Globally, cervical cancer is the second most common cancer in women, and in the U.S., nearly 4,000 women will die from the disease this year, according to the National Cancer Institute. Consequently, doctors and public-health experts are touting the new vaccine as a landmark drug in women’s health.
The vaccine is targeted to females 9 to 26 years old—the only age range tested in the drug’s preliminary research trials. The hitch is this: Cervical cancer typically occurs in midlife, with nearly half of the women diagnosed with the disease being between the ages of 35 and 55, according to the CDC.
The hailed advent of Gardasil, produced by pharmaceutical giant Merck, has left many women wondering whether this drug is only for the innocent young, or if it could also safeguard mature and sexually active women who are at a higher risk for cervical cancer.
Experts weigh in on who may and may not benefit from the vaccine.
Partial Immunity Better Than None
HPV is a group of viruses that includes more than 100 different strains. “You can get infected with one of these strains on your first sexual encounter, and it is not easy for your doctor to tell if you are infected,” says Dr. Harry Hull, the state epidemiologist from the Minnesota Department of Health. Dr. Hull is also one of 15 experts on the CDC’s immunization advisory committee, which will endorse federal recommendations for Gardasil later this month. These recommendations mandate how and when the vaccine should be administered, who should get it and if it is a mandatory or voluntary immunization.
If a woman is infected with an HPV strain before receiving the vaccine, future immunity against that strain is impossible. As a consequence, sexually active women and women already infected with HPV strains are not ideal candidates for the vaccine, says Dr. Hull.
But women within these categories shouldn’t discount the drug just yet. Among the many HPV strains, only four cause nearly all of the world’s cervical cancers and genital warts: Types 16 and 18, and Types 6 and 11, respectively. Gardasil is designed to target these. “So even if you've been infected with one of these strains, you are still going to benefit from vaccination against the other three strains,” says Dr. Hull.
So sexually active women may not achieve total immunity, but partial immunity is certainly better than none.
Off-Label Prescription
Gardasil is licensed only for females ages 9 to 26, and it will take years for Merck to test the vaccine’s efficacy on a broader age range. Until then, doctors may choose to prescribe Gardasil for women beyond the age of 26, but only if the conditions are right. “This means that the patient has had normal Pap smears all of her life and there is no evidence that she is infected with an HPV strain,” says Dr. Bradley Busacco, a gynecologist and obstetrician in Cincinnati, Ohio.
Not all physicians will feel comfortable prescribing the vaccine off-label. (Off-label means that the drug will be used in a way that is not specifically endorsed by its manufacturer—in this case, prescribing it for women exceeding Merck’s age recommendations.) Women beyond the age of 26 who wish to be vaccinated must discuss their medical history and the issue of off-label prescribing with their gynecologist.
Women in older age demographics may soon have another option for cervical cancer protection. By the year’s end, the FDA is expected to review and approve a second HPV vaccine, Cervarix (produced by GlaxoSmithKline). Initial studies indicate that Cervarix is safe and effective against HPV infection in women age 15 to 55 years. Unlike Gardasil, GlaxoSmithKline’s drug is not designed to immunize against genital warts, but it will protect women against the two leading cancer-causing HPV strains: Types 16 and 18. Previous infection of one of these HPV strains will compromise Cervarix’s immunity, and previous infection of both of these HPV strains will negate the vaccine’s immunity
Men: Important Members of the HPV-Infected Population
Due to a lack of research, boys and young men, even older men, are not immediate candidates for the HPV vaccines. But males are important members of the HPV-infected population, and they should not be overlooked, says one of the vaccine’s inventors, Shin-je Ghim. “Men move the virus from one woman to another. They also run the risk of contracting genital warts,” says Ghim, who is an assistant professor of immunology at the University of Louisville. “I think it would be nice if boys were immunized not only for themselves, but for their future partners, too.”
According to Merck, that day may not be far off. The company is currently testing Gardasil’s efficacy on young males, and it anticipates results within the next year or two, says Kelley Dougherty, director of public affairs for Merck vaccines.
Pregnancy
Gardasil is a pregnancy Category B drug. Studies have shown the vaccine to be safe and effective in reproduction experiments involving female rats, but Merck must conduct more human reproduction studies before recommending Gardasil during pregnancy, says Dougherty.
