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The coital alignment technique and directed masturbation: A comparative study on female orgasm

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The coital alignment technique and directed masturbation: A comparative study on female orgasm

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Abstract

To evaluate the effectiveness of two sexual therapy techniques, a non-clinical population of 36 married women were randomly assigned with their spouses to either a sexual enrichment workshop with instruction on the coital alignment technique (19 women) or directed masturbation (17 women). Both workshops yielded clinically significant improvements in orgasm consistency during sexual intercourse, orgasm strength, and the overall number of orgasms experienced in partner-related activities. In instances where differences in the workshop were discovered (increases in orgasm consistency during sexual intercourse), the coital alignment technique yielded a somewhat more positive outcome than did directed masturbation. Treatment approaches that combine the two techniques, such as orgasm consistency training, may prove more beneficial than a treatment model that depends on either one or the other.

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... Penile-vaginal penetration in coitus with clitoral contact completes a basic genital ''circuitry'' and constitutes complete genital contact (Eichel et al., 1988;Hurlbert and Apt, 1995). ...
... LoPiccolo and Lobitz (1972) have described a nine-step masturbation training procedure that has been widely used (Andersen, 1981;Andersen, 1983;Hurlbert and Apt, 1995;LoPiccolo and Stock, 1986;Munjack et al., 1976;Riley and Riley, 1978;Trudel and Laurin, 1988). ...
... OCT uses directed masturbation in the early stages of treatment. In the final stage the ''coital alignment technique'' opens the possibility of a level of experience in which partners are interdependent in the attainment of coital orgasm (Hurlbert and Apt, 1995). ...
Article
Based on a review covering 80 research papers selected from a larger material on effect of non-pharmacological treatment of sexual problems, treatment methods and techniques for common sexual problems are presented and the treatment effects are discussed in relation to the specific problem. Treatment methods are organised according to different groups: Psychodynamic, hypnosis, behavioural, cognitive, cognitive-behavioural, educational, marital, group therapy, sex therapy and bibliotherapy. Treatment methods and techniques within each group are described and studies within each group are presented. The results show positive effect for most approaches, but to varying degree. Therapy that focuses on the sexual problem is more effective than indirect treatment of underlying problems like anxiety or communication problems. The PLISSIT-model is recommended to differentiate between problems that can be solved through simple education or bibliotherapy with minimal therapist intervention, and problems that require specialist therapeutic assistance. Therapy research that focuses on linear relationships between problem and therapy method seem to give way to circular research designs that take more variables, like therapist characteristics, client characteristics, treatment format, and treatment content into account. The bio-psycho-social model is recommended as an integrative multidisciplinary approach to treatment of sexual problems.
... It seems that in trying to take the patient away from worries and distractions, the ''therapists'' might also be taking patients away from a direct path to intimate relatedness. There is also evidence that directed (clitoral) masturbation might be inferior to more coitally focused interventions (Hurlbert & Apt, 1995;Pierce, 2000). Although clitoral masturbation might result in previously globally anorgasmic women having an increased likelihood of climax from clitoral masturbation per se, clitoral masturbation is inferior to at least one coital intervention (the coital alignment technique) in acquiring the ability to orgasm from intercourse (Hurlbert & Apt, 1995;Pierce, 2000). ...
... There is also evidence that directed (clitoral) masturbation might be inferior to more coitally focused interventions (Hurlbert & Apt, 1995;Pierce, 2000). Although clitoral masturbation might result in previously globally anorgasmic women having an increased likelihood of climax from clitoral masturbation per se, clitoral masturbation is inferior to at least one coital intervention (the coital alignment technique) in acquiring the ability to orgasm from intercourse (Hurlbert & Apt, 1995;Pierce, 2000). Another outcome study found that the more often women masturbated at the beginning of sex therapy, the poorer were the results of attempts to treat their secondary orgasmic dysfunction (Libman et al., 1984). ...
Article
In a large representative sample of the Swedish female adult population (N = 1256), having an orgasm from purely penile stimulation of the vagina (as opposed to orgasms from clitoral stimulation) was associated with greater satisfaction (with sex life, mental health, relationships with both partners and friends, and life in general), more frequent sexual desire, greater likelihood of having one's first ever orgasm from intercourse rather than masturbation, and lesser recent masturbation frequency. The association of vaginal orgasm with these measures was unconfounded by a marginal association of vaginal orgasm with frequency of vaginal intercourse (which was independently associated with most of the measures of greater satisfaction). Vaginal orgasms were not associated with having had orgasms from partner masturbation or cunnilingus. The results are discussed in terms of recent advances in sexual physiology showing different pathways for vaginal versus clitoral sensation and orgasm, other empirical research showing psychological and physiological advantages of penile – vaginal intercourse over other sexual behaviours, psychoanalytic theory, and the need to overhaul the practices of sex therapy and sex education.
... 290). We assume that the encouragement to move the pelvis explains why this technique has been shown to be somewhat more effective in treating coital anorgasmia than encouraging women to self-stimulate during vaginal intercourse (Hurlbert & Apt, 1995). ...
Article
Full-text available
Very few studies have investigated the relationship between women’s ability to experience an orgasm during vaginal intercourse and specific stimulation techniques. We examined two common techniques during vaginal intercourse both with and without simultaneous external clitoral stimulation: (1) body movement, in particular back-and-forth swinging movements of the pelvis and trunk; and (2) precise rubbing of the clitoris with an immobilized body. Structural equation modeling was used to compare the effects of the two stimulation techniques on women’s orgasm frequency (N = 1,239). As hypothesized, the frequency of orgasm during vaginal intercourse with simultaneous clitoral stimulation was positively associated with a preference for body movement during arousal. Body movement, as opposed to body immobilization, was also associated with a higher frequency of orgasm during vaginal intercourse without simultaneous clitoral stimulation. We conclude that body movement is associated with more orgasms during vaginal intercourse, whereas precise rubbing of the clitoris with an immobilized body is not associated with more orgasms. Teaching women to move their pelvis and trunk in a swinging back-and-forth movement during vaginal intercourse might therefore facilitate reaching an orgasm, whereas encouraging them to self-stimulate the clitoris might be less helpful if done with an immobilized body.
... The success rates for directed masturbation training (administered individually or in groups, with or without involvement of the partner) in women with primary anorgasmia are generally high: 60–90% of the women become orgasmic with masturbation and 33–85% will become orgasmic with partnered sexual activity. Some studies have shown significant results after four sessions of 30 minutes, while other studies were able to demonstrate that beneficial effects remained up to two months after the end of therapy (Heinrich, 1976; Hurlbert & Apt, 1995). Heiman (2002) concluded that behavioural and cognitive behavioural treatments for primary orgasmic disorder fulfill well-established criteria for ''efficacy'', while for secondary orgasmic disorder they are only ''probably efficacious''. ...
Article
Full-text available
A consistent finding in the literature has been that only about half of the women experiencing orgasm difficulties also report associated distress. This may suggest that orgasms are less important for women's sexual satisfaction than they are for men. Evidence is provided to suggest that orgasms are important for women's sexual satisfaction. The lack of distress seems related to women's lesser consistency of orgasm during partnered sexual activity and not to orgasms being less important per se. In contrast to current suggestions that inability to orgasm during vaginal intercourse points to psychological immaturity, data are presented that imply that women's orgasm consistency in all forms of partnered sexual activity is associated with sexual autonomy (i.e., the extent to which one feels that one's sexual behaviours are self-determined). This paper ends with a brief overview of organic and psychosexual factors associated with problems with sexual excitation and sexual inhibition and reviews evidence-based treatment of anorgasmia. For orgasm problems that are related to problems with sexual excitation, effective treatments are available. We recommend that more effort is given to studying factors associated with sexual inhibition.
