Introduction

Author’s Note

This e-book is a collection of articles from GreatSexGuidance.com and GreatSexAfter40.com. Each was written to be free-standing.

As a result, key concepts are repeated. Please pardon any tedium.

About the Author

Michael Castle­man writes about health and sex­u­al­ity, as well as mys­tery nov­els set in San Fran­cisco. For over 40 years, his jour­nal­ism focused on health defined broadly, includ­ing: opti­mal well­ness, main­stream med­icine,­ alter­na­tive thera­ pies,­ nutri­tion, fit­ness, and sexuality.

Castle­man has writ­ten more than 3,000 mag­a­zine and web arti­cles. He has been nom­i­nated twice for National Mag­a­zine Awards. He has also con­tributed to dozens of mag­a­zines, among them: Smith­son­ ian, Reader’s Digest, Pre­ven­tion, Play­boy, AARP Mag­a­zine, Fam­ily Cir­cle, Psy­chol­ogy Today, The Nation, Red­book, Men’s Health, Self, Mother Jones, Glam­our, Cos­mopoli­tan, Men’s Fit­ness, Good House­keep­ing, Ladies’ Home Jour­nal, Health, Men’s Jour­nal, Sierra, Par­ent­ing, Nat­ural Health, Yoga Jour­nal, and Herb Quarterly.

In addi­tion to reg­u­lar posts on PsychologyToday.com, he is a fre­quent con­trib­u­tor to AARP.com and has writ­ten for WebMD, Salon.com, and many other sites.

Castleman’s 17 books have sold more than 2.5 mil­lion copies.

He has been inter­viewed on hun­dreds of tele­vision­ and radio pro­grams, among them: Today, Good Morn­ing, Amer­ica, Char­lie Rose, and Phil Don­ahue.

You can read addi­tional details about Castleman’s back­ground, edu­ca­tion, and career on his Wikipedia page.

Great Sex Guidance: Introduction – © Michael Castleman – 2 – Table of Contents Introduction ����������������������������������������������������������������������������������������������������������������������������������������� 2

Most Popular The Cure For Premature Ejaculation: The Simple Program That Teaches Men To Last As Long As They’d Like �������������������������������������������������������������������������������������������������������������������������� 166 Desire Differences: How Sex Therapists Recommend Overcoming Them ����������������������������� 8 Caressing Women: Advanced Erotic Tips For Men ���������������������������������������������������������������������� 16 Six Ways to Help Her Have Orgasms �������������������������������������������������������������������������������������������� 22 Orgasm During Intercourse - Improving Women’s Chances ������������������������������������������������� 19 Penis Size: How to Make The Most of What You’ve Got And How Best to Please Women With It...... �������������������������������������������������������������������������������������������������������������������������������������� 176 How Women REALLY Feel About Penis Size ������������������������������������������������������������������������������� 315 The Plain Truth About “Tight” and “Loose” Vaginas ��������������������������������������������������������� 274 Pubic Hair Removal: How Do The Porn Stars Get So Smooth? ����������������������������������������������� 124

Better-Than-Ever Sex ������������������������������������������������������������� 7 Desire Differences: How Sex Therapists Recommend Overcoming Them ����������������������������� 8 Caressing Women: Advanced Erotic Tips For Men ���������������������������������������������������������������������� 16 Orgasm During Intercourse - Improving Women’s Chances ������������������������������������������������� 19 Six Ways to Help Her Have Orgasms �������������������������������������������������������������������������������������������� 22 Women Know Best: Men Should Heed Women’s Sexual Wisdom �������������������������������������� 24 Oral Sex: Enhancement Suggestions for Men and Women ������������������������������������������������� 27 Sex Therapy: An Intimate Examination ��������������������������������������������������������������������������������� 36 Older Sex Can Be the Best of Your Life ��������������������������������������������������������������������������������� 42 Better Sex Fast—Using Just One Word, YES ��������������������������������������������������������������������������������� 44 Some Aphrodisiacs Stimulate More Than Just The Imagination (But Probably Not The Ones You Expect). ���������������������������������������������������������������������������������������������������������������������������������������� 46 Drugs That Might Cause Sex Problems ��������������������������������������������������������������������������������� 64 New Sexual Moves: “You Want To Try What?!” ���������������������������������������������������������������������� 69 Fantasies During Sex: Welcome Them ��������������������������������������������������������������������������������� 72 Forget “Foreplay,” Cultivate Loveplay �������������������������������������������������������������������������������������������� 75 No One “Gives” Anyone an Orgasm �������������������������������������������������������������������������������������������� 78 Great Sex Without Intercourse: A Creative Alternative For Older Couples ��������������������������� 81 Kegel Exercises: More Pleasure From Orgasms ���������������������������������������������������������������������� 85 Lubricants: The Slippery Secret Of Great Sex, Especially After 40 �������������������������������������� 87

Great Sex Guidance: Contents – © Michael Castleman – 3 – Massage: Whole Body Touch is the The “Language” of Great Sex at Any Age ���������������� 93 Massage: Beyond Sexual Enhancement - Many Benefits ����������������������������������������������������������� 97 Beyond Reciprocity - When He Massages Her, Both Enjoy Erotic Enhancement �������������� 100 Masturbation: Beyond Guilt or Shame ������������������������������������������������������������������������������������������ 103 The Mystery of Kissing ��������������������������������������������������������������������������������������������������������������� 107 Pornography: The Real Problem Is It’s Bad for Sex �������������������������������������������������������������������� 109 Porn On The Internet - Is My Man A Porn Addict? �������������������������������������������������������������������� 121 Pubic Hair Removal: How Do The Porn Stars Get So Smooth? ����������������������������������������������� 124 Sex and Exercise: How Does One Affect the Other? ��������������������������������������������������������� 132 Getting in Shape for Great Sex ����������������������������������������������������������������������������������������������������� 135 The Joys and Challenges of Sex During Pregnancy and Parenthood ������������������������������������ 140 Food And Sex: How You Eat Can Help Or Hurt It �������������������������������������������������������������������� 142 The Brain in Love: We Have Great Chemistry �������������������������������������������������������������������� 146 Pheromones: Scent-Ual Attractiveness ������������������������������������������������������������������������������� 151 The Kama Sutra: What The Ancient Indian Sex Manual Really Says ������������������������������������ 153 Liberals, Conservatives: Both Wrong About Teen Sex ������������������������������������������������ 158 Women Are from Venus, Men Are From Mars �������������������������������������������������������������������� 162

About Men ������������������������������������������������������������������������������� 165 The Cure For Premature Ejaculation: The Simple Program That Teaches Men To Last As Long As They’d Like �������������������������������������������������������������������������������������������������������������������������� 166 Penis Size: How to Make The Most of What You’ve Got And How Best to Please Women With It...... �������������������������������������������������������������������������������������������������������������������������������������� 176 Premature Ejaculation - Sex Therapy Beats Drugs �������������������������������������������������������������������� 185 Erection Myths — And The Truth About Erections �������������������������������������������������������������������� 187 Erectile Dysfunction (ED), Part 1- Varieties, Prevalence, Causes, & Relationship Implications ������������������������������������������������������������������������������������������������������������������������������������� 192 Erectile Dysfunction (ED), Part II - Evaluation And Treatments ����������������������������������������������� 203 Everything You Need To Know About Viagra, Cialis, and Levitra ����������������������������������������������� 210 The Most Popular Erection Drug is Not Viagra �������������������������������������������������������������������� 216 Hazards of Viagra, Cialis, and Levitra - For Some Men, They Are Potentially Fatal �������������� 219 Viagra Falls: Surprise! Older Men Just Aren’t That Into Erection Drugs ������������������������� 221 Viagra-Vation - Erection Medications May Cause Relationship Strife ������������������������������������ 227 Orgasm/Ejaculation Problems: Causes And Treatments of This Surprisingly Common Problem...... �������������������������������������������������������������������������������������������������������������������������������������� 230 Testosterone Replacement: New Male Vigor? Or Health Hazard? ������������������������������������ 239 The Man’s Guide to Buying Lingerie for Women - Especially For Valentine’s Day �������������� 242 Boobs! Men’s Complex Feelings About Women’s Breasts ����������������������������������������������� 244

Great Sex Guidance: Contents – © Michael Castleman – 4 – Healthy Lifestyle Preserves Sexual Function In Men Over 45 ����������������������������������������������� 247 Men and Menopause: Helping Women Through the Transition ����������������������������������������������� 251 Older Men Become Sexually More Like Women �������������������������������������������������������������������� 257 Extended Bicycling: Hazardous To Erections �������������������������������������������������������������������� 261 Middle-Aged Virgin Men - Overcoming The Secret Shame ����������������������������������������������� 264 Man-O-Pause: Is There Male Menopause? ������������������������������������������������������������������������������� 271

About Women ������������������������������������������������������������������������ 273 The Plain Truth About “Tight” and “Loose” Vaginas ��������������������������������������������������������� 274 Desire In Women - Does It Lead to Sex? Or Result from It? ����������������������������������������������� 277 Women’s Many Possible Sexual Response Cycles: New Findings, New Insights �������������� 282 Orgasm During Intercourse: Only 25% Of Women Consistently Do ������������������������������������ 285 How the Menstrual Cycle Affects Women’s Libido �������������������������������������������������������������������� 287 Effective Self-Help for Women with Low or No Libido ��������������������������������������������������������� 291 How Birth Control Pills Affect Women’s Sexuality �������������������������������������������������������������������� 294 Androgens (Male Sex Hormones) Help Some Women With Low Libido ������������������������� 298 The Clitoris: New Insights ����������������������������������������������������������������������������������������������������� 300 Female Ejaculation: The Latest Findings ������������������������������������������������������������������������������� 309 Menopause and Women’s Sexuality: New Perspectives from the Largest, Best Study to Date ��������������������������������������������������������� 312 How Women REALLY Feel About Penis Size ������������������������������������������������������������������������������� 315 Pelvic Pain? Pain During Intercourse? A Guide to Women’s Sexual Pain ������������������������� 318

Medical Issues ������������������������������������������������������������������������ 325 Everything You Must Know About Sexually Transmitted Infection (STIs) ������������������������� 326 Dating After 50: - Are Condoms Still Necessary? �������������������������������������������������������������������� 337 Sex and Urinary Tract Infection (UTI) ������������������������������������������������������������������������������������������ 342 Diabetes Effects on Sex ��������������������������������������������������������������������������������������������������������������� 349 Heart Disease and Sex ��������������������������������������������������������������������������������������������������������������� 352 Does Hysterectomy Affect Women’s Sexuality? �������������������������������������������������������������������� 355 Does Sex Increase Risk of Prostate Cancer? �������������������������������������������������������������������� 358 Sex After Breast Cancer ��������������������������������������������������������������������������������������������������������������� 361 Sex After Prostate Cancer ����������������������������������������������������������������������������������������������������� 364 Don’t Douche: It’s Very Bad for Women’s Health �������������������������������������������������������������������� 369 Sexual Healing - Sex Is Good for Health ������������������������������������������������������������������������������� 373 Sex Helps Prevent The Common Cold ������������������������������������������������������������������������������������������ 375

Great Sex Guidance: Contents – © Michael Castleman – 5 – Out of the Ordinary ����������������������������������������������������������������� 377 Anal Play — Without Pain ����������������������������������������������������������������������������������������������������� 378 Rimming (Analingus) - The Curious Lovers’ Guide to Oral-Anal Contact ������������������������� 384 What Fifty Shades Got Wrong About BDSM ������������������������������������������������������������������������������� 395 Voyeurism And Exhibitionism: How Common Are They? ��������������������������������������������������������� 398 Bisexuality - What The Research Shows ������������������������������������������������������������������������������� 400 Talking Dirty: The Origins of Sexual Obscenities �������������������������������������������������������������������� 404

Sex Toys and Erotic Enhancements ������������������������������������ 408 Vibrators - Myths vs. Reality ����������������������������������������������������������������������������������������������������� 409 The Best Vibrator For You ����������������������������������������������������������������������������������������������������� 412 Caring for Vibrators, and Making Them Last ������������������������������������������������������������������������������� 415 How Women Can Persuade Men to Welcome Vibrators into Partner Sex ������������������������� 418 The 125-Year History of Vibrators: It’s Stranger Than Fiction ����������������������������������������������� 421 The Joy of Blindfolds (Especially for Women) �������������������������������������������������������������������� 424 An Introduction To BDSM Accessories ������������������������������������������������������������������������������� 426 Strap-On Harnesses and Dildos: The Curious Couple’s Guide ����������������������������������������������� 428 “An Enchanting Evening” - The Erotic Game That Enhances Couple Intimacy �������������� 433 “Wildly Sexy Dares” - Dare to Have More Naughty Fun Together ������������������������������������ 436 Sex Toys and Lingerie Glossary ������������������������������������������������������������������������������������������ 439 The History of Sex Toys from 25,000 B.C. to Today ��������������������������������������������������������� 452

Great Sex Guidance: Contents – © Michael Castleman – 6 – Section I Better-Than-Ever Sex Desire Differences: How Sex Therapists Recommend Overcoming Them

At any age, when couples first fall in love, they often can’t keep their hands off each other. The hot- and-heavy period in relationships varies, but typically lasts six months to a year, two at most. After that, sexual urgency subsides for one partner or both, and so does sexual frequency.

When both people are in synch on reducing their sexual frequency, the issue does not become a sore point. But typically, couples fall out of synch on desired sexual frequency and develop a desire differ- ence. Differing levels of sexual desire often cause rancor in relationships. Today, desire differences are one of the leading reasons why couples consult sex therapists.

Why Time Cools Sexual Urgency

Several reasons:

* Initially people have fantasy pictures of each other—the “perfect stranger.” But get to know someone, and even if they’re terrific, they’re not perfect. As time passes, fantasies fade, and you’re left with reality. Now, that reality might be good enough for a long and happy relationship. But fantasies generally heat up libido. Reality has a way of cooling it.

* When couples first connect, they give each other undivided attention. But over time, the de- mands of daily life intrude: career, family, household chores, paying bills. Dealing with daily life is distracting—and often sexually distracting as well.

* People start taking their relationships for granted. Combine that with concerns about financing the kids’ college educations, and planning for retirement, and sex often takes a back seat.

* Finally, novelty—that is, a new love interest—triggers release of the brain chemical (neurotrans- mitter) dopamine. As dopamine levels rise, people become more energized, exhilarated, and obsessed. Their hearts pound. They have difficulty sleeping. They lose their appetites. And they become persistent and tenacious. In other words, they fall in love. And as dopamine rises, so does testosterone, the hormone that fuels sexual desire in both men and women. Heightened libido is, of course, a hallmark of falling in love. But as new lovers become more familiar with each other,

Great Sex Guidance: Desire Differences- How Sex Therapists Recommend Overcoming Them – © Michael Castleman – 8 – their dopamine levels fall, and the heat of new love cools. (But someone new can trigger another dopamine surge, which is one reason why people have affairs.)

Whatever the reason(s) for the end of the hot-and-heavy period, after a while, in almost all long-term relationships, the sexual heat cools and frequency declines. When both people are in synch on this change, then reduced sexual frequency does not become a sore point. But typically, couples fall out of synch on desired sexual frequency and develop a desire difference that often causes rancor in the relationship. Today, desire differences are one of the leading reasons why couples consult sex thera- pists.

The High Cost of Desire Differences

When desire differences cause chronic conflict, both lovers typically lose their sense of humor, and a grim chill descends over their sex life. Good will erodes. To the extent that the couple remains sexual, the quality of their lovemaking declines. The deterioration often extends to nonsexual aspects of the relationship, finding expression in irritability, bickering, and loss of generosity with each other.

The one who wants more sex typically feels rejected, unloved, confused, angry, unattractive, and de- ceived. Meanwhile, the one who wants less sex typically feels guilty, unloved, confused, and resentful of being turned into a sex object besieged by seemingly relentless sexual demands. Over time, desire differences often becomes festering sores that make both people feel miserable and estranged.

A major casualty of a desire difference is nonsexual affection, for example, cuddling while watching TV. The one who wants sex more typically initiates such affection, and interprets any positive re- sponse as a “go” sign for sex. As a result, the one who wants sex less, shrinks from nonsexual af- fection for fear that any reciprocation might be misinterpreted as sexual interest. The one who wants it more complains, “You’re cold as ice.” Meanwhile, the one who wants it less complains, “Can’t you experience affection without immediately assuming it’s sexual?”

As resentments deepen, what began as one problem, a desire difference, becomes two problems: the desire discrepancy and the hurt and resentment the situation causes.

Who Wants Sex More? And Less?

An informal survey of sex therapists suggests that the man has more libido in 60 to 70 percent of cases, while the woman wants sex more in 30 to 40 percent.

In our culture, men are assumed to be more eager for sex than women. When the man wants greater sexual frequency, the couple may experience distress, but they have a problem that feels culturally expected, therefore, “normal.” However, when the woman has more libido, the problems engendered by their desire difference become compounded by the fact that both people are likely to view the situ- ation as culturally unexpected, “abnormal,” and therefore, even more distressing.

Who Controls the Sex?

When sex therapists counsel couples dealing with desire differences, they often ask, “In your relation- ship, who controls the sex?”

Great Sex Guidance: Desire Differences- How Sex Therapists Recommend Overcoming Them – © Michael Castleman – 9 – Invariably, each spouse points at the other—and both are astonished to learn that their other half thinks they wield the sexual power. Meanwhile, each one feels utterly powerless. The one who wants more sex feels powerless because the less sexually inclined partner can shut sex down by saying “no.” Meanwhile, the one who wants less sex feels powerless from being worn down by seemingly constant sexual demands and acquiescing to sex when not in the mood.

What Do You Really Want?

Therapists typically ask the partner who wants more sex: What do you really want? Sex? Or other things? Inevitably, the reply is: “I want sex.” True enough.

But typically the higher-libido lover also wants more nonsexual affection, which has faded away be- cause of acrimony over the desire difference. That person also usually wants more spousal attention in general, but it has faded or disappeared because of the couple’s mutual resentments. Of course, it’s quite possible to increase nonsexual affection and mutual attention without sex.

Therapists typically ask the partner who wants less sex: How often do you want sex? Is there any- thing else you want? The typical reply: “I don’t know how much I want sex because I never get the chance to experience my own libido. I’m either fending off sexual advances or giving into them. It’s never about what I want, only what he/she wants.” True enough.

But typically, the lower-libido lover also wants the same things the greater-libido lover wants—more nonsexual affection and more attention in general—and doesn’t get them for the same reasons, the erosion of good will in the relationship.

The realization that desire differences often mask nonsexual issues gives couples some room to ne- gotiate. The higher-desire person might say, “I’m willing to have less sex if you pay more attention to me out of bed.” The lower-desire person might say, “I’m willing to have more sex if you make me feel special out of bed.”

More Things to Think About

There is no magic formula for dealing with desire differences. But here are some guidelines that often help:

* Count your blessings. So you want sex twice a week, and your lover would be happy with sex twice a month. That’s a drag, but at least the low-desire partner wants sex sometimes. Many people don’t want it at all— according to recent surveys, as many as one-quarter of women and 10 percent of men. In cases of desire differences, sex itself if not the issue, just frequency.

* Be flexible. Some people enjoy sex late at night when their lovers are tired. Some like sex under warm quilts, while others prefer it on the sofa with no covering at all. Over time, little differences can add up to big desire differences. Lovers with more libido might try to accommodate the intimate preferences of lovers with less.

* Find a friend on the opposite side of a desire difference. Great Sex Guidance: Desire Differences- How Sex Therapists Recommend Overcoming Them – © Michael Castleman – 10 – If your friends have been coupled up for a few years, it’s safe to assume that they, too, have de- sire differences. If possible, try to find a same-sex friend who is on the opposite side of the differ- ence. If you’re a man who wants more sex, try to find a guy who wants less, or visa versa. Explore how that person feels. It might give you a better understanding of that side of the issue.

* Experience your power. You feel that your lover controls the sex in your relationship, and by extension, controls you. But that’s not the case. You have more power than you think. It doesn’t matter whether you’re the one who wants sex more or less. You have the power to make your spouse think you have all the sexual power in your relationship. You have the power to turn sex into a subject that makes your lover miserable. And you have the power that comes from nursing a grudge, the power to destroy good will by obsessing about your complaints.

A desire difference is like an ancient walled city under siege. The besieging forces have not bro- ken through, but their presence and their demands for surrender places tremendous pressure on every aspect of the city’s life. That’s not victory, but it is power. Meanwhile, the defending forces have not repelled the attackers, but their resistance keeps the besieging army pinned down and preoccupied with the city and its inhabitants. That’s not victory either, but it is power.

* Explore underlying psychological issues. If the lower-desire partner has issues with self-esteem or body image, or if the higher-desire part- ner seems obsessively preoccupied with sex, or if either partner is dissatisfied with other aspects of the relationship or the rest of their lives, try to resolve these issues, or seek professional coun- seling.

* You can’t change your lover’s libido. In couples with desire differences, each person hopes the other will somehow “come around” to their position on the libido spectrum. Libido can change. But any change must come from within that person, not from a lover’s demands or cajoling. In fact, pressure to “see the light” is most likely to cement intransigence.

You Have Three Choices

A chronic desire difference creates three stark choices: You can break up. You can live in misery (with the more libidinous lover possibly seeking sex outside the relationship). Or you can negotiate a mutu- ally workable accommodation. Which will it be? If you don’t want to break up, or live in misery, you have only one choice, compromise.

To work out a desire difference, use the same negotiation skills involved in resolving any difference of opinion. State your own feelings as clearly as possible. Listen to the other person respectfully. Work to separate your love for the person from your disagreement over the frequency issue. Avoid name- calling and other signs of contempt. Try to maintain a sense of humor. Try to view the other person as a teammate, not as a player on an opposing team. With any luck, you’ll be able to thrash out a compromise you can both live with.

But remember, compromise does not produce happiness. It merely reduces unhappiness to accept- able levels. If one person wants sex two or three times a week, while the other would be happy with once or twice a month, a reasonable compromise might be once every week or 10 days. Agreeing to, say, weekly sex means that neither of you gets what you truly want. It also acknowledges that you’ll Great Sex Guidance: Desire Differences- How Sex Therapists Recommend Overcoming Them – © Michael Castleman – 11 – probably never get what you really want. But by compromising, you show flexibility and good faith, and a willingness to invest in the happiness and longevity of your relationship.

No negotiated frequency is set in stone. You might agree to weekly sex for, say, four months, and then agree to re-evaluate. Your compromise should also be flexible. Weekly lovemaking doesn’t mean sex absolutely once every seven days. People get sick. Obligations arise. Adjustments become nec- essary. Try to be kind and understanding.

Of course, it’s no fun to compromise. But if you don’t want to break up, and you don’t want misery (and possibly affairs), then compromise is the only alternative—and the sooner you negotiate a com- promise sexual frequency, the better off you are.

The Solution Sex Therapists Recommend: Scheduled Sex Dates.

One of the most maddening aspects of a desire difference is the feeling that you’re constantly arguing about sex. One begs, pleads, and grovels: “Tonight?” “Tonight?” “Tonight?” The other says, “No,” “I have a headache.” “I’m not in the mood.” Or the worst response, “Maybe.”

“Maybe” is worst because it drives the more libidinous partner crazy: “Well, what’ll it be? Sex? Or no sex?” That person becomes even more miserable and plaintive, which makes the lower-desire part- ner feel even more miserable and defensive.

These battles cease when you get out your calendars and schedule sex. Many people think the “best sex” is spontaneous. Perhaps that’s true in new relationships, but in established relationships, sex therapists agree that couples’ best chance for long-term sexual happiness comes from scheduling sex.

Scheduling means you both know exactly when you’ll be making love. That’s usually a tremendous relief for both lovers. Evenings become calmer, conversations less strained, resentments less sting- ing. Sexual uncertainty and accompanying resentments get replaced by sexual certainty and, over time, usually by grudging acceptance of the scheduled compromise solution. The one who wants more sex knows it will happen on specified dates and can look forward to it.The one who wants less knows sex will happen only when it’s scheduled, and gets a welcome break from fending off advanc- es.

What If I’m Not In The Mood?

A pervasive myth holds that sex should “just happen” when lovers are “in the mood.” But by the time people have been together long enough for a desire difference to become a festering sore, sex never “just happens” because one person always seems to be in the mood while the other rarely, if ever, is.

In the classic formulation, libido precedes sex. That’s true for many people. But not all, especially women. University of British Columbia psychiatrist Rosemary Basson, M.D., has discovered that many women say they experience no particular desire for sex before it begins, but warm up to it as they make love. For these women, sexual desire is not the cause of sex, but the result of enjoyable lovemaking. Basson’s research has focused only on women. But it’s not much of a leap to extend her findings to low-desire men.

If these women (and presumably men) don’t experience a drive for sex, why do they do it? For other Great Sex Guidance: Desire Differences- How Sex Therapists Recommend Overcoming Them – © Michael Castleman – 12 – reasons. Psychologists Cindy Meston and David Buss, of the University of Texas, at Austin, asked 442 people, aged 17 to 52, just one question: “Please list all the reasons you can think of why you or someone you have known has engaged in sexual intercourse.” They 237 reasons why people have sex.

Here are women’s top five reasons (from most to least frequently expressed):

1. I felt attracted to the person. 2. I wanted to experience the physical pleasure. 3. It feels good. 4. I wanted to show my affection for my partner. 5. I wanted to express my love for my partner.

Here are men’s top five:

1. I was attracted to the person. 2. It feels good. 3. I wanted to experience the physical pleasure. 4. It’s fun. 5. I wanted to show my affection for the person.

Note that in addition to experiencing the physical pleasure of sex, both men and women often have sex for reasons that are not strictly sexual—wanting to express love and affection.

What about new relationships when lovers can’t keep their hands off each other? Basson’s model still holds. People who feel a classic sex drive revel in their libido as they fall in love and enjoy hot sex. Meanwhile, people who feel more interested in physical and emotional closeness know that sex opens a door to them, so early in relationships, when they feel hungry for closeness, they, too, are up for lots of sex. But as the relationship develops, and the lovers settle into life together, needs for physical and emotional closeness become less intensely felt, and people for whom those needs are primary feel less interest in sex.

It’s important for those who want more sex not to pressure their lovers by saying, “If desire doesn’t precede sex for you, then your desire doesn’t really matter. Just have sex with me whenever I want, and you’ll get in the mood as we make love.” This misconstrues Basson’s research. Imagine a situa- tion where your partner loves to socialize with certain friends. You like them, sort of, and usually come away from get-togethers having enjoyed yourself. But those friends are not entirely your cup of tea. How would you feel if your partner said: “It doesn’t matter that you don’t really care for them. Just play along and you’ll have a good time by the end of the visit.” That may be true once a month—but not twice a week. The key here is to negotiate a compromise sexual frequency you both consider work- able. Sex should never feel coerced.

But in the context of resolving a desire difference, it’s equally important for those who want less sex to let go of the idea that they must feel “in the mood” before it’s okay to become sexual. If you’re feeling neutral about sex, and you have a sex date scheduled, there’s nothing wrong with psyching yourself up for it. That’s part of your frequency agreement. It’s for the good of your relationship. You’ve been freed from the constant fights about doing it. Chances are you’ll ultimately feel good about the experi- ence.

Great Sex Guidance: Desire Differences- How Sex Therapists Recommend Overcoming Them – © Michael Castleman – 13 – Embrace Your Schedule In Good Faith

Once you’ve negotiated a compromise frequency, accept it. You’re not getting what you truly want, of course. But both of you gain a frequency you can live with. Try to see the glass as half full. Stop mak- ing snide, sarcastic remarks that remind your lover that you’ve made a huge sacrifice by accepting the compromise. Your lover already knows this—and has made a similar sacrifice. Do your best to put the bickering and divisiveness of your desire difference behind you.

Enjoy More Nonsexual Affection

Once you have regular sex dates, you both earn an immediate dividend—the freedom to give and receive nonsexual affection without it being misconstrued as a sexual invitation.

Being touched, held, and cuddled are among life’s most satisfying little pleasures. Affectionate touch gives physical expression to the emotional connection you and your lover share. It’s a tremendous boon to relationships. Once your sex is scheduled, affectionate touch loses its sexual charge. Both of you can initiate hugging and cuddling secure in the knowledge that all you’re doing is sharing nonsex- ual physical affection. That’s usually a relief—and it allows affectionate touch to resume its important place in the relationship. (Note to the more libidinous partner: Don’t misinterpret spontaneous affec- tion as a sexual invitation. Your sex dates are scheduled. Stick to your schedule.)

Work to Restore Good Will

Desire differences can poison a relationship, making both people feel frustrated, angry, misunder- stood, isolated, abandoned, and betrayed. A compromise frequency regulates your sexual frequency, but it doesn’t automatically provide an antidote to the poison. You must create that antidote your- selves with acts of love, kindness, tenderness, and compassion. When lovers have chronic conflict, they often look for signals that the other person has declared a truce. They want the other person to start being nicer. But you don’t control your lover. The only person you control is yourself. If you want to declare a truce, if you want to begin to restore good will in your relationship start being nicer your- self. Try to perform at least one act of loving kindness a day, preferably more.

Savor Your Solution

When couples negotiate a compromise sexual frequency with scheduled sex, at first, both feel wary. That’s reasonable. Good will has eroded. Trust has been damaged. And both people may focus more on what they’ve given up than what they’ve gained.

But over time, assuming you both honor your agreement, return to nonsexual affection, and restore good will, tension subsides. You probably still have your desire difference, but the resentments slowly fade, and the quality of the relationship improves. As this happens, your sex usually improves as well. Over time, you both realize you’ve weathered a hard time and enhanced your relationship. You still probably have your differences, but you’ve negotiated a resolution you can both live with comfortably. Congratulations.

For individualized help coping with desire differences, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Great Sex Guidance: Desire Differences- How Sex Therapists Recommend Overcoming Them – © Michael Castleman – 14 – Reference: Clement, U. “Sex in Long-Term Relationships: A Systemic Approach to Sexual Desire Problems,” Archives of Sexual Behavior (2002) 31:241.

Great Sex Guidance: Desire Differences- How Sex Therapists Recommend Overcoming Them – © Michael Castleman – 15 – Caressing Women: Advanced Erotic Tips For Men

Compared with men, it takes most women longer to feel erotically warmed up enough to enjoy breast and genital fondling and intercourse (if the sex involves it). How much longer? For most women, a lot longer. “It takes me a good 20 to 30 minutes,” says Betty Dodson, Ph.D., a noted New York City sex educator. “It takes other women even longer.” Before you reach for a woman’s breasts or between her legs, caress the rest of her. Gently run your fingers through her hair. Fondle her ears, her face, neck, shoulders, arms, the small of her back, her buttocks, her sides, the backs of her knees. All these spots can feel charged with erotic sensation—and help her warm up to be the enthusiastic lover men hope for.

“Coach Me”

But don’t just caress these spots—and everywhere else. Ask how it feels when you do. Frame your questions carefully. It’s much easier to say that a certain touch feels good than it is to say that it feels uncomfortable or hurts. Try to frame your questions to minimize the need for the woman to say: “That hurts.”

Instead of asking “Does this feel good?” which might elicit “No, it’s uncomfortable,” try saying, “Would you prefer lighter touch here?” That way, “yes” is a request for an adjustment, and “no” means all’s well. You might also ask, “Would you prefer firmer touch here?” Or try asking, “Would you prefer me to touch you somewhere else?” Or just invite her to tell you what she enjoys by saying, “Coach me.”

“Yes” or Silence

Another way to identify places a woman enjoys being caressed is to suggest that whenever she en- joys your touch, she should say “yes,” and whenever she feels discomfort, she should remain silent. It shouldn’t take long to discover all her “yes” spots and the pressure that makes her say “yes.”

Ticklishness Means Discomfort

Watch out for ticklishness. Sometimes, it can be fun to be tickled, but in lovemaking ticklishness often means discomfort. Different women have different spots that feel ticklish. Often ticklishness depends less on the spot, and more on the way it’s touched. A finger tracing figure eights on a woman’s belly

Great Sex Guidance: Caressing Women- Advanced Erotic Tips For Men – © Michael Castleman – 16 – might feel ticklish, while a warm palm placed gently on the same area might not. The Subtle Art of Kissing

One crucial form of erotic touch that rarely gets its due in sex manuals is kissing. “A kiss,” a wit once said, “can be a comma, period, question mark, or exclamation point.” Don’t just clamp your lips on a woman’s or thrust your tongue into her mouth. Kissing is a dance. It involves a constant interplay of lips and tongues and moist warm breath. Brush her lips with yours. Nibble at each other’s lips. Run your tongue over her lips. Let your tongues chase each other as they dart in and out of each other’s mouths. Run your tongue over her teeth. The poet Percy Bysshe Shelley defined kissing as “soul meeting soul on lovers’ lips.” Put your soul into it.

Breast Play: The Best Way

In pornography, the men often maul women’s breasts and pinch, twist, and suck their nipples roughly. This is a big mistake. Nipples are very sensitive, and if you treat them callously, the woman may get turned off, and your erotic connection may be destroyed. Be very gentle with women’s nipples. Ca- ress them lightly with your fingers, lips, and tongue. Once aroused, some women enjoy somewhat firmer nipple caresses. Check in with your lover about when she likes what kind of nipple fondling.

Leisurely, Playful, Whole-Body Sensuality

In porn, the men and women say “hello,” and then almost immediately, the men are reaching be- tween the women’s legs. Another big mistake. It takes most women quite a while to become sensually aroused enough to welcome genital caresses. That’s the whole point of leisurely, playful, whole-body sensuality. Touching everywhere else first allows women the time they need to warm up to sensual pleasure and feel receptive to genital explorations.

Now, some men like to have their penises fondled early in lovemaking. But instead of asking for it directly, they try to communicate this request obliquely by reaching between the woman’s legs in an effort to encourage her to reach between theirs. Meanwhile, if the woman feels like her lover grabs her genitals before she feels ready for such intimate touch, she might make a point of not reaching for his penis early on, hoping that this might encourage the man to refrain from doing the same to her.

If you like your penis fondled shortly after the first kiss, fine.There’ s nothing wrong with that. Ask for it directly: “You know, when we make love, I’d really like it if you’d start stroking my penis early on, almost as soon as we get started.” Then ask how much nongenital caressing your lover would like before you touch or kiss her between the legs. Better yet, make this offer: “I’m not exactly clear when you feel comfortable with me touching you between the legs, so I’m not going to touch you there at all—until you take my hand and move it down there yourself.” For many women, this would be a god- send, allowing them to postpone genital play until they feel truly ready.

Be Extra Gentle Down There

Once you’re clear that a woman is open to having her vulva caressed, treat it very gently. In porn, the men often pry open the vaginal lips as though they’re opening a zip-loc plastic bag. Major mistake. The vaginal lips develop from the same cells that, in men, become the scrotum. Do you like yours pinched, gouged, or treated roughly. Probably not. Be gentle with the vaginal lips. Don’t pull them apart. As women become sexually aroused, their vaginal lips eventually begin to part on their own.

Great Sex Guidance: Caressing Women- Advanced Erotic Tips For Men – © Michael Castleman – 17 – Even worse, the men in porn often go at the clitoris like they’re polishing shoes or scooping finger- fuls of peanut butter out of the jar. Huge mistake. The clitoris has just as many touch-sensitive nerve endings as the head of the penis, but it’s much smaller, so all those nerve endings are concentrated, packed tightly together, and super-sensitive to touch. Be extremely gentle with the clitoris.

In fact, when initially caressing a woman’s vulva, don’t try to open it up at all. Simply lay the palm of your palm between her legs, press gently, and invite the woman to move in ways that give her plea- sure. Once her outer and inner lips part, there’s plenty of time to fondle, kiss, and lick her inner vulva and clitoris.

When Are Women Ready for Intercourse?

In young men, assuming that everything works as it should, erection is the first sign of sexual arousal. In women, it’s vaginal lubrication. A wet vagina does not necessarily mean the woman feels ready for intercourse. All it means is that she is starting to become sexually aroused.

When are women ready for intercourse? That varies from woman to woman. Many women would feel deeply appreciative if men said, “I’m not exactly sure when you feel ready for intercourse, so I’m not going to go for it until you invite me in.” You might arrange a nonverbal signal, for example, she might tug on your ear lobe. Or she might say, “Ready.” Do what works for you. Just remember that despite what you see in porn, wet doesn’t necessarily mean ready.

Appreciate Afterglow

Finally, like kissing, afterglow rarely gets the sensual respect it deserves. Many women complain that after orgasm, men just roll over and fall asleep. Most lovers focus on the “after” when they could have more fun—and feel more sensually intimate—if they appreciated the “glow.” Try exploring the unique possibilities of post-orgasmic sensuality. Hold each other close. Kiss one another in unusual places. Try some light massage. Facial massage of the forehead, cheeks, nose, and jaw can feel wonderful especially if you gaze deeply into each other’s eyes. (Don’t press on the eyes. Most people find this unpleasant.) For a final sensual touch, try cupping your palms gently over your lover’s ears. Closing off external sounds ushers the recipient into a womb-like world of breath and heartbeat. The fact is, the term “afterglow” is a misnomer. In truly sensual lovemaking, it should be called “et cetera.”

Ancient Secrets of the Kama Sutra

For more on sensual lovemaking, a wonderful video is The Ancient Secrets of the Kama Sutra: The Classic Art of Lovemaking (available from Amazon.com). Produced in consultation with noted Los Angeles sexologist Patti Britton, Ph.D., this 60-minute, lavish, erotic tour de force is a wonderfully sensual take on the ancient Indian Kama Sutra’s eight stages of lovemaking: preparation (bathing), massage, ambiance (candlelight, music, etc.), seduction (undressing), kissing, lingual love (oral sex), intercourse (many positions), and union (intimate spiritual merging during afterglow). Each stage is enthusiastically enacted by attractive lovers who are clearly enjoying themselves. While The Ancient Secrets of the Kama Sutra is explicitly sexual, unlike pornography, it’s very sensual, and beautiful to watch, a unique work of video art. You can use this video for instruction or entertainment or arousal— or all three.

For more information on sensual caressing, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Great Sex Guidance: Caressing Women- Advanced Erotic Tips For Men – © Michael Castleman – 18 – Orgasm During Intercourse - Improving Women’s Chances

In her book, The Case of the Female Orgasm (2005), Elisabeth Lloyd reviews every authoritative sex survey, and concludes that only 25 percent of women consistently experience orgasm during vaginal intercourse. About half of women have orgasms during intercourse sometimes. And about 25 percent of women rarely or ever have orgasms during intercourse.

Why? The old in-and-out just doesn’t provide enough direct clitoral stimulation to get most women aroused enough to have orgasms. There is nothing wrong with this. It’s perfectly normal.

On the other hand, many couples love the special closeness of intercourse, and would like the wom- an to have an orgasm during intercourse. With a little sexual creativity, this is quite possible.

Three of the most popular positions—woman-on-top, rear entry, and spooning (side-by-side, her back to his chest—allow men to provide direct clitoral stimulation quite easily. In addition, a slight variation of the man-on-top (missionary) position also enables some women who can’t have an orgasm in the regular missionary position to have them. Here’s how:

Woman-On-Top

The man lies on his back with his legs together. The woman either kneels over his hips or lies on top of him with her legs apart. Many women enjoy the freedom of movement this position provides. Many men also enjoy this position because it contributes to the man’s ejaculatory control. And it leaves both lovers’ hands free for sensual massage over much of the body.

To help a woman have an orgasm in this position, she should kneel over the man. He should make a fist and place it where their two pelvises meet. The woman leans into the man’s fist, which allows her to press her clitoris and vulva into it, which may provide enough direct clitoral stimulation for her to express orgasm.

Great Sex Guidance: Orgasm During Intercourse - Improving Women's Chances – © Michael Castleman – 19 – Alternatively, in the woman-on-top position, she can also use a vibrator on her clitoris during inter- course. Vibrators are a great boon to couples who want the woman to come during intercourse. (For a huge selection of vibrators, visit Adam & Eve.

Vibrators in Partner Sex?

Some men feel threatened by incorporating a vibrator into partner sex, and in such cases, women often feel badly about making their lovers uncomfortable. But the best carpenters use power tools. Power tools don’t reflect badly on the carpenter. They just get the job done more easily. Many men who are skilled lovers welcome vibrators into partner lovemaking because they understand that many women need the intense stimulation vibrators provide. They don’t feel “replaced” any more than a car- penter feels diminished by an electric drill.

Other women might feel uncomfortable using a vibrator on themselves during intercourse. It may feel a bit too close to masturbating in front of a lover, something many women feel too shy to do. But many men enjoy seeing women stimulate themselves to orgasm. And if you both want her to have an orgasm during intercourse, combining woman-on-top and a vibrator is usually an effective approach.

Rear Entry (Doggie Style)

The woman is on her hands and knees, or elbows and knees. The man kneels or stands behind her. This position allows both of you to move freely. She can easily reach between her legs and fondle his erection and scrotum during intercourse. To help her have an orgasm, he can each around and mas- sage her clitoris and vulva. Or she can use a vibrator.

However, rear entry may also cause her discomfort. This position allows unusually deep penetration. The head of his penis may bang into her vaginal wall, or possibly her cervix, the neck of the uterus that hangs down into the back of the vagina. This may cause the woman pain on contact, or diffuse abdominal pain during and/or after intercourse. Sex should never hurt. If this position causes her pain, consider eliminating it from your sexual repertoire. Or the man might stay still, and invite the woman to do all the moving until you both know at what depth of insertion she begins to feel discomfort. Once the man knows, he should not cross that line.

Spooning

You both lie on your sides, the woman’s back against the man’s chest. He’s free to caress her, includ- ing clitoral massage, which may allow her to have an orgasm during intercourse. Or she can use a vibrator.

The Coital Alignment Technique (CAT)

In the regular man-on-top position, she’s on her back, legs spread, and he’s on top of her. Some women love to feel the weight of their lover on top of them. Others dislike feeling pinned down. This position is also among the more physically demanding for men, who must use their arms to hold themselves up. As a result, when on top, many men have trouble maintaining ejaculatory control and/ or erection. For lasting longer and erection maintenance, the woman-on-top position is usually prefer- able.

Great Sex Guidance: Orgasm During Intercourse - Improving Women's Chances – © Michael Castleman – 20 – The regular version of the missionary position does not provide enough direct clitoral stimulation for most women to express orgasm. Unlike the other popular positions, neither lover’s hands are free to provide it. In this position, use of a vibrator on her clitoris is problematic. But with a little adjustment of missionary-position intercourse, some women can have an orgasm. The adjustment is known as the Coital Alignment Technique (CAT).

First publicized in 1988 by sex researcher Edward Eichel, the CAT is simple: Instead of the man ly- ing on top of the woman chest-to-chest with his erection moving in and out more or less horizontally, he shifts forward and to one side so that his chest is closer to one of her shoulders. With this minor adjustment, the man’s penis moves more up-and-down, and his pubic bone, the one at base of his penis, makes more direct contact with her clitoris. This extra clitoral contact may provide enough stimulation for the woman to have an orgasm.

Eichel’s original touting of the CAT led to a brief flurry of media attention and a book, The Perfect Fit. But the CAT quickly faded from the headlines. By the early 1990s, it was largely forgotten.

But research continued. A report in the Journal of Sex and Marital Therapy (2000) affirmed what Eichel asserted a dozen years earlier: The CAT increases women’s likelihood of orgasm during man- on-top intercourse. In one study typical of several in this report, researchers worked with 36 women who were unable to have an orgasm in the missionary position. The couples enrolled in an eight-week sexual enrichment course that taught whole-body massage, a standard sex-therapy approach to en- hancing pleasure in lovemaking. In addition, 17 were encouraged to masturbate between lovemaking sessions to become more comfortable with their sexual responsiveness, another standard component of sex therapy. The remaining 19 were taught the CAT. Women in the masturbation group reported a 27 percent increase in orgasm during missionary-position intercourse. Women in the CAT group reported twice the increase, 56 percent.

Of course, the CAT in no way guarantees orgasm during intercourse. Many women simply cannot have an orgasm during intercourse, period. There’s nothing wrong with them. That’s just the way they are. The CAT is no substitute for gentle, direct clitoral stimulation. But the CAT improves some wom- en’s ability to have orgasms during man-on-top intercourse.

Mock-Intercourse

Finally, a variation on the man-on-top or woman-on-top positions can help many women enjoy or- gasm during erotic embrace that feels very close to intercourse, though technically it’s not because the man’s penis remains outside the woman’s vagina. Instead of the man’s erection entering the vagina, the man presses his erection into her vulva. Assuming that both her vulva and his erection are well lubricated, a little hip grinding allows his erection to slip into the highly sensitive groove between her inner lips, the area known as the urethral sponge. As they move against one another, the shaft of the man’s erection presses against the woman’s urethral sponge, while the head of his penis rubs against her clitoris. This often provides enough direct clitoral stimulation for her to experience orgasm.

For individualized help with the CAT, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Reference: Great Sex Guidance: Orgasm During Intercourse - Improving Women's Chances – © Michael Castleman – 21 – Six Ways to Help Her Have Orgasms

Many men believe that one goal of lovemaking is to “give” women earth-shattering orgasms. But no one “gives” anyone an orgasm. Orgasms are like laughter. Comedians might be funny, but they don’t “make” us laugh. We release laughter from deep within ourselves when conditions feel right. Rather than “giving” women orgasms, men should focus on what allows women to have them. These suggestions increase the likelihood of happy endings:

(1) Don’t expect her to have orgasms during intercourse

On TV and in movies and pornography, women always seem to have orgasms during intercourse. That’s more fantasy than reality. In real sex, only about one-quarter of women are consistently orgasmic during intercourse. If you’re still having intercourse after 50, the old in-and-out can be great fun, but it brings only a minority of women to orgasm. Three-quarters of women need stimulation of the clitoris.

The clitoris is the little nub of tissue that sits outside and a few inches above the vagina beneath the upper junction of the vaginal lips. Even vigorous prolonged intercourse seldom provides enough clitoral stimulation for orgasm. Most women really need clitoral caresses from your hand, tongue, or a vibrator. Unless she specifically requests intense touch, caress her clitoris very gently. It contains as many touch-sensitive nerves as the head of the penis, but they’re packed into a much smaller space. As a result, even gentle caresses may feel too intense for many women. Discuss this. If she doesn’t enjoy direct clitoral touch, caress around her clitoris.

(2) Touch her all over, not just those places

From the scalp to the soles of the feet, every square inch of the body is a sensual playground, but too many men focus on just a few corners and forget the rest. Touch her all over. Think of sex as whole- body massage that eventually includes the genitals. Whole-body massage produces deep relaxation, which helps women (and men) have orgasms. Massage her gently from head to toe. Try massage lotion (available at bath and body shops). Some non-genital spots that can feel surprisingly erotic include: the scalp, ears, face, neck, feet, and the backs of the knees.

Great Sex Guidance: Six Ways to Help Her Have Orgasms – © Michael Castleman – 22 – (3) Slow down

Extended sensual warm-up time helps women have orgasms. Compared with men, most women need considerably more time to warm up to genital play. Forget the wham bam you see in porn. When making love, do everything at half speed. Sex therapists recommend at least 30 minutes of kissing, cuddling, and whole-body sensual caressing before reaching between her legs.

(4) Use a lubricant

Wetter is better. In just seconds, lubricant makes women’s (and men’s) genitals more erotically sensitive, so it helps women have orgasms. In addition, for women experiencing post-menopausal vaginal dryness, sex may feel uncomfortable without a lubricant.

The most widely used lube is saliva. It’s wet, free, and always available, but saliva dries quickly and it’s not very slippery. Vegetable oil is another possibility, but it can be messy and stain linens. Try commercial lubricants. They’re safe, inexpensive, and slippery. If they dry out, they can be refreshed with a few drops of water, or just apply a bit more. But don’t squirt lubricants directly on women’s genitals. That can feel cold and jarring. Instead, squeeze some into your hand, rub it with your fingers to warm it, then touch her. Lubricants are available at at Adam & Eve, as well as pharmacies, near the condoms.

(5) Break out of routines

Ever notice how sex feels more arousing in hotels? That’s because hotel sex is non-routine. Biochemically, the brain chemical (neurotransmitter) dopamine governs libido. As dopamine rises, so does arousal and likelihood of orgasm. What raises dopamine? Novelty. So try something different— anything. Make love in a new location, in a different way, at a different time, or with a different ambiance, for example, candle light, music, and sex toys. Beforehand, try bathing or showering together, or treat yourselves to professional massages.

(6) Take a vibrator to bed

Even if you do all of the above, some women still have trouble with orgasm, and need the intense stimulation only vibrators can provide. Today, one-third of American women own vibrators, but few couples include them in partner sex. Some men fear being “replaced.” Nonsense. Power tools don’t replace carpenters. They just get the job done more efficiently. Vibrators can’t kiss and cuddle, or make women laugh, or love them. They do just one thing, and some women need that one thing to have orgasms. Hold her close as you invite her to use the vibrator. Adam & Eve offers a wide selection of vibrators.

But remember, you don’t “give” her orgasms. In a loving relationship, the man’s job is to create an erotic context that’s comfortable, relaxed, and sufficiently arousing enough so the woman can let go and climax.

Great Sex Guidance: Six Ways to Help Her Have Orgasms – © Michael Castleman – 23 – Women Know Best: Men Should Heed Women’s Sexual Wisdom

If men made love the way most women prefer, both sexes would feel more sexually fulfilled—and many relationships would improve out of bed as well as between the sheets.

If men made love the way most women prefer, women would receive the leisurely, playful, massage- inspired, whole-body sensuality every sex survey shows they want.

Meanwhile, if men made love the way most women prefer, men would enjoy more aroused lovers and enjoy more reliable erections and better ejaculatory control.

All men have to do is let go of the idea that sex should proceed like it does in pornography.

Women’s Biggest Complaint About the Way Men Make Love

Women’s biggest complaint about the male lovestyle is that it’s too rushed, too mechanical, and too narrowly focused on the breasts and genitals. In many women’s experience, too many men simply want to plunge into intercourse. That’s porn-style sex. It can be summed up by the phrase, “wham, bam, thank you, ma’am.”

The breasts and genitals should certainly be included in lovemaking, but every major sex survey agrees that most women prefer a shift away from genital preoccupation and toward slow, playful, whole-body massage. Most women consider the entire body one big erogenous zone, and can’t understand why so many men explore only a few corners of the wonderful sensual playground that is our flesh. Many women resent men for rushing through sex.

Men’s Biggest Complaint About the Way Women Make Love

Menwhile, men’s biggest complaint about the female lovestyle is that many women simply aren’t interested. They need to be wined, dined, and coaxed into bed, and when they get there, they take little or no initiative, which men resent. Many men also feel deep sexual self-doubt. The women on TV, in the movies, and certainly in pornography are very interested in sex. Some are consumed by it. Many men think: If the woman in my life isn’t interested, there must be something wrong with me. But instead of asking women what’s wrong, men often internalize what they’ve experienced from the sex

Great Sex Guidance: Women Know Best- Men Should Heed Women’s Sexual Wisdom – © Michael Castleman – 24 – media: Their penises are “too small” to provide women adequate pleasure. Surveys show that most men are convinced this is true. Many men also worry about coming too soon, or erection problems— especially afer 40—or not coming at all.

Time for a Truce in the Battle of the Sexes

Since the mid-1960s when research by William Masters, M.D., and Virginia Johnson led to the de- velopment of modern sex therapy, it has become clear why so many couples’ love lives are agony instead of ecstasy. The rushed, mechanical, all-genital lovestyle most men learn at the curb side, in the locker room, and from pornography ignores women’s needs and contributes significantly to men’s sex problems. Men learn that except for a few quick swipes at women’s breasts, the only part of the body that counts is the area between the legs. They should listen to women: The whole body is one big erogenous zone. In fact, whole-body, massage-inspired caressing is the key the high-quality lovemaking. Sure, genital appreciation is part of great sex. But so are foot massage, back rubs, fin- ger sucking, scalp, face, and back-of-the-knee caresses, and kisses on the earlobes, shoulders, and neck. Unfortunately, few men connect the male all-genital lovestyle with its all-too-frequent results, erection problems, premature ejaculation, and resentful women prone to late-night headaches.

Men’s sexual miseducation is not men’s fault. Young men feel tremendous pressure to know the ins and outs of sex, as it were, so they’ll be able to lead their presumably sexually naive girlfriends in intimate explorations. Few parents discuss sex the details of erotic technique with their sons. School-based sex education is all about sperm, eggs, sexually transmitted diseases, and (with any luck) contraception. But even the best school-based sex ed communicates not one iota of information about whole-body sensual caressing in lovemaking. So young men fall back on the only resources available to them—other young men, and the sex media, which largely ignore sensuality, and instead, feature men with elephantine penises (the main reason why just about every many is convinced his is too small). It’s a classic case of the blind leading the blind.

The Key to Great Sex At Any Age

It’s also why sex therapists need not fear unemployment. Modern sex therapy has made many star- tling discoveries, but none more important than this: The key to great sex is leisurely, playful, whole- body caressing. How leisurely? Very. Song lyrics endlessly gush about making it last “all night long,” but for many men, all sex is a “quickie.” Sex therapists spend a good deal of their time urging men to slow down, then slow down some more, and appreciate sex as an extension of whole-body mutual massage. Singer-songwriter Michelle Shocked put it well: “If love is a train, I think I’ll ride me a slow one. I want to ride right through the night making every stop.”

When men drop the wham-bam attitude and begin to appreciate the pleasure potential of such secret pleasure spots as their calves, shoulders, chests, and ear lobes—along with everyplace else—some amazing things begin to happen. Women start to enjoy lovemaking because they’re getting what they wanted all along—creative, non-mechanical, whole-body intimate sharing. And because lovemaking unfolds more slowly, there’s plenty of time for women to become truly aroused and take some sexual initiative.

A more sensual style of lovemaking is also a major ingredient in sex therapy for many male sex prob- lems. When men adopt the sensual lovemaking style most women prefer, they find it much easier to learn voluntary control over ejaculation. Many erection problems clear up. And those who have dif- ficulty ejaculating are more likely to enjoy release. Great Sex Guidance: Women Know Best- Men Should Heed Women’s Sexual Wisdom – © Michael Castleman – 25 – Men should heed women’s sexual wisdom. They should slow down, forget genital preoccupation, and learn to appreciate leisurely, playful, whole-body sensuality. When men make love the way women prefer, men have fewer sex problems, women enjoy sex more, and both men and women feel more loving toward one another and more erotically fulfilled.

References: Miller, AS and ES Byers. “Actual and Desired Duration of Foreplay and Intercourse: Discordance and Misperceptions in Heterosexual Couples,” Journal of Sex Research (2004) 41:301.

Mohn, T. “The Spa Experience as Tuneup: Reports Discover That Men and Women See Massage Dif- ferently,” New York Times, 5-31-2005.

NewScientist.com. “Scientists Reveal the Secret of Cuddles.” 7-28-2002.

Great Sex Guidance: Women Know Best- Men Should Heed Women’s Sexual Wisdom – © Michael Castleman – 26 – Oral Sex: Enhancement Suggestions for Men and Women

Oral sex is ubiquitous in pornography—especially fellatio. Porn actors—both men and women—can’t get enough of giving head, and receiving it. As a result, pornography has introduced many people to oral sex, shown them the basics of performing it, and helped make oral sex not only culturally acceptable, but also something many people assume is a routine element in partner sex.

But it isn’t. According to the landmark “Sex in America” survey (1999), about three-quarters of American lovers have provided and received oral caresses at some point in life. But only about one- quarter said they played orally the last time they had sex before being surveyed. A similar survey by University of California researchers shows that only about half of respondents recalled giving or receiving oral sex during the 12 months before they were surveyed. Other surveys show that socioeconomic status predicts willingness to engage in oral sex. As education and income increase, so does comfort with oral sex.

In sex, no one should feel obligated or pressured to do anything they don’t want to do. If you’d rather not give or receive oral, you don’t have to. This may cause relationship conflict, but no one should feel coerced into oral play.

On the other hand, some people feel uncomfortable about oral sex, or avoid it, not because they find it objectionable, but rather because they’re uncertain if they’re doing it properly. Here are some suggestions:

Cunnilingus: When Women Receive Oral

“Cunnilingus,” comes from the Latin cunnus for vulva, women’s external genitals, and lingere, to lick. Licking a woman’s vulva is a lot like kissing her lips: The basics are pretty simple, but there are countless creative variations that keep it interesting, fresh, passionate, and fun. “Cunnilingus is among the most intimate sexual experiences two people can enjoy together,” says Fair Oaks, California, sex therapist Louanne Weston, Ph.D. “For some women, it’s the source of their most intense orgasms. For others, it’s embarrassing. Men feel similarly. Some love providing it, while others feel reluctant or refuse.”

The myth is that men just want to be sucked and don’t enjoy going down on women. In fact, many men love to provide oral. It’s much more likely than intercourse to bring women to orgasm. For many men, providing enjoyable cunnilingus is proof that they’re good lovers.

Great Sex Guidance: Oral Sex- Enhancement Suggestions for Men and Women – © Michael Castleman – 27 – Hygiene Issues

Some women feel reluctant to receive oral sex because they are convinced their genitals are unattractive or malodorous. For women who deal with used tampons and vaginal infections, that part of the body may not seem like the most attractive place. It only takes one joke about “smelly pussy” to make women so self-conscious that they don’t want oral.

Anxiety about the taste and smell of their genitals accounts for the fact that American women spend $150 million a year on douches. According to leading gynecologists, women should not douche. It’s hygienically unnecessary, and has been linked to an increased risk of many health problems, some of them serious, for example, pelvic inflammatory disease.

The fragrance and taste of the vulva and vagina depend on several factors: personal hygiene, genital health, the menstrual cycle if the woman is premenopausal, and the extent of vaginal lubrication loss and atrophy if she is postmenopausal. Normal washing with soap and water keeps the vulva and vagina clean, and tasting rather like the mouth does in deep kissing, except that oral sex includes the flavor and fragrance of the woman’s sexual arousal, which many men find delicious.

Some men and women feel concerned about oral sex during a woman’s menstrual period. Discuss this. Menstrual flow does not come in contact with the vulva or clitoris, so the man’s tongue does not come in contact with it either. Women may also insert a tampon or diaphragm to catch the flow. However, menstruation may change the aroma and taste between a woman’s legs. If either partner would rather not enjoy cunnilingus during the woman’s period, the couple can take a few days off.

Menopausal changes may also affect vaginal fragrance and taste. As vaginal lubrication subsides, normal vaginal microorganisms may not be flushed out. In addition, one of the lesser known changes of menopause is vaginal atrophy, thinning of the vaginal membrane. In most women, regular washing and use of a vaginal lubricant eliminates any problem.

However, if a woman feels self-conscious, try a flavored lubricant. And if a man has any objections, he can suck on a mint lifesaver while providing oral caresses. But in the vast majority of women of any age, the vulva smells and tastes fine—and men are happy—eager—to provide oral caresses.

“If a woman thinks her genitals look, smell, or taste unattractive,” says Palo Alto, California, sex therapist Marty Klein, Ph.D., “it’s highly unlikely that any man will be able to persuade her otherwise. But a man can certainly say: ‘I love how you taste.’ ‘I love to eat you.’”

The Basics For Men

Women’s external genitals include the fleshy outer vaginal lips, the thinner pink inner lips, the clitoris nestled under the clitoral hood at the upper junction of the vaginal lips, the vaginal opening, and the erotically sensitive urethral sponge between the clitoris and vagina. Basic cunnilingus involves licking the vulva from the vaginal opening to the clitoris. As women become sexually aroused, their outer vaginal lips fill with extra blood, which parts them somewhat, exposing the inner lips and the sensitive tissue between them.

The tongue is much softer than fingers, so it can provide the gentlest possible stimulation of the clitoris and vulva. “For many women,” Weston explains, “the gentleness of oral sex is what makes it so enjoyable.” Great Sex Guidance: Oral Sex- Enhancement Suggestions for Men and Women – © Michael Castleman – 28 – Tell a new lover that you’d like to go down on her. Either say something, or kiss her on the way down—her neck, the tops of her breasts, her nipples, her belly, so she gets the idea where you’re headed. You might check in saying, “I’d like to keep going down. Is that okay?” Move down slowly. Make sure she’s in a comfortable position. Lying on the bed on your stomach between the woman’s legs might strain your neck. You might slip a pillow under the woman’s hips to raise her a bit. Or you might coax her butt to the side of the bed and kneel on the floor to lick her.

Don’t dive into cunnilingus all at once. Begin slowly—and very gently. Start by nuzzling, kissing, and licking her inner thighs and the area around her vulva. Anticipation of cunnilingus can feel very arousing to women. As you move toward her genitals, begin by licking the fleshy outer lips. Run your tongue up and down them. Nibble them gently with your lips. Next, work your tongue in between the outer lips to caress the smaller, thinner inner lips. Then circle the vaginal opening and perhaps insert your tongue—or a finger or two—inside her vagina.

Lick very gently. In porn, the men don’t do this. They go at the vulva like a dog dying of thirst. As a result, some men infer that intense, rapid-fire tongue play is the way to go. Check in with the woman. Ask if she prefers gentle licking or if she’d like more intensity. Many women prefer very gentle oral caresses at first, and then some more intensity as they become highly aroused and approach orgasm. Check in often until you’re confident that you know her preferences.Then check in periodically after that. Preferences change, or she may just be in the mood for something a little different.

Approach the clitoris very slowly and gently. Some women enjoy a man’s tongue directly on the clitoris. Others find direct clitoral licking too intense, even uncomfortable.They prefer it when the tongue only lightly caresses the clitoris or circles it, which stimulates it but less directly.

Some women feel reluctant to discuss their reactions to oral sex. Instead they use “body language.” They might squirm if they find a certain lick uncomfortable. Unfortunately, it’s very easy for a man to misinterpret body language and think that when she’s writhing in discomfort, she’s actually in the throes of delight. That’s why it’s important to check in verbally: “Is this okay?” “Is this too intense?”

The Fine Points

* Alternate using the tip of your tongue, the flat of it, and your lips as you move around her vulva. All three feel a little different and provide subtly different sensations.

* Combine licking with finger and palm massage. After circling her vulva with your tongue, do the same with a finger or two, using light, moderate, or deep pressure, as the woman prefers. Use your fingers to gently part her vaginal lips. Massage her inner thighs. Finger around her anus as you provide oral caresses, or gently insert a well-lubricated finger. (Nothing that touches the anal area should touch the vagina or vulva. If it does, the woman may develop a urinary tract infection.)

* Combine oral sex with massage of other parts of her body. Some women enjoy having their breasts caressed while receiving oral. Others enjoy whole body massage. Try slipping a finger or two into her mouth so she can suck them while you’re licking her. Or combine oral sex with any sex toy(s) the woman enjoys.

* Some women who prefer very light licking of the clitoris early in oral sex, need more intensity later on to run up to orgasm. Keep checking in. Great Sex Guidance: Oral Sex- Enhancement Suggestions for Men and Women – © Michael Castleman – 29 – * Try what’s variously known as the “little lick trick,” “quicky licky,” or “snaky licky.” Instead of steady tongue pressure on the clitoris or swirling moves around it, you use the tip of your tongue to tease just the underside of the clitoral shaft with light little licks about once every 10 to 15 seconds. This move helps some women who feel highly aroused get over the hump and express orgasm.

* Some women like having their anuses licked (rimming). As long as it’s clean, there’s nothing “dirty” about licking that opening as part of oral sex. To ease hygienic concerns, wash or shower together beforehand. Beyond resolving the anal hygiene issue, bathing together is a marvelous sensual appetizer before lovemaking.

* Beyond the various cunnilingus techniques, something else affects many women’s enjoyment of oral sex—her lover’s enthusiasm about providing it. “Few things detract from a woman’s enjoyment of oral sex,” Weston explains, “as much as the suspicion that her lover considers it a duty or, worse, a chore.” If you enjoy providing cunnilingus, by all means, say so.

Female Ejaculation

Some women produce fluid on orgasm. If they ejaculate during oral sex, many women feel concerned about “squirting” in their lover’s face. This is also an issue for many men. Another issue is the possibility of the lover ingesting some of this fluid. Discuss your feelings about this.There’ s no right or wrong, just personal preferences. Many men enjoy being very close to the vulva as the woman ejaculates, and have no problem ingesting some of the fluid. It’s safe to ingest. Female ejaculate is not urine, though it may contain some dilute urine. It appears to be chemically closer to prostate fluid, so ingesting it is not all that different from a woman swallowing a man’s semen.

After orgasm, many women experience unusual clitoral sensitivity and don’t like to be touched or licked there. This is normal. If you like “last licks” after she comes, check in about where and when she might like to be licked. If not her clitoris, perhaps her vaginal lips or vaginal opening. Or come up from between her legs and hold her, kiss her, and massage her any way she likes.

Fellatio: When Men Receive Oral

“Fellatio,” comes from the Latin, fellare, to suck. “Fellatio can be profoundly symbolic,” Klein explains, “For many men, it’s the ultimate in sexual acceptance from a lover. Even when it isn’t, fellatio is an opportunity for the man to lie back and just receive pleasure, which is something many men find very arousing. Fellatio is very wet, which increases the penis’ sensitivity. And most women can be more varied and creative with their lips and tongues than with their vaginas.”

Some women don’t enjoy providing oral caresses, but many do. “Lots of women derive pleasure from feeling a firm erection in their mouths,” Weston explains. “But few women relish what you often see in pornography—having their heads held firmly while their lovers push erections deep down their throats. That makes most women gag and feel used. But with the man on his back and the woman above him, she has a great deal of control and can be as playful and creative as she likes. Many women enjoy that—as well as seeing how much their lovers enjoy fellatio.”

Just like women, many men feel self-conscious about their genitals. Most men are convinced that their penises are “too small,” even though the overwhelming majority are normal-size. And if a man is among the one in 200 men who have hypospadias, a usually-minor birth defect in which the urethral Great Sex Guidance: Oral Sex- Enhancement Suggestions for Men and Women – © Michael Castleman – 30 – opening is located not dead-center at the tip of the penis, but rather toward the underside of the penis, he may feel reluctant to have a lover’s eyes get close enough to notice.

Meanwhile many women feel reluctant—or unable—to provide oral sex. Some worry than he might accidentally urinate during fellatio. This can’t happen. A valve in the penis allows urine—but not semen—to flow when the penis is flaccid, and semen—but not urine—to flow when sit’ erect. Some women feel repulsed by having semen squirted into their mouths. Others rebel against the idea of swallowing it. If a woman is adamantly opposed to providing fellatio, her feelings should be respected. No one should ever feel badgered or pressured into doing anything sexually they don’t want to do.

Hygiene Issues

Every man should wash his penis and scrotum with soap and water whenever he bathes or showers. Men who are not circumcised should retract the foreskin and wash its inner skin. If a man neglects this, dirt and bacteria build up that may make the penis smell and taste foul—and increase risk of transmitting sexual infections.

The Basics for Women

Fellatio is as simple as eating a banana—without using your teeth. Start by kissing the head of his penis. Next lightly part your lips and lick the head and the corona, the little ridge around the base of the head. Then take the head into your mouth, using your lips and tongue to caress it and the cornona—particularly the frenulum, the part of the corona on the underside of the head. Eventually, move your head up and down so that your lips caress as much of the shaft as you can comfortably take in your mouth. However, the shaft is considerably less sensitive than the head, corona, and frenulum, so return frequently to these sensitive places—unless the man asks for something different.

The Fine Points

* Alternate sucking with licking the head and shaft.

* Flick your tongue rapidly around the head.

* Lick or nibble the scrotum.

* Stroke the shaft with one or both hands while sucking or licking the head.

* Cup and fondle the scrotum while sucking.

* Alternate sucking with gently squeezing the head or shaft between your thumb and forefinger.

* Gently slap his erection against your lips or outstretched tongue.

* Try the “little lick trick,” discussed in the section on cunnilingus. Lightly lick the underside of the head of the penis once every 10 to 15 seconds.

* While sucking, massage him elsewhere. Some men enjoy massage of the anus during fellatio. Others like being anally fingered—use plenty of lubricant, and trim that finger’s nail.

Great Sex Guidance: Oral Sex- Enhancement Suggestions for Men and Women – © Michael Castleman – 31 – * Some men enjoy rimming. As long as the man’s anus is clean, there’s nothing “dirty” about licking it. Bathing or showering together beforehand resolves hygiene concerns and can be a sensual appetizer to lovemaking.

* Finally, if providing fellatio gives you pleasure, say so. Most men get turned on knowing that their lovers enjoy providing oral caresses.

Men should feel free to direct women’s oral explorations in ways that heighten their arousal. But gentle requests are usually more welcome than terse commands. No one likes to feel ordered around. “Remember, this is a gift of pleasure you’re receiving,” Weston explains, “not something you are demanding of a slave.”

About using teeth during fellatio: Many men prefer lips and tongue only, no teeth. However, the erect penis is a tough little organ, so light nibbling with teeth along the shaft are unlikely to cause harm. Ask if the man is open to this. If so, keep it gentle, and check in: “Is this okay?” Adjust your moves according to his reactions.

Deep Throating and Gagging

The 1972 pornographic film, Deep Throat, invented a character whose clitoris was supposedly located in her throat. In order to have orgasms, she had to take men’s erections deep down there. Deep Throat became the first—and virtually only—X-rated movie to break out of the porn ghetto and play to mainstream audiences. It grossed $600 million. Since then, many men have wanted to push their erections down their lovers’ throats, and many women have been interested in providing this variation on fellatio. The problem is that deep throating—and even a good deal of ordinary fellatio— triggers gagging.

Stick anything too far down the throat, and the body gags. It’s a defensive reflex that helps prevent choking. In addition, some women have “short palates.” They gag very easily, which can make them afraid to take a penis into their mouths at all. There are several ways to deal with this:

* Gagging is to some extent triggered by anxiety. A woman is much more likely to gag when the man pushes his penis down her throat than when he remains still and she’s in control of how deep it goes. If a man wants his lover to take him more deeply, he should stay still and let her accept his penis into her mouth in the way and at the speed that’s most comfortable for her. When the woman is in control, she’s less likely to gag.

* It’s possible for women to take some conscious control of their gag reflex so they don’t gag so quickly. To desensitize the gag reflex, start in a nonsexual situation, for example, while brushing your teeth. Dentists recommend brushing the back of the tongue to prevent bad breath. Practice introducing your toothbrush into the back of your mouth. Play with brushing the back of your tongue. Breathe deeply and visualize yourself not gagging. Discover the point at which you gag. Over a few weeks, as you continue to experiment with your gag reaction, you should notice that you don’t gag quite as easily.

* For women who gag easily, another option is mock-deep-throating: Rub your hands together vigorously to warm them. Apply some lubricant to one hand. Take as much of his penis into your mouth as you can comfortably accommodate, then use your warm, well lubricated hand to stroke Great Sex Guidance: Oral Sex- Enhancement Suggestions for Men and Women – © Michael Castleman – 32 – the rest of his shaft. “This comes very close to the sensation of being deep-throated,” Weston explains.

Ejaculation Into Her Mouth?

Another potentially dicey fellatio issue involves ejaculation into the woman’s mouth. Many women are happy to accept semen in their mouths, and have no problem with the taste of semen or swallowing it. Others can’t stand the idea. There are several reasons why women might not want men to ejaculate into their mouths. Some fear injury from the force of ejaculation. Others don’t care for the taste of semen. And some object to swallowing semen, preferring to spit it out. Women need not fear injury from the force of ejaculation. It’s not forceful. It feels more like chewing that brand of gum with the liquid center. As you bite down on this gum, the liquid squirts out, but gently.

“If I can’t come in your mouth,” many men say, “I feel like you don’t accept me or truly love me.” Many men feel the same way about a woman’s refusal to swallow semen. Try not to read such meanings into a woman’s aversion to having semen in her mouth or swallowing it. It’s simply a personal preference, and probably no reflection on how she feels about you. Don’t badger her. Respect her sexual boundaries.

If a woman would rather not have semen in her mouth, the couple might compromise on fellatio with the man using a condom. That way he can ejaculate inside her mouth, but not into it. For condom- covered fellatio, the man’s pleasure can be enhanced by placing a drop of lubricant on the head of his penis before rolling on the condom. The woman’s pleasure can be increased by using flavored condoms or sucking a lifesaver.

As for swallowing semen, when women learn that it’s more than 95 percent water, some become less squeamish. Or a woman might keep a strong-flavored drink in a glass with a straw within arm’s reach, for example, grape juice, chocolate milk, ice tea, red wine, or a liqueur. It’s not difficult for most women to suck on a straw while holding a teaspoon of semen in their mouths. The beverage can help the semen go down easier. But if a woman would rather not swallow, that personal preference should be respected. In porn, the women rarely swallow. Instead, they make a great show of letting semen dribble out of their mouths and massaging it into their skin. This can be quite an erotic sight.

Some women don’t want to taste or swallow semen because they fear it may spread sexually transmitted infections (STIs). It is possible for a man to give a woman gonorrhea this way. However, the AIDS virus is unlikely to spread orally, unless the woman has bleeding gums or a sore that allows semen-to-blood contact. To eliminate fear of spreading STIs, get tested and treated if you have any. Or wear a condom during fellatio—and intercourse.

“Coming in the woman’s mouth and having her swallow are overrated,” Klein says. “They’re largely symbolic. A woman can be head-over-heels in love with a man and totally accept him—and still feel that a mouthful of semen isn’t her erotic cup of tea.”

Weston agrees: “A man once told me: ‘Coming is the fun part. Once the stuff leaves my body, I don’t care where it goes.’ I wish men would let go of the idea that to feel erotically accepted, women have to ‘drink their essence.’”

Here’s how men can enjoy the sensation of ejaculating in a woman’s mouth without actually doing so: As you approach your point of no return, the moment ejaculation feels imminent, signal the woman. Great Sex Guidance: Oral Sex- Enhancement Suggestions for Men and Women – © Michael Castleman – 33 – She withdraws her mouth and strokes your erection with two well-lubricated hands until you ejaculate.

How to Improve the Taste of Semen

Some women who are fine with accepting semen in their mouths complain about its taste, and as a result, are reluctant to provide oral sex, or allow men to ejaculate into their mouths, or swallow semen. Not surprisingly, many people ask if there’s any way to improve the taste of semen.

An extensive search of the medical literature and the Internet turned up no reliable research on this subject—but no shortage of opinions.

Urologists generally say men can’t do anything about the taste of semen. “In healthy men,” says Lawrence Ross, M.D., of the University of Illinois, Chicago, “the composition of seminal fluid is constant because it includes a precise mixture of components necessary to support sperm.” If its composition is constant, its taste must be, too.

However, many women contend otherwise, insisting that what the man eats and drinks makes a significant difference in the taste of his semen. One-time porn star, Annie Sprinkle, who claims to have tasted the semen of 1,000 men, says vegetarians taste best, that drinking fruit juices improves the taste, and that smoking, alcohol, meats, and asparagus make semen taste worse.

Semen is mostly water, but it contains many other components, notably: * Sperm, which account for about 2 percent of ejaculate volume. * Fructose, fruit sugar, which nourishes sperm. * Vitamin C, which helps maintain the integrity of sperm cells. * Sodium bicarbonate, an alkaline compound that helps protect sperm from the slightly acid environment of the vagina and uterus. * Various minerals: magnesium, phosphorus, potassium, and zinc. * Various proteins, amino acids, and enzymes.

Internet discussions of the taste of semen generally agree that a diet high in fruit and fruit juices, especially pineapple and apple juice, sweeten the taste of semen. They also generally agree on the list of foods that purportedly foul its taste: asparagus (which makes sense because of its well-known ability to alter the aroma of urine), broccoli, cauliflower, Brussels sprouts, deep fried foods, meats, dairy foods, alcohol, and coffee, plus one nonfood item, cigarettes.

While there is no authoritative research on this subject, there’s no harm in men increasing consumption of the foods that supposedly sweeten the taste, and going easy on the ones said to spoil it. In fact, increasing consumption of fruit and decreasing meats, fried foods, alcohol and cigarettes is good for health.

If a man would rather not change his diet, or if diet changes don’t work, any foul taste can be masked if the woman sucks on a lifesaver while providing fellatio. Women who go this route tout peppermint and wintergreen lifesavers.

If a woman swallows, she need not worry about her waistline. Estimates vary, but most suggest that the typical ejaculation contains only 15 to 25 calories.

Great Sex Guidance: Oral Sex- Enhancement Suggestions for Men and Women – © Michael Castleman – 34 – Finally, while fellatio can be great fun for both lovers, some men who have no difficulty having orgasm during masturbation or vaginal intercourse have problems climaxing in a woman’s mouth. The reason is usually that oral caresses, while sublime, may not provide enough of the kind of stimulation the man needs to trigger orgasm. A combination of oral attention to the head of the penis plus vigorous stroking the shaft by hand is usually sufficient to trigger ejaculation. Some men really enjoy the combination of light, feathery lip and tongue action with tight-grip shaft stroking. For different, possibly preferable sensations, the woman might wear a glove on her hand.

For individualized help dealing with oral sex issues, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Great Sex Guidance: Oral Sex- Enhancement Suggestions for Men and Women – © Michael Castleman – 35 – Sex Therapy: An Intimate Examination

Diane, 46, and Alan, 51, had been married 16 years had and two sons when they first consulted sex therapist Louanne Weston, Ph.D., of Fair Oaks, California. They loved each other, and insisted they had a good marriage. But they also had a festering problem: Alan wanted sex more often than Diane did—twice as often. She was perfectly happy making love once a week, and insisted that most of her friends did it less. Alan wanted sex twice a week or more.

Alan had insisted they see a sex therapist. Diane consented but reluctantly, fearing that Weston would take her husband’s side and urge her to have sex more than she wanted to. Weston did no such thing. She explained that they had a common problem, that there was no “right,” “wrong,” or “normal” sexual frequency, and that she would do her best to help them solve their problem by reach- ing a workable compromise that respected both of their feelings. Diane felt reassured.

During weekly sessions that lasted 18 months, Alan and Diane discussed their sex life—and the rest of their lives as well. It turned out that their problem involved more than just a desire difference. Di- ane came from a fundamentalist religious family. She was raised to view sex as dirty, especially oral sex, which she was willing to perform, but refused to receive, much to Alan’s chagrin. He very much wanted to give his wife this intimate gift, and felt rejected by her refusal. Alan had other feelings of re- jection as well. In addition to his wife’s comparative lack of libido, Diane was also not as non-sexually affectionate as he wanted. He craved more hugging, hand-holding, and cuddling, and felt hurt when she pushed him away. Alan was a successful contractor, but did not make as much money as Diane, a real estate broker. She wanted to work less and spend more time at home. She nagged Alan to make more money, which made him feel insecure, angry, and emotionally needy. When he felt needy, he want the validation and reassurance that sex provided him, which contributed to the strain around their desire discrepancy.

The Newest Mental Health Profession

Among the mental health professions, sex therapy is comparatively new, explains Bloomfield Hills, Michigan, sex therapist Dennis Sugrue, Ph.D., a past president of the American Association of Sex Educators, Counselors, and Therapists (aasect.org). It was born in the 1960s, when pioneering sex researchers William Masters, M.D., and Virginia Johnson showed that a combination of three ap-

Great Sex Guidance: Sex Therapy- An Intimate Examination – © Michael Castleman – 36 – proaches—sex education, whole-body sensual massage (which Masters and Johnson called “sen- sate focus”), and specific sexual techniques—could resolve many sex problems. Using the Masters- and-Johnson model and subsequent refinements, many women who had never had orgasms learned to enjoy them, and many men learned ejaculatory control and restored lost or flagging erections.

This was revolutionary. At the time of Masters’ and Johnson’s original work, marriage counselors gen- erally believed that once traditional talk therapy improved troubled relationships, sexual improvement automatically followed. “Marriage counselors didn’t focus on sex,” Weston explains. “Masters and Johnson showed that by zeroing in on it, sex therapy could usually improve sexual functioning, often without much focus on the relationship.”

But sex therapy was also controversial. There was a tendency for early sex therapists to say the opposite of what the marriage counselors had said, that once the sex problems were resolved, the marriage would automatically improve. In reaction, marriage counselors accused sex therapists of a mechanical, “cookbook” approach, and of under-emphasizing the many relationship issues that con- tribute to sex problems and sexual fulfillment.

Fortunately, by the 1980s, this controversy was history. Relationship counselors and sex therapists have buried the hatchet. “These days,” says University of Maryland psychiatrist Michael Plaut, Ph.D., a past president of the Society for Sex Therapy and Research (sstarnet.org), “sex therapy almost always involves relationship therapy as well. Some sex problems are independent of the relationship, for example, rapid, uncontrolled (‘premature’) ejaculation in men. But for most sex problems, you have to deal with both the relationship and the sex.”

What’s the difference between sex therapy and relationship counseling? “Couple counseling,” says University of Wisconsin psychologist Janet Hyde, Ph.D., a past president of the Society for the Scien- tific Study of Sexuality (sexscience.org), “often deals with issues of communication and control—how the two people make decisions and resolve differences. It may not deal with sex. But when couples consult a sex therapist, sex is definitely on the agenda.”

Marital and sex therapists also have different training. Currently, the gold standard of sex therapy is AASECT certification. “To earn it,” Sugure says, “you must start out as a licensed mental health professional, and practice psychotherapy for at least 1,000 hours a year for several years. Then you obtain additional training in human sexuality, followed by 100 hours of sex therapy supervised by an AASECT-certified mentor, and then amass 500 hours of sex therapy practice.” Currently, there are some 650 AASECT-certified sex therapists in the U.S.

Of course, every marriage has sexual issues: disagreements over sexual frequency, the pace of lovemaking (extended or “quickies”), the mix of whole-body and genital caresses, types of sexual ex- pression (oral sex, swallowing semen, etc.), and other issues (use of sex toys or x-rated media, etc.). How do you know if your disagreements are serious enough to warrant sex therapy? “It’s subjective,” Hyde says. “People come in when they feel stuck, troubled by a persistent problem they can’t resolve on their own.”

Problems Sex Therapy Can Help

“The first step toward resolving sex problems,” Plaut explains, “is to consult your family doctor, and maybe a urologist or gynecologist. Many sex problems have medical elements. Unfortunately, many doctors are not very comfortable dealing with sexual issues. You may have to shop around for a phy- Great Sex Guidance: Sex Therapy- An Intimate Examination – © Michael Castleman – 37 – sician who is. If medical treatment doesn’t resolve things to your satisfaction, then it’s time to consider sex therapy, especially if you experience a persistent loss of libido, difficulty becoming aroused, prob- lems reaching orgasm, painful sex, or festering resentment around sexual issues.”

In the early days, sex therapists counseled many women unable to have orgasms, other women with vaginal muscle spasms that prevented intercourse (vaginismus), and many men who lacked ejacula- tory control. Sex therapists still treat these problems, but they can often be resolved by reading self- help books (see end of article).

In addition to the problems that lend themselves to self-help, the issues couples typically bring to sex therapists include:

* Low or diminished libido. There may be a medical cause, for example, antidepressants (notably, the Prozac family of drugs), or low blood levels of testosterone—even in women. Testosterone is the “male” sex hormone, but both sexes have it, and it’s responsible for sex drive in both men and women. Relationship problems and other life stresses may also play a role in loss of libido.

* Desire differences. Both spouses have libidos in the normal range, but, like Alan and Diane, one wants sex more often than the other. Relationship problems and other life stresses may be in- volved, but in many cases, the people simply have different levels of desire. The stereotype is that compared with women, men want sex more frequently. But that’s not necessarily so. “I’ve seen plenty of couples,” Weston says, “where the woman wanted sex more often than the man.”

* Erection problems. Many factors can contribute to erection impairment: illnesses (heart disease, diabetes, and chronic pain), drugs (alcohol, smoking, antidepressants, narcotics, and certain blood pressure medications), prostate surgery, and relationship problems or other life stresses. When the erection pill, Viagra, first became available, some sex therapists feared a loss of busi- ness. In fact, Hyde says, erection medications have been a boon to sex therapy: “It put erection impairment in the news. It gave men permission to admit they had a problem and get help. The research shows that the erection drugs work best when combined with the kind of talk therapy sex therapists provide.”

* Sexual aversion. People with this condition not only have no libido, they feel a deep visceral fear of sex, and may not know why. Frequently, the cause is past sexual trauma, for example, incest, rape, or sexual abuse.

* Pain on intercourse. Women’s pain may be caused by: endometriosis, reproductive tract infec- tions, anxiety, relationship stress, an unusually low pain threshold, and a history of sexual trauma.

* Virginity or minimal sexual experience in people over 30. For some people (more men than women) sex just doesn’t happen. As these people grow older, this problem becomes increasingly problematic.

Sex Therapy Works

Sex therapists claim considerable success treating all these problems. “In a cooperative relationship where both people are committed to working together,” Plaut explains, “sex problems usually improve with therapy.”

Great Sex Guidance: Sex Therapy- An Intimate Examination – © Michael Castleman – 38 – Studies of sex therapy outcomes support this claim. In a report published in the Journal of Sex and Marital Therapy, University of Pennsylvania researchers tracked 365 couples who sought sex therapy for a variety of problems. In two-thirds (65 percent), sex therapy resolved the problem. Treatment outcome was unaffected by the specific problem, the gender of the person with the main complaint, or that person’s history of sexual trauma. Among couples who did not respond to sex therapy, the rea- son often had to do with an illness, for example, heart disease or diabetes, both of which can impair sexual functioning. The researchers concluded, “Sex therapy is effective in the real world.”

Confirming this conclusion, a Penn State researcher surveyed sex therapists about their sex prob- lems. Compared with the general population, sex therapists reported as many or more lifetime sex problems. But when asked about sex problems during the past 12 months, compared with the gen- eral population, sex therapists reported fewer problems. Conclusion: Despite initially experiencing as many sex problems as other Americans, the knowledge gained by training for sex therapy and practicing it reduced sex therapists’ sex problems to levels significantly lower than average. In other words, sex therapy works.

What If One Person Refuses To Go?

The outcome study involved cooperative couples. Sometimes, however, one spouse refuses to con- sult a therapist. Then what? “Even when one person has the symptom or complaint,” Hyde explains, “the couple has the problem. The solution involves them both. Sex therapy is not some awful experi- ence. The spouse who wants it should appeal to the other saying it’s likely to improve their sex and strengthen their relationship, which helps both of them.”

If one lover still flatly refuses, the one who wants sex therapy can be seen solo. “I always prefer to see couples,” Weston explains, “but if only one is willing to come in, that person can still get informa- tion, explore feelings, and take home new information that might help or eventually persuade the other to come in.”

What Happens? Duration? Cost?

Sex therapy is very similar to talk psychotherapy. Clients never have sex with the therapist or in the presence of the therapist.

For most problems, sex therapy takes four to six months of weekly, one-hour sessions, often with “homework,” for example, conversations to gain experience in new communication skills, or sensual assignments in bed to practice new lovemaking techniques. “My shortest course of therapy,” Plaut recalls, “took just seven sessions. My longest is still going on after three years. But on average, sex therapy takes four to six months, 16 to 24 sessions.”

Depending on location, sex therapy costs $100 to $200 an hour. Some health insurers cover it. Oth- ers don’t. And some place limits on the number of covered sessions, after which you pay out-of-pock- et. Check your policy.

Some people wonder if the sex therapist’s gender affects the quality of the therapy. “People have personal preferences, which is fine,” Sugrue says. “But the research shows that the therapist’s gen- der doesn’t matter. Men and woman respond equally well to male or female therapists. What matters most is the rapport between the clients and therapist.”

Great Sex Guidance: Sex Therapy- An Intimate Examination – © Michael Castleman – 39 – A Happy Ending

Alan and Diane saw Weston for 44 sessions. Diane described her sexually repressed upbringing and what a struggle it had been—and continued to be—for her to open up to Alan sexually and emotion- ally. This was a revelation to Alan, who apologized for having been so sexually demanding. Both Alan and Diane realized that her complaints about being the major breadwinner had less to do with the money than with her need to keep some emotional distance between them. Meanwhile, when she carped about money, he just became more sexually needy. Weston also gave them some educational materials about oral sex, showing that it was hygienic and safe for women to receive, which allayed Diane’s fears.

Thanks to sex therapy, Diane stopped putting Alan down for making less money, and he became less sexually demanding. They evolved toward a more affectionate relationship, with more of the cuddling that Alan wanted. Diane tried receiving oral sex and enjoyed it. She still felt less interested in sex than Alan did, but their desire discrepancy became a less thorny an issue. They enjoyed each other more, and they enjoyed sex more as well.

“Good sex is one of life’s greatest pleasures,” Sugrue says. “If you’re not enjoying it as much as you’d like, there’s no reason to feel inadequate, embarrassed, ashamed, or resentful of your partner. Sex therapy can usually help. The effort not only improves the quality of sex, but also deepens the trust and intimacy in the relationship.”

How to Find a Sex Therapist Near You

* Ask your family doctor or gynecologist. Medical problems contribute to many sex problems, so it’s a good idea to begin with a check-up. If nothing turns up, ask the doctor for a referral to a sex therapist.

* Visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

* Once you have a short list of possible therapists, interview them briefly by phone.Ask about their experience dealing with your problem. Ask about their credentials, approach, when you might ar- range sessions, and cost. Select the one with whom you feel the best rapport.

References:

Althof, S.E. et al. “Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction,” Journal of Sexual Medicine (2005) 2:793.

Blizter, J. et al. “Sexual Counseling in Elderly Couples,” Journal of Sexual Medicine (2008) 5:2027.

Corty, E.W. “Self-Reported Sexual Problems in American Sex Therapists,” presented at the 2009 an- nual meeting of the Society for Sex Therapy and Research, Washington, D.C.

Gehring, D. “Couple Therapy for Low Sexual Desire: A Systemic Approach,” Journal of Sex and Mari- tal Therapy (2003) 29:25.

Great Sex Guidance: Sex Therapy- An Intimate Examination – © Michael Castleman – 40 – Leiblum SR and RC Rosen (eds). Principles and Practice of Sex Therapy, 3rd edition. Guildford Press, NY, 2000.

McCabe, M.P. “Evaluation of a Cognitive Behavior Therapy Program for People with Sexual Dysfunc- tion,” Journal of Sex and Marital Therapy (2001) 27:259.

Sarwer, DB and JA Durlak. “A Field Trial of the Effectiveness of Behavioral Treatment for Sexual Dys- functions,” Journal of Sex and Marital Therapy (1997) 23:87.

Wesley, S. and E.M. Waring. “A Critical Review of Marital Therapy Outcome Research,” Canadian Journal of Psychiatry (1996) 41:421.

Great Sex Guidance: Sex Therapy- An Intimate Examination – © Michael Castleman – 41 – Older Sex Can Be the Best of Your Life

The myth is that after 50, sex is like older men’s hair—it recedes then disappears. There’s a germ of truth to this. After 50, libido declines. Older women develop vaginal dryness and/or atrophy. And older men suffer balky erections or erectile dysfunction (ED). These changes can render intercourse diffi- cult or impossible, even with lubricants and erection medication.

But if you let go of the idea that sex equals intercourse and expand your erotic horizons to encom- pass pleasure that includes the genitals but involves the whole body, older sex just might be the best sex of your life. Here’s why:

Older lovers are more erotically in synch Young love is hot and juicy, but many young men are all finished and falling asleep before young women have even warmed up to genital play. In addition, young women tend to be less genitally focused than young men and more interested in playful mutual whole-body massage. These gender differences often cause conflict.

But after 50, men’s and women’s erotic sensibilities converge. Men need more time to become aroused, and as erection and intercourse become problematic, men who remain sexual usually warm up to the whole-body sensuality that women enjoy. “Compared with young lovers,” says developmen- tal psychologist Richard Sprott, Ph.D., of California State University, East Bay, in Hayward, “older couples are more sexually similar. Couples who appreciate this can enjoy richer, more fulfilling sex at 65 than they had at 25—even if the men can’t raise erections or manage intercourse.”

Older men don’t need erections to enjoy sexual pleasure Sexologists agree that at every age, satisfying lovemaking has less to do with rock-hard erections and pounding intercourse than with kissing, cuddling, and leisurely, playful touching all over—mutual whole-body massage that includes the genitals but is not fixated on them.This message is often lost on young men driven by testosterone. They plunge into intercourse before their lovers or their penises are ready, resulting in irate women and premature ejaculation. Older men are less ruled by their hor- mones. Despite balky or absent erections, if older men embrace what sexologist call “outercourse,” that is, mutual whole-body pleasuring with fingers, lips, tongues, and sex toys, they can enjoy deeply satisfying lovemaking without erections or intercourse.

Great Sex Guidance: Older Sex Can Be the Best of Your Life – © Michael Castleman – 42 – Women are more likely to get the sex they want As older men slow the pace and learn to enjoy playful whole-body mutual massage, women get more of what they’ve always wanted. Many resent men less and relax and enjoy sex more, which increases women’s erotic responsiveness, creativity, and satisfaction.

Older men don’t need erections to have marvelous orgasms This surprises many men, but it’s true. In an erotic context with vigorous, extended manual or oral stimulation, men with semi-firm or even flaccid penises can still enjoy satisfying orgasms. Many men have difficulty adjusting to sex and orgasms without erections, but when men adapt to their new situa- tion, they often report orgasms as enjoyable as any they’ve ever experienced.

Concerns about pregnancy and contraception disappear Remember the hassles of preventing unplanned pregnancy? Condoms, diaphragms, the Pill—all in the past. Older couples can make love with no anxiety about its consequences. This new freedom al- lows deeper relaxation, which boosts erotic pleasure.

The kids are gone—finally! Many couples enjoy music during lovemaking and some like to whoop it up. But if teen or young adult children are still at home and coming and going at all hours, their parents often feel constrained and self-conscious about playing too enthusiastically in the sack. Once the nest empties, this issue disap- pears, and lovemaking can be enjoyed anywhere around the house, anytime, at any volume.

Of course, it’s not easy adjusting to the sexual changes of older adulthood. Change is always chal- lenging, especially when it involves sex. But if you can transition from sex focused on intercourse to sex based on outercourse, you may be surprised to discover that older sex can feel marvelously fulfilling—and just might be the best sex.

Great Sex Guidance: Older Sex Can Be the Best of Your Life – © Michael Castleman – 43 – Better Sex Fast—Using Just One Word, YES

When tongues are dancing, do you find yourself suddenly tongue-tied? Many lovers do. It’s often difficult to say anything in the throes of passion, let alone ask for changes in the way your partner makes love. If you say anything critical, your lover might feel offended. Or think you’re weird. As a re- sult, many people who would like to speak up while lying down can’t find the words. But clamming up when things aren’t quite right means that your pleasure suffers and your partner remains in the dark about what you really want.

Yes!

If you’re reluctant—or unable—to provide the direction you think your lover needs, here’s a simple, effective, one-word remedy. Simply say “yes” when you enjoy what’s happening, and remain silent when you’re less than thrilled. That’s all there is to it—and it works. Over a few months, just saying “yes” is virtually guaranteed to get you more of what you want and less of what you don’t.

Erotic arousal is contagious. The more you show that you’re turned on, the more turned on your lover is likely to become—and provide what clearly arouses you. Sighs, moans, and groans can com- municate arousal. But “yes” works better, especially when you say it with feeling: “Oh, God, yes!” or “Ooooo, ye-e-es!” Lovers naturally provide more of whatever elicits that magic word, and less of what’s greeted by silence.

No Need to Say “No,” “Don’t,” or “Stop”

Saying “yes,” largely eliminates the need to say “no,” “don’t,” “not so rough please,” or “stop doing that, you idiot!” It’s easier—and better for relationships—to keep things positive. And once you start saying “yes,” your silence becomes an eloquent—and effortless—way to communicate that what’s happening isn’t ringing your bell.

If you’d like something different that your lover is far from providing, for example, certain manual caresses when you’re receiving oral, “yes” can also help. Say “yes” when your lover does anything close to what you want. By reinforcing successive approximations of your goal behavior, your lover is likely to move closer and closer to what you want.

Great Sex Guidance: Better Sex Fast—Using Just One Word, YES – © Michael Castleman – 44 – Talking During Sex?

Once you feel comfortable saying “yes,” chances are you’ll feel better able to make additional com- ments during sex, for example, loving endearments: “I love you,” or “You’re so sexy,” or “You’re the greatest.” Not that you should feel obligated to say these things during sex. Some couples enjoy it, others don’t. You don’t have to talk during sex. It’s up to you. There’s no right or wrong here. But if the two of you typically say little or nothing, you might enjoy opening your mouths for more than kissing and oral sex. Everyone loves to hear those three little words, and many (most?) enjoy hearing their lovers whisper other endearments. Or expansions on “yes,” for example: “I love that. Don’t stop.” Or perhaps the phrases one might hear in porn. Or a comment after orgasm: “Thank you,” or “Oooh, that was intense.”

Of course, talking during sex might also cause conflict. One of you might prefer sex in silence while the other enjoys a running commentary. One might prefer clinical terms—“penis” and “vagina”—while the other might prefer earthier terms. Discuss this. A good time for such conversations is shortly after your orgasms as you float in afterglow.

Speaking of afterward, beyond general appreciation for your honey, afterglow is a good time to pro- vide any coaching your “yes” comments didn’t quite communicate. You might say: “You know when you stroked me while sucking me, I really liked that.” Or “I love it when you suckle my nipples, but next time, no teeth, okay?”

Yes.

Great Sex Guidance: Better Sex Fast—Using Just One Word, YES – © Michael Castleman – 45 – Some Aphrodisiacs Stimulate More Than Just The Imagination (But Probably Not The Ones You Expect)

What do ginseng, chocolate, oysters, coffee, alcohol, powdered rhinoceros tusk, a ground up Mediterranean beetle, and the bark of a certain West African tree all have in common? They are just a few of the many items people have used through the ages to set off sexual fireworks. For almost as long, scientists have dismissed all these traditional aphrodisiacs as sexually worthless—and sometimes dangerous.

But old beliefs die hard when they promise to add extra zing to lovemaking. The rhinoceros has been hunted almost to extinction in part because its powdered horn reputedly boosts virility. (It doesn’t.) And Spanish fly, a drug made by pulverizing the Mediterranean Cantharis beetle, is no libido-booster, but it can be poisonous.

Until the 1980s, scientists insisted that nothing ingested, inhaled, or injected could possibly have the effect promised in that old rock song, “Love Potion #9,” whose narrator recalls that after downing the herbal brew, he “started kissing everything in sight.” The sad fact is that there are many more ways to kill sexual interest than enhance it (see sidebar: The Sex Killers).

Nonetheless, belief in aphrodisiacs runs deep. It’s embedded in the very terms we use to describe sexual attraction. Why do people fall head over heels for each other? Chemistry. Recent research shows that those love-sick chemists of yore were on to something. Science has still not identified anything that charms reluctant objects of desire into ripping their clothes off. But a surprising number of herbs, drugs, and foods have physiological effects that just might make reluctant paramours more receptive to erotic invitations. In addition, if we define “aphrodisiac” broadly to include anything that adds extra excitement to lovemaking, then the possibilities become as boundless as the erotic imagination.

How Aphrodisiacs of Yore Gained Their Sexy Reputations

Three reasons account for belief in most traditional aphrodisiacs: ancient myths, medieval medical theory, and traditional herbal medicine.

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 46 – The mythological genesis of some purported sex boosters takes us back to the origin of the term “aphrodisiac.” It comes from Aphrodite, Greek goddess of beauty and love. In Greek mythology, when Uranus, the first ruler of the heavens, was killed in a battle among the gods, his flesh fell into the sea, and Aphrodite was created from it. Ever since the love goddess’ mythological nativity, products of the sea have been considered sex stimulants, especially oysters, whose soft fleshy moistness bears some fanciful resemblance to the vagina. (It turns out that oysters boost men’s reproductive capabilities—read on.)

Resemblances such as oysters and the vagina lie at the heart of the medical philosophy that dominated the Middle Ages. Known as the Doctrine of Signatures, the idea was that same God who had cursed humanity with illness had also blessed his children with natural cures that announced their utility by their appearance, or “signature.” Plants with heart-shaped leaves were prescribed for heart disease. Yellow flowers were used to treat jaundice. Walnuts, whose shells suggest the brain, were prescribed for headache, etc. Using the same logic, plants with phallic parts—for example, carrots and bananas—were considered virility boosters, according to George Armelagos, Ph.D., a professor of anthropology at Emory University in Atlanta and author of Consuming Passions: The Anthropology of Eating, while anything soft and moist—oysters and ripe, juicy fruits—were linked to the vulva/ vagina and were considered women’s aphrodisiacs. Echoes of the Doctrine of Signatures remain to this day. An attractive woman may be called a peach, and breasts are sometimes called melons.

The Doctrine of Signatures held sway from China to Kenya. It partly explains why Asians have revered ginseng root for centuries as a male aphrodisiac. Some ginseng roots are shaped like little people, with body-like centers and branches that resemble arms and legs—and sometimes central protuberances that look rather penile. In Africa, rhinoceros horns looked phallic enough to spur a belief that they were sex stimulants. The horns of other animals, deer and reindeer, gained similar aphrodisiac reputations—and gave us a term for feeling sex-starved, “horny.”

Finally, the Doctrine of Signatures extended to taste. “Hot” spices, particularly peppers and ginger, were believed to promote the heat of lust.

Beyond the Doctrine of Signatures, in traditional herbal medicine, plants containing stimulant compounds gained reputation as sex stimulants. In the Middle East, before Arab caliphs visited their harems, they sipped coffee, which contains the potent stimulant, caffeine. Montezuma and Casanova fortified themselves for sex by drinking hot chocolate, which also contains caffeine. Ginseng has no caffeine, but it contains other stimulants (ginsenosides) that enhance work performance and were generalized to include performance of a more intimate nature.

In addition, many herbs and other things with action on the genitourinary system gained reputations as aphrodisiacs, particularly Spanish fly, a powerful urinary irritant, and diuretics, among them: sarsaparilla and saw palmetto. And down through the ages, several other herbs have clung tenaciously to aphrodisiac reputations, for example, the West African yohimbe tree, wild yam, and damiana, whose scientific name is Turnera aphrodisiaca.

Despite traditional aphrodisiacs’ amorous reputations, until recently, scientists dismissed them all as quaint frauds whose powers had less to do with sex than suggestion. Sexual enjoyment involves the mind as much as the body, so anything people believe is arousing becomes arousing.

The Viagra Effect

With all due respect to the power of suggestion, over the past few decades—and especially since

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 47 – 1998—scientists have discovered that it was a mistake to scoff at traditional aphrodisiacs. Nineteen- ninety-eight was important because that was the year Pfizer’s erection drug, Viagra, took the world by storm. The hoopla surrounding Viagra’s release spotlighted the result of arousal in men, and suddenly arousal itself, previously unmentioned outside of sex-research journals, shone in the reflected glow.

Pfizer believed that Viagra was more than simply a chemical way to increased blood flow into the penis. The company felt strongly that the drug was also a libido-booster. If that were true, it might do as much for women as men. And why not? Viagra coaxes extra blood into the genitals of both men and women. In men, this aids erection. Viagra is not an aphrodisic in the traditional sense. It has no direct effect on men’s libidos. All it does is make erection more likely. But most of the time, when men experience erection, they also feel turned on. Pfizer researchers theorized that increased genital blood engorgement should also increase women’s sexual desire, arousal, and responsiveness. The company spent tens of millions of dollars trying to prove that Viagra was just what the doctor ordered for low libido and arousal problems in women.

But that effort failed. While a few studies showed that Viagra enhanced desire in women, most showed no benefit. In 2004, after eight years of research involving 3,000 women, Pfizer gave up on the drug as a female aphrodisiac.

Ironically, the drug that flopped as a women’s libido-enhancer spurred many women to look for solutions to low desire. “Among my patients,” says Mary Lake Polan, M.D., chair of the department of obstetrics and gynecology at Stanford University, “lack of desire is quite common. Since the publicity around Viagra brought the issue into the open, women have become more interested in addressing it.”

Men too. Many tried Viagra thinking it would aid arousal. But it didn’t. All it did was make erection more likely. This showen men—many for the first time—that arousal was distinct from erection.

Supplements for Better Sex?

No wonder that since Viagra, health food store shelves have become crowded with supplements that promise sexual fireworks. Of course, the search for sexual enhancement is nothing new. But scientists now take traditional aphrodisiacs more seriously, especially purported sex-enhancing herbs. “Unfortunately,” says Mark Blumenthal, executive director of the American Botanical Council, the nation’s leading nonprofit devoted to education about herbs, “the claims often go far beyond the research. Not much is known about many of these herbs. But quite often, scientists find that folkloric claims have some truth.” While the traditional aphrodisiacs don’t unleash unbridled lust, the latest research shows that several stimulate more than just the imagination.

Coffee If your honey’s thoughts turn to dreamland as yours turn to dallying, a cup of coffee just might keep your lover awake long enough to make the most of the evening. “Coffee is a powerful central nervous system stimulant,” says Chris Kilham, an ethnobotanist at the University of Massachusetts, Amherst, and author of Hot Plants: Nature’s Proven Sex Boosters for Men and Women. “It excites nerves all over the body, including the ones involved in sex.”

But caffeine does more than simply keep the Sandman at bay. In one study, University of Michigan researchers surveyed 744 married couples, age 60 or older, and discovered that women who were

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 48 – daily coffee drinkers were more likely to call themselves sexually active—62 percent versus just 38 percent of the women who abstained from coffee. In addition, coffee was a boon to erection. Fifty- nine percent of non-coffee-drinking men reported erectile dysfunction (ED). Among coffee drinkers, the figure was only 36 percent. “Caffeine is a powerful central nervous system stimulant,” Blumenthal explains. “When people get a caffeine buzz, some feel a sexual buzz as well.”

Dose and Safety: Most coffee drinkers consume one to two cups a day, and become tolerant to their accustomed intake. To get an extra buzz they may feel aphrodisiac, you have to consume a bit more than usual. Meanwhile, coffee causes insomnia, jitters, and irritability. It has also been accused of contributing to heart disease and cancer. But the largest, most authoritative studies show that one to two cups a day do not increase risk of heart disease or cancer.

Cocoa and Chocolate Cocoa and chocolate contain caffeine but considerably less than coffee. However, they stimulate the release of endorphins in the brain. “Endorphins,” explains Hank Wuh, M.D., author of Sexual Fitness, “are pleasure messengers that signal feelings of well-being and happiness—and may help you become more receptive to sex.” Chocolate also contains L-arginine, an amino acid involved in sexual responsiveness (see ArginMax, below).

Finally, chocolate contains phenylethylamine (PEA), the “molecule of love,” according to the late sexual pharmacology authority Theresa Crenshaw, M.D., author of The Alchemy of Love and Lust. PEA is a natural form of amphetamine. It’s also a natural antidepressant. Both love and lust increase blood levels of PEA, but after a heartbreak, PEA levels plummet. Chocolate contains high levels of PEA, which may explain why the broken-hearted sometimes binge on chocolate. It may be a way to raise their PEA levels. “Cocoa and chocolate are not great sex enhancers,” Kilham explains, “But they recreate the brain chemistry of being in love. And if being in love makes you feel more sexual, then cocoa and chocolate might do that.”

Critics contend that chocolate’s PEA is metabolized so quickly that it couldn’t have much sexual effect. Perhaps, but giving chocolates has become a worldwide courtship ritual. Maybe it’s the silky texture and creamy taste. Or maybe it’s the PEA. The artificial sweetener, NutraSweet (aspartame), also increases blood levels of PEA. Maybe lovers should forget the champagne, which contains alcohol, a depressant that dampens sexual function, and instead, toast one another with diet soda containing NutraSweet.

Dose and Safety: My wife swears there’s no such thing as too much chocolate. However, chocolate contains caffeine (see Coffee). And (sorry, honey) chocolate may also cause heartburn, migraine headaches, and allergic reactions.

Damiana The ancient Mayans used this herb as a sex-booster. One species’ scientific name includes aphrodisiaca. With a name like that, you’d think this herb would have attracted considerable research interest. Oddly, only one study has investigated its sexual effects. Italian researchers showed that damiana “improves the copulatory performance of sexually sluggish or impotent rats. These results seem to support damiana’s folk reputation as a sex stimulant.” Wuh says damiana is a mild stimulant that can cause tingling in the genitals, sensations that can be experienced as sexual.

Or maybe not. One animal study isn’t much, and a pharmacological analysis of this plant concluded:

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 49 – “No substantive data are available to support its aphrodisiac effects.” Kilham agrees: “As far as I can tell, sexual claims for damiana are baseless.”

Dose and Safety: The typical dose is 3 to 4 g of powdered leaf in tablets or capsules, taken twice a day. No significant adverse effects have been reported. “At this point,” Blumenthal says, “about all we can say about damiana is that it’s safe.”

Ginkgo Ginkgo has no historical reputation as an aphrodisiac, but since the 1980s, many studies have shown that it improves blood flow through the brain, slowing the progression ofAlzheimer ’s disease. Ginkgo also boosts blood flow into the genitals.

At the University of California, San Francisco (UCSF), researchers gave ginkgo (240 mg/day) to 63 men and women suffering sexual side effects from antidepressants: libido loss, erectile dysfunction, loss of vaginal lubrication, and problems with orgasm. After two years, the herb helped 76 percent of the men, and 91 percent of the women. There was no placebo group, however, placebos usually benefit around one-third of those who use them. The response rate in this study was twice that, suggesting real benefit. On the other hand, in two other studies, ginkgo provided no benefit for antidepressant-induced sex problems. But those studies were comparatively brief—just a month or two. Apparently, it takes longer for ginkgo’s sexual benefits to appear. “There’s no question that ginkgo opens blood vessels and improves blood flow,” Blumenthal says, “so it’s certainly plausible that it would improve blood flow into the genitals.”

Dose and Safety: Participants in the UCSF study took 60 mg of ginkgo extract four times a day or 120 mg twice a day. Possible side effects include: stomach upset, headache, jitters, rashes, dizziness, and heart palpitations.

Ginseng For centuries, Asians have considered ginseng a tonic, meaning that it subtly strengthens the entire body. It’s only a short step from this claim to sex enhancement. Recent research suggests that ginseng increases the body’s production of nitric oxide, a compound essential to blood flow into the genitals.

Korean researchers gave 45 men with erection problems either a placebo or ginseng (900 mg three times a day). After eight weeks, the ginseng group experienced significant erection improvement. Another Korean study came up with similar results. “I’m persuaded that ginseng helps with erection problems,” Blumenthal says.

Colorado physician Linda B. White, M.D., coauthor (with Steven Foster) of The Herbal Drugstore, adds that ginseng “enhances overall physical vitality. As vitality increases, people often feel more interested in sex.” “Ginseng provides an unquestionable boost for libido and men’s erections,” Kilham says. “The problem is, people often don’t take enough for long enough. You have to use what that Korean study used, around 900 mg three times a day for a few months.”

Dose and Safety: Try the dose used in the Korean study—900 mg three times a day. There are few reports of significant problems, however, possible side effects include: caffeine-like stimulation, jitters, and lower blood sugar (which is good for people with diabetes). Ginseng also has anticoagulant action. You may notice increased bruising. If bleeding becomes a problem, stop using it.

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 50 – Maca When the Spanish conquered Peru, the fertility of their horses and livestock declined high in the Andes. The Incas showed them the cure, this Andean ground cover. The Spanish were impressed and maca’s local reputation as a fertility-enhancer became generalized to include libido enhancement.

Turns out the Incas were right about maca’s effect on fertility. In a recent animal study, Peruvian researchers showed that maca does, indeed, prevent altitude-induced decreases in sperm count.

Maca also appears to be a sex stimulant. Chinese researchers treated male rats with either a placebo or the herb for 22 days, then placed each one with sexually receptive females. Subsequently, the females’ vaginas were examined for sperm. Compared with females mated with control rats, those mated with maca-treated animals were more than twice as likely to contain sperm, demonstrating greater sexual activity in the maca-treated animals. “You give maca to animals,” Kilham explains, “and they copulate like there’s no tomorrow.”

Maca might also be a sex-booster in humans. In the one trial to date, Peruvian researchers gave men a daily placebo or maca (1500 or 3000 mg). After eight weeks, the men who took the herb reported greater sexual desire. “Maca has a long history of historical use as a food,” Blumenthal explains, “so I’m persuaded that it’s safe. As for it’s sexual effects, the jury is still out.” Only one human trial has been conducted and one study can never be considered definitive. But Kilham believes in maca: “Personally, I think it’s one of the two or three best sex-enhancing plants on the planet. But you have to use a lot of it to get an effect, on the order of 500 mg/day. Peruvian doctors routinely give it to men who complain of erection problems.”

Dose and Safety: The best dose remains unclear. In the clinical trial, the men took 1500 or 3000 mg. Other sources suggest up to 6000 mg a day. No one really knows. No significant side effects have been reported, but this herb has not been well researched.

Muira Puama Known as “potency wood,” this Amazon shrub is a traditional aphrodisiac. French researchers surveyed the sexuality of 202 healthy women complaining of low libido, then gave them a combination of muira puama and ginkgo. Two-thirds reported improved sexual function: greater libido, more frequent intercourse, increased likelihood of orgasm, more intense orgasms, and greater sexual satisfaction. “The research is scant,” Blumenthal says, “but often, when a plant gets a name like ‘potency wood,’ there’s something to the claim.”

Dose and Safety: The typical dose is 1 to 2 ml of muira puama extract in water two to three times a day. No serious side effects have been reported, but this herb has not been well researched.

Saw Palmetto This small palm tree native to the Southeast U.S. was recommended by early American folk healers as a diuretic, breast enlarger, and a treatment for benign prostate enlargement, a common problem among men over 50. Recent research shows that this herb won’t boost anyone’s bra size, but it is a mild diuretic, and several double-blind studies show that saw palmetto extract does, in fact, help treat prostate enlargement. In one study, 305 men with typical enlarged-prostate symptoms—urinary difficulty and several nightly wake-ups to urinate—were given saw palmetto extract (320 mg/day). After 90 days, 88 percent of them reported significant improvement in urine flow and quality of life. However, this herb’s effect, if any, on libido remain to be determined. Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 51 – Dose and Safety: Try the dose that helps treat prostate enlargement, 320 mg/day. There are no reports of significant side effects.

Tribulus Terrestris In India, this herb is an age-old treatment for sex problems. It contains protodioscine, a compound the body converts into the male sex hormone dehydroepiandosterone. Tribulus also increases production of nitric oxide, a compound that increases blood flow into the genitals.T o date, no human trials have investigated its sexual effects. But in two animal studies, the herb increased erection firmness and sexual frequency of male rats. The researchers concluded: “Tribulus appears to possess aphrodisiac activity,” at least in rats. “Animal studies don’t always translate into human effects,” Blumenthal explains. “We need human trials. But tribulus increases nitric oxide, so I wouldn’t be surprised if it improves sexual function.”

Dose and Safety: The typical dose ranges from 250 to 750 mg a day. No serious side effects have been reported, but this herb has not been well researched.

Yohimbe For centuries, the bark of the West African yohimbe tree was reputed to restore faltering erections. Scientists laughed—until the 1980s, when several studies showed that a chemical in the bark, yohimbine, increases blood flow into the penis. More recent studies have confirmed yohimbine’s benefits. Years before Viagra, the Food and Drug Administration (FDA) approved yohimbine as a prescription treatment for erection problems under the brand names Yocon and Aphrodyne.

Yohimbine may also boost women’s sexual arousal. University of Texas researchers gave 25 women complaining of arousal difficulties either a placebo or a combination of yohimbine and L-arginine (see ArginMax). The women then viewed erotic videos. Compared with those taking the placebo, the women who took the herb combination product reported greater sexual arousal.

Dose and Safety: Sexual benefits have been produced using 6 mg to 18 mg. Possible side effects include: increased heart rate and blood pressure, nervousness, irritability, headache, dizziness, tremor, and flushing.

NOTE: Yohimbine drugs are available by prescription only, however, many yohimbine preparations are available over the counter (OTC) at health food stores and supplement shops. Unfortunately, according to a 1995 analysis by FDA chemists, many OTC products contain only trace amounts of yohimbine. The FDA analyzed 26 over-the-counter yohimbine products. The yohimbine content of yohimbe bark is 7,089 parts per million (ppm). Concentrations found in the tested products ranged from less than 0.1 ppm to 489 ppm, probably not enough to have much sexual effect. If you’re interested in using yohimbine for a sexual boost, ask your doctor for a prescription.

Foods with Possible Sex-Enhancing Action

Oysters Scientists dismissed at oysters’ reputation as a sex-booster until nutritionists discovered that they are “exceptionally rich” in the essential trace mineral, zinc. Zinc is intimately related to male sexual health. Men with zinc-deficient diets are at high risk for infertility, prostate problems, and loss of libido. University of Rochester researchers have restored sperm counts in infertile men using zinc supplements. The mineral’s effect, if any, on sexual desire has not been researched. But processed foods are often low in zinc. In addition to oysters, whole grains and fresh fruits and vegetables contain Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 52 – this mineral. It can’t hurt to eat more of them.

Wild Yam This tuber’s sexual reputation springs from its traditional use in Latin America as a treatment for gynecological ailments. It turns out that wild yam is a potent source of diosgenin, a chemical resembling female sex hormones, which was used in the manufacture of the first birth control pills. Many herbalists tout wild yam salves for vaginal dryness, which makes intercourse uncomfortable for many women of all ages, particularly those who are postmenopausal.

Does wild yam have any effect on sexual desire? That remains to be investigated. But if it helps relieve vaginal dryness, it might make intercourse more enjoyable for women, which might spur some desire.

Wild Oats Many ranchers swear that horses fed wild oats become friskier and more libidinous. When humans behave that way, we say they’re “sowing their wild oats.” The research is scant, but many herbalists recommend wild oats, often in combination with ginseng and yohimbe, to boost libido.

In addition, oat bran is well known for its ability to reduce artery-clogging cholesterol. If oat products help improve blood flow into the heart, they just might do the same for blood flow into the genitals, which might enhance erection.

Commercial Combination Products

Experiment with individual aphrodisiac herbs if you like, you might prefer commercial products that combine some or many of these herbs. Dozens have come-hither names and line health food store and supplement shop shelves. But the mere presence of potentially aphrodisiac herbs is no guarantee of benefit. The dose may be too low. To date only three combination products have any studies to back them up:

ArginMax ArginMax for Women is a multivitamin that also contains ginseng, gingko, damiana, and L-arginine, an amino acid involved in the synthesis of nitric oxide, which plays a key role in sexual responsiveness. Several studies (but not all) have shown that L-arginine increases blood flow into the genitals. Stanford researchers gave a placebo or ArginMax for Women daily to 77 women with various sex problems. After two months, the ArginMax group reported significant increases in libido, frequency of lovemaking, and sexual satisfaction. ArginMax caused no significant side effects.

ArginMax for Men is similar, except that instead of damiana, it contains zinc. University of Hawaii researchers gave either a placebo or ArginMax to 21 men with erection problems. A month later, 89 percent reported improvement.

Dr. Polan, who conducted the study of ArginMax for Women, says she was “surprised” by her findings. “I didn’t expect it to work, let alone as well as it did.” She is quick to point out thatArginMax is not an aphrodisiac in the popular sense of the term—something that quickly throws libido into overdrive. It takes several weeks to experience benefit, and not everyone does. “ArginMax studies have had small numbers of subjects,” she explains, “so I’m not ready to get up on a soapbox and declare these products sure cures for male or female sexual dysfunction. On the other hand, ArginMax is safe. It costs only about a dollar a day. Mainstream medicine has no good treatments Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 53 – for female sexual dysfunction. And many men can’t take Viagra because of medical problems. My attitude is: If you have desire or arousal problems, why not try ArginMax? It just might help.”

Dose and Safety: Follow package directions. Ginseng has anticoagulant action. You may notice increased bruising. If bleeding becomes a problem, stop using ArginMax and consult your physician. ArginMax is not estrogenic, so it can be used by women who cannot take estrogen.

Zestra Developed by a research pharmacist, Zestra is a genital lotion for women that increases blood flow into the clitoris and vulva. Its ingredients include: borage seed oil, evening primrose oil, angelica root, and coleus extract. Borage and evening primrose oil are rich in gamma-linolenic acid, which increases the skin’s synthesis of prostaglandin E1, which improves blood flow and nerve conduction. Angelica root and coleus also improve blood flow. In the one small study published to date, 20 women used either a placebo or Zestra, and kept diaries documenting their reactions. Zestra significantly increased their arousal, genital sensation, sexual pleasure, and orgasm. “I’ve recommended Zestra to many patients,” says Chicago area gynecologist Elizabeth Baron-Kuhn, M.D. “In my experience, it works. It helps women have more enjoyable sex.”

Dose and Safety. The recommended dose is a fingerful massaged into the vulva five minutes before intercourse. The effect lasts about 45 minutes. Some women experience a mild burning sensation. Zestra is not easy to find in stores. To obtain it, call 1-877-4-ZESTRA or visit www.zestra-women.com

Xzite This is the only sex supplement whose active ingredients are Chinese herbs. Creator Barry Heck, M.D., a research physician in Los Angeles, says he relied on translated Chinese medical documents to screen 300 Chinese herbs, and selected the three most frequently recommended for women’s sexual problems: chrysanthemum, lovage, and spiny panax (a cousin of ginseng). Heck says these herbs increase synthesis of nitric oxide, which increases blood flow into women’s genitals. Efrem Korngold, O.M.D., a practitioner of Chinese medicine in San Francisco, confirms that the three herbs in Xzite “could improve libido and genital sensitivity.” In a study at UCLA, 48 women took Xzite or a placebo daily for two weeks. Those taking Xzite reported increased vaginal lubrication, sexual desire, clitoral sensitivity, and frequency of orgasm.

Dose and Safety: 1 capsule daily (500 mg). Headache and abdominal distress are possible. Xzite is available from drugstore.com and elsewhere on the Internet. Korngold says Xzite’s ingredients are safe at the recommended dose.

Two Surprise Aphrodisiacs: Exercise and Weight Loss

Want more sexual heat? Then work up a sweat. One indisputable aphrodisiac is exercise. James White, Ph.D., a professor emeritus of physical education at the University of California at San Diego, recruited 95 healthy but sedentary men, average age 47, into one of two exercise programs. One engaged in low-intensity, 60-minute walks four times a week. The other participated in an hour of aerobics. After nine months, both groups reported increased sexual desire and pleasure, but the aerobics group reported the greatest increase in fun in the sack. Exercise leads to fitness, and fitness, says Fair Oaks, California, sex therapist Louanne Weston, Ph.D., boosts self-esteem: “You feel healthier and more attractive, and you project that, so you look more alluring to prospective lovers.”

The same goes for weight loss. It’s amazing that Weight Watchers and Jenny Craig have not picked Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 54 – up on the this, but shedding extra pounds often boosts interest in sex. Ronette Kolotkin, Ph.D., a psychologist at the Duke University Diet and Fitness Center, noticed that people who lost weight at her Center often remarked that they felt more sexual. Curious, she surveyed 70 male program participants, aged 18 to 65, before and after weight loss of eight to 30 pounds. “After losing weight,” she says, “they all reported more sexual desire.” Excess weight makes most people feel less desirable, and more anxious about being seen naked. In other words, fat causes stress, and stress interferes with desire. Carrying extra weight also requires a good deal of energy. Dropping pounds frees that energy for use in more pleasurably erotic ways.

