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How To Give A Signature Blowjob

A blowjob can be run of the mill, or it can be amazing. Here’s how to make the blowjob you give one to remember by developing your own signature style.

I love to give head: but it’s amazing when you can drop to your knees to perform a blowjob on a guy and truly rock his world. And I don’t mean in the ‘hooray my girlfriend is giving me head’ way; I mean in a way that will have him screaming, “Wow! That was AMAZING!” Well good news, this is what we’re going for!

Now whilst giving head to girls is often seen as a bit more of an art form; sometimes we can be a bit lazy when going down on guys. You may think that they’re happy with the same old in-out motion: but try these tricks and you’ll have them begging for more.

So listen up ladies (or men), and I’ll tell you how you can make your guy squirm with some advanced added extras to a basic oral sex position.

Choosing The Right Oral Sex Position

Get your guy to lie on his back (preferably erect) and kneel between his legs. Kneeling is better than lying, as if you spread your knees wide apart on the bed, and lean down to give him head, he’ll get a great view of your back and pert ass. Perfect for giving him a taster of what’s coming later.

Tips For Developing Your Own Blowjob Style

1. Make sure your hands are sufficiently lubricated with saliva (a lot of guys will like the sound of you spitting) or a good dose of lubricant. Silicone based lube is a particular favorite of mine, as it is deliciously viscous, and will make you sliding your hands up and down his shaft even easier.
2. Begin to massage, using your lead hand, up and down his shaft using a firm grip (the more lubricated he is the harder you can hold) and then lean over to take his penis in your mouth.
3. As you move up and down keep your mouth and lead hand at a rhythm. Try varying the pace: faster when you want to get him worked up to orgasm, mixed with slowing things down to help him keep going for longer.
4. As you get warmed up you’ll be able to take him deeper and deeper. Make sure to keep your mouth open wide: lots of guys will like you to be able to take them to the entrance to your throat. With a little practice this maneuver will help you to practice deep throat.
5. Now this is where most people would stop; instead go beyond the vanilla blow job and get bonus points for incorporating your other hand. As a first step you can use it to add extra pressure to the penis by holding one hand over the other.
1. Once you’ve got your balance, begin to move your hands independently. One hand can continue the up-down motion, whilst the other holds the base of his penis in a tight grip. Alternatively, you can use it to pleasure yourself, and give him a seductive side show. There are few things sexier than him watching you getting off whilst giving him head.
2. Feeling adventurous? Then insert the palm of your hand underneath his ball sack on the sensitive perineum (lots of lovely nerve endings there) and apply gently pressure by cupping the area of skin at the base of the penis. From here you can gently massage his balls with your hand… Yes at the same time as the other hand/ mouth perform fellatio!
3. Feeling really naughty (as I usually am)? Then swap to giving him a double handed jerk-off whilst you lick his balls. Start at his anus (I told you this was rude) and work up to his balls; sliding your tongue up the shaft of his penis, eventually returning to your original position.
4. Work out what really turns your guy on. Men have different preferences just like women. Get to know whether he enjoys saliva, sounds, licking (or even sniffing!) his balls and then combine his favorite moves to make him go wild.

Practice Makes Perfect

I’m not going to lie: putting these sexy twists on the classic blow job does require practice, determination and a good dose of enthusiasm for the job.

If you find giving a blowjob anything but thrilling, then getting him to thoroughly wash, shave and using flavoured lubricant will help to make your task more pleasurable. Personally, though I think there’s a lot of pleasure you can have knowing how much you can turn someone else on. Do this right and he’ll be so in awe of your multi-tasking womanly powers that he’ll claim it will feel like there are two women giving him oral sex at once, and not just one.

The result? A very happy man, and a whole lot of ‘I owe you’s!

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10 Ways To Become An Oral Sex Master (For Women)

Oral sex is something every guy craves, but a lot of girls aren’t good at it. They try to imitate what they see porn stars do in adult films, but that’s actually not the best way to give a guy a blowjob. It’s all for the cameras - but here’s the REAL way to be great at oral sex. If you follow these ten easy tips, you’ll have him begging you for more!

Go Slow At First

Yes, guys like a lot of sucking and they like it fast, but not always when you’re first starting to give him head. Instead of licking your partner’s penis like there’s no tomorrow to get his erection going, start slow and let his erection build in your mouth. Slowly suck him and roll his soft penis around in your mouth as he’s getting hard. He’ll love the feeling of having his entire penis in your mouth as he’s becoming aroused!

Learn To Deep Throat

Guys love a deep throat blowjob, but girls often don’t like to give them because taking a penis so deep into their throats make them gag or vomit. If you gag now while deep throating, you can learn to do it well with practice. Learn to breathe through your nose while you’re performing oral sex and relax your throat. Take a little bit more each time until you can deep throat your partner with ease.

Give Him A Handjob

If you can’t take him really deep into your throat, it’s not the end of the world. You can still give a great blowjob to your guy by giving him a handjob with it! Use your hand as an extension of your mouth and grasp the base of his penis while you suck on the head of it. Move your hand up and down as you move your mouth up and down, and don’t be afraid to let your saliva drip a little and function as a lube to make things go more smoothly. Gently tug on his scrotum or hold it gently to give your man even more pleasurable sensations.

Don’t Use Your Teeth

Teeth hurt during a blowjob and that’s all there is too it! Every once in awhile, a guy will enjoy teeth gently scraping against his penis, but odds are your man doesn’t want your chompers anywhere near his shaft. Keep your teeth out of his way by wrapping your lips over them while giving oral sex, so you don’t accidentally scrape or bite him during the blowjob.

Try Different Sex Positions

As opposed to letting him lie there and receive oral sex, try using some different sex positions to spice it up. Let him stand while you kneel on a pillow to give him head, or let him stand over you and lower his penis into your mouth as you’re lying down. Be creative and try all kinds of different sex positions – he’ll love how adventurous you are with just oral sex so much that he’ll be begging you for sex all the time!

Surprise Him With It

Give your man oral sex the next time he least expects it. Next time you are driving a long distance, surprise him with a blowjob in the car (which will probably lead to some amazing car sex!) or sneak off to the bathroom at a party to give him an impromptu blowjob. He will absolutely go wild over oral sex that happens anytime, anywhere!

Give Just A Blowjob

Instead of expecting sex after giving your man head, or expecting him to return the favor, give him a blowjob just for the sake of giving him a blowjob. Make sure he has anorgasm, and leave it at that! Let him know that you just wanted to go down on him – because you enjoy it so much. He’ll be thrilled that you like to give him head just because. Don’t be surprised if he asks for a blowjob next time “just because” he wants one!

Be Enthusiastic And Make Noise

No guy wants quiet oral sex, nor does he want to feel like giving him head is a chore for you and that you don’t enjoy it. Instead, show some enthusiasm while you’re giving himfellatio and let him know how much you enjoy it by giving him a moan or groan here and there. He’ll also love hearing the wet sucking noises, so make sure there are plenty of those too!

Give Him A Show

Men are essentially visual creatures and even though a blowjob will feel great if he can’t see what is going on, he’ll like it much better if he can. If you’re lying in the bed, prop his head up on a few pillows so he can look down and see what you’re doing. Better yet, have him sit on the couch or in a chair and kneel while you do it, giving him a full visual. Make sure to make eye contact with him every now and then while you’re sucking on him – it will drive him absolutely insane!

Let Him Grab Your Head

Most women don’t like it when a man grabs their head during oral sex, and for good reason. It can be uncomfortable, especially if he grabs your hair, and it can make you gag or vomit if he pushes your head too far down on his penis. However, men really enjoy this so if you have a partner you trust completely, try this the next time you give your partner head. He will love the way it feels to be in control like that, but make sure you both communicate about a sound or gesture that means “stop.” If this is going to work, he’s going to need to stop immediately if you give him the signal.

