Articles on sexual wellness

Sexual Response Cycle in Males

Dr. Ramesh Maheshwari, Sexologist
Men and woman, with some sexually arousing stimulus, proceed through orgasm and end with a return of the body to a sexually unstimulated state. This is described in four stages: Excitement, Plateau, Orgasm, and Resolution. There is no sharply defined moments when one stage ends and the next begins. Each phase merges with the next phase.ExcitementMen: Erection of penis, marked increase in its size, and a rise in its angle. Erection may be triggered by penis itself or by sexually stimulating sight, smell or thought. It occurs in 3 to 8 seconds.A small penis may double in length, while in a large penis lengthening is less marked.Partial elevation and increase in the size of testes.Plateau Full erection of penis. Increase in size and full elevation of testes. Little secretion from Cowper’s glands appears at the Urethral meatus.OrgasmOrgasm occurs in two distinct stages. In the first stage the Vas deferens, the prostate and Seminal vesicles begin a series of contractions that forces semen into the bulb of the urethra. The man experiences a sensation of ‘Ejaculatory inevitability –the feeling of having reached brink of control. At this point ejaculation cannot be stopped. In the second stage of orgasm contraction of urethra and penis combined with contraction in the prostate to cause ejaculation (spurting of semen out of tip of penis). During ejaculation the neck of the urinary bladder is tightly shut to avoid any mixture of semen and urine. The rhythmic contractions of prostate, the perineal muscles and the penis occur initially at 0.8 seconds intervals.Male orgasm and ejaculation are not one and the same process. Although the two occur simultaneously, orgasm refers to muscular contraction and release of sexual tension, while ejaculation refers to the release of semen. Orgasm without ejaculation is common in boy before puberty.ResolutionMan is not able to have multiple orgasms. Immediately after the ejaculation man enters a ‘refractory period’ during which further orgasm or ejaculation is impossible. Usually the erection subsides quickly. There is grate variability in the duration of refractory period. It may last from few minutes to many hours. This period gets longer with each repeated ejaculation. As the man gets older, the refractory period gets longer. The period of return to the unaroused state is called the ‘resolution phase’. The anatomical and physiological changes that occurred during excitement and the plateau phase reverse. Blood is pumped out of penis and therefore loss of erection. The testes decrease in size and descend in scrotum.

Psychology of Sexual Response

Dr. Ramesh Maheshwari, Sexologist
One of the qualities of human being is its capacity to be modified by its experience. The process is known as learning & conditioning. Most of the aspects of human sexual behavior appear to be the product pf learning and conditioning. As individual may prefer a particular type of individual as sexual partner-tall/short, younger/older single /variety of partners, heterosexual /homosexual ,petting/immediate coitus, single/variety of positions.Flagellation Masochism, Transvestism and variety of fetishes appear to be the products of conditioning fortified by some other aspects of personality and by inherent capacities.So called aberrant types of behavior meaning the less usual types of conditioned responses may be disadvantageous, but they are of social concern.  The classification of behavior as normal or abnormal represents moralistic Classification rather than any scientific one. Once known as perversion was later called as Deviation and now as variation.Individuals become erotically aroused when they observe other individuals engaging in sexual activity. Most males are likely to respond quite immediately to such stimuli to come to erection and to seek the opportunity for sexual activity. These are Sympathetic Response. The restriction which the human societies place upon the public performances of sexual act arose from attempt to control the sympathetic response of the bystanders.Males are more often conditioned by their sexual experience than females. There is tremendous variation in which different individuals may be affected by psychological stimuli females differ from average males. Females masturbate without associated sexual fantasies while all males do fantasize while masturbating. Females never had sexual drams while they slept while all the males have nocturnal sex dreams. Males are erotically aroused by seeing photographs or paintings of nudes are produced primarily for consumption of males. There are no male/female nude photographs or magazines produce for consumption of females. Heterosexual males are aroused by observing females breasts, genitalia or some other part of  the females body while most of the females are not aroused by observing male genitalia. Males are inclined to initiate a sexual relationship trough genital stimulation. Most females prefer to be stimulated tactilely in various other parts of the body before the activity is concentrated on the genitalia. It is complaint of married females that the husband is interested in nothing but intercourse. On the other hand it is a constant complaint of married male that his wife will do nothing to him which means that she does not tactilely stimulate his genitalia.Many males have their sexual activities where there is some light. Male is stimulated by seeing genitalia or other parts of the body of sexual partner while females are much less attracted by observing the male partner genitalia. Females do not prefer light during their sexual activity.   Many husband fail to comprehend that their wives may need general physical stimulation before they are sufficiently aroused and aroused and want a genital union.Males are erotically stimulated by seeing pornographic literature or films, while females are not stimulated by the same. Females like to deal with general emotional situations affectional relationship and love.Wall inscriptions in public toilet provide information on extent and nature of the suppressed sexual desires of males and females sexual material on the walls of male toilet are drawings slang words phrases or genitalia. In female toilet walls the inscriptions referred to love associated names lipstick impressions or drawings of hearts; but no genital action inscriptions are observed.Many males marry so as to have an opportunity to have coitus regularly with their wife; while an average female marries to establish a home to establish a long term affect ional relationship with her spouse and to have children whose welfare becomes the prime business of her life.Average male has a greater need than for females for regular and frequent sexual outlet.It is difficult for the males to understand that females are not aroused by seeing male genitalia. Many males conclude that she is no longer in love with him. On the contrary many females feel that their husbands are vulgar or perverted because they want to display their genitalia. Difficulties develop in marital relationship because of this failure of females to understand male psychology, and of males to understand female psychology. 