Appeal to All Five Senses

Mention “aphrodisiacs,” and most people think only of herbs or drugs. But that view is as limited as the missionary position. The most neglected ingredient of great sex is the context. When lovemaking becomes routine, the stimulating physical setting is usually the first thing to go. Instead of a deep-pile carpet by a roaring fire in a ski chalet with a magnificent view, it’s a dark bedroom on musty sheets when you’re both exhausted. For ordinary sex to become great sex, the setting is crucial. Appeal to your senses. Arouse all five of them.

Sight: Candles, Lingerie, and Videos One reason so many people are in the dark about great sex is that they make love with the lights off. Try candles. They illuminate lovemaking with a shimmering, romantic glow.

Speaking of getting an eyeful, when you receive a gift, opening the wrapping is half the fun. The same goes for sex. Dressing up in sensual outfits—then slowly undressing each other—turns ordinary lovemaking into a gift-wrapped surprise. “Unfortunately,” says Amy Levinson, of the My Pleasure collection of sensual enhancements (mypleasure.com), “most men think that sexy clothing means sheer teddies and skimpy underwear. Not many women have bodies that look good in those items, and even if they do, skimpy lingerie just doesn’t appeal to some women. Instead of feeling sexy, they feel self-conscious and turned off.”

Levinson says that visual sexiness has less to do with what’s revealed all at once than with what’s hidden and then slowly revealed. “In my experience, most women feel sexier in full-coverage silk or satin gowns that allow their charms to be revealed slowly, inch by arousing inch.”

The glow from a TV screen can also spice up sex, especially if the program you watch features couples enthusiastically coupling. Many sex therapists recommend X-rated videos as visual aphrodisiacs. Most men need little convincing. But many women consider traditional male-oriented pornography demeaning.

Some years ago, one former porn starlet, Candida Royalle, launched Femme Productions to produce X-video designed to appeal to women. Femme videos feature plenty of hardcore action, but the characters also have loving relationships and some emotional complexity.

According to two studies, Royalle’s videos do, indeed, turn on women. Donald Mosher, Ph.D., a professor of psychology at the University of Connecticut in Storrs, and Paula MacIan showed 395 college students (200 men, 195 women) one of six X-rated programs—three traditional porn videos, and three by Femme. Most men said they found both sets of videos equally arousing. However, the women clearly preferred the Femme programs. Compared with women who watched traditional porn,

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 55 – those who viewed the Femme videos reported considerably more arousal and subsequent intercourse.

In a similar study at the University of Amersterdam in the Netherlands, Ellen Laan and colleagues surveyed 47 women undergraduates’ reactions to traditional pornography and Femme videos. But this study delved deeper, as it were, into the participants’ sexuality. In addition to filling out a survey, the women were also fitted with tampon-like devices that measured vaginal engorgement, an indication of sexual arousal. In the survey arm of the study, the women greatly prefered the Femme programs, calling them much more arousing. Unexpectedly, however, both types of x-videos elicited similar vaginal reactions, suggesting that women’s feelings of sexual arousal are more subjective than objective.

Femme videos can be ordered from Adam & Eve.

Sound: Music Nothing complements the sound of heavy breathing better than your favorite tunes. And if your bedroom walls are thin, cranking up the volume can mask love’s little noises, and help you feel more comfortable whooping it up.

Touch: Bath or Shower and Massage “Every square inch of the body is a sensual playground,” sex therapist Weston says. “It’s sad that so many lovers, especially men, explore only a few corners.”

To discover the sensuality of the whole body, try a hot bath or shower together using a fragrant herbal soap. Bathing is a wonderfully arousing prelude to lovemaking. The warmth relaxes muscles made tense by the daily grind. And soaping and drying each other slowly can be marvelous turn-ons. For extra enjoyment, dry off with warm towels. Before you get into the water, drape your towels over a radiator or pop them into the dryer, so they’ll be warm when you use them.

Sharing massages is another way to get literally in touch with a lover. Massage is an intimate conversation without words. Simply pour some massage lotion on your hands, and stroke your honey’s hands, arms, legs, feet—and everything else. Many herbal massage lotions are available at bath, body, and aromatherapy shops.

Taste: Fine Food If you doubt that food can enhance sex, watch the video of Nine and A Half Weeks, (with Mickey Rourke and Kim Bassinger) and fast-forward to the refrigerator scene. Fine food—and the conversation that goes along with it—can be a wonderful form of foreplay that makes what happens after dessert taste even more delicious. Just go easy on the alcohol.

Smell: Scent-ual Aromatherapy and Pheromones What’s the aroma of lust? According to Alan Hirsch, M.D., neurologic director of the Smell and Taste Research Foundation in Chicago, it’s the familiar spice, cinnamon. Hirsch fitted male medical students’ penises with gauges that detected erection, and then exposed them to dozens of fragrances. The only one that got a rise was the smell of hot cinnamon buns. But other aromas may also add sensuality to sex. Try scented candles on your night table, or a bouquet of flowers, or a fragrant herbal potpourri, or a new perfume.

Or try pheromones, the odorless scent of sexual attraction. Odd as this may sound, the key to a new love affair—or heating up the one you’re involved in—might be right under your nose, or actually just inside it. That’s the location of the little-known, sixth human sense organ, the vomeronasal organ

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 56 – (VNO). The VNO detects virtually odorless chemicals called pheromones. Scientists have known for decades that animals have organs very similar to the VNO. They have also known that animals release pheromones during mating season to signal their sexual availability. But until twenty years ago, anatomists believed that humans did not possess a VNO and did not produce pheromones. Now we know differently.

Back in the 1980s, a research team led by David Berliner, M.D., at the time, an anatomist at the University of Utah, discovered the tiny VNO in pits of the nasal passageways of every person they examined. If people had VNOs, then they had to produce pheromones.

Many animals release pheromones from glands in areas that correspond to the human armpit. Berliner’s team looked there and isolated human pheromones from underarm secretions. In a series of studies, they discovered that heterosexuals respond only to human pheromones released by the opposite sex, while homosexuals respond to those of the same sex. How do they respond? Not sexually. Pheromones are not aphrodisiacs. But under the influence of pheromones people become friendlier, more vivacious, and more attractive. And with these qualities comes a greater likelihood that a social connection might lead to something more.

Pheromones are not a hot area of research. But a few intriguing studies have been performed:

* British researchers showed 32 young women photographs of men’s faces and asked them to rate their attractiveness. While viewing the photos, some of the women were also exposed without their knowledge to human male pheromones. The women exposed to the pheromones rated the men significantly more attractive.

* San Francisco State University researchers took these findings into the bedroom.They asked 36 heterosexual women, average age 27, to record their social connections with men for several weeks, everything from dating to intercourse. Then the scientists gave the women a vial of either a placebo or a laboratory synthesized female pheromone, and asked them to add it to cologne and use it daily. After six weeks, the pheromone group recorded significantly more social connections with men: conversations, more dates, more kissing, more sleeping in the same bed, and more intercourse.

Pheromones work the same way for men. Researchers at the Athena Institute for Women’s Wellness in Chester Springs, Pennsylvania added a placebo or male pheromones to cologne worn by 38 heterosexual men, aged 26 to 42. Like the women, the men who used the pheromones proved more attractive and reported social interactions with women, more dates, more kissing, more sleeping in the same bed, and more intercourse.

Pheromones work for people of all ages. Harvard researchers asked 44 postmenopausal women, average age 57, to use either a placebo perfume or one laced with human female pheromones. Again, the pheromone group reported significantly more interest from men, more affection from them and more lovemaking.

People produce pheromones in extremely tiny quantities, so the chemical cannot be harvested the way, say, sperm can be. All pheromone products use laboratory-synthesized pheromones, either male or female. Some commercial pheromone products claims to be mixtures of male and female chemicals that work on both sexes. However, all the research to date has used either female pheromones (which attract men) or male pheromones (which attract women).

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 57 – Pheromones are not fragrant. In fact, they are virtually odorless. So don’t be surprised when you rub them into your skin and smell nothing. Despite the lack of scent, their tiny molecules get into the VNO and make the gender you’re interested in feel more sociable toward you.

Pheromones also go a long way. You don’t have to use much to send the scent signal you want to broadcast.

Many companies market what they claim to be pheromone products. Unfortunately, consumers have no way to knowing if the products they buy contain pheromones. The San Francisco State researchers used a product called Realm, which costs about $70.

Aroused By Intimacy

Okay, so you’ve got a roaring fire in the hearth, soft music, scented candles, a pot of ginseng tea, and a plate oysters ringed by Chocolate Kisses. Now what? Your author wholeheartedly recommends the boardgame, “An Enchanted Evening.” It’s a delightfully sensual aphrodisiac-in-a-box.

“An Enchanted Evening” began in 1979 as a kiss-and-make-up offering from then-37-year-old Barbara Jonas of Scottsdale, Arizona, to her husband, Michael. They had a wonderfully erotic interlude playing the original version, and friends encouraged them to refine the game and market it commercially. Today, “An Enchanted Evening” is one of the nation’s best-selling adult board games. (It’s available at game stores nationwide, lingerie shops, and department store lingerie departments, or timefortwo.com)

“An Enchanted Evening” begins with each player writing a secret wish for later that evening. The first one around the board, wins his or her wish. Then you roll dice and draw game cards. Some are “talk” cards that ask open-ended questions designed to celebrate your relationship, for example: “You have lunch with a long-lost friend who asks, ‘What attracted you to your spouse?’ What did?” Others are “touch” cards with deliciously ambiguous directions, for example: “Kiss your spouse in a place that’s soft and warm.”

“An Enchanted Evening” made a believer out of Marty Klein, Ph.D., a Palo Alto, California, sex therapist, “When I first heard about it, I felt totally cynical. My wife and I had tried several so-called erotic games over the years, and I’d spent most of the time coming up with ways to improve them. But I thoroughly enjoyed ‘An Enchanted Evening.’ It encourages the kind of playful touch and supportive communication most couples stop sharing after a while. And it shows a profound understanding of how intimacy and sexual desire go hand in hand.”

They do, indeed. Take it from your author, “An Enchanted Evening” is one game no one ever finishes. The intimacy it enhances becomes an irresistable aphrodisiac within a half-dozen moves. Which just goes to show that the world’s greatest sex-stimulant is that crazy, wonderful emotion called love. Without love’s special magic, sexual enhancements fall flat. But for couples who share that intimate, chemical bond, aphrodisiacs, defined broadly, can transform lovemaking from “eh” to ecstatic.

Beware The Sex Killers

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 58 – If you want to rev up your sex life, first make sure you don’t shut it down. A surprisingly large number of everyday items are bad news in bed.

Alcohol In Macbeth, Shakespeare wrote that the substance used worldwide to coax reluctant lovers into bed “provokes the desire, but takes away the performance.” Truer words were never penned. If people of average weight drink more than two beers, cocktails, or glasses of wine in an hour, alcohol becomes a powerful central nervous system depressant. It interferes with erection in men, and impairs sexual responsiveness in women. Drink too much, and all you’ll do in the prone position is pass out.

Smoking One herb is hell on sex: tobacco. Smoking narrows the blood vessels, impairing blood flow into the penis in men, and causing an increased risk of erection impairment. In women, the same mechanism limits blood flow into the vaginal wall, decreasing vaginal lubrication.

Tranquilizers, Sedatives, and Narcotics There’s a good reason why these drugs are called “downers.” That’s what they do to sexual desire. Valium, Xanax, codeine, and synthetic narcotics (pain medications) depress libido.

Antidepressants Antidepressants usually work—but at a price. All except one (see sidebar: “Wellbutrin”) carry a considerable risk of sexual side effects: loss of desire and difficulty reaching orgasm in both sexes, erection impairment in men, and lubrication problems in women. Currently, the most popular antidepressants are the selective seratonin reuptake inhibitors (SSRIs): Prozac, Zoloft, Paxil, and a few others. According to Jamie Grimes, M.D., chief of outpatient psychiatry at the Walter Reed Army Medical Center in Washington, D.C., SSRIs cause sex problems in more than half of those who use them.

If you take an antidepressant, what can you do to preserve sexual function? Ask your physician about switching to Wellbutrin. It’s as effective as Prozac, but significantly less likely to cause sexual side effects including loss of libido.

Other Drugs An enormous number of prescription and over-the-counter medications can cause sexual impairment—even the antihistamines people take for allergies and cold symptoms. If a drug label says, “May cause drowsiness,” it can impair sexual desire or performance.” Unfortunately, few physicians mention the possible sexual side effects of the drugs they prescribe, for example Prozac or high blood pressure medication. Ask your doctor and pharmacist about the possibility of sexual side effects whenever you get a prescription.

High-Fat, High-Cholesterol, Meat-Centered Diet

Researchers at the University of South Carolina School of Medicine in Columbia tested the cholesterol levels of 3,250 men, aged 25 to 83, then asked them to complete questionnaires that explored sexual issues. Compared with the men whose total cholesterol was below 180 milligrams per deciliter of blood (mg/dl), those with levels above 240 were almost twice ask likely to report erection problems. Cholesterol levels relate directly to consumption of dietary fat and cholesterol, primarily in meats and whole-milk dairy products. Ironically, many Americans consider meat a “virility

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 59 – food.” In fact, it’s the opposite. Men who want sex without erection problems should cut down on or eliminate red meat and eat virility-preserving salads instead.

The Truth About Testosterone in Men and Androgens in Women

Everyone knows that testosterone is the primary male sex hormone. It’s only a short leap to the notion that extra testosterone might give men a sexual boost. It does—but only if you’re deficient. The vast majority of men are not.

“Testosterone,” says sexual medicine expert Theresa Crenshaw, M.D., author of The Alchemy of Love and Lust, “has been one of the most abused, misused, and overprescribed medications for male sexual dysfunction in medical history.” She compares the hormone to oil in a car: If you have enough, adding more doesn’t make your care run better. In fact, it may cause problems. Extra unnecessary testosterone throws the body’s hormonal circuitry out of whack, and may increase irritability, aggression, blood pressure, hair loss, and risk of prostate cancer.

But like a car low on oil, supplemental testosterone for men who are truly deficient can restore sexual functioning. The normal range for total testosterone (both “free” and “bound”) is 250 to 1,200 ng/ dl (nanograms per deciliter of blood), with free testosterone normally ranging from 1.0 to 5.0 ng/dl. Dr. Crenshaw recommend testosterone replacement only if total testosterone falls below 250, with the free hormone at 1.5 or less. Supplemental testosterone may be administered in several ways. Injection produces the greatest increase in blood level with the fewest side effects.i

Testosterone is not for men only. The ovaries also produce male sex hormones (androgens), though women have much lower blood levels than men. Androgens are responsible for female libido.

But at menopause, along with the drop in estrogen, women’s androgen production also declines. Several studies have shown that women with low sexual desire who have documented androgen deficiencies feel more libidinous. Years ago, high-dose androgen supplements caused acne and masculinizing side effects such as facial hair growth. Today’s lower doses are less likely to cause these problems. Side effects are even less likely with topical androgen creams.

Women with low or no desire who are interested in androgens should first ask their physicians to test their levels. If a few tests consistently show low androgen, then supplementation might help restore lost libido.

Selected References:

Adaikan, PG et al. “Proerectile Pharmacological Effects of Tribulus Terrestiris Extract on the Rabbit Corpus Cavernosum,” Annals of the Academy of Medicine of Singapore (2000) 29:22.

Adimeolja, A. “Phytochemicals and the Breakthrough of Traditional Herbs in the Management of Sexual Dysfunctions,” International Journal of Andrology (2000) 23(Suppl. 2): 82.

Anon. Review of Natural Products. “Ginseng.” 2-2001.

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 60 – Anon. Review of Natural Products, “Maca.” 8-1999.

Anon. Review of Natural Products. “Damiana.” July 1996.

Anon. Review of Natural Products, “Oats,” 1-91.

Anon. “Aphrodisiacs: Myth and Reality, Medical Aspects of Human Sexuality, Dec. 1991, p. 60.

Anon. “Weekend Therapy for a Depressed Libido,” Health, 1-2/96.

Anon. “Why Buns Turn Men On.” Men’s Health, 12-94.

Anon. “High Cholesterol May Raise Risk of Impotence,” Medical Tribune, 12-15-94.

Anon. “Trials Validate Some of Ginseng’s Mystical Powers,” Family Practice News, 3-1-96.

Arletti, R et al. “Stimulating Property of Turnera Diffusa (Damiana) and Pfaffia Paniculata Extracts on the Sexual Behavior or Male Rats,” Psychopharmacology (1999) 143:15.

Ashton, AK et al. Lettter to the Editor: “Antidepressant-Induced Sexual Dysfunction and Ginkgo Biloba,” American Journal of Psychiatry (2000) 157:836.

Betz, JM et al. “Gas Chromatographic Determination of Yohimbine in Commercial Yohimbine Products,” Journal of the Assocation of Official Analytical Chemistry (AOAC) International (1995) 78:1189.

Carey, M.P. and B.T. Johnson. “Efectiveness of Yohimbine in the Treatment of Erectile Disorder: Four Meta-Analytic Integrations,” Archives of Sexual Behavior, (1996) 25:341

Chen, J. et al. “Effect of Oral Administration of High-Dose Nitric Oxide Donor L-Arginine in Men with Organic Erectile Dysfunction: Result of a Double-Blind Randomized Placebo-Controlled Study,” BJU International (1999) 83:269.

Choi, HK et al. “Clinical Efficacy of Korean Red Ginseng for Erectile Dysfunction,” International Journal of Impotence Research (1995) 7:181.

Cicero, AF et al. “Lepidium Meyenii (Maca) Improves Sexual Behavior in Male Rats Independently from its Action on Spontaneous Locomotor Activity,” Journal of Ethnopharmacology (2001) 75:225.

Cohen, AJ and B Bartlik. “Ginkgo Biloba for Antidepressant-Induced Sexual Dysfunction,” Journal of Sex and Marital Therapy (1998) 24:139.

Crenshaw, T. Alchemy of Love and Lust.

Crenshaw, T. and J. Goldberg. Sexual Pharmacology.

Diokno, AC et al. “Sexual Function in the Elderly,” Archives of Internal Medicine (1990) 150:197.

Duke, J. Ginseng: A Concise Handbook, pp106-109. Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 61 – Ferguson, DM et al. “Randomized, Placebo-Controlled, Double-Blind Crossover Design Trail of the Efficacy and Safety of Zestra in Women With and Without Female Sexual Arousal Disorder,” Journal of Sex and Marital Therapy (2003) 29(s):33.

Furlow, F.B. “The Smell of Love,” Psychology Today, 3-4/96.

Gauthaman, K et al. “Sexual Effects of Puncture Vine (Tribulus Terrestris) Extract (Protodioscinn): An Evaluation Using a Rat Model,” Journal of Alternative and Complementary Medicine (2003) 9:257.

Gauthaman, K et al. “Aphrodisiac Properties of Tribulus Terrestris Extract (Protodioscin) in Normal and Castrated Rats,” Life Sciences (2002) 71:1385.

Gerber, J. “A Longitudinal Study of the Effects of Free Testosterone....” Fertility and Sterility (2003) 80(Suppl 3):S243.

Gillis, CN. “Panax Ginseng Pharmacology: A Nitric Oxide Link?” Biochemistry and Pharmacology (1997) 54:1.

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Gonzales, GF et al. “Effect of Lepidium Meyenii (Maca) on Sexual Desire and Its Absent Relationsip with Serum Testosterone Levels in Adult Helathy Men,” Andrologia (2002) 24:367.

Gonzales, GF et al. “Effect of Lepidium Meyenii (Maca), a Root with Aphrodisiac and Fertility- Enhancing Properties, on Serum Reproductive Hormone Levels in Adult Healthy Men,” Journal of Ethnopharmacology (2003) 176:163.

Hobbs, C. The Ginsengs: A User’s Guide.

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Ito, T. et al. “A Double-Blind, Placebo-Controlled Study of ArginMax, A Nutritional Supplement, for Enhancement of Female Sexual Function,” Journal of Sex and Marital Therapy (2001) 27:541.

Ito, T. et al. “The Effects of ArginMax, a Natural Dietary Supplement, for Enhancement of Male Sexual Function,” Hawaii Medical Journal (1998) 57:741.

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Klotz T et al. “Effectiveness of Oral L-Arginine in First-Line Treatment of Erectile Dysfunction in a Controlled Crossover Study,” Urology International (1999) 63:220.

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 62 – Klotz T et al. “Effectiveness of Oral L-Arginine in First-Line Treatment of Erectile Dysfunction in a Controlled Crossover Study,” Urology International (1999) 63:220.

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Morales, A et al. “Is Yohimbine Effective in Treatment of Organic Impotence?” Journal of Urology (1987) 137:1168.

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Mosher, D. and P. MacIan, “College Men and Women Respond to X-Rated Videos Intended for Male or Female Audiences: Gender and Sexual Scripts,” Journal of Sex Research (1994) 31:99.

Murray, M. “Saw Plametto in the Treatment of Benign Prostatic Hyperplasia: Abstracts and Commentary,” Americal Journal of Natural Medicine, 11-95, and Lawrence Review of Natural Products, March 1994.

Polan, ML et al. “Estrogen Bioassay of Ginseng Extract and ArginMax....” Journal of Women’s Health (2004) 13:427.

Reid, K et al. “Double-Blind Trial of Yohimbine in Treatment of Psychogenic Impotence,” Lancet (1987) 8556:421.

Rowland, D and W. Tai. “A Review of Plant-Derived and Herbal Approaches to the Treatment of Sexual Dysfunctions,” Journal of Sex and Marital Therapy (2003) 29:185.

Sohn, M. and R. Sikora, “Gingko Biloba Extarct in the Therapy of Erectile Dysfunction,” Journal of Sex Education and Therapy (1991) 17:53.

Stanislavov, R and V. Nikolova. “Treatment of Erectile Dysfunction with Pycnogenol and L-Argenine,” Journal of Sex and Marital Therapy (2003) 29:207.

Takihara et al. “Zinc Sulfate Therapy for Infertile Male...,” Urology, June 1987.

Waynberg, J and S Brewer. “Effects of Herbal vX on Libido and Sexual Activity in Premenopausal and Postmenopausal Women,” Advances in Therapy (2000) 17:255.

Werlinger K et al. “Perceived Changes in Sexual Functioning and Body Image Following Weight Loss in an Obese Female Population,” Journal of Sex and Marital Therapy (1997) 23:74.

White. J.R. et al. “Enhanced Sexual Behavior in Exercising Men,” Archives of Sexual Behavior (1991) 19:193.

Great Sex Guidance: Aphrodisiacs That Work – © Michael Castleman – 63 – Drugs That Might Cause Sex Problems

After 40, medication use becomes quite common. Three drugs are notorious for causing sex prob- lems: alcohol, antidepressants, and blood pressure medications (antihypertensives). But they are just the tip of the iceberg of drug-induced sexual side effects. Here is a comprehensive guide to drugs that might impair libido or sexual function.

The Key Word is “Might”

Before we delve into the drugs, however, it’s important to understand that the key word here is might. These drugs might have sexual side effects, but if you take any of them, you’re not fated to suffer them. Some people can have great sex after a few drinks, while others have one drink and sex is out of the question. Some people have no sex problems while taking Prozac, or blood pressure medica- tion, or other drugs linked to sexual impairment. Meanwhile, others take these medications and lose their libidos, erections, clitoral sensitivity, vaginal lubrication, or orgasms. Sexual side effects are highly individual. The important point is to understand that these drugs might cause sex problems. That way, if you develop any, you realize that the problem is probably a drug effect and not some col- lapse of sexual interest or function on your part or on the part of your lover.

If you believe you’re experiencing sexual side effects from any drug, consult your physician and phar- macist. It’s possible that another drug might be substituted, or that some other treatment might mini- mize the sexual side effects.

Over-The-Counter Drugs

Alcohol

In Macbeth, Shakespeare wrote that the substance used worldwide to coax reluctant lovers into bed “provokes the desire, but takes away the performance” (Act II, Scene 3). Truer words were never penned. The first drink reduces inhibitions. People are more likely to accept sexual invitations. How- ever, if people of average weight drink more than two beers, cocktails, or glasses of wine in an hour, alcohol becomes a powerful central nervous system depressant. It interferes with erection in men, and impairs sexual responsiveness in women. Sexual impairment depends on the individual (some people are more sensitive than others), on the dose (the more alcohol, the greater risk of impairment),

Great Sex Guidance: Drugs That Might Cause Sex Problems – © Michael Castleman – 64 – and on your weight (heavier people can tolerate more than lighter folks). But in large enough doses, alcohol’s impairment of sexual function is undeniable.

Tobacco

Smoking narrows the blood vessels, impairing blood flow into the penis in men, and causing an in- creased risk of erection impairment. Compared with nonsmokers, men who smoke are much more likely to suffer erectile dysfunction. In women, the same mechanism limits blood flow into the vaginal wall, decreasing vaginal lubrication.

Other Over-the-Counter Drugs

In addition, the following over the counter drugs have caused sex problems for some people:

* Aleve. Erection problems, no ejaculation in men. * Antihistamines (Benadryl, Dramamine). Erection problems. * Tagamet. Erection problems, with possible libido loss. * Zantac. Libido loss, erection problems.

Prescription Drugs

Blood Pressure Medications (Antihypertensives)

An enormous number of drugs are prescribed to lower high blood pressure. The bad news is that most of them have been linked to sexual side effects. The good news is that some are more likely than others to cause sexual impairment. If you experience problems while taking one class of anti- hypertensive medication, it’s reasonably likely that you can be switched to another class that doesn’t cause so many problems.

Here are the more problematic blood pressure drugs with their most common sexual effects.

* Aldactone. Libido loss, erection problems, decreased vaginal lubrication. * Aldomet. Libido loss, erection problems, delayed or no ejaculation in men, delayed or no orgasm in women. * Dibenzyline. Delayed or no ejaculation in men, ejaculation with no release of semen. * Esidrix. Erection problems. * Hydro-Diuril. Erection problems. * Hygroton. Libido loss, erection problems. * Hylorel. Libido loss, erection problems, delayed or no ejaculation in men. * Inderal. Erection problems. * Ismelin. Libido loss, erection problems, delayed or no ejaculation in men. * Normodyne. Erection problems, delayed or no ejaculation in men, with some reports of libido loss and priapism (painful, persistent erection). * Oretic. Erection problems. * Propranolol. Erection problems. * Tenormin. Erection problems. * Thalitone. Libido loss, erection problems. * Wytensin. Erection problems.

Great Sex Guidance: Drugs That Might Cause Sex Problems – © Michael Castleman – 65 – Antidepressants

The most popular antidepressants are the selective seratonin reuptake inhibitors (SSRIs), among them: Prozac, Zoloft, and Paxil. Unfortunately, SSRIs often cause sexual side effects.

The more sexually problematic antidepressants include:

* Prozac. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erec- tion problems. * Zoloft. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erection problems. * Paxil. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erection problems. * Celexa. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erec- tion problems. * Luvox. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erec- tion problems. * Tofranil. Erection problems, delayed or no ejaculation in men, no orgasm in women. * Nardil. Libido loss, erection problems, delayed or no ejaculation in men, no orgasm in women. * Desyrel. Priapism, with possible delayed or no ejaculation in men, no orgasm in women. * Effexor. Delayed or no ejaculation in men, with possible erection problems.

If you take an antidepressant, what can you do to preserve sexual function? Ask your doctor to re- duce your dose. You might find a dose that preserves mood elevation while relieving sexual side effects.

Or ask your physician to switch you to Wellbutrin. This antidepressant has occasionally been associ- ated with sexual side effects (libido loss and erection problems), but in general, it causes far fewer sex problems than other antidepressants.

Or try a “drug holiday.” This advice comes from Anthony Rothschild, M.D., a psychiatrist at McLean Hospital in Belmont, Massachusetts. He studied 30 couples, each with one member taking an SSRI, and reporting sexual side effects annoying enough to consider going off the medication. Rothschild advised them to go drug-free on weekends, from Thursday morning to Sunday at noon. Among the 20 taking Paxil and Zoloft (10 on each drug), half reported better sexual functioning and more desire over the weekend, and only two said they felt more depressed. But of the 10 taking Prozac, only one reported sexual improvement, probably because Prozac takes longer than the other SSRIs to clear from the blood. Note: Do not take a drug holiday without consulting the physician who prescribed your SSRI.

Anti-Anxiety and Psychiatric Medications

When drugs alter mood, they often affect sexuality. Here are the medications most often linked to sex problems:

* Anafranil. Libido loss, erection problems, delayed or no ejaculation in men, no orgasm in women. * Eskalith. Erection problems. * Lithonate. Erection problems. * Mellaril. Erection problems, delayed or no ejaculation in men, no orgasm in women. Great Sex Guidance: Drugs That Might Cause Sex Problems – © Michael Castleman – 66 – * Orap. Erection problems. * Permitil. Libido loss, erection problems. * Prolixin. Libido loss, erection problems. * Sulpitil. Erection problems. * Supril. Erection problems. * Thorazine. Erection problems, with possible priapism, libido loss, and delayed or no ejaculation in men and no orgasm in women. * Trilafon. Delayed or no ejaculation in men. * Xanax. Delayed or no ejaculation in men, no orgasm in women, with possible libido loss.

Seizure Medications

Many drugs used to treat seizures and convulsions cause sex problems. Here are the ones most frequently cited:

* Diamox. Erection problems, with possible libido loss. * Atretol. Erection problems, with possible libido loss. * Carbatrol. Erection problems, with possible libido loss. * Dilantin. Erection problems, with possible libido loss. * Epitol. Erection problems, with possible libido loss. * Mysoline. Erection problems, with possible libido loss. * Primidone. Erection problems, with possible libido loss. * Tegretaol. Erection problems, with possible libido loss.

Narcotics, Sedatives, and Tranquilizers

All narcotics, sedatives and tranquilizers can cause sex problems.

* Phenobarbitol (sedative). Erection problems, with possible libido loss. * Valium and similar drugs (anti-anxiety, anticonvulsant, muscle relaxant). Libido loss, delayed or no ejaculation in men, no orgasm in women.

Miscellaneous Prescription Drugs

Dozens of other medications have been linked to sexual impairment. Here are the ones most fre- quently cited:

* Atromid (cholesterol-lowering). Erection problems, with possible libido loss. * Danocrine (endometriosis). Libido loss, sometimes libido boost. * Digitek. (congestive heart failure). Libido loss, erection problems, with possible breast enlarge- ment in men. * Digoxin. (congestive heart failure). Libido loss, erection problems, with possible breast enlarge- ment in men. * Estrogen (hormone replacement therapy). Libido loss. * Ketoconazole. (antifungal) Libido loss, erection problems. * Lanoxin. (congestive heart failure). Libido loss, erection problems, with possible breast enlarge- ment in men.

Great Sex Guidance: Drugs That Might Cause Sex Problems – © Michael Castleman – 67 – * Methadone (drug addiction). Libido loss, erection problems, delayed or no ejaculation in men, no orgasm in women. * Mintezol (antiparasitic). Erection problems. * Niacin (high-dose for cholesterol-lowering). Libido loss. * Niacor ((antifungal) Libido loss, erection problems. * Nizoral. (antifungal) Libido loss, erection problems.

Illegal Drugs

Amphetamines, cocaine, crack, and other stimulants boost sexual desire, but impair orgasm, making sex decidedly frustrating. With regular use, desire fades as well.

The most sexually unpredictable illicit drug is marijuana. Some say it enhances lovemaking. But it makes other people withdraw or become anxious or irritable, which can ruin sex.

Help

If you believe that a sex problem is drug-related, but your doctor does not share your opinion, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References: Crenshaw, TL and JP Goldberg. Sexual Pharmacology: Drugs That Affect Sexual Function. Norton, NY, 1996.

Finger, W. et al. “Medications That May Contribute to Sexual Disorders,” Journal of Family Practice (1997) 44:33.

Great Sex Guidance: Drugs That Might Cause Sex Problems – © Michael Castleman – 68 –

New Sexual Moves: “You Want To Try What?!”

Your sex life isn’t exactly boring, but it’s not fireworks either, not like it was in the early days of your relationship. Perhaps you’re in a sexual rut. But even if you’re not, maybe your groove feels like it’s headed in that direction. Maybe you’ve been fantasizing about trying some variations to keep things fresh and exciting – perhaps some lingerie, or a certain sex toy, or something a little kinky. But you’re not sure how your honey will react to your ideas.

It’s Difficult to Request Any Change, Sexual or Not

Asking for a change in any aspect of couplehood means taking a risk. But when you ask for sexual changes, the risks can feel overwhelming. You might fear that your lover will think you’re more dissatisfied that you really are. You might fear accusations of being “weird.” And if you’re always the one interested in sexual experimentation, you might feel reluctant to appear pushy or demanding. These are all legitimate concerns.

But, on the other hand, you crave some novelty in the sack. How do you make it happen? It may be less difficult that you think.

Try Some New Things Out of Bed

Trying new things in bed is a subset of trying new things in general. As people become more willing to try new things out of bed, they tend to become at least a little more open to sexual experimentation as well. So, a good place to start promoting sexual novelty is in the area of nonsexual fun. Suggest a new restaurant, a new hiking trail, golf course, or some home redecoration. Keep things playful. Try to see your injections of novelty as experiments. Many experiments fail. That’s fine. So what if you or your honey decides you don’t like the new restaurant or whatever. What’s important is a mutual willingness to continue experimenting to try new things together.

New things need not be major things. When you’re trying to persuade a lover of the joys of experimentation, small changes are significant steps in the right direction. Be patient.T ry to keep a sense of humor.

Great Sex Guidance: New Sexual Moves- “You Want To Try What?!” – © Michael Castleman – 69 – If your honey is a real stick-in-the-mud, no matter how much that trait might frustrate you, you can, ironically, use it to encourage experimentation. Many fuddy-duddies don’t abhor change as much as they really enjoy what’s familiar. But the familiar always feels more comfortable and cozy when you return to it from something else. In other words, to truly appreciate the familiar, it helps to take some breaks from it. One of the pleasures of vacations is returning home to your own bed, your familiar surroundings. But to enjoy that pleasure, you have to take the vacation. If you’d like your honey to experiment more, it usually helps to celebrate returning to the tried and true. Try gently pointing out that novelty is the gateway to appreciating the familiar.

Surprise Dates

One way to enjoy playful mutual experimentation is to take turns planning “surprise dates.” Here are the rules: One of you takes complete responsibility for planning the date and keeps it a secret until it’s time to leave home. The other agrees to go along for the ride. The planner specifies what to wear and when to meet, and agrees not to plan anything that will truly unnerve the other. The follower agrees to play along, even if the date involves something unfamiliar, for example, dance lessons or a moonlight canoe ride.

Even without an overtly sexual component, secret dates carry an intimate, erotic charge. You’re focused on each other. You’re sharing special time together. Both of you must trust one another. Both share in the anticipation of special, possibly unusual time together. And both know that next time, the tables will turn.

For your first several surprise dates, don’t introduce any sexual novelty. Give your lover time to warm up to the notion of regular novelty-and to trusting you not to overdo any surprises. When you decide to introduce some sexual novelty, say so in advance, refrain from anything too out of the ordinary, and reassure your lover that what you have in mind is new, but not threatening.

Because they are intimate-and implicitly erotic-even when they’re not overtly sexual, surprise dates can be easily, and deliciously transformed into opportunities for sexual experimentation. Say you’re the planner, and you take your reluctant-to-experiment honey to an old familiar bar, then on to an old favorite restaurant, and from there, to a stroll along an old familiar route. By the time, you’ve walked 50 yards, your spouse is bound to ask: “So, what’s the surprise? What’s new and different?” To which you reply: “Wait till we get home.”

Birthdays, Anniversaries, Valentine’s Day

Once you’ve introduced the idea of ongoing experimentation, your birthday, anniversary, Valentine’s Day, and other dates that hold special meaning for the two of you are good times to take things a bit further. Again, don’t expect any great leaps beyond your lover’s comfort level. But compared with other days of the year, it’s often easier to ask for experimentation on special days – and the other person tends to be more likely to grant such requests.

Why Hotels Often Spur Erotic Novelty

When it comes to sex, the setting has a great deal to do with willingness to experiment. That’s why so many couples discover that romantic getaways produce sexual enhancement. Hotel rooms contain nothing that reminds you of all your responsibilities back home or at work. They’re a time-out from your life. At a hotel, it’s easier to live in the moment, to step out of familiar routines, and try new Great Sex Guidance: New Sexual Moves- “You Want To Try What?!” – © Michael Castleman – 70 – things.

You can bring a bit of the same freshness to sex at home by making love at a different time or in a different room of the house.

Lubricant as Gateway to Novelty

But how do you introduce something really different into your sex life? For example, how do you persuade a reluctant lover to try sex toys? A good place to begin is to introduce lubricant into your lovemaking. For the vast majority of people who try them, lubricants enhance sex immediately. As a result, your novelty-shy lover is very likely to enjoy instant sexual benefits from this little experiment. In addition, if your ultimate goal is to introduce sex toys into your relationship, vibrators, dildos, and many other toys provide the most pleasure and fun when they are well lubricated, so you’ll want lubes to be familiar and handy when you introduce toys.

Be Patient

When working to coax a reluctant lover to try new things in bed, it’s very important to be patient. Warming up to sexual novelty often takes time. Give your lover the gift of that time. Take small steps along the path to your ultimate goal.

This is especially true when a lover says: “We’re too old for that.” Advancing age makes many people reluctant to try new things. But it also opens doors to novelty. If your partner dismisses your promotion of sexual novelty by saying “you can’t teach an old dog new tricks,” ask what your spouse plans to do after retirement. Retirement plans often include: more travel, more time for hobbies, more socializing, and perhaps moving to a new home—all new things for old dogs. If you can consider a huge change like moving, is it so difficult to conceive of playing with a vibrator?

Half a Loaf Is Better Than None

As you move slowly away from your old routines and toward experimentation, you may have some ultimate sexual goal in mind. If you reach that goal, great. But most lovers find that getting part of what they desire is almost as good. There’s an old saying: Half a loaf is better than none. In sex, half a loaf can feel quite wonderful. If you don’t get the whole loaf, count your blessings. Half a loaf often feels like a major improvement.

Adam & Eve offers a wide variety of sex toys.

For individualized assistance dealing with negotiating a mutually satisfying sexual repertoire, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Great Sex Guidance: New Sexual Moves- “You Want To Try What?!” – © Michael Castleman – 71 – Fantasies During Sex: Welcome Them

The New York Times magazine published the results of a survey that asked married couplesof all ages: “As long as you’re sexually faithful to your spouse, do you think it’s okay to fantasize about hav- ing sex with someone else?” More respondents said “no” (48 percent) than “yes” (46 percent). (Six percent declined to answer).

Meanwhile, other surveys have shown that while making love with spouses or regular lovers, the vast majority of people fantasize at least briefly about having sex with other people. In fact, in a survey by University of Vermont researchers, sex with a partner other than one’s regular lover was the single most popular fantasy: 84 percent of the 178 respondents admitted having it during intercourse.

In the Vermont survey, many respondents expressed “significant guilt” about such fantasies, believing them the moral equivalent of unfaithfulness, and harmful to their relationships.

In addition, those who felt the most guilt about fantasies of other lovers also reported the least overall sexual satisfaction.

Fantasy and Friction

Fulfilling lovemaking is a combination of friction and fantasy. Most lovers enjoy the friction. But many feel uncomfortable with their own fantasies. What a shame to feel guilty about something as normal— and healthy—as sexual fantasies during lovemaking.

If you feel “mentally unfaithful” when you have fantasies of others lovers during lovemaking with your main squeeze, you might be able to forgive yourself if you view sex as a interpersonal form of spiritu- ality, a mutual meditation, if you will.

In meditation people take an uninterrupted break from their usual activities. They sit quietly, breathe deeply, empty their minds of all conscious thoughts, and focus on their breath or repeat a word or phrase (mantra). With a little practice, you feel connected to the universe. But emptying the mind is not easy. For most people, it’s impossible. Random thoughts dart in and out of consciousness. Medi- tation teachers advise simply accepting these thoughts without judging them, no matter how dis- concerting they might be. Your thoughts during meditation are no reflection on you. They are simply

Great Sex Guidance: Fantasies During Sex- Welcome Them – © Michael Castleman – 72 – there, like dreams. You’re not responsible for them. Observe them, and then let them go.

Sex As Meditation

Lovemaking is surprisingly similar. It involves an uninterrupted break from the routine. Lovers breath deeply, relax, and feel deeply connected with each other. Lovers don’t sit quietly (at least I hope not). Instead, they substitute sensuality for mantra. But in most respects, sex is similar to meditation.

It might be nice during sex to empty your mind of all thoughts other than those of your lover. But as in meditation, that’s impossible. Other thoughts—including fantasies of other lovers—almost inevitably come and go. Perhaps you flash on making love with a movie star or an adult vision of the kid who sat next to you in high school English. Perhaps you have fantasies of group sex, sex in public, or BDSM. As in meditation, try to accept your fantasies without judging them. They are no reflection on your morality, faithfulness, or mental health. In sexual fantasy, as in meditation, everything is permit- ted and nothing is wrong.

The only time a sexual fantasy of another lover might signal a problem is if you take steps to make it happen. But here we’re not focusing on affairs. We’re concerned with true fantasies—the strange, marvelous, weird, impossible, fleeting notions that occupy the mind for a moment then go their merry way.

Accept Your Fantasies

Sexual fantasies happen naturally. They are no reflection on you, your mental health, or the quality of your relationship.

Sexual fantasies also tend to diminish with age—in one study, 60-year-old women reported only half as many as 25-year-old women. But no matter how many you have, accepting them allows greater relaxation during lovemaking, and relaxation is key to sexual enjoyment. Feeling guilty about sexual fantasies injects anxiety into sex, and anxiety interferes with the pleasure of lovemaking. No wonder that in the University of Vermont survey, respondents who said they felt guilty about their fantasies of others lovers were also the ones who reported the least overall sexual fulfillment.

The late comedian, Rodney Dangerfield, used to tell a story about making love with his girlfriend. But something is wrong. Neither of them feels passionately aroused. Finally, Dangerfield disengages and says: “What’s the matter? Can’t you think of anyone either?”

Adam & Eve offers a wide variety of sex toys that might encourage fantasies.

References:

New York Times Magazine, May 7, 2000.

Cado, S and H. Leitenberg. “Guilt Reactions to Sexual Fantasies,” Archives of Sexual Behavior (1990) 19: 49

Hicks, TV and H. Leitenberg. “Sexual Fantasies About One’s Partner Vs. Someone Else: Gender Dif- ferences in Incidence and Frequency,” Journal of Sex Research (2001) 38:43.

Great Sex Guidance: Fantasies During Sex- Welcome Them – © Michael Castleman – 73 – Purifoy, FE et al. “The Relationship of Sexual Daydreaming to Sexual Activity, Sexual Drive, and Sexual Attitudes for Women Across the Life Span,” Archives of Sexual Behavior (1992) 21:369

Smith, D and R. Over. “Enhancement of Fantasy-Induced Sexual Arousal in Men Through Training in Sexual Imagery,” Archives of Sexual Behavior (1990) 19:477.

Great Sex Guidance: Fantasies During Sex- Welcome Them – © Michael Castleman – 74 – Forget “Foreplay,” Cultivate Loveplay

Everyone knows about foreplay. It’s what lovers do before intercourse. That’s why it’s called fore-play. It comes before the main event. But enlightened lovers who want really hot, erotic sex should forget foreplay, jettison the very notion. Foreplay makes no sense, and can actually detract from great sex.

Take Your Time

Foreplay tends to be rather brief. Inspired by what they see in pornography and on TV and in the movies, many couples rush through the preliminaries to get to intercourse. This robs both lovers of pleasure. Sex experts agree that the best, hottest sex—and the most intense orgasms—emerge from slow, playful, extended, non-formulaic lovemaking.

Speaking of brief, that’s one of women’s biggest complaints about how men make love—too quickly. Most women prefer a slower pace. It takes most women longer than men to warm up to sex, particularly genital play. In the foreplay-leads-to-intercourse model of lovemaking, women often don’t get enough warm-up time to be able to enjoy genital play.

Beyond Linear Lovemaking

Fundamental to the idea of foreplay is the notion that lovemaking proceeds in a linear progression: first, some kissing and hugging, and after that, some touching and rubbing here and there.Then the foreplay is over and the real deal begins, intercourse.

But the best sex isn’t linear. The best sex doesn’t go from A to B to C and then jump to I, for intercourse. Linear lovemaking is too predictable. Over time, it becomes boring. The best sex, the kind that never becomes boring, involves playfully unpredictable moves.

“Foreplay” implies that intercourse is the last activity of lovemaking, that once intercourse begins, foreplay is over, and the intercourse continues until the lovers have orgasms. But this model of lovemaking shortchanges both women and men—especially those over 40.

How “Foreplay” Shortchanges Women of All Ages

Lovemaking that begins with foreplay and ends with intercourse means that half of women—or more—don’t have orgasms. Forget what you see in movie and TV sex. Dozens of studies show

Great Sex Guidance: Forget “Foreplay,” Cultivate Loveplay – © Michael Castleman – 75 – that only about one-quarter of women are reliably orgasmic solely from vaginal intercourse. Another quarter of women or so have orgasms from intercourse only rarely or occasionally. Not that there’s anything wrong with intercourse. It involves intimate closeness and can be great fun, even for the majority of women who rarely or never experience orgasm with an erection inside their vaginas. But intercourse just doesn’t provide enough direct clitoral stimulation to allow most women to have orgasms.

Some women who find it difficult or impossible to have orgasms during intercourse are convinced that something is wrong with them. Nothing is wrong. Absolutely nothing. It’s a sad commentary on the state of sex education in America that so few people understand that a solid majority of women need direct clitoral stimulation to express orgasm—by hand, tongue, sex toy, or an erection that leaves the vagina and presses against the vulva, allowing the head of the penis to rub up against the clitoris.

The fixation on foreplay as prelude to intercourse is also particularly problematic for women over 40. After 40 as menopausal changes begin and then accelerate, vaginal dryness becomes a problem for many women. Lubricants can often alleviate this problem. But for many older women, even with lots of lube, intercourse becomes uncomfortable, and possibly even painful.

How “Foreplay” Shortchanges Men Over 40

After around age 40, erections change. The reliable, solid erections of young adulthood become the iffy, balky, temperamental erections of middle age. This is normal. It happens to every man. Even with the help of erection drugs, many men over 40 have erections that may not be firm enough to insert into even a highly-aroused, well-lubricated vagina.

As a result of the problems that both older women and men develop, intercourse becomes increasingly problematic with age. The conventional view that sex involves a linear progression from foreplay to intercourse limits their pleasure and may frustrate them or leave them feeling inadequate. The fact is, vaginal intercourse is not necessary for erotic pleasure and fulfillment.There are plenty of marvelous ways to make love that don’t include it.

It’s All Loveplay

Forget “foreplay.” From the moment you begin undressing until the last delicious vestiges of afterglow subside, you’re making love. Everything you and your lover do together is “loveplay.”

Loveplay isn’t cookbook. Instead of plowing from A to B to C to I, make an effort to inject some unpredictability into your lovemaking. That helps keep it exciting.

Loveplay isn’t linear. Loveplay doesn’t put intercourse on a pedestal at the end of a one-way street. If you can have intercourse comfortably, feel free to enjoy it for a while, and then return to massaging each other, playing with toys, or having oral sex—whatever you like. And afterward perhaps some more intercourse, if that’s possible for you.

Sex therapists agree that great sex is based on slow-paced, leisurely, playful, mutual whole-body massage that includes the genitals once lovers feel erotically warmed up. Massage is a marvelously meandering experience. There’s no predicting which part of the body will be massaged next or for how long. Great lovemaking is similar, only it includes the genitals. Massage them for a while with

Great Sex Guidance: Forget “Foreplay,” Cultivate Loveplay – © Michael Castleman – 76 – your hand or mouth or a sex toy, then massage some other part of your lover’s wonderful body for a while, and return to the genitals later.

Rather than the linear model of foreplay-then-intercourse, great sex is more circular. It moves from one form of mutual touch to another and back again, over and over, as many times as you like or have time for.

So forget “foreplay,” and treat yourself and your lover to whole-body loveplay. It’s more fun, more erotic, and ultimately, more fulfilling.

References: Miller, AS and ES Byers. “Actual and Desired Duration of Foreplay and Intercourse: Discordance and Misperceptions in Heterosexual Couples,” Journal of Sex Research (2004) 41:301.

Mohn, T. “The Spa Experience as Tuneup: Reports Discover That Men and Women See Massage Differently,” New York Times, 5-31-2005.

NewScientist.com. “Scientists Reveal the Secret of Cuddles.” 7-28-2002.

Great Sex Guidance: Forget “Foreplay,” Cultivate Loveplay – © Michael Castleman – 77 – No One “Gives” Anyone an Orgasm

Many people have difficulty having orgasms, especially during partner sex. Only 25 percent of women are consistently orgasmic during intercourse. An estimated 5 to 10 percent of men have trouble with orgasm. Their lovers often make an erotic project of “giving” them fabulous orgasms—and wonder how to do that.

On the one hand, the wish to “give” great orgasms is laudable, especially for men who hope to “give” them to women. In the Western world, until the early-20th century, sex was something for men to enjoy, and women to tolerate. Men “took” sex from women. Women were considered merely fleshy receptacles for men’s lust. Many people believed that women were unable to experience sexual plea- sure, so men had no responsibility to provide it.

Today, we know that women are just as capable of sexual pleasure as men are, and that good love- making involves both lovers taking turns receiving and giving erotic enjoyment. Compared with how men felt a century ago, the wish to “give” women orgasms represents sexual progress.

But no one “gives” anyone else an orgasm.

Orgasms: Like Laughter

Orgasms emerge from deep inside us when conditions are right. Comedians can tickle our funny bones. But they don’t “make” us laugh. They allow us to. They create the conditions that encourage us to produce laughter from deep within ourselves.

Orgasms are similar. They, too, emerge from deep within us when conditions are right. For most people, the conditions that encourage orgasms include: trust, comfort, relaxation, love, and whole- body massage that eventually focuses on tender caresses of the genitals.

Lovers create the physical and emotional context that allow orgasms to happen. A lover can be trust- worthy. A lover can help you relax. A lover can caress you the way(s) you enjoy, the way(s) that allow you to dive deep enough into your own sexuality and sexual fantasies to produce your own orgasms.

Great Sex Guidance: “Giving” Orgasms – © Michael Castleman – 78 – A lover can also destroy the conditions that allow orgasm by being untrustworthy and causing grief instead of relaxation and comfort.

But lovers don’t “give” each other orgasms. Each of us is responsible for our own orgasms. We pro- duce them ourselves.

How to Make Erotic Requests

That’s why it’s so important for lovers to tell one another what they enjoy, what turns them on. Of course, this is often not easy. Here are some suggestions:

* No one is a mind-reader. Forget all the romantic Hollywood nonsense about knowing instinc- tively which erotic moves your lover wants. Being in love doesn’t confer magical powers that allow people to read each other’s sexual minds. Your lover doesn’t know what turns you on unless you say so. * You don’t have to be didactic. You don’t have to say: I love having my nipples sucked gently, but I hate having them squeezed, pinched, or bitten. Instead, when your lover does something you en- joy (or close it), just say “yes” or “ahhh.” When your lover’s moves don’t thrill you, simply remain silent. Most lovers quickly provide more of what elicits a “yes” and less of what greets them with silence. Over time—usually a month or two—you can get a lot more of what you want, and less of what you don’t, simply by saying “yes” and/or “ahhh.”

* Review sex afterwards. It’s often difficult to direct a lover’s moves while you’re in the throes of lovemaking. Even “yes” or “ahh” can be difficult. But afterwards, it’s often easier to comment. Be- gin with compliments. Highlight what you enjoyed, and ask for more of it. For example: “Remem- ber when you were giving me oral and you circled my clit with out your tongue? That was great. I’d love that every time.”

* Be positive about negatives. If a lover does anything you really can’t stand, feel free to say so, but give it a loving spin. List a few moves you enjoy, then criticize the one you don’t. For example: I really love the way you stroke my penis and suck me, but when you squeeze my balls, it kinda hurts. Can we leave that out from now on?

* Be experimental. As marvelous as sex can be, the same old moves can get boring after a while. You might try a new place, for example, a romantic weekend getaway. You might try candles, mu- sic, or sex toys.

* Be patient. It takes some people—both men and women—quite a while to work up to orgasm. Sometimes, it’s situational. If you’re feeling anxious, tired, ill, or unhappy about your relationship or sex, it can take longer then usual. But some people always take quite a while. That’s just who they are. That’s fine. If your lover takes what you consider to be a long time, or if he or she has ever apologized for “taking so long,” reassure the person that you’re there for them, no matter how long it takes. Invite them to relax and focus on their own erotic feelings, not on how impatient they imagine you to be. The anxiety people feel about thinking that they take too long actually interferes with orgasm ability. So be patient, and tell your lover you’re patient. That should help with their orgasms. (Vibrators often help people have orgasms more quickly. Adam and Eve offers a wide selection of vibrators)

Great Sex Guidance: “Giving” Orgasms – © Michael Castleman – 79 – If you incorporate these suggestions into your lovemaking, your lover should feel comfortable, re- laxed, trusted, accepted, and loved enough to have orgasms. But remember, you don’t “give” or- gasms. You’re the catalyst. You help create the conditions that allow them to emerge.

The question is not: How can I give my lover wonderful orgasms? The question is: What can I do to help my lover relax, feel accepted, trusting, comfortable, and loved so that his or her orgasms will emerge?

Great Sex Guidance: “Giving” Orgasms – © Michael Castleman – 80 – Great Sex Without Intercourse: A Creative Alternative For Older Couples

We live in a sexual culture focused on intercourse. To many Americans “sex,” means intercourse— with the man able to raise and maintain a firm erection and the woman’s vagina naturally well-lubri- cated enough for comfortable accommodation of the man’s erection. Pornography, the leading source of sex education, is fixated on huge, rock-hard erections and the in-and-out of intercourse. iagraV and the other erection medications currently have sales of $2.5 billion a year.

There’s nothing wrong with intercourse—assuming that it’s consensual and well-lubricated, and that men understand that only about 25 percent of women are consistently orgasmic during it. But our culture fixation on sex-means-intercourse leaves many men and couples over age 40 feeling inad- equate, and frustrated. Even with erection drugs, a considerable proportion of men over 40 have trouble raising erections persistent enough and firm enough to allow vaginal intercourse.

The New Sexual Frontier for Older Couples: Erotic Fulfillment Without Intercourse

Fortunately, there’s an erotically fulfilling alternative that offers older couples relief from the pressures and frustrations of intercourse-dominated sex—lovemaking without intercourse.

Sex without intercourse requires both the man and woman to make adjustments—and at first, many couples find them disconcerting. But sex without intercourse allows lovers over 40 to enjoy hot, fulfill- ing lovemaking for the rest of their lives no matter how long they live.

It’s actually quite easy to enjoy great sex without intercourse. As far as non-genital sensual play is concerned, great sex minus intercourse involves the same leisurely, playful, whole-body touching, caressing, and massage that sexuality authorities recommend to lovers of all ages. But genitally, it leaves vaginal intercourse behind, and focuses instead on all the other ways couples can enjoy geni- tal sex: hand massage (your own hand and/or your lover’s), oral sex, and sex toys, particularly penis sleeves for men, and dildos and vibrators for women.

For many couples, great sex without intercourse means experimenting with new approaches to mutu- al pleasure. This novelty can feel strange at first. But novelty is a key element in sexual zing. In other words, if you incorporate new approaches you both enjoy, lovemaking without intercourse can feel hotter than ever.

Great Sex Guidance: Great Sex Without Intercourse- A Creative Alternative For Older Couples – © Michael Castleman – 81 – Age-Related Sexual Changes: Men and Women Are Out of Synch

Typically, after 45 sex becomes more challenging for men than women. Young men are generally eager for sex. They’re often so consumed with sexual energy that young men are often said to have “only one thing on their minds.” While erection problems are possible in young men (usually the result of illness or major life stresses), most young men raise erections easily. Their main problem is post- poning ejaculation.

Meanwhile, women tend to have their most challenging sex problems before age 30. Young women often feel ambivalent about sex, on the one hand, curious about it and perhaps eager to experience it, but on the other, conflicted about the many ways society judges them harshly for being sexual. It they’re too reluctant, they’re “prudes.” If they’re too eager, they’re “tramps” or “sluts” and they become saddled with “bad reputations.” Complicating matters, there’s no clear definition of what it means to be “too” reluctant or “too” eager.

Many young women also have difficulty becoming sexually aroused, and having orgasms. Our culture exhorts women to be desirable. Preoccupied with the challenges of appearing attractive, many young women don’t pay much attention to their own desire. Fortunately, as the years pass, most women become more comfortable with who they are sexually, and learn to enjoy lovemaking.

Fast-forward to the years after 40. Women face a few menopausal sexual issues, notably, vaginal dryness and for most, some decline in libido. In the vast majority of cases, dryness can be eliminated fairly easily with the help of a sexual lubricant. And while desire usually diminishes in the early years of menopause, it often rebounds to some extent by 60. Most post-menopausal women are still capa- ble of enjoying sex and don’t want to see lovemaking disappear from their lives and relationships.

Meanwhile, as men grow older, they face more daunting sexual issues. Erection capacity declines. Starting around 40, some men find they can no longer raise firm, or even partial erections simply by imagining sexual scenes. This becomes a problem for most men after 50.

In addition, as time passes, it takes increasing amounts of manual and/or oral stimulation for older men to raise erections and maintain them long enough of have intercourse—if they are able to have intercourse at all. Many men find these changes very upsettting.They remember decades of trying to keep erections down. Suddenly, they have trouble getting them up. They recall decades when just about anything could get them sexually aroused. But after 40 or 50, quite often even an alluring, will- ing lover who suggests having sex may not arouse them.

This is totally normal. As men age, the nervous system loses some of its sensitivity to sexual stimula- tion. Touch that gave men firm erections at 22 might not do much for them at 59. And even in healthy men largely free of the deposits that limit blood flow through the arteries and cause heart disease and most strokes, older arteries still narrow somewhat and less blood flows into the penis.As a result, it becomes more difficult to raise and maintain firm erections.

Erection decline can be postponed with a healthy lifestyle (more fruits and vegetables, less meat and cheese, regular exercise, weight control, and limiting alcohol), and ameliorated to some extent with erection medication. But as the years pass, many men find that erection capacity declines despite a healthy lifestyle, and that they need larger doses of the drugs to gain any benefit.At some point—age 65 or 70 or 75—even high-dose erection drugs may not help much any more.

Great Sex Guidance: Great Sex Without Intercourse- A Creative Alternative For Older Couples – © Michael Castleman – 82 – As erection function declines, some men decide they’ve reached the end of their sexual rope. Raised in our intercourse-focused culture, they can’t imagine sex without erection, without intercourse.

But it doesn’t have to be that way. Sex can still be fun and fulfilling even when intercourse is difficult or impossible. Surveys of men who lose erection capacity—young men involved in serious motorcycle accidents and older men who have experienced erection loss because of prostate cancer surgery— show that it can take several years for men to adjust to sex without intercourse. But over time, most men who are open to sexual alternatives learn they can still enjoy sexual pleasure without erections and without intercourse. Eventually they learn to enjoy lovemaking without genital union. As time passes, they often say they feel as sexually satisfied as they did when they had erections and inter- course.

Great Sex Without Intercourse—For Men

Hand-massage of the penis is a major part of sex without intercourse. Many men over 40 find that they can raise their firmest erections through masturbation. But they often find that being stroked by their lover doesn’t have the same effect. One option is for the man to show the woman how he likes to be stroked by demonstrating it for her. If a man has never masturbated in the presence of a lover, this can feel awkward for both of them. It’s an adjustment to masturbate before an audience. But self-stimulation in front of a lover serves an important function. It demonstrates clearly which strokes turn her man on, and helps her provide the most stimulating caresses. It also deepens the couple’s intimacy. Intimacy involves self-revelation. What’s more self-revealing than showing a lover how you enjoy sex with yourself? Once the woman knows exactly what her man finds most arousing, she can provide what he finds most pleasing. She can also enjoy the satisfaction of knowing that she’s giving him what he truly wants.

Fellatio is also a major component of great sex without intercourse. Forget the telephone poles women suck in porn. The fact is that men can enjoy considerable pleasure from having their penises sucked even if they are only partially erect or even flaccid.

Contrary to popular mythology, a firm erection is not necessary for ejaculation and orgasm. It’s quite possible to ejaculate with a partial erection or no erection—if the man receives sufficient stimulation, for example, fellatio with one of the woman’s hands stroking the shaft of the penis while the other gently fondles his scrotum.

Couples engaged in non-intercourse lovemaking might also want to try penis sleeves, artificial va- ginas or mouths that, when lubricated, feel remarkably close to the real thing. A man whose erec- tions are not firm or persistent enough for real vaginal intercourse may be able to slip his penis into a sleeve. Penis sleeves can be easily incorporated into partner lovemaking. Sex toy marketers sell sleeves. Adam & Eve offers many different penis sleeves.

Great Sex Without Intercourse—For Women

Hand massage of the vulva and clitoris and cunnilingus are certainly available to couples with men who can’t manage intercourse. In fact, at every age, women are much more likely to be orgasmic from hand massage and/or oral sex than from intercourse. Only 25 percent of women are reliably orgasmic during intercourse. Three-quarters of women of all ages need direct clitoral stimulation to experience orgasm.

Great Sex Guidance: Great Sex Without Intercourse- A Creative Alternative For Older Couples – © Michael Castleman – 83 – Meanwhile, for women who enjoy feeling filled up, dildos and vibrators can be a godsend when the man has difficulty with erection. The woman can use these toys on herself with the man watching or gently holding and caressing her. Or the man can insert the toys. Most women prefer to have the toy and the vagina well lubricated before slow, gentle insertion. Or the man might use a strap-on dildo for more of an intercourse feel. Adam & Eve offers a wide selection of sex toys.

Great Sex for Life

For older couples whose sex lives have been dominated by intercourse for decades, it can be a chal- lenge to discover the joys of great sex without intercourse. The transition requires adjustments by both lovers that take some getting used to. But lovemaking without intercourse allows older lovers to remain sexual and enjoy erotic, mutually fulfilling lovemaking for the rest of their lives—even if they live to 100.

For individualized help coping with age-related sexual changes, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Great Sex Guidance: Great Sex Without Intercourse- A Creative Alternative For Older Couples – © Michael Castleman – 84 – Kegel Exercises: More Pleasure From Orgasms

In 1948, urologist Arnold Kegel, M.D., (Kay-gell) was treating women with stress incontinence, urine leakage triggered by coughing, sneezing, or laughing. He reasoned that his patients had weak uri- nary sphincter muscles, which could not stay closed under the abdominal pressure caused by these actions. The urinary sphincter muscles are part of the pelvic floor muscle group, the ones that run between the legs. Kegel theorized that strengthening the pelvic floor muscles might help women keep their urinary sphincters closed and cure stress incontinence.

The exercises Kegel developed to condition the pelvic floor muscles worked. Many studies show that Kegel exercises improve bladder control significantly, often completely curing stress incontinence.

But Kegel’s patients also confided that the exercises provided an unexpected benefit—more intense, more pleasurable orgasms. The reason: The pelvic floor muscles, notably the pubococcygeus (pew- boh-coxy-GEE-us, or PC), are also the muscles that contract during orgasm. As the pelvic floor mus- cles becomes stronger, so do orgasms—in men as well as women.

Identify Your PC

To do Kegels, first you must identify your PC. It’s the muscle you contract to interrupt urinating, or to squeeze out the last few drops. Try stopping your stream a few times to identify your PC. PC contrac- tions also cause a tightening around the anus.

Slow Kegels, Quick Kegels

Once you’ve identified your PC, sex therapists recommend doing both slow and quick Kegels. For slow Kegels, flex your PC and hold it contracted for a slow count of three, then relax. For quick Keg- els, contract and relax your PC as rapidly as you can, then relax.

Begin by doing five slow contractions and five quick ones three times a day. Each week, increase the number of contractions by five (i.e. to 10, 15, etc.) until you’re up to 50 slow and fast three times a day, for a total of 300 contractions a day. Do not increase the number of contractions more quickly

Great Sex Guidance: Kegel Exercises- More Pleasurable Orgasms – © Michael Castleman – 85 – than recommended, or you may suffer soreness between the legs.

Practice Kegels Any Time, Anywhere

Kegels can be practiced almost anywhere. No one but you knows you’re doing them. You might do Kegels while showering or driving or talking on the phone. Find a time that works for you.

Typically, it takes a month or two of daily Kegel exercises to notice orgasm enhancement.

Great Sex Guidance: Kegel Exercises- More Pleasurable Orgasms – © Michael Castleman – 86 – Lubricants: The Slippery Secret Of Great Sex, Especially After 40

It takes only 10 seconds to demonstrate that sexual lubricants enhance lovemaking:

* Close your mouth and dry your lips. * Run a finger lightly over them, paying close attention to how it feels. * Now, lick your lips. * Run the same finger lightly over your moist lips, again focusing on how it feels. * Notice any difference?

Chances are the caress with lips moist felt more sensual. If so, sexual lubricants can help you enjoy more pleasurable lovemaking. This is especially true after age 40 when women’s natural vaginal lubri- cation begins to diminish.

The Best Sex Is Wet Sex

Have you ever suffered discomfort because intercourse took place without sufficient natural lubrica- tion? Commercial lubricants eliminate this problem. Has a woman ever run out of natural lubrication during extended intercourse, chafing one or both of your genitals? Lubricants to the rescue. Have you ever wished that condoms transmitted more sensation? With a lubricant, they can. Have you ever suffered discomfort during anal play? Lubricants make it much more comfortable.

The Overlooked Element in Lovemaking

In the finger-on-the-lips exercise, the lubricant was saliva. Good old saliva is the world’s most popular sexual lubricant. It’s effective, readily available, and free. But saliva is also more watery than slip- pery. It dries quickly. And for pleasure enhancement, it’s not as effective as commercial lubricants. For modest cost, commercial lubes add new sensuality to lovemaking.

Great Sex Guidance: Lubricants- The Slippery Secret Of Great Sex, Especially After 40 – © Michael Castleman – 87 – Unfortunately, only a minority of American lovers use lubricants. Why? Because most people believe that “normal” sex involves only the body, and nothing else. Actually, lubricants are as natural as any other sex enhancer: candlelight, music, lingerie, or a glass of wine.

Many sex guides overlook the pleasure lubricants add to lovemaking, mentioning them only in pass- ing for women who do not produce sufficient vaginal lubrication on their own.They make insufficient lubrication seem abnormal. It isn’t. It’s quite normal, especially after age 40. Some young women just don’t produce much, and even if a woman self-lubricates copiously, she and her lover might enjoy a little more. But after 40, as menopausal changes begin, many women notice that they produce less vaginal lubrication. Finally, lubricants are not only for women. Many men find that they add new com- fort and pleasure to both masturbation and intercourse, especially intercourse using a condom.

Most sex researchers have also ignored lubricants. The landmark 1999 “Sex in America” survey by University of Chicago researchers asked nothing about them. However, the survey asked women if they’d suffered insufficient vaginal lubrication during the previous year. Almost 20 percent said yes. Such a high prevalence of vaginal dryness suggests that millions of Americans are in the dark about commercial lubricants, which, in seconds, eliminates this problem.

Lubrication in Women: Masters and Johnson Got It Wrong

In the 1960’s, pioneering sex researchers William Masters, M.D., and Virginia Johnson described vaginal lubrication as the initial hallmark of sexual arousal in women, paralleling erection in men. They maintained that the vagina produces lubrication fairly quickly as women become aroused.

This is true for many women, but not all, particularly women over 40. In addition, for many perfectly normal women, vaginal lubrication is not the first physiological sign of arousal. It may take a while to appear, and when it does, there may not be much of it. To make matters worse, the fantasies in print pornography imply that every woman’s vagina overflows with lubrication at the wink of any alluring eye. “I soaked my panties just looking at him!” Actually, it’s just as likely for women to feel erotically aroused and not produce much lubrication. Possible reasons include:

* Individual differences. Some women naturally produce more vaginal lubrication than others. It’s simply who they are. Unfortunately, women who do not produce much often feel abnormal, even though they are not. (Women who become “too” wet may also feel abnormal, and suffer embar- rassment about soaking the sheets. Try making love on a towel or two.)

* Age. The female sex hormone, estrogen, plays an important role in vaginal lubrication. Estrogen production begins to declines as menopausal changes commence. This process starts well before age 50. Some women notice decreased lubrication as early as their late thirties, and many experi- ence it by their mid-forties. After menopause, many women experience persistent vaginal dryness.

* The menstrual cycle. Because estrogen influences vaginal lubrication, women often produce dif- ferent amounts at different times of the month.

* Childbirth. Hormonal fluctuations may suppress lubricating for a while after delivery.

* Stress. Everything from job hassles to relationship tensions can impair sexual response in both men and women. In many women, stress reduces lubrication.

Great Sex Guidance: Lubricants- The Slippery Secret Of Great Sex, Especially After 40 – © Michael Castleman – 88 – * Drugs. Many over-the-counter and prescription medications decrease vaginal lubrication. The list of potential lubrication suppressors includes: alcohol, cigarettes, antihistamines, cold formulas, birth control pills, marijuana, antidepressants and many other psychiatric medications, Lomotil for diarrhea, Urised and Ditropan for incontinence, scopolamine for motion sickness, and any medica- tion that causes dry mouth.

* Travel. Everyone knows that flying across time zones induces jet lag. Jet lag may temporarily decrease lubrication.

* Extended loveplay. Even women who produce a good deal of natural lubrication sometimes need more during extended sex.

Lubrication in Men

According to Masters and Johnson, shortly before orgasm, the Cowper’s gland produces a few drops of lubricating fluid to moisten the head of the penis, facilitating insertion.This, too, is by no means automatic. In addition, men’s natural lubrication rarely covers any more than the head of the penis. Without addition lubrication, the shaft of the penis may become irritated during extended lovemaking.

Unexpected Erotic Pleasure

The simple, economical, pleasurable answer to lubrication problems is a commercial lubricant. “Wet- ter is better,” says Palo Alto, California, sex therapist Marty Klein, Ph.D. “Don’t just limit yourself to just one application. Apply lube several times during extended sex.”

About applying lubricants: Don’t squirt them directly on your lover’s genitals. Right out of the con- tainer, they feel cold and jarring. Unless you’re with someone who likes a cold shock, apply a small amount to your hand, rub it between your fingers to warm it, and then caress your lover with lubri- cated fingers.

Try applying lubricants:

* During masturbation. A few drops can boost the pleasure of solo sex. Your hand glides easily over your genitals. Close your eyes, and it’s easy to fantasize that you’re receiving oral sex.

* On the clitoris. Women’s natural lubrication may not make it all the way up to the clitoris. Most women say they enjoy the greatest pleasure from gentle, well-lubricated clitoral caresses.

* On the penis and scrotum. Lubricant adds an extra dimension to caresses of men’s genitals.

* During vaginal intercourse. Don’t just lubricate the vagina. Try lubricating both the vagina and penis. When a well-lubricated penis enters a well-lubricated vagina, the coupling feels more com- fortable, closer, and more erotically satisfying.

* On the nipples. In both men and women, erotically aroused nipples are exquisitely sensitive to touch. A few drops of lubricant make them even more so. Massage lotions can also add lubricant- like sensuality to nipple and breast caresses.

* Between the breasts. Many couples enjoy “tit fucking,” pressing the breasts together, and insert- Great Sex Guidance: Lubricants- The Slippery Secret Of Great Sex, Especially After 40 – © Michael Castleman – 89 – ing the penis between them. Lube helps this go much more smoothly and comfortably.

* Anal play. The most common complaint about anal play (fingering or intercourse) is, “It hurts.” A key reason is lack of lubrication. “Unlike the vagina,” says Louanne Weston, Ph.D. a sex therapist in Fair Oaks, California, “the anal canal produces no natural lubrication. It’s also a smaller, tighter opening. No wonder that probing it often causes discomfort. Lubricants are a must for enjoyable anal play.” Use lubricant liberally in and around the anus, and on whatever enters it—usually just a finger, but also possibly a sex toy or penis. Replenish your lubricant frequently. In addition, the inserter should enter this erotic opening slowly and gently. Recipients often feel most comfortable when they control the speed, depth, and duration of insertion.

Note: Some lubricants marketed specifically for anal play contain an anesthetic (lidocaine or ben- zocaine), to help reduce discomfort. Be careful with these products. Discomfort is the body’s way of saying that something is wrong. Use of desensitizing products turns off the body’s own warning system and increases risk of injury. Anesthetics should not be necessary. Loving, gentle anal play should not cause discomfort.

* Sex toys. Lubricants enhance the pleasure of vibrators, dildos, and other sex toys. Sex toy mar- keters say toys should not be used without it. Lubricate both the toy and the flesh it touches.

* Condoms. Most condoms come lubricated with silicone powder. But for many lovers, a dusting of silicone is insufficient for comfortable insertion. Coat condoms with a water-based lubricant. For extra pleasure for the man, rub a drop of lubricant into the head of the penis before placing the condom over it.

* Erotic pauses. Some skeptics view the time it takes to apply lubricant as “an interruption.” Not at all. The beauty of music involves more than just the notes. It includes the silences between the notes. Similarly, sexual pleasure comes not only from intimate caresses, but also from the moments between them, as lovers savor the fondling they have just experienced and anticipate additional touch. Think of the time it takes to apply lubricant as erotic breaks that add spice to your lovemaking.

“I urge couples to use lube even when they don’t need it,” Klein explains. “It’s a good habit to get into. It makes sex more comfortable. And when you use it routinely, nobody gets anxious or self-conscious, about why the woman isn’t getting wet tonight.”

Four Kinds of Lube

It may take a while to get used to using lubricants. Initially, you might find them messy or slimy. But it shouldn’t take long to appreciate the joy of well-lubricated sex.

Four types of lubricants are available over-the-counter: water-based, oil-based, petroleum-based, and silicone-based. Each has advantages and disadvantages. Consider the pros and cons, then experi- ment to see which you prefer.

Water-Based Most lubricants are water-based. They typically contain water; glycerine, a syrupy-sweet emulsifier; propylene glycol, which helps the product retain moisture; and a preservative. Water-based lubricants

Great Sex Guidance: Lubricants- The Slippery Secret Of Great Sex, Especially After 40 – © Michael Castleman – 90 – also come in two different consistencies, liquid and jelly: Liquid lubes include Astroglide, Slippery Stuff, Probe Silky Light, and KY Liquid. Jelly lubes include: Probe, KY jelly, and Elbow Grease.

Water-based lubricants are safe to use on the vulva, clitoris, and penis, and in the vagina and anus. They do not stain bed linen or clothing. It’s safe to ingest small amounts during oral sex. And they do not eat holes in latex condoms or diaphragms as petroleum-based lubricants do.

Although water-based lubricants are safe, some of the ingredients might cause irritation or allergic re- actions in sensitive individuals. Water-based lubricants work fine on the genitals, but they are not de- signed to be used as massage lotions on large expanses of skin. Many water-based lubricants claim to be “taste-free,” but that’s not quite true. If you don’t like the taste, consider flavored lubricants. Or suck on a lifesaver while providing oral sex.

During extended lovemaking, water-based lubricants may dry out. Apply more, or refresh them with a little water. Keep a small bowl of water by the bed and dip their fingers into it. Or try using a spray mister. After sex, rinse water-based lubricants off with a moist wash cloth.

Oil-Based Oil-based lubricants include: vegetable oils (olive, corn, etc.), Crisco, butter, and nut oils (peanut, coconut, etc.). They are inexpensive and available at supermarkets. Oil-based lubricants can be used both on the genitals and as massage lotions. They may be safely applied to the vulva, clitoris, and penis, and used inside the vagina and anus. Crisco is a particularly good lubricant for anal play. Oil- based lubes are safe to ingest during oral sex. They do not eat holes in latex condoms, diaphragms, or cervical caps. However, they increase the likelihood that a condom might slip off the penis. That’s why authorities in sexually-transmitted-infection prevention discourage oil-based lubes with condoms for safe sex. Oil-based lubes rarely cause irritation or sensitivity reactions. However, they may feel more greasy than slippery. They may stain bed linens and clothing, and require soap and water to wash off. (Water-based lubes rinse off with just water.)

Petroleum-Based Made from petroleum jelly, mineral oil, or petrolatum, these include: Vaseline and baby oil. Petroleum- based lubricants destroy latex and should never be used with condoms, diaphragms, or other latex contraceptives. Latex deterioration occurs remarkably quickly, according to a study by the Kinsey Institute. Within 60 seconds of contact, microscopic holes appear that are large enough for passage of sperm or sexually transmitted infection organisms.

In addition, petroleum lubricants should not be used inside the vagina. They are difficult to wash out, may irritate the vaginal lining, and change vaginal chemistry, increasing risk of infection. They should not be ingested, and may cause allergic reactions. Finally, petroleum lubricants may stain linens and bed clothes. Despite these drawbacks, many couples like petroleum-based lubricants, particularly for anal play.

Silicone-Based Silicone lubricants are the newest class of lube. They were introduced in the mid-1990s, a personal adaptation of industrial silicone lubricants (WD-40). Some couples like silicone because it feels silky and is not messy. It also retains its slickness longer than water-based lubes. Silicone lubricants do not damage latex. They are safe for use on the vulva, clitoris, and penis, and in the vagina and anus. They do not stain bed linen or clothing. It’s not clear how safe they are to ingest, so it would be pru- dent not to. Although silicone lubricants are safe, some of the ingredients might cause irritation or Great Sex Guidance: Lubricants- The Slippery Secret Of Great Sex, Especially After 40 – © Michael Castleman – 91 – allergic reactions in sensitive individuals.

Lubricants Appear to Kill the Virus that Causes AIDS Samuel Baron, M.D., a professor of microbiology at the University of Texas Medical Branch at Galves- ton, identified another good reason to use lubricants. A few brands—Astroglide, Silken Secret, Vagisil, and ViAmor—contain compounds that kill HIV, the AIDS virus, and can reduce risk of HIV transmis- sion. Baron’s team tested 22 brands of lubricants. They added a little of each to samples of HIV- infected human semen. The four lubricants destroyed HIV in the white blood cells the virus infects. They also killed free HIV in the semen. The four HIV-killing lubes reduced viral replication by more than 99 percent. Baron is now working to identify the HIV-killing compounds in the four lubricants.

This was a laboratory study. It’s not clear if the four lubricants—or others containing the still-uniden- tified HIV-killing compounds—would prevent HIV transmission in the real world. “I want to be very clear,” Baron says, “that to prevent HIV transmission, people should use condoms. Condoms first. But sexual lubricants help prevent condom breakage, so apart from any HIV-preventive value they might have, they help keep condoms intact, which is valuable. In addition, lubricants are safe and inexpen- sive, and they make intercourse more comfortable. Sexuality authorities recommend them. If I were non-monogamous or with a new partner, the situations where HIV transmission is an issue, I’d use a lubricant that has shown activity against HIV, even if only in a laboratory study. I mean, why not? There’s no downside, and there’s a potentially major upside.”

Adam & Eve has a great selection of Lubricants.

Great Sex Guidance: Lubricants- The Slippery Secret Of Great Sex, Especially After 40 – © Michael Castleman – 92 – Massage: Whole Body Touch is the The “Language” of Great Sex at Any Age - Especially After 40

Beyond feeling deep emotional attachment, what is the key ingredient of fulfilling lovemaking? Sex therapists agree that it’s leisurely, playful, whole-body, massage-style caresses. Every square inch of the body is a sensual playground.

Most women understand this intuitively. Unfortunately, many men do not. As men become sexual, many focus on only a few corners of the body—their penises and women’s breasts and genitals—and largely ignore everything else. For many men, this habit persists well into adulthood. But as men en- ter their 40s, as erections begin to become balky and as sexual urgency begins to subside, most men come around to appreciating massage-based whole-body sensuality—and if they don’t, they should.

The skin is the body’s largest organ. When massage-style caresses excite it—all of it—anxiety melts away, mood improves, and pain subsides, all of which contribute to enjoyable sex. In addition, lei- surely, playful, whole-body massage helps prevent and treat men’s sex problems, notably rapid ejacu- lation and erection difficulties. It’s also critical to women’s sexual responsiveness. Without extended, whole-body massage, many women find it difficult or impossible to become sexually aroused, let alone have orgasms.

Erotic Arousal: Men and Women Are Different

Compared with women, men tend to become more aroused visually. Men love watching a lover un- dress or seeing her in lingerie. Men’s visual orientation is a big reason why pornography is produced for men, and why so many men become hypnotized by it.

Women tend to become aroused through touch—gentle, whole-body massage. Sex therapists often advise couples to take turns arousing each other the way they like best. A woman can dance a strip-

Great Sex Guidance: Massage- Whole Body Touch is the The “Language” of Great Sex atAny Age - EspeciallyAfter 40 – © Michael Castleman – 93 – tease for her man, and then once she’s naked or close to it, the man can take her in his arms and massage her all over, so both of them can get turned on.

Touch is the Only Sense We Can’t Live Without

Human beings can live rich lives without sight, hearing, taste, or smell. But deprive infants of loving touch and they die. That’s what happened toward the end of the 19th century when some leading American infant-care experts insisted that holding and cuddling babies was “primitive.” Hands-off in- fant care was embraced by many affluent, well-educated Americans determined to greet the new 20th century with the latest scientific wisdom. The staffs of the nation’s many orphanages also stopped cuddling infants on the advice of the experts. However, this message did not trickle down to poor, less educated women, who continued to hold, hug, and cuddle their infants as their ancestors always had. By 1910, pediatricians were reporting a strange new disease that caused healthy infants to withdraw, lose weight, and die. They called it “marasmus” from the Greek for wasting away. Marasmus, now called failure to thrive, became epidemic in orphanages. It also struck infants in affluent families. But poor families were unaffected. Eventually, physicians identified its cause—lack of cuddling. When parents and orphanages returned to “primitive” infant cuddling, marasmus disappeared. Today, child development experts agree that infants cannot be held and cuddled too much. Failure to thrive has never been documented after infancy. But the fact that lack of touch can cause death even for a brief period of life shows just how important it is. We should think of touch as an es- sential nutrient transmitted through the skin. Cuddling and massage are deeply nurturing and relax- ing. They are also fundamental to mutually fulfilling sex.

The skin contains two types of touch-sensitive nerves. The sensation of pain—fingers on a hot plate, or a pebble in a shoe—is transmitted to the brain through nerve fibers that trigger release of stress hormones. But the skin also contains other nerves, C-tactile fibers, that respond to pleasing touch and stimulate release of other hormones that produce feelings of relaxation and well-being. Gentle massage stimulates release of oxytocin, a hormone associated with feelings of pleasure and attach- ment. Oxytocin enhances sexual pleasure and contributes to arousal and orgasm.

Why Many Men Resist Massage-Based Sex. And Why They Should Reconsider

Unfortunately, many men remain unconvinced of the importance of massage in great sex. Their skep- ticism stems, in part, from the fact that as they leave childhood and enter adulthood, many men “lose touch” with touch. Men slap each other’s backs, but they don’t share gentle, affectionate touch the way women do. Rediscovering the pleasure of whole-body touch and massage is an important part of sex therapy for many men.

Another reason men are often skeptical of massage-based lovemaking has to do with the term typi- cally used to discuss loving touch: “foreplay.” Foreplay implies something you do before the main event, intercourse, something separate and distinct from it. Many men engage in very perfunctory foreplay, most of it focused on women’s breasts and genitals. In their headlong rush into intercourse, they ignore the rest of women’s skin.

Rushed foreplay represents a major misunderstanding of how women respond sexually. Most women prefer extended, playful, total-body massage that includes their breasts and genitals—but is not fix- ated on them. In fact, to experience sexual arousal, most women absolutely require total-body ca- ressing.

Great Sex Guidance: Massage- Whole Body Touch is the The “Language” of Great Sex atAny Age - EspeciallyAfter 40 – © Michael Castleman – 94 – Rushed foreplay is also a one-way ticket to young men’s sex problems, notably rapid ejaculation and erection difficulties. Many rock songs talk about doing it “all night long.” But with rushed foreplay, many men can’t even do it for two minutes. The reason is that the penis is a very sensitive fellow. He enjoys getting aroused, but if he gets too hot too quickly, he can’t take the pressure, and he either ejaculates quickly, or goes soft. Extended, whole-body caresses distribute sexual arousal around the entire body, which takes the pressure off the penis. It still becomes highly aroused—in fact, more aroused—but because you’re aroused from head to toe, your penis isn’t the focus of all the arousal, which helps the little guy behave as you’d like him to.

Finally, rushed foreplay is out of synch with how men over 40 respond sexually. After 40, the male nervous system loses some of its sexual excitability. As men age, it takes them longer to become aroused and respond to erotic play. In other words, older men become more like women. As men age, they, too, need leisurely, playful, whole-body massage to get the most pleasure from sex.

Try a Professional Massage

Men who feel skeptical of whole-body touch might change their minds if they experience a profes- sional massage—not what’s offered at massage parlors, but a nonsexual, 60- to 90-minute massage by a certified massage therapist. Professional massages help men get used to the idea of slowing the sensual pace to allow plenty of time for mutual whole-body touch. My advice to skeptical men: Give massage a chance. Make love a few times shortly after a professional massage. I bet your penis be- haves better, your lover becomes more aroused and responsive, and “all that touchy-feely crap” starts making more sense. My advice to women: Give your man a gift certificate for a good massage with the promise of something even better afterwards.

Formal massages can be wonderful preludes to horizontal romps, but they’re not necessary for whole-body sex. You can enjoy many of the same benefits simply by taking a hot bath or shower together before making love. Use soft washcloths and scented soap over every square inch of each other’s bodies. The warmth relaxes muscles made tense by the daily grind. And soaping and drying each other can be a marvelous whole-body, massage-like turn-on. For extra sensual enhancement, dry off with warm towels. Before you get into the water, drape your towels over a radiator or pop them into the dryer, so they’ll be warm when you use them. You can do the same with bathrobes.

Replacing rushed foreplay with leisurely, playful, whole-body caresses is probably the single most woman-pleasing change men can make in their lovemaking. And once men get used to it, they usu- ally find that extended sensuality also enhances their own experience of sex.

Not “Foreplay,” Loveplay

Now, back to “foreplay.” Forget it. Instead, think of every moment of sex as “loveplay.” Foreplay im- plies linear lovemaking, first kissing, then the man’s hands on her breasts and between her legs, then intercourse, then it’s all over.

In contrast, loveplay is more open to sensual creativity. You might light some scented candles, and have a glass of wine, listen to music, or watch an erotic video while, gently holding each other, kiss- ing, and stroking each other’s faces and arms. Next you might feed each other little snacks as you undress, caressing each other some more. Then you might shower together, dry each other. After that, you might repair to bed, turn on some music, and lie face-to-face, kissing, lightly caressing each other. Then, you might suckle each other’s nipples for a while. Next, you might trade foot massages, Great Sex Guidance: Massage- Whole Body Touch is the The “Language” of Great Sex atAny Age - EspeciallyAfter 40 – © Michael Castleman – 95 – and after that, fondle each other’s genitals for a time, and then treat each other to oral sex. After a while, you might have intercourse (if that’s possible for you), then uncouple and feed each other some more snacks, while continuing to kiss and caress one another. Next, you might return to oral sex or genital hand massage or intercourse, but in some different positions. And on and on, all night long. None of this is foreplay. None of this necessarily comes before anything else. It’s all lovemaking. It’s all loveplay.

Many women wish men would learn that sex is best when it involves the whole body. The genitals are certainly important, but so is everything else. Every square inch of the body is a sensual playground. Great sex excites all of it.

Adam & Eve has a great selection of Massage Oils.

References: Miller, AS and ES Byers. “Actual and Desired Duration of Foreplay and Intercourse: Discordance and Misperceptions in Heterosexual Couples,” Journal of Sex Research (2004) 41:301.

Mohn, T. “The Spa Experience as Tuneup: Reports Discover That Men and Women See Massage Dif- ferently,” New York Times, 5-31-2005.

NewScientist.com. “Scientists Reveal the Secret of Cuddles.” 7-28-2002.

Stubbs, KR and LA Saulnier. Romantic Interludes. Secret Garden Press, Larkspur, CA. 1988.

Great Sex Guidance: Massage- Whole Body Touch is the The “Language” of Great Sex atAny Age - EspeciallyAfter 40 – © Michael Castleman – 96 – Massage: Beyond Sexual Enhancement - Many Benefits

Sex experts agree that leisurely, playful, whole-body caresses are the sensual foundation of fulfilling lovemaking. The entire body is a sensual playground. Mutual massage excites the skin, the nervous system, and the mind, setting the stage for great erotic fun.

But there’s more to massage than just great sex. Massage has become recognized as a highly thera- peutic treatment for many conditions, among them: pain, stress, anxiety, and depression. These conditions are extremely common. They also interfere with sexual enjoyment. The research shows that by incorporating whole-body massage into lovemaking, you do more than enhance sex. You also contribute to each other’s well-being, which increases mutual comfort, deepens intimacy—and makes sex feel more fulfilling.

The Many Benefits of Massage

Massage has been used therapeutically since ancient times. Hippocrates, the father of Western medi- cine, is reputed to have said, “The physician must be experienced in many things, but most assuredly, in rubbing.” But modern research into massage dates from the mid-1980s, when a study by Univer- sity of Miami (FL) psychologist Tiffany Field, Ph.D., examined the effects of daily massages on pre- mature infants in a neonatal intensive care unit. Compared with preemies who were not massaged, those who were grew faster, were healthier, and left the hospital sooner. Field went on to establish the Touch Research Institute. She and her colleagues have conducted a great deal of research showing how beneficial massage can be.

Pain Relief

Massage is particularly helpful in treating pain. Pain, of course, can be a major impediment to good sex, so cultivating a massage approach to sex can enhance lovemaking by reducing pain.

Massage relieves pain in two ways. First, according to Dr. Field, it increases blood levels of endor-

Great Sex Guidance: Massage- Beyond Sexual Enhancements - Many Benefits – © Michael Castleman – 97 – phins, the body’s own pain-relievers. In addition, massage is relaxing, so it helps treat all stress-relat- ed conditions, among them, pain problems. Pain is stressful, and the muscular tension engendered by stress and anxiety exacerbate pain. The result is often a vicious cycle: pain, stress, greater pain, more stress, more pain. Massage (and other relaxation therapies) help break this cycle and provide at least partial pain relief.

In a study at the University of South Carolina, researchers gave 28 hospitalized cancer patients standard psychological tests to assess their pain. Then some received a 10-minute visit, the others a 10-minute massage. The massage group enjoyed significantly greater pain relief.

In Seattle, University of Washington researchers worked with 262 people with low-back pain. They received one of three treatments: self-care (a book and two videos about back care), acupuncture (8 to 10 sessions), or massage (8 to 10 sessions). Compared with self-care, massage and acupuncture provided significantly greater pain relief after 10 weeks. But after a year, the massage group fared better than those who received acupuncture.

In African folk medicine, women called “doulas” gently massage women in labor to ease the deliv- ery. Dr. Field divided women going into labor into two groups, each with a labor coach. She told the coaches of one group to help by doing “what comes naturally.” In the other group, she trained the coaches in massage, and had them give 20-minute massages regularly throughout labor. The mas- saged women had lower levels of cortisol, a stress hormone, in their saliva, and reported less pain and anxiety during their labors.

Anxiety and Depression

Massage also helps relieve two other sex-killers, anxiety and depression. In a Florida psychiatric hos- pital, Dr. Field divided 72 adolescents into two groups. Twenty controls viewed relaxing videos, while the 52 others received a 30-minute back massage every day for five days. Based on staff evalua- tions, the massaged group showed less depression and anxiety.

Immune Boost

Some evidence suggests that massage enhances immune function, so it might help prevent and treat illness in general. Boston researchers gave 32 people either a 10-minute rest on a massage table, or a 10-minute back rub. Both groups provided saliva samples before and after. The non-massaged showed no a disease-fighting protein produced by the immune system. But in the massaged group, levels of the protein increased significantly.

Swedish or Shiatsu

In the U.S., two styles of massage predominate—Swedish and deep-tissue massage, notably, shiat- su. Swedish massage is the type most easily inocorporated into sex. It was developed 150 years ago by Per Henrik Ling, of Sweden, who integrated ancient Asian massage techniques with a Western understanding of anatomy and physiology. Swedish massage involves long, gliding strokes using the whole hand or the heel of the palm, or kneading strokes with the fingers. Depending on your prefer- ence, the pressure of Swedish massage strokes can vary from light, feathery touch to firmer, deeper pressure. Be sure to specify the kind of strokes you prefer.

Great Sex Guidance: Massage- Beyond Sexual Enhancements - Many Benefits – © Michael Castleman – 98 – Massage involves use of massage oil or lotion. Try bath and body shops, or Adam & Eve.

In general, it’s not a good idea to use a sexual lubricant as a massage lotion and vice versa. The two products are formulated differently. Massage lotion feels marvelous on the skin during massage, but it’s generally not slippery enough to work well as a genital lubricant. Meanwhile, sexual lubricants work great for lovemaking, but when used in whole-body massage, they may dry too quickly and feel sticky. It’s best to limit lubricant use to the genitals and use massage lotions on the rest of the body.

In addition to incorporating massage into lovemaking, you and your partner might also consider treat- ing each other to professional massages as a prelude to sex. A professional massage is deeply relax- ing, and might get you in the mood for sex better than dinner and a movie.

For a professional massage, don’t go to a massage parlor. Most massage parlors are fronts for prosti- tution where about the only thing you can’t get is a good massage.

Instead, look for a licensed or certified massage therapist. States that regulate massage allow those who pass credentialing requirements to call themselves licensed massage therapists (L.M.T.), certi- fied massage therapists (C.M.T.) or some other designation. Currently, more than half the states and the District of Columbia regulate massage therapy. Most use the criteria developed by three national organizations: the National Certificant Board for Therapeutic Massage and Bodywork (NCBTMB), the American Massage Therapy Association (AMTA), or the Associated Bodywork and Massage Profes- sionals (ABMP). All three organizations require 500 hours of training at a massage school accredited by the Commission on Massage Therapy Accreditation, an independent, quality-control organization.

If you live in a state without credentialing, you can still find a well-trained massage therapist by ask- ing: Are you certified by the NCBTMB? Or are you a “professional member” of the AMTA? Or do you hold an A.C.M.T. credential from the ABMP?

All three organizations also make referrals to credentialed members around the country:

The American Massage Therapy Association, 820 Davis St., Suite 100, Evanston, IL 60201; (847) 864-0123; www.amtamassage.org.

Associated Bodywork and Massage Professionals (ABMT) 1271 Sugarbush Dr., Evergreen, CO 80439; (800) 458- 2267; www.abmp.com.

The National Certification Board for Therapeutic Massage and Bodywork, 8201 Greensboro Dr. #300, McLean, VA 22102; (703) 610-0236; www.ncbtmb.com.

Great Sex Guidance: Massage- Beyond Sexual Enhancements - Many Benefits – © Michael Castleman – 99 – Beyond Reciprocity - When He Massages Her, Both Enjoy Erotic Enhancement

Want to enjoy hotter, more fulfilling lovemaking? Here’s a novel idea: Have the man give the woman an extended whole-body massage. Try letting go of reciprocity. She need not massage him in return. Try playing with the man doing most of the massaging, and the woman enjoying most of the receiv- ing.

Why Should He Provide the Massage?

At first glance, this suggestion flies in the face of the egalitarianism at the core of a considerable amount of 21st century lovemaking advise, the idea that lovers should take turns giving and receiving pleasure equally. If the man gives the woman an extended massage, and she does not reciprocate— or gives him only a brief massage in return—it appears that he gives more than he gets.

But on further consideration, that’s not the case. When the man massages the woman, they both get what turns them on most. Men tend to respond to visual stimuli. Massaging the woman provides a lot to look at. Women, on the other hand, tend to respond by being touched. Receiving massage fills the bill.

Most Men Become Most Aroused Visually

Want proof that most men get sexually turned on visually, by what they see? Then consider the fact that the audience for visual pornography is about 80 percent men. Pornographic drawings, cartoons, photos and videos appeal disproportionately to men. Porn is very graphic, and that’s a huge turn-on for the gender that gets aroused by what they see.

Meanwhile, most women feel much differently about porn. They’re not as turned on by what they see so visually graphic depictions of sex hold no special allure for most women.

In addition, the sex in porn is virtually all genital with very little sensual touch. Many women find this incomprehensible—and offensive. They can’t understand how porn actresses can appear to become so turned on without it. (Simple. They fake it.) Nor can most women understand how so many men ignore the touch women need and instead plunge into intercourse like the couples in porn.

Great Sex Guidance: Beyond Reciprocity- When He Massages Her, Both Enjoy Erotic Enhancement – © Michael Castleman – 100 – Most Women Become Most Aroused By Sensual Touch

Many studies show that most women have a deep need for gentle sensual touch before they can become warmed up enough to enjoy genital play. Women are more interested than men in how things feel on the skin: the luxurious touch of silk, the comforts of skin lotions—and cuddling, kissing, and hugging. Compared with most men, most women value, in fact, crave whole-body massage as their preferred path into lovemaking.

Most men are not as interested in sensual touch (except penis play). Plenty of men enjoy cuddling, kissing, hugging, and massage, but compared with women, these moves are not as necessary a pre- requisite for genital sex. That’s why women often complain that men’s lovemaking is “too rushed,” that men speed through sensual touch, or ignore it, and grab women’s breasts and genitals before women feel ready for it. Faced with this criticism, many men say, “Huh?” The fact is, the need for sensual— that is, whole-body, non-genital—touch is much more necessary for women’s arousal than men’s.

Win-Win

Given this difference in preferred paths to arousal, is there any way to bridge the chasm? Is it possi- ble to make love in such a way that women get the sensual touch that turns them on, while men enjoy the erotic sights that turn them on? If the man massages the woman, the answer is a resounding yes.

When the man massages the woman, he sees her in all her naked glory. There she is, her lovely face, her beautiful breasts, the alluring curves of her hips, the sweet mounds of her buttocks, and the deliciousness of what’s between her legs. She is not only a wonderful sight to behold. As far as visu- ally aroused men are concerned, her willingness to appear naked before him—and the implication that she is sexually available to him—are tremendous turn-ons.

Meanwhile, when the man massages the woman, she feels loving hands carress every square inch of her. His hands, moistened by massage lotion, glide up and down all over her, from her scalp to the bottoms of her feet. She luxuriates in the leisurely playfulness of fingers kneading her neck muscles, her shoulders, arms, legs, fingers, and toes. She gets what she wants, gentle, loving, sensual touch from head to toe, and a man who takes his time and doesn’t rush into genital play.

When the man massages the woman, both lovers get what they like—and need—to become turned on. She experiences the thrill of loving touch, and he enjoys the thrill of seeing his lover gloriously naked before him.

Two Excellent Videos

If you’ve never played with massage as part of your lovemaking, why not give it a try? All you need is a warm room, a soft surface (sofa, bed, or cushions), a sheet under the recipient (to absorb any excess massage lotion), some skin lotion or massage oil, and some suggestions for sensual strokes. Good suggestions are provided by two 60-minute instructional massage videos, Massage Your Mate, and Erotic Massage: The Touch of Love.

Start with Massage Your Mate. It’s a friendly, nonsexual, 90-minute guided tour of both Swedish and Shiatsu massage hosted by noted massage therapist Rebecca Klinger. She guides you through mas- sage preparations and easy-to-learn techniques for massaging the back, legs, feet, arms, hands, chest, neck, face, and scalp. This video is an engaging introduction to whole-body massage that both Great Sex Guidance: Beyond Reciprocity- When He Massages Her, Both Enjoy Erotic Enhancement – © Michael Castleman – 101 – men and women enjoy watching—and using as a massage guide.

Erotic Massage: The Touch of Love is a bit more advanced. Like The Lovers’ Guide, it’s beautiful to watch and demonstrates a variety of strokes that should inspire both massage novices and veterans. But this video has no narration. Nothing is explained. The visuals are everything. Because there is no narration, couples new to massage might want to begin with the other video. But as you watch this sensual tour-de-force, you quickly realize that like a great massage, words are unnecessary. Mas- sage is all about communicating without words, through touch alone. While this video is extremely sensual, it also includes a few minutes of genital massage. If you’ve been fondling each other be- tween the legs in the same old way, these sequences might provide new inspiration to try things a bit differently. From MyPleasure.com. Adam & Eve offers a variety of massage lotions.

Of course, there’s no reason why the man should do all the massaging, and the woman all the receiv- ing. Feel free to switch roles. But given the ways most men and women experience arousal, both lov- ers win when the man massages the woman. He gets to view every square inch of her naked beauty. And she gets to enjoy gentle, loving touch from the crown of her head to the bottoms of her feet. Both lovers become aroused. And by the time the massage is over, both feel ready to move from the sen- sual into the sexual

References:

Miller, AS and ES Byers. “Actual and Desired Duration of Foreplay and Intercourse: Discordance and Misperceptions in Heterosexual Couples,” Journal of Sex Research (2004) 41:301.

Mohn, T. “The Spa Experience as Tuneup: Reports Discover That Men and Women See Massage Dif- ferently,” New York Times, 5-31-2005.

NewScientist.com. “Scientists Reveal the Secret of Cuddles.” 7-28-2002.

Great Sex Guidance: Beyond Reciprocity- When He Massages Her, Both Enjoy Erotic Enhancement – © Michael Castleman – 102 – Masturbation: Beyond Guilt or Shame

It’s perfectly normal to masturbate. Here’s an old joke: Ninety-eight percent of people have done it— and the other 2 percent are lying. Masturbation is fine at any age: 10, 25, 45, 105.

Masturbation is our original sexuality. It’s one of the first ways children learn to experience physical pleasure. Left to themselves, children are enthusiastic masturbators. Why not? It’s such fun. Kids stop masturbating (or more often, go underground and do it in secret) largely because the adults in their lives prohibit it and make them feel ashamed of it.

Who Has Masturbated in the Past Year?

While virtually everyone has masturbated at some point in their lives, recent masturbation is another story. University of Chicago researchers surveyed self-love among a representative national sample of 3.432 adults, aged 18 to 60. During the previous 12 months, 61 percent of the men and 38 percent of the women said they’d masturbated.

Causes No Harm

Forget everything you ever heard about hair on the palms, mental health problems, or physical harm. Masturbation causes absolutely no physical or emotional damage.

Physically, your biggest risk is a little chafing of tender genital skin during extended sessions. The solution: A lubricant. Try saliva, vegetable oil, or a commercial lube.

Psychologically, the main issue is the guilt many people feel about it after a youth spent hearing that masturbation is evil or perverted. It isn’t. Every sex expert agrees: Masturbation is normal and healthy.

Masturbation Doesn’t Sexually “Use You Up”

Masturbation does not use you up sexually, even if you do it more than once a day. At birth you’re not given some predetermined number of orgasms, and once you run through them, that’s it. There is no

Great Sex Guidance: Masturbation- Beyond Guilt or Shame – © Michael Castleman – 103 – limit on the number of orgasms healthy people can experience. There may be a limit on the number you want to have, but you can have as many as you wish.

Masturbation does not use up men’s sperm or semen. The testicles are always making sperm and the prostate gland and men’s other reproductive glands are always making seminal fluid. The only way men run short on sperm is if they become sterile. The only way men run out of semen is if they have their prostate glands removed, and even then they can still experience orgasm. If a man masturbates several times in a day, he might notice that his final orgasm produces less semen than his first one did. But if he refrains for about a few days, seminal fluid builds up and ejaculatory volume returns to what it was.

Do Vibrators “Ruin” Women for Sex Without Them?

Some women fear that masturbation with a vibrator might “ruin” them for any sex without the intense stimulation vibrators provide. Relax. Does driving ruin you for walking? No, it just gets you to your destination faster. The same is true for sex with and without vibrators. The vulva, clitoris, nipples, and other parts of the body respond to erotic stimulation no matter where it comes from: fingers, tongue, penis, or vibrator. Vibrators produce the most intense sensations, so most women reach orgasm faster than they do with other types of stimulation. But using a vibrator—even frequently—does not change women’s ability to respond to other types of sexual stimulation.

“Addicted” To Vibrators?

Some women fear that they might become “addicted” to their vibrators. No way. Over time, some women become particularly fond of vibrator stimulation. That’s a personal preference, not an “addic- tion.”

In fact, far from ruining women for sex that does not include them, vibrators actually help women re- spond to other forms of erotic stimulation. Vibrators allow women to experience the full range of their sexual responsiveness. Greater sexual self-knowledge learned with a vibrator usually helps women respond to other types of sexual stimulation.

Losing Its Stigma

Available evidence suggests that masturbation is more socially acceptable—at least in private—than it was 35 years ago. German researchers gave the same sexuality survey to German university students in 1966, 1981, and 1996. In it, they asked about masturbation. Over these three decades, both the men and the women started masturbating in their teens. In the 1966 survey, 20 percent of the women said they were masturbating at age 15. At age 19, the figure was 30 percent. By the 1996 survey, those figures had increased to 60 percent and 85 percent respectively. In the 1966 survey 50 percent of the men said they were masturbating at age 15. At age 19, the figure was 85 percent. By the 1996 survey, those figures had increased to 80 percent and 95 percent. It’s not clear from this survey if young people actually begin masturbating earlier, or if they are simply more willing to admit what has always been true. Either way, these surveys suggest that young people feel more comfort- able about solo sex. Whatever the reason, the researchers concluded that “masturbation is losing its stigma.”

Great Sex Guidance: Masturbation- Beyond Guilt or Shame – © Michael Castleman – 104 – In a Relationship? You Don’t Have to Stop Masturbating

However, when people become involved in sexual relationships, some think it’s wrong to continue masturbating, that it should no longer be necessary. That’s like saying there’s no reason to go to the movies once you have Netflix. While both masturbation and partner sex are sexual, the two experi- ences are quite different, just as the big screen and a TV or computer screen produce different enter- tainment experiences. As wonderful as partner sex can be, it also involves responsibilities. You have to be sensitive to your lover, provide pleasure, and provide coaching about what turns you on, not to mention that you probably have to make sexual compromises to maintain peace in the relationship. “But in masturbation,” explains Palo Alto, California, sex therapist Marty Klein, Ph.D., “there’s no one else to attend to, no one making any demands, no one to please except yourself—and even if you’re in a fabulous relationship, at times, or quite often, that can feel wonderful.”

The German researchers mentioned earlier also asked about masturbation in the context of relation- ships. Again, over the three decades, masturbation became more acceptable. In the 1966 study, 72 percent of the men and 43 percent of the women admitted that they enjoyed solo sex while in a com- mitted relationship. By the 1996 study the figures had increased to 92 and 71 percent respectively. Masturbation as Sex Education

In addition to being our original sexuality, masturbation is how people learn about their own sexual responsiveness. The vast majority of people masturbate for years—maybe decades—before meet- ing their lovers. Why give up chocolate cake once you’ve discovered apple pie? Partner sex doesn’t replace masturbation. The two are complementary.

Many psychologists say you can’t love another person until you learn to love yourself. By the same token, you can’t have great sex with anyone else until you learn to have great sex with yourself. In sex therapy for several common problems—including rapid ejaculation in men and lack of orgasm in women—masturbation is a fundamental part of standard treatment.

If It Interferes With Your Life…

While masturbation is perfectly normal and nothing to feel guilty about, it also has implications for the rest of your life. It’s possible that frequent, obsessive masturbation might interfere with school, work, or other life necessities. Masturbation is a healthy, enjoyable part of life, but like other diversions, it may cause problems if it becomes your major focus. If you have difficulty reconciling your masturba- tion with the rest of your life, counseling is a good idea.

Masturbation may also cause relationship problems. “The two members of the couple may attach dif- ferent meanings to it,” says San Francisco sex therapist Linda Alperstein, L.C.S.W. “For men, mas- turbation is often simply an enjoyable way to relax, a form of self-comfort. But some women see it as a form of unfaithfulness. I suggest that couples check in with each other about what masturbation means to them.”

It’s also possible that frequent masturbation might mean less interest in partner sex. From time to time, it’s fine to prefer making love with yourself rather than with your honey. But if you frequently use masturbation to avoid partner sex, that’s usually a sign of a relationship problem. Consider couples counseling or sex therapy.

Great Sex Guidance: Masturbation- Beyond Guilt or Shame – © Michael Castleman – 105 – Lovers in committed relationships need to work out a sexual frequency they can both live with com- fortably—and work their masturbation around it. It’s reasonable to curtail masturbation somewhat in the interest of maintaining a mutually agreeable frequency with your lover. You might schedule part- ner sex in advance, and not masturbate that day or for a day before. But it’s unreasonable for one member of a couple to demand that the other stop masturbating entirely. People have every right to masturbate. There’s nothing wrong with it at any age or in the context of any relationship.

References:

Das, A. “Masturbation in the United States,” Journal of Sex and Marital Therapy (2007) 33:301.

Dekker, A. and G Schmidt. “Patterns of Masturbatory Behavior: Changes from the 1960s to the 1990s,” Journal of Psychology and Human Sexuality (2002) 14:35.

Hale, VE and DS Strassberg. “The Role of Anxiety on Sexual Arousal,” Archives of Sexual Behavior (1990) 19:569.

Coleman, E. “Masturbation as a Means of Achieving Sexual Health,” Journal of Psychology and Hu- man Sexuality (2002) 14:5.

Cornog, M. The BIG Book of Masturbation. Down There Press, San Francisco, 2003.

Bullough, VL. “Masturbation: A Historical Overview,” Journal of Psychology and Human Sexuality (2002) 14:17.

Kontula, O and Haavio-Mannila, E. “Masturbation in a Generational Perspective,” Journal of Psychol- ogy and Human Sexuality (2002) 14:49.

Zamboni, BD and I. Crawford, “Using Masturbation in Sex Therapy,” Journal of Psychology and Hu- man Sexuality (2002) 14:123.

Great Sex Guidance: Masturbation- Beyond Guilt or Shame – © Michael Castleman – 106 – The Mystery of Kissing

Kissing is a frequently overlooked element of sexuality. Also known as smooching, necking, snogging, making out, lip locking, bussing (archaic), and osculation, kissing is rarely mentioned in sexology resources.

One reason is that kissing often occurs in nonsexual contexts with non-erotic meanings, among them: kissing another’s cheek (or air kissing) to signal greeting or farewell, kissing children’s minor injuries to heal them, kissing the Pope’s ring or kings’ hands or garments to signal reverence and fealty, kiss- ing dice for good luck, and kissing that signals betrayal, condemnation, or contempt as in Judas’ kiss, the Mafia’s kiss of death, or the phrase “kiss my ass.”

The poet Percy Bysshe Shelley defined kissing as “soul meeting soul on lovers’ lips.” It’s certainly possible for lips-only kissing to express deep love, but for soul to meet soul, most lovers engage in deep, open-mouth kissing with tongue contact, also known as French kissing. Most—but not all— people consider kissing with tongue contact to be extremely intimate. Some people consider it as intimate as intercourse. Kissing’s intimacy is also reflected in a term used to describe fellatio and cunnilingus—“genital kissing.” Meanwhile, many sex workers who routinely provide fellatio and vagi- nal and anal intercourse refuse to kiss customers because, they say, it’s “too intimate.”

Ancient Sanskrit texts (c. 1000 B.C.) provide the earliest documented evidence of human kissing. Ancient Europeans kissed, but the paucity of references in ancient Greek literature suggests that the practice was less frequent two thousand years ago than it is among Europeans today. Most cultures around the world kiss, but not all. Europeans introduced the practice to the indigenous peoples of Australia, Tahiti, and several locales in Africa. In some Asian cultures, lovers kiss only in private. Do- ing so in public is considered indecent.

Kissing is a mystery. Only two other species are known to kiss as humans do, chimpanzees and bonobos. They kiss to communicate attachment and to reduce group social tensions. But only hu-

Great Sex Guidance: The Mystery of Kissing – © Michael Castleman – 107 – mans and bonobos kiss deeply during sex. Nor is it clear why kissing evolved. Some scientists specu- late that it originated with mammalian infant suckling. Human lips contain a wealth of touch-sensitive nerves, and lip stimulation activates a surprisingly large area of the brain. But all mammal mothers suckle their young while only a tiny minority of mammals kiss. Other researchers suggest that kissing originated in mammal mothers pre-chewing food before feeding it to their young mouth to mouth. But again, many more mammalian species pre-chew food than kiss. Some scientists theorize that kissing evolved to brings noses close enough to sense others’ pheromones, chemicals that play a subtle but well documented role in attraction and attachment. Again, many species respond to pheromones but only a few kiss.

Kissing boosts levels of the neurotransmitters dopamine, serotonin, and the endorphins. Dopamine regulates sexual desire while serotonin and endorphins elevate mood. Kissing also increases blood levels of the hormone oxytocin, which mediates interpersonal attachment, and decreases levels of the stress hormone cortisol. As a result, kissing reduces anxiety and lowers blood pressure.

Many people use kissing as a test of compatibility. In one survey, 59 percent of men and 66 percent of women said they’d ended budding relationships because the other person kissed badly.

Studies show that men are more likely than women to initiate kissing with tongue contact. Saliva contains trace amounts of testosterone, the hormone responsible for sexual desire in both men and women. Researchers speculate that unconsciously men may kiss with their mouths open to deliver this hormone and perhaps increase women’s sexual receptivity.

Among English speakers, open-mouth kissing was not called French kissing until World War I, when large numbers of English and American soldiers fought in France, and discovered that the French commonly engaged in it. However, open-mouth kissing is not called French kissing in France. It’s baiser amoureux (the kiss of love) or baiser avec la langue (kissing with the tongue).

Studies show that kissing is erotically more important to women than to men. Women are more likely to insist on kissing before, during, and after sex.

Kissing often makes people feel self-conscious, especially about the freshness of their breath. This concern accounts for significant sales of lifesavers, breath mints, toothpaste, and dental floss.

One study asked 1,041 young adults how best to kiss. The vast majority said that fresh breath, clean teeth, and good grooming were essential prerequisites. A large majority also valued soft, moist lips, deep breathing, mutual caressing, and assertiveness—leaning in and putting emotion into kissing rather than remaining passive. Finally, most said the best kissing begins with mouths closed, and with mouths opening only if things heat up.

References

Kirshenbaum. Sheril. The Science of Kissing: What Our Lips Tell Us. Grand Central Publishing, 2011.

Ryan, Christopher and Cacilda Jetha. Sex At Dawn: The Prehistoric Origins of Modern Sexuality. Harper-Collins, 2010.

Teifer, Lenore. “The Kiss: The Kinsey Institute 50th Anniversary Lecture,” Oct. 24, 1998. Great Sex Guidance: The Mystery of Kissing – © Michael Castleman – 108 – Pornography: The Real Problem Is It’s Bad for Sex

Marie Silva and her husband, Jack, both act in pornographic videos. Marie has made a modest name for herself, appearing in two dozen productions, among them: Sex Across America 5, Anal Addicts 2, and Nasty Nymphos 31. She looks the part, with a shaved vulva and a pierced clitoral hood. But in real life, she’s nothing like the women she portrays on screen: “I play strong characters, biker chicks, dominants, and wild women [who demand sex]. But in my personal life, I’m actually very shy, never a sexual initiator.”

The stark contrast between the lives Marie and Jack live on and off camera extends to their lovemak- ing. They had to learn pornography-style sex, as they relate in Marie and Jack: A Love Story, a docu- mentary about their relationship (amazon.com). “Sex on camera is very raw,” Marie explains, “It’s wild and crazy. It can be exciting. But it’s not satisfying. It’s not the same as our personal sex. Jack and I have a deep emotional connection. [For sex to feel satisfying], I need more than sucking and fucking. I need emotional fulfillment.”

Pornographic sex is so different from the way Marie and Jack like to make love that at the start of their video careers, they had to schedule rehearsal sessions. “We needed to practice having sex [the way the directors wanted],” Jack explains, “so we could perform correctly on camera.”

Directors wanted Marie to talk dirty. “I’d never done that before. I didn’t know how. Jack coached me. He’d tell me, ‘Say ‘Fuck me!’ Say it louder.’” Directors wanted Marie to use butt plugs and do anal intercourse scenes. She’d never done anything anal, but learned how for work. “She was doing anal on camera,” Jack recalls, “before we ever tried it at home.” Directors insisted that Marie and Jack dispense with tenderness, sensuality, and mutual massage, and play up raw, pounding, hardcore action. That felt bizarre, Marie explains, because their lovemaking with one another had always been “tender, playful, and intimate.” And directors wanted them to have intercourse in positions that would challenge a contortionist.

As they became more involved with making porn, Marie and Jack found themselves slipping into porn-style sex at home. “We’d do a movie” Jack recalls, “then the next day, have personal sex. I’d find myself holding her leg up or doing some of the weird things you see in porn. Or she would say, ‘Hard- er!’ or ‘Oh, yeah!’ Then we’d stop and say, ‘Wait. We’re not machines. Let’s just make love.”

Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 109 – Marie and Jack quickly learned to separate “work sex” from “personal sex.” At home, they rarely do anything anal, don’t talk dirty, and don’t use sex toys. They enjoy mutual, sensual, whole-body mas- sage, tender caresses, with lots of eye contact. “If we were making love,” Jack says, “and all of a sudden, I pulled out and said, ‘Baby, I want to come all over your face,’ Marie would say, ‘Are you kid- ding? You can’t be serious.’”

Imitating Porn Ruins Sex and Causes Sex Problems

Marie and Jack understand the difference between pornographic sex performed by actors who do what they’re told to fulfill men’s fantasies, and great sex enjoyed by real lovers who do what creates mutual pleasure for the two of them. Unfortunately, millions of people who view pornography—particu- larly men, the target group for porn—don’t appreciate this crucial distinction.

The cultural debate over pornography’s place in society is usually couched in terms of free speech vs. censorship. Porn producers and their defenders wrap themselves in the First Amendment, and excori- ate those who criticize X-rated media as Nazi prudes. Personally, I’m all for free speech and against censorship. I believe X-rated media that depicts adult sex should be freely available to adults. When I was a teen, I peeked at Playboy and thought it incredibly racy. Playboy seems so tame now, so inno- cent. When my two kids were teenagers, we never had any filters on our computers.They had instant free access to millions of sexually explicit images on the Internet—and I didn’t lose any sleep over their viewing them.

While I defend any adult’s right to buy and view porn, I firmly believe that the debate about pornogra- phy needs to be expanded beyond its relationship to the First Amendment. Porn has some legitimate uses in sex education and therapy, but ultimately, pornography is bad for sex. Those who use it as a guide to lovemaking are on a one-way trip to sex problems, relationship problems, and as Marie and Jack attest, unfulfilling lovemaking. Here’s why:

Everyone in Pornography Is Eager for Sex All The Time.

This can help some people overcome guilt feelings about their sexual desire, but it makes many people, particularly men, feel distressed that everyone seems to be getting more than they are. “It’s amazing,” says Bloomfield Hills, Michigan, sex therapist Dennis Sugrue, Ph.D., “how some people don’t understand that pornography presents a fantasy world, a Neverland that’s very different from the world real people live in.”

Every Man in Pornography Is Hung like a Horse.

Male porn actors are selected for extra-large penises. They really are bigger than the rest of us. Now, professional basketball players are much taller than the average man, but the typical guy doesn’t feel inadequate in comparison to them because he knows that most men are more or less his size. He has some perspective. That’s not the case with penises. Heterosexual men may see other men’s flaccid equipment from a distance in locker rooms. But other than their own, the only flaccid penises and erections the typical heterosexual man ever views up close hang between the legs of the guys in porn. Porn penises have become the standard by which men judge themselves, and that standard is

Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 110 – seriously skewed toward King Kongs, or, as one porn actor was dubbed, King Dong. As a result, all the normal-sized men of the world are justified in believing that they have one of the smallest penises they’ve ever seen. No wonder men almost universally believe their penises are “too small.” Blame it on porn.

Every Man in Pornography Raises Instant Erections.

By the time the men in porn drop their pants, they have full, firm erections.This is total fiction. In fact, the dirty little secret of pornography is that porn sex is so alienating, unarousing, and stress-provoking that before Viagra, most of the male actors had trouble getting it up. Even with Viagra, now de rigeur on porn sets, many of the male actors continue to suffer balky erections. Some—but by no means all—men in their teens and twenties can raise instant erections from fantasy or from a glance at an al- luring woman or erotic image. But past age 40 or so, most men notice that this ability fades. At every age—especially for older men—erection requires relaxation, playful, sensual touch, and for partner sex, a decent relationship with a loving partner whom you find arousing. Unfortunately, inspired by pornography, many perfectly normal men think something is wrong with them because they’re not rock hard at the drop of a zipper. “Porn encourages men to have unrealistic expectations of their pe- nises,” says Palo Alto, California, sex therapist Marty Klein, Ph.D. “Most men can’t raise instant erec- tions or become erect from simply looking. They need touch. Porn underemphasizes men’s real need for direct stimulation.”

The Erections in Pornography Never Subside.

Porn actors are rock-hard from the moment you see their penises until they ejaculate. For men un- der 40, this may be possible. But after 40, erections change. They no longer rise from fantasy alone. Penis-stroking—perhaps extended, vigorous fondling—becomes necessary. Erections after 40 are not as firm as they once were. And if an older man becomes distracted, his erection may subside right in the middle of sex, and require more direct caresses to firm up again—if it does. None of these problems ever happen in porn.

Every Man in Pornography Lasts Forever.

They pump, and pump, and pump even more—often thanks to deft editing. No one in porn every suf- fers premature ejaculation. But back in the real world, this problem, coming too soon, frustrates one- third of men in all adult age groups. Good ejaculatory control requires leisurely, playful, whole-body sensuality. That’s the opposite of the rushed, mechanical, genitally-preoccupied sex in porn. “Imitate pornography,” Sugrue explains, “and men, especially young men, are likely to ejaculate before they want to.”

Every Man in Pornography Ejaculates on Cue.

No one in porn ever suffers ejaculatory difficulties. But in real life, this problem is fairly common. One reason why men have problems ejaculating is that they don’t get the stimulation they need to express orgasm. For many men, that stimulation is not all genital. It involves whole-body sensuality. But the men in porn come every time with little or no sensuality. Because of pornography, many men infer that Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 111 – whole-body sensuality doesn’t matter, that all they need to let lose a major load is sucking and fuck- ing. Wrong.

The Women’s Bodies Are Way Too Perfect.

Until recently, porn actresses have always been women aged 18 to 29. Porn actresses in this age group are free of facial wrinkles, and have flat bellies, firm breasts, thighs, upper arms, and buttocks. However, since the arrival of Internet porn, women in other age groups also make porn. Women in their 30s are called “MILFs“ (Mothers I’d Like to Fuck.) Women in their 40s are “mature.” And women over 50 are known as “grannies.”

Nonetheless, the vast majority of women in porn are still in their late teens or 20s. In addition, many have had plastic surgery: breast enlargement, tummy tucks, liposuction—you name it. “Many men don’t understand how most women compare themselves to porn actresses,” Louanne Weston, Ph.D., a sex therapist in Fair Oaks, California, explains. “The typical woman feels very distressed that her body is nowhere near as flawless as what she sees on screen. Her man is sitting there thinking, ‘I’d love a blowjob like that.’ Meanwhile she’s thinking, ‘I’m a tub of lard.’ Women are no longer judged only by their looks. But to a great extent, women are still judged and valued based on how their physi- cal attributes, much more than men are. Very few women look like the women in porn. When women see the men in their lives enjoying those women they often feel hopelessly outclassed. They fear rejection, and it’s a deep and chilling fear, one few men appreciate.”

The Women in Pornography Are All Exhibitionists.