How To Deep Throat (Without Gagging)

Oral sex is incredibly pleasurable for a guy. In fact, it can even be more pleasurable thanpenetration and intercourse! The best part about oral sex for a guy is feeling a hot, wet mouth all over him – especially when a woman takes his entire penis in her mouth in a deep throat move.

While just about every guy loves deep throating, most girls do not. This is because deep throating often causes a woman to gag – and sometimes even vomit. The gag reflex, however, can be controlled with a little effort and some practice. Here’s how you can deep throat your lover without gagging.

Learn How To Breathe Through Your Nose

When giving a guy a blowjob, it’s important that you learn to breathe through your nose, even when you’re not deep throating. Even a small penis can block the airway from the mouth to the lungs, making it near impossible to breathe through your mouth during a blowjob. This is because your partner’s penis will go into your esophagus when you deep throat, blocking off the passage of air through the windpipe. Instead, learn how to breathe through your nose so the air can go directly from your nose to your lungs, completely bypassing your esophagus.

If you try to breathe through your mouth during a blowjob, you’re much more likely to gag or even vomit. Learning to breathe through your nose during a blowjob and while deep throating is an important skill to have in your oral sex tool belt.

Get Your Throat Parallel To His Penis

A big reason that the gag reflex gets stimulated during a blowjob is because the angle between the mouth and the throat isn’t set up to have a straight penis go in. You can actually overcome this easily by switching sex positions and getting your throat parallel to your lover’s penis.

Usually, the easiest way to do this is to lie on a bed on your back, with your head at the very edge of the bed. Scoot up so your head is basically hanging off the edge of the bed, which puts your mouth and throat in almost a straight line. This will make it much easier for your partner to insert his penis down your throat without rubbing so hard against the top of your throat (which is where the gag reflex is.)

Learn To Relax Your Throat Muscles

Relaxing your throat muscles is essential when it comes to giving your partner a gooddeep throat. Slowly insert your partner’s penis into your mouth, pushing past your gag reflex and down into your throat. When you feel the urge to gag, work on closing your eyes, breathing through your nose and relaxing your throat muscles.

This isn’t a technique that will come easily – it’s one that must take a lot of practice to really get the hang of it. Your partner probably won’t mind if you want to practice on him though!

Make Sure You’re In Control Of The Thrusting

While having your head hanging off the edge of the bed doesn’t exactly put you in a prime position to control your partner’s thrusting during oral sex, make sure that you at least have your hands on his hips and can guide him in and out of your mouth. If your partner is in complete control over his thrusting during fellatio, you’re much more likely to gag because you can’t control how deep he goes and when.

Trusting Your Partner

Since this type of oral sex can go wrong in so many ways (who wants a lap full of vomit?), it’s important to have a partner that you truly trust and can be open and honest with. Talk with your partner about the level of trust you’re putting in him to allow him to deep throat you, and make sure he agrees not to abuse it by going too hard or too fast without your explicit consent.

Having A Safe “Gesture”

While this type of oral sex is generally safe, you should still consider having a safe “gesture” that will let your partner know to stop immediately. You can’t use words while deep throating, so decide hand signal of some kind before you and your partner get busy. Use the safe “gesture” as though you would a safe word during bondage or kinky sex to let your lover know that you’re uncomfortable, in pain or want to stop for any reason. Make sure that you and your lover are on the same page about stopping whatever is going on immediately if the gesture is used.

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sexology

TOUCH AND SEXUALITY

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Touch and Childhood Development
Developmental Neuropsychology of Touch
An Obstacle to Affection

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It has been unusual for the majority of college-level human sexuality texts to discuss the topic of touch, except in the most cursory of descriptions. Most of these texts do not have the word "touch" in their index. Few have more than a page or two on the subject. This is dismaying, for a couple of reasons. The most obvious is that the expression of much of our sexuality occurs through touch and the largest organ of our body, our skin. Also, there is a growing body of writings, theory, and research in the field of touch that is of extreme importance to the studies of human development, health, and sexuality. The contributors to this body of work span the fields of philosophy, medicine, physiology, psychology, sociology, and anthropology. This article is a summary and synthesis of this work, with a special emphasis on the findings related to touch and human sexuality.

Touch and Childhood Development

Arguably, it was not until the appearance of the clinical reports by Spitz (in 1945 and 1947) that the seeds of research in the field of touch were sown. Spitz's reports reflect his anguished quest for a solution to the unexplained deaths and pathologies of infants and toddlers in his care. The diagnosis of that era for these terminal children was marasmus, the withering away and dying of no apparent cause. Spitz finally discovered that medicine, good nutrition, and clean surroundings had not the least impact on the tragic outcome. Only what Harlow was to later call contact comfort turned out to be the "cure" for the excruciating deaths of these children. Touch deprivation is probably most damaging to an infant because, unlike the other four senses, the neonate has an extremely small amount of control over somatosensory self-stimulation due to underdeveloped motor control capacities.

In the arena of social behavior and mother-offspring relationships, Harlow could easily and appropriately be called the "father of touch research." His "deprivation and wire mother" primate research remains one of those classic studies in the evolving history of psychology. However, we are only recently discovering just how important Harlow's work was.

Prior to Harlow's research, Freudian thought dominated, even in the informal field of touch. It was generally believed that touch is a somewhat minor component of the more important feeding process provided by a mother to her child. Mother-child attachment (or bonding) was assumed to occur in humans as a primary result of the mother providing food to the infant.

Harlow's studies done between 1962 and 1979 involved taking newborn monkeys from their mothers and raising them in isolation. The young monkeys were deprived of maternal and social touch (i.e., contact comfort). In every other way, the monkeys were very well cared for. They were well fed, their cages kept clean, and their medical needs attended to. They were "merely" isolated from any physical contact with their mother or other monkeys. Even physical contact with the researchers was severely limited.

In his original classic "wire mother" study, Harlow placed the touch-deprived monkeys in a large cage that contained two crude dummy monkeys constructed of wood and chicken wire. One dummy was bare wire with a full baby bottle attached. The monkeys had been regularly nursed from similar bottles. The other dummy was the same as the first, except that it contained no bottle and the chicken wire was wrapped with terry cloth. Placed in this strange environment, the anxious young monkey very quickly attached itself to the cloth-wrapped dummy and continued to cling to it as the hours passed. The infant monkey could easily see the familiar baby bottle no more than a few feet away on the other dummy. Many hours passed. Although growing increasingly distraught and hungry, the infants in these studies would not release their hold on the soft cloth of the foodless dummy. It was soon apparent that the young monkeys would likely dehydrate and starve before abandoning the terry cloth surrogate mother.

As the isolated monkeys grew older, they were observed to display a highly predictable constellation of behavioral symptoms, even when they were later reunited with their mother and social group. They included highly unusual patterns of self-clasping and self-orality; idiosyncratic patterns of repetitive stereotyped activity; an almost total lack of gregariousness or interest in exploring the environment; timidity and withdrawal from virtually all social situations, with concomitant self-directed stereotyped behaviors; obvious aversion to physical contact with others; hyperaggressivity; gross abnormalities in sexual behaviors; and, later in adulthood, the inability to nurture offspring, with failure to nurse, neglect, and abusive behaviors being highly predictable. In addition, negative physical health consequences and hormonal imbalances were noted in these primate studies.

Additional studies by the Harlow team and others clearly demonstrated that the psychoanalytic "wisdom" of the day was incorrect in its assumptions regarding mother-child attachment. At least with infant and young monkeys, there appeared to be a hunger more powerful than the craving for food. It was science's first view of the pervasiveness and intensity of "touch hunger."

Beginning in the same general era as the Harlow investigations was another direction of research in the area of mother-child attachment. These attachment-theory studies were conducted by the British scientist Bowlby and his American colleague, Ainsworth. As a major extension of the work of Lorenz, their investigations focused directly on the ways human mothers and infants succeeded or failed to bond to one another. In general, Bowlby and Ainsworth discovered that there are highly predictable outcomes to the differing styles of early mother-child attachment patterns. More than two decades of scientific research on human parents and their offspring has generated a wealth of vital information regarding essential requirements for normal human development. Affectionate touch versus neglect or punishing touch is a central theme of attachment theory, and much of this work may be viewed as the human research counterpart to the Harlow studies.

