Orgasm for women

WE hear a lot these days about how people can and should make love, but there are virtually no rules for good sex.

It isn't compulsory to have an orgasm. As long as a woman is left feeling satisfied, neither she nor her partner should feel that they have in any way failed because she hasn't had an orgasm.

Sex is for your pleasure, not to pass some test or keep up with the Jones's.

Many women, however, while they enjoy intercourse with their partner, never or rarely reach orgasm, and are left feeling dissatisfied as a result.

Women's problems over orgasm vary. Some women have never experienced an orgasm at all. This is often because they were brought up to think of sex as something not quite nice.

Parents worried about daughters getting pregnant may keep impressing on them that they mustn't get carried away. It is small wonder that, when they have a partner, they can't suddenly undo all those lessons to their sub-conscious.

Before a woman who has never experienced an orgasm can help her partner to help her to climax, she has to learn for herself what pleases her.

Sex is a positive pleasure, and there is nothing wrong with enjoying it, even when you are alone.

Having given yourself permission to enjoy your sexuality, you have to find out what turns you on, explore the effect of different caresses of the genital area.

There is nothing wrong with self-stimulation - in fact it is a basic part of the treatment prescribed by sex therapists.

It's not stimulation of the vagina, by the way, but of the clitoris that leads to orgasm for most women - the clitoris is the little peak you can feel in the front of the vagina.

When you have an orgasm it feels like an internal throbbing. The intensity varies widely. It can be fierce and wild, it may be quiet and sensuous. The common denominator is it certainly should feel pleasurable.

Some women learn how to masturbate, perhaps as teenagers, but find they are unable to reach a climax with their partner, even if he stimulates them in a similar way.

The most likely cause of this is a variation on the inhibited feelings mentioned before. Their sub-conscious will not let them admit to anyone else that they are enjoying sex.

Sharing regular sessions of all-over massage can help a couple start communicating physically and sexually. Use a little cream or oil, massage and stroke one another all over. Say what feels good and what not-so-good.

When the time feels right, you can begin showing one another how to give the most pleasure by stroking and massaging the sexual areas, too. The only rule is that you should both enjoy it.

Modern-style vibrators designed especially to suit women's sexual responses can make a terrific difference.

Check out www.emotionalbliss.co.uk, www.durex.co.uk and www.passion8.co.uk.

Tingletip is a tiny but powerful vibrator for clitoral stimulation only, designed to fit on the head of an electric toothbrush - so great for travelling (www.tingletip.com).

The Vielle range (www.vielle.co.uk), which includes a non-electrical clitoral stimulator, lubricant and stimulating gel, is widely available in pharmacies and Boots.

Some women can climax when masturbating or when stimulated in some similar way by their partner, but cannot reach orgasm during intercourse.

In fact, this is normal, as only a minority of women do climax during intercourse. Most reach orgasm through other stimulation.

Many couples have perfectly happy ways of making love which involve the man stimulating the woman until she climaxes, either before or after intercourse.

It really doesn't matter how or when a woman reaches her climax, as long as she enjoys it, but if a couple feel that they very much would like the woman to climax during intercourse, they may find a change in position will help or he can caress her at the same time.

The vagina has comparatively few nerve endings and the clitoris has many. Basically, few women can possibly climax unless they are receiving some form of clitoral stimulation.

Of course, it is important for the man to be sure that the woman is really aroused before he attempts intercourse, so they must share lots of loving foreplay first.

Also the man has to be able to sustain intercourse for a reasonable length of time, since it is important to keep stimulating a woman right up to and during orgasm.

If premature ejaculation is a problem, however, let me know because I can send you a free leaflet on how to solve the problem.

Reaching a climax needs some muscle tension and you can give this a nudge in the right direction.

You need to have at least half an hour of foreplay to be sure the woman is fully aroused. Then she shouldn't try to relax but tense the pelvic-floor muscle (if you're unsure how to do this, my free leaflet on increasing sexual sensation explains).

If she then arches her back and puts her head back, this gets her body in the right position to reach climax, as long as her partner carries on pleasuring her.

Assuming a couple feel free to experiment with what feels good to them, then they have a good chance of discovering what will lead to the woman achieving full sexual satisfaction pretty frequently, if not every time.