The vaccine is administered in a series of three injections spaced over six months, and if a woman becomes pregnant during that time frame, she should discontinue the series until her pregnancy ends. Women can then resume the vaccination where they left off. There is no need to restart the series.
In regards to Cervarix, it is too soon in the drug’s development process to make any pregnancy recommendations, according to Danielle Halstrom, director of product communications for GlaxoSmithKline.
How Early Can You Vaccinate?
Scientists have not examined Gardasil’s effectiveness on children below age 9, but there is little need to vaccinate children at birth, assures Professor Ghim. “Sexual activity—not age—is the major factor in deciding when to vaccinate someone.”
Preliminary studies indicate that Gardasil guarantees HPV immunity for at least five years and Cervarix will protect patients for at least four and a half years. Yet, researchers do not know the exact endpoints of immunity for either vaccine. Children vaccinated at birth may need a booster shot to bolster their immunity before becoming sexually active. As a result, immunization experts recommend that parents wait to vaccinate their children until they are closer to the age of sexual activity. Merck is currently conducting trials to track Gardasil’s staying power, and GlaxoSmithKline has similar longevity tests underway.
Mixing Gardasil and Cervarix
If booster shots are necessary to sustain immunity throughout a person’s lifetime, doctors will need to know if Gardasil and Cervarix are compatible vaccines. To date this issue is a matter of speculation, not hard science. “So far, nobody’s looked at mixing the two drugs,” says epidemiologist Hull. “I think that there will be some studies done on this in the future, but it probably won’t be a problem,” he says. “Gardasil and Cervarix are very closely related products.
“The bottom line is that women who may be or who already are sexually active should be encouraged to get vaccinated for HPV,” says Dr. Hull. “Immunization will save lives.”
Saturday, February 16, 2008
Thursday, November 1, 2007
On call: Wife’s disinterest in sex
On call
Wife’s disinterest in sexQ.My wife and I, who both read your column, have
always enjoyed our intimate relations. Since she went through the change last
year, however, she’s lost interest in sex. She’s only 53, and although I’m 8
years older, I’m as amorous as ever. Do you have any suggestions for us?
A.We’re glad to have you both as readers; in many
households, after all, it’s women who watch over men’s health.
Doctors have learned a lot about the male sexual response in the Viagra era,
but there is less information about female sexuality. Menopause signals an
abrupt drop in female hormones such as estrogen and progesterone, but that
shouldn’t affect the female sex drive. In fact, libido depends on
testosterone, the male hormone, in both men and women.
Testosterone levels are very much lower in women than men, but they drop even
lower as menopause approaches, then remain stable during and after menopause as
the adrenal glands continue to produce small amounts of male hormones. Still,
some women are testosterone deficient and might benefit from testosterone
therapy. Unfortunately, however, data are scant, and much more research is
needed to learn if testosterone is safe and effective — and if it is, which
women should receive it and what dose and preparations are best. At present,
those answers are a long way off; in fact, the same questions about testosterone
replacement remain to be answered for men.
Another area for research is the use of Viagra for women. An early trial
found the drug safe but not beneficial for healthy postmenopausal women. More
research is under way, and other drugs are being developed for sexual
dysfunction in both genders. The FDA has already approved a hand-held
battery-powered clitoral stimulator for women with sexual dysfunction. Your
wife’s problem, though, may be a good deal simpler. Postmenopausal women who do
not take hormone therapy (and with research showing more harm than good, most
should not) develop vaginal dryness, which can make intercourse unpleasant or
even painful. So a simple place to start would be a nonprescription vaginal
lubricant such as Replens. If that doesn’t help, your wife should ask herself if
she might be feeling subtle stress or unhappiness or if she may be reacting to
personal, marital, or family conflicts. Her doctor may be able to help her sort
out possible physiological and psychological issues.
Discuss the problem with your wife frankly, but be patient and supportive,
always looking for mutually satisfactory ways to achieve intimacy and express
love and affection.
How To Spice Up Your Sex Life
Since the dawn of time, people have looked toward elixirs and potions to
improve their sex lives. Why else, after all, would one consume ground tiger
penis, horny goat weed and Spanish Fly?
Perhaps because nearly one in five men in the U.S. suffer from erectile
dysfunction, according to a recent study in the American Journal of
Medicine. Some researchers have estimated that as many as 40% of U.S. women
have low libido or inability to reach orgasm. Most quick fixes simply don't
work, and some, like Spanish Fly, a supposed aphrodisiac derived from beetles
that can cause kidney damage, are harmful.