... In section 8f, Laan et al. [1] provide grudging acknowledgment of the coital alignment technique (an intercourse-based treatment for orgasmic dysfunction), and mischaracterize it as simply increasing clitoral stimulation during intercourse (the approach relies heavily on coital synchronization [41]). Laan et al. [1] also report that the coital alignment technique was equally effective as directed masturbation, but the cited study actually showed that masturbation was inferior to the coital alignment technique in improving intercourse orgasm consistency [42]. The description of the coital alignment technique approach and results were reported more accurately in the recent JSM review of etiology and treatment of orgasm disorders in women [43] (another review article ignored by Laan et al. [1]). ...
... 307 In the only study evaluating the coital alignment technique, 314 a significantly higher rate of orgasms during intercourse, simultaneous orgasms between partners, and satisfying orgasms was reported. 315 Taken together, we recommend CBT for women with anorgasmia (recommendation ¼ grade A). Although the coital alignment technique is often used for women who wish to become orgasmic during vaginal penetration with intercourse, only one study evaluated the effectiveness of this method. ...
Article
Introduction: Psychological, interpersonal, and sociocultural factors play a significant role in making one vulnerable to developing a sexual concern, in triggering the onset of a sexual difficulty, and in maintaining sexual dysfunction in the long term. Aim: To focus on psychological and interpersonal aspects of sexual functioning in women and men after a critical review of the literature from 2010 to the present. Methods: This report is part 1 of 2 of our collaborative work during the 2015 International Consultation on Sexual Medicine for Committee 2. Main outcome measures: Systematic review of the literature with a focus on publications since 2010. Results: Our work as sexual medicine clinicians is essentially transdisciplinary, which involves not only the collaboration of multidisciplinary professionals but also the integration and application of new knowledge and evaluation and subsequent revision of our practices to ensure the highest level of care provided. There is scant literature on gender non-conforming children and adolescents to clarify specific developmental factors that shape the development of gender identity, orientation, and sexuality. Conversely, studies consistently have demonstrated the interdependence of sexual function between partners, with dysfunction in one partner often contributing to problems in sexual functioning and/or sexual satisfaction for the other. We recommend that clinicians explore attachment styles of patients, childhood experiences (including sexual abuse), onset of sexual activity, personality, cognitive schemas, infertility concerns, and sexual expectations. Assessment of depression, anxiety, stress, substance use and post-traumatic stress (and their medical treatments) should be carried out as part of the initial evaluation. Clinicians should attempt to ascertain whether the anxiety and/or depression is a consequence or a cause of the sexual complaint, and treatment should be administered accordingly. Cognitive distraction is a significant contributor to sexual response problems in men and women and is observed more consistently for genital arousal than for subjective arousal. Assessment of physical and mental illnesses that commonly occur in later life should be included as part of the initial evaluation in middle-aged and older persons presenting with sexual complaints. Menopausal status has an independent effect on reported changes in sex life and difficulties with intercourse. There is strong support for the use of psychological treatment for sexual desire and orgasm difficulties in women (but not in men). Combination therapies should be provided to men, whenever possible. Conclusion: Overall, research strongly supports the routine clinical investigation of psychological factors, partner-related factors, context, and life stressors. A biopsychosocial model to understand how these factors predispose to sexual dysfunction is recommended.
... Another study showed the effectiveness of a technique called "coital alignment" for women with secondary anorgasmia. In this study (Hurlbert & Apt, 1995), 37% of women on coital alignment technique and 18% of women on DM technique reported ≥ 50% improvement in orgasmic ability during intercourse. Some women who learn to achieve orgasm with DM transfer this skill successfully to their sexual activity with their partners, whereas others who experience orgasm exclusively with masturbation need additional stimulation techniques during their sexual interaction. ...
... [41,70,165,2071 Parmi ces indications, ce sont les dysfonctionnements orgasrniques féminins qui ont suscité le plus grand nombre de publications scientifiques. Il s'agit probablement de la plainte fonctionnelle la plus commune en sexologie [125]. «Une femme atteinte de dysfonctionnement orgasmique primaire, expliquent Masters et Johnson, est une femme qui n'a jamais connu d'orgasme (...) Et cela quelles que soient les formes de stimulation physique employées (...) Appartiennent à la même catégorie les femmes qui ne connaissent l'orgasme que lors de certains rêves ou par l'imagination. ...
Thesis
Cette thèse relate de façon chronologique l'évolution du discours médical sur l'onanisme avant 2004, en Occident. Elle est fondée sur une recherche bibliographique étendue. La lutte anti-masturbatoire a débuté à Londres avec la publication d'Onania, vers 1710. L'Onanisme de Tissot (1760), qui décrit les dangers physiques, moraux et sociaux de la masturbation, a eu un écho durant tout le XIXème siècle. L'émergence de la psychanalyse et de la sexologie a mis fin au concept d'onanisme-maladie. Ce travail propose une synthèse originale des idées des psychanalystes sur l'onanisme. De nos jours, la masturbation est considérée par les médecins comme une pratique sexuelle normale, quasi universelle, pouvant être bénéfique pour la santé.
... Cognitive behavioral treatment (CBT) using sensate focus, systemic desensitisation and DM reported success rates of up to 90% (Meston and Frohlich, 2001;Heiman and Meston, 1997). Hurlbert and Apt (1995), using a nonclinical population of married women, compared the efficacy of the DM technique (n 5 17 women) against the 'coital alignment technique (CAT) (n 5 19 women) to enhance orgasmic consistency during coitus. While CAT yielded 'somewhat more positive outcome' than DM in 'instances where differences in workshop were discovered' their conclusion, however, was that combining the two treatment modes would prove more beneficial than either alone' a conclusion not surprisingly overlooked by Brody, Costa, and Hess (2013) in their criticism of the use of DM. ...
Article
This article reviews clitoral structures, their functions and how they are activated during the stages of female life. The paradox that occurs is that different procedures of activation are claimed by some to favour ‘noxious outcomes' to the physical and psychic health of women who use it to achieve sexual arousal/orgasm with or without penile vaginal intercourse. A number of the difficulties and inconsistencies in relation to these claims are explored. The proposed justification for the ‘noxious outcomes' is that ‘evolution' punishes sexual arousals other than by coitus because it is the only one that leads to gene propagation. In this context, however, the new, evolutionary interpretation of clitoral function in the fertile years as a fundamental proximate mechanism for facilitating female reproductive fitness makes such a justification improbable. The role of coital alignment technique (CAT) in the treatment of female orgasmic disorder is discussed in relation to its features of introital, clitoral and periurethral glans stimulation. Attempts to control female sexuality through various ‘clitoridectomies' are examined and unanswered questions about clitoral stimulation are listed. This article is protected by copyright. All rights reserved.
... Directed masturbation is intended to educate women about what their bodies respond to and then eventually encourage women to use this information for reaching orgasm during partnered sexual activity. If OC during masturbation is not associated with OC during intercourse, however, then alternative therapeutic techniques, such as coital alignment technique (e.g., Hurlbert & Apt, 1995;Meston et al., 2004;Pierce, 2000), may be more beneficial. ...
Article
Sexual concordance (the relationship between genital and self-reported sexual responses) may be associated with orgasm consistency (OC; the proportion of sexual acts leading to orgasm) during penile–vaginal intercourse (PVI) in women. We investigated the relationship between women’s sexual concordance (assessed using different stimulus modalities and self-reported sexual arousal methods) and OC during various sexual activities (assessed using different types of questions). For Study 1 (n = 51), when sexual concordance was assessed using audiovisual sexual stimuli, we did not find a statistically significant relationship between OC and poststimulus self-reports of sexual arousal or genital sensations, raw values of OC, or ranges of OC. For Study 2 (n = 44), where sexual concordance was assessed using audionarrative sexual stimuli, we did find a statistically significant relationship between PVI OC and sexual concordance using change in self-reported sexual arousal, and ranges of orgasm consistency. Two findings were inconsistent with previous research. First, OC varied significantly by activity type in both studies; masturbation yielded the highest OC. Second, PVI OC was significantly related to oral sex and masturbation OC (Study 2). We discuss the need for further research and various factors that may affect women’s orgasm consistency and sexual concordance.
