Written by Dr David Delvin, GP and Christine Webber, psychotherapist
Growing numbers of people are finding their sex life suffers because they work too hard. Find out what you can do to redress the balance.
Working too hard can take its toll on your relationship.
Britain's long hours work culture means we are seeing an increasing number of people whose sex lives are going badly because of their jobs.
They say they are not making love as often as they used to and don't seem to have the energy for it either.
One high-powered exec told us: 'When I first moved in with my husband, we had sex almost every night. Now we only do it once a month. I think it's because both of us are exhausted.'
The effect of long hours on sex drive
Ebb and flow of desire
Less sex doesn't automatically point to a problem in the relationship.
Human desire tends to ebb and flow quite a bit.
Sometimes we feel really sexy and sometimes we don't.
Also, there is a natural tendency in relationships for sex to get less frequent as time goes by.
This is due to two things:
as the couple grow used to each other, the novelty of the relationship wears off
the desire for sex tends to decline with age, particularly for men.
A study published in the Journal of Sexual Medicine confirms that couples tend to have less sex as they get older, especially after the age of 50.
If you are tired, you are unlikely to have much strength left for sex - whether you are a man or a woman.
When a job is very stressful, the effect of that stress will be to diminish the amount of energy you have for sex.
You may be so stressed out, you don't even think of sex for quite long periods.
The above has always been true, but in recent years we would say long hours have become commonplace and this is having a damaging effect on a lot of people's sex lives.
We first noticed this among patients who work in the financial sector. Some of our clients start work at six in the morning, and carry on for more than 12 hours.
Often, they do not stop for lunch and many of them have a long commute at either end of the day.
So when we see a man or a woman who leaves home at 4.30am and gets back at 8.30pm, it's not surprising that they're likely to have trouble with their sex life.
Sexual difficulties caused by excessive work
No matter what your job, excessive work can cause the following sexual difficulties.
You will have less time for sex.
You will be tired so it may be difficult to summon up much interest.
You may find it more difficult to climax.
You will find it difficult to relax in bed.
If you're female, you may find it hard to produce adequate lubrication pre-intercourse.
If you're male, you may not be able to get erections easily.
Feelings of stress may make you less likely to give your partner sufficient romance and love play.
You will probably opt for doing the same things during sex.
Your partner may show disappointment or even anger towards you because of these work-induced symptoms.
Letting things continue as they are could lead to the breakdown of your relationship.
If work is affecting your love life, you need to do something about it fast. Doing nothing and just hoping things will sort themselves out is folly.
What changes can I make?
Short of giving up your job, there are no instant or magical solutions. But everyone can make small changes in their lives – no matter how busy they are.
These changes need to be ones that will bring some sort of balance into your lifestyle that does not exist currently. Such changes should help your health as well as your love life.
1. Be honest with your partner
The first thing you can do is to be honest with your partner.
We have had clients who have no desire for sex on weekdays. What they want during the week is a loving companion who will snuggle up to them and listen to what has happened in their day, but not demand sex.
If the busy person has never discussed this with their partner, it can cause a lot of upset and rowing because, understandably, the other person tends to feel rejected.
It may not be ideal to only have sex at the weekends or during holidays, but at least if both parties know this, there will be fewer unrealised expectations and fewer quarrels. In other words, the relationship should become more relaxed.
2. Give your partner some attention
It has to be said that honesty is not going to be enough to fix a rocky relationship, unless you pay your partner some real attention. He or she needs to feel affirmed and important – despite the paucity of sex.
3. Think about how you talk to your partner
It's easy to take workplace language into the home, but it can be abrupt and terse. Try not to bark out instructions to your beloved.
Use the journey home from the office to unwind and to get into a softer frame of mind. Instead of working on your laptop all the way, read a book or do a Sudoku puzzle.
You need to change gear from working mode to something a little more empathetic and human if you are to have a healthy romantic life at home.
4. Don't let work encroach on weekends and holidays
If you want to maintain your relationship, your partner will want to feel that you put him or her first at weekends and holidays. This means a complete change of pace.
Try not to bring work home or to keep checking your emails – and switch off your mobile phone.
5. Make sex special
When you do make love, try to wind down first so that you are in a more relaxed frame of mind. Partners do not want to feel that they're being used as a substitute for quick masturbation and all you care about is a swift climax.
Partners want to feel cared for and loved, so cuddle up together first or have a romantic meal. And then spend half an hour giving your loved one a massage, or have a bath or shower together.
6. Add variety in the bedroom
Try to vary your lovemaking. In our experience, very busy people tend to get into a set sexual pattern. They find a routine that works and is fast - and then use it every time.
This is boring and unimaginative. If you keep doing it, it's likely you'll both go off sex and this can spell doom for your relationship.
Lifestyle changes to reduce stress
You also need to make some lifestyle changes that will benefit your mental and physical health – and impact positively on your love life.
Eat breakfast
It is crazy to skip breakfast when it only takes three minutes in the microwave to make some porridge. This is a good way to start the day.
Oats give you a slow-release of energy and line your stomach before a tension-packed day. Or eat some muesli or another healthy cereal. If you can't face that, at least eat a couple of bananas.
Take a lunch break
You may say no-one in your office takes lunch, but why not be the exception? If you can get out of the workplace for half an hour and get some fresh air, you will feel more relaxed.
On days when you have to eat in the office, try ordering in salads, fruit and nuts. This is good fuel for your hard working body.
Drink more water
Make full use of the water cooler. People often get more tense and irritable when they are dehydrated. You will feel better if you drink water all day and cut down your coffee intake to a maximum of two or three cups a day.
Exercise more
Somehow you need to get some exercise. If you look carefully at your timetable, you should be able to find the odd half hour where you can fit in a workout or go for a swim.
If none of this is possible, get off the bus or train two stops early or park your car a few streets away and walk to work. At the office, take stairs instead of lifts between floors.
What if I don't have time to make these changes?
When you are busy and your career is going places, you probably feel you must put work first.
But unless you strive to bring some balance into your life - and you find the time to be loving and close to anyone who matters - you may find that your life begins to feel rather empty and meaningless, despite your healthy bank balance.
Further help
Specific sex problems may be disrupting your sex life that can only be resolved with specialist help. See the factsheets below for more information.
Erectile dysfunction (inability to get or maintain an erection).
Premature ejaculation (ejaculating too quickly to satisfy your partner).
Retarded ejaculation (male inability to climax).
Difficulties in climaxing (women).
Pain on intercourse.
Who to contact for sex therapy.
Friday, April 3, 2009
Who to contact for sex therapy
Written by Christine Webber, psychotherapist and Dr David Delvin, GP and psychosexual specialist
In 2009, more and more people are seeking help with their sex lives.
Whether sex and relationship problems are on the increase, or whether numbers have grown because of people's willingness to seek help, is unclear. What is clear is that if you have concerns regarding any area of your sex life, there are plenty of ways in which you can get assistance.
However, our research suggests that you may have to try pretty hard to get that help – particularly in areas of the country where therapists are rather thin on the ground.
Current NHS policy means there is very little money available for treatment of sex problems. So in most parts of the UK, you will probably have to pay for therapy or counselling.
We've put together a quick checklist of the best professionals and organisations to approach.
Your GP
For most problems, a good starting point is to visit your GP for a preliminary chat about your issues.
Of course it’s not always easy to speak about sex problems. In fact, it can be downright embarrassing. And unfortunately, it’s not only the patients who are embarrassed. Some doctors are not at all comfortable talking about sex difficulties. But it is important to speak frankly to your doctor.
If you find that your own GP isn’t very helpful, it might be worth asking to see one of the other doctors who work at the same surgery. Usually the medic who is responsible for family planning in the practice is a good bet as he or she will be used to talking about sex.
Most GPs allow 10 minutes per patient these days, but as talking about sexual problems can take a while, it might be a good idea to book a double appointment (usually 20 minutes), if this is permitted in your practice.
Your doctor may be able to offer you some immediate help. For instance, in recent years GPs have started prescribing erection drugs such as Cialis (tadalafil), Levitra (vardenafil) and Viagra (sildenafil), although the government places severe restrictions on who can receive them free of charge.
If your family practitioner can't help you, then he or she should discuss the viability of you getting free treatment on the NHS. Unfortunately, in large areas of the UK, no such free treatment is available. Nevertheless, your GP may know of private therapists in your region.
Family planning clinics
NHS family planning (FP) clinics used to be the main providers of psychosexual advice in the UK, particularly for women.
However, the current situation is that the clinics are mostly working under great pressure, so they tend to concentrate on their main job, which is providing contraception.
Many of the nurses and doctors do still have an interest in sexual problems, and will try to help you if time permits. They’re particularly good with the following difficulties:
vaginismus
low libido
poor technique
difficulty reaching orgasm
not being able to conceive.
FP clinics make no charge for giving help.
NHS hospitals
In some areas of the country there are psychosexual units at large hospitals - London and Sheffield are relatively well off in this respect.
There is invariably a waiting list, but people eventually get seen and helped. When you do get an appointment, it may be for some time well in the future. Please try to summon up the courage to attend your appointment. A lot of people get ‘cold feet’ and don’t turn up, which means a wasted appointment slot.
Treatment is free, but you will need to be referred by your GP.
Genitourinary medicine (GUM) clinics
GUM clinics treat sexually transmitted infections and can also help on all sorts of sexual issues.
They have good knowledge and lots of common sense, although the doctors are not generally highly trained in psychosexual issues because their forte is diagnosing and treating infections. In 2009, we have found that a number of clinics have doctors or nurses who offer psychosexual advice to women, but they will often specify that they do not treat erectile dysfunction (ED) or prescribe Viagra, Cialis and similar drugs.
There are concerns that waiting times for GUM clinics are growing, but it should be possible for you to see a doctor within two weeks to get some general advice. However, specialist psychotherapy and marriage guidance are definitely not provided.
All consultations are free. Your nearest GUM clinic is likely to be situated in your nearest big hospital. Ring that hospital for details of opening times. Or you can simply google ‘GUM’ – plus the name of your home town/city –and often nowadays a clinic near your home will then pop up.
NHS gynaecologists and urologists
The NHS should be able to help if a sex problem is essentially physical, for example a too wide vagina after childbirth or a bent penis.
Women are generally referred by their GPs to a gynaecologist and men to a urologist.
Some gynaecologists and urologists now provide psychosexual counselling services, and many urologists are prescribing erection-inducing drugs.
Treatment is free. Your GP should be able to advise you about who to go to and, most essentially, write you a referral letter.
Relate and Relationships Scotland
Relate is not just a relationship counselling agency.
A number of Relate counsellors have specific psychosexual training, mainly in the school of Masters and Johnson. So when you phone (0300 100 1234), make it clear that you are looking for sex therapy rather than guidance concerning relationship issues.
Relate sex counsellors are highly rated for doing an excellent job in treating various ‘technical’ bedroom problems such as:
premature ejaculation
lack of sex drive
inability to climax.
But they are not doctors, and therefore cannot examine you or prescribe medication.
Relate's fees are relatively modest and are means-based.
Relationships Scotland (until recently known as Relate Scotland) does similar good work to Relate, but north of the border. The number of your nearest clinic will be in your local phone book. The central number is 0845 1196088.
Institute of Psychosexual Medicine
The Institute of Psychosexual Medicine is an organisation of family planning doctors who have had special training in sex problems, particularly:
vaginismus
poor libido
difficulty in climaxing.
Some work in family planning clinics; others treat clients privately. Some of the latter will see a patient without a GP's referral – but not all will do this. Fees can be up to £ 150 an hour in the more expensive parts of large cities, so make sure you check beforehand.
Call the Institute on 0207 580 0631, or email them: admin@ipm.org.uk
British Association for Sexual and Relationship Therapy
The British Association for Sexual and Relationship Therapy consists mostly of non-medical personnel though some of its members are qualified doctors. All the association’s accredited members have had extensive training.
The best way to find out about a therapist in your area is to email info@basrt.org.uk
Therapists charge fees, which vary greatly in different parts of the country.
Always check what the costs will be before booking yourself in. Currently, you are likely to pay anything from around £45 to over £100.
Prices vary enormously according to the therapist’s experience and also to his or her location. Obviously, Harley Street and other central London areas are very expensive as the therapist is having to pay very high rents for a consulting room. If therapists work from home, clearly they don’t have rental costs and this tends to keep their fees down.
Sexual Dysfunction Association (SDA)
Formerly the Impotence Association, the Sexual Dysfunction Association is a national charity that tries to help both men and women find a suitable therapist or clinic for sex problems. It doesn't provide treatment or see patients, but it does have some good factsheets.
You can contact them on 0870 77 43571.
In 2009, more and more people are seeking help with their sex lives.
Whether sex and relationship problems are on the increase, or whether numbers have grown because of people's willingness to seek help, is unclear. What is clear is that if you have concerns regarding any area of your sex life, there are plenty of ways in which you can get assistance.
However, our research suggests that you may have to try pretty hard to get that help – particularly in areas of the country where therapists are rather thin on the ground.
Current NHS policy means there is very little money available for treatment of sex problems. So in most parts of the UK, you will probably have to pay for therapy or counselling.
We've put together a quick checklist of the best professionals and organisations to approach.
Your GP
For most problems, a good starting point is to visit your GP for a preliminary chat about your issues.
Of course it’s not always easy to speak about sex problems. In fact, it can be downright embarrassing. And unfortunately, it’s not only the patients who are embarrassed. Some doctors are not at all comfortable talking about sex difficulties. But it is important to speak frankly to your doctor.
If you find that your own GP isn’t very helpful, it might be worth asking to see one of the other doctors who work at the same surgery. Usually the medic who is responsible for family planning in the practice is a good bet as he or she will be used to talking about sex.
Most GPs allow 10 minutes per patient these days, but as talking about sexual problems can take a while, it might be a good idea to book a double appointment (usually 20 minutes), if this is permitted in your practice.
Your doctor may be able to offer you some immediate help. For instance, in recent years GPs have started prescribing erection drugs such as Cialis (tadalafil), Levitra (vardenafil) and Viagra (sildenafil), although the government places severe restrictions on who can receive them free of charge.
If your family practitioner can't help you, then he or she should discuss the viability of you getting free treatment on the NHS. Unfortunately, in large areas of the UK, no such free treatment is available. Nevertheless, your GP may know of private therapists in your region.
Family planning clinics
NHS family planning (FP) clinics used to be the main providers of psychosexual advice in the UK, particularly for women.
However, the current situation is that the clinics are mostly working under great pressure, so they tend to concentrate on their main job, which is providing contraception.
Many of the nurses and doctors do still have an interest in sexual problems, and will try to help you if time permits. They’re particularly good with the following difficulties:
vaginismus
low libido
poor technique
difficulty reaching orgasm
not being able to conceive.
FP clinics make no charge for giving help.
NHS hospitals
In some areas of the country there are psychosexual units at large hospitals - London and Sheffield are relatively well off in this respect.
There is invariably a waiting list, but people eventually get seen and helped. When you do get an appointment, it may be for some time well in the future. Please try to summon up the courage to attend your appointment. A lot of people get ‘cold feet’ and don’t turn up, which means a wasted appointment slot.
Treatment is free, but you will need to be referred by your GP.
Genitourinary medicine (GUM) clinics
GUM clinics treat sexually transmitted infections and can also help on all sorts of sexual issues.
They have good knowledge and lots of common sense, although the doctors are not generally highly trained in psychosexual issues because their forte is diagnosing and treating infections. In 2009, we have found that a number of clinics have doctors or nurses who offer psychosexual advice to women, but they will often specify that they do not treat erectile dysfunction (ED) or prescribe Viagra, Cialis and similar drugs.
There are concerns that waiting times for GUM clinics are growing, but it should be possible for you to see a doctor within two weeks to get some general advice. However, specialist psychotherapy and marriage guidance are definitely not provided.
All consultations are free. Your nearest GUM clinic is likely to be situated in your nearest big hospital. Ring that hospital for details of opening times. Or you can simply google ‘GUM’ – plus the name of your home town/city –and often nowadays a clinic near your home will then pop up.
NHS gynaecologists and urologists
The NHS should be able to help if a sex problem is essentially physical, for example a too wide vagina after childbirth or a bent penis.
Women are generally referred by their GPs to a gynaecologist and men to a urologist.
Some gynaecologists and urologists now provide psychosexual counselling services, and many urologists are prescribing erection-inducing drugs.
Treatment is free. Your GP should be able to advise you about who to go to and, most essentially, write you a referral letter.
Relate and Relationships Scotland
Relate is not just a relationship counselling agency.
A number of Relate counsellors have specific psychosexual training, mainly in the school of Masters and Johnson. So when you phone (0300 100 1234), make it clear that you are looking for sex therapy rather than guidance concerning relationship issues.
Relate sex counsellors are highly rated for doing an excellent job in treating various ‘technical’ bedroom problems such as:
premature ejaculation
lack of sex drive
inability to climax.
But they are not doctors, and therefore cannot examine you or prescribe medication.
Relate's fees are relatively modest and are means-based.
Relationships Scotland (until recently known as Relate Scotland) does similar good work to Relate, but north of the border. The number of your nearest clinic will be in your local phone book. The central number is 0845 1196088.
Institute of Psychosexual Medicine
The Institute of Psychosexual Medicine is an organisation of family planning doctors who have had special training in sex problems, particularly:
vaginismus
poor libido
difficulty in climaxing.
Some work in family planning clinics; others treat clients privately. Some of the latter will see a patient without a GP's referral – but not all will do this. Fees can be up to £ 150 an hour in the more expensive parts of large cities, so make sure you check beforehand.