Sexual Problems in Men

Dr. Rahman, Sexologist
Sexual problems in menFortunately, most sexual problems are treatable, so it is important to share your concerns with your partner and doctor.What causes sexual problems?Sexual dysfunction can be a result of a physical or psychological problem.Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular ( blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medicines, including some antidepressant medication, can affect sexual desire and function.Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.Who is affected by sexual problems?Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the older population, which may be related to a decline in health associated with ageing.How do sexual problems affect men?The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.What are ejaculation disorders?There are different types of ejaculation disorders, including:Premature ejaculation -- This refers to ejaculation that occurs before or soon after penetration.Inhibited or retarded ejaculation -- This is when ejaculation is slow to occur.Retrograde ejaculation -- This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation is often is due to nervousness over how well a man will perform during sex. Certain medications, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord.Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backwards and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medicines, particularly those used to treat mood disorders, may cause problems with ejaculation. This does not generally require treatment unless it impairs fertilityWhat is erectile dysfunction?Also known as impotence, erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse. Causes of erectile dysfunction include diseases affecting blood flow, such as atherosclerosis (narrowing of the arteries); nerve disorders; psychological factors, such as stress, depression, and performance anxiety (nervousness over his ability to sexually perform); and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie's disease (scar tissue in the penis) can also cause erectile dysfunction.What is inhibited sexual desire?Inhibited desire, or loss of libido, refers to a decrease in desire for, or interest in sexual activity. Reduced libido can result from physical or psychological factors. It has been associated with low levels of the hormone testosterone. It also may be caused by psychological problems, such as anxiety and depression; medical illnesses, such as diabetes and high blood pressure; certain medications, including some anti-depressants; and relationship difficulties