In Pictures: Thirteen Steps To Better Sex
But modern medicine has found ways--both proven and experimental--to improve
your sex life. One place to start: old-fashioned remedies, which some say work
best. Regular exercise can actually improve erectile function in
most men, says Andrew McCullough, a urologist at New York University Medical
Center--and we're talking jogging, not the acrobatic feats found in the back of
a magazine. Not particularly athletic? Therapists say that paying attention to
your feelings is as important as any pill, nose spray or cream.
"Have a really wonderful role-play with your partner, have a really great
dinner out or watch a romantic movie together," says Robert Dunlap, who has
researched aphrodisiacs at the Institute for Advanced Study of Human Sexuality
in San Francisco. "The greatest aphrodisiac is your mind."
Hope In A Bottle
But that's not stopping the $600
billion global pharmaceutical industry from trying to think up new sex drugs.
Viagra, the little blue pill Pfizer launched a decade ago, brings in $1.7
billion in sales every year. Cialis, the longer-acting imitator made by Eli
Lilly, rakes in another $1 billion, with several hundred million more for
Levitra, from Bayer and Schering-Plough. Other remedies increase blood flow,
like the penis injection Caverject, and bring in $30 million more.
A product that could improve women's sexual function might bring in even more
money, if it were truly effective. So far, though, companies have been
unsuccessful. Viagra failed in tests on women. Procter & Gamble tried to
push a testosterone patch for female sexual dysfunction through the Food and
Drug Administration (FDA) but in 2004 the agency balked, citing a lack of
long-term safety data.
Now the idea of using testosterone as a sex-booster for women is being pushed
by Lincolnshire, Ill.-based BioSante Pharmaceuticals, Inc. Its LibiGel is rubbed
on the upper arm daily, delivering testosterone, which is thought to increase
libido, to the bloodstream over time. The company just began late-stage trials,
and, after discussions with the FDA, will start a big safety trial before
submitting data to regulators in 2009.
Palatin Technologies, of Cranbury, N.J., is trying to get in on the game,
developing a nose spray, called bremelanotide, to treat men and women with
sexual dysfunction. Applied 10 to 15 minutes prior to sex, it travels through
the central nervous system to increase blood flow in the penile or vaginal
tissue. The company hopes to get FDA approval for men in 2009 and women around
2011. "On the female front, we've got a chance to be first to market," says CEO
Carl Spana. "People wonder how many women will come in for treatment, but my gut
tells me they will come in."
What Really Works
Right now, the treatment available for
women with female sexual dysfunction that has been reviewed by the FDA is a
handheld vacuum that can be used with a doctor's prescription to increase blood
flow to the clitoris. Called Eros Therapy, it is made by NuGyn of Minnesota.
Devices such as this go through fewer hurdles than drugs; the Eros device has
been tested in several dozen people, compared with hundreds for a pill such as
Viagra.
Joy Davidson, a Manhattan-based certified sex therapist, worries that all
this technology may cause some people to ignore important cultural factors that
can cause sexual dysfunction. "There are agendas here that are not health-based,
they're profit-based," she says. "If you're not looking at these elements--the
emotional, psychological and cultural--then giving somebody a so-called magic
pill is not going to solve the problem."
Future Fixes
Meanwhile, drug researchers keep coming up
with even more out-there approaches. For instance, a gene therapy, which seeks
to fix erectile function by altering the DNA of cells in the penis, then
injecting them back in to the patient. It should work for six months, according
to inventor Arnold Melman, the researcher at New York's Albert Einstein College
of Medicine. He has co-founded a tiny biotech, Ion Channel Innovations, to
develop the product, which even he doesn't expect to reach the market before
2012. No gene therapy has ever been approved.
"People always say gene therapy doesn't work, but at one point it will," says
Melman. "We think this is the one."
Aphrodisiacs That Really Work
For as long as humans have been having sex, they've been trying to get in the
mood--or get their partners in the mood. And if necessity is the mother of
invention, it's no surprise that humans have developed a wide variety of creative
solutions for the old "I've-got-a-headache" problem.