Call the Institute on 0207 580 0631, or email them: admin@ipm.org.uk
British Association for Sexual and Relationship Therapy
The British Association for Sexual and Relationship Therapy consists mostly of non-medical personnel though some of its members are qualified doctors. All the association’s accredited members have had extensive training.
The best way to find out about a therapist in your area is to email info@basrt.org.uk
Therapists charge fees, which vary greatly in different parts of the country.
Always check what the costs will be before booking yourself in. Currently, you are likely to pay anything from around £45 to over £100.
Prices vary enormously according to the therapist’s experience and also to his or her location. Obviously, Harley Street and other central London areas are very expensive as the therapist is having to pay very high rents for a consulting room. If therapists work from home, clearly they don’t have rental costs and this tends to keep their fees down.
Sexual Dysfunction Association (SDA)
Formerly the Impotence Association, the Sexual Dysfunction Association is a national charity that tries to help both men and women find a suitable therapist or clinic for sex problems. It doesn't provide treatment or see patients, but it does have some good factsheets.
You can contact them on 0870 77 43571.
Sex, heart disease and physical disability
Reviewed by Dr Neal Uren, consultant cardiologist and Dr David Delvin, GP and sex and relationships expert
There are a many medical conditions and disabilities that make it difficult to enjoy a normal sex life.
For example, sexual intercourse may be difficult for people with any of the following conditions:
paralysis (following a stroke or a spinal injury)
severe arthritis
heart failure
severe respiratory problems (such as chronic bronchitis or emphysema)
kidney (renal) failure.
Numerically, the problem which most often affects people’s sex lives is heart disease.
Heart attacks and heart failure (cardiac insufficiency) are common, and can easily make patients feel frightened about re-starting sexual intercourse.
Unfortunately, a lot of people are embarrassed about discussing such issues. So a disabled person may find it hard to talk about his or her sexual problem or to ask for any kind of help. A reluctance to discuss things often makes the problem worse.
So do try and talk matters over with your partner and (if necessary) your doctor.
Heart disease
A patient's sex life may suffer following a heart attack or other form of heart disease, even after recovery. The patient or their spouse may be afraid that the physical strain of sexual intercourse will provoke serious heart problems.
In fact, the exertion of sexual intercourse does not usually exceed that of climbing four floors of stairs at an easy pace, provided people take things easily.
If the patient can climb four floors without breathing difficulties, significant palpitations or any much chest pain (angina), they should be able to have sex as well. Having sex may even restore their faith in their health.
After the shock of heart disease, and the natural fear of losing each other, a couple may find that their relationship is made stronger by resuming their sex life. Anyone who has had a heart attack and is concerned about having sex should ask their doctor for guidance.
Based on a text by Dr Erik Fangel Poulsen, specialist
There are a many medical conditions and disabilities that make it difficult to enjoy a normal sex life.
For example, sexual intercourse may be difficult for people with any of the following conditions:
paralysis (following a stroke or a spinal injury)
severe arthritis
heart failure
severe respiratory problems (such as chronic bronchitis or emphysema)
kidney (renal) failure.
Numerically, the problem which most often affects people’s sex lives is heart disease.
Heart attacks and heart failure (cardiac insufficiency) are common, and can easily make patients feel frightened about re-starting sexual intercourse.
Unfortunately, a lot of people are embarrassed about discussing such issues. So a disabled person may find it hard to talk about his or her sexual problem or to ask for any kind of help. A reluctance to discuss things often makes the problem worse.
So do try and talk matters over with your partner and (if necessary) your doctor.
Heart disease
A patient's sex life may suffer following a heart attack or other form of heart disease, even after recovery. The patient or their spouse may be afraid that the physical strain of sexual intercourse will provoke serious heart problems.
In fact, the exertion of sexual intercourse does not usually exceed that of climbing four floors of stairs at an easy pace, provided people take things easily.
If the patient can climb four floors without breathing difficulties, significant palpitations or any much chest pain (angina), they should be able to have sex as well. Having sex may even restore their faith in their health.
After the shock of heart disease, and the natural fear of losing each other, a couple may find that their relationship is made stronger by resuming their sex life. Anyone who has had a heart attack and is concerned about having sex should ask their doctor for guidance.
Based on a text by Dr Erik Fangel Poulsen, specialist
Sex and neurological disorders
Written by Dr David Delvin, GP and family planning specialist
What is a neurological disorder?
A neurological disorder is a disease or injury of the nervous system – which is the ‘communications network’ of the body. Common neurological disorders include strokes, multiple sclerosis (MS), Parkinson’s disease and spinal injuries – mainly caused by road accidents. Head injuries are also common, and may interfere with sexual function.
It is important to realise that the vast majority of sexual problems are not caused by any kind of neurological disease.
However, nerve disorders which can cause sexual difficulties include all the above conditions.
Strokes
Strokes (cerebrovascular accidents or CVAs) are tremendously common, and affect well over 100,000 people each year in the UK.
Many of them make a good recovery. Quite a few CVA survivors do want to continue with their sex lives – particularly men.
With the help of a cooperative and loving partner, it is often possible to continue with a reasonable amount of sexual activity, though lack of mobility may be a problem. Some couples successfully get round this with the use of vibrators.
Multiple sclerosis (MS)
Free treatment
MS is one of the few disorders which entitle the patient, under the NHS, to free treatment with drugs for erection problems.
Many men and women who have multiple sclerosis (MS) do manage to maintain a rewarding sex life. However, some patients do have difficulty in achieving orgasm. Men may sometimes have problems in getting an erection.
Fortunately, the recently developed ‘erection helping’ drugs have proved a great boon to many male MS sufferers.
Viagra (sildenafil) works in about half of these patients. If it is not successful, then it’s well worth trying its newer successors: Cialis (tadalafil) and Levitra (vardenafil).
If these drugs fail, there is also the possibility of penile injections, or of using a vacuum pump.
Parkinson’s disease
Parkinson's disease is extremely common, and has become more so as people have started to live longer.
It causes trembling and incordination in various parts of the body. The difficulty in coordination may cause problems with intercourse, and sometimes with erection.
Fortunately, the oral treatments for erectile dysfunction (ED) can help these patients, and they are not contraindicated in men with Parkinson's disease. Under the NHS regulations, these drugs are available free if you have Parkinson’s disease.
Spinal injuries
Serious spinal injuries – most commonly sustained in traffic, riding or aircraft accidents – are likely to cause paralysis and loss of sensation in regions of the body below the level of the damage to the spinal cord.
Unfortunately, sexual function is very often affected. Men may lose the ability to get an erection – and obviously this may make it very difficult for them to have children.
However, many people with spinal injuries do manage to have a fairly active sex life – particularly if they have a considerate, loving and inventive partner.
Furthermore, the new drugs to treat ED will help many men who have sustained spinal trauma. NHS rules allow free prescription of these drugs if you have a spinal cord injury.
If the man wants to father children, this may sometimes be possible using recently developed methods of obtaining sperm, such as electro-ejaculation – in which an electric stimulus is applied to the prostate area, via the rectum.
The cost of this treatment is considerable, but if you were injured in an accident through no fault of your own, your compensation payment may cover it.
At a conference we attended in 2008, it was stated that a cheaper alternative to electrotherapy is the use of a male specially-designed vibrator, operating at a particular frequency.
Useful organisations
Organisations which can provide further information that may help your sex life include:
The Stroke Association: helpline: 0845 3033100.
Multiple Sclerosis Society: helpline: 0808 800 8000.
Parkinson's Disease Society: helpline: 0808 800 0303.
Spinal Injuries Association: helpline: 0800 980 0501.
Outsiders Sex and Disability helpline: telephone: 0707 499 3527.
What is a neurological disorder?
A neurological disorder is a disease or injury of the nervous system – which is the ‘communications network’ of the body. Common neurological disorders include strokes, multiple sclerosis (MS), Parkinson’s disease and spinal injuries – mainly caused by road accidents. Head injuries are also common, and may interfere with sexual function.
It is important to realise that the vast majority of sexual problems are not caused by any kind of neurological disease.
However, nerve disorders which can cause sexual difficulties include all the above conditions.
Strokes
Strokes (cerebrovascular accidents or CVAs) are tremendously common, and affect well over 100,000 people each year in the UK.
Many of them make a good recovery. Quite a few CVA survivors do want to continue with their sex lives – particularly men.
With the help of a cooperative and loving partner, it is often possible to continue with a reasonable amount of sexual activity, though lack of mobility may be a problem. Some couples successfully get round this with the use of vibrators.
Multiple sclerosis (MS)
Free treatment
MS is one of the few disorders which entitle the patient, under the NHS, to free treatment with drugs for erection problems.
Many men and women who have multiple sclerosis (MS) do manage to maintain a rewarding sex life. However, some patients do have difficulty in achieving orgasm. Men may sometimes have problems in getting an erection.
Fortunately, the recently developed ‘erection helping’ drugs have proved a great boon to many male MS sufferers.
Viagra (sildenafil) works in about half of these patients. If it is not successful, then it’s well worth trying its newer successors: Cialis (tadalafil) and Levitra (vardenafil).
If these drugs fail, there is also the possibility of penile injections, or of using a vacuum pump.
Parkinson’s disease
Parkinson's disease is extremely common, and has become more so as people have started to live longer.
It causes trembling and incordination in various parts of the body. The difficulty in coordination may cause problems with intercourse, and sometimes with erection.
Fortunately, the oral treatments for erectile dysfunction (ED) can help these patients, and they are not contraindicated in men with Parkinson's disease. Under the NHS regulations, these drugs are available free if you have Parkinson’s disease.
Spinal injuries
Serious spinal injuries – most commonly sustained in traffic, riding or aircraft accidents – are likely to cause paralysis and loss of sensation in regions of the body below the level of the damage to the spinal cord.
Unfortunately, sexual function is very often affected. Men may lose the ability to get an erection – and obviously this may make it very difficult for them to have children.
However, many people with spinal injuries do manage to have a fairly active sex life – particularly if they have a considerate, loving and inventive partner.
Furthermore, the new drugs to treat ED will help many men who have sustained spinal trauma. NHS rules allow free prescription of these drugs if you have a spinal cord injury.
If the man wants to father children, this may sometimes be possible using recently developed methods of obtaining sperm, such as electro-ejaculation – in which an electric stimulus is applied to the prostate area, via the rectum.
The cost of this treatment is considerable, but if you were injured in an accident through no fault of your own, your compensation payment may cover it.
At a conference we attended in 2008, it was stated that a cheaper alternative to electrotherapy is the use of a male specially-designed vibrator, operating at a particular frequency.
Useful organisations
Organisations which can provide further information that may help your sex life include:
The Stroke Association: helpline: 0845 3033100.
Multiple Sclerosis Society: helpline: 0808 800 8000.
Parkinson's Disease Society: helpline: 0808 800 0303.
Spinal Injuries Association: helpline: 0800 980 0501.
Outsiders Sex and Disability helpline: telephone: 0707 499 3527.
Sex and diabetes
Reviewed by Dr David Delvin, GP and psychosexual specialist, Christine Webber, Psychotherapist and Dr Dan Rutherford, GP
If diabetes causes sexual problems, talk to your GP.
Twenty-five per cent of all women with diabetes and about 50 per cent of men will experience some kind of sexual problems or loss of sexual desire as a result of their condition.
What problems does diabetes cause?
In men
Long-term diabetes can cause damage to the nervous system, which is involved in the complex process of erection.
This means men with diabetes may suffer from erectile dysfunction (ED) and be unable to get or maintain an erection. As many as a third of men with diabetes eventually experience ED.
Some men only discover they have diabetes when they seek treatment for their erectile dysfunction.
Once diabetes has been regulated through diet, pills or insulin injections, sexual problems often disappear and the ability to get an erection is restored.
In women
A number of women with diabetes may suffer from recurring vaginitis (inflammation of the vagina), which is usually due to yeast (thrush) infection. This makes sex painful. You may suffer itching or burning sensations, and a white discharge.
Women with diabetes may also get recurring cystitis.
There is also some suggestion that women with diabetes have problems with arousal, and just as the penis fails to become erect in the man, the clitoris in a woman may not respond to stimulation in the normal way.
Can you make your sex life work when you have diabetes?
If you feel diabetes is causing problems with your sex life, talk to your doctor.
While no-one relishes talking about sexual problems with a doctor, these issues can only be addressed if you seek help.
Your GP will try to find out whether sexual problems are caused by defects in the nervous or circulatory system as a result of the diabetes, or whether they are of a more psychological nature. Often this distinction is difficult to make.
In any case, when sexual dysfunction begins to happen on a regular basis it tends to get worse unless it is properly treated, so the psychological element inevitably builds up.
An increasing number of men who have diabetes and ED are being helped by medicines such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).
If tests confirm that your nervous system hasn't been damaged by diabetes, and there are no associated circulatory problems, there's no reason why your sex life shouldn't recover.
Sometimes a little help and support from your partner and doctor is all that's needed.
What can be done about sexual problems that are not caused by diabetes?
This is a sensitive issue, but help is available.
Generally the most useful first port of call is your family doctor, who can refer you (and your partner) to a psychosexual therapist – or relationship counsellor if this is more appropriate.
Try not to dwell on the fact diabetes can cause sexual problems – just because it can, doesn't mean it will.
And if you do experience difficulties, be reassured that nowadays there is a lot of help available:
Diabetes UK
Relate
British Association for Sexual and Relationship Therapy.
Based on a text by Dr Erik Fangel Poulson, Specialist
Sex and cancer
Reviewed by Christine Webber, psychotherapist and lifecoach and Dr David Delvin, GP and family planning specialist
Does cancer cause sexual problems?
Yes, very frequently. You see, it is always a shock for people to be told that they have cancer or any other serious illness. Their lives are suddenly dominated by medical examinations and treatment – and quite naturally all of their attention is focused on the disease.
In this frightening situation, it's not unusual for sex to take a back seat for a time. But after a while, when the patient has gathered enough strength to look forward and to take an interest in good health and a normal life once again, he or she will almost certainly rediscover an interest in sex. But it may be difficult to resume sexual relations - particularly if you are tired or in pain.
Does cancer cause problems in a relationship?
In most relationships, serious illness can result in anxiety and uncertainty. Furthermore, the patient may be afraid that sex could cause physical injuries.
Even after patients recover, they may worry that having sex will cause the illness to break out again. People may also have irrational fears that the illness may be contagious or sexually transmitted.
These kinds of thoughts and misconceptions can make a relationship come to a standstill. It's vital for couples in this situation to talk to each other - and to a doctor - to dispel any fears or uncertainties.
They may also benefit greatly from being referred to a medical expert specialising in psychosexual medicine, or from getting some counselling with a sex or relationship therapist.
Can it be dangerous to have sex when you have cancer?
Unless the cancer affects the genital area, there is usually no reason why the patient should not have sex.
It is a good idea for cancer patients to discuss with their doctor whether or not they can have sex. If possible, this question should be raised early in the illness before any potential operation or complicated medical treatment such as chemotherapy has begun.
Unfortunately, it has to be said that – even today – not all doctors are comfortable talking about this subject. Sometimes a nurse, or a counsellor, is a better person to chat to.
It is extremely important that patients are kept well informed about their illness and its immediate consequences in the short term and in the long term.
They will want to know what impact it will have on every aspect of their life – including their sex life. For instance, people need to know whether the treatment will have any effect on their sexual function or fertility.
Are the patient's sexual problems caused by factors other than cancer?
If a patient experiences difficulties with sex after cancer or any other serious disease, it may help if they ask themselves the following questions: 'Are my sexual problems a result of the disease itself or are they caused by other things in my relationship?'
If a person is not sure that he or she is capable of functioning sexually it might help to try to achieve orgasm by masturbation. If this ‘works', then that is a sign that the basic mechanics of the sexual apparatus are functioning properly.
If sexual difficulties arise, it is essential that you ask a GP or specialist whether the problem is due to:
the cancer
the treatment of the cancer
other factors such as psychological causes.
What can be done if cancer has led to a physical disability that affects the performance of the sex organs?
Remember that loss of sensation does not mean loss of feelings. If the illness has resulted in a male patient becoming impotent he should bear in mind that there are many highly effective treatments for impotence these days.
But he should also realise that he can still be loving towards a partner and help him or her have orgasms by methods other than intercourse. It is very possible for people to have sexual relationships even if the function of their genitals has been lost.
Any cancer patient – male or female – who has sex or relationship problems will also probably benefit from being involved in one or other of the excellent cancer patients' support groups. It is very useful to chat to other people who are going through similar problems to your own. This communication will help you feel less hopeless and less isolated.
Based on a text by Dr Erik Fangel Poulson, specialist
Does cancer cause sexual problems?
Yes, very frequently. You see, it is always a shock for people to be told that they have cancer or any other serious illness. Their lives are suddenly dominated by medical examinations and treatment – and quite naturally all of their attention is focused on the disease.
In this frightening situation, it's not unusual for sex to take a back seat for a time. But after a while, when the patient has gathered enough strength to look forward and to take an interest in good health and a normal life once again, he or she will almost certainly rediscover an interest in sex. But it may be difficult to resume sexual relations - particularly if you are tired or in pain.
Does cancer cause problems in a relationship?
In most relationships, serious illness can result in anxiety and uncertainty. Furthermore, the patient may be afraid that sex could cause physical injuries.
Even after patients recover, they may worry that having sex will cause the illness to break out again. People may also have irrational fears that the illness may be contagious or sexually transmitted.
