SEX AND HEART ILLNESS: SEXUAL RESPONSE

The famous sexual researchers William Masters and Virginia Johnson once made the point that every man and every woman periodically experience difficulties in progressing through the sexual response cycle. Every man has periods of erectile failure or of ejaculation control difficulty. Every woman sometimes has difficulty becoming sexually aroused or experiencing climax. This does not mean that we all suffer from sexual dysfunction. It simply means that we all are human and that the human sexual response cycle is rather fickle—contrary to popular mythology, which suggests that all of us "real" men and women are sexual machines, ready to strike as soon as a breedable mate slows down long enough for us to mount.
Sexual dysfunction occurs when a person experiences persistent , difficulty in progressing through any of the phases of the sexual response cycle.
In understanding your own and your partner's sexuality, it is important to know the basics about the human sexual response cycle. If all goes well during attempted sexual interaction, our bodies progress through fairly predictable stages.
First comes sexual arousal, during which time males experience erection because blood is flowing into the penis, and females experience vaginal lubrication and swelling because of similar vascular activity. Next comes the plateau phase of arousal. Continued sexual interaction is experienced as pleasurable and results in growing sexual tension and arousal. Finally, sexual tension and arousal culminate in the pleasurable release of orgasm, which may or may not be accompanied by ejaculation for males.
Some women are capable of experiencing multiple orgasms, but many women and most men experience a physical resting phase following orgasm. During this resting phase (which is sometimes also called the refractory phase), the body shuts down the sexual response cycle. Further physical signs of arousal from sexual stimulation may not be possible during this resting phase, even if high levels of mental arousal still exist. In other words, during this sexual resting phase, it may not be possible for a man to gain another erection or for a woman to experience another orgasm, even though they may continue to feel sexy. As one of my patients put it, "After I have an orgasm, I feel so close to my wife and am so attracted to the sight of her body lying next to me that I want to keep making love to her. At that point, I can do all kinds of things in my head, but my penis won't cooperate."
This resting phase begins quite abruptly for men, resulting in rapid loss of erection. A woman's body both turns on and reverses the sexual response much more gradually. I believe that herein lies the reason why many men want to roll over and go to sleep after sex, whereas women tend to want to cuddle, talk, or continue to interact in affectionate or sexual ways. It is not just that we men are insensitive and uncommunicative (even though that may also be true); the abrupt turning off of the sexual response cycle can result in temporary feelings of sleepiness and relaxation.
Although a woman's physical sexual response is more gradually reversed, a woman does not always desire prolonged sexual stimulation. In fact, many women find sexual stimulation unpleasant after orgasm, like the feeling of over stimulation that results if you get tickled for too long.
Another result of this sexual resting phase is diminishment of sex drive. The length of time during which sex drive is quieted after orgasm varies from individual to individual and varies during a person's life. As will be seen in our discussion of the sexual effects of aging, lengthening of the resting phase of sexual response occurs inevitably as we grow older.
Finally, it is important to emphasize that no one always progresses neatly through the phases of sexual response. Rather, you move all along the continuum of sexual responding during a typical lovemaking encounter. You may become highly aroused, then momentarily lose arousal, only to regain it if pleasurable interaction and relaxation continue. In fact, research studies charting penile blood flow during sexual arousal have shown that blood actually flows into and out of a man's penis in a manner that can be charted as an upwardly moving stock market graph. Knowing this fact can help prevent needless anxiety if you notice a momentary lessening of arousal as you are making love. Just relax, and arousal will return.
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TAKING ESTROGEN

With the onset of menopause, many women suffer from hot flashes and night sweats. Arlene March, 56, a Los Angeles psychotherapist, says she started getting hot flashes 5 years ago. “I’d be working,” she recalls, “and suddenly feel intense heat all over my body. I’d break out in a sweat. I’d have to stop work. Then Dr. Mishell prescribed estrogen pills, and I’ve not had a day of discomfort.”
Some women experience a drying and thinning of vaginal tissues in the absence of estrogen, making sex painful. They also might suffer urinary tract infections and incontinence. Estrogen therapy often helps.
Among the physicians consulted, the most cautious was Dr. Morris Notelovitz, founder of the nation’s first Menopause Center, at the University of Florida, and head of the Women’s Medical and Diagnostic Center in Gainesville, Florida. He says each symptom needs a different treatment and advises that genital tract problems be given estrogen treatment for a couple of years at most. He also urges special measurements of the bones before prescribing estrogen therapy for osteoporosis.
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WOMEN’S HEALTH

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