sexology

The Sexual Response - Stimulus and Response

Human sexual activity, like any other activity, follows the pattern of "stimulus and response". Every healthy woman as well as every healthy man can respond to sexual stimulation. While this response is never exactly the same in any two individuals, its basic physiological pattern is shared by all human beings, regardless of sex. The Sexual Response - Stimulus and Response The Basic Pattern: Mounting Tension - Sudden Release Sexual activity produces many changes in the human body, such as an increase in pulse rate and blood pressure, the swelling of the sex organs (tumescence), muscular contractions, glandular secretions, and many other signs of mounting excitement until, eventually, the tension is released in a pleasurable, seizure-like reaction known as orgasm. As a result, the swelling of the sex organs decreases (detumescence) and the body returns to its former unexcited state. The Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation Human beings can be sexually aroused at nearly all times, in many different ways, and by a great variety of objects.   In human females and males, sexual excitement may be triggered at any hour of the day or night, by the sight or touch of certain persons or things, by certain smells or sounds, or simply by some thoughts, recollections, or fantasies. Since the possible sources of sexual stimulation are so numerous and varied, they are not easily listed or classified, and no such attempt is made here. Nevertheless, it may be useful to cast at least a cursory glance at some of the more obvious stimuli that can produce sexual responses. he Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation Touch: Erogenous ZonesOf all the human senses, the sense of touch seems to be the one most often responsible for erotic arousal. A person becomes aware of being touched through nerve endings in the skin and some deeper tissues. Since some areas of the body surface contain many more of these nerve endings than others, they are also more sensitive to the touch and, as a result, they may be especially receptive to sexual stimulation. These particular regions have, therefore, also often been called erogenous zones (literally, love-producing zones, from gr. eros: love and genesthai: to produce). The best known erogenous zones are the glans of the penis in men and the clitoris and the minor lips in women, the area between the sex organs and the anus, the anus itself, the buttocks, the inner surfaces of the thighs, the breasts (especially the nipples), the neck, the mouth, and the ears. The Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation The response to touch is not automaticTouching, stroking, tickling, rubbing, slapping, kissing, or licking these areas can often create or increase sexual excitement. However, this response is by no means automatic. A great deal depends on a person's previous conditioning and on the circumstances under which the stimulation occurs. For instance, when a doctor touches a patient's erogenous zones in the course of a physical examination, there may be no sexual response at all. Neither is such a response likely in cases of rape. In short, psychological factors usually play a decisive role in tactile stimulation. (There are some exceptions to this rule, as in certain cases the body may produce a reflexive reaction to touch. For example, a man who suffers from a certain type of spinal cord injury can have an erection when his penis is fondled, although the stimulation may not register in his brain). The Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation The response to touch is not the same in everyoneBecause of their different experiences, different individuals are likely to develop different degrees of sensitivity. Negative mental associations can prevent any sexual response to touch. In fact, there are people who want to be touched as little as possible even during sexual intercourse. On the other hand, pleasurable sexual encounters can develop a welcome sensitivity almost anywhere in the body and thus lead to the discovery of new erogenous zones. In the final analysis, people have to find out for themselves which parts of their own (or their partner's) bodies most readily respond. The Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation The Other SensesMost people are well aware of the fact that they can become sexually aroused not only by persons or things they touch, but also by what they may see, hear, smell, or taste. The sight of a beautiful body, the sound of a musical voice, the smell of a perfume, the taste of certain foods or of a lover's glandular secretions can be powerful stimulants. However, their effect depends entirely on mental associations. A particular individual becomes excited by a particular sight, sound, smell or taste because he associates it in his mind with a previous pleasant sexual experience. (Unpleasant associations, on the other hand, produce a negative reaction. They can reduce or extinguish sexual excitement.) The Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation Psychosocial Conditioning There are no erotic sights, sounds, or smells as such. They only become so through certain erotic experiences. It is not surprising, therefore, that different times and cultures have felt attracted to very different ideals of beauty, or that a certain piece of music may appear stimulating to some but not to others. Human beings in general depend very much on psychological factors in their sexual responses, and many people become aroused by mental images alone. Indeed, there are some individuals who are able to reach orgasm simply by fantasizing about sexual matters.   The Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation Differences between Females and MalesIt seems that erotic thoughts, fantasies, and anticipations have a more certain effect on males than on females. In general, men are more easily aroused by visual stimuli (sights), women more by tactile and acoustic stimuli (touch and sound). During sexual intercourse, most women reach orgasm only as a result of continuing physical stimulation.   The Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation Responses without sexual stimulation Certain seemingly sexual responses can occur for entirely nonsexual reasons. For example, many men know that they may have erections when lifting heavy weights or when a full urinary bladder causes some physical irritation.   There is also a rare pathological condition called priapism in which a man is unable to lose his erection. This disease can be quite painful and may, eventually, do serious damage to the penis. (The condition was named after the ancient Greek fertility god Priapos, who was always portrayed with an erect penis.) Ancient small statue of Priapos The Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation Changing stimuli - unchanging responseOnce people have become fully aroused, they tend to seek release through some kind of sexual activity. The type of activity they choose depends, of course, on the circumstances. However, no matter what the choice, the reactions of the body always follow the same pattern. In other words, from a physiological point of view it makes no difference whether the sexual response is brought about by solitary masturbation or any conceivable form of sexual intercourse. Psychologically, the experience may very well feel quite different, but the basic physical reactions remain unchanged. The Sexual Response - Stimulus and Response The Basic Pattern: Sources of Sexual Stimulation Individual DifferencesEven the physiological reactions are never exactly identical in any two persons or even in the same person on different occasions. People are not machines built on the same assembly line. Any general description of the human sexual response can be only just that - general. The specific responses of a particular individual are bound to show some individual variation. (For example, it is very well possible for some men to experience orgasm and to ejaculate with a limp penis.) The following summaries of the female and male sexual response should, therefore, not be considered a norm or an ideal of physical performance toward which everybody must strive.  