Long before infants develop a useful vocabulary, they employ innate and powerful methods to communicate moods, interests, and needs to their caretakers. This is accomplished with a splendid and increasingly sophisticated variety of sounds, movements, and facial expressions. It is a difficult struggle for any infant to teach its parents about himself or herself. However, we know that babies are universally good "teachers." Sadly though, it has been discovered that most parents and caretakers in the United States are less than adequate "students." As with all good teachers, if you have a poor student the teacher must work harder to help the student learn.

Bowlby and Ainsworth learned that, for healthy parent-child attachments, the parent was a good "student." These parents usually noticed, understood, and responded appropriately to the "lessons" offered by the infant or toddler. Almost all the infants' lessons involved touch. They signal to their parents to "pick me up, hold me, feed me, burp me, soothe me, stimulate me, change me, and make the pain or discomfort go away." Of course, occasionally the signal was, "I'm overstimulated, so please leave me alone for a few minutes." These healthy "parent students" and "child teachers" are synchronized to each other, communicating and learning in a rhythm of increasing complexity.

It was found that, for the "inadequately attached" parent and child, there is a great deal of obvious neglect of the offspring by the parent. The parent "students" usually are uninterested in the lessons offered by their daughter or son and generally ignore the signals of the child. When the infant "teacher" tries even harder to interest these parents, the mother or father usually responds with even more neglect or with verbal or physical abuse. These infants rapidly become impatient teachers and the home "classroom" is filled with the turmoil of rapidly escalating frustration of teacher and student. Within the first year or two, these children eventually give up most efforts to "teach," learn to suppress their signals for attention, and are likely to become sullen, chronically miserable, or ill. Whichever child responses occur, the outcome is commonly devastating on many levels for the child, the parent-child attachment, and subsequent relationships as the child grows to adulthood. Grade schools and high schools are filled with severely withdrawn and troublesome, acting-out children and teens who have given up hope of affectionate pleasure and happiness.

Ainsworth's third category of the "anxiously attached" child is not a median category somewhere between the "adequate" and "inadequate" attachment classifications. The parent of the anxiously attached child may sometimes appear to be a "supermom" or "superdad," in that they tend to hold and give just as much, or more, attention to their child than do the parents of the healthy attachment children. The primary difference is that these, like the inadequate attachment parents, are also very poor parent "students." They and their child are, more often than not, out of synchronization with one another. This frequently "overinvolved" parent is not actually responding to the signals of the child, but instead responds to his or her own personal needs and desires. Because these parents are busily working at trying to care for the child, the toss of the dice says that the parent and child will occasionally be in synch and the child's needs will be met. When this occurs, it confuses the child into believing that the parent is finally "getting it," only to be followed by the majority of situations in which the child's signals are unanswered (or incorrectly answered). The randomly reinforced and anxiously attached child usually does not give up, even though it may be in her or his best interest. In a frustrated and disconsolate manner, the child continues to try to get through to the unreceptive parent and will likely continue these patterns into adulthood with poor choices of enabling relationships.

These studies reveal that the potential for a great deal of psychological human damage occurs at a very early age. Essential aspects of development, including, most importantly, sexual-affectional development, is arrested or severely damaged. In the United States, some researchers estimate that only about 25 percent of children come from a functional home in which adequate attachment occurs.

In the early 1970s, Prescott had been engaged in brain research studying the effects of touch deprivation on laboratory animals. He suspected that neurological deterioration, which had been found to be a predictable sequela to touch deprivation, was also a central and etiological agent in the expression of the violent behavior, as noted by Harlow.

Using the Human Relations Area Files, he examined some 400 societies and concluded that those societies that lavish affectionate touch on their infants and children, and also are tolerant or encouraging of adolescent sexual-affectional behaviors, were the least violent societies on earth, with the converse also being true. His findings, however, remain controversial because the data in the files do not usually give the kind of information he sought, and others who examined them did not classify the data the same way. Still, the fact that American society is often violent as well as one of the least openly physically affectionate societies on this planet might give some support to Prescott's ideas. We do not lavish affectionate touch on our infants and children; we push them aside into high chairs, playpens, car seats, baby beds, their rooms, the backyard, and so forth. We throw toys to them, and we expect television and video games to occupy their time. Moreover, in the United States, we have endless proscriptions against adolescent sexual-affectional behaviors. From very early childhood, the parental admonition, "Don't touch!" has been a powerful one. But just when the pubescent child begins the important physiological changes of puberty and the psychological separation-individuation task, our society warns, "Don't touch anyone, don't let anyone touch you, and don't touch yourself."

Since the normally developing adolescent is increasingly less interested in parental touch and more interested in touch and other forms of interaction with his or her peers, the obedient girl or boy is therefore effectively sentenced to several years of extreme touch deprivation and arrested psychological development. That the majority of teenagers eventually, to some degree, ignore these parental and societal warnings actually results in placing today's teens at higher risk for anxiety, depression, unwanted pregnancy, and sexually transmitted diseases due to "sex guilt." Research by Mosher and his colleagues demonstrates that sex guilt is powerfully related to the avoidance of self-care as well as lower self-esteem. In the United States, we have decided, with no data whatsoever, to support our strongly held beliefs that adolescents are "too immature" to deal with a sexual-affectional relationship. Actual developmental research has largely avoided this topic, although opinions are abundant.

Other researchers have found that the affectional touch climate in the subject's family of origin and parental religiosity are the major psychosocial variables related to a person's current sexual attitudes and behaviors, as well as nongenital affectional behaviors with a partner. Subjects who originated from physically affectionate families were more likely to enjoy more pleasurable, and more frequent, experiences in the sexual-affectional aspects of their adult relationships. These studies clearly demonstrate that adults who experienced rejection and touch deprivation in their childhood tend to treat their adult partners and their own offspring in a similar manner.

The rich findings of the Harlow and Bowlby-Ainsworth research teams, coupled with the reports of Spitz and Prescott, have complemented, and in many ways paralleled, each other. The outcomes of these studies provide clear facts regarding the most central components of human development and relationships. Whether in part or taken as a whole, the results from these findings lead to one inescapable conclusion. That is, the quality of our relationships throughout our lives is massively affected by the quality of our attachments in infancy and early childhood. The quality of these early attachments is primarily influenced by specific aspects of the communication and touch relationship between the child and his or her primary caretakers.

Developmental Neuropsychology of Touch

On the day of our birth, we entered the world with an intense touch hunger. Of all of our neonate senses, neural pathways subserving cutaneous sensation and responses to somasthetic stimulation are the first to develop in the human fetus and infant. Physiological primatologists instruct that the organism's biological systems that are first to develop are those most necessary to survival. A substantial proportion of the central and peripheral nervous systems is dedicated to the reception and processing of somatosensory information and make up what have been labeled "topographic maps" of nervous system utilization. The neonate derives the vast majority of useful information for the first several months of life through his or her skin.

Touch deprivation and somasthetic stress (e.g., pain and "touch trauma") are rapidly followed by dramatic elevations in pituitary-adrenal plasma cortisol levels, while affectionate and soothing touch are associated with low serum plasma cortisol levels. Plasma cortisol levels have been shown to be a reliable physiological indicator of an organism's detection of environmental change or stress. Further, it has been shown that with chronic imbalances of plasma cortisol and other hormones and neurochemicals, there results abnormal brain tissue development as well as the destruction of previously normal brain tissue. In other words, frequent pleasurable touch results in positive changes in brain tissue, and chronic touch deprivation or trauma results in measurably significant brain damage.