... D. F. Hurlbert, C. Apt[48]сравнили эффективность DM и техники коитального выравнивания при лечении женщин с вторичной аноргазмией. При этом выявилась большая эффективность данной техники, обусловленная тем, что благодаря клиторальному и, возможно, парауретральному контакту стимуляция была максимальной. ...
Article
Full-text available
Various recommendations, techniques and psychotherapeutic approaches are submitted aimed at overcoming difficulties in achieving orgasm and to treat its disorders. Key words: orgasm, disorders, overcoming, men, women. Представлены различные рекомендации, техники и психотерапевтические подходы, направленные на преодоление трудностей в достижении оргазма и лечение его расстройств. Ключевые слова: оргазм, расстройства, преодоление, мужчины, женщины.
... 307 In the only study evaluating the coital alignment technique, 314 a significantly higher rate of orgasms during intercourse, simultaneous orgasms between partners, and satisfying orgasms was reported. 315 Taken together, we recommend CBT for women with anorgasmia (recommendation ¼ grade A). Although the coital alignment technique is often used for women who wish to become orgasmic during vaginal penetration with intercourse, only one study evaluated the effectiveness of this method. ...
Chapter
To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research.<br /
... Additional sex therapeutic interventions are e.g. exercises that encourage the identification of sexual stimuli, or exercises that can help the woman to reach orgasm, such as masturbation exercises for women and coital techniques that allow for optimal clitoral stimulation [89]. Cognitive restructuring aims at thoughts that can inhibit sexual desire and arousal, such as negative self-esteem ('I am unattractive', 'I am a rubbish partner because I don't feel like having sex'), restrictive cognitions with regard to physical intimacy or sexual initiative ('If I kiss him, it will have to lead to intercourse') and negative expectations about one's own sexual response ('I never become turned on quickly enough anyway'). ...
Article
Full-text available
In this contribution, female sexual desire and arousal disorders are viewed from the perspective of incentive motivation and information processing models of sexual response. The effects of hormones, somatic disease, and medication on sexual arousability are discussed, as well as the influence of psychological factors, such as stimulus meaning, mood and cognition, and relational context on female sexual desire and arousal. Specific topics to attend to during the anamnesis of sexual desire and arousal problems, and empirically evaluated psychological and pharmacological treatments for these problems are discussed.
... La masturbation dirigée a démontré sa réussite en améliorant les problèmes orgasmiques, avec des taux de réussite de 80 à 100 % (Andersen, 1983). Deux études consacrées à la technique de l'alignement coïtal Eichel et Eichel (1980) (Hurlbert et Apt, 1995) confirment son l'efficacité dans le traitement des problèmes d'orgasmes. Crow et al. (1981) ont étudié 48 couples présentant une anorgasmie, une impuissance et une perte de la libido, qui ont tous été répartis de façon aléatoire dans les groupes suivants : Masters et Johnson, deux thérapeutes ; Masters et Johnson modifié, un thérapeute ; thérapie de couple et relaxation. ...
Article
D’après une synthèse fondée sur 80 articles de recherche sélectionnés à partir du plus grand nombre de documents consacrés à l’effet des traitements non pharmacologiques des problèmes sexuels, les méthodes et techniques de traitement pour les problèmes sexuels les plus courants sont décrits ainsi que les effet des traitements abordés en rapport avec le problème spécifique. Les méthodes de traitement sont organisées selon différents groupes : thérapie psychodynamique, comportementale, cognitive, cognitivo-comportementale, éducative, de couple, de groupe, hypnose, sexothérapie et bibliothérapie. Les méthodes et techniques de traitement au sein de chaque groupe sont décrites et les études réalisées sur chaque groupe font l’objet d’une présentation et d’une discussion. Les résultats mettent en évidence un effet positif pour la plupart des approches, mais à des degrés divers. Les thérapies centrées sur le problème sexuel paraissent plus efficaces que les traitements indirects des problèmes sous-jacents comme l’anxiété ou les problèmes de communication. Le modèle PLISSIT est recommandé pour différencier les problèmes susceptibles d’être résolus au travers d’une simple thérapie éducative ou d’une bibliothérapie nécessitant une intervention minime du thérapeute, des problèmes nécessitant une assistance thérapeutique spécialisée. La recherche portant sur les thérapies qui s’attachent aux relations causales entre le problème cible et la méthode thérapeutique semble donner lieu à des schémas de recherche circulaires qui prennent en compte davantage de variables, comme les caractéristiques du thérapeute, les caractéristiques du client, le cadre du traitement et le contenu du traitement. Le modèle bio-psycho-social est recommandé en tant qu’approche pluridisciplinaire intégrative du traitement des problèmes sexuels.
... One of such intercourse techniques has been proposed by Eichel et al. The coital alignment technique is a "riding high" variation of missionary position that provides both vaginal and clitoral stimulation during vaginal intercourse [96]. Their study showed that couples using this technique achieved higher rate of coital orgasm, simultaneous orgasm, and orgasms that were "complete and satisfying." ...
Article
Full-text available
Disorders of orgasm in women, defined as the persistent or recurrent delay in or absence of orgasm, affect up to a quarter of the female population. To review existing research findings on the etiology and treatments of disorders of orgasm in women to provide a useful reference tool for clinicians who evaluate and treat patients with these conditions. PubMed and PsycINFO search for articles published between 1980 and 2009 using the keywords "orgasm*,"anorgasmia," and "female*,"woman," or "women," in addition to "female orgasmic disorder" and "disorders of orgasm in women." Findings on the etiological factors and effects of a variety of treatment interventions on improving disorders of orgasm in women. Results.  Literature on prevalence and causes of disorders of orgasm in women is abundant, yet more reports of successful treatments are needed. Nevertheless, many promising approaches have been suggested, and data support several potential treatments such as bupropion, sildenafil, estrogen, and testosterone among others. Although more research is needed to better understand and manage disorders of orgasm in women, significant progress is being made.
... It is interesting to note that Brody et al. [124], in their highly partisan criticism of the Laan et al. [119] review of Standard Operating Procedures for Female Orgasmic Disorder (FOD), claimed that when quoting the study of Hurlbert et al. [127] that compared the efficacy of CAT with directed masturbation treatment for FOD they did not report that CAT showed differences with the latter because it increased orgasm consistency in coitus. In fact Brody, Costa & Hess were themselves guilty in not stating the full conclusions of Hurlbert and Apt namely, that 'In instances where differences in the workshop were discovered (increases orgasm consistency during sexual intercourse), the CAT yield a somewhat more positive outcome than did directed masturbation. ...
An extensive series of papers by Brody and co-workers using questionnaires have correlated penile vaginal intercourse (PVI) and clitoral stimulation with various female functions and malfunctions. A major claim is that only PVI 'competently performed and sensitively experienced' leading to orgasm is 'associated with. and in some cases, causes processes associated with better psychological and physical functioning'. Clitoral stimulation to orgasm per se or to facilitate orgasm even during PVI, however, is not beneficial to women's psychological, interpersonal or behavioural health and can lead to 'noxious consequences'. Recently , as correlations are no guarantee of causation, independent studies have not confirmed some of their claims. The present review examines critically and rejects :- the demonising of the clitoris as an organ inducing 'deadly pleasures' or that it should become vestigeal by self-creating a 'psychological clitoridectomy', that evolution 'rewards' PVI but punishes clitoral stimulation, that cervical buffeting is normally involved in PVI-orgasms or that a longer penis facilitates these, that orgasm is involved in sperm transport and thus reproductive fitness, that prolactin released at orgasm is an instigator of sexual satiation, that the coital alignment technique does not involve clitoral and periurethral glans stimulation by the penis and that women who cannot have orgasms induced by PVI alone are sexually dysfunctional and that their male partners are sexually inadequate.