Have perfect body, will flaunt it, especially when it’s in the script. The women in pornography routinely flash their breasts and genitals in scenes that look as though they’re in public, and strut around naked just about anywhere. Few real women are exhibitionists—according to one study, only 1 to 2 percent. Because of their insecurities about their bodies, many women feel reluctant to reveal themselves even to the men they love. Meanwhile, men who view porn often expect their lovers to prance around in the buff and can’t understand why they insist on wearing robes until a moment before they slip into bed and pull the covers over themselves.

Pornography-Style Sex Is About 95 Percent Genital.

After a kiss or two, and a few swipes at the woman’s breasts and perhaps a bit of cunnilingus, it’s all fellatio and intercourse. Of course, the genitals are important in lovemaking, and oral sex can feel wonderful. But the genitals often don’t work right without leisurely, playful, whole-body sensuality— gentle touch all over. Pornographic sex is totally preoccupied with the genitals. Men who imitate it are on their way to rapid, involuntary ejaculation, erectile dysfunction, and ejaculatory difficulties—and to sexually unsatisfied women. “Pornography ignores sensuality,” Sugrue says. “It’s hard to have satis- fying sex without sensuality. That’s a big reason why porn-style sex isn’t satisfying. That’s also a big reason why so many women have problems with it.”

Pornographic Sex Is Impersonal.

Because porn is all-genital, nothing but sucking and fucking, it also depicts sex without relationships. There is never any flirting in porn, no dating, no courtship, no conversations or shared interests, no laughter, no seduction—nothing but hardcore action. Boy meets girl. They make eye contact. Her top comes off, her skirt comes up, and she’s on her knees with her mouth open. Many women find this Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 112 – incomprehensible—and offensive. Revolting against the sterility of pornography, former porn actress Candia Royale launched Femme Productions, a leading producer of X-rated videos with women’s sensibilities. Compared with mainstream porn, Royale’s videos develop storylines, characters, and relationships. It’s still porn, but it’s different (see, Does Porn Arouse Women?, below). Of course, Femme Productions accounts for only a tiny fraction of pornography’s output. The vast majority of X- rated media depict impersonal sex, which, many women feel demeans them.

Every Woman In Porn Can’t Wait for Genital Sex.

Compared with men, women usually need considerably more time to warm up before they feel com- fortable with genital sexuality. They need intimate conversation and extended loveplay that includes kissing, hugging, mutual whole-body massage, and playful, creative sensuality. Porn totally ignores this very real need. Instead, it encourages men to plunge into intercourse long before women feel receptive. When surveys ask women what they dislike about the way men make love, they consis- tently reply that men rush into intercourse too quickly. Blame it on porn. Porn sex leaves many women cold—and turned-off women aren’t much fun in bed.

The Women in Porn Almost Never Experience Orgasm.

This is actually the X-rated media’s only realistic element. After the man comes, known in the indus- try as the “money shot,” the sex is over. The women scream and moan in the throes of supposed pas- sion, but virtually never do they actually have orgasms. One reason is that the vast majority of porn is produced by men for men. The culture of porn has little interest in women’s sexual satisfaction. In ad- dition, given the rushed, mechanical, nonsensual nature of porn sex, under those circumstances, it’s a rare woman who could come, even if she wanted to. No wonder so many men are in the dark about women’s orgasms. They never see them in porn, and have no idea that porn-style sex leaves many women so turned off and unfulfilled that they can’t possibly express orgasm. “Lots of women look at porn,” Weston says, “and think: When I do it, I never get as excited as those women. Therefore, there must be something wrong with me.” Of course, nothing is wrong with them. What’s wrong—complete- ly wrong—is the portrayal of women’s sexuality in porn.

Pornography Ignores The Unique Individuality of Sexual Expression.

Porn sex is cookbook sex. Take two people. Get them naked. She sucks. He licks. Then they fuck in any number of acrobatic positions. Some people may enjoy making love this way, but most people prefer more variety, more creativity. Porn never shows lovers massaging each other’s shoulders, or running fingers through each other’s hair, or tracing fingers on the backs of knees, or sucking each other’s fingers or ear lobes. All of these little moves can add zing to lovemaking. Pornography rarely shows eye contact, never zooms in to catch one lover whispering, “I love you.” Nor does pornography ever show lovers asking each other, “Is this okay?” “How’s this? Too light? Just right? Too intense?” Or “What can I do for you?” Porn never presents lovemaking as a sensual quest, a journey to explore what lovers find sensually arousing and fulfilling. In porn, one script fits all. “Porn sex is very narrow,” Klein says. “That’s why, after a while, it gets boring. Great sex doesn’t become boring.”

Pornographic Sex Rarely Involves Sexual Lubricants, At Least Not On-Camera.

The actors and actresses in porn use lubricant by the gallon. But viewers never see it on screen. Just as the men in porn produce instant erections, the women appear to be perpetually wet between the thighs. In fact, even with loving, playful, extended whole-body sensuality, many perfectly normal Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 113 – women don’t produce much vaginal lubrication. To enjoy intercourse comfortably, many women need a commercial sex lubricant. You’d never know this from watching pornography. As a result, many men push too quickly into poorly lubricated vaginas, and then blame it on the woman: “She’s too tight.” Meanwhile, many women suffer pain on intercourse, which ruins sex for them.

In Pornography, Oral Sex Is Universal.

Every woman sucks, and every man licks. This significantly overstates the popularity of oral sex in America’s bedrooms. According to the best current sex research—studies at the University of Chi- cago and the University of California in the 1990s—only about 25 to 50 percent of lovers routinely engage in oral sex. For porn viewers who receive less oral than they’d like, the ubiquity of oral sex in porn creates the impression that everyone in the world is getting head every time—except them.

Oral Sex In Pornography Is Too Intense.

The men in porn plunge into cunnilingus like parched dogs presented with bowls of water. Porno- graphic fellatio is not much different. The women are often quite rough on the penises they suck. Many people prefer gentler oral caresses. In fact, for many women, the clitoris is so sensitive that di- rect tonguing, no matter how gentle, feels uncomfortable. Some women prefer men to lick the clitoris very gently, or to lick around it, but not directly on it. Others enjoy a tongue directly on the clitoris—but only after considerable licking around it. You’d never know this from watching porn. “Oral sex in por- nography is like slapstick in theater,” Weston says. “overdone for effect. Enjoyable sex is gentler.”

Anal Sex In Pornography Is Totally Unrealistic.

Not all porn includes anal play, but any video with “anal” in the title typically focuses on just one type of anal sex, penis-in-anus intercourse—with a vengeance. In fact, among real lovers, this is the least popular form of anal play. Most anal sex involves sphincter massage or gentle fingering. In addition, porn actors rarely take the time to use lubricant. The inserter never asks the recipient, “Is this okay?” And the inserter pushes in too deeply too quickly, and then pumps in and out much too vigorously. No wonder so many people complain that anal sex hurts. Imitate porn and it’s bound to. “The presenta- tion of anal sex in porn is ridiculous,” Klein says. “It’s totally unrealistic how much everyone enjoys it. And on camera, it’s totally unlubricated. The actors lube up off-camera, but viewers never see it. All the audience sees is huge erections plunging into little rosebuds.” To make matters worse, some anal sex in porn is so unsanitary that it’s medically hazardous. “I’ve seen videos where the guy’s erection goes right from the woman’s anus into her vagina or mouth,” Sugrue recalls. “No one should ever do that.”

Pornography Ignores Contraception.

Viewers may infer that they can, too. This is a big mistake for two reasons. First, unprotected sex risks unwanted pregnancy. Second, sex without birth control often makes one lover—or both—feel anxious, producing stress that reduces the pleasure of lovemaking and contributes to sex problems.

Pornography Ignores Sexually Transmitted Infections (STIs).

Except for a brief period in the early 1980s when the pornography industry panicked about AIDS, very few people in porn use condoms, and STIs are never mentioned. “Pornography is one big fantasy of sexual abundance with no responsibility,” Sugrue says. Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 114 – Pornography Is Extremely Internally Consistent.

Motion pictures were invented in 1890. By 1891, pornography was being produced. Recently, some of the first pornographic movies ever filmed have been released on video.The actors’ clothing and hairstyles are antique, but the sex in century-old porn looks remarkably like the sex in porn today. Porn sex is The Big Lie told over and over and over again. Because all porn depicts the same sexual style, viewers infer that rushed, mechanical, nonsensual, genitally preoccupied porn sex is the way lovemaking should be.

Finally, Pornography Has Become the Single Most Influential Sex Educator in The Country.

A generation ago, widely available sex media consisted of softcore Playboy, somewhat raunchier Penthouse, and a dozen other girlie magazines. Pornography was confined to seedy theaters and sex shops tucked away on the wrong side of the tracks, accessible only to a small fraction of adults. Today, that era feels quaint. These days, home pages of more than 100 million pornographic Web sites are easily available in every home with an Internet connection. You don’t even have to look for them. Junk email for everything from “Horny Housewives” to “Teenage Anal Gangbangs” fill in- boxes. Access requires a credit card, but what you can see for free could make Hugh Hefner’s hair curl. Meanwhile, the sheer volume of Internet porn persuades many viewers that porn sex is the way sex should be. While there are some legitimate uses for pornography in sex education and therapy, on balance, pornography is bad—very bad—for sex. Pornography is like the chase scenes in action movies—exciting and fun to watch, but definitely not the way to drive.

The “Pornogrification” of America

Elected officials in Provo, Utah, like to boast that the town is one of the most conservative communi- ties in the United States. So no one was too surprised at the dawn of the new millennium, when a petition circulated to indict a local video store owner on obscenity charges because he rented X-rated DVDs. More than 4,000 Provo residents signed the petition, and the local prosecutor filed charges, figuring on an easy victory. He developed his case based on the landmark 1973 U.S. Supreme Court rule that defined obscenity as anything sexual that was offensive “to the average person, applying contemporary community standards.” In a town as conservative as Provo, the prosecutor was confi- dent the jury would view the video store’s material as offensive to Provo’s community standards, and convict the owner.

But as Fate would have it, according to a report in the New York Times, the defense attorney’s office was across the street from the Provo Marriott Hotel. The lawyer had stayed in Marriotts elsewhere and recalled that the hotel’s in-room TV system offered pay-per-view sex films. He wondered if such entertainment was available at the Provo Marriott. He subpoenaed the hotel’s records, and discov- ered that every year, 3,000 guests paid to view sex films there. Intrigued, the defense lawyer obtained the records of the cable and satellite TV companies that served Provo. These businesses distributed 20,000 X-rated movies annually to subscribers in Provo, dwarfing the 4,000 videos the indicted store owner rented each year. With a little more digging, the defense lawyer determined that Provo con- sumed more X-rated media than many more liberal communities of the same size. Why, he asked in court, should his client face criminal charges as a porn peddler when the same material was freely available—in fact, more available—all over town? He reminded the jury of the standard specified by the U.S. Supreme Court, that to be obscene, X-media had to be offensive “to the average person, applying contemporary community standards.” Clearly, Provo had embraced porn in a big way, so clearly, the video store did not violate community standards. It took only a few minutes for the jury to Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 115 – acquit the defendant.

When the Supreme Court developed its obscenity test in 1973, prosecutors hailed it as a major tool for ridding the country of an “epidemic” of smut. At the time, the porn industry was estimated to gross $10 million a year. Pornography was not widely available, and jurors could be counted upon to say they were offended by it—even if they had a stack of X-rated magazines hidden in their dressers.

Then, in 1975, the videocassette recorder first appeared. Today more than 75 percent of American homes have one (or a DVD player). By the beginning of the 21st century, U.S. X-rated video rentals and downloads totaled 711 million annually, almost 3 per capita. Video stores currently gross more than $4 billion a year from pornographic rentals, which account for about one-third of total video rental revenue. Cable TV has also proliferated. One of its selling points has been that, unlike broadcast tele- vision, cable—and satellite—networks are not sexually censored. Showtime grossed $54 million from sex films in 1993. By 1999, the figure had increased almost seven-fold to $367 million.

Then, in the mid-1990s, the Internet roared into prominence. From day one, sex has always been one of the biggest interest areas on the World Wide Web. According to Web tracking services, some 21 million Americans visit sex-oriented Web sites each month.

With video rentals, cable and satellite TV and the Internet, porn has boomed. Compared with 1973, according to the New York Times, it has grown by a factor of 1,000. Today porn is a $10 billion a year industry. Americans now spend more on porn than they do on all other movies, more than they spend on all theater and dance, more than they spend on professional football, basketball, and baseball tick- ets—combined. “Porn is no longer a sideshow to mainstream culture,” notes New York Times colum- nist Frank Rich. “It is the mainstream.”

The pornogrification of America has put X-rated media literally in bed with some of the nation’s larg- est corporations. General Motors is now a bigger porn merchant than Hustler publisher Larry Flynt. GM owns the DirecTV satellite TV service, which earns $200 million a year from pay-per-view sex films. EchoStar, the nation’s #2, satellite TV provider, grosses more money than Playboy. It’s owned by media mogul Rupert Murdoch. And AT&T, the nation’s largest communications company, offers a hardcore sex channel call the Hot Network on its broadband cable service. Twenty percent of AT&T customers subscribe to it. AT&T also owns a company that sends sex movies into more than 1 million hotel rooms around the U.S. Hotels have become major centers for sex media because solo business travelers, overwhelmingly men, enjoy masturbating to it. Forty percent of U.S. hotel rooms—some .5 million—are equipped to provide pay-per-view sex movies. A major provider of in-hotel-room movies is LodgeNet, of Sioux Falls, SD. The company’s annual gross from X-rated media is $180 million a year.

But don’t look for any T&A in the annual reports of AT&T, GM, or Murdoch’s News Corporation. The companies’ connections to pornography are either ignored, or mentioned only in vaguest euphe- misms.

The pornographication of America has not gone unopposed. When AT&T announced its Hot Network, several religious groups, who happened to be major shareholders, denounced it. The same thing happened when Marriott Corp., which is owned by several prominent Mormons (though not affiliated in any way with the Mormon Church), began offering in-room sex films. But profit won out over the protests. For mainstream Hollywood movies, the producer splits revenue 50-50 with the exhibitor. For

Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 116 – pornography, the exhibitor keeps 80 percent.

Sex conservatives still denounce pornography and political candidates who accept contributions from Playboy executives. But America’s “community standards” have clearly changed. If anything, the future promises more porn that’s even easier to obtain. The day is not far off when streaming video on the Internet means that theater-quality porn is just a click away. And as porn becomes increasingly mainstream, Americans will see ever more porn-style sex—and run even greater risk of developing the sex problems it causes.

Recently, a University of Michigan researcher searched the Internet for sex education sites aimed at teenagers. She found three dozen devoted to abstinence, and two dozen that provided information about contraception. Meanwhile, a Google search of the term “porn” turned up 700 million sites. By sheer volume, porn has become the nation’s leading sex educator—only it teaches the wrong way to make love.

“The Real Thing”

Marie Silva and her husband, Jack, continue to make porn films, but their personal sex life is the antithesis of what they do on camera. “At home, we don’t put on a show,” Marie explains. “And it’s certainly not work. Our personal sex is fun. There’s a wonderful playfulness to it. Jack has a tender, sensual mouth. [When he gives me cunnilingus,] he makes me feel so good. We have intercourse in maybe three positions, usually ending with spooning [on their sides, her back against his chest]. He’s inside me, but I don’t come from just intercourse, so he also massages my clitoris by hand. Our per- sonal sex is very intimate, very tender and playful. [After having porn sex at work], it’s so nice to come home and enjoy the real thing.”

The Sexual Benefits of Porn

Some sex educators and therapists use sexually explicit media in their work. “I’ve used it from time to time,” Weston explains. “I don’t use mainstream porn that much. But I’ve recommended Candida Royale’s videos. They show plenty of sex, but they have better developed story lines than what’s typical in mainstream porn, and there’s more chemistry between the actors. I’ve also recommended books of erotic art or photography.”

Experts note these benefits from pornography:

* It helps people get past any guilt they feel about their sexual desire. “Porn depicts a world of sexual abundance,” explains Advisory Board member Marty Klein, Ph.D. “That’s a big reason why people enjoy it. It’s a fantasy, of course, but there’s something compelling about a world where no one makes anyone else feel badly simply because they have sexual desires and act on them.”

* Pornography gives people permission to be sexual. “It shows people wanting sex and enjoying it,” says San Francisco sex therapist Linda Alperstein, L.C.S.W. “For those who feel sexually re- pressed, that can feel liberating: ‘Oh, so other people aren’t ashamed of wanting this. They actu- ally do this. Maybe I’m not a pervert for wanting it. Maybe I can have sex, too.’”

* Pornography gives people permission to be more passionate in bed. “Seeing passionate sex,”

Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 117 – Sugrue says, “can free people to let themselves go more than they might otherwise.”

* Pornography helps allay guilt feelings about masturbation. Both the men and women in porn fondle themselves frequently, and no one gets upset. On the contrary, porn depicts a world where masturbation is completely accepted. “I’ve worked with preorgasmic women who learned how to masturbate by watching porn,” Weston says.

* Pornography can provide a pleasant libido boost before sex. “The research is quite clear,” Sug- rue explains. “After viewing porn, people are more likely to have sex.” However, sexually explicit visual media tend to be more arousing for men than women.

* Pornography is an aid to erotic fantasy. Sex fantasies get fatigued after a while and lose their power to arouse. Porn offers new fantasies.

* Pornography can help free lovers who feel stuck in sexual ruts. Porn is stuck in a rut itself, but the range of sexual moves it depicts may be broader than what some lovers are used to. In such cases, it can suggest new sexual possibilities.

* Pornography can help lovers ask for sexual variations, notably oral sex. “A picture is worth 1,000 words,” Weston explains. “Some people can’t say, ‘Hey, I’d like oral sex. Would you do that for me?’ But when they see it in a video they can say, ‘That looks like fun. Want to?’”

* Pornography provides some instruction in sexual positions and oral sex. The positions are too acrobatic, and the oral is often too rough. Nonetheless, porn teaches basic positions and oral sex skills.

Does Porn Arouse Women?

Women’s feelings about pornography depend on the kind of X-rated material they view. Research- ers at the University of Connecticut showed 395 college students (200 men, 195 women) one of six X-rated videos—three standard male-oriented programs, and three produced by Candida Royalle, a former pornography actress who left porn in the mid-1980s to produce erotic videos from a woman’s point of view through her company, Femme Productions. Most men said they found both mainstream porn and Femme videos equally arousing. However, the women clearly preferred the Femme pro- grams. Compared with women who watched traditional pornography, those who viewed the Femme videos reported considerably more enjoyment—and more intercourse afterward.

In a similar study at the University of Amsterdam in the Netherlands, researchers evaluated 47 wom- en undergraduates’ reactions to mainstream pornography and Femme videos. But this study delved deeper, as it were, into the participants’ sexuality. In addition to filling out a survey, the women were also fitted with tampon-like devices that measured blood flow into their vaginal walls, an indication of sexual arousal. In the survey arm of the study, the women greatly preferred the Femme programs, calling them much more enjoyable and arousing. Unexpectedly, however, both types of X-videos elic- ited similar vaginal reactions, demonstrating that women’s feelings of sexual arousal are more subjec- tive than objective.

Candida Royalle has produced seven feature-length videos. Many of those in her casts also work in

Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 118 – mainstream porn. Femme videos are clearly inspired by mainstream pornography, but relationships are more developed, the sex is more sensual, and the women appear more real. To obtain Femme videos, visit Adam & Eve.

Royalle is not the only producer of X-rated videos that are woman-oriented. Other videos likely to ap- peal to women are offered by Good Vibrations, the woman-oriented sex shop in San Francisco. The Good Vibrations catalog includes nifty icons to inform shoppers of videos that are woman-centered, have interesting plots, and depict relationship chemistry between lovers (see Resources).

In addition, many instructional sex videos are artfully produced and erotic. I particularly recommend two:

Ancient Secrets of the Kama Sutra: The Classic Art of Lovemaking. Produced with the help of Los Angeles sexologist Patti Britton, Ph.D., this 60-minute, lavishly erotic tour de force is a sensual, pulse- quickening take on the ancient Indian Kama Sutra’s eight stages of lovemaking: preparation (bathing), massage, ambiance (candlelight, music, etc.), seduction (undressing), kissing, lingual love (oral sex), intercourse (many positions), and union (spiritual merging during afterglow). Each of the eight stages is enthusiastically acted out by attractive, sexy lovers who clearly enjoy themselves. Unlike most mainstream porn and many instructional sex videos, Ancient Secrets of the Kama Sutra is beautiful to watch, a unique work of video art that combines education and entertainment in a loving, arousing package. To obtain it, visit amazon.com.

Erotic Massage: The Touch of Love. A central message of this book is that great sex requires sensu- ality, notably whole-body massage. Every square inch of the body is a sensual playground and whole- body massage makes genital sexuality feel all the more erotic and fulfilling.This book is a wonderful introduction to sensual massage—everything from a basic back rub to advanced genital fondling. It teaches lovers to communicate through the language of touch. Use the Erotic Massage Book during a romantic weekend getaway, or any time you want to make an afternoon or evening of sensual togeth- erness. To obtain it, visit amazon.com.

If the Idea of Kiddie Porn Turns You On....

Great sex involves mutual consent. Because of the inherent developmental and power differences between adults and kids, children, especially those who have not reached puberty, cannot consent to sex as adults can. Therefore, kiddie porn is inherently abusive. While many sexuality authorities would defend the right to fantasize about sex with children, sharing or spending money on media that depict child sex or adult-child sex supports an industry based on child abuse. If you find yourself seeking out kiddie porn, get professional counseling from a mental health professional or sex thera- pist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References: Bay-Cheng, L. “SexEd.com: Values and Norms in Web-Based Sexuality Education,” Journal of Sex Research (2001) 38:241.

Beggan, J.K. and S.T. Allison. “Reflexivity in the Pornographic Films of Candida Royalle,” Sexualities

Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 119 – (2003) 6:305.

Bergner, R.M. and A.J. Bridges. “The Significance of Heavy Pornography Involvement for Romantic Partners: Research and Clinical Implications,” Journal of Sex and Marital Therapy (2002) 28:193.

Bridges, A.J. et al. “Romantic Partners’ Use of Pornography: Its Significance for Women,” Journal of Sex and Marital Therapy (2003) 29:1.

Brown, J.D. “Mass Media Influences on Sexuality,” Journal of Sex Research (2002) 39:42.

Egan, T. “Technology Sent Wall Street into Market for Pornography,” New York Times, Oct. 23, 2000.

Garos, S. et al. “Sexism and Pornography Use: Toward Explaining Past (Null) Results,” Journal of Psychology and Human Sexuality (2004) 16:69.

Goodson, P. et al. “Searching for Sexually Explicit Materials on the Internet: An Exploratory Study of College Students’ Behavior and Attitudes,” Archives of Sexual Behavior (2001) 30:101.

Hald, G.M. “Gender Differences in Pornography Consumption Among Young Heterosexual Danish Adults,” Archives of Sexual Behavior (2006) 35:577.

Hald, G.M. and N.M. Malamuth. “Self-Perceived Effects of Pornography Consumption,” Archives of Sexual Behavior (2008) 37:614.

Keller, S.N. and J.D. Brown. “Media Interventions to Promote Responsible Sexual Behavior,” Journal of Sex Research (2002) 39:67.

Laan. E. et al. “Women’s Sexual and Emotional Responses to Male- and Female-Produced Erotica” Archives of Sexual Behavior (1994) 23:153.

Mosher, D. and P. MacIan, “College Men and Women Respond to X-Rated Videos Intended for Male or Female Audiences: Gender and Sexual Scripts,” Journal of Sex Research (1994) 31:99.

Rich, F. “Naked Capitalists,” New York Times Magazine, May 20, 2001, p. 51.

Striar, S. and B. Bartlik. “Stimulation of the Libido: The Use of Erotic in Sex Therapy,” Psychiatric An- nals (1999) 29:60.

Strossen, N. Defending Pornography: Free Speech, Sex, and the Fight for Women’s Rights. New York University Press, NY, 2000.

Traeen, B. and T.S. Nilsen. “Use of Pornography in Traditional Media and on the Internet in Norway,” Journal of Sex Research (2006) 43:245.

Youn, G. “Subjective Sexual Arousal in Response to Erotica: Effects of Gender, Guided Fantasy, Erotic Stimulus, and Duration of Exposure,” Archives of Sexual Behavior (2006) 35:87.

Great Sex Guidance: The Real Problem with Pornography- It’s Bad for Sex – © Michael Castleman – 120 – Porn On The Internet - Is My Man A Porn Addict?

With the advent of the Internet, people interested in pornography can view X-rated media anytime day or night at home on their computers.

Who views porn? Overwhelmingly, men. According to Adult Video News, the pornography trade magazine, 71 percent of X-rated media is viewed by men solo, 19 percent by heterosexual couples, 7 percent by homosexual male couples, and 2 percent by women, either solo or in lesbian couples. Men who use porn solo account for almost three-quarters of pornography consumption, almost three times as much as all other users combined.

This should come as no surprise. Compared with women, men tend to be more aroused visually. (Women tend to be more aroused by touch.) Mainstream pornography presents a world tailored to men’s sexual fantasies. In the world of porn, all women are perpetually horny, sexually available, enthusiastic, and happy to service men endlessly, plus they’re indifferent to courtship, intimacy, mar- riage, birth control, STI prevention, and their own sexual satisfaction. In porn, all men are buffed, sexually alluring studs with huge erections that rise instantly, never falter, and last as long as the men want. And when the men in porn decide to ejaculate, it occurs without any difficulty.

Men who view porn by themselves typically use it as a masturbation aid. They don’t consider it a betrayal of their marriages or relationships. They don’t love their spouses, fiancees, or girlfriends any less because of it, nor do they judge their lovers harshly compared with the women they see on screen. And except for a small group of compulsive porn consumers (see below), the vast majority of men don’t consider pornography a substitute for their lovers. As one man said, “When I look at porn, it’s not about my wife or our relationship at all. It’s about me and my sexual fantasies. I sometimes get tired of my own fantasies. With porn, I can masturbate to someone else’s, and sometimes I like that.”

But many women feel differently. Illinois State University researchers visited Internet message boards dealing with heterosexual relationships and collected 100 posts by wives, fiancees, and girlfriends who had discovered that the men in their lives were frequent viewers of Internet porn. They did not consider it an innocent masturbation aid. On the contrary, they felt traumatized and confused by the discovery, and considered it incomprehensible that their lovers would spend time this way. They considered porn viewing a form of infidelity, proof that their lovers no longer desired them. They also

Great Sex Guidance: Porn On The Internet- Is My Man A Porn Addict? – © Michael Castleman – 121 – experienced deep feelings of loss—loss of the man’s affection, his sexual interest, and intimacy and trust in the relationship. In addition, they often described themselves as feeling old, fat, ugly, and worthless because of their lovers’ Internet porn interest. The women who were more accepting called their men “sick” and hoped they could be “cured.” Those who were less tolerant called them “perverts, degenerates, or sex addicts” and questioned whether the relationship could endure.

What Does Porn Mean?

Clearly men and women differ about the meaning of a man’s viewing Internet pornography—and by extension any porn. The Illinois State researchers believe men when they say that porn is nothing more than a handy masturbation aid, and no reflection on the man’s mental health, his relationship, or his love for the woman in his life. They offer this reassurance to women: “It’s not about you.”

For most men, porn represents a form a self-soothing, a way to take a little break from daily hassles, and find comfort in masturbating. Women often self-soothe by taking a hot bath, or shopping. Many men use porn.

Women’s Body Insecurities

But as the Illinois study shows, many women become distraught when the men in their lives view porn. “One reason,” Weston explains, “is that so many women feel so insecure about their bodies, especially in comparison with the bodies of the women in porn. Another is that many women have an overly romanticized view of relationships. They think they should be able to fulfill all of their man’s needs. But they can’t fulfill his needs around masturbation, which, by definition happens solo.T oo many women think a marriage license is a license to run the other person’s life, especially his sex life. It isn’t.”

“Men and women attach very different meanings to many things,” Klein explains. “A visit to her par- ents may be a pleasure for her, but a joyless obligation for him. The same is true of how couples view pornography. Men like it because it appeals to their fantasies of sexual abundance without responsi- bility. But women often feel threatened by it because they think: You enjoy looking at those beautiful naked girls because you think I’m fat and ugly.”

“As a man myself,” Sugrue says, “and as a mental health professional, I know that what guys say is true: Overwhelmingly, they love their partners, think they’re great, and have no desire to toss them aside to be with the women in pornography. But they still like to watch porn, and use it for fantasy while masturbating. They don’t see it as cheating or a sign of relationship dissatisfaction. And they don’t think any less of their lovers’ bodies.”

I agree. I’m a fairly typical man. I’ve used pornography as a masturbation aid, and I’ve never con- sidered it to mean anything more than that. I don’t consider it a form of cheating or unfaithfulness. I don’t desire my wife any less. I don’t consider the women in porn any more alluring than she is. I don’t long to get involved with porn actresses in real life—and unlike most men, I’ve met several. I’m quite content in my marriage, and porn has never impinged on that. It doesn’t matter where you get your appetite—as long as you come home for dinner.

Do Men in Relationships Have a Right to Masturbate?

Some of women’s objections to porn have to do with mixed feelings about the men in their lives Great Sex Guidance: Porn On The Internet- Is My Man A Porn Addict? – © Michael Castleman – 122 – masturbating at all. Some people believe that self-loving should not be necessary for people who are in committed relationships, that spouses should meet all of each others’ sexual needs. That view is naive. Masturbation is our original sexuality. The vast majority of men were happily masturbating long before they met their spouses. Why deny yourself apple pie once you’ve discovered peach? Most men don’t use masturbation to withdraw from their relationships, but rather to relax, to take a little time out, much the way some women enjoy hot baths. Spouses cannot meet each others’ needs to masturbate, which involve solitude. It’s fine for men to masturbate, and it’s fine for them to use por- nography to spice it up. The only problem is trying to imitate porn in real life.

Compulsive Porn Viewing

Some of the women whose posts the Illinois State researchers collected were involved with men who viewed pornography for up to several hours a day, in some cases, losing their jobs as a result. When anything sexual interferes with one’s ability to live a normal, productive life or maintain an intimate relationship, that’s not healthy. Like anyone engaged in any obsessive-compulsive behavior, men who can’t control their porn consumption should seek professional counseling. A sex therapist would be a good choice. To find a sex therapist near you, visit the American Association of Sex Educators, Coun­ selors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexol­ ogy.

References:

Bergner, R.M and A. Bridges. “The Significance of Heavy Pornography Involvement for Romantic Partners: Research and Clinical Implications,” Journal of Sex and Marital Therapy (2002) 28:193.

Bridges, A.J. et al. “Romantic Partners’ Use of Pornography: Its Significance for Women,” Journal of Sex and Marital Therapy (2003) 29:1.

Great Sex Guidance: Porn On The Internet- Is My Man A Porn Addict? – © Michael Castleman – 123 – Pubic Hair Removal: How Do The Porn Stars Get So Smooth?

These days, the vast majority of women—and men—in porn have smooth-shaved genitals, or close to it. What’s shaved always looks very smooth. Silky smooth. Baby smooth. And if you’ve ever tried to duplicate that “porn smooth” look, impossibly smooth. What’s the porn stars’ secret?

“I wish I knew,” says Fair Oaks, California, sex therapist Louanne Weston, Ph.D., who blogs for Web- MD.com. “But I’ll tell you one thing: There’s a surprising amount of interest in pubic hair removal. The column I did on it got more responses than anything else I’ve ever written—and not just from women. Many men are also very interested in shaping or getting rid of their pubic hair. I was surprised at all the interest.”

From Hirsute To Hairless: Pubic Fashion Through the Ages

It’s not easy to track the history of pubic presentation. Ancient Chinese, Greek, and Roman erotic art generally depict genitals—both male and female—with only a little pubic hair, if any. Did the ancients remove it? Or did the artists simply not include it? Art historians are silent on the subject.

Verifiable pubic fashion dates from the mid-19th century invention of photography. Compared with today’s crotch close-ups, surviving erotic photos of nude women from the Civil War era tend to be demure. They show naked breasts and buttocks, but often not the pubic area. However, in those that show frontal nudity, the amount of pubic hair varies from lush (a “full bush”) to none (“bald”).

Early pornography, the “blue movies” filmed from around 1900 through World War II show a similar range of pubic hair in both men and women, from bushy to bald, with most of the men and many of the women on the bushy side.

But in recent decades, there has been a clear trend in the sex media toward bush wacking. “If you track Playboy and Penthouse over the years,” explains Palo Alto, California, sex therapist Marty Klein, Ph.D., “you see full bushes through the 1970s, then from around 1980 through the present day, a steady trend toward less and less pubic hair.”

“I was a Penthouse model in the early 1980s,” says retired porn actress Kelly Nichols, “and I posed with a full bush. I also had a full bush in my films. No one in adult entertainment shaved back then.

Great Sex Guidance: Pubic Hair Removal- How Do The Porn Stars Get So Smooth? – © Michael Castleman – 124 – Now everyone does.”

“For many years, I’ve been a lifeguard at a pool at a large university,” writes a woman contributor to one of the many Web sites devoted to pubic shaving, “so I see a lot of naked college-age women in the shower and locker room. Over the years, there’s been a trend toward pubic trimming and shaving. Most college women these days keep their pubic hair trimmed short. And it’s not uncommon to see them completely shaved.”

Is pubic shaving a real trend? Or simply a momentary fashion statement? No one knows. But Betty Dodson, Ph.D., a New York City sex educator and producer of “Viva La Vulva,” a video celebrating the beauty of women’s genitals, thinks pubic trimming and shaving are here to stay: “We have changing ideas about what’s public and what’s private. Nudity is less private than it used to be. When women’s clothing began showing bare arms and legs in the 1920s, leg and underarm shaving followed soon after. Not all women shave their legs and armpits, but most do. And now that nudity is more pub- lic—nude beaches, routine nudity in film, and the enormous amount of exhibitionism and porn on the Web—I’m not surprised to see a trend toward pubic shaving. It’s a way of saying: I’m into showing it off, so I’ll really show it off by removing the hair. I think the bald look is probably here to stay.”

If anyone should know how the porn stars get so smooth, the producer of “Viva la Vulva” should. Does she? “Honey,” Dodson says, “I have no idea.”

While some view the smooth look as sexy, others view the trend toward pubic hair removal as pos- sibly sinister, a “Lolita” fixation by male pedophiles who fantasize sex with young girls and want grown women to look like them. It’s possible that such proclivities play a role in some people’s lust for pubic hairlessness, but the evidence suggests otherwise. People who post on Web sites devoted to pubic shaving never mention any fascination with underage youth. They just love the smooth look—and not just on women, on men as well:

“I’m a 40-year-old woman, married for many years. Our sex life was getting a little boring, so as a sur- prise one night, I shaved my genitals. I’m not going back. I am so happy with my bold, out-there vulva. It looks beautiful. I love to look at my labia. Without the hair, they invite touching, caressing. And since I shaved, my husband is continuously aroused. Sex is great again. I love how my naked vulva feels when we fuck, and when he gives me oral sex. Now, when I see a woman with a bush, I feel sorry for her. Why hide it when it’s beautiful?”

“I am a 38-year-old married man. I’ve shaved my balls for five years. I don’t shave the hair above my cock, but I keep it trimmed short. My wife also shaves her pubic hair—all of it. Hairlessness feels so different from having a bush. It keeps me thinking about sex all day. I like the look as well. And I love fucking with both of us shaved. It feels much closer and deeper. The best part is when I feel my bald balls nestled up against my wife’s bare pussy lips. I’m so glad my wife shaves. I think the vulva and labia are beautiful. Why hide them under all that hair? Dare to go bare!”

“I absolutely love gazing at, touching and licking my fiancee’s shaved labia. She is simply stunning when shaved! It is hard to describe how arousing a newly shaved pussy is.”

It’s clear that many lovers enjoy hairless genitals. But what’s the best way to accomplish it? Several options are available: razor shaving, waxing/sugaring, electrolysis, tweezing/plucking, and depilato- ries. Here’s an introduction to each approach:

Great Sex Guidance: Pubic Hair Removal- How Do The Porn Stars Get So Smooth? – © Michael Castleman – 125 – Razor Shaving

Every summer, many women shave the “bikini line” around their upper thighs and lower abdomens to keep unsightly hairs from poking out of their bathing suits. It’s a short step from there to shaving the vulva, or for men, the penis and scrotum.

On Web sites that discuss the joys—and hassles—of baldness below the belt, razor shaving rules. Very few people even mention other options. Shaving is easy, convenient, cheap, and can be done at home, most easily in the shower.

One happily razor-shaved woman posted this: “I recently shaved my pussy as a surprise for my boy- friend. Our sex was incredible. I love the feeling of being shaved and enjoy touching my soft lips. Of course, to stay smooth, I have to shave almost every day and use a quality shaving cream and razor. I follow with a cold water rinse and then use baby oil or a good moisturizer. Those little red bumps stay away if you take the proper precautions. I intend to stay shaved. Sex has never been better.”

Other people, however, aren’t so enthusiastic. Another post: “I need to find a better way than shaving. For me, it’s just too itchy and painful.”

“Shaving can be a real hassle,” Dodson explains. “Many women find that it irritates the vulva. Or that it gives them ugly red razor bumps. Or that the area itches unbearably as the hair grows back. Or that they get painful ingrown hairs.”

Razor bumps are the most common complaint among public shavers. They’re ugly and they itch. The bumps develop because razor shaving leaves hair with a thick blunt end, instead of the fine tapered end of unshaved hair. Some shaved hairs get cut below the skin line. As they grow out, those blunt ends irritate the hair follicle walls, causing inflammation and bumps.

Ingrown hairs develop similarly. They begin with hairs cut below the skin line. As they grow out, the blunt end gets caught on the follicle wall. Instead of growing out, it curls over and becomes ingrown.

A few products claims to prevent razor bumps and ingrown hairs. The one with the most testimonial support is TendSkin. According to one post: “TendSkin after-shave works very well for me. It almost entirely eliminates razor bumps and ingrown hair.” The manufacturer claims the product lubricates the follicles, preventing blunt ends from snagging and causing inflammation.

Ex-porn star Nichols, who is now a Hollywood make-up artist, concurs: “TendSkin definitely helps pre- vent razor bumps and ingrown hairs.”

Waxing/Sugaring

Based on an informal tally of Web site posts, after razor shaving, waxing—and sugaring, which is similar—are the second most popular approaches to going smooth in the nether region. Waxing has become a celebrity fad with several movie stars talking about their “Brazilian” wax jobs—most of their pubic hair removed, with just a little tuft remaining (a “landing strip” or “welcome mat”) as a surprise under a thong bikini. But few people committed to pubic smoothness recommend waxing or sugaring.

Waxing can be performed at home with kits available at pharmacies. Or it can be done by state- licensed aestheticians. Waxing involves applying a thin layer of warm wax to the target area, and then Great Sex Guidance: Pubic Hair Removal- How Do The Porn Stars Get So Smooth? – © Michael Castleman – 126 – applying cloth strips. The wax dries, encasing the hair in it. Then you or the aesthetician yanks the cloth off—and the hair comes with it. Waxed hair grows back after a few weeks. One San Francisco salon charges $75 for complete pubic waxing.

Sugaring is similar, except it uses a sugar solution instead of wax.

“Waxing was torture for me,” says Cheryl Greene, a clinical sexologist in Berkeley, California. “I had my bikini line done once—and once was enough. Never again. But my daughter gets her legs waxed regularly and has no problem.”

According to the California State Department of Consumer Affairs (DCA), licensed aestheticians may wax any part of the body. But some aestheticians have reportedly told clients that pubic waxing is ille- gal. It is not, but apparently they feel uncomfortable doing it. People in other states should check with their DCAs.

Is waxing the porn stars’ secret? “No,” insists Nichols, the ex-porn-star-turned-make-up-artist. “If you can stand it when the hair gets pulled off, waxing is good for the occasional tropical beach vacation. One waxing and your bikini-line or all your pubic hair is gone for the week you’re away. But the prob- lem with waxing is that you have to start with fairly long pubic hair or there’s not enough down there for the wax to grab on to. For best results, you have to let your hair grow out pretty bushy between waxings, and people in porn can’t do that. They need to be smooth all the time.”

Electrolysis

Electrolysis is usually used to remove a small number of unsightly hairs, for example, on women’s up- per lips. But it can be used to remove pubic hair, and it claims to remove hair forever.

However, electrolysis takes a great deal of time, patience and money. Electrolysis kills one hair at a time. It can take months, even years to depilitate large areas, such as the genitals. A state-licensed electrologist inserts a fine needle into the hair follicle, zaps it with electricity, which kills the follicle. Then the electrologist tweezes the hair out and it doesn’t grow back...usually.

Electrolysis is supposed to be permanent—but may not be. Sometimes the first zap doesn’t kill the follicle and hair grows back, necessitating repeat treatment. Electrolysis can also be painful. And it’s expensive—on the order of $50 per half hour, which means that for a person who’s furry between the legs, complete pubic hair removal could easily cost $1,000 or more.

But electrolysis is not popular for pubic hair removal. Few people who post messages on bare-geni- tals Web sites use it.

In California, a licensed electrologist may remove hair from any part of the body, including pubic hair. However, some may decline to work in the genital area. Outside California, check with your state DCA.

Tweezing/Plucking

Tweezing is commonly used to remove a small number of hairs, for example, in the eyebrows. Most people consider it too time-consuming and painful for large areas such as pubic hair. On the Web sites devoted to pubic hair removal, tweezing is rarely mentioned, but occasionally, someone touts it. Great Sex Guidance: Pubic Hair Removal- How Do The Porn Stars Get So Smooth? – © Michael Castleman – 127 – “My wife’s vulva is silky smooth, but she doesn’t shave. She plucks it. Now this might seem extreme, but shaving got to be such a chore (stubble, rashes, nicks) that she resorted to plucking. It takes a lot of time but she has no more coarse stubble or rashes or razor burn.”

Depilatories

Depilatory creams dissolve hair chemically. They work well for some people. But most find the chemi- cal ingredients too irritating for sensitive genital skin. Few people who post on pubic-shaving Web sites use them.

And Now: The Porn Stars’ Secret

All right. No more beating around the you-know-what. I asked four present and former porn actresses how they get their vulvas “porn-smooth.”

The four actresses include Nichols, who quit acting in the mid-1980s, but who continues to work on porn productions as a make-up artist; longtime X-rated star Nina Hartley, who discusses pubic hair removal on her website (www.nina.com); Adajja, a working porn actress; and Gina Rome, who re- cently retired after six years of porn acting to become a film editor. Nichols, Adajja, and Rome were interviewed by phone from their homes in the Los Angeles area.

All four agreed that the porn stars’ secret is no secret at all. Just like the vast majority of people who post on bare-genitals Web sites, they all shave with razors. All four insist that they have never waxed, sugared, tweezed, or used depilatories, or electrolysis.

“I just shave,” Adajja says. “I’ve never used anything but a razor. Everyone I know in adult entertain- ment does what I do. They just shave.”

How To get a porn-smooth pubic shave, the stars recommend:

* Wet your pubic hair before shaving it. “Warm, wet hair is easier to shave,” Rome explains. “I al- ways showered before shaving. Many porn people do their shaving in the shower.” Hartley soaks in a hot bath.

* Use a fresh razor. Hartley uses hers no more than three times before switching to a new one. Adajja uses hers only twice: “I go through a lot of razors, so I use cheap Bic twin-blades.” The best razor, Nichols says, is the three-blade Mach-3. “Like the commercials claim,” she explains, “with three blades, there’s a noticeable difference in smoothness over a twin-blade razor. The commer- cials are talking about men’s faces, but three-blade razors also work best on the pubes.”

* To just look smooth, shave in the direction the hair grows. “The problem,” Adajja explains, “is that pubic hair rarely grows in just one direction. I have clumps that grow one way and clumps that grow another. So I shave spot-by-spot to get a close shave.”

* To look and feel smooth, shave in all directions. “If you just shave in the direction the hair grows,” Nichols explains, “you can look smooth, but when you run your fingers over the area, or when a lover touches or licks you, the skin feels rough. To feel smooth, go with the grain and go against it, Great Sex Guidance: Pubic Hair Removal- How Do The Porn Stars Get So Smooth? – © Michael Castleman – 128 – too.”

* Take your time. Careful, spot-by-spot shaving can be time-consuming. Taking your time also helps prevent unsightly shaving cuts.

* Shave frequently. Most people in porn, the stars say, shave daily.

* Used TendSkin after shaving. It helps prevent razor bumps and burn and ingrown hair.

* To treat razor bumps, use Visine eye drops. “If there’s any porn secret to pubic shaving,” Nichols says, “it’s Visine. You put it on, and the bumps disappear like magic in about five minutes.” Visine is an astringent. It helps relieve the inflammation that cause razor bumps.

* Wear loose underwear and clothing. A shaved vulva or scrotum chafes more easily than one covered with a soft cushion of pubic hair. Avoid tight clothing that binds.

* Experiment. See what works best for you. Rome preferred shaving cream and a moisturizing lo- tion afterward. Adajja uses soap and no moisturizer. Try various skin care products.

In addition to careful daily shaving, the porn stars I interviewed all share one other attribute that contributes to their smoothness—pubic hair on the fine and sparse side. “I’m just not very hairy down there,” Rome explains, “and what I have isn’t very coarse. I think that’s true of many of the women in adult entertainment. That kind of hair is easier to shave.”

But fine, sparse pubes and careful daily shaving don’t exempt porn stars from the hassles other people experience with razor shaving of the genitals. “I’ve seen many women on porn sets with razor bumps and ingrown hairs,” Rome says. “But you don’t see it in the video. A woman can touch herself and examine herself very closely, and feel any irritation, and see the bumps. A lover can do the same. But even for close-up shots, the camera doesn’t get as close to the genitals as you do yourself, or as close as a lover gets, so in porn videos, the people may look smoother than they really are.”

“Video cameras don’t pick up the little razor bumps you or your lover can see and feel,” Nichols ex- plains. “But cameras do pick up really red, angry-looking bumps. That’s why I always carry Visine—for quick bump removal on the set.”

“I’m surprised people think porn stars have some big pubic-shaving secret,” Adajja said. “It really doesn’t take much to become ‘porn smooth.’”

Great Sex Guidance: Pubic Hair Removal- How Do The Porn Stars Get So Smooth? – © Michael Castleman – 129 – Quickies: Secrets of Satisfying Quickies

Sex therapists agree that the most satisfying, most deeply erotic lovemaking involves slow sex—lei- surely, playful, massage-inspired, whole-body sensuality. But sometimes there’s no time for it, and some lovers enjoy fast, rip-your-clothes-off quickies. Sex doesn’t always have to be elaborate. Seven- course banquets are wonderful, but every now and then, fast food hits the spot.

Quickies can be fun, but they’re also fraught with erotic peril, the possibility of leaving one partner (usually the woman), or both, frustrated and unfulfilled. Fortunately, with a little forethought and plan- ning, the perils can be minimized, and the joy of quickies maximized. Here’s how.

Quickie Quicksand

The upside of quickies—fast, furious fun—is also their downside. Quickies don’t allow much warm-up time. Warm-up is critical to both sexual arousal and function, which is why the best, most satisfying sex is the leisurely, playful variety.

Arousal is rarely a problem for young men, those under around 40, but it’s a real issue for women of all ages and older men. Young men become aroused quickly and often feel horny much of the time. The situation is very different for young women, who often complain that young men are as hot as fire before they’ve even become interested, let alone sufficiently aroused to enjoy sex. Older women also need time to become aroused, and after 40, so do men. As instant arousal fades into the past, men discover that it takes effort to feel ready for sex. Hence, the old saying: What young men want to do all night takes older men all night to do.

Sexual function is not a problem for the vast majority of young men, who can raise an erection at the drop of a zipper. But it’s a different story for men over 40, whose erections rise more slowly, if at all.

Sexual function is also problematic for women of all ages. It takes time for young women to feel open to genital sex, and this continues throughout life. In addition, as women age, quickies become less

Great Sex Guidance: Quickies - Secrets of Satisfying Quickies – © Michael Castleman – 130 – comfortable. The reason is vaginal dryness, which becomes common in women over 40.

Finally, for most lovers of all ages, the intensity of orgasm is typically a function of the time spent mak- ing love, so don’t expect your best orgasms from quickies.

Checklist for Satisfying Quickies

On the other hand, quickies can still be fun. Here’s how to make the most of them:

Make them as sensual and playful as time allows. As much as possible, savor kissing, hugging, whole-body massage, and whispered words of endearment as you tear each other’s clothes off. The more sensuality you include, the more satisfying your quickie is likely to be.

Heat up the anticipation. Start warming up before you get together. If you have to travel to enjoy your brief rendez-vous, call or text beforehand and declare how eager you are to play, and how much your lover excites you. That way, by the time you fall into each other’s arms, you’ve both already begun to feel aroused.

Value the setting. You may not have much time, but that’s no reason to jettison a sexy ambiance. Ar- range your tryst to include music, fragrance (perfume or flowers), tasty little munchies, and perhaps even massage lotion.

Use a lubricant. Commercial lubricants are necessities for many older couples, who have all the time in the world. They’re even more crucial for quickies, which don’t allow women much time to self- lubricate enough to enjoy intercourse comfortably. Lubes also help men. Applied to the penis, they increase the pleasure of genital touch, which helps older men raise erections.

Keep a vibrator handy. The faster the sexual pace, the more difficult it is for women to have orgasms. Vibrators come in very handy. Vibrating penis sleeves can do the same for men. For a wide selection of vibes and sleeves, visit a sex toy site, for example, Adam & Eve.

Orchestrate surprises. Variety is the spice of life. That goes double for lovemaking and triple for quick- ies. Most couples develop sexual routines that may become ruts. Quickies present opportunities to try new moves. So try some.

Savor afterglow. Afterwards, as time allows, hold each other, kiss, and whisper words of endearment. If you must part company immediately after, try savoring afterglow by phone, texting, or email.

Those are my ideas, now it’s your turn. What have you done to make your quickies erotically satisfy- ing?

Great Sex Guidance: Quickies - Secrets of Satisfying Quickies – © Michael Castleman – 131 – Sex and Exercise: How Does One Affect the Other?

Do people who exercise have better sex? Do people who have sex the night before, or shortly before athletic events perform better or worse? There is no doubt that exercise enhances sex, but contro- versy surrounds the effect, if any, of sex before major athletic contests.

Sex Is Exercise

Sex involves physical movement, so it’s a form of exercise, closest to gentle stretching. It moves the major joints through their range of motion rather like walking, dance, gardening, or yoga. This type of exercise is especially beneficial for people with arthritis. In fact, theArthritis Foundation recommends sex for people with joint problems and publishes a guide to help those with severe arthritis continue to enjoy sex comfortably.

Sex increases heart rate, but it’s not aerobic. It does not condition the heart, but on the other hand, it doesn’t tax the heart. As a result, sex can be enjoyed by those with heart disease, even most heart attack survivors, starting a month or so after the heart attack. It’s about as strenuous as walking up one flight of stairs. (Check with your physician for individual recommendations.)

Sex is Cross-Training

In general, any physical activity boosts enjoyment and performance of other forms of exercise. That’s the idea behind cross-training, which alternates different regimens. Your might run or walk on some days and lift weights or swim on others. Each helps performance of the others. The same goes for sex. Other forms of exercise improve it. At the University of California, San Diego, James R. White and colleagues enrolled 95 sedentary, middle-aged men in one of two exercise programs. One group did aerobics for one hour, three days a week. The other took less vigorous walks on the same sched- ule. The researchers asked the men to keep diaries that included their frequency and enjoyment of sex. After nine months, both groups reported increased sexual frequency and enjoyment, but the aerobics group reported the greatest increase. In fact, the increase in sexual enjoyment was most closely correlated with participants’ increase in aerobic capacity. “Exercise,” White concluded, “is a powerful instrument for sexual enhancement.”

Physical fitness improves stamina, which means less fatigue during extended lovemaking. Fitness

Great Sex Guidance: Sex and Exercise- How Does One Affect the Other – © Michael Castleman – 132 – also improves muscle tone. Orgasm involves contraction of the muscles that run between the legs. Weight-bearing exercise (walking, running, dance, etc.) helps keep those muscles toned and can help intensify orgasm. Exercise also improves cardiovascular function. The blood vessels work better. Both erection and vaginal lubrication depend on blood flow into the genitals, so here again, exercise can help sex. In fact, Massachusetts researchers worked with 593 middle-aged men who were at risk for erection impairment because they smoked, drank heavily, were overweight, and didn’t exercise. The researchers encouraged the men to exercise regularly. Nine years later, they re-evaluated them. Compared with those who remained sedentary, the men who took up regular exercise reported signifi- cantly less erectile dysfunction—even if they continued smoking and drinking, and didn’t lose weight. Finally, fitness improves self-esteem and contributes to weight control. When you feel better about yourself, you tend to project that to others—and become more sexually attractive.

Of course, you don’t want to overdo exercise. Exhaustion isn’t good for the body, or for sex. But doc- tors and exercise physiologists agree that regular moderate exercise improves sex.

Sex Before the Big Game?

What about the flip side? How does sex affect exercise—especially sex the night before the Big Game? Athletic folklore is filled with stories of coaches telling their players to refrain from sex the night before major contests. Mike Ditka, coach of the Chicago Bears, told his team the afternoon be- fore they appeared in the Superbowl, “You can only play this game once. If your wives and girlfriends can’t wait, tell them to take a cold shower.” And Muhammad Ali made no secret of the fact that he abstained for as much as six weeks before fights. He said it got him angry, which made him a better fighter.

On the other hand, there are less well-known but equally plentiful tales of world-class athletes having sex the night before—or even shortly before—major contests and winning. Olympic long jumper Bob Beamon had a habit of abstaining the night before, but he broke his rule the night before he jumped in the 1968 Mexico City Olympics. He broke the world record by an amazing two feet, setting a mark that stood for 22 years. Wilt Chamberlain, the only professional basketball player ever to score 100 points in one game, did it shortly after sex. The late sex researcher William Masters, M.D., said that a world-class sprinter once confided that he’d set a world record just minutes after masturbating.And the Minnesota Vikings’ coaches insisted on separating players from their wives or girlfriends the night before the team’s four Superbowls. The Vikings’ Superbowl record: 0-4.

Oddly, there have been very few studies of the effects of sex on competitive athletics. The one that’s always cited (from way back in 1968) tested the grip strength of married men, aged 24 to 49, who were current or former competitive athletes. They were tested the morning after intercourse and the morning after abstinence. There were no differences in grip strength. A few years later, a similar study tested grip strength plus aerobic capacity and coordination. Again, sex the night before made no dif- ference.

This should come as no surprise. As mentioned earlier, sex is rather light exercise, the equivalent of walking up one flight of stairs. Coaches don’t tell athletes to avoid stairs, so why tell them to avoid sex? Where does the classic sexual prohibition come from?

It’s Not the Sex, It’s the Carousing

Quite possibly it’s a hold-over from ancient times when athletic contests were enmeshed with religion. Great Sex Guidance: Sex and Exercise- How Does One Affect the Other – © Michael Castleman – 133 – In the ancient world, the goal of athletic contests was not just victory, but also spiritual purity. Absti- nence has gone hand-in-hand with purity for centuries.

In our own age, however, the prohibition against sex the night before appears to have different roots. Casey Stengel, manager of the great New York Yankees teams of the 1950s crystallized what many experts believe: “Being with a woman all night is not what hurts. It’s staying up all night chasing the woman.” Staying up all night and carousing with alcohol and possibly other drugs.

Stengel was right about the importance of sleep. Before major athletic contests, it’s important to get a good night’s rest. One activity that can help in that department is guess what, sex. Bob Arnot, M.D., a champion triathlete and director of a sports medicine clinic before he became a medical correspon- dent for CBS News, made a point of having sex the night before triathlons. He always felt anxious before triathlons. Sex calmed him and helped him sleep.

Sex and Athletics: The Key Is How It Affects Sleep

However, some people, especially women, find that sex disrupts sleep, that they tend to stay awake afterward and have trouble falling asleep. After her upset victory in the 1992 Winter Olympics, Cana- dian ski racer Kerrin Lee Garnter said she avoided sex with her husband the night before because it interfered with her sleep. But they made love the morning of the race, and she won.

Bottom line: Sex is gentle exercise. Other forms of exercise make it better. And if you’re a competitive athlete, there’s no reason to abstain the night before, or even shortly before your event. Just consider how sex affects you. If it’s calming and helps you sleep, then sex the night before might help your performance. But if it keeps you up, then it might work best for you the morning of your event.

References:

Bacon, C.G. et al. “A Prospective Study of Risk Factors for Erectile Dysfunction,” Journal of Urology (2006) 176:217.

Bacon, C.G. et al. “Sexual Function in Men Older Than 50: Results from the Health Professionals Follow-Up Study,” Annals of Internal Medicine (2003) 139:161.

Derby, C.A. et al. “Modifiable Risk Factors and Erectile Dysfunction: Can Lifestyle Changes Modify Risk?” Urology (2000) 56:302.

DeSouza, C.A. et al. “Regular Aerobic Exercise Prevents and Restores Age-Related Declines in Endothelium-Dependent Vasodilation in Healthy Men,” Circulation (2000) 102:1351.

Levin, S. “Does Exercise Enhance Sexuality?” The Physician and Sportsmedicine (1993) 21:3:199.

Thornton, J.S. “Sexual Activity and Athletic Performance: Is There a Relationship?” The Physician and Sportsmedicine (1990) 18:3:148.

White, J.R. “Enhanced Sexual Behavior in Exercising Men,” Archives of Sexual Behavior (1990) 19:193. Great Sex Guidance: Sex and Exercise- How Does One Affect the Other – © Michael Castleman – 134 – Getting in Shape for Great Sex

Mention great sex, and you probably don’t visualize a long walk, eating a salad, meditating, or get- ting an extra hour of sleep. But the fact is, boring, old, not-particularly-sexy health advice significantly boosts libido, and enhances sexual functioning and pleasure. Of course, a reasonably happy relation- ship is a prerequisite for deeply satisfying sex. But beyond spousal contentment, each lover’s physi- cal condition plays an important role in erotic interest and fulfillment. antW hot sex? Then:

* Get regular exercise, the equivalent of a at least a brisk, 30- to 60-minute walk a day. * Eat a plant-based diet .Eat at least five daily servings of fruits and vegetables, and preferably seven to nine. Eat less meat, fewer whole-milk dairy products, and less junk food. * Maintain recommended weight for your height and build. * Incorporate a stress-management program into your life. * Don’t smoke. * Don’t have more than two alcoholic drinks a day.

Physiologically, enjoyable sex requires:

* A healthy nervous system, so you can feel pleasure fully, and respond robustly to sexual stimu- lation. * A healthy heart and blood vessels (cardiovascular system), so that sufficient blood can flow into the genitals for erection in men, and clitoral sensitivity and vaginal lubrication in women. * Deep relaxation, which opens the mind to erotic enjoyment, and allows the nervous and cardio- vascular systems to function at their sexual best.

Healthy-lifestyle recommendations support the physiology of good sex. Here’s how:

Engage in Regular Moderate Exercise

Massachusetts researchers surveyed 1,709 men over 40 about sex and lifestyle. Those who exer- cised the most reported the greatest sexual satisfaction, and the fewest sex problems, notably erec- tion impairment.

Exercise improves arterial function, which helps extra blood flow into the genitals. It boosts sex-fuel- ing testosterone levels in both men and women. It contributes to weight control, promotes deep relax- ation, reduces insomnia, elevates mood, and contributes to feelings of self-esteem and well-being, all

Great Sex Guidance: Getting in Shape for Great Sex – © Michael Castleman – 135 – of which enhance libido and sexual satisfaction. In women, regular moderate exercise also minimizes premenstrual syndrome, menstrual cramps, and the discomforts of menopause.

It hardly matters what type(s) of exercise you choose. Do anything you enjoy—or used to enjoy: walking, swimming, yoga, dancing, tennis, gardening—whatever. Just do it for the equivalent about at least 30 minutes a day, ideally every day, and at least several times a week.

It’s never too late to begin to exercise. Studies have shown that even 90 year olds who have been sedentary all their lives show improved health and fitness with modest exercise.

Regularity of exercise is more beneficial than intensity. It’s better for sex and overall health to take daily 45-minute walk than it is to hike five miles twice a month.

As you plan your exercise program, don’t forget horizontal workouts. Sex is exercise equivalent to strolling or light stretching. Sex takes about as much energy as walking up two flights of stairs. It burns 100 to 150 calories an hour.

Eat a Plant-Based Diet

Eat less meat, fewer whole-milk dairy products, and less junk food, and more fruits, vegetables, beans, and whole grains. You don’t have to become a vegetarian. But the closer you are to one, the better your sex life is likely to be.

University of South Carolina researchers checked the cholesterol levels of 3,250 men, aged 25 and up, and then surveyed their sex lives. The higher the men’s cholesterol, the more likely they were to report sexual dissatisfaction and erection dysfunction.

Forget the myth is that eating beef is manly. The saturated fat in means and whole-milk dairy foods accelerates the growth of deposits that narrow the arteries, limiting blood flow into the genitals. Cho- lesterol and saturated fat are found in animal products: meats, egg yolks, and dairy foods. They also abound in fast foods, junk food, fried foods, and rich desserts.

Want to do it like a rabbit? Then eat like Bugs Bunny—lots of carrots and other fruits and vegetables. They contain no cholesterol or saturated fat. Instead, they contain antioxidant nutrients that help keep the cardiovascular system healthy. And healthy blood flow around the body helps keeps the nervous system healthy, too.

It’s easier to begin transforming your diet than you might think. Have some fruit with breakfast. Eat at least one salad a day. And one night a week, instead of a meat-centered meal, try a hearty vegetable- bean soup. Make a big pot and you also get a few lunches.

Get Serious About Weight Control

Researchers at the Duke University Diet and Fitness Center program surveyed the sexual effects of weight loss on 70 participants. Moderate weight loss—10 to 30 pounds—significantly improved both men’s and women’s libidos, sexual functioning, and satisfaction.

Another study in Minneapolis followed 161 obese women and 26 obese men, average age 45. They were all enrolled in a weight loss program. After two years, they lost 13 percent of their body weight Great Sex Guidance: Getting in Shape for Great Sex – © Michael Castleman – 136 – (26 pounds for those who weighed 200). Before and after the study, and every three months during it, the participants completed surveys about many aspects of their quality of life, including how they felt about their sex lives. Before the study, 68 percent of the women said they felt unattractive. One year later, only 26 percent did. Initially, 63 percent of the women said they did not enjoy having their lover see them undressed. By the end of the study, only 34 percent felt that way. These figures were similar for the men.

It’s possible to be overweight and still enjoy a wonderful sex life. But the research shows that weight loss improves sex. Brown University researchers surveyed the sexual frequency and satisfaction of 32 overweight women as they enrolled in a physician-supervised weight-loss program. They lost an average of 56 pounds. In a subsequent survey, more than half reported greater sexual frequency and satisfaction.

Sexuality is one way the body celebrates vitality. Increased interest in sex and improved sexual func- tion is the body’s way of saying “thanks” for losing weight.

It’s not easy to lose weight, especially over age 40. But regular exercise and a plant-based diet help. Exercise burns calories and increases your basal metabolic rate, the rate at which the body burns calories while at rest. A plant-based diet is low in fat, which also helps in weight control.

Avoid quick weight-loss schemes. Instead of major lifestyle changes over the short term, adopt mod- est changes you can live with over the long term, for example, a brisk daily half-hour walk, and a vegetable-bean soup for dinner one night a week. A reasonable weight-loss goal is two pounds a month. At that rate, you lose 24 pounds in a year.

Embrace a Stress Management Regimen

In one recent survey, 60 percent of Americans said they felt “under significant stress” at least once a week. Stress is also a major cause of sex problems in both men and women. Stress reduces blood flow into the genitals. It release two hormones (cortisol and adrenaline) that depress testosterone lev- els. It increases risk of anxiety and depression, both major sex killers. And it increases risk of cardio- vascular disease.

The antidote to stress is a regular stress-management program. Proven stress relievers include: ex- ercise (aerobic or nonaerobic, e.g. yoga), meditation, music (playing or listening), massage, laughter, hot baths, gardening, having a pet, visualizing relaxing scenes, and spending quality time with friends, family, or a lover. Incorporate one—or more—into your daily life. Ideally, combine them: Exercise with friends. Bathe with your spouse.

Get A Good Night’s Sleep

Blame it on Thomas Edison. Before electric light, most Americans took Ben Franklin’s advice: Early to bed, early to rise. A 1910 survey showed that the average American slept nine hours a night. Then in 1913, Edison introduced his light bulb. Americans continued to get up early, but they started staying up later—and sleeping less.

Great Sex Guidance: Getting in Shape for Great Sex – © Michael Castleman – 137 – There is no “normal” amount of sleep. Individual needs vary. But experts agree that the vast majority of adults need at least seven hours a night to function optimally. Many need eight or more.

Meanwhile, half the nation’s adults experience occasional insomnia, and millions suffer chronic sleep problems serious enough to need sleep medication.

Sleep problems contribute to sex problems. Insomnia depresses libido and testosterone levels. It also contributes to anxiety and irritability, which interfere with libido and sex appeal.

Sleep problems become more prevalent with age. Time spent in deepest sleep declines. But regular exercise has been shown to boost sleep quality. Quitting smoking also helps. Nicotine is a stimulant. Limiting alcohol also helps. Alcohol disrupts sleep.

Quit Smoking

The ads portray smoking as sexy. In fact, it’s the opposite. Since the mid-1980s, 19 studies involving 3,800 men have investigated the connection between smoking and erection dysfunction. Researchers at the University of California, Irvine, analyzed their results. About one-quarter of Americans smoke. But among men with erection problems, considerably more are smokers—40 percent. And if smoking hurts erection in men, it has similar sex-killing effects in women.

Smoking damages the cardiovascular system. It raises blood pressure and accelerates the growth of artery-narrowing deposits that reduce blood flow to the genitals. Smoking is also associated with sex- impairing nerve damage, especially among diabetics. And it’s linked to sedentary lifestyle, obesity, and sleep problems, all contributors to sex problems.

The good news is that while risk of lung cancer remains high for years after quitting, the sexual--dam- age caused by smoking largely disappears a few years after quitting.

If you smoke, talk with your doctor about quitting.

If You Drink Alcohol, No More Than Two Drinks A Day

In Macbeth, Shakespeare wrote that alcohol “provokes the desire, but takes away the performance.” Truer words were never penned. Alcohol is by far the world’s leading drug cause of sexual impair- ment.

When people of average weight drink more than two beers, cocktails, or glasses of wine in an hour, alcohol becomes a powerful central nervous system depressant that interferes with sexual respon- siveness in both men and women. (A “drink” is one 12-ounce beer, one shot of 80-proof spirits, or five ounces of wine, a standard wine glass about half full.)

If you drink more than two drinks a day, or if you ever binge on alcohol—five or more drinks in one sit- ting—consult your doctor for advice on drinking less.

Great Sex Guidance: Getting in Shape for Great Sex – © Michael Castleman – 138 – References:

Anon. “Fitter Women Enjoy Better Sex Lives,” New York Times Online. 10-15-2003.

Anon. “High Blood Pressure Leads to Sexual Problems in Women,” Medical Tribune, 12-18-1997.

Bacon, C.G et al. “Sexual Function in Men Older Than 50: Results from the Health Professionals Follow-Up Study,” Annals of Internal Medicine (2003) 139:161.

Bacon, C.G. et al. “A Prospective Study on the Risk Factors for Erectile Dysfunction,” Journal of Urol- ogy (2006) 176:217.

Duncan, JJ et al. “Women Walking for Health and Fitness: How Much Is Enough?” Journal of the American Medical Association (1991) 266:3295.

Kim, SC. “Hyperlipidemia and Erectile Dysfunction,” Asian Journal of Andrology (2000) 2:161.

Levin, S. “Does Exercise Enhance Sexuality?” The Physician and Sportsmedicine, March 1993, 199.

Mann, D. “Weight Loss Linked to Improved Sex Life,” Medical Tribune 5-12-1997.

Nikoobakht, M. et al. “The Relationship Between Lipid Profile and Erectile Dysfunction,” International Journal of Impotence Research (2005) 17:523.

Rao, K. et al. “Correlation Between Abnormal Serum Lipid and Erectile Dysfunction,” Zhonghua Nan Ke Xue [Chinese journal] (2005) 11:112.

Wei, M et al. “Total Cholesterol and HDL Cholesterol as Important Predictors of Erectile Dysfunction,” American Journal of Epidemiology (1994) 140:930.

White, JR. et al. “Enhanced Sexual Behavior in Exercising Men,” Archives of Sexual Behavior (1990) 19:193.

Wuh, H. Sexual Fitness. Putnam, NY, 2001.

Great Sex Guidance: Getting in Shape for Great Sex – © Michael Castleman – 139 – The Joys and Challenges of Sex During Pregnancy and Parenthood

Americans are marrying and having children later in life. Today, many couples get pregnant and have children when one or both are over 40. They face sexual issues that, in previous generations, only younger people experienced. In addition, young parents may turn to older friends and relatives for advice about sex during pregnancy and parenthood, but few people know more than mythology about this major life and sexual transition.

From the positive pregnancy test to weaning an infant typically takes up to two years. This period involves big relationship changes, some wonderful, others challenging. Unfortunately, few pregnancy guides address the sexual issues of pregnancy and new parenthood in sufficient depth.That’ s why sex educators Anne Semans and Cathy Winks surveyed 700 women about sex during and after preg- nancy for their book Sexy Mamas.

The conventional wisdom holds that women’s libidos decrease during the first trimester because of the enormous emotional shift into pregnancy and because of morning sickness, which may last much of the day. Libido rebounds during the second trimester, only to fall again during the third because of the fatigue and the awkwardness of having such a big belly.

But Semans and Winks found that pregnant women’s feelings about sex vary tremendously. “Some experienced a sexual awakening,” Semans explains. “Others felt turned off.”

Men may also experience libido changes during the wife’s pregnancy. Swedish researchers studied 112 pregnant couples. Some of the men loved sex with a pregnant wife, while others lost interest, especially during the third trimester.

One commonly reported benefit of pregnancy was better orgasms. Many pregnant women reported the most intense orgasms of their lives. Some women who had never had orgasms had them. And many said it was easier to come while pregnant.

Some people avoid sex during pregnancy for fear of harming the fetus. Relax. Even enthusiastic in- tercourse does not harm the baby.

Another reason expectant parents avoid sex is fear that orgasmic muscle contractions might trigger premature labor. But a study of 596 women shows that late-pregnancy orgasms were associated with Great Sex Guidance: The Joys and Challenges of Sex During Pregnancy and Parenthood – © Michael Castleman – 140 – decreased risk of prematurity. The same goes for vibrators. Assuming a normal pregnancy, vibrators are safe.

However, some pregnancy complications warrant abstinence: placenta previa, multiple fetuses, seri- ous uterine irritability, and high risk of prematurity.

Many baby books say couples can resume lovemaking a few weeks after a normal vaginal delivery without episiotomy, and later with episiotomy or C-section. However, until the baby sleeps through the night, most new parents feel too exhausted for sex. Most infants don’t sleep through the night until 12 weeks at the earliest, so don’t expect much sex until then.

It often takes longer for the woman to regain her pre-pregnancy libido. One reason is possible pain around the vagina, which can last up to several months. Another is nursing. Postpartum, levels of two hormones rise, prolactin and oxytocin. “Both dampen libido,” Winks explains. “Some women don’t regain their pre-pregnancy libidos until they wean.”

Couples must also come to terms with breastfeeding. Some women fear their partners will be turned off by huge breasts dripping milk. Meanwhile, some men consider breast milk a turn-on.

A third reason new moms retreat from sex is the cultural perception that motherhood isn’t sexy. “Moth- erhood has a lot to do with self-sacrifice,” Winks explains. “Sex is the opposite of that, so many wom- en—and some men—view it as an indulgence and desexualize themselves.”

Even if you’re not having genital sex for a while, work to maintain a sensual connection. Kiss, hug, cuddle, and trade massages. Sex may be on hold, but most new parents find nonsexual affection reassuring as they adjust to being parents.

To maintain your sexual relationship as parents, make it a priority. With a child, impulsiveness and spontaneity disappear. Everything must be planned, including sex. “Make sex dates,” Winks advises. “Once or twice a month, have your child spend the night elsewhere, and enjoy a romantic evening together. Work out a regular trade with another family. Trading sleep-overs can be a godsend for par- ents’ sex lives.”

If sexual issues persist after weaning, consider sex therapy. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Great Sex Guidance: The Joys and Challenges of Sex During Pregnancy and Parenthood – © Michael Castleman – 141 – Food And Sex: How You Eat Can Help Or Hurt It

What happens at your table can have surprising effects on what happens in your bedroom. “Sexual function,” says New York City nutritionist Shari Lieberman, Ph.D., “depends on the cardiovascular system, the heart and blood vessels, and the nervous system, the body’s electrical wiring. Food choices can keep these sexually crucial systems functioning at their best, or poison them—and your sex life.”

Sex-Damaging Foods

You don’t have to avoid these foods entirely. But for great sex, eat them sparingly, and work to base your diet on the foods that are good for sex (below) because they’re good for the body as a whole.

Fatty Meats: Steak, Prime Rib, Bacon, Sausage, and Lunch Meats

The myth is that eating red meat is manly. On the contrary: The saturated fat and cholesterol in fatty meats are hell on erections. “Saturated fat and cholesterol narrow the arteries that nourish the heart and increase risk of heart attack,” Lieberman explains. “They also narrow the arteries that carry blood into the penis and contribute to erectile dysfunction (ED).”

Researchers at the University of South Carolina School of Medicine checked the cholesterol levels of 3,250 men, aged 25 and up, and then surveyed their sex lives. The higher their cholesterol, the more likely they were to report ED. Compared with men whose cholesterol was below 180 milligrams per deciliter of blood (mg/dl), those with levels above 240 were almost twice as likely to report ED.

Fatty meats also narrow women’s arteries, which limits blood flow into the clitoris, vulva, and vaginal wall, interfering with vaginal lubrication and sexual responsiveness.

Finally, compared with fruits, vegetables, and things like pasta, fatty meats take longer to digest. They sit in the gut, and make you feel sluggish. After a fatty meal, you might want to have sex, but when you get into bed, you’re more likely to fall asleep.

Great Sex Guidance: Food And Sex- How You Eat Can Help Or Hurt It – © Michael Castleman – 142 – Cheese and Whole Milk

Most cheeses are made with whole milk, which is high in saturated fat and cholesterol—and just as damaging to the arteries as prime rib. The worst mistake is to combine meat, milk, and cheese, for example, a bacon cheeseburger with a shake. A meal like that is loaded with saturated fat. Men and women who eat this type of diet—for example, fast-food burgers several times a week—are at con- siderable risk for sex problems.

Transfats: Cookies, Crackers, Chips, Donuts, Muffins, Croissants, and Other Commercial Baked Goods

Transfats are created when hydrogen is added to vegetable oil to turn it solid. The prime example is margarine. But any food item whose label lists “hydrogenated” or “partially hydrogenated vegetable oil” contains transfats.

“Transfats are worse for the arteries than saturated fats,” says American Dietetic Association spokes- person Leslie Bonci, M.P.H., R.D., director of sports nutrition at the University of Pittsburgh Medical Center. “They boost levels of LDL, bad cholesterol, and reduce levels of HDL, good cholesterol.”

Transfats are being removed from many foods, but may still be found in cookies, crackers, chips, muffins, donuts, croissants, and other commercial baked goods. Read food labels. If they say hydro- genated or partially vegetable oil, ask yourself if you really need it. Eating foods containing transfats damages the arteries.

Junk Foods, and Highly Processed Foods

Transfats are not the only reason to avoid junk foods and highly processed foods such as white bread, sugary sweets, and many breakfast cereals. Processing removes most of their nutrients. “You’re eating empty calories,” Bonci explains. “You get full, but your body doesn’t get much nutrition- al benefit. For health, for fitness, and definitely for good sex, you want a well nourished body, not one filled up on junk with few nutrients.”

A key nutrient processing removes is zinc. When whole wheat is processed into white flour, about three-quarters of the zinc is removed, Lieberman explains. Subsequent “enriching” adds back many nutrients, but not zinc. Zinc is essential to men’s sexuality and reproduction. “One of the highest con- centrations of zinc in the body is found in the prostate gland, which produces most of the fluid in se- men,” Lieberman says. “There is some evidence that a diet high in zinc helps prevent midlife prostate enlargement and prostate cancer.” Low zinc levels also suppress libido in both men and women.

Good dietary sources of zinc include whole grains, beans, peas, and seafoods, particularly oysters.

Alcohol

In Macbeth, Shakespeare wrote that the substance used worldwide to coax reluctant lovers into bed “provokes the desire, but takes away the performance.” How true. The first drink is “disinhibiting.” Sweet young things are more likely to accept your sexual invitations. But if you drink more than two beers, cocktails, or glasses of wine in an hour, alcohol becomes a powerful central nervous system depressant that interferes with erection. “Alcohol might help you talk a reluctant lover into bed,” Bonci says, “but once you get there, you may not have much fun. If you drink heavily, all you’ll do between Great Sex Guidance: Food And Sex- How You Eat Can Help Or Hurt It – © Michael Castleman – 143 – the sheets is pass out.”

Alcohol also hurts sex in another way. “It stimulates appetite at the same time it compromises judg- ment,” Bonci explains. “So you’re likely to choose foods that aren’t very good for you or your sex life.”

Sex-Enhancing Foods

Fruits and Vegetables

Plant foods are the basis of a healthy diet. “They’re packed with nutrients,” Bonci says, “and they’re low in fat. They help keep the arteries unclogged so they help prevent heart disease, ED, and loss of lubrication and responsiveness in women. They also help prevent cancer. The National Cancer Insti- tute recommends eating at least five servings of fruits and vegetables a day. I couldn’t agree more. Eat your fruits and vegetables. If you don’t like some, eat others. There are so many to choose from. Eat the ones you like, and eat lots of them.”

Tomatoes

For men’s sexual and reproductive health, one of the best vegetables is tomatoes. “Tomatoes are rich in lycopene,” Lieberman explains. “Studies show that this nutrient, a member of the vitamin A family, helps prevent prostate cancer.”

Nuts

Almonds, cashews, hazelnuts, Brazil nuts, pistachios—they’re all high in the amino acid, arginine. Arginine is crucial to the synthesis of nitric oxide, a compound in the body involved in erection in men and sexual responsiveness in women. Nuts also have a reputation for being high in fat. “But nut oils are nowhere near as harmful as saturated fat or transfats,” Lieberman explains. “In fact, recent stud- ies show that nuts help reduce cholesterol.”

Pumpkin Seeds

Instead of roasting and munching these seeds just once a year when you carve a Halloween pump- kin, enjoy them year-round. Pumpkin seeds are a rich source of zinc. “Next time you want a satisfy- ing snack,” Bonci suggests, “reach for a handful of toasted pumpkin seeds instead of a granola bar. In addition to zinc, pumpkin sees are packed with nutrients including the antioxidants selenium and vitamin E, which are good for the arteries.”

Olive Oil

Saturated fat and transfats narrow the arteries, but olive oil is high in monounsaturated fat, which helps keep them healthy. “Instead of spreading butter or margarine on your bread,” Lieberman sug- gests, “do what they do in Italy: Dip it in olive oil.”

Wheat Germ

Toss the Captain Crunch into the garbage. Instead, start your day with a fruit salad topped with apple- sauce or nonfat yogurt garnished with crunchy, nutty wheat germ. “Wheat germ is a rich source of vitamin E, which helps keeps the arteries healthy,” Lieberman explains. Great Sex Guidance: Food And Sex- How You Eat Can Help Or Hurt It – © Michael Castleman – 144 – Start Now

If you’ve recently downed a bacon cheeseburger, fries, a pepperoni double-cheese pizza, and a buck- etful of junk snacks, you might be worried that your sex life is headed south. Possibly, but the foods that poison sexuality take decades to do their dirty work. What should you do? “Start eating healthier today,” Bonci explains, “and commit to improving your diet in the future. Every time you eat a salad instead of a grilled cheese sandwich, you’re helping your arteries stay healthy—and that contributes to good sex as well.”

Great Sex Guidance: Food And Sex- How You Eat Can Help Or Hurt It – © Michael Castleman – 145 – The Brain in Love: We Have Great Chemistry

You meet. You click. Suddenly, what Juliet felt for Romeo is nothing compared with the intensity of your passion. You’re head-over-heels in love.

Our word “love” is derived from the ancient Sanskrit lubh, meaning desire, as in lust. But your love is much deeper than a mere physical connection. As the Biblical Song of Songs says, you’re “faint with love.” You’re ignited with what Elvis Presley called “burning love.”

You’re also obsessed. You can’t think of anyone—or anything—else. When your eyes meet, your heart skips a beat. Rod Stewart captured the feeling in “Maggie Mae:” “In my eyes, you’re everything.”

As for the sex—oh, the sex. But, unfortunately, not for long. A year later you wonder: What happened to that incredible intensity? You still love each other. Truly, you do. You could happily spend the rest of your lives together.

But the special magic you once felt has somehow disappeared. You feel as Abigail Adams did in 1793 when she wrote to her husband, President John Adams, “Years subdue the ardor of passion. But affection deep rooted persists.” Yes, you still love, but no longer madly. The fireworks are over. The Fourth of July has somehow morphed into Thanksgiving.

Of course, this strange transformation from passionate heat to cozy warmth is nothing new. You’ve experienced it in other relationships. So have all your friends. You tell yourself: That’s just how rela- tionships work. Accept it.

But Helen Fisher, Ph.D., couldn’t accept it. A decade ago, the Rutgers anthropologist wondered: Why do people fall madly in love? Why doesn’t lusty passion last? What Fisher discovered provides intriguing insights into why we love as we do—and how to keep the flame of romance burning bright and hot.

Animal Magnetism

A museum in Turkey holds the oldest know written words, a 4,000-year-old Sumerian clay tablet. It’s a love letter. Anthropologists surveyed 147 cultures around the world. Every single one, from Siberia to

Great Sex Guidance: The Brain in Love- We Have Great Chemistry – © Michael Castleman – 146 – San Diego, experiences romantic love. If people in every culture fall in love, and have since time im- memorial, then perhaps, Fisher speculated, love is innate, wired into us through evolution like hunger or thirst. Or lust. But lust is indiscriminate. Love involves a magical connection to one very special person.

Studies of “animal magnetism” strengthened Fisher’s conjecture that romantic love might be innate. Many mammals—dogs, elephants, baboons—fall in love. They show clear preference for a single mate, tenderness toward that individual, fidelity and possessiveness, pining if the two become sepa- rated, and grieving if the mate leaves or dies.

If animals experience romantic love, Fisher reasoned, it must be wired into their brains. Research has shown that it is—through special brain chemicals called neurotransmitters, notably dopamine. Fisher wondered if this chemical might also govern human love.

“Have You Just Fallen Madly In Love?”

To find out, Fisher posted a notice on a bulletin board at the State University of New York at Stony Brook: “Have you just fallen madly in love?” Respondents were placed inside a magnetic resonance imaging (MRI) machine, allowing Fisher to track their brain activity, including levels of neurotransmit- ters. Subjects alternated looking at two photographs, one, a face that meant nothing to them, the other, their new beloved. When Fisher’s volunteers looked at pictures of their sweethearts, their brain scans lit up like Christmas trees—and their brain levels of dopamine soared.

When dopamine levels are elevated, people become energized, exhilarated, and obsessed. Their hearts pound. They have difficulty sleeping. They lose their appetites. And they become persistent and tenacious. In other words, they fall in love.

Dopamine also governs cravings and dependency. These two traits are hallmarks of drug addiction. All addictions raise brain levels of dopamine. Those madly in love sometimes compare the experience to intoxication. Falling in love has also been compared with addiction. Fisher says romantic love is an addiction: “It involves blissful, drug-like euphoria and dependency when one’s love is returned, painful craving when one’s love is absent, and very painful withdrawal when one’s love is spurned.”

As dopamine rises, so does testosterone, the hormone that fuels sexual desire in both men and women. Heightened libido is, of course, a hallmark of falling in love.

Finally, high levels of dopamine depress brain levels of another neurotransmitter, serotonin. Low levels of serotonin are associated with obsession, another element of falling in love. Love-obsession takes many forms. Lovers often find themselves daydreaming about their beloved, calling them con- stantly. In the words of Sting: “Every breath you take, every move you make…I’ll be watching you.”

Such actions are reminiscent of obsessive-compulsive disorder (OCD). Italian researchers tested serotonin levels in three groups: some who had just fallen in love, others with OCD, and controls who were neither in love nor abnormally obsessive. The controls had normal levels of serotonin, but levels were significantly lower in both the OCD sufferers and those newly in love. “Poets often call love mad- ness or insanity,” Fisher says. “As far as the brain is concerned, it really is.”

Great Sex Guidance: The Brain in Love- We Have Great Chemistry – © Michael Castleman – 147 – From Mad Love to Long-Term Attachment

How long do people stay madly in love? “It depends,” says Palo Alto, California, couples therapist Marty Klein, Ph.D., “but the hot-and-heavy period generally lasts six months to a year.” In Fisher’s MRI studies, dopamine stayed high and serotonin remained low for an average of seven months. New lovers may feel crazy in love, but as Ambrose Bierce wrote, it’s “temporary insanity.”

After mad love, brain levels of dopamine and serotonin return to normal. If the relationship continues, it evolves into still-warm, but not hot “married love.” Fisher calls it “attachment,” affection, security, trust, and contentment with a long-term partner. Attachment also has a chemical basis, two hor- mones, oxytocin and vasopressin.

Both are produced in two locations: the sex organs (ovaries or testes), and the hypothalamus, the emotion center of the brain. Levels of both of these hormones rise after orgasm. “Oxytocin and vaso- pressin are ‘cuddle chemicals,’” Fisher explains. “They contribute to the sense of fusion, closeness, and attachment lovers experience after sweet sex.”

Under some circumstances, release of testosterone also triggers release of oxytocin and vasopres- sin. This is the chemical reason why sex with a lover can deepen feelings of attachment. Under other circumstances, rising levels of ocytocin and vasopressin trigger release of testosterone. This may help explain why long-term couples continue to have sex beyond their reproductive years. But some- times high levels of testosterone suppress oxytocin and vasopressin. When lust trumps attachment, people might have affairs or leave familiar partners for new ones.

Did We Evolve to Cheat and Divorce?

In fairy tales, the prince marries the princess and they live happily ever after. In real life, of course, things are messier. Many marriages end in divorce. Clearly, neither love nor attachment are necessar- ily permanent. Fisher wondered: Is that also Nature’s plan?

Returning to animal research, she learned that only about 3 percent of mammals, humans among them, rear their young as male-female couples. Even fewer animal species mate for life. Serial mo- nogamy is much more common. Most animals pair up only long enough to rear young. Then they find new mates and raise new offspring.

We don’t know how our human ancestors lived millions of years ago. But anthropologists have gained some insights by studying the modern world’s few remaining stone-age cultures, for example, the Bushmen of Southern Africa. Reproductive-age women in these cultures generally have a child ap- proximately every four years. Analyzing divorce data from 58 cultures worldwide, Fisher noticed that while couples may divorce at any time, an unusually large number of breakups occur after about four years together. Fisher speculates that this may be an echo of an ancestral human pattern, coupling up long enough to rear a single child through infancy, about four years. “People talk about a ‘seven- year itch,’” Klein says. “Fisher says it’s a four-year itch. With all due respect to happily ever after and the Seventh Commandment—Thou shalt not commit adultery—it’s clear that many people have sex outside of marriage.”

How many? A University of Chicago study of 3,432 American adults found that 25 percent of the men and 15 percent of the women admitted marital infidelity. The true figures are undoubtedly higher

Great Sex Guidance: The Brain in Love- We Have Great Chemistry – © Michael Castleman – 148 – because many people lie about behavior that’s socially stigmatized. Sometimes, philanderers have children by their clandestine lovers. In a 1998 program that screened for genetic diseases, scientists were shocked to discover that 10 percent of the children tested were not the offspring of their legal fathers.

Fisher believes that love’s very capriciousness—including the pain of break-ups—is part of Nature’s design. The primary drive of living things is to reproduce, hence our sex drive. But Fisher contends that we also evolved two other reproductive drives: falling in love and attachment, which allowed our ancestors to follow what she calls “two different but complementary reproductive paths.” Romantic love enabled them to focus courtship attention on one individual at a time, thereby conserving pre- cious reproductive time and energy. Meanwhile, male-female attachment evolved to motivate our ancestors to stay with this special person long enough to rear a child through infancy.

“However,” Fisher insists, “chemistry is not destiny. Many people remain monogamous. We can tri- umph over our basic drives. But as most people know, it’s a struggle. The chemistry of falling in love and attachment begin to explain why.”

Making Long-Term Love Last

With attachment and falling in love sometimes (often?) pulling people in opposite directions, many couples become very interested in blowing on the embers of married love to spark hot flames of re- newed passion. Fisher’s research reinforces couple therapists’ recommendations for keeping relation- ships exciting:

* Do new, exciting things together. “This is standard relationship-enhacement advice,” says Fair Oaks, California, sex therapist Louanne Weston, Ph.D. “It’s no coincidence that weekend vaca- tions are often called ‘romantic getaways,’ or that sex often feels more passionate in hotel rooms. The reason is that you’re in a new and different setting. That’s exciting and romantic.”

Novelty also elevates brain levels of dopamine. In one experiment, psychologists gave 28 couples questionnaires dealing with the depth of their love. Then half the couples completed a dull task, while the others engaged in a new and exhilarating activity. Afterwards, all the couples completed the questionnaire again. The couples who participated in the exciting, dopamine-releasing activity registered greater relationship satisfaction, and said they were more in love.

* Laugh. Humor is funny because the punch line is a surprise—in other words, something unex- pected. Like other new activities, humor raises dopamine levels. “In relationships that endure, people generally hang on to their sense of humor,” Weston says. “When humor dies, the relation- ship is usually in trouble.”

* Keep ’em guessing. “The essence of romance is uncertainty,” Oscar Wilde wrote. An age-old strategy for winning a love is to play hard-to-get. It spurs anticipation, but delays the reward. Guess what surprises, uncertainty, and delayed rewards trigger in the brain? Release of dopa- mine. Romance experts Barbara and Michael Jonas, coauthors of The Book of Love, Laughter, and Romance, urge couples to make regular “surprise dates.” One plans an afternoon or evening outing, but keeps it secret, telling the other only what to wear and what time to be ready. “The an- ticipation makes surprise dates very romantic and enriching,” Barbara says.

Great Sex Guidance: The Brain in Love- We Have Great Chemistry – © Michael Castleman – 149 – * Make love. The skin-to-skin contact and massage-like caresses of lovemaking and especially orgasm trigger release the hormones of attachment. In addition, sex increases levels of testoster- one, which in turn, promotes production of dopamine. To make sex more exciting and to inject an element of playful surprise, try incorporating a new sex toy.

Why We Love

Studies of the brain in love are still in their infancy. Nonetheless, it’s clear that brain chemicals play key roles in the obsessive madness of falling in love, and in the secure comfort of long-term attach- ment. Perhaps that’s why, when two people fall in love, they say: We have great chemistry.

Reference:

Fisher, H. Why We Love: The Nature and Chemistry of Romantic Love. Henry Holt, NY. 2004.

Great Sex Guidance: The Brain in Love- We Have Great Chemistry – © Michael Castleman – 150 – Pheromones: Scent-Ual Attractiveness

What’s the aroma of lust? According to Alan Hirsch, M.D., neurologic director of the Smell and Taste Research Foundation in Chicago, it’s the familiar spice, cinnamon. Hirsch fitted male medical stu- dents’ penises with gauges that detected erection, and then exposed them to dozens of fragrances. The only one that got a rise was the smell of hot cinnamon buns. But other aromas may also add sen- suality to sex. Try scented candles on your night table, or a bouquet of flowers, or a fragrant herbal potpourri, or a new perfume.

Or try pheromones. the odorless scent of sexual attraction. Odd as this may sound, the key to a new love affair—or heating up the one you’re involved in—might be right under your nose, or actually just inside it. That’s the location of the little-known, sixth human sense organ, the vomeronasal organ (VNO). The VNO detects virtually odorless chemicals called pheromones. Scientists have known for decades that animals have organs very similar to the VNO. They have also known that animals re- lease pheromones during mating season to signal their sexual availability. But until twenty years ago, anatomists believed that humans did not possess a VNO and did not produce pheromones. Now we know differently.

Back in the 1980s, a research team led by David Berliner, M.D., at the time, an anatomist at the Uni- versity of Utah, discovered the tiny VNO in pits of the nasal passageways of every person they exam- ined. If people had VNOs, then they had to produce pheromones.

Many animals release pheromones from glands in areas that corresponds to the human armpit. Berliner’s team looked there and isolated human pheromones from underarm secretions. In a series of studies, they discovered that heterosexuals respond only to human pheromones released by the opposite sex, while homosexuals respond to those of the same sex. How do they respond? Not sexu- ally. Pheromones are not aphrodisiacs. But under the influence of pheromones people become friend- lier, more vivacious, and more attractive. And with these qualities comes a greater likelihood that a social connection might lead to something more.

Pheromones are not a hot area of research. But a few intriguing studies have been performed:

* British researchers showed 32 young women photographs of men’s faces and asked them to rate their attractiveness. While viewing the photos, some of the women were also exposed without their

Great Sex Guidance: Pheromones- Scent-Ual Attractiveness – © Michael Castleman – 151 – knowledge to human male pheromones. The women exposed to the pheromones rated the men sig- nificantly more attractive.

* San Francisco State University researchers took these findings into the bedroom.They asked 36 heterosexual women, average age 27, to record their social connections with men for several weeks, everything from dating to intercourse. Then the scientists gave the women a vial of either a placebo or a laboratory synthesized female pheromone, and asked them to add it to cologne and use it daily. After six weeks, the pheromone group recorded significantly more social connections with men: con- versations, more dates, more kissing, more sleeping in the same bed, and more intercourse.

Pheromones work the same way for men. Researchers at the Athena Institute for Women’s Wellness in Chester Springs, Pennsylvania added a placebo or male pheromones to cologne worn by 38 het- erosexual men, aged 26 to 42. Like the women, the men who used the pheromones proved more at- tractive and reported social interactions with women, more dates, more kissing, more sleeping in the same bed, and more intercourse.

Pheromones work for people of all ages. Harvard researchers asked 44 postmenopausal women, av- erage age 57, to use either a placebo perfume or one laced with human female pheromones. Again, the pheromone group reported significantly more interest from men, more affection from them and more lovemaking.

People produce pheromones in extremely tiny quantities, so the chemical cannot be harvested the way, say, sperm can be. All pheromone products use laboratory-synthesized pheromones, either male or female. Some commercial pheromone products claims to be mixtures of male and female chemi- cals that work on both sexes. However, all the research to date has used either female pheromones (which attract men) or male pheromones (which attract women).

Pheromones are not fragrant. In fact, they are virtually odorless. So don’t be surprised when you rub them into your skin and smell nothing. Despite the lack of scent, their tiny molecules get into the VNO and make the gender you’re interested in feel more sociable toward you.

Pheromones also go a long way. You don’t have to use much to send the scent signal you want to broadcast.

Many companies market what they claim to be pheromone products. Unfortunately, consumers have no way to knowing if the products they buy contain pheromones. The San Francisco State research- ers used a product called Realm.

Great Sex Guidance: Pheromones- Scent-Ual Attractiveness – © Michael Castleman – 152 – The Kama Sutra: What The Ancient Indian Sex Manual Really Says

Mention the Kama Sutra, and everyone knows it’s ancient India’s racy sex manual. The very title con- jures up titillating visions of erotic frescos in which regal maharajas with outsized genitals cavort with naked bejeweled nymphs in positions exotic enough to slip the discs of a yoga master.

But for all the Kama Sutra’s notoriety, few Americans have ever read it—not even the “good parts,” the sexual positions that made the book famous, but which, in reality, account for only about one- quarter of its content. To the extent that Americans have dipped into the Kama Sutra at all, most have explored it via derivative products, one the best being, the erotic instructional video “Ancient Secrets of the Kama Sutra: The Classic Art of Lovemaking.” But products derived from the Kama Sutra don’t really do justice to the ancient Sanskrit book.

Meanwhile, even those few who have read the major English translation of the Kama Sutra have not fully appreciated the book because that translation misrepresented it. It dates from 1883 and was published just once in the U.S., 40 years ago in 1962. Richard Burton, the British army officer respon- sible for it, altered the text considerably to shoehorn it into Victorian views about sexuality, notably the then-popular notions that only men experience sexual desire and pleasure, and that women are noth- ing more than the passive recipients of men’s lust. The real Kama Sutra holds much different—and more contemporary—views.

Happily, some 1700 years after it was written, the English-speaking world can now read what the real Kama Sutra says, thanks to a new translation that rights Burton’s wrongs, and reveals the Kama Sutra for what it truly is, much more than a manual of sexual positions, but rather a guidebook for cultivating an eroticized life. It’s “Sex and the City” circa 300 A.D., only the focus is on men instead of Sarah Jessica Parker and her girlfriends (though some of the text is clearly intended for fourth-century Indian women).

The new translation reveals a Kama Sutra in some ways remarkably modern and progressive: Wom- en are as sexual as men, and men should work to provide women with erotic pleasure, including orgasms. But before you embrace the Kama Sutra as your new sexual Bible, be forewarned. Some of what it says is controversial: Adultery is a fact of life and it’s all right, even fun—for men only—as long as the women’s husbands don’t find out. And some of the Kama Sutra is callous and repugnant: If a woman persistently refuses a man’s advances, he is justified in raping her. Perhaps most remarkable, the Kama Sutra’s vaunted sex advice is surprisingly tame. For example, the book expresses consid- erable ambivalence about oral sex, a popular element in modern Western lovemaking.

Great Sex Guidance: The Kama Sutra- What the Ancient Indian Sex Manual Really Says – © Michael Castleman – 153 – The new translation (available from Amazon) has been compiled by Wendy Doniger, 61, a professor of the history of religions at the University of Chicago, and Sudhir Kakar, 63, an Indian psychoanalyst and senior fellow at Center for Study of World Religions at Harvard. They returned to the original San- skrit, and produced a translation at once more honest and more erotic than it’s Victorian predecessor. They also include copious notes that place the text in its historical and linguistic context, rather like a well annotated edition of a Shakespeare play. The Doniger-Kakar Kama Sutra is unlikely to make the bestseller list, but if you and your honey want to read each other a different kind of pillow book, the new translation is fascinating, thought-provoking, at times, disturbing, and occasionally amusing.

Treatise on Sexual Pleasure

Kama Sutra literally means “treatise on sexual pleasure.” Unlike the Christian view that the sole purpose of sex is procreation, in the fourth-century Hindu world of the Kama Sutra, the cultivation of sexual pleasure independent of procreation was considered one of life’s highest callings. The ancient Hindus believed that life had three purposes: religious piety (dharma), material success (artha), and sexual pleasure (kama). All three were equal, and the erotic was celebrated as the seat of earthly beauty. In the Hindu world the pursuit of sexual pleasure was revered as a sort of religious quest. Imagine a world where having sex was just as important as religious observance.

The Kama Sutra was written by one Vatsyayana Mallanaga, about whom nothing else is known. However, from the text, it’s clear he was upper class. He takes servants for granted, and assumes his readers have the leisure to spend their time seducing virgins and other men’s wives, and the money to buy the gifts he recommends giving to accomplish this. Vatsyayana also claims to have written his treatise “in chastity and highest meditation.” It’s hard to know what to make of this. Some commenta- tors have scoffed that given his subject matter, “chastity” seems highly unlikely. But considering the reverence with which the ancient Hindus approached matters sexual, it’s also possible that Vatsy- ayana wrote his book with the gravity of say, a modern art critic discussing a cache of just-discovered erotic paintings by Picasso. We’ll never know.

The Kama Sutra may be the ancient world’s most famous sex book, but it was by no means the first. The Chinese had sex manuals 500 years earlier, and Ovid’s Ars Amatoria, a handbook for courte- sans, preceded the Kama Sutra by some 200 years. The Kama Sutra is not even the first Indian sex guide. Vatsyayana mentions several sages who trod his erotic path before him. What makes the Kama Sutra unique in world literature is that it’s the first comprehensive guide to living an eroticized life. It’s an ancient Joy of Sex meets Miss Manners.

The sexual culture it describes is also surprisingly like our own. While the Kama Sutra describes girls and women as dependent on their fathers, husbands, and adult sons, in the manner of women in today’s Arab Middle East, in the India of the text, women enjoyed an independence and freedom of movement today’s Saudi or Pakistani women can only dream of. While their wealthy fathers and husbands were running businesses and the government (not to mention having affairs) young women were often free to date men and select their own husbands, and married women were free to select lovers and entertain them.

Great Sex Guidance: The Kama Sutra- What the Ancient Indian Sex Manual Really Says – © Michael Castleman – 154 – Life as a Play in Seven Erotic Acts

The Kama Sutra is organized into seven sections that track men through life. In Book One, the bache- lor sets up his pad. In Book Two, he perfects his sexual techniques. This is the book that has inspired the videos, games, and everything else that flies the Kama Sutra flag. In BookThree, our young man seduces a virgin. In Book Four, he marries and sets up a household for his wife and servants. By Book Five, he has grown sexually bored with his wife, and turns to seducing other men’s wives. Even- tually, as he ages, the effort necessary for such dalliances loses its charm, so in Book Six, he takes up with courtesans, who work to please him—but for a price. Finally, in old age, he fears he is losing his potency and attractiveness, so Book Seven contains recipes for herbal potions to preserve them.

Although Vatsyayana was a man writing for men, some of the Kama Sutra speaks directly to women: Book Three tells virgins how to attract husbands. Book Four instructs women how to be good wives. Book Six deals with the skills required of courtesans—including how they should provide for their own old age by stealing from their patrons.

Of the Kama Sutra’s seven sections, Books Two through Five are the most interesting.

Book Two, the sex manual, recognizes women as full, lusty participants in sex, and exhorts men to learn ejaculatory control to last long enough to bring them to orgasm: “Women love the man whose sexual energy lasts a long time, but they resent a man whose energy ends quickly because he stops before they reach a climax.” Apparently, Vatsyayana didn’t know that most women never have or- gasms solely from intercourse no matter how long it lasts. Nonetheless, the Kama Sutra is very atten- tive to women’s pleasure, a view that arrived in our culture only a few decades ago.

Book Two also instructs men to treat women in such a way “that she achieves her sexual climax first.” How can a man do this? By following Book Two’s extensive discussion of the fine points of embrac- ing, cuddling, kissing, and other types of sensual touch calculated to heighten sexual arousal. The Kama Sutra gets a little wild here. It touts slapping and spanking with accompanying shrieks and moans, and is particularly enamored of scratching and biting: “There are no keener means of increas- ing passion than acts inflicted by tooth and (finger)nail.” It even sings the praises of scars caused by erotic scratching. It considers them advertisements of erotic prowess: “Passion and respect arise in a man who sees from a distance a young girl with the marks of nails cut into her breasts.”

Book Two advocates use of sex toys, and suggests sex while bathing. It also describes how a man can best satisfy two women at the same time (fondle one while having intercourse with the other), and how two or more men should comport themselves when sexually sharing one woman (take turns having intercourse, and while one is inside her, the others should fondle her).

About the Kama Sutra’s unexpected aversion to oral sex: Vatsyayana declares, “It should not be done because it is opposed to the moral code.” But apparently, he understood that ancient Indian men enjoyed fellatio as much as men do today. After condemning oral sex, he provides elaborate instruc- tions to women on how to perform what the Kama Sutra calls “sucking the mango.” Then Vatsyayana reiterates his condemnation of oral sex, saying it should be enjoyed only with “loose women, servant girls, and masseuses” with whom a man “does not bother with acts of civility.” Finally in an ambivalent aside, the he allows that some men enjoy sucking each other’s mangoes, and that some even per- form cunnilingus: “Sometimes men perform this act on women, transposing the procedure for kissing a mouth.”

Great Sex Guidance: The Kama Sutra- What the Ancient Indian Sex Manual Really Says – © Michael Castleman – 155 – In Book Three, the Kama Sutra insists that men who seduce virgins should do so very tenderly. It advises courting a virgin for many days before bedding her. The suitor should engage her in interest- ing conversation, shower her with gifts, play board games with her, and work to win her trust, all the while remaining sexually abstinent to set her at ease. As the big moment approaches, he should send her little sculptures of goats and sheep with major erections. If she takes the hint, she should signal her willingness by flashing him—“revealing the splendid parts of her body.” Finally, they make a date to meet and have sex.

But tenderness toward women goes only so far in the Kama Sutra. If a virgin is unwilling to go all the way, men are instructed to have a brother ply her with liquor, and “when the drink has made her unconscious, he takes her maidenhead,” i.e. rapes her. In the Kama Sutra’s view, rape is acceptable not only for reluctant virgins, but also for other women: “A man may take widows, women who have no man to protect them, wandering women ascetics, and women beggars...for he knows they are vulnerable.....”

In Book Three, the Kama Sutra devotes only nine pages to the care of wives, but in Book Four, al- most three times the real estate, 26 pages, to the seduction of other men’s wives. It exhorts wives to be doting, dutiful, careful managers of servants, and always well-mannered, well-dressed, and faith- ful. But it also assumes that wives eventually bore their husbands. As a result, a man is perfectly justi- fied in seducing other men’s wives, who are exciting, challenging, worthy of indefatigable pursuit, and great fun in bed. If a wife discovered that her husband had been unfaithful, she was over a barrel. In fourth-century India, she couldn’t leave him as a modern woman might. She was obligated to remain dutiful. But the Kama Sutra allows her to be “mildly offended” and “scold him with abusive language.” However, she was forbidden to resort to “love sorcery,” i.e. herbal potions, to win him back, presum- ably because that might ruin his adulterous fun.

When it comes to seducing other men’s wives, the Kama Sutra is not above a little shameless self- promotion either. It asks: Which men are the most successful at it? Those “who know the Kama Sutra.”

The Kama Sutra’s matter-of-fact acceptance of infidelity is tempered by only one caveat: Men were not to go that route if it was likely to “bring disaster,” i.e. violence or financial reverses. To prevent disaster, the Kama Sutra lists women who should be avoided, notably those who are “well guarded or with their mothers-in-law.” Once a man selected an eligible extra-marital target, the Kama Sutra in- structs him to woo her with all the focus and creativity he would bring to courting a virgin, except that in the case of another man’s wife, he had to be more stealthy and deceptive, which made the chase all the more exciting and intellectually diverting.

Of course, if a man seduced another man’s wife, chances were good that some other sexually itchy gent might decide to seduce his. In fourth-century India, wives were expected to be faithful, but with so many men getting action on the side, many wives must also have been cheating. The Kama Sutra concludes its discussion of extra-marital affairs by saying that it does not advocate philandering, but rather seeks to prevent it by describing all the ways libidinous lotharios might cuckhold them in or- der to warn husbands worried about their wives’ wandering eyes. Given the extraordinary detail with which the Kama Sutra describes infidelity, it’s doubtful that any fourth-century reader believed this. (The Kama Sutra does not discuss how a husband should deal with a wife’s infidelities, but it’s unlike- ly that all she got was a scolding.)

Great Sex Guidance: The Kama Sutra- What the Ancient Indian Sex Manual Really Says – © Michael Castleman – 156 – An Ancient Mirror

In the end, the Kama Sutra describes a highly sexual world, one that does not condemn unbridled pleasure as our culture often does, but prefers amoral pleasure that’s somewhat restrained simply because it’s easier for all concerned. It’s a sexual world committed to erotic tenderness, yet capable of casual cruelty, a lusty world that venerated sex for its own sake, not just for procreation.

What good is Kama Sutra today? The book deals with many of the erotic and relationship concerns we have. It’s about love, lust, flirtation, courtship, seduction, rejection, marriage, and sexual power, manipulation, and deceit. It presents a vision of the lives many 21st century Americans are struggling to create, lives that are simultaneously safe, sane, and erotically rich. In reading the Kama Sutra, we enter the bedroom of an exotic society long ago and far away—and find an ancient mirror in whose reflection we see aspects of ourselves.

This translation is available on Amazon.

Great Sex Guidance: The Kama Sutra- What the Ancient Indian Sex Manual Really Says – © Michael Castleman – 157 – Liberals, Conservatives: Both Wrong About Teen Sex Everyone wants to reduce rates of teen pregnancy and sexually transmitted infections (STIs). But how?

Conservatives demand limiting school sex education to promotion of abstinence until marriage. Liberals insist on lessons about contraceptives and STI prevention, which means promoting condoms. The two sides are locked in passionate antagonism, but actually, they share remarkably similar core values, and neither of their strategies has been shown to reduce teen sex, pregnancies, or STIs.

Meanwhile, the research literature reveals that the real key to reducing teen sexual irresponsibility is parents willing to discuss their sexual values with their kids. If schools jettisoned sex education classes and instead sponsored classes to help parents become better sex educators at home, it’s clear that teen pregnancies and STIs would decline. Parents might also encourage teen sexual responsibility based on a concept totally foreign to both the Liberals and Conservative agendas, the simple idea that safe sex means better, more erotic sex.

Surprise: Teens Are Sexually Conservative

Both Liberals and Conservatives rail about the “teen sex crisis.” Hence the political tug-of-war over sex education in schools. If there ever was a teen sex crisis, it has clearly abated. Over the past 20+ years, surveys by the Centers for Disease Control and Prevention (CDC) show that teens have become considerably more conservative and responsible. Since 1991:

* The proportion of teens reporting intercourse has dropped from 54 percent to 47 percent.

* Teen condom use has jumped from 46 percent to 63 percent.

* Births to teens have fallen 33 percent.

* And teen STI rates have remained largely unchanged, despite billions of Web pages of free pornography and the unprecedented sexual content of hip-hop song lyrics.

Great Sex Guidance: Liberals, Conservatives- Both Wrong About Teen Sex – © Michael Castleman – 158 – Who Deserves Credit?

Conservatives insist that the decline in teen sex proves the value of abstinence education. However, the abstinence push began in 1998, but the teen birth rate started falling seven years earlier. Abstinence-only sex education is most deeply entrenched in the South and less popular elsewhere. Guess where the teen pregnancy rate is highest—the South. Teen birth rates in Alabama, Georgia, and South Carolina are two to three times higher than those in Vermont, New York, and Michigan. Many abstinence programs ask teens to sign a vow of virginity until marriage. But a CDC study shows that only 12 percent of those who make virginity vows keep them. In other words, abstinence education has an 88 percent failure rate. Finally, researchers at McMaster University in Hamilton, Ontario, analyzed 26 studies of programs aimed at reducing teen pregnancy. Abstinence-only programs did not delay first intercourse at all. In fact, pregnancies increased.

Liberals sex education fares no better. Before I became a journalist, I worked in family planning. I talked up contraceptives and STI prevention in countless middle and high schools. I thought I got through to the students, but I didn’t. The McMaster analysis included many Liberal programs. They, too, had no impact: no delay of intercourse, no increased use of contraceptives, no reduced risk of STIs, and no fewer pregnancies.

“Dangers-of-Sex” Education

The schools in my hometown, San Francisco, teach a Liberal sex education program in grades five through eight that beats kids over the head with information about contraceptives and STI prevention. Nonetheless, when my son was in fifth grade, he came home and announced that only one contraceptive is 100 percent effective—abstinence.

Nonsense. Another method is 100 percent effective—not to mention, popular, lots of fun, and free. It’s non-intercourse lovemaking: genital massage (hand jobs), oral sex, and sex toys. But even the most Liberal school sex education programs never mention it. Doing so would acknowledge that kids might experience sexual pleasure, and negate the core value that unites Liberals and Conservatives more than anything divides them, namely, that for teens, sex is dangerous. Forget “sex education.” What schools teach is “dangers-of-sex” education.

The Answer: Parents Talking About Sex

If neither Conservatives nor Liberals deserve credit for the substantial long-term decline in teen sexual irresponsibility, who does? Parents. They have been discussing sex with their children—and getting through to them.

Now I hasten to add that I parented two children (now in their twenties), and like most parents, I was convinced that my kids rarely, if ever, listened to me. As a result, it was hard for me to believe that parents actually get through to kids about sex.

But yes, parents do get through. The research consistently shows that when parents discuss sex, teens delay it, and, when they become sexual, teens are more likely to use condoms. According to the CDC, compared with teens whose mothers never mentioned condoms, those whose moms did were three times more likely to use condoms during first intercourse and 20 times more likely to use Great Sex Guidance: Liberals, Conservatives- Both Wrong About Teen Sex – © Michael Castleman – 159 – them subsequently.

Sex educators moan that parents feel uncomfortable discussing sex, refuse to do so, and are often misinformed—hence sex education in schools. I contend that to be effective sex educators, parents need not be comfortable, eloquent, or erudite. All they have to do is try.

Parents are trying—even if they don’t want to. AIDS forced it on them. AIDS was identified in 1981, but wasn’t widely perceived as a threat to heterosexuals until the early 1990s, when parents flipped out that sexual irresponsibility might kill their children. Uncomfortable as they felt about discussing sex, they felt an urgent need to protect their kids from AIDS, so they started talking—and that’s when teen sex began its steady decline, and when teen condom use began increasing.

Welcome to Sex Education Class—For Parents

A Bruce Springsteen song says, “We learned more from a three-minute record than we ever learned in school.” As far as sex education is concerned, that’s true. It doesn’t matter if school-based sex education programs embrace the Liberal or Conservative approach, they have no impact on teens. They’re a waste of money and should be abolished. Instead, schools should invest their sex education dollars in offering classes to parents to help them discuss sex with their children, whatever their values. Conservatives argue that sex education belongs in the home. They’re right—not just because parents control the message, but because home-based sex education actually works. Could parent-empowerment classes work? Yes. Penn State researchers offered mothers of teens two brief classes on discussing sexual issues. Afterwards, their children said it was easier to talk about sex with their moms, and the mothers and teens spent more time discussing sexual issues.

If Conservative parents want to urge abstinence until marriage, that’s their prerogative. But my wife and I took a different tack with our kids. We promoted consent, condoms, lubrication, and pleasure.

* Consent. No coercion ever. If you feel coerced, do whatever is necessary to extricate yourself from the situation.

* Condoms. When used carefully, condoms virtually eliminate pregnancy and STI risk. Conservatives vastly over-estimate condom failure rates. As contraceptives, condoms are 85 to 98 percent effective. This does not mean two to 15 pregnancies per 100 acts of condom-covered intercourse. It means that if 100 couples use condoms exclusively for a year, two to 15 can expect an accidental pregnancy, and when used carefully and consistently the failure rate is much closer to two than 15. When condoms are used carefully, they’re almost as effective as the Pill. Overall, they’re better than the Pill because they also prevent STIs, including AIDS.

* Lubrication. Vaginal lubrication reduces risk of condom breakage and increases comfort during intercourse. Many women don’t produce much natural lubrication, among them many teenage girls anxious about sex. Commercial lubricants are inexpensive, take only a few seconds to apply, and greatly enhance sexual comfort. When my children became sexually active, my wife and I gave them vials of lubricant. They thanked us.

* Pleasure. The most enjoyable sex is fueled not only by lust, but also by trust and relaxation. Who can trust a lover who ignores the risks of pregnancy and STIs? Safe sex is more than public health hype. It’s crucial to the deep relaxation necessary for sexual pleasure. Great Sex Guidance: Liberals, Conservatives- Both Wrong About Teen Sex – © Michael Castleman – 160 – This country sells everything with sex. Why not use sexual pleasure to sell sexual responsibility? It’s one of the few places where a “sex sell” is actually appropriate.

My wife and I told our kids, “When you feel ready for partner sex, embrace sexual responsibility because it leads to better sex.” A radical notion, perhaps. But I believe our approach might further reduce teen pregnancy and STIs. It might also help teens grow up to be something they all truly want to be, namely, good lovers.

Great Sex Guidance: Liberals, Conservatives- Both Wrong About Teen Sex – © Michael Castleman – 161 – Women Are from Venus, Men Are From Mars

Women use sex to have relationships, men use relationships to have sex. Women want partners, men want something else that begins with “p.”

We’ve all heard these little nuggets of conventional wisdom—but how wise are they, really? Men and women are different, of course, and feel differently about sex. But most discussions of the male- female gender divide claim the differences are as vast and unbridgeable as the Grand Canyon, that men and women cannot possibly understand each other.

A recent study of gender differences around sexuality paints a different picture. Researchers at the University of Wisconsin at Madison used statistical techniques to combine the results of more than 500 studies published from 1943 to 2007. Then they combined those results with the findings of several other large ongoing surveys that together include tens of thousands of American, English, and Australian adults. The time span and enormity of these studies suggests valid, reliable results.

And what were the results? While men and women do, indeed, show gender differences with regard to sex, their differences are much smaller than the Venus-Mars dichotomy suggests.

Heterosexual Intercourse

The myth is that men are eager to jump into bed with any woman who seems halfway interested, while women pick and choose very carefully. As a result we would expect men to report a great deal more intercourse than women (in part because they patronize sex workers).

Gender differences in reported intercourse are, indeed, large among teens and those in their twenties. But over time, these differences decrease. Considering adults of all ages, rates of heterosexual intercourse reported by men and women are roughly equivalent. Men report slightly more frequent intercourse with a slightly larger number of partners, but given the broad belief in huge gender differences, the actual differences are surprisingly small.

Great Sex Guidance: Women from Venus? Men from Mars? The Real Sexual Gender Divide – © Michael Castleman – 162 – Age at First Intercourse

The myth is that testosterone-crazed young men lose their virginity much earlier than supposedly timid young women. Again, the actual differences are much smaller than the mythology suggests. Before 1970, the average age at first intercourse for men was 18, for women, 19. But since the mid- 1990s, the average age of first intercourse for both men and women has been 15 to 16.

Oral Sex

From World War II through the 1960s, oral sex (cunnilingus and fellatio) represented the sexual frontier. Today, oral is far from ubiquitous, but most people have tried it, with very little gender difference. Most of the studies in this analysis did not distinguish between providing and receiving oral, but the National Health and Social Life Survey did, and it shows that 77 percent of men report performing cunnilingus, while 73 percent of women report receiving it, and 68 percent of women report performing fellatio while 79 percent of men report receiving it. Again, the gender differences are modest.

Extra-Marital Sex

The myth is that horny men have lots of affairs, while more demure women do not. It’s difficult to study extra-marital sex because, even in anonymous surveys, many people are reluctant to admit affairs. But the studies in this analysis are fairly consistent in showing that about 25 percent of men and 15 percent of women report affairs. This is a significant difference—but it’s smaller than many people imagine.

Masturbation

Like extra-marital affairs, solo sex is also difficult to study because many people are reluctant to admit it, or admit their actual frequency. Compared with older studies, more recent research shows less difference in admissions of masturbation. However, auto-eroticism is one of the few elements of sexuality that show substantial gender difference. The best estimate is that during the past year, 63 percent of men and 42 percent of women have masturbated.

One indication of this difference is use of pornography. Porn is huge on the Internet, and according to porn industry sources, 80 percent of it is viewed by men solo—typically with one hand busy.

Sexual Guilt

Historically, women’s sexuality has been more closely regulated than men’s—with women’s violations of perceived sexual propriety more severely punished. As a result, we would expect women to experience more sexual guilt than men. In studies before 1960, this was the case. But since then, women’s sexuality has been less stigmatized in the media, and women have become less confined to the home and more fully engaged in the world. As a result, women’s sexual guilt has plummeted, and today, men and women report much smaller differences.

Great Sex Guidance: Women from Venus? Men from Mars? The Real Sexual Gender Divide – © Michael Castleman – 163 – Sexual Satisfaction

The studies in this huge analysis show little or no gender difference in sexual satisfaction.

I want to emphasize that these findings come not from a single study, but from more than 500 studies published over the past 68 years. They may not be perfect, but as a group—a huge group—they strike me as persuasive.

Women are not from Venus and men are not from Mars. The two genders are increasingly finding common sexual ground between those to planets. Women and men are both from Earth.

The study: Petersen, J.L. and J.S. Hyde. “Gender Differences in Sexual Attitudes and Behaviors: A Review of Meta-Analytic Results and Large Datasets,” Journal of Sex Research (2011) 48:149.

Great Sex Guidance: Women from Venus? Men from Mars? The Real Sexual Gender Divide – © Michael Castleman – 164 – Section II About Men The Cure For Premature Ejaculation: The Simple Program That Teaches Men To Last As Long As They’d Like

You CAN last as long as you’d like.

Yes, you can, no matter if that’s five minutes or five hours. This pamphlet shows you how. It describes the surprisingly easy—and enjoyable—do-it-yourself sex therapy program that works for at least 90 percent of men.

The official name of this problem is “premature ejaculation” (PE). But some men fear that “premature” implies they are immature. Relax. Maturity has nothing to do with it. The key to curing this problem is to gain voluntary control over something that’s been involuntary. That’s why I prefer the term “involun- tary” ejaculation. It implies a learning process—what’s involuntary today can become voluntary tomor- row as you learn how to control your ejaculatory timing. Unfortunately, most physicians, sex counsel- ors, and sex therapists continue to call this problem “premature” ejaculation, so this booklet uses the terms “involuntary ejaculation” or “PE.” But no matter what you call it, you CAN cure yourself and last as long as you’d like.

Men’s Most Common Sex Problem—In All Age Groups

The most widely publicized men’s sex problem is erectile dysfunction (ED), but erection impairment is uncommon until after 50. Meanwhile, according to the landmark University of Chicago “Sex in Ameri- ca” surveys (1999 and 2008), rapid, involuntary ejaculation is much more prevalent. In fact, it’s men’s most common sexual concern. The myth is that PE affects only men under 30. In fact, in every age group, about one-quarter to one-third of men report it, that is, they admit it. True prevalence is prob- ably greater because many men feel reluctant to admit sex problems.

Age Group Men Who Admit Involuntary Ejaculation During the Past Year

18 to 29 30% 30 to 39 32% 40 to 49 28% 50 to 59 31%

Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 166 – 57 to 64 30% 65 to 74 28% 75 to 85 22%

(sources: Laumann, EO et al. “Sexual Dysfunctions Among Older Adults: Prevalence and Risk Factors from a Nationally Representative U.S. Probability Sample of Men and Women Age 57-85,” Journal of Sexual Medicine (2008) 5:2300. Lau- mann, EO et al. “Sexual Dysfunction in the United States,” Journal of the American Medical Association (1999) 281:537.)

Other studies report PE ranging from 3 percent to 41 percent of men over 18, but the large majority estimate a prevalence of 20 to 30 percent, with occurrence not varying significantly with age.

Fortunately, for the vast majority of men of all ages, this problem is fairly easy to cure once and for all. No matter whether you’re single or coupled, newly in love or celebrating your twenty-fifth anni- versary, the self-help program developed by sex therapists and described here works for around 90 percent of men. The small proportion who need more help can consult sex therapists for individual or couple coaching, which is usually effective. The sex therapy program does not use drugs or anes- thetic creams. Usually men just need to fine-tune their lovemaking style. But the sexual adjustments that cure this problem are fun, and lead to better sex for both men and women—usually within a few weeks to months. Finally, for the tiny proportion of men who do not respond to the sex therapy ap- proach, drug treatment can manage the problem.

How Soon Is Too Soon?

