Sex is not supposed to hurt, but for many women it does. There are many medical reasons for painful intercourse (clinically called dyspareunia), and a physician should always be consulted. Pain might occur around the lips and clitoris, right around the vaginal opening, or deep within the vagina or abdomen. The pain might be experienced as a burning sensation, a sharp pain, or a dull ache. Women should be willing to talk with their doctors in detail, describing the location of the pain, the nature of the pain, and the activities that trigger the discomfort.
There are some women who, even though aroused, do not lubricate well. This might be due to age or medications that are being taken... or just something about the woman's biology. If this is all it is, the problem is likely to be solved with the use of a good, safe, water-soluble lubricant such as ASTROGLIDE. There is an article on this site that addresses the use of artificial lubrication.
There can also be discomfort during intercourse if a partner's penis is too long or too thick. This can be a real concern for some couples. If the problem is one of length and the woman feels discomfort when something internal is bumped, it might help if after being entered she closes her legs. This prevents deep penetration and might help avoid that particular kind of pain (that I call bumper dyspareunia). The problem of girth or thickness is not so easily solved. With time and learning to relax the vaginal muscles, this might eventually resolve itself. Strange as it sounds, it is often easier to relax the muscles surrounding the vaginal opening if a woman first has learned how to tighten them. Read about the Kegel Exercises.
There are a number of medical conditions that will cause sharp localized pain within the genital lips or around the vaginal opening, or a burning sensation along the vaginal walls. Persistent deep pain, or pain that seems related to a woman's monthly cycle, should be discussed with a physician.
There are some women who feel discomfort with attempted penetration of even the smallest penis, finger, or tampon. This might be the result of a condition known as Vaginismus. Vaginismus is the involuntary contraction of the band of muscles that surround the vaginal opening. The tightness prevents entry and the resulting pain causes the muscles to contract even more. The woman typically will feel out of control of this and is probably unaware of the involuntary tightening at the opening of her vagina. Sometimes the harder she or her partner tries, the worse the problem becomes.
Well over 85 percent of women treated for vaginismus will be having pain-free intercourse within six months of beginning treatment. The problem is best treated by a qualified sex therapist who will give the woman relaxation exercises to do at home. The video Treating Vaginismus portrays this therapeutic process.
As the woman learns to relax her body in general and especially her troublesome pelvic floor muscles, the therapist will introduce her to homework using vaginal dilators. These dilators come in a graduated series of sizes. A woman works her way up from a dilator perhaps no thicker than a piece of chalk to a dilator approximating the size of her partner's erection.
Much of what a woman needs to learn about relaxing and being comfortble with vaginal containment can be learned alone. However, if the woman is in a relationship, her partner will most likely be involved early in the treatment so that he understands what the purpose of the homework. He will be most certainly be involved later in the therapy as the couple approach the point when it is time to insert his penis.
A free brochure is available on the topic of vaginismus, but remember, this condition is best treated by a qualified sex therapist.
The purpose of this article is to educate, and nothing is intended to diagnose or treat sexual pain.
©2001 Robert W. Birch, Ph.D.
Learn about the video TREATING VAGINISMUS, hosted by internationally recognized sex therapist Joseph LoPiccolo, Ph.D.
Learn about PRIVATE PAIN, a book on understanding and overcoming Vaginismus and sexual pain by Ditza Katz, PT, Ph.D. and Ross Lynn Tabisel, CSW, Ph.D.
Learn about the video VAGINISMUS, a documentary on the revolutionary treatment of Vaginismus and Sexual Pain by Ditza Katz, PT, Ph.D. and Ross Lynn Tabisel, CSW, Ph.D.
Learn about a self-help approach to overcoming vaginismus at Vaginismus.Com.
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Free Brochure on Vaginismus
THE TERMS/THE DEFINITION
It used to be called IMPOTENCE but now is referred to as ERECTILE DYSFUNCTION. It doesn't matter what it is called, it is a major concern for men (and the partners) when it happens. An erectile problem is defined as the inability to get or to maintain an erection sufficiently hard enough to make penetration. Thus, it might be that a man is unable to get an erection, even with stimulation. Another man might get an erection, but lose it before ejaculating. Finally, a man might get partial filling of his erectile tissue, but his penis does not firm up enough to be useful. All of these men are said to have an erectile dysfunction.