Sexual Problems in Men

Dr. Rahman, Sexologist
Many men have sexual problems. They become more common as men age. Problems can include:• Erectile dysfunction• Reduced or lost interest in sex• Problems with ejaculation• Low testosteroneStress, illness, medicines, or emotional problems may also be factors. Occasional problems with sexual function are common. If problems last more than a few months or cause distress for you or your partner,The main types of male sexual dysfunction are:• Erectile dysfunction (difficulty getting/keeping an erection)• Premature ejaculation (reaching orgasm too quickly)• Delayed or inhibited ejaculation (reaching orgasm too slowly or not at all)• Low libido (reduced interest in sex)How does sexual dysfunction affect men?The most common problems men face with sexual dysfunction are troubles with ejaculation, getting and keeping an erection, and reduced sexual desire.Ejaculation disordersProblems with ejaculation are:• Premature ejaculation (PE) — ejaculation that occurs before or too soon after penetration• Inhibited or delayed ejaculation — ejaculation does not happen or takes a very long time• Retrograde ejaculation — at orgasm, the ejaculate is forced back into the bladder rather than through the  end of the penisThe exact cause of premature ejaculation (PE) is not known. While in many cases PE is due to performance anxiety during sex, other factors may be:• Stress• Temporary depression• History of sexual repression• Low self-confidence• Lack of communication or unresolved conflict with partnerWhile male sexual dysfunction cannot be prevented, dealing with the causes of the dysfunction can help you better understand and cope with the problem when it happens. To help maintain good sexual function:• Follow your doctor’s treatment plan for any of your medical/health conditions• Limit your alcohol intake• Quit smoking• Communicate better and more often with your partner

Things You Must Know About Sexually Transmitted Diseases

Dr. Parmjit Singh Walia, Dermatologist
Over the last few years, a lot of patients have been coming to our clinic who are actually not suffering from HIV or any other sexually transmitted disease but are still struggling to find a solution to their problems related to their private parts. A major part of their suffering is rather related to reading a lot of database from Google or finding tedious ways to treat them with naturopathy. The fear of getting a sexually transmitted infection (STI) is the one that perpetuates the vicious cycle of existence of these "NOT SO TALKED ABOUT"diseases. STIs are very common and easily transmitted through sexual contact. Many STIs are curable and all are treatable, but the only way to know if you have one is to talk about them, consult a dermatologist and get yourself tested if required.Common Symptoms of STIs:Talking to your doctor about your sex life might seem too personal to share but ideally seeing a dermatologist takes you to the fast track of solution of the problem. Here are some common symptoms that may alert you to the presence of an STI:Pain and/or burning sensation when urinating Discolored, smelly, or particularly heavy discharge Abnormal vaginal discharge Warts, lesions, or sores in the genital area Rash or itching in the genital area Painful intercourseLower abdominal pain, fatigue & Low back pain (females)Q: How can you protect yourself ? A: Protecting yourself sexually involves not only learning about STIs but practicing safer sex every time you engage in any sexual activity.Avoid or minimize direct oral, anal and genital contact by using a barrier method correctly and consistently. Avoidance of impulsive intercourse with a complete stranger Form a trusted, honest, and communicative relationship. Always examine your partner for any wart, ulcer or any other obvious lesion on the genital parts Limit your number of sexual partners. Talk to your partner about your STI status. Include STI testing as part of your regular medical check up. Learn the common symptoms of STI’s. Do not use drugs or alcohol in potentially intimate situations as they can inhibit your ability to make decisions and may affect your dexterity. Get vaccinated for Hepatitis B and C. Get vaccinated for HPV if you are a woman between the ages of 9 and 26.Q: How do you get tested for STIs? A: There is no one test for all STIs. Get yourself examined by a dermatologist and get the tests recommended as it saves money and avoid unnecessary investigations.Q: How are STIs treated? A: The treatment depends on the type of STI. Only use medicines prescribed or suggested by your doctor. There are products sold over the Internet that falsely claim to prevent or treat STIs but the safety of these products is not known. Consult your dermatologist to speak about how you can protect yourself or to get tested and treated accordingly.