... This suggests that orgasm might be even more rewarding for women, in whom the response is more variable. However, ''orgasm consistency training'' in women resulted in only modest increases in sexual desire (Hurlbert & Apt, 1995; Hurlbert, White, Powell, & Apt, 1993; McVey, 1997). Orgasmic reconditioning often fails even in men (Conrad & Wincze, 1976) and has run into resistance and negative results as a ''treatment'' for sexual orientation (Turkat, Bruch, Kuczmierczyk, & Stechow, 1980). ...
Article
Full-text available
Orgasm is assumed to be the height of sexual pleasure, reinforcing the recurrence of sexual behaviors. Surprisingly, data supporting the role of orgasm as a reward in women appear lacking. The most likely psychological function of orgasm in women, consistent with the very limited empirical information, is as a secondary reinforcer. In other words, sexual arousal is the primary reward for sexual behavior in women and orgasm associates sexual arousal with the partner. Data from a small (n = 38 women) pilot are presented to highlight the challenges of studying female orgasm. Challenges include differentiating vaginally- or clitorally-generated orgasms by self-report and the large proportion of women who are unsure if they experience orgasms. Finally, the recent spate of publications purporting to show differences in penile-vaginal intercourse induced orgasms is critiqued in light of the information reviewed.
Article
In the “Second International Consultation on Sexual Medicine” orgasmic dysfunction was defined as “Despite high sexual arousal/excitement there is either lack of orgasm, markedly diminished intensity of orgasmic sensations or marked delay of orgasm from any kind of stimulation”. In a recent review of 34 studies, the figures of anorgasmia ranged between 20% and 50%. In Spanish women the estimated rate is between 5% and 40%. In the Instituto Andaluz de Sexología y Psicología orgasmic dysfunction is the 2nd cause of consultations by female patients, after hypoactive sexual desire disorder.In spite of these data, there is no specific pharmacological approach, mirtazapine, yohimbine, IPDE5 and apomorphine having been used without much success.In the last years clitoris gels have been used and also vacuum devices such as Eros®. According to Billups et al., 42% of women with any sexual dysfunction improved with Eros. However in IASP only 1.25% claimed to be satisfied with the device. Likewise, only 6.25% improved using gels such as Viacrem® or Donacrem®.In short there is no specific pharmacological therapy, unlike in male erectile dysfunction, that has proved to be adequate in orgasmic disorder and the best therapeutical approach is still sexual therapy.
Article
Masturbation may be useful in treating hypoactive sexual desire disorder. To examine this possibility, the current study examined the relationships between masturbation, sexual desire, sexual fantasy, and dyadic sexual activity. The relationships between masturbation and other constructs were also examined: overall sexual dysfunction, relationship satisfaction, life stress, and sexual attitudes. Mediational analyses suggest several causal pathways between masturbatory desire, masturbatory frequency, sexual fantasy, sexual desire, and sexual activity. Developing a model of masturbation may help illustrate its role in sexual functioning and highlight its potential role in sex therapy.
Article
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Introduction: Since the 1960 s, there has been debate in academia, the women’s movement, and the general public about the fact that women experience orgasms less frequently than men during heterosex as well as why, and additionally about if and how to close this gender orgasm gap. Within a bio-psycho-social model of sexuality, gender orgasm gaps are explained theoretically in very different ways. Objectives: The aim of this research review is to report the empirical findings to date on the size of the gender orgasm gap as well as to present and critically discuss the proposed practice measures intended to close it. Methods: In the course of a systematic literature search n = 20 empirical publications on the orgasm gap and an additional n = 16 original research papers promoting its closure were identified and coded (1982–2021). Results: The surveys included are based on the self-reports of N = 49 940 women and N = 48 329 men, and show that typically 30 % to 60 % of women report reaching orgasm during heterosex in contrast to 70 % to 100 % of men. Depending on the context of heterosex, the size of the orgasm gap varies from –20 % to –72 % to the disadvantage of women. The ten population-representative surveys presented yield a weighted mean orgasm gap of –30 % [95 % confidence interval: –31; –30]. The measures proposed in previous literature for closing the orgasm gap relate to personal factors, relationship factors, sexual interaction factors, and societal factors: Women are advised to strive more consciously for their own orgasm and to talk more openly about their sexual wishes in the relationship. In addition, women and men are advised to integrate more direct clitoral stimulation into heterosex and to demarginalize women’s orgasms socially. Conclusion: Based on the current state of research, there is a need to continue addressing issues around the gender orgasm gap in both research and practice. However, given the limited successes of recent decades, it also seems imperative to critically examine the approaches taken so far in the “battle for orgasm equality”.
Article
Introduction: As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment of Female Orgasmic Disorder (FOD). Aim: The objective is to provide standard operating procedures for FOD. Methods: The SOP Committee was composed of a chair, selected by the International Society for the Study of Sexual Medicine, and two additional experts. To inform its key recommendations, the Committee used systematic reviews of available evidence and discussions during a group meeting, conference calls and e-mail communications. The Committee received no corporate funding or remuneration. Results: A total of 12 recommendations for the assessment and treatment of FOD were generated, including suggestions for further research. Conclusions: Evidence-based, practice recommendations for the treatment of FOD are provided that will hopefully inform clinical decision making for those treating this common condition.
Chapter
Female sexual dysfunction (FSD) is a complex set of conditions associated with multiple anatomical, physiological, biological, medical, and psychological factors. It can be age-related and appears to be highly prevalent, affecting 20 to 50% of women (1). Data from the National Health and Social Life Survey (NHSLS), a large representative sample of US women, reported that one-third of women experienced loss of sexual interest, and nearly one-fourth reported lack of orgasm during the past year (2). Sexual dysfunctions are associated with problems of mood, self-esteem, quality of life, emotional distress, and relationship difficulties (1).
Chapter
Both cancer and cancer treatments can have ­deleterious effects on women’s ability to attain orgasm. The degree to which sexual functioning at large is impacted depends on a number of medical, psychological, and social factors including severity of the disease, treatment intensity and length, emotional status during cancer diagnosis and management, access to social support, and comorbid psychological problems. In this chapter, we discuss the diagnosis, prevalence, and treatment of female orgasmic disorder (FOD), with an emphasis, where possible, on how they pertain to women with current or past cancer. Orgasm is a fundamental component of sexual response in both men and women, and is affected frequently in humans from the studies of cancer survivors. KeywordsOrgasm-anorgasmia-SSRI medications-Sex therapy
Article
Female orgasmic disorder (FOD) is defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, as a persistent or recurrent delay in, or absence of, orgasm following a 'normal' sexual excitement phase. FOD is a common problem affecting sexual function in a substantial proportion of women. Studies suggest that it is prevalent in 11-41% of women worldwide and can have a tremendous impact on the individual's quality of life, relational satisfaction and general well-being. The etiology of FOD tends to be multifactorial as it relates to genetics, medical conditions, medications, alcohol and drug use, other sexual dysfunctions, mental illness, life stressors, communication deficits and relationship issues. It is critical that sexual functioning in patients is assessed frequently through interview and/or validated questionnaires to aid in treatment strategy and/or referral. Currently, there are no approved medications to treat FOD. However, there are medications and psychological treatments that have shown promise in either treating FOD or thwarting the side effects of medications that can cause FOD. This chapter discusses the epidemiology and etiology of FOD and provides a comprehensive critical review of the literature on assessment and treatment of FOD.