Failure to get an erection might happen every time, or sporadically. A man might fail to get an erection with one partner, but not another. The onset of his erectile dysfunction might be gradual or might seem to happen suddenly. The nature of erectile dysfunctions vary.
CAUSES OF ERECTILE DYSFUNCTIONS
Age is a major factor. As a man ages, there is a gradual decline in his ability to get and secure a firm erection. The process slows and the quality begins to wax and wane. Perhaps the biggest cause of erectile problems for older men is the narrowing of their blood vessels. As young men they were pumping blood into their penises through a garden hose, but at 70, they are trying to accomplish the same thing through a soda straw!
Other illnesses and disabilities will disrupt the process of becoming erect. Certain medications also will cause sexual dysfunctions. Stress, anger and relationship problems will also interfere.
Perhaps the biggest cause of erectile failure among younger health men is PERFORMANCE ANXIETY. This has been called the "I gotta" syndrome. The man is worrying about his performance and saying to himself, "I gotta get it up... I gotta get it in... I gotta finish the performance." With a severe case of the "I gottas," a man ain't going ta! The FEAR OF FAILURE, although psychological, can devastate a man's ability to become erect... and even to stay erect. Such men are monitoring their penises, watching to see how they are doing. Masters and Johnson called this "spectatoring." The man actually becomes a spectator of his own performance (or lack thereof).
The fear of failure is a form of mild panic. For some men, this is enough to trigger their built-in, hard-wired "fight of flight panic response." Their bodies automatically flood with adrenaline, and this causes superficial blood vessels to constrict, forcing blood into the larger muscles that would be needed to run or fight. In the process, the vessels carrying blood to the penis are unable to do their job and the erection fails. The fear of failure often precipitates what it was that was feared!
HELP FOR ERECTILE DYSFUNCTION
When erectile dysfunction is the result of a physical cause, it is called BIOGENIC or ORGANIC. When the problem is caused by anxiety or other psychological factors, it is referred to as PSYCHOGENIC erectile dysfunction. Ofter there is an overlapping of the biogenic and psychogenic, as with an aging male who would naturally be taking more time, but begins to worry that he is no longer responding as he did when he was twenty years younger. His age might have slowed him down, but his worry can wipe him out completely! Sex therapy is very effective in treating the psychogenic aspects of erectile dysfunction, particularly if there is a cooperative partner. Of course, today there is Viagra!
©2001 Robert W. Birch, Ph.D.
Information about Viagra
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I am always a bit concern when professional sexuality experts make unqualified mention of "compulsive masturbation." First of all, those of us calling ourselves sexuality educators are committed to the endorsement of masturbation as a normal (if not essential) aspect of healthy sexual development, and we have even gone on record as saying that the good feelings associated with it are OK! Both males and females masturbate to relieve sexual tension and because it feels good. If "normal" masturbation feels good, how should "compulsive" masturbation feel? Should "compulsive" masturbators feel bad about feeling good? So the question, like the morning erection, arises, "If sexuality is good and masturbation is normal, should it feel better if it is not compulsive, but feel bad if it is?" Or, more basically, have we sex educators lied, and is masturbation really habitual, and is feeling good really bad?
One might legitimately wonder, when is masturbation "compulsive," verses just "frequent." I'm thankful that we hear less these days about "excessive" masturbation, but is compulsive masturbation excessive? (Or should the question have been, is excessive masturbation compulsive?) Should excessive masturbation feel good or...well, just excessive. It seems to me that if one orgasm feels good, frequent orgasms are better, but what if they are excessive or, gulp, even the result of compulsive acts? If a little feels good, wouldn't a lot feel even better? I'm confused! Is it OK, on our own, to feel just a little bad about a lot of feeling really good, or should we join a sex addicts group that would help us feel really bad, so we can stop feeling good altogether?