Beyond the study of body chemicals and neural tissue, it has been discovered that pleasurable touch is associated with enhanced learning, improved IQ, language acquisition, reading achievement, memory, general neonate development, preterm infant development, reduced self-mutilating behavior in the severely mentally retarded, expanded external awareness in autistic patients, improved geriatric health, decreased childhood clinginess and fears of exploring the environment, elimination of inappropriate self-stimulation and public masturbation behavior in children, and improved visual-spatial problem solving. Hospitalized patients recover more rapidly from injury and physical or psychiatric illness with attention to touch needs. Current thinking defines touch as the primary organizer (or, in the case of neglect and abuse, "disorganizer") of normal human development when viewed at biological, psychological and even social levels. A person's sense of self apparently originates in body awareness, body functions, and body activities that center around the sense of touch.

For this reason, the writer often refers his partnerless and isolated psychotherapy clients to a masseuse or massage therapist whenever appropriate. Couples in treatment are usually instructed and assigned touch and massage homework exercises, even for the non - sex therapy clients. Although Masters and Johnson borrowed extensively from researched therapy techniques developed by others when constructing their broad sex therapy treatment regimen, the unique technique they called sensate focus was one of their most important contributions. Perhaps unknowingly borrowing from the treatment methods of physical therapists and speech therapists who deal with their patient's neurological damage, Masters and Johnson devised a method of graduated, lengthy, and redundant touch exercises for their patients.

The neurological damage discussed in this chapter is, by definition, permanent damage since the brain produces no new nerve cells beyond about age five. Fortunately, if the neurological damage is not too severe, the remaining healthy portions of the brain may be "taught" to recover functioning, given the appropriate treatment method. The highly motivated individual or couple can begin to engage in specific graduated and frequent touch exercises to improve receptivity, sensation, and functioning. Masters and Johnson and the large body of subsequent sex therapy research provides potentially important solutions to a large and multiaxial problem for those individuals and societies that seek answers to repairing the damage. Of course, the most obvious solution would be to change the child-rearing practices of those same individuals and societies. To say, "All we need is to be receptive and affectionate with our children," though correct, may miss the greatest obstacle to this major change. That most parents are not neurologically receptive to reciprocal affectionate touch with their child is only one, though important, dilemma.

An Obstacle to Affection

In its most rigid and fundamentalist form, the Judeo-Christian philosophy is staunchly antitouch, antibody, antipleasure, and antisexual. To our not-so-distant ancestors, the formula touch equals sex equals sin was a bromide to live by. This nonequation is now our cultural heritage in the United States. Some may argue that this is an overstatement of the present-day importance of a dying or changing philosophy. Some may feel a bit smugly insulated because their upbringing did not include a highly fundamentalist or highly orthodox religiosity.

One of the outcomes of prolonged touch deprivation and the resulting neurological deterioration is a hypersensitivity to touch. Some researchers propose that the average person's experience with affectionate touch in the United States and several other countries is so inadequate that it is almost a certainty that the majority of the citizens suffer from some degree of significant neurological impairment. This is especially true if you are male, since males in the United States tend to receive far less affectionate touch from birth than do females. By early adulthood, most of these males have as much or more experience with overstimulating, aversive, painful, and traumatic touch than with soothing and affectionate touch. Even though they move through life with a growing touch hunger, most of these males can tolerate prolonged physical contact with another human only if forced or if they are sexually aroused.

So the cultural philosophy that may have initiated our ancestor's avoidance of touch may not be as important a maintaining factor as some might believe. It is possibly not the direct impact of religious philosophies today that causes a culture to be relatively touch phobic but, rather, a long history of parents who, due to the neurological damage unknowingly inflicted by their parents, were hypersensitive to touch and therefore did not nurture their offspring with the necessary somatosensory stimulation. Highly religious homes tend to provide significantly less affectionate touch (and more punishing touch), beginning in late childhood as the child approaches puberty and more overt sexuality.

For many adults, highly fundamentalist religions probably become an attraction for those who are most touch and sex phobic. The child of the high-religiosity parent or parents will likely experience significantly more difficulty with affectionate touch and sexuality in their adult relationships, even if the offspring no longer subscribe to their parents' beliefs.

We are beginning to understand many more of the developmental issues that impact on our attempts at healthy sexuality and relationships. Touch experiences in childhood appear to be powerful determining influences.

Many people tell of their highly interested and attentive lovers (mostly male) who seem to disappear very soon after orgasm occurs. He or she rolls away, goes to sleep, or gets up, grabs a beer, and goes to the den to watch the ball game—without even saying goodbye. Without the benefit of continuing high levels of sexual arousal, he can no longer tolerate prolonged tactile contact. One report of touch-deprived women revealed that only a tiny percent had ever had an orgasm. A study of touch-deprived men revealed that when given the hypothetical choice between giving up their recreational drugs and alcohol and giving up sex and orgasm, almost all of them said they would give up sex and orgasm. It seems that those who harbor these conflicts between a strong desire for touch and the confusing discomfort with it resolve the conflict by avoiding the difficulties and discomforts associated with touch and finding a replacement in the form of behaviors and chemicals, prescription and nonprescription. Such palliatives ultimately pile brain damage upon brain damage.

Virtually everyone has an intense need to be held and soothed and stimulated, but we find ourselves receptive at relatively brief moments of our lives. If we are not receptive to a given touch, the effect is deleterious rather than beneficial. So it is that we do not hold our partners or our infants for very long or very often.

In addition, the United States culture has created handy myths and philosophical constructs that merely serve our touch discomforts. Most parents are too easily convinced that they will "spoil" the child if they run to her "too quickly" when she cries or hold him "too often" or for "too long." We find a substantial percentage of parents who justify their homophobia by withdrawing meager affectionate touch from their toddlers and young children, stating, "Well, I don't want him to turn out homosexual." Some of our incorrect theories of the past are still with us, perhaps doing more damage than ever. Antitouch and antisexual societies have spawned fathers who panic if they happen to experience sexual arousal with their child squirming on their lap, and essentially punish the child severely by withdrawing physical affection from his daughter or son. Worse still is the father who acts on his sexual arousal, using the child as the defenseless object.

sexology

PROSTATE

The prostate is a male gland that is located just below the urinary bladder and close enough to the rectum that it can be felt when a finger is inserted. Although the size may vary from man to man, the normal gland is usually about one and one-half to two inches at its widest point, weighs from 15 to 20 grams, and is composed of a glandular and muscular portion. It is usually described as being about the size of a chestnut or walnut. A portion of the urethra (the tube that leads from the urinary bladder) passes through the gland. The ejaculatory ducts, which are produced from the union of the vas deferens and the tubes from the seminal vesicles, run their entire length through the prostate gland and unite with the prostatic urethra. The glandular portion of the prostate produces about 30 percent of the seminal fluid, which is thought to be necessary before sperm can fertilize an egg. Tissue hormones called prostaglandins are produced by the prostate (as well as by many other tissues in the human body) and produce physiological reactions, usually in those tissues adjacent to the location at which they are produced.

Some workers have postulated that women have a "female prostate," which is rudimentary glands (Skene's glands) found around the urethra near the neck of the urinary bladder. These glands are produced from the same embryological tissue that produce the prostate gland. It has been suggested that the "female prostate" is the Grafenberg or G spot, or is at least anatomically related to it. The existence of either the "female prostate" or the G spot has not been adequately demonstrated to the satisfaction of many workers, and certainly not in all women.

The prostate contracts during the various stages of male orgasm. These contractions, along with contractions of other glands and various muscles, cause the semen to spurt from the end of the penis. The prostate is also a source of sexual pleasure for some men who enjoy being recipients of anal sex. The prostate can be stroked by inserting a finger, penis, or some other item into the anus to a depth of about three inches and gently pressing toward the navel. This is actually what a physician does when he or she conducts a digital examination of the prostate. Although these sensations are pleasurable to many men, some find them uncomfortable and, for that reason, are hesitant to submit to a digital examination.