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According to incentive motivation theory, sexual desire is the result of the interplay between a sensitive sexual response system and stimuli that activate the system. From this notion it follows that sexual desire is not a cause but a consequence of sexual arousal. The effects of hormones, somatic disease and medication on sexual arousability are discussed, as well as the influence of psychological factors - such as stimulus meaning, mood and cognition - and relational context on female sexual desire and arousal. At present, much attention is being paid to possible pharmacological treatments for decreased desire and arousal problems, even though desire and arousal seem more strongly associated with psychological and relational factors. Empirical evidence of the effect of psychological treatments for decreased desire and arousal problems in women is scarce. A cognitive-behavioral therapy approach with explicit attention to relational context and a focus on improving arousal and sexual satisfaction has shown to be effective. Knowledge about which treatment elements bring about change is still lacking.
Article
The diagnosis of sexual dysfunction(s) or disorder(s) is paramount to the development of the field of sexual medicine. Historically, the diagnoses of these disorders have been considered reliable. The validity of diagnoses of sexual disorders (and the rest of our classification systems) has recently been questioned, especially from the point of clinical utility and homogeneity. This review discusses the issues involved in the development of valid and useful diagnoses of sexual disorders, reviews the proposed changes in the upcoming Diagnostic and Statistical Manual of Mental Disorders, 5th edition, as well as the problems inherent in the revision of this (and any) diagnostic system, and suggests some possible remedies to this process.
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Sexual dysfunctions in women are classified into disorders of desire, arousal, orgasm, and pain (including dyspareunia and vaginismus). As the cognitive behavioral treatment (CBT) procedures differ among these sexual disorders, the treatments for each disorder are reviewed separately. The efficacy of CBT differs depending on the specific sexual dysfunction to be treated. It is concluded that only a few CBT treatments for women's sexual dysfunction have yet been empirically investigated in a methodologically sound way and little is known about which of the treatment components are most effective.
Article
Introduction: Disturbances of emotional and physical awareness can impair female sexual function. Previous research revealed that immature psychological defense mechanisms (impairing emotional awareness) are associated specifically with impaired vaginal orgasm (orgasm triggered solely by penile-vaginal stimulation). Alcohol consumed before sex (ACBS) might impair vaginal orgasm or lead to avoiding the opportunity for it, but research examining immature defenses, ACBS, and specific sexual behaviors has been lacking. Aim: To test the hypothesis that greater use of immature defenses and greater ACBS are inversely associated with vaginal orgasm consistency, but unrelated or positively correlated with greater frequency of other sexual behaviors. Methods: Three hundred twenty-three coitally experienced women (predominantly Scottish) responded to an online survey reporting their frequency of various sexual activities (and corresponding orgasms) and their ACBS, and completed the Defense Style Questionnaire DSQ-40. Main outcome measures: Univariate and multivariate correlations of immature defenses, ACBS, and various sexual behaviors. Results: Both immature defenses and ACBS were associated with less vaginal orgasm consistency, but unrelated or positively correlated with frequency of other sexual behaviors (including clitoral masturbation during penile-vaginal intercourse). Immature defenses were associated with more ACBS. Immature defenses explained the association between ACBS and both lack of vaginal orgasm and greater frequency of other sexual behaviors. Conclusions: The results provide further evidence that difficulty in having a vaginal orgasm is associated with immature defenses (and associated disturbances of sensibility), among other indicators of poorer health and relatedness. ACBS might impair vaginal orgasm or increase the likelihood of choosing other sexual activities, but this effect might be somewhat contingent on immature defenses. Based on various empirical studies, we call for examination of the possibility that lack of vaginal orgasm (given an adequate man) should qualify as a female sexual dysfunction.
Article
Female sexual dysfunction is a common problem, yet it is often under-treated. Sexual function is an integral part of the human experience and sexual dysfunction can negatively impact quality of life, yet many patients suffer in silence with their problems. This article provides a common case scenario, along with information on prevalence of female sexual dysfunction, definitions and classifications of female sexual dysfunction as well as some of the treatment options available.
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Background: In recent years, a growing number of interventions for treatment of female orgasmic problems (FODs) have emerged. Whereas orgasm is a extra biologically and learnable experience, there is a need for practitioners that to be able to select which therapy is the most appropriate to their context. Objective: In this critical literature review, we aimed to assess areas of controversy in the existing therapeutic interventions in FOD with taking into accounted the Iranian cultural models. Materials and Methods: For the present study, we conducted an extensive search of electronic databases using a comprehensive search strategy from 1970 till 2014. This strategy was using Google Scholar search, “pearl-growing” techniques and by hand-searching key guidelines, to identify distinct interventions to women's orgasmic problem therapy. We utilized various key combinations of words such as:" orgasm" OR "orgasmic "," female orgasmic dysfunction" OR Female anorgasmia OR Female Orgasmic Disorder ", orgasmic dysfunction AND treatment, “orgasm AND intervention”. Selection criteria in order to be included in this review, studies were required to: 1 employ clinical-based interventions, 2 focus on FOD. Results: The majority of interventions (90%) related to non-pharmacological and other were about pharmacological interventions. Self-direct masturbation is suggested as the most privilege treatment in FOD. Reviewing all therapies indicates couple therapy, sexual skill training and sex therapy seem to be more appropriate to be applied in Iranian clinical settings. Conclusion: Since many therapeutic interventions are introduced to inform sexually-related practices, it is important to select an intervention that will be culturally appropriate and sensitive to norms and values. Professionals working in the fields of health and sexuality need to be sensitive and apply culturally appropriate therapies for Iranian population. We further suggest community well defined protocols to screen, assessment and management of women’ sexual problems such as FOD in the Iranian settings.
Article
Die weibliche Orgasmusstörung (,,female orgasmic disorder“, FOD) ist die zweithäufigste Sexualstörung der Frau. Allerdings gibt nur die Hälfte der Frauen an, wirklich darunter zu leiden. Neben dem Orgasmusproblem liegen sehr häufig gleichzeitig andere Sexualprobleme vor. Die umfassende Beurteilung der Orgasmusstörung erfordert deswegen, dass alle relevanten biopsychosozialen Faktoren – im kulturellen Kontext – berücksichtigt werden. Hierzu gehören psychosoziale, kognitive/affektive und Beziehungsfaktoren sowie die Einnahme von Medikamenten, die negativen Einfluss auf die Orgasmusfunktion haben. Die Behandlung der Orgasmusstörung sollte sowohl kognitive als auch verhaltenstherapeutische Interventionen beinhalten. Wenn Orgasmusprobleme nur im Zusammenhang mit dem Partner auftreten, sollte dieser in die Behandlung einbezogen werden. Eine Hormonersatztherapie kann für (postmenopausale) Frauen mit niedrigem Testosteron-/Östrogenspiegel indiziert sein.
Chapter
Human sexual response is covered in this chapter, including the male and female genitalia, the biological and psychological influences on our sexual response, theories of sexual response, sexual arousal, and sexual desire.
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Kleinplatz and her research team (Kleinplatz et al., 2009) set out to study what the “sex of our dreams” consists of. They interviewed 67 participants who were in relationships for at least 25 years and identified their sex as “great.” They were aged, on average, 66 years (ranging from 60 to 82), and described various components to their great sexuality: •Optimal sex requires that the participants be completely present, focused, embodied, and immersed in the experience. •Partners have a sense of connection, being in sync, and losing of self with one another. •Deep erotic intimacy is characterized by deep mutual respect, caring, genuine acceptance, and admiration. •Interpersonal risk-taking through exploration is viewed as fun. Sex is perceived as an adventure, an exploration that expands sexual boundaries together with humor and laughter. •Participants feel free, during sex, to be themselves, authentic, genuine, uninhibited, and totally free to express their wishes. •Great sex requires “letting go,” allowing oneself to be vulnerable, reveling in the sensation, and completely surrendering to their partners. •These sexual experiences are often characterized by a sense of peace, bliss, and a feeling of utter timelessness, growth enhancing and healing, similar to what Maslow (1971) called peak experiences.