The most recent solution, of course, is Viagra. But in ancient India, a young
man who proved passionless in the sack might have tried goat testicles boiled in
milk. Oysters are another common turn-on; the Roman satirist Juvenal was the
first to note their seductive qualities. In medieval times, honeyed mead was the
equivalent of Bud Lite for loosening up carousing swains.
Fresh snake blood is still revered as a stimulant in parts of Asia, as are
bat blood, reindeer penises, shark fins and ground rhino horns. And what
sad-sack hasn't at least contemplated Spanish Fly? It's not a fly at all,
actually, but the dried remains of beetles, which irritate the male urogenital
tract, causing a prolonged erection--and potentially causing serious discomfort
and even death, according to the Food and Drug Administration.
In
Pictures: Ten Aphrodisiacs That Work
Beyond their collective exoticism, the only thing the above have in common is
that they don't work. Named for Aphrodite, the Greek goddess of sex and beauty,
an aphrodisiac is just about anything that awakens or increases sexual
desire--be it your own, or the object of your desire's. In reality, however,
most aphrodisiacs are folklore at best and hazardous to your health at worst. As
the Food and Drug Administration has declared: "There is no scientific proof
that any over-the-counter aphrodisiacs work to treat sexual dysfunction."
But there is still some hope for those seeking a libido boost. The herbal
supplement Ginkgo
Biloba is being studied by the Office of Dietary Supplements, a subsidiary
of the National Institute of Health, as a treatment for erectile dysfunction.
The FDA has called animal studies of yohimbine "encouraging." Derived from the
bark of an African tree, yohimbe has been used as a sexual stimulant for
centuries. But the FDA notes that animal studies can't be used to prove
effectiveness in humans.
Even when aphrodisiacs do show promise, they don't always work for everybody.
Sexual desire is rooted in the mind more than the genitals. One person's fantasy
could be another's turn-off. "We're all unique individuals, and we all respond
differently to different things," says Dr. Beverly Whipple, a professor emerita
at Rutgers University and author of, most recently, The Science of Orgasm.
At the root of human sexual desire is the "core erotic personality"--a.k.a.
"sexual template"--which, in a nutshell, is whatever gets you off. "Everyone has
in their mind an image of someone or thing they find sexually desirous,"
explains Dr. William Granzig, dean of clinical sexology at Maimonides University
in North Miami Beach and president of the American Board of Sexology.
That image might be a person of specific age, race or hair color, or it might
be every person. It could be a fondness for a particular style of dress, objects
such as women's shoes or fur-lined handcuffs, or behavior such as cross-dressing
or exhibitionism. Whatever it is in particular, the sexual template is believed
to develop early on during a childhood erotic experience--perhaps as early as
age three or four--and it sticks with you for life.
The difficulty of maintaining sexual desire over the long term, of course, is
that if your partner falls outside of your sexual template--or you fall outside
theirs--sooner or later one of you could lose interest. "Many people whose
template is not, say, age-specific, can have great sex throughout their lives,"
notes Granzig. "But if you're only attracted to 20-year-olds, once your partner
hits 30, your desire will decrease. Unless, of course, you can figure out some
ways to spice things up."
Spicing things up is where sex gets complicated, because men and women
sometimes have wildly divergent desires. For men, a sexy photo is often enough to get blood flowing in the right direction. For
women, pornography can be a major turn-off. Orgasms are also less central to
women, who sometimes need full body stimulation, not to mention mental
seduction, in order to achieve climax. "There are just so many variables that go
beyond the physical in sex for women," says Dr. Janice Epp, a clinical
sexologist at the Institute for Advanced Study of Human Sexuality in San
Francisco.
There are also a host of external nuisances that weigh heavily upon sexual
desire--and that may dampen the mood. Studies routinely rank American culture as
one of the most sexually repressed in the world thanks to its forbidding
Judeo-Christian origins, high incidence of sexual problems and dysfunction, and
a lingering Puritan discomfort with the very topic of sex.
And while Europeans take mandatory month-long vacations, Americans routinely
work 60-hour weeks, and stretch their ten vacation days over the entire year.
With the demands of our modern day technological society, it's little wonder the
search for aphrodisiacs continues. "I see a lot of highly evolved, highly
skilled people who are losing desire because they have such an overriding focus
on their profession," says Epp, who works in Silicon Valley. "For them, the
temptation to believe that there's a magic pill that will make them desirous of
sex again is very strong."