A digital examination of the prostate can reveal changes that are important to the health of the man. The prostate remains about the same size from the time of puberty until about age 50, when it begins to enlarge. This growth can lead to a condition known as benign prostatic hypertrophy (BPH), which affects almost all men after the age of 60. The condition may cause reduction in the size of the prostatic urethra and ejaculatory ducts, thus producing problems of urination and ejaculation. Prostate cancer is the most common cancer of the male sex organs and is the third most common cancer of men. Its cause is unknown. Although it is uncommon in men younger than age 60, some workers believe that virtually all men who reach the age of 80 will have the beginnings of the disease. Because it is such a slow-growing cancer, most men of that age will not show symptoms before they die of some other cause. However, it does cause 17 percent of cancer in men, and, because men are living longer, about 70,000 new cases are reported annually.

Prostatitis (inflammation of the prostate) is an extremely common condition among men. Infectious prostatitis is caused by a bacterium, yeast, or virus and can be sexually transmitted. The condition can be either acute or chronic. Congestive prostatitis is a condition caused by abrupt change in the frequency of sexual activity. Thus, a man who greatly increases his number of ejaculations over a short period of time (this sometimes happens to men who are newly married) or a man who suddenly decreases his number of ejaculations may both develop the condition. This may happen when a spouse becomes ill and sexual contact is no longer possible. Masturbation is sometimes recommended in this case.

The initial symptoms of all of these conditions are general. They are lower-back pain, painful urination, urinary urgency or frequency, pain or discomfort during or after ejaculation, unexpected discharges from the penis, and blood in the urine or semen. Any combination of these symptoms should send the man to his physician, who will palpate the prostate to discover changes in the size, shape, or texture of the gland.

Most problems of the prostate are treated with antibiotics or surgery, especially if the condition is discovered early. Usually, there are no lasting effects from the treatment, although retrograde ejaculation and loss of some erectile ability may be a result of some surgery.

sexology

ORGASM

Alfred Kinsey and his associates defined sexual climax, or orgasm, as an explosive discharge of neuromuscular tensions at the peak of sexual response. Most authorities attribute it to a reflex, but some focus on the subjective perception of activity in specific genital muscles and organs. After conducting extensive interviews with researchers studying the physiological components of orgasm, Gallager indicated that the consensus focuses on the involuntary response. The stimulus is usually thought to be physical, although recent research demonstrates that imagery is an adequate eliciting stimulus.

On the basis of the results of the research of others as well as their own findings, Komisaruk and Whipple have defined orgasm as the peak intensity of excitation generated by stimulation from visceral and somatic sensory receptors and cognitive processes, followed by a release and resolution of excitation. Under this definition, orgasm is characteristic of, but not restricted to the genital system.

There was little research concerning the physiology of orgasm until the pioneering work of Masters and Johnson, published in the 1960s. They reported that two major alterations in the genital organs—vasocongestion (engorgement with blood) and myotonia (muscle tension)—were the cause of orgasm. The response to these stimuli was specifically focused in the pelvic area, but there was also a total body response.

Orgasm for the male included contractions, beginning with the testes and continuing through the epididymis, vas deferens, seminal vesicles, prostate gland, urethra, penis, and anal sphincter; three or four powerful ejaculatory contractions at 0.8-second intervals, followed by two to four slower contractions; testes at their maximum elevation; sex flush at its peak; heart and respiratory rates at a maximum; general loss of voluntary muscle or motor control; and, in some instances, vocalization. For the female, strong muscle contraction started in the outer third of the vaginal barrel, with the first contraction lasting for two to four seconds and later contractions occurring at 0.8-second intervals; slight expansion of the inner two-thirds of the vagina; contraction of the uterus; peak intensity and distribution of the sex flush; frequently strong muscular contractions in many parts of the body; possible doubling of respiratory rate and heart rate; blood-pressure elevation to as much as a third above normal; and vocalization in some instances.

Masters and Johnson concluded that there were two major differences between the sexual responses of men and women: only men could ejaculate, and only women could have a series of orgasms in a short period. Subsequent findings by Hartman and Fithian have shown that men are capable of multiple orgasms, and research by Beverly Whipple and others has indicated that some women ejaculate a fluid from their urethra at orgasm. However, for the most part, later research has supported and expanded the findings of Masters and Johnson.

According to Mould, the clonic contractions of pelvic and abdominal muscle groups that characterize orgasm are initiated by a spinal reflex. Sherfey has proposed that the orgasmic response is initiated by the firing of stretch receptors in the pelvic muscles. Pelvic engorgement stretches the receptors, which, when reaching a certain point, initiate the spinal reflex.

Hartman and Fithian question the necessity of myotonia (muscle tension). They found that though myotonia was involved in the majority of their subjects, some individuals easily had orgasm without any signs of myotonia.

In a study of the orgasmic response among 751 volunteer research subjects, Hartman and Fithian found that male and female orgasmic patterns are undifferentiated within the orgasmic parameters measured. However, response patterns in individual subjects were individualized. Everyone had their own pattern. In a group of records that included several of the same subject, the records could be pulled out without looking at the name. Of all the parameters studied, the widest variation between people occurred in the cardiovascular functions.

Orgasm in both men and women consists of rhythmic muscular contractions that affect all the sexual organs and the whole body. A few people report spastic contractions of the voluntary muscles of the hands and feet. The respiratory rate may increase to 40 per minute, and pulse rates may increase to 110 to 180 beats per minute. The systolic blood pressure may be elevated 30 to 80 mm Hg. A sex flush, which parallels the intensity of orgasm, is present in about 75 percent of women and 25 percent of men. Extra heart beats and skipped beats are not uncommon in the sexual-response cycle of healthy people during sexual arousal or response. They are much more extensive in those who are not in good physical condition.

The length of an orgasm is variable. Male orgasm usually lasts about 10 to 13 seconds. Bohlen reported muscle contractions during female orgasm lasting between 13 and 51 seconds, although the same women reported their subjective perceptions that orgasm lasted between 7 and 107 seconds.

Ejaculation in men occurs in two stages, both of which involve contraction of the muscles associated with the internal sex organs. During the first stage of emission, sperm and fluid are expelled from the vas deferens, seminal vesicles, and prostate gland into the base of the urethra near the prostate. As the fluid collects, there is a consciousness of imminent ejaculation. During the ejaculation stage, the seminal fluid is propelled by the muscular contractions of orgasm into the portion of the urethra within the penis and then expelled from the urethra! opening.

Many people cannot tell if their partner is having orgasm, and both men and women have admitted to faking orgasm. Some women expel fluid at orgasm. This is because lubrication may pool in the back of the vagina and be expelled by the contractions at orgasm, or they may ejaculate from the urethra. In laboratory experiments, some women may need to stimulate themselves for an hour or more before reaching orgasm, but generally, with experience, the time grows shorter. The shortest time for a woman to reach orgasm recorded in the research laboratory is 15 seconds, but this, it should be emphasized, is rare. The average time for most women to reach orgasm in the laboratory is 20 minutes.

Women have reported a variety of orgasmic experiences. Some women have sequential orgasms, a series of orgasms with short breaks in between; others have multiple orgasms with no break in between while stimulation is continued. Women make subjective distinctions between orgasms resulting from stimulation of different areas of their body. A vaginally induced orgasm is described as feeling more internal and deeper than an orgasm resulting from clitoral stimulation. The Singers described three types of female orgasm. They called the orgasm described by Masters and Johnson a vulval orgasm because it was characterized by involuntary rhythmic contractions of the vaginal entrance and was produced by clitoral stimulation. The second kind, the uterine orgasm, results from vaginal stimulation. This type of orgasm appears very similar to the orgasm triggered by stimulation of the Graefenberg spot, a sensitive area felt through the anterior wall of the vagina. The Singers' third type of orgasm, the blended orgasm, is a combination of the vulval and uterine orgasm, usually resulting from stimulation of the clitoris and the vagina.

For most men, orgasm remains concentrated in the genital region. Many men ejaculate rapidly. This is the norm since Kinsey reported that three-quarters of all males reach orgasm within two minutes of the beginning of sexual intercourse. The problem is that this does not give most women enough time to reach orgasm. Men, however, can learn to delay orgasm.