Female Sexual Dysfunction & Diabetes

Dr. Sharmila Majumdar, Sexologist
Causes of FSD in DiabetesVascular damage can affect blood slupply to the vagina and clitoris which can cause problems with dryness and arousal.Neuropathy can reduce sensitivityDiabetes can also lead to low oestrogen levels which can also affect the lubricationDepression can lead to FSD in a diabetic women and can affect relationships.FSD in the Diabetics Assessed in a SurveyFemale sexual response cycle is a complex non linear progression from desire to arousal and orgasm.Diabetes particularly affects arousal with decreased genital sensation and lubrication.Vaginal dryness & infections may lead to dyspareunia.Sexual functioning can be affected by Vaginitis caused by yeast infection and cystitis often result of a UTI.Predictors of sexual dysfunction in women include depression.Neither age, duration of diabetes, glycemic control nor complications in predict sexual dysfunction in women as they do in men.Low androgens and possibly estrogens may be etiologic, as may numerous medications used by patients with diabetes.Recognition of the high prevalence of FSD (up to Results show that women with type one diabetese, depression and marital status are the main predictors of FSD, whereas glycaemic control & complications were not associated with FSD.Further studies are needed to elucidate the mechanisms underlying these differences.Considering that FSD can have an important negative effect on quality of life and partner relationships, the sexual difficulties of women with diabetes warrant more attention in both research & practice.50%) & potential increase, in tandemwith that of diabetes, is needed.In. The absence of definitive treatment, psychosexual counselling, relationship & sex therapy, DHEA supplements, vaginal lubricants, Flibanserin, low doses of estrogens or androgens, and Vitamin T(touch) have been used toRelieve the personal distress of  FSD.Conclusion- FSD is more frequent in diabetic than in control women, but it is still poorly understood; low Female Sexual Function Index is associated with high BMI.Sexual functioning of women with diabetes, has received far less attention in research, and results are less conclusive than those of studies in men. Further studies are necessary to better understand the risk factors for FSD in diabetic women.

Female Sexual Disorder & the Current Thinking Internationally!

Dr. Sharmila Majumdar, Sexologist
Sexual dysfunction is broadly defined as the inability to fully enjoy sexual intercourse. The disorder must be deemed to have caused significant distress. In addition to the existing specifiers of lifelong vs acquired & generalized vs situational, a new severity scale was added: the disorder can be described as mild, moderate or severe.A new criteria called “associated features” was introduced. It is subdivided into 5 categories: Partner factors (e.g., partner sexual problem; partner health status); Relationship factors (e.g., poor communication); Individual vulnerability factors (e.g., poor body image; history of sexual or emotional abuse), psychiatric comorbidity (e.g., depression; anxiety), or stressors (e.g., job loss; bereavement);Cultural or religious factors (e.g., inhibitions related to prohibitions against sexual activity); andMedical factors relevant to prognosis.Causal Factors in Sexual Dysfunction - predisposing factors, precipitating factors and maintaining factors.About 43% of women and about 31% of men have experienced sexual dysfunction based on several surveys. This makes sexual dysfunction one of the most common psychological problem.Specific techniques to overcome some of the disorder symptoms are to increase communication between the couple, increase self understanding and sensate focus exercises will help the couple Immensely alleviate some issues with immediate intervention and help of their doctor i.e. A sexologist or an andrologist.