These kinds of thoughts and misconceptions can make a relationship come to a standstill. It's vital for couples in this situation to talk to each other - and to a doctor - to dispel any fears or uncertainties.
They may also benefit greatly from being referred to a medical expert specialising in psychosexual medicine, or from getting some counselling with a sex or relationship therapist.
Can it be dangerous to have sex when you have cancer?
Unless the cancer affects the genital area, there is usually no reason why the patient should not have sex.
It is a good idea for cancer patients to discuss with their doctor whether or not they can have sex. If possible, this question should be raised early in the illness before any potential operation or complicated medical treatment such as chemotherapy has begun.
Unfortunately, it has to be said that – even today – not all doctors are comfortable talking about this subject. Sometimes a nurse, or a counsellor, is a better person to chat to.
It is extremely important that patients are kept well informed about their illness and its immediate consequences in the short term and in the long term.
They will want to know what impact it will have on every aspect of their life – including their sex life. For instance, people need to know whether the treatment will have any effect on their sexual function or fertility.
Are the patient's sexual problems caused by factors other than cancer?
If a patient experiences difficulties with sex after cancer or any other serious disease, it may help if they ask themselves the following questions: 'Are my sexual problems a result of the disease itself or are they caused by other things in my relationship?'
If a person is not sure that he or she is capable of functioning sexually it might help to try to achieve orgasm by masturbation. If this ‘works', then that is a sign that the basic mechanics of the sexual apparatus are functioning properly.
If sexual difficulties arise, it is essential that you ask a GP or specialist whether the problem is due to:
the cancer
the treatment of the cancer
other factors such as psychological causes.
What can be done if cancer has led to a physical disability that affects the performance of the sex organs?
Remember that loss of sensation does not mean loss of feelings. If the illness has resulted in a male patient becoming impotent he should bear in mind that there are many highly effective treatments for impotence these days.
But he should also realise that he can still be loving towards a partner and help him or her have orgasms by methods other than intercourse. It is very possible for people to have sexual relationships even if the function of their genitals has been lost.
Any cancer patient – male or female – who has sex or relationship problems will also probably benefit from being involved in one or other of the excellent cancer patients' support groups. It is very useful to chat to other people who are going through similar problems to your own. This communication will help you feel less hopeless and less isolated.
Based on a text by Dr Erik Fangel Poulson, specialist
Sex and alcohol
Written by Dr David Delvin, GP and family planning specialist
Alcohol affects people’s sex lives in many ways. We can divide its effects into ‘bad’ and ‘good.’
Good effects of alcohol
Small amounts of alcohol oil the social wheels and reduce shyness – thereby making it easier for people to meet up.
Similarly, a little wine or a cocktail will often make a person feel romantic – or perhaps less ‘uptight’ about sex.
Also, a very small ‘dose’ of alcohol can extend the time which a nervous young man takes before he climaxes – thus combating any slight tendency to come too soon or experience mild premature ejaculation (PE). However, alcohol is not a treatment for this condition.
Bad effects of alcohol
Unfortunately, the list of ‘bad’ effects of alcohol is much longer! Here they are:
Alcohol makes people far more likely to have unwise sex with the wrong person – and therefore to get pregnant, to catch infections, and to embark on affairs that cause marriage break-ups. In fact, booze is the main reason why in 2005, there is a massive demand for the ‘morning-after pill’ on Saturday, Sunday and Monday mornings.
Alcohol makes people fuddled, so that they don’t take proper contraceptive precautions.
Alcohol is bad for the unborn baby – so it should only be taken very sparingly in pregnancy. During 2008, there have been conflicting reports about how safe it is for pregnant women. Some authorities feel that during pregnancy it should be avoided totally. At present we don’t know whether alcohol taken on the night of conception could be bad for the baby.
Alcohol is a major cause of impotence (erectile dysfunction). A lot of younger males don’t realise this, because they think that booze boosts ‘horniness'. But as Shakespeare says in the Scottish play: ‘It increases the desire, but it takes away the performance.’
A lot of men who are hooked on alcohol develop permanent ‘Brewer’s droop’ – and often loss of interest in sex as well.
We do not yet know if excessive alcohol use can cause female sexual problems, but on the basis of probabilities it does seem likely that some cases of diminished libido are due to excessive alcohol consumption.
If you have problems with excessive alcohol use or think you may be suffering from alcoholism, we suggest you contact Alcoholics Anonymous.
Alcohol affects people’s sex lives in many ways. We can divide its effects into ‘bad’ and ‘good.’
Good effects of alcohol
Small amounts of alcohol oil the social wheels and reduce shyness – thereby making it easier for people to meet up.
Similarly, a little wine or a cocktail will often make a person feel romantic – or perhaps less ‘uptight’ about sex.
Also, a very small ‘dose’ of alcohol can extend the time which a nervous young man takes before he climaxes – thus combating any slight tendency to come too soon or experience mild premature ejaculation (PE). However, alcohol is not a treatment for this condition.
Bad effects of alcohol
Unfortunately, the list of ‘bad’ effects of alcohol is much longer! Here they are:
Alcohol makes people far more likely to have unwise sex with the wrong person – and therefore to get pregnant, to catch infections, and to embark on affairs that cause marriage break-ups. In fact, booze is the main reason why in 2005, there is a massive demand for the ‘morning-after pill’ on Saturday, Sunday and Monday mornings.
Alcohol makes people fuddled, so that they don’t take proper contraceptive precautions.
Alcohol is bad for the unborn baby – so it should only be taken very sparingly in pregnancy. During 2008, there have been conflicting reports about how safe it is for pregnant women. Some authorities feel that during pregnancy it should be avoided totally. At present we don’t know whether alcohol taken on the night of conception could be bad for the baby.
Alcohol is a major cause of impotence (erectile dysfunction). A lot of younger males don’t realise this, because they think that booze boosts ‘horniness'. But as Shakespeare says in the Scottish play: ‘It increases the desire, but it takes away the performance.’
A lot of men who are hooked on alcohol develop permanent ‘Brewer’s droop’ – and often loss of interest in sex as well.
We do not yet know if excessive alcohol use can cause female sexual problems, but on the basis of probabilities it does seem likely that some cases of diminished libido are due to excessive alcohol consumption.
If you have problems with excessive alcohol use or think you may be suffering from alcoholism, we suggest you contact Alcoholics Anonymous.
Sex after abdominal diseases
Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist and lifecoach
Do abdominal diseases affect your sex life?
Yes, they certainly do! Almost all of the diseases which occur in the abdomen can affect a couple's sex life. This is because symptoms such as pain, soreness, burning, discharge and bleeding may cause discomfort during sexual intercourse.
The very thought of having an abdominal disorder can also psychologically affect your sex life and reduce your sex drive. When trying to make love, you may find it difficult to switch off and relax.
After having an operation on your abdomen you might experience after-effects that make you uncomfortable.
For instance, the area that has been ‘cut’ may feel strange and painful for several months. So even if the rest of your body is healthy and working normally, your desire for sex may be low. This means that at first you may not be able to have sexual intercourse or feel the kind of pleasure you used to.
It is also important to realise that in some major abdominal operations the nerve supply to the genital area may possibly be cut through. If you are going to have lower abdominal surgery, do discuss this possibility beforehand with the surgeon.
The very thought of having such a disease can also psychologically affect your sex life and reduce your sex drive. When trying to make love, you may find it difficult to switch off and relax.
How do you recommence your sex life?
It is important that you talk to your partner about your low sex drive and also let them know when desire returns. If you don’t tell them, they have no way of knowing how you feel or what you are capable of doing.
If you say nothing, your partner may initiate sex before you feel ready. In such a case, it's likely you'll either refuse or agree through a sense of duty. Either way, sex may not go very well.
On the other hand, your partner may be overly hesitant about initiating sex through consideration for your feelings. He or she may assume you don't feel like it and you, in turn may conclude that your partner has lost interest in you. Consequently, nothing happens and neither of you knows how the other is really feeling.
What to do after pelvic inflammatory disease (PID)
It can be difficult for women to resume their sex life after having a bout of pelvic inflammatory disease PID. They may feel discomfort for months or believe that the infection has returned. During this time, any attempt to have sexual intercourse is likely to run into trouble.. However, most women will eventually feel like returning to sex.
Talk to your partner about it. Find a time when you are both in the mood and begin by kissing and caressing. Then you can very gradually progress to loveplay.
Don't move on to sexual intercourse before you are completely ready. In other words, you should feel like making love – and in addition, your vagina should also feel moist enough for your partner to enter you easily.
If there is pain or discomfort, do not attempt further penetration but continue your lovemaking with sexual stimulation that does not involve intercourse.
Do abdominal diseases affect your sex life?
Yes, they certainly do! Almost all of the diseases which occur in the abdomen can affect a couple's sex life. This is because symptoms such as pain, soreness, burning, discharge and bleeding may cause discomfort during sexual intercourse.
The very thought of having an abdominal disorder can also psychologically affect your sex life and reduce your sex drive. When trying to make love, you may find it difficult to switch off and relax.
After having an operation on your abdomen you might experience after-effects that make you uncomfortable.
For instance, the area that has been ‘cut’ may feel strange and painful for several months. So even if the rest of your body is healthy and working normally, your desire for sex may be low. This means that at first you may not be able to have sexual intercourse or feel the kind of pleasure you used to.
It is also important to realise that in some major abdominal operations the nerve supply to the genital area may possibly be cut through. If you are going to have lower abdominal surgery, do discuss this possibility beforehand with the surgeon.
The very thought of having such a disease can also psychologically affect your sex life and reduce your sex drive. When trying to make love, you may find it difficult to switch off and relax.
How do you recommence your sex life?
It is important that you talk to your partner about your low sex drive and also let them know when desire returns. If you don’t tell them, they have no way of knowing how you feel or what you are capable of doing.
If you say nothing, your partner may initiate sex before you feel ready. In such a case, it's likely you'll either refuse or agree through a sense of duty. Either way, sex may not go very well.
On the other hand, your partner may be overly hesitant about initiating sex through consideration for your feelings. He or she may assume you don't feel like it and you, in turn may conclude that your partner has lost interest in you. Consequently, nothing happens and neither of you knows how the other is really feeling.
What to do after pelvic inflammatory disease (PID)
It can be difficult for women to resume their sex life after having a bout of pelvic inflammatory disease PID. They may feel discomfort for months or believe that the infection has returned. During this time, any attempt to have sexual intercourse is likely to run into trouble.. However, most women will eventually feel like returning to sex.
Talk to your partner about it. Find a time when you are both in the mood and begin by kissing and caressing. Then you can very gradually progress to loveplay.
Don't move on to sexual intercourse before you are completely ready. In other words, you should feel like making love – and in addition, your vagina should also feel moist enough for your partner to enter you easily.
If there is pain or discomfort, do not attempt further penetration but continue your lovemaking with sexual stimulation that does not involve intercourse.
Painful intercourse (dyspareunia)
Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist
Do you get pain during intercourse? If so, then the odds are that you're a woman – though at the end of this article, you'll find advice for the small number of men who get intercourse pain.
It's not much fun having pain during sex. After all, sex is meant to be an enjoyable and happy experience. If you get pain, it isn't.
Fortunately, the trouble will often resolve if the man takes more time with love play so that the woman's vagina relaxes and her natural lubricant flows, and if the couple use one of the newer sex lubricants like Eros or Liquid Silk.
When to seek help
You can safely disregard one isolated episode of pain during sex. It's easy to feel pain when a sensitive part of you is being prodded quite hard.
But if the pain keeps on happening, you shouldn't feel you have to put up with it. Get something done to improve things.
How? If you know that your GP is skilled at dealing with these matters, then he or she would be a good person to consult. But we have to admit that most family doctors are not trained in dealing with pain during intercourse.
It might be more realistic to go to your local family planning clinic. Many family planning clinic doctors (usually women) have spent a long time being trained by the Institute of Psychosexual Medicine (IPM) to deal with this type of pain.
Unfortunately, family planning clinics have become rather swamped with patients needing help, and they don’t have as much time as they used to for helping women with intercourse difficulties.
An alternative is to see a female IPM-trained doctor privately. There are also excellent NHS psychosexual clinics in some parts of the country - notably Sheffield, Preston, Paddington and Tooting.
A very good low-cost sexual counselling service is provided by both Relate and Relationships Scotland – formerly known as Relate Scotland.
The emotional factor
In a minute, we'll look at the possible cause of intercourse pain, or dyspareunia, to give it its medical name. But it's important to realise that there is usually some emotional element in this problem.
If you experience pain during sex, it's almost certain to be distressing for you. This distress may well make you tighten up down below. And this tightening up will very likely make the pain worse next time.
Unfortunately, painful intercourse can often have a destructive emotional effect on a relationship. Sometimes couples split up because of it. So that's a clear reason why you should get the problem sorted out as soon as possible.
What causes it?
There are dozens of possible causes of dyspareunia. Fortunately, many of them aren't too serious, but a few are.
Ideally, the assessment should be done by a doctor who is skilled in the technique of vaginal examination.
One of the first things to establish is: is the pain deep inside you? Or is it near the outside?
This may not be easy for you to say. Sometimes a pain is both superficial (near the outside) and deep. But deciding which it is can help sort out what's wrong.
Vaginismus
Vaginismus can cause both deep and superficial pain and is a common cause of pain during sex. It's a spasm of the vaginal muscles, caused mainly by fear of being hurt.
This spasm is often so painful that intercourse is impossible – sometimes for years.
Some women with vaginismus have never been able to have full sex or even use tampons. They also tend to be very fearful of vaginal examinations and so may never have had a smear test.
Vaginismus arouses strong emotions, and women who have it are often very angry with partners, doctors and themselves. But the condition is no one's fault.
Common causes include:
a restrictive upbringing, in which the woman was brought up to view sex as nasty or dirty.
an upbringing in which the woman was given the idea that the vagina is very narrow and so sex must be very painful.
a background where rape or childhood sexual abuse has taken place. Experiences like these understandably make women fearful of sex and of being hurt.
painful vaginal infections.
unease with their partner – perhaps at an unconscious level.
It is a common misconception that women with vaginismus dislike sex altogether.
In fact, many women with this condition enjoy closeness with their partners.
Many get great pleasure from love play and some are able to reach orgasm in this way. But the enjoyment ceases when penetration is attempted or suggested.
In the UK, women doctors who have been trained by the Institute of Psychosexual Medicine have by far the greatest experience of treating vaginismus.
What are the other causes of deep pain during sex?
Problems with your cervix: the man's penis hits the cervix at the farthest extent of his thrust. So infections of the cervix and tender places on it can cause pain during deep penetration. This is called 'collision dyspareunia'.
Womb trouble: various womb disorders, including fibroids, can cause deep intercourse pain.
Endometriosis: this very common disorder often affects the womb and surrounding tissues. It makes them very tender, particularly near period times. The pressure of the penis on an area of endometriosis may cause intense, deep pain.
Ovary problems: cysts on the ovary can cause deep pain. Pain may also be caused if the tip of the penis hits an unusually positioned ovary.
Pelvic inflammatory disease (PID): this is caused by infection, and has become more common in the UK largely thanks to the bug called chlamydia. If chlamydia isn't treated, there is quite a chance of PID developing. In PID, the tissues deep inside become badly inflamed and so the pressure of intercourse causes deep pain.
Ectopic pregnancy: this means a pregnancy outside the womb, usually in the Fallopian tube. Pressure on it can be very painful.
What are the other causes of more superficial pain?
Lack of lubrication
This can be due to nervousness, hang-ups and failure to relax. Unskilled foreplay by the man is a common cause, especially when it doesn't go on long enough. (Many women would like half an hour – but don't get it!)
Well-endowed partner
Some women complain that their partner’s penis is too big.
In fact, when a woman is aroused and relaxed, the vagina extends by several inches – so any female should be able to accommodate any male.
But being unused to a larger man or previous problems with bladder infections or endometriosis can lead to anxiety and tension about sex.
A recent invention may be of use here. It's called the 'Come Close' and is a kind of cushioned ring that the man wears on the base of his penis. This reduces the length of the penis that goes into the vagina. For more details, visit: www.comeclose.co.uk. Currently, the 'Come Close' retails at £24.99.
Menopausal or post-menopausal dryness
This is usually due to a fall in female sex hormones. Treatment with HRT pills or hormone cream will usually put matters right. Ordinary sex lubricants will help, too.
Vaginal infections
These are very common. The one that huge numbers of women get is thrush. But there are numerous others, such as trichomonas. The blisters of herpes can also be really painful.
Injury
Injury to the vulva or vagina can occur during rape or sexual assault and later cause dyspareunia.
Much more commonly, injury is caused by a childbirth tear or the episiotomy cut that is often made during labour. Badly healed stitching can also cause pain.
Genital warts
These are awfully common in these days of fairly promiscuous sex. Occasionally the warts can cause pain, especially if they get infected.
Vulvitis
This means inflammation of the vulva (the opening to the vagina). It can be due to all sorts of causes, including chemicals in bubble-baths or soaps.
Haematoma of the clitoris
I first encountered this about 30 years ago, but it's still not widely known. It's a bruise (or collection of blood) in the clitoris, caused by excessive friction. It nearly always gets better within a few weeks.
Urethral caruncle
This is a tender patch that develops at the urinary opening.
Foreign body in the vagina
The usual culprit is a forgotten tampon. It may cause pain, especially if the tampon leads to an infection.
