorrhea and chlamydia, the treatment is ceftriaxone and doxycycline. Treatment is usually started before the culture results return from the laboratory and is based on what is seen on examination. The treatments for chlamydia, gonorrhea, herpes, LGV, and syphilis are described in the respective sections in this part of the book.

The treatments for the bacterial causes of enteritis, such as salmonella and shigella and Campylobacter infections, are antibiotics. Giardia infections are usually treated with metronidazole.

Sexual contacts must be examined and treated. For some organisms that cause enteritis, such as giardia and shigella, evaluation of nonsexual household contacts(parents, spouses, children, and siblings) is also recommended, since these infections are fairly easy to transmit nonsexually as well, especially through improper food handling.

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HERPES IN PREGNANT WOMEN: CULTERES PERFORMING AT DELIVERY

admin — Fri, 27 Mar 2009 10:55:26 +0000

Cultures performed on the mother at delivery, or even the polymerase chain reaction test,will usually take at least several days to show up positive if virus is present, and tests to detect shedding that are performed several days before delivery do not reveal anything about shedding at the time of delivery. The only benefit of performing these tests at delivery is to help guide therapy should the infant become ill; that is, a positive test for herpes may help diagnose the infant’s symptoms as being caused by herpes, and treatment may be started more quickly. A test may show up as positive even before a baby becomes symptomatic, and in that situation herpes medication should be started for the baby right away. Even though the presence of virus on the mother’s test doesn’t necessarily mean that the baby has been infected, it is probably better to be safe. Symptoms indicating that the infant may be infected include lack of appetite, skin lesions like blisters, fever, and sluggishness. These symptoms may take up to a month to develop in an infected infant.

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STD GENITAL WARTS: WHAT ARE THE SYMPTOMS?

admin — Fri, 27 Mar 2009 10:39:11 +0000

Fewer than 1 percent of people who are infected with HPV develop symptoms. For those who do, the visible symptom is the external genital wart or warts, which look like the warts one might have on the hand: they are usually flesh colored or a little bit darker, and they are harder than the surrounding tissue. They can be raised or flat. The raised warts tend to have a cauliflowerlike appearance when looked at closely or with a hand-held lens. Warts may occur singly or in groups, often of varying size, and they may grow together to form larger warts. They do not hurt unless scratched or picked at, in which case they can become irritated. In about 20 percent of people they itch, and in 20 percent of people, they disappear on their own. They may remain the same size for some time, or they may continue to enlarge.

It can be difficult to know whether or not these “bumps” are warts, because the genital skin is somewhat irregular in appearance in most men and women anyway. Bumps can be a normal part of the genital anatomy—pearly penile papules in men, sebaceous cysts in men and women, or hymen remnants for women. An experienced health care provider can help determine whether the bumps are simply normal anatomy, are caused by HPV infection, or are due to another infection, such as molluscum contagiosum.

Warts can occur anywhere in the anal and genital area, as high up as the lower abdomen and as low down as the upper thighs. A man may have warts in the urethral opening, where they may or may not be noticed. Symptoms include urethral bleeding or discharge, or a change in the stream of urine, although generally warts in the urethra do not cause symptoms.

Women may have warts on the soft surfaces of the inner labia and vagina and on the cervix. Warts on the inner labia and vagina may be raised or flat. Warts on the cervix are usually flat. Internal warts may not be noticed by the woman and may only be revealed upon examination by a health care provider.

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