Toss your stopwatch. The issue is control. You have involuntary ejaculation if you ejaculate before you want, whether that’s two minutes into lovemaking or two hours.

A Brief History

Ejaculatory control issues have been documented for more than 1,500 years. The Kamasutra, the 4th century Indian sex handbook, declares: “Women love the man whose sexual energy lasts a long time, but they resent a man whose energy ends quickly because he stops before they reach a climax.”

In Western culture, women’s sexual pleasure was also important—but only until the 17th century, when male doctors decided that women were not sexual. By the 19th century Victorian era, men— and most women—believed that women were little more than fleshy receptacles for men’s lust who endured sex to retain husbands and have children. Modern sex research has thoroughly debunked this idea, showing that men and women are equally capable of sexual arousal, pleasure, and orgasm.

During the era when women were considered non-sexual, ejaculatory control was not an issue for men. Because women were believed to be incapable of sexual pleasure, men were under no obliga- tion to last long enough to provide it.

In fact, 19th century authorities considered rapid ejaculation a sign of masculine vigor. Other mam- mals ejaculate quickly during intercourse, prompting biologists to declare that rapid ejaculation had evolved into men’s genetic makeup to increase their chances of passing their genes to future genera- tions.

Well into the 20th century, sexuality authorities considered rapid ejaculation normal. In 1948, when Al-

Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 167 – fred Kinsey, the first modern American sex researcher, released Sexual Behavior in the Human Male, he noted that 75 percent of men said they ejaculated within two minutes of vaginal insertion. Kinsey did not view this as a problem.

More recent surveys suggest that for men aged 18 to 30, the average time from vaginal insertion to ejaculation ranges from one to six minutes, but many men wish they could last longer. How much longer? To quote countless popular songs, “all night long.”

As Victorian notions about sexuality faded, Westerners returned to the ancient view that women are as sexual as men, and men came to believe that it was their responsibility to provide women with erotic pleasure. Rapid ejaculation interfered with this, and after World War I, it began to be viewed as a problem.

The first Western clinicians to focus on this new sex problem were psychoanalysts, followers of Sig- mund Freud. Freudian theory postulated that rapid ejaculation was a symptom of underlying neuro- sis: The man suffers unconscious hostility toward women, so he ejaculates quickly, which satisfies him but frustrates his lover, who is unlikely to experience orgasm that quickly. Freudians claimed that premature ejaculation could be cured using psychoanalysis. But even years of psychoanalysis rarely taught men ejaculatory control.

Freudian theory was mistaken on two counts. There is no evidence that men with premature ejacula- tion harbor unusual hostility toward women. And while many women enjoy the closeness and intimacy of intercourse, only about 25 percent are consistently orgasmic from sexual intercourse, no matter how long it lasts (and no matter how large the penis). To experience orgasm, most women require direct, sustained stimulation of the clitoris.

Another theory is that men with PE have penises that are unusually sensitive to touch. But research- ers have measured penile sensitivity to touch and have found no sensitivity differences based on how long men last.

A Bad Habit

For the vast majority of men, involuntary ejaculation is a simply a bad habit. Most men develop it dur- ing their teens or twenties as they become sexual with partners. The young male nervous system is very sexually excitable, and sexual arousal makes it more so. In other words, young men’s bodies are primed to ejaculate quickly, and the vast majority of young men are unfamiliar with the subtle skills that allow them to maintain sexual arousal without ejaculating. As a result, in early partner sexual experiences, many young men have no ejaculatory control and come quickly.

In addition, involuntary ejaculation is stress-related. For many (most?) young men, early lovemak- ing experiences are fraught with anxiety. Young men know what goes where, but they’re generally unschooled in the fine points of lovemaking. They often fear that their equipment is “too small.” (It’s probably smaller than the freakishly huge ones in porn, but that’s fine.) Men also fear that the woman might change her mind. Or that someone might walk in. Or that the woman might tell her friends he’s a lousy lover. These and other worries often conspire to trigger rapid, involuntary ejaculation.

Without training in how to last longer, over time, rapid ejaculation becomes cemented as a habit, one that can feel very hard to break. Actually, in the vast majority of men, involuntary ejaculation is fairly easy to resolve. Any man can learn how to last as long as he’d like—including YOU. Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 168 – Start with a Check-Up

The first step is to consult a physician, especially if you haven’t had a check-up in a while, or if you believe that an illness might contribute to your situation. The doctor should review your medical his- tory, including all the drugs you take, perform a physical exam, test for genito-urinary tract conditions, and assess your stress situation. Chances are you’ll be told there’s nothing medically wrong with you. That’s good news.

But be forewarned: Few doctors are trained in sex counseling or therapy. Doctors are unlikely to tout the simple, do-it-yourself, sex therapy program that teaches reliable ejaculatory control. They’re much more likely to offer an antidepressant drug. Antidepressants have several side effects, among them, delayed ejaculation. However, only a small fraction of men truly need medication. And if you go the drug route, to maintain good control, you have to take the drug for the rest of your life. Why not just learn the skills that give you ejaculatory control? Then you don’t need drugs. A tiny proportion of men can’t learn good control and really need drugs, but that’s rare. Try either the do-it-yourself program or sex therapy before resorting to medication.

Don’t Tune Out Your Body. Tune Into It.

Faced with rapid, involuntary ejaculation, most men try to distract themselves, believing that by think- ing about other things, they can trick themselves into lasting longer. Usually, that only makes things worse.

Don’t tune out your body. Tune into it. You need to become more intimately familiar with your differ- ent levels of sexual arousal. You also need to recognize how you feel as you approach your point of ejaculatory inevitability, the “point of no return,” the moment you know you’re going to come. Once you recognize how you feel as you approach to your point of no return, it’s not difficult to make small sexual adjustments that allow you to remain highly aroused without ejaculating.

In men, sexual arousal is a four-phase process. In the Excitement Phase, breathing deepens, erec- tion begins, and you start to feel turned on. In the Plateau Stage, erection becomes firm (though in men over 40, firmness may wax and wane), and you feel highly aroused. When arousal peaks, the next phase occurs, Orgasm and Ejaculation. Most men consider orgasm and ejaculation synony- mous. Actually, this is not the case. Each can occur without the other. However, typically, they happen simultaneously. Finally, during the Resolution Phase, breathing returns to normal and erection sub- sides.

The key to ejaculatory control is learning to extend the Plateau Phase, to maintain high arousal with- out triggering Orgasm and Ejaculation.

It Helps to Stay Sober

To tune into your body, it helps to stay sober. Many men mix sex with alcohol and/or other recreational drugs. That’s up to you. But if you’re learning to last as long as you’d like, it helps to take a break from intoxicants. They’re distracting and they interfere with the self-awareness crucial to learning ejaculatory control.

Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 169 – The Sex Therapy Last-Longer Program

Books have been written on gaining ejaculatory control (see the References), but here’s a brief but comprehensive synopsis of the sex therapy program:

Appreciate whole-body sensuality. Men often think that their only sexual body part is the penis. That view is a one-way ticket to uncontrolled ejaculation (not to mention erection problems, and wom- en with those proverbial, “not tonight, dear” headaches). The best sex actually involves whole-body arousal, from head-to-toe and everything in between. Men learning how to approach their point of no return—without going over the cliff—need to appreciate whole-body sensuality, that is, massage, the pleasure they can experience from being touched all over, every square inch of the body.

Whole-body sensuality releases tension and feels deeply relaxing—but it’s not the kind of relaxation that includes a recliner, a six pack, and Monday Night Football. It’s the kind you feel after a good mas- sage or a hot bath. In fact, bathing or showering together before lovemaking can help men relax, ap- preciate whole-body sensuality, and last longer. That’s important because if you’re tense during sex, your body may have no way to release it other than ejaculating before you’d like. But as you learn to appreciate whole-body sensual pleasure from head to toe, whole-body arousal takes pressure off the penis, and you last longer.

Most women prefer lovemaking based on whole body sensuality, and many women complain that men plunge into intercourse before they feel ready for it. So as you cultivate an appreciation for being touched all over, give your partner that special gift, too. Most women warm up to genital sex more slowly than men. Give them the warm-up time they need. Wait a while before reaching for her breasts and between her legs. How long? At least 30 minutes.

That’s right, spend a good half hour—or longer—kissing her, hugging her, and gently running your hands all over her, from her shoulders to her fingertips, her scalp to her feet. Leisurely, playful, massage-based sensuality allows women the time they need to warm up to genital sex. It also al- lows slows the sexual pace, which helps you last longer. And as you massage her all over, encourage her to do the same to you. Whole-body touch helps you last longer. It spreads arousal all around the body. When your penis is the only part of you that gets touched, arousal concentrates there. The little guy can’t take it and suddenly, you come. But when she touches you all over, when every square inch of your skin becomes sensually aroused, that takes pressure off your penis and you last longer.

Breathe deeply. One easy way to stay deeply relaxed during lovemaking is to breathe slowly and deeply. The body has a natural tendency to breathe deeply during sex. But many men fight it. In- stead of breathing deeply and making the little love-moan sounds that go along with it, they stifle their breath—and sacrifice ejaculatory control. Why? Because when you’re tense, you’re more likely to ejaculate quickly. Deep breathing is very relaxing. It dissipates tension and helps you last longer. Let your breath go and breathe deeply. Many men are amazed how much this one little change improves ejaculatory control.

Adjust your fantasies. Sex is all about friction and fantasy. Some men have specific sexual fantasies that get them so hot that they have trouble maintaining ejaculatory control. Give those fantasies a rest, and focus on others that are exciting, but don’t put you over the edge.

Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 170 – Step #1. Masturbate with a dry hand Now that you appreciate whole-body sensuality, and are prepared to slow the erotic pace, breathe deeply, and adjust your fantasies, you’re ready to focus on your penis. Of course, you’re familiar with masturbation, and that’s good because masturbation is crucial to learning to last longer. But mastur- bating to last longer is different from what you may have done until now.

Adopt a slow, sensual masturbatory pace and vary how you caress your penis. Over time, this should allow you to stay highly aroused for extended periods without coming. When you feel yourself ap- proaching the point of no return, stroke more gently or stop and simply hold your penis. Breath deeply and over a minute or two, you should notice that you retreat from your point of no return. Then, as you feel less ejaculatory urgency, feel free to reintroduce more vigorous self-stimulation. Practice this exercise until you can last reliably for 30 minutes or as long as you’d like.

Repeat this exercise several times over several sessions until you can consistently last for 30 min- utes. Approach your point of no return, then back off, then approach, and retreat again and again. For most men, it doesn’t take long to develop good ejaculatory control with a dry hand while alone.

Note: Accidents happen. As you practice approaching your point of no return, you might not back off in time. You might come. That’s fine. Try not to become frustrated. Learning a new skill takes time. In baseball fielding practice, a hot grounder might get by you. The same goes for practicing ejaculatory control. If you ejaculate before you want to, don’t berate yourself. Instead, focus on what happened. Try to figure out why your arousal got away from you. Then return to the program and keep practicing.

Step #2. Masturbate with a lubricated hand

Sexual lubricants—saliva, vegetable oil, or a commercial lubricant (e.g. Astroglide)—make the geni- tals more sensitive to touch, and increase the intensity of erotic fondling. It’s more challenging to maintain ejaculatory control with a lubricated hand, which is why practicing that is the next step.

Follow the same program: With a lubed hand, masturbate until you approach your point of no return, then back off. Repeat this several times over several sessions over a week or two until you can last around 30 minutes or as long as you’d like.

Translating the Solo Program to Partner Sex

Say you’re single and gain good control solo, then get involved with a woman. Don’t be surprised if you initially experience involuntary ejaculation with her.

Why? You might feel anxious with your new lover. Anxiety interferes with ejaculatory control. You may be over-eager to get it on. That, too, can impair control. Or she may not stimulate you the way you stroke yourself.

If you encounter any problems translating Steps 1 and 2 to partner sex, follow these steps:

Tell her that you’re very excited to have sex with her, in fact, so excited that you might come before you’d like. Tell her you enjoy the best control in the context of slow, sensual sex based on whole-body massage, and that you hope she feels the same way. The vast majority of women do.

Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 171 – Follow through on leisurely, playful, massage-based lovemaking.

Breathe deeply.

Adjust your fantasies.

If you come before you’d like, laugh it off saying, “Wow, you really excite me.” Then say that next time, a renewed focus on slow, massage-based, whole-body sex should allow you to last longer.

If you continue to come before you’d like, and your partner is willing, proceed to the couple’s program.

Step #3. She strokes you with a dry hand

If you’re in a couple, now it’s time to invite your partner to participate in the program. First, arrange “stop” and “start” signals. You might use the words “stop” and “start,” or you might prefer nonverbal signals—a light tap or pinch for “stop” and two for “start,” whatever communicates your needs quickly and clearly.

You lie still and invite your lover to stroke your penis with a dry hand. When you approach your point of no return, give the “stop” signal. She immediately stops stroking you and simply holds your penis gently, as you continue to breathe deeply and pay close attention to the sensations you’re feeling as you back off from your point of no return. When you no longer feel close to ejaculation, give the “start” signal, and your lover returns to stroking you.

How many stops and starts should you do? A half-dozen over a 15-to-30-minute period works well for most couples. Do what feels comfortable for you. Practice this way during a few sessions a week for a few weeks to a month.

Note: It’s possible that your girlfriend or wife might not be all that interested in helping you learn to last longer for any of several reasons:

• If the two of you have a desire difference and you want sex more than she does, she might fear that as soon as you gain ejaculatory control, you’ll want sex even more. In that case, pledge that you won’t pressure her for more frequent sex. (Desire differences are very common. If your relationship is troubled by one, visit GreatSexGuidance and read “You’re Insatiable.” “You Never Want To.” How Sex Therapists Recommend Overcoming Desire Differences.)

• She might not be all that eager for all-night-long lovemaking. If you take turns stimulating each other to orgasm by hand, mouth, or sex toy, then, even if you come quickly, you’re taking care of her—and she might not see any point to you lasting longer. In that case, tell her how important it is to you to learn ejaculatory control and appeal for her assistance.

• Or she might fear that once you learn to last as long as you want that you’ll be more likely to have an affair or leave her. In that case, it might be a good idea to consult a couples counselor.

Note: The focus here is on you—your involuntary ejaculation and your commitment to learn how to last longer. She’s a helper for sure, but she’s not the focus, so she might feel a little left out. Don’t for- Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 172 – get her sensual needs. Ask if there’s anything she’d like you to do differently during sex, for example, she might guide your hand over some sensitive sports to show you the kind of touch she enjoys. Even when you’re the focus, lovemaking is still a couple activity. Don’t forget your lover’s erotic needs.

Step #4. She strokes you with a lubricated hand

As you approach your point of no return, signal her to stop. As the urge to come subsides, signal her to resume stroking. Play with different stroke speeds and the tightness of her grip. Repeat this sev- eral times over several sessions over a week or two until you can last 15 to 30 minutes or as long as you’d like. Step #5. Try the same stop-start approach, but with oral caresses.

At first, you should lie still. Coach her about the kinds of licks and caresses that keep you highly aroused but don’t push you off the cliff. Once you’ve gained good control during fellatio while remain- ing still, feel free to start moving your hips.

Step #6. If vaginal intercourse is part of your lovemaking … incorporate stop-start into it, first, in the woman-on-top position—you on your back lying still with the woman straddling your hips. For most men, the woman-on-top position is the best for ejaculatory control because it’s the least stressful for men. The man-on-top (missionary) position can be fun, but ejaculatory control is more of a challenge because you have to hold yourself up. Once you develop good control with the woman on top, feel free to extend your stop-start practice to other positions.

If you have trouble gaining control, try The Squeeze. The squeeze was developed in the 1960’s by pioneering sex researchers William Masters, M.D. and Virginia Johnson, who invented sex thera- py. It’s like stop-start, but during stops, the man or woman pinches the head of the penis with thumb and index finger, which helps suppress the urge to ejaculate.

Make some noise. Love moans help men (and women) breathe more deeply and relax. As a result, they often help men last longer.

Give it time. It’s important to understand that learning ejaculatory control takes time and practice. You may feel a little awkward along the way. Try to maintain a sense of humor about any accidental spills.

Drugs?

In 1987, the Food and Drug Administration approved a new antidepressant, Prozac, the first selective serotonin reuptake inhibitor (SSRI). Prozac and subsequently approved SSRIs (Paxil, Zoloft, Celexa, Luvox, Lexapro) elevate mood by increasing levels of the brain chemical (neurotransmitter) serotonin in the spaces (synapses) between brain cells. Early male users of Prozac reported that the drug had an unusual side effect, delay or elimination of ejaculation.

By the early 1990s, physicians were prescribing low-dose SSRIs to treat PE. Recently, an SSRI was developed specifically for this purpose, Priligy (dapoxetine). Approved in several European countries, including Finland, Sweden, Portugal, Austria and Germany, the drug is currently (2013) awaiting FDA approval.

Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 173 – Drug treatment is often effective, but unlike the sex therapy program, it does not teach men ejacula- tory control. When drug therapy ceases, PE returns. Drug treatment is also costly, and may cause side effects, among them: nausea, diarrhea, headache, dizziness, fatigue, decreased libido, erectile dysfunction, and reduced fertility.

Doctors generally prescribe drugs as first-line PE treatment, however, after receiving comprehensive training in the condition, most change their minds and recommend the sex therapy approach first, with drugs reserved for those who need additional help.

Even when medication proves necessary, combination treatment with both a drug and sex therapy works significantly better than drug treatment by itself.

Desensitizing Topical Anesthetic Creams?

Before Masters and Johnson proved that most PE was a simply bad habit, some physicians believed that the penises of men who suffered it were overly sensitive to touch (“penile hypersensitivity”). They treated PE with ointments containing topical anesthetics, for example, lidocaine. However, studies have shown that the penises of men with PE are no more touch-sensitive that those of men who en- joy good ejaculatory control.

Nonetheless, several anesthetic ointments have been introduced to treat PE, and studies show that they provide modest benefit, allowing men who ejaculated in less than one minute to last for two or three minutes.

However, many men want to last longer than that. Desensitizing products don’t teach ejaculatory control so they don’t cure PE. They don’t help men learn ejaculatory control. They dull sensation, while the key to lasting longer is to focus on your sensations, to become more familiar with what you feel as you approach your point of no return, so you can back away from it while still remaining highly aroused. Desensitizing creams must be applied 10 to 15 minutes before intercourse, which may interrupt lovemaking. Many men complain that topical anesthetics reduce the pleasure of sex. Finally, some women complain that desensitization products desensitize their genitals, and make fellatio less palatable.

Masturbate Beforehand?

This approach helps young men, who can raise second erections shortly after ejaculating. The sec- ond time around they usually last longer. But as the years pass, men need more time to become erect again, after 40, often several hours. Chances are you can learn good control without masturbating beforehand.

How This Program Enhances Lovemaking for Women

The program for learning ejaculatory control is very likely to provide your lover with greater sexual enjoyment—and not just because you last longer. When researchers have surveyed women asking what kind of lovemaking they prefer, they generally say leisurely, playful, whole-body, massage-orient- ed sensuality that includes the genitals but is not limited to them. Women often complaint that men are too eager for intercourse, that men have sex too quickly and too mechanically, and that men focus too much on women’s breasts and genitals. Women generally feel that the whole body is a sensual Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 174 – playground, and can’t understand why so many men explore only a few corners of it. Like women, penises generally prefer leisurely, playful, whole-body, massage-oriented lovemaking. A rushed, penis-centered, intercourse-fixated sex style puts a lot of pressure on the penis, and contributes to involuntary ejaculation. But when men make love the way women prefer, whole-body arousal takes the pressure off your penis and you last longer.

Bottom line: When men make love the way women prefer, women have fewer complaints, and men have fewer sex problems.

Need More Help?

If self-help doesn’t cure you, sex therapy almost always can, usually in a few months.

To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Great Sex Guidance:The Cure For Premature Ejaculation-The Simple ProgramThat Teaches MenTo LastAs LongAs They’d Like – © Michael Castleman – 175 – Penis Size: How to Make The Most of What You’ve Got And How Best to Please Women With It

In a magazine survey some years ago, 1,000 men were asked about their size. Almost every respon- dent said he was “too small” and wished he were larger. “Men are obsessed with penis size,” says Palo Alto, California, sex therapist Marty Klein, Ph.D, “During more than 20 years as a therapist, male clients have raised the issue so many times, I’ve lost count.” And a report in the British Journal of Medicine (now called BMJ) declares that male anxiety about penis size is so pervasive, it might be considered a “disease.” No wonder that expensive—and useless—offers for extra inches fill email inboxes.

Many men are convinced that it takes a large penis to please a woman. Pornography certainly sup- ports that view. All penises in porn are much larger than average and the women ooh and ahh over them. In addition, ads for casual partners often request men with unusually large penises.

Some women do, indeed, prefer men with a particular penis size (larger or smaller than average), just as some men have clear preferences about women’s breasts, buttocks, weight, and figure. That’s fine. People have a right to their personal preferences.

But many men are convinced that women judge lovers by their penis size. No, they don’t. Women are much less fixated on size than men think they are. Croatian researchers surveyed 556 women, age 19 to 49. Only 17.5 percent called penis size “important.”

Beyond personal preferences, there is no connection between a man’s size and the pleasure he can provide a lover. “It’s sad how few men understand this,” Klein explains. “Any size penis can bring great pleasure to the man it’s attached to. As for women’s pleasure, it rarely has much to do with the man’s penis or how he uses it to fill her vagina. Women’s pleasure has more to do with the woman’s clitoris and how the man uses his fingers, palm, lips and tongue to caress it—especially his tongue.”

The Vast Majority: Average

I know of no published scientific surveys of penis size. But during my 20+ years of reporting on this is- sue, I’ve interviewed several urologists, physicians who have closely examined thousands of penises.

Great Sex Guidance: Penis Size- How to Make The Most of What You’ve Got And How Best to Please Women With It – © Michael Castleman – 176 – How many men are noticeably smaller than average? “At most, 5 percent,” says Baltimore urologist James Smolev, M.D., who been in practice more than 30 years.

How many are noticeably larger? “Maybe 10 percent,” Dr. Smolev says.

And how many are truly huge? “Very, very few. The vast majority of men are average, or a little bigger or smaller. In my entire career, I recall only a few guys I’d call really enormous.”

Why Most Men Think They’re Too Small

Where do average-size men get the idea they’re too small? “From pornography,” explains Richard Pacheco, a male porn star of the 1970s, now retired. “The men in porn are a self-selecting group. Only the guys with the biggest dicks audition, and of those, the directors select the largest.”

The only penises heterosexual men get to see really up close—other than their own—are the ones in x-rated media. They really are significantly larger than the vast majority of penises. Porn penises are the standard against which men judge themselves, and that standard is seriously skewed toward Go- liaths. As a result, all the Davids of the world are justified in believing that they’re “small.” (Speaking of David, have you ever taken a good look at the famous statue by Michelangelo? David’s penis is quite small. The same goes for virtually all classical male nude sculptures.)

In addition, men look down on their own penises from above, which makes them look even smaller, Pacheco explains. But they view porn penises from other angles: “So many of the penis shots are photographed up from underneath. That makes any penis look big.”

Size: For the Record

According to urology textbooks, the average flaccid penis measures 3 to 4 inches in length, but this is Great Sex Guidance: Penis Size- How to Make The Most of What You’ve Got And How Best to Please Women With It – © Michael Castleman – 177 – a rather “soft” figure, as it were, because it depends on several factors. Most men notice that the size and hang of their penises vary. Sometimes they look shriveled, other times larger and better hung (more later). Flaccid size also depends on how much you stretch your organ while measuring it (most men pull hard), and where you measure from—medical sources measure from the base of the top of the shaft where it attaches to the lower abdomen. As for the erections, they typically measure from 5 to 7 inches.

Flaccid size has nothing to do with erection size, says Martin J. Resnick, professor of urology at Case Western Reserve University in Cleveland. It’s quite possible to have a flaccid penis on the small side, but a 7-inch erection. In general, the smaller the flaccid penis, the more length and girth it gains in erection.

Racial Differences?

In male folklore, a great deal is made of racial differences in penis size. Black men are reputed to be larger than whites, who are supposedly larger than Asian men. Urologists and others I’ve interviewed generally concurred with these stereotypes, but insisted that racial characteristics take a back seat to individual differences. “I’ve seen penises bigger and smaller than average in men of every race,” says New York City sex educator Betty Dodson, Ph.D.

8 Safe, Natural Ways to Make the Most of What You’ve Got

Whether flaccid or erect, penis size depends on the amount of blood that enters the organ through the pudendal arteries, and the amount of blood in the penis’ central corpus cavernosa, the spongy tis- sues that fill with extra blood during erection. So size depends on filling the penis with as much blood as possible. Here’s how:

Eat Less Meat and More Fruits the Vegetables

No doubt you’re familiar with exhortations to eat a diet low in animal (saturated) fat to prevent heart disease. Maybe more men would heed this advice if the American Heart Association added that a low-fat diet also helps penis size. A diet high in animal fat raises cholesterol, which narrows the ar- teries, including the ones that carry blood into the penis. As these arteries narrow, less blood gets in there, and the penis shrinks. If you eat meat and cheese, eat less. In addition, eat more fruits and vegetables, at least five servings a day. Fruits and vegetables contain antioxidant nutrients that help prevent arterial narrowing so as much blood as possible can get into the penis.

Quit Smoking

If you need another reason to quit, smoking accelerates arterial narrowing, which is why smokers are at high risk for heart disease. Cigarettes hit men below the belt as well, limiting blood flow into the penis.

Embrace a Relaxation Regimen

The pudendal arteries are surrounded by smooth muscle tissue. When men feel anxious, explains Bloomfield Hills, Michigan sex therapist Dennis Sugrue, Ph.D., a past president of theAmerican As- sociation of Sex Educators, Counselors, and Therapists (AASECT), this muscle tissue constricts, limiting blood flow into the penis. But as men relax, this tissue also relaxes, allowing increased inflow. Great Sex Guidance: Penis Size- How to Make The Most of What You’ve Got And How Best to Please Women With It – © Michael Castleman – 178 – As a result, deep relaxation, the kind associated with meditation, coaxes more blood into the penis. (Viagra and other erection drugs work by relaxing the penis’ smooth muscle tissue.)

In addition, anxiety triggers the “fight or flight” response. This reflex sends blood away from the cen- tral body, including the penis, and out toward the limbs for escape or self-defense. But as men relax, more blood becomes available to the penis. “When men become distressed about their size,” Klein says, “the anxiety may contribute to penis shrinkage. If you want to be all you can be, relax, and stop worrying about it.”

Warm Penis, Larger Penis

You’ve probably noticed that in chilly locker rooms, your penis seems to shrink and your scrotum hugs your body tightly. But after a hot shower, your penis looks larger and your scrotum hangs much lower. Warmth is relaxing, Resnick explains, which increases blood flow into the penis and encourages the scrotum to relax and hang lower.

Cultivate a Comfortable, Committed Relationship

Sure, flings can be fun and new relationships are exciting. But they also involve sex with women you don’t know very well, if at all. That can produce anxiety. A familiar lover may not be as exciting as a new one, but familiarity allows you and your penis to relax, which helps your organ look its largest.

Exercise Regularly

Exercise improves arterial function, allowing the circulatory system to carry more blood into the penis.

But exercising the penis itself doesn’t help. The sex media sometimes refer to the penis as the “love muscle,” which implies that like the biceps, certain exercises can buff it up. “The penis contains muscle tissue,” Klein explains, “but there are different kinds of muscle. The penis contains smooth muscle, not the kind that gets bigger with exercise.”

In addition to increasing blood flow into the penis, here are other size-enhancing suggestions:

Lose the Belly

“When a man has a big gut,” Sugrue explains, “excess fat tissue encroaches on the base of his penis, which makes it look smaller. Lose the abdominal fat pad, and you look larger.” One way to lose weight is to exercise more, another good reason to be physically active.

Try a Pubic Haircut

“When less of the penis is obscured by hair,” Sugrue explains. “it looks larger.”

Do Older Men’s Penises Shrink?

Possibly. Recall that size depends on blood flow into the penis. Recall also that a typical American diet—lots of meats, cheeses, and other fatty foods, and low in fruits and vegetables—narrows the arteries. Constricted penile arteries mean that less blood flow into the organ, which makes it look smaller. Most American men spend their lives eating a diet that narrows the arteries. Arterial narrow- Great Sex Guidance: Penis Size- How to Make The Most of What You’ve Got And How Best to Please Women With It – © Michael Castleman – 179 – ing increases over the decades of life and by 50 or so may become significant enough to make the penis look smaller.

In addition, as men age, they tend to gain weight, and many men show this extra weight abdominally. An expanded lower abdomen encroaches on the base of the penis, making the organ appear smaller because less of it sticks out from the fat pad.

Finally, if you feel anxious about a shrinking penis, that causes stress/anxiety, which narrows the ar- teries even more and further reduces blood flow into the penis.

What can an older man do about his size? Follow the advice already recommended: Eat less meat and cheese, and more fruits and vegetables, at least five servings a day. Exercise more. Try a brisk walk for 30 minutes a day and over several months work up to a daily hour-long walk. Regularity is key. Exercise every day. And try not to become anxious about your size.

DON’T Buy Pills or Devices That Promise Enlargement—They’re Frauds

Chances are you’ve received dozens (hundreds?) of junk emails promising extra inches using vari- ous miraculous pills, potions, and devices. The Web sites for these products often feature videos of sincere-sounding men who gush that they were skeptical, but “this really works.” Nonsense. None of these products actually enlarge the penis. They are all cynical frauds, every one of them.

True story: A friend of mine owns a sex toy store. Some years ago, a salesman approached him of- fering a penis-enlargement pill. “You buy bottles wholesale for $19.95 and retail them for $79.95,” the salesman gushed, “a marvelous mark-up.”

My friend declined, saying, “No pill can increase penis size.”

“You’re right,” the salesman replied. “But no one ever asks for a refund or sues. They’re too embar- rassed.”

That embarrassment can mean big bucks for the cynical criminals who market penis pills. No one knows how many companies are involved in this fraudulent, immoral business, but a report in the New York Times (2003) suggests that producing bogus penis pills costs as little as $2.50 a bottle, while marketers sell them for around $50. The Times estimates that some marketers gross as much as $10,000 a day ($3.65 million a year)—which is why so many of them can afford to bombard men with junk email promising extra inches.

All penis enlargement pills, potions, and supplements are frauds. The same goes for traction devices that supposedly stretch the penis. In masturbation, most men yank on their penises, stretching them. Has that ever added permanent inches to yours? Those who market penis enlargement products are criminals preying on anxious, misinformed men. Don’t fall for their BS.

Jelqing?

Jelqing is supposedly an ancient Middle Eastern penis-enlargement technique. But none of the stan- dard works on the history of sex mention it. Jelqing involves making an circle with the thumb and index finger, wrapping it around the semi-erect penis, and then pulling the organ 200 to 500 strokes a day using a rhythmic milking motion. On some Internet sites, men make extravagant claims of extra Great Sex Guidance: Penis Size- How to Make The Most of What You’ve Got And How Best to Please Women With It – © Michael Castleman – 180 – inches. But jelqing is very similar to the way many men masturbate. Has masturbation boosted your size? Forget jelqing. It has zero effect on size.

Two Sex Toys May Produce Temporary Enlargement

C-Rings

If you enjoy playing with sex toys, two devices may temporarily boost erection size—C-rings (also known as cock rings) and vacuum constricting devices, generally known as penis pumps.

C-rings are rubber or leather donut-shaped devices that tightly encircle the erect penis. Typically used to help maintain erection, they may also provide a small, temporary size boost. Just don’t expect miracles.

Some men think of the penis as a balloon, filled with blood when erect, and empty when flaccid.This is incorrect. Whether flaccid or erect, blood circulates in and out of the penis all the time.The arter- ies that carry blood into the penis run through the center of the organ, so during erection, as blood fills the penis’ spongy erectile tissues, a C-ring doesn’t keep blood out. However, one of the two veins that carry blood out of the penis, the superficial dorsal vein, runs close to the organ’s outer skin (on top). As the penis expands in erection, both the superficial and deep penile veins naturally get somewhat compressed, which restricts blood outflow and contributes to blood pooling and erection. A C-ring restricts outflow a bit more by compressing this superficial vein. The net effect is somewhat greater blood build-up in the penis, and a slightly larger, firmer erection. Just bear in mind that any ef- fect is modest.

There are two kinds of C-rings, adjustable and not. If you’re at all concerned about damaging your penis—bruising is possible from a ring that’s too tight—use an adjustable ring. “Some guys swear by C-rings,” Dodson observes. “Others say they do little, if anything.” If you’d like to try a C-ring, they’re available from sex toy marketers.

Penis Pumps

Penis pumps are plastic tubes that create a partial vacuum around the penis. The vacuum draws blood into the organ, resulting in temporary size enhancement. They were invented about 40 years ago, not as sex toys, but as therapeutic devices designed to produce temporary erections in men who otherwise couldn’t raise them. (This was long before erection drugs. Pumps are still used by men who get no benefit from erection drugs.) Once a pump has raised an erection, users roll on a constriction band similar to a C-ring to help maintain turgidity. “For temporary erection,” Smolev explains, “vacuum devices are reliable, safe, and effective, and usually produce good results.”

Even if your penis has no trouble becoming erect, pumps can be used for temporary size enhance- ment. Models differ, but all include a plastic tube that fits over the penis, fitted with a pump operated by a hand bulb. You squeeze the bulb, which evacuates the air from the plastic tube, drawing blood into the penis. Just remember, the effect is modest and temporary. It also depends on the tightness of the seal created where the tube meets the base of the penis. Sex toy pumps may not create a tight seal. Prescription pumps, available through urologists work better but are custom-made and cost a lot more.

Great Sex Guidance: Penis Size- How to Make The Most of What You’ve Got And How Best to Please Women With It – © Michael Castleman – 181 – Surgical Enhancement: Don’t

The ad say: “Give Yourself a Major Confidence Boost: Surgical Penis Lengthening and Girth Enlarge- ment” with a urologist’s contact information. Surgical enlargement might boost your self-esteem. Then again, it might also destroy it.

Two surgical approaches are available. The more popular is lengthening. It’s based on the fact that you have more penis than what you see between your legs. The penis extends into the lower abdo- men. The internal penis is held in there by the penile suspensatory ligament. Cut this ligament, and much of the internal penis emerges, adding about an inch to visible length.

But cutting this ligament also has a significant downside. The suspensatory ligament is what makes erections stand up. A surgically lengthened penis still becomes firm during erection, but it no longer salutes. Instead, it hangs down between your legs, requiring you or your lover to direct it by hand into erotic openings.

The other surgical option is girth enhancement. This is a two-step procedure involving fat removal (li- posuction) from the buttocks, then injection of that fat under the penile skin. The before-and-after pic- tures offered by urologists who perform this procedure show pencils transformed into bratwurst. But again, there are downsides. The fat injections may not “take,” meaning you’ve wasted your money. In addition, they may take unevenly, producing a lumpy, mutant-looking organ.

The Web sites of urologists who perform penile enlargement surgery are filled with testimonials. But Resnick said these procedures carry a significant risk of infection and deformity. Smolev was even more emphatic: “Any surgery to lengthen or thicken the penis should be outlawed.” And the Web site of a prominent penis-enlargement surgeon warns that many urologists who perform penis enlarge- ment “lack the skills needed to produce good results.....A large part of [this doctor’s] practice involves repairing the numerous men damaged by [other] surgeons.”

“You couldn’t pay me to have my penis surgically altered,” Klein says. “The horror stories I’ve heard are horrendous.”

If you’re interested in surgery, the cost is about $6,000 for lengthening and $7,000 for girth enhance- ment, plus airfare, hotel, and food for several days. Lengthening comes first, then six to 12 months later, girth enhancement. Figure $15,000 for both—all out of pocket. Insurers don’t pay for penis enlargement.

There is, however, one type of minor surgery that’s quick and safe and can make the penis look larger, Smolev explains: “Liposuction of the suprapubic area.” That’s the fat pad in the lower abdomen above the penis, better known as a pot belly or beer belly. “If you eliminate suprapubic fat, the penis looks bigger.”

The Downside of a Big One: Most Guys Who Are Huge Wish They Were Smaller

Most men wish they were bigger, but ironically, the few men with phone polls in their jeans typically wish they were smaller. “This may come as a shock to men,” says Southern California sex therapist Patti Britton, Ph.D., past president of the Foundation for the Scientific Study of Sexuality, “but many women are afraid of really big penises. A large penis can feel uncomfortable during intercourse and even hurt the woman.” Great Sex Guidance: Penis Size- How to Make The Most of What You’ve Got And How Best to Please Women With It – © Michael Castleman – 182 – “Every now and then,” Dodson recalls, “I’ve talked with men who are really huge. I’ve shown women photographs of their penises. The women would ooh and ahh, but almost all said, ‘No way I’d ever want that thing in me.’ To a man, the huge men I’ve interviewed have said that having an enormous penis brought them very little joy. It was more of a burden.”

Most Women Don’t Care

“Women are right,” Klein says. “Men are too preoccupied with penis size. Some women may be size queens, but after more than 30 years in practice as a sex therapist, I’ve counseled thousands of cou- ples, and I can’t recall a single women ever raising it as an issue. Men hung up on penis size don’t understand good sex. No matter what your size, your penis can bring you great pleasure. But the best way to impress women in bed is to find creative ways to give them pleasure without using your penis. Only 25 percent of women are consistently orgasmic during vaginal intercourse. Most women need direct clitoral stimulation with a hand, a toy, or a tongue.”

“There’s nothing worse,” says Dodson, “than a big penis on a guy who thinks size is everything. Sex with a guy like that is a nightmare. He plunges in before the woman is ready. The sex often hurts. Personally, I’d rather make love with a guy on the small side who knows how to use his tongue on my clitoris than a guy with a huge penis who thinks stuffing that turkey inside me is all there is to sex.”

How Best to Please Women—No Matter What Your Size

In an old blues song, a woman sings: “It ain’t the meat, it’s the motion/ That makes your momma wanna rock./ It ain’t the meat, it’s the motion./ It’s the movement that gives it the sock.”

Dodson prefers a tongue on her clitoris to a penis in her vagina. But she also appreciates the close- ness and intimacy of vaginal intercourse. She just wishes men were gentler about insertion, more pa- tient as lovers, and had a better sense of the slow, sensual, erotic rhythm most women prefer during intercourse. Here are her suggestions for skillful use of what’s between your legs:

* Don’t plunge in the moment a woman spreads her legs. Go slow. Give her time to warm up to intercourse. “It takes a good 20 minutes of kissing, touching, and fooling around for my vagina to relax enough to comfortably accept an erection.”

* Use a lubricant. “A good lover always uses lube. Spread some on the penis and around the vagi- nal opening. Lube makes intercourse so much more comfortable.” Sexual lubricants are available at pharmacies. Vegetable oil may also be used (but it may stain linens).

* Enter slowly. “Most men push in too quickly. I’ve always preferred to be on top. That way I have more control of the speed and depth of insertion. In my experience, most women share that prefer- ence.”

* Don’t go deep right away. “The most erotically sensitive part of the vagina is the lips. Use the head of your penis to tease her lips. Then run it up her vulva to her clitoris. And even after you’ve gone deep, pull out and tease her lips some more.”

* Cultivate a rhythm. “Don’t pump in and out furiously like the men in pornography. Develop a slow, sensual rhythm. Talk about the kind of rhythm the woman likes. Some like in and out, but many prefer a slow grind around in circles, or a combination of in-out and circular movement.” Great Sex Guidance: Penis Size- How to Make The Most of What You’ve Got And How Best to Please Women With It – © Michael Castleman – 183 – * It ain’t the meat, it’s the clitoris. The clitoris, women’s pleasure organ, develops from the same embryonic cells as the head of a man’s penis. It’s located outside the vagina and a few inches above it, under the top junction of the vaginal lips. Intercourse provides very little direct clitoral stimulation. That’s why only 25 percent of women are consistently orgasmic during intercourse. Three-quarters of women need direct clitoral stimulation with fingers, lips, tongue and/or sex toy. “I wish men would get over their preoccupation with penis size,” Dodson says. “If you want to please a woman, focus on her clitoris. Fondle it gently, and especially lick it. That’s much more enjoyable than feeling impaled on any size erection.”

Positions to Play With

With all due respect to the clitoris, many women enjoy the feeling of having a penis deeply filling their vaginas. “Some women love deep penetration because it makes them feel closer to the man,” Britton says, “with a more intimate connection to him. And men like it because it makes them feel larger.” The good news is that deep penetration depends less on penis size than on sexual position.

The standard man-on-top (missionary) position doesn’t allow particularly deep penetration, Britton explains, but a few variations do. With a pillow under the woman’s hips to raise her a bit, she bends her knees over her chest, then the man can kneel between her legs and enter her. Or he can hold her legs over her head.

The woman-on-top position allows the woman maximum freedom of movement. Many women enjoy this position best, Britton says. Encourage her to experiment with variations that give her a filled-up feeling.

Rear entry (doggie style) allows some of the deepest penetration. In this position, even an average- size penis can bang into the vaginal wall and cause the woman discomfort or even pain. Enter slowly and be careful not to thrust too deeply. For an erotic variation, try this one with the woman standing and bent over a table with you behind her.

Warning: For the few men with unusually large penises, deep penetration should be avoided because of the possibility of hurting the woman.

Make Peace with Your Penis

“It’s a real shame so many men feel inadequate because of their size,” Dodson says. “I urge men to make peace with their penises. It’s fine as it is. If you can enjoy what you’ve got, you’ll be a happier lover, which will probably make you a better lover.”

If you still think yours is inadequate, consult a sex therapist. Find one near you at aasect.org, the American Association of Sexuality Educators, Counselors, and Therapists, or sstarnet.org, the Soci- ety for Sex Therapy and Research.

References:

Stulhofer, A. “How (Un)Important Is Penis Size for Women with Heterosexual Experience?” Archives of Sexual Behavior (2006) 35:5.

Great Sex Guidance: Penis Size- How to Make The Most of What You’ve Got And How Best to Please Women With It – © Michael Castleman – 184 – Premature Ejaculation - Sex Therapy Beats Drugs

Forty years ago, pioneering sex researchers William Masters, M.D. and Virginia Johnson, invented sex therapy by developing a simple, effective program that cures men’s number one sex problem, rapid or “premature” ejaculation (PE).

But today, few physicians have the time or sex therapy training to teach men to last as long as they’d like. Physicians are more likely to prescribe low-dose antidepressant medication. However, drugs are not the best treatment.

Not the Drug, but a Side Effect

The drugs work, sort of, but actually what “works” is a side effect. When today’s most popular anti- depressants were introduced (Prozac, Paxil, Zoloft, etc.), many people complained of sexual side effects, loss of libido, delayed orgasm, or inability to have orgasms. In men, delayed orgasm meant lasting longer. Drug makers began urging doctors to harness this side effect to treat PE.

But the drugs don’t work that well. SSRIs typically delay ejaculation several minutes. But that’s a far cry from what hundreds of songs say lovers want: “all night long.” The drugs may also cause other side effects: nausea, headache, diarrhea, libido loss, and erection impairment.

The pharmaceutical companies now tout low-dose antidepressants for PE, telling doctors that the drugs “show men they can last longer and boost their confidence.”Then, when men stop taking the drugs, they magically continue to last as long as they’d like. Not true. Typically, when men who gain better ejaculatory control from antidepressants stop taking them, they revert to PE.

Better Results Without Drugs

The non-drug approach works better. It teaches men to last longer for good and causes no side ef- fects. It’s also preferable for other reasons:

* It’s cheaper. All most men need is a book that explains the sex therapy approach to this prob- lem. My book, Great Sex, explains it in detail for less than $20. Drugs cost a lot more. Get it from amazon.com.

Great Sex Guidance: Premature Ejaculation- Sex Therapy Beats Drugs – © Michael Castleman – 185 – * It’s more empowering. Drugs just delay ejaculation. They don’t teach men anything about them- selves or about lovemaking. But when men learn to last longer without drugs, they feel empow- ered. They gain self-esteem. And when people feel better about themselves, they enjoy better sex.

* It’s better for sex. Drugs don’t change the way couples make love. The sex therapy program for lasting longer increases erotic sensuality. It takes pressure off the penis by spreading erotic stimu- lation around the man’s entire body. In other words, it teaches men the value of whole-body mas- sage. One of women’s leading complaints about the way men make love is that it’s too focused on the genitals. Many women prefer sex that’s based on whole-body massage. The sex therapy approach to lasting longer shows men that the way women prefer to make love is also good for them.

* It’s better for the relationship. When the man pops a pill, there is no change in the couple’s intimacy. Using the non-drug approach, both lovers work together to teach the man to last longer. Working together on an intimate problem enhances the couple’s intimacy.

Sex therapists estimate that they can successfully teach 90 to 95 percent of men to last as long as they’d like without drugs. But if you’re one of the 5 to 10 percent who need medication, try it. Unfortu- nately, many doctors view drugs as the first-choice treatment. Actually, drugs should be the last re- sort.

If the self-help program in Great Sex doesn’t provide sufficient relief, try sex therapy. Sex therapists can usually help single men or couples resolve this problem in a few months. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Great Sex Guidance: Premature Ejaculation- Sex Therapy Beats Drugs – © Michael Castleman – 186 – Erection Myths — And The Truth About Erections

In many men, sexual myths contribute to normal middle-age erection balkiness and to more serious erectile dysfunction (ED). Here are the most erection-deflating myths—and the truth about these is- sues:

Myth: Erection is something men “achieve.”

The American Urological Association (AUA) defines erectile dysfunction (ED) as “inability for at least 3 months to achieve or maintain erection sufficient for satisfactory sexual performance.” Note the word “achieve.” The implication is that erection is something a man must work to produce, as though he were running a race or erecting a building.

But how exactly does a man “achieve” an erection? Most men take theirs for granted until sometime after 40 (and usually by 50), when erections begin to change. The site of an alluring woman no longer necessitates re-arranging the underwear. Erections no longer rise without some (or a good deal of) fondling, by hand, mouth, or sex toy. Post-40 erection balkiness is often unnerving—or worse. Some- thing men have always taken for granted can’t be anymore. All of a sudden, erection requires effort, work, achieving.

The problem with “achieving” erections is that the best way to raise one after 40 is to do the opposite of achieving. The key to erections after 40—at any age, really—is relaxation, the kind that involves deep breathing and whole body-massage. Deep breathing and sensual touch open (dilate) blood vessels around the entire body, including those that carry blood into the penis. As the penile arteries dilate, more blood flows into the organ, and an erection rises.

The struggle to “achieve” erection is actually counterproductive. It generates considerable stress, and stress constricts blood vessels around the body, including those in the penis. Stress limits blood flow into the organ, and contributes to normal middle-age erection balkiness and to ED.

Forget about “achieving” erections. You can’t will or force them. Erection is the result of deep sensual relaxation. The more sensual a couple’s loveplay, the more likely the man is to be able to rise to the occasion, though after 50 this may take a while. Sex therapists describe the situation this way: What young men want to do all night takes older men all night to do.

Great Sex Guidance: Erection Myths - And The Truth About Erections – © Michael Castleman – 187 – In addition, leisurely, playful, whole-body, massage-inspired sensuality is critical to women’s sexual arousal—and arousal is contagious. The more turned on the woman becomes, the more turned on— and erect—the man is likely to become.

Myth: Sex is a performance.

The AUA definition of ED mentions “satisfactory sexual performance.” Like the word “achieve,” the term “performance” has pernicious implications. It makes men feel they’re being judged, that women are rating them as lovers and telling everyone they know.

When men think of sex as a performance they’re likely to do what sex therapists call “spectatoring.” Instead of feeling relaxed and fully engaged, sex assumes aspects of an out-of-body experience. Part of the man is making love, while the rest of him is somewhere else, watching him do it, a spectator at a performance.

Most people are extremely self-critical. Spectatoring invites self-criticism—and the stress and dis- tractions that accompany it. Stop spectatoring. Sex is not a performance to be watched and judged. Great sex is a form of adult play. It’s best when the two lovers feel deeply relaxed, when the focus is entirely on giving and receiving pleasure. There’s no performance, no audience cheering or booing, no reviews. It’s just the two of you enjoying each other’s intimate company.

Myth: Men are sex machines, always ready, always hard.

An old joke asks: What single word can a woman say to sexually arouse a man? Answer: Hello.

The assumption is that men are so easily aroused that any female attention produces a bulge in their pants. That may be true at age 23. But after 40, things usually change. Men over 40 still think about sex frequently, but erections become balky, arousal is no longer automatic, and like women, men de- velop a set of conditions that must be met before they can raise erections, feel turned on, and enjoy sex.

The conditions necessary for erection vary from man to man, but typically include: privacy, deep relaxation, a feeling of emotional closeness with the woman, a romantic setting, no interruptions or distractions, and specific types of sexual stimulation. (Now, an estimated 1-3 percent of people get turned on by risky sex, for example, sex in public. But 97 to 99 percent of lovers prefer—and re- quire—privacy, comfort, and safety.)

It’s perfectly normal to have conditions for sex. In fact, it’s unusual not to. Many men love to attend professional football games. But if the game is outdoors and it’s 10 below zero, and snowing with gale-force winds, a man might decide not to go. Sex is similar. Men can love sex, but still need certain conditions to enjoy it. If those conditions are not met, a man’s penis might not be interested. Espe- cially a man over 40.

Myth: You get only one chance at erection per sexual encounter. If it wilts, sex is over, and you’re a failure.

Some 22 year olds can stay rock-hard from the drop of a zipper through orgasm. But as the years pass, even men who once had perpetually firm erections during sex begin to experience some waxing and waning. For many (most?) men over 40, sex involves erections that go from firm to less firm—or Great Sex Guidance: Erection Myths - And The Truth About Erections – © Michael Castleman – 188 – even flaccid—and then back to firm, possibly several times. As men age from 40 to 50 and beyond, they need more and more direct penis fondling to raise and maintain erections. This is normal and natural, and no cause for alarm. But it marks a sexual change. After 40, a man may have to ask for more direct penis fondling, and the specific kind(s) of stimulation he enjoys.

Unfortunately, when men who believe the “only once chance” myth experience any erection subsid- ence, they become anxious—or worse. This is self-defeating. Anxiety deflates erection. If an erection subsides during sex, don’t tense up and think: It’s all over. Instead, breathe deeply, relax, ask your lover to caress your penis in a way you enjoy, and focus on an erotic fantasy. Chances are, your erec- tion will return.

Many women also believe the myth that erections “should” remain hard throughout lovemaking. If an erection subsides, they may feel less desirable, or think they are sexual failures. Reassure them that after 40, it’s perfectly normal for erections to wax and wane. When they subside, both lovers should understand that the man needs more direct caressing.

Myth: I blew it last time. I’ll never get it up again.

This myth is similar to the previous one—and equally false. Of course, it’s disconcerting not to be- come erect during sex. But it’s a big mistake to over-generalize a single experience to a subsequent lifetime of ED. If a man misses a shot in basketball, does it mean he’ll never make another? If he los- es a hand of poker, does it mean he’ll never win again? If a relationship ends, are you fated to remain single forever? Sometimes things work, sometimes they don’t. But in most aspects of life, men know that another day means another chance to succeed. Unfortunately, many men believe their penises don’t give them second chances. Relax: They do.

If a man finds that he’s having erection difficulties, he should take a careful look at the situation. Here are some possible reasons why things might not work: Fatigue, sleepiness, alcohol, physical discom- fort, distractions, and emotional stress (job, money, family, or relationship problems, or jackhammers in the street). If men can’t give sex the undivided attention it deserves—especially men over 40—their erections may decide to wait until next time. Work to eliminate stresses and distractions. Invest extra time and effort in your relationship, in relaxation and sensuality. Your penis (and your lover) will thank you.

Myth: When I can’t get hard, she says it doesn’t matter. She’s lying.

In surveys that have asked women how they feel about men with erection problems, here is by far their most frequent comment: I wish he wasn’t as obsessed about the situation as he is.

For most women, a man’s lack of erection is less of a problem than his anxiety, depression, anger, confusion, and emotional withdrawal because of it. Erection matters to women, largely because it matters so much to men. Women know that if a man can’t get it up, he’s going to be miserable, which affects her.

But erections are not necessary for women’s sexual satisfaction. Only 25 percent of women are consistently orgasmic from vaginal intercourse. To have orgasms, most women need direct clitoral stimulation, with fingers, tongue, or a vibrator. In this context, erections don’t matter to most women’s orgasms. When a woman says that erection doesn’t matter, what she usually means is that the cou- ple can still have plenty of sensual fun—and great orgasms—without the man having an erection, and Great Sex Guidance: Erection Myths - And The Truth About Erections – © Michael Castleman – 189 – that things are likely to be better next time.

Myth: If a man can’t raise an erection, the woman can’t be sexually satisfied.

No, no, no. Men who believe this myth put tremendous pressure on themselves to get hard and stay hard. That stress wreaks havoc on erections.

This may come as a surprise, but the vagina is not well endowed with nerves that respond to sexual stimulation, and the deeper inside the vagina your penis goes, the fewer touch-sensitive nerves it finds. Most women enjoy intercourse for the physical closeness it involves, and because it’s such a turn-on for so many men. But vaginal intercourse is not the key to most women’s sexual satisfaction. Women’s main source of sexual pleasure and satisfaction is the clitoris, located outside the vagina and a few inches above it, under the top junction of the vaginal lips.

Dozens of sexological studies show that only 25 percent of women are consistently orgasmic from vaginal intercourse. Three-quarters of women need direct clitoral stimulation at least some of the time, and an estimated one-quarter to one-third of women rarely if ever have orgasms during inter- course. Erection is not necessary to satisfy a woman, nor to have her consider a man a good lover.

Myth: If a man can’t get an erection, he can’t come.

Not true. Different sets of nerves control erection and orgasm. Men can have orgasms without erec- tions (and erections without orgasm). Many men older men develop prostate cancer and as a result of treatment, lose the ability to have erections. But they can still have orgasms—marvelous, fulfilling orgasms—if they relax, enjoy leisurely, playful, mutually erotic massage, and receive vigorous penile stimulation by hand, mouth, or sex toy.

Myth: If I can’t get hard, she’ll leave me.

It’s possible, of course, but people tend to be more self-critical than they are critical of others. If a man can’t raise an erection, the woman is more likely to believe that he’s lost sexual interest in her, that he no longer finds her desirable, or that he’s having an affair and is about to leave her. Couples rarely break up solely because of sex problems. If a man develops an erection problem, chances are she won’t pack her bags. She’s much more likely to want to help her lover resolve the problem or adjust to it.

Myth: Intercourse requires a rigid erection.

Actually, a semi-erection is usually good enough. There’s no need to feel anxious if you’re not com- pletely firm. To enjoy intercourse with a semi-erection:

* Relax. Anxiety is likely to make erections subside even more.

* Ask for the stimulation you need. Tell your lover how you would like to be caressed to maintain your semi-erection. You might need more vigorous stroking than she’s likely to provide without a specific request.

* Make sure the woman is highly aroused and well lubricated before you attempt insertion. It takes at least 30 minutes of kissing, hugging, and non-genital sensual massage for most women to be- Great Sex Guidance: Erection Myths - And The Truth About Erections – © Michael Castleman – 190 – come fully aroused—especially women over 40. When women are fully aroused, their vaginal lips part, allowing easier entry. Also, in women under 40, full arousal usually (but not always) means self-lubrication adequate for comfortable intercourse. But some women under 40 and most women over 40 do not produce enough vaginal lubrication for comfortable intercourse. There is nothing wrong with a woman who does not self-lubricate copiously. Some women simply don’t produce much. And beginning after 40, as menopausal changes develop, self-lubrication diminishes. At any age, if lubrication is a problem, use a commercial lubricant. Many sex therapists recommend lubricant every time, no matter how well the women self-lubricates.

* Ask her to keep fondling you as you insert and guide you in. She shouldn’t let go until the head and upper shaft of your penis are inside her. This is easiest in the missionary and woman-on-top positions. If you enjoy the rear entry (doggie style), stroke yourself.

Myth: Lovemaking is impossible without an erection.

Absolutely not. Plenty of men who cannot physically have erections—prostate cancer survivors, men with spinal cord injuries, etc.—enjoy active sex lives, marvelous orgasms, and fully satisfied lovers. There’s more to great sex than a firm erection. Even without an erection, kissing, cuddling, and ex- tended erotic whole-body massage can lead to wonder sexual fulfillment.The vast majority of women need direct clitoral stimulation to have orgasms. Erection is not necessary for that. Use fingers, a tongue, and sex toys. And erection is not necessary for men to have orgasms. Vigorous stimulation of a flaccid penis by hand, mouth, or sex toys can produce fulfilling orgasms.

Myth: With age, all men develop ED.

Aging brings erection changes. After 40, men gradually lose the ability to raise an erection from fanta- sy alone. They need direct stimulation by hand, mouth, or sex toys. As the years pass, and men enter their 60s, it may take vigorous, extended stimulation before their penises respond, and when they do, erections may not become as firm as they used to, and they may subside without ongoing fondling. But that’s not ED. That’s normal, age-related erection balkiness. ED is the persistent inability to raise erections at all, even during masturbation.

ED is not inevitable with age. Even among men over 70, severe ED affects only about one-third of men.

Great Sex Guidance: Erection Myths - And The Truth About Erections – © Michael Castleman – 191 – Erectile Dysfunction (ED), Part 1- Varieties, Prevalence, Causes, And Relationship Implications

The bad news: Erection difficulties are fairly common among men of all ages— especially men over 40, and risk increases with age. The good news: In many cases, men with faltering or lost erections can restore them (with or without drugs), and if that’s not possible, there are many satisfying, orgas- mic ways to make love without an erection.

Until the 1998 introduction of Viagra, the term usually used to describe erection problems was “im- potence,” literally “powerlessness.” This term reflected the common view that men who couldn’t raise erections were sexual failures. This implication made many men reluctant to discuss their erection difficulties. As a result, pre-Viagra sex surveys suggested that erection problems were not particularly common, typically affecting men over age 60, and younger men with chronic medical conditions, nota- bly: diabetes, heart disease, depression, and spinal cord injuries.

The Varieties of ED

Today, the picture looks very different. In the decade since Viagra was approved (with Cialis and Levi- tra approved in 2003), men have become much more willing to discuss what is now called “erectile dysfunction” (ED), and a great deal of research shows that erection difficulties—from mild and occa- sional to persistent and severe—affect about half of men over 40, and some younger men as well.

While severe, persistent ED—not being able to raise an erection by masturbation—is generally lim- ited to men over 60 and younger men with erection-impairing medical conditions (notably diabetes and heart disease), mild, occasional erection balkiness—now often called “erection dissatisfaction”— is quite common among men over 40 and even younger men may suffer from it. Based on what they see over and over again in pornography, many men believe rock-hard erections spring out instantly at the drop of a zipper. However, porn isn’t real life. For men over 40, and many younger men as well,

Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 192 – instant, firm erections are the exception, not the rule. Today, the term ED is used to describe a broad range of erection issues, from occasional mild balkiness to severe ED.

Men with erection dissatisfaction don’t have true ED. They can still raise erections sufficient for inter- course. However, their erections are neither as firm nor as reliable as they used to be, and as men would like.

Erection dissatisfaction includes:

* Inability to raise an erection from fantasy alone. The man’s penis must be stroked to raise one.

* Erections that are less firm and reliable than they were during men’s teens and twenties.

* Erections can no longer be taken for granted. Men who walked about with rockets in their pock- ets as teens suddenly find themselves worried about getting it up.

Meanwhile, severe ED involves:

* Chronic inability to raise or maintain an erection by masturbation despite vigorous penile strok- ing. Prevalence of ED

How common is ED? No one really knows. The research is spotty, and there are real questions about how forthright men are when discussing erection difficulties.

Some of the best information comes from the Massachusetts Male Aging Study, an ongoing survey of 1,709 men over 40. More than half the participants (52 percent) report at least some erection dif- ficulty:

At 40: Mild Occasional Erection Dissatisfaction: 18% Moderate, Frequent ED: 17% Severe, Constant ED: 5% Total: 40%

At 50: Mild Occasional Erection Dissatisfaction: 18% Moderate, Frequent ED: 19% Severe, Constant ED: 8% Total: 45%

At 60: Mild Occasional Erection Dissatisfaction: 18% Moderate, Frequent ED: 27% Severe, Constant ED: 11% Total: 56%

At 70: Mild Occasional Erection Dissatisfaction: 18% Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 193 – Moderate, Frequent ED: 32% Severe, Constant ED: 15% Total: 65%

Note: This study surveyed no one under age 40. But with almost 20 percent of 40 year olds report- ing erection dissatisfaction, it seems highly unlikely that the problem suddenly pops up on men’s 40th birthdays. Clearly a significant proportion of men under 40 must also share this problem.

A 1999 survey by University of Chicago researchers also addressed the prevalence of ED based on a survey of 1,410 men age 18 to 59. The men were asked: Have you experienced any erection prob- lems during the previous year? The results:

Age 18-29 7% 30-39 9% 40-49 11% 50-59 18%

Again, it’s clear that while ED increases with age, many younger men also report some problems.

It’s also quite possible that men remain reluctant to admit this problem. True rates of erection dissatis- faction and ED are probably higher.

Causes of ED

The erection medications have shone a spotlight on the causes of ED related to the cardiovascular system, that is, the heart (cardio) and blood vessels (vascular). Viagra, Cialis, and Levitra open (di- late) the arteries that carry blood into the penis. Dilated arteries carry more blood, hence improved erections. Conversely, anything that constricts the arteries reduces blood flow into the penis and con- tributes to erection dissatisfaction and ED. The risk factors for cardiovascular disease (heart disease and stroke) constrict the arteries, as a result, these same risk factors also increase risk of erection problems:

* High Blood Pressure. Chronically high blood pressure damages the delicate lining of the arteries, causing injuries that lead to the development of fatty, cholesterol-rich deposits (plaques) that nar- row the arteries. When plaques form in the coronary arteries that nourish the heart, several condi- tions become more likely: angina, heart attack, and congestive heart failure. When plaques narrow the arteries in the brain, stroke and Alzheimer’s disease become more likely. And when plaques narrow the blood vessels in the penis, ED becomes more likely.

* High Cholesterol. High cholesterol contributes to the plaque deposits on inner artery walls that narrow them and limit blood flow around the body, including into the penis.

* Smoking. Smoking accelerates arterial narrowing, limiting blood flow into the penis.

* Diabetes. Diabetes accelerates arterial damage. Diabetes approximately quadruples risk of heart disease. It also substantially increases risk of ED. In addition, diabetes can damage the nerves involved in erection.

Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 194 – *Obesity. Obesity means you’re more than 20 percent heavier than your recommended weight. Obesity is strongly associated with high blood pressure, high cholesterol, diabetes, and a high-fat diet.

* High-Fat Diet. A diet based on fatty meats, cheeses, fast food, and junk food is associated with high cholesterol, high blood pressure and obesity.

* Cardiovascular disease. If a man has a history of heart disease or stroke, he’s at high risk for ED. In fact, these days, when men complain of ED, doctors typically work them up for cardiovas- cular disease because sometimes erection difficulties are the first symptom of heart disease.

While cardiovascular disease is a major cause of ED, it’s not the only one. Here’s the proof: Sev- eral studies of couples in treatment for ED agree that outcomes are best when erection drugs are combined with sex therapy focused on issues in the relationship and on how the couple makes love. In other words, there’s more to resolving ED and restoring couple’s sexual satisfaction than just coaxing more blood into the man’s penis.

* Aging. Even if a man maintains normal weight, cholesterol, and blood pressure, doesn’t smoke, and doesn’t have diabetes or cardiovascular disease, at some point, usually in his 50s, he notices erection dissatisfaction. The reason is that with age, the nervous system becomes less excitable. The reflexes slow somewhat. Similarly, men’s ability to become sexually aroused also slows. By age 50 or so, most men can no longer raise an erection from just thinking sexual thoughts. Their penises require direct stimulation, perhaps a considerable amount. This is normal.

* Sexual Misinformation. In many young men and some older men, a key cause of erection prob- lems is stress caused by belief in erection myths. Here are the most common myths, and the truth about them:

The majority of ED is caused by a combination of cardiovascular risk factors, aging, and sexual mis- information, emotional stress, acute illness, depression, drugs and drug side effects, neurological disorders, and hormone imbalances.

Myth: Erection is something men “achieve.”

The American Urological Association (AUA) defines erectile dysfunction (ED) as “inability for at least 3 months to achieve or maintain erection sufficient for satisfactory sexual performance.” Note the word “achieve.” The implication is that erection is something a man must work to produce, as though he were running a race or erecting a building.

But how exactly does a man “achieve” an erection? Most men take theirs for granted until sometime after 40 (and usually by 50), when erections begin to change. The site of an alluring woman no longer necessitates re-arranging the underwear. Erections no longer rise without some (or a good deal of) fondling, by hand, mouth, or sex toy. Post-40 erection balkiness is often unnerving—or worse. Some- thing men have always taken for granted can’t be anymore. All of a sudden, erection requires effort, work, achieving.

The problem with “achieving” erections is that the best way to raise one after 40 is to do the opposite of achieving. The key to erections after 40—at any age, really—is relaxation, the kind that involves

Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 195 – deep breathing and whole body-massage. Deep breathing and sensual touch open (dilate) blood vessels around the entire body, including those that carry blood into the penis. As the penile arteries dilate, more blood flows into the organ, and an erection rises.

The struggle to “achieve” erection is actually counterproductive. It generates considerable stress, and stress constricts blood vessels around the body, including those in the penis. Stress limits blood flow into the organ, and contributes to normal middle-age erection balkiness and to ED.

Forget about “achieving” erections. You can’t will or force them. Erection is the result of deep sensual relaxation. The more sensual a couple’s loveplay, the more likely the man is to be able to rise to the occasion, though after 50 this may take a while. Sex therapists describe the situation this way: What young men want to do all night takes older men all night to do.

In addition, leisurely, playful, whole-body, massage-inspired sensuality is critical to women’s sexual arousal—and arousal is contagious. The more turned on the woman becomes, the more turned on— and erect—the man is likely to become.

Myth: Sex is a performance.

The AUA definition of ED mentions “satisfactory sexual performance.” Like the word “achieve,” the term “performance” has pernicious implications. It makes men feel they’re being judged, that women are rating them as lovers and telling everyone they know.

When men think of sex as a performance they’re likely to do what sex therapists call “spectatoring.” Instead of feeling relaxed and fully engaged, sex assumes aspects of an out-of-body experience. Part of the man is making love, while the rest of him is somewhere else, watching him do it, a spectator at a performance.

Most people are extremely self-critical. Spectatoring invites self-criticism—and the stress and dis- tractions that accompany it. Stop spectatoring. Sex is not a performance to be watched and judged. Great sex is a form of adult play. It’s best when the two lovers feel deeply relaxed, when the focus is entirely on giving and receiving pleasure. There’s no performance, no audience cheering or booing, no reviews. It’s just the two of you enjoying each other’s intimate company.

Myth: Men are sex machines, always ready, always hard.

An old joke asks: What single word can a woman say to sexually arouse a man? Answer: Hello.

The assumption is that men are so easily aroused that any female attention produces a bulge in their pants. That may be true at age 23. But after 40, things usually change. Men over 40 still think about sex frequently, but erections become balky, arousal is no longer automatic, and like women, men de- velop a set of conditions that must be met before they can raise erections, feel turned on, and enjoy sex.

The conditions necessary for erection vary from man to man, but typically include: privacy, deep relaxation, a feeling of emotional closeness with the woman, a romantic setting, no interruptions or distractions, and specific types of sexual stimulation. (Now, an estimated 1-3 percent of people get turned on by risky sex, for example, sex in public. But 97 to 99 percent of lovers prefer—and re- quire—privacy, comfort, and safety.) Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 196 – It’s perfectly normal to have conditions for sex. In fact, it’s unusual not to. Many men love to attend professional football games. But if the game is outdoors and it’s 10 below zero, and snowing with gale-force winds, a man might decide not to go. Sex is similar. Men can love sex, but still need certain conditions to enjoy it. If those conditions are not met, a man’s penis might not be interested. Espe- cially a man over 40.

Myth: You get only one chance at erection per sexual encounter. If it wilts, sex is over, and you’re a failure.

Some 22 year olds can stay rock-hard from the drop of a zipper through orgasm. But as the years pass, even men who once had perpetually firm erections during sex begin to experience some waxing and waning. For many (most?) men over 40, sex involves erections that go from firm to less firm—or even flaccid—and then back to firm, possibly several times. As men age from 40 to 50 and beyond, they need more and more direct penis fondling to raise and maintain erections. This is normal and natural, and no cause for alarm. But it marks a sexual change. After 40, a man may have to ask for more direct penis fondling, and the specific kind(s) of stimulation he enjoys.

Unfortunately, when men who believe the “only one once chance” myth experience any erection subsidence, they become anxious—or worse. This is self-defeating. Anxiety deflates erection. If an erection subsides during sex, don’t tense up and think: It’s all over. Instead, breathe deeply, relax, ask your lover to caress your penis in a way you enjoy, and focus on an erotic fantasy. Chances are, your erection will return.

Many women also believe the myth that erections “should” remain hard throughout lovemaking. If an erection subsides, they may feel less desirable, or think they are sexual failures. Reassure them that after 40, it’s perfectly normal for erections to wax and wane. When they subside, both lovers should understand that the man needs more direct caressing.

Myth: I blew it last time. I’ll never get it up again.

This myth is similar to the previous one—and equally false. Of course, it’s disconcerting not to be- come erect during sex. But it’s a big mistake to over-generalize a single experience to a subsequent lifetime of ED. If a man misses a shot in basketball, does it mean he’ll never make another? If he los- es a hand of poker, does it mean he’ll never win again? If a relationship ends, are you fated to remain single forever? Sometimes things work, sometimes they don’t. But in most aspects of life, men know that another day means another chance to succeed. Unfortunately, many men believe their penises don’t give them second chances. Relax: They do.

If a man finds that he’s having erection difficulties, he should take a careful look at the situation. Here are some possible reasons why things might not work: Fatigue, sleepiness, alcohol, physical discom- fort, distractions, and emotional stress (job, money, family, or relationship problems, or jackhammers in the street). If men can’t give sex the undivided attention it deserves—especially men over 40—their erections may decide to wait until next time. Work to eliminate stresses and distractions. Invest extra time and effort in your relationship, in relaxation and sensuality. Your penis (and your lover) will thank you.

Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 197 – Myth: When I can’t get hard, she says it doesn’t matter. She’s lying.

In surveys that have asked women how they feel about men with erection problems, here is by far their most frequent comment: I wish he wasn’t as obsessed about the situation as he is.

For most women, a man’s lack of erection is less of a problem than his anxiety, depression, anger, confusion, and emotional withdrawal because of it. Erection matters to women, largely because it matters so much to men. Women know that if a man can’t get it up, he’s going to be miserable, which affects her.

But erections are not necessary for women’s sexual satisfaction. Only 25 percent of women are consistently orgasmic from vaginal intercourse. To have orgasms, most women need direct clitoral stimulation, with fingers, tongue, or a vibrator. In this context, erections don’t matter to most women’s orgasms. When a woman says that erection doesn’t matter, what she usually means is that the cou- ple can still have plenty of sensual fun—and great orgasms—without the man having an erection, and that things are likely to be better next time.

Myth: If a man can’t raise an erection, the woman can’t be sexually satisfied.

No, no, no. Men who believe this myth put tremendous pressure on themselves to get hard and stay hard. That stress wreaks havoc on erections.

This may come as a surprise, but the vagina is not well endowed with nerves that respond to sexual stimulation, and the deeper inside the vagina your penis goes, the fewer touch-sensitive nerves it finds. Most women enjoy intercourse for the physical closeness it involves, and because it’s such a turn-on for so many men. But vaginal intercourse is not the key to most women’s sexual satisfaction. Women’s main source of sexual pleasure and satisfaction is the clitoris, located outside the vagina and a few inches above it, under the top junction of the vaginal lips.

Dozens of sexological studies show that only 25 percent of women are consistently orgasmic from vaginal intercourse. Three-quarters of women need direct clitoral stimulation at least some of the time, and an estimated one-quarter to one-third of women rarely if ever have orgasms during inter- course. Erection is not necessary to satisfy a woman, nor to have her consider a man a good lover.

Myth: If a man can’t get an erection, he can’t come.

Not true. Different sets of nerves control erection and orgasm. Men can have orgasms without erec- tions (and erections without orgasm). Many men older men develop prostate cancer and as a result of treatment, lose the ability to have erections. But they can still have orgasms—marvelous, fulfilling orgasms—if they relax, enjoy leisurely, playful, mutually erotic massage, and receive vigorous penile stimulation by hand, mouth, or sex toy.

Myth: If can’t get hard, she’ll leave me. It’s possible, of course, but people tend to be more self-critical than they are critical of others. If a man can’t raise an erection, the woman is more likely to believe that he’s lost sexual interest in her, that he no longer finds her desirable, or that he’s having an affair and is about to leave her. Couples rarely break up solely because of sex problems. If a man develops an erection problem, chances are she won’t pack her bags. She’s much more likely to want to help her lover resolve the problem or adjust to it. Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 198 – Myth: Intercourse requires a rigid erection.

Actually, a semi-erection is usually good enough. There’s no need to feel anxious if you’re not com- pletely firm. To enjoy intercourse with a semi-erection:

* Relax. Anxiety is likely to make erections subside even more.

* Ask for the stimulation you need. Tell your lover how you would like to be caressed to maintain your semi-erection. You might need more vigorous stroking than she’s likely to provide without a specific request.

* Make sure the woman is highly aroused and well lubricated before you attempt insertion. It takes at least 30 minutes of kissing, hugging, and non-genital sensual massage for most women to become fully aroused—especially women over 40. When women are fully aroused, their vagi- nal lips part, allowing easier entry. Also, in women under 40, full arousal usually (but not always) means self-lubrication adequate for comfortable intercourse. But some women under 40 and most women over 40 do not produce enough vaginal lubrication for comfortable intercourse. There is nothing wrong with a woman who does not self-lubricate copiously. Some women simply don’t produce much. And beginning after 40, as menopausal changes develop, self-lubrication dimin- ishes. At any age, if lubrication is a problem, use a commercial lubricant. Many sex therapists recommend lubricant every time, no matter how well the women self-lubricates.

* Ask her to keep fondling you as you insert and guide you in. She shouldn’t let go until the head and upper shaft of your penis are inside her. This is easiest in the missionary and woman-on-top positions. If you enjoy the rear entry (doggie style), stroke yourself.

Myth: Lovemaking is impossible without an erection.

Absolutely not. Plenty of men who cannot physically have erections—prostate cancer survivors, men with spinal cord injuries, etc.—enjoy active sex lives, marvelous orgasms, and fully satisfied lovers. There’s more to great sex than a firm erection. Even without an erection, kissing, cuddling, and ex- tended erotic whole-body massage can lead to wonder sexual fulfillment.The vast majority of women need direct clitoral stimulation to have orgasms. Erection is not necessary for that. Use fingers, a tongue, and sex toys. And erection is not necessary for men to have orgasms. Vigorous stimulation of a flaccid penis by hand, mouth, or sex toys can produce fulfilling orgasms.

Myth: With age, all men develop ED.

Aging brings erection changes. After 40, men gradually lose the ability to raise an erection from fanta- sy alone. They need direct stimulation by hand, mouth, or sex toys. As the years pass, and men enter their 60s, it may take vigorous, extended stimulation before their penises respond, and when they do, erections may not become as firm as they used to, and they may subside without ongoing fondling. But that’s not ED. That’s normal, age-related erection balkiness. ED is the persistent inability to raise erections at all, even during masturbation.

ED is not inevitable with age. Even among men over 70, severe ED affects only about one-third of men.

* Stress. Erection myths are stress-provoking. But many other stressors can also cause erection Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 199 – difficulties. Erections are very sensitive to stress. Stress impairs erection in two ways. It limits the amount of blood available to the penis, and the blood that is available has more difficulty getting into the organ. When stressed, the body initiates the “fight or flight reflex” that sends blood away from the core (the abdominal organs including the penis) and out to the arms and legs for escape or self-defense. As a result, less blood is available for erection. Stress also constricts the arteries, including the ones that carry blood into the penis. Erection-killing stressors include: sexual misin- formation, and relationship problems, and problems involving one’s family, job, or finances.

* Acute Illness. Don’t expect your penis to stand up if you can’t. Any illness or injury can impair erection. Decreased sexual function is the body’s way of directing its energy toward healing.

* Neurological Disorders. Multiple sclerosis, spinal cord injuries, and other conditions can damage the nerves involved in erection.

* Depression. About one person in eight suffers serious depression at some point in life. In men, depression may cause the classic symptoms: deep melancholy, weepiness, and an inability to get out of bed. But it also might cause anxiety, angry outbursts, and alcohol or drug abuse. Depres- sion impairs erection.

* Antidepressants. The most popular medications used to treat depression are the selective sero- tonin reuptake inhibitors (SSRIs), including Prozac, Paxil, Zoloft, Luvox, and Celexa. The SSRIs cause sexual side effects in many people who use them. According to several studies, about 10 percent of men taking SSRIs report ED. Meanwhile, depression is a serious, potentially life-threat- ening condition that should be treated. The antidepressant least likely to cause sexual side effects is Wellbutrin.

* Alcohol. In Macbeth, Shakespeare wrote that the substance used worldwide to coax reluctant lovers into bed “provokes the desire, but takes away the performance.” Alcohol is a leading erec- tion-killer.

* Other drugs. Hundreds of drugs are associated with ED. Among over-the-counter medications, the ones most often linked to ED include: antihistamines (Benadryl, Dramamine). Prescription drugs associated with ED are too numerous to list here. Whenever you get a prescription, ask if it has sexual side effects. And if you develop erection difficulties shortly after starting a new drug, consult your physician. Perhaps another drug can be substituted with less risk of sexual side ef- fects.

* Hormonal Imbalances. Other than diabetes, hormonal disorders are rare. But man-made hor- mone imbalances are increasing common, notably, the ones caused by athletes taking anabolic steroids. These hormones increase muscle mass, but often cause erection problems.

* Prostate Cancer Treatment. A common treatment for prostate cancer is removal of the gland (radical prostatectomy). Unfortunately, this operation often damages the nerves involved in erec- tion, even with so-called nerve-sparing surgery.

Talking To A Lover About ED

Men and women have different feelings about ED. Men typically feel like failures and withdraw into brooding silence, or blame the woman for “not being sexy enough.” Men tend to view ED as a me- Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 200 – chanical problem and look for a quick fix, e.g. Viagra.

Women typically view ED as a relationship problem and want to work on the couple’s issues. They may also blame themselves for the situation. When men withdraw, as far as women are concerned, that only aggravates the problem because it interferes with couple communication, and makes the woman feel more isolated and responsible. Women say they wish men wouldn’t become as obsessed with ED as they do. For most women, a man’s lack of erection is less of a problem than his anxiety, depression, anger, confusion, and withdrawal because of it.

If you’re a man with ED, don’t blame your lover and don’t withdraw from her. Instead, talk about how you feel. Ask her how she feels. Review the causes of ED and see if any apply to you or your relation- ship. If you have any medical problems that might contribute to ED, consult a physician. If you have sexual issues or relationship problems, discuss them, try to work them out, and perhaps consult a couples counselor or sex therapist. ED can usually be resolved, but couples need to work together to do so. It’s a team effort. To find a sex therapist near you, visit the American Association of Sex Educa­ tors, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

If you’re a woman in a relationship with a man suffering ED, don’t say, “It doesn’t matter.” It may not matter to your sexual satisfaction, but it matters a great deal to him. Don’t blame yourself for the prob- lem. You and your lover may have some sexual or relationship issues to work out, but his problem is not your fault, nor is it proof that something is terribly wrong with your relationship. Review the causes of ED and see if any apply. Reassure the man that his ED can be resolved, that you still love him, and don’t consider him less of a man. Encourage him to confide in you. Offer to contact doctors and/or therapists to explore the causes of the problem and work toward a solution.

References:

Aschka, C. et al. “Sexual Problems of Male Patients in Family Practice,” Journal of Family Practice (2001) 50:773.

Bacon, C.G. et al. “A Prospective Study on the Risk Factors for Erectile Dysfunction,” Journal of Urol- ogy (2006) 176:217.

Dunn, K.M. et al. “Systematic Review of Sexual Problems: Epidemiology and Methodology,” Journal of Sex and Marital Therapy (2002) 28:399.

Heiman, J.R. “Sexual Dysfunction: Overview of Prevalence, Etiological Factors, and Treatments,” Journal of Sex Research (2002) 39:73.

Nikoobakht, M. et al. “The Relationship Between Lipid Profile and Erectile Dysfunction,” International Journal of Impotence Research (2005) 17:523.

Rao, K. et al. “Correlation Between Abnormal Serum Lipid and Erectile Dysfunction,” Zhonghua Nan Ke Xue [Chinese journal] (2005) 11:112.

Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 201 – Simons, J.S. and M.P. Carey. “Prevalence of Sexual Dysfunctions: Results from a Decade of Re- search,” Archives of Sexual Behavior (2001) 30:177.

Thompson, I.M. et al. “Erectile Dysfunction and Subsequent Cardiovascular Disease,” Journal of the American Medical Association (2005) 294:2996.

Great Sex Guidance: Erectile Dysfunction (ED), Part I- Its Varieties, Prevalence, Causes,And Relationship Implications – © Michael Castleman – 202 – Erectile Dysfunction (ED), Part II - Evaluation And Treatments

There is no sure cure for ED. However, most cases can be resolved by combining lifestyle adjust- ments, stress management, relationship counseling, and medication. There have never been as many treatment options as there are today.

But First, Do You Really Want Erections?

Oddly enough, most men over 40 decide they don’t. Somewhere between 25 and 50 percent of men over 40 report erection difficulties, but in the decade since Viagra’s 1998 introduction, fewer than 10 percent of men over 40 have tried it, and only a fraction of them has refilled a prescription.

The fact is that after the reproductive years, reproductive-oriented sex, that is, intercourse, becomes problematic. Men develop erection issues, and even with today’s erection drugs, may not have enough firmness for intercourse. And postmenopausal women develop vaginal dryness and atrophy, which, despite lubricants, may make intercourse uncomfortable or impossible.

Most older couples who remain sexual slowly bid vaginal intercourse farewell, and opt for other ways to enjoy mutual sensual pleasure: massage, genital fondling, oral sex, and sex toys. Sex without in- tercourse does not require an erection. Couples who let go of intercourse no longer need the man to get hard.

Meanwhile, men don’t need erections to have orgasms. Men with semi-erect or flaccid penises can be brought to orgasm with vigorous fondling or oral sex.

So treat ED if you want to. Many couples do. But more don’t. Something to think about.

Great Sex Guidance: Erectile Dysfunction (ED), Part II- Its Evaluation And Treatments – © Michael Castleman – 203 – Consult A Doctor

If you decide to pursue ED treatment, the first step is a physical exam. Medical conditions—notably cardiovascular disease and its many risk factors— contribute to a substantial proportion of ED. Start with a check-up. Beforehand, make a list of all the medications you take: over-the-counter, prescrip- tion, and recreational. Take the list with you. Be honest about your use of alcohol and recreational drugs.

Your doctor should:

* Ask about the problem: When did it start? How? What else was happening in your life? Can you raise an erection by masturbation? Do you wake with morning erections?

* Review your medical history. Relevant items include: your age, weight, cholesterol level, blood pressure, smoking, drinking, medication use, recent illnesses, and any history of depression and use of antidepressants, anxiety, heart disease, stroke, diabetes, prostate surgery, pelvic injury, and hormonal or neurological problems.

* Review your psychological history. Relevant items include any symptoms of anxiety or depres- sion, your satisfaction with your relationship, and how the problem has affected your relationship.

The doctor should also take your blood pressure, and order tests including cholesterol, testosterone, blood sugar, thyroid function, and possibly others.

The Ladder Of Treatment

Don’t simply ask for Viagra. You might not need it. Think of ED treatment as a ladder, with Viagra sitting on a high rung. Climb the ladder one rung at a time. Other approaches may also help—and they’re good for your health and relationship.

* Healthy Lifestyle. Good health contributes to firm erections. If you smoke, quit. Get regular exer- cise. Eat a low-fat, low-cholesterol diet, with little fast and junk foods, and lots of fruits and veg- etables (five to nine servings of fruit and vegetables a day). Control your weight. Limit alcohol and recreational stimulants and depressants. Sleep at least seven hours a night.

* Manage Stress. Do you have relationship problems? Family trouble? Money woes? Job dissat- isfactions? Chronic stress can hit below the belt. Exercise helps manage stress. So does profes- sional counseling.

* Reach Out. Men are raised to avoid asking for help. When faced with ED, many men withdraw into a cocoon of silence. Big mistake. Tell your lover how you feel about your situation. Ask her how she feels about the problem. If you have relationship or sexual issues, work on them, perhaps with professional help. ED treatment is a team effort. To find a sex therapist near you, visit aasect. org, the American Association of Sex Educators, Counselors, and Therapists, or sstarnet.org, the Society for Sex Therapy and Research.

* Have sex. You don’t need an erection to thrill a woman. Only 25 percent of women are consis- tently orgasmic during vaginal intercourse. Most need direct clitoral stimulation. You don’t need an

Great Sex Guidance: Erectile Dysfunction (ED), Part II- Its Evaluation And Treatments – © Michael Castleman – 204 – erection to provide that. Use your fingers, tongue, or a sex toy. It’s likely to feel odd at first mak- ing love without an erection. Give it a chance. Sensual lovemaking can help (see below)—not to mention that your lover probably needs reassurance that you don’t blame her for your ED, and still want to make love with her.

* Focus on sensuality. Enjoy mutual whole-body massage. Sex does not happen only in the geni- tals and only during intercourse. Appreciate the pleasure of every square inch of your body and hers. Try sensual enhancements: showering together, music, candlelight, bedroom snacks, sex toys, a romantic getaway. When your erections return, continue to emphasize sensuality in sex. Your penis needs sensuality for erection.

* Try new fantasies. Sex fantasies can get stale. Try some hot new ones.

* Ask for the stimulation you need. Erection is automatic for many young men, but with age, the type of direct stimulation becomes more important. If you like your penis caressed in particular ways, say so. Take turns giving and receiving pleasure. When it’s your turn to receive, lie back and enjoy it.

* Try sex therapy. Sex therapy for ED typically involves:

* Reducing sexual anxieties. * Correcting sexual misinformation. * Managing stress. * Resolving relationship issues. * Helping you both ask for the sexual moves you want. * Encouraging more sensual lovemaking.

Sex therapy may quickly produce dramatic relief from ED. Australian sex therapists worked with 32 men suffering moderate-to-severe ED. After just 10 sessions, half regained their erections. Visit aas­ ect.org.

Sex Toys Might Help

Sex toys help in general by making sex more playful and sensual. Try using a vibrator all over each other. Explore massage toys, fantasy toys—any toys that appeal to you.

Beyond sensuality, some toys help treat or compensate for ED. All the toys discussed here are avail- able from Adam and Eve.

* Penis pumps. These devices create a temporary partial vacuum around the penis that draws blood into the organ, raising temporary erections. Pumps include a plastic tube that fits over the penis, and a bulb hand pump. Squeezing the bulb evacuates air from the tube, drawing blood into your penis. Once you’re erect, you slip a cock ring, similar to a rubber band, over it to com- press the veins that drain blood from the penis. This helps maintain the erection. The key to pump success is a good vacuum from a tube that seals tightly around the base of the penis. If sex-toy pumps don’t provide a tight seal, a urologist can prescribe a custom pump (vacuum constriction device, VCD). Most studies of custom VCDs report 70 percent effectiveness. The American Uro- logical Association endorses them. Penis pumps are safe.

Great Sex Guidance: Erectile Dysfunction (ED), Part II- Its Evaluation And Treatments – © Michael Castleman – 205 – * Cock rings. Cock rings are elastic bands that fit around the penis.They may provide some tem- porary erection assistance. The arteries that carry blood into the penis run through the center of the organ, so rings don’t keep blood out. But veins that carry blood out are close to the penis’ outer skin. As the penis expands in erection, these veins get somewhat compressed, restricting outflow. Rings reduce outflow some more, resulting in somewhat firmer erection. Rings also have a psychological effect. Belief in their benefit reassures men, allowing greater relaxation, which is key to erection. The main risk with a ring is bruising if it’s too tight. Some rings are adjustable.

* Extenders. Extenders are penis-shaped dildos with hollow bases. You insert an erect or semi- erect penis inside, and you’re much bigger. Extenders are usually used by those who enjoy play- ing with penis size. But men with erection balkiness may also find them helpful.

* Prosthetic Penis Attachments (PPAs). Similar to extenders, PPAs fit over a flaccid penis and at- tach to the user with straps.

* Strap-ons. In porn, only women use strap-ons. But men can also enjoy them, particularly men with ED. A strap-on includes a harness worn around the waist or hips that includes a front piece that sits over the base of the penis. The front piece contains a circular opening or straps that hold an O-ring. A special dildo with a flared base slips through the opening or O-ring. The dildo’s base rests against the wearer’s public bone or against the front piece, allowing the wearer to enjoy the realism of pushing the dildo into erotic openings using hip movements.

Everything You Need To Know About Viagra, Cialis, and Levitra

Viagra, Cialis, and Levitra work by relaxing the smooth muscle tissue that surrounds the arteries that carry blood into the penis. As this muscle tissue relaxes, the arteries open up, and more blood flows into the penis, producing erection.

Advantages:

* Generally good effectiveness. Most studies show the drugs effective in 75 percent of cases, with greater effectiveness among men with mild or occasional problems. * They’re pills. They’re easy to take. * Viagra and Levitra work best taken an hour or two before sex, so the woman need not know you’re using it. Cialis works for 36 hours, allowing even more spontaneity. * The drugs help men with ED caused by both physical illness and anxiety. * They raise erection only with sexual stimulation. No walking around with an embarrassing bulge in your pants. * They’re safe for most men. Side effects include: headache (16 percent of users), flushing (10 percent), upset stomach (7 percent), nasal congestion (4 percent). * They’re affordable. Few health insurers cover erection drugs, but these drugs may be affordable for most men.

Disadvantages:

* They don’t work in about 25 percent of cases. * As severity of ED increases, effectiveness decreases. * Even in men with mild erection balkiness, they may not work if you feel particularly fatigued, Great Sex Guidance: Erectile Dysfunction (ED), Part II- Its Evaluation And Treatments – © Michael Castleman – 206 – stressed, or unexcited about the woman. * Side effect may become a problem.

IMPORTANT WARNING: Some men should never use erection drugs—those taking nitrate medica- tion for heart disease, notably nitroglycerine for angina, or the party drug, amyl nitrate (“poppers”). The combination of Viagra and nitrate drugs can cause death. Before this problem was identified, 500 men taking nitrate drugs died while using Viagra. If you take nitrate medication, don’t take Viagra.

Other Treatments

* Yohimbine. For centuries, West African yohimbe tree bark was reputed to boost erection. In the 1980s, studies showed that a chemical in the bark, yohimbine, increases blood flow into the penis. Ten years before Viagra, the FDA approved yohimbine for ED. It’s available in two prescriptions drugs: Ahprodyne and Yocon. Possible side effects include: increased heart rate and blood pres- sure, fluid retention, nervousness, irritability, headache, dizziness, tremor, and flushing. Yohimbe is also available in supplements, but studies have shown that over-the-counter products often don’t contain enough yohimbine to have any effect. If you’re interested in yohimbine, ask your doctor for a prescription.

* L-Arginine. L-arginine is an amino acid and the chemical precursor of nitric oxide, a compound crucial to erection. Some studies show that supplementation helps treat ED. L-arginine is available as a nutritional supplement. Follow package directions.

* Ginkgo. This medicinal herb increases blood flow into the penis. In one study, 60 men with ED were given ginkgo (60 mg/day). After one year, half regained their erections. Ginkgo is available over-the-counter. Follow package directions. It’s safe for most men.

* Ginseng. For centuries, Asians have considered ginseng a sex enhancer. Korean researchers gave 45 ED sufferers a placebo or ginseng (900 mg three times a day). The ginseng group expe- rienced significantly greater erection improvement. Ginseng is available over the counter. Follow package directions. It’s safe for most men. However, ginseng is an anticoagulant. If you take anti- coagulant medication or use other anticoagulants (blood thinners)—aspirin, garlic, vitamin E—you may experience bruising or bleeding problems. Consult your physician.

* ArginMax for Men. This over-the-counter supplement contains ginkgo, ginseng, and L-arginine. University of Hawaii researchers gave a placebo or ArginMax to 52 men with ED. A month later, 24 percent of the placebo group reported improvement, compared with 84 percent of those taking ArginMax. ArginMax caused no significant side effects, except increased bruising because ginkgo and ginseng are anticoagulants. ArginMax is available where supplements are sold. Follow pack- age directions.

* Implants. If other treatments don’t help, implants are your last resort. Implants don’t interfere with urination, ejaculation, or orgasm. But they involve surgery, and risk of surgical complications. Still, some men opt for implants.

Two types are available, flexible rods and hydraulic cylinders. Rods are the simpler option. The sur- geon inserts a rod into the penile shaft in place of erectile tissue. Afterward, you have a permanent erection. You bend the rod down so it’s usually inconspicuous, and bend it up for sex. However, the

Great Sex Guidance: Erectile Dysfunction (ED), Part II- Its Evaluation And Treatments – © Michael Castleman – 207 – surgery may cause scarring, and a rod can be embarrassing if you wear tight clothing or undress in a locker room.

Hydraulic implants consist of nested cylinders inserted into the penile shaft, a reservoir of salt water implanted in the lower abdomen, and a squeeze bulb inserted into the scrotum. The penis usually looks normally flaccid. For sex, you squeeze the bulb, and fluid flows from the reservoir into the cylin- ders, which inflate and extend producing erection. After ejaculation, you hit a release valve, and erec- tion subsides as fluid refills the reservoir. Hydraulic implants may malfunction, necessitating corrective surgery.

If you’re interested in an implant, consult a urologist. Also consult your health insurer. Most insurers do not cover implant surgery.

“Viagra-Vation:” The Return of Erections May Cause Relationship Problems

With ED successfully treated, many couples get an unpleasant surprise. They find it difficult to return to lovemaking. If they have not been physically affectionate in quite a while, they often feel uncomfort- able with sex. If one did not previously enjoy sex, ED no longer works as an excuse not to. One might be eager for sex, and the other not. One might harbor unexpressed resentments. A woman might view ED as a guarantee of her man’s fidelity, and feel threatened when his erections return. A man might feel he is now free to seek another relationship. And if the woman has become menopausal during the period of the man’s ED, she may have less libido, and produce less vaginal lubrication.

Couples returning to sex after ED should proceed slowly. Don’t rush intercourse. Work up to it by having nonsexual fun together for a while. Go out on dates. Flirt with each other. Cuddle. Treat your relationship as new because in some ways, it is. Even with a restored erection, you can’t have good sex without feeling emotionally close and trusting.

If closeness eludes you, consider professional therapy. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Burnett, A.L. “Erectile Dysfunction: Science and Medicine,” Annual Review of Sex Research (2006) 17:101.

Carbone, D.J. et al. “Erectile Dysfunction: Diagnosis and Treatment in Older Men,” Geriatrics, Sept. 2002, p. 18.

Carey, M.P. and B.T. Johnson. “Effectiveness of Yohimbine in the Treatment of Erectile Disorder: Four Meta-Analytic Integrations,” Archives of Sexual Behavior (1996) 25:341.

Chen, J. et al. “Effect of Oral Administration of High-Dose Nitric Oxide Donor L-Arginine in Men with Organic Erectile Dysfunction: Results of a Double-Blind, Randomized, Placebo-Controlled Study,” BJU International (1999) 83:269.

Cookson, M.S. and P.W. Nadig. “Long-Term Results with the Vacuum Constriction Device,” Journal of Urology (1993) 149:290. Great Sex Guidance: Erectile Dysfunction (ED), Part II- Its Evaluation And Treatments – © Michael Castleman – 208 – Ernst, E. and M.H. Pittler. “Yohimbe for Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials,” Journal of Urology (1998) 159:433.

Esposito, K. et al. “Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men,” Journal of the American Medical Association (2004) 291:2978.

Hong, B. et al. “A Double-Blind Crossover Study Evaluating the Efficacy of Korean Red Ginseng in Patients with Erectile Dysfunction: A Preliminary Report,” Journal of Urology (2002) 168:2070.

May, M. et al. “Erectile Dysfunction, Discrepancy Between High Prevalence and Low Utilization of Treatment Options: Results from the Cottbus Survey,” British Journal of Urology International (2007) 100:1110.

Miller, T.A. “Diagnostic Evaluation of Erectile Dysfunction,” American Family Physician, Jan. 1, 2000.

Mulhall, J. et al. “Importance of and Satisfaction with Sex Among Men and Women Worldwide: Re- sults of the Global Better Sex Survey,” Journal of Sexual Medicine (2008) 5:788.

Mobley, D.F. et al. “What You Need to Know Before Prescribing Viagra,” Hospital Medicine, May 1999, p. 20.

Padma-Nathan, H. “Current Paradigms in Treating Erectile Dysfunction,” in A Special Report: Educa- tional Advances in Sexual Dysfunction, Postgraduate Medicine, May 2000, p. 14.

Phelps, J.S. et al. “The PsychoPlusMed Approach to Erectile Dysfunction Treatment: The Impact of Combining a Psychoeducational Intervention with Sildenafil,” Journal of Sex and MaritalTherapy (2004) 30:305.

Rosen, R. et al. “Psychological and Interpersonal Correlates in Men with Erectile Dysfunction and Their Partners: A Pilot Study of Treatment Outcome with Sildenafil,” Journal of Sex and Marital Thera- py (2006) 32:215.

Teloken, C. et al. “Therapeutic Effects of High-Dose Yohimbine Hydrochloride on Orgaic Erectile Dys- function,” Journal of Urology (1998) 159:122.

Great Sex Guidance: Erectile Dysfunction (ED), Part II- Its Evaluation And Treatments – © Michael Castleman – 209 – Everything You Need To Know About Viagra, Cialis, and Levitra

The world of erection impairment changed dramatically on March 27, 1998, the day the Food and Drug Administration approved the little blue pill, Viagra, for treatment of erection impairment, now medically called “erectile dysfunction” (ED). Viagra was not the first approved drug treatment for ED (see yohimbine below), but it was the one that captured the public’s imagination. Viagra took the U.S.—and the world—by storm. During its first month of availability, American doctors wrote more than 300,000 prescriptions, making Viagra the fastest-selling new drug in history.

In 2003 two other drugs similar to Viagra were approved, Levitra and Cialis.

Erection medication is not the answer to every man’s erection problem. Many erection difficulties are caused by relationship stresses and resolve when the problems are resolved. Other cases of ED are caused by sexual anxiety, and clear up when men learn more about sex, relax about it, and adopt a less penis-centered, more whole-body-sensuality approach to lovemaking. Medical problems, par- ticularly diabetes and heart disease are major causes of ED, and may resolve when the illnesses are treated. Many erection problems are caused by drugs (notably alcohol and cigarettes) and drug side effects, and can be helped by cutting back on alcohol, quitting smoking, and tinkering with prescrip- tions.

In addition, for several reasons, many older couples evolve their lovemaking away from vaginal in- tercourse, and don’t need drugs that make it possible or easier. Despite lubricants, many postmeno- pausal women find vaginal intercourse uncomfortable. Recent research shows that fewer than 10 percent of men over 50 have tried the erection drugs, and many who have find them ineffective or disappointing and don’t refill their prescriptions. Nonetheless, erection medications certainly have a place in the treatment of ED.

How Erection Medications Work

Viagra, Levitra, Cialis, and yohimbine all work basically the same way: Sexual arousal stimulates release of a compound in the penis, nitric oxide. It triggers synthesis of another compound, cGMP, which relaxes the penis’ smooth muscle tissue. As smooth muscle tissues relax, the arteries that carry blood into the penis open (dilate), and extra blood flows into the organ’s spongy central erectile

Great Sex Guidance: Everything You Need To Know About Viagra, Cialis, and Levitra – © Michael Castleman – 210 – tissues. Erection drugs enhance this smooth muscle relaxation, spurring greater blood flow into the penis.

Advantages

Erection drugs work reasonably well. Most studies show “significant benefit” in about 60 to 80 percent of men.

They help men with ED caused by both physical illness and stress/anxiety problems.

They do not produce instant erection. Erotic fondling is still required. No walking around with an em- barrassing bulge in your pants that signals you’ve taken a drug. The effect looks and feels natural— and the lover may never know that a man has used a drug.

For most, but not all men, these drugs are also quite safe. The only significant side effects are head- ache (16 percent of users), flushing (10 percent), upset stomach (7 percent), nasal congestion (4 per- cent), and rarely, visual disturbances, mostly in men with severe diabetes or chronic eye conditions such as macular degeneration.

Few health insurers cover erection medications. But even without insurance coverage, these drugs are quite affordable. The Viagra dose most men take, 50 mg, costs about $10, a modest price to pay for an amorous evening free from erection worries.

Disadvantages

Erection drugs don’t work in about 25 percent of cases. As severity of ED increases, their effective- ness decreases. For example, the drugs work well in many men with the beginnings of diabetic ED, but less well in diabetics with considerable cardiovascular and neurological damage. Even in men with mild erection balkiness, these drugs may not work in some situations, for example, if you feel particularly stressed, distracted, or alienated from the sexual experience.

Even when they work, the erection drugs do not produce the kind of rock-hard erections men see in pornography. Porn actors are overwhelmingly young men at the stage of life when erections are most firm (not to mention that porn actors pop erection drugs like candy).After 40, erections become less firm and firmness continues to subside with advancing age. A man in his fifties who takes a drug may have a firmer erection than he would without the medication. But chances are it won’t be as firm as the erections he recalls from his twenties.

Erection medications are not aphrodisiacs in the traditional sense of libido stimulants. They do not boost sexual desire. All they do is increase the likelihood of erection. This is a major reason why some men feel disappointed with the drugs. In young men, erection and arousal are typically linked. When a man feels aroused, he gets an erection, and when he has an erection, he feels aroused. But in older men, erection and arousal become uncoupled. For some, this begins around age 40. By age 50, most men find it more difficult to become aroused. Even when a drug aids an older man’s erec- tions, he may not feel particularly aroused.

Finally, some men should absolutely never use Viagra, Levitra, or Cialis—those taking nitrate medi- cation for heart disease, notably nitroglycerine for angina, or the party drug, amyl nitrate (“poppers”).

Great Sex Guidance: Everything You Need To Know About Viagra, Cialis, and Levitra – © Michael Castleman – 211 – The combination of Viagra and nitrate drugs can cause a precipitous drop in blood pressure—and possibly death. Before this problem was identified, the combination of iagraV and nitrate medication killed more than 500 men. If you take any nitrate drug, don’t use Viagra, Levitra, or Cialis. However, yohimbine drugs do not have this problem, so the vast majority of men taking nitrate drugs can use them safely. (There have been a few deaths with yohimbine drugs, but they are very rare.)

In addition, Viagra, Levitra, and Cialis are associated with a small increased risk of heart attack and stroke. They slightly increase the tendency for blood to clot. Internal blood clots trigger heart attack and most strokes. Men with histories of heart attack and stroke should consult their doctors before us- ing these drugs, and consider taking an anticoagulant, for example, aspirin, along with them to reduce risk of internal clots.

Duration of Action: A Few Hours or Up to 36

Viagra and Levitra take about an hour to begin having an effect. They last another 2 hours or so, longer in some men. In fact, the latest studies show that many men experience benefit for up to eight hours.

Cialis also takes about an hour to work, but it lasts for 24 to 36 hours, hence the claim that it’s the “hot weekend drug.” Take Cialis on Saturday morning, and you’re good to go through most of Sunday.

Many men, it seems, like the longer-lasting drug. When Cialis was approved, the pundits predicted it would not sell well because the Viagra brand was so well-established. However, Cialis has proved quite popular, and in head-to-head tests of Viagra vs. Cialis, men and couples have uniformly pre- ferred Cialis because it allows more sexual flexibility.

The main reason not to use Cialis is that it stays in the bloodstream longer than Viagra or Levitra, so any side effects are likely to bother you for longer, too.

Higher Dose, More Side Effects

Viagra comes in 50 and 100 mg pills. The typical dose is 25 to 100 mg. For 25 mg, cut a 50 mg pill in half using a pill cutter available at pharmacies. Higher doses are more likely to cause side effects.

Levitra and Cialis are available in doses of 5, 10, and 20 mg. Larger doses are more likely to cause side effects.

Over Time, Most Men Need More

Over time, many men find they need to increase their dose. University ofAlabama researchers tracked 150 men who took Viagra regularly for two years or more. During that period one-third of them had to increase their dose from 50 to 100 mg. The same is presumably true of Levitra and Cia- lis.

To Boost the Drugs’ Effectiveness

For men who respond poorly to erection drugs, it may help to combine the medication with the over- the-counter supplement, ArginMax. ArginMax contains the amino acid L-arginine, a chemical precur-

Great Sex Guidance: Everything You Need To Know About Viagra, Cialis, and Levitra – © Michael Castleman – 212 – sor of nitric oxide, plus ginkgo, ginseng, two medicinal herbs that some studies show aid erection. Researchers at University of California, Davis, worked with men with ED, who did not get much ben- efit from Viagra. The men took Viagra plus either ArginMax or a placebo. After four weeks, erections improved significantly in 22 percent of those taking the placebo, but among men usingArginMax, the figure was 60 percent.

From ED Treatment to “Erection Insurance”

Viagra was originally approved for a medical problem, persistent ED. The original ads featured elderly Senator Bob Dole talking about how it helped his medical problem.

But once a drug is approved for any reason, doctors are free to prescribe it for other, so-called “off label” uses. Today, all erection medications are most widely used as “erection insurance” by men who don’t have persistent ED, but have the balky, slow-rising, not-so-firm erections typical of the 40 to 60 age group. A recent ad for Viagra features a young, buffed, professional baseball player saying: “I take batting practice. I take fielding practice. I take Viagra.” Ads for Levitra and Cialis are similar, featuring men who appear to be in their 30s or early 40s, and healthy, but just a little concerned about erection reliability.

If you’re concerned about erection reliability, there are several nondrug approaches to raising an erec- tion and keeping it firm: Don’t smoke. Don’t drink any alcohol for a few hours before sex, and don’t drink more than 2 drinks a day. Eat lots of fruits and vegetables. Get seven hours of sleep a night. In other words, live a healthy lifestyle and you’re likely to have a penis that behaves the way you want.

But if you still have balky erection—and this is perfectly natural for men over 45—then you might de- cide you want to use erection medication for erection insurance. Start with a low dose and take more if necessary

Don’t Buy Erection Drugs Over the Internet

Junk emails offer the erection drugs at huge discounts. There are two reasons not to buy them. You can’t be sure what you’re getting. And in men over 40, erection problems can be the first symptom of diabetes or cardiovascular disease. If you are concerned about your erections, get a checkup.

Yohimbine

For centuries, the bark of the West African yohimbe tree was reputed to restore faltering erections. Scientists scoffed—until the 1980s, when several studies showed that a chemical in the bark, yohim- bine, increases blood flow into the penis. More than 10 years before iagra,V the Food and Drug Ad- ministration approved yohimbine as a prescription treatment for erection problems. The herbal extract is available under the brand names Aphrodyne and Yocon.

However, since its approval, yohimbine has been attacked as ineffective. The situation is controver- sial—and confusing. An analysis of 208 studies published from 1979 through 1994 led the American Urological Association to conclude that yohimbine is no better than a placebo. However, two other analyses—a 1996 review of 16 studies at Syracuse University, and a 1998 British analysis of seven studies—both showed that yohimbine is an effective treatment for ED. The British group called it “a reasonable therapeutic option.”

Great Sex Guidance: Everything You Need To Know About Viagra, Cialis, and Levitra – © Michael Castleman – 213 – But the naysayers may have a point, at least about the yohimbine products sold over-the-counter in supplement shops and health food stores. In 1995, the FDA analyzed 26 over-the-counter yohimbine products. The yohimbine content of yohimbe bark is 7,089 parts per million (ppm). Concentrations found in the tested products ranged from less than 0.1 ppm to 489 ppm, probably not enough to have much effect. If you want to try yohimbine, ask your physician for one of the prescription drugs. Rec- ommended dosage ranges from 18 to 100 mg/day.

Possible side effects include: increased heart rate and blood pressure, fluid retention, nervousness, irritability, headache, dizziness, tremor, and flushing.

If you’d like to try Aphrodyne or Yocon, consult your physician.

An Important Note

Erection medication is a boon to men who need it, but the publicity surrounding it reinforces an idea that hurts both men and women sexually. It’s the idea sticking an erection into erotic openings is basi- cally all there is to sex. Wrong.

The basis of great sex is leisurely, playful, whole-body sensuality that includes the genitals, but is not fixated on them. For most men over 45 to raise erections, whole-body sensuality—kissing, hugging, massage strokes and fondling all over—are necessary prerequisites. Contrary to the all-genital sex in pornography, truly great sex is a whole-body experience. Without whole-body sensuality, many pe- nises don’t become erect—even if the man uses erection medication.

Unfortunately, erection drugs have shone a spotlight on the penis and erection, and have reinforced the false notion that sex is all about erection. If you use erection medication, incorporate it into love- making based on whole-body sensuality. And if you don’t, your penis will work best if you let go of porn-style, all-genital sex, and embrace whole-body sensuality.

References:

Ahn, T.Y. et al. “Treatment Preferences in Men with Erectile Dysfunction: An Open Label Study in Ko- rean Men Switching from Sildenafil to Tadalafil,” Asian Andrology (2007) 9:760.

Carbone, D and AD Seftel. “Erectile Dysfunction: Diagnosis and Treatment in Older Men,” Geriatrics, 9-2002, p. 18.

Carey, MP and BT Johnson. “Effectiveness of Yohimbine in the Treatment of Erectile Disorder: Four Meta-Analytic Integrations,” Archives of Sexual Behavior (1996) 25:341.

Carrier, S et al. “Viagra: Long-Term Efficacy and Quality of Life,” presented at the World Congress of Sexology, 2005.

Conaglen, H.M and J.V. Conaglen. “Investigating Women’s Preference for Sildenafil or Tadalafil Use By Their Partners with Erectile Dysfunction: The Partners’ Preference Study,” Journal of Sexual Medi- cine (2008) 5:1198.

Ernst, E and MH Pittler. “Yohimbine for Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials,” Journal of Urology (1998) 159:433. Great Sex Guidance: Everything You Need To Know About Viagra, Cialis, and Levitra – © Michael Castleman – 214 – Hatzichrisou, D. et al. “Patterns of Switching Phosphodiesterase Type 5 Inhibitors in the Treatment of Erectile Dysfunction: Results from the Erectile Dysfunction Observational Study,” International Journal of Clinical Practice (2007) 61:1850.

Ishikura, F et al. “Effects of Sildenafil Citrate (Viagra) Combined with Nitrate on the Heart,” Circulation (2000) 102:2516.

Ito, TY et al. “The Effects of ArginMax, A Natural Dietary Supplement, for Enhancement of Male Sexu- al Function,” Hawaii Medical Journal (1998) 57:741.

May, M. et al. “Erectile Dysfunction, Discrepancy Between High Prevalence and Low Utilization of Treatment Options: Results from the Cottbus Survey,” British Journal of Urology International (2007) 100:1110.

Mika, M. “Some Men Who Take Viagra Die: Why?” Journal of the American Medical Association (2000) 283:590.

Mobley, DF and NH Baum. “What You Need to Know Before Prescribing Viagra,” Hospital Medicine, 5-1999, p. 20.

Phelps, JS et al. “The PsychoPlusMed Approach to Erectile Dysfunction Treatment: The Impact of Combining a Psychoeducational Intervention with Sildenafil,” Journal of Sex and MaritalTherapy (2004) 30:305.

Teloken, C et al. “Therapeutic Effects of High-Dose Yohimbine Hydrochloride on Organic Erectile Dys- function,” Journal of Urology (1998) 159:122.

Great Sex Guidance: Everything You Need To Know About Viagra, Cialis, and Levitra – © Michael Castleman – 215 – The Most Popular Erection Drug is Not Viagra

Since its 1998 introduction, Viagra (sildenafil) has become one of the world’s most recognizable brand names, up there with Coca-Cola and Rolls Royce. But in terms of user satisfaction, Viagra runs a distant second behind Cialis (tadalafil).

Men express remarkable preference for Cialis. I found 12 studies in which men tried both drugs and then reported which they chose to continue. The score was a shut-out: Cialis 12, Viagra 0. And the 8,300 participants favored Cialis by a wide margin, on average, three to one. In studies that also included the third major erection drug, Levitra (vardenafil), Cialis was substantially more popular than either competitor.

Women also prefer Cialis. In four studies, couples used Viagra then Cialis, or visa versa. Another shut-out. In all four trials, the women strongly preferred Cialis.

Why? Because Cialis has a longer duration of action. Viagra and Levitra last for around four hours, but Cialis lasts for 36. If a man takes Cialis on Friday evening, he has erection assistance through Sunday afternoon. Both men and women say they like the fact that Cialis allows them to take their eyes off the clock and make love whenever they wish. So Cialis has a clear advantage for dating couples or new lovers still in the hot-and-heavy period who value sexual spontaneity.

But oddly, Cialis is also the clear favorite among long-term spouses who are less likely to be sexually spontaneous and more likely to make sex dates. The larger window of opportunity apparently makes for friendlier spousal negotiations. How about tonight? No, I’m exhausted. How about tomorrow? Okay, when? Maybe in the afternoon, maybe evening. Can we check in after lunch?

Except for duration of action, the erection medications are all quite similar. They begin to work in about an hour. They work equally well if taken on an empty stomach or after a meal. None produce spontaneous erections—no embarrassing bulges in the supermarket. They enhance firmness only in the context of erotic fondling. And their side effects are very similar: headache (16 percent of users), stomach upset (7 percent), and nasal congestion (4 percent). (Important note: Never use erection medications if you’re taking nitroglycerin for angina. If you do, the combination can be fatal.)

But while Cialis clearly trumps Viagra and Levitra, the surprising little secret is how few older men use

Great Sex Guidance: The Most Popular Erection Drug is NOT Viagra – © Michael Castleman – 216 – any of them. Sales are only about half of what pundits predicted when “vitamin V” was first approved. Cornell researchers surveyed 6,291 older men on the subject. Almost half—48 percent—reported some ED. How many had ever tried an erection drug? Just 7 percent.

Why so few? One reason is that, compared with women, men are less willing to take medication.

But the main reason is that the drugs enhance intercourse, while older couples generally evolve away from the old in-out toward genital hand massage, oral sex, and vibrator play. For many older lovers, intercourse is a hassle. Even with drugs, men’s erections may be iffy, and despite lubricant, vaginal dryness and/or atrophy cause many women pain during intercourse. So older lovers who remain sexual generally switch from intercourse toward other pleasures. And if you’re no longer having inter- course, erections aren’t necessary, so why take a drug?

In addition, men don’t need erections to have orgasms. That’s right, with sufficient fondling, men can have marvelous orgasms with semi-firm or even flaccid penises.

Among men who try erection medications, only half refill their prescriptions. Why? Effectiveness is one reason. The manufacturers claim the drugs are 70 to 85 percent effective, but the research shows effectiveness in the range of 50 to 60 percent, and possibly lower for men with diabetes, heart disease, or high cholesterol or blood pressure. In addition, in the studies, “effectiveness” does not mean rock-hard porn-star erections. It means any increase in firmness that enables intercourse. Drug-fueled erections can be on the soft side, so many men feel disappointed.

Side effects may also be problematic. Medically, they’re minor, but headaches, stomach distress, and nasal congestion can be annoying enough to disrupt sex.

Bottom line: If you’re over 40 and have never tried an erection medication, you’re in the majority. But if you use one, you’ll probably be happiest with Cialis.

References:

Ahn, TY, et al. “Treatment Preferences in Men with Erectile Dysfunction: An Open Lavbel Study in Korean Men Switching from Sildenafil to Tadalafil,” Asian Journal of Andrology (2007) 9:760.

Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psy- chgenic Erectile Dysfunction: A Pilot Study,” Journal of Sexual Medicine (2007) 4(4, Pt 2):1117.

Brock, G. et al. “The Treatment of Erectile Dysfunction Study: Focus on Treatment Satisfaction of Patients and Partners,” BJU International (2007) 99:376.

Chia, S.J. et al. “Clinical Application of Prognostic Factors for Patients with Organic Causes of Erec- tile Dysfunction on 100 mg of Sildenafil Citrate,” International Journal of Urology (2004) 1:11 104.

Conaglen, H.M. and J.V. Conaglen. “Investigating Women’s Preference for Sildenafil or Tadalafil Use by their Partners with Erectile Dysfunction: The Partner’ Preference Study,” Journal of Sexual Medi- cine (2008) 5:1198.

Great Sex Guidance: The Most Popular Erection Drug is NOT Viagra – © Michael Castleman – 217 – Dean, J. et al. “Psychosocial Outcomes and Drug Attributes Affecting Treatment Choice in Men Re- ceiving Sildenafil and Tadalafil for Treatment of Erectile Dysfunction: Results of a Multicenter, Ran- domized, Open Label, Crossover Study,” Journal of Sexual Medicine (2006) 3:650.

Dzelaludin, J and S. Bajramovic. “Evaluation of Therapeutic Responses Of Patients with Erectile Dys- function,” Medicinski Arhiv [Bosnian journal] (2009) 63:274.

Eardley, I. et al. “Factors Associated with Preference for Sildenafil and Tadalafil for Treating Erectile Dysfunction in Men Naïve to PDE-5 Inhibitor Therapy: Post Hoc Analysis of Data from a Multicenter, Randomized Open-Label, Crossover Study,” BJU International (2007) 100:122.

Eardley, I. et al. “An Open-Label, Multicenter, Randomized, Crossover Study Comparing Sildenafil and Tadalafil for Treating Erectile Dysfunction in Men Naïve to PDE-5 Inhibitor Therapy,” BJU Interna- tional (2005) 96:1323. Fonseca, V. et al. “Impact of Diabetes Mellitus on the Severity of Erectile Dysfunction and Response to Treatment: Analysis of Data from Tardenafil Clinical Trials,” Diabetologia (2004) 47:1914.

Fusco, F. “Tadalafil Versus Sildenafil in the Treatment of ED: Italian Patients’ Preferences and Explan- atory Notes,” Urologia (2008) 75:24.

Gong, B.S. “ED Patients and their Female Partners Prefer Tadalafil,” Zhonghua, Nan Ke Xue [Chi- nese journal] (2011) 17:571.

Hatzichristou, D. et al. “Patterns of Switching PDE-5 Inhibitors in the Treatment of Erectile Dysfunc- tion: Results from the Erectile Dysfunction Observational Study,” International Journal of Clinical Prac- tice (2007) 61:1850.

Lee, J. et al, “Physician-Rated Patient Preference and Patient- and Partner-Rated Preference for Tadalafil and Sildenafil: Results from the Canadian Treatment of Erectile Dysfunction Observational Study,” BJU International (2006) 98:623.

Melnik T. and C.H. Abdo. “Psychogenic Erectile Dysfunction: Comparative Study of Three Therapeutic Approaches,” Journal of Sex and Marital Therapy (2005) 31:243.

Morales, A.M. et al. “Patients’ Preference in the Treatment of Erectile Dysfunction: A Critical Review of the Literature,” International Journal of Impotence Research (2011) 23:1.

Mulhall, J. et al. “Importance of and Satisfaction with Sex Among Men and Women Worldwide: Re- sults of the Global Better Sex Survey,” Journal of Sexual Medicine (2008) 5:788.

Von Keitz, A. et al. “A Multicenter, Randomized, Double-Blind, Crossover Study to Evaluate Patient Preference Between Tadalafil and Sildenafil,” European Urology (2004) 45:499.

Great Sex Guidance: The Most Popular Erection Drug is NOT Viagra – © Michael Castleman – 218 – Hazards of Viagra, Cialis, and Levitra - For Some Men, They Are Potentially Fatal

Since it was introduced in 1998, the erection pill, Viagra (sildenafil) has revolutionized the way doctors treat erectile dysfunction. But almost from the day it was approved, reports of deaths shortly after tak- ing the drug have tarnished the erection pill’s luster and raised troubling questions about this medica- tion.

The Big No-No: Nitrate Medication for Heart Disease

Viagra—and the two other drugs in its class, Levitra (vardenafil) and Cialis (tadalafil)—can be fatal when used by men with heart disease. The risk of Viagra-related death increases for men with heart disease who use the drug while also using nitrate medications, for example, nitroglycerin, a standard treatment for the chest pain of angina. This combination of erection drugs and nitrate medication can cause a precipitous drop in blood pressure, leading to life-threatening shock.

At last count, more than 500 men have died while taking Viagra.

The first 50 deaths garnered headlines, and eight months after it approved the drug, the Food and Drug Administration required Viagra’s manufacturer, Pfizer, to update its label, warning of possible fatality if the drug is taken by men using nitrate drugs.

Is It The Drug Or The Heart Disease?

Sexual activity does not place great strain on the heart. Sex is about as strenuous as walking up one flight of stairs. But in men with serious heart disease, it might stress the heart enough to trigger heart attack.

Viagra, Levitra, and Cialis are the most popular erection medications, but they are not the only ones. The others include: Caverjet (alprostadil), which is injected into the penis; MUSE (alprostadil), insert- ed into the urethra; and Yocon (yohimbine), made from an extract of the bark of the African yohimbe tree, a traditional herbal aphrodisiac.

Researchers at the University of California, San Francisco, figured that if underlying heart disease were the main problem with erection medication, the other drugs should cause about as many prob-

Great Sex Guidance: Hazards of Viagra, Cialis, and Levitra- For Some Men, They Are Potentially Fatal – © Michael Castleman – 219 – lems as Viagra. But that is not the case. According to a report in the Journal of the American Medical Association:

Caverjet: Approximately 1.3 million prescriptions through July 1999. 5 known deaths. 4.5 deaths per million prescriptions.

MUSE: Approximately 1.3 million prescriptions. 2 known deaths. 1.5 deaths per million prescriptions.

Yocon: Approximately 4 million prescriptions. 1 known death. 0.25 deaths per million prescriptions.

Viagra: Approximately 11 million prescriptions. 564 known deaths. 49 deaths per million prescriptions.

In other words, the death rate from Viagra is 9.8 times higher than Caverjet’s, 33 times higher than MUSE’s, and a whopping 196 times higher than Yocon’s.

These figures strongly suggest that while underlying heart disease may play some role in erection- drug deaths, Viagra—and Levitra and Cialis—appear to be inherently more hazardous than any com- petitor medication.

Poppers

Erection medications should also not be used by men taking the recreational drug amyl nitrate, popu- larly known a poppers. This party drug produces a rush of physical excitement and feelings of clarity and power. But it’s also a nitrate. If a man mixes erection medication and poppers, he risks death.

References:

Ishikura, F et al. “Effects of Sildenafil Citrate (Viagra) Combined with Nitrate on the Heart,” Circulation (2000) 102:2516.

Mika, M. “Some Men Who Take Viagra Die: Why?” Journal of the American Medical Association (2000) 283:590.

Mobley, DF and NH Baum. “What You Need to Know Before Prescribing Viagra,” Hospital Medicine, 5-1999, p. 20.