Vulvodynia
A distressing and long-lasting condition in which the outside part of the sex organs (the vulva) is so sensitive, just touching the area makes the woman jump with pain.
Its cause is not yet known, but it can often be successfully treated.
The experts in dealing with it are the doctors at genitourinary medicine (GUM) clinics.
Cancer
This is a rare cause of intercourse pain, but it must be borne in mind for a woman who develops this kind of pain for the first time after the age of 40.
Does intercourse pain affect men?
Sometimes men experience pain during intercourse.
Common causes are skin disorders on the penis such as eczema or psoriasis.
It can be that the woman's vagina is too tight for her partner. A good sex lubricant can help here.
Occasional causes of male pain include:
thrush – in which case the female partner will probably have thrush too
a forgotten stitch left in the woman's vagina after childbirth
an IUD thread or a displaced IUD in the vagina
Peyronie's disease – a male disorder that causes bending of the penis.
Do you get pain during intercourse? If so, then the odds are that you're a woman – though at the end of this article, you'll find advice for the small number of men who get intercourse pain.
It's not much fun having pain during sex. After all, sex is meant to be an enjoyable and happy experience. If you get pain, it isn't.
Fortunately, the trouble will often resolve if the man takes more time with love play so that the woman's vagina relaxes and her natural lubricant flows, and if the couple use one of the newer sex lubricants like Eros or Liquid Silk.
When to seek help
You can safely disregard one isolated episode of pain during sex. It's easy to feel pain when a sensitive part of you is being prodded quite hard.
But if the pain keeps on happening, you shouldn't feel you have to put up with it. Get something done to improve things.
How? If you know that your GP is skilled at dealing with these matters, then he or she would be a good person to consult. But we have to admit that most family doctors are not trained in dealing with pain during intercourse.
It might be more realistic to go to your local family planning clinic. Many family planning clinic doctors (usually women) have spent a long time being trained by the Institute of Psychosexual Medicine (IPM) to deal with this type of pain.
Unfortunately, family planning clinics have become rather swamped with patients needing help, and they don’t have as much time as they used to for helping women with intercourse difficulties.
An alternative is to see a female IPM-trained doctor privately. There are also excellent NHS psychosexual clinics in some parts of the country - notably Sheffield, Preston, Paddington and Tooting.
A very good low-cost sexual counselling service is provided by both Relate and Relationships Scotland – formerly known as Relate Scotland.
The emotional factor
In a minute, we'll look at the possible cause of intercourse pain, or dyspareunia, to give it its medical name. But it's important to realise that there is usually some emotional element in this problem.
If you experience pain during sex, it's almost certain to be distressing for you. This distress may well make you tighten up down below. And this tightening up will very likely make the pain worse next time.
Unfortunately, painful intercourse can often have a destructive emotional effect on a relationship. Sometimes couples split up because of it. So that's a clear reason why you should get the problem sorted out as soon as possible.
What causes it?
There are dozens of possible causes of dyspareunia. Fortunately, many of them aren't too serious, but a few are.
Ideally, the assessment should be done by a doctor who is skilled in the technique of vaginal examination.
One of the first things to establish is: is the pain deep inside you? Or is it near the outside?
This may not be easy for you to say. Sometimes a pain is both superficial (near the outside) and deep. But deciding which it is can help sort out what's wrong.
Vaginismus
Vaginismus can cause both deep and superficial pain and is a common cause of pain during sex. It's a spasm of the vaginal muscles, caused mainly by fear of being hurt.
This spasm is often so painful that intercourse is impossible – sometimes for years.
Some women with vaginismus have never been able to have full sex or even use tampons. They also tend to be very fearful of vaginal examinations and so may never have had a smear test.
Vaginismus arouses strong emotions, and women who have it are often very angry with partners, doctors and themselves. But the condition is no one's fault.
Common causes include:
a restrictive upbringing, in which the woman was brought up to view sex as nasty or dirty.
an upbringing in which the woman was given the idea that the vagina is very narrow and so sex must be very painful.
a background where rape or childhood sexual abuse has taken place. Experiences like these understandably make women fearful of sex and of being hurt.
painful vaginal infections.
unease with their partner – perhaps at an unconscious level.
It is a common misconception that women with vaginismus dislike sex altogether.
In fact, many women with this condition enjoy closeness with their partners.
Many get great pleasure from love play and some are able to reach orgasm in this way. But the enjoyment ceases when penetration is attempted or suggested.
In the UK, women doctors who have been trained by the Institute of Psychosexual Medicine have by far the greatest experience of treating vaginismus.
What are the other causes of deep pain during sex?
Problems with your cervix: the man's penis hits the cervix at the farthest extent of his thrust. So infections of the cervix and tender places on it can cause pain during deep penetration. This is called 'collision dyspareunia'.
Womb trouble: various womb disorders, including fibroids, can cause deep intercourse pain.
Endometriosis: this very common disorder often affects the womb and surrounding tissues. It makes them very tender, particularly near period times. The pressure of the penis on an area of endometriosis may cause intense, deep pain.
Ovary problems: cysts on the ovary can cause deep pain. Pain may also be caused if the tip of the penis hits an unusually positioned ovary.
Pelvic inflammatory disease (PID): this is caused by infection, and has become more common in the UK largely thanks to the bug called chlamydia. If chlamydia isn't treated, there is quite a chance of PID developing. In PID, the tissues deep inside become badly inflamed and so the pressure of intercourse causes deep pain.
Ectopic pregnancy: this means a pregnancy outside the womb, usually in the Fallopian tube. Pressure on it can be very painful.
What are the other causes of more superficial pain?
Lack of lubrication
This can be due to nervousness, hang-ups and failure to relax. Unskilled foreplay by the man is a common cause, especially when it doesn't go on long enough. (Many women would like half an hour – but don't get it!)
Well-endowed partner
Some women complain that their partner’s penis is too big.
In fact, when a woman is aroused and relaxed, the vagina extends by several inches – so any female should be able to accommodate any male.
But being unused to a larger man or previous problems with bladder infections or endometriosis can lead to anxiety and tension about sex.
A recent invention may be of use here. It's called the 'Come Close' and is a kind of cushioned ring that the man wears on the base of his penis. This reduces the length of the penis that goes into the vagina. For more details, visit: www.comeclose.co.uk. Currently, the 'Come Close' retails at £24.99.
Menopausal or post-menopausal dryness
This is usually due to a fall in female sex hormones. Treatment with HRT pills or hormone cream will usually put matters right. Ordinary sex lubricants will help, too.
Vaginal infections
These are very common. The one that huge numbers of women get is thrush. But there are numerous others, such as trichomonas. The blisters of herpes can also be really painful.
Injury
Injury to the vulva or vagina can occur during rape or sexual assault and later cause dyspareunia.
Much more commonly, injury is caused by a childbirth tear or the episiotomy cut that is often made during labour. Badly healed stitching can also cause pain.
Genital warts
These are awfully common in these days of fairly promiscuous sex. Occasionally the warts can cause pain, especially if they get infected.
Vulvitis
This means inflammation of the vulva (the opening to the vagina). It can be due to all sorts of causes, including chemicals in bubble-baths or soaps.
Haematoma of the clitoris
I first encountered this about 30 years ago, but it's still not widely known. It's a bruise (or collection of blood) in the clitoris, caused by excessive friction. It nearly always gets better within a few weeks.
Urethral caruncle
This is a tender patch that develops at the urinary opening.
Foreign body in the vagina
The usual culprit is a forgotten tampon. It may cause pain, especially if the tampon leads to an infection.
Vulvodynia
A distressing and long-lasting condition in which the outside part of the sex organs (the vulva) is so sensitive, just touching the area makes the woman jump with pain.
Its cause is not yet known, but it can often be successfully treated.
The experts in dealing with it are the doctors at genitourinary medicine (GUM) clinics.
Cancer
This is a rare cause of intercourse pain, but it must be borne in mind for a woman who develops this kind of pain for the first time after the age of 40.
Does intercourse pain affect men?
Sometimes men experience pain during intercourse.
Common causes are skin disorders on the penis such as eczema or psoriasis.
It can be that the woman's vagina is too tight for her partner. A good sex lubricant can help here.
Occasional causes of male pain include:
thrush – in which case the female partner will probably have thrush too
a forgotten stitch left in the woman's vagina after childbirth
an IUD thread or a displaced IUD in the vagina
Peyronie's disease – a male disorder that causes bending of the penis.
Depression - how it affects sex and relationships
Written by Christine Webber, psychotherapist and lifecoach
Most people who are depressed lose interest in sex, but it's unlikely your partner's depression has anything to do with you.
Depression adversely affects every aspect of our lives - including our relationships - and when one partner is depressed, the relationship may suffer very badly.
This is a great shame as a good relationship is very therapeutic for somebody with depression, because when we're really low we need love, support and closeness more than ever - even if we’re not very good at showing it.
What is likely to happen if your partner has depression?
Depressed people usually feel withdrawn. They don't feel they can raise enough energy to pursue their normal routine, do things with the family or even notice when their partners are being attentive.
This can quickly lead to the non-depressed partner feeling that he or she is in the way, unwanted, or unloved. It can be easy to misinterpret the low moods as hostility, or as evidence that the depressed person wants out of the relationship.
Frankly, it’s really hard to stay calm and confident when the person you thought you knew is acting strangely and appears to be so unhappy. So if you’re finding your partner’s depression a real pain, try to take heart from the fact that this is natural.
Being the partner of a depressed person is very, very difficult. So, even if you're at your wits' end because your loved one has lost the ability to concentrate on what you're saying, or to raise a smile, or to appreciate any of the good moments in life, try to accept that all these things are part of the illness.
Sex and performance
We don't know enough about the chemical changes that occur in the brain during depression and little research has been done on how these changes affect sex.
From a clinical point of view, however, it's clear that a depressive illness tends to affect all the bodily systems, dislocating them and often slowing them down.
This effect is most marked with regard to sleep, which is invariably disrupted. But there can be adverse effects on any activity that requires verve, spontaneity and good co-ordination – and that includes sex.
So many people who are depressed tend to lose interest in sex. Admittedly, this isn't always the case, and some depressed people manage to maintain normal sex lives - sometimes even finding that sex is the only thing that gives them comfort and reassurance.
In men, the general damping down of brain activity causes feelings of tiredness and hopelessness, which may be associated with loss of libido and erection problems.
In women, this diminished brain activity tends to be associated with lack of interest in sex, and very often with difficulty in reaching orgasm.
All these problems tend to diminish as the depressive illness gets better. Indeed, renewed interest in sex may be the first sign of recovery.
Sex and antidepressants
It's not just the illness that affects a person's sex-life - antidepressant medicines such as Prozac can interfere with sexual function.
One of the most common side-effects is interference with the process of orgasm so that it's delayed or doesn't occur at all. If this happens – and you are keen to have and enjoy sex – you should ask the doctor about changing medication.
How depressed people can help themselves and their relationship
Some days will seem better than others. On your better days, try to make an effort to show love and appreciation to your partner.
Try to go for a walk every day, preferably with your partner. Walking not only gets you out in the fresh air, which will give you a bit of a lift, but like other forms of exercise it releases endorphins in the brain. These are 'happy' chemicals that rapidly elevate your mood.
Even on your worst days, try to spot happy moments like a bird singing or a new flower blooming in your garden. Try to train yourself to notice three of these heart-warming moments per day.
You may have an odd relationship with food while you're depressed (you could have little appetite or constantly comfort eat), but try to eat five pieces of fruit per day. This is a caring thing to do for yourself and is good for your physical and mental health.
Listen to music that matters to you.
Have faith that the depression will pass, and that you will enjoy your life again.
Even if you don’t feel like full-on sex, do make the effort to have a cuddle. If you are worried that cuddling will project you into full sex when you don’t want it, just tell your partner that you’re not feeling like having sex, but that you would really like to cuddle up. If you do this, you may both feel a lot better. Touch and closeness can keep a relationship intact.
How to help your depressed partner
Don't keep saying that you understand what your partner is going through. You don’t. Instead say: 'I can't know exactly how you're feeling, but I am trying very hard to understand and help.'
Many people who are depressed lose interest in sex. Try to remember that this loss of interest is probably not personal, but connected with the illness.
Don't despair. Some days you'll feel your love for your partner doesn't seem to make any difference to them at all. But hang on in there. Your love and constant support should be of great help in persuading your partner of his or her value.
Do encourage your partner to get all the professional help available. Nowadays, there are plenty of alternatives to anti-depressants. Cognitive behaviour therapy (CBT), for example, is becoming much more readily available on the NHS. In fact, the government is committed to providing 10,000 extra therapists. Many GP practices can also provide CBT by means of Internet programmes. These can have a good effect quite quickly in many cases.
Try to act as though your partner were recovering from a serious physical illness or from surgery. Give plenty of tender loving care. But don't expect improvement to be rapid.
Do something nice for yourself. Being around a depressed person is very draining, so make sure you look after yourself. Have some time alone, or get out to a film or to see friends. Depressed people often want to stay home and do nothing, but if you do this too, you'll get terribly fed up.
Remember that this period in your life will pass and that your partner is the same person underneath the depression that he or she was before.
Try to take some exercise together. Most depressed people feel an improvement in their spirits if they do something active. And doing something that will raise the heartbeat – for example, sport or dancing – may well help you too.
Women's sexual response
Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist
Do all women have the same sexual feelings? No they don't. In actual fact, women vary enormously in their sexual drive. Some don't feel very interested in sex at all – whereas others are passionate and wild about it.
But an extraordinary change has taken place in the last 50 years or so. Back in the mid-20th century, it was generally felt by doctors that most women fell into the 'not very interested' group - and that only a few were enthusiastically sexy.
By the 21st century, all that had changed. Today, it is widely assumed by the media - and by many of the public - that most women are easily aroused by sexual stimuli and that only a minority have little interest in sex.
In fact, that isn't really true. Our research indicates that although most modern females are much more 'open' about sex, and are keen to enjoy it; it takes them time to learn how to do this.
Indeed, a small study which we completed in 2005 indicated that a considerable proportion of young women just starting at university have thus far developed very little interest in sex (or knowledge about it), and have not even learned to reach orgasm yet. However, many of them do become very much more ‘sexually charged’ as the years progress.
Learning how to reach orgasm
We have found that younger females frequently have no real knowledge of the process of sexual arousal. In particular, women often need quite a lot of help to learn how to reach orgasm.
Unlike males – most of whom can 'come' easily from the moment they reach puberty – females will often spend a couple of years experimenting with their sexual feelings before they eventually learn how to come regularly and reliably.
But once women have learned to cast off their inhibitions and enjoy sex, they tend to respond to sexual stimuli in very much the same way.
What are women's sexual reactions?
A woman's first response to sexual stimulation is usually a nice, warm feeling all over her body – as she begins to let herself go.
At the same time her pulse rate starts to go up, and the pupils of her eyes get bigger. Incidentally, this widening of the pupils makes her more attractive sexually. In the olden days, drugs like belladonna ('beautiful woman') were used to produce this effect.
What happens to her sex organs as she gets aroused?
Laboratory studies carried out in Holland in 2004 show that as s soon as a woman starts thinking with interest about sex, her vagina begins to moisten. (This is the female equivalent of erection in men.)
The reason for this moistening is to lubricate her vagina, in preparation for possible sexual activity.
At the same time, various other things happen:
her clitoris – the most erotically sensitive part of her body – swells up.
her labia (the lips of the opening of her vagina) also swell up. The effect of this is to open up her vaginal opening slightly, in preparation for intercourse.
inside her, her vagina opens up – making room for the possible entry of a penis.
What happens next?
As she gets more and more aroused, her breasts will swell a little and her nipples will become more prominent. Her breathing gets faster and she starts to gasp. Her eyes tend to become glazed and she is likely to lick her lips - thus making them even more attractive to her partner.
If she is fair-skinned, a faint pink 'rash' will develop at the base of her neck and over her breasts.
And finally?
And finally, she climaxes. What generally happens here is that she experiences a series of waves of ever-increasing pleasure, till eventually the last one is so mind-blowing that she nearly passes out.
At that moment, nearly all women cry out – sometimes very loudly! The muscles of their faces and bodies contract violently (but very enjoyably) – and then after a while everything relaxes.
So that's the end?
No, not really. These days, most women can – if they want to - go on to have further climaxes. But this will only happen if:
they are happy and relaxed
they are being skilfully stimulated
they have learned how to have multiple orgasms.
This is of course, a dramatic difference between the sexual response of females and males. Nearly all men have no chance whatsoever of enjoying multiple climaxes!
Do all women have the same sexual feelings? No they don't. In actual fact, women vary enormously in their sexual drive. Some don't feel very interested in sex at all – whereas others are passionate and wild about it.
But an extraordinary change has taken place in the last 50 years or so. Back in the mid-20th century, it was generally felt by doctors that most women fell into the 'not very interested' group - and that only a few were enthusiastically sexy.
By the 21st century, all that had changed. Today, it is widely assumed by the media - and by many of the public - that most women are easily aroused by sexual stimuli and that only a minority have little interest in sex.
In fact, that isn't really true. Our research indicates that although most modern females are much more 'open' about sex, and are keen to enjoy it; it takes them time to learn how to do this.
Indeed, a small study which we completed in 2005 indicated that a considerable proportion of young women just starting at university have thus far developed very little interest in sex (or knowledge about it), and have not even learned to reach orgasm yet. However, many of them do become very much more ‘sexually charged’ as the years progress.
Learning how to reach orgasm
We have found that younger females frequently have no real knowledge of the process of sexual arousal. In particular, women often need quite a lot of help to learn how to reach orgasm.