Its only purpose is to shed some light on a previously mysterious subject and to provide men and women with some elementary knowledge of certain body functions. The Sexual Response - 4 Phases of Response In the simplest terms, the sexual response pattern can be described as a build-up and release of tension. However, in an attempt to gain a greater understanding of the processes involved, various scientists have divided the sexual response into not only two but three, four or more different phases. One has to keep in mind, of course, that every individual human sexual experience is a continuous whole, and that all divisions into stages and phases are always artificial and somewhat arbitrary. Nevertheless, they can help us recognize and understand the many ways in which our bodies respond to sexual stimulation. The Sexual Response - 4 Phases of Response Why four phases? When we divide the sexual response cycle into four phases - arbitrary as this may be - we follow a convenient scientific tradition. Albert Moll (1862-1939) In modern times, the sexual response cycle was first analyzed and described by Albert Moll in his study "The Sexual Life of the Child" (1909). He also proposed its division into four major phases: 1. the onset of voluptuousness, 2. the equable voluptuous sensation, 3. the voluptuous acme, and 4. the sudden decline Wilhelm Reich (1897-1957) Later, Wilhelm Reich offered a different description in his book "The Function of the Orgasm" ([1927] 1942): 1. mechanical tension, 2. bioelectric charge, 3. bioelectric discharge, and 4. mechanical relaxation William H. Masters (1915-2001) Virginia Johnson (1925-) More recently, William H. Masters and Virginia Johnson, in their book “Human Sexual Response” (1966) relabeled these phases as 1. excitement, 2. plateau, 3. orgasm, and 4. resolution. In addition, they have introduced the concept of a fifth phase, the refractory period. The following descriptions of the female and male sexual responses are based on the four-phases division proposed by Masters and Johnson. Although there may very well be room for finer distinctions and a more sophisticated terminology in the future, the Masters and Johnson model is quite adequate for our present purposes. he Sexual Response - The Female Response Modern scientific sex research has clearly demonstrated that that the sexual response follows essentially the same pattern in both sexes. Indeed, the sexual capacity of females is at least equal to and, in some respects, even greater than that of males. Today, we know that both women and men can respond sexually to the same sensory stimuli. Touch, vision, hearing, smell, and taste play an important role in all human sexual arousal. Women as well as men possess a special sensitivity in the same general areas of the body, and they can develop the same erogenous zones. The Sexual Response - The Female Response Similiarities and Differences In spite of the basic similiarity of female and male sexual responses, there are a few differences. Some of these are biologically based and others are the result of general and individual psychosocial influences. Indeed, the latter are more important than is often realized, especially in women. Therefore, a purely medical, physiological descripton of the female sexual response is bound to be inadequate. Feminist researchers have now presented a new view of female sexuality that emphasizes its relational aspects. Still, as is typical in sexual matters, it is not always easy to distinguish between biological base and psychosocial conditioning in each individual case. The sexual response follows the same basic pattern in males (blue) and females (red): A = Excitement, B = Plateau, C = Orgasm, D = Resolution. However, there are some possible variations in the female pattern, e.g. multiple orgasms.  Sexual Response - The Female Response Similiarities and Differences Some differencesThere are a few differences between the female and male responses that may have a biological basis. For instance, it has been found that the average female is less easily stimulated by mental images alone. Women in general are more easily distracted even when aroused, and many of them reach orgasm only as a result of continuing physical stimulation. (There are exceptions to this rule. Some women can achieve orgasm in response to purely psychological stimuli.) However, the greatest difference between female and male sexual responses lies in the realm of psychology. Women tend to care more about their subjective feeling of arousal than about its physical manifestation. In fact, the character of the relationship with their sexual partners largely determines how women experience their own responses. Therefore, no physiological measurement can adequately reflect their degree of sexual satisfaction. The Sexual Response - The Female Response Similiarities and Differences The Obsolete "Double Standard"In spite of the biological facts and well-established psychological findings, women in our Western culture have, for a very long time, suffered from cultural restrictions that denied them the full expression of their sexuality. It was generally assumed that men were possessed by a powerful "sex drive" while women were considered incapable of strong sexual feelings. As a consequence, men were encouraged to enjoy their sexual capacities; women were taught to regard sexual desire as base, improper, and degrading. This so-called double standard for male and female sexual behavior has had some very unfortunate consequences, not only for the moral health of society but also for the physical well-being of the individual woman. The Sexual Response - The Female Response Similiarities and Differences Unrealized female potentialWomen often find it hard to develop their sexual responsiveness, and a great number of them go through life without ever realizing their erotic potential. While practically all men easily achieve orgasm after a certain amount of stimulation, there are many women who fail to reach this simple goal. (For details, click here.) Some women have their first orgasmic experience only after many years of sexual intercourse. Aside from a few rare cases of physical disability or illness, these strange and unnecessary difficulties are clearly related to the way women are brought up in our society. During their formative years, many girls are forced to deny their sexual urges even to themselves. The resulting inhibitions can become strong enough to prevent any normal sexual functioning. In addition, there is a variety of other potentially negative factors, from a simple lack of information to non-functioning partnerships and the unintended effects of medical treatment. Therefore, new scientific approaches now group female sexual problems in four categories: 1. Socio-cultural problems in the widest sense, 2. Relationship problems, 3. Psychological problems, 4. Medical problems. A more detailed discussion of this can be found in our course “Sexual Dysfunctions and Their Treatment”. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm The following summary of the human sexual response is not meant to establish a norm or an ideal of sexual performance. The only purpose of our summary is to provide women and men with some general information about those physiological processes that may accompany sexual activity. Individual variations should always be expected. Still, a particular woman's basic responses are usually the same throughout her life, no matter what kind of sexual activity she chooses. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 1. Excitement Some general observationsNot only men but also women can become sexually aroused very suddenly, and some of them may experience one or more orgasms within a few minutes. As a matter of fact, there are women who reach orgasm fifteen to thirty seconds after they begin sexual intercourse. It seems, however, that during the first stages of arousal women are more easily distracted than men and depend more on continued direct physical stimulation. For this reason, many females seem to need a longer time to reach orgasm during coitus than their male partners, whose excitement is often sustained and increased by psychological factors. In general, females are less easily stimulated by mere sights and sounds, or by erotic fantasies and anticipations. On the other hand, when the average woman is able to concentrate on her preferred method of stimulation (during masturbation, for instance), she achieves orgasm just as quickly as the average man. he Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 1. Excitement The VaginaMounting sexual excitement produces two major changes in the vagina: 1. An engorgement with blood, i.e. tumescence2. A widening of the inner two thirds of the vaginal barrel, i.e. a tenting effect. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 1. Excitement Tumescence:During sexual excitement, the sex organs become engorged with blood, i.e. they become tumescent (from lat. tumescere: to swell). In females, the first and most obvious sign of sexual excitement and tumescence is the lubrication of the vagina. In response to effective stimulation, the vaginal walls begin to secrete a clear fluid which soon provides a moist coating for the entire vagina in preparation for coitus. Without such lubrication, the insertion of a penis into a vagina could be painful for both partners. (The corresponding sign of tumescence in males is the erection of the penis. In short, as the penis becomes ready to enter the vagina, the vagina becomes ready to receive it). Left: The “sweating” (transsudation) of the vaginal walls. Right: Vaginal blood vessels and clear fluid (A), muscular wall of the vagina (B), lubricating “sweat” (C). The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 1. Excitement Tenting effect: The inner two thirds of the vagina increase. Tenting effect:With continued arousal, the inner two thirds of the vagina increase in both length and width, creating a tenting or ballooning effect. (In its unexcited state, the vagina is a collapsed tube, i.e., its walls are touching). At the same time, there is a vaginal color change from the usual red to a deep purple that becomes even darker during the following phases. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 1. Excitement The Major LipsA woman's major lips (the outer lips of the vulva) respond differently, depending on whether she has given birth to children or not. If she has not given birth, sexual excitement will cause her major lips to flatten out and expose the vaginal opening. The major lips of a woman who has given birth, on the other hand, are rather large and now grow even larger as a result of engorgement. Nevertheless, they also expose the vaginal opening. The Minor LipsThe minor lips (the inner lips of the vulva) swell considerably in all women and also change their color to a progressively deeper red. The clitoris (just as the penis) increases in size as its erectile tissue becomes filled with blood. This increase is usually most noticeable in the diameter of the clitoral shaft. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 1. Excitement The UterusThe uterus also begins to swell and is pulled upward into the abdomen, thus contributing to the lengthening of the vagina mentioned above. During sexual excitement, the nipples of the breasts become erect and maintain this erection throughout the other phases. However, since the dark area around each nipple, and, indeed the whole breast, soon also becomes engorged and swollen, the nipple erection itself gradually appears less conspicuous. Muscle contractions and sex flushMounting sexual tension further produces voluntary and involuntary muscular contractions in various parts of the body as well as a rise in pulse rate and blood pressure. In addition to all the above signs of growing sexual excitement, most women also show a socalled sex flush, i.e., a red rash which begins in the stomach area and then spreads to the breasts and neck. This rash lasts through the orgasmic phase. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 2. Plateau Some general observationsThe plateau phase is nothing more than the continuation of the excitement phase. The word "plateau" is meant to indicate that a certain even level of excitement has been reached which is then maintained for a while before orgasm occurs. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 2. Plateau The Vagina: Orgasmic PlatformDuring this phase, there is only a slight increase in length and width of the inner two thirds of the vagina. However, its outer onethird becomes congested with blood. As a result, this part of the vagina, which might have widened somewhat during the excitement phase, now narrows by about 33 percent. This congested and tightening outer third of the vagina has been named the''orgasmic platform" by Masters and Johnson. The Major and Minor LipsWhile the major lips show no further changes during the plateau phase, the minor lips continue to darken in color, especially in women who have given birth. This marked color change is a sign that orgasm is approaching. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 2. Plateau The ClitorisOnce a certain level of excitement has been reached, the clitoris retracts under the clitoral hood or foreskin, and thus becomes inaccessible to direct stimulation by the woman or her sexual partner. (In the past, it was not always understood that this retraction of the clitoris indicates an increase, not decrease, of sexual excitement). With mounting sexual excitement, the glans of the clitoris retracts under its hood. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 2. Plateau The Greater Vestibular (Bartholin's) GlandsThe greater vestibular (Bartholin's) glands (which correspond to the bulbourethral [Cowper's] glands in the male) may secrete a small amount of fluid during the plateau phase or late in the excitement phase. Uterus and BreastsThe uterus is pulled further upward into the abdomen and further increases in size. The breasts also reach their greatest expansion during the plateau phase. Sex Flush and Increasing Muscular TensionThe sex flush, if indeed it should have occurred, may now become more intense and cover a wider area. Voluntary and involuntary muscular tension greatly increases throughout the body. The pulse rate and blood pressure rise, and breathing becomes faster. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm Some general observationsOrgasm (gr. orgasmos: lustful excitement) is the sudden release of muscular and nervous tension at the climax of sexual excitement. The experience represents the most intense physical pleasure of which human beings are capable and is basically the same for females and males. An orgasm lasts only a few moments and is felt very much like a seizure or rather a series of convulsions which involve the whole body and soon lead to complete relaxation. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm The VaginaIn females, orgasm begins with strong, rhythmic contractions of the outer onethird of the vagina, which Masters and Johnson call the orgasmic platform. These contractions, which may number from three to fifteen, first recur within less than a second, then, as they become weaker, at longer intervals. Uterus and Anal SphincterAlmost at the same time, the uterus begins to contract. However, the uterine contractions are irregular. They start at the top, working their way down, not unlike the contractions during the first stage of labor. The sphincter muscles of the rectum may also contract a few times at the same intervals as the orgasmic platform. Muscular Tension, Pulse Rate and Blood PressureIn general, there is great muscular tension, not only in the entire pelvic area, but also in other parts of the body, such as the neck, arms, hands, legs, and feet. The pulse rate and blood pressure rise slightly even beyond the level reached during the plateau phase, and breathing is very fast. The intensity of all of these physical reactions depends, of course, on the degree and duration of sexual tension. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm Possible PatternsMasters and Johnson found only one sexual response pattern in males. However, in females, they discovered some possible variations. 1. The male sexual response follows a simple basic pattern: From excitement (A) to plateau (B), orgasm (C) to resolution (D). 2. The female response usually follows the same pattern (dark red) but females may also experience additional orgasms before reaching the resolutuon phase (light red). 