I also worry about the number of orgasms we are allowed, but worry even more about who it is that should set the limit. Are men allowed to have more self-induced orgasms than women? And how is this allocation of self-induced pleasure measured? Do we measure excessive or compulsive masturbation in terms of the number of strokes or should the number of orgasms be counted? If it's strokes, then the premature ejaculator is much less likely to be judged compulsive, but if one counts orgasms, a non-orgasmic woman could rub herself all day and would be home free. And who should really be doing the counting anyway... our spouse, our therapist, our minister... maybe our state? The unqualified mention of "compulsive masturbation" makes me very uneasy.
I have always assumed that our libido (our sexual appetite) is individually unique, and that the level of this sexual desire varies widely among normal folks, as does intelligence and height and other human qualities and attributes. But if the experts talk without qualification of masturbatory compulsion, then it would seem that there is some fixed frequency that must be rigidly maintained. If this is so, should people with strong sexual needs limit their orgasms so as to fall in line with the expectations of those who claim authority to regulate our sexual frequencies? And who will regulate the regulators? If he or she who judges has low desire, what standard will he or she set for the rest of us to maintain. Must men and women with strong sex drives limit their expression, lest those who count orgasms apply the dreaded "C" label... "Compulsive"... the new scarlet letter for the millennium.
If someone with a high sexual desire masturbates every third day, despite feeling horny on a daily basis, have they demonstrated that they are not compulsive in this act? What if they do in fact masturbate every day? Does that change the "diagnosis?" And what of the person who feels horny every third day? Should they wait a week to demonstrate that they are really under control? Is someone who is horny every day but fights the urge and only masturbates every third day somehow healthier than the person who is horny every third day and masturbates each time the need is felt? Do we mean to say that there is some virtue in waiting even when no other person is involved? Is abstinence from something that is satisfying a treatment, and if so, for what? Do we really get extra credit for postponing self-gratification, and anyway, who's giving out the brownie points?
Confused? Imagine the reaction when a "sexuality expert" fails to define and qualify that vague behavioral description, "compulsive masturbation?" All sorts of images and emotions are stirred. Those who believe that masturbation is "self-abuse," and maintain that this solitary behavior is sinful, must love the unqualified term. We know these self-righteous self-appointed guardians of morality are out there, and growing in number. For those who would control our thoughts and behaviors, even an innocent child's normal, natural, and beautiful process of self-discover might be seen as "compulsive,"A spouse with lower desire might believe a hornier partner should never ever masturbate, and quickly label his as a sure sign of sexual addiction. "Addiction" and "compulsion" are such convenient words for arrogant folks, professionals and otherwise, who are hateful of variation, scornful of intensity, jealous of frequency, and distrustful of pleasure! These are the people who would point and cry out "Addict," with the intent to shame and control us.
In a recent article, a highly credentialed sex therapist wrote about "sexually compulsive behavior," and stated that one of the "...most common forms..." is (without qualification) "compulsive masturbation." Let me get back then to this unqualified mention of "compulsive self-stimulation" and ask the question again: When should we label this self-pleasuring "compulsive?" This therapist offered "five basic criteria." First, there will be "cognitive distortions (that) allow the person to convince himself/herself that a behavior is acceptable." But I thought we sex-positive educators have proclaimed that self-pleasuring is acceptable (and respectable sexologists have even produce a variety of "training videos" to show how to do it)! The second criterion offered in the article was evidence of "...repeated efforts to discontinue or decrease the activity." Wow, as a teenager with hormones racing wildly through my body and religious guilt racing wildly though me head, I sure made repeated efforts to discontinue or decrease my masturbation, not because it felt excessive, but because there were those who were committed to shaming me. Then the sexuality educators came along and said, "It's natural.... so go ahead and enjoy it!" Is it the behavior that is confusing, or what people are saying about it?
The next criterion proposed in the article was spending "...hours in preparation for the act, or.... fantasizing about it afterwards." Gosh, that's what I call "foreplay" and "afterplay!" Let's be careful how we talk of preparation and of reminiscing. The pre- and post-orgasmic thoughts and fantasies are, in my thinking, the threads that weave together the erotic fabric of our sexuality, tying the individual patches together to form the colorful quilt of our total sensuality. We need to remember that most sexologists endorse the use of fantasy, visual stimulation and an assortment of vibrating and/or penetrating toys when one freely elects to self-pleasure, and we've got more videos to show how the toys work.