Unlike males – most of whom can 'come' easily from the moment they reach puberty – females will often spend a couple of years experimenting with their sexual feelings before they eventually learn how to come regularly and reliably.
But once women have learned to cast off their inhibitions and enjoy sex, they tend to respond to sexual stimuli in very much the same way.
What are women's sexual reactions?
A woman's first response to sexual stimulation is usually a nice, warm feeling all over her body – as she begins to let herself go.
At the same time her pulse rate starts to go up, and the pupils of her eyes get bigger. Incidentally, this widening of the pupils makes her more attractive sexually. In the olden days, drugs like belladonna ('beautiful woman') were used to produce this effect.
What happens to her sex organs as she gets aroused?
Laboratory studies carried out in Holland in 2004 show that as s soon as a woman starts thinking with interest about sex, her vagina begins to moisten. (This is the female equivalent of erection in men.)
The reason for this moistening is to lubricate her vagina, in preparation for possible sexual activity.
At the same time, various other things happen:
her clitoris – the most erotically sensitive part of her body – swells up.
her labia (the lips of the opening of her vagina) also swell up. The effect of this is to open up her vaginal opening slightly, in preparation for intercourse.
inside her, her vagina opens up – making room for the possible entry of a penis.
What happens next?
As she gets more and more aroused, her breasts will swell a little and her nipples will become more prominent. Her breathing gets faster and she starts to gasp. Her eyes tend to become glazed and she is likely to lick her lips - thus making them even more attractive to her partner.
If she is fair-skinned, a faint pink 'rash' will develop at the base of her neck and over her breasts.
And finally?
And finally, she climaxes. What generally happens here is that she experiences a series of waves of ever-increasing pleasure, till eventually the last one is so mind-blowing that she nearly passes out.
At that moment, nearly all women cry out – sometimes very loudly! The muscles of their faces and bodies contract violently (but very enjoyably) – and then after a while everything relaxes.
So that's the end?
No, not really. These days, most women can – if they want to - go on to have further climaxes. But this will only happen if:
they are happy and relaxed
they are being skilfully stimulated
they have learned how to have multiple orgasms.
This is of course, a dramatic difference between the sexual response of females and males. Nearly all men have no chance whatsoever of enjoying multiple climaxes!
For women: things your Mum never told you about sex
Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist
What did your Mum tell you about sex?
Even today, many British women say that they never got enough sexual information from their mothers (and fathers!). So no wonder so many UK females are less than satisfied with their love lives.
Here are four facts that you almost certainly weren't told by your mother. But knowing them could help you to a more enjoyable sex life.
Fact one: climaxing isn't that easy
For most females, learning to climax is quite a difficult and time-consuming business. Nowadays, men tend to suggest to women that they should be able to reach orgasm very easily. The media – and that includes romantic novels and erotic films – often give the same impression. And nowadays the proliferation of porn online has given men some very strange ideas about what is pleasurable for women. In a lot of this material the woman squeaks with orgasmic passion the moment a guy enters her. In real life, this very rarely happens.
Our research shows that the average British female doesn't start having reliable orgasms until about two years after she first has sex with a man!
However, there are many women who don't conform to this pattern: for instance, a lot of teenage girls learn to climax on their own - through masturbation – long before they ever go near a guy. But in general, the ability to 'come' has to be learned over a considerable period of time.
So if you haven't managed it yet, don't be downhearted – as you almost certainly will get there. Some of our patients first ‘rang the bell’ when they were in their 40s!
Fact two: almost any woman can ‘come’
Practically any woman should be able to have orgasms - and indeed multiple orgasms - if she really wants to.
Back in your mum's day, sex was still quite a taboo subject and talking about orgasms was even more taboo.
Even as late as the early 1990s, it was widely felt among middle-aged women that for a 'lady' to want orgasms badly wasn't quite 'nice'. And for her to want multiple orgasms was a bit outrageous!
Furthermore, when your Mum was young, many so-called 'experts' suggested that multiple orgasms were almost impossible for most females.
However, we now know that:
virtually any woman can have an orgasm – if her clitoris is stimulated long enough and expertly enough (and of course provided that she's in the right mood!).
similarly further intense stimulation after the first orgasm will usually produce another.. and another... and another...
We're not saying that you can achieve all this overnight but, if you stimulate your own clitoris for long enough over a period of time, you are quite likely to eventually achieve as many orgasms as you like. Clearly you can also have multiple orgasms if you have a partner - male or female - who is devoted to giving you pleasure, and who you love and cherish.
Fact three: masturbation is OK
There is nothing wrong with 'do it yourself sex'.
Indeed, sex experts now agree that masturbation can be enormously useful in helping a woman:
to learn how to reach orgasm
to learn how to reach multiple orgasm.
So don't hesitate to go for it. It is particularly useful and healthy to enjoy masturbation if you are widowed or divorced or single. Masturbation is a lot more reliable and safe than having sex with a stranger!
Fact four: oral sex is OK too
A generation ago, oral sex was widely considered to be something rather ‘dirty'.
One of us worked with a professor of bacteriology who actually refused to process ‘throat swabs’ for sexually transmitted infections – because he couldn’t believe that people were doing such things …
So your mum probably didn’t tell you that:
oral sex is a great help to many women in reaching a climax
it’s very helpful to men who have erection difficulties
for a lot of people (admittedly, not everyone), it’s jolly good fun!
If you haven’t attempted it before, then can we assure you that it’s well worth a try!
You mum may also have never spelled out to you how desire can fluctuate according to where you are in your menstrual cycle, and also depending upon how well you are currently getting on with your partner.
Sustaining a long-term relationship is not just about sex but about companionship and sharing chores and laughing together and so on. All these things can affect our sex lives.
Also, stress and tiredness have big adverse effects on sex. Your mum may not have known this – let alone have thought to tell you – because perhaps her life was not quite as complicated as yours. Today’s woman is so often juggling a full-time job, children, elderly parents, maybe step-children and so on – which is an awful lot to cope with. No wonder sex sometimes slips down our list of priorities.
There are a lot of articles in the sex and relationships health centre that will give you plenty of up to date information on every kind of sex and relationship problem. You are likely to find this more comprehensive than anything your mum told you!
What did your Mum tell you about sex?
Even today, many British women say that they never got enough sexual information from their mothers (and fathers!). So no wonder so many UK females are less than satisfied with their love lives.
Here are four facts that you almost certainly weren't told by your mother. But knowing them could help you to a more enjoyable sex life.
Fact one: climaxing isn't that easy
For most females, learning to climax is quite a difficult and time-consuming business. Nowadays, men tend to suggest to women that they should be able to reach orgasm very easily. The media – and that includes romantic novels and erotic films – often give the same impression. And nowadays the proliferation of porn online has given men some very strange ideas about what is pleasurable for women. In a lot of this material the woman squeaks with orgasmic passion the moment a guy enters her. In real life, this very rarely happens.
Our research shows that the average British female doesn't start having reliable orgasms until about two years after she first has sex with a man!
However, there are many women who don't conform to this pattern: for instance, a lot of teenage girls learn to climax on their own - through masturbation – long before they ever go near a guy. But in general, the ability to 'come' has to be learned over a considerable period of time.
So if you haven't managed it yet, don't be downhearted – as you almost certainly will get there. Some of our patients first ‘rang the bell’ when they were in their 40s!
Fact two: almost any woman can ‘come’
Practically any woman should be able to have orgasms - and indeed multiple orgasms - if she really wants to.
Back in your mum's day, sex was still quite a taboo subject and talking about orgasms was even more taboo.
Even as late as the early 1990s, it was widely felt among middle-aged women that for a 'lady' to want orgasms badly wasn't quite 'nice'. And for her to want multiple orgasms was a bit outrageous!
Furthermore, when your Mum was young, many so-called 'experts' suggested that multiple orgasms were almost impossible for most females.
However, we now know that:
virtually any woman can have an orgasm – if her clitoris is stimulated long enough and expertly enough (and of course provided that she's in the right mood!).
similarly further intense stimulation after the first orgasm will usually produce another.. and another... and another...
We're not saying that you can achieve all this overnight but, if you stimulate your own clitoris for long enough over a period of time, you are quite likely to eventually achieve as many orgasms as you like. Clearly you can also have multiple orgasms if you have a partner - male or female - who is devoted to giving you pleasure, and who you love and cherish.
Fact three: masturbation is OK
There is nothing wrong with 'do it yourself sex'.
Indeed, sex experts now agree that masturbation can be enormously useful in helping a woman:
to learn how to reach orgasm
to learn how to reach multiple orgasm.
So don't hesitate to go for it. It is particularly useful and healthy to enjoy masturbation if you are widowed or divorced or single. Masturbation is a lot more reliable and safe than having sex with a stranger!
Fact four: oral sex is OK too
A generation ago, oral sex was widely considered to be something rather ‘dirty'.
One of us worked with a professor of bacteriology who actually refused to process ‘throat swabs’ for sexually transmitted infections – because he couldn’t believe that people were doing such things …
So your mum probably didn’t tell you that:
oral sex is a great help to many women in reaching a climax
it’s very helpful to men who have erection difficulties
for a lot of people (admittedly, not everyone), it’s jolly good fun!
If you haven’t attempted it before, then can we assure you that it’s well worth a try!
You mum may also have never spelled out to you how desire can fluctuate according to where you are in your menstrual cycle, and also depending upon how well you are currently getting on with your partner.
Sustaining a long-term relationship is not just about sex but about companionship and sharing chores and laughing together and so on. All these things can affect our sex lives.
Also, stress and tiredness have big adverse effects on sex. Your mum may not have known this – let alone have thought to tell you – because perhaps her life was not quite as complicated as yours. Today’s woman is so often juggling a full-time job, children, elderly parents, maybe step-children and so on – which is an awful lot to cope with. No wonder sex sometimes slips down our list of priorities.
There are a lot of articles in the sex and relationships health centre that will give you plenty of up to date information on every kind of sex and relationship problem. You are likely to find this more comprehensive than anything your mum told you!
The G-spot
Written by Dr David Delvin, GP and Christine Webber, psychotherapist
If you think the G-spot equals mind-blowing orgasms, think again. With Italian research the latest to lay claim to this fabled female erogenous zone, our experts explain why medical opinion remains to be convinced.
What is the G-spot?
Some experts say a zone called the G-spot can help a woman to orgasm.
There is still much controversy about whether the female G-spot really exists. Few doctors will give you a definite answer to this query.
Most standard gynaecological textbooks make no mention of the G-spot at all.
Anatomy manuals used by medical students and postgraduates do not show such a structure.
No gynae surgeon has seen a G-spot during an operation.
No anatomist has yet found one while dissecting a human body.
On the other hand, there is quite a lot of evidence from women’s personal experiences of sex that there is a particular area, located very close to the front wall of the vagina, which seems to give some females a remarkable amount of pleasure.
And there are women who claim that stimulation of this area helps them to reach orgasm – and sometimes an orgasm of an unusual kind.
So it does seem likely there is, at the very least, a collection of highly sensitive nerve-endings in the region that has come to be known as the G-spot.
What is the evidence that it exists?
1944: Gräfenberg makes discovery
In 1944 a German gynaecologist called Ernst Gräfenberg discovered a new erogenous zone, located somewhere near the front wall of the vagina.
He published his conclusions in the International Journal of Sexology in 1950 in a paper called The Role of the Urethra in Female Orgasm.
The urethra is the female urinary pipe and is about four centimetres long. It carries urine from the bladder to outside the body.
The important thing to grasp is that the urethra is embedded in the front wall of the vagina. Therefore, pressing on the lower part of the anterior vaginal wall will create pressure on the urethra.
Dr Gräfenberg claimed that stimulating this area would cause the tissues to swell up, and would give the woman intense sexual pleasure and orgasm. He also linked this erogenous zone to the phenomenon of female ejaculation.
In 1950, few people paid Gräfenberg any attention. Throughout the fifties and sixties, his name was only known to doctors as the inventor of the coil (intra-uterine device).
1981: the spot is named
The spot started attracting attention again in 1981, when Dr Addiego and his colleagues published an article in the Journal of Sex Research called Female Ejaculation: A Case Study.
This report was based on a study of just one woman, who said she experienced 'a deeper orgasm' when the front wall of her vagina was rubbed.
The authors started calling this area of the body the G-spot in honour of Gräfenberg.
1982: the phenomenon begins
In 1982, US researchers Ladas, Whipple and Perry published a bestselling book called The G Spot and Other Discoveries About Human Sexuality.
This attracted headlines all over the world, and millions of people got the idea that you would have wonderful orgasms if you could find this fabled spot.
1983-2007: a modern gynaecological myth?
During the 1980s and 90s, a lot of scientists tried to establish what the G-spot actually was, but with fairly inconclusive results.
Their studies were limited by the fact that scanning of female genitalia was still in its infancy.
In 2001 this led to the American Journal of Obstetrics and Gynecology calling the Gräfenberg spot 'a modern gynecologic myth'.
2008: ultrasound breakthrough
In March 2008 the G-spot again caused a worldwide sensation when an Italian team from the University of L'Aquila reported they had done ultrasound scans on 20 women.
They found about half of the women had a 'thickened area' between the vagina and the urethra.
Females who had this thickened area were more likely to say they experienced vaginal orgasms.
Vaginal orgasms are those caused by stimulating the vagina alone, as opposed to direct stimulation of the clitoris.
This somewhat ambiguous finding has been interpreted by many to mean 'the Italians have found the G-spot'.
But this was a very small sample of women, so the majority of scientists and doctors remain skeptical. A far more significant number of women would need to be scanned before this research is taken more seriously.
What about future research?
Possible future lines of investigation include the following.
Is the G-spot really made up of Skene's glands - tiny glandular structures that are rather like the male's prostate?
Is the spot really part of the wall of the urethra that contains erectile tissue?
Is the G-spot actually part of the 'roots' of the clitoris, which an Australian doctor has now shown to extend far further than had previously been thought?
What does all this mean for your sex life?
At the moment, more research needs to be done to confirm where the G-spot is and whether all women have it.
Women: if your partner is able to stimulate your G-spot, you may find it gives you new and exciting sensations. It's unlikely you'll be able to stimulate yourself in this way, because it's hard to reach the right area unless you've got very long fingers.
Men: knowing how to stimulate this area with your fingertips may be a useful addition to your bedtime repertoire and give extra pleasure to your partner. But trying to reach the G-spot with your penis during sex is not easy. You might have success if the woman is sitting astride you and facing you, and then leans backwards, so the penis presses against her front vaginal wall.
You can also buy G-spot vibrators. They have a kink in the end so the tip can reach the front wall of the vagina. But they are quite difficult to use, unless you have a good knowledge of female anatomy.
What will it feel like?
If you or your man are trying to rub the G-spot, it may at first just feel uncomfortable and give you an overwhelming desire to pee.
If you try to ignore this feeling for a few seconds, you may be lucky and suddenly experience quite a thrilling sense of building excitement.
But we cannot stress too much that this is not the case in all women.
Some women say they definitely have a G-spot and it's something that gives them enormous pleasure when it's stimulated.
Others tell us they hate having this area rubbed.
Plenty say its okay, but not nearly as good as clitoral stimulation.
And contrary to what you may have heard, stimulation of the G-spot alone is not very likely to bring the woman to a shattering orgasm. In our experience, few women will climax unless the clitoris is being stimulated at the same time.
So, in conclusion, you may want to have a go at finding your G-spot and giving it some attention - but we cannot guarantee that it will be your cup of tea.
For the average person, the most important thing to know about the G-spot is how to find it - or at least, how to find the place where it's supposed to be.
Both partners should agree they are going to search for the G-spot. The man shouldn't spring it on the woman as a surprise.
The woman should lie on her back and make sure she is comfortable, relaxed and well-lubricated.
With his palm upwards, the man should gently insert his index finger into her vagina.
When it is fully in, he should make a 'beckoning' movement until his fingertip comes into contact with the front wall of her vagina.
He should then rub that area.
If he is in the right zone, she will immediately experience a desire to pee.
With luck, she will also experience considerable pleasure.
If you think the G-spot equals mind-blowing orgasms, think again. With Italian research the latest to lay claim to this fabled female erogenous zone, our experts explain why medical opinion remains to be convinced.
What is the G-spot?
Some experts say a zone called the G-spot can help a woman to orgasm.
There is still much controversy about whether the female G-spot really exists. Few doctors will give you a definite answer to this query.
Most standard gynaecological textbooks make no mention of the G-spot at all.
Anatomy manuals used by medical students and postgraduates do not show such a structure.
No gynae surgeon has seen a G-spot during an operation.
No anatomist has yet found one while dissecting a human body.
On the other hand, there is quite a lot of evidence from women’s personal experiences of sex that there is a particular area, located very close to the front wall of the vagina, which seems to give some females a remarkable amount of pleasure.
And there are women who claim that stimulation of this area helps them to reach orgasm – and sometimes an orgasm of an unusual kind.
So it does seem likely there is, at the very least, a collection of highly sensitive nerve-endings in the region that has come to be known as the G-spot.
What is the evidence that it exists?
1944: Gräfenberg makes discovery
In 1944 a German gynaecologist called Ernst Gräfenberg discovered a new erogenous zone, located somewhere near the front wall of the vagina.
He published his conclusions in the International Journal of Sexology in 1950 in a paper called The Role of the Urethra in Female Orgasm.
The urethra is the female urinary pipe and is about four centimetres long. It carries urine from the bladder to outside the body.
