In 2008, the Mayo Clinic published a case study of treating compulsive sexual behaviors with pharmaceuticals:
A male patient first presented to a psychiatrist (J.M.B.) at age 24, with the explanation, “I’m here for sexual addiction. It has consumed my entire life.” He feared losing both marriage and job if he could not contain his burgeoning preoccupation with Internet pornography. He was spending many hours each day chatting online, engaging in extended masturbation sessions, and occasionally meeting cyber-contacts in person for spontaneous, typically unprotected, sex.
The story is a familiar one. A young man seeking sexual activities outside of his marriage or relationship experiences guilt because of his compulsive behaviors. He feels he cannot stop and is at a loss for solutions. He wants to be good, by whatever measure his culture dictates, but feels he can’t.
The term “sex addiction” is the new darling of sensational media. The narrative of an addict is a compelling one, their struggle with external forces in the world leaves much room for pity. After all, this isn’t their fault but the fault of the pesky stimulus hijacking their tender neurological reward circuitry. Right?
Not really. The picture of compulsive sexual behaviors is far more complicated than (male) brain + (non-monogamous) sexual stimulation = addiction. Dopamine may indeed play a role in all compulsive behaviors but the narrative of porn as an external factor that takes over your system is a false (and overwhelmingly Christian) explanation that fails to recognize sexual histories and user conceptions of sexuality.
Vaginas are magical. These self-cleaning, elastic, muscular life and love canals that can give amazing amounts of pleasure to their owners and others are sophisticated in both design and function. But with great complexity comes the great potential for system hiccups.
The common umbrella term for many hiccups is “Vulvovaginitis” and describes any irritation of the vulva or vaginal areas. Often the irritation comes in the form of painful swelling or itching caused by an external factor irritating sensitive mucous membranes. (Ever gotten something in your eye, be it infection or irritant? Same idea. ) Many cases of vulvovaginitis occur because of an imbalance of naturally occurring bacteria and yeasts and sometimes parasites or viruses.
But don’t fret! These are easy to remedy. Here’s a handy guide to the more common causes:
I don’t know if you can help me, but maybe you know somebody who can.
I am 34 years old and unable to have a penetrative, penis-induced orgasm. I have been having clitoral orgasms since I was 18. Just about anybody can make me orgasm with their finger or mouth. I can also come if I touch my own clitoris during penetration. But nobody has been able to make me come from penetration alone.
I have two amazing male partners right now, one of almost three years, and the other of almost one year. Both of them are open to helping me and trying different things, but so far unsuccessfully.
I know that I have trust issues. I know that I don’t fully trust either one of my partners and am not sure I am emotionally able to fully trust any man.
I don’t know what other emotional blocks I may have.
Please let me know if you have any recommendations for me.
Thank you! Blocked Vagina
Dear Blocked Vagina,
Thanks for writing to me about this; your question is a very common one among women.
First things first: an orgasm is an orgasm is an orgasm. Popular culture (women’s magazines especially) push the idea that there are different types of orgasms. Not really. Continue reading →
Hi, a few semesters back I was in Dr. [So and So's] courses at SFSU. You were my aide, I’m not sure whether you still do teacher’s aid stuff or not but I remember how knowledgeable you were about the topic of human sexuality and I have a longstanding question and debate I need answered by someone who know what they’re talking about. The question is: does men’s prejaculation contain sperm? I know it comes from a different part and is not manufacutred in the same place but I’m wondering whether it is in fact produced with a sperm count. If you could help me at all that would be wonderful! Thanks
Yes, it *can*. Here is why.
Semen is made of two parts: seminal fluid and sperm. Most of seminal fluid originates from the seminal vesicles, followed by fluids from the prostate, bulbourethral (aka Cowper’s) glands and a teeny bit from the testes. A small amount of that fluid contains sperm, somewhere under 10%.
For sperm to survive the urethral journey it must travel in an alkaline instead of acidic environment. Enter the alkaline leaning precum.