Great Sex Guidance: Hazards of Viagra, Cialis, and Levitra- For Some Men, They Are Potentially Fatal – © Michael Castleman – 220 – Viagra Falls: Surprise! Older Men Just Aren’t That Into Erection Drugs

In March 1998 when Viagra was first approved, Maryland anesthesiologist Ken Haslam, M.D. (Cal B.S. 1956) was 64, single, and dating. “I was meeting lots of women. It was exciting. And for me, new relationships lead to great sex. I heard about Viagra, of course. But with all the excitement in my life, I didn’t need any erection help, so I didn’t try it.”

A few years later, however, Haslam became concerned about his erections. Sexual thoughts no lon- ger caused a stirring between his legs. Raising an erection took effort, vigorous manual or oral stimu- lation. His erections were not as firm as they’d once been. And minor distractions wilted them. As a doctor, he recognized mild erectile dysfunction (ED), normal for men over 60, but still annoying. “So I tried Viagra, 50 mg. It worked. It worked well.”

Today, at 75, Haslam still leads an active sex life, and he still uses Viagra—but for only about 10 per- cent of his lovemaking. “There’s more to sex than an erection,” he explains. “Erection is not the goal. Shared intimacy is, a close, loving relationship. I’ve had wonderful sex and great orgasms without an erection. Occasionally it’s fun to use Viagra. But most of the time, I don’t even think about it.”

Viagra-Vation

Haslam’s reaction is not what the experts predicted a decade ago when Viagra became the most successful new-drug launch in pharmaceutical history. Pundits proclaimed that older men would embrace the little blue pill the way type 1 diabetics use insulin, as an indispensable part of daily life. Analysts forecast sales of $4.5 billion a year or more as the male population aged, and as advertising wars among what eventually became the three brands—Viagra, Levitra, and Cialis (both approved in 2003)—heated up and continually reminded men and couples about the medications. Social com- mentators even coined a new word, “viagra-vation,” to describe the distress women felt when partners using Viagra pressed for more frequent sex, or when men with newly restored erections suddenly became interested in philandering.

However, through 2005, sales of erection medications reached only about half of the predictions, just $2.5 billion annually. That’s still a great deal of money, but older men did not flock to the drugs in any- where near the numbers the experts anticipated. During the first two months after iagra’V s approval, U.S. doctors wrote 275,000 prescriptions. But seven months later, only one-third of those men—fewer

Great Sex Guidance: Viagra Falls- Older Men Just Aren’t That Into Erection Drugs – © Michael Castleman – 221 – than 100,000—had obtained refills. According to Pfizer, maker of Viagra, as many as half of men over 40 experience some ED, but only about 15 percent of them have even tried erection drugs, let alone become regular users.

Recent research makes the Pfizer estimate look optimistic. In 2007, German researchers surveyed 3,124 older men. Forty percent of them had some form of ED. Of that group, 96 percent could name an erection drug, but only 9 percent had used one. And last year [2008], researchers at Cornell’s medical school surveyed 6,291 men in 27 countries. Almost half—48 percent—reported some ED. How many had tried an erection drug? A mere 7 percent.

Only One Thing on Their Minds?

In other words, the vast majority of men who might benefit from erection medications don’t try them, or try them and then stop. This flies in the face of a key cultural assumption about men and sex—that men are perpetually horny, and therefore, obsessed with erection. Who hasn’t heard: “Men have only one thing on their minds.” “Men have two heads—and the little one does the thinking.” “Women have sex to gain relationships. Men have relationships to gain sex.”

Now this stereotype contains more than a germ of truth. Most men think about sex a great deal. According to the Kinsey Institute at the University of Indiana, the average male teen has a sexual thought once every five minutes, while the typical man over 40 has one about every half hour. But if that’s true why don’t more older men try the drugs? And continue to use them?

Addressing the latter issue first, there are several reasons why men would rather not refill their pre- scriptions:

* The drug industry may have exaggerated effectiveness. The makers of Viagra, Levitra, and Cialis say the drugs benefit about 70 percent of users. That figure comes from the pre-approval studies they submitted to the Food and Drug Administration, in Viagra’s case, trials involving ap- proximately 3,000 men. But a review of 14 recent studies involving more than six times as many participants—18,337 men—shows effectiveness results ranging from 0 to 89 percent. Most results cluster in the ballpark of 70 percent, but several trials show success rates ranging from 40 to 60 percent. In drug studies, disparate results are not unusual. But the surprisingly low rate of pre- scriptions refills suggests that erection drugs may be less effective than the public has been led to believe.

* When the drugs work, they don’t produce instant erections. American men get much of their sex education, if not most, from pornography. In porn, the man unzips and out flops a telephone pole. After years of viewing porn, many men come to believe that erections are supposed to rise instant- ly to full firmness. In men under 30 they often do. “But in older men, they just don’t,” explains San Francisco sex therapist Linda Alperstein, L.C.S.W., a former lecturer in human sexuality at the Cal School of Social Welfare. “The drugs require erotic play and direct penile stimulation. Men expect- ing instant erections may feel disappointed.”

* Erection medications may not produce firm erections. When erection drug advertising promises “benefit,” many men expect what they see in porn, erections that are rock-hard. But the actors in porn are usually in their twenties, the stage of life when erections are firmest.And just in case,

Great Sex Guidance: Viagra Falls- Older Men Just Aren’t That Into Erection Drugs – © Michael Castleman – 222 – these days, they all use erection drugs. “Even with the drugs, middle-aged erections are not as firm as the ones men see in porn or recall from their youth,” says Paul Joannides, Psy.D., of Wald- port, Oregon, author of the best-selling sex manual for young adults, The Guide to Getting It On (Cal BA 1976). “Men who expect porn firmness might feel disappointed, and figure the drugs don’t work for them.”

* Viagra et al. are not aphrodisiacs. In young men, erection and arousal are virtually synonymous. When young men feel aroused, they raise erections, and when they have erections, they feel aroused. “But in middle age, arousal and erection become uncoupled,” explains developmental psychologist Richard Sprott, Ph.D., a lecturer in the Department of Human Development at Cal State University, East Bay, in Hayward (Cal Ph.D. 1994). “You can take a pill and get hard, but you may not feel aroused. This astonishes many men. It goes against all their previous experience, and it defies gender role expectations. The myth is that men are always horny. But older men aren’t. In middle age, arousal takes effort. It becomes work. Viagra may give you an erection. But that’s all it does. It doesn’t help men become aroused. Men who expect an aphrodisiac are disap- pointed.”

* They drug industry underestimates side effects. In Viagra’s pre-approval trials, side effects were mild and uncommon—headache (16 percent of users), stomach upset (7 percent), and nasal con- gestion (4 percent). Some post-approval studies have reported similar findings. But others have documented much higher rates of side effects—40 percent of users. This issue remains unre- solved, but for some men, the side effects might outweigh the benefits.

* Cost may be an issue. Many health insurers don’t cover erection medications. Cost can be $10 to $20 per pill.

* The drugs don’t repair damaged relationships. All that Viagra et al. do is increase the likelihood of erection. But many couples have unfulfilled sex—or no sex—for reasons that have nothing to do with the man’s penis. “If the intimacy in a relationship is broken,” Joannides explains, “if the couple lives in an erotic void or has other festering relationship problems that ruin sex, the most perfect erection in the world isn’t going to fix things. The couple needs sex therapy.”

At the University of Sao Paulo in Brazil, researchers analyzed 11 studies comparing the benefits of Viagra by itself versus the drug plus sex therapy. In every trial, combination treatment worked better than Viagra by itself. In one trial, researchers at the Center for Sexual Health in San Jose, California, researchers gave 53 couples either Viagra by itself or the drug plus weekly sex therapy for eight weeks. Using the drug alone, 38 percent of couples expressed satisfaction. But among those who used Viagra and sex therapy, the figure was almost twice that, 66 percent. “The evi- dence is clear,” Joannides says. “There’s more to good sex than a stiff penis. Erection drugs work best combined with sex therapy focused on the relationship.”

Older Men: Sexually More Like Women

While many reasons explain the low rate of prescription refills, another question is perhaps more intriguing: Why do so few older men—less than 10 percent—try erection drugs in the first place? Because couples who remain sexual in older adulthood evolve away from vaginal intercourse. As a result, they no longer need erections.

Great Sex Guidance: Viagra Falls- Older Men Just Aren’t That Into Erection Drugs – © Michael Castleman – 223 – After around 40, Sprott explains, sex changes: “Men’s testosterone production gradually falls, so men’s sex drive becomes tempered. They mellow. They don’t feel the same urgent need for sex that they experienced in their twenties. This change requires a major adjustment. But it also creates an opportunity to explore sex that’s less preoccupied with the genitals. Some men focus on what they’ve lost—perpetual arousal, reliable erections, and the primacy of intercourse. But others focus on what they can gain, pleasure that expands from the genitals to the whole body.”

“For many older men and couples, this transition is difficult,” Alperstein says. “People need time to grieve what they’ve lost. Our sexual culture is so focused on intercourse. Take the word ‘foreplay.’ It’s what comes before the main event, which, of course, is intercourse. And Hollywood sex and pornog- raphy are largely focused on intercourse. So it takes real effort to move beyond an intercourse-based sexual worldview. But couples who make this transition usually discover a whole new realm of plea- sure.”

Quality lovemaking, sex experts agree, has less to do with rock-hard erections and piston-like in- tercourse than with extended kissing and cuddling, and leisurely, playful, whole-body massage that includes the genitals, but is not fixated on them. “The first thing older couples need to know,” says Haslam, who teaches workshops on sex after 40, “is that men don’t need erections to have orgasms. I’ve had wonderful orgasms without one, thanks to manual stimulation or oral sex. The second thing they need to know is that sex in older adulthood is less about intercourse than ‘outercourse.’ Outer- course is like foreplay, only there’s no intercourse after it. Outercourse includes mutual pleasuring with fingers, lips, tongues, and sex toys. With creative outercourse, you can enjoy very erotic, orgas- mic sex without intercourse.”

“My older clients tell me that the drugs feel contrived,” Alperstein explains. “They’re all about inter- course. But if you’re not trying to make a baby, intercourse isn’t necessary, and as the years pass, it becomes problematic. The man probably has erection issues. The woman is probably postmeno- pausal, and even with a lubricant, intercourse may feel uncomfortable. At some point, many couples decide they’d rather be sexual without intercourse, so who needs the drugs?”

Compared with young men, young women tend to take longer to become aroused. This often causes conflict. Many young women complain that sex is over for their young lovers before they’ve even warmed up to it. Young women also tend to be less genitally focused than young men and more ex- cited by playful whole-body sensuality. This, too, can cause conflict. She wants to kiss and cuddle and maybe try a foot massage, meanwhile, he has only one thing on his mind.

But as men age, men’s and women’s sexual sensibilities converge. Men become sexually more like women. They need more time to become aroused, and as erection and intercourse become more problematic or impossible, whole-body sensuality becomes more attractive. “Compared with young lovers,” Sprott explains, “older couples are more sexually in synch. Couples who appreciate this can enjoy richer, more fulfilling sex at 65 than they had at 25—even without erection and intercourse.”

Viagra and the other erection medications will, no doubt, continue to generate sales in the billions— in part because men in the porn industry pop the pills like candy, and because men under 50 (both straight and gay) now use them for “erection insurance.” But the drugs were developed for men over 50—and a decade after Viagra’s launch, surprisingly few of them are interested. It’s ironic. It has taken drugs entirely focused on erection and intercourse to show the world that older lovers move beyond erections and intercourse.

Great Sex Guidance: Viagra Falls- Older Men Just Aren’t That Into Erection Drugs – © Michael Castleman – 224 – References:

L.A. Times, July 6, 2001, “Lights! Camera! Viagra!”

New York Times, Dec. 4, 2005. “Sales of Impotence Drugs are Declining.”

NY Times, Dec. 14, 2003, “In An Oversexed Age, More Guys Take a Pill.”

New York Times, May 11, 1998, “For Some Couples, A Remedy for Impotence May Become a Home Wrecker.”

New York Times, June 12, 1998, “Viagra’s Other Side Effect: Upset in Many a Marriage.”

Newsweek, Oct. 26, 1998, “Not Quite Viagra Nation.”

Althof, S.E. et al. “Self-Esteem, Confidence, and Relationships in MenT reated with Sildenafil Citrate for Erectile Dysfunction: Results of Two Double-Blind, Placebo-Controlled Trials,” Journal of General Internal Medicine (2006) 21:1069.

Ahn, T.Y. et al. “Treatment Preferences in Men with Erectile Dysfunction: An Open Label Study in Ko- rean Men Switching from Sildenafil to Tadalafil,” Asian Andrology (2007) 9:760.

Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psy- chgenic Erectile Dysfunction: A Pilot Study,” Journal of Sexual Medicine (2007) 4(4, Pt 2):1117.

Carrier, S. et al. “Treatment Satisfaction with Sildenafil in a Canadian Real-Life Setting. A 6-Month Prospective Observational Study of Primary Care Practices,” Journal of Sexual Medicine (2007) 4:1414.

Chia, S.J. et al. “Clinical Application of Prognostic Factors for Patients with Organic Causes of Erec- tile Dysfunction on 100 mg of Sildenafil Citrate,” International Journal of Urology (2004) 1:11 104.

Conaglen, H.M and J.V. Conaglen. “Investigating Women’s Preference for Sildenafil or Tadalafil Use By Their Partners with Erectile Dysfunction: The Partners’ Preference Study,” Journal of Sexual Medi- cine (2008) 5:1198.

DeBusk, R.F. et al. “Efficacy and Safety of Sildenafil Citrate in Men with Erectile Dysfunction and Stable Coronary Artery Disease,” American Journal of Cardiology (2004) 93:147.

Fonseca, V. et al. “Impact of Diabetes Mellitus on the Severity of Erectile Dysfunction and Response to Treatment: Analysis of Data from Tardenafil Clinical Trials,” Diabetologia (2004) 47:1914.

Gingell, C. et al. “Duration of Action of Sildenafil Citrate in Men with Erectile Dysfunction,” Journal of Sexual Medicine (2004) 1:179.

Hatzichrisou, D. et al. “Patterns of Switching Phosphodiesterase Type 5 Inhibitors in the Treatment of Erectile Dysfunction: Results from the Erectile Dysfunction Observational Study,” International Journal of Clinical Practice (2007) 61:1850.

Great Sex Guidance: Viagra Falls- Older Men Just Aren’t That Into Erection Drugs – © Michael Castleman – 225 – Kadioglu, A. et al. “Quality of Erections in Men Treated with Flexible-Dose Sildenafil for Erectile Dys- funtion: Multicenter Trial with a Double-Blind Randomized, Placebo-Controlled Phase and an Open Label Phase,” Journal of Sexual Medicine (2007) 5:726.

Lamberg, L. “New Drug for Erectile Dysfunction Boon for Many, “Viagravation” for Some,” Journal of the American Medical Association, (1998) 280:867.

Lee, J. et al. “Physician-Rated Patient Preference and Patient- and Partner-Rated Preference for Tadalafil or Sildenafil Citrate: Results from the Canadian Treatment of Erectile Dysfunction Observa- tional Study,” British Journal of Urology International (2006) 908:623.

Martin-Morales, A. et al. “Therapeutic Effectiveness and Patient Satisfaction After 6 Months of Treat- ment with Tadalafil, Sildenafil, and Vardenafil: Results from the Erectile Dysfunction Observational Study (EDOS),” European Urology (2007) 51:541.

May, M. et al. “Erectile Dysfunction, Discrepancy Between High Prevalence and Low Utilization of Treatment Options: Results from the Cottbus Survey,” British Journal of Urology International (2007) 100:1110.

McCullough, A.R. et al. “Randomized, Double-Blind, Crossover Trial of Sildenafil in Men with Mild to Moderate Erectile Dysfunction: Efficacy at 8 and 12 Hours Post-dose,” Urology (2008) 71:686.

Melnik T. and C.H. Abdo. “Psychogenic Erectile Dysfunction: Comparative Study of Three Therapeutic Approaches,” Journal of Sex and Marital Therapy (2005) 31:243.

Melnik, T. et al. “Psychosocial Interventions for Erectile Dysfunction,” Cochrane Database Systematic Review (2007) CD004825.

Mirone, V. et al. “Flexible-Dose Vardenafil in a Community-Based Population of Men Affected by Erec- tile Dysfunction: A 12-Week Open-Label, Multicenter Trial,” Journal of Sexual Medicine (2005) 2:842.

Mulhall, J. et al. “Importance of and Satisfaction with Sex Among Men and Women Worldwide: Re- sults of the Global Better Sex Survey,” Journal of Sexual Medicine (2008) 5:788.

Ochia, A. et al. “Efficacy of Sildenafil as the First-Step Therapy Tool for Japanese Patients with Erec- tile Dysfunction,” International Journal of Impotence Research (2005) 17:339.

Pickering T.G. et al. “Sildenafil Cirate for Erectile Dysfunction in Men Receiving Multiple Antihyper- tensive Agents: A Randomized Controlled Trial,” American Journal of Hypertension (2004) 17(12 Pt 1):1135.

Pickering, T.G. et al. “Sildenafil Cittrate for Erectile Dysfunction in Men Receiving Multiple Antihyper- tensive Agents: A Randomized Controlled Trial,” American Journal of Hypertension 17:1135.

Skoumal, R. et al. “Efficacy and Treatment Satisfaction with On_demand Tadalafil (Cialis) in Men with Erectile Dysfunction,” European Urology (2004) 46:362.

Zinner, N. “Do Food and Dose Timing Affect the Efficacy of Sildenafil? A Randomized Placebo-Con- trolled Study,” Journal of Sexual Medicine 4:137. Great Sex Guidance: Viagra Falls- Older Men Just Aren’t That Into Erection Drugs – © Michael Castleman – 226 – Viagra-Vation - Erection Medications May Cause Relationship Strife

Back in 1998, the little blue, diamond-shaped pill, Viagra, took the world by storm. During the first month after the Food and Drug Administration (FDA) approved it, doctors wrote almost 300,000 prescriptions, and the drug’s sales topped $96 million, making it the biggest launch of a new drug in history. Sales of Viagra and the other erection drugs (Cialis and Levitra) are now more than $2 billion a year.

Erection Insurance

If you ask the people who developed Viagra, the drug was designed to help the 10 percent of men who cannot raise erections because of diabetes, other illnesses, and the sexual side effects of other drugs, notably antidepressants. But the rush to Viagra and the other drugs came primarily from men who did not have these problems, men who wanted “erection insurance,” greater confidence that when the clothes came off they’d be able to get it up.

Erection insurance appeals to millions of men. According to the Massachusetts Male Aging Study (1994), fewer than half of men over 40 (48 percent) reported “no difficulties at all” with erection. Sev- enteen percent admitted “occasional” problems. One-quarter said they had “frequent difficulty.” And 10 percent said they could “not raise an erection at all.”

The majority of the 42 percent of men who can get it up, but have occasional or frequent erection difficulties are regular guys who experience normal, age-related erection changes.After 40, most men gradually lose the ability to raise an erection just from sexual fantasy or the sight of an erotically dressed—or undressed—lover. They find they need direct penile stimulation by hand, mouth, or sex toy. In addition, compared with the rock-solid erections of men’s youth, post-40 erections tend to be less firm and less persistent without ongoing fondling. If men don’t understand that such changes are natural and do not signal a sex problem, they often assume that they have one. Many of these men have viewed Viagra as a godsend. Even if a man over 40 knows that his erection changes are natural and not a sex problem, erection medication can be reassuring. It takes the worry out of being close. Or does it?

Great Sex Guidance: Viagra-Vation- Erection Medications May Cause Relationship Strife – © Michael Castleman – 227 – No Panacea

Erection drugs are not erection panaceas. They do not produce erection all by themselves. Rather, they strengthen the penis’ ability to respond to erotic signals. If a man is not in the mood for sex, or is turned off to his lover or their relationship, the drugs don’t do much. Even when conditions are right, the drugs still only work about 70 percent of the time.

Erection medications may also cause side effects: headache, nasal congestion, indigestion, facial flushing, blurred vision, and in rare cases, more serious vision problems.

Then there’s the far more serious problem of the erection drugs’ interaction with nitrate medications (nitroglycerin for angina, and the party drug amyl nitrate or “poppers”). If a man taking nitrate medica- tion takes an erection drug, the combination can prove fatal. This combination can cause a precipi- tous drop in blood pressure, leading to life-threatening shock. The interaction of nitrates and erection drugs is particularly troubling because heart disease is a significant risk factor for erection impairment, so men taking nitrates for the former would tend to gravitate to erection drugs for the latter.

Viagra-Vation

Even when it works, Viagra & Co. often cause as many problems as they solve. “Viagra-vation” is the term coined to describe the relationship problems that often result when a man with erection impair- ment can suddenly produce a pharmaceutical erection. “Viagra can create erections,” says Marty Klein, Ph.D., a sex and marital therapist in Palo Alto, California, “but it can’t fix problems that aren’t erection problems. In my 20-plus years of treating impotence, I’ve seen very few pure erection prob- lems. But I’ve seen lots of erection difficulties compounded by guilt, shame, anger, anxiety, violence, alcoholism, drug abuse, religious differences, and relationship problems. Even if erection drugs re- store lost erections, they can’t resolve the other problems that are usually the cause of the erection trouble.”

Men and Women See Erection Problems Differently

Men tend to view erection impairment as a mechanical problem, and drugs as a quick fix. omenW tend to view erection difficulties as an emotional issue, and want to work on the couple’s intimacy—or lack of it—before they feel comfortable attempting intercourse again. Erection problems are a drag, but a surprisingly large number of couples adapt, especially those who have intimacy issues. Lack of erection means they don’t have to deal with their intimacy issues or struggle over sexual frequency. However, when drugs change the sexual equilibrium in the relationship, instead of being a solution, these medications may aggravate underlying relationship problems.

Enhancing Intimacy

So how do you deepen the intimacy in your relationship? First, it’s critical to understand that these issues are important, that after 40, it’s difficult for men to enjoy good sex without feeling emotion- ally close to the woman and trusting her, no matter what’s up with his penis, with or without erection drugs. If aloofness, anger, or other emotional issues have dimmed the erotic spark in your relation- ship, it might be a good idea to consult a couples therapist or sex therapist before you ask for that prescription. To find a sex therapist near you, visit the American Association of Sex Educators, Coun- selors, and Therapists www.aasect.org.

Great Sex Guidance: Viagra-Vation- Erection Medications May Cause Relationship Strife – © Michael Castleman – 228 – If things are fine between you, but you’re out of erotic practice because of an erection problem, con- sider giving each other whole-body massages or experimenting with sex toys or other erotic enhance- ments. Eroticism grows from mutual attraction and shared sensuality, a heightening of all five senses that excites you and your lover. Massage products and sex toys enhance sensuality. They also slow sex down, which most women enjoy, and which also helps men over 40 become aroused enough to raise erections.

Use Lubricant

Once women are in their 40s, many develop menopause-related vaginal dryness. If a couple hasn’t had intercourse in a while and then erection drugs make it possible again, without a lubricant, the woman may suffer vaginal irritation and soreness. Use a lubricant. They’re available at pharmacies and Adam & Eve. Vegetable oil also works (but may stain bed linens).

There’s More to Enjoyable Sex Than Erection

Within a year after Viagra’s approval, prescription refills fell below analysts’ expectations. The same is true for Cialis and Levitra. That’s actually good news. Erection medications can be a boon to some men and couples. But there’s more to great sex than erection. People seem to be figuring that out.

References:

Lamberg, L. “New Drug for Erectile Dysfunction Boon for Many, ‘Viagra-vation’ for Some,” Journal of the American Medical Association (1998) 280:867.

Nordheimer, J. “For Some Couples, Remedy for Impotence May Become a Homewrecker,” New York Times, 5-11-1998.

Steinhauer, J. “Viagra’s Other Side Effect: Upsets in Many A Marriage,” New York Times, 6-23-1998.

Great Sex Guidance: Viagra-Vation- Erection Medications May Cause Relationship Strife – © Michael Castleman – 229 – Orgasm/Ejaculation Problems: Causes And Treatments of This Surprisingly Common Problem

Problems with orgasm/ejaculation—difficulty with release, or an inability to have orgasms or ejaculate at all—are men’s hidden sex issue. Erectile dysfunction is all over the media, and premature ejacu- lation (rapid, involuntary ejaculation) is also frequently discussed, but not men’s orgasm/ejaculation problems. This is a shame because many men have trouble with orgasm/ejaculation. Studies vary, but two comprehensive surveys, one by the University of Chicago researchers, the other from the University of California, San Francisco, suggest that about 5 percent of adult men of all ages have this problem. That’s one man in 20.

First, a word about male orgasm and ejaculation. In the vast majority of men orgasms and ejaculation occur simultaneously. The rhythmic muscle contractions of orgasm propel semen out of the penis. However, physiologically, male orgasm and ejaculation are two distinct events controlled by different nerves. It’s possible, though rare, to experience “dry orgasm”—the pleasure of coming without any ejaculation of semen. It’s also possible to experience “numb come”—ejaculation of semen with little if any orgasmic pleasure. However, for purposes of this discussion, we’ll assume that orgasm and ejaculation happen at the same time.

Possible Causes

* Masturbation Style Some men develop a highly idiosyncratic masturbation pattern, and train themselves to have orgasms/ejaculate only that way. For example, some men grip their penises tighter and yank them harder than any woman would without prompting. Others bend it off to one side, or whatever. There’s nothing wrong with this. But when men train themselves to have orgasms and ejaculate only in certain ways, they sometimes can’t with a lover who isn’t clued into their little secret.

* Aging With age, the nervous system loses some of its excitability. After around 45, men often notice that their penises need more stimulation than they once did to trigger orgasm and ejaculation. This is normal, but it can be disconcerting. Many men who struggled to delay coming as young men find they have difficulty triggering it as they grow older.

Great Sex Guidance: Ejaculation-Orgasm Problems- CausesAnd Treatments of This Surprisingly Common Problem – © Michael Castleman – 230 – Aging also brings a gradual loss of strength in the pelvic floor muscles, the ones involved in ejacu- lation. The pelvic floor muscles form a figure-8 around the base of the penis and the anus. Their contractions propel semen out of the penis, and play a crucial role in the pleasure and intensity of orgasm. As pelvic muscle tone wanes, semen may dribble out instead of spurting, and orgasms may feel less intense.

Age-related orgasm/ejaculation difficulties do not mean that you’re inadequate, abnormal, or near- ing the end of your sexual rope. Nor do they mean that you feel turned off to your lover. They just mean you’re not a kid anymore.

* Alcohol Alcohol is usually associated with erection impairment, but in some men, it causes orgasm/ejacu- lation problems. * Depression Mention depression, and the big sex problem is loss of libido. But sex therapists report that in some men, depression causes orgasm/ejaculation problems. In addition, many antidepressant medications have a side effect—impairment of orgasm/ejaculation.

* Genital and Prostate Problems Infection of the urethra or prostate (urethritis or prostatitis) can cause pain on orgasm/ejaculation. If you experience this, you might train yourself not to come in order to avoid the pain.

* Surgery Surgery for benign prostate enlargement has no effect on orgasm. But it often causes “retrograde ejaculation.” Instead of semen emerging from the penis, the muscle contractions of orgasm/ejacu- lation propels it backwards into the bladder. The result is “dry orgasm.” Semen “backfired” into the bladder mixes with urine and is eliminated during urination. This causes no ill effects. However, because the man’s urine contains semen, it may appear milkier than it did before the surgery.

* Neurological Problems Diabetes, multiple sclerosis, paraplegia, or other neurological conditions might damage the nerves that control orgasm/ejaculation. But having any of the conditions does not mean a man is doomed to orgasm/ejaculation problems.

* Drug Side Effects Many drugs have side effects that may delay or eliminate orgasm/ejaculation. The key word is “may.” If you take any of the drugs listed below, you’re not necessarily fated to suffer orgasm/ ejaculation problems. Sexual drug side effects are highly individual. But if you begin to develop or- gasm/ejaculatory difficulties within a few weeks after starting one of the drugs listed below, consult the physician who prescribed the medication. It’s possible that another drug might be substituted, or that some other treatment might minimize the sexual side effects. Drugs most frequently associ- ated with orgasm/ejaculation problems are starred (*).

Over-The-Counter Drugs

Aleve. Pain reliever. Naprosyn. Pain reliever.

Great Sex Guidance: Ejaculation-Orgasm Problems- CausesAnd Treatments of This Surprisingly Common Problem – © Michael Castleman – 231 – Prescription Drugs Blood Pressure Medications (antihypertensives) Aldomet.* Arfonad, Catapres. Demser. Dibenzyline.* Hylorel.* Ismelin.* Minipress. Normodyne.* Reserpine.* Trandate.*

Antidepressants Asendin. Celexa.* Desyrel.* Effexor.* Janimine.* Luvox.* Nardil.* Norpramin. Paxil.* Pertofrane. Prozac.* Surmontil. Tofranil.* Zoloft.*

Anti-Anxiety and Psychiatric Medications Anafranil.* Barbiturates.* BuSpar. Compazine. Haldol. Klonopin. Librium. Mellaril.* Mitran. Orap. Permitil Prolixin. Serentil. Stelazine. Thorazine. Trilafon.* Valium.* Xanax.* Great Sex Guidance: Ejaculation-Orgasm Problems- CausesAnd Treatments of This Surprisingly Common Problem – © Michael Castleman – 232 – Other Prescription Drugs Accutane. Acne. Amicar. Bleeding. Dolophine. Heroin addiction. Fastin. Obesity. Ionamin. Obesity. Lioresal. Muscle relaxant. Methadone. Heroin addiction. Methotrexate. Rheumatoid arthritis. Cancer chemotherapy. Naprosyn. Pain and inflammation. Naproxen. Pain and infalmmation. Valium. Anti-anxiety, anticonvulsant, muscle relaxant.

Recreational Drugs Amphetamines.* Amyl nitrate. Cocaine.* Crack.* Ecstasy (MDMA).*

* Emotional Stress and Distraction Just as stress gives some men headaches and others stomachaches, in the sexual arena, stress causes rapid ejaculation or erection problems in some men and orgasm/ejaculation difficulties in others. However, sex therapists often cite several particular stressors as frequently associated with orgasm/ejaculation difficulties: fear of rapid ejaculation or erectile dysfunction, fear of unwant- ed pregnancy or sexually transmitted diseases, anger at the lover, or a fundamentalist religious background that discourages sex. So relationship issues can cause or aggravate the problem.

* “Delivery Boy” Attitude Another common cause of orgasm/ejaculation problems is a “delivery boy” attitude toward sex, the notion that sex is something men should do for women, even if they themselves are not interested in making love. When a man becomes too focused on his lover’s pleasure, and pays little or no at- tention to his own, he loses erotic focus. That can interfere with orgasm/ejaculation.

Bernard Apfelbaum, Ph.D., director of the Berkeley Sex Therapy Group in Berkeley, California, and an expert in orgasm/ejaculation difficulties, explains that men with this problem typically have erections that are out of synch with their level of desire. They have highly responsive penises and can raise firm, long-lasting erections, but they experience little or no actual sexual arousal.Their lack of arousal finds expression in difficulty having orgasms and ejaculating or an inability to do so. When asked if they feel turned on, they often say they feel numb. Many men with orgasm/ejaculation difficulties feel that their penises are not their own, but simply instruments for pleasing women. They believe that sex has nothing to do with their own pleasure, just the woman’s.

Some psychologists have suggested that orgasm/ejaculation difficulties signal the man’s subcon- scious withdrawal from the relationship. Apfelbaum disagrees: Men with orgasm/ejaculation problems are not withdrawn, he insists. On the contrary, they are usually too focused on the woman’s pleasure and not enough on their own. “In all my cases of ejaculatory inhibition,” he explains, “the man is un- able to receive pleasure, to be responsible for his own satisfaction. He’s overly preoccupied with his partner’s satisfaction.” Great Sex Guidance: Ejaculation-Orgasm Problems- CausesAnd Treatments of This Surprisingly Common Problem – © Michael Castleman – 233 – Washington, D.C. sex therapist Barry McCarthy, Ph.D., coauthor (with Emily McCarthy) of Male Sex- ual Awareness, agrees. Men with orgasm/ejaculation problems, he explains, often believe that they shouldn’t need a woman’s cooperation and stimulation to become highly aroused and reach orgasm, that arousal and orgasm/ejaculation should happen automatically. These men tend to view sex as a performance and they focus on their performance, that is, what they give the woman, over any plea- sure they receive from her. But they tend to be unaware that they’re not turned on because they can raise firm erections easily. They don’t understand that erection doesn’t necessarily mean arousal. Erection medication has aggravated this problem because men may raise chemical erections, but not feel aroused enough to experience orgasm and ejaculate.

Effective Treatments

The first step in dealing with orgasm/ejaculation problems is to consult a physician to investigate pos- sible infections, neurological problems, or pain problems.

Beyond that, there are three basic approaches to treatment: letting go of the idea that you “must” ejaculate every time you make love, getting the stimulation you need to ejaculate, and understanding that you’re more than a delivery boy providing sex to your lover, that you also deserve to enjoy sexual pleasure.

You Don’t Have to Ejaculate Every Time

Most men consider orgasm/ejaculation an integral part of sex, and can’t imagine making love without it. Orgasm and ejaculation are certainly enjoyable. But every now and then, once you get used to the idea, it’s fine not to ejaculate. In traditional Chinese sexology, men over 40 were advised not to ejacu- late every time, in the belief that coming every time depleted their vitality.

The notion that you don’t have to have an orgasm and ejaculate every time strikes many men as bizarre or ridiculous. They often say: “If I can’t come, why bother with sex?” Because there’s more to sex than orgasm/ejaculation. Try rethinking sex and focusing on the pleasure of the rest of the experi- ence, the sensuality, the closeness, intercourse, oral, whatever, even if you don’t climax.

Enjoyable sex without orgasm/ejaculation is often hard to imagine for men who recall the “blue balls” or “lover’s nuts” of their youth. Young men often experience soreness between their legs if they be- come highly aroused and then don’t experience the release of ejaculation and orgasm. But the dis- comfort, if any, fades in men over 40. Older men generally feel less urgency to ejaculate, and if they don’t come, less discomfort. This situation might be compared with a stifled sneeze. A tickle in the nose that does not result in the release of a sneeze causes momentary consternation, but breathing quickly returns to normal. Similarly, a man, especially a man over 55, who does not ejaculate every time he makes love may initially feel that something is missing, but over time, lovemaking without or- gasm/ejaculation becomes more routine—and believe it or not, enjoyable. The sex can still feel quite fulfilling if the focus is on massage-based give and take—no matter what happens in the orgasm/ ejaculation department.

When men experience orgasm/ejaculation difficulties, they often become quite anxious.This stress is self-defeating. It makes orgasm/ejaculation even less likely. Try to relax about ejaculation problems. If you don’t come during partner sex every time, it’s not the end of the world. If you’d like to have an orgasm and ejaculate, you can probably accomplish them through masturbation, perhaps by your-

Great Sex Guidance: Ejaculation-Orgasm Problems- CausesAnd Treatments of This Surprisingly Common Problem – © Michael Castleman – 234 – self, or maybe with your lover holding you, or helping. In fact, masturbating in front of your lover often helps resolve this problem (below).

Getting the Stimulation You Need

Some men can have orgasms and ejaculate in almost any circumstances. But most men, especially men over 40, discover that the context becomes increasingly important, that certain conditions of comfort and erotic arousal must be met for them to raise and maintain erections (if they do) and even- tually have an orgasm and ejaculate. If you don’t get the stimulation you need, you may not come.

To trigger orgasm/ejaculation, you may need a particular kind of stimulation—and you may have to ask specifically for it. You may find that you have trouble with orgasm/ejaculation in certain inter- course positions and gravitate to others. Or you might not be able to have an orgasm or ejaculate in your lover’s vagina at all, and need simultaneous oral and manual stimulation to climax. Don’t be- come alarmed. Your penis is not giving up on you. You’re fine. Stressing only makes things worse. Instead, try to relax and accept what’s happening as normal, and as an opportunity to experiment with new sexual techniques that provide the stimulation you need.

Typically, men with orgasm/ejaculation problems have no difficulty masturbating to orgasm. Expand- ing on that ability is key to resolving this problem.

Try masturbating with your lover watching. You may never have done this before. Both you and she may feel awkward or embarrassed. If so, try to talk about it. If this feels difficult, say so. It’s perfectly natural to feel bashful. Remember, you and your lover are working together to resolve a problem that’s bothering you. Demonstrating how you enjoy masturbating not only teaches your lover what kinds of stimulation you need, it also involves self-revelation, which deepens the intimacy in your re- lationship, and helps you feel closer and more tuned into one another. For orgasm/ejaculation prob- lems, all of this helps.

Once you overcome the awkwardness of masturbating in front of your lover, show her exactly how you need to be caressed in order to have an orgasm and ejaculate. As you do, explain the fine points of what works for you—the strokes, pressure, pace, and any little creative extras that turn you on the most. Pay particular attention to the sensations you feel as you approach your point of no return, the moment when orgasm/ejaculation feels inevitable. Focus on the kind of stimulation that brings you to your point of no return, because once you’re there, you’ll come.

To heighten arousal, a lubricant usually helps. Place some on your hand as you stroke yourself.

After you’ve masturbated to orgasm a few times with your lover watching, then take her hand in yours and show her exactly how you like your penis caressed. Let her experience providing everything that you demonstrated previously. Only this time, you’re doing it together. Use lubricant generously on your penis and on both her hand and yours. Coach her. Tell her exactly which strokes you enjoy, which bring you to your point of no return.

While working with her, remember to breathe deeply. Deep breathing helps the nervous system relax so that erotic stimulation triggers orgasm/ejaculation. In addition, close your eyes and call up the fantasies that have helped you trigger orgasms/ejaculation in the past. (They need not include your lover.) What’s important is that you find them highly arousing. If you like, you might keep your eyes

Great Sex Guidance: Ejaculation-Orgasm Problems- CausesAnd Treatments of This Surprisingly Common Problem – © Michael Castleman – 235 – open and watch an X-rated video. Use your hand to gently guide hers until she feels comfortable stimulating you to orgasm/ejaculation several times over a period of a few weeks.

Next, withdraw your hand part of the time and turn things over to her. She should stroke you in the way(s) she did while you were guiding her hand with yours. She might use one hand or two. If you like, she can use a masturbation sleeve, a men’s sex toy designed to simulate a woman’s vagina or mouth. Some masturbation sleeves vibrate. Your lover should use lots of lubricant, and you should coach her as necessary while breathing deeply and enjoying the fantasies that turn you on. Again, practice this until she has brought you to orgasm several times over a few weeks.

Next, withdraw your own hand entirely, and have your lover stroke you to orgasm/ejaculation several times over a few weeks.

Then generalize your lover’s new understanding of what arouses you enough to ejaculate. She might try stroking your penis while sucking it, or as part of vaginal intercourse. Here, too, don’t be bashful. Tell your lover what you need to become highly aroused and ejaculate.

Try These Techniques

In addition, here are several techniques sex therapists recommend for helping men trigger orgasm/ ejaculation:

* Kegel exercises. These simple exercises tone the pelvic floor muscles, the ones that contract during orgasm/ejaculation. The pelvic floor muscles are the ones you contract to squeeze out the last drops of urine. If you contract them while not urinating, you’re doing Kegels. Try sets of five to 10 a few times a day. Most men (women too) notice more pleasurable orgasms in about of month of daily Kegels.

* While masturbating, move your hips, not your hand. Many men masturbate with hips and penis still, but a hand moving vigorously. Try it lying on your side with your hand still. Thrust your hips. This is a lot closer to vaginal intercourse, and training one’s masturbation style often helps men come in the vagina.

* The man-on-top position is usually better than woman-on-top. The latter is recommended for lasting longer. It’s generally more difficult for men to delay orgasm/ejaculation in the man-on-top position, so it’s often a good one for men with orgasm/ejaculation difficulties.

* If you have problems in the man-on-top position, ask your lover to close her legs, so that her in- ner thighs provide you with extra stimulation. It usually helps to use lubricant on her inner thighs.

* Rear entry. Some men find that doggie style intercourse helps them ejaculate.

* The Snakey Lick Trick. This variation on oral sex involves the woman removing the man’s erec- tion from her mouth, and then lightly licking the underside of his penis directly behind the head. In many men, this area is highly sensitive. Stimulating it often helps trigger orgasm/ejaculation.

* Caressing behind the scrotum. With either the man or woman on top, the woman reaches down and teases or massages the area between the man’s scrotum and his anus. In many men, this area is highly sensitive. Stimulating it may help trigger orgasm/ejaculation. Great Sex Guidance: Ejaculation-Orgasm Problems- CausesAnd Treatments of This Surprisingly Common Problem – © Michael Castleman – 236 – * Anal massage. In many men—gay, straight, and everything in between—the anus is highly sensitive to erotic touch. The pelvic muscles that contract during orgasm circle the anus. Teasing or massaging the anal sphincter helps stimulate these muscles toward contraction, which helps some men have orgasms and ejaculate. Use lots of lubricant.

* Anal fingering. If you enjoy anal sphincter massage, but it doesn’t provide quite enough stimula- tion to trigger orgasm/ejaculation, try being gently anally fingered.That might trigger ejaculation. Use lots of lube.

* Prostate massage. If you enjoy anal fingering, but still can’t ejaculate, prostate massage can trigger powerful orgasms. To do this, your lover should insert a finger deeply into your anus—using lots of lubricant.

Note: Anal play does not mean you’re gay. Both heterosexual and homosexual lovemaking involve kissing, hugging, massage, genital fondling, oral sex, and maybe anal play. Sexual moves have noth- ing to do with sexual orientation, and everything to do with which gender you fantasize about.

For Yourself

For Yourself (available from Amazon.com) is the name of a classic self-help book by sex therapist Lonnie Barbach, Ph.D. It has helped many women learn to have orgasms for the first time. Its basic message is that each of us is responsible for our own sexual satisfaction. A lover can help create the erotic environment that allows the other to become aroused enough to have an orgasm. But no one “gives” an orgasm to anyone else. Orgasms come from deep within us, and they emerge only when we allow ourselves to experience enough arousal to release them. For Yourself is aimed at women, but its message applies equally to many men with orgasm/ejaculation difficulties. Men who have dif- ficulty reaching orgasm, Apfelbaum explains, are similar to women with the same problem. They don’t orchestrate lovemaking to focus enough erotic attention on their own arousal.

If your orgasm/ejaculation problems have been caused or aggravated by a “delivery boy” approach to lovemaking, you have every right to enjoy sex, to become aroused, and receive pleasure—in fact, to spend some time lying back and doing nothing but receiving pleasure. Great sex involves both give and take. Chances are you’ve been giving generously, but not receiving enough pleasure to really arouse you. It’s also possible that if this situation has persisted for a while, that you may resent your lover for monopolizing the pleasure. The stress engendered by your resentment may aggravate your problem.

If you think you’ve been so preoccupied with providing pleasure that you haven’t allowed yourself to receive enough to bring you to orgasm, discuss this issue with your lover—or simply show her this material. Don’t get down on yourself. It’s not your fault that your lovemaking has fallen a bit out of balance. Men are socialized to believe they should orchestrate things, and that’s what you’ve been doing—only you’ve gone a little overboard on the giving side. And don’t berate your lover. It’s not her fault that she hasn’t been providing you with enough stimulation. Women are still raised to follow men’s lead in sex and not take much initiative. Explain that you need to receive more pleasure than you’ve been getting, and ask her to provide it.

Think carefully about what arouses you and ask specifically for that stimulation. If you find it difficult to describe in words, show her using the approach in the section “Getting the Stimulation You Need.”

Great Sex Guidance: Ejaculation-Orgasm Problems- CausesAnd Treatments of This Surprisingly Common Problem – © Michael Castleman – 237 – If you’re not sure what arouses you, consider reading For Yourself and a similar, excellent book also aimed at women, Becoming Orgasmic by Julia Heiman, Ph.D., and Joseph LoPicollo, Ph.D. (available from Amazon.com) The book has been turned into an instructive and erotic video (bettersex.com). Although these resources were produced for women who have not been able to have orgasms, much of the information also applies to men whose orgasm/ejaculation problems are based on a delivery- boy approach to sex.

In both genders, resolution of the problem often hinges on figuring out your own conditions for enjoy- able sex, not what you think you “should” feel, and not what you think your lover wants you to feel, but what actually turns you on. The biological purpose of life is to reproduce life. For men, that means ejaculation. Your body is hardwired to ejaculate. All you need to do is discover the context that allows that to happen.

If self-help approaches don’t provide sufficient relief after a few months, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Apfelbaum, B. “Retarded Ejaculation: A Much Misunderstood Syndrome,” in Principles and Practice of Sex Therapy, 3rd ed. Sandra R. Leiblum and Raymond C. Rosen, eds. Guildford Press, NY, 2000.

Aschka, C et al. “Sexual Problems of Male Patients in Family Practice,” Journal of Family Practice (2001) 50:773.

Dunn, K.M. et al. “Systematic Review of Sexual Problems: Epidemiology and Methodology,” Journal of Sex and Marital Therapy (2002) 28:399.

Giuliano, F. and P. Clement. “Neuroanatomy and Physiology of Ejaculation,” Annual Review of Sex Research (2005) 16:190.

Heiman, JR. “Sexual Dysfunction: Overview of Prevalence, Etiological Factors, and Treatments,” Journal of Sex Research (2002) 39:73.

Laumann, EO. “Sexual Dysfunction in the United States,” Journal of the American Medical Associa- tion (1999) 281:537.

McCabe, MP. “Evaluation of a Cognitive Behavior Therapy Program for People with Sexual Dysfunc- tion,” Journal of Sex and Marital Therapy (2001) 27:259.

Perelman, MA. “Retarded Ejaculation,” in Current Sexual Health Reports, Current Science, Inc. 2004.

Simons, JS and MP Carey. “Prevalence of Sexual Dysfunctions: Results from a Decade of Resarch,” Archives of Sexual Behavior (2001) 30:177.

Great Sex Guidance: Ejaculation-Orgasm Problems- CausesAnd Treatments of This Surprisingly Common Problem – © Michael Castleman – 238 – Testosterone Replacement: New Male Vigor? Or Health Hazard?

An expert panel of the Food and Drug Administration recently voted overwhelmingly to impose strict new limits on physician prescribing of the male sex hormone testosterone.

The FDA is not required to follow the recommendations of its expert panels, but the agency usually does, especially when the vote is as lopsided as this one—19 to one.

Advocates of hormone replacement call testosterone a fountain of youth that restores older men’s flagging sex drive and erections and returns them to lean, muscled, youthful vigor. Perhaps. But per- sonally, I hope the FDA tightens up on testosterone big time. Here’s why:

• There’s good evidence that many men taking testosterone don’t need it and that serious safety is- sues remain unresolved.

• Since the millennium, the number of men taking the hormone has quadrupled to more than 2 million. But audits show that many received the hormone without sufficient blood testing to see if they really have what’s become known as Low T.

• Verifiable testosterone deficiency is rare in men under 65, but currently men 45 to 64 account for 60 percent of testosterone prescriptions.

• The debate over testosterone replacement feels eerily similar to the controversy decades ago sur- rounding hormone replacement therapy (HRT) in older women—also initially touted as youth restorer and later shown to increase risk of heart disease and breast cancer.

Background

Testosterone is produced in the testicles. For decades, scientists have known that an unusually low blood level causes fatigue, depression, libido loss, erectile dysfunction, weight gain, and reduced muscle mass. All these problems can be cured with supplementation that returns blood levels to the normal range.

But supplemental testosterone also causes thickening of the blood, a risk factor for heart disease and

Great Sex Guidance: Testosterone Replacement- New Male Vigor? Or Health Hazard? – © Michael Castleman – 239 – stroke, and the hormone may spur the growth of prostate cancer, which is as common—and deadly— in men as breast cancer in women. Until recently, concerns about the hormone’s potentially serious downsides have prevented most doctors from prescribing it.

But at the end of the 20th century, a few researchers, notably Harvard’s Abraham Merganthaler, M.D., demonstrated that testosterone does not increase risk of prostate cancer, at least in short-term stud- ies, and other researchers showed that supplementation may not be as closely associated with car- diovascular disease risk as was previously believed. As a result, increasing numbers of physicians have been prescribing it to an increasing number of men complaining of vague symptoms like fatigue.

Over-Prescribed?

The Endocrine Society, the medical organization that publishes authoritative guidelines for supple- mental hormone therapy, recommends testosterone supplementation only for men who have unequiv- ocally low levels, a finding that requires several blood tests. Multiple tests are necessary because testosterone levels fluctuate considerably during the day. Men who appear to have low levels in one test often show normal levels in others.

Meanwhile, a recent report by researchers at the University of Texas (UT) Medical Branch in Galves- ton shows that 25 percent of the men taking testosterone had just one blood test prior to receiving prescriptions, which suggests that doctors have prescribed it carelessly.

In addition, even if blood tests show a clear deficiency, the Endocrine Society guidelines insist that testosterone should not be prescribed unless men also report clear symptoms of deficiency, notably li- bido collapse. There is no evidence that the number of men reporting this has quadrupled since 2001, another suggestion that doctors are over-prescribing the hormone.

Finally, the UT study shows that the fastest growing group of men taking testosterone are in their 40s. But clear, symptomatic hormone deficiency is unusual before age 60, another indication that doctors are over-prescribing.

Rerun of the HRT Debacle in Women?

Furthermore, the testosterone story looks like a rerun of what happened with HRT for women thirty years ago. Doctors initially touted HRT as a sure way to preserve youthfulness, femininity, and sexual function while reducing risk of heart disease. Short-term studies showed that HRT reduced heart disease risk without increasing risk of breast cancer. But longer-term studies showed the opposite—a clear increase in heart disease and breast cancer risk. We have no long-term studies of testosterone supplementation, just short-term reports that all is well. But is it?

We may find out next year when researchers with the National Institutes of Health are scheduled to release the results of the T Trial, a years-long effort to determine the long-term effects—and side ef- fects—of taking the hormone. Until then, we just don’t know.

Maybe testosterone is a godsend for older men. Maybe it doesn’t cause potentially life-threatening side effects. But the quadrupling of prescriptions over the past dozen years to many men who were inadequately tested suggests it’s being over-prescribed—which is why the FDA’s expert panel has exhorted to agency to limit prescriptions.

Great Sex Guidance: Testosterone Replacement- New Male Vigor? Or Health Hazard? – © Michael Castleman – 240 – If you take testosterone, be aware that you’re a guinea pig in a vast uncontrolled experiment that may one day repay your current vitality boost with potentially serious consequences.

If you didn’t have multiple blood tests and clear deficiency symptoms before you received your pre- scription, you might want to rethink use of the hormone.

And if you’re considering supplementation because of breathless claims about stronger libido, firmer erections, and boosted vitality, I suggest you think twice. By a vote of 19 to one, the FDA expert panel shares my opinion.

References: Tavernise, S. “FDA Panel Backs Limits on Testosterone Drugs,” New York Times, 9-18-2014.

Rabin, R.C. “A High Price for Vigor,” New York Times, 2-4-2014.

LaPuma, J. “Don’t Ask Your Doctor About ‘Low T’,” New York Times, 2-4-2014.

O’Connor, A. “Study Adds Concerns About Cardiac Risks for Older Men Taking Testosterone,” New York Times, 1-30-2014.

Singer, N. “Selling That ‘New Man’ Feeling” New York Times, 11-24-2013.

Great Sex Guidance: Testosterone Replacement- New Male Vigor? Or Health Hazard? – © Michael Castleman – 241 – The Man’s Guide to Buying Lingerie for Women - Especially For Valentine’s Day

As Cupid’s holiday approaches, many men dream of the horizontal tango, and how hot their honeys might look in new lingerie…

Beware, dude, one false move and you might wind up in the doghouse. Most men are clueless about buying lingerie, and Internet sites favor items like open-crotch panties and peek-a-boo bras that few 19-year-olds would wear, let alone older women. But this Valentine’s Day, when she opens the box, you just might hit the erotic jackpot—if you follow Mike’s lingerie shopping advice:

• She’s probably not an exhibitionist. Porn is full of women who appear thrilled to flaunt their as- sets in skimpy, see-through outfits, but surveys show that only about 2 percent of women consider themselves exhibitionists. Behind closed doors that figure increases, but less than most men imag- ine. Chances are your sweetie will greet a fishnet body suit with less joy than trepidation.

• So forget skimpy. Except for the tiny number of (often surgically enhanced) lingerie models, most women feel self-conscious about their bodies, and as the years pass, their discomfort often be- comes seasoned with self-loathing. If she wants to buy skimpy outfits for herself, fine. But for gift giving, go with something she’s actually likely to enjoy wearing.

• Forget bras, panties, thongs, and G-strings. To look good, these garments must fit like a glove, which means knowing her size. Do you? I thought not. So you peek into her underwear drawer. But unlike the sensible sizing of men’s clothing—small, medium, and large—women’s sizes are a minefield of incomprehensible labels: Misses, Petites, Juniors, and oman’W s, with a raft of sizes in each, sizes that are anything but standard.

For male shoppers, bras are particularly tricky. Professional corset fitters often chide women for buying bras that don’t fit, so even if her bras say 36C, there’s no guarantee that lingerie in that size will flatter her. Meanwhile, if you buy a bra that’s too large, she’ll believe you think she’s a whale. And if you select one that’s too small, she’ll believe you want her to lose weight. Mike’s advice: Avoid bras and panties altogether.

• It’s not about how much she reveals, but how she feels. Men get turned on visually, which is why guys can’t get enough of scantily-clad women. But women respond more to touch, for example,

Great Sex Guidance: The Man’s Guide to Buying Lingerie for Women (Especially for Valentien's Day) – © Michael Castleman – 242 – the feel of luxurious fabrics such as silk. If what you buy her feels sensuous and luxurious, she’s likely to radiate sexiness—and you’re more likely to get lucky.

Another problem with skimpy lingerie: It often leaves women cold, that is, shivering, even if you crank up the thermostat. Silk is insulating. It keeps her warm, which helps her feel hot.

• Go with loose-fitting, full-coverage outfits. Shop for baby dolls, negligées, and robes. Baby dolls are short nightgowns, usually thigh-high and sleeveless. Negligées are longer, calf- or ankle- length and may include sleeves. Lingerie robes resemble bathrobes, but they’re lighter weight, and usually semi-sheer. Some baby dolls and negligées include lace, ruffles, spaghetti straps, and slits up the sides. Go with what you think she’d enjoy.

• Give her control. The beauty of full - or almost-full - coverage lingerie is that the woman is in control of what she reveals how and when. You may adore her boobs, but she may not. If she sashays around the house in a negligée, she can show off what she considers her charms with- out baring the bits that make her cringe. “Many women choose lingerie according to how well it disguises what they consider flaws,” says Joan Price, author of Naked At Our Age, a sex guide for older lovers (available at Amazon.com). “Men can’t go wrong giving a silk nightie or robe.”

• Buy more than one and invite her to model and choose. If you buy a few baby dolls, negligées, and/or robes in different colors and styles, imagine the fun you both can have at your own inti- mate fashion show. As she models each outfit, tell her why you selected it: “You look so hot in red.” “That semi-sheer bodice drives me wild.” “Those straps show off your neck so beautifully.” Then decide together which one(s) she’ll keep. Return the rest. Most lingerie shops and catalogs prohibit returns of panties, thongs, and G-strings, but allow returns of baby dolls, negligées, and robes.

And have a very lucky Valentine’s Day (or Birthday, etc).

Adam & Eve offers a wide selection of lingerie.

Great Sex Guidance: The Man’s Guide to Buying Lingerie for Women (Especially for Valentien's Day) – © Michael Castleman – 243 – Boobs! Men’s Complex Feelings About Women’s Breasts

An old joke tells of four women who interview for a job with a male boss. All four are clearly qualified, making the choice difficult. Who gets the job? The one with the largest breasts.

Men typically smile at the punch line, but women often cringe, feeling tyrannized by breast size the way many men feel oppressed by the size of something else—except that penises are usually hid- den, while women’s chests are routinely visible and clothing often draws the eye to them.

Personally, I’ve never understood men’s supposed preference for big boobs. In my relationships, the women’s breasts have ranged from small to large, and I never cared. When I found women who were smart, kind, and fun—and who could put up with me and were willing to remove their bras—I felt so grateful that I thoroughly enjoyed whatever fell out of them. To my way of thinking, when women are desirable, their breasts are a marvelous gift, no matter what their size.

The Conventional Wisdom: Men Prefer Large Breasts

But apparently, I’m in the minority. Two recent studies support the notion that men prefer big boobs:

French researchers fitted women with various size padded bras and then sent them to cafés where they sat alone. As bra size increased, so did the number of men who approached them.

New Zealand researchers used eye-tracking technology to assess how men view women with various size breasts. While small breasts attracted and held some men’s attention, most men gazed at the women with medium to large breasts. (Many women complain that men talk to their breasts, not to their faces.)

In addition, the bra industry supports the idea that bigger is better. Soon after the first modern bra

Great Sex Guidance: Boobs! Men’s Complex Feelings About Women’s Breasts – © Michael Castleman – 244 – design was patented n 1914—two handkerchiefs sewn together with straps made of ribbon—padded bras appeared to make women look larger. In 1948, Frederick Mellinger, founder of Frederick’s of Hol- lywood, introduced the push-up bra that made breast look even larger. And in 1994 the Wonderbra became a sensation. A refinement of the push-up concept that accented cleavage, Wonderbra in- creased sales of push-up bras from less than 3 percent of the market to 10 percent.

Finally, since 1990, the average American bra size has increased from 34B to 36C. Ditto for England. Part of the reason is breast augmentation. Surgeons now perform 317,000 boob jobs annually (vs. around 100,000 breast reductions). But more importantly, over the past few decades, women have gained weight. As weight increases, so does breast size, and with one-third of the adult population now considered overweight, many women’s breasts have grown heftier.

Plenty of Men Love Them Smaller

Meanwhile, flat-chested models dominate the fashion runways of Paris, Milan, and NewY ork. And because top models often wed celebrities, some of the world’s richest, most visible women are small of chest.

I googled “women’s breast size men’s preference,” and found several discussions. Participants were self-selected and not representative, but the comments were all over the map. A few said they could feel attracted only to women with a specific endowment. (The leading preference was large, followed by medium then small.) But like me, many men insisted that they when they fell in love with women, they fell in love with their breasts, whatever the size.

This dovetails with the visual evidence displayed in that major window into men’s erotic desires, pornography. Back in the days before the Internet, all the girls in Playboy had huge breasts because that’s what Hugh Hefner likes. But visit any of the zillion free porn-sampler sites (lobstertube.com, cliti. com, etc.) and you can view men enthusiastically having sex with women of every imaginable size from utterly flat to zeppelins.

Finally, English and Malaysian researchers showed full-body photos of women to 361 men, who rated their attractiveness. The women with large breasts were not considered the most attractive. The honor when to the women with medium-size endowment.

Breast Size and Evolutionary Psychology

Paleolithic cave art dating back 35,000 years portrays naked women with enormous hips and breasts. Perhaps that’s pre-historic porn, or maybe it has to do with reproductive fitness. Just as any size penis can cause a pregnancy, any size breast can swell with milk and nurture an infant. But evolution seems to have primed men to believe that women with larger breasts are a better reproductive bet.

Most breast tissue is fatty. Long before the contemporary obesity epidemic, when food was scarce and starvation a real threat, large breasts suggested ample fat reserves, which in turn suggested that the women had reliable access to food, which increased their offsprings’ (and men’s) chances of survival. English and Malaysian researchers showed photographs of women with varying breast size to 266 Malaysian men whose socioeconomic status ranged from poor to wealthy. Poor men showed a significantly greater preference for large breasts than middle-class men, who in turn were more likely to prefer larger breasts than the wealthy men who had plenty of resources and didn’t “need” women with substantial fat reserves. (This may explain why the wealthiest men often fall for skinny models.) Great Sex Guidance: Boobs! Men’s Complex Feelings About Women’s Breasts – © Michael Castleman – 245 – Then the researchers showed the photos to 66 Englishmen men who were hungry and 58 others who’d just eaten. Compared with the satiated men, those who felt hungry rated larger breasts signifi- cantly more attractive. Taken together, these studies suggest that resource security may play a role in men’s breast size preferences.

Breast Size and Sexism

Some evidence also suggests that oppressive attitudes toward women may play a role in men’s size preference. Recall the 361 Englishmen who considered women with medium-size breasts the most attractive. The researchers also asked them to complete a survey that explored their feelings about women in society. The most sexist showed a strong preference for large breasts, while the more egalitarian men preferred smaller breasts.

So do men really want women with big boobs? Many do, at least in fantasies, hence the joke about the woman who gets the job. But many prefer medium or small breasts, and many others don’t care. Turns out that men’s feelings about women’s breasts are more complex than the stereotype would have us believe.

References:

Dixson, B.J. et al. “Eye Tracking of Men’s Preferences for Female Breast Size and Areola Pigmenta- tion,” Archives of Sexual Behavior (2011) 40:51.

Gueguen, N. “Women’s Bust Size and Men’s Courtship Solicitation,” Body Image (2007) 4:386. Swami, V. and M.J. Tovee. “Resource Security Impacts Men’s Female Breast Size Preferences,” PloS One. (2013) 8:e57623.

Swami, V. and M.J. Tovee. “Men’s Oppressive Beliefs Predict Their Breast Size Preferences in Wom- en,” Archives of Sexual Behavior (2013) Feb. epub ahead of print.

Great Sex Guidance: Boobs! Men’s Complex Feelings About Women’s Breasts – © Michael Castleman – 246 – Healthy Lifestyle Preserves Sexual Function In Men Over 45

Erection pills come in handy—for men who need them and can use them safely. But there’s a down- side. America is a pill-loving culture, and as soon as a pill appears for any ill, many people think: That’s the way to go, the best way, the only way. When it comes to sexual function, that’s a mistake. While some men need erection medication, those who commit to a healthy lifestyle may be able to postpone, or even avoid drugs.

Not Just Age: Lifestyle Is Critical

Harvard researchers recently analyzed data on lifestyle and sexual function in a large group of men (31,742 men age 53 to 90) whose health and lifestyle have been carefully assessed every two years since 1986. The men’s risk of sexual difficulties (lack of desire, arousal difficulties, erection problems, orgasm/ejaculation impairment, and overall satisfaction) rose significantly with age, with one-third of the men reporting some erection impairment.

But erection difficulties were strongly correlated to smoking, heavy drinking, obesity, lack of exercise, and time spent watching TV.

If It’s Good for Health, It’s Good for Sex

Perhaps you’ve heard of “cross training,” the idea that any exercise helps performance in other forms of exercise. Sex is a form of exercise, albeit, a rather modest workout. But a body that’s in decent physical shape is better conditioned for sex than one that isn’t. So anything that’s good for health in general is good for sex.

Before you ask your doctor for a prescription for erection medication, embrace a healthy lifestyle and you might not need it:

Great Sex Guidance: Healthy Lifestyle Preserves Sexual Function In Men Over 45 – © Michael Castleman – 247 – * Don’t smoke. * Eat a low-fat diet: less meat, less whole-milk dairy, fewer rich desserts. * Eat more fruits and vegetables, at least five servings a day. * Get regular exercise, at least the equivalent of a half-hour walk a day. * Don’t have more than two alcoholic drinks a day. (A “drink” is one 12-ounce beer, one shot of 80-proof spirits, or five ounces of wine, a standard wine glass about half full).

The Nervous and Cardiovascular Systems

In both men and women, sexual response depends on the interaction of the nervous and cardiovas- cular (heart and circulatory) systems. Sexual stimuli trigger reactions in the nervous system that open the arteries in the genital area, allowing greater inflow of blood. In men, this produces erection. In women, it causes vaginal lubrication, the parting of the vaginal lips, and clitoral erection. If your ner- vous system is not functioning properly, the nerve impulses that trigger sexual response can’t do their job. Meanwhile, if your cardiovascular system is not functioning properly, the flow of extra blood into the genital area becomes impaired, and penile and clitoral erection and vaginal lubrication suffer. In other words, good sex depends on keeping your nervous and cardiovascular systems healthy.

Fight Free Radicals

Smoking and high-fat diet are hell on the cardiovascular system. They fill the bloodstream with harm- ful oxygen ions known as “free radicals.” Nasty free radicals injure the sensitive cells that line artery walls. Once the arterial lining becomes injured—which starts happening to most Americans in child- hood—the body mounts a defensive reaction, and the injury sites scab over.

But if large numbers of free radicals continue to circulate in the bloodstream—from continued smok- ing or a diet heavy on fast food and junk food—fatty, cholesterol-rich deposits known as “plaques” begin to collect around the tiny scabs covering arterial injury sites. Over time, these plaques grow larger in a process called “atherosclerosis.” After several decades, atherosclerotic plaques can grow large enough to partially block blood flow through affected arteries. When plaques severely narrow the arteries that nourish the heart, the result is heart disease: angina, heart attack, or congestive heart failure. In the brain, this process causes most strokes. And in the genitals, it can cause erection impairment in men, and loss of vaginal lubrication and clitoral sensitivity in women. Several studies show that compared with the general population, smokers have more sex problems and report less sexual satisfaction. Other studies show that as cholesterol levels increase, so does risk of erection impairment.

Help From Fruits and Vegetables

Fortunately, we’re by no means defenseless against the health-damaging, sex-killing onslaught of free radicals. The harm they cause can be largely prevented with certain nutrients, antioxidants, no- tably vitamins A, C, and E, and several minerals, notably selenium and zinc. (Vitamin A is actually a family of about 600 different compounds, all known as carotenoids, the best-known of which is beta- carotene.) Antioxidant supplements can help, but nutritionists and public health officials agree that the best way to get antioxidants is directly from foods rich in them: fruits, vegetables, beans, and whole grains. That’s why the American Heart Association and the National Cancer Institute urge Americans to eat at least five servings of fruits and vegetables every day. Many, many studies show that as fruit and vegetable consumption increases, risk of heart disease and every major cancer decreases. There have been no big studies of dietary antioxidants and sexual satisfaction, but the link is biologi- Great Sex Guidance: Healthy Lifestyle Preserves Sexual Function In Men Over 45 – © Michael Castleman – 248 – cally clear: The more antioxidants you consume, the less atherosclerosis you’re likely to have, which means better blood flow through your arteries, and move blood available to flow into your genitals when sexual stimuli cause arousal.

Quit Smoking

No one should smoke, and if you smoke, talk with your doctor about quitting. But studies show that even among smokers, those whose diets contain the most fruits and vegetables suffer the fewest smoking-related illnesses—less heart disease and less lung cancer.

Get Regular Exercise

Exercise also helps keep your cardiovascular system in shape. A study at UCLA showed that as people become more physically fit they also become more sexually active.They have more energy, including sexual energy, and they feel better about themselves, which makes them appear more at- tractive to others.

Fewer Pounds, Better Sex

The combination of regular exercise and a low-fat diet rich in antioxidants is also the foundation of successful weight-control programs. Many people who are heavy have very active and pleasurable sex lives. But studies at the Duke University Diet and Fitness Center have shown that as people lose weight and become more physically active, they usually report greater sexual interest and enjoyment. Again, weight loss typically produces more energy because you have less weight to carry around, and this includes more sexual energy.

A Leading Sex-Killer: Alcohol

The best way to keep your nerves in good condition for great sex is to steer clear of excess alcohol. As Shakespeare wrote in Macbeth, alcohol “provokes the desire, but takes away the performance.” Alcohol is a central nervous system depressant. One drink helps people relax and function socially. But beyond two drinks at one sitting, the nerves in your genitals get plastered and can’t function. Alco- hol is undoubtedly the world’s leading cause of sexual impairment.

Avoid Type-2 Diabetes

A less obvious cause of nerve damage that can interfere with sex is type 2 diabetes (what used to be called “adult onset,” the kind that usually does not require insulin injections). This disease is an epi- demic, affecting an estimated 20 million Americans. It is caused by the combination of obesity and a sedentary lifestyle. Diabetes often causes nerve damage—including damage to the nerves involved in sexual response and enjoyment.

Bottom line: If you spend a good deal of your free time munching on junk food while watching TV, you’re on a one-way ride to sexual impairment. But if you get off the sofa, take walks, and replace the chips and Big Macs with salads and fruit snacks, you’re on your way to not only becoming healthier, but also more sexually fulfilled.

Great Sex Guidance: Healthy Lifestyle Preserves Sexual Function In Men Over 45 – © Michael Castleman – 249 – References:

Bartolotti, A et al. “The Epidemiology of Erectile Dysfunction and Its Risk Factors,” International Jour- nal of Andrology (1997) 20:323.

Chung, WS et al. “Is Obesity an Underlying Factor in Erectile Dysfunction?” European Urology (1999) 36:68

Derby, CA et al. “Modifiable Risk Factors and Erectile Dysfunciton: Can Lifestyle Changes Modify Risk?” Urology (2000) 56:302.

Jancin, B. “Coronary Risk Factors Flag Future Erectile Woes,” Family Practice News, 9-1-2003.

Jensen, J et al. “The Prevalence and Etiology of Impotence in 101 Male Hypertensive Outpatients,” American Journal of Hypertension (1999) 12:271.

Johannes, CB et al. “Incidence of Erectile Dysfunction in Men 40 to 69 Years Old: Longitudinal Re- sults from the Massachusetts Male Aging Study,” Journal of Urology (2000) 163:460.

Kim, SC. “Hyperlipidemia and Erectile Dysfunction,” Asian Journal of Andrology (2000) 2:161.

Levin, S. “Does Exercise Enhance Sexuality?” The Physician and Sportsmedicine. March 1993, p. 199.

Mann, D. “Weight Loss Linked to Improved Sex Life,” Medical Tribune 5-12-1997.

Mannino, DM et al. “Cigarette Smoking: An Independent Risk Factor for Impotence?” American Jour- nal of Epidemiology (1994) 140:1003.

Spangler, JG et al. “Smoking, Hypertension, and Erectile Dysfunction,” Journal of Family Practice (2001) 50:73.

Wei, M et al. “Total Cholesterol and HDL Cholesterol as Important Predictors of Erectile Dysfunction,” American Journal of Epidemiology (1994) 140:930.

White, JR. et al. “Enhanced Sexual Behavior in Exercising Men,” Archives of Sexual Behavior (1990) 19:193.

Wuh, H. Sexual Fitness. Putnam, NY, 2001.

Great Sex Guidance: Healthy Lifestyle Preserves Sexual Function In Men Over 45 – © Michael Castleman – 250 – Men and Menopause: Helping Women Through the Transition

Menopause is not an illness, not a disease. It’s a life passage—a perfectly natural passage. It might be easy for the woman in your life. Or it might be difficult for her—and for you.The challenges of menopause vary from woman to woman. But if you would you like it to be as easy as possible for both of you, become better informed about menopause so you know what to expect and how to help.

A Recent Phenomenon

Medically speaking, menopause marks the end of a woman’s fertility. Her production of the female sex hormone, estrogen, gradually declines, and as it does, ovulation (egg release) and menstrual periods become less regular, and eventually cease.

Menopause is actually a fairly new phenomenon in human history, so we’re still learning about it. As recently as 1900, women’s life expectancy was around 48, so comparatively few experienced post- menopausal living. Today, women’s life expectancy is about 80, so most women live 30 years beyond menopause.

A Normal Life Passage

As women’s life expectancy increased, and menopause became common, medicine mistakenly con- sidered menopause as an illness, something that needed to be professionally treated. But in the last 25 years, women’s health activists have reclaimed menopause for what it really is—a normal life pas- sage into a new stage of life. In fact, for many women, menopause is the door into a promising new stage of life, one of productivity, wisdom, and increased personal fulfillment.

Takes Many Years

Mention menopause, and many men envision a brief period of time around women’s 50th birthday. Actually, menopause is a long, slow process that can take many years. It usually begins during a woman’s late 30’s as estrogen production in the ovaries begins to decline. During their 40’s, most women notice some menstrual changes—skipped periods, heavy periods, spotting between periods, periods lasting longer than seven days, or periods happening more frequently than every 21 days. After 45, most women notice the beginnings of the two major menopausal complaints: hot flashes and

Great Sex Guidance: Men and Menopause-Helping Women Through the Transition – © Michael Castleman – 251 – vaginal dryness, which become increasingly noticeable as they approach 50 and may last into the mid-50s.

Highly Individual

But these generalizations about menopause obscure the fact that women pass through it individually. About 20 percent of women experience no physical changes other a gradual cessation of menstrua- tion. About half of women notice mild discomforts. And some 30 percent experience considerable distress.

The Top Three Discomforts

* Hot Flashes. These sudden feelings of heat occur without warning and last from 30 seconds to five minutes. Usually, the face, neck, and chest are the areas most affected. Hot flashes often cause significant perspiration. They can strike during the day or at night. At night, they often dis- rupt sleep, and cause women to kick the covers off. The discomfort caused by hot flashes ranges from mild to severe. Noticeably uncomfortable hot flashes typically last for a year or two, though some women experience them for several years. The cause of hot flashes remains unclear, but it appears that the estrogen decline disrupts the body’s temperature-control center in the brain.

* Vaginal Dryness Causing Irritation and Pain on Intercourse. As estrogen declines, the mucous membrane that lines the vagina thins and women produce less natural vaginal lubrication. This often causes discomfort during intercourse, and may also cause irritation in everyday nonsexual situations.

* Emotional Upsets. The myth is that women become irritable during menopause. The truth is that emotional reactions vary tremendously. Some women experience no noticeable mood changes, while others become depressed, nervous, and irritable, with the possibility of insomnia as well. There’s no way to predict which women will experience menopausal emotional changes. But a history of significant premenstrual syndrome (PMS) or post-partum depression (PPD) suggest increased risk. Both PMS and PPD are emotional reactions to hormonal changes—and so are the emotional upsets of menopause.

Then there’s “surgical” or “chemical” menopause, sudden loss of estrogen production because of sur- gical removal of the ovaries (during hysterectomy or treatment of ovarian cancer), or chemotherapy (usually for breast cancer). Compared with gradual, natural, menopause surgical and chemical meno- pause tend to cause moderate-to-severe discomforts because they occur suddenly and all at once.

Because menopause varies so greatly among women, men need to inquire about it to understand how it affects the woman in your life. Ongoing communication not only provides valuable information, but it also shows that you care, that you’re thinking about your spouse and your relationship. Discus- sions of menopause can deepen your couple intimacy at a time when many women feel a need for reassurance that they are valued and loved.

Ask About It

Don’t wait for her to announce: “I’m having a hot flash.” If she’s over 40, raise the issue periodically. Let her know that you’re interested. Ask her to keep you informed of her passage through menopause and her feelings about it as the process unfolds. Great Sex Guidance: Men and Menopause-Helping Women Through the Transition – © Michael Castleman – 252 – Listen To Her

Be emotionally available for her. If she doesn’t experience significant menopausal discomforts, she may not have much to say. But if she does, she may need to discuss things during her menopausal years, repeatedly and at length. Invest your time and energy in listening to her experiences and feel- ings. Menopause marks a significant personal change, and as such, it means a change in your rela- tionship. Be ready for it. Be there for her.

Gently Correct Her Misconceptions

This brief discussion doesn’t make men experts on menopause. But men aren’t the only ones in the dark about this passage. Many women are more familiar with menopause mythology than with the facts. Just because a woman’s friends have had a rough passage doesn’t mean that she will. You might suggest—or better yet, buy—a book for your spouse that contains good information, for exam- ple Women’s Bodies, Women’s Wisdom by Christiane Northrup, M.D., (Bantam, NY, 1998, $24.95), which contains an excellent discussion of menopause, including both mainstream and alternative approaches to dealing with it.

Dealing With Hot Flashes

Until a few years ago, many doctors automatically prescribed hormone replacement therapy (HRT) for hot flashes. It works, but it’s also problematic (see below). Fortunately, there are several other helpful treatments men:

* Diet. In China and Japan, few women experience hot flashes. The reason? Their diet is rich in soy foods, notably tofu. Tofu and other soy items (but not soy sauce) contain plant estrogens (phy- toestrogens, specifically isoflavones), weak versions of human estrogen.They may be weak, but in the body, they act like estrogen. Many studies show that soy foods help relieve hot flashes. For example: Italian researchers gave 104 menopausal women either 60 g of soy powder or the same amount of a placebo, and asked them to keep diaries of their menopausal symptoms. After three months, those taking the soy reported significantly fewer hot flashes. Men can encourage women to try soy foods. Men can also signal a willingness to eat them. Tofu itself is bland and tasteless, but it quickly acquires the flavor of anything cooked with it. Add it to soup, pasta sauces, or cas- seroles—just about anything.

Men might also signal a willingness to eat less meat. Andrew Weil, M.D., a professor of medicine at the University of Arizona, notes that vegetarians “often glide through menopause with little dis- comfort.” That’s because, in addition to soy, many other plant foods also contain phytoestrogens, among them: peanuts, cashews, almonds, wheat, corn, oats, apples, green beans, garbanzos, and carrots. You don’t have to become a strict vegetarian. But the woman in your life may benefit if you signal a willingness to eat less meat and include a few more meatless meals in your menu plan each week. You might begin by replacing one meat meal a week with a hearty vegetable- bean soup.

* Supplements. Studies since the 1940’s have shown that vitamin E helps relieve menopausal complaints. “Women in my practice have had excellent results using vitamin E to treat hot flash- es,” says Shari Lieberman, Ph.D., a clinical nutritionist in New York City. Dr. Lieberman recom-

Great Sex Guidance: Men and Menopause-Helping Women Through the Transition – © Michael Castleman – 253 – mends 800 IU of vitamin E a day. (Vitamin E also reduces risk of heart disease, the leading killer of postmenopausal women.) Men can encourage women to take this vitamin.

* Relaxation Therapies. Stress makes any discomfort more annoying. It also makes hot flashes feel hotter. Several studies show that deep relaxation cools hot flashes. At Harvard’s Mind-Body Medical Institute, researchers led by Judy Irvin, Ph.D. asked 33 menopausal women to record the intensity of their hot flashes. Then the women were divided into three groups. One did nothing extra. Another engaged in recreational reading. The third listened to relaxing visualization audio- tapes daily. After seven weeks, only the women in the relaxation-tape group noted any decrease in hot-flash intensity.

Men can encourage women to incorporate a relaxation program into their lives.

* Exercise. The more a woman sweats, the fewer hot flashes she’s likely to experience. Re- searchers at the University of Newcastle, in Australia, surveyed 220 women over age 40 about their health, moods, and lifestyle. Some exercised regularly; others did not. The more the women exercised, the less likely they were to feel bothered by menopausal hot flashes, night sweats, and mood swings. The researchers expected exercise to help only those who were not taking hor- mone replacement therapy. In fact, even those on hormones said regular exercise helped ease their passage through menopause. A Swedish study came up with the same findings. The re- searchers surveyed 900 women about their menopausal symptoms and exercise habits. As exer- cise increased, menopausal symptoms decreased. Women who exercised at least a half hour a day generally reported the fewest, mildest hot flashes.

Men can help by encouraging women to take the time to exercise several times a week. Better yet, exercise with the woman in your life: Take walks together. Go for bike rides. Swim. Take a yoga class. Join a gym. (Exercise also helps prevent osteoporosis and heart disease, which be- come major health issues for women after menopause.)

* Herbal Medicine. A Native American herb, black cohosh (Cimicifuga racemosa), helps relieve hot flashes. This herb contains phytoestrogens, so it’s a natural alternative to hormone replacement. In Germany, where herbal medicine is considerably more mainstream than it is in the U.S., a black cohosh extract, Remifemin, is very popular. Several studies show that Remifemin compares favorably with conventional hormone therapy. Remifemin is available in many health food stores. Follow the label directions. Or buy tincture of black cohosh and follow the package directions. If the woman in your life is unfamiliar with Remifemin or black cohosh, you might offer to buy one or both for her.

Dealing With Vaginal Dryness

If you don’t already use a sexual lubricant, start now. Lubricants substitute for lost natural vaginal lubrication and usually eliminate menopausal women’s discomfort during intercourse. Saliva is rarely enough. Many menopausal women simply cannot enjoy intercourse without a commercial lubricant. If you object to lubricants as “artificial” or “an interruption,” you would do well to reconsider. For meno- pausal women—and this can mean women over 40—lubricants often mean the difference between enjoying intercourse and not. Sexual lubricants are available over the counter at pharmacies.

In addition, the phytoestrogens mentioned above—soy, other plant foods, and black cohosh also help

Great Sex Guidance: Men and Menopause-Helping Women Through the Transition – © Michael Castleman – 254 – replace lost estrogen and preserve natural vaginal lubrication.

Adam and Eve offers a wide selection of lubricants.

Dealing With Emotional Upsets

A T-shirt proclaims: “I’m Menopausal. Watch Out.” For some women, menopause involves significant irritability and blues. Others notice few, if any, emotional upsets. Many women find that the diet, ex- ercise, and relaxation approaches to hot flashes also help them minimize mood swings. A kind man with patience also helps

Dealing With Changes in Sexual Interest

The myth is that as menopause progresses, women lose interest in sex. For some women, this is the case. However, other women notice an increase in sexual interest, especially if they leave unsatisfy- ing relationships and embark on new ones. Surveys show that the majority of women experience a decline in libido, but continue to be interested in affirming their relationships through lovemaking. Men involved with women who experience decreased libido during menopause may have to adjust to a situation they don’t care for. You may have to renegotiate your sexual frequency. See the article: “You Never Want To.” “You’re Insatiable.” Overcoming Desire Differences.

Contraception

One nice thing about menopause is that it marks the end of the need for birth control. But don’t rush this. Even though a woman has periods infrequently, if she still has them, she’s still ovulating, and might become pregnant. Keep using birth control until she hasn’t had a menstrual period for several months.

HRT Issues

The most controversial aspect of menopause is hormone replacement therapy (HRT). Space here does not permit an exhaustive discussion, but briefly, HRT involves trade-offs: prevention of meno- pausal discomforts, but increased risk of breast cancer. For many years, physicans believed the increased breast cancer risk was offset by a reduction in risk of heart disease, which kills many more women than breast cancer. But according to the latest research, HRT may not help prevent heart disease.

There is no blanket advice about HRT. Each woman must choose for herself in consultation with her physician based on her own personal and family medical history. Currently in the U.S., a significant majority of menopausal women do not take HRT.

HRT raises very confusing issues, issues many women feel a need to consider over time and discuss at length. Invite the woman in your life to use you as a sounding board. Be willing to discuss HRT— not just once, but several times as she weighs the pros and cons. Remind her that she can always change her mind later—stop it if she doesn’t like it, or start it if she wishes.

If a woman opts for HRT, she’ll get better results if she also incorporates the other suggestions in this article into her life.

Great Sex Guidance: Men and Menopause-Helping Women Through the Transition – © Michael Castleman – 255 – The Promise of Greater Intimacy

Bottom line: When men are willing to focus on issues raised by menopause, discuss them, and be there for the woman, the couple is more likely to emerge from this life passage feeling close, content, and more intimate.

Great Sex Guidance: Men and Menopause-Helping Women Through the Transition – © Michael Castleman – 256 – Older Men Become Sexually More Like Women

All the press about the sexuality of older men focuses on erection problems, and the drugs now avail- able to treat them. But another equally important issue has received almost no attention—the prob- lems men over 40 have becoming sexually aroused in the first place.

Most Young Men: Instant Arousal

An old joke asks: What single word can a woman say to sexually arouse a man? Answer: Hello. This joke needs to be revised. The question should specify young men, those under 40 or so. From the teen years into the forties, arousal is not an issue for most men. Many men feel almost perpetually aroused, and a sexual thought or the sight of an attractive woman or an erotic image is all it takes to start developing an erection.

Most Young Women: Arousal Takes Time and Effort

While instant arousal is the rule for young men, the same cannot be said for young women. Many young women complain that they have difficulty becoming aroused. When they say this, most men, especially young men, have no idea what they’re talking about. Trouble getting turned on? How can that be? I’m aroused most of the time.

As time passes, as young women become more comfortable with sex and who they are sexually, they learn what turns them on, and arousal problems usually subside (but remain an issue for quite a few). Many women over 30 continue to talk about the “work” involved in sex, the “effort” it takes to become aroused enough to enjoy sex and express orgasm.

What does this effort involve? Women say they must consciously clear their minds of distractions and focus on fantasies that turn them on. They also say they need considerable leisurely, playful, whole- body massage—often with sex toys—to feel warmed enough to enjoy genital play and full arousal. Again, until men are in their 40s, they find this hard to believe. orkW to get turned on? You must be kidding. It’s no work at all. This attitude is part of the reason why some men resist women’s requests for extended whole-body sensuality before genital play. Many women absolutely require this to be- come aroused. But it makes no sense to young men, for whom sexual arousal is effortless.

Great Sex Guidance: Older Men Become Sexually More Like Women – © Michael Castleman – 257 – Older Men: Arousal Takes Time and Effort

After around 40, men’s sexuality changes. Testosterone production gradually falls, so men’s sex drive becomes tempered. They mellow. They don’t feel the same urgent need for sex that they experienced in their twenties. This change requires a major adjustment. But it also creates an opportunity to ex- plore sex that’s less preoccupied with the genitals. Some men focus on what they’ve lost—perpetual arousal, reliable erections, and the primacy of intercourse. But others focus on what they can gain, pleasure that expands from the genitals to the whole body.

As men grow older, they can still become aroused, but things are not like they once were. For some men, arousal changes begin as early as 40, for others, the late forties, for others around fifty, for a few, later. For some, the process is gradual, for others, more sudden. But whenever and however it happens, at a certain point, men over 40 realize that sexual arousal, something they took for granted for so long, is no longer automatic. Now it takes concentration, effort.

As arousal becomes an issue, many men find that it takes longer to raise erections during masturba- tion. It can take even longer during partner sex and sometimes it might not happen. In addition, all of a sudden, minor distractions that would have had no sexual effect a decade or two earlier—a loud motorcycle roaring up the street, thoughts of job tasks, etc.—now weaken arousal and lead to erec- tion wilting, even in the presence of a naked woman whom the man loves, feels excited by, and who responds enthusiastically to lovemaking.

As older men develop arousal difficulties, the change can feel immensely disconcerting.After de- cades of becoming effortlessly aroused—often with women criticizing how horny they are all the time—instant arousal and taken-for-granted sexual function become things of the past. Hence an old saying: What young men want to do all night takes older men all night to do.

Why? No one really knows, but evolutionary biology offers a plausible explanation. The biological purpose of life is to reproduce life. Early humans were not long-lived. Our prehistoric ancestors were elders at 40 and ancient if they survived to 50. In other words, men evolved to function well sexu- ally only until what today is considered early middle age. Modern nutrition and medicine have almost doubled the human lifespan of 100,000 years ago. They have also extended the duration of sexual function. But even robustly healthy 50 year olds no longer have a nervous system that’s as easily sexually excitable as it was in their 20s. That’s just how it is.

Erection Drugs Don’t Help with Arousal

Most men equate arousal with erection. If I’m aroused, I get hard. If I get hard, I must be aroused. As a result, when arousal becomes an issue, many men’s first thought is: I must have an erection prob- lem. Given the equation between arousal and erection in most men’s minds, and the publicity about erection medications, this is a reasonable conclusion. So they get a prescription. But the market for erection medications has fallen far short of what was once predicted. Only half of men who get a pre- scription for erection drugs refill it, and most men don’t get a first prescription.

Why? Largely because erection medications have been over-hyped. They just don’t work as well as many men imagine they will. While erection drugs coax a statistically significant amount of extra blood into the penis, they do not produce the rock-hard erections men recall from their youth, or see in pornography. As a result, despite Viagra, Cialis, and Levitra, many men continue to experience less

Great Sex Guidance: Older Men Become Sexually More Like Women – © Michael Castleman – 258 – firmness, less ability to raise erections, and greater likelihood of erections wilting because of minor distractions.

While these issues relate to erection, they have as much to do with arousal. But erection drugs have no effect on arousal. None. All they do is increase blood flow into the penis. They are not aphrodi- siacs. But many men think they are. When men try erection drugs but find it no easier to become aroused, they feel disappointed (or disgusted), and don’t refill their prescriptions. Some withdraw from lovemaking altogether, convinced that they’re sexually all washed up.

There is no research estimating the proportion of older men who give up on sex when arousal stops being automatic. But a review of Web sites with sex Q&A’s reveals that many older women voice a complaint that is by no means rare, variations on: “My boyfriend/husband is over 40. He used to want sex all the time. But now he hardly wants it at all. What’s wrong with me?” Women often blame them- selves when their man turns off to sex. But for older men, the reason often has less to do with the woman than with the man’s arousal problems—and lack of experience in the effort it takes to become aroused.

How Men Over 40 Become Sexually More Like Women

If erection drugs don’t increase arousal, what does? The same things that allow women to become aroused: consciously clearing their minds of distractions, focusing on fantasies that turn them on, and lots of leisurely, playful, whole-body massage before genital play. The same approaches also help older men.

As men age, men’s and women’s sexual sensibilities converge. Men become sexually more like women. They need more time to become aroused, and as erection and intercourse become more problematic or impossible, whole-body sensuality becomes more attractive. Compared with young lovers, older couples are more sexually in synch. Couples who appreciate this can enjoy richer, more fulfilling sex at 65 than they had at 25.

Clearing the Mind. This is not easy for anyone. The mind has a way of remaining active with all sorts of unpredictable—and not-sexy—thoughts. To become sexually aroused, it’s not necessary for older men to totally empty their minds. Stray thoughts always intrude. But it helps to take conscious steps out of your daily life and into the realm of eroticism. This takes effort, but without it, older men have difficulty becoming aroused.

* Minimize distractions. * Relax. * Take a shower either solo if you’re masturbating, or with your lover. * Set an erotic mood with soft lighting, perhaps candles, soft music, and if you’re with a lover, lots of kissing and cuddling.

These are the kinds of approaches women often enjoy, and young men sometimes deride as unnec- essary. But they are necessary for many, if not most women. They also become necessary for older men.

Focus on Hot Fantasies. Are you still running through the same old fantasies you used years ago? If so, chances are they’re stale. Dream up some new ones. This also takes effort, but without fresh, hot fantasies, it’s often difficult for older men to become aroused. Depicting new fantasies is one of Great Sex Guidance: Older Men Become Sexually More Like Women – © Michael Castleman – 259 – the functions of pornography. The conventional wisdom is that men use porn as a masturbation aid. That’s true. But it’s also an arousal aid, a source of new fantasies.

Whole-Body Sensuality. According to leading sex therapists, leisurely, playful, massage-inspired, whole-body touch is a fundamental prerequisite for good sex. Many women absolutely need it to be- come aroused. Many young men wonder why. They find out after 40. Like women, older men require whole-body sensuality to become sexually aroused.

In other words, older men become sexually more like women. The transition is often disconcerting, in- deed, painful for many men. Change is never easy, particularly when the changes involve men having work at becoming sexually aroused. But the effort allows men to enjoy lovemaking into old age, even as erection capacity declines. And it brings older men and women closer together. As men’s arousal patterns become more similar to women’s, lovers are more likely to enjoy sharing whole-body sensual pleasure.

Great Sex Guidance: Older Men Become Sexually More Like Women – © Michael Castleman – 260 – Extended Bicycling: Hazardous To Erections

Exercise is good for sex. Regular exercisers report fewer sex problems and more enjoyment of love- making. But the latest research suggests that extended cycling—more than three hours a week on a standard bike seat—can cause erection impairment. Fortunately, men who love to ride can still enjoy their sport without erection problems—if they’re careful about how they sit on their bikes.

Pedaling to Erection Impairment

As early as the fourth century B.C., Hippocrates speculated that long-duration horseback riding might cause erection problems. His observation was largely forgotten—until case reports began popping up of erection problems in healthy young men who had no risk factors—except a devotion to bicycle riding.

Subsequent studies suggested an unusually high risk of erection problems in long-distance bicycle racers. Danish researchers surveyed 800 bicycle racers. More than 300 of these healthy young men (38 percent) reported difficulty raising erections for a few days after races.

Researchers involved in the Massachusetts Male Aging Study investigated bicycling and erection dysfunction among the study’s 1,709 participants. Riding less than three hours a week was not as- sociated with erection difficulties. In fact, occasional or short-duration riding significantly reduced risk of erection problems. However, bicycling more than three hours a week raised risk 72 percent above average in all age groups.

Why Bicycling Raises Risk of Erection Impairment

When you sit, you bear your weight on the bones of you buttocks (the ischial tuberosities or “sit bones”), which have no nerves, arteries, or organs attached to them. But most bicycle saddles are too narrow to reach the sit bones. As a result, most cyclists bear their weight on the area between the sit bones, the perineum, the line of soft tissue between the scrotum and anus. Sit on the perineum long enough, and you risk erection problems.

The good news is that your penis is actually twice as long as you think it is. The bad news is that half of it resides deep within your pelvis. Like the roots of a tree, the internal penis gives the penis struc- tural stability so erections don’t buckle as they enter erotic openings. The internal penis also contains

Great Sex Guidance: Extended Cycling- Hazardous To Erections – © Michael Castleman – 261 – nerves and arteries involved in erection. Straddling a narrow bicycle seat compresses these nerves and the arteries that supply blood to the penis. Nerve compression may produce numbness of the ex- ternal penis. Arterial compression may limit blood flow into the organ. Either or both can compromise erections. Recent studies show that standard long narrow bike saddles reduce blood and oxygen flow to the penis by about 70 percent within a few minutes.

Worse yet, over time, compression of the arteries that run through the perineum can actually injure them, causing the development of deposits (plaques) that narrow them, limiting blood flow. Elite bicy- clists have few plaques in their other arteries, but often have significant plaque formation in the arter- ies of the perineum. Localized plaques may also result from arterial injury that occurs when men slip off the pedals and fall on to bicycle seats or crossbars.

Studies to date show that men who ride less than three hours a week are unlikely to develop persis- tent numbness of the penis, localized plaques, or erection difficulties. But men who ride longer are at considerable risk. “There are only two kinds of long-distance male cyclists,” says Boston urologist Ir- win Goldstein, who has researched the link between riding and sex problems, “those who have erec- tion problems, and those who will have them.”

The first sign of trouble is numbness or tingling after riding. These sensations indicate that blood flow and nerve conduction to the penis have been compromised.

Better Bike Seats

Since the link between narrow bike seats and erection problems came to light, the bicycling industry has been pedaling furiously to develop seats that don’t cause this problem. But fancy split seats or saddles with holes in the center may not be any better than traditional bike seats. The key is to take weight off the perineum and sit on the sit bones. The key to accomplishing this is to sit on a wide bike seat. These seats may not look sexy, but they’re the best way to preserve sexual function.

In addition, tilt your seat down and your handlebars up. That way you sit in an upright position instead of leaning forward, which compresses the nerves and arteries of the internal penis. It also helps to ride standing from time to time.

So far, all the research on this issue has focused on men. However, the female perineum contains the same arteries and nerves, and narrow bike saddles can be presumed to have the same effects: numbness, reduced blood flow and nerve conduction to the clitoris, and problems with sexual func- tion.

References:

Blakeslee, S. “Serious Riders, Your Bicycle Seat May Affect Your Love Life,” New York Times, 10-4- 2005.

Deutsch, G. “Guarding Your Gearshift,” Men’s Fitness, 8-1996.

Goldstein, I. “Erectile Dysfunction and Bicycling,” Focus on Sexual Health Medicine, Winter-Spring 2002.

Great Sex Guidance: Extended Cycling- Hazardous To Erections – © Michael Castleman – 262 – Marceau, L et al. “Does Bicycling Contribute to Risk of Erectile Dysfunction? Results from the Massa- chusetts Male Aging Study,” International Journal of Impotence Research (2001) 13:298.

Randrup, E and N Baum. “Bicycle Riding as a Cause of Erectile Dysfunction,” Medical Aspects of Hu- man Sexuality, 11-2000, p. 23.

Great Sex Guidance: Extended Cycling- Hazardous To Erections – © Michael Castleman – 263 – Middle-Aged Virgin Men - Overcoming The Secret Shame

Roger Andrews, of Fort Lauderdale, Florida, is 49 and has never had a sexual relationship with any- one except himself. In fact, he’s had intercourse just once—at age 48 with a surrogate partner he engaged to help him, in his words, “get over his terrible handicap and join the world.”

To look at Andrews you’d never imagine his dreadful secret, or the deep shame he has suffered be- cause of it. He’s an attractive man: light complexion, thinning blond hair, strong chin. He’s a success- ful computer engineer. He has friendly dealings with coworkers and clients. He’s smart, articulate, and insightful, especially about the issue that makes him “a freak.” He’s a jazz drummer, and he showed enough acting talent in college to consider a theater career. He’s well traveled, and has scuba dived all over the Caribbean. But he’s always been painfully shy, and never learned how to have an intimate relationship. “I never grew up in that way.”

Andrews is not alone. No studies have estimated the prevalence of virginity over age 30, but many of the nation’s sex therapists report a small, steady stream of older-virgin clients. During 23 years in practice, psychologist David Johnston, Ph.D., of San Jose, California, says he’s counseled 50 middle- aged virgins, collaborating with various surrogate partners. “One was 72. A few have been women. But the vast majority have been men in their thirties or forties.”

Fair Oaks, California, sex therapist Louanne Weston, Ph.D., in practice 20 years, has teamed up with surrogates to treat approximately 40 older virgins, all men. “There are more older virgins out there than people imagine. Many are tech guys. They’re often charming, but they tend to be nerdy, so women don’t go after them. They don’t feel socially adept enough to handle the challenges of the dating scene.”

Los Angeles surrogate partner Vena Blanchard, Ph.D., president of the International Professional Surrogates Association (IPSA, surrogatetherapy.org), says older virgins account for 50 percent of her practice. Like other legitimate, i.e. non-prostitute surrogates, Blanchard works only with men referred by psychotherapists. “Some live in Southern California. They see me and their therapist weekly. Oth- ers live elsewhere and come to Southern California for two weeks of intensive therapy, seeing me ev- ery morning and the therapist every afternoon. Most are Americans, but I’ve had clients from Canada, the UK, India, China, and Australia. It’s a real commitment for them: air fare, a hotel room and food for two weeks, a rental car, my fee, and the therapist’s fee. Intensive therapy can run $10,000. But they

Great Sex Guidance: Middle-Aged Virgins- Overcoming The Secret Shame – © Michael Castleman – 264 – do it because they’re tired of feeling stuck in their lives. They’re determined not to be alone for the rest of their lives.”

It’s not clear if older virgins are disproportionately men, but it’s the men who seek therapy. “It’s pos- sible that there are as many older virgin women,” Weston explains. “But men generally have more insistent libidos. It’s the men who eventually decide to do something about it.”

Johnston says that in the last few years, he’s seen an uptick in the number of middle-aged virgins seeking therapy. The reason, he says, is the World Wide Web. “Before the Internet, older virgins were isolated. Now they can go to sex information sites, and hear about surrogates. They search ‘surrogate partners,’ find IPSA, and through the organization, find a surrogate and psychotherapists who work with surrogates.

That’s how Andrews found Blanchard. He’s still painfully shy, and consented to be interviewed only under a pseudonym. But he says he feels “a mission” to publicize the plight of older virgins to encour- age them to get the kind of help he received.

****

Except for his college years, Roger Andrews has lived in Fort Lauderdale his entire life. He recalls his childhood as a happy time, with a warm, nurturing mother compensating for a cold, distant father. As a boy, Andrews was no loner. He had male friends. But around girls, he was always painfully shy. “My first relationship with a girl, in junior high, went very wrong. eW liked each other, and went out a few times. But I felt totally inept. I didn’t know what to say or do. So I stopped seeing her, cut her off. I couldn’t tell her why. She was hurt, and cried. I felt awful.”

Andrews’ experience describes many people’s adolescent relationship fumblings. But instead of soldiering on and learning interpersonal skills by painful trial and error, he became socially paralyzed. “I shut myself off. I can’t really explain why, except to say I was very shy. I was keenly interested in women, but I felt intimidated by them. I had no idea how to get beyond casual friendships to anything romantic. And I haven’t improved much to this day. The teen years—that’s when you should begin to experience intimacy, not just sex, but the ability to feel close to potential lovers. That part of me got stuck at 12 years old—and here I am, 49, still trying to figure out how to grow up.”

“Every older virgin has a unique story,” Johnston explains. “They run the gamut from terrible shyness to emotionally barren families to sexual abuse. But all older virgins feel terrible shame. They feel em- barrassed and humiliated by their lack of relationship experience.”

Age 30 is a line of demarcation. “By 30,” Blanchard explains, “older virgins feel so socially awkward and ‘out of synch’ with the world around them that they choose to hide.”

Andrews hid. Throughout his teens, on Saturday nights, he stayed home. His parents noticed. To en- courage him socially, his father pushed him to play a musical instrument. He picked drums and gravi- tated to jazz. “I was into Bill Evans, Wes Montgomery, Chick Corea. I was in a decent garage band. We played weddings, and I played in theatrical orchestras for musicals.”

Andrews’ work in musicals led to an interest in acting. In college at a university in the South, he be- came involved in theater. “I was a good actor. Every spring, the theater faculty voted for awards like Great Sex Guidance: Middle-Aged Virgins- Overcoming The Secret Shame – © Michael Castleman – 265 – the Tonys. I won Best Actor my junior and senior year.”

How does a guy who’s painfully shy stand up in front of an audience and act? “It was surprisingly easy,” Andrews explains. “You have a script. You have lines and you say them. You don’t know if you’ll get the laughs you want, but you know you’ll get the girl because it’s in the script. My shyness was never a problem on stage, just in real-life where there is no script.”

Friends invited him to parties, but he never attended. After a while, they stopped asking. “I became skilled at pushing people away. I don’t think anyone ever tried to fix me up. I wouldn’t let them. I think they thought I was gay.” But he knew he wasn’t. At one point, he tried a dating service, but that went nowhere. “I just didn’t have the social skills for dating, and the older I got, the more different I felt from everyone else, the more handicapped.”

Living in near isolation, Andrews found solace in computers. It was the mid-1970s. He became a hob- byist like the young techies who invented PCs. After college, he wanted to work in a field that provid- ed steadier employment than music or theatre. His computer skills and family connections landed him a job with a data management company. “The work wasn’t difficult. The hard part was dealing with customers. But I needed the paycheck. I used the phone a lot. It was easier than face-to-face con- tact. When I had to meet people, I forced myself.” Coworkers and clients invited him out for lunch or drinks, but Andrews declined. “I couldn’t shift from technical topics to social conversation, so I never socialized. I couldn’t. After work, I just went home and spent my free time by myself, except for the one night a week I had dinner with my parents.”

In his solitude, Andrews developed what he calls his “evening ritual.” He drank a beer while smoking cigarettes and cooking himself a nice dinner. Then he downed more beers and smoked more while watching the TV news, followed by cooking shows or tech programs on cable. He ended his evenings polishing off what became a daily six-pack while smoking, watching movie videos, or reading best- sellers: Grisham, Clancy, King. “My ritual wasn’t just about killing time and getting drunk. It was really a substitute for human relationships. It was comforting. I didn’t feel lonely. I could have gone on like this for the rest of my life—except that I want to have a meaningful relationship with a woman.”

Andrews found many women attractive. With some, he was able to overcome his shyness, and initi- ate casual conversations, but nothing more. The only woman he saw over time was the girlfriend of a close friend. “But she was unattainable, therefore she was safe.” He also kept a diary. “It was filled with agony and despair over my social ineptitude.”

Some men in Andrews’ position might opt for prostitutes. He never did. “It crossed my mind, of course. A few times I even went through the phone book looking for escort services. But I knew my problem wasn’t just a lack of sex. Hell, I could masturbate, and often did. The problem was—and is— my inability to develop an intimate human relationship. You don’t get that from a prostitute, so I wasn’t interested.”

As the years passed Andrews became “obsessed with the intimacy and sex I was missing.” By age 31, he realized that he would never find intimacy on his own, that he needed professional help. “I pulled out the phone book, looked up psychiatrists, and called one at random.” He’s been in therapy for most of the past 18 years.

Andrews’ psychiatrist prescribed anti-anxiety medication and an antidepressant. But he wanted more than drugs, so he contacted a clinical psychologist, who urged him into group therapy to deal with his Great Sex Guidance: Middle-Aged Virgins- Overcoming The Secret Shame – © Michael Castleman – 266 – shyness. “I hated the group. I didn’t want to talk. I was too shy and clammed up.” The group quickly learned that his issue was profound shyness, especially around dating, and reassured him that it’s challenging for everyone. “They seemed to think that their reassurances would allow me to step out and date. No way. I just couldn’t.” At one point, a man in the group confessed sexual frustration and said he might go to California and have sex with a surrogate. (Most surrogates work in California be- cause it’s unambiguously legal there. But some surrogates work in other states.) Andrews had never heard of surrogates. Soon after, he left the group, and opted for individual psychotherapy. He’s been with his current therapist, a woman, for six years. He likes her, and feels she’s helping him. But he still wasn’t dating. He was still a virgin.

Eventually, Andrews recalled the man in his therapy group who had mentioned surrogates. On a whim, he did an Internet search. “I got tons of porno, and then I noticed IPSA.” He emailed the or- ganization, and heard back from Blanchard, now in her mid-40s who’s been a surrogate for more than 20 years. She provided a phone number and invited Andrews to call. He learned several things: that she was not a prostitute but an intimacy coach and therapist, that surrogates don’t always have intercourse with clients, that what they do is introduce clients to loving touch and relationship skills. Blanchard said she would send him an application, and asked for a $200 good-faith deposit, which would be applied to her fee. “The deposit discourages frivolous inquiries,” she explains. Andrews agreed.

The application asked why Andrews wanted to work with a surrogate. He replied: “I feel alone and anxious because I haven’t had any intimate, sexual relationships.” It asked for his treatment goals. He listed seven: “(1) To learn to touch and be touched to fulfill my yearning for physical contact. (2) To feel better about myself because I’ve had sexual experience. (3) To increase my chances of relation- ships with women. (4) To end my confusion about the appropriate place for sex in relationships. (5) To satisfy my burning curiosity about women’s bodies. (6) To better understand my own body and feel- ings. (7) To find out what the ‘joy of sex’ is all about.”

Blanchard presented Andrews with options for surrogate partner therapy: He could involve his local therapist and bring a surrogate to his area, or he could travel to California to work with a therapist and surrogate team there. He wanted to stay in Fort Lauderdale so his therapist could be involved. Blanchard was willing to come East, but before that, she wanted to talk with his therapist.

Andrews’ therapist was very skeptical. “She kept saying, ‘This can’t be legal. It’s prostitution. I could lose my license.’” Andrews urged her to read an Internet interview with Blanchard (www.sexuality. org...Vena Blanchard interview), and to call her. The therapist balked. Finally, Andrews said, “Your license is safe if I see a prostitute and tell you about it. What’s wrong with seeing a surrogate and telling you about it? I want to work with you on this, but if you won’t work with me, I’ll go to California and see a therapist there.” His therapist relented (and has since become a big supporter of surrogate therapy for older virgins).

Frequently, however, it’s the psychotherapist who suggests surrogate therapy to older virgins. Weston has arranged for several middle-aged virgin clients to see surrogates. “The surrogates I work with rely on me to screen the guys, to make sure they’re safe and not crazy.”

Before embarking on surrogate therapy, however, there was one thing Andrews felt he had to do— tell his parents. “We’re close—and not close. It’s like a business relationship, which might explain why I’m good at business relationships, but no good at intimate ones. I told my parents I was taking a two-week vacation to do something unusual. When I explained, they were surprised, shocked. I’d Great Sex Guidance: Middle-Aged Virgins- Overcoming The Secret Shame – © Michael Castleman – 267 – never told them I was a virgin, and they’d never asked. I left a copy of Vena’s Internet interview with my mother. She wrote me a note expressing concern and support. My father had no reaction, and has never mentioned it.”

Blanchard flew to Florida. Andrews took two weeks vacation, and spent about $8,300 for her trans- portation, hotel, and fee. He felt excited to meet her, but also apprehensive. “Initially, most clients feel anxious,” Blanchard explains. “They don’t know what to expect. But in deciding to work with a sur- rogate, they’ve already confessed their big, dark secret. They don’t have to hide anymore, and that’s very liberating. They quickly discover that surrogate work is a slow gentle process of building relation- ship skills. I don’t promise they’ll have relationships, just that they’ll feel more comfortable with the process of trying.”

Over several daily three-hour sessions, Blanchard and Andrews talked extensively about his life, past and present, and Blanchard directed him in relaxation and touching exercises. “First, she had me touch an apple, then a comb, then other objects to experience what sensual touch feels like.” They talked about what he felt. “Next, she asked me to touch my own arms and face.” They talked some more. Then she offered her hands, arms, and eventually her face for him to explore, and she touched his arms, feet, and face.

“Gentle, nurturing touch is new for most older virgins,” Blanchard explains. “Many don’t recall ever being touched that way before by anyone. Imagine what it must feel like never to have known gentle touch, and then to have someone hold your hand, stroke your arm, run their fingers through your hair. It’s a profound experience. Often, clients cry.”

Meanwhile, every afternoon, Andrews met with his psychotherapist, and discussed what happened that morning. “Vena asked good questions and was a very good listener,” he explains, “but it helped to have someone else listening to me and asking questions, too. I needed the extra support and per- spective.”

Weston says it’s important to have a therapist backing up the surrogate. “Many older virgins can hardly believe it when they kiss a woman’s lips or touch her breasts or vulva. I reassure them, “Yes, it really did happen. You really did that.”

Blanchard talked with Andrews’ psychotherapist daily. She also provided him with basic sex educa- tion. Many older virgins have never had much, she explains “I often lend them books written for ado- lescents because developmentally, around sex, that’s how old they feel.” Blanchard also answers clients’ sex questions: Does my penis look weird? What’s a tampon? How do you unfasten a bra? What’s the real story about the clitoris, G-spot, and women’s orgasms?

As their sensual explorations continued, Blanchard told Andrews she was open to becoming more intimate, but that she had one firm rule: Before every move they would both ask the other’s permis- sion, and would absolutely respect each other’s answers. He agreed. Andrews asked if they might kiss. Blanchard consented, but first instructed him to practice by kissing his own arm, then hers, and finally her lips. “At first, kissing felt very awkward,” he explains. “I’d never kissed anyone before.”An - drews encountered the problem many young teens have with kissing—where your nose goes. “Vena showed me how to position my head and lips so our noses didn’t get in the way.” They practiced kissing quite a bit. “As I relaxed, I began to enjoy it. Kissing is great.” But they stuck to lip-kissing with closed mouths, no tongue action. “I didn’t feel comfortable with open-mouth kissing.”

Great Sex Guidance: Middle-Aged Virgins- Overcoming The Secret Shame – © Michael Castleman – 268 – Eventually, Blanchard suggested they discuss the possibility of undressing. “That was nerve wrack- ing,” Andrews recalls. “I was a blubbering fool for a few minutes.” So Blanchard encouraged him to imagine how disrobing would feel. They discussed it. She asked how far he wanted to go with un- dressing. The first time, Andrews chose to stop at their underwear. “I really wanted to see her breasts and genitals, but I didn’t want her to see my erection.” They stood facing each other, Andrews in his bulging shorts, Blanchard in a bra and panties. “She talked me through looking at her body. I looked at her hair, eyes, nose, shoulders, and on down, scanning everything very slowly and methodically, getting accustomed to it.” The next day, Andrews felt comfortable getting completely undressed, and revealing his erection. “It was fine. It just took me a little while to get used to the idea.” Next they spent time looking at each other together in the mirror. “Seeing himself in the mirror next to a friendly naked woman helped make it real for him,” Blanchard recalls.

Once they both felt comfortable being naked together, Blanchard eased Andrews into mutual whole- body massage. Andrews caressed her face, arms, belly, legs--and eventually, with Blanchard’s permission, her breasts. “Touching her breasts,” he recalls, “was very intense. Vena’s breasts are fantastic. I think it’s the most wonderful thing in the world to touch a woman there.” Eventually their massage exercises included genital caressing with lubricant.

Andrews continued to see his psychotherapist daily. “It was very valuable. I can’t overemphasize it. She helped me process things, and gave me great feedback about what was happening with Vena. I felt very lucky to have her. Still do.”

Andrews felt uncomfortable with the idea of oral sex, so they didn’t explore it. But by the end of his second week with Blanchard, he asked if they might have vaginal intercourse. Some surrogates don’t do this, but Blanchard agreed. “The intercourse itself was not that big a deal,” Andrews explains. “I mean, I was glad to have it. I was glad I wasn’t a virgin anymore, that I’d finally ‘done it.’ But I didn’t need it more than once. Our whole process of becoming physically intimate and talking about it was much more important to me. I felt freed from some of my shame about being so naive and confused about sex. I actually enjoyed whole-body massage more than I enjoyed intercourse, especially touch- ing Vena’s face and breasts.”

But finally having intercourse was important to Andrews in another way: “Once I’d done it, I felt I could move on and think about dating and getting into a relationship.”

One potential hazard of surrogate work for older virgins is the possibility of falling in love with the surrogate partner. This is not surprising. The surrogate knows their terrible secret and doesn’t think the less of them. She is friendly, supportive, and willing to become physically intimate. But Andrews did not fall in love with Blanchard. “She’s very attractive, but I was clear that ours was a professional relationship. I consider her a friend, and hope she thinks the same of me.”

During their last few days together, Blanchard and Andrews talked a great deal about his next step— dating. “It’s hard for me to imagine,” Andrews says. “People say: Just do it, just ask someone out. But I’m still so shy, so inexperienced. The prospect is frightening.” Blanchard suggested some books for him to read, among them, Dating for Dummies. And he’s been discussing the challenges of dating with his psychotherapist as well.

Weston says dating issues are a major stumbling block for older virgins who have completed sur- rogate therapy. “I support them to date,” she says. “I help them figure out their best approach. Some want to place Personals ads. I help them write their ads, and respond to anyone who contacts them. Great Sex Guidance: Middle-Aged Virgins- Overcoming The Secret Shame – © Michael Castleman – 269 – Some want to use professional matchmaking services. I help them with their personal profiles. Some like speed dating, where a roomful of singles spend five minutes with each other and afterward de- clare who they’d like to see again. If there’s a match, the service puts the two people in touch. And when clients begin dating, I help them evaluate the relationship and decide if they should pursue it. It’s often slow going, but most of my older-virgin clients have dated and had relationships.”

“I can’t claim that every guy I’ve worked with has fallen in love and gotten married,” Blanchard says, “but I’ve received quite a few wedding and birth announcements.”

***

Currently, Andrews says he’s “getting ready to date.” He’s working to quit smoking, and he’s drink- ing less. “They’re bad habits that turn women off.” He’s decided not to place or answer any Person- als. “They’re too impersonal. I want human contact.” He’s toying with joining a gym, in part to meet women and in part to break the habit of his isolated evening ritual. He plans to join a scuba club that caters to singles. And he says he’s intrigued by speed-dating.”

Andrews is still processing his work with Blanchard, and doesn’t know how he’ll fare in the dating game. But already, he says, he feels better about himself. “Working with Vena has made a big differ- ence in my life. I’m less ashamed of my sexlessness. I don’t feel so stigmatized, or as naive about how intimate relationships work. I’ve realized that T&A is much less important than sensual touch. I was surprised how much I enjoyed the nonsexual touching we did. I feel more open to other people than I ever have. I feel like a real person now, like I’m becoming a citizen of the world.”

Great Sex Guidance: Middle-Aged Virgins- Overcoming The Secret Shame – © Michael Castleman – 270 – Man-O-Pause: Is There Male Menopause?

Two men over 40 are having lunch. One says: “I’ve been feeling out of sorts lately. Unsatisfied. Wom- en in their thirties are looking real good to me. And the other day I found myself pricing sports cars. You think this is male menopause?”

“I don’t know,” his friend replies, “but if that’s male menopause, I’ve had it since I was 12.”

Controversy rages over the issue of middle-age menopause-like changes in men—and the use of testosterone replacement to treat them. Everyone agrees that men do not experience anything as dramatic as menopause in women. They don’t experience hot flashes, and never lose the ability to father children. But men experience some changes in middle age that some physicians call man-o- pause, andropause, or male menopause. Many of these physicians advocate treating the condition with testosterone.

The Case For Male Menopause

Supporters of man-o-pause contend that male menopause was first recognized by the ancient Ro- mans and Chinese. They cite research showing that starting in middle age, men’s testosterone level declines rather like women’s estrogen level. However, testosterone level declines slowly, only about 10 percent per decade after age 40, much more slowly than estrogen level declines in women. As a result, male menopause produces less dramatic changes and has been less of a medical issue. An estimated 5 percent of 40-year-old men and 70 percent of those over 70 have bioavailable testos- terone levels below the level typical in young men. Supporters of man-o-pause cite this as proof that men experience changes similar to menopause.

Just as hormone replacement therapy in women can alleviate symptoms of menopause, supporters of man-o-pause argue the same goes for testosterone replacement in men. Testosterone replace- ment has some clear benefits: It increases appetite, and reverses the weight loss that occurs in many elderly men. It improves mental functioning, and increases muscle mass and strength (including the strength of the heart). Finally, for men who suffer libido loss and sexual impairment because of abnor- mally low testosterone, hormone replacement returns them to sexual functioning.

However, testosterone replacement accelerates the growth of prostate cancer.

Great Sex Guidance: Man-O-Pause- Is There Male Menopause? – © Michael Castleman – 271 – The Case Against

Opponents of man-o-pause concede that testosterone levels gradually decline in men starting around age 40, and that some men experience a loss of sexual function due to testosterone deficiency. While agreeing that some 5 percent of 40-year-old men and 70 percent of those over 70 have bioavailable testosterone levels below the normal level in young men, they contend that in most men, even natu- rally lower levels are still high enough to fuel normal sex drive and sexual functioning.

Critics say that men do not experience the symptoms women develop during menopause: hot flashes, night sweats, loss of feelings of well-being, and anything analogous to vaginal dryness. They are also very wary of testosterone replacement for the vast majority of men who do not have clearly abnormal- ly low levels. They say the risk of prostate cancer outweighs any benefits testosterone replacement might provide.

Testosterone Replacement: No Panacea, Has Risks

The controversy over male menopause is likely to continue because the gradual decline in testoster- one level men is similar enough to estrogen loss in women to invite comparisons. But men should not look to testosterone replacement as a panacea for the health and sex problems that begin to develop in middle age. Most are caused by heart disease, diabetes, high blood pressure, obesity, lack of ex- ercise, and a diet deficient in fruits and vegetables. Testosterone does nothing to change them. What helps is age-old health wisdom: don’t smoke, get regular exercise, don’t drink to excess, and eat a low-fat, moderate-calorie diet.

If you’re concerned about having an abnormally low testosterone level, ask your doctor to check it— or consult an endocrinologist. Even though testosterone declines as men age, few men wind up with levels below the normal range. Testosterone should not be supplemented in men with levels in the normal range, even low normal. You get no sexual benefit from this. You may get some increase in lean muscle mass, but the price is increased risk for prostate cancer. Is it worth it?

References:

Gambert, S. “Andropause and the Aging Male,” Clinical Geriatrics (2003) 11:12.

Jacobs, HS. “The Idea of Male Menopause is Not Useful,” Medical Crossfire (2001) 3:1.

Morley, JE. “Male Menopause is Underdiagnosed and Undertreated,” Medical Crossfire (2001) 3:1.

Great Sex Guidance: Man-O-Pause- Is There Male Menopause? – © Michael Castleman – 272 – Section III About Women The Plain Truth About “Tight” and “Loose” Vaginas

Many women complain that their vaginas are “too tight” or “too loose,” and many men raise the issue about lovers. Notions of vaginal tightness and looseness are fraught with mythology. Here’s the rare truth.

First, let’s review the myths. Many people believe that (1) the virgin vagina is extremely tight, (2) that loss of virginity permanently loosens it, (3) that frequent sex loosens it more (so don’t be promiscu- ous, girls!), and (4) that childbirth loosens the vagina even more and for a long time after, possibly forever. All wrong.

The vagina is filled with folded, tightly packed, very elastic muscle tissue, rather like an accordion … or like the mouth. Try this: Open your mouth and using a finger of each hand, pull the corners of your mouth toward your ears. Hold for a while then let go. What happens? The mouth immediately re- turns to its pre-stretched state because the tissue is elastic. Do this 100 times. There’s no permanent stretching. The mouth quickly returns to its pre-stretched state and no one would ever know you’d stretched it.

The same goes for the vagina, with two exceptions I’ll discuss shortly. When the vagina is at rest, that is, at all times except during sexual arousal and childbirth, its muscle tissue remains tightly folded like a closed accordion. Anxiety makes the muscles clench even tighter. That’s why girls sometimes have problems when first trying to insert tampons. Their vaginal muscle tissue is naturally tight to begin with, and many girls feel anxious about touching themselves and inserting anything, so their vaginal muscles constrict even tighter.

As women become sexually aroused, their vaginal muscle tissue relaxes. Biologically, this makes per- fect sense. Evolution is all about facilitating reproduction. A tight vagina would impede intercourse and reproduction, so the female body evolved to have sexual arousal signal the vaginal muscles to relax to allow easy insertion of erections, which means greater chance of reproductive success. Arousal-related vaginal loosening does NOT produce a big open space like the inside of an empty vase. Rather, that vagina goes from being like a tight fist to a fist loose enough to insert a finger or two. If the vagina feels “too tight” during sex, the woman is either (1) not interested in sex, or (2) she has not had enough warm-up time to allow her vaginal muscles to relax so she feels comfortable hav- ing anything inserted (finger, penis, toy).

Great Sex Guidance: The Plain Truth About “Tight” and “Loose” Vaginas – © Michael Castleman – 274 – A man who attempts intercourse before the woman feels fully aroused—before her vagina has re- laxed and become well lubricated—is either sexually unsophisticated, or a boor. It takes most women at least 30 minutes to become sufficiently aroused to enjoy intercourse, that is, for their vaginas to re- lax enough to allow the penis to slide in comfortably. That’s why kissing, hugging, fondling, massage, and oral sex are so important. They allow both lovers to become fully aroused, and they allow vaginas to relax and (in most women) produce enough natural lubrication to enjoy intercourse comfortably. In other words, the solution to vaginal tightness is extended foreplay and more lubrication, i.e., a com- mercial lubricant.

One final note about vaginal tightness: If it’s accompanied by pain and/or an inability or great difficulty inserting a tampon, the cause may be vaginismus, unusual clenching of the vaginal muscles that requires medical treatment. Now about vaginal looseness:

After sex, vaginal muscle tissue naturally constricts—tightens—again. Sex does NOT permanently stretch the vagina. This process—loosening during arousal and tightening afterward—happens no matter how many times the woman has sex. She could have sex daily for years and afterward her vagina would return to its tight, resting state.

The vagina stretches a great deal during childbirth, like an accordion opened all the way. Post-partum does it re-tighten completely? Yes, at least in young women, that is, women under around 30. Within three to six months after delivery, the typical young woman’s vagina feels indistinguishable from how it was before she gave birth.

Now the two exceptions I mentioned earlier. If you stretch elastic a great deal over a long period, it fatigues and no longer snaps back entirely. That can happen to the vaginas of young women after multiple births. Their vaginal muscles can fatigue and not fully contract.

In addition, age fatigues the vaginal muscles. Whether or not women have given birth, as they grow older, they may complain of looseness. Today, many woman delay childbearing until after 30, and a growing number of women now have children after 40. Combine childbirth with the effects of aging, and risk of vaginal looseness increases. Women who give birth after around 30 may notice persistent looseness after delivering only one child. (Individual differences account for the fact that birth- and age-related looseness happens to some women and not others.)