Article
Introduction Female orgasmic disorder (FOD) is defined as the absence, delay, infrequency, or marked diminishment in intensity of orgasm in at least 75% of sexual experiences, persisting for at least 6 months and causing distress, has specified subtypes, and affects up to 28% of women in the United States and up to 46% in countries across Asia. Orgasmic difficulties are relatively common and create distress for a substantial number of women, though efficacious treatments exist. Objective This article provides a review of psychological treatment of FOD. Methods A literature search was conducted using PsycINFO to identify research reporting methods and outcomes of psychological treatment of FOD in peer-reviewed journals and textbooks. Search terms were female orgasmic disorder, anorgasmia, female sexual dysfunction, and orgasm. This search was supplemented with hand-searching references of review articles and journal articles. Results Psychological treatment has been shown to be effective in helping women with FOD to gain or regain the ability to have orgasms, with higher success rates overall of treating lifelong or generalized vs acquired or situational FOD. Of the variety of treatment approaches that have been tested, the most consistent support emerges for directed masturbation, sensate focus, and psychotherapy. Approaches with little evidence for efficacy as a primary mode of treatment include systematic desensitization, bibliotherapy, and coital alignment technique training. Conclusion While existing research provides a solid foundation of knowledge, treatment of FOD has seen little innovation since the 1980s. Future research should aim for broader understanding of etiologies of all types of FOD, understanding reasons for lack of treatment success for women who have not improved with treatment, and identifying ways of tailoring FOD treatment and success rates for multicultural and community populations. Erica Marchand. Psychological and Behavioral Treatment of Female Orgasmic Disorder. Sex Med Rev 2020;XX:XXX–XXX.
Article
Introduction: This study examines the effectiveness of integrating mindfulness-based techniques within therapy for women suffering to achieve orgasm. Although widely applied in psychotherapy, this approach has only recently been introduced in the treatment of female sexual dysfunction. Aim: To compare the effectiveness of a video-based self-administered treatment, rooted within the cognitive behavioral treatment (CBT) framework, with a video-based self-administered mindfulness treatment applying cognitive behavioral sexual therapy (mindfulness-based cognitive therapy), the latter of which was specifically created to increase women's ability to achieve orgasm. Methods: A convenience sample of 65 women suffering from difficulties to achieve orgasm, aged 18 to 58 years (mean = 32.66, standard deviation = 9.48), were randomly allocated using a randomization procedure to either a mindfulness-based cognitive therapy (N = 35) or CBT (N = 30) group. Each participant completed questionnaires before and after the start of treatment and 2 months after its completion. Main outcome measure: We applied repeated-measure general linear models to compare the 2 groups (ie, between participant factor) on each dependent variable across time (ie, the within-participant factor). Compare mean analyses for paired samples were only conducted when the interaction effect between condition and time was significant (ie, P <.05). Results: Statistical analyses show that women in both groups presented increased sexual functioning (P = .001) and decreased sexual distress (P < .001), as well as improved desire, arousal, orgasm, and sexual satisfaction (P < .05) after their respective treatments. Contrary to our hypothesis, significant reductions in sexual pain were only observed in CBT participants. Clinical implications: To the best of our knowledge, this is the first study to apply a randomized allocation procedure to evaluate the effectiveness of a video-based mindfulness intervention for women struggling to achieve orgasm. These results should guide clinicians' decisions with respect to evaluating the relevance and the real added value of proposing mindfulness exercises to their patients with such difficulties. Conclusion: When women suffering from difficulties to achieve orgasm are randomly assigned to a mindfulness group or an active control, improvements in sexual functioning and reductions in sexual distress can be observed after both treatments. Adam F, De Sutter P, Day J, et al. A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Treatment in a Sample of Women Struggling to Achieve Orgasm. J Sex Med 2019;XX:XXX-XXX.
Article
As described in ethnographies, the ‘floating signifiers’ of social anthropology appear akin to similar categories in contemporary Western societies such as energy. Both may be embodied in actual experience. The practice of ritual orgasm, Pra-Na, and its relation to the group’s cosmology, are intrinsic to a religio-therapeutic community in San Francisco whose ideas derive from reified Western notions of ‘vital energy’ along with popular Chinese medicine, and in which the second author conducted fieldwork involving participant observation between 2008 and 2009. The article examines closely the formulations of ‘energy’ in the Western world, and similarities to non-Western concepts such as Melanesian mana, and asks whether the experience of ritualised orgasm by members of the group leads to their notion of cosmic energy, or whether the understanding of embodied energy is purely arbitrary from a somatic perspective. With reference to Durkheim’s ([1912]1976. The Elementary Forms of the Religious Life. London: Allen & Unwin) ­effervescence, we suggest the former is most likely.
Article
Résumé Objectif L’anorgasmie féminine est une des difficultés sexuelles les plus fréquentes. La pleine conscience (PC) est souvent utilisée en psychopathologie et son efficacité a été largement prouvée scientifiquement. L’objectif de cet article est de comprendre l’intérêt d’intégrer la PC dans le traitement du trouble de l’orgasme féminin. Dans cette perspective, nous présentons une revue de la littérature du trouble de l’orgasme féminin et ses traitements. Ensuite, la pleine conscience et son efficacité pour les dysfonctions sexuelles féminines sont abordées. La discussion permet de mettre en avant l’intérêt d’intégrer la PC dans le traitement du trouble de l’orgasme féminin. Matériel et méthode Analyse de la littérature de 1952 à 2018 effectuée principalement dans les bases de données Sciencesdirect et Scopus avec comme mots clés mindfulness, female orgasmic disorder, anorgasmia, women sexual dysfonction. Résultats La PC est efficace pour les traitements des troubles psychopathologiques et son utilisation s’est étendue aux difficultés sexuelles féminines. Si plusieurs traitements de l’anorgasmie se sont focalisés sur l’amélioration des habilités comportementales et la réduction de l’anxiété, peu se sont consacrés aux cognitions et aux émotions dysfonctionnelles responsables du trouble de l’orgasme féminin. Au regard de la littérature, la PC améliore toute la fonction sexuelle féminine. Conclusion La PC propose des exercices qui faciliteraient l’atteinte de l’orgasme. Cette étude souligne l’intérêt d’intégrer la PC dans la prise en charge du trouble de l’orgasme féminin et d’élaborer d’un protocole de traitement directement utilisable par les cliniciens.
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Female sexual dysfunction (FSD) includes different disorders that are highly prevalent in perimenopausal and older women which require precise diagnosis and management. Screening of FSD should be based on clinical history and the use of screening tools such as the 14-item Changes in Sexual Functioning Questionnaire, the 19-item Female Sexual Function Index (FSFI-19) and its short version (FSFI-6), or the Decreased Sexual Desire Screener. The clinical exam should include the assessment of menopausal symptoms, vulvovaginal atrophy, and comorbidity including pelvic floor disorders, endocrine disorders, depressive symptoms, cancer diseases, and chronic medication use that may interfere with sexuality. The management of genito-pelvic pain/penetration disorders includes the appropriate treatment of the genitourinary syndrome of menopause, urinary incontinence, and pelvic floor disorders with appropriate selection for surgery and/or other treatments. The management of female sexual interest/arousal disorder (also known as hypoactive sexual desire disorder) may include systemic or topical steroid hormone therapy, including dehydroepiandrosterone sulfate, central-acting agents (flibanserin, bupropion, bremelanotide), and/or natural remedies (Tribulus terrestris, Trigonella foenum-graecum). Female orgasmic disorder may be managed by conductual methods and/or drugs.