Although precum is there to clear it out, and give a little lube love, residual sperm can reside on the tubes and exit with the fluid. One easy solution: pee. Urinating beforehand will kill the straggling sperm. Urinating after ejaculation will kill any straggling sperm. The lesson? Sperm in pre-ejactulate is possible but pee will kill it. Pregancy from precum is not very probable, in my opinion.
Oh, oh, oh: Orgasm. A tasty, potent hypothalamic chemical cocktail released through nerve ending stimulation. When many people think about sexual pleasure, orgasm is the ultimate goal.
But some people have a hard time getting on the orgasm bus, which the medical community calls “anorgasmia.” Among men, the prevalence is between 8%-14%. The rates for women are wildly divergent: anywhere from 5% to 75% depending on the literature. I would put the estimate of actual anorgasmia (different from “dysfunction” estimates, where we lump “low sexual” desire in with everything else) somewhere around 10-20% of females, not far off from male prevalence estimates.
Maybe you’re in that anorgasmic category. Or maybe your mojo is flagging and you can’t quite trigger that neuro-chemical delivery. Our sex drives fluctuate and vary throughout our lives. Many, many factors contribute to orgasm blockage. So how to get around orgasm barriers like sex-negative cultural messages or physiological blocks?
Relax. You know that saying: “It’s all in your head?” This is especially true for orgasms and arousal. When we tense up or become anxious our bodies route blood to our heart and lungs instead of exposed skin like the lips and genitals. Tantric breathing practices are really helpful here. Sit with yourself or your partner and take slow deep breaths. You will start to feel high and relaxed.
Enjoy sensation. Once you start to feel zen-like and anxieties subside, start exploring the vast expanse of skin. If I’ve said it once, I’ve said it a million times. And I’ll say it a million more: Brain and skin. Largest sex organs. Focus on those first. Feel your whole body starting with your feet and moving all the way up. Forget the genitals for now, just concentrate on finding the most responsive non-genital areas on your body. Ironically, having an orgasm is best served by not trying to have one. The more you focus and make it the end goal, the more anxious you’ll feel about having one. Saturate yourself with sensation for the sake of sensation.
Check your medicine cabinet. Sometimes the issue is not anxiety but medications to deal with anxieties or depression. SSRIs (Selective Serotonin Reuptake Inhibitors) are a class of antidepressants that boost serotonin levels. While serotonin helps alleviate depression it also acts as a hand brake on orgasms so sexual activity can feel like driving a car with the hand brake on. If you’re on SSRIs, talk to your healthcare provider about newer SSRI options that have fewer side effects. Or see tip #2 above.
Diet and Exercise. I recently hooked up with a past lover after three years. He went from hot-bodied sexy mofo to an aging alcoholic and the sexual side effects were not fun. Your circulatory system is important in sexual arousal and pleasure. Excessive smoking, drinking, drugs, bad diet and no exercise inhibit sexual arousal and orgasm by dulling nerve endings and messing with blood flow. This doesn’t mean that smoking or drinking or eating cheetos on the couch will absolutely prevent pleasurable sexual experiences. But if you’re having a hard time and you do any of those to excess, try stopping for a bit. (I quit smoking after 10 years, started exercising regularly and my sexual response capacity/level of sensation/orgasm intensity shot up like a rocket.)
Love your body. Remember the whole “sex is in your head” rhetoric? Self-perception is all in your head as well. Sexiness is not limited to lithe, caucasian, photoshopped and surgically enhanced bodies. Turn off the TV, ignore the glossy mags, and realize that you have a perfectly touchable, huggable, kissable, masturbatable, fuckable body. The beauty is in difference. Dont believe me? For the next two weeks avoid mass produced media. Look at people around you instead. Find photographs in National Geographic or any media outlet that depicts lots of regular people. Marvel at the diversity and how so many different body shapes can look so attractive. Enjoy where your body fits in with that spectrum. Once you realize that sexiness comes from within, letting go and experiencing sex will be so much easier.