Here’s a quick fix for vaginal looseness: Have intercourse in the man-on-top position. Once the man inserts, he lifts himself up and the woman closes her legs. Her thighs squeeze the penis and make her feel tighter.

The approach most often recommended by sex therapists is Kegel exercises. Kegels (named for the doctor who popularized them) involves contracting the muscles used to interrupt urine flow or squeeze out the last few drops. Kegels are totally private and can be practiced anytime anywhere. Start slowly and over several weeks, work up to a half-dozen sets of 10 contractions several times a day. In a few months, you should feel tighter.

Ironically, Kegels have no effect on the vaginal muscles. They strengthen the pelvic floor muscles that surround the vagina. Age and childbirth fatigue these muscles. Kegels tighten them. Kegels also indi- rectly tighten the vagina. Why? Imagine filling a sock with a small towel and holding it in your hands. When you squeeze the sock, the towel compresses. Your hands are the pelvic floor muscles, the sock is the vagina, and the towel is vaginal muscle tissue. As the pelvic floor muscles become stronger and

Great Sex Guidance: The Plain Truth About “Tight” and “Loose” Vaginas – © Michael Castleman – 275 – hold the vagina more tightly, the tissue inside the vagina feels tighter.

(Kegels also intensify orgasms for both women and men since the pelvic floor muscles contract dur- ing orgasm. As they become stronger, so do orgasms.)

If several months of daily Kegels don’t produce the tight feeling women or their lovers want, women can try ben-wa balls or vaginal cones. Ben-wa balls are sold as sex toys. Woman insert them then walk around the house while trying to keep them from falling out. When the pelvic floor muscles are weak, the balls drop out quickly, but as these muscles grow stronger, women can hold the balls inside for longer periods. Vaginal cones are similar, except that they’re prescribed by physicians. (To obtain ben-wa balls, visit Adam & Eve.)

If vaginal cones don’t work, electrical stimulation of the vaginal muscles is your last resort. A probe similar to a tampon is inserted and a mild electrical current causes muscle contraction, passive ex- ercise that can make the vagina feel tighter. Treatments are typically administered by a technician or nurse in a urologist’s office in 20 to 30 minute sessions, twice a week, for about eight weeks.

Great Sex Guidance: The Plain Truth About “Tight” and “Loose” Vaginas – © Michael Castleman – 276 – Desire In Women - Does It Lead to Sex? Or Result from It?

Ever since Pfizer’s erection-boosting drug, Viagra, was approved 1998, the drug companies have been working overtime to develop treatments for women’s sexual issues, notably, low libido. In a few studies, some women reported restored libido and enhanced arousal with Viagra. In several others, however, most experienced no benefit. In 2004, after eight years of efforts to turn Viagra into a drug for women, a disappointed Pfizer, pulled the plug, conceding that women and men are sexually differ- ent (surprise!), and that, for reasons that remain unclear, Viagra just doesn’t do much for women.

What Causes Arousal?

Pfizer’s research was based on the conventional notion that desire precedes arousal. You feel sexual desire, and then, if possible, take steps to satisfy it, either by masturbating or partner sex.

Pfizer might have saved a bundle if they’d studied the research on women’s libido by Rosemary Bas- son, M.D., a clinical professor of psychiatry at the University of British Columbia in Vancouver. She asked hundreds of women to describe how they experience sexual desire and arousal. The results were surprising. Basson discovered that, contrary to the conventional wisdom, for many women, sexual desire is not the cause of lovemaking, but rather, its result. “In a blend of mind and body,” she notes, “arousal often precedes desire.” For these women—and Basson’s research suggests it’s a large group—pills aimed at boosting desire before slipping into bed with a lover is the erotic equiva- lent of putting the erotic cart before the horse.

Basson’s research has not been widely publicized. But it promises to help many women feel more normal and discover greater fulfillment in lovemaking—if their lovers learn to appreciate leisurely, playful, massage-based, whole-body sensuality.

The Masters and Johnson Sexual Response Cycle

Most of our cultural assumptions about how sex proceeds date from the mid-1960s, when pioneering researchers William Masters, M.D. and Virginia Johnson assumed that sexual desire, that is, libido or sex drive, preceded sexual expression. Given desire, they described a four-stage sexual response cycle in both men and women:

Great Sex Guidance: Desire In Women- Does It Lead to Sex? Or Result from It? – © Michael Castleman – 277 – * Arousal. Breathing deepens. Erection or vaginal lubrication. * Plateau. A high level of arousal in both sexes. * Orgasm. Pelvic muscle contractions with intense pleasure and release. * Resolution. Return to a state of non-arousal.

Why Masters And Johnson Got Women Wrong

This four-stage model and the assumption of desire preceding it works well for the vast majority of men—but according to Basson’s research, it’s valid for only a minority of women. When Basson asked women how they respond sexually, many described patterns that bore little resemblance to the four phases described by Masters and Johnson.

Why? Because Masters and Johnson had a bias that distorted their findings—the conviction that men’s and women’s sexual response patterns are virtually identical. At the time of their work, this was a breath of fresh air. It debunked once and for all the lingering Victorian notion that women are inca- pable of sexual desire and pleasure, that they are merely passive receptacles for men’s lust. Masters and Johnson established beyond scientific doubt that women are as sexually responsive as men.

But they erred when they claimed that women are as sexual as men in the same way men are sexual. It was an honest mistake. Masters and Johnson set out to study sexually normal women. But during the 1960s, “normal” women were presumed to experience orgasm during intercourse. To qualify as Masters and Johnson research subjects, women had to be reliably orgasmic during intercourse.

Orgasmic During Intercourse—Only 25 Percent of Women

How many women are actually reliably orgasmic during vaginal intercourse? Fewer than most people think. For her recent book, The Case of the Female Orgasm, (available from Amazon.com), Indiana University biology professor Elisabeth A. Lloyd, analyzed 32 studies of women’s orgasms, and found that only 25 percent of women consistently have orgasms during intercourse. The rest are all over the map, reporting orgasm during intercourse usually, often, seldom, rarely, or never.

The reason intercourse brings so few women to orgasm is that women’s pleasure organ is not the vagina, but rather the clitoris, which sits outside and above the vagina, under the upper junction of the vaginal lips. For most women, vaginal intercourse—even loving, extended intercourse—does not provide enough direct clitoral stimulation to trigger orgasm. Because Masters’ and Johnson’s female subjects were consistently orgasmic during intercourse (not to mention while using dildos and being observed and filmed in a laboratory), the famed sex researchers based their conclusions about wom- en’s sexuality on a small subset of women and produced an unrealistically narrow view of women’s sexuality.

Does Desire Lead To Sex? Or Does Good Sex Lead To Desire?

Most young men are coiled springs of libido and fairly easily aroused. Men under 40 typically describe their libido as a compelling drive similar to hunger or thirst. Twentieth-century sexologists assumed that women’s experience of libido was, if not identical, then similar—and that if women didn’t feel a drive for sex, there had to be something wrong with them.

Using this reasoning, something would be wrong with about one-third of women. That’s what Univer- sity of Chicago researchers found in a landmark 1999 survey of more than 3,000 Americans aged Great Sex Guidance: Desire In Women- Does It Lead to Sex? Or Result from It? – © Michael Castleman – 278 – 18 to 59. Only 15 percent of the men said they felt little or no desire—and among them, alcohol, emotional stress, and health problems (diabetes, heart disease, disabilities) were clear predictors. But among the women, 30 percent said they lacked libido, and predictors were more elusive. Many reported having little or no sexual desire for no apparent reason. The Chicago researchers concluded that low libido—or in current sexological parlance, “hypoactive desire disorder”—was a disturbingly prevalent problem.

However, the Chicago researchers based this conclusion on the male model of sex, the one that says sexual desire precedes arousal. But according to Basson’s research, for many women, desire does not precede arousal, but rather, results from it. “Women,” Basson explains, “often begin sexual experi- ences in a state of sexual neutrality.” But as things heat up, so do they. Assuming that these women enjoy the way lovemaking proceeds, by the time they feel highly aroused, they report feeling desire.

The idea that libido is often the product of good sex turns conventional notions of desire upside down. If a substantial proportion of women don’t experience desire before becoming sexual, then drugs and supplements that try to pique it before the fact may be a waste of money.

This new concept of women’s desire neatly explains why Viagra doesn’t work for most women, and why sex-boosting herb blends help only some. These products do not affect desire, per se. Instead, they increase blood flow into the genitals, the physiological basis of sexual arousal. Men are always aware of feeling aroused. It’s hard to miss an erection, and for the vast majority of men, it’s a short step from having an erection to feeling desire. But a good deal of research shows that women are often unaware of genital blood engorgement. “Many women have little awareness of vaginal lubrica- tion,” Basson notes. Even when women are aware it, they often deny feeling interested in sex.

Why Women Have Sex

If so many women don’t experience male-style lust or even mild desire before sex, then why do they make love? According to Basson, often for reasons that affirm their relationships but are not inher- ently sexual, wanting to please their lover, feel close and intimate, prevent relationship strife, or make up after it. Meanwhile, as lovemaking proceeds and these women become aroused and eventually feel desire, what they desire most may not be orgasm but rather physical closeness with their lover. Basson’s model supports an old saying about the difference between men and women: Men become intimate to have sex. Women have sex to become intimate.

Whole-Body Sensuality: An Often-Overlooked Key To Desire

If many women experience desire as the result of lovemaking, then the critical question becomes not how to ignite their desire before sex, but rather: What kind of lovemaking arouses women sufficiently to enable them to experience their libidos? According to leading sexologists, the type of sex that fuels desire is leisurely, playful, sensual lovemaking based on whole-body massage that includes the geni- tals but is by no means limited to them.

Whole-body massage is a fundamental tool of modern sex therapy. Unfortunately, it’s often missing from sex. One of women’s main complaints about the way men make love is that the male sex style is non-sensual, too rushed, and too focused on the breasts, genitals, and quick, plunge into intercourse. Given Basson’s view of women’s desire, this complaint makes perfect sense. Rushed lovemaking doesn’t give many women the time they need to become aroused enough to experience desire.

Great Sex Guidance: Desire In Women- Does It Lead to Sex? Or Result from It? – © Michael Castleman – 279 – Basson’s perspective also explains, in part, why so many women object to pornography. In addition to depicting sex without relationships, porn sex utterly lacks sensuality. It’s all genital all the time. In fact, every square inch of the body is a sensual playground. It’s sad that pornography and so many men explore only a few corners, and often ignore everything else.

Forget “Foreplay,” Embrace “Loveplay”

In conventional sex, lovers engage in foreplay for a while and then proceed to intercourse. The very word, “foreplay,” implies that it happens before the main event, intercourse.

Forget foreplay. Foreplay implies linear lovemaking, first kissing, next some fondling here and there, and finally intercourse, after which sex is over. Instead, lovers—men in particular—should focus on “loveplay,” extended, playful, whole-body massage. “Loveplay” carries no implication that it comes before anything else. It allows more sensual creativity. You might begin by gently holding one another, kissing, and stroking each other’s faces and arms. Next you might undress, shower together, dry each other, and have a glass of wine. After that, you might repair to bed, light candles, turn on some music, kiss, and massage each other’s necks, shoulders, and backs. Then, well, you get the idea. None of this is “foreplay.” It’s all loveplay. “I wish men would learn that sex is best when it involves a slow pace and loving touch that explores the whole body,” says New York sex educator Betty Dodson, Ph.D. “Sure, the genitals are important, but so is everything else. Guys who rush into genital sex are clueless. Give me a lover who knows how to use his fingers, palms, lips, and especially his tongue all over me for a nice long time.”

Now, some men recoil from the idea of whole-body loveplay. They object to “all that touchy-feely stuff.” They’re convinced that “sex” means intercourse and nothing more. They view women’s prefer- ence for whole-body sensuality as an annoyance that just postpones “real” sex, intercourse. But the fact is, leisurely, playful, whole-body massage not only enhances women’s experience of lovemak- ing—but also men’s.

The sexual style that allows women to experience their libidos is the very same style that sex thera- pists recommend for men who want to cure premature ejaculation and overcome erection difficulties. In other words, a sensual, massage-based approach to lovemaking is a win-win. Men’s penises act the way men want. And women are much more likely to become the aroused, enthusiastic, libidinous lovers that both they and their lovers would like them to be.

For individual help with desire issues, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Chaffai, I. et al. “Body-Related Factors Associated with Female Sexual Dysfunction…” presented at the World Congress of Sexology, 2005.

Harris, G. “Pfizer Gives Up Testing Viagra On Women,” New York Times, 2-28-2004

Heiman, JR. “Sexual Dysfunction: Overview of Prevalence, Etiological Factors, and Treatments,”

Great Sex Guidance: Desire In Women- Does It Lead to Sex? Or Result from It? – © Michael Castleman – 280 – Journal of Sex Research (2002) 39:73.

Laumann, EO. “Sexual Dysfunction in the United States,” Journal of the American Medical Associa- tion (1999) 281:537.

Simons, JS and MP Carey. “Prevalence of Sexual Dysfunctions: Results from a Decade of Resarch,” Archives of Sexual Behavior (2001) 30:177.

Wood, JM et al. “Women’s Sexual Desire: A Feminist Critique,” Journal of Sex Research (2006) 43:236.

Great Sex Guidance: Desire In Women- Does It Lead to Sex? Or Result from It? – © Michael Castleman – 281 – Women’s Many Possible Sexual Response Cycles: New Findings, New Insights

Arousal, plateau, orgasm, resolution. These are the four classic phases of the sexual response cycle identified by William Masters. M.D., and Virginia Johnson in their pioneering sex research during the 1960’s. This model works well for the vast majority of men—but unfortunately, not for many normal, healthy, orgasmic women. When asked to describe their own sexual response cycles, these women describe patterns of sexual arousal and response very different from the classic, four-stage, Masters and Johnson paradigm.

Since the 1990s, a few sex researchers have questioned the assumption that women’s sexuality is governed by the four-stage response cycle. Now the insurgents are declaring themselves more bold- ly. A leader of the researchers calling for reconsideration of women’s sexual response cycle is Rose- mary Basson, M.D., of the departments of psychiatry and obstetrics and gynecology at the University of British Columbia in Vancouver. Based on in-depth interviews with hundreds of women, she has pro- posed a different model—actually several different models—of the range of normal, healthy women’s sexual response. These new models should be a comfort to many women who know that they don’t fit the classic, four-stage pattern.

Why Masters and Johnson Got Women Wrong

Before delving into these new models, it may help to explain why Masters and Johnson developed a sexual response cycle that describes only a fraction of women. The reason is that they studied a very particular subset of women—those willing to be observed and filmed having sex in their laboratory in the mid-1960s, who were also orgasmic from intercourse with Masters and Johnson’s mechanized dil- dos. We now know that only 25 percent of women are consistently orgasmic from intercourse—and presumably an even smaller fraction are orgasmic from intercourse with dildoes while being observed (and filmed) in a laboratory. To experience orgasm, three-quarters of women need direct clitoral stimulation. Masters and Johnson studied none of these women, so it should come as no surprise that they produced an unrealistically narrow view of women’s sexual response.

Great Sex Guidance: Women’s Many Possible Sexual Response Cycles- New Findings, New Insights – © Michael Castleman – 282 – The following observations come from Dr. Basson’s surveys that asked women to describe what arouses them and how their sexual response cycles proceed.

Arousal Differences

Men, especially men under 40, typically describe the beginning of sexual arousal as a “drive,” a deep biological need for sex, often independent of the context and relationship. In other words, when men become sexually aroused, many can imagine having sex with just about any woman just about any- where just about any time.

In the first blush of a passionate new relationship, women often feel a similar need for sex with the new lover. But often fairly quickly, women’s motivation for sex loses its strictly sexual dimension, and becomes more a desire for physical closeness and intimacy with the partner.

When men are exposed to sexual imagery—provocatively posed women, simulated sex, or pornog- raphy—they are usually well aware of feeling aroused. Many develop erections. Meanwhile, many studies show that women are often unaware of genital arousal when exposed to sexual imagery. For example, many studies show that women exposed to pornography experience increased blood flow to the clitoris and vaginal wall, a sign of arousal, but a significant proportion are unaware of it.

In other words, arousal is much more of a physical on-off switch for men than for women. Many women need to feel emotionally excited by a lover’s attention or desire for them, or touch before they can become sexually aroused. When they become aroused, what they desire most may not be the release of sexual excitement through orgasm, but rather physical intimacy with the lover.

These observations basically support an old saying about the sexual differences between men and women: Men become intimate to have sex. Women have sex to become intimate.

Orgasm Differences

In the Masters and Johnson model, after a period of intense arousal (the plateau phase), sexual ex- citement builds to a clearly discernible peak, orgasm. Again, this is what happens to the vast majority of men and to many women—but not to many other women.

Some women describe very mild, yet still satisfying orgasms. Others report several orgasms, either one after another, or periodically during sex. Some say they have satisfying sex without distinct or- gasm. Others describe orgasm not as a peak moment, but rather as a higher plateau of arousal that may last quite a while.

In addition, many women describe completely different patterns of sexual response from masturbation and partner sex.

Bear in mind that the women who volunteered these descriptions were not in therapy for any sexual problem. Lack of orgasm or weak orgasm might certainly be experienced as a problem, but not nec- essarily. For some women, that’s just the way they are.

Great Sex Guidance: Women’s Many Possible Sexual Response Cycles- New Findings, New Insights – © Michael Castleman – 283 – Women: Enjoy Who You Are

These new models of women’s sexual response may help many women accept and enjoy their own individual sexual responses. They may help the male partners of women who don’t follow the Masters and Johnson pattern accept their lovers as sexually unique, but still normal. And they challenge sex therapists to expand the range of female sexuality they consider normal, and narrow the range they label dysfunctional.

Dr. Basson’s bottom line for women: Experience your own individual sexual response in your own unique way. And enjoy it.

References:

Basson, R. “The Female Sexual Response: A Different Model,” Journal of Sex and Marital Therapy (2000) 26:51.

Heiman, JR. et al. (eds) “Women’s Orgasm,” Annual Review of Sex Research (2004) 15:173.

Great Sex Guidance: Women’s Many Possible Sexual Response Cycles- New Findings, New Insights – © Michael Castleman – 284 – Orgasm During Intercourse: Only 25% Of Women Consistently Do

About one-quarter of women are usually orgasmic during intercourse. Half of women have orgasms during intercourse half the time. About 20 percent rarely or ever have orgasms during intercourse. And about 5 percent never have orgasms, period.

This finding comes not from just from one study, but from an analysis of 33 studies over the past 80 years by Elisabeth Lloyd in her book The Case of the Female Orgasm (Harvard University Press). As studies always do, the studies in Lloyd’s analysis came up with different figures for the proportion of women who experience orgasm during intercourse. But taken as a group, they were remarkably consistent, which makes her conclusion more compelling: Only one-quarter of women are reliably orgasmic during intercourse.

Now neither Lloyd nor I are knocking intercourse. Vaginal intercourse can be great fun and during it, lovers can feel a very special closeness and intimacy. Many men love filling a woman’s vagina, and many women revel in feeling filled up. But contrary to what many people believe, intercourse is not the be-all and end-all of lovemaking. Only 25 percent of women consistently experience orgasm dur- ing it.

The vast majority of women need direct clitoral stimulation to experience orgasm. They don’t get it during intercourse because the clitoris is located outside the vagina a few inches above it under the top junction of the vaginal lips. The in-out of vaginal intercourse just doesn’t provide enough direct clitoral stimulation to allow most women to experience orgasm.

There is nothing wrong with women who cannot have orgasms during intercourse, or who rarely have them. They are perfectly normal. They just need direct clitoral stimulation to have orgasms.

Fortunately, there is no shortage of ways to provide direct clitoral stimulation. A man can gently caress the clitoris or the area around it with his fingers or the palm of his hand. He can reach between the woman’s legs and cup her buttocks with his hand, which presses his inner wrist against her clitoral area. Then she can “ride his wrist,” that is, press her vulva into his inner wrist. The man might also press the top of his knee or his thigh between the woman’s legs so she can ride those body parts. Or a man can provide oral sex. Or the man or woman can use a vibrator or other sex toy.

Great Sex Guidance: Orgasm During Intercourse- Only 25% Of Women Consistently Do – © Michael Castleman – 285 – Vibrators are the most reliable way to bring women to orgasm. The stimulation they produce is con- siderably more intense than other forms of sexual stimulation. In fact, easier, faster, more intense or- gasms rank as the number one reason why women own vibrators, according to a recent study by sex researcher Laura Berman, Ph.D., of the Berman Center in Chicago. (An estimated one-third of adult women now own vibrators.) The sex toy store affiliated with this site, mypleasure.com, sells dozens of different models—cylindrical or phallic vibes, ball-topped models, and others in many different shapes and sizes, and at many different prices. Browse their catalog.

Many men believe that if only they had a larger penis, their lovers would be more likely to have or- gasms during intercourse. Not so. Only 25 percent of women are reliably orgasmic during intercourse no matter what the size of the man’s penis. Now, if a man would like a larger penis for aesthetic rea- sons or his own self-esteem, fine. My recent book, Great Sex, contains information on safe, natural ways to make the most of what men have between their legs. It’s available from Amazon.com. But if only 25 percent of women are consistently orgasmic during intercourse, then for the majority of wom- en, a man’s size doesn’t matter to their orgasms. The fact is, any size penis can give great pleasure to the man it’s attached to. But women’s pleasure comes from direct clitoral stimulation.

Many men are preoccupied with lasting a long time during intercourse. If a man ejaculates quickly and wants to last longer for his own pleasure and sexual self-esteem, and his love’s pleasure, fine. Great Sex contains a chapter devoted to the state-of-the-art sex therapy program that teaches men how to last as long as they’d like, either solo or in a couple. But many men want to last longer because they believe that extended intercourse brings women to orgasm. Perhaps. And many women do, indeed, enjoy extended intercourse. But only one-quarter of women are consistently orgasmic during it no matter how long it lasts. Even if a man can last for hours, most women still need direct clitoral stimula- tion to experience orgasm.

Bottom line: If only 25 percent of women consistently experience orgasm during intercourse, then it’s perfectly normal for women not to have orgasms during intercourse. There’s absolutely nothing wrong with women who cannot have orgasms during intercourse. And assuming that the man appreciates leisurely, playful, whole-body sensuality, there’s nothing wrong with him or the way he makes love. A substantial majority of women can’t come during intercourse. That’s just the way they are—and they’re fine. But fortunately, there are many very enjoyable ways to provide the direct clitoral stimula- tion that brings most women to orgasm—notably vibrators. Browse the mypleasure.com catalog for the vibrators that appeal to you.

Great Sex Guidance: Orgasm During Intercourse- Only 25% Of Women Consistently Do – © Michael Castleman – 286 – How the Menstrual Cycle Affects Women’s Libido

Many reproductive-age women say that their interest in sex--and their sexual responsiveness--vary during the menstrual cycle. Women don’t experience “heat,” but their libidos spike around ovulation.

Most female mammals experience periodic “heat,” occasional periods when they can become preg- nant and as a result, become eager for sex. But human women don’t go into heat. They can become pregnant—and have sex—year-round. Women don’t behave like dogs, cats, and deer, but a good deal of research shows that in reproductive-age women, libido is to some extent cyclical across the menstrual cycle, with peak erotic motivation occurring around the time of ovulation midway between menstrual periods. It’s evolution’s way of spurring procreation.

Libido Peaks at Ovulation: The Studies

• University of Virginia, Charlottesville, researchers used standard surveys to chart libido and sexual functioning in 115 women, age 23 to 45. Each participant completed the survey twice, once mid-cycle around ovulation, and once pre-menstrually. The women reported significantly more interest in sex and greater satisfaction from orgasm at mid-cycle.

• Dutch researchers showed erotic videos to 20 women whose genitals were wired to detect blood flow. Increased blood flow is an indicator of physiological arousal. Genital blood flow increased the most around the time of ovulation, and in an accompanying survey, the women said they felt most aroused at that time of the month.

• Researchers at the University of Rhode Island recruited 96 college-age women who were asked to rate their interest in four types of films: comedies, romances, action-adventure, and erotica.The researchers recorded “a postmenstrual surge” in interest in the erotic films as the women approached ovulation.

• Arizona State University researchers asked 236 women to keep diaries tracking their masturbation while recording their basal body temperature, which spikes at ovulation. Masturbation peaked around ovulation.

Great Sex Guidance: How the Menstrual Cycle Affects Women’s Libido – © Michael Castleman – 287 – • Researchers in Canada videotaped 19 women as they walked down a street during ovulation and menstruation. Thirty-five men viewed the videos and rated the women’s sexual attractiveness. Com- pared with the menstrual women, the ovulating group swayed their hips more, and the men rated them sexier.

• Swedish researchers have reported that women’s sexual fantasies and interest in sex, erotic art, and buff, muscular men all increase around the time of ovulation.

• Finally, Spanish scientists reviewed the literature on sex and the menstrual cycle, concluding that “women at mid-cycle [ovulation] exhibit increased sexual motivation.”

On the other hand, studies of libido across the menstrual cycle are not unanimous. Australian re- searchers asked 173 college-age women to rate their arousal to various sexual fantasies. The women showed no significant cyclical differences. In fact the researchers noted “a high level of stability [in arousal] across the menstrual cycle.” Nonetheless, the weight of the evidence suggests that women experience a slight-to-moderate libido increase around ovulation.

Why Mid-Cycle Heat?

It makes sense for women to be most sexually receptive around ovulation. The biological purpose of life is to reproduce life, so evolution primed women to feel most sexually aroused when they’re most likely to get pregnant.

In addition, pre-menstrual and menstrual days can be a turn-off. Studies vary but somewhere around half of women experience pre-menstrual discomforts—irritability, anxiety, and blues—and every month, about half of reproductive-age women experience menstrual cramping. PMS and cramps tend to suppress interest in sex.

Confounding Factors

The menstrual cycle may nudge women to feel more sexual around ovulation, but many other factors influence women’s libido:

• The Pill. Hormonal contraception alters the natural menstrual cycle. A few of the studies showing cy- clic libido divided participants by their use of birth control pills. Women on the Pill showed no monthly libido changes, but those not taking hormonal contraception did.

• Work. Studies of women stressed at work show little cyclic interest in sex and less interest in sex in general. But on vacation, these same women experienced libido rebound and the cycle of erotic inter- est became more evident.

• A long-term relationship. Compared with women in established couples, single gals show a greater ovulatory spike in sexual interest. This lends some credence to an old joke: What can a man do to destroy his girlfriend’s interest in sex? Marry her.

Great Sex Guidance: How the Menstrual Cycle Affects Women’s Libido – © Michael Castleman – 288 – The Upshot

While women’s interest in sex may not vary much throughout the month, if it does, women might track their own erotic thoughts and feelings, and plan romantic evenings or getaways accordingly.

Meanwhile, not many men follow the menstrual cycles of the women they’re involved with. Here’s a reason to. You’re most likely to get lucky during her mid-cycle. But always remember, the menstrual cycle is not destiny. Many women don’t notice cyclic libido changes.

I’d love to hear from women about this. Do you notice cyclic erotic ups and downs? What’s been your experience.

References:

Bullivant, SB et al. “Women Sexual Experience During the Menstrual Cycle: Identification of the Sex- ual Phase by Noninvasive Measurement of Luteinizing Hormone,” Journal of Sex Research (2004) 41:82.

Burleson, MH et al. “Sexual Behavior in Lesbian and Heterosexual Women: Relations with Menstrual Cycle Phase and Partner Availability,” Psychoneuroendocrinology (2002) 27:489.

Clayton, A. et al. “Assessment of Sexual Functioning During the Menstrual Cycle,” Journal of Sex and Marital Therapy (1999) 25:281.

Dawson, SJ et al “Sexual Fantasies and Viewing Times Across the Menstrual Cycle: A Diary Study,” Archives of Sexual Behavior (2012) 441:173.

Gangestad, SW et al. “Changes in Women’s Sexual Interests and Their Partners’ Mate-Retention Tac- tics Across the Menstrual Cycle: Evidence for Shifting Conflicts of Interest,” Proceedings of Biological Sciences, The Royal Society (2002) 269:975.

Little, AC et al. “Preferences for Masculinity in Male Bodies Changes Across the Menstrual Cycle,” Hormones and Behavior (2007) 51:633.

Meuwissen, I. and R. Over. “Sexual Arousal Across Phases of the Human Menstrual Cycle,” Archives of Sexual Behavior (1992) 21:101.

Pillsworth EG et al. “Ovulatory Shift in Female Sexual Desire,” Journal of Sex Research (2004) 41:55.

Provost, MP et al. “Differences in Gait Across the Menstrual Cycle and Their Attractiveness to Men,” Archives of Sexual Behavior (2008) 37:598.

Rudski, JM et al. “Effects of Menstrual Cycle Phase on Ratings of Implicitly Erotic Art,” Archives of Sexual Behavior (2011) 40:767.

Great Sex Guidance: How the Menstrual Cycle Affects Women’s Libido – © Michael Castleman – 289 – Silber, M. “Menstrual Cycle and Work Schedule: Effects of Women’s Sexuality,” Archives of Sexual Behavior (1994) 23:397.

Slob, AK et al. “Sexual Arousability and the Menstrual Cycle,” Psychoneuroendocrinology (1996) 21:545.

Tarin, JJ and V. Gomez-Piquer. “Do Women Have a Hidden Heat Period?” Human Reproduction (2002) 17:2243.

Zillmann, D. et al. “Menstrual Cycle Variation of Women’s Interest in Erotica,” Archives of Sexual Be- havior (1994) 23:579.

Great Sex Guidance: How the Menstrual Cycle Affects Women’s Libido – © Michael Castleman – 290 – Effective Self-Help for Women with Low or No Libido

If you’re a woman troubled by little or no erotic desire, a recent study shows that a self-help book by a woman sex therapist provides a significant libido boost.

The book is A Tired Woman’s Guide to Passionate Sex (2009) by Laurie B. Mintz, Ph.D., a professor of psychology at the University of Florida. Compared with controls who did not read it, women who did experienced significant increases in desire, arousal, and sexual satisfaction.

“The Most Common Sexual Complaint”

How many women feel little or no sexual desire at some point in their lives? About one-third. Land- mark studies by University of Chicago researchers (1999 and 2008) have estimated prevalence by age:

18-29: 32% 30-39: 32% 40-49: 30% 50-59: 27% 60-74: 38% 75+: 49%

A leading women’s sexuality researcher, Rosemary Basson, Ph.D., director of the University of British Columbia’s Sexual Medicine Program, says, “Low or absent sexual desire is without a doubt the most common sexual complaint of women of all ages.”

It’s also one of the more difficult to treat. Sex therapists enjoy a high rate of success treating many sexual issues—notably men’s ejaculatory control problems, women’s inability to have orgasms, and desire differences in couples—but they’ve been less successful helping women with low or no libido rediscover desire.

After Viagra was approved, the drug industry worked overtime todevelop drugs to treat low desire in women—and so far have struck out. Turns out desire is quite complicated and not something pills can resolve.

Great Sex Guidance: Effective Self-Help for Women with Low or No Libido – © Michael Castleman – 291 – Part of the issue involves women’s socialization. Society accepts men’s lust as “vigorous” and “stud- ly,” but disparages lusty women as “tramps” and “sluts.” In addition, women are raised to focus not on their own desire, but on appearing desirable to men.

Another piece of the issue has to do with gender differences in sex drive. While an estimated one- third of women have more erotic interest than the men they’re involved with, in two-thirds of couples men’s libidos surpass women’s—and women hounded by horny men for sex have little opportunity to experience their own desire.

Meanwhile, a good deal of research shows that women with desire issues tend to feel exhausted by their daily responsibilities—their marriages, parenting, families, and jobs—and have difficulty finding enough space in their hectic lives for sexual desire.

In 2008, Basson and colleagues conducted a pilot study with 26 women complaining of low or no desire. They used a group-therapy approach that included education about desire and mindfulness meditative techniques to help women take emotional time-outs from their day-to-day responsibilities to focus on their own desire. The program helped. Pre- and post-tests showed significant increases in participants’ desire and arousal. Mintz’s self-help book uses a similar approach.

Six-Step Program

For the study, the researchers (Mintz among them) worked with 45 women who had sought help for low libido. All of them completed a survey that assessed their sexual desire, arousal, lubrication, orgasms, sexual pain, and overall erotic satisfaction. Nineteen were instructed to read the book. The others did not. All the women were heterosexual, married (4.5 to 29 years), with education ranging from high school to graduate degrees, and household incomes from low to high.

The book focuses on six subjects:

• Thoughts. Women with low desire often slip into negativity: I feel overwhelmed and that’s not attrac- tive. I don’t feel anything sexual therefore I can’t. The book provides cognitive therapy techniques that promote positive feelings about self and sexuality, and mindfulness meditative techniques to promote deep relaxation.

• Talk. Low desire often provokes relationship conflict. Partners ask, What’s wrong with you?! The book advocates standard psychotherapy suggestions for constructive couple discussion of both day- to-day hassles and the couple’s sex life.

• Time. Women with low desire typically complain of feeling harried. The book presents strategies for improved time management—setting goals, prioritizing them, and making the time to accomplish them.

• Touch. Many men get their sex education from pornography, which focuses almost entirely on genital touch. Of course, sex involves the genitals, but to experience desire and arousal, most women need a good deal of whole-body sensual caressing—30 minutes or so— before men reach for their breasts or between their legs. The book strongly advocates whole-body massage as a fundamental element in lovemaking.

Great Sex Guidance: Effective Self-Help for Women with Low or No Libido – © Michael Castleman – 292 – • Spice. When sex becomes routine, desire suffers. The book provides suggestions for adding nov- elty and variety to erotic play to keep it fresh and exciting.

• Tryst. Many people believe that sex happens—and should happen— spontaneously when lovers are “in the mood.” That may be true initially during the hot-and-heavy stage of relationships, but after a year or so, for couples to remain regularly sexual, sex therapists universally recommend scheduling sex in advance. The book advocates scheduling, which allows women to anticipate sex, which helps them look forward to it.

Six weeks after completing the initial survey, all participants were surveyed again.

Those who read the book reported significant increases in desire, arousal, and sexual satisfaction.

Don’t Pin Your Hopes on Drugs or Supplements

For many (most?) women, desire is a mind-body phenomenon. This is especially true for women with low or no libido. Drugs and the sex supplements found in the vitamin aisle don’t address the full spectrum of issues that govern desire, which is why there isn’t—and probably never will be—a magic pill that lights women’s erotic fire. But a more comprehensive approach, a class or self-help book that deals with desire in the context of women’s lives, can put women back in touch with their erotic yearn- ings.

If you’re a woman with low libido or none at all, check out A Tired Woman’s Guide to Passionate Sex and/or another book that’s similar, Wanting Sex Again by sex therapist Laurie J. Watson (2012).

References:

Brotto, L. et al. “A Mindfulness-Based Group Psychoeducational Intervention Targeting Sexual Arous- al Disorder in Women,” Journal of Sexual Medicine (2008) 5:1646.

Laumann, E.O. et al. “Sexual Dysfunction in the United States,” Journal of the American Medical As- sociation (1999) 281:537.

Laumann, E.O. et al. “Sexual Dysfunction Among Older Adults: Prevalence and Risk Factors from a Nationally Representative U.S. Probability Sample of Men and Women 57-85 Years of Age,” Journal of Sexual Medicine (2008) 5:2300.

Mintz, L.B. “Bibliotherapy for Low Sexual Desire: Evidence for Effectiveness,” Journal of Consulting Psychology (2012) 5

Great Sex Guidance: Effective Self-Help for Women with Low or No Libido – © Michael Castleman – 293 – How Birth Control Pills Affect Women’s Sexuality

After the first oral contraceptive was approved in 1960, The Pill quickly became the world’s most pop- ular birth control method. More than 100 million women worldwide have used it, and among American women age 18 to 44, The Pill has been used by a whopping 82 percent.

Oral contraceptives have been the subject of more than 44,000 research publications, but fewer than 100—less than one-half of 1 percent—have dealt with its effects on women’s sexuality. The findings of those several dozen reports have been all over the map. Some show increased erotic interest, better sexual functioning, and greater sexual satisfaction. Others show the opposite—libido loss and sexual impairment—while some show no sexual effects at all.

This article summarizes the current confusion and suggests ways women might deal with it.

How The Pill Works

Birth control pills contain a combination of two female sex hormones, estrogen and progesterone (progestin). Formulations vary and over the past 50 years, dosages have diminished, but whatever the brand, the hormones in The Pill tinker with women’s pituitary hormones to suppress ovulation.

In addition, oral contraceptives decrease ovarian production of androgens, the female form of testos- terone, which kindles sexual desire. This suggests that The Pill might suppress women’s libido. But most women produce more androgens than necessary for fully functional sexuality, so despite Pill- induced suppression, most women still synthesize enough androgens to maintain libido and sexuality.

Potentially Sex-Enhancing Effects

The Pill has many effects that may increase erotic interest and improve sexual function:

• Effective contraception. The Pill gives women total control over their reproduction, virtually eliminat- ing anxieties about unintended pregnancy. This can feel freeing and boost sexual interest and energy.

• Relief from painful menstrual cramping. Monthly cramps can destroy interest in sex. By taming cramps, The Pill can restore it.

Great Sex Guidance: How Birth Control Pills Affect Women’s Sexuality – © Michael Castleman – 294 – • Relief from premenstrual syndrome. The irritability, bloating, breast tenderness, and other symptoms of PMS can reduce libido and impair sexual functioning. The Pill minimizes PMS symptoms, making sex more possible and enjoyable.

• Less menstrual bleeding. Profuse bleeding can lead to iron-deficiency anemia, which saps energy, including sexual energy. The Pill reduces the volume of menstrual flow, and can restore energy.

• Suppression of endometriosis. Endometriosis causes severe menstrual cramping, pelvic pain, pain on intercourse, and other symptoms that detract from lovemaking. The Pill largely relieves them.

• Reduced risk of uterine fibroids. These benign growths increase menstrual bleeding and can cause iron-deficiency anemia. The Pill makes them less likely, preserving sexual energy. • Relief from severe acne. Severe acne destroys self-esteem, often taking sexual interest with it. The Pill is so effective at reversing this condition that three brands of birth control pills are FDA-approved treatments.

• Increased libido. Because The Pill suppresses androgens, one would think that it would reduce libido. However, some Pill-takers report greater sexual interest.

Potentially Sex-Impairing Effects

The Pill has effects that may also impair sexual function:

• Loss of libido. Pill-induced androgen suppression can diminish or destroy erotic feelings.

• Less vaginal lubrication. Vaginal dryness can make sex less comfortable and enjoyable. Lubricants usually take care of it, but not always.

• Vulvar pain. Pill use for more than a year or two increases risk of pain during and/or after inter- course.

• Thinning of the inner vaginal lips and vaginal entrance. Thinning of this tissue can make genital play uncomfortable.

• General sexual malaise. In one of the largest studies, German researchers surveyed 1,086 women medical students, 752 of them oral contraceptive users. The Pill takers scored lower on the Female Sexual Function Index.

The Upshot

What should we make of all this? For women concerned about unintended pregnancy or plagued by severe cramps, PMS, endometriosis, fibroids, severe acne, or profuse menstrual bleeding, Pill-in- duced relief may well pique libido and enhance lovemaking. But for women who develop vaginal dry- ness, vulvar pain, thinning of the vaginal lips, or general sexual malaise, The Pill, may deflate libido and impair sexual function.

This explains why some studies find sexual enhancement while others find impairment and still others find no effect. It comes down to the individual woman, her medical situation, and how she reacts. In the words of one research review: “The inconsistent, contradictory findings make a case for individual Great Sex Guidance: How Birth Control Pills Affect Women’s Sexuality – © Michael Castleman – 295 – variation.”

If you’re taking The Pill or considering it here are my suggestions:

• Understand that it can have a wide range of sexual effects.

• Be sensitive to your own reactions. Disregard friends and clinicians who say, “The Pill doesn’t do that.” On the contrary, almost any sexual effect is possible.

• Consult an expert. Family doctors can prescribe The Pill, but if you notice any changes in your sexual demeanor, you might consider consulting a family planning or Planned Parenthood clinician, who is probably more familiar with the nuances. • Continue to focus on your reactions over time. Some of the Pill’s possible sex-impairing side effects can take a year or more to develop, for example, vulvar pain.

• If The Pill’s disadvantages for you outweigh its advantages, choose another contraceptive. With proper use, many are very reliable. A counselor at a family planning clinic or Planned Parenthood can itemize the pros and cons of all methods.

References: Bancroft, J. and N. Sartorius. “The Effects of Oral Contraceptives on Well-Being and Sexuality,” Ox- ford Review of Reproductive Biology (1990) 12:57.

Battaglia, C. et al. “Sexual Behavior and Oral Contraceptives,” Journal of Sexual Medicine,” (2012) 9:550.

Burrows, L. J. et al. “The Effects of Hormonal Contraceptives on Female Sexuality: A Review,” Journal of Sexual Medicine (2012) 9:2213.

Caruso, S. et al. “Preliminary Study of the Effect of Four-Phasic Estradiol Valerate and Dienogest (E2V/DNG) Oral Contraceptive on the Quality of Sexual Life,” Journal of Sexual Medicine (2011) 8:2841.

Davis, A.R. and P.M. Castano, “Oral Contraceptives and Libido in Women,” Annual Review of Sex Research (2004) 15:297.

Grham, C.A. et al. “The Relationship Between Mood and Sexuality in Women Using an Oral Conta- ceptive as a Treatment for Premenstrual Symptoms,” Psychoneuroendocrinology (1993) 18:273.

Hatcher, R.A. et al. Contraceptive Technology. Ardent Media, NY, 2004.

Mathlouthi, N. et al. “Sexuality and Contraception: A Prospective Study of 85 Cases,” Tunisia Medi- cine (2013) 91:179.

Pastor, Z. et al. “The Influence of Combined Oral Contraception on Female Sexual Desire: A System- atic Review,” European Journal of Contraception and Reproductive Health Care (2013) 18:27.

Schaffir, J. et al. “Oral Contraceptives Vs. Injectable Progestin in Their Effect on Sexual Behavior,” American Journal of Obstetrics and Gynecology (2010) 203:545. Great Sex Guidance: How Birth Control Pills Affect Women’s Sexuality – © Michael Castleman – 296 – Schaffir, J. “Hormonal Contraception and Sexual Desire: A Critical Review,” Journal of Sex and Mari- tal Therapy (2006) 32:305.

Strufaldi, R. et al. “Effects of Two Combined Hormonal Contraceptives with the Same Composition and Different Doses on Female Sexual Function and Plasma Androgen Levels,” Contraception (2010) 82:147.

Wallwiener, M. et al. “Effects of Sex Hormones and Oral Contraceptives on Female Sexual Function Score: A Study of German Medical Students,” Contraception (2010) 82:155.

Wallwiener, M. et al. “Prevalence of Sexual Dysfunction and Impact of Contraception in Female Ger- man Medical Students,” Journal of Sexual Medicine (2010) 7:2139.

Great Sex Guidance: How Birth Control Pills Affect Women’s Sexuality – © Michael Castleman – 297 – Androgens (Male Sex Hormones) Help Some Women With Low Libido

Over the past decade, evidence has accumulated that the male sex hormones, testosterone and DHEA (dehydroepiandrosterone)—collectively known as androgens—help restore sexual interest and function in women with low or no libido.

Women Produce Male Sex Hormones

Both sexes produce these hormones, though men’s testicles produce much more than women’s ova- ries and adrenal glands. In both sexes, male sex hormones play key roles in sexual desire, blood flow into the genitals, and the ability to experience orgasm.

From age 20 to 40, women’s blood levels of androgens decline by about 50 percent. As women become menopausal, levels decline even more. This is usually no cause for alarm. Most women continue to produce enough androgens to maintain sexual interest and enjoy pleasurable orgasms. But for some women, androgen levels fall to the point where libido fades and orgasm is no longer possible.

When Levels Fall Abnormally Low

Much of what we know about the effects of androgens on women’s sexuality comes from studies of women whose levels suddenly plummeted because their ovaries were surgically removed. These women generally report a sharp drop in sexual interest, fewer sex fantasies, less genital sensitivity to touch, and an inability to have orgasms no matter how intense or prolonged the stimulation. Nonsex- ual symptoms also develop: dry skin and hair, thinning of pubic hair, loss of muscle tone, and reduced feelings of mental sharpness and general well-being.

Other studies show that both pre- and post-menopausal women who complain of reduced or lost libido enjoy renewed sexual interest and satisfaction when they take supplemental androgens, either testosterone or DHEA.

Supplemental Androgens Can Help

In one study, Australian researchers worked with 31 premenopausal women, average age 40, who

Great Sex Guidance: Androgens (Male Sex Hormones) Help Some Women with Low Libido – © Michael Castleman – 298 – complained of low libido and showed abnormally low androgen levels. They were given either a pla- cebo cream or a cream containing 1 percent testosterone, which they rubbed into their inner thighs daily for 12 weeks, all the while maintaining diaries of their sexual interest and activity. Then all the women had no treatment for four weeks, after which the groups were switched so that those who initially used the placebo cream began using the testosterone and visa versa. During testosterone treatment, sexual interest and function increased significantly. So did the women’s feelings of overall well-being.

In the U.S., no drug company offers testosterone cream, but it’s available from compounding phar- macists, special pharmacists who make their own medicines. Ask your doctor for a prescription and a referral to a compounding pharmacist in your area.

The second recent study was conducted by researchers at George Washington University in Wash- ington, D.C. They gave experimental testosterone patches to 562 women, average age 49, who’d had their ovaries removed. They stopped producing their own androgens, and as a result, suffered libido loss. Once the women affixed the adhesive patches to their skin, a measured amount of testos- terone (300 micrograms/day) passed through their skin into their bloodstreams. Using the patch for six months, the women reported a 56 percent increase in sexual desire and a 74 percent increase in sexual satisfaction. (The testosterone patch is still experimental and currently not available outside of research studies.)

Side Effects?

Early studies of androgen supplementation in women produced troubling side effects: increased risk of heart disease and liver abnormalities, and masculinization: growth of facial hair, hair loss atop the head, and acne. Most clinicians continue to discourage women with heart or liver disease from taking androgen supplements. However, recent studies of androgen supplementation have used much lower doses, and these side effects, while still possible, have become considerably less common.

Breast cancer survivors are often warned to avoid androgen replacement because the body converts testosterone into estrogen, which may stimulate tumor recurrence.

If you’re a woman who is not in any of the risk groups just mentioned, and you feel troubled by low libido or a lack of sexual enjoyment, it’s prudent to get your testosterone and DHEA levels tested. If yours are below the normal range, or in the bottom quarter of the normal range, show this article to your doctor, and discuss the advisability of taking DHEA or a topical androgen cream.

Or consult a sex therapist. TTo find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Goldstat, R et al. “Transdermal Testosterone Therapy Improves Well-Being, Mood, and Sexual Function in Premenopaus- al Women,” Menopause (2003) 10:390.

Shifren, JL et al. “Transdermal Testosterone Treatment in Women with Impaired Sexual Function After Oophorectomy,” New England Journal of Medicine (2000) 343:682.

Simon, JA. “Study Of The Testosterone Patch In Women,” presented to the 2004 annual meeting of the American College of Obstetrics and Gynecology. Great Sex Guidance: Androgens (Male Sex Hormones) Help Some Women with Low Libido – © Michael Castleman – 299 – The Clitoris: New Insights

Quick: What is the clitoris? Where is it? The standard view is that the clitoris is the little bump of eroti- cally sensitive, orgasm-triggering tissue nestled outside the vagina above the vaginal opening be- neath the upper junction of the vaginal lips.

Actually, the clitoris is much more than that. But unfortunately, for some 500 years, the clitoris has been minimized, misrepresented, and misunderstood. It’s time to rehabilitate the clitoris and see it for what it really is—an organ as large and multifaceted as the penis, just arranged a little differently.

Women’s Genitals—All of Them

Our term “clitoris” comes from the Greek kleitoris, meaning the female genitals—all of them, more than just the little nub we know as the clitoris today. The ancients knew more about the female geni- tals than many modern folks. One of the foremost ancient Greek physicians, Claudius Galen, said, “All parts that men have, women also have. The only difference is that in men, they are on the out- side, in women, on the inside.” Modern anatomists have proved him correct, so correct, in fact, that we need a new term to describe the parts of the clitoris other than the little bump. Let’s call this collec- tion female erotic body parts the “Clitoral System.”

Introducing the Clitoral System

Just as all parts of the penis and its surrounding tissue can become sexually aroused, the same goes for all parts of the Clitoral System. Many men would feel erotically short-changed if a lover focused only on the head (glans) of the penis and ignored the shaft and scrotum. By the same token, many women feel short-changed when their lovers focus only on the clitoris and not the entire Clitoral Sys- tem.

The penis and Clitoral System develop from the same germ cells. At eight weeks of fetal develop- ment, they appear virtually identical. The bump of the clitoris is the equivalent of the glans of the penis. But just as the penis is more than its head, the Clitorial System is more than the clitoris.

Great Sex Guidance: The Clitoris- New Insights – © Michael Castleman – 300 – More Sensitive to Touch Than the Penis

The clitoris holds some 7,000 sensory nerve endings, more than the glans of the penis, in fact, a greater concentration of touch-sensitive nerves than any other structure in the body. This concentra- tion of sensory nerve endings makes the clitoris more sensitive to touch than the penis. It’s the reason why many women feel discomfort, even pain, when their clitoris is fondled in any way other than very gently. Even when fondled gently, direct pressure on the little bump with a finger, lips, tongue, penis, or sex toy may be hard to take. There is nothing wrong with women who feel this way. If a woman has a super-sensitive clitoris, a lover should fondle around it, not directly on it.

The Clitoral Shaft

Under the clitoris, is another part of the Clitoral System, the clitoral shaft. It’s analogous to shaft of the penis, only much smaller. Like the penile shaft, it contains spongy erectile tissue. When women become sexually aroused, the clitoral shaft fills with blood and becomes longer and firm. In some women, this is visible. The erect clitoral shaft pokes out from between the top junction of the vaginal lips. However, in other women, the clitoral shaft is no more visible when sexually aroused than when not. There are two possible reasons for this. In some women, although they feel highly aroused, the clitoral shaft does not lengthen enough to be noticeable. In other women, the vaginal lips become so blood-engorged and swollen that they continue to cover the clitoris, even thought the shaft has be- come firm and longer.

As the penis becomes erect, a ligament in the lower abdomen, the suspensory ligament, causes it to stick out or up. Women also have a suspensory ligament, which is part of the Clitoral System. It tight- ens during sexual arousal and typically retracts the flap of tissue that covers the clitoris, the clitoral hood, exposing the clitoris as it becomes erect.

The Clitoral Hood

The clitoral hood is analagous to the foreskin of the penis. Just as the foreskin retracts when the penis becomes erect (assuming it has not been removed by circumcision), in most women, the cli- toral hood gets pulled upward by the tightening suspensory ligament as a woman becomes sexually aroused, allowing the growing clitoris to become more prominent and visible.

The Inner Vaginal Lips

The inner vaginal lips are also part of the Clitoral System. Like the clitoral shaft, they also correspond to the shaft of the penis. The inner vaginal lips contain a great many nerve endings sensitive to erotic sensation. Some women say their inner lips are actually more erotically charged than their clitoris. The inner lips also contain some erectile tissue. As women become sexually aroused, the inner lips often extend outward beyond the outer lips and separate, providing easier access to the sensitive area between them, and to the vaginal opening.

Inner lips vary enormously in appearance: in color from pale pink to burgundy or even gray, in shape from thin and narrow, to fluted, to thick and fleshy. Some women feel self-conscious about theirs, thinking they don’t look like they “should.” But inner lips come in all shapes, sizes, and colors. In the words of noted sex educator Betty Dodson, Ph.D., of New York City, producer of the video, Viva the Vulva, the inner lips are snowflakes—all unique, all beautiful.

Great Sex Guidance: The Clitoris- New Insights – © Michael Castleman – 301 – The Urethral Sponge and G-Spot

While men’s erectile tissue is concentrated in the shaft of the penis, women’s is distributed throughout the Clitoral System. A good deal of female erectile tissue occupies the area between the inner vaginal lips, particularly around urethral opening, about halfway between the clitoris and the vaginal opening. This area is known as the urethral sponge. When its erectile tissue becomes engorged with blood, it bulges somewhat and becomes firm. But the bulging is hardly visible externally between the vaginal lips. Instead, the urethral sponges bulges inward, around the pubic bone, causing a little mound in the front vaginal wall. This mound can be felt on the inside of the vagina, about two inches in from the vaginal opening, on the upper vagina when a woman lies on her back. It’s the G-spot, yet another facet of the Clitoral System. But the G-spot isn’t really a spot. It’s the internal manifestation of the erotically aroused urethral sponge. It may be as large as a quarter coin.

The Perineum and Anus

Below the vaginal opening is the perineum, the little bridge of skin that separates the vagina from the anus. The perineum and anus mark the lowest portion of the Clitoral System. Both can become very sensitive to erotic caresses, thanks to several muscles that surround the Clitoral System, the pelvic floor muscles. The most widely known of these is the pubococcygeus, or PC, the one that contracts when women (or men) squeeze out the last few drops of urine. The PC also contracts during orgasm. The PC is the muscle strengthened by Kegel exercises, which increase the power and pleasure of orgasm. In addition to the PC, there are also other pelvic muscles that form a figure-eight around the vaginal opening and anus. That’s why many women enjoy anal massage and fingering, and why a small proportion of people also enjoy gentle anal intercourse. The musculature around the anus is part of the Clitoral System. (In men the pelvic floor muscles form a figure-eight around the base of the penis and the anus. Many men, both homosexual and heterosexual, also enjoy anal sphincter mas- sage, and anal fingering, and a small proportion enjoy gentle receptive anal intercourse.)

The Paraurethral Glands

Between the inner vaginal lips, around the female urethral opening are a group of tiny paraurethral glands (“para” means around). On orgasm, some women produce fluid similar to male prostatic se- cretions. Not all women produce this fluid, and among those who do, the amount varies from a few drops to considerably more. The fluid is female ejaculate, similar to male semen, except that it lacks sperm.

The Outer Vaginal Lips

The outer lips develop from the same embryonic tissue as the scrotum in men. They are not part of the Clitoral System, just as the scrotum is not part of the penis. However, the outer lips are just as erotically excitable as the scrotum.

The Vagina

Most people consider the vagina a key female sex organ, sometimes, the only one. Actually, it is not part of the sexual Clitoral System—except to the extent that the G-spot is accessible through it. For women, the vagina is a reproductive organ. However, it’s a sex organ for men because it receives the penis during intercourse.

Great Sex Guidance: The Clitoris- New Insights – © Michael Castleman – 302 – Vaginal intercourse certainly provides many women with sensual pleasure. It allows the woman and her lover to share a special intimacy, and many women enjoy the sensation of feeling filled, and hold- ing the man’s erection inside them. Intercourse also produces some indirect stimulation to the vari- ous parts of the Clitoral System, allowing about some—but by no means all—women to experience orgasm during vaginal intercourse. Nonetheless, the vagina is more of a sex organ for men than for women.

Ancient Wisdom Abandoned

As early as 500 B.C., Chinese and Indian sex treatises mentioned female ejaculation, and from an- cient Greek times until the 18th century, the penis and Clitoral System were considered to be equiva- lent organs in all aspects, except for their arrangement.

But after 1700, the concept of male-female genital and sexual equivalence began changing. Over the next few centuries, physicians and anatomists increasingly viewed women as “less sexual” than men, and came to deny the very existence of the Clitoral System. By Victorian times in the latter half of the 19th century, women were viewed as not sexual at all, but merely passive recipients of men’s lust. The clitoris was reduced to the little nub the term connotes today. Sigmund Freud went so far as to tout the completely erroneous notion that only immature, neurotic women have “clitoral orgasms,” while mature, mentally healthy women have “vaginal orgasms.” In fact, all orgasms involve contrac- tion of the pelvic floor muscles. Depending on the circumstances, orgasms can feel different. But they all involve rhythmic contraction of the same muscles.

What accounted for this misrepresentation of women’s sexuality? No one really knows. Feminists say it had to do with the rise of modern obstetrics and gynecology, when male physicians seized control of women’s medicine from midwives. Some historians contend that the change reflected the rise of the modern industrial state, the transition from men and women working side by side as approximate equals in agriculture to a division of labor with men as breadwinners and women as homemakers. Whatever the case, the ancients’ appreciation of the Clitoral System faded.

The Clitoris Resurrected

It was not until the mid-20th century that William Masters, M.D., and Virginia Johnson refuted Freud’s notion of the vaginal orgasm, and began to restore the clitoris to its rightful place in women’s sexual- ity. But they did not fully connect it to the Clitoral System.

It wasn’t until the 1980s that sex researchers Beverley Whipple, Ph.D. and John Perry, Ph.D, docu- mented female ejaculation and the G-Spot. And only since the 1980s have sexuality authorities come to a renewed appreciation of the full extent of the Clitoral System. Nonetheless, most people still view the clitoris as the little bump tucked under the apex of women’s inner vaginal lips. The full extent of the Clitoral System remains to become fully repopularized.

So what is the clitoris? And where is it? The clitoris is the little nub, but the Clitoral System encom- passes the entire vulva, from the clitoral hood to the anus, and has surprisingly little to do with the vagina.

Finally, why are so many women sexually frustrated, nonorgasmic, and unfulfilled? Perhaps because they and their lovers don’t fully appreciate the wonder and beauty of the Clitoral System.

Great Sex Guidance: The Clitoris- New Insights – © Michael Castleman – 303 – References:

Chalker, Rebecca The Clitoral Truth. Seven Stories Press, NY, 2000). $19.95.

Heiman, JR. et al. (eds) “Women’s Orgasm,” Annual Review of Sex Research (2004) 15:173.

Great Sex Guidance: The Clitoris- New Insights – © Michael Castleman – 304 – The G-Spot: Everything You Need to Know

If you’re confused about the G Spot, you’re not alone. Many women—and men—wonder: What is it? Where is it? Why can’t I find mine (or hers)? What’s it got to do with female ejaculation? Why do I “pee” when I come? Why can’t I ejaculate?

First, it’s important to understand that many questions about the G-spot remain unanswered. The reason, sadly, is political opposition to sex research. The U.S. federal government, a key source of funding, has largely withdrawn from G-spot research. And the drug industry, the other major source of funding, has not been interested because the G-spot seems unlikely to lead to the development of new medications. So we’re left with American research that was carried out largely in the 1980’s, and since then, with the reports of many women, and some research in Eastern Europe. A good deal is known, but many questions remain.

Graffenberg’s Forgotten Discovery

Back in the early 1940s, a German gynecologist, Ernst Graffenberg, along with an American col- league, Robert Dickinson, discovered “a zone of erogenous feeling... located along the suburethral surface of the anterior vaginal wall,” meaning, inside the vagina on the front wall (or top if the woman is on her back). In a 1950 article in the International Journal of Sexology, Graffenberg asserted that this erogenous zone contained erectile tissue, and swelled when massaged, and during orgasm.

Graffenberg did not name this area. At the time it was called, the “urethral sponge,” the area on the front wall of the vagina about a finger length in from the vaginal opening that surrounds the urethra. Many sexologists continue to call this area the urethral sponge today.

Graffenberg’s research lay virtually forgotten until the 1980s when sexologists John Perry, and Bev- erly Whipple rediscovered the fact that virtually all women have an area of sexual sensitivity on the front wall of their vaginas. In their studies, 90 to 100 percent of up to 400 women identified a sensitive area in the front vaginal wall. Perry and Whipple unearthed Graffenberg’s old research, and decided to rename the area known as the urethral sponge after him, the Graffenberg spot, or G-spot.

In 1982, Perry and Whipple publicized their findings in a best-selling book, The G-Spot And Other Recent Discoveries About Human Sexuality. It triggered a stampede of interest in the suddenly-trendy

The G-Spot: Everything You Need to Know – © Michael Castleman – 305 – G-spot. Millions of women and couples tried to find it. But only some succeeded, making the G-spot controversial.

G-Spot Backlash

Citing reports that many women feel nothing in the area Perry and Whipple identified as the G-spot, other researchers dismissed it. In the 1988 edition of their classic book, Human Sexuality, pioneering sex researchers William Masters, M.D., and Virginia Johnson (along with a new coauthor, R.C. Kolod- ny) asserted that Perry and Whipple had overstated the case, that only about 10 percent of women had sexually sensitive G-spots.

Perry and Whipple retorted that those unable to find the fabled spot were possibly misinformed.The G-spot was not really a “spot,” like a button or the navel, but rather a general area on the front wall of the vagina. And it did not lie on the front wall, but rather deep within it. It was most easily detect- able when women were highly sexually aroused, when G-spot swelling made it easier to find.And it was easier for a lover to find than for the woman herself. Nonetheless, many women and couples still could not find theirs, or if they did, the woman did not find G-spot massage particularly pleasurable.

Highly Individual Reactions

Everybody’s different. Some women adore having their nipples suckled. Others like it, but don’t love it. And some find it uncomfortable. The same goes for the G-spot. Some women report mind-blowing orgasms from sustained G- spot stimulation. Others call it a modest sexual enhancement. And some feel nothing, or find G-spot stimulation uncomfortable. Explore your G-spot if you like, but try to avoid any preconceptions. Accept what you feel, whatever that may be.

How To Find It

The G-spot is easiest to locate—and most sensitive to touch—when a woman is already highly aroused. Women who want to find theirs should explore themselves during masturbation. It’s not that easy for a woman to feel her own G-spot. You can reach an inch or two into the vagina, but it’s difficult for a woman to press on the front wall of her own vagina. If you try, you may miss your G-sot.

Many women say it’s easiest to locate the G-spot if they are (1) on their backs with their knees pressed against their breasts, (2) squatting down, or (3) using a sex toy designed for G-spot explora- tion. G-spot toys are phallic vibrators or dildos with curved tips. When a woman lies on her back, she can insert the toy with the curved tip pointing up, and press it into the front (top) wall of her vagina. Move the toy around until you feel a change in erotic sensation, usually enhancement. Remember, the G-spot is not a “spot,” but a general area. Feel around. Your most sensitive area may be off to one side or the other.

Some women can only enjoy G Spot stimulation when a partner does it. With the woman on her back, legs spread, insert your index or middle finger, then hook it upward and stroke what in this position is the top of her vaginal wall.

The best position for G-spot stimulation during intercourse is doggie-style or rear entry, with the woman on hands and knees and the man behind her. In this position, the head of the penis can press against the G-spot. This makes some evolutionary sense. Other than humans, all other mammals have intercourse only in this position. It would make sense for it to have evolved to be pleasurable for The G-Spot: Everything You Need to Know – © Michael Castleman – 306 – the female.

When they find the G Spot, some women feel a momentary urge to urinate.This usually passes. If not, try urinating beforehand.

The G-Spot and Female Ejaculation

Meanwhile, researchers other than Perry and Whipple had independently investigated the urethral sponge, not for its sexual potential, but rather because they were interested in the paraurethral glands it contained. “Para” means around. The paraurethral glands are tiny fluid-producing structures lo- cated around the female urethra (urine tube). The first two were discovered by Alexander Skene in the 1880’s and were called Skene’s glands. Since then, several others have also been identified. The arrangement of these glands, and the fact that they produced fluid reminded the researchers of the male prostate gland, and some began calling the urethral sponge the “female prostate.” Recent research has strengthened the case that the paraurethral glands are, in fact, the female prostate.

Perry and Whipple incorporated this into their book, saying that when a woman is highly sexually aroused, with an aroused G-spot, the paraurethral glands secrete fluid that emerges on orgasm as “female ejaculation.”

Urination on Orgasm?

This observation seemed to explain a good deal of sexual history. Writers dating back to the first-cen- tury Roman physician, Galen, had remarked that women produce a “thin” fluid that “manifestly flows when they experience the greatest pleasure in coitus.” The ancient Indian Kama Sutra and centuries- old Japanese erotic works also mention fluid issuing from women during sexual arousal.

But both Alfred Kinsey, the first modern American sex researcher, and Masters and Johnson rejected the notion of female ejaculation, saying that some women simply produced a great deal of vaginal lubrication.

However, vaginal lubrication does not squirt out during orgasm. Many women notice that they release fluid this way. They may feel concerned about or embarrassed by the fact that they “urinate” during orgasm. Some women have examined this fluid and determined by color and odor that it is not urine. The most recent research confirms this.

It’s Not Urine

Female ejaculatory fluid is not urine. It appears to be a combination of dilute urine and secretions from the paraurethral glands. Some researchers say it’s most similar to the prostatic fluid that forms the bulk of semen in men.

Normal and Safe

How many women ejaculate? Depending on the survey, somewhere between 10 and 50 percent. But the amount released varies considerably from a few drops to much more.

It is perfectly safe for women to ejaculate. You may have to change the sheets or make love on a towel, but no harm has ever been associated with female ejaculation. In fact, one study suggests that The G-Spot: Everything You Need to Know – © Michael Castleman – 307 – women who ejaculate appear to enjoy some protection from bladder infections, presumably because ejaculation helps expel bacteria from the urethra.

It’s also perfectly normal not to ejaculate. Many women do not. If you don’t but would like to, we sug- gest extended foreplay with lots of G Spot massage.

Why do some women ejaculate while others do not? No one knows. But the process seems to be related to G-spot sensitivity. Women with sexually sensitive G-spots are the ones most likely to ejacu- late. This makes physiological sense because the nerves that excite the clitoris also run along the sides of the vagina and cover the area around the G-spot, which includes the paraurethral glands.

How Men View It

Some lovers of women who ejaculate love the juiciness of it, the realization that the woman feels comfortable, relaxed, and loving enough to utterly let go. Others, however, are put off by the fluid, usually because they believe it’s urine. To help a dubious lover become more comfortable with your ejaculation, explain that the fluid is not urine, that female ejaculation is fairly common, and that it adds to the pleasure of your orgasm. You might share this article.

The G-Spot: Everything You Need to Know – © Michael Castleman – 308 – Female Ejaculation: The Latest Findings

Since it was first reported in modern sex research in the early 1980s, controversy has surrounded fe- male ejaculation. But recent research—most of it conducted in Slovakia in Eastern Europe—strength- ens the case for female ejaculation, and suggests that the fluid comes from the same gland that produces most of the fluid in semen, a female analogue of the male prostate gland.

Depending on the survey cited, somewhere between 10 and 50 percent of women ejaculate, that is, they produce fluid from their genitals at orgasm. The amount of fluid released varies considerably, from a few drops to considerably more, enough so that some women must make love on a towel to keep from soaking the sheet.

If so many women ejaculate, why is female ejaculation controversial? Because in Western medicine, medical phenomena must be explained before they are accepted. Female ejaculation has remained unexplained. It was not clear where the fluid came from, hence the controversy. The recent Slovakian research provides the missing explanation. The main researcher, Milan Zaviacic, contends that wom- en’s ejaculate comes from the female prostate, a gland he contends has been misnamed for more than 100 years.

From the Paraurethral Glands to the Female Prostate

Women’s external genitals are collectively called the vulva. In the middle of the vulva, above the vaginal opening and below the clitoris, is the opening of the urine tube, the urethra. A group of glands are embedded around this opening in the vulva, the paraurethral glands. “Para” means around, in this case, around the urethral opening.

In the 1880s, Alexander Skene discovered the first two paraurethral glands, called Skene’s glands. Skene documented that the glands he discovered produce a little fluid. Since then, several other paraurethral glands have been identified. The arrangement of these glands, and the fact that they produce fluid reminded researchers of the male prostate gland. As a result, some sexologists call these glands the “female prostate.” But the name has not caught on. As far as non-sexologists are concerned, men have prostates and women don’t.

Great Sex Guidance: Female Ejaculation- The Latest Findings – © Michael Castleman – 309 – Confirming What the Ancients Observed

Nonetheless, Skene’s observation that the glands named for him produced fluid explained a good deal of sexual history. Writers dating back to the ancient Romans, reported that women produce a thin fluid that “flows when they experience the greatest pleasure.”The Kama Sutra and centuries-old Japanese erotic works also mention fluid issuing from women during orgasm.

Unfortunately, however, both Alfred Kinsey, the first modern American sex researcher, and Masters and Johnson, the pioneers of modern sexology and sex therapy, dismissed female ejaculation as sim- ply extra-copious vaginal lubrication.

Urination on Orgasm?

But such dismissals do not ring true for many women who notice that they release fluid on orgasm. Some feel embarrassed about “peeing” during orgasm. Others realize that the fluid was not urine. It neither looks nor smells like urine.

In the 1980s, sexologists John Perry, Ph.D., and Beverly Whipple, Ph.D., popularized the G-spot, the area of sexual sensitivity that most—but not all—women feel when fingers or a sex toy press on the front wall of the vagina (the top when the woman is on her back), about an inch or two in from the vaginal opening. Perry and Whipple also documented the fact that vigorous G-spot stimulation in- creased the likelihood of female ejaculation on orgasm.

Definitely Not Urine

They and other researchers analyzed female ejaculatory fluid and found that it is not urine, but rather a combination of secretions from the paraurethral glands that chemically resemble prostate secre- tions in men. But how could women produce prostate fluid when they have no prostate?

Women Have a Prostate

In a series of studies spanning 10 years, Zaviacic and his colleagues have unraveled some of the mystery surrounding female ejaculation and the female prostate. But because this research has been carried out in Eastern Europe, much of it published in Slovakian journals, it has not received much at- tention in Western Europe or the U.S.

* Microscopic studies of the Skene’s glands show “secretory” cells, i.e., cells that secrete fluid.

* Women produce prostate-specific antigen (PSA). PSA is a compound unique to the prostate gland. If women produce PSA, they must have a gland analogous to the male prostate.

* One theory was that women’s breast tissue might produce PSA. However, it does not. The source is the Skene’s glands.

* Enzymes characteristic of the male prostate are also found in the Skene’s glands.

* When men develop prostate cancer, PSA levels rise. When women develop cancer of the Skene’s glands, their PSA levels rise.

Great Sex Guidance: Female Ejaculation- The Latest Findings – © Michael Castleman – 310 – * Tumors of the Skene’s glands contain cells very similar to those found in prostate tumors in men.

Skene’s Glands Are the Female Prostate

Zaviacic’s conclusion: The Skene’s glands are, in fact, the female prostate. Zaviacic contends that the term Skene’s glands should be dropped in favor of the female prostate. Female ejaculate is analo- gous to male semen.

The Remaining Mystery

Virtually every healthy man who has a prostate produces prostate fluid. But only a fraction—10 to 50 percent—of women ejaculate. If women have a fluid-producing prostate gland, why don’t they all ejaculate? Currently, no one knows. It’s possible that most or all women do ejaculate, but that stud- ies to date have not been sophisticated enough to document it. It’s also possible that for reasons that remain unclear, some women don’t ejaculate.

What About the Copious Squirting in Porn?

Some porn videos feature women who produce cups, pints, even quarts of fluid while in the supposed throes of sexual ecstasy. Is this for real? Yes and no. As mentioned, some women ejaculate enough fluid to necessitate placing a towel under them. Based on current research, it’s not clear what propor- tion of women are in this group. But available evidence suggests it’s small. It’s possible that produc- ers of squirting videos select for women who ejaculate unusually large amounts of fluid. But it’s more likely that these videos rely on women filmed after having used vaginal enemas. If you enjoy such videos, fine. Just don’t expect this to happen when you make love.

References:

Zaviacic, M et al. “Ultrastructure of the Normal Adult Female Human Prostate Gland (Skene’s Gland),” Anatomy and Embryology (2000) 201:51.

Zaviacic, M and RJ Ablin. “The Female Prostate and Prostate-Specific Antigen…Reasons for Using the Term ‘Prostate’ in the Human Female,” Histology and Histopathology (2000) 15:131.

Zaviacic, M et al. “The Normal Female and Male Breast Epithelium Does Not Express Prostate-Spe- cific Antigen…” General Physiology and Biophysiology (1999) 18(Suppl 1):41.

Zaviacic, M. “The Adult Human Female Prostata Homogogue and the Male Prostate Gland: A Com- parative Enzyme-Histochemical Study,” Acta Histochemica (1985) 77:19.

Zaviacic, M et al. “Prostate-Specific Antigen and Prostate-Specific Acid Phosphatase in Adenocarci- noma of Skene’s Paraurethral Glands and Ducts,” Virchows Arch A Pathol [Slovakian journal] (1993) 423:503.

Zaviacic, M and B. Whipple. “Update on the Female Prostate and the Phenomenon of Female Ejacu- lation,” Journal of Sex Research (1993) 30:148.

Great Sex Guidance: Female Ejaculation- The Latest Findings – © Michael Castleman – 311 – Menopause and Women’s Sexuality: New Perspectives from the Largest, Best Study to Date

Here’s the conventional wisdom on sex and menopause:

* During and after menopause, most women’s libidos decline (though this may sometimes be re- versed using androgen hormone replacement).

* Most older women experience vaginal dryness (though this may be minimized using a sexual lubricant).

* Most older women’s frequency of intercourse declines in part because of reduced libido, and in part because of partner loss or sex problems on the part of partners.

The Largest Study Ever

These findings are the consensus results of quite a few studies. But most of them involve small num- bers of women, and they are cross-sectional, meaning that they asked menopausal women: What is your sexuality right now? Small trials can provide valuable insights. But they are not as authoritative as large studies. There’s strength in numbers. Cross-sectional trials can also provide important infor- mation. But they are not as authoritative as studies that follow people over time, ideally many years— prospective trials.

In 2002, Australian researchers published results of the world’s largest, longest-duration prospective study ever on the sexual effects of menopause. To some extent, it confirms the conventional wisdom. But it adds important new perspective, largely because it compares how women feel early in the pro- cess of menopause (age 45 to 50) and years later.

The Melbourne Women’s Midlife Health Project (MWMHP) study involves 2,001 randomly selected Australian women who enrolled when they were 45 to 55 and were followed for at least 11 years. The women were interviewed extensively at enrollment, and have been re-interviewed many times since.

The menopausal sexuality study reports on 438 women. Most (224) had natural menopause. Some

Great Sex Guidance: Menopause and Women’s Sexuality- New Perspectives from the Best Study to Date – © Michael Castleman – 312 – (37) had surgical menopause—removal of their ovaries, usually during hysterectomy. And some (91) had taken hormone replacement therapy. These figures are roughly equivalent to American women’s experiences of menopause.

The Sexual Stages of Menopause

Year-to-year, two-thirds of the women reported no change in sexual functioning or desire, but one- third reported declines. Over time, declining sexual interest and activity affected virtually all the wom- en.

However, the largest declines occurred during the early years of the menopausal transition. Declines from baseline to early menopause were much greater than declines from early to later menopause. In other words, menopause does not appear to produce an unrelenting downward spiral in women’s sexual interest and frequency. In most women, it declines during the decade of the fifties, but later, the rate of decline slows considerably.

Vaginal dryness also increases from baseline through early menopause and through late menopause. Dryness can feel uncomfortable, but for most women, it need not become a sexually limiting problem, thanks to sexual lubricants.

The Changing Emotional Lives of Menopausal Women

The biggest surprises in the MWMHP concern women’s feelings for their partners and their assess- ment of their own sexual responsiveness. During early menopause, women report more problems with their lovers and more negative feelings about them. But by later menopause, feelings for part- ners have returned to baseline. It appears that the early transition into menopause is emotionally dif- ficult for women—and the men in their lives—which causes friction and resentments. But as the years pass, couples accommodate to menopausal changes and most women feel renewed love and affec- tion for their partners.

In Late Menopause, Sexual Responsiveness May Increase

Something similar happens to women’s feelings about their own sexual responsiveness. From base- line to early menopause, the women in the MWMHP reported a precipitous drop in responsiveness. But as the years passed, responsiveness improves. By late menopause, the women said their sexual responsiveness was almost back to baseline.

Menopause is an intensely personal transition. Every woman passes through it in her own way. But the MWMHP provides reassurance for those women and couples who hope to remain active lov- ers for life. Yes, menopausal women experience vaginal dryness and a decline in libido and sexual frequency, so the MWMHP confirms the conventional wisdom. But this study, the largest and most authoritative to date, also shows that women’s sexuality does not shrivel up and disappear during menopause. In fact, women with partners tend to remain interested in sex and sexually active, albeit at lower levels than when they were younger. And during later menopause, women’s feelings of love and warmth for their partners tends to increase along with their sexual responsiveness.

To be sure, menopause is a sexually mixed bag. But for couples who can adjust to reduced sexual frequency without major resentments, sex in later life is increasingly tender, and women remain sexu-

Great Sex Guidance: Menopause and Women’s Sexuality- New Perspectives from the Best Study to Date – © Michael Castleman – 313 – ally responsive—in fact, from early to late menopause, this study shows that responsiveness im- proves.

Reference: Buster, J.E. and P. Amato. “Low Libido After Menopause: Considerations and Therapy,” SRM (2007) 5:17. Dennerstein, L et al. “Menopause and Sexual Functioning: A Review of Population-Based Studies,” Annual Review of Sex Research (2003) 14:64. Kingsbury, SA. “The Impact of Aging on Sexual Function in Women and their Partners,” Archives of Sexual Behavior (2002) 31:431. Nachtigall, L and D Shoupe. “Sexual Dysfunction and Menopause: The Health Consequences of Atro- phic Vaginitis,” Women’s Health in Primary Care (Suppl). 8-2002, p. 3.

Great Sex Guidance: Menopause and Women’s Sexuality- New Perspectives from the Best Study to Date – © Michael Castleman – 314 – How Women REALLY Feel About Penis Size

In previous articles, I’ve tried to reassure anxious men that penis size doesn’t matter to the substan- tial majority of women. And every time, comments have poured in from gals calling me a fool, saying that size matters a great deal to them.

Okay, size matters to some women. I’ve never said it didn’t. But based on decades of conversations with sex therapists and many women, I’ve concluded that the substantial majority of women don’t care, that they’d rather be with men who are warm, kind, solvent, caring, and funny, who share their values and interests than one who has a phone pole in his pants. Unfortunately, I couldn’t back that up with research because I knew of no study that explored women’s feelings on the subject. Now I do.

Recently, researchers at UCLA and Cal State LA published a report showing that 84 percent of women feel “very satisfied” with their man’s penis size. Fourteen percent wish it were larger and 2 percent would prefer smaller. The 84 percent figure means that seven out of every eight women think their man is just fine, corroborating my assertion that size doesn’t matter to the substantial majority of women.

This study is particularly persuasive because its methodology goes way beyond your run-of–the-mill survey of 100 college undergraduates. The researchers posted their questions on MSNBC.com and got responses from 26,437 women ages 18 to 65. Respondents were a self-selected group, which raises questions about demographic representation. But 26,437 is a huge number, a number so large that statistically it obviates concerns about self-selection and strongly suggests that the findings are truly valid.

Women Are More Satisfied Than Men About Men’s Size

The survey also attracted responses from 25,594 men. Two-thirds of them rated their penises as “average,” exactly matching what the women said about their partners. But women were only half as likely as men to call their man’s penis “small,” and were more likely to call it “large.”

Men who called theirs “small:” 12% Women who called their man’s “small:” 6%

Great Sex Guidance: How Women REALLY Feel About Penis Size – © Michael Castleman – 315 – Men who called theirs “large:” 22% Women who called their man’s “large:” 27%

From Ancient Greece to Michelangelo to Porn

Our equation of manhood with a big penis stands in marked contrast to how the ancients viewed genital size. In Aristophanes’ play, The Clouds (423 B.C.), a character admonishes delinquent young men that if they continue to behave badly, as punishment, their penises will grow larger, but that if they repudiate their wicked ways, their organs will remain as they should be, small.

Five centuries later, the Roman novel, Satyricon, (c. 50 A.D.) describes bathers at a public bath who make fun of one character’s large penis, calling it as ridiculous as contemporary reactions to the outsized shoes of circus clowns. Like the Greeks, the ancient Romans thought the most attractive penises were on the small side. The classic view that small is beautiful persisted through the Renaissance. Consider Michelangelo’s David or male nudes sculptures by other artists of that period. The penises are surprisingly small. At that time, “masculinity” had less to do with the size of a man’s penis than with the size of his scrotum. A big scrotum that hung full and low suggested large testicles, which in turn, suggested great potency. During the Renaissance, penises were considered little more than incidental injection devices for what really counted, sperm.

That changed in the second half of the nineteenth century as photography (invented around 1840) and motion pictures (1890) paved the way for modern pornography. Porn has always been primarily a masturbation aid for men. Male masturbation is all about erections, so porn transformed penises from injection devices into the center of attention—and for portrayal in photography or film, the bigger the better.

Got a Ruler?

To most people, “penis size” implies length. Some two dozen studies have measured it. Most mea- sure on the top side from the pubic bone at the base of the penis to the tip of the glans—without pushing the ruler into the gut or pulling on the shaft to stretch it. The results:

Flaccid: • The typical flaccid penis is 3.5 inches long. (Small flaccid penises grow more to erection than large flaccid organs.)

Erections: • Only 2.5% of erections measure less than 3.8 inches. • 13.5% are 3.8 to 4.5 inches. • 68% are 4.6 to 6.0 inches. • 13.5% are 6.1 to 6.8 inches • And only 2.5% are longer than 6.9 inches.

Ironically, among women who said care about size, fewer care about length than girth.

Great Sex Guidance: How Women REALLY Feel About Penis Size – © Michael Castleman – 316 – Be All You Can Be

The taller the man, the longer his arms and legs—and penis. But according to the survey, compared with the shortest men (5 feet 2 inches) the tallest (over 6 feet 4 inches) reported feeling only slightly more satisfied with their size.

Weight is another story. The slimmest men are much happier about their penis size than men who are obese. This makes sense because as weight increases, the lower abdominal fat pad grows and envelopes the base of the penis, making it look considerably smaller.

Want to make the most of what the good Lord gave you? Forget all the pills and potions advertised on the Internet. They’re all cynical frauds. To be all you can be between the legs, lose weight. But do it for yourself because there’s an 84 percent chance that the woman in your life is perfectly happy with your penis as it is.

References:

Lever, J. et al. “Does Size Matter? Men’s and Women’s Views on Penis Size Across the Lifespan,” Psychology of Men and Masculinity (2006) 7:129.

Clarke, J.R. Roman Sex. Harry N. Abrams, NY, 2003.

Great Sex Guidance: How Women REALLY Feel About Penis Size – © Michael Castleman – 317 – Pelvic Pain? Pain During Intercourse? A Guide to Women’s Sexual Pain

Many women suffer sexual pain. It can occur at any age, but beyond pain associated with early sexu- al experiences, sex-related genital pain often occurs after age 40.

The landmark 1999 survey, Sex in America, estimated that 20 percent of American women experi- ence pain on intercourse. Other surveys suggest that 15 percent of premenopausal women and 33 percent of postmenopausal women complain of genital pain. Genital pain and pain on intercourse are frequent reasons why women consult gynecologists and sex therapists.

Women experience two kinds of sexual pain: chronic genital pain independent of lovemaking, and pain during sex, typically during intercourse.

Unfortunately, until recently, doctors often dismissed women’s genital or sexual pain (medically: dyspareunia or vulvodynia) as “neurotic” and suggested they consult a psychiatrist. This left women doubly wounded—in pain, and made to feel emotionally troubled as well.

Compounding the problem, some men haven’t believed women who said they experienced sexual pain. Others have believed, incorrectly, that sex is supposed to be painful for women. But that situa- tion is changing. “Guys I see in therapy often feel really guilty about lovers’ pain during intercourse,” says sex therapist Dennis Sugrue, Ph.D., a former president of the American Association of Sex Edu- cators, Counselors, and Therapists. “They don’t understand it. They’re convinced it’s their fault. They want sex, but they don’t want to hurt their lovers.”

Pain is a mind-body experience. It has both physical and emotional components. For example, stress, anxiety, and depression make all pain hurt more no matter where in the body it occurs. Having pain exacerbated by psychological factors does not mean you’re neurotic. It simply means you have some psychological factors aggravating the physical causes of your pain. It helps to identify both pain’s physical and psychological components because each responds to different treatments. Even if one component resists treatment, you may experience significant relief by treating the other.

Great Sex Guidance: Pelivc Pain? Pain During Intercourse? A Guide to Women’s Sexual Pain – © Michael Castleman – 318 – Genital Play and Intercourse Should Never Hurt

Attention, men: Forget those song lyrics about how love “hurts so good.” Genital play and intercourse should never hurt. Some men feel so eager to plunge into intercourse that they ignore or dismiss women’s complaints about discomfort and pain. Big mistake. If sex hurts her, she can’t become aroused or responsive, which means unsatisfying sex for both of you. Not to mention that she’s likely to resent you (or worse). Your relationship may suffer serious strains. And she might complain to her friends that you’re a lousy lover.

Most Sexual Pain Can Be Cured

The good news is that sexual pain can usually be resolved. In a two-year study, two-thirds of women with sexual pain reported significant improvement.

There are many possible causes of sexual pain in women over 40:

Lack of Lubrication

In pornography, women become wet between the legs when an attractive man walks into the room. That’s total garbage. Many perfectly normal women don’t produce much vaginal lubrication, even when they feel highly aroused by partners they love deeply. Lubrication problems become particularly common after age 40, as women begin to experience menopausal changes. Intercourse without suf- ficient lubrication is a major cause of women’s sexual pain.

Nonsensual Lovemaking

Attention, men: It takes women considerably longer than men to feel sufficiently aroused and relaxed to enjoy intercourse comfortably. If men push into women before they feel truly receptive, they experi- ence pain. The key to pain-free lovemaking is sex based on leisurely, playful, whole-body sensuality. Men should consciously slow the pace of lovemaking. Intercourse can wait. Give women all the time they need to become relaxed, aroused, and receptive. A man should tell his lover: I won’t attempt to enter you until you invite me in. Then be creative. Kiss, hug, roll around, massage each other, and en- joy oral sex and other caresses, play with sex toys—anything you both enjoy. “Warm-up time is very important,” says San Francisco sex therapist Linda Alperstein. “Men need to allow women the time they need. And women need to insist on making love at a pace that gives them the time they need to become aroused.” Most sex therapists recommend at least 30 minutes of kissing, cuddling, and mu- tual whole-body massage, and oral sex before attempting intercourse.

Cunnilingus can supplement women’s natural vaginal lubrication. Or use a commercial lubricant, or vegetable oil (though it might stain linens). Once women become menopausal, most need extra lu- brication every time. “Use lubricant on her vulva and vagina and your penis,” advises Palo Alto, Cali- fornia, sex therapist Marty Klein, “and after a while, use some more. I recommend lube to everyone every time.”

The Man Pushing In Too Quickly Or Deeply

Even if women are highly aroused and well lubricated, they may experience pain if men push into them too forcefully, the way the male actors often do in pornography. Men should not try to imitate Great Sex Guidance: Pelivc Pain? Pain During Intercourse? A Guide to Women’s Sexual Pain – © Michael Castleman – 319 – porn. They should ease in slowly.

The skin around the vaginal opening is richly endowed with touch-sensitive nerve endings. Rubbing the head of the penis on her vaginal lips before entering her is erotically stimulating, and helps wom- en warm up to intercourse. When the penis enters the vagina, men should slide in slowly. The vagina is not a hollow space like the inside of a basketball. It is comprised of folds of muscular tissue that yield most comfortably when the penis enters slowly.

Men should be especially careful about depth of insertion in the doggie position, which allows unusu- ally deep penetration—and may cause pelvic pain or abdominal pain during and/or after intercourse. To enjoy this position, the man should initially remain still. The woman should move back onto the penis. She should be in control of the speed and depth of insertion. This way, she can identify her comfort zone, and let the man know how deeply he can insert without causing her pain. Similar issues arise in the woman-on-top position. Again, the man should lie still at first. The woman should slowly sit down in his erection, controlling the speed and depth of insertion.

Relationship Issues

If a woman’s relationship causes her emotional pain, she may experience physical pain during sex. If you’ve been fighting more than usual, or if a relationship crisis has occurred recently, for example, an affair, the woman might experience pain on intercourse. While it’s a mistake to jump to the conclusion that sexual pain means a serious relationship problem—there are many physical causes of sexual pain—nonetheless, relationship issues may cause or contribute to sexual pain. If you suspect a rela- tionship issue, consult a couples counselor or sex therapist to help deal with your issues.

Birth Control Pills

Vuvlar pain expert Andrew Goldstein, M.D., editor of the medical text, Female Sexual Pain Disorders, says that today’s birth control pills are “one of the leading causes of women’s sexual pain.” Compared with pills prescribed before the 1980s, the pills prescribed since then have a different formulation, one that causes overproduction of a protein called sex hormone-binding globulin (SHBG). This pro- tein binds to male sex hormones (androgens) in vulvar tissue, and causes a cascade of biochemical changes that produces pain. Goldstein says that women with pelvic/sexual pain should stop taking birth control pills and take supplemental estrogen and androgens to normalize the levels of these hormones in vulvar tissue. With this treatment, he says most women with pain caused by the Pill are pain-free in six months.

Vulvar Skin Conditions

Women’s external genital skin is very sensitive to irritation. Intercourse may feel painful if this tender skin becomes chafed by: douching, pubic shaving, sunburn, an allergy to latex from condoms, or con- tact dermatitis from harsh or perfumed soaps, feminine hygiene products, or underwear made from synthetic, heat- and moisture-trapping fabrics. If a woman’s vulva appears red or irritated, she should consult a physician.

Sexually Transmitted Infections

Chlamydia, genital warts, and pelvic inflammatory disease may cause pain on intercourse. If pain

Great Sex Guidance: Pelivc Pain? Pain During Intercourse? A Guide to Women’s Sexual Pain – © Michael Castleman – 320 – persists despite increased sensuality and lubrication, the woman should see a doctor and ask to be screened for these infections.

Other Vaginal Infections

Chronic yeast infection, or vaginal bacterial infections (vaginosis) may cause pain on intercourse. The pain may feel worse the day after lovemaking. Yeast infections are treated with antifungal medication, bacterial infections with antibiotics.

Constipation

Constipation makes the pelvic area less flexible, which can contribute to pain. It also makes women feel bloated, uncomfortable, and self-conscious, which can aggravate any sexual discomfort. Consti- pation is very common. U.S. laxative sales approach $500 million a year. Women can prevent con- stipation by eating a bran cereal for breakfast with fruit (especially prunes and raisins), plus a diet based on lots of fruit and vegetables, beans and whole grains; by drinking plenty of nonalcohbolic fluids; getting regular moderate exercise, e.g. brisk walking for at least 30 minutes a day; and never ignoring the urge to go.

Emotional Trauma and Childhood Sexual Abuse

Years after sexual abuse, some survivors experience genital pain or pain during intercourse. In a recent Canadian study, compared with women who had vulvar medical problems but no pain, those who had genital pain reported more life stresses: job and relationship problems, recent marriage or childbirth, the death of someone close, and/or a history of sexual abuse. There may be a time lag of months or even years between the traumatic event and the onset of the pain. Sex therapy can help you overcome the lingering effects of the trauma. Survivors of child sexual abuse may also benefit from the excellent book, The Survivor’s Guide to Sex: How to Have an Empowered Sex Life After Child Sexual Abuse by Staci Haines (Cleis Press, San Francisco, 1999).

Oxalate Irritation

Oxalates are byproducts of the oxalic acid in some foods. Women sensitive to oxalates may develop urethral irritation, which can cause pain on intercourse. High-oxalates foods include: celery, coffee, chocolate, rhubarb, spinach, and strawberries. A more extensive list can be obtained from the Vulvar Pain Foundation (vulvarpainfoundation.org). It can take three to six months on a low-oxalate diet to experience improvement. Another way to reduce oxalate irritation is to take a calcium citrate supple- ment, for example, Citracal. Women interested in this approach should discuss dosage with their doctors.

Vaginismus

Vaginismus causes spasms of the pelvic floor muscles, which makes them clamp down and close the vaginal opening. In mild cases, intercourse is possible, but causes discomfort. In severe cases, insertion is impossible and attempts may cause sharp pain. During any medical evaluation for pain on intercourse, the doctor should check for vaginismus. If it’s diagnosed, the condition is best treated by a physician-sex therapist team. Standard therapy includes Kegel exercises, biofeedback-based pelvic muscle relaxation exercises, and gentle insertion of graduated dilator rods that gradually coax the vagina open enough to receive an erection. Great Sex Guidance: Pelivc Pain? Pain During Intercourse? A Guide to Women’s Sexual Pain – © Michael Castleman – 321 – Vulvar Vestibulitis (VV)

This poorly understood condition involves inflammation of the vestibular glands, tiny glands inside the vaginal opening, notably the Bartholin’s glands, which produce some vaginal lubricating fluid. To test for VV, the clinician presses a Q-tip into the tissue around the opening. In women with VV, Q-tip pres- sure causes sharp pain. Some VV clears up with time and supplemental lubrication. Other potentially helpful treatments include: Kegel exercises, a low-oxalate diet, and participation in a support group.

Biofeedback may also be beneficial. Many women with VV have trouble relaxing their pelvic floor muscles. Unlike vaginismus, these muscles don’t clamp down, closing the vaginal opening. Instead, they become tense, which makes intercourse painful. Biofeedback can teach women to relax their pelvic floor muscles. Cornell researchers taught 33 VV sufferers pelvic floor relaxation using home biofeedback equipment fitted with small, tension-sensing electrodes placed in their vaginas.After 16 weeks, the women’s pelvic floor muscles were more relaxed and stronger. The women reported significantly less VV pain. Researchers in Montreal, Canada, worked with 35 VV sufferers. Using a relaxing combination of deep breathing, self-massage, biofeedback, and simulated intercourse with dildos, within a year, 72 percent reported noticeable improvement. Women with VV should consider asking their physicians for a referral to a biofeedback therapist, or contact the Association for Applied Psychophysiology and Biofeedback for a list of certified biofeedback therapists near them.

Finally, VV can be treated with surgical removal of the vestibular glands (vestibulectomy). Research- ers at McGill University in Canada tried three treatments on 78 VV sufferers: education and Kegel exercises, biofeedback, and surgery. Six months later, 35 percent of the biofeedback group reported significant improvement, 39 percent of the education/exercise group, and 68 percent of those who had vestibulectomies. It’s prudent to try the noninvasive approaches before opting for surgery.

Other Medical Conditions

Many other conditions can contribute to women’s pain on intercourse, among them: uterine prolapse, endometriosis, interstitial cystitis, irritable bowel syndrome, and gynecological cancers. A VV work-up should investigate all of them.

For more information about pain on intercourse, contact: the International Pelvic Pain Society (pel­ vicpain.org), the National Vulvodynia Association (nva.org), or the Vulvar Pain Foundation (vulvarpa­ infoundation.org).

Message to men: If your lover complains of discomfort or pain on intercourse, don’t criticize her for resisting you and sabotaging lovemaking. Instead, slow things down, embrace a more sensual style of lovemaking, and used plenty of lubricant. If the problem persists, urge her to consult a physician for investigation of the conditions discussed above, and if that doesn’t resolve the problem, the two of you might consult a sex therapist. Remember, intercourse is not necessary for enjoyable, mutually fulfilling sex. While she’s being treated, you can still have great sex using your hands and tongues and perhaps sex toys—everything but your penis inside her vagina.

Sexual pain is often medically complex and emotionally trying. Women appreciate men who take their pain seriously, men who are patient and supporting during its evaluation and treatment.

Great Sex Guidance: Pelivc Pain? Pain During Intercourse? A Guide to Women’s Sexual Pain – © Michael Castleman – 322 – Issues Women Should Discuss with Clinicians

* Where does it hurt? Being as specific as possible can help pinpoint the cause(s). Pain in the outer vagina suggest vestibulitis, or possibly scar-related pain from previous episiotomies. Pain deep in the vagina may mean the penis is banging into the cervix. Or it may have to do with vagi- nal shortening during hysterectomy or other pelvic surgery. Or you may have endometriosis.

* When do you feel pain—before, during, or after intercourse? If you experience pain before inter- course, you may have tissue irritation or an infection, for example, yeast, UTI, bacterial vaginosis, trichomonas, herpes, or genital warts. The infection may not have typical symptoms so your doc- tor may have missed it.

Pain that begins shortly before intercourse may have to do with the expectation of nonsensual, rushed lovemaking. It may also relate to past sexual trauma.

Pain during intercourse might be vaginismus or vulvar vestibulitis. It might also be caused by micro-abrasions to tender vaginal tissue. A sexual lubricant can help prevent and treat this.

Pain after intercourse might be vestibulitis , or a sign of poor muscle tone in the pelvic floor. If so, Kegel exercises might help.

* How does the pain feel? Is it aching? Throbbing? Stabbing? Burning? What? Describing the quality of pain can help with diagnosis.

* Can you masturbate to orgasm without pain? If yes, then the search for physical causes should focus inside the vagina. It’s also possible that situational relationship factors may play a part in the problem.

* Does using a sexual lubricant relieve your pain? If so, use lots of lube every time.

* If you’ve had more than one sex partner recently, does the pain happen with just one of them, or all? If just one, relationship and lovemaking issues may be involved: a lack of whole-body sen- suality and/or the man rushing into intercourse before you’re fully aroused and lubricated. Sexual position may also be involved in pain. In particular, some women find doggie-style rear entry inter- course uncomfortable because it allows unusually deep thrusting. Relationship issues may also play a role: conflicts, disappointments, and other stresses. Consult a sex therapist to help deal with them.

If you suffer genital pain or pain on intercourse, take this article—and the citations below—to your physician and/or sex therapist and explore the various points together. But be aware of the fact that not every internist or gynecologist is an expert in sexual medicine. To find such an expert, contact a sex therapist. Visit aasect.org, the American Association of Sex Educators, Counselors, and Thera- pists, or sstarnet.org, the Society for Sex Therapy and Research.

References:

Bergeron, S et al. “A Randomized Comparison of Group Cognitive-Behavioral Therapy, Biofeedback, Great Sex Guidance: Pelivc Pain? Pain During Intercourse? A Guide to Women’s Sexual Pain – © Michael Castleman – 323 – and Vestibulectomy in the Treatment of Dyspareunia Resulting from Vulvar Vestibulitis,” Pain (2001) 91:297.

Binik, Y.M. et al. “Female Sexual Pain Disorders: Genital Pain or Sexual Dysfunction?” Archives of Sexual Behavior (2002) 31:425.

Dunn, K.M. et al. “Systematic Review of Sexual Problems: Epidemiology and Methodology,” Journal of Sex and Marital Therapy (2002) 28:399.

Graziottin, A. “Clinical Approach to Dyspareunia,” Journal of Sex and Marital Therapy (2001) 27:489- 501.

Graziottin, A. et al. “Vulvodynia: The Challenge of Unexplained Genital Pain,” Journal of Sex and Marital Therapy (2001) 27:503-512.

Graziottin, A and L.A. Brotto. “Vulvar Vestibulitis: A Clinical Approach,” Journal of Sex and Marital Therapy (2004) 30:125.

Heiman, J.R. “Sexual Dysfunction: Overview of Prevalence, Etiological Factors, and Treatments,” Journal of Sex Research (2002) 39:73.

Lamont, John, et al. “Psychosexual and Social Profiles of Women with Vulvodynia,” Journal of Sex and Marital Therapy (2001) 27:551-555.

MacReady, N. “Biofeedback, Kegels Can Ease Pain in Vestibulitis,” Family Practice News 9-1-2003.

Metts, JF. “Vulvodynia and Vuylvar Vestibulitis: Challenges in Diagnosis and Management,” American Family Physician 3-15-1999. 59:1547.

Reissing, E.D. et al. “Vaginal Spasm, Pain, and Behavior: An Empirical Investigation of the Diagnosis of Vaginismus,” Archives of Sexual Behavior (2004) 33:5.

Simons, J.S. and M.P,. Carey. “Prevalence of Sexual Dysfunctions: Results from a Decade of Re- search,” Archives of Sexual Behavior (2001) 30:177.

Great Sex Guidance: Pelivc Pain? Pain During Intercourse? A Guide to Women’s Sexual Pain – © Michael Castleman – 324 – Section IV Medical Issues Everything You Must Know About Sexually Transmitted Infection (STIs)

At any age, great sex requires deep relaxation. It’s difficult--or impossible--for most people to relax when they feel anxious about the possibility of contracting a sexually transmitted infection (STI, also known as sexually transmitted disease or STD). Great sex also requires communication and trust. Most people find it difficult--or impossible--to trust a lover who doesn’t care about the possibility of passing an STI, or who neglects to mention that they have one. Finally, great sex requires leisurely, playful, whole-body sensuality. This allows plenty of time for lovers to check in with one another about STI prevention.

Having an STI does not mean that you’re damaged or condemned to a life without partner sex. Most STIs can be cured fairly easily. Even if you have one that persists, notably, herpes, genital warts, or HIV, you can still enjoy great sex--as long as you take the simple steps that prevent their transmis- sion.

This article should answer most questions about STIs. Additional information can be obtained quickly, easily, anonymously and for free by visiting the National Center for HIV/AIDS, Viral Hepatitis STD and TB Prevention (www.cdc.gov/nchhstp)

Risk By Age Group

Although anyone can contract an STI, risk varies enormously by age. Those at highest risk are 15 to 29. Those at moderate risk are 30 to 40. Those over 40 are at low risk, but not zero. Because anyone can contract an STI, everyone who is nonmonogamous or involved with a nonmonogamous partner should practice safe sex. But safe sex is most important for those age 15 to 40.

Speak Up!

It’s difficult to mention that you have an STI, but it’s essential to speak up. Those who attempt to con- ceal STIs risk their lover’s anger and resentment when the truth comes out. And men who fail to in- form women about the possibility that they might have an STI risk women’s lives. Two common STIs, chlamydia and gonorrhea, rarely cause symptoms in women, but may progress to pelvic inflammatory disease (PID), a serious condition that in women can cause infertility, serious illness, and possibly even death. Women have died because a lover was too embarrassed or unconcerned to inform them

Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 326 – about infections that could have been cured easily if treated early.

Did Your Partner Cheat? Maybe....But Maybe Not

As if discussing intimate infections isn’t challenging enough, having an STI may also raise suspicions of infidelity. Some people assume that if a lover develops an STI, the person has been unfaithful. This may be the case, of course, but it’s possible to contract several STIs without recent infidelity and in some cases even without sexual contact.

Only three STIs are transmitted exclusively sexually: gonorrhea, syphilis, and genital warts. Herpes and chlamydia are almost always passed sexually, through nonsexual transmission is theoretically possible. All other STIs may be contracted nonsexually.

In addition, several STIs--HIV, herpes, chlamydia, gonorrhea, and genital warts--may cause no symp- toms for quite a while after infection. HIV, herpes, and warts may not cause symptoms for years. It’s quite possible for a person become infected with these STIs in one relationship, yet develop no symp- toms until involved in a subsequent relationship that’s completely monogamous.

Getting Treated

Some people feel reluctant to consult their doctors about STIs, especially those who live in small towns. Even when physicians respect confidentiality, support staff may read medical records and gos- sip. Most family planning clinics screen for STIs, and treat them. Contact Planned Parenthood, which operates 875 clinics in 49 states and Washington, D.C. (plannedparenthood.org).

Genital Warts (HPV) 5.5 million new cases annually

Transmission prevention Condoms provide the best protection. However, HPV can be transmitted from skin-to-skin contact in areas not covered by condoms. Condoms for women prevent spread of warts in and around the vagina, but not the anus.

Cause A virus, the human papillomavirus (HPV). There are more than 70 types of HPV. Some cause warts on the genitals, others warts on the hands or feet.

Transmission Sexually through genital skin-to-skin contact during vaginal, anal, or (rarely) oral sex. Warts of the hands and feet cannot spread to the genitals and visa versa.

Warts may erupt within a few weeks of sex with an infected lover--or they may takes months or years to appear. They may never appear. As a result, it’s often impossible to be sure when you contracted the virus, and from whom.

Symptoms Genital warts appear as small persistent bumps on the penis, vaginal lips, cervix, or in or around the anus. They may be raised or flat, single or multiple, large or small. Many look like warts of the hand. Others resemble miniature cauliflowers. Some warts cause itching, pain, or bleeding.Anal warts may Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 327 – be mistaken for hemorrhoids.

Diagnosis By appearance. When in doubt, physicians apply acetic acid (vinegar) to suspect areas. Vinegar turns warts white and makes them easier to see. Or if a woman has an abnormal Pap test, the physician submits some cervical cells for analysis that can identify HPV.

Treatment To treat genital warts, do not use over-the-counter treatments for warts of the hands or feet. They are ineffective. All medical treatments for genital wart are prescription drugs. Several caustic chemicals may be applied: podofilox (Condylox), imiquimod (Aldara), podophyllin, or trichloroacetic acid. Or warts may be frozen off with liquid nitrogen (cryotherapy), or zapped with laser light. Repeat treat- ments are often necessary, especially for anal warts, which tend to be the most persistent. During treatment, two medicinal herbs, echinacea and astragalus, can help the immune system control the virus. Both are safe when used as directed. They are available at health food stores and supplement shops. Follow package directions. Do not take echinacea or astragalus longterm, just when treating an outbreak.

Medical treatment suppresses warts, but does not eradicate the virus, which remains in the body. If the person’s immune system becomes compromised by another illness, warts may reappear.

Cervical HPV may be treated by removing abnormal cells (cone biopsy), freezing (cryosurgery), and laser treatment.

Other Important Information In women, HPV infection significantly increases risk of cervical cancer. Each year, about 13,000 American women develop cervical cancer, and an estimated 7,000 die from it. Cervical cancer can almost always be cured if caught early using Pap tests. Women with active warts or a history of HPV should be sure to have annual Paps.

Chlamydia 3 million new cases a year.

Transmission prevention Condoms. Diaphragms and cervical caps also help prevent transmission, but not as reliably.

Cause Bacteria, Chlamydia trachomatis.

Transmission Direct contact during vaginal or anal intercourse. However, chlamydia may be transmitted by contact with infected eye secretions, or congenitally from a pregnant woman to her unborn child. After expo- sure, if infection occurs, it typically develops in a week to a month.

Symptoms So mild, they often go unnoticed. Half of men and 75 percent of women notice no symptoms. If men notice symptoms, they typically include: mild burning on urination and a discharge from the penis. If

Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 328 – women develop symptoms, they usually include: an unusual vaginal discharge, lower abdominal pain, pain during intercourse, or bleeding between menstrual periods. Rectal chlamydia may cause anal itching, cramping, a watery discharge, and diarrhea.

Diagnosis A urine test, or analysis of any discharge from the penis, vagina, or anus.

Treatment Antibiotics

Other Important Information Chlamydia is most prevalent among those under 35, especially those 18 to 24. Four percent of young adult men have the infection, 6 percent of young adult women. The vast majority don’t know they are infected.

Because women rarely show symptoms, and because chlamydia is responsible for so much pelvic inflammatory disease, women should request screening during every pelvic exam.

Chlamydia infection triples women’s risk of contracting HIV if exposed.

Birth control pills and IUDs increase susceptibility.

All pregnant women should be screened. A mother can pass chlamydia to her baby. Infected new- borns may develop potentially serious eye, ear, and lung infections.

Gonorrhea (The Clap) 650,000 new cases a year.

Transmission prevention Condoms for men are most reliable. Condoms for women protect against vaginal gonorrhea, but not against infection of the throat or anus. Diaphragms and cervical caps offer some protection against vaginal gonorrhea, but not against infection of the throat or anus.

Cause Bacteria, Neisseria gonorrhoeae.

Transmission Gonorrhea can only be passed during vaginal, oral, or anal intercourse. The bacteria die almost im- mediately on exposure to air. It is impossible to catch gonorrhea from toilet seats, towels, sex toys, or showers.

Symptoms In men, symptoms usually include: frequent urination, pain or burning on urination, and a white, green, or yellow pus discharge from the penis. Oral gonorrhea may or may not cause a sore throat. Anal gonorrhea may or may not cause pain on bowel movement. Women with vaginal gonorrhea usu- ally show no symptoms, but may develop an unusual vaginal discharge, pain or burning on urination, and bleeding between menstrual periods.

Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 329 – Diagnosis Diagnosis is made in men by symptoms and by laboratory identification of the bacteria. omenW are usually diagnosed by an infected lover’s referral, then by a lab finding of gonococci in the cervical mucus, or by screening during pelvic exams or contraceptive medical consultations. Every possibly infected orifice should be tested.

Treatment Antibiotics. However, some strains of gonorrhea are resistant. Take all the pills prescribed, even if your symptoms clear up quickly. Then schedule a follow up test a few weeks after treatment to make sure the infection has been cured.

Other Important Information In women, untreated gonorrhea is a common cause of pelvic inflammatory disease (PID), a fertility- and life-threatening condition. Because of this risk, women should be screened for gonorrhea during every pelvic exam. If diagnosed with gonorrhea, men must inform all recent sex partners of their risk of infection and urge them to be tested.

Babies born to women with gonorrhea are at risk for blindness. Pregnant women should be tested before they deliver.

Herpes 200,000 to 500,000 new cases annually. 45 million Americans are infected, about one adult in five.

Transmission prevention Condoms. However, herpes can be transmitted from skin-to-skin contact in areas not covered by condoms. Condoms for women protect against vaginal infection, but not against infection of the lips or anus. Herpes sores are painful and may cause a general ill feeling (malaise). Few herpes sufferers feel like making love when they have a sore.

Cause Either of two viruses, Herpes simplex 1 or 2. Either may infect the penis, vagina, or anal area (genital herpes), or the lips (cold sores or fever blisters).

Transmission Usually direct skin-to-skin contact with an infected individual who has a visible sore, or during the day or two before one erupts (prodrome). It is also possible to transmit the virus without showing any symptoms (asymptomatic shedding). It’s not clear how often this occurs. Finally, many people with herpes don’t develop symptoms and don’t know they’re infected--but may still transmit the virus to others who develop symptoms.

Oral herpes is usually spread by kissing or oral sex, genital herpes by oral, vaginal, or anal inter- course. However, the virus can live for up to a few hours outside the body, so it could conceivably transmitted by sharing a towel (genital herpes) or lipstick (oral herpes). On the other hand, the virus needs warmth and moisture to survive, and most environments outside the body--notably toilet seats- -do not provide that.

Symptoms Twenty-five percent of infected individuals show no symptoms, but may still transmit the infection. It’s Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 330 – possible to carry the virus for years without developing any sores, without even knowing you’re in- fected.

When symptoms develop, the herpes virus causes an open, red, tingling, itchy, painful sore or blister (lesion), or a group of lesions surrounded by red, irritated skin. In men, lesions can appear anywhere on the penis, scrotum, thighs, buttocks, anus, or perineum, the area between the scrotum and anus. In women, genital sores typically develop on the vaginal lips, vulva, anal area, buttocks, thighs, or perineum. Sores may also develop internally in the vagina or on the cervix.

First herpes outbreaks are the worst. Without antiviral drug treatment, they typically last seven to 10 days then clear up on their own. With treatment, they clear up faster. In addition to pain and itching, first herpes lesions may also cause fever, swollen glands, and malaise. The immune system imme- diately goes to work on the virus, attempting to suppress it. Depending on your overall health and immune function, your immune system may get the better of the virus quickly or slowly. Some people suffer only one outbreak, and never experience another. Others suffer just one recurrence. Some have several. Only a small proportion of people suffer repeated recurrences over several years. And some suffer no recurrences for years--until they develop a significant illness that preoccupies their immune systems and gives the virus an opening to cause a lesion. Recurrences tend to be mild and last only a few days as the immune system begins to contain the virus--unless the immune system is seriously compromised, for example, by serious illness or injury.

Diagnosis Usually by visual inspection of the sore, and the fact that it causes pain. A painless sore suggests syphilis. A lab test is also available that identifies the virus.

Treatment Antiviral medication speeds the healing of herpes sores, but no drug eradicates the virus, which re- mains in the body. During treatment, two medicinal herbs, echinacea and astragalus, can help bolster the immune system so it can better control the virus. These herbs are safe when used as directed. They are available at health food stores and supplement shops. Follow package directions. Do not take echinacea or astragalus longterm, just when treating an outbreak.

A few studies suggest that diet may play a role in herpes treatment. Proteins are comprised of amino acids, one of which, arginine, spurs herpes virus replication, while another, lysine, inhibits it. Some- -but not all--studies of avoidance of foods rich in arginine plus supplementation with lysine have shown preventive benefit. In one successful trial, University of Indiana researchers gave 52 people with recurrent herpes either a placebo or lysine (1,000 mg three times a day) with counseling to avoid foods high in arginine. After six months, the placebo group averaged 4.2 outbreaks with moderate symptoms, while the lysine-diet group averaged just 3.1 outbreaks with mild symptoms. High-arginine foods to avoid include: nuts, seeds, cocoa, chocolate, grains, raisins, gelatin, and carob.

One medicinal herb, lemon balm (Melissa officinalis) has considerable antiviral action.T wo recent German studies show that lemon balm ointments speed the healing of herpes sores. In one, 116 people with herpes sores were given either a placebo cream or one containing lemon balm extract. Both creams were applied to the sores four times a day. Sores treated with the herbal cream healed significantly faster, prompting the researchers to call the treatment “conclusively superior.” In a simi- lar study, 66 herpes sufferers applied either a placebo cream or one containing lemon balm extract. Sores treated with the herbal cream healed significantly faster. Lemon balm ointment is now sold in

Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 331 – the U.S. as Herpalieve. Many health food stores and some pharmacies carry it. Follow package direc- tions.

Other Important Information Don’t touch herpes sores. Fingers can become contaminated with virus and spread it to other loca- tions around the body.

Recurrences usually develop in the same spot as the original eruption. Sores tend to develop when you’re stressed, tired, run down, fatigued, or sick. That’s why cold sores, herpes on the lips, generally erupt in association with colds and flu.

If you develop recurrent herpes, chances are that the day or two before sores erupt you feel an odd itching or tingling in the area where they develop. This prelude to eruptions is your prodrome. You’re contagious from the moment your prodrome begins until your sore completely heals. If you experi- ence asymptomatic shedding, you may pass the virus at other times.

The media sometimes call herpes “incurable.” This is incorrect. Even though the virus remains in the body for life, the immune system is usually able to contain it after the initial episode or a recurrence or two. Once the virus is contained, herpes sufferers are unlikely to infect lovers. Of course, infection is still possible, so couples with one infected partner should discuss using condoms.

Because of the possibility of recurrences and transmission, herpes sufferers should inform every new lover before the relationship becomes sexual. Because of the possibility of asymptomatic shedding, use condoms.

Herpes lesions may be confused with syphilis sores. Syphilis left untreated can cause life threatening complications. If you think a sore may be herpes, have it definitively diagnosed. If it turns out to be syphilis, it can be cured easily.

Herpes is not life threatening to healthy adults, but it can be to those with impaired immune systems and to newborns who come in contact with it at birth. Active herpes in a woman entering labor is an indication for cesarean section.

HIV/AIDS 20,000 to 40,000 new cases a year. 900,000 Americans are infected.

Transmission prevention Sexual transmission can be prevented if the couple uses condoms. Condoms for women prevent vaginal transmission, but do no protect against transmission during anal sex.

Spermicides containing nonoxynol-9 may increase risk of HIV transmission. This chemical apparently irritates vaginal tissue, and may provide a route for the virus into the woman’s bloodstream. To pre- vent HIV transmission, use condoms, but not spermicide.

Cause The human immunodeficiency virus (HIV).

Transmission HIV can be transmitted in three ways: semen to blood contact through vaginal, oral, or anal inter- Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 332 – course; blood to blood contact, through transfusions with virus contaminated blood or use of contami- nated syringes; or from infected mothers to their unborn children.

The receiving partner in anal intercourse is at highest risk of contracting HIV.

Transmission during oral sex is possible, but rare, according to several studies.

Risk of sexual transmission also increases among those with other STIs and genital health conditions.

Symptoms The most insidious aspect of HIV infection is its long incubation period, the time from infection to the development of symptoms. The incubation period may be several years. During this time, infected individuals may not know they are infected--yet spread the infection to others.

When HIV infection causes symptoms, it may cause an enormous number: chronic fevers, night sweats, chills, swollen glands, weakness, loss of appetite, weight loss and a number of so-called op- portunistic infections, which have the opportunity to develop because those with the infection don’t have enough immune function to contend with them. Common HIV-related opportunistic infections include: a particular type of pneumonia (pneumocystis carinii pneumonia, or PCP), herpes, tuber- culosis, yeast infections of the genitals and/or mouth, non-Hodgkins lymphoma, dementia, a type of meningitis (cryptococcal), and wasting, life-threatening weight loss, among many others.

Diagnosis A blood test.

Treatment No drug cures HIV infection. Several drugs reduce viral load to near zero (protease inhibitors). How- ever, these medications are very expensive (around $10,000 per year). They require taking many different pills throughout the day, every day. They may cause side effects.

Other Important Information Although AIDS in the U.S. was first identified in gay men, anyone can become infected, and everyone is potentially at risk. Men who have sex with men account for 42 percent of infections, intravenous drug users, 25 percent, and heterosexual non-IV drug users, 33 percent. More than half of HIV suf- ferers are African-American (54 percent), with 26 percent white, 19 percent Hispanic, and 1 percent other.

Since the beginning of the epidemic in 1981, more than 400,000 Americans have died of AIDS.

In new or nonmonogamous relationships, it’s crucial to discuss your AIDS risk before you become sexual . Here’s one possible ice breaker: “I’d like to become more intimate with you. I’m sure you’re as concerned about AIDS as I am, so let me tell you a bit more about myself.” Personal revelations invite reciprocity without asking prospective lovers point blank if they have ever used IV drugs or had a lover who was HIV-positive. The problem with AIDS risk discussions is that people may not tell the truth. This underscores the need to take some time to get to know a prospective lover before becom- ing sexual.

Condoms provide substantial--but not absolute--protection against transmission of HIV. Condoms should be a routine part of AIDS safe lovemaking if you have any suspicions that your lover might be Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 333 – HIV-positive. But it’s important to understand that partner selection is the most important element in safe sex.

Syphillis 7,000 new cases annually

Transmission prevention Condoms are best. However, syphilis can be transmitted from skin-to-skin contact in areas not cov- ered by condoms. Condoms for women offer no protection against transmission during oral and anal intercourse.

Cause A bacterialike microorganism, Treponema pallidum.

Transmission Vaginal, oral, or anal intercourse.

Symptoms First, a painless open sore develops at the site of infection. Sores on the penis are easily visible. Sores in the vagina, throat, or anus may not be. The sore heals by itself in a few weeks. Then, a non- itchy rash develops somewhere on the body, often accompanied by fatigue and a feeling of being ill. The rash disappears in a few weeks. Syphilis then becomes hidden in the body for many years, after which severe, possibly fatal complications may develop.

Diagnosis A blood test.

Treatment Antibiotics. Those treated should abstain from intercourse for a month after treatment.

Other Important Information Because women are often unaware of syphilis sores, men diagnosed with syphilis must inform all their lovers.

Babies born to women with syphilis are at risk for birth defects and infant death. That’s why most states require syphilis tests before issuing marriage licenses.

Urinary Tract Infections in Women (UTIs, cystitis or bladder infection) Number of annual cases not reported, but an estimated 50 percent of women develop at least one UTI, and millions sufferer recurrent infections.

Transmission prevention Careful sexual hygiene largely prevents sexual transmission. Nothing that touches either lovers’ anal area should come in contact with the woman’s vulva or vagina.

Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 334 – Cause Bacteria that normally inhabit the intestine and anal area. Their introduction into the urethra, which opens in the middle of the vulva, cause the infection.

Transmission Sexual transmission is possible, but UTI may develop without sexual involvement.

Symptoms Burning on urination, an urgent need to urinate frequently, possible blood in urine, itching, and an unpleasant odor.

Diagnosis By symptoms and by microscopic identification of the bacteria.

Treatment Antibiotics. Some drugs contain a dye that turns urine bright red orange. Don’t be alarmed.

In addition, at the first twinge of infection, immediately start drinking lots of water--10 cups a day. This helps flush the bacteria out of the bladder before they become established firmly enough to cause a full-blown infection.

Other Important Information UTIs rarely cause complications, but potentially serious kidney infection is possible.

Sulfa drugs are often used to treat UTIs. African-Americans should be cautious about taking them. Fifteen percent of African-Americans don’t make a certain enzyme. If they take sulfa drugs, the medi- cation may destroy their red blood cells and prove fatal. Before taking sulfa, African-Americans should be tested for “G6PD deficiency.” Anyone with this enzyme deficiency should avoid sulfa drugs and be treated with other antibiotics.

To prevent UTIs, sexual adjustments often help:

* Make love hygienically.

* Make love less frequently. Many women develop bladder infections after making love unusually frequently. Back when premarital sex was less common than it is today, many virgin newlyweds spent their honeymoons making love daily or more frequently. So many brides developed UTIs that the condition was called “honeymoon cystitis.” But women don’t have to make love daily to develop bladder infections. In one study of 796 women age 18 to 40, compared with those who had no sex the previous week, the women who made love three times were twice as likely to develop UTIs.

* Make love less vigorously. Vigorous sex can irritate a woman’s urethra, and increase risk of mov- ing anal bacteria into it.

* Consider more or less lubrication. Some women find that commercial lubricants help prevent UTis. Others notice the opposite. Women should consider how lubricants affect their UTI risk.

* Go oral. Some women have intercourse gently and with excellent hygiene--and still get UTIs. In Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 335 – that case, try refraining from vaginal intercourse and going all oral. Oral sex does not guarantee protection against bladder infections, but it often helps.

* Steer clear of spermicide. The research is scant, but for reasons that remain unclear, use of non- oxynol-9, the spermicidal compound in contraceptive foam and diaphragm and cervical cap jellies, may increase risk of UTI.

In addition, women should:

* Urinate before and after lovemaking. This also helps flush bacteria out of the urinary tract.

* Embrace cranberries: Drink cranberry juice, eat dried cranberries (Craisins), and cook with cran- berries. Cranberries have an age-old folk reputation as a treatment for urinary problems. Animal study suggested that cranberries prevent UTI by interfering with their attachment to the bladder wall. Harvard researchers gave 153 women either a placebo or a cup of cranberry juice a day. Six months later, the cranberry group reported fewer than half as many UTIs. Other researchers have obtained similar results using dried cranberries or cranberry extract capsules.

* Go when they feel the urge. Studies of women with recurrent UTIs show they have a tendency to hold their urine. Don’t. Women who feel any urge to urinate, should go. Women troubled be recurrent UTIs should go every hour or two even if they don’t feel the urge.

* Wipe from front to back. This keeps anal bacteria away from the urethra.

* Eliminate urinary irritants. The list includes: cigarettes, spicy foods, alcohol, coffee, and tea Some women even find that decaf coffee is a urinary irritant.

* Don’t irritate the vulva. Use a mild unscented soap. Avoid perfumed, deodorant soaps, which can cause irritation. Wear cotton underwear, which is less irritating than synthetics. Stay away from restrictive, tight-fitting clothing, for example, leotards, which may move bacteria forward.

* Change tampons or pads frequently. Blood is an excellent bacterial growth medium.

Men may develop urinary tract infections, but compared with women, their risk is much lower because men’s and women’s urinary systems are constructed differently. Women’s urethras are only about two inches long, while men’s are about eight inches, so bacteria are more likely to reach women’s blad- ders. In addition, the female urethra opens closer to the anus making bacterial contamination easier.

Great Sex Guidance: Everything You Must Know About Sexually Transmitted Infection (STIs) - At Any Age – © Michael Castleman – 336 – Dating After 50: - Are Condoms Still Necessary?