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Orgasmusschwierigkeiten sind das zweithäufigste Sexualproblem der Frau, aber verglichen mit den Lust- und Schmerzstörungen erheblich seltener Anlass, professionelle Hilfe zu suchen. In den großen repräsentativen Erhebungen zur Sexualität berichtet deutlich weniger als die Hälfte der Frauen mit Orgasmusproblemen über einen signifikanten Leidensdruck. Zudem schwanken auch die Zahlen zur Prävalenz von Orgasmusproblemen je nach Stichprobe und Definition (v. a. bezogen auf Dauer und Durchgängigkeit der Schwierigkeiten) in einem großen Bereich, der von 3–34 % reicht (Graham 2010), wenngleich die Vorkommenshäufigkeit in kaum einer Studie unter 15 % liegt (s. Abschn. 10.4). Diese markante Heterogenität in Prävalenz und Leidensdruck setzt sich bei einer Reihe weiterer Merkmale des weiblichen Orgasmus fort, der gekennzeichnet ist durch ein variantenreiches Spektrum von subjektivem Erleben, Art und Ort seiner Auslösung, Quantität und Qualität der erforderlichen Reize sowie vieler weiterer Faktoren. Den weiblichen Orgasmus gibt es demnach nicht, was entsprechende Konsequenzen für Definition und Klassifikation, Diagnostik und Behandlung nach sich zieht, da es äußerst schwierig ist, Normen und Kriterien festzulegen, die Diversität von Dysfunktion trennt.
Article
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A strong theme in the social work literature contends that randomized experiments are an impractical, inappropriate, unethical, and rarely undertaken research method for use in social work. In a test of this claim, the author undertook a review of the English-language published literature and prepared a provisional bibliography of primary social work studies that used experimental methodology. Astonishingly, over 740 such studies were located, with the first being published in 1949. The existence of this large experimental social work literature has been largely unrecognized, in part, because much of it has appeared in a diverse array of journals associated with other disciplines. It is no longer tenable to claim that experiments are either impractical or inappropriate as a social work research method of value in making causal inferences. This bibliography will be amended in coming years, and subsequent analyses of the types of problems and interventions, which are the focus of these studies, will add to the empirical foundations of social work practice.
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Many cultures throughout history have passed down knowledge rumored to enhance sexual performance of both men and women including sexual techniques, foods, and nutritional supplements. Sexual techniques can take the form of stimulating certain aspects of the female anatomy and sexual positions such as stimulation of the Grafenberg “G” spot. Other techniques focus on the psychological aspects of sex including synchronization of orgasms and ejaculation prolongation. Cultures around the world have imbued foods as aphrodisiacs, in addition to herbs, plants, and other dietary supplements, collectively known as nutraceuticals. Among the more common ones are pomegranates, antioxidant rich foods, omega-3, basil, cardamom, garlic, watermelon, oysters, l-arginine, caffeine, and dehydroepiandrosterone (DHEA). Herbs such as Chlorophytum borivilianum of the Indian subcontinent to Lepidium meyenii of the South American Andes have long been reported to have aphrodisiac qualities. Many of these products are rich in components that promote cardiovascular health, produce anti-inflammatory activity, cause vasodilatation and increase androgen levels—all important factors in sexual performance. This chapter reviews the various sexual enhancement techniques, foods, and nutraceuticals and the evidence to support their use.
Article
Sex and intimacy presents special challenges for the ostomate. Since some colorectal surgery patients will require either temporary or permanent stomas, intimacy and sexuality is a common issue for ostomates. In addition to the stoma, nerve damage, radiotherapy, and chemotherapy are often used in conjunction with stoma creation for cancer patients, thereby adding physiological dysfunction to the personal psychological impact of the stoma, leading to sexual dysfunction. The purpose of this paper is to describe the prevalence, etiology, and the most common types of sexual dysfunction in men and women after colorectal surgery and particularly those patients with stomas. In addition, treatment strategies for sexual dysfunction will also be described.
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The most recent iteration of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013) defines female orgasmic disorder (FOD) as delay, infrequency, absence, or reduced intensity of orgasm in the majority of sexual experiences. Although pharmacotherapy for female sexual dysfunctions has received an enormous amount of interest in recent decades, cognitive and behavioral techniques remain the most effective and are recommended as first-line treatments for FOD by the International Society for Sexual Medicine. Psychoeducation is a necessary but insufficient component of treatment for FOD. It is an important foundation for intensive treatment of FOD. In addition to psychotherapies directly targeting sexual behavior, a number of evidence-based psychotherapies appear to improve orgasmic function among women or serve as valuable adjuncts to sex therapy. Many forms of couples therapy, for example, are effective in addressing problems within intimate relationships that can contribute to orgasmic dysfunction.
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The occurrence of the female orgasm, or lack thereof, has fueled productive research regarding gender differences in sexuality. Both scientific research and popular beliefs support the idea that men orgasm more frequently than women do and, given the biological nature of the orgasm phase of sexual responses, it is easy to assume that the gender difference in orgasm frequency is “natural” and unresponsive to contextual factors (e.g., relationship styles). While it may be true that men orgasm more frequently than women in partnered sex, using sociocultural approaches to understanding orgasm, we argue that it is inaccurate to suggest that men’s orgasms are easier and women’s are more difficult to invoke. In other words, yes—men orgasm more frequently than women—but this is not because women are biologically hardwired not to orgasm or receive sexual pleasure. Yet remains the question: Why do women orgasm less frequently than men do? What factors might narrow this gap in orgasm frequency between men and women? In this chapter, we critically examine gender differences in orgasm and, in doing so, provide science-based suggestions for individuals and relationship partners to close the orgasm gap between heterosexual men and women. We will begin our examination of women’s orgasm with providing an overview anatomy and orgasm. For the remainder of the chapter, we consider orgasm frequency in the context of both short-term (casual sex and hookup scenarios) and long-term relationships. Throughout, we offer suggestions for women and their sexual partners to increase women’s orgasm frequency across both short-term and long-term relationships.
Article
Sexual dysfunction is a highly prevalent, multifactorial, and often undertreated condition in men and women. Sexual dysfunction may be a symptom of underlying, chronic illnesses, and can have a negative impact on quality of life, psychosocial health as well as relationships. In men, sexual dysfunction presents in most cases as erectile dysfunction (ED) and premature ejaculation (PE). This chapter discusses the physiology of erection, the pathophysiology of ED, and modern patient evaluation and presents management options, including the status of traditional therapeutic approaches and the new generation of oral agents. The chapter also discusses different types of PE, their assessment, and their therapies. Female sexual dysfunction (FSD) has gained interest in the medical community after the successful introduction of medical therapy for male ED. This chapter reviews updated classification systems and definitions of the different disorders, epidemiologic aspects, and new pathophysiologic and therapeutic implications and approaches.
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Dans cette thèse de doctorat, nous avons souhaité mettre à jour les différentes habiletés érotiques favorables à la fonctionnalité sexuelle féminine, afin de tester un protocole de traitement des dysfonctions sexuelles féminines, basé sur le développement de ces habiletés. Ces dernières sont utilisées avec succès dans certaines thérapies sexuelles, telles que la thérapie Sexofonctionnelle ou l’approche Sexocorporelle. Pour cela, nous avons dans un premier temps, identifié les habiletés érotiques auprès d’une population de femmes satisfaites sexuellement en comparaison de femmes insatisfaites. Puis dans un deuxième temps, nous avons testé les liens entre ces habiletés et la fonctionnalité sexuelle, c’est-à-dire le fonctionnement et la satisfaction sexuelle, selon différentes méthodologies. Enfin, nous avons construit, puis testé avec de bons résultats, un protocole de traitement des dysfonctions sexuelles féminines basé sur le développement de ces habiletés érotiques.