Bohlen found little correlation between perception of orgasm and the physiological parameters measured in the laboratory. The reported intensity of orgasm did not correlate with increases in physiological parameters. This means that pleasure may not be correlated positively with changes in autonomic activity. He monitored women in the laboratory who reported that they experienced orgasms but experienced no contractions. Whipple and colleagues also reported that in their laboratory, some of the women who had orgasm from imagery appeared to be lying still. It may be that these women have isometric skeletal muscular tension during orgasm, or muscle contractions may not be necessary for orgasm to occur.

Similarly, Hartman and Fithian monitored a group of 20 female therapy clients who claimed they were not orgasmic. Three-fourths were found to be undergoing the physiological responses associated with orgasm. Once the women had these changes identified for them as equivalent to an orgasm, all but one were able to identify it for themselves the next time they were monitored. Many had read extensively on orgasm, and they perceived their response to be different from what they believed the literature reported; their preconceived notions about orgasm did not fit the reality.

Orgasm has been reported to occur in response to imagery in the absence of any physical stimulation. Whipple and colleagues compared orgasms from self-induced imagery and from genital self-stimulation. Each generated significant increases over resting control conditions in systolic blood pressure, heart rate, pupil diameter, and pain thresholds. Additionally, the increases in the self-induced-imagery orgasm were comparable in magnitude to those in the genital-self-stimulation-produced orgasm. On the basis of this study, it appears that physical genital stimulation is not necessary to produce a state that is reported to be an orgasm.

Not everyone has an orgasm. It has been estimated that about one-third of women do not have orgasm at all, one-third have orgasm part of the time, and one-third fairly consistently have orgasm. Some men who can have an orgasm through masturbation have difficulty in heterosexual intercourse. One reason might be that they use heavy pressure in masturbating, far stronger than the pressure of vaginal intercourse. Until they learn to have orgasm with lighter pressure, they typically have problems in ejaculating or having orgasm during coitus.

There are other factors related to a lack of orgasm. Some of these are stress, anxiety, anger, fear of loss of control, medication, fatigue, and time pressure. Anger in some individuals can result in such strong emotional feelings against their partners that it inhibits orgasm, while in others it can provide the stimulation that produces arousal. This is why some couples fight and then have sex. For them, the fighting acts as an erotic stimulus. If they seek therapy to end the fighting, they may end their marriage unless they develop other methods of erotic stimuli to replace the fighting they have given up.

Erotic stimulation, in various forms, including overall body stroking, caressing, and fondling, is an important part of lovemaking activity. It produces the engorgement in the vascular tissue of the vagina and the penis. This results in erection in the male and the sweating effect that produces vaginal lubrication in the female. The engorgement also often masks areas that are painful or uncomfortable in the vagina. Where there is insufficient engorgement and lubrication, there may be abrasion from the penile thrusting, pain, or discomfort where the stimulation is of areas that are uncomfortable in an unengorged state.

Large numbers of women who have orgasm do so with manual or oral stimulation or masturbation. Many couples do not have intercourse with sufficient frequency, or do not take enough time, for the women to learn to have orgasm through intercourse.

Orgasm, in a sense, is a learned behavior, and it is learned by trying different activities. Masturbation is the easiest way to learn. Orgasm with intercourse does not feel the same as it does with masturbation, since different areas are usually being stimulated. Actually, orgasm can be elicited from various parts of the body and even by imagery alone. Such orgasms can also produce a pelvic response. The most nerve endings tend Co exist in the clitoris in women and the penis in males, although about 10 percent of women have more nerve endings in the labia than in the clitoris. Subjects have been seen to have orgasm in a back caress, as well as through stimulation of other parts of their body. That is why it is suggested that a total body caress be done as a part of erotic stimulation to enhance the probability of response.

There is a hormonal connection between the vagina and breast in the female. Oxytocin (the hormone that triggers the breast milk reflex in women) is released at orgasm. If she is a nursing mother, she may exude milk from her nipples, while even nonnursing mothers may see a drop of fluid on their nipples. Nursing itself has been reported to give genital sensations of pleasure and even orgasm in some women.

When asked to describe an orgasm, most people will smile and say it's like an expulsion, like paradise, like a release, like a volcano, or like a big shiver. People can describe what an orgasm is like, but they cannot say what it is. The scientific explanations for orgasm have clarified the process somewhat, and contemporary researchers are studying the neurophysiology of orgasm and the role of hormones in orgasm, as well as determining the areas of the brain involved in orgasm. Perhaps in future editions we will be able to answer further the question as to what orgasm is.

sexology

MULTIORGASM

Early-20th-century sex researchers focused on female orgasm as a major topic. Their questioners sought interviews with female subjects concerning their orgasmic response patterns. Small numbers of these respondents reported multiorgasmic patterns. In 1929, for example, G.V. Hamilton reported that five of his 100 female subjects were "repeaters," that is, they had multiple orgasms. He said that they reported anywhere from two or three to a score or more orgasms to the man's one. Lewis Terman, in 1938, reported that 96 of his sample of 792 women were typically multiorgasmic. This was 12.6 percent of those responding. Multiorgasm was not closely correlated to the reported marital happiness of respondents.

Next, chronologically, came the studies of Kinsey and his associates in 1948 and 1953. It is not always clear whether the Kinsey data on multiorgasm resulted from interview or direct observation. Kinsey made it clear that "orgasm may occur without the emission of semen" in men, thus clearly differentiating orgasm from ejaculation. He found that 55.5 percent of his preadolescent male sample was multiorgasmic and explained that this capacity was lost rapidly; by age 15, only 20 percent were still multiorgasmic. Less than 10 percent of the males were multiorgasmic between the ages of 25 and 60. Even though Kinsey clearly distinguishes between ejaculation and orgasm, he apparently used the terms synonymously, along with "climax," in describing the high frequency of male sexual outlet.

Kinsey reported that 14 percent of his female sample of 5,940 subjects "regularly responded with multiple orgasm" in human coitus. He made a comparison of multiple orgasm in females and males, reporting about 15 percent of each to be multiorgasmic at ages 15 to 20. From ages 25 to 60, females remained at the 15-percent level, with 5 percent more typical of the males for this 40-year period. Finally, Kinsey emphasized that only small percentages (5 percent-15 percent) of adult males and females regularly experience multiorgasm in the social context of either petting or coitus.

Masters and Johnson further documented the multiorgasmic capacity of both females and males. In their interviews of multiorgasmic females following the laboratory experience, the respondents reported that they found the subsequent orgasms more subjectively pleasurable than the initial one. These continuous orgasmic experiences contrasted with male subjective reports that the discrete orgasms following the initial orgasm and ejaculation were less pleasurable. Masters and Johnson indicated that many women were unsatisfied with one orgasm and desired multiorgasms for full satisfaction.

Since that time, others have continued to report multiorgasms in various studies. Robbins and Jensen studied multiple orgasm in men at the Center for Marital and Sexual Studies, in Long Beach, California. Individuals associated with the laboratory continued to do research on the topic, on the basis of a sample of 751 subjects, 469 females and 282 males, ranging in age from 18 to 70. The study did not rely on verbal reports of orgasm but monitored it with a Beckman R411 dynograph. Measurement of orgasm involved monitoring of capillary blood flow in various parts of the body, as well as heartbeat, heart rate, respiration, galvanic skin response, and pelvic contractions; the latter was monitored in the anus, vagina, and uterus.

Though the parameters of change varied with the subject, all showed change at orgasm, and the pattern of individual function was established for each subject. These patterns could not be differentiated by sex. During orgasm, the heart rate, which had been at a baseline of approximately 70 beats per minute, rises to approximately 120–130 beats per minute at orgasm for females and to 150–160 beats per minute for males. The subject then returns to a normal resting state. This is called a discrete orgasm. Physical condition and drugs are significant factors in wide variations of cardiac data.