Most singles over age 50 think they’re no longer at risk for sexually transmitted infections (STIs). In 2009, AARP asked older singles how committed they felt to condoms. Only one in five said they used them every time, 32 percent of the women, 12 percent of the men.

They’re right—almost.

Age is, indeed, a key risk factor for syphilis, gonorrhea, chlamydia, herpes, genital warts, and HIV, and STIs are by far most prevalent among those under 30. Risk after 50 is much lower—compared with twenty-somethings, around 90 percent lower.

In addition, singles over 50 aren’t into condoms because, compared with young adults, they’re less likely to engage in the main route of STI transmission, vaginal intercourse. With age, intercourse fades from the erotic repertoire. After 50, men’s erections become iffy, and the drugs are less effec- tive than advertised. In older women, menopausal changes—vaginal dryness and atrophy—often make intercourse uncomfortable or impossible even with lubricant. As a result, older couples who remain sexual become more interested in sex without intercourse: hand massage, oral sex, and sex toys. (Gonorrhea can infect the throat and herpes the lips (cold sores), but most other STIs are rarely transmissible orally.)

So older daters generally assume they don’t need condoms. Or do they?

Public health authorities insist they do. As 50 has become the new 30, older adults’ STI rates have risen. Since 2005, risk of syphilis among older adults has jumped 67 percent, chlamydia 40 percent, which is why health officials recommend condoms every time for everyone who dates until both lovers test STI-free and pledge monogamy.

I’m 63, married, and monogamous, but if I were single, here’s how I’d approach the issue. Despite the urgency of male lust, I would try not to jump into bed with a hot new friend. I’d want to get to know her over several dates before getting to know her in the Biblical sense.

I’d gently inquire about her sexual history—the more lovers, the greater the STI risk.

Great Sex Guidance: Dating After 50-Are Condoms Still Necessary? – © Michael Castleman – 337 – I’d declare my history with illicit drugs and probe hers. The vast majority of heterosexuals infected with HIV have a history of IV drug use. And people reckless enough to abuse opiates, cocaine, and methamphetamine are often sexually reckless as well. Of course, new friends might lie about their STI risk. So I’d carry condoms, and if we had intercourse, I’d insist on using them.

Ideally, I’d raise the issue of STIs before we first disrobed, declare myself uninfected, ask the woman about her situation, and offer to make a date of getting mutually tested. Many county health depart- ments offer free STI testing. If she were willing and we both tested negative, guess how I’d suggest celebrating.

If she declared herself infection-free, and said testing wasn’t necessary, I’d gently insist on testing. One never knows. If she said she was being treated for anything other than HIV, I’d commend her honesty, and use con- doms until she tested infection-free.

If she had a history of herpes, I’d ask about her last eruption. If it happened more than five years previously, I’d assume her immune system had suppressed the infection and I’d feel comfortable not using condoms. I’d also ask if she could identify her “prodrome,” the tell-tale itching, tingling, or discomfort in the spot where the sores erupt the day or so before they appear. If she said she could recognize her prodrome and was confident no sore was imminent, I’d feel comfortable not using con- doms.

Now about HIV. Here are the facts about transmission: Condoms used properly reliably prevent it. Un- less you have bleeding gums or a canker sore, HIV is very unlikely to be transmitted by oral sex. And even without condoms, HIV is one of the less transmissible STIs. So I’d like to respond rationally and tell an HIV-positive prospective lover that if I’d be fine making love—if we used condoms religiously. But I’m not always rational, and HIV is scary. So I think I’d express openness to a sexual relationship, but postpone sex for a while, until I’d calmed down about her being HIV-positive. Then I’d use con- doms every time.

Great Sex Guidance: Dating After 50-Are Condoms Still Necessary? – © Michael Castleman – 338 – Have A Chronic Medical Condition? You Can Still Enjoy Great Sex

The bad news: You’ve just been diagnosed with diabetes, high blood pressure, heart disease, or some other chronic condition. Your doctor says it “can’t be cured,” but it can be “managed,” which you’ll need to do “for the rest of your life.” The doctor asks, “Do you have any questions?” You ask several—all except: “What about my love life?” Every chronic condition is different. But the best ap- proaches to sexual coping are pretty much the same.

Where There’s a Will, There’s a Way

Faced with a chronic condition, some people think: Sex is over for me. In studies of people who have withdrawn from sex, the two biggest reasons are (1) no partner, and (2) a chronic medical condition.

You’re free to retire from partner lovemaking if you want. But even if you can no longer have vaginal intercourse, there are still many ways to enjoy physical intimacy and fulfilling lovemaking. Fundamen- tally, satisfying sex involves playful whole-body massage that includes the genitals. Even those with severe disabilities can often kiss, cuddle, receive massage, and perhaps give it. If you want to be sexual, you can be, either solo or with a lover. You just have to figure out what you can do to enjoy sensual pleasure. Focus on your abilities, not your disabilities.

Flexibility Is Key

Studies of people with chronic conditions and disabilities agree that the single most important element in remaining sexually active is flexibility. If you define “sex” as only vaginal intercourse, and can no longer do that, you’re justified in concluding: Sex is over for me. But if you’re flexible, if you define sex more broadly, then bidding farewell to vaginal intercourse becomes more like passing up one dish at a huge buffet. Can you kiss and cuddle? Can you give and receive whole-body massage? Can you provide or receive oral sex? Can you use sex toys? The more flexible you are about sexuality, the more likely you are to continue to enjoy sexual fulfillment.

Find Information and Support

Start by asking your doctor about the sexual effects of any and all medications prescribed for your condition. Then ask your pharmacist. Then search the Internet: sexual effects of—then the names of Have A Chronic Medical Condition? You Can Still Enjoy Great Sex – © Michael Castleman – 339 – your medications. You may get different answers. But you’ll come away with a useful overview.

Over time, continue to discuss the sexual implications of your condition or medications with your doc- tor. At first, you may feel awkward or embarrassed. Remember: Sex is a normal, natural part of life. You have every right to enjoy lovemaking within your physical abilities—and health professionals can and should help you identify the types of sexual enjoyment that are available to you.

Join the organization(s) devoted to your condition. It’s a very rare chronic condition that doesn’t have a national organization. To find the organization(s), search the Internet. Once you find the organization(s) focused on your condition, ask for a referral to an expert on its sexual implications. Chances are that someone in the organization has good information for you.

Join a support group. Most organizations that focus on chronic medical conditions also sponsor sup- port groups. Support groups are a wonderful tool for coping with all aspects of chronic conditions, including sex. They take a situation that’s usually isolating—and turn it into the sole criterion for mem- bership. There’s nothing quite like talking with people who know exactly what you’re going through.

Work to Stay As Healthy As Possible

“How can I be healthy?” you ask, “I have this damn chronic condition.” Yes, you do. But chances are you’ll feel better, have an easier time managing your condition, and retain more sexual interest and ability if your lifestyle is as healthy as possible:

* Don’t smoke. * Don’t drink more than two alcoholic drinks per day. * Eat at least five servings of fruits and vegetables a day. * Within your abilities, strive for regular moderate exercise, ideally, at least 30 minutes a day. * Get at least seven hours of sleep a night.

Look For New Opportunities

As the reality of having a chronic condition sinks in, people grieve the loss of their previous life and the things they can no longer enjoy as they once did, among them, the ways they used to make love. This is normal. But if you stop there, you wind up depressed—and depression kills libido and erotic enjoyment.

Every passage in life closes some doors and opens others. Which doors have opened for you? If you answer “none,” you’re still grieving the loss of your pre-diagnosis life. Let some time pass, then recon- sider new opportunities. Eventually, most people embrace their new opportunities for fun and person- al growth—including new approaches to making love.

Experiment with Sex Toys

If your condition causes a decrease in genital sensitivity, lubricants can help. In addition, a vibrator might help women and a vibrating penis sleeve might help men. Depending on your situation, other sex toys might also enhance your lovemaking. Adam & Eve offers a wide selection of sex toys.

Have A Chronic Medical Condition? You Can Still Enjoy Great Sex – © Michael Castleman – 340 – Consider Sex Therapy

Many Americans have chronic medical conditions: arthritis, 32 million; high blood pressure, 22 mil- lion; allergies, 20 million.; diabetes,16 million; heart disease, 14 million; asthma, more than 5 million. You’re not alone. The prevalence of chronic conditions means that help abounds: specialists, resourc- es, books, and counseling.

A sex therapist can help you and your lover adjust to your condition yet still enjoy fulfilling lovemaking. The process typically takes a few months of weekly consultations. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Reference:

Barsky, J.L. et al. “Sexual Dysfunction and Chronic Illness: The Role of Flexibility in Coping,” Journal of Sex and Marital Therapy (2006) 32:235.

Nusbaum, M.R.H. et al. “Chronic Illness and Sexual Functioning,” American Family Physician, Jan. 15, 2003, pp. 347-354.

Have A Chronic Medical Condition? You Can Still Enjoy Great Sex – © Michael Castleman – 341 – Sex and Urinary Tract Infection (UTI)

It’s known variously as urinary tract infection, UTI, bladder infection, and cystitis (“cyst” is Greek for bladder). It occurs mostly in women, and causes urinary urgency--I have to go NOW--burning pain on urination, and possibly lower abdominal pain, sometimes even fever. It tends to recur, with many women suffering several UTIs a year. And it’s closely related to sex.

Women often develop UTIs shortly after intercourse, and sometimes blame their infections on the men in their lives, possibly with good reason. This, in turn, can drive a wedge between lovers, with women avoiding sex to evade this infection, and men wondering what they’ve done wrong. Fortunate- ly, UTIs can be prevented, usually pretty easily.

UTIs are caused by intestinal bacteria, typically Escherichia coli (E. coli). These bugs aid in digestion, but if they get into a woman’s bladder, they cause UTI.

During digestion, E. coli become incorporated into stool. Even with careful wiping, some remain around the anus. Vigorous or careless sex can move them the few inches to a woman’s urethra, and then they work their way to her bladder.

Compared with men, women are more susceptible to UTI because their anuses and urethral openings are much closer, and their urethras are considerably shorter. Meanwhile moisture promotes bacterial transit from the anal area to the urethra. Sex leads to increased vaginal lubrication (natural or a com- mercial), which moistens the area and increases UTI risk.

Prevention: What Women Can Do

* When you feel the urge, go. Urination flushes out bacteria before they can cause infection. Hold- ing urine is associated with increased UTI risk. Even if you don’t feel the urge, go every hour or two. And be sure to go before and after sex.

* Wipe from front to back, away from your urethra. Never wipe from back to front, which moves E. coli toward the urethra.

* Avoid external irritants. Use a mild unscented soap, e.g. Ivory. Avoid perfumed and deodorant

Great Sex Guidance: Sex and Urinary Tract Infection (UTI) – © Michael Castleman – 342 – soaps, and bubble baths, which may irritate the urethra. Wear cotton underwear, which is less irritating than synthetics. Stay away from tight-fitting clothing, for example, leotards.Their rubbing may move bacteria toward the urethra.

* Avoid internal irritants. Some evidence suggests that cigarettes, alcohol, and caffeine (coffee, tea, many soft drinks, and some over-the-counter drugs) may increase UTI risk. Experiment with reducing your intake or eliminating them.

* Go with your flow. During menstruation, change tampons or pads often, Blood is an excellent bacterial growth medium.

* The contraception connection. Compared with women who use other forms of birth control, diaphragm users are at increased risk for UTI. Not too long ago, doctors believed that diaphragm rims were to blame. When the rim presses against the urethra, it may cause irritation and increase risk. Now it appears that the spermicide used with diaphragms also plays a role in UTI risk. Don’t stop using birth control. But if you use a diaphragm and suffer recurrent bladder infections, con- sider a different contraceptive.

* The aging connection. As women become menopausal, the chemical environment of the genitals changes, which may allow E. coli to pass more easily into the urethra. Soy foods and an estrogen cream may help.

* Drink cranberry juice and eat cranberries. During the 1840s, German researchers discovered that people who eat cranberries pass a bacteria-fighting chemical, hippuric acid, in their urine. Sixty years later, American researchers speculated that urine acidified by a steady diet of cranber- ries might prevent UTIs. Women began drinking cranberry juice, and several studies endorsed the practice. But by the late 1960s, nay-sayers claimed that the tart berries did not significantly acidify urine and therefore could not prevent UTIs. However, many studies have shown that cranber- ries do, in fact, reduce risk of UTIs, among them, reports in the New England Journal of Medicine (1991), the Journal of the American Medical Association (1994 and 1998), the Journal of Family Practice (1997), and the Journal of Urology (2008). It turns out that the reason has nothing to do with acidifying urine. Actually, cranberries add compounds to urine that deter E. coli from adhering to the bladder lining, thus reducing their ability to clause infection. There are several ways to eat cranberries. You can drink cranberry juice cocktail, a glass or two a day. You can snack on dried cranberries. You can cook with the berries (cranberry bread). Or you can take a concentrated extract in pill form, available where supplements are sold. No matter which form of cranberry you use, take some before and after lovemaking.

* Try probiotics. One possible reason E. coli can invade the bladder is that women’s vaginas may lack healthful (“probiotic”) bacteria. One way to support these friendly bacteria is to eat yogurt containing a live-culture of Lactobacillus acidophilus. Probiotic bacteria supplements are also available.

Prevention: What Men Can Do

* Make love gently. Back when premarital sex was less common than it is today, newlyweds spent their honeymoons engaged in very vigorous sex, and so many brides developed UTIs that the con- dition was called “honeymoon cystitis.” Vigorous sex can irritate a woman’s urethra, and move anal

Great Sex Guidance: Sex and Urinary Tract Infection (UTI) – © Michael Castleman – 343 – area bacteria toward her urethra. Make love gently.

* Make love hygienically. Another reason honeymoon cystitis was so common was that many new- lyweds were uninformed about sexual hygiene. Shower before sex, then during lovemaking, noth- ing that touches a woman’s anal area should come in contact with her vulva. Keep track of where your fingers and any sex toys have been.

* Go oral. Some women have sex gently, with lots of lubricant and excellent hygiene, and still get UTI’s. They’re just prone to these infections. One alternative worth trying, is oral sex instead of intercourse.

* The condom connection. Diaphragms are not the only contraceptive to employ spermicide. Condoms often come coated with the spermicide, nonoxynol-9. A study of 1,200 Seattle women showed that UTI risk increased for women whose lovers wore spermicide-coated condoms. If you use condoms and she suffers recurrent UTIs, consider another method. Treatment

* At the first twinge of infection, immediately start drinking lots of water--10 cups a day. You may be able to flush the bacteria out of your bladder before they become established firmly enough to cause a full-blown infection.

* Increase your cranberry consumption. It might help.

* See your doctor for antibiotics, and take the entire course even if you feel better before you finish all the pills.

* Talk about it. While recurrent sex-related UTIs can drive a wedge between lovers, working to- gether to prevent the infection can increase intimacy and enhance the relationship.

Great Sex Guidance: Sex and Urinary Tract Infection (UTI) – © Michael Castleman – 344 – Osteoarthritis and Sex

Has a doctor ever advised: “For your condition, go home and make love frequently.”

Probably not. But for the estimated 20 million American adults with osteoarthritis, the most common form of joint disease, this prescription makes a great deal of sense.

The Arthritis Foundation Recommends Sex

Here’s why: First, “arthritis” is not a disease. It’s a symptom. It simply means joint inflammation, and the soreness, stiffness, and pain that typically accompany it. Dozens of illnesses cause arthritis. If you experience persistent joint pain and/or inflammation, see a doctor.

But quite often your doctor says that what you have is the most common joint condition, osteoarthri- tis (OA), which is what people mean when they say “arthritis.” According to the American College of Rheumatology, osteoarthritis afflicts more than all other forms of arthritis combined.

Osteoarthritis typically results from decades of wear and tear on the joints. Joints are lined with carti- lage, the tough, flexible, shock-absorbing material that keeps the bones from grinding into one anoth- er. In osteoarthritis, cartilage breaks down, causing morning stiffness and pain, stiffness after periods of rest, pain that worsens with strenuous use of affected joints, joint swelling, and limitation of range of motion. Most people experience their worst stiffness and aching first thing in the morning, with di- minishing discomfort as the day progresses.

Risk Factors for Osteoarthritis

* Age. The older you are, the more abuse your joints have taken, so the more likely you are to suf- fer OA .

* Weight. The heavier you are, the more stress you place on your joints, and the more likely you are to develop OA. Today, Americans tend to be heavier than they were a generation ago. In fact, more than half of American adults are now considered overweight. Not surprisingly, rates of OA are rising and the condition is affecting younger (heavier) people.

Great Sex Guidance: Osteoarthritis and Sex – © Michael Castleman – 345 – * A history of injury. That knee you messed up in high school sports may return to haunt you as OA later in life.

* Repetitive tasks. OA of the hands has increased considerably since so many Americans spend their lives working computer keyboards.

Sex to the Rescue

Years ago, to manage OA, doctors advised minimizing physical activity. But that causes a vicious cycle: The stiffness and pain leads to reduced activity, which leads to more pain, not to mention loss of muscle strength and cartilage mass, which makes it harder to be active. Inactivity also contributes to weight gain, which aggravates OA.

Today we know that one of the best ways to manage osteoarthritis is to be as physically active as your condition allows. Doctors and the Arthritis Foundation now strongly recommend low-impact ex- ercise that gently moves joints through their full range of motion. And guess what does this? Sex.

“Sex is terrific exercise for people with arthritis,” says Palo Alto sex therapist Marty Klein, Ph.D. “It provides gentle, low-impact, massage-like exercise. It moves the major joints through their full range of motion. It releases pain-relieving endorphins. And the closeness of lovemaking, the feeling of being loved, also helps relieve pain.”

Sex involves gentle, range-of-motion exercise, so it:

* Minimizes pain, reduces inflammation, and helps keep joints supple.

* Promotes blood flow into cartilage, which keeps it healthy.

* Strengthens the muscles around the joints, which helps support them.

* Releases endorphins, the body’s own pain-relieving compounds.

* Helps control weight.

Of course, sex is not the only form of exercise that provides these benefits.Any low-impact workout helps manage OA. Cornell researchers recruited 102 people with OA of the knee and encouraged some to take regular walks, and the rest to take anti-inflammatory pain relievers. After eight weeks, the drug group reported no changes in their condition, but those who took up walking reported 27 percent less pain and a significant decrease in use of pain medication.

However, you might wonder: Won’t exercise wear out my joints? That’s possible, but only if you overdo it with high-impact activities, for example, running or contact sports.

The best exercise for you depends on which of your joints are affected and how severely. But in gen- eral, good forms of exercise for OA include: walking, gardening, swimming, cycling, in-pool calisthen- ics—and sex.

Great Sex Guidance: Osteoarthritis and Sex – © Michael Castleman – 346 – How to Incorporate Sex into OA Self-Care

* Make sex dates in advance. Living with any chronic condition requires lifestyle adjustments and planning. Scheduling sex allows you to prepare in advance, perhaps with other gentle exercise (walking), or by taking pain medication a few hours beforehand.

* Get some other exercise before sex. To feel intimate, many couples like to spend some close, nonsexual time together before they begin to shed clothing. Try taking a walk together. Walking helps manage OA, and it’s one of the best ways to warm up the joints for sex.

* Bathe or shower together. Heat soothes the joints. Bathing or showering together not only reduc- es the discomfort of OA, it’s also a sensual way to begin to become sexually aroused.

* Take your medication. About half of people with OA notice benefit from daily doses of the supple- ments, glucosamine and chondroitin. But an hour or so before sex, check in with your body. If you’re feeling achy, sore, or stiff, the discomfort can interfere with your erotic focus and ruin sex. There’s no harm in taking some pain medication an hour or so before sex. If you feel only pain, acetaminophen (Tylenol) should help. If you notice joint inflammation in addition to pain, then take an anti-inflammatory pain reliever—aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve). How- ever, acetaminophen may cause liver damage, and aspirin, ibuprofen, and naproxen may cause stomach distress.

* Move your whole body. Don’t rush into intercourse and limit yourself to pelvic gyrations. The type of exercise that’s best for the management of OA moves all the joints—the fingers, wrists, elbows, shoulders, neck, back, hips, knees, and ankles—through their full range of motion. So incorporate whole-body massage into your lovemaking. Roll around together. Move all your major joints. This type of lovemaking not only helps manage OA, it’s also the kind of lovemaking sex experts recom- mend as the most erotic and fulfilling.

* Incorporate sex toys. OA stiffens many people’s fingers, which can make loving caresses difficult. Vibrators and other toys can help.

* Make any necessary adjustments. Knees are often affected by OA. If you or your lover has chronically stiff, sore knees, experiment with sexual positions that don’t strain them. For example, you might decide to forego doggie-style intercourse that puts you on your knees. Use other posi- tions.

* Check in. During sex—or before or after—discuss the moves that feel best, and the ones that hurt. Over time, develop a sexual style than emphasizes feel-good moves.

* Remain sexual. Some people think: I’m in pain. Pain ruins sex. Therefore, I’m not going to have sex any more. Others think: I’m in pain. But I’m a sexual person. I’m going to make accommoda- tions, and I’m going to remain sexual. The latter approach is what OA experts recommend. Sex provides gentle, low-impact, massage-like exercise that moves your major joints through their full range of motion, while releasing pain-relieving endorphins. In other words, sex helps minimize the pain and stiffness of OA.

* If arthritis continues to interfere with your lovemaking, a sex therapist can help you adjust your

Great Sex Guidance: Osteoarthritis and Sex – © Michael Castleman – 347 – lovemaking to minimize pain and maximize mutual pleasure. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Bacon, C. et al. “Sexual Function in Men Older Than 50: Results from the Health Professionals Fol- low-Up Study,” Annals of Internal Medicine (2003) 139:161.

White, JR. et al. “Enhanced Sexual Behavior in Exercising Men,” Archives of Sexual Behavior (1990) 19:193.

Great Sex Guidance: Osteoarthritis and Sex – © Michael Castleman – 348 – Diabetes Effects on Sex

There are two sexual myths of diabetes: Men with the disease are fated to suffer erectile dysfunc- tion (ED). And diabetic women suffer few, if any, sexual effects. Both are wrong. Diabetes can impair sexual function in both men and women. But people with diabetes can also enjoy great sex.

Sex Problems In Diabetic Men

Almost as soon as men get diagnosed with diabetes, they begin hearing dire warnings about their risk of ED. In a classic case of self-fulfilling prophecy, the anxiety this engenders can cause the problem. Diabetes may, indeed, impair erection. But ED is by no means inevitable, and if it occurs, several safe, effective treatments are available. With the right treatment, any man with diabetes can enjoy satisfying sex despite his medical condition.

Syracuse University researchers reviewed 23 studies of ED in diabetic men. Their conclusion: About 30 percent suffer severe problems. That’s about twice the risk of nondiabetic men, but this research shows that 70 percent of diabetic men do not develop severe ED.

Risk Factors For Diabetic ED

* Poorly controlled blood sugar (glucose). Poor blood glucose control increases risk for all diabe- tes complications, including the two most responsible for diabetic ED: cardiovascular disease and nerve damage (neuropathy).

Cardiovascular disease involves the development of cholesterol-rich deposits (plaques) inside the arteries, which narrows them and reduces blood flow. When the arteries that nourish the heart narrow, the result is heart disease. When the arteries that carry blood into the penis narrow, the result is ED.

Neuropathy is nerve damage. Over time, many diabetics develop peripheral neuropathy—numb- ness, tingling, or pain in the extremities. But neuropathy can also develop in the nerves involved in erection. When this happens, the result is ED.

* Duration of diabetes. The longer you’ve had the disease, the greater your risk. Cardiovascular disease and neuropathy develop over time.

Great Sex Guidance: Diabetes Effects on Sex – © Michael Castleman – 349 – * Other diabetic complications. Men who experienced other complications are more likely to suffer erection problems.

* High blood pressure and/or use of blood pressure medication. High blood pressure damages the arteries. Many blood pressure medications cause erection impairment as a side effect.

* Being overweight. It’s associated with high blood pressure and cardiovascular disease.

* Smoking. It accelerates the development of cardiovascular disease.

Prevention of Diabetic ED

The most effective way to prevent diabetic ED is to practice tight control of your blood sugar. Test many times a day. Regulate your drugs and/or insulin in consultation with your physician and/or endocrinologist. If you’re not familiar with tight control, consult a certified diabetes educator. Find one through the nearest chapter of the American Diabetes Association.

Treatment of Diabetic ED

If you suffer diabetic ED, don’t despair. Today, numerous treatment options can help you regain your lost erection, and enjoy sex despite diabetes.

* First, see your doctor. Tighter control may help. Doctors can also prescribe erection medication, which may help if the cause of your problem is cardiovascular.

* Next, consult a sex therapist. Compared with doctors, sex therapists are generally better in- formed about all the possible causes of erection impairment, including its psychological dimen- sions, among them, stress, depression, relationship problems. Sex therapy enjoys considerable success helping diabetic men. The therapist works with both partners, teaching the couple to adopt a more communicative, more sensual, whole-body, massage-oriented approach to lovemak- ing. Treatment typically takes several months of weekly or biweekly sessions. Ask your physician for a referral or contact the American Association of Sex Educators, Counselors, and Therapists (AASECT) at www.aasect.org. Click the map of the U.S. and Canada, and get a list of all the AASECT-certified sex therapists in your state or province. Sex therapy usually costs about $100 to $150 an hour. Health insurance may or may not cover it. Check your policy.

* Vacuum devices. These devices create a vacuum around the penis that coaxes extra blood into the organ, resulting in temporary erection. Models differ, but all include a plastic tube that fits over the penis, fitted with a pump typically operated using a squeeze bulb. The user squeezes the bulb, which evacuates the air from the plastic tube, drawing blood into the penis. Once the man raises an erection, he slips a rubber ring over his erection to compress the veins that drain blood from the penis. This helps maintain the erection. One study evaluated the effectiveness of vacuum constricting devices in 21 men—six with diabetes. Seventeen (81 percent) reported full erections or semi-erections sufficient for intercourse. Two kinds of vacuum devices are available, penis pumps available from sex toy marketers and prescription devices custom fitted to the individual. Prescription devices are more effective. If you’re interested in one, talk to your doctor.

* Enjoy lovemaking without erection. Our sexual culture is extremely erection-focused. But there are wonderfully fulfilling ways to make love without an erection. Erection is not necessary for or- Great Sex Guidance: Diabetes Effects on Sex – © Michael Castleman – 350 – gasm. Men with severe ED can still enjoy marvelous orgasms from vigorous hand massage or the penis, or oral sex, or use of sex toys.

Sex Problems in Diabetic Women

So little is written about the effects of diabetes on women’s sexuality that you’d think the disease has none. But it does. The effects in women are more subtle than those in men. Nonetheless, they are quite real, and deserve more attention than they receive.

The main problem is loss of vaginal lubrication. You need healthy blood flow into the vaginal wall to produce natural vaginal lubrication. Just as cardiovascular disease reduces blood flow into the penis, it does the same to blood flow into the vaginal wall. The solution is a commercial lubricant.

Neuropathy in diabetic women can reduce clitoral responsiveness to erotic touch, impairing a wom- an’s ability to enjoy orgasm. A lubricant can also help with this problem. Sexual lubricants increase sensitivity to touch, and can help compensate for neuropathy.

Another way to increase stimulation of the clitoris, the vagina, and anywhere else you enjoy being caressed is to use a vibrator. The sex toy store affiliated with this site,mypleasure.com , sells several.

Help

For individualized help coping with the sexual impact of diabetes, consult a sex therapist. TTo find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Bacon, C. et al. “Sexual Function in Men Older Than 50: Results from the Helath Professionals Fol- low-Up Study,” Annals of Internal Medicine (2003) 139:161.

Weinhardt, LS and MP Carey. “Prevalence of Erectile Disorder Among Men with Diabetes Melllitus: Comprehensive Review,” Journal of Sex Research (1996) 33:205.

El-Bahrawy, M. et al. “Noninvasive Vacuum Constriction in the Management of Erectile Dysfunction,” International Journal of Urology and Nephrology (1995) 27:331.

DePalma, R.G. et al. “Vascular Interventions for Impotence: Lessons Learned,” Journal of Vascular Surgery (1995) 21:576.

Great Sex Guidance: Diabetes Effects on Sex – © Michael Castleman – 351 – Heart Disease and Sex

Ever hear of the “mistress’ nightmare?” A middle-aged man is having sex with a woman other than his wife. While making love, he has a heart attack and dies, leaving his lover with a difficult choice: She can slip away, perhaps calling 911 later anonymously. Or she can stand by her (dead) man, call 911, and risk having his wife learn of his affair as she’s coping with his death.

Can Sex Trigger Heart Attack?

The mistress’ nightmare is usually presented as a moral dilemma, a what-would-you-do? situation. But underlying it is the assumption that sex is a risk factor for heart attack. Many people—both men and women—believe this is true. After men or women suffer heart attacks or episodes of angina, a form of heart disease that causes chest pain during (possibly minor) exertion, many become very nervous about sex, convinced that it might do them in. The same thing often happens to those told by doctors that they need treatment for heart disease (angioplasty or bypass surgery), or those warned that they have a combination of risk factors that raise their risk of heart disease, among them: smok- ing, diabetes, obesity, social isolation, high cholesterol, high homocysteine, high blood pressure, a high-fat diet, lack of exercise, a stressed-out Type A lifestyle, and a strong family history of heart disease or stroke.

Heart Attack During Sex: Rare

It’s certainly possible to suffer a heart attack while making love. But contrary to the conventional wis- dom, it’s rare.

Strenuous exercise can trigger heart attack. During the late 1970s, Jim Fixx, author of the Complete Book of Running, the man who popularized running for fitness and recreation, dropped dead of a heart attack while running. And every winter, people die of heart attacks while shoveling snow. Sex is exercise, but it’s nowhere near as strenuous as running or shoveling snow. Sometimes it feels that way, but according to a recent analysis in American Family Physician, the typical sexual interlude taxes the heart no more than walking up two flights of stairs.

Great Sex Guidance: Heart Disease and Sex – © Michael Castleman – 352 – Sex After Heart Attack: Enjoy

Depending on the results of various medical tests, most heart attack survivors and people recovering from heart disease surgery can safely return to lovemaking in few months. But when doctors say, “It’s okay,” many people don’t believe them. Two recent studies should provide some perspective:

* After reviewing a large number of studies of sex and heart attack, Stanford researchers conclud- ed that sex is a “weak” risk factor, “accounting for only 0.5-1.0 percent” of heart attacks, in other words somewhere between one in 100 and one in 200.

* Swedish researchers interviewed 699 survivors of first heart attacks. Only nine (1.3 percent) were sex-related—and those heart attacks tended to occur in the individuals who were among the least physically fit. The researchers concluded that risk of sex-related heart attack is “very low. Sex once a week [among heart attack survivors] increases the annual risk of heart attack only slightly.”

Heart Disease? How To Enjoy Sex

* Follow your doctor’s advice. There might be special circumstances that make sex inadvisable, for example, moderate-to-severe congestive heart failure, which involves substantial heart fatigue and shortness of breath with minor exertion. But in general, heart disease, including surviving a heart attack, need not limit lovemaking. If you can walk up a few flights of stairs without chest pain, chances are you can make love.

* Adopt a heart-healthy lifestyle. It’s never too late to quit smoking, lose weight, manage stress, get regular exercise, eat less meat and cheese and more fruits and vegetables, enjoy social support from those you love, and take medication to reduce blood pressure and cholesterol. In addition to helping the heart, heart-healthy lifestyle changes are also associated with increased libido and bet- ter sexual function, notably fewer erection problems.

* Speaking of stress management, heart-healthy exercise, and spending time with loved ones, here’s a heart-saving tip: Make love regularly. Sex involves meditative deep relaxation, which helps reduce stress. It’s gentle exercise that can help strengthen the heart. And assuming a loving relationship, it’s a marvelous way to enjoy social support. Maybe that’s why so many people call their lovers “sweetheart.”

* If either partner continues to feel uncomfortable with sex after heart attack, consult a sex thera- pist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

DeBusk, RF. “Evaluating the Cardiovascular Tolerance for Sex,” American Journal of Cardiology,” (2000) 86:51F.

Moller, J. et al. “Sexual Activity as a Trigger of Myocardial Infarction: A Case-Crossover Analysis in the Stockholm Heart Epidemiology Program (SHEEP),” Heart (2001) 86:387. Great Sex Guidance: Heart Disease and Sex – © Michael Castleman – 353 – Nusbaum MRH et al. “Chronic Illness and Sexual Functioning,” American Family Physician, (Jan. 15, 2003) 67:2:347.

Stein, RA “Cardiovascular Response to Sexual Activity,” American Journal of Cardiology (2000) 86(2A):27F.

White, JR. et al. “Enhanced Sexual Behavior in Exercising Men,” Archives of Sexual Behavior (1990) 19:193.

Bacon, C. et al. “Sexual Function in Men Older Than 50: Results from the Helath Professionals Fol- low-Up Study,” Annals of Internal Medicine (2003) 139:161.

Great Sex Guidance: Heart Disease and Sex – © Michael Castleman – 354 – Does Hysterectomy Affect Women’s Sexuality?

Hysterectomy, the removal of a woman’s uterus, is the nation’s number one gynecological surgery, and ranks among the nation’s most frequently performed operations. More than 600,000 women have hysterectomies every year, typically women in their forties. Currently, one American woman in four has had a hysterectomy.

Two Controversies

Hysterectomy is controversial. Most are performed to treat fibroids, fibrous, noncancerous growths in the uterine wall that may cause bleeding and discomfort. Fibroids typically go away by themselves at menopause, and critics of hysterectomy charge that many are performed unnecessarily. In Western Europe, fibroid-related hysterectomy is performed much less frequently than it is here.

But there is another hysterectomy controversy—its effects on women’s sexuality. The conventional wisdom is that hysterectomy does not affect sexuality, and that if it has any effect, the operation improves sex. The theory is that once women are freed from the bleeding and abdominal discomfort caused by fibroids, they can revel in increased sexual desire, enjoyment, and satisfaction. But some women complain that after hysterectomy, they experience a variety of sex problems: decreased de- sire, problems with arousal and orgasm, and a decrease in sexual satisfaction. What’s going on?

Most Studies: No Sexual Impact

Most published studies support the conventional wisdom of no sexual impact, or sexual enhance- ment. Three reports are typical:

* Dutch researchers asked 352 married women to complete a questionnaire dealing with their sex lives before they had hysterectomies. Six months after surgery, the women were surveyed again. No matter which of the three types of hysterectomy they had, their overall sexual satisfaction improved. Thirty-two were not sexually active with their partners before surgery. Afterwards, 17 returned to having sex. The medical press hailed this study as good news.

* Researchers at the University of California, at San Francisco, followed 63 women with fibroids. Some were treated with hormonal drugs. Others had hysterectomies. Before and six months

Great Sex Guidance: Does Hysterectomy Affect Women’s Sexuality? – © Michael Castleman – 355 – after treatment, the women completed surveys dealing with their sexuality. The women who had surgery reported improved quality of life, and more sexual desire. Half of the women taking drug treatment eventually requested hysterectomy.

* At Northwestern University, 70 women were surveyed before and six months after hysterectomy. Seventy percent of them said the operation had either no effect on their sexuality, or that it in- creased their sexual desire and satisfaction.

But On Closer Examination…

However, behind all this good news, lurks some not-so-good news:

In the Dutch study, about 40 percent of the women reported some post-hysterectomy sex problems: loss of lubrication, difficulty with arousal, and feeling less sexually sensitive and responsive. In the San Francisco study, compared with the drug group, women who had hysterectomies were twice as likely to report “interference with sex.”

And in the Northwestern study, if 70 percent experience no sexual impact or improvement, then 30 percent experienced sexual impairment.

The Latest Research: Sex Problems Happen

Recently, sex researchers have entered the fray. In 2004, two reports were published that shed new light on the controversy surrounding the sexual impact of hysterectomy.

At the University of Texas, at Austin, researchers worked with 15 women who had hysterectomies, and 17 who did not. All the women inserted standard instruments into their vaginas that allowed researchers to measure their physiological arousal in response to erotic videos. Overall, the differ- ences were not statistically significant, but the hysterectomy group registered somewhat lower vaginal responsiveness, suggesting the possibility of sexual impairment.

The most comprehensive investigation of the sexual effects of hysterectomy was a report by Dutch researchers (a different group than in the study mentioned above). They describe several ways that hysterectomy might interfere with women’s sexuality:

* Hysterectomy sometimes shortens the vagina, which may cause the woman pain during inter- course.

* The uterus is involved in orgasm. It’s muscular tissue contracts during orgasm. Without a uterus, the uterine component of orgasm is lost.

* Hysterectomy severs some of the nerves that service the vaginal wall. These nerves are involved in production of vaginal lubrication and blood engorgement of the vaginal wall. After hysterectomy, some women notice a loss of lubrication. A loss of blood engorgement might reduce sexual sensi- tivity and change how women experience sex.

* Hysterectomy may also contribute to hormonal changes that affect sexual function.

Great Sex Guidance: Does Hysterectomy Affect Women’s Sexuality? – © Michael Castleman – 356 – The Dutch group criticized studies of hysterectomy outcomes for their generally simplistic notions of sexuality. For example, in two of the three studies discussed above, some of the women experienced a significant loss of sexual function, but these results were ignored in the “good news” conclusions.

Any Sexual Outcome Is Possible

So where does this leave us? It appears that many women enjoy an increased quality of life after hysterectomy, especially those who had the operation to treat fibroids that were causing them prob- lems. Increased quality of life often included improved sex: greater desire, easier arousal, and greater sexual satisfaction.

However, it’s also apparent that some women’s hysterectomies leave them sexually handicapped. This has been under-reported and deserves more publicity. Women should know that sexual impair- ment is a possible side effect of hysterectomy.

A 2010 report corroborates this finding. Researchers at Hofstra University in Hempstead, New York, surveyed 969 women about their post-hysterectomy sexuality. They found frequent sexual changes, particularly alterations in the way women experience orgasm.

Help

If you would like individualized help dealing with sex after hysterectomy, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Askew, J. “Women’s Sexuality After Hysterectomy.” Presented at the 2010 annual meeting of the So- ciety for Sex Therapy and Research, Cambridge, MA.

Kupperman, M. et al. “Effect of Hysterectomy vs. Medical Treatment on Health-Related Quality of Life and Sexual Functioning,” Journal of the American Medical Association (2004) 291:1447.

Maas, CP et al. “The Effect of Hysterectomy on Sexual Functioning,” Annual Review of Sex Research (2004) p. 83.

Macready, N. “Hysterectomy Did Not Impair Sexual Function in Two Studies,” Family Practice News, Feb. 1, 2004, reporting on the annual meeting of the Central Association of Obstetricians and Gyne- cologists.

Metson, CM. “The Effects of Hysterectomy on Sexual Arousal in Women with a History of Benign Fibroids,” Archives of Sexual Behavior (2004) 33:31.

Roovers, J-P et al. “Hysterectomy and Sexual Well-Being: Prospective Observational Study of Vginal Hysterectomy, Subtotal Abdominal Hysterectomy, and Total Abdominal Hysterectomy.” BMJ [formerly British Medical Journal] (2003) 327:774.

Great Sex Guidance: Does Hysterectomy Affect Women’s Sexuality? – © Michael Castleman – 357 – Does Sex Increase Risk of Prostate Cancer?

Could sex raise men’s risk for prostate cancer? That disturbing possibility has been raised by several studies over the past 10 years. Prostate cancer is to men what breast cancer is to women. It currently strikes 232,000 American men annually and kills 30,000—numbers similar to the toll of breast cancer on women.

More Sex, Greater Risk?

Here are summaries of selected studies suggesting a sex-prostate cancer link:

* Italian researchers found that compared with men who never married, those who were married— and presumably had more sex—had significantly greater risk of prostate cancer. For men married more than twice, risk was three times that of never-married men.

* University of Illinois researchers correlated prostate cancer risk with men’s age at first intercourse and estimated lifetime number of women sex partners. The younger the men became sexually active, the greater their risk. And the more sex partners they reported, once again, the greater their risk.

* And University of Iowa researchers found that as the number of women sex partners increased, so did risk of prostate cancer, with men who reported sex more than three times a week showing the greatest risk.

More Sex, Less Risk?

But the largest study shows just the opposite—that frequent sex protects against prostate cancer. This study, by researchers at the National Cancer Institute, Johns Hopkins, and Harvard, surveyed 29,000 men, aged 46 to 81, who were asked to estimate their number of weekly ejaculations dur- ing their twenties, their forties, and during the past year. Compared with men who reported seven or fewer ejaculations per month (especially during their twenties), the men who experienced 21 or more were 33 percent less likely to develop prostate cancer.

So what’s going on? Does frequent sex contribute to prostate cancer? Or protect against it?

Great Sex Guidance: Does Sex Increase Risk of Prostate Cancer? – © Michael Castleman – 358 – The Link to Sexually Transmitted Infections

The smart money says sex is protective. In medical research, the larger the study, the more valid it is likely to be. The studies showing that sex increases prostate cancer risk involved a few hundred men. The study showing that sex reduces risk involved 29,000.

But if sex reduces risk of prostate cancer, it’s only protective if men avoid sexually transmitted infec- tions (STIs). In women, infection with genital warts substantially boosts risk of cervical cancer. In fact, many experts now consider cervical cancer an STI. Researchers wondered if STIs might also in- crease risk of prostate cancer.

Many studies—including the University of Iowa study discussed above— show that a history of STIs, especially gonorrhea and syphilis, approximately doubles prostate cancer risk. It’s not entirely clear how STIs spur development of prostate cancer, but these infections cause inflammation and other cellular disruptions, which apparently either trigger cancerous cell changes, or accelerate the growth of slow-growing cancers.

Many studies have linked frequency of sex and an increasing number of sex partners to increased risk of STIs. So it now seems likely that it’s the STIs, not the sex per se, that increases prostate can- cer risk in the studies showing that finding. It seems increasingly likely, that like cervical cancer, pros- tate cancer is, at least to some extent, sexually transmitted.

“Hey, Babe, Let’s Prevent Prostate Cancer Tonight.”

Women might be hearing more of that come-on line if subsequent studies confirm that sex protects against prostate cancer. Or maybe not. The large study tracked ejaculations, but did not distinguish between those that occurred during partner sex or masturbation. If a woman is not in the mood to help her man prevent prostate cancer, men can reduce their risk solo.

Nonsexual Ways To Reduce Prostate Cancer Risk

* Eat less meat and dairy. The animal (saturated) fat in meats and diary products has been strong- ly linked to increased risk of prostate cancer.

* Eat more fruits and vegetables. The antioxidant nutrients found in plant foods (but not animal foods) help reduce risk of all cancers, including prostate.

* Eat more tomato foods. Among fruits and vegetables, tomatoes are the most strongly protective against prostate cancer. Tomatoes contain an antioxidant, lycopene, a form of vitamin A, which has been shown to substantially reduce risk of prostate cancer. Any tomato products help, but the best involve cooked tomatoes: tomato soup, sauce, pizza, etc. Cooking makes lycopene more available to the body.

* Eat more fish. Fish tends to displace meat in the diet, and less meat means less risk of prostate cancer. In addition, cold water fish, especially salmon, contain omega-3 fatty acids that recent studies show help reduce risk of prostate cancer.

* Take a multivitamin with selenium. Selenium is a potent antioxidant nutrient found in plant foods. But the amount in food depends on the selenium content of the soil in which it was grown, and Great Sex Guidance: Does Sex Increase Risk of Prostate Cancer? – © Michael Castleman – 359 – some soils are low in this nutrient. It’s prudent to take a supplement. Look for multivitamins that contain 50 to 100 micrograms (mcg).

* Finally, to prevent STIs, if you or your partner is nonmonogamous, use condoms every time.

References:

Dennis, LK and DV Dawson. “Meta-Analysis of Measures of Sexual Activity and Prostate Cancer.” Epidemiology (2002) 13:72.

LaVecchia, C et al. “Marital Status, Indicators of Sexual Activity, and Prostatic Cancer,” Journal of Epidemiology and Community Health (1993) 47:450.

Leitzmann, MF et al. “Ejaculation Frequency and Subsequent Risk of Prostate Cancer,” Journal of the American Medical Association,” (2004) 291:1578.

Rosenblatt, KA et al. “Sexual Factors and Risk of Prostate Cancer,” American Journal of Epidemiol- ogy (2001) 153:1152.

Great Sex Guidance: Does Sex Increase Risk of Prostate Cancer? – © Michael Castleman – 360 – Sex After Breast Cancer

The bad news is that breast cancer is a fairly common illness, and it can wreak havoc with a woman’s sexuality and the love life of the relationship she’s involved in.

The good news is that with a little effort, within several months after treatment, couples in loving, sup- portive relationships usually adjust and enjoy sex as much as they did before the diagnosis—some- times more.

One Woman in Nine

Breast cancer is the most frequently diagnosed malignancy in women. In 2008, some 184,000 Ameri- can women were diagnosed and 41,000 died of the disease. Women’s lifetime risk of breast cancer, that is the chance that a woman will get diagnosed sometime from age 18 to 85, is approximately one in nine, or 11 percent.

Compared with cardiovascular disease (heart disease and stroke), breast cancer kills far fewer wom- en (505,000 vs. 41,000 annually). Nonetheless, breast cancer is generally regarded as the disease women fear most, in part because it strikes so many women in their thirties and forties, and in part because it strikes a part of the body profoundly connected to women’s feelings of femininity, mother- hood, and sexuality.

Sexually, Breast Cancer is Special

Any cancer can affect sexuality because of the emotional shock of the diagnosis. In addition, the trauma and side effects of surgery, radiation, and/or chemotherapy often include: severe fatigue, de- pressed mood, hair loss, and nausea, all of which wreak havoc with sexual desire and response.

But sex after breast cancer is often particularly problematic because breasts are so intimately con- nected to women’s—and men’s—experience of sexual attractiveness and sexual play. Many women lose a breast to the disease (mastectomy), which can have a profound impact on lovemaking. And even those who have just the tumor removed and keep their breast (lumpectomy) wind up with a scar and possibly a breast whose shape has been altered by the surgery.

Great Sex Guidance: Sex After Breast Cancer – © Michael Castleman – 361 – For years, cancer counselors and sex counselors have advised breast cancer survivors and their lov- ers that within a year after treatment most survivors return to their previous sexual functioning. But this was merely impressionistic advice.

Findings of the Major Study on Sex After Breast Cancer

Fortunately, researchers at UCLA, Georgetown University, and the University of Southern California teamed up on a sexuality survey of 863 breast cancer survivors. Participants were a statistical snap- shot of the female U.S. population: racially diverse, mostly married and employed (some retired), with an income range from low to high, and sexually active at diagnosis and at the time of the survey. About half had lumpectomies, and half mastectomies, with about one-third of the women who lost breasts having had reconstructions. About half received radiation (standard with lumpectomy), and about one-third had chemotherapy. Participants were surveyed an average of three years after their diagnosis, meaning two to 2.5 years after the end of their treatment.

Overall, at the time of the survey, the women’s feelings about their libido, responsiveness, orgasm, and overall sexual satisfaction hardly differed at all from a control group of women who had not had breast cancer.

However, some women noted significant cancer-related sexuality changes. The most frequent area of change involved comfort touching—or having a lover touch—the affected breast area. Before diagno- sis, 19 percent said this caused discomfort. At the time of the survey, the figure was 32 percent. But about 15 percent said they felt better about having the affected breast or chest area touched.

Another frequent area of change involved discomfort undressing in front of a lover, that is, baring the affected breast—12 percent said they felt uncomfortable before diagnosis vs. 25 percent at the time of the survey. Two percent said they felt more comfortable.

Having sex in the nude was uncomfortable for 5 percent prior to diagnosis, and 15 percent in the sur- vey. One percent said it was more comfortable.

Another aspect of sexuality affected by breast cancer included loss of lubrication, and greater pain as- sociated with intercourse (from loss of lubrication). Chemotherapy typically induces chemical meno- pause, and menopause is strongly associated with decreased lubrication.

Big Link to Relationship Satisfaction

However, the breast cancer survivors most likely to report these problems, and less sex, and less sexual satisfaction were the ones who also reported the least overall relationship satisfaction. Among women who rated their relationships satisfying, far fewer complained about these discomforts, or less sex, or loss of sexual satisfaction.

The researchers concluded that for women in enjoyable, loving, supportive relationships, breast can- cer has little lasting impact on sexuality, though it may have some.

They also concluded that the most frequent problem—sudden menopause with loss of vaginal lubri- cation—could be easily corrected with commercial lubricants. They noted that fewer than one-third of women in the total population use sexual lubricants routinely, and that after breast cancer, doc-

Great Sex Guidance: Sex After Breast Cancer – © Michael Castleman – 362 – tors, counselors, and friends should encourage it, or encourage couples to explore sex without inter- course—mutual hand massage, oral sex, and sex toys.

Help

For individualized help dealing with sex after breast cancer, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Reference:

Meyerowitz BE et al. “Sexuality Following Breast Cancer,” Journal of Sex and Marital Therapy (1999) 25:237.

Great Sex Guidance: Sex After Breast Cancer – © Michael Castleman – 363 – Sex After Prostate Cancer

Erectile dysfunction after prostate cancer treatment is common, but not inevitable

The myth is that prostate cancer treatment destroys men’s erections. The truth is more complicated. Men facing treatment for this disease should prepare themselves emotionally for permanent erectile dysfunction (ED) that can’t be treated with erection medication. But ED is not inevitable. And if you develop it, you can still enjoy a fulfilling sex life—including satisfying orgasms.

All Treatments Are Equally Effective

Most prostate cancer is diagnosed early, before it has spread outside the gland. With early detection, the prognosis is excellent. The American Cancer Society estimates 220,000 new diagnoses in 2015, but only 27,500 deaths, a mortality rate of 12.5 percent. For comparison, here are the numbers for breast cancer—232,000 diagnoses expected in 2015, and 40,000 deaths, a mortality rate of 17 per- cent.

Early-stage prostate cancer can be treated in three ways: surgical removal of the gland (radical pros- tatectomy), high-dose radiation from an external source (external beam), or insertion of a radioactive pellet (seed implantation, brachytherapy).

All three are equally effective. Researchers at M.D. Anderson Cancer Center in Orlando, Florida, reviewed outcomes for 2,991 consecutive men: 1,034 had prostatectomy, 785 had external beam radiation, and 950 had seed implantation, and 222 had combined external beam and seed. Five-year survival rates were 81 percent for prostatectomy, 81 percent for external beam, 83 percent for seeds, and 77 percent for combined therapy—statistical equivalence. An eight-year study of 1,682 men at the Cleveland Clinic also showed equivalent survival: 72 percent for prostatectomy, 70 percent for radiation (both kinds).

ED Risk After Treatment

Researchers with the National Cancer Institute followed 1,187 men for five years—901 had surgery, 286 had external beam. Sexual function declined in both groups, but ED was more prevalent in those who had surgery, 79 percent after prostatectomy vs. 64 percent after radiation.

Great Sex Guidance: Sex After Prostate Cancer – © Michael Castleman – 364 – Harvard researchers conducted a similar study in 987 men treated for prostate cancer. Two years later, surgery left 65 percent with ED. External beam radiation caused ED in 63 percent. And radioac- tive seed implantation caused ED in 57 percent.

Other researchers have reported somewhat different findings—rates of ED ranging from 60 percent to 82 percent. But almost every study shows that prostatectomy causes somewhat more erection im- pairment than radiation.

Risk Factors for ED After Treatment

However, these figures are averages. Depending on the man, post-treatment ED rates ranged from a high of 92 percent to a low of just 30 percent.

• Age. In healthy men, erection capacity declines with age. In some men, particularly smokers, this may start as young as 40, while most men notice erection decline in their early 50s. Erection capacity continues to decline with advancing years. The younger the man at treatment, the more likely he is to retain erection capacity.

• Type of treatment. All prostate cancer treatments cause considerable ED, but surgery causes the most. Type of treatment also affects how ED develops. After surgery, most men experience sudden erection impairment, but over time, some recover partial function. After radiation, fewer men report sudden ED. But over time, ED becomes more common.

• PSA. PSA, prostate-specific antigen, is a compound released by the prostate. Its use as a screen- ing test for prostate cancer risk is controversial, but several studies show that the lower a man’s PSA before treatment, the more likely he is to retain erection capacity after.

• Pre-treatment sexual function. Compared with men who reported infrequent, unsatisfying sex be- forehand, those who had regular, satisfying sex before treatment show better erection capacity after.

• Morning erections or partial erections. Young men often wake with morning erections. Some older men continue to wake with partial penile firmness. Compared with men who rarely or never wake with semi-erections, those who experience at least occasional firmness on waking are more likely to recover erection function after prostate cancer treatment.

Nerve-Sparing Surgery?

Why does prostate cancer treatment cause such a high rate of ED? Because the nerves involved in erection, specifically two nerve bundles, run very close to the gland. Surgery typically cuts these nerves, and radiation usually damages them.

For years, surgeons have strived to remove the prostate while leaving the nerve bundles intact (nerve-sparing prostatectomy) thus reducing risk of ED. Unfortunately, nerve-sparing surgery does not work miracles. At Fred Hutchinson Cancer Center in Seattle, researchers checked in with 1,291 men 18 months after prostatectomies performed in the mid-1990s. Among those who had ordinary surgery, 66 percent reported serious ED. Those who had nerve-sparing surgery reported less ED, but not much less—57 percent. In this group, age was a better determinant of sexual function than the type of surgery. Among men under 60, 39 percent could raise erections. For the men 60 or older, the figure was 20 percent. Great Sex Guidance: Sex After Prostate Cancer – © Michael Castleman – 365 – More recent studies have reported somewhat better results. And recently, robot-assisted prostatecto- my has improved erection retention rates. A 2012 Italian review of six studies showed that 12 months after surgery, 54 to 90 percent of men could raise erections.

However, these studies measure “any degree of erection.” Rates of erection sufficient for intercourse generally come in at 25 to 70 percent—according to surgeons. But ask the men who’ve been treated, and you get different numbers. Researchers at Memorial Sloan-Kettering Cancer Center in New York surveyed 180 men two years after nerve-sparing radical prostatectomy. Among those not using erec- tion drugs, just 22 percent said their erections were back to baseline. Among those using the drugs, the figure was 43 percent—meaning that 57 percent had suffered a significant post-surgical loss of erection capacity.

Finally, if the tumor is located near a nerve bundle, nerve-sparing surgery may not be possible.

Bottom line: Compared with ordinary surgery, nerve-sparing surgery produces better results, but not much better. For best results opt for robot-assisted nerve-sparing surgery.

Erection Drugs Might Help

Several studies show that in some men, Viagra and other erection drugs may help restore erection after prostate cancer treatment. But this depends on nerve function.

Erection medications work by coaxing more blood into the penis. But if a man doesn’t have enough nerve function for erection, the amount of blood in the penis doesn’t matter. Damaged or severed nerves mean iffy or no erections. However, with nerve-sparing surgery, much or all of nerve function remains, and erection drugs can help.

Italian researchers analyzed 11 studies of erection in men who took Viagra or similar drugs after pros- tatectomy. After non-nerve-sparing surgery, erection medication helped from 0 to 15 percent of men. (Non-nerve-sparing surgery sometimes accidentally spares some nerves.) After surgery that spared one nerve bundle, the drugs helped 10 to 80 percent of men. When both nerve bundles were spared, Viagra helped 46 to 72 percent of men.

Bottom line: For best chance of sexual function, have bilateral nerve-sparing surgery and use erection medication.

Penile Implant?

Penile implants are nested rods surgically inserted into the penile shaft along with a squeeze bulb and fluid reservoir inserted into the scrotum. Squeeze the bulb and the fluid fills the rods, hydraulically extending them to produce erection.

However, there are two major problems with implants. Insertion surgery may leave the penis looking deformed. And implants can malfunction, necessitating more surgery for repairs.

As a result, only a small proportion of men opt for implants after prostate cancer surgery.

Great Sex Guidance: Sex After Prostate Cancer – © Michael Castleman – 366 – Great Sex and Satisfying Orgasms Without Erection

All the attention on erection after prostate cancer treatment obscures a key fact: Men don’t need erec- tions to have satisfying sex and orgasms. In an erotic context—candle light, music, and an erotically- motivated woman who turns a man on—vigorous penile stimulation can trigger orgasm even if the penis is flaccid. If a man develops ED from prostate cancer treatment, he can still enjoy a fulfilling sex life and have orgasms that feel just as pleasurable as those he used to have when he could raise erections.

Different nerves control erection and orgasm. Even if a man’s erection nerves are damaged or sev- ered, chances are that the nerves that govern orgasm remain intact. It’s an adjustment to have a flac- cid penis stimulated to orgasm. But it’s not all that difficult—and after prostate cancer treatment, most men say they’d rather have orgasms without erections than erections without orgasms. How do men have orgasms without erections? The regular way—with direct, sustained penis stimu- lation by hand, mouth, or sex toy, or any combination. It may take several months after treatment to return to orgasm, but if you work at it, either solo or with a lover, you can enjoy fulfilling orgasms with a flaccid penis.

For individual help with sex after prostate cancer, consult a sex therapist. To find one near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Alemozaffar, M. et al. “Prediction of Erectile Function Following Treatment for Prostate Cancer,” Jour- nal of the American Medical Association (2011) 306:1205. Christian, JN et al. “Back to Baseline: Erectile Function Recovery After Radical Prostatectomy from the Patients’ Perspective,” Journal of Sexual Medicine (2013) 10:1636. Ficarra V et al. “Systematic Review and Meta-Analysis of Studies Reporting Potency Rates after Robot-Assisted Radical Rrostatectomy,” European Urology (2012) 62:418.

Kupelian, PA et al. “Radical Prostatectomy, Extermal Beam Radiotherapy, Permanent Seed Implanta- tion, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer,” Internation- al Journal of Radiation Oncology, Biology, and Physics (2004) 58:25.

Kupelian, PA et al. “Comparison of Efficacy of Local Therapies for Localized Prostate Cancer: A Large Single Institution Experience with Radical Prostatectomy and External Beam Radiation,” Journal of Clinical Oncology (2002) 20:3376.

Megas, G et al. “Comparison of Efficacy and Satisfaction Profile Between Penile Prosthesis Implan- tation and Oral PDE5 Inhibitor Tadalafil Therapy, in Men with Nerve-Sparing Radical Prostatectomy Erectile Dysfunction. BJU International (formerly British Journal of Urology) (2013) 112:169-76.

Montorsi, F and A. McCullough. “Efficacy of Sildenafil (Viagra) in Men with Erectile Dysfunction Fol- lowing Radical Prostatectomy: A Systematic Review of Clinical Data,” Journal of Sexual Medicine (2005) 2:658.

Montorsi, F. et al. “Effects of Tadalafil Treatment on Erectile Function Recovery Following Bilateral

Great Sex Guidance: Sex After Prostate Cancer – © Michael Castleman – 367 – Nerve-Sparing Radical Prostatectomy: a Randomised Placebo-Controlled Study (REACTT),” Euro- pean Urology (2014) 65:587.

Noldus, J et al. “Patient-Reported Sexual Function After Nerve-Sparing Radical Retropubic Prostatec- tomy,” European Urology (2002) 42:118.

Potosky, AL et al. “Five-Year Outcomes After Prostatectomy or Radiotherapy for Prostate Cancer: The Prostate Cancer Outcomes Study,” Journal of the National Cancer Institute (2004) 96:1358.

Shimizu, T et al. “Erectile Dysfunction Following Nerve-Sparing Radical Retropubic Prostatectomy and Its Treatment with Sildenafil,” International Journal of Urology (2005) 12:552.

Sivarajan G, et al. “Ten-Year Outcomes of Sexual Function After Radical Prostatectomy: Results of a Prospective Longitudinal Study,” European Urology (2014) 65:58.

Great Sex Guidance: Sex After Prostate Cancer – © Michael Castleman – 368 – Don’t Douche: It’s Very Bad for Women’s Health

Behind “that clean, fresh feeling” touted in ads for feminine hygiene products is a nasty implication women fear—the mistaken notion that the vagina is a dirty, malodorous organ. But the ads have struck a nerve. According to the Centers for Disease Control and Prevention (CDC), they have per- suaded an estimated 15 percent of U.S. women to douche regularly. Some use home-made water- vinegar douches, but most spring for disposable, commercial products that ring up sales of $150 million a year. Douche ads have also persuaded many mothers to advise their daughters to douche regularly.

What the ads don’t mention is that douching is not only unnecessary, it’s also surprisingly harmful. The healthy vagina contains a variety of bacteria that have complex relationships with one another. Within 10 minutes of douching, some of these bacteria get killed off, which upsets the ecological bal- ance. The vaginal micro-environment reverts to normal within 72 hours. But before it does, bacteria no longer held in check by those that have been killed off may multiply to the point that they cause a variety of infections:

Bacterial Vaginosis (BV)

Many women douche for fear that their vaginas smell bad. Ironically, douching increases risk of bac- terial vaginosis, an infection that causes an unpleasant fishy-smelling discharge and other symp- toms. University of Pittsburgh researchers surveyed 1,200 reproductive age women. As douching increased, so did risk of BV. Compared with those who did not douche at all, women who douched once a month, were 40 percent more likely to develop BV. In those who douched weekly, BV risk doubled.

Great Sex Guidance: Don’t Douche- It’s Very Bad for Women’s Health – © Michael Castleman – 369 – Trichomonas

Trichomonas is a common vaginal infection. CDC researchers tested 3,754 women, aged 14 to 49. Three percent had trichomonas. Compared with those who remained free of trichomonas, women who douched regularly were significantly more likely to be infected.

Chlamydia

Chlamydia is now the nation’s leading sexually transmitted infection. University of Washington re- searchers correlated douching and chlamydia risk in 1,692 women. Compared with those who never douched, those who did even once in the previous 12 months had double the risk of chlamydia. Those who douched weekly had almost four times the risk.

Yeast Infection

Italian researchers surveyed 931 women about their lifestyles, including douching, and their history of yeast infections. Frequent douching was associated with an increased risk of yeast infection.

Pelvic Inflammatory Disease (PID)

Chlamydia often causes no symptoms in women. As a result, in some cases, the infection progresses from the vagina through the cervix and into the uterus and fallopian tubes, where it causes pelvic inflammatory disease (PID), a serious infection that may threaten women’s fertility and possibly even their lives. In one study, researchers at Mount Sinai School of Medicine in New York City discov- ered that monthly douching almost doubled risk of PID. More frequent douching raised it even more. Compared with women who never douched, those who did so weekly had four times the risk of PID. Another study by researchers at University of Washington School of Medicine in Seattle compared the douching habits of 100 women hospitalized for PID and 762 healthy controls. Those with PID douched significantly more. Women who douched three times a month or more were 3.6 times more likely to develop PID.

Why would douching, which takes place in the vagina, be linked to PID, which infects the uterus and fallopian tubes? Researchers speculate that in addition to altering the micro-environment of the va- gina, the douche stream pushes bacteria from the vagina into the uterus and fallopian tubes, where they cause PID.

Douching has also been linked to an increased risk of cancer:

Cervical Cancer

Researchers with the U.S. military’s Uniformed Services University of the Health Sciences in Bethes- da, Maryland, investigated the douching habits of 266 Utah women who developed cervical cancer, and 408 very similar Utah women who did not. The study focused on Utah women because they were Mormon, a religion that forbids smoking and extramarital sex, both risk factors for cervical cancer. Compared with the nondouchers, those who douched more than once a week had four times the risk of cervical cancer.

Finally, douching has been linked to reproductive harm:

Great Sex Guidance: Don’t Douche- It’s Very Bad for Women’s Health – © Michael Castleman – 370 – Infertility

Washington, D.C. researchers followed 840 married couples who were trying to get pregnant. After one year of unprotected intercourse, 10 percent of the women who never douched failed to conceive, but among women who douched weekly, 27 percent did not.

Ectopic Pregnancy

In ectopic pregnancy, the newly conceived fetus grows in a fallopian tube instead of the uterus. As it grows, it ruptures the tube, a medical emergency that puts the mother’s life at risk. In one study, com- pared with women who never douched, those who did had 3.8 times the risk of ectopic pregnancy.

Preterm Delivery

CDC researchers surveyed 812 pregnant women. Compared with those who did not douche at all, those who did during pregnancy had nearly double the risk of preterm delivery, which may cause a host of medical problems in the newborn, some of them potentially life-threatening.

Low Birth Weight

Even when they are not delivered prematurely, babies with unusually low birth weight face medical problems, some possibly life-threatening. University of Rochester researchers tracked 4,665 preg- nant women around the U.S., about half of whom douched regularly. Six percent of the nondouchers’ babies had unusually low birth weight, but among those who douched more than once a week during pregnancy, the figure was 10 percent.

What about the ads’ claims that douching contributes to personal hygiene? Those claims are bunk. Cervical mucus and other natural secretions that lubricate the vagina, for example, during sex, also keep it clean. Douching is unnecessary. “The vagina is a self-cleansing organ,” says David Eschen- bach, M.D., a professor of gynecology at the University of Washington. “With regular bathing, femi- nine hygiene products, particularly douches, are completely unnecessary.”

A Food and Drug Administration advisory panel noted the mounting evidence against douching, but called it insufficient to ban commercial douches. The panel timidly suggested that perhaps douches should carry warning labels. Currently, the case against douching is not epidemiologically air-tight. But why buy a product that’s at best worthless, and at worst, hazardous? “There is no good reason to douche and many good reasons not to,” says, Johns Hopkins gynecologist Jean Anderson, M.D. “Douching should be actively discouraged.”

References:

Annang, L. et al. “Vaginal Douching Practices Among Black Women at Risk: Exploring Douching Prevalence, Reasons for It, and Sexually Transmitted Diseases,” Sexually Transmitted Diseases (2006) 33:215.

Brotman, R.M. et al. “A Longitudinal Study of Vaginal Douching and Bacterial Vaginosis: A Marginal Structural Modeling Analysis,” American Journal of Epidemiology (2008) 168:188.

Great Sex Guidance: Don’t Douche- It’s Very Bad for Women’s Health – © Michael Castleman – 371 – Bruce, F.C. et al. “Is Vaginal Douching Associated with Preterm Delivery?” Epidemiology (2002) 13:328.

Corsello, S. et al. “An Epidemiological Survey of Vulvovaginal Candidiasis in Italy,” European Journal of Obstetrics, Gynecology, and Reproductive Biology (2003) 119:66.

Cottrell, B.H. “Vaginal Douching,” Journal of Obstetrics, Gynecology, and Neonatal Nursing (2003) 32:12.

Fiscella, K. et al. “Risk of Preterm Birth Associated with Vaginal Douching,” American Journal of Ob- stetrics and Gynecology (2002) 186:1345.

Holtzman, C. et al. “Factors Linked to Bacterial Vaginosis in Nonpregnant Women,” American Journal of Public Health (2001) 91:1664.

Koumans, E.H. “Prevalence of Bacterial Vaginosis in the U.S., 2001-2004: Associations with Symp- toms, Sexual Behaviors, and Reproductive Health,” Sexually Transmitted Diseases (2007) 34:864.

Ness, R.B. et al. “Douching, Pelvic Inflammatory Disease, and Incident Gonococcal and Chlamyd- ial Genital Infection in a Cohort of High-Risk Women,” American Journal of Epidemiology (2005) 161:186. Rothman, K.J. et al. “Randomized Field Trial of Vaginal Douching, Pelvic Inflammatory Disease, and Pregnancy,” Epidemiology (2003) 14:340.

Rupp, R. et al. “Intergenerational Transfer of Douching Information,” Journal of Pediatric and Adoles- cent Gynecology (2006) 19:69.

Sutton, M. et al. “Prevalence of Trichomonas Vaginalis Among Reproductive-Age Women in the U.S., 2001-2004,” Clinical Infectious Disease (2007) 45:1319.

Thorp, J.M. et al. “Alteration in Vaginal Microflora, Douching Prior to Pregnancy, and Preterm Birth,” Pediatric and Perinatal Epidemiology (2008) 22:530.

Tsai, C.S. et al. “Does Douching Increase Risk for Sexually Transmitted Infections? A Prospective Study in High-Risk Adolescents,” American Journal of Obstetrics and Gynecology. (2009) 200:38.

Great Sex Guidance: Don’t Douche- It’s Very Bad for Women’s Health – © Michael Castleman – 372 – Sexual Healing - Sex Is Good for Health

Years ago, Marvin Gaye had a hit with “Sexual Healing.” The song dealt with the emotional benefits of lovemaking. True enough. But sex is also good for physical health. Here’s what the latest research shows:

Fitness Fitness involves three elements: stamina, strength, and flexibility. Many people focus on stamina (aer- obics) and strength, but don’t put much effort into flexibility. However, exercise physiologists agree that flexibility—moving the joints through their full range of motion—is as important as stamina and strength. Leisurely, playful sex gently moves many joints through their range of motion. This helps fit- ness in general, and it’s therapeutic for musculoskeletal injuries and particularly for osteoarthritis.

Deep Relaxation Good sex involves whole-body sensual massage. Massage is deeply relaxing. So are sex-related deep breathing and orgasm. The deep relaxation obtained through sex is very similar to the physi- ologic relaxation that comes from meditation, biofeedback, yoga, tai chi, and other stress manage- ment regimens. Meditative relaxation has been shown to help treat an enormous number of physical ailments, among them: pain problems, asthma, high blood pressure, heart disease, depression, and arthritis. Regular sex with a loving partner offers similar benefits.

Pain Relief Sex helps relieve pain in two ways. First, it’s an enjoyable distraction. While having sex, people focus less on their pain—and as a result, suffer less. In addition, as a form of gentle exercise, sex releases endorphins, the body’s own pain-relieving compounds. One of the nation’s most prevalent chronic- pain conditions is osteoarthritis. The Arthritis Foundation recommends regular sex to help control arthritis pain.

Mood Elevation Good sex is certainly a feel-better activity. For those with a tendency to feel depressed, sex is an effective mood-elevator. The endorphins released during sex not only relieve pain, but also have a mood-improving, antidepressant effect. Massage is also a mood-enhancer. Good sex includes whole- body massage.

Great Sex Guidance: Sexual Healing- Sex Is Good for Health – © Michael Castleman – 373 – Immune Enhancement Regular moderate exercise boosts immune function, which helps prevent all manner of illness. Sex is moderate exercise, so it, too, boosts immune function. In a study at Wilkes-Barre University in Penn- sylvania, researchers found that compared with those who have sex less than once a week, people who enjoy sex once or twice a week are less likely to catch colds. This finding was surprising because colds are passed by close personal contact, so you’d expect sex to increase risk as lovers pass their colds to each other. But the researchers found that something else outweighed the risk-raising effect of close contact. It was immunoglobulin A (IgA), a component of the immune system that helps the body defend against colds. Sex raises IgA levels significantly enough to account for the finding that sex helps prevent colds.

Stress Incontinence Many women suffer from stress incontinence, urine leakage when they cough, sneeze, or laugh. The reason is that the muscles that control the urinary sphincter weaken and can’t keep urine in against the pressure produced by coughing, sneezing, and laughing. In 1948, Arnold Kegel, M.D., developed Kegel exercises to help resolve stress incontinence. Kegels involve tensing and relaxing the muscles used to cut off urine flow, or to squeeze out the last few drops. These very same muscles are also involved in orgasm. Kegels not only cure stress incontinence, they also increase the intensity of or- gasm. Try Kegels in sets of 10 three or four times a day.

Menstrual Problems A few studies have shown that regular sex—once a week or so—helps relieve menstrual cramps and promotes menstrual regularity. In addition to it’s pain-relieving action, sex subtly alters the balance of women’s sex hormones, which helps resolve menstrual complaints.

Longevity Exercise, immune enhancement, and deep relaxation are all associated with longer life. Sex incorpo- rates all three, so it should come as no surprise that regular sex helps extend life. That’s what British scientists at the University of Bristol discovered in a study of some 900 middle-aged men. Compared with those who had sex once a month or less, those who reported it twice a week had only about half the death rate.

Critics argued that the association between sex and longevity might not be causal. Health generally leads to greater sexual frequency, so perhaps it’s overall health and not sex that prolongs life.

But the researchers took care to correct statistically for this possibility. Comparing the men with low, medium, and high sexual frequency, there were no significant differences in age, smoking, weight, blood pressure, or heart disease, all of which have major impact on longevity. The researchers’ con- clusion: Sex helps prevent death in middle-aged men.

Of course, no one makes love simply because it’s health-enhancing. But the health benefits of sex are a little extra that can make it more fulfilling. And if you like making love to music, try playing “Sex- ual Healing.” It’s a catchy tune—and it’s true.

Great Sex Guidance: Sexual Healing- Sex Is Good for Health – © Michael Castleman – 374 – Sex Helps Prevent The Common Cold

Want to prevent colds and nip early colds in the bud? Then have good sex once a week in a satisfy- ing, long-term relationship. That’s what psychologists Carl Charnetski, Ph.D., and Francis Brennan, Jr., Ph.D., of Wilkes-Barre University in Pennsylvania discovered in a study of the healing powers of lovemaking.

Charnetski and Brennan surveyed 111 college students (44 men, 67 women) about their love lives: frequency of partner sex, the length of the relationship, and their satisfaction with it. They categorized sexual frequency as: no sex, infrequent sex (less than once a week), frequent sex (once or twice a week), or very frequent sex (3 or more times a week).

Immunoglobulin A

Then the researchers took saliva samples from the students. Saliva contains an immune-system protein, immunoglobulin A (IgA), the body’s first line of defense against the common cold and other respiratory infections. The more IgA you have in your saliva, the less likely you are to catch colds.

The frequent-sex group (once or twice a week) had the highest levels of IgA, and enjoyed the most protection from colds. This group had 30 percent more IgA than the two groups who had less frequent sex and the group that had sex more often—too much of a good thing.

In addition, as length of relationship and satisfaction with it increased, so did IgA level.

Don’t Kiss Me. I Have a Cold.

Why would frequent sex in a happy, long-term relationship help prevent colds? At first glance, this seems counter intuitive. After all, colds spread directly from person to person. The more time you spend in intimate contact with a lover, the more likely you should be to catch their colds and spread yours.

However, sex provides two things that enhance immune function enough to override this risk: relax- ation and social support.

Great Sex Guidance: Colds- Sex Helps Prevent Them – © Michael Castleman – 375 – Many studies show that deep relaxation, the kind that results from meditation or hypnosis/visualiza- tion, is a powerful immune stimulant. Psychologists at Washington State University had 65 people watch a video describing the immune system. Then one group did nothing else. Another was taught to meditate, and practiced twice a day for a week. The third learned to visualize their immune systems growing stronger, and practiced that visualization twice a day for week. The researchers then counted the number of infection-fighting white cells in their blood. The control group experienced no increase in white cells. But the meditation and visualization groups did.

Social Support

Other studies show that social support revs up the immune system, and helps prevent colds. At the University of Pittsburgh, psychologist Sheldon Cohen, Ph.D., studied 276 healthy volunteers, who completed a survey of their social ties—to lovers, friends, family, and organizations—and then had live cold virus squirted up their noses. Those with the most social support were least likely to catch the cold.

I Feel a Cold Coming On. Let’s Do It.

Which brings us back to the Wilkes-Barre study showing a cold-preventive effect for sex once or twice a week in a satisfying, long-term relationship. Satisfying sex is a deeply relaxing, meditative experi- ence. And having a good long-term relationship provides plenty of social support. Both increase IgA substantially, so both help prevent colds. Although the study involved college students, older adults’ immune systems work the same way.

People often say, “Not tonight, dear, I feel a cold coming on.” Assuming you’re in a good relationship, it’s time for an update: “I feel a cold coming on. Let’s do it.”

Great Sex Guidance: Colds- Sex Helps Prevent Them – © Michael Castleman – 376 – Section V Out of the Ordinary Anal Play — Without Pain

What exactly is anal sex? In pornography, it means just one thing—penis-anus intercourse. But ac- cording to San Francisco sex therapist Jack Morin, Ph.D., author of Anal Pleasure and Health, a highly regarded guide to anal play, among couples who include anal in their lovemaking, penis-anus intercourse is the least popular variation. Most lovers prefer anal sphincter massage, anal fingering, or insertion of small butt plugs (dildos specially designed for the anal canal).

A Minority Experience

Anal play, particularly anal intercourse, is much more popular in porn than it is in the lives of real lovers. No matter how you define it, anal play appeals to only a minority ofAmerican lovers. In the landmark 1999 University of Chicago “Sex in America” survey, 26 percent of the men and 20 percent of the women said they’d tried it—but only a small fraction said they’d included anal play the last time they had sex before being surveyed—2 percent of the men, 1 percent of the women. In a similar survey by University of California researchers, 7 percent of respondents said they’d experienced anal play during the previous 12 months.

“Anal sex is certainly not mainstream,” says Michigan sex therapist Dennis Sugrue, Ph.D., “but in- creasingly, it’s on the list of sexual experiences Americans are curious about. For most, it’s a novelty, forbidden fruit. Those who enjoy it often say it deepens intimacy in a special way. It’s a way for the recipient to say: No part of me is out of bounds to you, and a way for the inserter to say: No part of you turns me off. All of you turns me on.”

Beyond the Pain and Misconceptions Unfortunately, many women have had bad experiences being on the receiving end of anal sex, par- ticularly penis-anus intercourse. The anus is much less receptive than the vagina or mouth, so many men have had difficulty entering it—and when they do, many women experience sharp pain, which

Great Sex Guidance: Anal Play — Without Pain – © Michael Castleman – 378 – typically ends things, often permanently.

Misconceptions also abound about anal play, for example, that it’s dirty, that it must hurt women, that men who enjoy receiving it must be gay, and that it spreads HIV.

However: * With some forethought and care, anal sex need not be painful. * With careful hygiene, it’s clean, and free from fecal contact. * Many men who are 100 percent heterosexual experience intense pleasure from receptive anal play. * And while receptive anal intercourse is the most efficient sexual route for transmission of HIV, the reason is not anal sex per se, but rather the fact that anal intercourse is more likely than oral or vaginal intercourse to allow semen-blood contact. Anal intercourse with condoms is just as HIV- safe as any other type of safe sex.

Anal Anatomy Surprises

The anus is more complicated than most people think. Morin explains: “One crucial fact is that the human body has two rings of anal sphincter muscles, the external one that’s visible and another ring slightly inside. The external sphincter is pretty easy to relax, but the internal one is less so. Different parts of the nervous system control each of these two sphincters, so relaxing the external opening doesn’t necessarily relax the internal one. Many people store up stress in their internal anal sphincter muscles, just as some people store stress in their backs or necks. As a result some have a harder time than others learning to relax the internal sphincter, and enjoy comfortable anal play. But if you want to, over time, you probably can.”

Moving internally from the anal sphincters, the narrow, muscular anal canal extends an inch or two. The sphincters and anal canal are richly supplied with nerves and are highly sensitive to touch, which is why many people find anal touch erotic. In addition, the anus is surrounded by the pelvic floor muscles, notably the pubococcygeus (PC) muscle, a key muscle that contracts during orgasm. Anal stimulation can excite the PC and intensify orgasm.

The anal canal widens to become the rectum, a five-inch tube of soft tissue.The rectum is not a straight cylinder. It has curves that vary from person to person. Anything inserted into the rectum must negotiate these curves, one reason why insertion of anything into the anus should proceed very slow- ly, with lots of lubrication, and with the recipient always in control of the speed and depth of insertion. There are usually only traces of stool in the rectum and anal canal. Most fecal material is stored just above the rectum in the descending colon. When you feel “the urge,” stool moves into the rectum and fairly quickly passes out of the body. Most of the time, when you feel no urge to defecate, there are only small amounts of stool in the rectum. However there may be enough to leave traces on anything that enters the anus.

Finally, unlike the vagina, the anus and rectum are not self-lubricating. To enjoy anal sex, you must use plenty of lubricant—the more the better. Even with liberal lubrication, anal insertion of anything or its vigorous movement may abrade the soft tissue of the anal canal and rectum, and cause minor bleeding, especially if the recipient is among the estimated one-third of the U.S. population with hem- orrhoids.

Minor bleeding of the anal canal is no cause for concern—unless the object inserted is an erec- Great Sex Guidance: Anal Play — Without Pain – © Michael Castleman – 379 – tion, and the inserter is infected with HIV. If HIV-contaminated semen comes in contact with blood, the receiving partner is at considerable risk of becoming infected. Unless you’re confident that your lover is HIV-negative and free of other sexually transmitted infections, all sex should be safe sex with condoms. Safe sex is especially important during anal play because it’s more likely than other sexual activities to result in semen-blood contact.

Hygiene Issues

“Our culture views the anus as dirty and disgusting,” Morin explains. “It’s an area considered taboo. On an intellectual level, plenty of people might like to explore anal pleasure, but they have a hard time because emotionally, they can’t handle it. The anal taboo can be overcome, but it takes time. Take all the time you need. Otherwise, anal sex is no fun, or even worse, it becomes coercive.”

In anal play, cleanliness is crucial. Wash, bathe, or shower beforehand. Clean the area with a soapy finger. Some people also rinse the rectum and anal canal with an enema. Disposable enemas (Fleet) are available over the counter at pharmacies. If you’re new to enemas, take your time. The first few may feel odd. Use the prepared solution, or fill the plastic bottle with warm water. Lubricate your anus and anal canal, bend over—or drop down to your elbows and knees—then insert the flexible nozzle, gently squeeze the bottle, wait a minute or two, and then expel the water into the toilet. Anal rinsing not only cleans the area, but also helps both lovers relax and feel less apprehensive about anal play. If the receiving anus and anal canal have been washed well beforehand, then anal play—including oral-anal contact (rimming)—is as clean as any other form of lovemaking. But nothing that has had contact with the anal area should be introduced into the vagina. Anal bacteria may cause a urinary tract infection.

Recipients Should Start Solo

If you’re new to anal play (and even for most people who are experienced), forget penis-anus inter- course. It’s often difficult for the inserter and painful for the recipient. Most women in pornography refuse to do it. Start with well-lubricated anal sphincter massage, without any insertion. If both lovers feel comfortable with that, then consider inserting one finger, and as you become more experienced, perhaps a second finger or well-lubricated butt plug.

If you are interested in being the receiving lover, begin your explorations by fingering yourself. “Lubri- cate the opening,” advises New York City sex educator Betty Dodson, Ph.D. “Touch around it. Pay at- tention to the different sensations you feel. Using one finger, slowly press in as you slightly bear down to open your sphincter muscles. See if you can feel both rings of anal sphincter muscles.” Use plenty of lube. Try different brands to see which one(s) you like best. Liquid water-based prod- ucts may be your lube of choice for other forms of lovemaking, but they may not feel best for anal play. Try the thicker jellies, or experiment with vegetable oil or Crisco. Petroleum-based lubricants may cause vaginal irritation, so they should not be used for vaginal intercourse. But for anal sex, some people enjoy them.

During solo explorations, pay attention to your external and internal sphincters and to the unique curves of your rectum. Practice relaxing your sphincters. Breathe deeply. Try different positions to see which ones feel most comfortable.

Then, move on to experimenting with a well-lubricated butt plug. Start with a small, thin plug, and progress to larger, thicker ones only if you feel inclined. “Butt plugs are specially designed for anal Great Sex Guidance: Anal Play — Without Pain – © Michael Castleman – 380 – play,” Dodson says. “The flared base keeps them from getting lost in there. They come in a variety of sizes and are designed to stay in place once they are inserted. This leaves your hands free to do other things.” Or try anal beads, designed to serially open and close the anal sphincters, which trig- gers sensations some people find erotic. The lover on the receiving side of anal play should become as comfortable as possible with solo play before complicating things with anyone else. Anal toys are available through Adam & Eve.

Rule #1: It Should Never Hurt

“If it does,” Morin explains, “the recipient is not sufficiently relaxed, the receiving anus and the object being inserted are not sufficiently lubricated, and/or the inserter is being insensitive and pushy.” Pain—and fear of pain—are the main reasons why women (and recipient men) nix anal play. “Wom- en’s biggest complaint about anal sex is that men push in too quickly,” Dodson explains. “That can re- ally hurt. I had my earliest experience with anal intercourse in my twenties. It was a disaster. We were both young and inexperienced. We didn’t even know enough to use lubrication. And I was far from relaxed. He pushed in and I felt this a hot, burning sensation. I cried out in pain, but my boyfriend mistook my cries of pain for passion and pushed in deeper. I yanked away from him, furious. It took me 20 years to try anal again.”

“Penis-anus intercourse is too much for most couples,” Sugrue says. “The typical erection is too large for women to receive comfortably. It’s intimidating. Most people prefer anal fingering. I encourage couples to just touch and massage each others’ anuses. That can feel incredibly erotic for both the massager and the recipient.”

“Some men enjoy being deeply fingered,” says Fair Oaks, California sex therapist Louanne eston,W Ph.D., “because it massages the prostate gland, which can be a source of unique pleasure.”

Whole-Body Relaxation Is Key

Couples interested in anal play should approach it slowly. First, focus on whole-body relaxation. Take a hot bath or shower together. While bathing, wash the anal area with soap and water, and wash inside the anus as well. Next enjoy some whole-body massage, and other sex play. Anal usually feels most enjoyable when both lovers are highly aroused. Then proceed to light, well-lubricated massage of the external anal sphincter. If the recipient says that feels okay, then try very gentle, shallow finger- ing. Most people go no further than this.

If you’re interested in penis-in-anus intercourse—or in the man being the recipient with the woman us- ing a strap-on dildo—the recipient should ALWAYS be the one in control, the one who does the mov- ing. The inserter should remain still—no pushing into the anus, and no thrusting in the anal canal until the recipient invites it, and if so, slow, gentle movements. The recipient should move back onto the inserting penis or toy. This allows the recipient to control the speed and depth of insertion, and stay relaxed and comfortable. Good positions include: recipient-on-top, back-to-chest spooning, or with the recipient standing and bent at the waist and the inserter behind.

The Recipient Should Always Control Anal Play

How deep can you go? Comfortable depth varies greatly from person to person. After a while, some recipients can accommodate much of the penis. But unlike what you see in pornography, most can- not. Many feel uncomfortable accepting anything but the head of the penis, if that. Some recipients Great Sex Guidance: Anal Play — Without Pain – © Michael Castleman – 381 – feel more receptive if they wear a butt plug for about 30 minutes before attempting to accommodate an erection or other sex toy. Don’t rush things. Deep insertion often takes months, and most recipi- ents never feel comfortable with it. This bears repeating: Most lovers who enjoy anal play limit them- selves to fingering.

Anal play can lead to particularly intense orgasms. Some recipients love having a finger or plug in- serted as their lover brings them to orgasm by hand, mouth, or vibrator. But many recipients prefer not to have orgasms during anal play, and especially not with a penis inside them. The reason is that orgasm causes involuntary muscle contractions and thrusting movements that may be painful for the recipient. But many inserters love orgasm during anal intercourse because the tight, muscular anal canal clamps down on erections quite firmly. Discuss this. It should be the recipient’s call.

If One Lover Wants to Try It and the Other Doesn’t

Frequently one lover is eager to explore anal play, but the other is reluctant or opposed. Morin ad- vises the eager lover: “Never force it. And don’t nag. In a calm, loving manner, explore your partner’s reluctance. What exactly puts off your lover? Listen carefully, and try to address the person’s con- cerns. Ask if there is any way your partner might feel comfortable exploring anal play. Remember, the majority of people limit it to sphincter massage and gentle fingering. Do only what’s mutually agreed. If your partner says stop, stop immediately. Respect your lover’s limits.” Morin also has some advice for those reluctant to try anal play: “You’re under no obligation to do anything you feel uncomfortable doing. Your lover should respect your limits. But don’t dismiss anal play out of hand. There’s nothing wrong, unnatural, weird, kinky, or perverted about it. Think about why you’re reluctant, and honestly tell your partner. Do your feelings have to do with the anal taboo? Memories of previous anal experiences that hurt? By discussing your issues, the two of you learn more about one another, and that knowledge can enhance intimacy even if you don’t have anal sex. Is there any type of anal play you might be willing to try? If so, declare it along with your limits. If you’re willing to be on the receiving side of any anal play, experiment solo until you feel comfortable inviting your lover to join you.”

After anal fingering or intercourse, the recipient may feel the urge to defecate. It may be a real urge. But it may be a false alarm, the reaction of a rectum not yet used to anal sex.

Many people worry that anal sphincters stretched during anal sex may never return to normal, result- ing in soiled underwear. This is highly unlikely. Your anal sphincters have opened and closed during defecation for your entire life. Physiologically, the body can’t tell if material is passing out of the anus or into it. Assuming your anal sphincters close normally after defecation, they should do the same after anal play.

If A Man Likes Receiving, Is He Gay?

Finally, many people feel concerned about the “meaning” of anal sex. For example: Does a man’s interest in receiving anal pleasure mean that he’s gay? Does a man’s desire to enter a woman anally mean that he wants to hurt, dominate, or humiliate her? And if a woman wears a strap-on dildo to enter a man, does that mean she’s “too dominant”?

These questions are reasonable because all sex practices exist in cultural contexts. In the U.S., anal sex is most prevalent among gay men, so it’s not surprising that some people would link it to homo- sexuality. But gay men also hold hands, hug, kiss, and enjoy oral sex, and none of them are consid- Great Sex Guidance: Anal Play — Without Pain – © Michael Castleman – 382 – ered “gay.” Sexual orientation is all about the gender you having sex with, and fantasize sex with. It has nothing to do with any specific sexual practices.

In men’s prisons, anal sex isn’t about pleasure. It’s about power. The inserter typically seeks to domi- nate and humiliate the receiver. This culture of exploitation has, to some extent, carried over to how people view anal play in general. It’s certainly possible for men to use anal play as a way to dominate or humiliate women. It’s equally possible for women wearing strap-ons to do the same to men. But not necessarily, or even typically. Most anal play is loving.

The fact is, anal play need not mean anything beyond the mutual pleasure and intimacy it provides. No matter what your sexual orientation, anal stimulation can feel erotic and pleasurable because physiologically it stimulates the pelvic floor muscles involved in sexual arousal and orgasm. With mutual consent and limits respected, anal sex has nothing to do with domination, humiliation, degra- dation, or rape. Many men and women enjoy anal play, and many heterosexual men enjoy receiving everything from fingers to strap-on dildos.

Anal sex requires more communication than most vaginal or oral sex. The extra communication—and the mutual trust required to enjoy anal play—can deepen intimacy and bring couples closer. In the end, as it were, anal play is just another sexual variation, one some people find loving, enjoyable, and sex-enhancing.

Help

For individualized help dealing with anal sex issues, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Morin, J. Anal Pleasure and Health: A Guide for Men and Women, 3rd ed. Down There Press, San Francisco, 1998.

Taormino, T. The Ultimate Guide to Anal Sex for Women. Cleis Press, San Francisco, 1998.

Great Sex Guidance: Anal Play — Without Pain – © Michael Castleman – 383 –

Rimming (Analingus) - The Curious Lovers’ Guide to Oral-Anal Contact

It’s quite possible that you’re turned off by the thought of kissing or licking your lover’s anus, or having this done to you. If that’s how you feel, don’t do it.

But the fact is, many lovers are curious about rimming, clinically known as analingus, and often feel surprised that they are interested. If they try it, some become quite turned on by rimming.

Many lovers have an accidental introduction to analingus during cunnilingus. The bottom of the vagi- nal entrance is quite close to the anus. Sometimes, a little lick meant for the lower vaginal lips slips further south than intended, and either the provider (the rimmer), the recipient (the rimmee), or both experience unexpected delight—and sometimes a surprisingly powerful urge to explore analingus further.

For other lovers, interest in rimming develops from anal play. The most popular anal activities are sphincter massage and fingering, with a much smaller proportion enjoying butt plugs and penis-anus intercourse. But as people explore any form of anal eroticism they feel comfortable with, some warm up to the idea of analingus.

Just Another Way to Play

There is absolutely nothing abnormal or wrong with being interested in rimming. If you feel tempted to condemn it, remember that not too long ago, oral sex was considered a disgusting perversion and was outlawed in many states. Now oral sex is generally accepted. In recent sex surveys, about three- quarters of Americans say they have given and received it.

Rimming probably won’t become as popular as oral, but in recent years, Americans have become somewhat more sexually experimental. Surveys by researchers at the University of Chicago and the University of California, San Francisco, suggest that around 15 percent of American adults have experienced some form of anal sex play—more than 20 million people. There are no statistics on rim- ming, but as lovers become more comfortable with sexual experimentation in general, and anal play in particular, it should come as no surprise that many—both heterosexuals and homosexuals—ex- press curiosity about analingus.

Great Sex Guidance: Rimming (Analingus)-The Curious Lovers Guide to Oral-Anal Contact – © Michael Castleman – 384 – Why Analingus Feels Erotic

Analingus feels erotic for the same reason that anal play in general feels arousing. The anus and sur- rounding tissue are richly endowed with nerves highly sensitive to gentle, playful, loving touch. The same is true for the lips and tongue. Put these areas together, and the combination can be powerfully erotic.

There’s another reason why anal stimulation, including analingus, feels erotic. Beneath the anal-area skin surface lie the pelvic floor muscles, which form a figure-8 around the anus and penis in men and the vulva in women. The pelvic floor muscles play an important role in sex. They’re the ones that con- tract during orgasm. Massaging the anal area with fingers, sex toys, or a tongue, or inserting anything into the anus stimulates the pelvic floor muscles, and heightens overall erotic sensations.

Finally, sex draws a good deal of its emotional power from lovers’ wholehearted acceptance of each other. Analingus involves acceptance of an area that’s often not accepted, in fact, one that’s usually rejected. Analingus becomes a way for the rimmer to say: I love every square inch of you. No part of your wonderful body turns me off. And it’s a way for the rimmee to say: I’m totally yours. No part of me is off limits to you. You are free to enjoy every square inch of me. This level of mutual acceptance can be a powerful turn-on.

Raising the Issue

If you’re interested in rimming, raise the issue before you dive into it. Some couples prefer to discuss sexual experimentation in nonsexual settings. Others like to discuss experimentation while making love. Raise the issue in the way you feel most comfortable in your relationship.

If you and your lover have open and frank sexual communication, you might simply announce that you’d like to try analingus. On the other hand, if you feel reluctant to admit your interest—the case for many people—you might raise the issue indirectly, perhaps by mentioning offhandedly that you read something about rimming—perhaps a question on GreatSexAfter40.com—and has your lover ever considered it?

If your honey gags and grimaces, chances are that analingus won’t become part of your intimate rep- ertoire. No one should ever feel pressured into try rimming—or anything else sexual.

But if your lover shows any interest—even if it’s couched in skepticism and concern about hygiene— you may detect enough of an opening, as it were, to pursue the issue, answer your lover’s questions, allay his or her concerns, and perhaps introduce rimming into your lovemaking.

If you decide to experiment with analingus, you also need to discuss who’s interested in which role. Some people are interested in only one side of a rimming interaction—rimmer or rimmee. Others feel equally comfortable in both roles. Before you begin, discuss this, and be sure you’re clear on who does what.

The Big Fear: Fecal Contact

Because the anus is involved in defecation, many people assume that rimming must involve contact with feces. This is possible. Even with good wiping, traces of fecal material may cling to the anus and the skin around it. Great Sex Guidance: Rimming (Analingus)-The Curious Lovers Guide to Oral-Anal Contact – © Michael Castleman – 385 – However, careful personal hygiene minimizes exposure. San Francisco sex therapist Jack Morin, Ph.D., author of Anal Pleasure and Health, the classic guide to anal sex, insists that contrary to the conventional wisdom, the anus, anal canal, and rectum usually contain surprisingly little stool. Most fecal material is stored above the rectum in the descending colon. When stool moves into the rectum, you feel “the urge,” and fairly quickly that material passes out of the body. Most of the time, when you feel no urge to defecate, there are only trace amounts of stool in the rectum, anal canal, and anus, traces that can be easily washed out.

Washing the anal area carefully with soap and water before lovemaking almost always removes any traces of fecal material—another good reason to bathe or shower together before sex.

The Infection Connection

Another important consideration is the possibility that analingus might expose the rimmer to digestive- tract bacteria. The anus is the end of the digestive tract. Millions of bacteria that assist in digestion eventually pass through it, notably E. coli. These micro-organisms get incorporated into stool and can be found in and around the anus. Although they help with digestion, they might also cause infection. If E. coli come in contact with the vagina or a woman’s urethra (urine tube, which opens slightly above the vagina), the woman might develop a vaginal infection (bacterial vaginosis), or a urinary tract infec- tion (UTI, also known as cystitis or bladder infection). That’s why a standard recommendation for anal play is that nothing that comes in contact with the anus should subsequently touch the vulva or va- gina.

The digestive tract might also contain other harmful micro-organisms that can be spread during oral- anal contact, among them:

* Other bacteria. Two significant germs are Shigella and Salmonella, which cause food poison- ing. Usually these germs cause acute—often vicious—diarrhea. But it’s possible for one person to have symptoms that are hardly noticed, yet transmit the infection to another, who develops severe symptoms.

* Intestinal parasites, notably Giardia lamblia, and amoebas, both of which cause of diarrhea.

* Viruses, notably the one that causes hepatitis A, and HIV, the AIDS virus. HIV typically spreads through blood-to-blood contact. Anal tissue bleeds easily, particularly in the estimated one-third of American adults who have hemorrhoids. (These varicose veins of the anal canal often cause pain, but frequently do not, so affected individuals may not know they have them.) If a rimmee’s HIV- contaminated blood enters the mouth of a rimmer who has a minor injury, for example, bleeding gums, the infection might be transmitted. This is not likely, but it’s possible.

Fun Without Fear

Because infections—including HIV—might be transmitted during analingus, it’s crucial that lovers who play this way take prudent precautions:

* Wash thoroughly with soap and water. Before any sexual encounter involving oral-anal play, the lover about to be rimmed should wash carefully around and inside his or her anus.

Great Sex Guidance: Rimming (Analingus)-The Curious Lovers Guide to Oral-Anal Contact – © Michael Castleman – 386 – * Consider showering together. Beyond washing, the prospective rimmer might feel more com- fortable if both of you shower together. That way, the rimmer can wash the rimmee’s anus to his or her satisfaction. In addition to cleanliness, showering together beforehand is a sensual way to relax and transition into lovemaking.

* Consider an enema. For an extra margin of hygiene safety, the rimmee might use an enema or two before washing. Enemas rinse the rectum and anal canal, removing most traces of fecal mate- rial. It’s easiest to use disposable Fleet enemas, available over-the-counter from pharmacies. The rimmee gets down on elbows and knees, and that person or the lover inserts the flexible nozzle into the receiving anus, then gently squeezes the bottle, pushing the enema fluid up the anal canal into the rectum. After a few minutes, the person sits on the toilet and allows the fluid to drain out. The bottle can be refilled with warm water and reused.

* Dam it. Dental dams are thin sheets of latex rubber that act as a physical barrier between the rimmee’s anus and the rimmer’s mouth. Think of them as condoms for the butt. At first, they may feel awkward to use, but like condoms, with a little practice (and a sense of humor), they can be easily incorporated into analingus. Dental dams are available at pharmacies. Or simply buy un- lubricated condoms or latex gloves and cut them into flat sheets. Or use plastic food wrap.T o heighten pleasure, massage a little sexual lubricant into the rimmee’s anus before applying the dam.

* Rinse after. After analingus without a dam, the rimmer should rinse his or her mouth, with water, or preferably with a commercial antiseptic mouthwash.

* Assess your risk. As discussed, oral-anal contact can be medically hazardous, and lovers who try analingus should take recommended precautions. This is especially true for those who are nonmonogamous, or who feel unsure about their partner’s HIV status or general health.

On the other hand, in truly monogamous couples, where both people are confident that neither has hepatitis, HIV, or intestinal parasites, the only real risk of analingus is contact with fecal material and digestive bacteria—and enemas and careful washing virtually eliminate this. According to Morin, in healthy, monogamous couples who practice careful anal hygiene, the risk of analingus causing infec- tion or illness is “extremely low.” Consider your situation carefully. Discuss it. Then decide for your- selves the appropriate level of precautions for the two of you.

Analingus Techniques and Tips

Certain positions allow oral-anal contact with a minimum of contortions:

* Knees and elbows. The rimmee assumes the position typically used for rear-entry (doggie style) intercourse. The rimmer kneels or squats behind. Either lover may gently spread the rimmee’s but- tocks cheeks to expose that person’s anus.

* Standing bent over. The rimmee stands and bends at the waist. The rimmer kneels, sits, or squats behind.

* Lying supine. The rimmee lies on his or her back, legs bent, knees drawn up to the chest or apart. The rimmer squats or lies on his or her stomach. It often helps in this position to place a pil-

Great Sex Guidance: Rimming (Analingus)-The Curious Lovers Guide to Oral-Anal Contact – © Michael Castleman – 387 – low or bolster under the rimmee’s hips. This raises the anus, allowing the rimmer easier access.

* Sixty-nine. Compared with mutual oral-genital contact, mutual analingus requires somewhat more physical flexibility, but some people enjoy this position.

Once you’re both in position for analingus, here are some tips on technique:

* Approach the anus slowly. Some rimmees enjoy having the rimmer plunge into analingus. But unless this is specifically requested, the rimmer should approach this highly sensitive area slowly. On the way, massage, kiss, and lick the person’s lower back, thighs, hips, and buttocks as you slowing work your way to his or her anus. A slow approach builds anticipation for what’s about to happen, and often heightens the eroticism of analingus.

* Talk it up. The rimmer can announce what’s about to happen: “I’m going to eat you like you’ve never been eaten before!” “Every part of you excites me.” Or something similar. The rimmee can beg for analingus: ‘Lick my ass!” “Give me your tongue.” Or cheer the rimmer on: “That feels so good. Don’t stop!” Knowing your lover is turned-on can feel very erotic.

* Use your lips. Kiss the rimmee’s anus and the area around it.

* Use the flat of your tongue. Press it against the rimmee’s anus.

* Use the tip of your tongue. Wiggle it around the rimmee’s anus, or slip it inside and move it in and out, or wiggle it around in circles.

* Make noise. Sucking or munching sounds can be a real turn-on.

The Intimacy Connection

Even if you and your lover ultimately decide not to try analingus, or to abandon it, the discussions involved in considering it can deepen the intimacy you share. You learn more about yourself and each other. You become clearer about what you’re willing and unwilling to try. In the end, as it were, these discussions help you both feel closer to one another, and better able to experience sexual pleasure from the activities you both enjoy.

Great Sex Guidance: Rimming (Analingus)-The Curious Lovers Guide to Oral-Anal Contact – © Michael Castleman – 388 – BDSM: A Loving Introduction To Bondage And Discipline (B/D) And Sadomasochism (S/M)

Have you ever played the child’s game, Trust Me? Two people play. One stands a few feet behind the other. The person in front falls backward, trusting that the one in back will catch that person before he or she crashes to the floor. It’s a game with an element of danger, the possibility that the person fall- ing might get hurt. There’s also an element of emotional vulnerability. The person falling places enor- mous trust in the person catching. When the falling player trusts the catcher enough to let go com- pletely, and when the catcher catches, both players experience a moment of exhilaration and intimate emotional connection that’s difficult to duplicate in any other way.

BDSM is similar. The myth is that it’s abusive and weird. Actually it’s all about trust. When trust trumps the possibility of harm, the result can feel incredibly exhilarating and intimate.

A Special Bond

This type of sexual play goes by several names: power-play because one lover has control (at least nominally) over the other; sadomasochism (SM), which involves spanking, flogging or other types of intense sensation; and bondage and discipline (BD), which involves restraint. But these days, the term most widely used is BDSM. People unfamiliar with BDSM often dismiss it as perverted, dehu- manizing, or worse. But for those who like to play this way, BDSM may well be the most loving and intimate form of lovemaking they share. Two people can have intercourse without much conversation, negotiation, or emotional connection. But for BDSM to work, the players must have very clear com- munication, which creates a special bond.

BDSM Throughout History

No one knows when people first began experimenting with BDSM, but clearly, it goes back more than 2,000 years. Ancient Greek art depicts what looks like SM.

The classic Indian sexuality book, the Kama Sutra (300 A.D,) touts erotic spanking with accompa- nying shrieks, and is particularly enamored of scratching and biting: “There are no keener means of increasing passion than acts inflicted by tooth and nail.” The Kama Sutra even sings the praises of scars caused by erotic scratching. It considers them advertisements of erotic prowess: “Passion and

Great Sex Guidance: BDSM-A Loving Introduction To Bondage And Discipline (B-D) And Sadomasochism (S-M) – © Michael Castleman – 389 – respect arise in a man who sees a girl with marks cut into her breasts.”

References to SM also appear in European sex writings dating from the 15th century. But BDSM came into its own during the mid-18th century, when some European brothels began specializing in flagellation and other SM-style “punishments” that dominant prostitutes meted out to willingly submis- sive men.

The first novel dealing with SM was published in France in 1791, Justine by Donatien Alphonse Fran- coise, comte de Sade, better known as the Marquis de Sade (1740-1814). De Sade’s name became the source of the term “sadism.” His highly controversial writings helped popularize BDSM—and the many toys used in sexual power play, among them: riding crops, whips, nipple clips, and restraints.

DeSade spent much of his life incarcerated in prison. He was judged criminally insane—part of the reason why many people consider the sexual practices he popularized equally aberrant and insane. In 1870, Leopold von Sacher-Masoch, published the novel, Venus in Furs, about male sexual submis- sion. His name inspired the term “masochism.”

In 1886, the medical text, Psychopathia Sexualis, mentioned sadism and masochism as sexual devia- tions.

Sigmund Freud coined the word, “sadomasochism” in 1905, postulating that those who found it attrac- tive were severely neurotic. The first edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-I, 1952) classified sexual sadism as a “deviation.” DSM- II (1968) did the same for masochism. DSM-IV (1994) continues to list SM as psychiatric conditions.

However, in Bound to Be Free: The SM Experience, coauthors Charles Moser, M.D., Ph.D.,and J.J. Madeson point out that people involved in BDSM suffer psychiatric problems no more frequently than the general population, and have no psychological issues unique to their sexual proclivities. Moser’s research also suggests that compared with the general population, people who enjoy power-play sexuality are better educated and more affluent. All available evidence shows that the vast majority of people who enjoy BDSM are a cross-section of the population, mentally healthy and typical in every respect—except that they find conventional (“vanilla”) sex unfulfilling and want something spicier and more exciting and intimate. Before condemning BDSM sexuality, remember that not too long ago, oral sex was considered “perverse.”

What proportion of Americans enjoy BDSM? That’s not clear. The subject is poorly researched. The Kinsey studies from the early 1950s showed that 22 percent of men and 12 percent of women report- ed at least some sexual arousal when exposed to erotic stories with BDSM themes. A University of Miami study from 1971 showed that 8 percent of men and 5 percent of women admitted engaging in sexual spanking, as either the spanker or recipient. And Morton Hunt’s book, Sexual Behavior in the 1970s (1974) suggested that 3 percent of men and 5 percent of women derived sexual pleasure from “intense sensation,” the BDSM term for pain.

Intense Sensation Without Harm

If you believe that BDSM is sick, perverted, cruel, or abusive, don’t play that way.

But Former Secretary of State Henry Kissinger was once quipped, “Power is the ultimate aphrodi- siac.” Throughout history, kings and nations have fought to subjugate others. Capitalist economics Great Sex Guidance: BDSM-A Loving Introduction To Bondage And Discipline (B-D) And Sadomasochism (S-M) – © Michael Castleman – 390 – assumes a dog-eat-dog world where succeeding means exerting control over others. And in sports, winners strive to “hurt” or “crush” the opponent, “break them,” and turn them into “doormats.” As a result, we’ve all been socialized to some extent to experience the adrenalin rush that comes from domination.

But what kind of person feels sexually aroused by pain? Many who are perfectly normal in every oth- er respect. Again, consider sports: After intercepting the football or sinking a tough shot in basketball, teammates often slap the heroic player’s butt, punch him in the shoulder, or hit his helmet. The recipi- ent accepts this “abuse” gratefully as a sign of appreciation and affection. Or consider a long hike up to a mountain peak. On the way, thorns scratch your legs. You get sunburned. And by the time you reach the ridge, you’re aching. Yet the pain of this experience allows you to enjoy the exhilaration of reaching the summit. Or take a yoga class with intense poses that push you to the edge of what you can tolerate. By the end of the class, the pain has been transformed into something else—deep relax- ation and contentment.

Some submissives, or “bottoms,” recall that while growing up, they were taught that wanting to be sexual was shameful and wrong. Later in life, a remnant of that training may contribute to an interest in submissiveness. Submission allows people to receive sexual pleasure without guilt because they didn’t really “want” it. It was “forced” on them. Of course, that’s all a fantasy, but it’s one that allows them to enjoy sex.

Sex workers who cater to powerful men often observe that many of them enjoy being submissive. Power may be an aphrodisiac, but the exercise of power can also be an emotional burden. It involves so much responsibility. Being submissive releases people from all responsibility and lets them focus entirely on themselves, on their own experience. They may be physically “restrained,” but ironically, it leaves them emotionally “free” to do nothing but receive pleasure—even if it hurts.

Sadly, media depictions of BDSM have grossly distorted the pain that submissives experience. Much of it is more theatrical than real. When performed with love by a nurturing dominant, or “top,” BDSM is never abusive.

“It’s always consensual,” says Jay Wiseman, author of SM 101. “Abuse is not.” You don’t need re- straints, gags, or whips to abuse someone. In loving hands, such equipment serves to heighten sensual excitement, allowing both players to enjoy their interaction, or “scene,” as good, clean, erotic fun. A great deal of power-play sexuality does not involve stereotypic whips and chains. It may in- volve nothing more than one player telling the other: “Hold on to the bed posts and don’t let go until I say you can.” And when BDSM sex inflicts real pain, it is always carefully controlled, well within limits clearly set by the submissive beforehand.

Bottoms are very particular about the kinds of pain that bring them pleasure. “They experience the pain of a bee sting or a punch in the face exactly like the rest of us,” Wiseman says, “and dislike it just as much.”

“Safe” Words

There’s a theatrical element to BDSM. Sessions are called “scenes.” And like theater, participants in BDSM scenes carefully chroeograph how the scene will proceed beforehand.

A key element of preparation involves agreeing on a “safe” word, a stop signal that the bottom is free Great Sex Guidance: BDSM-A Loving Introduction To Bondage And Discipline (B-D) And Sadomasochism (S-M) – © Michael Castleman – 391 – invoke at any time. This signal immediately stops the action—at least until the players have discussed the reason the bottom invoked it, and mutually agree to resume the scene. Popular safe words in- clude “yellow, light” as in a yellow traffic light, which warns the top that the bottom is getting uncom- fortable, and “red light,” which means stop everything now.

Some terms should not be used as safe words, among them: “stop,” “no,” or “don’t” because bottoms often enjoy “begging” tops to “stop,” secure in the knowledge that tops are free to ignore them. Mean- while, tops often enjoy hearing bottoms “plead” for them to cease what they’re doing, secure in the knowledge that they are free to say “No, you’re mine, and I can do anything I want with you.”

If the bottom is gagged and can’t speak, a nonverbal safe signal must be arranged. Two grunts often means lighten up, and three grunts mean stop.

Any top who fails to honor the pre-arranged safe signal violates the bottom’s trust and destroys the relationship. In private BDSM play, bottoms refuse to play with such tops and the relationship ends. In public play at any of the hundreds of BDSM clubs around the U.S., tops who fail to honor safe words are ostracized.

The Ultimate Irony: The Sub Is The One in Charge

Although submissives feign subservience, the irony of BDSM is that the bottom is actually the person in charge. The bottom is free at any time to invoke the stop signal, and the top vows to obey imme- diately. By the same token, while the top acts dominant and possibly verbally or physically abusive, tops must also be caring and nurturing, taking bottoms up to their limit, but never beyond it. In this way, BDSM provides an opportunity for everyone to experiment with taking power and surrendering it—while always feeling safe and cared for. People who enjoy this type of sexual play say it results in amazing erotic intensity.

Learning the Ropes

Everyone involved in BDSM recommends instruction beforehand: reading a book, taking a class, or investigating any of the groups around the country that have Web sites. It takes extensive negotiation to arrive at mutually agreeable power play. Wiseman says that before every scene, the players should come to agreement on 16 issues:

* People. Who will participate? Will anyone watch? Will photography or videotaping be permitted?

* Roles. Who’s the top? The bottom? What kind of scene will be played out? Will the top and bot- tom stay in role? Or switch roles? Will the submissive obey immediately? Or resist for a while?

* Place. Where? How private is it? How will privacy be guaranteed?

* Time. When will the scene begin and end?

* Accidents. They happen. If the safe signal is invoked, do both parties agree to discuss the reason in a constructive, non-blaming manner?

* Health. Does either party have any medical conditions that might factor into the scene?

Great Sex Guidance: BDSM-A Loving Introduction To Bondage And Discipline (B-D) And Sadomasochism (S-M) – © Michael Castleman – 392 – * Sex. Which types of sexual contact will be permitted? Will sex toys be used? What about contra- ception and prevention of sexually transmitted infections?

* Intoxicants. Which, if any, will be permitted? How much?

* Bondage. Will the submissive allow physical restraint? If so, what?

* Pain. Will the submissive allow it? If so, how intense? With which instrument(s)?

* Marks. Will the submissive allow any marks? If so, which? Where? Permanent?

* Verbal Humiliation. May the dominant call the submissive names? If so, which?

* Safe Signals. What are they?

* Follow-up. Will you see each other afterward?

* Etc. Do any other issues need to be discussed beforehand?

Additional Caveats for Beginners

* Stay sober. Intoxication may impair judgment.

* Start softly. If you’re interested in erotic spanking, begin with something soft, for example, with the top’s hand in an oven mitt. If that’s okay, next try spanking with a bare hand. If that’s all right, discuss progressing to a paddle, riding crop, or other equipment. (Most sex toy marketers offer a selection of BDSM equipment, for example, mypleasure.)

* Start without equipment. Before you try a blindfold, play with this command: “Keep your eyes shut until I tell you to open them.” Before trying a gag, play with: “Keep your mouth shut.”

* Be particularly careful about physical restraint. Before you try ropes, stockings, or neckties, first experiment with thread, so that the bottom can break free at any time. Thread provides the excite- ment of restraint—but safely. If you opt for “heavier” restraints, consider easy-release Velcro wrist and ankle cuffs.

* Treat the bottom very lovingly. Don’t jump right into sexual contact or spanking. Instead, tease the submissive for a while with a feather, a fur hat or massage mit, or your fingertips.

* Stay present. If you restrain anyone, never leave the room. Be there for your partner, especially if that person is tied up and helpless.

* Be extra-careful with anything that can burn or leave marks, for example, hot candle wax.

* Finally—and these two points cannot be emphasized enough: Every detail of the scene must be worked out in advance with mutual consent. And be sure to arrange mutually agreed upon stop signal.

Great Sex Guidance: BDSM-A Loving Introduction To Bondage And Discipline (B-D) And Sadomasochism (S-M) – © Michael Castleman – 393 – BDSM: A Possible Door into New, Deeper Intimacy

What is intimacy? Relationship authorities define it as clear, frank, self-revealing communication that begins with an emotional connection and takes that commitment to a deeper level. But many people equate “intimacy” and “sex.” To be intimate is to be sexual and visa versa. Only it isn’t. It’s quite pos- sible to be sexual with a person you hardly know, the “perfect stranger.”

Most couples don’t discuss their lovemaking very much, which diminishes its intimacy. But BDSM absolutely requires ongoing, detailed communication. Players must discuss every aspect of their scenes. Many BDSM aficionados say that pre-scene discussions are as intimate, erotic, and relation- ship-enhancing as the scenes themselves. And couples who enjoy occasional power play but who are not exclusively into BDSM often remark that it enhances their “vanilla” sex because the practice they get negotiating scenes makes it easier to discuss other aspects of their sexuality. The skills required for BDSM include communication, trust, self-acceptance, acceptance of the other person. Those same skills that enhance relationships and sex—no matter how you play.

Help

For individual help dealing with BDSM issues, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Adam & Eve offers a large selection of BDSM gear..

References:

Apostolides, M. “The Pleasure of the Pain: Why Some People Need S&M,” Psychology Today 9/10- 1999.

Cloud, J. “Bondage Unbound,” Time. 1-19-2004.

Renaud, C.A. and S.E. Byers. “Positive and Negative Cognitions of Sexual Submission: Relationship to Sexual Violence,” Archives of Sexual Behavior (2006) 35:483.

Wiseman, J. SM 101. Greenery Press, San Francisco, 1996.

Great Sex Guidance: BDSM-A Loving Introduction To Bondage And Discipline (B-D) And Sadomasochism (S-M) – © Michael Castleman – 394 – What Fifty Shades Got Wrong About BDSM

Both the book and movie versions of Fifty Shades of Grey got a good deal right about erotic bondage- discipline-sado-masochism (BDSM). But Fifty Shades also got one thing horribly wrong. It depicts dominant (dom, top) Christian Grey, as the product of horrendous child abuse and implies that it propelled him into BDSM. In other words, Fifty Shades plays into the widely held belief that those involved in BDSM are psychologically damaged if not pathological.

However, the research shows that people into BDSM are psychologically healthy and no more likely to have suffered child abuse or sexual trauma than anyone else. In fact, a recent Dutch study shows that compared with the general population, in some ways BDSMers just might be psychologically healthier.

What Fifty Shades Got Right

First, I’d like to commend author E.L. James for what she got right about BDSM:

• Communication. Before Grey lays a hand on his sub, Anastasia Steele, they discuss in great detail how they want to play. This is quite typical—and a foundation of BDSM. Dom/sub play opens a huge realm of possibilities, and doms and subs discuss them at length, revealing their fantasies and hear- ing the other person’s. In fact, some BDSMers consider these discussions the most intimate element of their play.

• Negotiation of limits. Grey presses Steele on her personal limits, the hard boundaries she can’t conceive of crossing, and the soft ones that she might cross under the right circumstances. Both play- ers declare their limits, and pledge to respect the other’s. As a result, BDSM is play, not abuse.

• Safe words. Grey tells Steele that if she feels at all uncomfortable at any time, she is always free to invoke their safe word, for example “red light.” Upon hearing it, doms pledge to cease all play immedi-

Great Sex Guidance: What Fifty Shades Got Wrong About BDSM – © Michael Castleman – 395 – ately and re-negotiate the scene. Safe words mean that, ironically, the person ultimately in control of BDSM scenes is the sub.

• Contracts. Grey hands Steele a proposed contract governing their play and they discuss it point by point. Steel agreeing to some clauses, modifies others, and nixes a few. Not all BDSM players codify their negotiations in written contracts, but many do.

• Intimacy. Steele is surprised by how intimate BDSM play feels, and how emotionally close it brings her to her lover. Aficionados say that BDSM produces a depth of intimacy beyond what’s possible in ordinary (“vanilla”) sex.

James captures these aspects of BDSM quite well. Unfortunately, she’s poorly informed about its psychology.

BDSM Folks Are Psychologically Healthy

For their recent survey, Dutch researchers solicited participants on the Netherlands’ largest BDSM web forum, and 902 people answered all questions (51 percent men, 49 percent women). For a con- trol group, the researchers used Dutch women’s magazines and news media to recruit participants, and 434 people answered all questions (30 percent men, 70 percent women). The questions probed many aspects of personality: agreeableness, attachment, conscientiousness, anxiety, introversion/extroversion, neuroticism, need for approval, comfort with interpersonal close- ness, openness to new experiences, and subjective well-being.

In general, doms and subs scored about the same as controls, showing that there’s nothing unusual about those into this type of play. But BDSMers were somewhat less neurotic. They were also slightly more conscientiousness, more extroverted, and more open to new experiences. For overall well-be- ing, doms scored higher than either subs or controls.

The researchers concluded: “BDSM practitioners are not psychologically maladapted, but rather char- acterized by psychological strength and autonomy. Our data do not support the persistent assumption that BDSM is associated with inadequate developmental attachment processes because of a history of trauma or for other reasons. BDSM should be considered a form of recreation rather than the ex- pression of psychopathological processes.”

Corroborating Evidence

The Dutch study is not the only one showing that those who enjoy BDSM are psychologically normal and healthy:

• Australian researchers surveyed 19,370 Aussies and found that the 2.2 percent of men and 1.3 percent of women who participated in BDSM were psychologically healthy, and no more likely than anyone else to have been victims of childhood trauma or sexual abuse or coercion.

• Scientists at the University of Illinois took saliva samples from 58 people before BDSM play, measur- ing cortisol, a key stress hormone. After a BDSM session, the researchers took new saliva samples, and found decreased cortisol levels, showing that BDSM reduced players’ emotional stress. The re- searchers concluded that far from being abusive, BDSM made participants feel more comfortable and “increased intimacy.” Great Sex Guidance: What Fifty Shades Got Wrong About BDSM – © Michael Castleman – 396 – If you’re into romance fiction, enjoy Fifty Shades of Grey—and if you find its BDSM titillating, so much the better. But don’t generalize Christian Grey’s history of child abuse to BDSM practitioners in gen- eral. BDSM is neither abusive nor about violence or pain. It’s just another way for consenting adults to play, and those who do are not perverted, but rather a snapshot of the general population.

If you wish to experiment with BDSM, Adam & Eve offers a variety of accessories.

References:

Richters, J. et al “Demographic and Psychosocial Features of Participants in Bondage and Discipline, Sadomasochism, or Dominance and Submission (BDSM): Data from a National Survey,” Journal of Sexual Medicine (2008) 5:1660.

Sagarin, B.J. et al. “Hormonal Changes and Couple Bonding in Consensual Sado-Masochistic Activ- ity,” Archives of Sexual Behavior (2009) 38:186.

Wismeijer, A.A.J., and M.A.L.M. Van Assen. “Psychological Characteristics of BDSM Practitioners,” Journal of Sexual Medicine (2013) 10:1943.

Great Sex Guidance: What Fifty Shades Got Wrong About BDSM – © Michael Castleman – 397 – Voyeurism And Exhibitionism: How Common Are They?

Do you like R-rated movies with steamy sex scenes? Most people do. There’s a little bit of voyeur in most of us.

Do you ever wear tight, form-fitting, or revealing clothing? Most people do from time to time at the beach, the gym, or socially. There’s a little bit of exhibitionist in most of us, too.

But how many people are really deeply into watching sex or exposing themselves in public? That’s been a mystery—until recently, when the journal Archives of Sexual Behavior published a Swedish study that investigated voyeurism and exhibitionism.

The researchers at the Karolinska Institute (the university that awards Nobel Prizes) surveyed a ran- dom sample of 2,450 Swedes age 18 to 60. Seventy-six (3.1 percent) reported at least one incident of feeling sexually aroused by exposing their genitals to a stranger. Men were more exhibitionistic than women (4.1 percent vs. 2.1 percent).

One hundred ninety-one (7.7 percent) reported at least one incident of being sexually aroused by spying on others having sex. Again men were move voyeuristic (11.5 percent vs. 3.9 percent).

Voyeurs are called peeping Toms, not peeping Tinas. It’s no surprise that men are more voyeuristic than women. The audience for pornography is clearly voyeuristic, and according to porn industry estimates, 80 percent of pornography is viewed by men solo. In the study, the single best predictor of voyeurism was frequent use of porn.

It’s risky to be an exhibitionist and/or voyeur. It’s illegal in most places. Not surprisingly, compared with the general population, voyeurs and exhibitionists were more likely to engage in other risky ac- tivities: gambling, heavy drinking, and illegal drug use.