3.Females may also experience an extended plateau phase actually reaching orgasm, and 4. females may very quickly reach orgasm followed by an equally quick resolution. he Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm Ejaculation?In sexually mature males, orgasm is accompanied by the ejaculation of semen. Women do not produce semen, and, as a rule, do not ejaculate. However, there are exceptions: In some women certain paraurethral glands (i.e. glands next to the urethra) have developed to a point where they produce an prostate-like fluid which can be expelled through the urethra during the muscular contractions of orgasm. In these cases, many researchers speak of a “female prostate” and female ejaculation. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm Sample pattern of three consecutive orgasms. (A=Excitement B=Plateau C=Orgasm D=Resolution) Multiple OrgasmsAs repeatedly emphasized, the sexual responses are comparable in both sexes. While the experience of orgasm itself is essentially the same in men and women, the latter seem to be better equipped to have more than one orgasm within a short time. There are some rare cases of males who, particularly in their younger years, are capable of several orgasms in quick succession. However, this capacity is quite common in females. There is one further difference: While the orgasmic pattern of males practically never varies, females may follow several different possible patterns (see there). In some women, orgasm is rather short and mild; in others, it is extended and violent. Even one and the same woman may find herself responding quite differently on different occasions. However, the basic physiological processes underlying these possible variations remain unchanged. he Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 4. Resolution Some general observationsAfter orgasm, the sex organs (and with them the whole body) need some time to return to their unexcited state. The Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 4. Resolution The VaginaDuring the so-called resolution phase, the congestion in the outer one-third of the vagina (the orgasmic platform) disappears quickly. The ClitorisThe clitoris reemerges from under the clitoral hood. The Major and Minor LipsThe major and minor lips again assume their former shape and size. The UterusThe uterus also shrinks back to its usual size, and, as it descends from its elevated position in the abdomen, the “tenting” or “ballooning” effect in the inner two thirds of the vagina is eliminated. The Sex FlushThe sex flush mentioned earlier vanishes. The BreastsThe nipples of the breasts and the breasts themselves slowly return to their normal state. With the release of muscular tension, the pulse rate and blood pressure decrease, and breathing becomes normal again. he Sexual Response - The Female Response The Response Cycle: An Observed Pattern, not a Norm 4. Resolution No "Refractory Period"It should be noted at this point that, unlike men, many women do not seem to have a "refractory period," i.e. a rest period in which they cannot respond to additional stimulation. At any rate, if they do have one, it is not as obvious. In many cases continued or repeated stimulation can bring a woman to a second and third orgasm immediately following the first one. Indeed, many women are capable of having many orgasms in quick succession. Obviously, in this case, the resolution phase as described here does not begin until after the last of these orgasms. The Sexual Response - The Male Response Modern scientific sex research has clearly demonstrated that the sexual response follows essentially the same pattern in both sexes. Today, we know that both men and women can respond sexually to the same sensory stimuli. Touch, vision, hearing,smell, and taste play an important role in all human sexual arousal. Men as well as women possess a special sensitivity in the same general areas of the body, and they can develop the same erogenous zones. The Sexual Response - The Male Response Similiarities and Differences In spite of the basic similiarity of female and male sexual responses, there are a few minor differences. Some of these are biologically based and others are the result of general and individual psychosocial influences. However, as is typical in sexual matters, it is not always easy to distinguish between biological base and psychosocial conditioning in each individual case. The sexual response follows the same basic pattern in males (blue) and females (red): A = Excitement, B = Plateau, C = Orgasm, D = Resolution. However, there are some possible variations in the female pattern, e.g. multiple orgasms. he Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm The following summary of the human sexual response is not meant to establish a norm or an ideal of sexual performance. The only purpose of our summary is to provide women and men with some general information about those physiological processes that may accompany sexual activity. Individual variations should always be expected. Still, a particular woman's basic responses are usually the same throughout her life, and it makes no difference whether they are brought about by masturbation or any conceivable form of sexual intercourse. Psychologically, these experiences may very well feel entirely different, but the reactions of the body remain unchanged. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 1. Excitement Some general observationsSexual excitement may mount rather unexpectedly and quickly, particularly in younger men, but it may also build up gradually over a longer period of time. In fact, some individuals deliberately distract themselves repeatedly, in order to prolong and savor their experience of becoming aroused. Especially in its early stages, sexual excitement can easily be reduced by some outside interference or by sudden anxieties or apprehensions. However, with increasing tension such negative influences become less and less effective. The ability for self-control is impaired, and the usual inhibitions are swept away. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 1. Excitement The PenisMounting sexual excitement produces an obvious change in the penis. Tumescence:The three spongy bodies inside the penis (the two corpora cavernosa and the corpus spongiosum) become tumescent, i.e. they are filled with blood and thus cause the penis to rise and stiffen. Therefore, the most obvious sign of sexual excitement in the male is the erection of his penis. Insufficient or Absent TumescenceSometimes a man may fail to achieve or maintain an erection of the penis, although he feels excited and is eager to have sexual intercourse. Obviously, in this case he is also unable to proceed to the other phases of sexual response. Such an occasional lack of erection may have many causes, but can usually be traced to particular circumstances in a specific situation. Both sexual partners should accept the incident with equanimity and perhaps turn to forms of lovemaking that do not require an erect penis. There is no cause for concern. However, if the same problem should occur frequently or even regularly, professional help may be advisable. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 1. Excitement The ScrotumAt the same time, the smooth muscles of the scrotum contract, its tissue thickens, and the testicles are pulled upward toward the abdomen by the contracting spermatic cords. Muscular Tension, Pulse Rate and Blood PressureAs sexual excitement increases, there is a corresponding increase in muscular tension. At the same time, the pulse rate and blood pressure rise. Sex FlushA number of men also experience what is known as a sex flush, i.e., a red rash that usually begins in the area of the lower abdomen and then spreads to the neck and face or even to the shoulders, arms, and thighs. The sex flush may start only late in the excitement phase and is more likely to appear in the plateau phase. In many cases, however, there is no sex flush at all. Erection of NipplesNot all males experience an erection of their nipples. In some men, it may be brought about by a direct stimulation of the breasts. When nipple erection occurs, it usually appears toward the end of the excitement phase or during the plateau phase and then lasts through the other phases. he Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 2. Plateau Some general observationsThe plateau phase is actually nothing more than the continuation of the excitement phase. The word "plateau" is meant to indicate that a certain even level of excitement has been reached which is then maintained for a while before orgasm occurs. Once sexual excitement has reached this stage, the individual is no longer easily diverted, but becomes gradually oblivious to his surroundings. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 2. Plateau Penis and TesticlesDuring the plateau phase, the now erect penis does not undergo any new major changes. However, the testicles swell noticeably and are pulled close to the abdomen. The Bulbourethral (Cowper's) GlandsThe bulbourethral (Cowper's) glands secrete a few drops of a clear liquid which may appear at the tip of the penis. (Such a drop may contain some stray sperm cells. This fact should be remembered by couples who want to avoid pregnancy.) Sex FlushThe sex flush mentioned earlier may now appear for the first time or, if it had been visible before, grow more obvious. Again, it should be remembered that not all men show a sex flush, and that some show it only occasionally. Muscular Tension, Pulse Rate and Blood PressureWith increasing sexual stimulation, the entire body experiences an increase in muscular tension, both voluntary and involuntary. At the same time, the pulse rate and blood pressure continue to rise, and breathing becomes faster. Erection of NipplesThe same is true for the erection of the nipples. However, if the nipples should become erect during the plateau phase, they will remain so through the other phases. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm Some general observationsOrgasm (gr. orgasmos: lustful excitement) is the sudden release of muscular and nervous tension at the climax of sexual excitement. The experience represents the most intense physical pleasure of which human beings are capable and is basically the same for males and females. An orgasm lasts only a few seconds and is felt very much like a short seizure or rather a quick succession of convulsions which involve the whole body and soon lead to complete relaxation. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm EjaculationIn males, orgasm begins with involuntary rhythmic contractions of the genital ducts and accessory organs (vasa deferentia, seminal vesicles, prostate gland), the urethra, the muscles at the base of the penis and finally the penis itself. The first three or four forceful contractions recur within less than a second, then, as they become weaker, at longer intervals. In sexually mature males, orgasm is usually accompanied by the ejaculation (lat.: throwing out) of semen: As a result of the orgasmic muscular contractions, the accumulated semen is forced through the urethra to the outside where it emerges in several quick spurts. At times, it may be projected a considerable distance; at other times, it may flow out rather gently. The force of a particular ejaculation is not related to a man's strength or virility. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm How much semen is ejaculated?The amount of semen ejaculated during one orgasm is usually about a teaspoonful. Repeated ejaculations within a short time produce less and less semen. The contractions in the sex organs and the subsequent ejaculation of semen produce the most obvious signs of orgasm. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm Orgasm without EjaculationIt is the sudden, convulsive release from this overall tension that constitutes orgasm. The ejaculation of semen is only incidental to this release. Orgasm and ejaculation are two different processes. While it is true that, in men, there can be no ejaculation without orgasm, there can very well be orgasm without ejaculation. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm - Orgasm without Ejaculation Before PubertyThe most obvious example is the orgasm of boys before puberty. Since their internal sex organs are not yet sufficiently developed to produce semen, there is nothing that could be ejaculated. Nevertheless, these boys can have orgasms. Supply ExhaustedCertain other men who are capable of several orgasms within a short time may, for a while, exhaust their supply of semen and thus stop ejaculating as they continue to have orgasms. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm - Orgasm without Ejaculation Some AdultsThere are also some adult men in whom ejaculation does not occur until a few seconds after orgasm, and for whom both experiences thus remain completely separated. Some men claim to have trained themselves to experience multiple orgasms while being able to withhold any ejaculation. In other words, for them orgasm and ejaculation remain two separate phenomena. This is said to be achievable through deep breathing throughout sexual activity. Usually, as sexual excitement mounts, breathing becomes increasingly shallow. By going against this "natural" tendency and deliberately maintaining deep breathing throughout, these men claim to achieve several orgasm without ejaculating. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm - Orgasm without Ejaculation Coitus reservatusSome men claim to experience orgasm without ejaculation while practicing a technique of sexual intercourse known as coitus reservatus or "karezza" (ital.carezza = caress). A man who uses karezza tries not to move his erect penis very much once it has entered the vagina. This procedure aims at a spiritual union of the sexual partners who are said to reach thereby a prolonged state of bliss with repeated orgasms. However, it rather seems that at least the men remain in the plateau phase which gives them adequate satisfaction. Their "orgasms," which they may very well experience as special climaxes of intercourse, are not identical with the physiological process discussed here. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm - Orgasm without Ejaculation Retrograde EjaculationA special case is presented by a phenomenon known as retrograde ejaculation. In a few men, certain internal muscles operate in such a way that the semen is not ejaculated to the outside, but instead into the bladder from where it then later is passed off with the urine. From all external evidence these men do not seem to ejaculate at all. This condition can result from prostate surgery, but there are also some men who claim to be able to achieve this particular muscular reaction voluntarily and use it as a means of contraception. Left: For a regular ejaculation, muscle A closes and muscle B opens, making it possible for the semen to be propelled through the urethra to the outside. Right: In a retrograde ejaculation, muscle A opens and muscle B closes, making it impossible for the semen to be propelled through the urethra to the outside. Instead, it is ejaculated into the urinary bladder. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 3. Orgasm Multiple Orgasms?Only very few men are capable of multiple orgasms, and usually only while they are young. Multiple orgasms are far more common among women. Some men claim to have trained themselves to experience multiple orgasms while avoiding ejaculation. For this, they use a technique of deep breathing. Anal SphincterDuring orgasm, the anal sphincter muscles contract at the same intervals as the sex organs. Muscular Tension, Pulse Rate and Blood PressureIt is important to remember that the whole body is involved. There is great muscular tension throughout the body, breathing becomes very fast, and the pulse rate and blood pressure rise even higher than during the plateau phase. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 4. Resolution Some general observationsAfter orgasm the sex organs (and with them the whole body) need a relatively short time to return to their former, unexcited state. The length of this so-called resolution phase is directly proportionate to that of the excitement phase. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 4. Resolution The PenisThe most visible physiological change during this period is the loss of penile erection which proceeds in two stages: The major loss occurs immediately after orgasm. However, the penis still retains some firmness which may persist for some time, especially if the excitement and plateau phases were extended. On the other hand, nonsexual activities or distractions can complete the loss of erection rather rapidly. The Sexual Response - The Male Response The Response Cycle: An Observed Pattern, not a Norm 4. Resolution Muscular Tension, Pulse Rate and Blood PressureThe muscular tension in the body subsides. Breathing, pulse rate, and blood pressure revert to normal. Sex Flush and Nipple ErectionThe sex flush mentioned earlier disappears quickly. In contrast, the erection of the nipples, if indeed it should have occurred, remains visible for some time. Some men perspire immediately after orgasm, although even then this reaction usually remains restricted to the palms of their hands and the soles of their feet. Refractory PeriodImmediately following orgasm males experience a so-called refractory period. During this period, which extends well into the resolution phase, the individual cannot respond to any additional or new sexual stimulation, i.e., he is incapable of having another erection and another orgasm. The refractory period may be very short in some individuals, especially while they are young, but it usually becomes longer with advancing age. There may also be such a refractory period in females, although many women can experience several orgasms in rapid succession. CASTRATION Castration—the removal of the male testes and sometimes the penis—was practiced in many cultures until quite recently. The emperor of China employed 3,000 eunuchs (Greek for "guardian of the bed") as late as 1896, and castration disappeared from the Ottoman Empire only when the empire itself disappeared in 1923. Although valued primarily for their loyal service as guards and bureaucrats, eunuchs were also prized, by those so inclined, for their sexual services. Some believed eunuchs developed highly eroticized mouths and anuses if they lost both penis and testicles. Some young males in China became eunuchs by choice and were emasculated by professional "eunuch makers." Such a sacrifice might provide them with secure employment at the Imperial Palace as guards, secretaries, and many other governmental posts; several rose to become virtual dictators. The position of eunuchs in the Byzantine Empire was even more exalted than in China—so much so that many ambitious young men voluntarily submitted to the knife. Eunuchs appointed to many prominent posts were loyal and reliable servants. Their privileged position in the paranoid world of Byzantium lay in the knowledge that they served as a foil to the hereditary nobility and, being unable to sire children, could not aspire to hereditary offices. The Christian church, probably because of the undertones of homosexuality and transsexuality of castration, denounced the practice. Deuteronomy 23:1 warns: "He that is wounded in the stones, or hath his privy member cut off, shall not enter into the congregation of the lord." Nevertheless, aware that the seat of human lust lies in the "stones," Origen, an early church father in Rome, emasculated himself in an overly literal interpretation of Matthew 19:12. The testicle issue was so important to the church at one time that it required new popes to submit to the inspection of the papal privates by its cardinals. Having ascertained the presence of the holy scrotum, the examiners solemnly proclaimed in Latin: "He has testicles and they hang well." The Catholic church prohibited women in church choirs, so it employed eunuchs to give voice to the higher notes in its musical repertoire while maintaining its opposition to castration. With the rising popularity of opera in Italy at the end of the 15th century, eunuchs were in high demand; many aspiring young opera stars submitted to the cruel operation hoping their fame would compensate them for their loss. These Italian eunuchs were the famed castrati. To maintain their high boyish voices, their testes had to be removed before their larynx enlarged under the influence of male hormones at puberty. (Castration after puberty has very little influence on voice pitch.) The pure tonal quality of these opera stars inspired their fans to cry "Long live the knife!" No one studied how long the castrati lived, but it is known that cutting off the testes eliminates the primary source of testosterone, and that testosterone is the "villain" in many diseases afflicting primarily males. It is also known that neutered tomcats live longer than their intact brothers (spaying females does not lengthen their life span). A study of 297 "surgically docilized" (castrated) men in a Kansas institution for the mentally retarded found they outlived a matched group of noncastrated inmates by almost 14 years; they also outlived a group of female inmates. Therapeutic castration of sex criminals has often been advised, but it is not particularly effective in adults, since testosterone and other androgens are also produced by the adrenal glands. Castration does not entirely eliminate the male sex drive; some eunuchs who retained their penises were sexually active, although, obviously, sterile. Castration after puberty often results in a penis of normal adult size that is capable of erection. More effective in the treatment of sex offenders is chemical "castration" through administration of anti-androgen drugs, such as medroxyprogesterone (Depo-Provera). CIRCUMCISION—MALE: EFFECTS UPON HUMAN SEXUALITY Medical Procedure Function of the Foreskin Circumcision, once accepted as the norm in the United States, has become controversial. Technically, circumcision is the surgical removal of the skin that normally covers and protects the head, or glans, of the penis. At birth, the penis is covered with a continuous layer of skin extending from the pubis to the tip of the penis where the foreskin (prepuce) folds inward upon itself, creating a double protective layer of skin over the glans penis. The inner lining of the prepuce is mucous membrane and serves to keep the surface of the glans penis (also mucous membrane) soft, moist, and sensitive. The prepuce is often erroneously referred to as "redundant" tissue, which allows the medical community and society-at-large to consider the foreskin an optional part of the male sex organ and, therefore, to condone its routine removal in a variety of procedures collectively known as "circumcision." Circumcision, however, was also a part of religious ritual, including Judaism and Islam as well as others. However, 85 percent of the world's male population is not circumcised. Circumcision in 1992 was still the most commonly performed surgical procedure in America, where 59 percent of newborn males underwent this operation. Circumcision reached its peak of 85 to 90 percent during the 1960s and 1970s. The surgery, usually performed on baby boys within the first few days of life, is often considered "routine." The most popular methods, the Gomco clamp and the Plastibell procedures, differ somewhat in technique and instrumentation but the effects on the penis and the baby are basically the same. Most of the American circumcisions are not done for religious reasons, but rather, for hygienic ones. Medical Procedure Usually, the procedure for circumcision in America involves the baby being strapped spread-eagle to a plastic board, with his arms and legs immobilized by Velcro straps. A nurse scrubs his genitals with an antiseptic solution and places a surgical drape—with a hole in it to expose his penis—across his body. The doctor grasps the tip of the foreskin with one hemostat and inserts another hemostat between the foreskin and the glans. (In 96 percent of newborns, these two structures are attached to one another by a continuous layer of epithelium, which protects the sensitive glans from urine and feces in infancy and childhood.) The foreskin is then torn from the glans. The hemostat is used to crush an area of the foreskin lengthwise, which prevents bleeding when the doctor cuts through the tissue to enlarge the foreskin opening. This allows insertion of the circumcision instrument. The foreskin is crushed against this device circumferentially and amputated. Anesthesia was not used to alleviate infant suffering until recently because it was believed that babies do not feel pain. Additionally, it was recognized that anesthesia was risky for the newborn, thus contributing to the medical reluctance to use it for painful procedures on infants, such as circumcision. Currently, some doctors use a dorsal penile nerve block to numb the penis during infant circumcision. While not always effective, this anesthesia may afford some pain relief during the surgery, although it offers no