In another pattern, the heart rate starts at a baseline of 70 beats per minute and reaches a peak, but rather than returning to the baseline, it remains high, dropping only 10 to 20 beats between orgasms in a series of continuous orgasms. A third pattern is a combination of the first two, usually with one or two discrete orgasms taking place before what Hartman and Fithian call "continuous orgasms" occur. The same multipleorgasm patterns are seen for both males and females.

In a control study by Hartman and Fithian, both orgasmic and multiorgasmic women were asked to rate their orgasmic intensity on a scale of 1 to 10, with 1 being least intense and 10 most intense. These evaluations were then correlated with physiological measurements. Multiply orgasmic women had more ratings in the 8–10 range than did the singly orgasmic women, who reported a less intense orgasm. This corresponded with their physiological response as measured by the parameters listed above.

The time to orgasm was markedly different for the two groups, with singly orgasmic women taking an average of 27 minutes to reach an orgasm, whereas the multiply orgasmic women averaged only 8 minutes. Multiply orgasmic women took only 1 to 2 minutes, on average, to reach a second orgasm. Subsequent orgasms tended to take less time, and 30-second intervals between orgasms were not uncommon; a few instances of 15-second intervals between orgasms were recorded. The greatest number of multiple orgasms recorded in the laboratory was 134 in an hour for a female and 16 for a male.

Dunn and Trost interviewed 21 multiply orgasmic men. Their primary group included 13 men who were always multiply orgasmic, and secondarily eight men who became multiorgasmic after age 35. The men attributed most of their multiorgasmic experience to genetic or fortuitous circumstances and rarely to deliberately planned learning. Dunn's and Trost's definition of multiple orgasm in males is similar to that at the Center, where orgasm and ejaculation are regarded as two separate phenomena. To be considered multiply orgasmic, a male must have two or more orgasms within an hour. The Dunn and Trost study differed from the Hartman and Fithian studies, which reported that in some instances the men could completely lose their erection and start over. In the Dunn and Trost sample, subjects reported a high state of arousal between orgasms.

Hartman and Fithian reported that several of their subjects had learned how to have multiple orgasms as adults by following up on an experience in which they had orgasm without ejaculation. They have concluded from their own studies and as a result of their teaching that potentially all males who are orgasmic can probably, with training and practice, become multiorgasmic; they hold the same to be true for women. Many may not want to be multiorgasmic, since time itself is always a factor in multiple orgasms. They simply take longer.

sexology

HORMONES: THE ENDOCRINE SYSTEM

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Fetal Sexual Development
Hormonal Control of Sexual Maturation
Gonadal Steroids and Sexual Maturation
Male Reproductive Function
Female Reproductive Function

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From the moment of conception to maturity, sexual development depends on a complex interaction of genetic and dynamic hormonal interrelationships that regulate hypothalamic, pituitary, and gonadal function. The development of neuroendocrine function in relation to growth and sexual maturation of both the female and the male throughout the life cycle is covered here. This discussion focuses on the normal patterns; the various changes, abnormalities, problems, and treatment modalities involving the neuroendocrine system are covered under such topics as castration, compulsion, gender, infertility, impotence, menopause, menstruation, pheromones, physical disabilities, pregnancy, and transsexualism.

Fetal Sexual Development

The sequence of embryonic and physiologic changes that control the sexual differentiation of the fetus begins with fertilization. The sex of the embryo is genetically determined at the instant of fertilization, with the XX karyotype conferring female sex and the XY karyotype conferring male sex.

The embryo has indifferent gonads that can become either testes or ovaries. In the absence of a Y chromosome, the indifferent gonads differentiate into ovaries nine to ten weeks after conception. At about 18 to 20 weeks, the internal and external female genitalia develop, establishing female genital sex. The presence of the Y chromosome causes the indifferent gonads to differentiate into testes at six to eight weeks. Shortly afterwards, testicular Leydig cells begin to secrete testosterone, which stimulates the development of internal and external male genitalia, establishing male genital sex.

In the human fetus of either sex, the fetal gonad is affected by three gonadotropins: placental chorionic gonadotropin (hCG) early in gestation, and later by follicle stimulating hormone (FSH) and luteinizing hormone (LH), both secreted by the fetal pituitary. Fetal serum hCG peaks around the tenth week of gestation and stimulates testosterone secretion by the testes of the male fetus. Unlike the testis, the fetal ovary is only minimally affected by the early appearance of hCG. Growth and function of the fetal ovary is more dependent on the later appearance of the pituitary gonadotropins.

Hormonal Control of Sexual Maturation

The hormonal relationship of the hypothalamic-pituitary-gonadal axis becomes established by two years of age in either sex, functioning quietly until the onset of puberty. In childhood, the negative-feedback response of this axis is extremely sensitive to the small amounts of circulating gonadal steroids, contributing to the low levels of gonadotropins secreted from the pituitary.

Adolescence generally refers to the time between the onset of puberty and the completion of physical maturation. During adolescence, maturation of the gonads is accompanied by accelerated growth, development of secondary sex characteristics, and attainment of reproductive capability manifested by spermatogenesis in the male and ovulation in the female. In anticipation of the onset of puberty, serum concentrations of pituitary FSH rise between the ages of 6 and 8, and at approximately 10 years of age there follows an increase in the secretion of LH by the anterior pituitary. The secretions of LH and FSH are believed to be controlled via the hypothalamus by a single gonadotropin releasing hormone (GnRH). The elevated serum levels of LH and FSH stimulate the growth of the gonads to their adult size, stimulate gametogenesis, and greatly increase the secretion of gonadal steroids. The gonadal-steroid secretion initiates the first physical signs of sexual maturation with development of secondary sexual characteristics. In the female, this includes breast development (thelarche), pubic hair growth (pubarche), axillary hair growth (which usually follows pubarche), somatic growth acceleration, and finally the menarche, or initiation of menses. In the male, a deepening voice; pubic, axillary, and facial hair growth, testicular and phallic enlargement; and somatic growth acceleration indicate sexual maturation. This process generally begins between the ages of 8 and 13 in females, and occurs about two years later in males, with full development over a three-year period. The order of appearance of pubertal features varies greatly among individuals.

In women, release of the gonadotropins occurs on a cyclical basis, creating the reproductive or menstrual cycle. In men, the release is relatively steady, although there are a number of pulses of gonadotropin release in a 24-hour period.

Gonadal Steroids and Sexual Maturation

In females, there are two major reproductive steroids, estradiol (an estrogen) and progesterone (a progestin). The most frequent first sign of female sexual maturation is breast budding, which occurs in response to the increased pubertal levels of estrogen. Both the mammary glands and the adipose tissue of the breast are stimulated to increase in size by estrogen. Increases in body fat and its characteristic deposition, a broader pelvis, and a shorter period of growth of long bones are also effects of estrogen. Progesterone is primarily involved in the menstrual cycle, which is discussed later on.

The major steroid secreted in males is testosterone, although the testes also secrete small amounts of estrogen. Testosterone is responsible for the development of male secondary sexual characteristics. Testosterone helps to initiate the growth spurt of male adolescence and also ultimately ends that growth spurt by stimulating closure of the epiphyses of the long bones. It causes enlargement of the larynx, which deepens the male voice, generally coinciding with the growth spurt. Testicular enlargement occurs, followed by phallic enlargement 12 to 18 months later. Testosterone stimulates growth of muscles and is probably responsible for the higher hematocrit level of men. Gynecomastia, or development of breast tissue, is a normal male response during early puberty, probably due to the higher ratio of estrogen to testosterone secreted by the testes during early and mid-puberty. Testosterone stimulates the growth of facial, body, and pubic hair, and it is a contributing factor in male pattern baldness. It is also required for spermatogenesis and plays an important role in the establishment of sexual interest, or libido.