Inspired by the phenomenal success of Viagra, which rang up over $1.6 billion
in sales for Pfizer in 2005, it's perhaps not surprising that there has been a
recent push to find more pharmaceutical remedies for flagging sexual desire.
It's a focus that throws many in the sex field into apoplexy. "The idea that you
can just give someone a pill, and they'll be interested in sex is like putting a
band-aid on a tumor," says Epp.
In the end, the only truly effective aphrodisiac seems to be that's been
working for humans all along. "Your biggest sex organ is the one between your
ears," says Dr. Granzig. "What is desire, after all, other than the hope that
you can fulfill your sexual fantasies? And that's all in your mind."
Sex and Your Psyche
You know the cliche: a woman is so uninterested in sex that she makes a
shopping list while making love. Jennifer and Laura Berman see such women all
the time, and it's frustration—not boredom—that brings them to the Bermans' new
clinic at UCLA.
"I was talking to a woman earlier today about her low libido, which was a
result of the fact that she can't reach orgasm," says psychologist Laura Berman,
Ph.D., who with her sister, urologist Jennifer Berman, M.D., is a founder and
codirector of the Center for Women's Urology and Sexual Medicine clinic.
"Because she can't reach orgasm, sex is frustrating. She feels a hopeless,
fatalistic complacency about her sex life. When she's having sex, her partner
picks up on that and feels rejected and angry, or notices she's withdrawing.
Then intimacy starts to break down. Her partner feels less intimate because
there's less sex, and she feels less sexual because there's less intimacy. The
whole thing starts to break down."
Acknowledgement of sexual dysfunction in America is booming. But with all the
attention on Viagra and prostate problems in men, most people would probably
never guess that more women than men suffer from sexual dysfunction. According
to an article in the Journal of the American Medical
Association, as many as 43 percent of women have some form of difficulty in
their sexual function, as opposed to 31 percent of men.
And yet female sexuality has taken a back seat to the penis. Before Viagra,
medicine was doing everything from penile injections to wire and balloon
implants to raise flagging erections, while female sexual dysfunction was almost
exclusively treated as a mental problem. "Women were often told it was all in
their head, and they just needed to relax," says Laura.
The Bermans want to change that. They are at the forefront of forging a
mind-body perspective of female sexuality. The Bermans want the medical
community and the public to recognize that female sexual dysfunction (FSD) is a
problem that may have physical as well as emotional components. To spread their
message, they have appeared twice on Oprah,
have made numerous appearances on Good Morning
America and have written a book, For Women
Only.
"Female sexual dysfunction is a problem that can affect your sense of
well-being," explains Jennifer. "And for years people have been working in a
vacuum in the sex and psychotherapy realms and the medical community. Now we are
putting it all together."
No single problem makes up female sexual dysfunction. A recent article in the
Journal of Urology defined FSD as including
such varied troubles as a lack of sexual desire so great that it causes personal
distress, an inability of the genitals to become adequately lubricated,
difficulty in reaching orgasm even after sufficient stimulation and a persistent
genital pain associated with intercourse. "We see women ranging from their early
twenties to their mid-seventies with all types of problems," Laura says, "most
of which have both medical and emotional bases to them." The physical causes of
FSD can range from having too little testosterone or estrogen in the blood to
severed nerves as a result of pelvic surgery to taking such medications as
antihistamines or serotonin reuptake inhibitors, such as Prozac and Zoloft. The
psychological factors, Laura says, can include sexual history issues,
relationship problems and depression.
The Bermans codirected the Women's Sexual Health Clinic at Boston University
Medical Center for three years before starting the UCLA clinic this year. At
present, they can see only eight patients a day, but each one receives a full
consultation the first day. Laura gives an extensive evaluation to assess the
psychological component of each woman's sexuality.
"Basically, it's a sex history," Laura says. "We talk about the presenting
problem, its history, what she's done to address it in her relationship, how
she's coped with it, how it has impacted the way she feels about herself. We
also address earlier sexual development, unresolved sexual abuse or trauma,
values around sexuality, body image, self-stimulation, whether the problem is
situational or across the board, whether it's lifelong or acquired." After the
evaluation, Laura recommends possible solutions. "There is some psycho-education
in there, where I'll work with her around vibrators or videos or things to try,
and talk about addressing sex therapy."