Article
The Coital Alignment Technique (CAT), a basic physiological alignment that provides consistent and effective stimulation for female coital orgasm, has been evaluated in a series of controlled studies. An overview of the CAT is discussed as well as related studies including replication studies, and subsequent studies of Orgasm Consistency Training (OCT), which incorporates the CAT technique. Classic sex problems like female coital anorgasmia and premature ejaculation and modern day epidemic-level sex problems such as hypoactive sexual desire are analyzed in relation to a syndrome of sexual dysfunction symptoms devolving from failed intercourse. Studies indicate that some symptoms of sexual dysfunction considered to have their etiological foundations in pathology are the result of ineffective intercourse techniques.
Article
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Reviews current knowledge on the treatment of sexual dysfunction, focusing on established techniques, recent developments, and methodological limitations in recent literature. Primary orgasmic dysfunction in women responds well to directed masturbation training programs. Lack of coital orgasm, which is not clearly a true dysfunction in that it involves value judgments about normality, is more resistant to change. More complex issues of habit formation, male partner performance, and marital satisfaction seem to be related to this lower treatment effectiveness. Male premature ejaculation is easily treated, although little is known about the causes of premature ejaculation or the mechanisms that account for treatment effectiveness. There has been much recent work on the differential diagnosis of physical and psychological causes of erectile failure but relatively little new offered beyond W. H. Masters and V. E. Johnson's (1966, 1970) standard treatment techniques. Much of the clinical literature on treatment of sexual dysfunction is difficult to interpret because of recurring problems in methodology, including small sample sizes, confounded treatments, and lack of objective outcome measures. (96 ref)
Article
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The following is a report of The Human Sexuality Program of the New York Hospital-Cornell Medical Center to personally replicate Edward W. Eichel's claims that his Coital Alignment Technique (CAT) enhances and increases female coital orgasms and mutual orgasms. We failed to replicate these claims. However, it was the consensus of the group that within the context of sex therapy, the CAT technique may have merit in certain clinical situations, and as such deserves to be further evaluated.
Article
Path analysis is employed to delineate the relationships among sexual behavior variables, including orgasm consistency, masturbation frequency, cognitive sexual arousal, and satisfaction with sexual responsivity. The analysis provides insights into the processes by which the variables are related to one another and generates specific hypotheses for future questionnaire and experimental research. The results are used to develop a psychosexual model for women, which holds that a masturbation/orgasm sequence may be a prerequisite for an understanding of cognitive elements leading to arousal and their physiological concomitants. Once this platform has been established, a single-partner-oriented sexual adjustment is possible, but a frequent exchange of partners at this time may prove detrimental to sexual satisfaction. Later on in life, intercourse frequency may diminish, and moderate sexual dissatisfaction may develop. The implications of this model for further research are explored. Replication and extension of this study with additional measures and older populations of women is recommended.
Article
While the role of individual characteristics has been examined for extramarital sexual involvement, the literature has yet to document personal factors associated with the termination of an affair. In doing so, this study examines the impact of a woman's sex role attributes ("masculinity") and attitudes toward sex (erotophobia-erotophilia) on her decision to terminate an extramarital affair. Masculinity was not related to affair length. The more positive a woman's attitude toward sex, the longer she continued the extramarital relationship. A further descriptive analysis suggests that this relationship may hold only for women in sexual affairs. The implications of these findings, methodological advances, and limitations of this study are discussed. Finally, recommendations for future research are explored.
Article
To enhance male-female sexual compatibility, principles of physical alignment were formulated to make clitoral contact possible in coitus. The Coital Alignment technique combines (a) the "riding high" variation of the "missionary" coital posture, with (b) genitally focused pressure-counterpressure stimulus applied in the coordination of sexual movement. It was hypothesized that the Alignment technique would correlate with high frequency of female orgasm and partner simultaneity. A questionnaire was given to a group of males and females (n = 43) who had learned the Alignment technique, and to a volunteer group (n = 43) who had no knowledge of the Alignment concept. The mean age for the experimental females (n = 22) was 39.7, and for the control females (n = 22) was 38.7. Analysis of variance and post-hoc LSD procedures conducted on the key dependent variables showed significant differences (p less than .05, two-tailed) between experimental and control females, favoring experimental females on the orgasmic attainment criteria of coital orgasm, simultaneous orgasm, and orgasm experienced as "complete and satisfying." Pearson Product Correlations were conducted across all four groups, experimental and control males and females combined (N = 86). Greater adherence to behaviors associated with the Coital Alignment technique--learned and incidental--had a significant positive correlation with the above and additional sexual satisfaction variables (p less than .01). The Alignment technique may be an important option for a majority of women that have difficulty in attaining orgasm in coitus.
Article
In this study, the authors have examined the masturbation practices of both male and female college students, attempting to test some of the premises long held that men and women differ significantly in such practices. The findings indicate that while there are differences in many of the variables examined, there are others which show striking similarities. Thus, they open to question a number of assumptions held regarding differences in sexual needs and responses of males and females.
Article
This study explores sexual desire, response, and behavior in satisfied versus dissatisfied marriages as perceived by women, while controlling for female sexual satisfaction. Seventy-eight married couples participated in a structured interview and a series of open-ended interviews designed to gather behavioral self-report sexual data. The study had three objectives. First, the association between sexual desire and frequency of sex for both husbands and wives was examined. Second, a typology for female sexual response was developed based on the wives' self-report description of their sexual activities. Five types of sexual responses were identified in these sexual activities through cluster analysis; there were significant differences in how the wives responded to sex between groups. Third, sexual behaviors experienced during the reported sexual activities were assessed in open-ended interviews. Significant differences were found between the groups of marriages in sexual activities. These differences in sexual behavior with women in satisfied and dissatisfied marriages are explored.
Article
Using a step-wise multiple regression analysis, this study examined the role, in nondistressed marriages, of such sexual variables as frequency of sexual activity, number of orgasms, sexual desire, and sexual excitability in the prediction of female sexual satisfaction as compared to the role of such personality and relationship variables as sexual assertiveness, sexual attitudes (erotophobia-erotophilia), and relationship closeness. The findings suggest that individual and relationship variables (sexual assertiveness, erotophilia, and relationship closeness) aid in the prediction of female sexual satisfaction over and above what can be learned from knowing about the frequency of sexual activity, the number of orgasms a woman has, her level of sexual excitability, and how much she desired the sexual activity. Findings, methodological advances in the use of sex diaries, and limitations of the study are explored.
Article
To evaluate and compare the effectiveness and maintenance of two group interventions using orgasm consistency training in the treatment of female hypoactive sexual desire, 57 women were randomly assigned to a women-only group, a couples-only group, or a waiting list control group. Controlling for social desirability, subjects were assessed on six variables: sexual compatibility, sexual esteem, sexual desire, sexual fantasy, sexual assertiveness, and sexual satisfaction. Independent assessments were made on these variables before treatment, after treatment, and at 6 months follow-up. Although the treatment was found to be generally effective in women reporting hypoactive sexual desire, a consistent pattern of change favoring the couples-only group was evident on all measures. Possible explanations for the superiority of couples-only interventions are explored in the discussion.
Article
In an experimental study, a standard group intervention for treating women with hypoactive sexual desire was compared to a standard group intervention plus orgasm consistency training. Specificity of sexual change following treatment was assessed in 39 women with hypoactive sexual desire disorder who completed either treatment. Following treatment, women in both groups reported significantly positive sexual changes on two of the four measures of sexual behavior. Compared with the women receiving only standard treatment, the women who also received orgasm consistency training reported greater sexual arousal and sexual assertiveness at posttreatment and at three-month and six-month follow-up evaluations and greater sexual satisfaction at the six-month follow-up. Implications for these findings, study limitations, and future research directions are explored.
Understanding die female sexual desire response
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