Finally, compared with the population as a whole, voyeurs and exhibitionists are more sexually active. They are more easily aroused, masturbate more often, and have intercourse more frequently. They’re more sexual in general, so they’re more into exploring the fringes of sexual expression.

Do these results apply to the U.S.? That’s not clear. But I suspect they do.

Great Sex Guidance: Voyeurism And Exhibitionism- How Common Are They? – © Michael Castleman – 398 –

Reference:

Langstrom, N. and M.C. Seto. “Exhibitionistic and Voyeuristic Behavior in a Swedish National Popula- tion Survey” Archives of Sexual Behavior (2006) 35:427.

Great Sex Guidance: Voyeurism And Exhibitionism- How Common Are They? – © Michael Castleman – 399 – Bisexuality - What The Research Shows

Many men and women who identify as heterosexual—and may well be married—have fantasies about same-gender sex. Some engage in periodic same-sex play. They often wonder: Am I gay/les- bian? Meanwhile, many heterosexual pornography videos feature “girl-girl” scenes, two women enjoy- ing each other, using vibrators and dildos on one another, and sharing cunnilingus. Clearly, both men and women who identify as hetero may also be sexual with people of the same sex. That’s bisexual- ity.

Compared with heterosexuality and homosexuality, much less is known about bisexuality. It has not been well researched. But a report by Paula Rodriguez Rust, Ph.D., a bisexuality expert at Hamil- ton College in East Brunswick, NJ, summarizes what’s known about this sexual variation—and how straight and gay people relate to those who, in slang terms, are “AC/DC,” or “swing both ways.”

Forced to Choose

Clearly, bisexuality is possible. But our sexual world is marked by a sharp divide between homo- and heterosexual. Bisexuals often feel forced to choose, and just as some heterosexuals believe (incor- rectly) that homosexuality is “abnormal,” some hetero- and homosexuals feel that way about bisexual- ity (also incorrectly).

The first scientific observations dealing with bisexuality date from the mid-19th century. These early observations culminated in the early 1950s when Alfred Kinsey of the University of Indiana, Ameri- ca’s first scientific sex researcher, argued in favor of a “sexual continuum.” Kinsey argued that most people are exclusively heterosexual or homosexual, but that some fall in between in various degrees of bisexuality. (Kinsey himself was bisexual, married and mostly heterosexual, but with some homo- sexual interest and many gay experiences.)

Does Bisexuality Really Exist?

But as soon as 19th-century researchers described bisexuality, other investigators insisted that it didn’t exist. Their dismissals rested on three arguments. (1) Bisexuals were actually heterosexuals who were “just experimenting.” Or (2) they were inmates in single-gender prisons who, for their period of their incarceration, reluctantly made due with the only gender that was sexually available to them.

Great Sex Guidance: Bisexuality- What The Research Shows – © Michael Castleman – 400 – Or (3) they were homosexuals who did not want to be stigmatized as such, and feigned attraction to the opposite sex.

These dismissals of bisexuality are still with us today. College women involved with other women are sometimes called LUGs, Lesbians Until Graduation, when presumably, their youthful experimentation ends and they enter the ranks of their “real” group, the heterosexuals. Meanwhile, some lesbians and gays see bisexuality as the cowardly refuge of those who lack the courage to come out fully as homo- sexual.

Heterosexuals began celebrating sex for pleasure (as distinct from procreation) in the so-called Sex- ual Revolution of the 1960s. Homosexuals began celebrating their sexuality—and fighting prejudice and discrimination against them in the 1970s. Around the same time, bisexuality emerged into the media spotlight. A 1974 Newsweek article was titled “Bisexual Chic: Anyone Goes.” Around that time, the first bisexual organizations formed, in Boston, a bisexual discussion group, the Bivocals, and in the West, the San Francisco Bisexual Center, which published a newsletter, the BiMonthly. Still, however, research into bisexuality remained an academic backwater. The Journal of Bisexuality did not begin publishing until 2001, and books about homosexuality outnumber books on bisexuality by at least 100 to one.

Ironically, as bisexuality gained more media notice, some homosexuals stepped up their attacks, call- ing it a “cop out” or “treason” against bisexuals’ presumed “true nature” as homosexuals.

AIDS, which appeared in 1981, transformed our understanding of bisexuality. A surprising number of heterosexually-identified, often married men began turning up with the disease. It soon became ap- parent that sexual identification was often distinct from sexual behavior. Men could identify as hetero and live hetero lives, yet have periodic, even regular, homosexual experiences—not just as “experi- ments,” but over the long term.

The Prevalence of Bisexuality

Recall that one traditional argument against the existence of bisexuality was the allegation that what appeared to be sexual interest in both genders was actually heterosexual “experimentation” with be- ing gay/lesbian before settling down as straight. While this does not explain away bisexuality, there is some truth to it.

In the Kinsey studies, about 4 percent of the women and 10 percent of the men admitted to having had sex with both men and women. Some of that was, indeed, experimental. Eventually, in the Kinsey sample, 2 percent of women and 5 percent of men claimed to be bisexual. A study by Morton Hunt for Playboy in the mid-1970s found that about 15 percent of postpubertal men and 10 percent of women had had sex with both genders. But Hunt and other researchers found that considerably lower propor- tions maintained a lifelong identify as bisexual—just 3 percent of women and 5 percent of men. (For comparison, depending on the study, 5 to 10 percent of the adult population identifies as homosexu- al.)

Prejudice Against Bisexuals

Homophobia is slowly becoming culturally unacceptable in the U.S., but “biphobia” is alive and well. In interviews, many people who switch from same-sex to opposite-sex lovers and back say they identify as either gay or straight, not as bisexual, depending on who they’re with because to maintain Great Sex Guidance: Bisexuality- What The Research Shows – © Michael Castleman – 401 – a bisexual identify means having to contend with disbelief and social awkwardness, even personal attacks. In a study of college students’ attitudes in the mid-1990s, participants were asked if they considered homosexuality acceptable or unacceptable. Forty-three percent said male homosexuality was unacceptable, while 38 percent said the same about lesbianism. Significantly larger proportions disapproved of bisexual men and women—61 percent and 50 percent respectively.

Other studies have shown that compared with gay men and lesbians, more people believe that bisex- uals are promiscuous, unfaithful to their lovers, unable to make a long-term commitment to a single person, and are more likely to infect a lover with a sexually transmitted infection.

Many homosexuals continue to believe that bisexuality is a “phase” in the process of coming out. In one study, 80 percent of lesbians felt that way about bisexual women, and 53 percent said that bisex- ual women are not as trustworthy as lesbians.

The Real Lives of Bisexuals

For heterosexuals and homosexuals, sexual attraction is gender-based. Straights feel attracted to the opposite sex, gays and lesbians, to the same sex. However, for some bisexuals—around 15 percent, according a study by Rodriguez Rust—sex is not about gender at all. It’s not that bisexuals are at- tracted to both men and women. It’s that they want to be sexual with other human beings regardless of their gender.

One myth about bisexuals is that they are involved with both men and women at the same time. The research on this is far from definitive, but available studies suggest that only a minority of bisexuals maintain simultaneous relationships with both men and women. They are more likely to switch back and forth. In one study self-identified bisexuals were asked if they had been sexually involved with both men and women during the past 12 months. About two-thirds said yes (66 percent of the men, and 70 percent of the women). However, only about one-third said they’d been simultaneously in- volved with both men and women.

Another myth is that bisexuals are more promiscuous than hetero- or homosexuals. The research is scant, but one study of 105 bisexual men, aged 19-62, found a lifetime average of 23 male sex part- ners and 23 female. This suggests that bisexual men have more lovers than the typical heterosexual, but fewer than many gay men. (There have been no studies of women bisexuals’ numbers of lifetime partners.)

It’s Not Easy Being Bisexual

Bisexuals talk about “coming out twice,” once as gay or lesbian in a heterosexual world when they acknowledge their attraction to the same sex, and then again when they acknowledge their continu- ing attraction to the opposite sex. This process is more complex than coming out as homosexual, and it typically takes longer. Most gays and lesbians realize they are homosexual in their teens or early twenties. But most people don’t realize they are bisexual until their late twenties.

Heterosexuality and post-coming-out homosexuality remain largely fixed over the lifespan. Bisexuality is different. The studies suggest that as young bisexuals approach middle age, they tend to gravitate toward same-sex or opposite-sex lovers, with most choosing heterosexuality. It’s not clear why this happens. Perhaps this is intrinsic to bisexuality. Or perhaps bisexuals become weary of the social pressure to choose a straight or gay identity. Great Sex Guidance: Bisexuality- What The Research Shows – © Michael Castleman – 402 – Once they come out as bisexual, the realization is often socially isolating. Gays and lesbians are much more numerous, with a well developed culture including meeting places (bars and organiza- tions), publications, even neighborhoods in many cities. But bisexuality is comparatively invisible. Fortunately for bisexuals, the Internet has provided a welcome sense of community.

If you are bisexual, or think you might be, you’re not alone, and there’s nothing wrong with you.

Great Sex Guidance: Bisexuality- What The Research Shows – © Michael Castleman – 403 – Talking Dirty: The Origins of Sexual Obscenities

Fuck. Cunt. Twat. Pussy. Cock. Until fairly recently, authorities on English considered the first three too sexually vulgar to include in standard dictionaries, while the genital connotations of the other two were equally unmentionable. But in many other languages, equivalent terms that describe the geni- tals and intercourse are not considered so vulgar. How did these English words become so tainted? The answer has nothing to do with sex—and everything to do with political conquest a thousand years ago.

Angles and Saxons

The story of our dirty words begins with the Angles and Saxons, two tribes of Scandinavian-Germanic Vikings that invaded the British Isles in successive waves from A.D. 750 to 1000, and drove the indigenous Celts west into Wales and Ireland. Thanks to the Angles, Great Britain became known as Angle-land and eventually England.

The Angles and Saxons spoke Old Norse and Old German, precursors of modern Norwegian and German. They used the forerunners of our dirty words matter-of-factly in everyday speech and from surviving records, it’s clear that the terms were not considered vulgar.

That changed after 1066, when the Norman French conquered Anglo-Saxon England. After a blood- bath, the Normans set themselves up as the new nobility and turned the vanquished descendants of the Angles and Saxons into their serfs. The Normans also made Old French the language of the royal court and the cultured elite. The Normans loved their language with it’s vowel-laced vocabulary and mellifluous, sing-song cadence. Meanwhile, to French ears, the guttural proto-English spoken by the people they’d conquered sounded harsh and vulgar.

The Normans scorned Germanic proto-English for 300 years. Norman-descended English kings did not speak English (actually Middle English), until the 14th century. The Normans also attempted to impose their melodic French on the peasantry in their new land. But few of them learned it. They continued to speak Anglo-Saxon proto-English with its short, hard, consonant-filled words, including those that became our vulgarities. This appalled the elite, who despised the “dirty” peasantry and their “dirty” words.

Great Sex Guidance: Talking Dirty- The Origins of Sexual Obscenities – © Michael Castleman – 404 – The French eventually lost the language war. English contains many words derived from French, but it’s more a Germanic language. But on their way to linguistic defeat, the French succeeded in driv- ing sexual Anglo-Saxonisms underground, banishing them from standard dictionaries and everyday speech until the mid-20th century.

In reality, there was nothing inherently unsavory about Anglo-Saxon sexual terms. They simply had the bad luck to be the vocabulary of the vanquished. But like a band of hardy guerrilla fighters that the conqueror’s army can never quite crush, Anglo-Saxon-derived genital and sexual terms inspired enduring grass roots loyalty, which is why they’re still with us today.

The Origins of Our Dirty Words

Here’s what we know:

PUSSY. This Anglo-Saxon term is intriguing because it has a double derivation from two Old Norse- Old German words: “puss” meaning cat, and “pusa,” meaning pouch. As far back as etymologists can go, “puss” meant cats, and women were poetically equated with them. Even today, Kat and Kitty are common nicknames for Katharine, and a woman who makes malicious remarks is “catty.” So it’s not difficult to imagine how “puss” evolved from a term for soft, furry little pets into a word for the soft, furry place between women’s legs.

At the same time, “pusa” evolved from a term for pouch into one that connoted pouch-like anatomi- cal structures, initially, the vaginas of cows and mares, and after a while, the human vulva-vagina. According to the Oxford English Dictionary (OED), the first printed reference to “pussy” in a sexual context was a bar-room toast from 1664: “Here’s health to thee, to good company, and good pussy.”

COCK. Just as women were compared to cats, men were linked to roosters, or “cocks.” It’s pos- sible that this term derives from the Old Norse “kok” or the Old German “kukko,” both of which refer to roosters. It’s also possible that it’s derived from the Latin “coco,” a term for a rooster’s call, which evolved into “coccus,” for rooster, then “coq” in French, and the Old English, “cok.” In any event, it didn’t take long for the word to evolve from the feisty bird whose call signals the time to get out of bed to the frisky organ that gets all excited in bed. Given how ancient “cock” appears to be, it’s odd that, according to the OED, its first appearance in print in a sexual context occurred relatively recently, in a poem from 1618 that asked: “Oh, man, what art thou when thy cock is up?”

TWAT. A clear example of Viking influence, it comes from the Old Norse “thviet,” meaning a cut or slit. In Old English, it became “thwat,” and finally around 1500, “twat.” Its first use in print dates from 1660, when an unnamed poet cursed an acquaintance by saying that all he deserved in life was “an old nun’s twat.” From then through the mid-20th century, the word was printed only rarely, but modern writers, notably novelist Norman Mailer and feminist Germaine Greer, helped repopularize it. Today it’s more widely used than it has been in 500 years.

CUNT. The OED traces this word to the Old Norse “kunta,” meaning women’s genitals. “Cunt” is the dirty word with the longest history in print. It first appeared around 1230 (some 300 years be- fore “fuck” was first published), when a street in what must have been London’s red-light district was called “Grope-cunte Lane.” Oddly, the term seems to have been accepted for a while by at least some Great Sex Guidance: Talking Dirty- The Origins of Sexual Obscenities – © Michael Castleman – 405 – of the medieval elite. A medical text from 1400 declared: “In wymmen pe neck of pe bladder is schort, & is maad fast to the cunte.” (In women, the neck of the bladder is short, and attached to the cunt.) But soon after, the word was driven underground.

In recent decades, “fuck,” has become so widely used in print and in R-rated movies that it has lost some its power to shock. “Cunt” is less widely used, making it comparatively more taboo and quite possibly today’s dirtiest word.

FUCK. Despite its recent emergence into semi-acceptability in the mass media in R-rated movies and on cable TV, “fuck” is the grand-daddy of dirty words. Its actual origins have been obscured by a persistent tale that’s clearly incorrect.

The erroneous explanation traces it to the Pilgrims. As the story goes, early Massachusetts settlers who fornicated out of wedlock were punished by confinement in special stocks bearing the legend: For Use of Carnal Knowledge. The first letters of these words form the acronym “fuck.”

A nifty story, but it doesn’t explain how, according to the OED, the word first appeared in print in 1503, more than a century before the Pilgrims landed, in a poem by Dunbar, who referred to copulation as “fukkit.” Then in 1535, some 85 years before the Pilgrims, another writer, Lyndesay, had this to say about top English clergy: “Bishops may fuck their fill and be unmarried.”The Pilgrims may have given us Nathaniel Hawthorne’s scarlet “A” for adultery, but “fuck” was well established long before they sailed for the New World.

Etymologists trace “fuck” to the Old Norse-Old German word “fokken,” meaning to thrust, strike, or penetrate, and by extension, to copulate.

Great Sex Guidance: Talking Dirty- The Origins of Sexual Obscenities – © Michael Castleman – 406 – Great Sex Guidance: Talking Dirty- The Origins of Sexual Obscenities – © Michael Castleman – 407 – Section VI Sex Toys and Erotic Enhancements Vibrators - Myths vs. Reality

Vibrators are by far the most popular sex toy. Sexual enhancement product catalogs offer dozens of models. According to one recent survey, one-third of adult American women own at least one vibrator. In other surveys, women laud vibrators for enhancing both solo and partner sex. But some women wonder if they might be harmful in some way, and many women who don’t use them avoid them for fear of harm. It’s time to set the record straight.

Myth: Vibrators are for loners and losers.

Truth: According to a recent survey by Chicago psychologist and noted sex researcher Laura Berman, Ph.D., director of the Berman Center, which specializes in women’s sexual health. about one-third of women now use vibrators—and women in relationships are more likely to use them than single women. According to a 1997 survey by sex researchers at the University of California, San Francisco, 10 percent of American couples use vibrators in their partner sex—and that number is growing as elderly lovers, who are the least likely group to use vibrators, die off, and as younger people, who are more open to vibrators, become sexual. Both of these surveys shows that vibrator users are a demo- graphic snapshot of middle class America, typical in every way, except that they enjoy using sex toys for erotic play. Rural women are as likely to use them as urban and suburban women. Low-income women are as likely to use them as high-income women. The only variable that affects vibrator use is education. As education increases, so does the likelihood of vibrator use.

Myth: If a woman needs a vibrator to have an orgasm, there’s something wrong with her.

Truth: Absolutely not. According to the Berman survey, vibrators just make it easier for women to be- come aroused and have orgasms. They also significantly improve women’s sexual satisfaction.

If a woman needs a vibrator, she’s perfectly normal. She just may have difficulty having an orgasm without the intense stimulation vibrators provide. Or it might take her an uncomfortably long time without one. Many women are in this situation. They are sexually normal in every way. They just need a little extra boost, the kind vibrators provide. There’s nothing wrong with that. Just like there’s noth- ing wrong with a carpenter who uses power tools. Electric tools don’t mean the carpenter is any less skilled. Power tools just help get the job done faster, more efficiently, and more enjoyably.

Great Sex Guidance: Vibrators - Myths vs. Reality – © Michael Castleman – 409 – According to a 1999 report in the Journal of the American Medical Association, about 25 percent of adult women have difficulty having orgasms, or can’t have them. Fortunately, sex therapists enjoy great success teaching women how to have the orgasms that are waiting to be released inside them. If you cannot have an orgasm, or have difficulty, read the excellent self-help book, Becoming Orgas­ mic by Julia Heiman, Ph.D., and Joseph LoPicollo, Ph.D. (available from Amazon.com). Guess what this book recommends as part of the learning process? A vibrator. The book has been turned into an instructive and erotic video (bettersex.com).

Myth: If a woman needs a vibrator to enjoy sex and have orgasms, there’s something wrong with the way her man makes love.

Truth: Not necessarily. To repeat, some perfectly normal women simply cannot have orgasms without the intense stimulation vibrators provide. Others can, but it takes them much longer than they or their lovers would like. Of course, couples should discuss the kinds of erotic play they enjoy, and coach each other about what turns them on. Men should also make love more slowly than many do, and more sensually, with an emphasis on whole-body massage that includes the genitals, but is not fixat- ed on them. That’s what women generally prefer. And it’s what sex therapists recommend for couples who say they are not getting as much out of sex as they’d like. Assuming a man engages in leisurely, playful, creative, whole-body sensuality—and pays erotic attention to the woman’s clitoris—there is absolutely nothing wrong with him or the couple if the woman needs, or prefers, to use a vibrator and have her orgasms with one.

Myth: If a woman needs a vibrator to enjoy sex and have orgasms, the man is left out.

Truth. Absolutely not. A vibrator provides one—and only—one thing, unusually intense erotic stimula- tion. A vibrator cannot kiss or hug, massage or embrace a lover, warm the bed, tell jokes, say, “I love you,” listen to a lover’s troubles, share a lover’s triumphs, or any of the other thousand things lovers do to support each other, and enjoy one another’s company. Vibrators don’t replace men. No way. All they do is provide especially intense erotic stimulation.

Most women prefer to hold the vibrator in their own hands and stimulate themselves with it. The rea- son is that vibe sensations are so intense that if not carefully controlled, they might cause discomfort and shatter the woman’s erotic focus. It’s possible that a woman might teach a man how to work the vibrator for her optimal enjoyment. But most women prefer to do this themselves. That’s fine. While a woman is enjoying her vibrator, the man can hold her close, kiss and hug her, massage other parts of her body, and tell her he loves her. Those gestures add a great deal to the woman’s experience of lovemaking, and help her enjoy her vibrator even more.

Myth: Vibrators are unnatural.

Truth: Vibrators don’t grow on trees. They’re manufactured, so in that sense, they are not “natural.” But vibrators are as natural in lovemaking as any other erotic enhancement: candle light, music, lin- gerie, little snacks, perfume, or any of the many little extras lovers enjoy.

Myth: Vibrators are addictive.

Truth: Are power tools addictive? No, they just get the job done faster. It’s true that many women re- ally love their vibrators. But that’s a personal preference, not an addiction. A true addiction involves the development of a tolerance—over time it takes more and more of the addictive agent to obtain the Great Sex Guidance: Vibrators - Myths vs. Reality – © Michael Castleman – 410 – desired effect. That’s not true with vibrators. In fact, over time, as women become more comfortable with vibrator use and the full range of their own erotic responsiveness, many women find that it takes less vibrator stimulation to give them the enjoyment they want.

Myth: Vibrators ruin women for sex without them.

Truth: Does driving ruin you for walking? No, it just gets you to your destination faster. The same is true for sex with and without vibrators. The vulva, clitoris, nipples, and other parts of the body respond to erotic stimulation no matter where it comes from: fingers, tongue, penis, or a vibrator. Vibrators pro- duce the most intense sensations, so most women reach orgasm faster than they do with other types of stimulation. But using a vibrator—even frequently—does not change your body’s ability to respond to other types of sexual stimulation. Far from ruining women for sex that does not include them, vibra- tors actually help women respond to other forms of erotic stimulation because vibrators allow them to experience the full range of their sexual responsiveness. Greater sexual self-knowledge learned with a vibrator usually helps women respond more enjoyably to other types of sexual stimulation.

Myth: Vibrators numb the genitals.

Truth: This is possible. Intense vibrations can numb the skin. Motorcyclists sometimes experience numbness of the thighs. Jackhammer operators sometimes develop numbing of the arms. If a vibra- tor causes any numbing, don’t press it so hard into the skin. Back off a little and move it to a slightly different location nearby. Once you stop using the vibe, any numbing quickly resolves.

Myth: Vibrators cause urinary tract infections.

Truth: Bacteria cause UTIs, not vibrators. These bacterial come from the digestive tract, and exit the body through the anus. As a result, the anal canal and the area immediately adjacent to the anus can be contaminated with UTI-causing bacteria. If a vibrator (or penis, finger or tongue) comes in contact with these bacteria, and then touches the vulva, where the urine tube (urethra) opens up, the bacteria can travel up the urethra and cause a UTI. To prevent this, keep track of where your vibrator (and pe- nis, fingers, and tongue) go. If they come near the anus, don’t use them to touch the vulva—or wash thoroughly before you touch the vulva. While vibrators may play a role in transmitting UTI bacteria, this can be easily prevented. It’s not vibrators, per se, that are the problem, but rather their careless use.

Adam & Eve offers a wide variety of vibrators.

Great Sex Guidance: Vibrators - Myths vs. Reality – © Michael Castleman – 411 – The Best Vibrator For You

Sex toy marketers—including Adam & Eve—offer dozens of different vibrators. Which one is best? That depends on you and the kind(s) of erotic stimulation you enjoy.

All vibrators have one thing in common. They vibrate. They all contain little motors that produce plea- surable sensations in the skin—in the genitals or anywhere else around the body. Beyond that, how- ever, vibrators vary tremendously. They come in many different shapes, sizes, colors, materials, and power sources.

Shapes And Sizes

* Realistic-looking penises, larger-than-life penises, and more abstract cylinders that don’t resem- ble penises. These may be inserted into the vagina, or pressed into the vulva and clitoris. They may also be used for whole-body massage. And if you like, they can be pressed against the anus, or even (with lots of lubricant) inserted inside it.

* G-spot stimulators. These enable a woman to reach her own G-spot, something that’s difficult to do with her own fingers. The G-spot is not really a “spot.” It’s an area about the size of a quarter lo- cated an inch or two inside the vagina on the front vaginal wall if the woman is standing, or the top if she is lying on her back. The G-spot is an area composed of erectile tissue similar to the tissue inside the penis. During sexual stimulation, G-spot tissue swells and often feels like a firm, domed area that protrudes a bit from the vaginal wall. Many (but not all) women find that applying a vibra- tor to the G-spot is highly erotic.

* Ball-topped vibrators. These are hand-held wands topped by a vibrating ball, typically the size of a plum. They are excellent for whole body massage, but may also be used on the genitals. The world’s most popular vibrator is a ball-top model, the Hitachi Magic Wand.

* Bullets. This is a general term for mini-vibrators. Bullets are typically too small to house the bat- teries and controls inside them, so these elements are contained in a separate unit wired to the bullet. Small and compact, bullets are a good choice for travel. They may also be slipped inside underwear to provide a little secret “buzz” in social situations without anyone knowing. Remote- control bullets—great fun at parties—allow someone else to “buzz” the person wearing the bullet.

Great Sex Guidance: The Best Vibrator For You – © Michael Castleman – 412 – * Double-Shaft Vibes. In addition to the typical penis- or cylinder-shaped toy, these vibrators have a small extra protrusion extending from the middle of the shaft for clitoral stimulation while the main shaft is inside the vagina.

* Tongues. The base looks like any phallic vibrator, but the top flattens out to become tongue shaped. Turn it on, and the tongue wags back and forth for a reasonable approximation of cunni- lingus. (Be sure to use plenty of lubricant.)

* Butterflies or vulva vibrators. Instead of a cylindrical shape, these are more flattened like a pan- cake. They are not meant for vaginal insertion, but rather, for pressing into the vulva. Some mod- els come with straps that wrap around the thighs to hold them in place over the clitoris.

* Unique vibes. These come in unusual shapes and sizes, but still vibrate and can be easily pressed against the clitoris or vulva.

Materials

Vibrators may be made of hard or soft plastic, jelly, or Cyberskin, a plastic material that feels similar to human skin. At this writing, the one thing vibrators are not made from is latex rubber, so if you’re allergic to latex, you should have no problem with vibrators.

Power Sources

There are three possibilities: traditional batteries, rechargeable batteries, or plug-in wall current. The basic distinction is batteries vs. plug-in. Each has advantages and disadvantages. Battery-powered vibrators generally weigh less than plug-in vibes. They are also more portable and versatile. They can be used in many places were wall current is unavailable: in cars, boats, theaters, or outdoors. Use your imagination. But the batteries must be changed or recharged periodically, and may lose power when you want it most. Wall current vibrators generally have more powerful motors so they deliver more intense sensations. Vibes powered by rechargeable batteries are generally more powerful than traditional battery models.

Speed(s)

Some vibrators have only one speed. Others are adjustable and multi-speed. Smaller more portable vibrators tend to have just one speed. Larger, more elaborate models often are multi-speed.

Waterproof?

Most vibrators are not waterproof. Because of the danger of electric shock and short-circuiting, they should not be used in the tub or shower. However, some vibrators are waterproof. The electrical com- ponents are carefully sealed within the housing. Waterproof vibes can be used in the tub or shower, or in hot tubs and swimming pools.

Kits And Attachments

Some vibrators come with multiple attachments that fit over the vibrating head.The various attach- ments alter the look of the vibrator and the sensations it provides.

Great Sex Guidance: The Best Vibrator For You – © Michael Castleman – 413 – Vibrators As Dildos

When turned off, any phallic or cylindrical vibrator can be used as a dildo for vaginal or anal insertion. Use plenty of lubricant.

Solo Or Couple Play?

Surveys show that while most vibrators are used by women solo, about 10 percent of American couples now use vibrators in partner sex. Lovers can take turns using vibrators on each other for whole-body massage. For genital play, many women insist on handling the vibrator themselves—the clitoris is very sensitive to touch, especially the intense sensations vibrators provide. The same goes for the penis, scrotum, and anus. But while the woman, or man, is pressing the vibe where it provides intense pleasure, they often enjoy being held and caressed by their lovers.

The “Best” Vibrator?

There is no “best” vibrator for everyone. It’s really up to you. Personal preferences differ, which is why sex toy marketers carry large selections. But factors to consider include: shape, size, material, insert- ability (and if so where?), your sexual fantasies, the power supply, and whether or not you want a waterproof model.

Start with a model you find aesthetically pleasing that meets your needs for size, shape, power sup- ply, etc. From there, consider adding others to your collection. Surveys show that most women who own vibrators have one or two vibrators, but a surprisingly large proportion own several. Compared with other forms of entertainment, vibrators are quite economical. For less than the price of one res- taurant dinner, a vibrator can provides hours—or weeks, even years—of erotic pleasure.

Adam & Eve offers a wide variety of vibrators.

Great Sex Guidance: The Best Vibrator For You – © Michael Castleman – 414 – Caring for Vibrators, and Making Them Last

Vibrators don’t cost much. But they’re more than a cheap thrill. They’re a little electric friend—and like any friendship, making it last takes a certain amount of effort. Follow these simple suggestions and your little friend should keep buzzing for a nice, long time.

You Get What You Pay For

Like any small electrical appliance, vibrators don’t last forever. The main limitations on their longevity are:

* The quality of the motor. * The power supply. * The number of speeds. * How often you use it, and for how long.

Small electrical motors are so common in our lives—coffee grinders, food processors, electric razors, and toothbrushes—that we often take them for granted. However, small motors are complicated, and can break.

With motors, in general, you get what you pay for. Vibrators range in price from around $20 to more than $100. In general, more expensive vibrators have better motors, and last longer.

Light-Weight Vs. Heavy-Duty

Plug-in vibrators generally last longer than battery-powered vibes. Two of the selling points for bat- tery-powered vibrators are their small size and lightweight. They often fit in a small purse and can travel almost anywhere. But small vibrators use lightweight motors. They just don’t last as long as the

Great Sex Guidance: Caring for Vibrators, and Making Them Last – © Michael Castleman – 415 – heavier-duty motors built into plug-in vibes. Of course, there’s a place for both small, lightweight vibra- tors, and larger, heavier ones. One of the advantages of plug-in vibes is that they usually last longer.

Many vibrator users love multi-speed vibes because they are so versatile. Sometimes you’re in the mood for a light buzz, while at other times, you want more intensity. But multi-speed vibrators require speed controls that may break. Breakage-resistant speed controls add more weight to the product, so here again, plug-in models tend to last longer than those that are battery-powered.

Just as marathon runners burn through running shoes faster than occasional joggers, a vibrator used daily can’t be expected to last as long as a vibe used less frequently. If you use a vibrator frequently, a plug-in model is best—or better yet, buy several different vibes that suit your needs in a variety of settings.

Finally, some people used their vibrators for a few minutes, while others keep them running much longer. Most battery-powered vibrators are not designed to run continuously for longer than about 20 minutes on low speed, and 10 minutes on high speed. Heavier-duty plug-in models can go longer. If you enjoy extended vibrator play—like an hour or so—buy a few different models, and alternate them every 10 to 15 minutes. That way none of them run continuously for a long time, not to mention that you can enjoy the different sensations the different models provide.

So, how long should a vibrator last? That’s impossible to predict. Some toasters burn out in a year. Others last 10 years. The same goes with vibrators.

Making Battery-Powered Vibrators Last

Battery-powered motors are designed to operate most efficiently when powered by batteries operat- ing at full strength. As batteries wear down, they put out less juice, which means less efficient opera- tion, and less pleasure for you. So change your batteries frequently.

In addition, it’s best to remove the batteries after each use. Now, that’s a hassle. Most people leave batteries in from first use until they die. But battery removal adds to vibrator longevity. It keeps the positive and negative contacts clean, and it prevents damage in case the batteries leak.

Waterproof vibrators can be lots of fun in the tub, shower, or hot tub. But water is a motor-killer. Wa- terproof vibrators are designed to isolate the motor and battery compartments from all water. This is for your safety. But if a tiny crack develops in the device’s housing, it’s possible for a little water to seep inside—not enough for a short-circuit that might cause harm, but enough to damage the mecha- nism. If you use waterproof vibrators, check them regularly for cracks, and use them carefully. Over- enthusiastic use can shorten the vibe’s life.

Making Plug-In Vibrators Last

The main issue with plug-in vibes is the cord. It’s only so long. If you get carried away and pull on the cord, it might pop out of the outlet, or the insulation might begin to tear, or the cord might begin to disconnect from the device. When using plug-in vibes, don’t stretch the cord. Give yourself plenty of slack. That might mean using an extension cord.

Never use plug-in vibrators around water or other liquids (beer, wine, etc.). Water and plug-in vibes are a dangerous combination. If you’d like to play with a vibrator in or around water, buy a waterproof Great Sex Guidance: Caring for Vibrators, and Making Them Last – © Michael Castleman – 416 – vibrator.

Washing and Caring for Vibrators

Some vibrators come with washing and care instructions. If so, follow them. But many don’t, so here’s a quick guide to cleaning and storage.

Many people simply wash their vibrators with soap and water after using them. If you do this, be sure the battery and motor compartments do not come in contact with any water, or you might short them out. Soap and water are fine for hygiene purposes, but for vibrator longevity, we recommend Adult Toy Cleanser. Plain soap and water can leave a filmy residue, and over time, cause product discol- oration. Adult Toy Cleanser is a mild detergent that cleans better than soap and water and leaves no residue. Adam & Eve sells it.

The harder and less porous the material, the easier it is to clean. With hard plastic vibrators, a quick cleaning with Adult Toy Cleanser is usually all that’s necessary. Afterwards, dry plastic vibes with a towel.

Jelly and silicone vibrators are softer and more porous, and therefore a bit more challenging to keep clean. Again, begin with Adult Toy Cleanser. Pat them dry with a towel, then allow them to air dry com- pletely. Finally, dust them with cornstarch before storing.

The type of lubricant you use also affects the cleaning process. Water-based lubes wash off quickly and easily with either soap and water or Adult Toy Cleanser. Vegetable oils and silicone lubes require a bit more effort. Crisco, Vaseline and other petroleum-based lubricants tend to stick to vibrators and require the most cleaning effort.

If you’re away from home and traveling light, you might not want to take Toy Cleanser and cornstarch with you. Another way to keep small vibrators clean is to cover them with a condom. That way, when you’re finished, just roll off the condom and throw it away.

Store vibrators in a cool, dry place away from water, direct sunlight, and dust that can gum up their works.

Storing Vibrators

How you store vibes can affect their longevity. People store their toys in a night stand or closet. That’s fine. But it’s best to store wired vibrators—plug-in models and egg-style vibes—separately so that the wires don’t snag or disconnect when you pull them out.

If you have a large number of vibes and other toys, invest in a hanging plastic shoe rack that comes with a dozen or so pouches. Each shoe pouch can hold a vibrator or other toy.

Adam & Eve offers a wide variety of vibrators.

Great Sex Guidance: Caring for Vibrators, and Making Them Last – © Michael Castleman – 417 – How Women Can Persuade Men to Welcome Vibrators into Partner Sex

How can I get my man to feel okay about bringing a vibrator into bed with us? Many women ask this question. On the one hand, no one should ever have to do anything sexually that they don’t want to do. If a man (or woman) is dead-set against incorporating a vibrator or other sex toys into the couple’s lovemaking, then that person’s wishes should be respected.

But on the other hand, many men (and a few women) express knee-jerk opposition to vibrators born mostly of unfamiliarity with the idea that they can enhance partner lovemaking.

A 2009 survey shows that 45 percent of American men have incorporated a vibrator into partner sex at least once, and that 10 percent have done so in the past month. So some men are perfectly happy to bring vibrators into bed with them. But most are still not. That’s a shame because vibrators are a fast, easy, inexpensive way to increase the sexual pleasure of both women and men.

Vibrators Enhance Women’s Pleasure

Chicago psychologist and sex researcher Laura Berman, Ph.D., is director of the Berman Center, which specializes in women’s sexual health. The Berman Center surveyed a random sample of 1,656 women of all races (white, black, Hispanic, and Asian), from all parts of the U.S. on their use of vibra- tors. This research stands as the most comprehensive study of women and vibrators to date.

One key finding is that vibrators are widely used by women from all walks of life:

Almost one-third of women age 18 to 60 currently use vibrators.

As women’s educational level increases, so does their likelihood of vibrator use.

Children, income, and sexual orientation play no role in women’s likelihood to use vibrators.

Contrary to conventional wisdom, rural women are almost as likely as urban-suburban women to use them.

Contrary to conventional wisdom, single women are considerably less likely to use vibrators than women in couples.

Great Sex Guidance: How Women Can Persuade Men to Welcome Vibrators into Partner Sex – © Michael Castleman – 418 – Among women in couples, only 9 percent say their lover knows they own one. Of these partners, two-thirds actively support women’s vibrator use.

The other key finding is that vibrators enhance women’s sexual satisfaction.

Vibrators make it easier for women to become highly aroused.

They make it easier for women to have orgasms.

And they improve women’s overall sexual satisfaction. In other words, when men welcome vibrators into partner lovemaking, men benefit.They gain lovers who become very turned on, and are more likely to have orgasms.

These simple facts should be enough to persuade many men to welcome vibrators into bed. Still, a considerable number or men (and a few women) raise objections.

“It Should Be Just You and Me”

One objection men raise is that your twosome suddenly becomes a threesome—you, me, and IT, that thing. Taking a vibrator to bed with you certainly introduces a new element into partner sex, one that requires some getting used to. But most men don’t really believe that partner sex should involve just the two lovers. Most men feel comfortable with all sorts of erotic enhancements: music, candle light, lingerie, porn. Vibrators are just another enhancement.

“Nobody Else Uses Vibrators in Partner Sex”

Not true. According to a 208 survey, 45 percent of men have used a vibrator in partner sex and 10 percent have used one during the past month.

“I’m Not Good Enough?”

This is a big fear for many men, the idea that they’re being replaced by a machine. But the best car- penters use power tools.

It’s true that vibrators deliver more intense stimulation than a man’s hands or tongue—or the woman’s own hand—can provide. But that’s all vibrators do. They can’t kiss, hug, snuggle up in bed, tell a joke, carry on a conversation, say “I love you,” or support a woman through the ups and downs of life. A woman who wants to introduce a vibrator into partner sex should make a point of distinguishing be- tween the one thing the vibrator does well, and all the many things her lover does for her, both in and out of bed. Vibrators are toys, not replacements for men.

“Why Do You Need It?”

Many men are in the dark about why a woman might like to use a vibrator. There are several possible reasons:

Variety. Many women who enjoy other forms of sexual contact—and are orgasmic in other ways—still enjoy the special sensations vibrators provide. It’s like ice cream flavors. Why limit yourself to just a few when there are more to try? Great Sex Guidance: How Women Can Persuade Men to Welcome Vibrators into Partner Sex – © Michael Castleman – 419 – Difficulty becoming aroused. Until around 40, most men become sexually aroused quite ealy. After 40, and especially after 50, things change. Men begin to experience what many women deal with throughout life—trouble becoming sexually aroused. Men need to understand that it’s normal for women to take quite a while to begin feel erotically aroused. That’s why the most fulfill- ing lovemaking is based on leisurely, playful, whole-body massage. It gives women the time they need to warm up to genital sex. Many women feel badly that they take “too long” to get turned on, or to have an orgasm. They fear the man will get bored or tired or disgusted. Vibrators help many women become highly aroused.

Can’t come without it. For some women, no amount of direct clitoral stimulation by hand or tongue can trigger orgasm. The only thing that does it is the intense stimulation a vibrator pro- vides. Women in this situation typically feel inadequate, like something is wrong with them. Some women in this situation have histories of sexual abuse or emotional problems that might account for their inability to come without a vibrator. But for many others, there is no discernible cause. That’s just the way they are. They might be wonderful women in every other way. They just need a vibrator to come. That’s fine. It’s normal. The situation is similar to those who need glasses. Usu- ally it’s not clear why their eyesight weakens. It just does. Fortunately, we have glasses for them— and vibrators for women who need them.

“I’m Afraid I Might Hurt You” Vibrators deliver intense sensations, so intense that some men become concerned about hurting the woman. Many women are also concerned about this, and prefer to use the vibrator on themselves, even in bed with their man. That’s fine. The man can still hold the women lovingly, caress her, kiss her, and make her feel comfortable, safe, and loved. And many men enjoy watching as women use vibrators on their own vulvas and clitorises.

Begin with Lube If a man enjoys sex with music, candles etc., but not a vibrator, a good way to introduce vibes is to begin with a sexual lubricant. For most men, lubes are less intimidating than vibrators, and they instantly make sex more pleasurable. It’s a rare man who doesn’t like the feeling of a well-lubricated hand stroking his penis, and a well-lubricated vagina is easier for an erection to enter, especially erections after 45 or so that are not as firm as they once were. Once a man experiences the added pleasure lubricants provide, he often becomes more willing to try other sexual enhancements, such as vibrators.

If All Else Fails… You might buy the vibrator you want, leave it in plain sight, and gently mention that it helps you get turned on enough to have orgasms or enhance orgasm. Adam & Eve offers a wide variety of vibra­ tors.

Or you might suggest a brief course of sex therapy. A sex therapist can help you both clarify your positions on this issue and work toward mutual accommodation. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Reference: Berman, L. “The Health Benefits of Sexual Aids and Devices,” Berman Center, Chicago, 2004. Reece, M. et al. “Prevalence and Characteristics of Vibrator Use by Men in the United States,” Jour- nal of Sexual Medicine (2009) 6:1867.

Great Sex Guidance: How Women Can Persuade Men to Welcome Vibrators into Partner Sex – © Michael Castleman – 420 – The 125-Year History of Vibrators: It’s Stranger Than Fiction

Mention vibrators, and most people immediately think of women’s sexual pleasure. And no wonder: Vibrators easily provide direct clitoral stimulation intense enough to produce orgasm reliably and en- joyably during either masturbation or partner sex. Vibrators can enhance the pleasure of lovemaking, and are especially helpful for women who have difficulty having orgasms in other ways.

But women’s sexual pleasure was the furthest thing from the minds of the male doctors who invented vibrators more than a century ago. These physicians were interested in a labor-saving device to spare their hands the fatigue they developed masturbating a steady stream of 19th century ladies who suf- fered from “hysteria,” a then-vaguely defined ailment that today we recognize as sexual frustration. Therein hangs a strange tale that provides quirky insights into both the history of sex toys, and cul- tural notions about women’s sexuality.

The Scourge of “Hysteria”

Until the 20th century, American and European men believed that women did not experience sexual desire, and that intercourse culminating in male orgasm was all women needed to experience sexual satisfaction. Women basically concurred. They were socialized to believe that “ladies” had no inde- pendent interest in sex, and were merely the passive receptacles for men’s unbridled lust, an unfortu- nate trait they had to endure in order to have children.

Not surprisingly, these beliefs led to a great deal of sexual frustration on the part of women, who com- plained to their doctors of anxiety, sleeplessness, irritability, nervousness, erotic fantasies, feelings of heaviness in the lower abdomen, and production of vaginal lubrication. This syndrome became known as “hysteria,” from the Greek term for uterus.

Over the centuries, doctors prescribed various remedies for hysteria. In the 13th century, physicians advised women to use dildos. In the 16th century, they told married hysterics to encourage the lust of their husbands. Unfortunately, that probably didn’t help too many wives because modern sexuality research clearly shows that only 25 percent of women are consistently orgasmic from vaginal inter- course. Three-quarters of women need direct clitoral stimulation some of the time or every time to have orgasms. For hysteria unrelieved by husbandly lust, and for widows, and single and unhappily

Great Sex Guidance: The 125-Year History of Vibrators- It’s Stranger Than Fiction – © Michael Castleman – 421 – married women, doctors advised horseback riding, which, in some cases, provided enough clitoral stimulation to trigger orgasm.

From Massage to “Paroxysm”

But many women found little relief from horseback riding, and by the 17th century, dildos were less of an option because the arbiters of decency had succeeded in demonizing masturbation as “self- abuse.” Fortunately, an acceptable, reliable treatment appeared—having a doctor or midwife mas- sage the genitalia. With enough genital massage, hysterical women could experience sudden, dramatic relief through “paroxysm,” which virtually no medical authority called orgasm, because, of course, everyone knew that women did not have sexual feelings, so they could not possibly experi- ence orgasm.

By the 19th century, physician-assisted paroxysm was firmly entrenched in Europe and the U.S. It was a godsend for many doctors. At that time, the public viewed physicians with tremendous distrust. Most doctors had little or no scientific training, and had few treatments that worked.This caused a great deal of patient dissatisfaction. But thanks to genital massage, hysteria was a condition doctors could treat with great success. Treatment produced large numbers of grateful women, who returned faithfully and regularly, eager to pay for additional treatments.

Physicians’ Fatigued Arms and Hands

Unfortunately for doctors, however, hysteria treatment had a downside—tired fingers and hands from all that massage. In medical journals of the early 1800’s, doctors lamented the fact that many hyster- ics taxed their physical endurance. They had trouble maintaining the treatment long enough to pro- duce the desired result.

Necessity being the mother of invention, physicians began experimenting with mechanical substi- tutes for their hands. They tried a number of genital massage contraptions, among them water-driven devices (the forerunners of today’s shower massage attachments), and steam-driven pumping dildos. But these machines were cumbersome, messy, often unreliable, and sometimes dangerous.

Granville’s Electromechanical Vibrator

Then in the decades after the Civil War, electricity became available for home use, and the first elec- tric appliances were invented: the sewing machine, the electric fan and teakettle, and the toaster—fol- lowed soon after, around 1880, by the electromechanical vibrator, patented by an enterprising British physician, Dr. Joseph Mortimer Granville. The electric (also battery-powered) vibrator was invented more than a decade before the vacuum cleaner and the electric iron.

The electric vibrator was an immediate hit. It produced paroxysm quickly, safely, reliably, and as often as a woman might desire it. By the dawn of the 20th century, doctors had lost their monopoly on vibrators and hysteria treatment as women began buying the devices for home use, thanks to ad- vertisements appearing in such magazines as Women’s Home Companion and Needlecraft, and the then-venerable Sears & Roebuck Catalogue, whose copy gushed: “...such a delightful companion.... all the pleasures of youth...will throb within you....”

Great Sex Guidance: The 125-Year History of Vibrators- It’s Stranger Than Fiction – © Michael Castleman – 422 – Vibrator Backlash—and Resurrection

Electricity gave women vibrators, but within a few decades, electricity almost took them away. With the invention of the motion picture, vibrators started turning up in stag films during the 1920’s, and as a result, lost their social disguise as “massagers,” and their acceptability along with it. Advertisements for them disappeared from the consumer media, and they were difficult to find well into the 1970’s.

But some inventions are so useful, so necessary for so many people that they are destined to survive and thrive despite lingering attempts at suppression, for example, bans on vibrators in Georgia and Texas. The latest research shows that today, an estimated one-third of American women own vibra- tors, and 10 percent of couples use vibrators reasonably regularly in partner sex.

And to think: We owe it all to physicians’ fatigue.

Adam & Eve offers a wide variety of vibrators.

Resource:

The Technology of Orgasm: “Hysteria,” The Vibrator, and Women’s Sexual Satisfaction, by Rachel Maines. Johns Hopkins University Press, 1999.

Great Sex Guidance: The 125-Year History of Vibrators- It’s Stranger Than Fiction – © Michael Castleman – 423 – The Joy of Blindfolds (Especially for Women)

Mention light BDSM (bondage, discipline, and sado-masochism), and the erotic enhancements that usually come to mind include: spanking, wrist and ankle cuffs, restraints, nipple clamps, and flog- gers. Unfortunately, blindfolds often get left off the list. That’s a shame because couples interested in exploring light, loving, sexually supercharged role-playing often find that blindfolds are a wonderfully erotic enhancement—especially when worn by the woman.

Men Love to See, Women Love to Feel

Sexologists agree that most men get turned on visually. It’s no coincidence that the vast majority of lingerie is made for women. Men love to see their lovers in sexy outfits. It’s also no coincidence that most erotic photography and pornography focuses on naked women. Men love to look at it.

Women certainly appreciate the erotic power of sight. But sexologists agree that most women are turned on more by touch than by what they see. Women love the feel of sexy outfits. They enjoy whole-body massage, bubble baths, warm fuzzy robes, and kissing and cuddling.

Deprive a man of sight with a blindfold, and it often interferes with his arousal because he can’t see his beautiful lover’s face, breasts, butt, and vulva. But use a blindfold on a woman, and her enjoyment of lovemaking often increases. Deprived of sight, she can often feel loving touch more deeply.

This is not to say that men can’t enjoy being blindfolded. Many do. But for men, it’s often an acquired taste. For those who enjoy being blindfolded, playing with sight deprivation can open a door to a new level of erotic enjoyment and satisfaction.

Erotic Blindfold Play—Without BDSM

Blindfolds are considered BDSM toys, but you don’t have to be into restraint or power play to enjoy them. Just slip one on your lover—with permission, of course—and let the fun begin.

Great Sex Guidance: The Joy of Blindfolds (Especially for Women) – © Michael Castleman – 424 – Deprived of sight, the other senses become immediately heightened. Scented candles smell more fragrant. Music sounds more intense. And the taste buds perk up when the blindfolded person’s lover feeds her—or him—tasty little treats.

But the sense that becomes most aroused by blindfolding is touch. Deprived of sight, every touch, from feathery strokes to firm pressure takes on an added dimension of erotic delight. Without sight, distractions disappear and allow blindfolded individuals to concentrate on the subtleties of sensation transmitted through their skin.

Try combining blindfold play with slow, sensual, whole-body massage. Use a massage lotion. Our sex toy affiliate, MyPleasure.com, offers several.

In addition, consider experimenting with massage toys. If you’re unsure how to give a good massage, relax. With massage toys—anything that vibrates—you don’t have to be trained in massage. All you have to do is run them around the recipient’s body, from head to toe. MyPleasure offers dozens of massage toys.

And don’t forget the imagination. It’s often easier to slip into vivid erotic fantasies when you can’t see. Perhaps the blindfolded person harbors secret (or not-so-secret) fantasies of sex in naughty places. While blindfolded, it’s easier to imagine that you’re enjoying pleasures you’d never actually feel com- fortable pursuing in real life.

Blindfolds and BDSM

Blindfolds add to the intensity of BDSM by making the submissive (bottom) all the more dependent on the dominant (top). For the sub to move around, the dom must lead. Blindfolds also provide an excel- lent opportunity for nurturing because a loving dom keeps his (or her) sub safe from harm, and the risk of harm—bumping into things, falling down stairs, etc.—rises when the sub cannot see.

For subs who feel nervous about being restrained, spanked, or flogged, blindfold play incorporates all the exciting elements of power-exchange role-playing—without the intense sensations of heavier BDSM. In fact, blindfold play can be a safe, sensual introduction to BDSM.

Portable, Discreet, and Inexpensive

One major advantage of blindfolds is that they attract no attention. Leave a vibrator or restraints on your night table, and children, friends, or family may see them and ask questions you’d rather not answer. But it’s easy to say that a blindfold is simply a “night mask” that helps you sleep.

In addition, blindfolds take up almost no space and are easily portable. Vibrators and BDSM toys can take up considerable space in luggage—and if you travel abroad, do you want customs agents finding them? Blindfolds travel easily and allow you to have a little bit of sexy spice wherever you go.

Finally, compared with many other sex toys, blindfolds are inexpensive. Adam & Eve offers a wide selection.

Great Sex Guidance: The Joy of Blindfolds (Especially for Women) – © Michael Castleman – 425 – An Introduction To BDSM Accessories

BDSM stands for bondage, discipline, and sado-masochism. Sex toy marketers offer quite a few ac- cessories including blindfolds, restraints, floggers, and nipple-pinching toys.T ry mypleasure.com.

Blindfolds Many doms love blindfolds because placing one over a sub’s eyes, denying the person sight, is an exercise in power and control. Meanwhile, many subs are equally enthusiastic about blindfolds be- cause they help that person turn inward and tune into the erotic dimensions of the other senses: hearing, smell, taste, and touch. By limiting one sense, the other four automatically become height- ened, which lends drama and intensity to sex. In addition, by eliminating the blindfold wearer’s power of sight, the dom is free to act out all sorts of fantasies that might erotically excite both lovers, for example, pretending to be someone else, perhaps a pirate or a movie star the blindfold wearer has fantasized about. Or the top might announce that several others have come to watch or join in the merriment—and adopt other voices to make that fantasy more vivid.

Collars And Leashes These toys playfully symbolize domination and submission. A collar says that the sub is “owned” by the dom. A leash reinforces that fantasy. Collars should never be so tight that they pinch the bottom’s neck. They’re not about strangulation, but rather, playful dominance and submission, being a pet, or turning a lover into one.

Restraints For beginners, who may feel nervous about being restrained, some sex toy marketers offer quick- lease handcuffs the sub can open at any time. In general, restraints for more experienced BDSM play can only be released by the top. Once handcuffed, the sub is at the top’s mercy, just like the person who falls in Trust Me. The dom is free to erotically tease, tickle, kiss, finger, or lovingly pinch, bite, or spank the cuffed sub. Or the dom might “order” the sub to bow or kneel, or provide or receive other sexual favors.

Whips, Floggers, and Riding Crops First, review the difference between pain and harm in BDSM: A Loving Introduction to Bondage And Discipline (BD) and Sadomasochism (SM). Before the scene begins, participants should work out how long it will last and the amount of intense sensation the sub can enjoy. Toys such as whips,

Great Sex Guidance: An Introduction To BDSM Accessories – © Michael Castleman – 426 – floggers, and crops are used to heighten both lovers’ fantasies. In light BDSM, all blows are soft, the equivalent of a mild slap. Many whips, floggers, and crops are designed to produce loud noises with only light blows.

Nipple Clamps

The nipples are exquisitely sensitive to touch. Many subs enjoy having their nipples playfully pinched. In addition to the intensity of sensation they deliver, nipple clamps also have tremendous visual ap- peal to many doms and subs. Many nipple clamps have padded graspers for the sub’s comfort, and they’re easily adjustable for just the right amount of pressure and no more.

Finally, any sex toy can be incorporated into BDSM play. Use your imagination.

Great Sex Guidance: An Introduction To BDSM Accessories – © Michael Castleman – 427 – Strap-On Harnesses and Dildos: The Curious Couple’s Guide

Mention strap-on harnesses fitted with dildos, and if people are familiar with them at all, most think of girl-girl scenes in porn videos. The actress wearing the harness plays at being a man, revels in having a pretend penis, and uses it enthusiastically to have intercourse with the other actress. Many lesbian lovers enjoy strap-on sex—but this variation on lovemaking is not just for lesbians, and not just about women playing at being men. Many heterosexual couples also enjoy strap-on play, as do some gay male lovers. Strap-on sex can be fun for anyone—if you’re inclined to play that way. With a little erotic imagination, strap-ons can add novelty, excitement, playfulness—and deeper intimacy—to any inter- ested couple’s relationship.

What Is A Strap-On?

A strap-on is a sex-toy ensemble that includes a harness worn around the waist or hips. The harness includes a triangular or rectangular front piece that sits over a woman’s vulva or the base of a man’s penis. The front piece contains a circular opening or straps that hold a circular ring (an O-ring). A spe- cial dildo with a flared, flat-bottom base slips through the opening or O-ring, giving women an artificial penis right where one should hang, or giving men an extra penis. The base of the dildo rests against the wearer’s public bone or against the front piece, allowing the wearer to enjoy the realism of push- ing the dildo into erotic openings using hip movements.

Some strap-ons can be worn by men or women. Others are designed exclusively for women and incorporate a vaginal plug on the inside of the front piece.

Seven Reasons Why Strap-Ons Are a Turn-On

Why fuss with a harness? Why not just use a regular dildo and guide it where you want it to go by hand? That’s what most dildo users do. But strap-on sex offers a different experience, one that pro- duces a unique erotic connection, and possibly deeper intimacy for the couple.

* Strap-ons free the hands, and allow dildo play to be complemented by two-handed caresses.

* Strap-ons invite gender-bending. Women can play at being men, thrusting their hips during inter- course the way men do.

Great Sex Guidance: Strap-On Harnesses and Dildos- The Curious Couple’s Guide – © Michael Castleman – 428 – * Strap-ons allow men to play at having two erections at the same time. Some men enjoy using strap-on dildos that are noticeably larger or smaller than their own erections. Using a smaller one, men feel larger by comparison. Using a larger one allows men to fantasize having a huge erection and using it like a porn actor would. In addition, having two penises opens the possibly of double penetration—one in the woman’s vagina, the other in her anus, assuming she enjoys that.

* Strap-ons can help compensate for erection problems. If a man has erectile dysfunction, a strap- on can provide a mutually satisfying way for the couple to experience intercourse.

* For those who enjoy lingerie and “undressing up” sexy, strap-on harnesses provide a unique visual treat that many lovers find exciting, an invitation to let go and get a little wild.

* The feel of a harness around one’s waist and hips or genitals also provides unique erotic sensa- tions that start raising erotic temperature even before the dildo is introduced into the front piece. Some women enjoy wearing harnesses under their clothing without a dildo attached to enjoy these sensations.

* Finally, strap-ons deepen couple intimacy. Many couples don’t talk much about their lovemaking. They just do it. Because strap-on sex expands erotic possibilities and encourages sexual experi- mentation—women playing at being men, men playing at having two erections-—couples need to discuss how they want to enjoy these new possibilities. Strap-ons encourage lovers to communi- cate more openly about sex, discussions that many couples find intimacy-enhancing, not to men- tion highly arousing and exciting.

Beyond the Myths: Who Uses Strap-Ons?

As we’ve mentioned, strap-ons are not just for lesbians. Unfortunately, some curious couples feel reluctant to experiment with strap-on sex because of myths that obscure the truth about harness-and- dildo play:

Myth: A man who enjoys being anally entered by a woman wearing a strap-on is gay.

Truth: Not at all. Some gay men enjoy recipient anal intercourse. Others don’t. Gay men also enjoy holding hands, kissing, massage, genital fondling, and oral sex. Heterosexual men don’t shrink from these erotic activities because they’re supposedly “gay.” Sexual orientation—straight, gay, or bisex- ual—has nothing to do with the kinds of sexual moves you enjoy, and everything to do with who you fantasize about and have sex with. Many 100 percent heterosexual men enjoy having their anuses massaged, fingered, and entered by butt plugs and/or dildos, including strap-ons. Heterosexual men who enjoy recipient strap-on play are not secretly gay. They are heterosexual men who enjoy adven- turous anal eroticism.

Myth: A man who enjoys being anally entered by a woman wearing a strap-on is abnormally submissive.

Truth: Not at all. Being on the receiving end of strap-on sex is not fundamentally different from being the recipient of any other erotic caresses. Strap-on play is not something the harness-wearer imposes on the recipient. A hallmark of fulfilling sex—including strap-on play—is mutual consent. Couples may play at domination and submission, but that’s all it is, play. Quite frequently, the recipient is the one in

Great Sex Guidance: Strap-On Harnesses and Dildos- The Curious Couple’s Guide – © Michael Castleman – 429 – charge, directing the strap-on wearer to provide the erotic contact he or she desires. In other words, the strap-on wearer is not necessarily dominant, nor the recipient necessarily submissive. That’s pos- sible, of course, but it’s only one of several possibilities. Couples interested in strap-on sex should discuss how they want to go about it, and then play in ways they find mutually satisfying.

Myth: Women who enter men anally with strap-ons secretly want to be men.

Truth: Nonsense. Not too long ago, women who wore pants were accused of harboring unconscious desires to be men. Now we know that slacks are just another form of clothing, and that wearing them carries no deep psychological implications. The same goes for strap-on play. Part of their al- lure for some women involves the opportunity to play at being a man. But for others, strap-ons carry no gender-bending implications. Instead, they experience wearing a harness as a type of lingerie, something that makes them look and feel sexy—with the added bonus that the harness also opens up other erotic possibilities.

Hitching Up: Everything You Need to Know About Strap-On Harnesses

There are two basic styles: thongs and jocks. Each has advantages and disadvantages. The choice is a matter of personal preference.

In thong-style harnesses, one strap circles the waist or hips and attaches to the front piece, which hangs down from it. The other strap connects to the base of the front piece then runs between wear- er’s legs attaching to the waist/hip strap in back. Things to consider:

* Some people prefer this look and find thongs more comfortable than jock-style harnesses.

* Thong harnesses have fewer straps than jock-style harnesses, which means fewer adjustments, an advantage for some, a disadvantage for others.

* The strap that runs between the wearer’s legs provides genital and anal stimulation some people enjoy. In fact, some women enjoy wearing thong-style harnesses without the dildo under clothing because of the discreet clitoral stimulation these harnesses provide.

* The strap that runs between the legs makes the anus and women’s clitoris, vulva, and vagina somewhat less accessible. This is an advantage for some, who enjoy pulling this strap aside to expose what they want to see and play with. It’s a disadvantage for others.

In jock-style harnesses, one strap encircles the waist or hips and attaches to the front piece. Two other straps attach to the base or sides of the front piece and circle the wearer’s thighs, attaching to the waist/hip strap in back. Things to consider:

* Some people prefer this look and find jock-style harnesses more comfortable than thongs.

* Jock harnesses have more straps than thong-style harnesses, which means more strap adjust- ments, an advantage for some, a disadvantage for others.

* The extra strap provides extra support for the dildo.

Great Sex Guidance: Strap-On Harnesses and Dildos- The Curious Couple’s Guide – © Michael Castleman – 430 – * The wearer’s anus and genitals remain exposed. They are not covered by any strap. This is an advantage for some, a disadvantage for others.

No matter which style you prefer, harnesses come in one size that fits most people. Some have elastic straps. Others have straps adjustable with buckles. And some feature backpack-style D-ring adjustments.

Harness strap material is another consideration. Possibilities include leather, nylon, and elastic. Each has a different feel. Nylon and elastic can be popped into a washing machine. Leather requires more care but some people prefer the look and feel of leather.

Front pieces are also fashioned from different materials: leather, velvet, stiffened neoprene, and rub- ber.

To don a harness:

* Slip the dildo into the O-ring. * Step into the harness. * With nonelastic harnesses, adjust the straps for a comfortable but snug fit. * If the wearer is thin and adjustments produce long tails of excess strap, you can trim it off. With nylon straps, singe the ends carefully with a lighted match to prevent fraying.

Fitting Your Harness with the Right Dildo(s)

Harnesses are typically marketed in kits that include dildos designed to fit their front piece opening or O-ring. However, you might also like to add one or more extra dildos. Some considerations:

* A strap-on dildo should have a flared, flat base. The flared base helps hold it snug in the front piece. You don’t want it slipping out. The flat base provides support as the harness-wearer’s hip movements push it into erotic openings.

* Some strap-on dildos stick straight out. Others curve. Curved models provide more possible vari- ety. Depending how they are positioned in the front piece, they can curve up, down, or to the side. Each position allows different erotic stimulation.

* Dildo firmness varies somewhat. Some people prefer very flexible dildos. Others prefer firmer models. Jelly dildos are most flexible.

Tips for Strap-On Enjoyment

* Compared with other sex toys, strap-ons are more elaborate. Stepping into one may feel odd. Straps may need to be adjusted. Dildos need to be fitted into the front piece.T ake your time. Be patient with these toys, with yourself, and with your lover. At first, you may feel awkward. Try to see the humor in your initial experimentation.

* Always use plenty of lubricant with strap-ons. All dildos and the erotic openings they enter should be generously lubricated before insertion.

Great Sex Guidance: Strap-On Harnesses and Dildos- The Curious Couple’s Guide – © Michael Castleman – 431 – * At first, the inserter should remain still, allowing the recipient to engulf the strap-on dildo instead of being penetrated. The rear-entry (doggie style) position is a good one to use. This is particularly important when a woman wears the harness. Compared with men, women are less experienced in male-style hip thrusting and penis insertion. Women who wear strap-ons should allow time to become comfortable with these new moves, and should request coaching from the recipient.

* Strap-on harnesses allow the wearer’s hands to remain free during erotic coupling. Use your hands. Massage your lover all over.

* Many couples who enjoy strap-on sex like to combine vaginal and anal dildo insertion with simu- lated fellatio. The recipient sucks on the dildo. If anal insertion precedes dildo-sucking, the dildo should be thoroughly washed with soap and water and/or Adult Toy Cleaner before it enters the recipient’s mouth.

* If a man wears the harness, he might alternate inserting his erection (if he has one) and the strap-on dildo into the woman’s erotic openings.

* If a man wears the harness and the woman is open to double penetration, the man can insert his penis and strap-on dido simultaneously into her vagina and anus.

* When women wear the harness, the front piece typically covers the clitoris. Some women enjoy the clitoral stimulation that results when the base of the dildo presses the front piece against it. Others miss direct clitoral stimulation. If so, reach under the front piece to fondle her clitoris. Or loosen the straps and lift the front piece or move it aside to allow access to her clitoris.

* Strap-on sex doesn’t mean exclusively strap-on sex. Most couples who own strap-ons, don’t use them every time they make love, but rather from time to time, when they’re in the mood. Even dur- ing a single sex session, feel free to put on your strap-on for a while, and then remove it.

* After strap-on sex, some couples prefer the wearer to take it off. Other prefer to recipient to un- dress the wearer. Discuss this.

Adam & Eve offers a wide selection of strap-on dildos and other toys.

Great Sex Guidance: Strap-On Harnesses and Dildos- The Curious Couple’s Guide – © Michael Castleman – 432 –

“An Enchanting Evening” - The Erotic Game That Enhances Couple Intimacy

The year was 1979, the place Scottsdale, Arizona, and Barbara Jonas was upset because she and her husband, Michael, had a spat shortly before Michael left on a business trip. Feeling lonely, Barba- ra, then 37, regretted the tiff, and did not want lingering bad feelings to spoil the couple’s reunion. She wanted Michael’s homecoming to celebrate all the playfulness and love in their marriage. But how?

A love letter, Barbara thought, pulling out some paper. But on reflection, she didn’t want to give Mi- chael something to read. She wanted to create something they could do together. Barbara traded her stationery for index cards. She typed up a series of questions, and designed a rudimentary game board. The evening of Michael’s return, she tacked a note to their front door, prepared the living room, and held her breath.

A Magical Evening

Suitcase in hand, a road-weary Michael trudged up the walk hoping his homecoming would be hap- pier than his departure. He wanted to tell Barbara how much he loved her, but he’d never been much good at expressing his feelings. Struggling with what to say, he noticed Barbara’s note: “Change into something comfortable, and meet me in the living room.”

Intrigued, Michael did as the note asked, and when he entered the living room, the lights were low, a fire crackled in the fireplace, fresh flowers graced the coffee table, and an alluringly-dressed Barbara handed him a glass of chilled champagne, a plate of hors d’oeuvres—and a stack of index cards. “I was so taken aback,” Michael recalls, “I just played along.” Which was exactly what Barbara had hoped.

The Jonases sat down at Barbara’s homemade game board. She handed Michael pencil and paper, and asked him to write a secret wish for later that evening. Barbara also penned a wish, and said, “First one around the game board, wins the wish.”

Then they took turns rolling dice and moving game pieces. After each move, they drew one card. Some were “talk” cards that asked open-ended questions designed to celebrate their relationship:

* In what way does your spouse support you?

Great Sex Guidance: “An Enchanting Evening-” The Erotic Game That Enhances Couple Intimacy – © Michael Castleman – 433 –

* Over the years, how has our marriage grown more satisfying?

* You have lunch with a long-lost friend who asks, “What attracted you to your spouse?” What did?

* Others were “touch” cards with playful directions:

* Gently massage your spouse’s feet.

* Kiss your spouse where he or she doesn’t expect it.

* Gently stroke your spouse’s body where it’s round and soft.

The Jonases don’t recall who won that initial game, but they have vivid memories of the evening they first played it. “Barbara’s game was a powerful experience for me,” Michael recalls. “It put me in touch with all the positive aspects of our relationship. It helped me say all the loving things I’d always want- ed to say but somehow never could.”

“The game put our disagreement behind us,” Barbara recalls. “We had a wonderful reunion, and felt very close.” The Jonas’ revived intimacy led from Barbara’s creation to another game they liked to play...in the bedroom.

Quitting Their Day Jobs

After that special evening, Barbara put her game away, thinking they might pull it out from time to time like an old photo album. But Michael couldn’t get it out of his mind. He suggested generalizing it— changing “spouse” to “partner” and “marriage” to “relationship”—and sharing it with friends.

“Our friends loved it,” he recalls. They suggested additional refinements, and urged the Jonases to market the game commercially. Three years later, they did, dubbing it “An Enchanting Evening.”

At first, the game business was a sideline to the Jonas’ day jobs—Barbara was a marketing execu- tive, Michael, an attorney. But “An Enchanting Evening” quietly took off at game shops and lingerie boutiques. Eventually, the Jonases quit their jobs, and today, through their company, Time For Two, they have sold hundreds of thousands, making “An Enchanting Evening” one of the nation’s top- selling adult-oriented games. In addition, many hotels include the game as part of romantic weekend get-away packages.

Maintaining the Magic of Falling in Love

“What happens in longterm relationships,” says Los Angeles couples therapist Lewis Richfield, Ph.D., “is that the spouses often lose sight of the things that originally attracted them to each other, both sexually and as companions. As the years pass, the magic evaporates, intimacy becomes distance, sexual frequency declines, and lovemaking gets boring. ‘An Enchanting Evening’ reminds couples why they fell in love in the first place, and helps restore intimacy, sensuality, and good sex.”

“My wife and I have tried several games that claim to build couple intimacy,” says Palo Alto sex thera- pist Marty Klein, Ph.D. “We’ve always been disappointed. So when I heard about ‘An Enchanting Eve-

Great Sex Guidance: “An Enchanting Evening-” The Erotic Game That Enhances Couple Intimacy – © Michael Castleman – 434 – ning,’ I felt skeptical. But we loved it. It’s elegant in its simplicity. It encourages the kind of supportive communication most couples stop sharing after a while. And it shows a profound understanding of how intimacy and sensuality can combine for great sex.”

Linking Intimacy and Lovemaking

The link between intimacy and sexuality is a problem for many couples. Many men have difficulty discussing their emotions, and believe that sex expresses their love. Meanwhile, many women have difficulty becoming sexually aroused, and feel that loving closeness helps them warm up to sex. “’An Enchanting Evening’ helps men discuss their feelings, which gives women the emotional connec- tion they want,” Klein explains. “And it helps women become sexually aroused, which gives men the responsive lovers they want.”

The Jonases have crafted “An Enchanting Evening” to be bias-free. It can be enjoyed by young and old, gay and straight, and people in any stage of intimacy from initial infatuation to 50th anniversa- ries. The “talk” cards all explore the loving, supportive side of relationships, and the “touch” cards are deliciously ambiguous. One says “Gently fondle something your partner has two of.” One player might caress a partner’s breasts. Another might massage a partner’s feet. “There’s no pressure,” Richfield explains. “Couples can play at any level of intimacy that feels right for them.”

Intimacy: Nourish to Flourish

Of course, “An Enchanted Evening” doesn’t create intimacy. The game enchances it for people who are interested in erotic closeness. Nor is “An Enchanted Evening” a panacea for couples on their way to divorce.

Thirty years after creating their game, the Jonases still play “An Enchanting Evening” themselves. “If we’ve learned anything from our more than three decades together,” Barbara says, “it’s that love and intimacy must be nurtured to flourish.”

To purchase “An Enchanting Evening,” visit timefortwo.com.

Great Sex Guidance: “An Enchanting Evening-” The Erotic Game That Enhances Couple Intimacy – © Michael Castleman – 435 –

“Wildly Sexy Dares” - Dare to Have More Naughty Fun Together

While traveling through Europe after college, Barbara Taylor of Ottawa, Ontario, entered France and had to pass through customs. She pulled her passport out of her purse and handed it to the agent. Wedged into the booklet was a photograph of a smiling Taylor showing off a skimpy lingerie outfit. “I had no idea how that photo got there,” she recalls, “but I remember an incredible feeling of horror when it fell onto the agent’s desk.”

When he saw the photo, the customs agent broke into a big grin. He returned Taylor’s passport and the photo, and said, “A special welcome to France.”

This Magic Moment

Time passed. Taylor married, pursued a career in publishing, and forgot all about the incident. Even- tually she decided to write a self-help book on keeping the romantic spark alive in long-term relation- ships. “I wanted to identify all the ingredients of ‘happily ever after,’” she explains, “and figured that many other people did, too.”

Taylor interviewed couples for her book, and learned that a good deal of the “glue” in their relation- ships had to do with magical moments they’d shared. Quite a few had to do with little erotic esca- pades that were not only intimate but a bit daring. She wanted her book to encourage those memo- rable zingy moments. “But the more I thought about it, the less happy I was with a book concept. I wanted to encourage playful, daring, fun. Instead of a book, a game involving daring escapades felt like a better way to go.”

No Game Board

Taylor bought some couple-oriented erotic board games. She enjoyed some of them. But even the best games had what she considered a serious flaw. “By their very nature, board games are a ‘time out’ from real life. I wanted my game to be part of real life—to spice it up.”

Taylor interviewed more than 100 couples and asked them to recall sexually charged incidents that had enhanced their relationships. She turned those escapades into “Wildly Sexy Dares,” an ingenious game of erotic surprises. “Just when you thought you’d run out of fresh ideas to tantalize and delight

Great Sex Guidance: “Wildly Sexy Dares” - Dare to Have More Naughty Fun Together – © Michael Castleman – 436 – your spouse,” Taylor explains, “Wildly Sexy Dares provides 175 fun, sexy, deliciously risky experi- ences to try. That’s why I call it ‘the game of naughty adventures for couples who think they’ve done it all.’”

“Wild Sexy Dares” begins with both lovers declaring a dream prize they’d like if they win. “We encour- age the prize to be a fun couple thing,” she explains, “a weekend getaway, a day at a spa, something they both like to do that makes them feel close.”

Mild, Hot, Extra-Spicy

The game comes with 150 “dare” cards—75 for him, 75 for her. Each deck is divided into three levels of play: mild, hot, and extra-spicy.

In addition, each card contains a Dare worth a certain number of points, a Double-Dare worth more points, and possibly a Bonus Dare worth even more. Players win points for accomplishing the dares they select. The spicier the activity, the more points. Players can raise the stakes further by wagering some of their points on 25 Challenge cards. The first player to accumulate 1000 points wins the prize. “Actually,” Taylor explains, “both players win because the game is so much fun, and because both share the prize.”

The dares get played out over several weeks or months as players weave the naughty antics from their cards into their daily lives. “One really fun aspect of the game is that your partner can fulfill a dare when you least expect it. So the dares are daring, and their fulfillment is often very surprising and exciting. That combination creates the magical moments that couples recall fondly for years. The greatest aphrodisiac is the mind. And just like in a good suspense movie, the build-up the game pro- vides is often half the fun.”

Here’s a Mild Dare for her: Place a pair of sexy panties in his pocket before he leaves for work (5 points). For the Double Dare, the panties go not into his pocket, but instead, around an item he uses in front of others, for example, his cell phone. (10 extra points). She earns 15 Bonus points if he tells her that someone else noticed the panties before he did.

Here’s a Mild Dare for him: Kiss her while in the middle of a crosswalk, in front of a row of cars stopped at the light (5 points). The Double Dare involves making it a long, intense movie star kiss (10 extra points). He earns 15 Bonus points if cars start honking.

In the Hot category for her: Snuggle up in bed and provide him with a vivid description of the most erotic dream you’ve ever had. For the Double Dare, confess a sexy experience that pre-dates your current relationship.

In the Extra-Spicy category for him, one Dare involves wearing a thick rolled up sock in his pants at a club or in his bathing suit at the beach (15 points). For the Double Dare, he poses for photos. He gets 25 Bonus points if anyone asks, “Is that for real?”

While designing “Wildly Sexy Dares,” Taylor recalled her experience entering France. It became an Extra-Spicy card For Her that involves sexy photos mixed into the pages of a book he’s reading.

Challenge cards are sexy contests. In one, both partners imagine a new sex toy for pleasuring the other. The card instructs them to create a prototype using household items. They wager points on Great Sex Guidance: “Wildly Sexy Dares” - Dare to Have More Naughty Fun Together – © Michael Castleman – 437 – who can up with the most outrageously fun plaything.

Fun At Any Comfort Level

In many couples, one person might be adventurous enough to try Extra-Spicy dares, while the other is bashful and might have difficulty with even the Mild dares. Such couples can still enjoy the game. “Every person has a personal comfort level,” Taylor explains. “It should be respected.” Players se- lect their own dares, the ones that appeal to them, ones they feel they can accomplish. Their partner doesn’t dictate, or even make requests. And you don’t have to perform all the dares in your deck to win the game. The spicier dares are worth more points. But if you perform mild dares frequently, the points add up quickly. Taylor compares “Wildly Sexy Dares” to downhill skiing. “You can be a begin- ner and have as much fun on the slopes as an advanced skier. No matter what your level, the fun comes from getting out on the slopes and skiing—and pushing yourself within your comfort level to do a little more than you’ve done before. The same goes for ‘Wild Sexy Dares.’ No matter what your personal comfort level, you can have fun and in your own way act wild and sexy and daring.”

While creating the game, Taylor tried to predict which dares would be most popular with players. From audience feedback, she discovered that her predictions were wrong: “Every couple is different. What delights them is highly individual. Some people love creating naughty fortune cookies. Others go wild over painting lingerie on each other. Some can’t get enough of arranging to meet the partner wearing nothing but a raincoat. We’ve received lots of reactions, including many stories about wild sexy es- capades players have enjoyed that are not in the game. We’re saving them and if we ever produce a sequel, ‘More Wildly Sexy Dares,’ we may use them.”

Falling in Love All Over Again

Taylor gains the most satisfaction knowing that her game has made a real difference in some couples’ relationships. “Just the other day, we got an email from a woman who said she never thought she had the courage to do one of the Extra Spicy dares. She did other dares but kept thinking about the one that was beyond her. Then one day she held her breath and tried it—and she and her husband rev- eled in naughty fun.”

Falling in love, committing yourself to another person—that’s a big risk, a wild sexy dare if you will. But as the years pass and things become routine, you forget that you ever did anything so daring. The game brings back the feelings of discovery and adventure that makes people fall in love in the first place. If you like surprise parties, you’ll love “Wildly Sexy Dares.” It’s 175 surprise parties in one box.

You can purchase Wildly Sexy Dares on Amazon.

Great Sex Guidance: “Wildly Sexy Dares” - Dare to Have More Naughty Fun Together – © Michael Castleman – 438 – Sex Toys and Lingerie Glossary

Note that most of the sex toys mentioned below are available at Adam & Eve.

Anal Beads Think of a pearl necklace, only the “pearls” are about the size of grapes and strung farther apart. When these beads are well lubricated and inserted into or withdrawn from a well-lubricated anus, the action can bring intense erotic pleasure. In anal play, the focus is typically on the anal canal—insert- ing a finger, penis, or toy in there. Unfortunately, the anal sphincter often gets neglected. Stimulation of this erotic opening can produce intensely pleasurable sensations because the pelvic floor muscles, which are involved in erotic pleasure and orgasm, surround the anus. Anal beads are a way to ex- plore anal sphincter pleasure. Make sure that both the beads and the anus are well-lubricated. Then insert the beads slowly, one at a time. Remove them the same way—slowly. Savor how they gently open the anus and how the sphincter closes after each bead has been inserted or withdrawn. Insert and withdraw just one or two beads if you wish, or the entire strand. The recipient may also wear the beads internally, providing an erotic secret that some couples enjoy.

Anal Dildo (Butt plug) Any non-vibrating cylindrical toy designed for insertion into the anus and/or rectum. Just as lovers de- rive pleasure from inserting a dildo into a woman’s vagina or a man’s or woman’s mouth, some also enjoy playing with a dildo in the anus. Any dildo can be introduced into the back door. But anal dildos tend to be slimmer for greater comfort. Most have flared bases to prevent loss inside the anal canal. Look for the flared base. It’s a safety feature. Materials vary: latex, Cyberskin, silicone, or jelly. Some are short and slim, for anal beginners. Others are longer and wider. Some vibrate. Others inflate. Whatever your anal pleasure, there’s a butt plug to enhance it. If you use an anal dildo be sure to use plenty of lubricant on both the plug and the anus. After using an anal dildo, don’t introduce it into any other erotic opening without thoroughly washing it with soap and water.

Artificial Vagina See Men’s Masturbator or Sleeve

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 439 – Baby Doll An item of women’s lingerie that includes a skirt. Who says sexy means as skimpy as possible? Sometimes a little extra coverage can be a special turn-on, especially when what’s covered is south of the navel and invites further exploration. Wearing a silky erotic skirt can make a woman feel very alluring. And lifting it can drive men wild. Babydolls are dress-like and typically cover the thighs. They also include panties, a thong, or G-string. But styles differ considerably. Some are lacy and see- through. Others are more opaque. Some are two-piece (panty and dress). Some have three pieces (panty, dress, bra). And some include little extras (matching hat, wristlets, gloves).

Ben-Wa Balls/Vibro Balls A pair of plum-sized spheres meant to be inserted into the vagina to intensify woman’s orgasms by strengthening the PC muscle in the lower pelvis. Ben-Wa balls are the most misunderstood sex toy. Many people believe this ancient Asian toy is supposed to be used during intercourse for enhance- ment, and then feel frustrated when the balls don’t make intercourse more fun. Ben-wa balls may be used during intercourse if you enjoy playing that way. But the original idea was for the woman to try to hold the balls inside her vagina, not when making love, but rather, during everyday activities. At first, the balls fall out, so initially you want to wear them discreetly just around the house. But after a while, many women learn to hold ben wa balls inside them. To do this, a woman has to strengthen her PC muscle, the one she contracts to interrupt urine flow or to squeeze out the last few drops.The PC is also one of the main muscles that contracts during orgasm. Learning how to hold ben-wa balls in helps women tone their PCs—and enjoy more pleasurable orgasms. In other words, ben-wa balls are another way to do PC-strengthening Kegel exercises.

BDSM Toys Any sex toy used in sexual play that explore giving or receiving intense sensation. BDSM toys in- clude: whips, floggers, and riding crops, and are often used with bondage toys: gags, blindfolds, and restraints. They are used in erotic power games, where one lover plays dominant (the dom or top), while the other plays submissive (the sub or bottom). The myth is that BDSM revolves around pain. Actually, it’s all about trust. BDSM is primarily theater, a highly stylized form of erotic play that toys with intense sensations—sometimes pain—without hurting anyone. BDSM scenes are best worked out in detail beforehand, with a “stop” signal the bottom can invoke at any time he or she feels un- comfortable. The top should commit to honor the stop signal immediately. Because the submissive partner can invoke the “stop” signal at any time, the irony of BDSM is that the bottom is actually the one in control. When playing with BDSM, no one should ever feel threatened or get hurt.

Blindfold An eye shade that eliminates vision. Blindfolds are popular among those who enjoy BDSM, but they can be used enjoyably by couples who are not into erotic power games, by simply want to spice things up with very light dominance and submission. Placing a blindfold on a lover asserts power: I can take sight away from you. Accepting a blindfold means erotic surrender: I grant you this power over me. With sight temporarily eliminated, the bottom can focus more intently on the other erotic senses: touch, taste, smell, and hearing. For both lovers, a blindfold allows creative fantasies of inviting others to watch or join in. (Simulate “others” with dildos or other toys.) If you’re new to erotic power games, blindfolds can be a comfortable introduction. The bottom’s hands are not bound so he or she can always feel safe and remove the blindfold. For more advanced BDSM enthusiasts, a

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 440 – blindfold can be used along with other restraints. Scenes involving restraints should be worked out in detail beforehand, with a “stop” signal the bottom can invoke any time he or she feels uncomfortable. The top should honor the stop signal immediately. Because the bottom can invoke the “stop” signal at any time, the irony of BDSM is that the submissive partner is actually the one in control. When using blindfolds or restraints, the bottom should ever feel threatened or get hurt.

Blow-Up Doll If you don’t have a real, live lover—or even if you do—you can inflate a male or female doll as a sur- rogate sex partner. Blow-up dolls are life-size and semi-realistic, with fairly realistic mouths, penises, vaginas, and anuses. Blow-up dolls are constructed from vinyl heavy enough to lie on top of. (But if vigorous use causes a leak, a repair kit is usually included. If not, use a bicycle tire patch.) Some fe- male dolls have removable vaginas for easy washing and for separate use if you’d rather not use the entire doll. Some come with vibrating erotic openings for added pleasure. A doll can’t replace a real, live lover, but on the other hand, a doll never says, “Not tonight, dear....”

Body Stocking/Body Suit Imagine lacy black stockings. Now imagine them covering not just the legs, but most of the body. When people think of lingerie, they usually envision teddies, babydolls, or sexy bra and panty sets. Body suits are a little different—which makes them all the more alluring. Most similar to hose, they’re figure-hugging, so they accent all of her beautiful curves. They come sheer, semi-sheer, or lacy, obscuring the breasts and vulva, but only a little. You can still see the woman’s loveliness. If you’re a man or woman who enjoys sexy black stockings, you’ll probably enjoy seeing your lover in a body stocking. And if you’re a woman who likes to slowly unroll stockings for your lover, or a man who likes removing stockings, a body suit gives you more to peel—and reveal.

Bondage Erotic play that involves restraint—one person ties up the other. Now often called BDSM. Scenes in- volving restraints are best worked out in detail beforehand, with a “stop” signal the bottom can invoke any time he or she feels uncomfortable. The top should honor the stop signal immediately. Because the bottom can invoke the “stop” signal at any time, the irony of bondage is that the submissive part- ner is actually the one in control. When using restraints, the bottom should ever feel threatened or get hurt.

Bondage Toys Any sex toy that restrains the limbs or senses or simulates this. Bondage toys include: gags, blind- folds, and restraints. They are used in erotic power games, where one lover plays dominant (the top), while the other plays submissive (the bottom). Scenes involving restraints are best worked out in detail beforehand, with a “stop” signal the bottom can invoke any time he or she feels uncomfortable. The top should honor the stop signal immediately. Because the bottom can invoke the “stop” signal at any time, the irony of bondage is that the submissive partner is actually the one in control. When us- ing restraints, the bottom should ever feel threatened or get hurt.

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 441 – Bridal Lingerie While most lingerie is naughty black or sexy red, bridal lingerie is as white as a wedding gown. Bridal white lingerie combines the virginal innocence of a classic wedding gown with the hot sexual allure of fashions that say: Feast your eyes upon me. I’m all yours. The combination gives a whole new mean- ing to: Here comes the bride (and groom). Bridal lingerie, in satin or lace, includes white teddies, baby dolls, gowns, camisoles, and bra and panty sets. It’s the perfect gift for anniversaries, second honey- moons, or anytime you and your honey want to recapture the romance and sensuality of your wed- ding night.

Bullet A tiny vibrator meant to be inserted in the vagina or anus. Bullets are thumb-size cylinders typically with two rounded ends. They are attached by wire to a battery pack. Bullets can be worn under cloth- ing so you can give yourself a sexy buzz any time you wish. Some come with panties that have a pocket allowing the bullet to nestle up against the clitoris for added pleasure. Bullets are also good sex toys for traveling. They pack easily and don’t take up much room, but still provide a nice buzz.

Bustier A lingerie item that accents the breasts. Think sexy bra—only more so. Fashioned from lace, satin, or a combination of the two, usually with underwires, some bustiers reveal the upper half of the breasts, while covering the nipples and what’s below them along with the midriff. Others cover the outsides of the breast, but feature a plunging V-cut design that reveals the insides and accents cleavage. And some provide shelf-like support for the breasts allowing them to project outward either partially cov- ered or fully bared. Most bustiers include garter straps to attach to stockings. Bustiers can be fun no matter what a woman’s breast size. In large-breasted women, they highlight abundance. In those who are small, bustiers present the breasts in an alluring way that invites playful enjoyment.

Butt Plug See Anal Dildo.

Clip Chains A delicate two-end or three-end chain with clips that attach to anything you want to visually highlight or sensually arouse. Got some erotic body parts you’d like to link together? Perhaps the nipples, labia, or scrotum. You can do this with a two- or three-end clip chain. Some women say that they feel more erotic sensation in the clitoris when their nipples are stimulated at the same time. A three-end clip chain can excite all three simultaneously. Clip chains originated as BDSM toys because the clips can provide intense sensation. But many chains are designed with easily adjustable clips so they can be enjoyed by just about anyone.

Clitoral Stimulator A toy designed to come in contact with the clitoris and erotically stimulate it. A variety of clitoral stimu- lators are available: strap-on “butterflies,” classic dildos or vibrators with extra clitoral nubs, and penis rings with clitoral extensions. For an estimated 75 percent of women, intercourse does not provide

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 442 – enough direct clitoral stimulation to trigger orgasm. Clitoral stimulators to the rescue. Butterflies are saucer-like vibrators that rest on the clitoris. They are typically held in place by straps placed around the hips. Some are remote controlled, allowing a woman’s lover to give her wonderful sensations at the touch of a button. Clitoral nubs on dildos and vibrators allow simultaneous direct clitoral stimula- tion and vaginal insertion. And penis rings with clitoral-stimulating extensions, enhance intercourse by allowing penile movement in the vagina to provide direct clitoral stimulation at the same time.

Corset A lingerie item that tightens around the waist, making it look smaller. When the waist looks smaller, the breasts and hips look fuller and more sensually curvy and erotic. Corsets were invented centuries ago to be worn under the dresses of that era. Today, they are a type of lingerie. Most corsets cover the area from the hips to the upper abdomen. (Some cover the breasts). They are cinched tight with laces, ties, or hooks. Most have garter straps to hold up stockings. Corsets are delightfully erotic as stand-alone lingerie items. But because they are fastened tight, they are a favorite among those who enjoy BDSM play.

Crotchless Panties Panties with a vertical opening that invites access to the vulva and vagina. A woman in panties can look so sexy that some lovers feel it’s a shame to have to remove them to reveal her genitals. With crotchless panties, you don’t have to. They open right where you want to look—or touch, or gently insert a finger, tongue, penis, or sex toy. Some crotchless panties are always open. Others have laces or zippers. All accommodate cunnilingus and vaginal intercourse.

Cyberskin™ A plastic material with a surprisingly realistic flesh-like feel, often used on the surface of vibrators and dildos. Close your eyes and touch a real penis. Then touch a Cyberskin dildo. The two feel remark- ably similar. Many women prefer life-like Cyberskin to other sex-toy materials (latex, silicone, or jelly).

Delay Cream/Desensitizer Anesthetic cream that helps some men delay orgasm/ejaculation when applied to the penis. Desen- sitizers are a quick fix for the common male problem of premature ejaculation. Just apply some and the topical anesthetic numbs the penis, which helps some men last longer. However, these products change the taste of the penis, and if the cream rubs off on the women, it can numb her genitals as well. For most men, delay products are unnecessary.

Dildo Any cylindrical or penis-shaped object used for erotic stimulation, typically inserted into the vagina. Dildos may be realistic-looking penis surrogates made from latex, jelly, silicone, or Cyberskin. Or they may be more abstract, arty plastic cylinders with one tapered end. Some dildos vibrate. Others do not. Some are two-headed, for simultaneous use by two people, or for insertion into two erotic open- ings of the same person. Some have cured ends for stimulation of the G-spot. For safety and greatest enjoyment, always use plenty of lubricant with inserted sex toys.

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 443 – Double Dildo (Double Dong) Any dildo that has two penis-like heads, one on each end. Double dildos can be used vaginally by two women, or in two orifices by the same person. They are much larger than even the largest penis, so for those excited by size, they inspire fantasy as well as pleasure.

Erection Ring (Cock Ring) Any rubber donut-shaped device or leather strap that tightly encircles the erect penis. Rings can be used for aesthetic enhancement, but typically they are used to help maintain erection. They don’t work miracles, but they can help a little. Blood circulates in and out of the penis both when it’s flaccid and erect. The arteries that carry blood into the penis run through the center of the organ, so during erection, as blood fills the penis’ spongy erectile tissues, a ring doesn’t keep blood out. However, the veins that carry blood out of the penis run closer to its outer skin. As the penis expands in erection, these veins naturally get somewhat compressed, which restricts blood outflow (but does not stop it).A ring restricts outflow a bit more (but doesn’t stop it.). The net effect is somewhat greater blood build- up in the penis, and a slightly firmer erection.

In addition, rings have a psychological effect. Nerves control how much the penile arteries expand to carry extra blood into the penis. These nerves—and the arteries as well—are sensitive to stress. If a man feels stressed, his erection are likely to be less full and firm. But if a man believes that a ring helps maintain his erection, he’s likely to feel reassured and relax, which helps usher more blood into the penis whether or not he uses a ring.

There are two kinds of erection rings—adjustable and nonadjustable. The former are easier to keep from becoming uncomfortably tight.

Extender Imagine a condom with a 2 to 3-inch dildo on the end. Extenders elongate the erect penis, allowing deeper insertion. The sleeve that fits over the penis is considerably thicker than a condom. This is necessary for the toy to say on. Extenders are easily washable and reusable. While it can be great fun to play with having a longer penis, be careful when using one for vaginal insertion. The extension may bang into the back of the vagina, the cervix, or the bladder. Many women find this uncomfortable. We suggest the woman-on-top position with the penis still. Let her sit down on it and discover what’s most comfortable for her. Extenders are also known as a PPA’s— prosthetic penis attachments.

Fetish Wear Any item of leather, latex, or PVC clothing intended to stimulate erotic excitement. They’re sexy, black (usually), figure-hugging, and light many people’s erotic fire. They’re the lingerie usually associated with BDSM: supple leather bra and crotchless panty sets, oh-so-tight latex bikini briefs and panties, studded leather G-strings and jockstraps, shiny PVC push-up bras, lace-up black leather miniskirts, breast-baring leather corsets, and much more.

Flogger A whip with more than one strand. Think cat-o-nine-tails. A whip has one long strand. A flogger has many short ones. Because the strands are short, floggers are easier to control than whips.Therefore, they are safer. They also strike a wider area. When using floggers or whips, be sure to pre-arrange a “stop” signal, one that the person holding the toy honors immediately. No one should ever feel threat- ened or get hurt during loving sex play. Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 444 – French Tickler A condom with little extras: nubs or other attachments that provide extra stimulation for the erotic opening the tickler-covered penis enters. French ticklers can provide extra stimulation for many parts of the body: the vaginal lips during intercourse; the clitoris if the penis slides up against it; the mouth, lips, and tongue during oral sex; the breasts when they are pressed together and the penis slides between them; or the anus during anal intercourse. When using a tickler in the vagina, on the clitoris, between the breasts, and especially in the anus, be sure to use plenty of lubricant.

French ticklers are sold as novelties. They are not manufactured to the same government specifica- tions as condoms, and should not be relied upon for contraception or prevention of sexually transmit- ted diseases.

While ticklers can enhance vaginal intercourse for women, their use during intercourse may not provide enough direct clitoral stimulation to allow the woman to express orgasm. Most women need direct clitoral stimulation for that.

G-spot Stimulator Any vibrator or dildo with a bent end to facilitate G-spot stimulation. The G-spot is an area on the front wall of the vagina (the top when a woman lies on her back). When women are sexually aroused and this area is pressed or rubbed, many—but by no means all—women experience intense erotic sensa- tions. To stimulate the G-spot, a lover can insert the index or middle finger, and hook it to rub the front of the vaginal wall. But women cannot do this to themselves, and some prefer a G-spot stimulator to a lover’s fingers. G-spot stimulators are most comfortable when used with plenty of lubricant.

G-String The skimpiest possible underwear—two tiny triangular loincloths, one covering the front, the other the back, held together by strings. In classic striptease shows, performers wore panties, and under them G-strings to provide one more layer that could be stripped off before baring all. G-strings have emerged from strip shows to become a popular item of home erotic “undressing up.” G-string loin- cloths come in lace, satin, leather, and other fabrics. Some have printed messages, for example, Happy Birthday. They are erotic and risqué, while still leaving something to the imagination.

Gag A toy that eliminates speech by covering or filling the mouth and tying behind the head. Some gags are simply piece of cloth or leather that cover the mouth. Others include balls (the size of golf balls) that fill the mouth in addition to covering it. Gags do not eliminate sound, just words.The person wearing the gag can still moan and grunt. Gags are used in BDSM play, where one lover plays domi- nant (the top), while the other plays submissive (the bottom). If you’re new to erotic power games, gags can be a comfortable introduction. The bottom’s hands and feel are not bound so he or she can always remove the gag. For more advanced BDSM enthusiasts, a gag can be used with restraints. Scenes involving restraints are best worked out in detail beforehand, with a “stop” signal the bottom can invoke any time he or she feels uncomfortable. With the bottom gagged, the stop signal cannot be a word. Be sure to negotiate a clear nonverbal stop signal if one lover is gagged. The top should honor the stop signal immediately. Because the bottom can invoke the “stop” signal at any time, the irony of bondage is that the bottom is actually the one in control. When using restraints, no one

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 445 – should ever feel threatened or get hurt.

Harness A plastic or leather device worn around the hips and pelvis used to house a strap-on dildo or butt plug. Harnesses may be used by either men or women on either men or women. Some men use har- nesses to play with penis size by using a strap-on that’s larger than their own penis. Other men have erection problems and use a strap-on as a substitute. Women who use harnesses typically want to play with gender roles. Porn videos often depict women using harnesses and strap-ons for oral, vagi- nal, or anal intercourse.

Jelly A rubbery material used to in the manufacture of some sex toys. It has the texture of gummy candies. Some people prefer jelly toys to latex, hard plastic, silicone, or Cyberskin™. It’s a matter of personal preference. But jelly toys have a soft suppleness that many sex toy users enjoy.

Kits A box containing a standard 7” vibrator, plus various erotic attachments that slip over it. Some kits focus on vaginal pleasure, with large French tickler and extender attachments. Others focus on anal pleasure, with probes and plugs of various shapes and sizes. Kits are an economical way to buy a half dozen toys for the price of one or two.

Latex The rubbery plastic commonly used in the manufacture of condoms and sex toys. Latex is strong, stretchy, and accepts water-based sexual lubricants well, allowing latex sex toys to slide easily into erotic openings. However, some people are allergic to latex, and develop a rash or itching. If you no- tice these symptoms, switch to sex toys made from either jelly, hard plastic, silicone, or Cyberskin™. If you use latex sex toys, don’t lubricate them with petroleum products (Vaseline). Petroleum causes latex to deteriorate.

Lubricant Any emollient applied to the skin or to a sex toy that increases its slipperiness. Lubricants enhance the comfort and pleasure of masturbation, vaginal intercourse, sex-toy use, and especially anal sex. It takes only seconds to demonstrate the value of sexual lubricants. Run a finger across your dry lips and note how it feels. Then lick your lips and repeat. Now, didn’t that feel more sensual? In sex, the wetter, the better. When sex toys or the genitals are well lubricated, they experience more sensual- ity from touch and they slide together more easily and comfortably. Lubricants can be water-based (Probe, Astroglide, Slippery Stuff, etc.) oil-based (vegetable oils), silicone-based (Eros Classic Body- glide), or petroleum based (Vaseline, Anal Lube). The myth is that the vagina self-lubricates copiously as the woman becomes sexually aroused. In fact, many women don’t produce much self-lubrication even when highly aroused, especially after menopause. In addition, women who usually self-lubricate well may not under some circumstances. Lubricants are a quick, convenient, safe, inexpensive en- hancement for vaginal and anal play.

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 446 – Marital Aid A euphemism for “sex toy.” Several decades ago, when married people were the only ones culturally permitted to have sex, sex toys were only considered appropriate for use in marriage, hence “marital aids.” Of course, millions of people who are not married have sex and use sex toys. “Marital aid” is a holdover from the era when the term “sex” was not used in polite company, and when sex toys were viewed as scandalously fringe items. This is no longer the case, but the term “marital aid” still sur- vives.

Mask Face coverings are used to heighten erotic excitement during BDSM play. They are placed by the dominant partner (top) and worn by the submissive partner (bottom). Some have eyeholes. Other do not and function as both masks and blindfolds. Some cover the mouth and function as gags. If you’re new to erotic power games, masks can be a comfortable introduction. The bottom’s hands and feet are not bound so he or she can always remove them. For more advanced BDSM players, a mask can be used along with restraints. BDSM scenes are best worked out in detail beforehand, with a “stop” signal the bottom can invoke any time he or she feels uncomfortable. If a mask is also a gag, a clear nonverbal stop signal should be negotiated. The top should honor the stop signal immediately. Be- cause the bottom can invoke the “stop” signal at any time, the irony of bondage is that the bottom is actually the one in control. In loving sex play, no one should ever feel threatened or get hurt.

Massage Oil A lotion applied to the whole body to enhance the comfort and sensuality of massage. Massage oils are emollients that moisturize the skin allowing massaging hands to glide more easily. Massage oils may also be used as sexual lubricants. However, some people find them too oily, and they may irritate sensitive genital skin. Sexual lubricants tend to work better on—and in—the genitals. But sexual lubri- cants dry out faster than massage oils and don’t work as well on nongenital area of the body.

Massager A euphemism for “vibrator.” Any vibrator can be used to massage sore muscles...and any massager can be used erotically. During the early 20th century, shortly after vibrators were invented, several major catalogues, for examples, Sears Roebuck, carried them, but called them “massagers.” Incred- ibly, even then, the copy hinted at their erotic use, calling them “every woman’s friend.” They still are—and couples’ friend, too.

Men’s Masturbator Also known as a sleeve or penis sleeve, masturbators are sex toys used by men to enhance mastur- bation. Most are crafted to look like vaginas. A hand can be dandy, but a masturbator grips the penis differently, allowing the man to vary the sensations he experiences during masturbation. Some mas- turbators vibrate for extra-intense stimulation. Some are made from latex, others from jelly, silicone, or Cyberskin™. All are easily washable.

Nipple Clamps/Nipple Clips Imagine screw-on or clip-on earrings, but substitute the nipples for the ear lobes. Nipple toys deco- rate this beautiful part of the male or female anatomy, and provide steady pressure that can produce Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 447 – deliciously erotic sensations. Nipple toys can be worn and enjoyed by both women and men. Some nipple clips screw on, the screw mechanism allowing you or a lover to provide just the right amount of pressure. Others look like hoop earrings and can be worn discreetly under clothing so just you and your honey know they’re on. Some come wired for attachment to a vibrator for intense erotic sensa- tions. And others are linked by a chain for decoration, or to lead the wearer around by the nipples.

Pearls See Anal Beads

Penis Pump A device that creates a near-vacuum around the penis. This temporarily coaxes more blood into the organ, resulting in a somewhat larger, firmer erection—or partial or complete erections in men who otherwise cannot have them. No mechanical device can permanently enlarge a penis. But for men or couples who enjoy playing with size, a penis pumps can provide temporary enhancement. The man inserts his penis into the pump cylinder, then uses the hand bulb to evacuate most of the air, creat- ing a near-vacuum. These conditions stretch the penis somewhat. The effect subsides after the penis leaves the cylinder, but many men can retain the extra firmness long enough to enjoy intercourse.

Penis pumps were originally developed by doctors to help men with erectile dysfunction produce erections firm enough for intercourse. Their use as sex toys came later. Many research teams have studied the effectiveness of penis pumps for men with impotence caused by such conditions as dia- betes and paraplegia. They work reasonably well—assuming a custom fit for a good vacuum seal.

Penis pumps are safe when used as directed. We are unaware of any reports of injury from them. Of course, misuse might cause problems, so follow the directions, and use your pump carefully.

Penis Sleeve See Men’s Masturbator

Pheromones Perfumes specially formulated to attract lovers and enhance sex. When animals go into heat, they attract the opposite sex chemically by releasing special aromatic chemicals called pheromones. Over the past 20 years or so, scientists have discovered that humans also release pheromones when sex- ually aroused and respond erotically when they encounter pheromones’ subtle scents. Human phero- mones have been identified and synthesized in laboratories so they can be produced in commercial quantities. Several perfumes, colognes, and massage oils contain pheromones. The fragrance is subtle, but some studies suggest that the effect is real.

Play Wear A general term for any type of lingerie. Great sex is a form of play, so it should come as no surprise that the clothing that complements great sex is called play wear. Whether it’s a purple satin come- hither gown, a lace-trimmed bridal teddy, a leather jockstrap, a latex bra and panty set, or a push-up bra, play wear can add variety, spice, and enchantment to your erotic play.

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 448 – PPA A “prosthetic penis attachment.” Imagine a condom with a 2 to 3-inch dildo on the end. Extenders elongate the erect penis, allowing deeper insertion. The sleeve that fits over the penis is consider- ably thicker than a condom. This is necessary for the toy to say on. Extenders are easily washable and reusable. While it can be great fun to play with having a longer penis, be careful when using one for vaginal insertion. The extension may bang into the back of the vagina, the cervix, or the bladder. Many women find this uncomfortable. We suggest the woman-on-top position with the penis still. Let her sit down on it and discover what’s most comfortable for her. PPA’s are also known as “extenders.”

PVC The abbreviation for polyvinyl chloride, a shiny, black or purple plastic fabric used in fetish lingerie. Tired of leather and latex? PVC is another option that some lovers find arousing and fun. In black or purple, PVC playwear provides a whole new erotic look. It feels deliciously different than leather or latex.

Realistic Any sex toy modeled on an actual person. Some dildos and vibrators are modeled on the penises of male porn stars. Some masturbators and dolls are modeled on female porn stars. Nothing like a little realism to make sexual fantasies feel—well, more realistic. If you’ve ever imagined having sex with a porn star, this is about as close as you’ll probably get.

Restraints Any device used to limit movement (ropes, ribbons, wrist or ankle cuffs) or reduce sensory aware- ness (blindfolds). Often used in BDSM play. Scenes involving restraints are best worked out in detail beforehand, with a “stop” signal the restrained person can invoke at any time he or she feels things have gone beyond the person’s comfort limit. The restrainer should commit to honor the stop signal immediately. Because the submissive partner can invoke the “stop” signal at any time, the irony of bondage is that the partner being restrained is actually the one in control. When using restraints, no one should ever feel threatened or get hurt.

Riding Crop A small equestrian whip. Riding crops have long flexible handles and one or two short whipping strands. When using crops—or floggers or whips—be sure to pre-arrange a “stop” signal, one that the person holding the toy honors immediately. No one should ever feel threatened or get hurt in loving sex play.

S&M Erotic play that involves domination and submission, also known as power play or BDSM. One lover plays dominant (the dom or top), while the other plays submissive (the sub or bottom). Scenes involv- ing restraints are best worked out in detail beforehand, with a “stop” signal the bottom can invoke any time he or she feels uncomfortable. The top should honor the stop signal immediately. Because the bottom can invoke the “stop” signal at any time, the irony of bondage is that the submissive partner is actually the one in control. When using restraints, the bottom should ever feel threatened or get hurt.

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 449 – Sexual Aid/Sex Toy General terms for any device used for sexual stimulation and enhancement. However, in current us- age, x-rated videos, erotic books, lingerie, and how-to sex guides are not considered as sexual aids/ sex toys, even though they are used for erotic stimulation and enhancement. A sexual aid/sex toy is a device or appliance used directly on the body.

Silicone A material used to make sex toys. It’s costly, so silicone toys are more expensive than latex, jelly, hard plastic or Cyberskin™. They’re a good option if you’re allergic to latex.

Strap-On A dildo specially designed to fit into a plastic or leather harness worn around the hips and pelvis. Strap-ons allow more realistic intercourse than hand-held toys. Strap-ons may be used by either men or women on either men or women. Men who use them typically want to play with penis size by using a dildo that’s larger than their own penis. Women who use strap-ons typically want to play with gender roles.

S&M Toys See BDSM toys

Sleeves Artificial erotic openings that can accommodate the entire length of the erect penis. Most sleeves look like vaginas, but some are crafted to resemble the mouth. Sleeves are mostly used by men during masturbation. They may be also used during partner sex. Some include built-in vibrators for extra- intense sensations. For comfort and erotic intensity, apply a sexual lubricant to both the sleeve and the penis before insertion.

Swing It hangs from the ceiling like a porch swing, but it seats only one person, usually a woman, and the seat is designed to allow access to her vagina. Most swings hang from a steel spring and rotating eyebolt, inviting an amazing range of new and exciting sexual positions. The seat, back, and stirrups are padded for comfort. An instruction manual suggests many sensual positions.

Teddy A one-piece item of women’s lingerie that highlights the breasts, genitals, and buttocks while covering them. Think of a one-piece women’s bathing suit—only in lace or satin or see-through fabric. Some teddies are cut very low to reveal most of the breasts. Others are cut high around the hips to reveal most of the buttocks and hint at the vulva. Some are open at the nipples, or have ties that open to reveal them. Others have snaps in the crotch that open to reveal the genitals.

Thong An item of lingerie that resembles a bikini bathing suit bottom. Thongs provides less coverage than bikini panties but more than G-strings. They cradle the vulva and accent the thighs and buttocks in a Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 450 – uniquely erotic way. Thongs come in lace, leather, satin, and other fabrics. They are available alone or in thong-and-bra sets. Some baby dolls include thongs.

Titilizer A chain with a wire loop at each end that slips over the nipples, adorning them. The wire loops are adjustable for a comfortable fit. The chain hangs between the breasts, drawing attention to them. Can be worn under clothing.

Tongue A vibrator shaped like an extended human tongue that can move like one. Tongues are typically used for clitoral stimulation, but may also be used vaginally or anally. The tip of the tongue can move up and down or around in circles, often at variable speeds. Most are battery powered.

Vaginal Simulator See Men’s Masturbator or Sleeve

Vibrator Any sex toy that uses electric power (batteries or wall current) to create erotic sensations. Imagine touching a washing machine or dryer while they’re in operation. That’s how most vibrators feel. Vibra- tors are the most popular type of sex toy. They may be made from a number of materials: latex, hard plastic, jelly, silicone, and Cyberskin™. They come large and small (bullet), single speed or variable, shaped like penises or vaginas, or attached to nipple clips or clitoral butterflies. Battery powered vibrators are portable but sacrifice power. Others use wall current, providing power but sacrificing portability. If you want to use a vibrator around water—in a pool, hot tub, bath, or shower—be sure to use one that’s waterproof.

Waterproof Toys Vibrators that can be used in the bath, shower, or hot tub safely. For many couples, vibrators enhance sex. So does bathing together. But vibrators and bathing don’t mix because of the risk of short circuits and electrocution from taking an electrical item into the water. Waterproof toys to the rescue. Water- proof toys are specially designed to be safe in and around water.

Whip Any toy used for striking another in BDSM play. “Whip” is a general term for any toy used to strike another—typically on the buttocks, but elsewhere as well—and trigger erotic sensations. Whips come in a variety of styles. A classic whip has one long striking strand. A flogger has many short ones. And a riding crop has a long flexible handle and one or two short strands. When using any whip, be sure to pre-arrange a “stop” signal, one that the person holding the toy honors immediately. No one should ever feel threatened or get hurt in loving sex play.

Note that most of the sex toys mentioned are available at Adam & Eve.

Great Sex Guidance: Sex Toys and Lingerie Glossary – © Michael Castleman – 451 – The History of Sex Toys from 25,000 B.C. to Today c. 25,000 B.C. Prehistoric carvings of clearly sexual figurines of women. First discovered in Wil- lendorf, Germany, in the 19th century, and dubbed the “Venus of Willendorf,” these faceless stone female nude sculptures boasted greatly oversized breasts, bellies, hips, buttocks, and vaginal lips. Similar prehistoric sculptures have been discovered throughout Europe from France to the Ukraine. Most experts consider them fertility goddesses. However, it’s also possible that they were the porn of their day, used to sexually excite men. c 2500 B.C. First documented dancing. Depiacted in Egyptian art, female dancers gyrated nearly na- ked carrying a sculpture of an oversized erect penis to honor the god Osiris. Possibly an agricultural fertility ritual. Possibly something else. c. 600 B.C. Debut of theater, as an offshoot of the ancient Greeks’ Festival of Dionysus, god of fertil- ity, wine, and the arts. Dionysian festivals lasted several days and featured public intoxication and public sex. Basically, they were drunken orgies. Ever since, sex has been closely associated with the arts, wine, and other drugs. c. 500 B.C. Invention of the dildo. This momentous event took place in Miletus, a Greek port on the western shore of today’s Turkey. Miletan traders sold what the Greeks called olisbos around the Medi- terranean as sexual refuges for lonely ladies. A Greek literary fragment from the third century B.C. tells of a young woman, Metro, whose husband is away. She visits her friend, Coritto, to borrow her olisbo, only to learn that Coritto has lent it to another lonely maiden. Metro departs crestfallen. c. 350 B.C. First mention of olive oil as a sexual accessory. Actually, it was touted for contraception. But ever since, couples have used vegetable oils as lubricants. c. 300 A.D. Invention of penis extenders, sex toys now known as prosthetic penis attachments (PPAs). First mentioned in the classic Indian sex manual, the Kama Sutra, these cylindrical toys fit over men’s erections to make them look larger. The Kama Sutra suggested crafting penis extenders from wood, leather, buffalo horn, copper, silver, ivory, or gold. c. 500. Invention of ben-wa balls. Single balls, usually made from silver, were mentioned in Asian sex writings from Burma to Japan. Some were solid, others hollow with clappers that make a ringing

Great Sex Guidance: The History of Sex Toys from 25,000 B.C. to Today – © Michael Castleman – 452 – sound as they roll around in the vagina (Burmese bells). Originally used to increase men’s pleasure during intercourse, ben wa balls eventually became paired, and were used by women to increase the strength of their pelvic floor muscles, the ones involved in orgasm. When these muscles are weak, the balls drop out when women stand or walk. As the pelvic floor muscles become stronger, women can hold the balls inside their vaginas—and enjoy more intense orgasms. Today, the pelvic floor muscles are usually strengthened through Kegel exercises. But ben wa balls also work. c 655. Introduction of mirrors as sexual accessories. Lady Wu Chao, consort to the Chinese Emperor Tai Tsung ordered large sheets of reflecting glass arranged around their bed. When other courtiers in- sisted that the mirrors were a bad omen, the Emperor ordered them removed. After Tai Tsung’s death, Wu Chao seized control of the throne and reinstalled the mirrors to enhance trysts with her subse- quent lovers. c 1200. Invention of the proto-cock ring. The first documented rings were made in China from the eyelids of goats (with eyelashes intact). The eyelids were processed to keep them flexible, while the lashes were processed to harden them. The flexible eyelids were tied around men’s erections, and the hardened lashes were said to increase the pleasure of intercourse. c. 1400. Coining of the term “dildo.” In Renaissance Italy, the Greek olisbo became “dildo,” possibly from the Latin dilatare, to open wide, or perhaps from the Italian diletto, to delight. Renaissance Italian dildos were made of wood or leather, and required liberal lubrication with olive oil for comfortable use. c. 1600. Invention of the modern cock ring, and clitoral stimulator. Chinese men slipped ivory rings over their erections to help maintain them. The rings were ornately carved, usually depicting dragons. Over time, the carved dragons’ tongues extended to form a nub that protruded from one side of the rings. The nub was placed against the woman’s clitoris to enhance her pleasure during intercourse, the forerunner of today’s clitoral stimulators. c. 1700. First mention of water-jet massage. Some European heath spas installed gravity-fed systems that sent powerful jets of water into bathing pools. These devices were the forerunners of the jets in- corporated into today’s jacuzzis. While not specifically developed for female genital massage, surviv- ing accounts hint that some women spent considerable time leaning into water-jet spouts. c. 1750. Appearance of modern BDSM. The Kama Sutra mentions sexual spanking and other SM practices. References to SM also appear in European sex writings dating from the 15th century. But BDSM came into its own during the mid-18th century, when some European brothels began special- izing in flagellation and other SM-style “punishments” that dominant prostitutes meted out to willingly submissive men.

1791. Publication of the SM novel, Justine by Donatien Alphonse Francoise, comte de Sade, better known as the Marquis de Sade (1740-1814). De Sade’s name became the source of the term “sa- dism.” His highly controversial writings helped popularize BDSM—and the many toys used in sexual power play, among them: riding crops, whips, nipple clips, and restraints. (In 1870, Leopold von Sach- er-Masoch, published the novel, Venus in Furs, about male sexual submission. His name inspired the term “masochism.”) c. 1830. Debut of the can-can. Parisian dancers inaugurated modern sexual dancing by lifting their skirts on stage and showing off their fishnet stockings, frilly petticoats, and lace panties. Soon after, the panties disappeared, which made the can-can much more popular with French men. The dance Great Sex Guidance: The History of Sex Toys from 25,000 B.C. to Today – © Michael Castleman – 453 – quickly spreads to the U.S.

1844. The vulcanization of rubber. Invented by Charles Goodyear, vulcanization made rubber stron- ger and more elastic. Goodyear went on to found the tire company that bears his name. Other name- less inventors used vulcanized rubber to develop rubber condoms, dildos, and other sex toys.

c. 1850. Debut of vaudeville. This earthy theatrical form combed burlesque with comedians telling jokes ranging from off-color to overtly sexual.

1869. Debut of the first vibrator. Developed by an American physician, George Taylor, M.D., it was a large, cumbersome, steam-powered apparatus. Taylor recommended it for treatment of an illness known at the time as “female hysteria.” Hysteria, from the Greek for “suffering uterus,” involved anxiety, irritability, sexual fantasies, “pelvic heaviness,” and “excessive” vaginal lubrication—in other words, sexual arousal during the Victorian era, a time when women were not considered to be at all sexual. Physicians of that era treated hysteria by massaging sufferers’ vulvas until they experienced dramatic relief through “paroxysm” (orgasm). Unfortunately, hysteria was a recurrent condition. After a few months, weeks, or in serious cases, days, repeat treatment was necessary. Physicians who be- came known for their skill in vulvar massage had women lined up for treatment of hysteria and earned large incomes. They also suffered sore hands and arms. Taylor touted his steam-driven massage device as speeding treatment while reducing physician fatigue.

1882. Debut of the first electromechanical vibrator. Forerunner of today’s vibrators, electromechanical vibrators were smaller and less cumbersome than Taylor’s steam-powered device. The original elec- tromechanical vibe was a battery-powered massager designed by British physician Joseph Mortimer Granville. It featured attachments similar to those in today’s vibrator kits, which allowed the physician treating hysteria to vary the vibratory sensations the device produced. However, Granville, was firmly opposed to using his device as a treatment for female hysteria. He considered it useful only for mas- sage of men’s skeletal muscles to treat injuries caused by overexertion.

1890s. Invention of the motion picture. Almost immediately, early filmmakers began producing por- nography, some of which featured women playing with dildos, including strap-ons, and vibrators.

1899. Publication of America’s first advertisement for a home electric vibrator, the Vibratile, in Mc- Clure’s magazine, as a cure for headache, wrinkles, and “neuralgia,” or nerve pain, a term that includ- ed hysteria.

1900. At the Paris Exposition, physician-inventors displayed more than a dozen electric vibrators. Medical journals and textbooks of that era extolled the devices as effective treatment for many medi- cal conditions, notably female hysteria.

1903. American physician Samuel Howell Monell, M.D., reported “wonderful results” for vibrator treat- ment of female hysteria. In Monell’s view, compared with vibrators, vulvar massage by hand offered “no value for the majority.”

1900-1920. Popularization of the vibrator. As electricity became widely available around the U.S., plug-in home vibrators were one of the first electrified home appliances.They were advertised in many consumer magazines, including: Needlcraft, Modern Women, Home Needlework Journal, and Woman’s Home Companion. Marketed to women as health and relaxation aids, vibrator advertising copy was filled with double-entendres, for example, “all the pleasure of youth...will throb within you.” Great Sex Guidance: The History of Sex Toys from 25,000 B.C. to Today – © Michael Castleman – 454 – The popular Sears & Roebuck catalogue offered a vibrator, it touted as “very satisfactory...[an] aid every woman appreciates.”

1907. The Penis Stiffener wins a U.S. patent. This device, the first American PPA was developed by Louis Hawley. It was a hollow, metal cylinder. It had a wide opening at one end for insertion of the pe- nis, and a small opening at the other to allow sperm into the vagina. It was designed for use by men with erection problems.

1921. The first vibrator advertisement aimed at men. Published in a 1921 issue of Hearst’s magazine, it exhorted men to buy vibrators for their wives as Christmas gifts to keep them “young and pretty” and free from the scourge of hysteria. c. 1925. Vaudeville shows morph into strip-tease. Starring the likes of Gypsy Rose Lee. strippers combined can-can moves with sexual bump and grind. Until the 1960s, strippers don’t strip naked. They slowly peeled down to nipple covers (pasties) and crotch covers (G-strings), both of which even- tually become sex toys. They also incorporated many props into their acts, among them: fans, furs, capes, and feather boas, which eventually were incorporated into lingerie and sex toys.

1927. Debut of KY Jelly. Originally marketed only to physicians to improve women’s comfort during pelvic exams, KY went over the counter as a sexual lubricant in 1980. Since then, many other lubri- cants have been introduced.

Late-1920s. Vibrators appear more prominently in porn, not as “massagers,” but as masturbation aids. One movie, The Widow’s Delight, showed a well-dressed matron at her front door bidding good night to her equally dashing suitor. He attempts to kiss her. She dodges him, then trots off to her bed- room, where she strips down to her underwear, grabs her vibrator, and presses it between her legs. c. 1930. Vibrator advertisements are banished from magazines and catalogues. As more pornograph- ic films showed women using vibrators for sexual self-stimulation, it became impossible for manufac- turers to defend the polite fiction that they were simply innocent “massagers.” Self-appointed guard- ians of rectitude branded them immoral, and very quickly, vibrators virtually disappeared. c. 1930. Development of latex rubber. Lighter, softer, and more pliable then vulcanized rubber, latex revolutionized contraception, allowing production of better condoms and diaphragms. It also led to the development of latex sex toys.

1948. Debut of amateur erotic photography for the masses. Pornographic images had been available ever since the invention of photography in the 1850s—but not widely because they were difficult to develop and reproduce. But in 1948, the Polaroid-Land camera arrived. It produced black and white photographs in just one minute without a third-party developer. It allowed anyone to become an erotic photographer.

1953. Debut of Playboy magazine. Hugh Hefner pasted up the premier issue on his kitchen table in Chicago,. It featuring Marilyn Monroe topless. Extremely tame by today’s standards, Playboy was at- tacked as “pornography.”

1964. Debut of topless dancing. Carol Doda pulled off her pasties and showed her nipples at the Con- dor Club in San Francisco. Bottomless dancing followed not long after.

Great Sex Guidance: The History of Sex Toys from 25,000 B.C. to Today – © Michael Castleman – 455 – c. 1965. Re-emergence of the vibrator. You just can’t keep a good sex toy down.

1970. Debut of the water bed. Inventor Charles P. Hall designed it for sleep comfort, but water beds quickly came to be considered sex enhancing. Hugh Hefner installed one in his bedroom at the Play- boy mansion. Many hotels added them to their honeymoon suites.

1972. Release of Deep Throat. This porn film about a woman (Linda Lovelace) whose clitoris was located in the back of her throat, became the first—and only—X-rated movie to break out of the porn ghetto and play to mainstream audiences. Produced for less than $100,000, it grossed $600 million, and helped porn go mainstream.

1975. Debut of the videocassette recorder (VCR). Within a few years, porn was widely available in video stores nationwide.

Late-1970s. Debut of the home video camera. Forget Polaroids. With a camcorder, anyone could produce porn videos.

1995. Debut of the Internet. Almost immediately, pornography becomes available online.

2009. A Google search of “sex toys” yields 33 million pages. A search of “porn” finds 248 million.

Adam & Eve offers a wide variety of most sex toys.

Great Sex Guidance: The History of Sex Toys from 25,000 B.C. to Today – © Michael Castleman – 456 – More Great Sex Guidance from Michael Castleman