Afterward, the patient is given a physiological evaluation. Different probes
are used to determine vaginal pH balance, the degree of clitoral and labial
sensation and the amount of vaginal elasticity. "Then we give the patient a pair
of 3-D goggles with surround sound and a vibrator and ask them to watch an
erotic video and stimulate themselves to measure lubrication and pelvic blood
flow," Jennifer says.
The identification of FSD has been called everything from the final frontier
of the women's movement to an attempt by the patriarchy to shackle women's
sexuality. But given the success that drugs such as Viagra have had in reversing
male sexual dysfunction, the Bermans found an unexpected amount of criticism
from their peers. "The resistance we got from the rest of the medical community
early on was surprising to us," Laura says, explaining that the urological field
in particular has been dominated by men.
Clearly, the Bermans will need hard data to win over their critics. Their
UCLA facility is enabling the Bermans to conduct some of the first systematic
psychological and physiological research on the factors that inhibit female
sexual function. One of their first studies suggests that the pharmaco-sexual
revolution that helped some men overcome their sexual dysfunction may prove less
effective for women. Their initial study of the effects of Viagra on women found
that Viagra did increase blood flow to genitalia and thereby facilitate sex, but
women who took the drug said it provided little in the way of arousal. In short,
subjects' bodies might have been ready, but their minds were not.
"Viagra worked half as often in the women with an unresolved sexual abuse
history as in those without it," Laura says. "So it's just not going to work
alone. Women experience sexuality in a context, and no amount of medication is
going to mask psychologically rooted, or emotionally or relationally rooted
sexual problems." Laura believes the results of the Viagra study counter those
who contend that FSD is simply a tool of pharmaceutical companies to
"medicalize" female sexuality.
"I'm less concerned about it, because I'm aware that it won't work," she
says. "And in some respects, pharmaceutical companies are closing the divide
between the mind and body camps of FSD. Clinical trials of new drugs for FSD are
requiring psychologists to screen participants, and that is an acknowledgement
that an accurate assessment of a drug's efficacy requires a consideration of the
test subjects' feelings about sex. So these physicians who may not be motivated
to bring on a sex therapist are now motivated to participate in a clinical
trial, and then that model becomes the norm."
Currently, the sisters are working on MRI studies of the brain's response to
sexual arousal, the place where mind and body meet. And although there is a lot
more research to be done on FSD, identifying it as a problem has already made a
significant impact on how women perceive their sexuality. "Women now feel more
comfortable going to their doctors, and they're not taking no for an answer, not
being told to just go home and have a glass of wine," explains Laura. "They feel
more entitled to their sexual function."
His & Hers: How To Have Them
Hers: a female orgasm can be frustratingly evasive. While about 85 to 90
percent of women are capable of having an orgasm, according to Beverly Whipple,
Ph.D., vice president of the World Association for Sexology, only about
one-third have had one during intercourse. That said, it's important to remember
that orgasm should never be the goal.
"In goal-oriented sexual interactions, each step leads to the top step, or
the big "O"—orgasm," says Whipple. "Goal-oriented people who don't reach the top
step don't feel very good about the process that has occurred. Whereas for
people who are pleasure oriented, any activity can be an end in itself; it
doesn't have to lead to something else. Sometimes, we're very satisfied holding
hands or cuddling. There would be a lot more pleasure in this world if people
would just focus on the process."
Whipple also points out that the psychological ramifications of dissatisfying
sexual interactions are not often suffered alone; they can cause distress in
both partners. "If one person in a relationship is goal-oriented and the other
is pleasure-oriented, and neither is aware of their own orientation, they don't
communicate that with their partner," she explains. "A lot of relationship
problems can develop. In my workshops with couples, I help them be aware of how
they view sexual interactions and then communicate this with their partner."
Types of Orgasm
Clitoral Orgasm
The most common, they result from directly stimulating the clitoris and
surrounding tissue. What many people don't realize is that the majority of the
clitoris is actually hidden inside the woman's body. Recently, Australian
urologist Helen O'Connell, M.M.E.D., studied cadavers and 3-D photography and
found that the clitoris is attached to an inner mound of erectile tissue the
size of your first thumb joint. That tissue has two legs or crura that extend
another 11 centimeters. In addition, two clitoral bulbs—also composed of
erectile tissue—run down the area just outside the vagina.