However, some couples experiment with different positions and techniques and still draw a blank. Too much alcohol can dry up the vaginal secretions and reduce the blood flow to the sex organs.

This in turn can make sex more painful and will affect a woman's ability to have an orgasm.

Loss of orgasm can also be linked with major changes in a woman's life such as childbirth or the menopause. Depression can severely damp down sexual feelings.

It could be that she's had a bad sexual experience in the past or that there's some problem in her relationship with her partner, and unaided you can't stop it getting in the way.

For more details about the help available, or if you want a step-by-step explanation of the self-help therapy suggested earlier, do write for my more detailed free leaflet on solving orgasm problems which explains all this and gives contacts for finding expert sex therapy.

Solving erection problems

IT is doubly frustrating for a man when he can't get or maintain a firm enough erection to make love.

Not only does he feel unfulfilled sexually but it is so maddening to know you want to make love, know you desire your partner, but find yourself unable to control the crucial bit of your body.


It's even worse when your partner feels very threatened by your not making love to her and starts accusing you of not loving her or of having an affair.

So one of the first steps you have to take to resolve this problem is to be honest with your partner.

I know it's hard for a man to admit he's experiencing erection problems but the overwhelming majority of women are very understanding - in fact, they are often relieved to discover that's what the problem is.

Sharing this with your partner will also have the effect of relieving some of your anxiety - and that in itself will help since anxiety alone can cause, or certainly contribute to erection problems.

Most cases of temporary erection difficulties are simply cleared up if you and your partner agree that you won't try to have intercourse for a while.

That absolutely does not mean that you give up all the other ways of making love - kissing, cuddling, caressing, doing everything loving, arousing and satisfying you feel like doing.

Massage is a good way to get that loving closeness, and stimulate your hormones and physical responsiveness. The only thing to avoid is attempting intercourse itself.

After a few days, or weeks, you should find that one time you have intercourse easily just because you weren't worrying about it.

If you're a man without a regular partner you may wonder how you can help yourself with this problem. I often hear from men who are avoiding all relationships for fear of failure. The answer is to enjoy as much masturbation as you feel like.

Just follow your fancy. Try allowing your arousal to subside and then build it up again. When you do meet a partner with whom sex seems likely, confide in her.

Most women will be very sympathetic about this problem as long as you explain, and an affectionate couple can share plenty of sexual pleasure without needing a rock-hard erection. In fact, most women reach orgasm through stimulation other than intercourse.

Although most cases of temporary impotence are psychologically based, keeping the body in reasonably good working order helps keep us ticking over well sexually, too.

Advertisement

Drinking too much alcohol lessens sexual responsiveness, both at the time (the notorious brewer's droop) and generally.

Three pints of beer or six single measures of spirits or small glasses of wine are as much as a man's body can cope with healthily in a day. Cut down if you're regularly drinking more than that and always have a couple of alcohol-free days a week.

Smoking has been realised to be an important cause of loss of sex drive and impotence in men. Smoking and unhealthy diet can both cause circulation problems which affect the blood supply to the crucial parts.

The first thing that many top specialists now recommend to people with such sexual problems, particularly if they are 40 or over, is to stop smoking and follow a healthy, high-fibre, low-fat diet. Regular exercise can also benefit your sexual well-being.

Be careful though about excessive cycling, either on an exercise bike or a real one with a hard narrow saddle.

This can damage the main artery to the penis, which in turn causes problems with erections.

Sexual problems are often also linked with anxiety. If you have been suffering from a lot of tension or worry it will help you recover your sexual responsiveness if you can learn to relax more out of bed as well as in it.

If you write to me I can send you my free leaflet on how to relieve stress.

If you feel your relationship is not close enough for you to begin loving and caressing one another as suggested, then that may be the problem causing the sexual failure.

Unresolved bitterness and unhappiness very often show up in sexual difficulties.

You may be subconsciously punishing your partner. If you can't sort out what are the real problems in your relationship by talking about it calmly between you, then make an appointment to see a counsellor at your local branch of Relate (0845 456 1310, www.relate.org.uk).