The important thing to grasp is that the urethra is embedded in the front wall of the vagina. Therefore, pressing on the lower part of the anterior vaginal wall will create pressure on the urethra.
Dr Gräfenberg claimed that stimulating this area would cause the tissues to swell up, and would give the woman intense sexual pleasure and orgasm. He also linked this erogenous zone to the phenomenon of female ejaculation.
In 1950, few people paid Gräfenberg any attention. Throughout the fifties and sixties, his name was only known to doctors as the inventor of the coil (intra-uterine device).
1981: the spot is named
The spot started attracting attention again in 1981, when Dr Addiego and his colleagues published an article in the Journal of Sex Research called Female Ejaculation: A Case Study.
This report was based on a study of just one woman, who said she experienced 'a deeper orgasm' when the front wall of her vagina was rubbed.
The authors started calling this area of the body the G-spot in honour of Gräfenberg.
1982: the phenomenon begins
In 1982, US researchers Ladas, Whipple and Perry published a bestselling book called The G Spot and Other Discoveries About Human Sexuality.
This attracted headlines all over the world, and millions of people got the idea that you would have wonderful orgasms if you could find this fabled spot.
1983-2007: a modern gynaecological myth?
During the 1980s and 90s, a lot of scientists tried to establish what the G-spot actually was, but with fairly inconclusive results.
Their studies were limited by the fact that scanning of female genitalia was still in its infancy.
In 2001 this led to the American Journal of Obstetrics and Gynecology calling the Gräfenberg spot 'a modern gynecologic myth'.
2008: ultrasound breakthrough
In March 2008 the G-spot again caused a worldwide sensation when an Italian team from the University of L'Aquila reported they had done ultrasound scans on 20 women.
They found about half of the women had a 'thickened area' between the vagina and the urethra.
Females who had this thickened area were more likely to say they experienced vaginal orgasms.
Vaginal orgasms are those caused by stimulating the vagina alone, as opposed to direct stimulation of the clitoris.
This somewhat ambiguous finding has been interpreted by many to mean 'the Italians have found the G-spot'.
But this was a very small sample of women, so the majority of scientists and doctors remain skeptical. A far more significant number of women would need to be scanned before this research is taken more seriously.
What about future research?
Possible future lines of investigation include the following.
Is the G-spot really made up of Skene's glands - tiny glandular structures that are rather like the male's prostate?
Is the spot really part of the wall of the urethra that contains erectile tissue?
Is the G-spot actually part of the 'roots' of the clitoris, which an Australian doctor has now shown to extend far further than had previously been thought?
What does all this mean for your sex life?
At the moment, more research needs to be done to confirm where the G-spot is and whether all women have it.
Women: if your partner is able to stimulate your G-spot, you may find it gives you new and exciting sensations. It's unlikely you'll be able to stimulate yourself in this way, because it's hard to reach the right area unless you've got very long fingers.
Men: knowing how to stimulate this area with your fingertips may be a useful addition to your bedtime repertoire and give extra pleasure to your partner. But trying to reach the G-spot with your penis during sex is not easy. You might have success if the woman is sitting astride you and facing you, and then leans backwards, so the penis presses against her front vaginal wall.
You can also buy G-spot vibrators. They have a kink in the end so the tip can reach the front wall of the vagina. But they are quite difficult to use, unless you have a good knowledge of female anatomy.
What will it feel like?
If you or your man are trying to rub the G-spot, it may at first just feel uncomfortable and give you an overwhelming desire to pee.
If you try to ignore this feeling for a few seconds, you may be lucky and suddenly experience quite a thrilling sense of building excitement.
But we cannot stress too much that this is not the case in all women.
Some women say they definitely have a G-spot and it's something that gives them enormous pleasure when it's stimulated.
Others tell us they hate having this area rubbed.
Plenty say its okay, but not nearly as good as clitoral stimulation.
And contrary to what you may have heard, stimulation of the G-spot alone is not very likely to bring the woman to a shattering orgasm. In our experience, few women will climax unless the clitoris is being stimulated at the same time.
So, in conclusion, you may want to have a go at finding your G-spot and giving it some attention - but we cannot guarantee that it will be your cup of tea.
For the average person, the most important thing to know about the G-spot is how to find it - or at least, how to find the place where it's supposed to be.
Both partners should agree they are going to search for the G-spot. The man shouldn't spring it on the woman as a surprise.
The woman should lie on her back and make sure she is comfortable, relaxed and well-lubricated.
With his palm upwards, the man should gently insert his index finger into her vagina.
When it is fully in, he should make a 'beckoning' movement until his fingertip comes into contact with the front wall of her vagina.
He should then rub that area.
If he is in the right zone, she will immediately experience a desire to pee.
With luck, she will also experience considerable pleasure.
Masturbation for women
Written by Christine Webber, psychotherapist and lifecoach
What is masturbation?
To masturbate means to stimulate yourself in a sexual way. This can be done by hand, or with sex aids - some highly-sexed women can even do it by rubbing their thighs together. And a tiny minority of women can do it with no genital contact at all, but simply through caressing their breasts.
Such stimulation often leads to orgasm, but not invariably, as many women enjoy stroking themselves and experiencing pleasure that does not necessarily culminate in a climax.
Most men have masturbated, often beginning at a fairly young age.
Women tend to start masturbation later however, and it does not tend to be such an automatic activity as it is for most men and boys.
Furthermore, even once a woman has learned to masturbate, she will probably do it less than the average man - and it seems that far fewer women than men do it regularly.
Various people have speculated on why this is the case. But most agree that it is to do with basic sex drive.
It does appear that if you compare the sex drive of an average young woman and an average young man, then the man is likely to be the more highly sexed of the two. This is partly because a woman’s fluctuating hormones tend to mean that her desire for sex is not as constant as a man’s is.
Another reason for masturbation being less important to women than men is that a man’s sexual apparatus is all outside his body and he is focused on the pleasure his penis provides him from a very young age.
Women’s sex organs are less obvious. For example, the clitoris - which is the main organ of pleasure in most women - is hidden away under the labia. Also, though this is less the case now than it used to be, girls have traditionally been brought up to be more modest and secretive about their bodies.
Even so, many young women nowadays will enjoy masturbation prior to experiencing love play or intercourse with a partner. But vast numbers of females do not discover masturbation till their late teens – and some never do it at all.
Is masturbation a good thing?
Years ago, girls were told that masturbation was an ‘immature’ activity and that it was important not to get too fixated on it and that if you did, then you might be unable to progress to ‘proper’ lovemaking with a man.
Most experts now regard this sort of advice as nonsense.
Indeed, most clinicians and counsellors working in the world of sex and/or relationship therapy believe that a woman can learn a great deal about her own sexual response through masturbation, and that she can then pass on what she knows to any partner - male or female - she may have.
So, masturbation should not be regarded as immature or shameful. It is something that most normally-sexed women do. They may reserve it for when they feel in need of a treat, or they may do it very regularly – even when they are in a relationship.
Some women choose to masturbate in order to ease abdominal cramps during their periods. Others only ever do it if they feel seriously frustrated. And yet others do it both privately and also as part of the loveplay they share with their partners. All this is normal.
What's the best way for women to have an orgasm?
If you don't know exactly what it is you like or what it takes for you to reach orgasm, it's a good idea to practise on your own.
For some people the very idea of stimulating themselves can seem worrying, or unappealing, or something to be ashamed of. It’s a good idea if women can rid themselves of these feelings.
Masturbation is a great way to lessen tension in your body. It’s a very safe way to have an orgasm. And it’s probably the best way to learn about how your body likes to be loved. . But masturbation, like most things, takes practice. And the only way to learn about your own sexual response is to try it.
If you have never tried masturbation, or you want to do it in such a way that will be more pleasurable and satisfying then it has been in the past, then you might need to plan how and when to do it, rather than leave it to chance. For a start, you need to ensure that you’re going to have adequate time to yourself and that you won't be interrupted
Begin by taking a shower, or a long, luxurious, scented bath. Soap your body all over and enjoy touching your breasts and your genitals in particular.
Dry yourself carefully, then rub your favourite lotion all over your body. Keep touching your body everywhere - it might be a good idea to stand in front of a mirror while you do it. This is your body – a body capable of giving you great pleasure – so enjoy looking at it and getting used to the sight and feel of it.
At this point, as long as you know that you're in no danger of being disturbed, move to your bedroom. Make sure that it is warm and comfortable. Put on some relaxing music if you like. And just enjoy yourself.
Lie down on your bed and use a mirror to look at your private and intimate places. Gently spread your labia: you may want to use a spot of lubrication There are very nice modern ones that increase the sensuouness of the occasion – such as Wet, Liquid Silk and Pjur. But if you don’t have any lubrication, then use saliva.
Try to tighten and relax the muscles at the base of the pelvis.
If you find it difficult to know whether you're doing this successfully, try inserting a couple of fingers inside your vagina. That way, you'll be able to feel whether you're tightening and relaxing the muscles or not. Many women much prefer masturbation if they can feel some bulk in the vagina at the same time as they stimulate the clitoris – so touching yourself internally might feel very good indeed.
If you now tighten and relax the muscles in rapid succession you will feel contractions of the kind that many women experience when having an orgasm.
You might also notice a warm sensation in your abdomen. Try touching yourself all over your body, including the breasts and your genitals where you will quickly find the most sensitive spots. In particular, experiment near the opening of the vagina and clitoris and stimulate yourself in whatever way feels best. So long as you do not rush, and you are keeping relaxed, then your own fingers will automatically do the right thing and will move with the right amount of speed and intensity for you.
Try to familiarise yourself with exactly how touching yourself makes you feel. Ignore everything around you. Just think about what is going on inside you, or fantasise about making love with someone you care for, or with a celebrity, or in some gorgeous and romantic place.
While you touch yourself, you might like to look at something that turns you on - pictures, perhaps, a film; even a sexy book. Interestingly men and women differ somewhat is what they find arousing. Most men like graphic pictures of sexy women or of people having sex. Women are frequently much more turned on by words – so an erotic novel can often increase a woman’s pleasure.
If, as is likely, your sexual tension rises, keep going. If you have never previously masturbated to orgasm, you might suddenly feel tired and want to stop. Or you may be nervous about the build up of excitement in your body. Don’t worry about this. Just take your time. And if you don’t want to go on right now, then that’s fine. You can always try again another day. Eventually, the pleasant feelings will build up and you’ll be comfortable with this and increasingly excited and you won’t want to stop. When that happens, you will almost certainly suddenly experience a huge rush of ecstatic feeling and you will bring yourself to orgasm.
For some women it is not enough to just use their fingers - they like to use sex aids as well. A vibrator may be useful, or you could try stimulating yourself with the hand spray when you are in the shower. Use your fingers at the same time.
If they follow the guidelines above, almost everyone should be able to learn to masturbate and have an orgasm. But remember, these are only guidelines. Experiment, and you may well find a better way to turn yourself on.
Like other sexual activity, masturbation can be improved by varying how you do it.
This is particularly true for women who are between relationships and for whom masturbation is the sole sexual activity at that period in their lives.
Most women find that their fingers do the trick wonderfully – as they instinctively match their speed or weight to our requirements. But a vibrator can help someone who finds it hard to get to orgasm and can also be useful as a change from digital masturbation.
When it comes to vibrators, don’t necessarily assume that something that is a market-leader is necessarily going to be the best thing for you. It might not be. We all have different likes and dislikes.
And do remember that not all vibrators now look like lurid penises! Some are quite different nowadays. Those which work on a suction principle can be very effective. And there are others that have been designed by women sex therapists that have quite unconventional shapes. One range, called Emotional Bliss, has been designed by Julia Cole, who is one of the UK’s most eminent sex and relationship experts.
Buying vibrators and other sex aids including lubrication and erotic literature is now much easier for women than it was in the past as there are a number of online sex shops run by women for women that are a pleasure to ‘shop’ in.
My favourite sites are:
Emotional Bliss: www.emotionalbliss.com
Gash: www. directory.co.uk
Passion 8: www.passion8.com
Sh!: www.sh-womenstore.com
Tickled: www.tickledonline.co.uk.
What is masturbation?
To masturbate means to stimulate yourself in a sexual way. This can be done by hand, or with sex aids - some highly-sexed women can even do it by rubbing their thighs together. And a tiny minority of women can do it with no genital contact at all, but simply through caressing their breasts.
Such stimulation often leads to orgasm, but not invariably, as many women enjoy stroking themselves and experiencing pleasure that does not necessarily culminate in a climax.
Most men have masturbated, often beginning at a fairly young age.
Women tend to start masturbation later however, and it does not tend to be such an automatic activity as it is for most men and boys.
Furthermore, even once a woman has learned to masturbate, she will probably do it less than the average man - and it seems that far fewer women than men do it regularly.
Various people have speculated on why this is the case. But most agree that it is to do with basic sex drive.
It does appear that if you compare the sex drive of an average young woman and an average young man, then the man is likely to be the more highly sexed of the two. This is partly because a woman’s fluctuating hormones tend to mean that her desire for sex is not as constant as a man’s is.
Another reason for masturbation being less important to women than men is that a man’s sexual apparatus is all outside his body and he is focused on the pleasure his penis provides him from a very young age.
Women’s sex organs are less obvious. For example, the clitoris - which is the main organ of pleasure in most women - is hidden away under the labia. Also, though this is less the case now than it used to be, girls have traditionally been brought up to be more modest and secretive about their bodies.
Even so, many young women nowadays will enjoy masturbation prior to experiencing love play or intercourse with a partner. But vast numbers of females do not discover masturbation till their late teens – and some never do it at all.
Is masturbation a good thing?
Years ago, girls were told that masturbation was an ‘immature’ activity and that it was important not to get too fixated on it and that if you did, then you might be unable to progress to ‘proper’ lovemaking with a man.
Most experts now regard this sort of advice as nonsense.
Indeed, most clinicians and counsellors working in the world of sex and/or relationship therapy believe that a woman can learn a great deal about her own sexual response through masturbation, and that she can then pass on what she knows to any partner - male or female - she may have.
So, masturbation should not be regarded as immature or shameful. It is something that most normally-sexed women do. They may reserve it for when they feel in need of a treat, or they may do it very regularly – even when they are in a relationship.
Some women choose to masturbate in order to ease abdominal cramps during their periods. Others only ever do it if they feel seriously frustrated. And yet others do it both privately and also as part of the loveplay they share with their partners. All this is normal.
What's the best way for women to have an orgasm?
If you don't know exactly what it is you like or what it takes for you to reach orgasm, it's a good idea to practise on your own.
For some people the very idea of stimulating themselves can seem worrying, or unappealing, or something to be ashamed of. It’s a good idea if women can rid themselves of these feelings.
Masturbation is a great way to lessen tension in your body. It’s a very safe way to have an orgasm. And it’s probably the best way to learn about how your body likes to be loved. . But masturbation, like most things, takes practice. And the only way to learn about your own sexual response is to try it.
If you have never tried masturbation, or you want to do it in such a way that will be more pleasurable and satisfying then it has been in the past, then you might need to plan how and when to do it, rather than leave it to chance. For a start, you need to ensure that you’re going to have adequate time to yourself and that you won't be interrupted
Begin by taking a shower, or a long, luxurious, scented bath. Soap your body all over and enjoy touching your breasts and your genitals in particular.
Dry yourself carefully, then rub your favourite lotion all over your body. Keep touching your body everywhere - it might be a good idea to stand in front of a mirror while you do it. This is your body – a body capable of giving you great pleasure – so enjoy looking at it and getting used to the sight and feel of it.
At this point, as long as you know that you're in no danger of being disturbed, move to your bedroom. Make sure that it is warm and comfortable. Put on some relaxing music if you like. And just enjoy yourself.
Lie down on your bed and use a mirror to look at your private and intimate places. Gently spread your labia: you may want to use a spot of lubrication There are very nice modern ones that increase the sensuouness of the occasion – such as Wet, Liquid Silk and Pjur. But if you don’t have any lubrication, then use saliva.
Try to tighten and relax the muscles at the base of the pelvis.
If you find it difficult to know whether you're doing this successfully, try inserting a couple of fingers inside your vagina. That way, you'll be able to feel whether you're tightening and relaxing the muscles or not. Many women much prefer masturbation if they can feel some bulk in the vagina at the same time as they stimulate the clitoris – so touching yourself internally might feel very good indeed.
If you now tighten and relax the muscles in rapid succession you will feel contractions of the kind that many women experience when having an orgasm.
You might also notice a warm sensation in your abdomen. Try touching yourself all over your body, including the breasts and your genitals where you will quickly find the most sensitive spots. In particular, experiment near the opening of the vagina and clitoris and stimulate yourself in whatever way feels best. So long as you do not rush, and you are keeping relaxed, then your own fingers will automatically do the right thing and will move with the right amount of speed and intensity for you.
Try to familiarise yourself with exactly how touching yourself makes you feel. Ignore everything around you. Just think about what is going on inside you, or fantasise about making love with someone you care for, or with a celebrity, or in some gorgeous and romantic place.
While you touch yourself, you might like to look at something that turns you on - pictures, perhaps, a film; even a sexy book. Interestingly men and women differ somewhat is what they find arousing. Most men like graphic pictures of sexy women or of people having sex. Women are frequently much more turned on by words – so an erotic novel can often increase a woman’s pleasure.