First there were just orgasms. Then Freud came along and declared female orgasms fell into either the immature clitoral or mature vaginal category. And thus began this century’s strange preoccupation with women attaining every orgasm type, like kids collecting baseball cards.
Already had clitoral? Experienced the remote lands of vaginal? Well move onto the mystical G-Spot orgasm. Or perhaps you’re skilled enough for the big, bad blended orgasm. Don’t worry if you haven’t gotten there; Cosmo will give you enough advice to keep trying.
In reality, the only true type of orgasm is the hypothalamic orgasm. That little section in our brains releases a delicious orgasmic chemical cocktail in our brains with enough pleasurable stimulation.
When it comes to female orgasms we focus on the area being stimulated, hence all the different categories and “types” of orgasm. And it isn’t just women’s magazines devoting discourse to this idea. In my early sex education training days, several professionals repeatedly taught me that a clitoral orgasm is different than a vaginal orgasm. Even Planned Parenthood gives primacy to the theory of distinct orgasms:
“Although some researchers believe there is just one type of female orgasm, others believe that stimulation of these two parts of the genitals can cause different types of orgasm. During a clitoral orgasm, the vagina becomes longer, and it causes a pocket to be formed beneath the uterus. During a vaginal orgasm, the uterus drops lower and shortens the vagina. Stimulation of both the vagina and clitoris can cause a blended orgasm, the third type of orgasm. All these orgasms may feel different from each other.”
On one hand, it’s not illogical to categorize orgasms by stimulation source. But the idea behind the categorization is that some orgasms are superior to others, an idea that drives Cosmo sales every month. Read their article and achieve sexual enlightenment by finding your G-Spot.
Feminist writer Anne Koedt argued against this hierarchy of female orgasm way back in 1970’s “The Myth of the Vaginal Orgasm“, pointing out that the vagina contains far fewer nerve endings and any importance placed on vaginal stimulation served straight men more than it did women. In Koedt’s construction of female sexuality, the clitoris is the puppet master:
Although there are many areas for sexual arousal, there is only one area for sexual climax; that area is the clitoris. All orgasms are extensions of sensation from this area.
Weirdly, Koedt’s argument towards clitoral orgasm centrality operates within the very Freudian paradigm she railed against. We have orgasms from nerve ending stimulation. Though nerve endings exist abundantly in the clitoral structure (about 8,000) nerve endings exist everywhere else on the body. Substituting the clitoris for the vagina does nothing but rearrange the sexual stimulation hierarchy and ignore that nerve endings exist in the vagina. For some, those nerve endings feel amazing when stimulated.
When I present sex ed lectures, my favorite question to ask participants is: “What are the two largest sexual organs?”
The answer? Brain and Skin. Stimulating skin sends signals to the brain, which processes the sensations and releases the appropriate neurotransmitters. That’s an orgasm. No clits, vaginas or G-spots to define it. If you’re still feeling unsure or confused about the social construction of orgasm vs. the physical realities, I recommend reading Heather Corinna’s With Pleasure: A View of Whole Sexual Anatomy for Every Body.
Tune in tomorrow for suggestions on how to have an orgasm!
Is precum in guys like vaginal wetness in girls? Is it a similar process? (-question asked during a sex ed talk.)
No. Vaginal wetness comes internally from transudation (water content in plasma pushes past cell walls when blood vessels/capillaries become engorged) and externally from the Bartholin’s (greater vestibular) glands. Lubrication is part of the arousal process in females and can vary greatly due to a long list of factors.
Precum, on the other hand, occurs for a very different reason: to prep the urethra for safe sperm transportation. Urine and semen both pass through the urethra in males. Because urine is acidic enough to kill sperm, males secrete a small amount of fluid prior to ejaculation to create a more alkaline environment.
Be aware: precum still contains enough sperm to impregnante someone.