Relate also aim to have a sex therapist within 20 miles of everyone in the country, and you can also find a qualified sex therapist near you by contacting the British Association for Sexual and Relationship Therapists (020 8543 2707, www.basrt.org.uk) but expect to pay private fees.

Now it can happen that, in spite of taking the emphasis off intercourse, and in spite of lots of loving and caressing, a man still can't manage to make love.

If you have been suffering from this problem for three months or more then you should see your GP to check whether there is a medical problem.

There have been considerable advances in treating this problem when it has a physical or hormonal cause, and seeing the doctor is important because erection difficulties can be an indicator of heart problems, for example.

You can also see a specialist at your local genito-urinary clinic - it's where they treat sexual infections but don't let that put you off benefiting from their expertise in this area.

What sorts of treatments are on offer? Viagra is the best known. It helps blood flow to the penis and seems to work in about 70 per cent of cases, whether the cause is physical or psychological, though it may not be so effective long-term if difficulties in your relationship are affecting your sex life.

There are worries about side-effects, such as heart attacks, especially if over-used, and it's obviously not suitable for some men, such as those with serious heart problems.

Viagra is only available on the NHS to patients falling into specific categories, such as men with diabetes and those who have had prostate surgery or spinal cord injuries, though others can obtain it as private patients.

If you're interested in Viagra, start with your GP. If he or she says you're not going to be eligible on the NHS but you could pay for private treatment, they will have to refer you to another GP or specialist. You'll have to pay for the consultation - costs can vary widely so it's worth shopping around - and then pay several pounds per tablet.

It may sound a lot but I suppose you have to decide whether a reliable erection is worth the price of a round of drinks down the pub.

I know Viagra is now on sale over the counter in Boots with certain restrictions but buying it this way tends to be even more expensive and a real snag is that Viagra needs to be taken at the correct strength to be safe but effective, so my advice is still to consult your GP, especially as erection difficulties can be a sign of a medical problem such as heart trouble.

While Viagra is still the best known, there are other drugs such as Uprima and Cialis, which can be more suitable than Viagra for some men. Cialis, for example, can now be prescribed in 36-hour and daily formulations, so you can choose to take one to cover the weekend, or a daily pill so you can always rely on being "up for it".

Cialis sales have overtaken those of Viagra now. The same prescribing restrictions apply as apply to Viagra, so it's a case of talking it all over with your own doctor first and whether you can afford it if you're not eligible on the NHS. And of course, none of these is a miracle drug.

A man still needs sexual stimulation and the desire to make love.

You can also talk to your doctor about other options. If you have been impotent for a prolonged period, treatment with the hormone testosterone might give your body the "kick-start" it needs to get back into action.

More and more is being understood now about how our body chemistry affects our sexual responsiveness.

However, hormones aren't a magic potion. Hormone treatment will only work if your hormone levels are the problem - though it can certainly be combined effectively with counselling or other talking-it through therapy. You can ask for a blood test to check your hormone levels.

Your GP can also prescribe the Muse system. This uses an applicator to insert a drug pellet into the urethra, the tube through which urine is passed.

It produces an erection in about five to ten minutes, during which time the penis needs stimulation, so you can continue with foreplay. It works well mainly for erection problems with a physical cause but you need precise instruction in how to use it.

Your doctor or a specialist can also instruct you in how to inject your penis with a drug that produces an erection. If your impotence has a physical cause, is not bound up with problems in your relationship, and you and your partner are happy about your producing erections with injections, this method may suit you.

Vacuum devices are also on the market but are clumsy to use, and rings which fit around the base of the penis to aid erection are available through your GP or specialist.

Gadgets, pills and potions sold in sex shops are often useless or even harmful. Do look for help via your doctor.

What it is important to realise about even reputable treatments is that they will never be the answer if the real problem lies in your relationship. Unless you have already seen a Relate counsellor or other properly qualified sex therapist about your impotence problem, I would strongly recommend that as the most promising place to start, as well as checking with your GP to see if medical treatment would help or perhaps a change of medication.

This is important, even if you find the idea of talking to your GP about sex problems embarrassing, as erection difficulties can be an indicator of heath problems.