pain relief during the recovery period (which can last up to 14 days) when the baby urinates and defecates into the raw wound. Function of the Foreskin To understand the function of the prepuce, it is necessary to understand the function of the penis. While it is commonly recognized that the penis has two functions—urination and procreation—in reality, it is essential only for procreation, since it is not required for urination. For procreation to occur, the normally flaccid penis must become erect. As it changes from flaccidity to rigidity, the penis increases in length about 50 percent. As it elongates, the double fold of skin (foreskin) provides the skin necessary for full expansion of the penile shaft. But microscopic examination reveals that the foreskin is more than just penile skin necessary for a natural erection; it is specialized tissue, richly supplied with blood vessels, highly innervated, and uniquely endowed with stretch receptors. These attributes of the foreskin contribute significantly to the sexual response of the intact male. The complex tissue of the foreskin responds to stimulation during sexual activity. Stretching of the foreskin over the glans penis activates preputial nerve endings, enhances sexual excitability, and contributes to the male ejaculatory reflex. Besides the neurological role of the preputial tissue, the mucosal surface of the inner lining of the foreskin has a specific function during masturbation or sexual relations. During masturbation, the mucosal surface of the foreskin rolls back and forth across the mucosal surface of the glans penis, providing nontraumatic sexual stimulation. During heterosexual activity, the mucosal surfaces of the glans penis and foreskin move back and forth across the mucosal surfaces of the labia and vagina, providing nontraumatic sexual stimulation of both male and female. This mucous-membrane-to-mucous-membrane contact provides the natural lubrication necessary for sexual relations and prevents both the dryness responsible for painful intercourse and the chafing and abrasions which allow entry of sexually transmitted diseases, both viral and bacterial. When normal, sexually functioning tissue is removed, sexual functioning is also altered. Changes of the penis that occur with circumcision have been documented. These may vary according to the procedure used and the age at which the circumcision was performed, nevertheless penile changes will inevitably occur following circumcision. Circumcision performed in the newborn period traumatically interrupts the natural separation of the foreskin from the glans that normally occurs somewhere between birth and age 18. The raw, exposed glans penis heals in a process that measurably thickens the surface of the glans and results in desensitization of the head of the penis. When circumcision is performed after the normal separation of the foreskin from the glans, the damage done by forcible separation of these two parts of the penis is avoided, but the glans must still thicken in order to protect itself from constant chafing and abrasion by clothing. The thickened, drier tissue covering the glans of the circumcised penis may necessitate the use of synthetic lubricants to facilitate nontraumatic sexual intercourse. Often, it is erroneously considered the woman's lack of lubrication that makes intercourse painful rather than the lack of natural male lubrication, which is more likely the cause. During masturbation, the circumcised male must use his hands for direct stimulation of the glans, and this may require synthetic lubrication as well. In addition to the predictable physical changes that occur with circumcision, there are inherent risks and potential complications from the surgery. These include, but are not limited to, hemorrhage, infection, surgical damage and, while rare, death. Surgical damage and healing complications can result in extensive scarring, skin bridging, curvature of the penis, and deformities of the glans penis and urethral meatus (urinary opening). Extreme mutilations have resulted from inappropriate electrocautery use in circumcision, causing loss of the entire penis. Sex-change operations have been used as a "remedy" for this iatrogenic condition. While circumcision has potential risks and alters normal, sexual functioning of the penis, proponents of the practice consider it to confer many "prophylactic" benefits on the recipient. This rationale was initiated in the English-speaking countries during the 19th century when the etiology of diseases was unknown. At that time, circumcision evolved from a religious ritual or puberty rite into routine surgery for "health" reasons. Within the miasma of myth and ignorance, a theory emerged that masturbation caused many and varied ills, so some physicians thought it logical to perform genital surgery on both sexes to stop masturbation. In 1891, P.C. Remondino advocated circumcision to prevent or to cure alcoholism, epilepsy, asthma, hernia, gout, rheumatism, curvature of the spine, and headaches. As scientific research uncovered legitimate pathological etiology for diseases previously thought to be prevented or cured by circumcision, new rationales were postulated to validate the practice. Prophylactic circumcision of females fell out of vogue in English-speaking countries, but the incidence of male circumcision steadily rose. In the early 20th century, circumcision was advocated as a hygienic measure. Though criticism of the practice mounted, it was not until 1975 that the American Academy of Pediatrics came out in opposition, arguing that good personal hygiene would offer all the advantages of routine circumcision without the attendant surgical risk. The advent of antibiotics negated the rationale that circumcision was needed to prevent venereal disease. As a religious ritual, circumcision is practiced by Jews and Moslems in accordance with the biblical account of Abraham's covenant with God. Even so, the "purpose" of the Jewish ritual of circumcision has been argued by Jews throughout history. Noted Rabbi Moses Maimonides, in the Guide of the Perplexed, explains a rationale for circumcision that merits attention when circumcision is considered relative to human sexuality. As regards circumcision . . . [s]ome people believe that circumcision is to remove a defect in man's formation; but every one can easily reply: How can products of nature be deficient so as to require external completion, especially as the use of the foreskin to that organ is evident. This commandment has not been enjoined as a complement to a deficient physical creation, but as a means for perfecting man's moral shortcomings. The bodily injury caused to that organ is exactly that which is desired; it does not interrupt any vital function, nor does it destroy the power of generation. Circumcision simply counteracts excessive lust; for there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment; the organ necessarily becomes weak when it loses blood and is deprived of its covering from the beginning. The Moslems, who also circumcise in accordance with the biblical covenant between Abraham and God, traditionally circumcised their males at age 13. More recently, however, Moslem boys are circumcised at varying ages from birth to puberty. In the United States, the religious rights of parents are being questioned in regard to the constitutional rights of infants and children. Freedom of religion became a legal issue when it was introduced in a circumcision lawsuit claiming a male had been denied his right to freedom of religion when his body was marked by circumcision in accordance with his parents' religion. The inalienable body ownership rights of infants and children continue to be addressed within the U.S. legal system in lawsuits asserting that the only person who can legally consent to a circumcision is a person making this personal decision for himself. The reports of dissatisfaction with parental circumcision decisions by circumcised men help to illustrate this point. Performed on their penises without their consent, thousands are now undergoing foreskin restoration, either medical or surgical, to reconstruct what they consider was violently taken from their bodies early in their lives. The Declaration of the First International Symposium on Circumcision acknowledges the unrecognized victims of circumcision