O'Connell's findings, published in the Journal of
Urology, show that this erectile tissue, plus the surrounding muscle
tissue, all contribute to orgasmic muscle spasms. With so much tissue involved
in a clitoral orgasm, it's no wonder they're the easiest to have.
Pelvic Floor or Vaginal Orgasms
These occur through stimulating the G-spot, or putting pressure on the cervix
(the opening into the uterus) and/or the anterior vaginal wall. Located halfway
between the pubic bone and the cervix, the sensitive G-spot—named after its
discoverer, German physician Ernest Grafenberg—is a mass of spongy tissue that
swells when stimulated. Because it's difficult to locate, experts have developed
a few guiding techniques:
- Lying on her back, the woman tilts her pelvis upward so that
her vulva presses flat against her partner's pelvic bone. According to the
Bermans, this allows the penis to make contact with the G-spot, simultaneously
stimulating the clitoris. Putting pillows beneath her buttocks makes angling her
pelvis easier. - Whipple suggests placing two fingers inside the vagina and
moving them in a beckoning motion. The fingertips should stroke the frontal
vaginal wall, just where the G-spot is located.
The Blended Orgasm
This can be attained through a combination of the first two.
Her Benefits
- Pain relief: Orgasms help alleviate menstrual cramps. In
addition, studies have shown that a woman's pain threshold increases
substantially during orgasm. - Enhanced mood: According to University of Virginia
researchers, orgasms boost levels of the female sex hormone estrogen, which in
turn betters your mood and helps ease premenstrual symptoms. They also release
endorphins, the body's natural painkillers and depression fighters. - Increased intimacy: Oxytocin, a hormone that promotes
feelings of intimacy, jumps to five times its normal level during climax. - Easier rest: Oxytocin also induces drowsiness. For women,
sleepiness comes about 20 to 30 minutes after orgasm. Men, on the other hand,
usually drift off after only two to five minutes. - Less stress: Stress in women is highly correlated with
arousal difficulties, lack of libido and anorgasmia, the inability to reach
orgasm, according to one 1999 study in the Journal of the American Medical
Association. Just 20 minutes of intercourse, however, releases the
lust-enhancing hormone dopamine, triggering a relaxation response that lasts up
to two hours.
Physiologically speaking, male and female orgasms are surprisingly similar.
The related problems men and women experience, however, are distinctly
different.
"There are men who can't orgasm, but I think it's less than I percent of
men," says Jed Kaminetsky, M.D., a professor of urology at New York University
and director of the school's male sexual dysfunction clinic. "That's a much less
common problem than premature ejaculation."
A study published in the Journal of the American
Medical Association found that premature ejaculation is even more common
than erectile dysfunction, especially among younger men. As with most
sex-related problems, it affects both partners—some studies suggest that nearly
30 percent of couples report premature ejaculation as the most prevalent sexual
problem in their relationship. One major obstacle to treating it is simply
defining the problem to begin with.
"It depends on the relationship," Kaminetsky explains. "If a woman takes an
hour to orgasm and the man can last 40 minutes, that's premature ejaculation for
that couple." At the other extreme, one minute is too short an amount of time
for most couples. "Not too many women are going to climax within a minute."
Kaminetsky also sees truth in Whipple's assessment of goal-oriented versus
pleasure-oriented interactions. "Men are very goal oriented; they see a task and
they want to successfully perform that task," he says. "Often that task is to
make their partner have an orgasm. If the woman knows that, she feels like a
laboratory animal—it's not a very sexy thing. That's why women fake orgasms,
which is a sign of lack of communication in a relationship."
Premature Ejaculation
Rarely a physiological problem, premature ejaculation can result from
over-excitement, positioning or rate of intercourse. "The roots of it go back to
the way men learn to orgasm, which is typically through masturbation," suggests
Kaminetsky. "A lot of young boys masturbate quickly, because they don't want
their mom to walk in on them. It becomes a trained behavior." To treat premature
ejaculation, experts suggest changing positions, breathing deeply, thinking
about something other than sex or simply stopping for a moment. Here, Kaminetsky
offers two additional techniques for delaying orgasm:
- Practice this before reaching "ejaculatory inevitability,"
the point when ejaculation cannot be stopped; most men recognize it as a
sensation of deep warmth or pleasure: Squeeze the head of the penis for about
four seconds or until the sensation subsides, then resume. - During intercourse, the man should press his pelvic bone
against the woman's and rock rather than thrust his body. "It won't be as
stimulating for him so he'll last longer, and it may be more stimulating for the
woman."