The adrenal cortex of both sexes also produces small amounts of androgen as a by-product of synthesis of aldosterone and cortisol. The major androgen produced is dehydroepiandrosterone (DHEA). Although a weaker androgen than testosterone, DHEA plays an important role in female sexual development. This adrenal androgen is primarily responsible for the growth of pubic and axillary hair in women and also contributes to the female adolescent growth spurt. DHEA, along with a small amount of androgen secreted by the ovaries, also appears to be responsible for female libido, rather than the "female" sex hormones estrogen and progesterone.

Male Reproductive Function

In the male, the hypothalamus secretes gonadotropin releasing hormone in pulsatile bursts throughout the day. One effect of GnRH is to stimulate the pituitary to increase secretion of the gonadotropins FSH and LH. Pituitary FSH controls spermatogenesis, which occurs in the Sertoli cells. Inhibin is then selected by the Sertoli cells, exerting a negative-feedback control and diminishing the amount of FSH released by the pituitary.

Biosynthesis and secretion of testosterone, the primary male androgen, are carried out by the Leydig (interstitial) cells. Pituitary LH is primarily responsible for stimulating the Leydig cells' secretion of testosterone. Testosterone then acts as an inhibitor of both GnRH secretion from the hypothalamus and LH secretion from the pituitary, another example of a hormonal negative-feedback loop.

Levels of testosterone rise throughout puberty and reach their maximum value by about the age of 20. These relatively high testosterone levels are maintained until the fourth decade, when they begin a gradual decline. The degree of decrease in testosterone levels varies widely from one individual to the next. This decreasing level of testosterone is often compared to the menopausal period of female development.

As testosterone levels decrease, so too does their negative-feedback inhibition on both the hypothalamus and pituitary. This creates a coincidental rise in gonadotropin levels in an effort to stimulate the aging testes to produce more testosterone. In response to diminishing levels of testosterone, target tissues up-regulate their testosterone receptors, cushioning the effects of the lowered levels of androgen. This promotes maintenance of functioning of accessory structures and also helps maintain a level of sexual interest. Spermatogenesis, which is mostly independent of testicular function and levels of testosterone, continues throughout the male life span following puberty.

Female Reproductive Function

The ovaries of the sexually mature female undergo regular cycles, beginning with maturation and ovulation of a follicle. A period of time follows during which hormones secreted by the remnant of the ovulated follicle create a uterine environment receptive to implantation of an embryo. The maturing follicle also functions as an endocrine organ, secreting estradiol, the main source of estrogen in women who are not pregnant. During ovulation, the mature follicle bursts, releasing an ovum into the body cavity, from which it is swept by the fimbriae into a Fallopian tube, where it may be fertilized.

As a follicle matures, it becomes an active endocrine tissue. Just as in the male reproductive system, the hypothalamus secretes GnRH, stimulating the anterior pituitary to secrete both LH and FSH. Both LH and FSH are needed for ovarian cycles. LH stimulates the thecal cells of the mature follicle to supply the granulosa cells of the follicle with androgen, which is converted by the granulosa cells to estradiol and secreted into the blood. Granulosa cells also secrete inhibin, which acts in a negative-feedback relationship as an inhibitor of anterior pituitary release of FSH. LH secretion is not affected by inhibin. Estradiol is responsible for the regulation of LH levels by a negative-feedback loop involving both the hypothalamus and the anterior pituitary. LH secretion does not always behave as if it were regulated by negative feedback, however; the surge of LH that causes ovulation occurs even though estradiol levels are rising. This surge can be explained by the fact that the anterior pituitary responds differently to rising levels of estradiol than it does to moderate, nonfluctuating levels. At moderate, steady levels of estradiol, the anterior pituitary predominantly shuts off its LH secretion by means of negative feedback. When estradiol levels rise rapidly to high levels, as they do during the follicular phase, the pituitary is actually stimulated to secrete a surge of LH.

In the final stage of follicular maturation, the follicle is called a graafian follicle and visibly bulges from the surface of the ovary. Occasionally, more than one graafian follicle is matured and ovulated. If both are fertilized, this multiple ovulation may lead to fraternal twins. Fraternal twins are genetically different and may be of different sexes.

The surge of LH that follows the rise in estrogen level at this time is coupled with a smaller increase in FSH. The rise in FSH level is considerably smaller due to the continued effects of inhibin on the anterior pituitary. The ovum is released from the graafian follicle about 12 to 24 hours after LH has reached its peak concentration. This is called the ovulation phase of the menstrual cycle and occurs 14 days prior to the onset of menstruation.

The ovum is then swept up by fimbriae and carried toward the uterus by the ciliary activity and smooth-muscle contractions of the Fallopian tube. An ovum can be fertilized for only 10 to 12 hours after ovulation. Spermatozoa can survive for up to three days in the female reproductive tract, allowing for a relatively brief span of time in which fertilization can occur during each menstrual cycle.

The female endocrine system relating to pregnancy is a complex interaction of hormones secreted by the corpus luteum, placenta, uterus, and pituitary. The hormones of pregnancy, labor, and lactation include estrogen, progesterone, placental somatomammotropin, oxytocin, relaxin, and prolactin. (Hormones of pregnancy, labor, and lactation are not covered in this entry.)

Following ovulation, the remnant of the follicle becomes a secretory organ called the corpus luteum, which maintains the receptivity of the uterus to a pregnancy by secreting estrogen and progesterone. If pregnancy does not occur, the corpus luteum degenerates approximately 14 days later, and the resultant decrease in levels of estrogen and progesterone causes the uterine endometrium to be shed, initiating menstruation.

The average menstrual cycle lasts 28 days, with a normal range from 21 to 35 days. The first menstrual day is numbered as day 1 and marks the beginning of the follicular phase of the ovarian cycle. Ovulation, which occurs approximately on day 14 of the 28-day cycle, marks the transition from the follicular phase to the luteal phase of the ovarian cycle. During the luteal phase of the cycle, the presence of progesterone secreted by the corpus luteum modifies the responsiveness of the pituitary to the high levels of circulating estrogen, preventing recurrent surges of LH. During the luteal phase, the negative-feedback system again predominates, and LH and FSH remain at relatively low levels. The estrogen and progesterone secreted by the corpus luteum also interact to convert the uterine endometrium into a structure specialized to receive an embryo. The endometrium thickens and becomes a secretory organ, secreting uterine milk, a carbohydrate-rich fluid capable of nourishing the embryo until implantation in the uterine wall occurs.

It is not uncommon for ovulating women to complain of a complex of symptoms during the last week of the menstrual cycle. This symptom complex, known as premenstrual syndrome (PMS), does not occur in children, pregnant women, or anovulatory women. The symptoms may include breast tenderness, bloating, edema of the extremities, and mood swings. Symptoms abate with the onset of menstruation. No specific etiology for PMS has been found, although progesterone secreted by the corpus luteum is strongly suspected to play a significant role.

The cycles of estrogen and progesterone secretion by the ovaries continue throughout the woman's sexually mature years until the menopausal transition, which usually takes place between 45 and 55 years of age. Menopausal transition is characterized by longer cycles and irregular bleeding. These irregular cycles can persist for months or years before complete amenorrhea occurs. During this time, the ovaries undergo an obliterative endarteritis that leads to a reduction in ovarian size and the replacement of the secretory parenchyma with connective tissue. As the ovaries become less able to secrete steroids in response to gonadotropins, the negative-feedback loop disintegrates and gonadotropin levels rise. Thus, as with the testes, the effect of aging is seen at the ovaries rather than the pituitary or hypothalamus. As gonadotropin levels rise and estrogen levels decline, the woman may experience a variety of signs and symptoms of menopause, including sweating, hot flashes, and a reduction in the feminization that occurred at puberty, such as diminishing fat deposits and atrophy of the breast, vulva, and vagina. Prolonged estrogen deficiency is a risk factor for a decrease in bone calcification, leading to the development of osteoporosis. It is increasingly common for women of menopausal years to take estrogen and progesterone supplements to reduce the effects of the failing ovaries.