If, as is likely, your sexual tension rises, keep going. If you have never previously masturbated to orgasm, you might suddenly feel tired and want to stop. Or you may be nervous about the build up of excitement in your body. Don’t worry about this. Just take your time. And if you don’t want to go on right now, then that’s fine. You can always try again another day. Eventually, the pleasant feelings will build up and you’ll be comfortable with this and increasingly excited and you won’t want to stop. When that happens, you will almost certainly suddenly experience a huge rush of ecstatic feeling and you will bring yourself to orgasm.
For some women it is not enough to just use their fingers - they like to use sex aids as well. A vibrator may be useful, or you could try stimulating yourself with the hand spray when you are in the shower. Use your fingers at the same time.
If they follow the guidelines above, almost everyone should be able to learn to masturbate and have an orgasm. But remember, these are only guidelines. Experiment, and you may well find a better way to turn yourself on.
Like other sexual activity, masturbation can be improved by varying how you do it.
This is particularly true for women who are between relationships and for whom masturbation is the sole sexual activity at that period in their lives.
Most women find that their fingers do the trick wonderfully – as they instinctively match their speed or weight to our requirements. But a vibrator can help someone who finds it hard to get to orgasm and can also be useful as a change from digital masturbation.
When it comes to vibrators, don’t necessarily assume that something that is a market-leader is necessarily going to be the best thing for you. It might not be. We all have different likes and dislikes.
And do remember that not all vibrators now look like lurid penises! Some are quite different nowadays. Those which work on a suction principle can be very effective. And there are others that have been designed by women sex therapists that have quite unconventional shapes. One range, called Emotional Bliss, has been designed by Julia Cole, who is one of the UK’s most eminent sex and relationship experts.
Buying vibrators and other sex aids including lubrication and erotic literature is now much easier for women than it was in the past as there are a number of online sex shops run by women for women that are a pleasure to ‘shop’ in.
My favourite sites are:
Emotional Bliss: www.emotionalbliss.com
Gash: www. directory.co.uk
Passion 8: www.passion8.com
Sh!: www.sh-womenstore.com
Tickled: www.tickledonline.co.uk.
Female ejaculation
Written by Dr David Delvin, GP
Dr David Delvin explains why the phenomenon of female ejaculation causes a great deal of distress to many women and is much misunderstood by people of both sexes.
What is female ejaculation?
Female ejaculation is a controversial subject.
Female ejaculation is when fluid shoots out of the vagina at the moment of orgasm. It is sometimes known as 'she-jaculation' or you may have heard the terms 'gushing' or 'squirting'.
It's a controversial subject, not least because pornography writers (most of whom are male) have repeatedly suggested that all women ejaculate at orgasm.
Even today, erotic novels tend to give the impression that every woman produces a jet of fluid when she climaxes - just like a man. As a result, some younger males are puzzled if their partner doesn't.
How common is female ejaculation?
The reality is female ejaculation isn't all that common. Some women do it once in a lifetime, but never again.
The actual percentage of females who ejaculate is uncertain. However, in Masters and Johnson's famous lab experiments with over 400 women, they did not record anyone who ejaculated at climax.
Nevertheless, the experience of gynaecologists and family planning doctors indicates there is a substantial minority of women who ejaculate regularly.
Agony aunts, too, get many anguished emails from females who are deeply embarrassed by the fact they wet the bed when they come.
How much fluid is produced?
I have heard claims that highly-sexed women can produce litres of fluid in a single orgasm. This seems very unlikely - where could such an amount be stored in the female body?
More realistic is the estimate of Beverley Whipple, American sex guru and co-author of the original G-spot book. At a recent conference, she told me that in most cases, the amount of fluid secreted is around 'half a coffee cupful'.
What effect does it have on women?
When a woman first discovers that she suddenly drenches the sheets when she climaxes, it's natural for her to feel anxious and embarrassed.
And because most women initially think the fluid they produce is urine, they assume what they are doing is dirty or nasty.
Their feelings are - quite understandably - linked to childhood prohibitions about not wetting the bed.
Unsurprisingly, quite a lot of these women tend to go through life avoiding sexual relations with other people.
Some have the unfortunate experience of going to bed with men who react negatively when they climax - but this is not the reaction of most males.
Is female ejaculation caused by urine leakage?
Until the 1980s, most doctors who were aware of the phenomenon of women ejaculating used to assume the fluid must be urine. As a treatment, they would tend to recommend exercises to build up the pelvic muscles.
And many women do leak a little urine during sex and during other activities as well. This is called 'stress incontinence' and it happens to vast numbers of females when they sneeze, cough or laugh. It is particularly common in those who have had children.
However, when urine leaks during sex, it's often during foreplay or vigorous intercourse rather than at orgasm.
In 1982 the publication of a highly influential book by sex experts Whipple, Perry and Ladas changed these views. They suggested the fluid wasn't urine, but was instead a 'juice' secreted by glands that were said to be the equivalent of the male prostate.
What research has been done on the fluid?
There hasn't been enough research on the fluid (ejaculate) - partly because it's difficult to obtain adequate supplies of it for investigation. Also, scientific funds tend to be available for life-threatening diseases rather than for sexual problems.
However, recent research suggests the ejaculate is an alkaline liquid that isn't like urine, because it doesn't contain urea or creatinine, which are normal urinary constituents.
The fluid tends to be clear coloured and doesn't stain bedclothes - again, unlike urine.
Researchers have claimed that it contains some chemical ingredients similar to those produced by the male prostate - notably PSA (prostate-specific antigen). It is also said to contain two sugars: glucose and fructose.
Since 2000, an increasing number of researchers have suggested the liquid may come from Skene's glands. These are tiny secretory structures which lie around the female urethra (the urinary pipe).
Is female ejaculation connected with the G-spot?
A vast amount of material on the internet suggests there is such a phenomenon as a G-spot orgasm, which is likely to be accompanied by a gush of fluid from the urethra.
The G-spot is said to be an erotic zone at the front of the vagina, and this area is intimately connected with the urethra. Indeed, pressure on the G-spot area will invariably produce a desire to pee.
There is no doubt that pressing on the area of the G-spot would affect the above-mentioned Skene's glands, which are said by some to be the source of female ejaculate.
However, much of what has been written over the last 25 years about the alleged link between the G-spot and female ejaculation is unscientific and has not be proven.
For example, there is no clear evidence that pressure on your G-spot will make you produce female ejaculatory fluid.
What does this mean for women?
It's now clear that a substantial minority of women do ejaculate when they climax. This could be urine in some cases, but in other cases it seems that it isn't.
Clearly, much more research needs to be done on the contentious subject of female ejaculation, and on the nature of the fluid.
Finally, women who experience ejaculation need to realise that many men have a positive attitude towards it. After all, if a woman ejaculates, the man can regard it as a tribute to his virility and skill in bed!
Dr David Delvin explains why the phenomenon of female ejaculation causes a great deal of distress to many women and is much misunderstood by people of both sexes.
What is female ejaculation?
Female ejaculation is a controversial subject.
Female ejaculation is when fluid shoots out of the vagina at the moment of orgasm. It is sometimes known as 'she-jaculation' or you may have heard the terms 'gushing' or 'squirting'.
It's a controversial subject, not least because pornography writers (most of whom are male) have repeatedly suggested that all women ejaculate at orgasm.
Even today, erotic novels tend to give the impression that every woman produces a jet of fluid when she climaxes - just like a man. As a result, some younger males are puzzled if their partner doesn't.
How common is female ejaculation?
The reality is female ejaculation isn't all that common. Some women do it once in a lifetime, but never again.
The actual percentage of females who ejaculate is uncertain. However, in Masters and Johnson's famous lab experiments with over 400 women, they did not record anyone who ejaculated at climax.
Nevertheless, the experience of gynaecologists and family planning doctors indicates there is a substantial minority of women who ejaculate regularly.
Agony aunts, too, get many anguished emails from females who are deeply embarrassed by the fact they wet the bed when they come.
How much fluid is produced?
I have heard claims that highly-sexed women can produce litres of fluid in a single orgasm. This seems very unlikely - where could such an amount be stored in the female body?
More realistic is the estimate of Beverley Whipple, American sex guru and co-author of the original G-spot book. At a recent conference, she told me that in most cases, the amount of fluid secreted is around 'half a coffee cupful'.
What effect does it have on women?
When a woman first discovers that she suddenly drenches the sheets when she climaxes, it's natural for her to feel anxious and embarrassed.
And because most women initially think the fluid they produce is urine, they assume what they are doing is dirty or nasty.
Their feelings are - quite understandably - linked to childhood prohibitions about not wetting the bed.
Unsurprisingly, quite a lot of these women tend to go through life avoiding sexual relations with other people.
Some have the unfortunate experience of going to bed with men who react negatively when they climax - but this is not the reaction of most males.
Is female ejaculation caused by urine leakage?
Until the 1980s, most doctors who were aware of the phenomenon of women ejaculating used to assume the fluid must be urine. As a treatment, they would tend to recommend exercises to build up the pelvic muscles.
And many women do leak a little urine during sex and during other activities as well. This is called 'stress incontinence' and it happens to vast numbers of females when they sneeze, cough or laugh. It is particularly common in those who have had children.
However, when urine leaks during sex, it's often during foreplay or vigorous intercourse rather than at orgasm.
In 1982 the publication of a highly influential book by sex experts Whipple, Perry and Ladas changed these views. They suggested the fluid wasn't urine, but was instead a 'juice' secreted by glands that were said to be the equivalent of the male prostate.
What research has been done on the fluid?
There hasn't been enough research on the fluid (ejaculate) - partly because it's difficult to obtain adequate supplies of it for investigation. Also, scientific funds tend to be available for life-threatening diseases rather than for sexual problems.
However, recent research suggests the ejaculate is an alkaline liquid that isn't like urine, because it doesn't contain urea or creatinine, which are normal urinary constituents.
The fluid tends to be clear coloured and doesn't stain bedclothes - again, unlike urine.
Researchers have claimed that it contains some chemical ingredients similar to those produced by the male prostate - notably PSA (prostate-specific antigen). It is also said to contain two sugars: glucose and fructose.
Since 2000, an increasing number of researchers have suggested the liquid may come from Skene's glands. These are tiny secretory structures which lie around the female urethra (the urinary pipe).
Is female ejaculation connected with the G-spot?
A vast amount of material on the internet suggests there is such a phenomenon as a G-spot orgasm, which is likely to be accompanied by a gush of fluid from the urethra.
The G-spot is said to be an erotic zone at the front of the vagina, and this area is intimately connected with the urethra. Indeed, pressure on the G-spot area will invariably produce a desire to pee.
There is no doubt that pressing on the area of the G-spot would affect the above-mentioned Skene's glands, which are said by some to be the source of female ejaculate.
However, much of what has been written over the last 25 years about the alleged link between the G-spot and female ejaculation is unscientific and has not be proven.
For example, there is no clear evidence that pressure on your G-spot will make you produce female ejaculatory fluid.
What does this mean for women?
It's now clear that a substantial minority of women do ejaculate when they climax. This could be urine in some cases, but in other cases it seems that it isn't.
Clearly, much more research needs to be done on the contentious subject of female ejaculation, and on the nature of the fluid.
Finally, women who experience ejaculation need to realise that many men have a positive attitude towards it. After all, if a woman ejaculates, the man can regard it as a tribute to his virility and skill in bed!
Are you having trouble reaching orgasm? A guide for women
Written by Christine Webber, psychotherapist and lifecoach and Dr David Delvin, GP and family planning specialist
'Coming' isn't all that easy - if you're a woman! Nearly all men can climax without difficulty, but women just aren't built that way.
But most people don’t realise that fact.
Let's face it, books, films and teen and women's magazines paint a very different picture in which today's females are hot, raring to go and effortlessly orgasmic.
So for women who are not all of those things - and that is a great many of them - this type of media portrayal is, at best, unhelpful and, at worst, painful and damaging. Indeed, today's teens and 20-somethings tend to believe that there's something wrong with them - or even that they're frigid - if they can't climax to order. This is not the case. In fact, mostly they're absolutely normal.
Interestingly, however, only a generation ago many doctors used to believe that a high proportion of the female population simply couldn't climax at all. Why did they think this way? Simply because most of them had had little or no training in sexual medicine. Also, the great majority of them were so embarrassed about sex themselves that they tried to avoid discussing it with their patients. Furthermore, since women don't need to climax in order to conceive, most doctors didn't rate the importance of the female orgasm very highly.
New attitude
Nowadays, fortunately, medics have a very different attitude. This is largely because they are now familiar with the results of sexual studies conducted by American researchers Kinsey, Masters and Johnson, Shere Hite and others.
In addition, the last 15 years have seen a number of sexual surveys conducted with large samples of people through newspapers and magazines. Indeed, our own company – the Medical Information Service – has designed many of these.
The results of these surveys have taken the lid off the sex life of the great British public. Now we know that virtually any woman can climax - and indeed have multiple climaxes - if the circumstances of her life are right. And these circumstances usually include having a caring, understanding partner who is knowledgeable about sex, and who uses that knowledge to help her relax and to reach orgasm.
As we've already said, orgasm is a much more automatic response for men than for women. It seems that even though there are plenty of deeply caring and decent guys around, their ability to climax does not necessarily have to be linked to feelings of love and romance. Women of all ages, by contrast, tend to find that their sexual confidence and competence flower in a climate of appreciation and deep affection.
Of course nowadays there are young 'ladettes' - females who set out to have as much uncommitted and uncomplicated sex as young men - but they are in the minority. And we have discovered that many of these youngsters are secretly quite miserable.
But to understand more about the female orgasm let's go back to the very start of a woman's sexual life.
The beginnings
A lot of very young women are worried about their lack of ability to climax. But the fact is, unlike males, most females have to learn to reach orgasm.
Our research shows that most younger women do not manage to climax until some considerable time after they have started sexual activity. Moreover, when they do 'come' for the very first time, they do so in a variety of ways. In a survey we conducted for our book The Big 'O', we found that:
47 per cent climaxed for the first time through masturbation
32 per cent through sexual intercourse
20 per cent through petting
1 per cent while sleeping.
In the same survey we found that the most common age of first orgasm was 18, but that it could be as late as the 40s!
The 20s and 30s
Even in their 20s and 30s, a lot of women have difficulty reaching that elusive orgasm. These days, most sex therapists believe that if you can't climax (or don't climax easily) it's a good idea to start by practising on your own.
This may seem obvious, but many women, even today, feel very inhibited about self-love and can't help feeling that it isn't something they should be doing. But the fact is, masturbating helps you to learn just exactly which pressures and rhythms you need in order to bring you to orgasm. In particular, you need to explore your own body in order to find out precisely how to stimulate your clitoris.
However, it's important that, if you are using masturbation to help learn about orgasm, you should always do it when you are warm, cosy, relaxed... and, above all, alone. Learning to love your own body should be a delicious experience, but it can't be if someone is hammering on your bedroom or bathroom door demanding that you come out and get their tea!
A good 'reaching orgasms' video (such as Betty Dodson's Selfloving) is very helpful in this respect.
Once you have learned to climax easily, you can then show your partner exactly what you need in order to make you come.
Of course this may feel embarrassing at first, but it's important that you learn to communicate your feelings and also to communicate how you like your body to be touched. When you can't find the words, use caresses. But try also to build up a vocabulary with your partner that is easy to use. A lot of couples find their sex lives fail simply because they don't have the right language. And saying: 'Could you rub my ...er ...er?' isn't specific enough to be helpful.
Some women, incidentally, find achieving orgasm much easier with the help of a vibrator. But for many females actually getting hold of a sex aid that they can rely on isn't easy.
If this applies to you, we'd like you to know that several excellent online mail order businesses have been set up in the last decade or so that are run by women for women. Their sex aids really work. And it's a great help for women to be able to buy such things without having to venture out into some kind of seedy sex shop where they're surrounded by men - and often not very attractive ones at that! These online sex shops also sell lingerie, and erotic literature and lubrication and are equally helpful to gay and heterosexual women.
These companies are:
Gash www.gash.co.uk.
Sh! www,sh-womenstore.com.
Passion 8 www.passion8.com.
Tickled www.tickledonline.co.uk.
Emotional Bliss www.emotionalbliss.com
30 plus
By the time you're in your 30s, 40s or 50s, you should be able to reach orgasm quite easily provided that you have a loving, understanding partner.
But do remember that most women find that their ability to climax varies according to what part of their menstrual cycle they're in. It's quite common for a woman to feel especially orgasmic half-way through her cycle. But some women feel particularly turned-on just before a period. Others notice that they don’t really feel like sex at all during some times of the month. All this is normal.
However, if you are still not having any orgasms at all, or if you're still having enormous difficulty 'getting there', then it's definitely time to seek practical help. In the UK, one way of doing this is to talk to a woman doctor at a Family Planning Clinic. Many of these medics have had special training in helping their patients to relax and to achieve orgasm. Unfortunately, it is not so easy nowadays to get this treatment as it was, because many clinics have had to cut back on their services. But it is always worth asking at your local clinic if they are able to help you.
So what can you expect if you pluck up courage to go for an appointment at an FPC? The woman doctor will take a history - which means that she'll ask you all about your sex life and relationships and your physical health as well. She'll then examine you to make sure that everything is okay physically and she'll then counsel you over a period of several weeks.
Other forms of sex therapy help are available – both private and NHS.
Various types of orgasm
Thanks to Freud, the father of psycho-analysis, people used to believe that vaginal orgasms were what mature women had, while clitoral orgasms were what immature women had.
Experts no longer believe this. And many of today's sex experts as well as ordinary women say that they really don't know the difference between a vaginal orgasm and a clitoral one.