His Benefits
- Long life: Men who have two or more orgasms a week tend to
live significantly longer than do those who have only one or none, according to
research at Cardiff University in Wales. - Less cancer: Breast cancer is rare in men, but once
developed, the mortality rate is high. Fortunately, a study published in the
British Journal of Cancer found that men who have more than six orgasms a month
are significantly less likely to develop breast cancer than are those who have
less frequent sex. - Healthy hearts: A study of 2,500 men at the University of
Bristol and Queens University of Belfast found that men who have at least three
or more orgasms a week are 50 percent less likely to die from heart failure or
coronary heart disease. - Good health: Having sex once or twice a week also fights off
the flu and other viruses by strengthening the immune system, psychologists at
the University of Pennsylvania recently found. - Youthful looks: A study of 3,500 aging people at the Royal
Edinburgh Hospital in Scotland found that those who looked the youngest also had
the most vigorous sex life. The effects were even greater if the subjects were
emotionally satisfied as well.
Getting Close And Personal
Bee, 25, Copywriter
Masturbating is the easiest way for women to learn how to have an orgasm.
Women who masturbate will be a lot more likely to have an orgasm during sex. I
think it helps you learn the actual mechanics of what turns you on, where things
need to happen.
Because the guy isn't going to know that; there's no reason he would. Every
woman is different. Also, the bonding that goes on during sex seems most extreme
with an orgasm. It's kind of like one or both people have gone completely over
the edge; they're suspended in the other person's grasp, and they're completely
surrendered to it. That intensifies any connection.
Gabriel, 25, Musician
There are guys who don't get a rise out of giving a woman an orgasm and would
just prefer not to have someone else there. I've even heard some guys say they
have better orgasms during masturbation than sex. The mere thought of it
astounds me, but it makes sense if a guy has a fear of intimacy or, even more, a
fear of performing. It probably takes away from his own orgasm if he's overly
concerned with his sexual performance or whether or not she's having one. It's
ironic, because an orgasm during sex is enhanced when it's with someone you
truly care about.
Getting Close and Personal
Kamara, 27, Musician
I'm amazed when I talk to anyone who claims to have never had an orgasm,
probably because I just can't imagine not having them or not being able to have
them. At the same time, it doesn't surprise me: I was raised in a very
conservative religious atmosphere that actually called masturbation "self
abuse," and all sexuality—not to mention orgasms—was beautiful and good only if
it happened in a marriage bed. It takes awhile to expel the load of guilt that
piles up around your sexuality if you're raised in that kind of culture, and I'm
sure some people never do. But there was no way I wasn't going to aim for the
prize once I knew what it felt like. Maybe it depends on your sexual drive—for
me the drive was strong enough that I could never feel guilty about an orgasm
for long.
Steven, 28, Veterinarian
Some guys think sex has to include an orgasm. Orgasms are great, but there's
so much more to sex. An orgasm is more of a physical experience; I guess there
is an emotional aspect, but it's over in a second. I think anybody can give you
an orgasm, but it's the person there after the orgasm that matters. But I think
I'm the exception.
Does Orgasm Equal Sex?
Our ever-changing definition of sex may hinge more on the climax than on the
act itself; Psychologist L.M. Bogart, Ph.D., gave Kent State students a list of
scenarios in which "Jim" and "Susie" engaged in vaginal, anal or oral
intercourse and either did or did not achieve orgasm. Vaginal intercourse was
considered sex 97 percent of the time, followed by anal intercourse (93 percent)
and oral sex (44 percent). Researchers were surprised to find that orgasm
occurrence dictated whether or not the activity was considered sex. Although the
woman was more likely to label vaginal intercourse sex if neither partner
climaxed, when it came to oral sex, the recipient was more likely to consider it
sex than the partner performing the act, especially if the recipient achieved
orgasm—because the stimulator was unlikely to achieve orgasm. For anal sex, it
was more likely to be called sex if Jim had the orgasm, but it was sex to Susie
regardless of whether she achieved orgasm. In general, the lack of orgasm for
women was less likely to affect her labeling the act sex. Although most sex
therapists argue against using orgasm as an end-all definition of sex, Bogart's
study indicates that orgasm is still an important gauge by which we measure
sexual activity.
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