Gender Scripts, Media, and Sexuality

Rajat Kaur Thukral
There are many gender specific role assumptions for men and women in every culture. For example, men are supposed to be strong and unemotional and women should be nurturing. According to the cognitive-social learning theory, individuals learn gender specific script early on in life from one’s own environment. Individuals tend to model other people in their lives or by watching television or reading magazines. The theory can be applied to sexual attitudes and behaviours as well. Learning gender specific sexual attitudes and behaviors from others has its advantages and disadvantages. One is likely to feel more accepted by the peer group which helps in building one’s self-esteem. But there are various negative consequences, such as, double standards for men and women, impact on women, and society does not appreciate expression of non-traditional forms of sexuality of LGBTQ population.In this day and age, there is a widespread impact of internet and other media channels on sexuality of the viewers. With the advancement of technology there has been bombardment of sexually explicit images and messages on internet, social media, newspapers, music videos, movies, television programs, and advertisements. There is a general trend of portraying women as sexy and attractive.  Women’s body has been objectified to attract men. According to recent survey, 80% of the pictures on the internet are of naked women. Men mostly appear to be dominant and leading whereas females were depicted as passive objects of desire. Music videos and movies capture the young audiences effectively and they are being targeted with these sexualized images which have long lasting impact on their developing identities and sexuality. The impact of sexually explicit content in mass media is pervasive and uncontrolled as they tend to get subliminally registered in the subconscious mind without one’s awareness.  Overall, there are differences between the sexual fantasy, sexual arousal, and expression of sexuality between men and women. These differences are based on various biological, psychological, social, cultural, and developmental factors. These differences are exacerbated and reinforced by the mass media that has long lasting impact on psyche of the audiences. People form sexual beliefs and attitudes subconsciously and unquestionably. This can positively or negatively impact their sexual expectations from oneself or from their partners. These implicit attitudes can have strong impact on relationship satisfaction between couples. When each individual in a relationship becomes aware of one’s beliefs related to sexuality, only then one will be able to become more comfortable with one’s own sexuality and truly respect their partner’s choices.There are certain myths in each society about gender specific roles and sexuality. Here are some stereotypes that are commonly observed in our culture and the possible effects of adhering to such gender scripts.Women do not engage in pre-marital sex.  In India, there is a huge power differential between the sexes and high restrictive standards for women’s sexuality.  Indian culture restricts women to experience sex before marriage.  Women who adhere to such gender specific sexual norm are more likely to perceive sex for reproductive function and not as a source for pleasure. They may run the risk of not having much awareness about their own sexuality which can have consequences for their later marital satisfaction. Women who do not adhere to such gender norms may feel more ashamed or guilty for engaging in premarital sex. Also, they may also feel that there are double standards in the society about sexuality for men and women and may feel the need to rebel against those standards and use sex as a medium for empowerment and liberation.Men are dominant and women are submissive in sex.  Men and women who adhere to these gender scripts are more likely to engage in heterosexual relationships with power imbalance.  Such couples are also more likely to prefer having sex in missionary pose.  Men and women who do not adhere to such gender script are more likely to experiment with their sexuality.  They may engage in trying different sexual positions, different partners, and use more sexual tools to enhance their experience.  Men who do not like to be in dominant role may be judgmentally perceived as more feminine and women who like being in dominant role may be perceived as more masculine.  This may impact their sexual preferences and sexual satisfaction.Men are sexually overactive and women are undersexed.  This is the most common assumption about gender specific sexuality.  It is portrayed in media and internet all around the world. Men who tend to adhere to this assumption are more likely to have multiple relationships and may have difficulties in committing to monogamous relationships. Men who may not adhere to that assumption are more likely to run the risk of being perceived as sexually impotent by their partners. Also, women who may like to have sex frequently may be perceived as more sexually promiscuous. Women may have a hard time asking one’s own partner to have sex. In couples, where both man and woman adhere to such gender specific stereotypes, are not likely to achieve satisfactory sexual intimacy as the woman in the relationship may not feel the need for sex due to repression. Also, the woman in such relationship is more likely to accept the extramarital affairs of her partner.  Hence, it is important to note that these gender scripts can have long-lasting impact on an individual’s sexual life. The cognitive-social theory contends that gender-specific norms are reinforced or internalized at a very young age. Boys and girls get rewarded or punished based on their selection of gender specific behaviors and attitudes. Boys are taught to engage in competitive sports or other physical activities early on, whereas girls are taught to focus on emotions and care-taking of others. Girls learn to be submissive at an early age and are also prohibited to have sex before marriage. So, the girls are more likely to fantasize more emotionally about sex and have more submissive themes in their fantasy. One way of transcending these rigid gender specific role attitudes and behaviors is to integrate both feminine and masculine aspects in each individual. Androgyny is the term that is used to describe an individual with masculine and feminine characteristics. Androgynous individuals who tend to integrate both masculine and feminine aspects of behavior are free to choose attitudes and behaviors that are not predetermined by the larger socio-cultural gender scripts. They are more likely to be comfortable with their own sexuality and can be respectful of other people’s choices. There is an emotional and a physical aspect to sexual intimacy. Androgynous individuals are comfortable in balancing both as they do not inhibit one aspect of oneself and allow full expression of their individuality and sexuality.ReferenceCrooks, R. & Baur, K. (2011). Our Sexuality (11th Ed.). Belmont, CA: Thompson Wadsworth.