The majority of women need clitoral stimulation in order to climax. This applies whether they're enjoying loveplay or intercourse.
Some women, on the other hand, believe they can 'come' through intercourse with no manual stimulation of the clitoris and claim that it is the vagina itself that sparks off the orgasm. However, many sex experts reckon what is happening during intercourse is that the clitoris is being stimulated by being pulled down or being rubbed by part of the man's torso.
There is also the G-spot to consider. Some women experience a particularly intense orgasm when that part of their anatomy is stimulated (you can find the G-spot inside you on the front vaginal wall). Indeed, many women who enjoy having their G-spots touched claim that they ejaculate during these intense orgasms. So, there may be a case for saying that there is a G-spot orgasm, as well as possibly a vaginal one, and one that originates in the clitoris.
Our feeling about all of this is that it really doesn't matter whether or not there are different types of orgasms. The important thing is that you should be having good, reliable orgasms whenever you want them - and that you should be enjoying them hugely.
Simultaneous orgasm
A lot of women write to us complaining that they can't reach simultaneous orgasm with their partners.
But in fact, simultaneous orgasm is quite uncommon. Surveys done by the Medical Information Service and others have found that most women rarely climax at exactly the same time as their partners.
However, it is certainly nice when this happens. And it can be achieved, if the man has good control of his own orgasm, and if he is skilled at using his fingers during intercourse to bring the woman to a climax just at the same moment as he comes.
Multiple orgasms
Until quite recent years doctor believed that only a tiny minority of women could have multiple orgasms. But research by the Medical Information Service and others has shown that in fact, the majority of females can have a series of climaxes, one after the other if, that is, they are happy and relaxed in the relationship and if the partner is willing to stimulate them to 'come' again and again.
Please note that the ability to have multiple orgasms increases with age. It's unusual at the age of 20, but many women in their 40s, 50s and 60s can do it.
Orgasms in mid-life
As we have already said, a woman's ability to climax tends to improve with age.
But we know that some women get well into mid-life before they manage to have an orgasm. However, the important thing is that you should never regard it as ‘too late’. Time and again we have heard of women who have learned to orgasm when they were in their 40s, 50s – and even later.
In February 2009, Danish psychosexual therapist called Pia Struck presented the results of a study at the Royal Society of Medicine she had made of 500 women.
These women all had long histories of difficulties with orgasm and 25 per cent of them had never climaxed. Their ages ranged from 18 to 88.
They were helped through the Betty Dodson method (see above) and were treated by use of group therapy, where they were encouraged to think more positively about their genitals and to learn acceptance of their sexuality through touch. They also embarked on practical sex-therapy by using clitoral vibrators.
Of these women, 465 (93 per cent) had an orgasm which was witnessed by a therapist. And it was reported that the post-menopausal women among them were just as able to achieve orgasm as the younger participants in the study. So, clearly, you are never too old to become orgasmic.
There can of course be other problems in midlife around the time of the menopause. Most of these difficulties occur because of all the hormonal changes going on in the body. And it's extremely common for women to 'go off' sex temporarily simply because it becomes too dry and uncomfortable.
Fortunately, there are all sorts of ways to remedy this nowadays. There are good over-the-counter lubricants like Wet, Silk, Astroglide, Senselle and K-Y Jelly. These are all suitable, by the way, for any age of woman.
In mid-life there is also the option of going on HRT, but this is something that any woman should think about very carefully indeed. Until recently, it was widely believed that HRT commonly helped a woman to feel much better generally, and to feel more sexy in particular. However, the picture has now changed significantly.
Extensive research into HRT now suggests that though it is still very effective for ridding a woman of unpleasant menopausal symptoms such as hot flushes and sweating attacks, it is not safe to use long term. So it should definitely not be viewed as a magical youth elixir that you start taking at the menopause and continue using till you’re a very old lady.
Nowadays, many women find that health supplements such as soya and red clover also alleviate menopausal symptoms, and actually help them to feel younger and fitter too. You can take these by mouth - Aria One-a-Day Soya tablets and Novogen Red Clover tablets are examples of the brands available – and there are also ‘natural’ oestrogen products for lubricating the vagina, such as Phyto Soya Vaginal Gel Pessaries.
However, it must be stressed that the use of these supplements is in its infancy, and you may want to consult a nutritionist before putting yourself on them. These sorts of supplements are readily available in high street pharmacies such as Boots and Lloyds and also in health food shops.
How can men help?
Remember that most women need stimulation of the clitoris. This is the part of them that would have turned into a penis had they developed as males - and it's just as important to women as the penis is to a guy.
Remember that love, romance, cuddling and a good atmosphere turn women on in the early stages of a sex session just as much as your caresses do.
Take your time.
Caress her breasts - a few women learn to climax through breast fondling alone.
Give her oral sex. Most women adore this and some claim that they cannot come unless a man 'goes down' on them.
Don't be too proud to ask her to show you what she wants.
Have some sex sessions where you encourage her to take the initiative and to decide the agenda.
If you lose control and come before her, do try to summon some energy to kiss and stimulate her so that she can climax, too.
Do tell her that she's marvellous, sexy and beautiful.
Summing up
Having an orgasm is a lovely feeling. You are entitled to it, but it's not easy to do if you are uptight, tired, stressed or unhappy in your relationship. If in doubt, seek help from an expert advisor.
Further help
Your GP.
Brook (if you are under 25). Call 08000 185023 for more details.
Family Planning Clinics.
NHS Psychosexual Clinics. Your GP will need to refer you.
Relate.
A private therapist from the British Association for Sexual and Relationship Therapy (BASRT).
A private medical therapist from the Institute of Psychosexual Medicine: www.ipm.org.uk.
If you fancy a trip to Denmark you can sign up for a course at the orgasm academy: http://www.orgasmacademy.eu.
'Coming' isn't all that easy - if you're a woman! Nearly all men can climax without difficulty, but women just aren't built that way.
But most people don’t realise that fact.
Let's face it, books, films and teen and women's magazines paint a very different picture in which today's females are hot, raring to go and effortlessly orgasmic.
So for women who are not all of those things - and that is a great many of them - this type of media portrayal is, at best, unhelpful and, at worst, painful and damaging. Indeed, today's teens and 20-somethings tend to believe that there's something wrong with them - or even that they're frigid - if they can't climax to order. This is not the case. In fact, mostly they're absolutely normal.
Interestingly, however, only a generation ago many doctors used to believe that a high proportion of the female population simply couldn't climax at all. Why did they think this way? Simply because most of them had had little or no training in sexual medicine. Also, the great majority of them were so embarrassed about sex themselves that they tried to avoid discussing it with their patients. Furthermore, since women don't need to climax in order to conceive, most doctors didn't rate the importance of the female orgasm very highly.
New attitude
Nowadays, fortunately, medics have a very different attitude. This is largely because they are now familiar with the results of sexual studies conducted by American researchers Kinsey, Masters and Johnson, Shere Hite and others.
In addition, the last 15 years have seen a number of sexual surveys conducted with large samples of people through newspapers and magazines. Indeed, our own company – the Medical Information Service – has designed many of these.
The results of these surveys have taken the lid off the sex life of the great British public. Now we know that virtually any woman can climax - and indeed have multiple climaxes - if the circumstances of her life are right. And these circumstances usually include having a caring, understanding partner who is knowledgeable about sex, and who uses that knowledge to help her relax and to reach orgasm.
As we've already said, orgasm is a much more automatic response for men than for women. It seems that even though there are plenty of deeply caring and decent guys around, their ability to climax does not necessarily have to be linked to feelings of love and romance. Women of all ages, by contrast, tend to find that their sexual confidence and competence flower in a climate of appreciation and deep affection.
Of course nowadays there are young 'ladettes' - females who set out to have as much uncommitted and uncomplicated sex as young men - but they are in the minority. And we have discovered that many of these youngsters are secretly quite miserable.
But to understand more about the female orgasm let's go back to the very start of a woman's sexual life.
The beginnings
A lot of very young women are worried about their lack of ability to climax. But the fact is, unlike males, most females have to learn to reach orgasm.
Our research shows that most younger women do not manage to climax until some considerable time after they have started sexual activity. Moreover, when they do 'come' for the very first time, they do so in a variety of ways. In a survey we conducted for our book The Big 'O', we found that:
47 per cent climaxed for the first time through masturbation
32 per cent through sexual intercourse
20 per cent through petting
1 per cent while sleeping.
In the same survey we found that the most common age of first orgasm was 18, but that it could be as late as the 40s!
The 20s and 30s
Even in their 20s and 30s, a lot of women have difficulty reaching that elusive orgasm. These days, most sex therapists believe that if you can't climax (or don't climax easily) it's a good idea to start by practising on your own.
This may seem obvious, but many women, even today, feel very inhibited about self-love and can't help feeling that it isn't something they should be doing. But the fact is, masturbating helps you to learn just exactly which pressures and rhythms you need in order to bring you to orgasm. In particular, you need to explore your own body in order to find out precisely how to stimulate your clitoris.
However, it's important that, if you are using masturbation to help learn about orgasm, you should always do it when you are warm, cosy, relaxed... and, above all, alone. Learning to love your own body should be a delicious experience, but it can't be if someone is hammering on your bedroom or bathroom door demanding that you come out and get their tea!
A good 'reaching orgasms' video (such as Betty Dodson's Selfloving) is very helpful in this respect.
Once you have learned to climax easily, you can then show your partner exactly what you need in order to make you come.
Of course this may feel embarrassing at first, but it's important that you learn to communicate your feelings and also to communicate how you like your body to be touched. When you can't find the words, use caresses. But try also to build up a vocabulary with your partner that is easy to use. A lot of couples find their sex lives fail simply because they don't have the right language. And saying: 'Could you rub my ...er ...er?' isn't specific enough to be helpful.
Some women, incidentally, find achieving orgasm much easier with the help of a vibrator. But for many females actually getting hold of a sex aid that they can rely on isn't easy.
If this applies to you, we'd like you to know that several excellent online mail order businesses have been set up in the last decade or so that are run by women for women. Their sex aids really work. And it's a great help for women to be able to buy such things without having to venture out into some kind of seedy sex shop where they're surrounded by men - and often not very attractive ones at that! These online sex shops also sell lingerie, and erotic literature and lubrication and are equally helpful to gay and heterosexual women.
These companies are:
Gash www.gash.co.uk.
Sh! www,sh-womenstore.com.
Passion 8 www.passion8.com.
Tickled www.tickledonline.co.uk.
Emotional Bliss www.emotionalbliss.com
30 plus
By the time you're in your 30s, 40s or 50s, you should be able to reach orgasm quite easily provided that you have a loving, understanding partner.
But do remember that most women find that their ability to climax varies according to what part of their menstrual cycle they're in. It's quite common for a woman to feel especially orgasmic half-way through her cycle. But some women feel particularly turned-on just before a period. Others notice that they don’t really feel like sex at all during some times of the month. All this is normal.
However, if you are still not having any orgasms at all, or if you're still having enormous difficulty 'getting there', then it's definitely time to seek practical help. In the UK, one way of doing this is to talk to a woman doctor at a Family Planning Clinic. Many of these medics have had special training in helping their patients to relax and to achieve orgasm. Unfortunately, it is not so easy nowadays to get this treatment as it was, because many clinics have had to cut back on their services. But it is always worth asking at your local clinic if they are able to help you.
So what can you expect if you pluck up courage to go for an appointment at an FPC? The woman doctor will take a history - which means that she'll ask you all about your sex life and relationships and your physical health as well. She'll then examine you to make sure that everything is okay physically and she'll then counsel you over a period of several weeks.
Other forms of sex therapy help are available – both private and NHS.
Various types of orgasm
Thanks to Freud, the father of psycho-analysis, people used to believe that vaginal orgasms were what mature women had, while clitoral orgasms were what immature women had.
Experts no longer believe this. And many of today's sex experts as well as ordinary women say that they really don't know the difference between a vaginal orgasm and a clitoral one.
The majority of women need clitoral stimulation in order to climax. This applies whether they're enjoying loveplay or intercourse.
Some women, on the other hand, believe they can 'come' through intercourse with no manual stimulation of the clitoris and claim that it is the vagina itself that sparks off the orgasm. However, many sex experts reckon what is happening during intercourse is that the clitoris is being stimulated by being pulled down or being rubbed by part of the man's torso.
There is also the G-spot to consider. Some women experience a particularly intense orgasm when that part of their anatomy is stimulated (you can find the G-spot inside you on the front vaginal wall). Indeed, many women who enjoy having their G-spots touched claim that they ejaculate during these intense orgasms. So, there may be a case for saying that there is a G-spot orgasm, as well as possibly a vaginal one, and one that originates in the clitoris.
Our feeling about all of this is that it really doesn't matter whether or not there are different types of orgasms. The important thing is that you should be having good, reliable orgasms whenever you want them - and that you should be enjoying them hugely.
Simultaneous orgasm
A lot of women write to us complaining that they can't reach simultaneous orgasm with their partners.
But in fact, simultaneous orgasm is quite uncommon. Surveys done by the Medical Information Service and others have found that most women rarely climax at exactly the same time as their partners.
However, it is certainly nice when this happens. And it can be achieved, if the man has good control of his own orgasm, and if he is skilled at using his fingers during intercourse to bring the woman to a climax just at the same moment as he comes.
Multiple orgasms
Until quite recent years doctor believed that only a tiny minority of women could have multiple orgasms. But research by the Medical Information Service and others has shown that in fact, the majority of females can have a series of climaxes, one after the other if, that is, they are happy and relaxed in the relationship and if the partner is willing to stimulate them to 'come' again and again.
Please note that the ability to have multiple orgasms increases with age. It's unusual at the age of 20, but many women in their 40s, 50s and 60s can do it.
Orgasms in mid-life
As we have already said, a woman's ability to climax tends to improve with age.
But we know that some women get well into mid-life before they manage to have an orgasm. However, the important thing is that you should never regard it as ‘too late’. Time and again we have heard of women who have learned to orgasm when they were in their 40s, 50s – and even later.
In February 2009, Danish psychosexual therapist called Pia Struck presented the results of a study at the Royal Society of Medicine she had made of 500 women.
These women all had long histories of difficulties with orgasm and 25 per cent of them had never climaxed. Their ages ranged from 18 to 88.
They were helped through the Betty Dodson method (see above) and were treated by use of group therapy, where they were encouraged to think more positively about their genitals and to learn acceptance of their sexuality through touch. They also embarked on practical sex-therapy by using clitoral vibrators.
Of these women, 465 (93 per cent) had an orgasm which was witnessed by a therapist. And it was reported that the post-menopausal women among them were just as able to achieve orgasm as the younger participants in the study. So, clearly, you are never too old to become orgasmic.
There can of course be other problems in midlife around the time of the menopause. Most of these difficulties occur because of all the hormonal changes going on in the body. And it's extremely common for women to 'go off' sex temporarily simply because it becomes too dry and uncomfortable.
Fortunately, there are all sorts of ways to remedy this nowadays. There are good over-the-counter lubricants like Wet, Silk, Astroglide, Senselle and K-Y Jelly. These are all suitable, by the way, for any age of woman.
In mid-life there is also the option of going on HRT, but this is something that any woman should think about very carefully indeed. Until recently, it was widely believed that HRT commonly helped a woman to feel much better generally, and to feel more sexy in particular. However, the picture has now changed significantly.
Extensive research into HRT now suggests that though it is still very effective for ridding a woman of unpleasant menopausal symptoms such as hot flushes and sweating attacks, it is not safe to use long term. So it should definitely not be viewed as a magical youth elixir that you start taking at the menopause and continue using till you’re a very old lady.
Nowadays, many women find that health supplements such as soya and red clover also alleviate menopausal symptoms, and actually help them to feel younger and fitter too. You can take these by mouth - Aria One-a-Day Soya tablets and Novogen Red Clover tablets are examples of the brands available – and there are also ‘natural’ oestrogen products for lubricating the vagina, such as Phyto Soya Vaginal Gel Pessaries.
However, it must be stressed that the use of these supplements is in its infancy, and you may want to consult a nutritionist before putting yourself on them. These sorts of supplements are readily available in high street pharmacies such as Boots and Lloyds and also in health food shops.
How can men help?
Remember that most women need stimulation of the clitoris. This is the part of them that would have turned into a penis had they developed as males - and it's just as important to women as the penis is to a guy.
Remember that love, romance, cuddling and a good atmosphere turn women on in the early stages of a sex session just as much as your caresses do.
Take your time.
Caress her breasts - a few women learn to climax through breast fondling alone.
Give her oral sex. Most women adore this and some claim that they cannot come unless a man 'goes down' on them.
Don't be too proud to ask her to show you what she wants.
Have some sex sessions where you encourage her to take the initiative and to decide the agenda.
If you lose control and come before her, do try to summon some energy to kiss and stimulate her so that she can climax, too.
Do tell her that she's marvellous, sexy and beautiful.
Summing up
Having an orgasm is a lovely feeling. You are entitled to it, but it's not easy to do if you are uptight, tired, stressed or unhappy in your relationship. If in doubt, seek help from an expert advisor.
Further help
Your GP.
Brook (if you are under 25). Call 08000 185023 for more details.
Family Planning Clinics.
NHS Psychosexual Clinics. Your GP will need to refer you.
Relate.
A private therapist from the British Association for Sexual and Relationship Therapy (BASRT).
A private medical therapist from the Institute of Psychosexual Medicine: www.ipm.org.uk.
If you fancy a trip to Denmark you can sign up for a course at the orgasm academy: http://www.orgasmacademy.eu.
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