Illnesses affecting nerve tissue, such as some cases of diabetes, can damage the nerves involved in causing erection. Circulation problems and some drugs, such as steroids, diuretics and those used to treat high blood-pressure problems, can make a firm erection difficult. Pain and infections can obviously damp down sex drive, as can depression and some of the drugs used for treating it.

GPs vary as to how knowledgeable they are at helping with sexual difficulties, but your GP can refer you for expert treatment if necessary. Some GPs have specialist training from the Institute of Psychosexual Medicine, and you can ask the Institute for details on 020 7580 0631 (www.ipm.org.uk ). Some hospitals have a special clinic attached to them, and you can ask for a referral there. However, most psychosexual medicine services are based in the community, usually attached to family planning services.

Some hospital genito-urinary medicine or GUM clinics - often called the special clinic - can help with this sort of problem. Treatment is totally confidential and you can usually refer yourself without having to go through your GP, which can be an advantage. It's certainly always worth asking.

If you can afford private treatment, you can also ask your GP to refer you to a private specialist. This is usually a better route to a reputable specialist than responding to an advertisement for a private sex clinic. You can also get advice from the Sexual Dysfunction Association on 0870 7743 571 (www.sda.uk.net).

I hope this has helped you understand the range of treatments available for impotence and will help you solve your erection problem. If you would like any further personal advice, do let me know. Write to problems@deardeidre.org. I'll look forward to hearing from you.

Do it daily to improve sperm Quality

Having sex every day improves men''s sperm quality, an Australian study has revealed.

In a study of men with fertility problems, researchers found that daily ejaculation for a week cut the amount of DNA damage seen in sperm samples.

"All that we knew was that intercourse on the day of ovulation offered the highest chance of pregnancy, but we did not know what was the best advice for the period leading up to ovulation or egg retrieval for IVF," Dr David Greening, an obstetrician and gynaecologist with sub specialist training in reproductive endocrinology and infertility at Sydney IVF, Wollongong, Australia, said.

"I thought that frequent ejaculation might be a physiological mechanism to improve sperm DNA damage, while maintaining semen levels within the normal, fertile range," he added.

To investigate this hypothesis, Greening studied 118 men who had higher than normal sperm DNA damage as indicated by a DNA Fragmentation Index (DFI).

Men who had a more than 15 percent of their sperm damaged were eligible for the trial. At Sydney IVF, sperm DNA damage is defined as less than 15 percent DFI for excellent quality sperm, 15-24 percent DFI for good, 25-29 percent DFI for fair and more than 29 percent DFI for poor quality; but other laboratories can have slightly different ranges.

The men were instructed to ejaculate daily for seven days, and no other treatment or lifestyle changes were suggested. Before they started, levels of DNA damage ranged between 15 percent and 98 percent DFI, with an average 34 percent DFI when measured after three days'' abstinence.

When the men''s sperm was re-assessed on the seventh day, Greening found that 81 percent men had an average 12 percent decrease in their sperm DNA damage, while 19 percent men and an average increase in damage of nearly 10 percent. The average for the whole group dropped to 26 percent DFI.

"Although the mean average was 26 percent which is in the ''fair'' range for sperm quality, this included 18 percent of men whose sperm DNA damage increased as well as those whose DNA damage decreased," Greening said.

"Amongst the men whose damage decreased, their average dropped by 12 percent to just under 23 percent DFI, which puts them in the ''good'' range. Also, more men moved into the ''good'' range and out of the ''poor'' or ''fair'' range. These changes were substantial and statistically highly significant.

"In addition, we found that although frequent ejaculation decreased semen volume and sperm concentrations, it did not compromise sperm motility and, in fact, this rose slightly but significantly.

"Further research is required to see whether the improvement in these men''s sperm quality translates into better pregnancy rates, but other, previous studies have shown the relationship between sperm DNA damage and pregnancy rates," he added.

Greening said he thought the reason why sperm quality improved with frequent ejaculation was because the sperm had a shorter exposure in the testicular ducts and epididymis to reactive oxygen species - very small molecules, high levels of which can damage cells.

"The remainder of the men who had an increase in DFI might have a different explanation for their sperm DNA damage," he said.

The study has been presented at the 25th annual meeting of the European Society of Human Reproduction and Embryology in Amsterdam.