I believe there are questions that must be answered before applying a label that implies a sexual behavior is a problem. Is an individual's masturbation excessive or is the masturbator simply an individual with a high drive who is appropriately managing his or her sexual energy (and having some fun in the process)? Individuals with high levels of desire will respond frequently to their physical need, will experience easy arousal and will, in due course, reach pleasurable and relaxing orgasms. These person will feel fulfilled, relaxed and good about their sexuality. There are in fact compulsive masturbators. The compulsive masturbators' masturbation will not be in response to their bodies, might be performed without feeling any prior sexual desire, and is likely to exceed his or her natural biological capacities. Responding to a psychological demand, they will often find their arousal difficult, and once started, they will probably not stop until some sort of orgasm is reached, or they become too exhausted or too sore to continue. Compulsive masturbators will feel incomplete, unfinished and (quite likely) guilty. The will want to stop, but feel powerless to do so.
We should evaluate any additions to videos, toys, etc. that are used during the masturbatory act. Such adult "sexual aids" are often use for playful novelty, to foster an easier turn on, to produce a more pleasurable erotic experience... and the reasonable use of such aids is not a sign of sexual compulsion or addiction. Some women only orgasm with the intense stimulation of a vibrator... should we call them addicted to their vibrators? What of the older man who finds that viewing an explicit video helps achieving a firm erection... is he automatically addicted to porn? On the other hand, what if considerable money and time are invested in toys, magazines or videos, cutting into money needed for necessities or time need for work? What if a toy has become a requirement that has been assigned exaggerated erotic power and must be compulsively employed to get the job done, with or without pleasure... and always needing to be replaced by an exciting new toy? Can a man or woman postpone their pleasure, putting it into perspective in his or her busy life, or must all other priorities be changed in order to complete the compulsive act?
If not in a relationship or having access to a willing adult partner, is the masturbation serving the purpose of fulfilling unmet sexual needs in a way that is pleasurable, or is it a way of avoid intimate relationships? (And, anyway, who says every human being must be in an intimate relationship?) If a willing partner is available, is the masturbator realistically filling gaps in discrepant levels of desire, or is he or she rejecting the partner's advances in order to go masturbate in private? If masturbation is preferred, is it because of sexual compulsivity, or is it a reflection of a relationship issue? In my office, a wife once complained that her husband was masturbating rather than accepting her invitations, but he, for the first time, acknowledged that his wife drank excessively, was verbally abusive, and did not bath before sex! I'm glad that I had not laid a guilt trip on him by labeling his masturbation compulsive.
Those claiming to be experts in the field of sexuality need to be very careful using vague unqualified catch phrases. With the guilt-laden history already associated with self-pleasuring, let's not contribute in any way to the confusion. It is normal and natural to masturbate and also normal and natural if an individual feel no need to do so. We should only be concerned when sexual behaviors are public (with an unwilling or underage audience), non-consensual (involving physical or psychological force/threat/coercion), exploitive (inappropriate use of power or age), and potentially destructive in terms of relationships, finances, freedom or health.
A sexual addiction or sexual compulsion has been defined as "Unstoppable sexual behavior that is repeated compulsively despite the awareness of dire consequences." A non-compulsive individual will not feel out of control and repeat something they know could cost them their marriage, cost them their job, cost them a large fine, cost them their freedom, or cost them their life.
When amazon.com was last searched with the keywords "sexual addiction," 34 books came up. If you feel that you must read something on this topic, be careful what you select. In the reviews on one book, a reviewer shared his or her impression that the book's only purpose was to make people feel bad. Avoid books such as this!
In his erotic novel, SETTLING THE SCORE, Dr. Birch follows one character through the diagnosis and misdiagnosis of his high sex drive.
Most typically, masturbation is a healthy, normal, safe, and fun way to deal with ones sexual desire, and often all manner of toys become involved.
Books, such as TICKLE YOUR FANCY, give both permission and instruction
on how to creatively engage in self-pleasuring.
©2001 Robert W. Birch, Ph.D.
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