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SEXUAL PERFORMANCE PROBLEMS: ORGASM DIFFICULTIES

Men can experience two forms of orgasm difficulty: quick ejaculation and retarded ejaculation. Men who have trouble maintaining control of ejaculation once high levels of sexual arousal are reached have the condition called quick ejaculation. I have worked with countless men who go to dehumanizing lengths to increase their ability to hold off ejaculation. Even though such strategies may allow them to "last longer," quick ejaculation may still happen once the distracting stimulus stops and sexual pleasure is noticed again.
One man I treated developed the habit of abruptly pointing his toes whenever he felt arousal mounting during lovemaking with his wife. In this way, he would cause the insteps of his feet to spasm in pain, thus distracting himself from his pleasurable sexual feelings. He did last a few minutes longer before ejaculating, but his feet surely did hurt after making love. Other men use desensitizing creams or multiple condoms to numb the pleasure of intercourse so as to last a few precious moments more. The problem with these techniques is that they mute all pleasure from sexual relating.
Ruining your sexual pleasure to prolong lovemaking is not a true solution to problems with quick ejaculation. Some men are probably quick ejaculators because of biological factors, but many such men can learn to control ejaculation better if they learn to be more, not less, aware of and sensitive to their body's progression through the sexual response cycle.
At the opposite end of the spectrum of male orgasm difficulties is the condition called retarded ejaculation. Here, the male can attain high degrees of arousal, fully firm erections, and full participation in intercourse or other forms of sexual stimulation. His penis cooperates wonderfully up to this point in the response cycle. But men with retarded ejaculation have persistent difficulty reaching a climax. It is as though such men get stuck in the arousal phase of sexual response, unable to progress to orgasm. This condition may sound heavenly to a man who suffers from quick ejaculation, but such is not the case. Retarded ejaculation is typically quite frustrating, both to the men who suffer it and to their spouses.
Comparable to the male condition of retarded ejaculation is female orgasmic dysfunction. Here, a woman is able to become highly aroused and experience vaginal lubrication and swelling, but she is unable to experience orgasmic release with any form of sexual stimulation. Some women are able to achieve orgasm from self-stimulation but not from any form of stimulation by a partner.
Many women and their male partners mistakenly assume that the only healthy form of female sexual response is experiencing orgasm in response to penile-vaginal stimulation of the sort that typically occurs during intercourse. The truth is that most women do not experience orgasm from intercourse stimulation. For most women to achieve orgasm, they must receive sufficient stimulation of the clitoris, the tiny sexual organ located above the vaginal opening. Most of a woman's sexually pleasurable nerve endings are located in the clitoris, not in the vagina. A penis moving in and out of a vagina does not provide enough clitoral stimulation for most women to progress to orgasm. The majority of women who do report regularly experiencing orgasm during intercourse typically describe, if interviewed carefully, a pattern of lovemaking that involves receiving rather direct clitoral stimulation. It is this clitoral stimulation, not the stimulation from penile-vaginal contact, that usually triggers orgasm for most women.
With these sexual facts in mind, it is important for you and your partner to be realistic in your sexual expectations. A perfectly normal and healthy variation of female sexual response occurs when a woman enjoys lovemaking that involves intercourse but has orgasmic response only to oral or manual clitoral stimulation.
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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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