and, in support of genital ownership rights of infants and children, states: "We recognize the inherent right of every human being to an intact body. Without religious or racial prejudice, we affirm this basic human right." Due to the lifelong consequences of the permanent surgical alteration of children's genitals, it becomes imperative that children have the right to own their own reproductive organs and to preserve their natural sexual function. These, then, are the human genitals. Considering their great delicacy, complexity and sensitivity, one might imagine that an intelligent species like man would leave them alone. Sadly, this has never been the case. For thousands of years, in many different cultures, the genitals have fallen victim to an amazing variety of mutilations and restrictions. For organs that are capable of giving us an immense amount of pleasure, they have been given an inordinate amount of pain. (Morris, 1985) EJACULATION Male Ejaculation Female Ejaculation Ejaculation is the expulsion of seminal fluid. Many people assume that ejaculation and orgasm are the same, since most males experience the two simultaneously. Even though this is true for 80 to 90 percent of males, it is not true for all men. For instance, in controlled studies some men have been observed to ejaculate but not have orgasm or have orgasm but are unable to ejaculate. And some men, after prostate surgery, have retrograde ejaculate. (This means the ejaculation goes into the bladder and is expelled during urination.) Retrograde ejaculation is a form of birth control in some cultures, and in certain religious groups men do not ejaculate, believing it debilitates them. Male Ejaculation Controlling Ejaculation Premature Ejaculation Ejaculatory Incompetence Ejaculation in the male generally occurs with coitus, during masturbation, or during sleep (in what is called a nocturnal emission, or a wet dream). It happens most often when the penis is erect, but can also occur when the penis is flaccid. The ejaculate usually spurts out as the prostate gland and surrounding muscles, as well as those at the base of the penis, contract at orgasm. In young males, the force of the spurt can be strong enough for the ejaculate to hit the upper chest; in older males, it may roll out or go an inch or two up the abdomen. The ejaculatory content in the male is called semen, and the amount ejaculated varies among men (a healthy male ejaculates about one tea-spoonful). The ejaculatory content contains an average of 200 to 400 million sperm. (When the sperm count is low, conception usually does not occur in the normal fashion.) The seminal vesicles release the sperm, which are developed in the testicles, and at ejaculation there is a thick, milky fluid secreted from the prostate gland and added to the mixture, which is yellow, grey, or whitish. Upon reaching puberty, a boy is able to ejaculate the fluid. Controlling Ejaculation Ejaculation can be controlled by (1) using the squeeze technique, (2) keeping the testicles from full elevation, and (3) controlling the pubo-coccygeus (PC) muscle. In the squeeze technique, strong fingertip pressure is applied to the top and underside of the penis. The pressure must be firm and applied without movement for about 15 seconds, and it must be applied before the point of ejaculatory inevitability. During coitus, either partner may apply the pressure to the base of the penis. Since ejaculation occurs when the testicles are fully elevated against the perineum, ejaculation can be controlled by applying light pressure to keep the testicles from reaching full elevation. The PC muscle—the same muscle that starts and stops the flow of urine—can be trained over a two- to three-month period to control ejaculation. Tightening and releasing the muscle 10 to 15 times several times a day will strengthen it. Contracting the muscle and holding the contraction three or four times for 15 seconds will train it to reverse the urge to ejaculate. The 15-second hold must be done before ejaculatory inevitability for ejaculatory control. Premature Ejaculation Some men ejaculate as soon as they are aroused, before penetration, or with one or two thrusts in coitus. In addition, because some men never or rarely touch their penis, or allow a partner to touch it, their penis may be so sensitive that any touch is painful or uncomfortable, or produces rapid ejaculation. More touching, stroking, or fondling of the penis in love making often desensitizes the penis enough to enable these men to go longer in intercourse without ejaculating. By masturbating several times a week for 15 or 20 minutes before ejaculating, a man can often reverse the urge to ejaculate rapidly. Erection, ejaculation, or orgasm is not necessary when masturbating for this desensitizing procedure. Often in premature ejaculation problems, not only is the man reluctant to allow his partner to touch him during foreplay, his partner is also. Both fear he will ejaculate too soon. This reluctance is one of the problems that causes rapid ejaculation in the first place: the penis has not been conditioned to be stimulated for any length of time. In treatment, the couple do pleasuring nondemand exercises, touching the penis for 15 to 20 minutes. These exercises are performed slowly and with light but total hand pressure over the genitalia without expectations of any kind. If the man comes close to ejaculation, he informs his partner and she can do the squeeze technique for about 15 seconds to reverse his urge to ejaculate. This procedure may occur several times in the 15- to 20-minute period. As the man learns to control the urge to ejaculate, he will be able to go longer without the need to squeeze. But until he learns to identify the point of ejaculatory inevitability, he may need to apply the squeeze as soon as he has an erection. He continues to stimulate the penis further, squeezing every few minutes, until he has gone 15 minutes without ejaculating and trying to come as close as he can to orgasm without having one. Once he has learned to control his climax he can typically go as long as he wishes in intercourse without ejaculating. The pleasuring nondemand exercises occur only after about an hour of body caressing so that the whole body is relaxed and excited. Although, very often, the man will have an erection during the body caressing stage, stimulation of the genitalia does not proceed until the nondemand pleasuring exercises are over. This allows the man to hold an erection for some time and learn to be comfortable doing so. In this way, both partners can become more secure knowing that the penis can remain erect for a time or realize that if it does subside it will become erect again (since typically erections come and go over a period of time). Men often panic when they begin to lose an erection, not realizing that this is normal and that it will return if they do not become anxious. Ejaculatory Incompetence In the research laboratory, men have been observed using unusually heavy pressure on the penis while masturbating, which often results in an inability to ejaculate during intercourse. In therapy, it is suggested that while masturbating they use very light pressure more typical of the pressure they feel in their partner's vagina. However, it may take time for them to develop less need for heavy pressure. Ejaculatory incompetence can also be a learned behavior. Despite the strong taboos against masturbation or touching the penis, boys often like the feeling it gives them and develop ways to masturbate that are not conducive to ejaculating in intercourse. Some ejaculatory incompetent men pull a sheet, towel, or whatever else they have learned to use between their legs to stimulate themselves to ejaculation. Others may lie on their stomach putting pressure on their penis from the mattress; some cross their legs with the penis between them and rub their legs together. Such masturbatory patterns are not conducive to intercourse even though they may work well in masturbation. Female Ejaculation Female ejaculation is the expulsion of fluid, other than urine, from the urethra at orgasm. This topic is debated among experts: some argue that the ejaculate is a mucuous-like secretion coming from the cervical os; others that it is vaginal wall secretions; and others that it is a nonurine expulsion from the urethra.